RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
SYNOPSIS PROFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION.
Mrs. Devi. D
IST year MSc (N),
Name of the candidate Florence College of Nursing
and Address No 509, 1st D Main, 3rd Block,
Kalyan Nagar, Kacharakana Halli
2 Name of the institution Florence College of Nursing
Course of study and M Sc. Nursing
subject Obstetrics & Gynaecological Nursing
Date of admission to the
4 11 August 2012
Evaluate the effectiveness of
structured teaching programme on
5 Title of the topic knowledge regarding “causes of
fertility problems in women”, among
adolescents at selected degree
6. BRIEF RESUME OF THE INTENDED WORK:
“A woman’s health is her total well-being, not determined solely
by biological factors and reproduction, but also by effects of work load,
nutrition, stress, war and migration, among others”
-van der Kwaak, 1991.1
Childbirth is viewed as an important life event for women. It is a natural and
normal physiological phenomenon which introduces new experiences in women's
reproductive life. Reproductive health is a crucial part of general health and a central
feature of human development. It is a reflection of health crucial during adolescence
and adulthood, sets the stage for health beyond the reproductive years for women, and
affects the health of the next generation.2
Reproductive health is a universal concern, but is of special importance for
women particularly during the reproductive years, since, child birth events got great
physiological, emotional and social impact to the women and her family. Women
reproductive health is important because woman bears the risk of fertility problems
due to biological inability and typically due to medical problems experienced by one
or the other partner.3
Most experts define fertility problems as not being able to get pregnant after at
least one year of trying. Women who are able to get pregnant but then have repeated
miscarriages are also said to be fertile problems. Lack of uniform definitions has
characterised research on fertility problems. It is accepted that the terms fertility
problems, childlessness or sterility all refers to the incapacity of couples to conceive
or bear children when desired.4
The common causes of fertility problems in women include: blocked fallopian
tubes due to pelvic inflammatory disease, endometriosis, physical problems with the
uterus, uterine fibroids and many things can affect a woman's ability to have a baby
such as age, stress, poor diet, being over weight or under weight, tobacco chewing,
smoking, alcohol, sexually transmitted diseases and health problems that cause
Fertility problems are not always a woman's problem. In only about one-third
of cases are fertility problems due to the woman (female factors). In another one third
of cases, fertility problems are due to the man (male factors). The remaining cases are
caused by a mixture of male and female factors or by unknown factors. Fertility
problems may have profound psychological effects. Partners may become more
anxious to conceive, ironically increasing sexual dysfunction. Marital discord often
develops in fertile problem couples, especially when they are under pressure to make
medical decisions. Women trying to conceive often have clinical depression rates
similar to women who have heart disease or cancer. Emotional stress and marital
difficulties are greater in couples where the fertility problem lies with the man.6-8
In many cultures, inability to conceive bears a stigma. In closed social groups,
a degree of rejection or a sense of being rejected by the couple may cause
considerable anxiety and disappointment. Some respond by actively avoiding the
issue altogether; middle-class men are the most likely to respond in this way. Fertility
problems have begun to gain more exposure to legal domains to care of parent or
spouse, or because of their own personal illness.9,10
6.1. NEED FOR STUDY:
Fertility is nature’s design to propagate the race. Having a child is the single
most wonderful thing to people, who love one another, can do. Nature may
occasionally default and may be responsible for infertility. In most of the societies
children are considered as a natural result of union of man and a woman in the
institution of marriage. In all cultures, being pregnant or to produce a child is
considered as a major event in the family. Everyone expects woman to sail through 9
months of pregnancy joyfully and give birth to a child.11
Fertility problems are not merely a health problem; it is also a matter of social
injustice and inequality. Tribal populations in India have high levels of morbidity
arising from poor nutrition, and coupled with high infant, child and maternal
mortality, and they also have low levels of literacy.12-13
Worldwide it is estimated that one in seven couples have problems
conceiving, with the incidence similar in most countries independent of the level of
the country's development. Fertility problems affect one in seven couples in the UK.
In Britain, male factor infertility accounts for 25%, while 25% remain unexplained.
