ch. 9 infertility

Question 1

infertility (what, affects who, increases with) (4)

Answer 1

the inability to become pregnant after 1 year of UNPROTECTED intercourse
- prolonged time to conceive (after one year)
- affects 1 in 5 individuals age between 15-49
- increases with age, esp. in women >35 years old

Question 2

sterility

Answer 2

inability to conceive
- d/t vasectomy, tubal ligation, anatomic issue

Question 3

factors associated with infertility female (4)

Answer 3

1) hormonal and ovulatory factors
2) tubal and peritoneal factors
3) uterine factors
4) vaginal-cervical factors
5) other: anemia, obesity, substance use, thyroid disfunction, genetic disorders (eg. turner syndrome)

Question 4

hormonal and ovulatory factors (infertility) (3)

Answer 4

• developmental anomalies
• high prolactin levels
• anovulation: ovary never releases ova, leads to primary amenorrhea

Question 5

tubal and peritoneal factors (infertility) (4)

Answer 5

• inflammation
• tubal adhesions (d/t ectopic pregnancy, STI)
• endometriosis (presence and overgrowth of endometrial tissue outside uterus)
• chronic cervicitis (inflammed cervix acts as toxic environment for fetus)

Question 6

uterine factors (infertility) (3)

Answer 6

• developmental anomalies (born w/o vagina/uterus)
• endometritis: inflammation of the inner lining of the uterus
• bicornuate uterus: septum runs down middle uterus, leads to increase chance miscarriage, can’t conceive after!

Question 7

factors associated with infertility male (3)

Answer 7

1) poor sperm quality
2) structural or hormonal disorders
3) other factors: genetic disorders, decrease in libido (d/t anti-htn meds, SSRIs, etc.), erectile dysfunction

Question 8

causes of poor sperm quality (8)

Answer 8

• substance use (smoking, marijuana)
• age
• STI’s-
• environmental hazards exposure (factory, construction, radiation, toxic materials)
• high temperatures around scrotum (construction, landscape)
• nutritional deficiencies
• obesity
• anti-sperm antibodies (men and women can both develop)

Question 9

structural or hormonal disorders (male infertility) (5)

Answer 9

• undescended testes
• hypospadias: urethra is behind penis, almost looks circumcised)
• varicocele: enlargement of veins within scrotum
• obstructive lesions
• low testosterone levels

Question 10

transgender fertility issues: options for reproduction (2)

Answer 10

1) cryopreservation: extract ova or sperm from patient before starting gender-reassignment hormone therapy to preserve option to have children later on in life
2) discontinue gender-reassignment hormone therapy to pursue fertility care (hold)

TIP: traumatic for patients with gender dysphoria, best care is provided by an interprofressional team!

Question 11

assessment of female infertility: diagnostic tests (3)

Answer 11

1) diagnostic tests:
- detection of ovulation (basal body temp., FSH/LH/prolactin)
- hormone analysis
- imaging: transvaginal ultrasound, MRI, sonohysterography, hysterosalpingography, laparoscopy

Question 12

assessment of male infertility (5)

Answer 12

1) evaluation of general health (smoke)
2) semen analysis (assess sperm number, morphology, and motility)
3) ultrasonography (scrotal, transrectal -> prostate gland location)
4) genetics
5) other tests:
- hormonal causes
- chronic disease causes
- causes from environmental hazards
- nutritional deficiency

Question 13

infertility care mgmt interventions (4)

Answer 13

1) psychosocial:
- major life stressor: can affect relationships, life goals, careers
- can exacerbate pre-existing anxiety or depression
2) nonmedical:
- lifestyle changes: vacation to relax
3) complementary and alternative measures
4) medical therapy:
- correcting pre-existing factors
- ovarian stimulation -> commonly used medications (fig 9.6)

Question 14

assisted reproductive therapy (ART) most common (4)

Answer 14

manipulation of eggs, sperm, and/or embryo
- intrauterine insemination (IUI)
- in vitro fertilization-embryo transfer (IVE-ET) -> intracytoplasmic sperm injection, assisted hatching, preimplantation genetic testing (PGT)
- gamete intrafallopian transfer (GIFT) -> ZIFT
- oocyte donation (sperm donation, ova donation)

Question 15

ART types (10)

Answer 15

• zygote intrafallopian transfer (ZIFT)
• oocyte donation
• cryopreservation
• fertility preservation (elective fertility preservation)
• sperm donation (therapeutic donor insemination (TDI))
• embryo donation
• surrogate mothers & embryo hosts
• risks of ART
• adoption
• choosing to live without children

Question 16

what can nurses do to advise couples (infertility) (6)

Answer 16

• avoid douching & use of artificial lubricants (gels, oils, saliva)
• promote retention of sperm-male dominant position; female remains recumbent (30 mins)
• avoid leakage of sperm
• instruct couple to have intercourse EOD during fertile period (increase sperm quality)
• avoid talking about conception during sex
• maintain good nutrition & reduce stress (women take folic acid 400mg)

TIP: folic acid can prevent bina spifida

Question 17

detection of ovulation (2)

Answer 17

basal body temp
production of FSH/LH/prolactin