Ch. 5 - Infertility Flashcards
Affects about 25% of reproductive-age couples
Considered be Diagnosis achieve pregnancy after 1 year of unprotected intercourse when woman is <35 years old or after 6 months of unprotected intercourse when woman is >35 years old
Causes: delay in starting fam until later in life: after establish careers
Couple experiencing infertility diagnosis and treatment expeirence lot phys and emotional and HUGE financial investements potentially over yrs
Four goals provide framework for nurses when providing care for those with infertility:
Infertility - Incidence
Provide the couple with accurate information about human reproduction and fertility treatments and prognosis for pregnancy and get rid of myths - educate on when and what ovulation is and how long cycle
Assist in identifying the cause of infertility - female and male factors
Provide emotional support - benefit from couseling and support group meetings
Guide and educate about forms of treatment - guide and educate those who cannot conceive biologically: heartbreaking: lots other avenues can take: IVF, donor eggs, surrogacy, adoption; goes through grieving process; can do plenty things help them as try to conceive
Four goals provide framework for nurses when providing care for those with infertility:
40% of infertility issues caused by female-specific issues - not always her fault; 85-90% couples treated with med/surgery with 3% with IVF/other assistory reproductive equipment - thousands dollars; more couples conceive with help with meds
Assessment/factors of female infertility
Factors associated with female infertility
Look at H&P = gen phys exam - may be structural component that can find here
Diagnostic testing - log menstrual history; serum hormone studies: FSH and LH surges appear: having them or ovulating: harder to get pregnnat
Not have parts not pregnant; not have ovaries producing no prengnacy; no hormones producing no prengnacy; no feedback sys working no pregnancy
Ovarian factors
Tubal and peritoneal factors
Uterine factors
Vaginal-cervical factors
Other factors
Assessment/factors of female infertility
Hysteroscopy - little microscope and inspect; see base of cervix with naked eye; need this to see structure of uterus
Evaluation of the anatomy - pelvic exam; anomaly in anatomy
Detection of ovulation
Hormone analysis
Ultrasonography
Endometrial biopsy
Hysterosalpingography - insert microscope into uterus and inject dye that flows through fallopian tube and out through fibriae - good pic of whether fallopian tubes patent - find structural anomalies
Laparoscopy - incision and laparoscope into abdominal cavity; look at outside other than US - 2-sided pic and visual if have endometriosis on outside and lyse it so helping with fertility as well
US - exterior of uterus
Care management - female: Assessment of female infertility: Test or examination
A common evaluation of ovarian reserve is measurement of the FSH levels on 3rd day of menstrual cycle
Hormone levels - ovulating
Hormone analysis
40% infertility attributed to male factors; other 20% both male and female factors
Assessment of male infertility
Factors associated with male fertility
Thorough H&P; assessment proceeds in sim manner as does with females - noninvasive and cheapest
Hormonal factors/issues - semen analysis: cheapest and easiest; sperm, swim right, act right, what looks like; FSH, LH, testosterone; sperm not have right chem combo at head not penetrate ovum - hormones play big factor
Testicular factors - structural issues; US of testicles: formed correctly; conduit for sperm and semen to leave body; structural issue: not reproduce - done via US
Factors associated with sperm transport - subways not working and sperm not reach egg and not leave body
Idiopathic male infertility - no pathological reason for why working other than not working
Assessment of male infertility
Assessment of male infertility
Favorable Findings
Care management - male
Semen analysis
Hormone analysis
Scrotal ultrasound
Assessment of male infertility
Basic test of male fertility
Semen analysis
Transrectal U/S evaluates ejaculatory ducts, vas deferens, and seminal vesicles
Scrotal ultrasound
Plan of care and implementation
Reproductive alternatives
Case management - males and females
Psychosocial considerations
Nonmedical treatments
Medical therapy
Surgical therapies
In general, fertility treatments are more successful in producing a live birth for women <35 years old; 35 bewitching age for women; fertility sharp decline after 35 - far less success after 35
Plan of care and implementation
Major life stressor affect self-esteem, relationships with spouse and fam and friends and careers
Impact ability giving and receiving phys and sexual closeness - huge stressor and not as loving but more mechanical process
Exhibit grieving behaviors
Nurses must be comfy with own sexuality so better help why certain aspects of couples’ intimacy need be shared with HCP; impacting everything and no longer enjoying intimacy - need be comfy with talking about it in the first place
Psychosocial considerations