About 50% are female causes with 25% being due to anovulation and 25% tubal
problems and others. In Sweden, approximately 10% of couples are infertile. In
approximately one third of these cases the man is the factor, in one third the woman is
the factor and in the remaining third the infertility is a product of factors on both
In Indian women reporting primary infertility and PID, STI prevalence was
high. The WHO estimates the overall prevalence of primary infertility in India to be
between 3.9% and 16.8%. Estimates of infertility vary widely among Indian states
from 3.7%t in Uttar Pradesh, Himachal Pradesh and Maharashtra, 5% in Andhra
Pradesh, and 15% in Kashmir. Moreover, the prevalence of primary infertility has
also been shown to vary across tribes and castes within the same region in India.15
The most common causes of female infertility are ovulatory disorders and
anatomical abnormalities such as damaged fallopian tubes. Less frequent causes
include, for example, endometriosis and hyperprolactinemia. Causes of male
infertility also contributed can be divided into three main categories: Sperm
production disorders affecting the quality and/or the quantity of sperm; anatomical
obstructions; other factors such immunological disorders. Approximately a third of all
cases of male infertility can be attributed to immune or endocrine problems, as well
as to a failure of the testes to respond to the hormonal stimulation triggering sperm
production. However, in a great number of cases of male infertility due to inadequate
spermatogenesis (sperm production) or sperm defects, the origin of the problem still
remains unexplained. Infertility can be due to problems with sperm production,
transportation through the male reproductive tract and delivery into the female
reproductive tract. On the female side, infertility may be caused by a lack of ovulation
(anovulation), blocked fallopian tubes, or inability of an embryo to implant and
establish a pregnancy in the uterus. Infertility often results from combinations of
several problems on both the male and female sides.15
A study was conducted to review existing population surveys on the
prevalence of fertility problem and proportion of couples seeking medical help for
fertility problems in more and less developed countries, were reviewed. The study
result showed that estimates on the prevalence of infertility came from 25 population
surveys sampling 1, 72,413 women. The 12-month prevalence rate ranged from 3.5%
to 16.7% in more developed nations and from 6.9% to 9.3% in less developed
nations, with an estimated overall median prevalence of 9%. The Proportion of
couples seeking medial care was, on average, 56.1% (range 42–76.3%) in more
developed countries and 51.2% (range 27–74.1%) in less developed countries. The
proportion of people actually receiving care was substantially less, to (22.4%). Based
on these estimates and on the current world population, 72.4 million women are
currently infertile; out of these, 40.5 million are currently seeking infertility medical
care. Thus study concluded that the current evidence indicates a 9% prevalence of
infertility (of 12 months) with 56% of couples seeking medical care. These estimates
are lower than those typically cited and are remarkably similar between more and less
A study was conducted to investigate the causes of infertility in women of
reproductive age among 110 fertility problem women using specifically designed
questionnaire, to collect data. The study result showed that Concerning the causes of
infertility, 27.4% of the problems were due to fallopian tubes dysfunction, followed
infertility of unknown cause in 24.5% of the cases, 20% were due to disorders of
menstruation, 9.1% due to problems of the uterus, 2.7% due to sexual disorders,
another 2.7% because of age and in a very small percentage, infertility was caused by
ovarian failure. Regarding the daily habits of the participants, 45.5% were smokers.
The study concluded that the causes of female infertility are problems in the fallopian
tubes and the uterus, disorders of menstruation, sexual disorders, age and ovarian
failure and habits. Female infertility is a complex problem that should be considered
carefully in order to find effective interventions and solutions.17
A prospective study was conducted to assess the infertility-related stress
among 1,153 women and 1,149 men attended the infertility treatment. Participants'
infertility-related stress was assessed by written questionnaire using the Fertility
Problem Inventory. Current levels of anxiety, depression, and marital satisfaction also
were determined. The study result showed that women described greater global stress
than men and higher specific stress in terms of social concerns, sexual concerns, and
need for parenthood. Both men and women facing male infertility reported higher
global stress and more social and sexual concerns than whom experiencing female
infertility. Social, sexual, and relationship concerns related to infertility were more
effective predictors of depression and marital dissatisfaction, than expressed needs for
parenthood or attitudes toward child-free living. Thus study concluded that the
fertility Problem Inventory provides a reliable measure of perceived infertility-related
stress and specific information on five separate domains of patient concern. Patterns
of infertility-related stress differed depending on gender, fertility history, and
infertility diagnosis. Among patients receiving treatment, social, sexual, and
relationship concerns appear central to current distress. Counselling interventions that
target these domains appear likely to offer maximal therapeutic benefit.18
Based on above statistics and reviews related to fertility problem and also
personal experiences, the investigator found that there is a need for imparting
knowledge to family about fertility problems to the adolescent who will in turn impart
their gained knowledge to family and community. Investigator wants to create
awareness among adolescents.
6.2. REVIEW OF LITERATURE:
To review of literature is an extensive, systematic selection of potential
sources of previous work, acquainted fact – findings after scrutinization and location
of reference to the problem under study. It is helpful in understanding and developing
insight into the selected problem under study and also to develop a conceptual frame
work for sutdy.19
A study was conducted to identify fertility problem among couples in rural
areas of India, utilizing the existing information structure. A three stage screening of
the cases was done. Initial record based listing was done with the help of the health
workers' records. In the second stage the cases on initial list were screened on the
basis of information obtained from key informants in villages. In the second stage,
verified cases were then individually contacted. Total catchment’s population was
(28,839) in 40 villages of a Primary Health Centre (PHC) was surveyed. The result
showed that total 4453 eligible couples in the PHC, 129 (2.9%), were infertile (46.5%
primary and 53.5% secondary fertility problem). The yield from the health workers'
record was 33% whereas from key informants it was 93%. The study concluded that
the key informants and existing information structure can be utilized to identify
conditions like fertility problem in rural areas, and take appropriate measures.20
A study was conducted to assess the epidemiology and causes of infertility
among 2000 married women aged 18-45 years. Among the respondents, 333 couples
were considered infertile. The infertile couples were offered comprehensive clinical
investigations, but only 186 couples completed them. The study result showed that
infertility rate was 16.7%, among this 52.7% were due to diseases of female
reproduction system and 6.4% were by male reproductive diseases. In 38.7% of
couples, both spouses suffered from infertility, while in 2.2% of cases the cause of
infertility was not determined. Among the causes of female infertility, secondary
infertility dominated (12.9% of all the women questioned), while primary infertility
affected 3.8% of the women. The most frequent causes of female infertility were
disturbances to tubal patency (36.5%) and pelvic adhesions (23.6%). Endocrine
pathology (32.8%) male infertility was inflammatory disease of male accessory
glands (12.9%). In 8.6% of cases infection resulted in obstructive azoospermia.
Varicocele was registered in 11.3% of cases, and idiopathic pathospermia in 20.9%.
Inflammatory complications among females were 4.2 times more frequent than males.
Thus study concluded that the finding causes of fertility problems among couple
investigation are very important to treat fertility problems among couples.21
A study was conducted to assess the impact of thyroid status on the menstrual
function and fertility among 160 women with primary infertility who attended the
Biochemistry department for hormonal evaluations. Eighty fertile women with similar
age and socioeconomic status were enrolled as the controls. The association between
thyroid dysfunction and levels of serum prolactin, LH and FSH as their menstrual
status were reviewed. The study results showed that the majority of the infertile and
fertile women were euthyroid. In infertile group, the crude prevalence of
hypothyroidism was slightly higher in the infertile group in comparison with that of
the general population. There was a positive correlation between serum TSH and
prolactin levels in the infertile subjects. Menstrual disorders (mainly
oligomenorrhea), were reported by about 60% of the infertile women.
Hyperprolactinemia was depicted in 41% of the infertile women while it was only
15% in the control group. The infertile women with hypothyroidism had significantly
higher prolactin levels when compared to the subjects with hyper- or euthyroidism.
There was a significant association between abnormal menstrual patterns and
anovulatory cycles, with raised serum prolactin levels. Thus study concluded that
there is a greater propensity for thyroid disorder in infertile women than the fertile
ones. There is also a higher prevalence of hyperprolactinemia in infertile women.22
A study was conducted to find the pathology detected at
Hysterosalpingography (HSG) in patients with infertility among 289 consecutive
patients. Clinical notes and radiological findings were analysed for demographic data,
uterine status, tubal and pelvic pathology. The study result showed that the
commonest age group seen was 26 – 30yrs. Most were of low parity. Secondary
infertility was commoner than primary infertility. Abnormal findings at HSG were
found in 83.4%. The commonest finding was tubal blockage. Thus study concluded
that the commonest pathology found on HSG in women presenting with infertility is
tubal blockage possibly secondary to chronic pelvic inflammation complicating
mismanaged pregnancies, septic abortions or sexually transmitted infections.23
A study was conducted to evaluate laparoscopy as a diagnostic procedure
among 54 infertile females in the Gynaecology Department. The study result showed
that of the 54 cases laparoscopic findings were normal in 17 (31.5%) and showed
some pathology in 37 (68.5%) cases. Amongst the primary infertility patients 10
(26.3%) revealed no abnormal laparoscopic findings. Blocked tubes were found in
8 (21.1%) cases. Six of these had bilateral blockade whereas two had unilateral one.
Hydrosalpinx was observed in 2 (5.3%) patients and pelvic adhesions were
encountered in 7 (18.4%). Adhesions were extensive in 5 of these 7 and mild in the
remaining 2. Endometriosis was seen in 4 (10.5%) cases. Fibroid uterus 2 (5.3%)
cases. Ovarian pathology was found in 4 (10.5%) patients. One of these patients had
absent ovulation, another had polycystic ovaries and the remaining 2 had ovarian
cysts, a rudimentary uterus 1(2.6%) of the case. The patients having secondary
infertility showed normal findings in 6 (37.5%) cases. Tubal block was present in 4
(25%) which was bilateral in all these cases. Three (18.7%) cases had pelvic
adhesions which were extensive in 2 cases and mild in one. Fibroid uterus was
encountered in 2 (12.5%) cases and they were multiple. One case (6.3%) was found
to have an ovarian cyst. Thus study concluded that the laparoscopic diagnosis for
infertility both primary as well as secondary is established and helpful to detect
infertility and continue treatment.24
A study was conducted on control and management of infertility among 200
infertile couples, selected by taking 10% from total number of all married female
patients, visited primary health care centre complaining from any health problem
during one month period. Data were collected by special questionnaire. The study
results showed that; 80% had primary infertility and 20% had secondary infertility.
Infertility due to husbands alone was 20.5%, that due to wives alone was 37.5% and
infertility due to both couple was 31%, while those with unknown aetiology was 11%.
The main cause of female primary infertility was anovulatory cycle and for secondary
infertility were tubal problems. Male infertility due to seminal abnormality was
42.5% and those with medical problem were 2%. Management varied from antibiotic,
hormonal therapy, surgical intervention and health education. By the end of the first
year, 52 women got pregnant. Outcome was 48 well new born babies. Thus study
concluded that the improving information, education and counselling on issues
pertaining treatment of fertility problem and in drawing up guidelines for the
management of fertility problem at all levels of health care.25
A study was conducted to assess the incidence, treatment and outcome of 914
polycystic overian syndromes (PCOS), patients attending the outpatient department
(OPD) for duration of 5 years. Out of 914 patients investigated, 814 were studied for
hormonal disturbances and their response to various modalities of treatment. The
result showed that overall pregnancy rate was 48.40% (394). The pregnancy rate per
cycle with timed intercourse (TI) was 44.77% (47), 17.09% (286) with intrauterine
insemination (IUI), 29.82% (51) with in vitro fertilization (IVF) and 22.22% (10)
with frozen embryo transfer (FET). The maximum number of pregnancies 85.29%,
(284) was achieved in the first three treatment cycles. The abortion rate was 19.01%
(73) and the incidence of ectopic pregnancy was 5.47% (21). Complications seen
were in the form of ovarian hyperstimulation (OHSS), retention cyst on day two and
multiple pregnancies in 11.71% (228) of the total treatment cycles. Thus the study
concluded that the most PCOS could be adequately controlled or eliminated with
proper diagnosis and treatment.26
A study was conducted to assess the knowledge, perception and myths
regarding infertility among 447 adults. Across-sectional survey was carried out by
interviewing. The study result showed only 25% correctly identified when infertility
is pathological and only 46% knew about the fertile period in women's cycle. People
are misinformed about the use of IUCD (53%) and OCPs (61%) which may cause
infertility. Beliefs in evil forces and supernatural powers as a cause of infertility are
still prevalent, especially amongst people with lower level of education. Seeking
alternative treatment for infertility remains a popular option for 28% of the participant
as a primary preference and 75% as a secondary preference. IVF remains an
unfamiliar among 78% and an unacceptable option for 55%. Thus the study
concluded that the knowledge about infertility is limited and a lot of misconceptions
and myths are prevalent in the society. Alternative medicine is a popular option for
seeking infertility treatment among people.27
A study was conducted to assess fertility knowledge more broadly in young
people. The sample (n = 149) consisted of 110 female and 39 male postgraduate and
undergraduate university students (average age 24.01, SD = 7.81). By using a 21
items questioner was used to investigate three areas of knowledge, risk factors
associated with female infertility (e.g. smoking), beliefs in false fertility myths (e.g.
benefits of rural living) and beliefs in the illusory benefits of healthy habits (e.g.
exercising regularly) on female fertility. The study result showed that significant
effect of factor (P < 0.001) and post hoc tests revealed that young people were
significantly better at correctly identifying the effects of risks compared with null
effects of healthy habits (P < 0.001) or fertility myths (P < 0.001). The study
concluded that the young people are aware that the negative lifestyle factors reduce
fertility but falsely believe in fertility myths and the benefits of healthy habits. Hence
the study suggests that the public education campaigns should be directed to
erroneous beliefs about pseudo protective factors. 28
A study was conducted to evaluate the effectiveness of structured teaching
program in improving knowledge and attitude of school going adolescents on
reproductive health among 200 adolescent school students. An experimental study
with pre test - post test control group design was carried out in four selected schools
with similar settings .The study result showed that the mean pretest score of the
experimental group on knowledge of reproductive health was 39.83±6.89 and of the
control group was 39.47±0.08. The same of experimental group after administration
of the structured teaching program 84.60±10.60 and of the control group with
conventional teaching method 43.93±10.08 was statistically significant (p<0.001).
Similarly, the post-test scores of knowledge of the groups on responsible sexual
behaviour and their attitude towards reproductive health were better in the
experimental group than in the control group (p<0.001). Thus study concluded that
the knowledge of adolescent school students on reproductive health was inadequate.
The use of structured teaching program was effective in improving knowledge and
attitude of the adolescents on reproductive health. 29
6.3. STATEMENT OF THE PROBLEM:
A study to evaluate the effectiveness of structured teaching programme on
knowledge regarding causes of fertility problems in women among adolescents at
selected degree colleges, Bangalore.
6.4. OBJECTIVES OF THE STUDY:
The objectives of the study are to:
assess the level of knowledge of adolescents regarding causes of
fertility problems in women.
find out the difference between the mean pre test and post test
knowledge score of adolescents regarding causes of fertility problems
find out the association between the mean pre test knowledge level of
adolescents regarding causes of fertility problems in women with
selected socio-demographic variables.
find out the association between the mean post test knowledge level of
adolescents regarding causes of fertility problems in women with
selected socio-demographic variables.
H1: There will be significant difference between the mean pre test and post test
knowledge score of adolescents regarding causes of fertility problems in women.
H2: There will be significant association between the mean pretest knowledge level
regarding causes of fertility problems in women among adolescents with selected
H3: There will be significant association between the mean post test knowledge level
regarding causes of fertility problems in women among adolescents with selected
6.6. OPERATIONAL DEFINITION OF THE TERMS:
In this study it refers to:
The method of estimating and interpreting the pre test and post test knowledge
Determining the extent to which the structured teaching programme has
achieved desired effect as measured in terms of significant gain in the post test
knowledge score of adolescent. The knowledge levels are interpreted as adequate,
moderately adequate and inadequate knowledge.
The level of understanding and awareness of adolescent regarding causes of
fertility problems in women, measured by the correct responses from the participants
to the items given in the tool.
17-21 years studying in different degree colleges.
Structured Teaching Programme:
An education material prepared by the researcher regarding the causes of
fertility problems in women to teach the adolescent.
The inability to conceive and bear children, the inability to become pregnant
through normal sexual activity.
It is of, relating to, or involving a combination of social and demographic
factors. Age, education, type of family, occupation, monthly income of the family,
personal habit, source of information.
In this study socio demography will focus on that Age, religion, education,
type of family, monthly income of the family, personal habit, area of residence, food
habits, and menstrual pattern. Have you undergone reproductive heath check-up, any
abnormality detected, and source of information.
The study is based on the following assumptions:
Adolescents may not have adequate knowledge regarding causes of fertility
problems in women.
Education may improve the knowledge of adolescents regarding causes of
fertility problems in women.
Adolescents will act according to the information they perceived through STP.
The study is delimited to:
the assessment of the knowledge will become only as correct
responses given to the items in knowledge questionnaire.
2. collection of data is only from adolescents from selected degree
3. knowledge of the adolescents varies based on their perception.
7. MATERIALS AND METHODS:
7.1. SOURCE OF DATA:
Adolescents from selected degree college Bangalore.
7.2. METHOD OF DATA COLLECTION:
Research method : Quasi experimental method.
Research design : One group pre test, post test design.
Sampling technique : Simple Random sampling.
Sample size : 60 adolescent.
Setting of the study : Selected degree colleges Bangalore.
7.2.1. CRITERIA FOR THE SELECTION OF SAMPLES:
The study includes adolescents, who are,
1.from selected degree colleges of Bangalore.
2.willing to participate in the study.
3.available at the time of data collection.
4. able to read and write in Kannada or English.
The study excludes adolescents who:
are studying Medical or Paramedical or Nursing courses.
have attended any awareness programme regarding causes of
fertility problems in women in the past 6 months.
are children of health personnels.
7.2.2. DATA COLLECTION PROCEDURE:
A structured questionnaire will be prepared to assess the knowledge of
adolescents regarding causes of fertility problems in women. A structured teaching
programme will be prepared on causes of fertility problems in women. Content
validity of the tool and structured teaching programme will be ascertained in
consultation with the guide and experts from nursing, obstetrics and gynaecology.
Reliability of the tool will be established by split half method. Prior to the
study, permission will be obtained from concerned authority. Further, consent will be
taken from the samples regarding their willingness to participate in the study. The
proposed period of data collection will be on June 2013.
7.2.3. DATA ANALYSIS METHOD:
Data analysis will be done by descriptive (mean, frequency, percentage and
standard deviation) and inferential (paired t-test and chi-square test) statistics.
Frequency and Percentage distribution will be done to analyze socio-demographic
variables. Mean and Standard deviation will be done to assess the knowledge of
adolescents regarding causes of fertility problems in women. A paired t-test will be
done to compare the mean pre- test and post test knowledge score of adolescents in
order to evaluate the effectiveness of structured teaching programme. A chi-square
(χ2) test will be used to find out the association between the mean pre-test knowledge
post-test levels of adolescents with selected socio-demographic variables.
7.3. DOES THE STUDY REQUIRE ANY INTERVENTIONS OR
INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS?
No, Only a structured questionnaire and structured teaching programme will
be used. No other interventions which cause any physical harm will be used in
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED?
ethical clearance is taken from ethical committee of college.
a written permission from the concerned authority will be obtained
prior to the study.
consent will be taken from the client before conducting the study.
confidentiality and anonymity of the subject will be maintained.
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teaching program in improving knowledge of reproductive health”,Kathmandu
Univ Med J (KUMJ). 2005 Oct-Dec; 3(4):380-3.
9 SIGNATURE OF THE
10 REMARKS OF THE This study would create awareness
among future generation people to
GUIDE maintain fertility. So this study is
feasible to conduct.
11 NAME AND Mrs. Amudha. K.
Associate Professor and Head of the
DESIGNATION OF Department
Florence College of Nursing,
11.1 GUIDE Bengaluru
11.3 CO-GUIDE Ms. Jayadeepa
Florence College of Nursing,
11.5 HEAD OF THE Mrs. Amudha. K.
Associate Professor and Head of the
Florence College of Nursing,
12 12.1 REMARKS OF THE It is a needed study to prevent fertility
problems in future. So this study
CHAIRMAN OR found to be feasible.