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Women's Health Test IV > Chapter 32: Infertility > Flashcards

Chapter 32: Infertility Flashcards

1
Q

define infertility

A
  • original definition: inability to conceive after 1 year of unprotected, regular sexual intercourse
  • more practical definition: involuntary inability to conceive when desired
    • often expanded to include couples who conceive but repeatedly lose a pregnancy before the fetus is old enough to survive
  • primary infertility: couples who have never conceived
  • secondary infertility: couples who have conceived before but are unable to conceive again
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2
Q

name the 4 contributing factors in the man that contribute to infertility

A
  • abnormalities in sperm
  • abnormal erections
  • abnormal ejaculations
  • abnormalities in seminal fluid
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3
Q

explain how abnormalities in the sperm contributes to infertility

A
  • number: some men may have azoosperma or oligospermia
    • average: 35-200 million sperm released at ejaculation
    • minimum for unassisted fertility: 20 million
  • structure: conduct a semen analysis to determine this
    • inflammatory process in the man’s reproductive organs leads to clumping of sperm and decreased motiility
  • function: inability to penetrate the ovum
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4
Q

factors that impair the number and function of the sperm:

A
  • abnormal hormonal stimulation of sperm production
  • acute/chronic illness like mumps, cirrhosis
  • infections of genital tract
  • anatomic abnormalities like varicocele or obstruction
  • exposure to toxins like lead, pesticides
  • therapeutic tx like chemo
  • excessive alcohol intake
  • use of marijuana or cocaine
  • elevated scrotal temp from fever, use of hot tubs, prolonged sitting
  • immunologic factors
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5
Q

explain how abnormal erections contributes to possible infertility

A
  • an abnormal erection reduces the ability to deposit sperm bearing seminal fluid in the woman’s upper vagina
  • there are physical and psychological factors to an erection
    • CNS dysfunction: caused by drugs, psychiatric disturbance, or chronic illness
    • surgery and disorders of the spinal cord
    • peripheral vascular disease: disrupting amount of blood entering penis
    • anti HTN and antidepressants
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6
Q

explain how abnormal ejaculations contribute to possible infertility

A
  • prevents deposition of sperm in ideal place to achieve pregnancy
    • may include retrograde ejaction: release of sperm backward into bladder instead of out of tip of penis
      • may be caused by: diabetes, surgery that impairs the sympathetic NS, antiHTN, psychotropics
    • anatomic abnormalities: hypospadias–sperm deposits near vaginal outlet rather than cervix
    • excessive alcohol or illicit drugs
    • premature ejaculation: from psychological disorders
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7
Q

explain how abnormalities in the seminal fluid contribute to possible infertlity

A
  • seminal fluid nourishes, protects, and carries sperm into vagina, but only sperm enter cervix and uterus
    • if seminal fluid remains thick rather than liquefying, the sperm will become trapped and their movement stopped
  • pH of seminal fluid is slightly alkaline to protect them from acidic vagina
  • causes:
    • seminal fluid that is abnormal in amount, consistency, or chemical composition suggests obstruction, inflammation, or infection along male repro tract
    • seminal fluid that has lots of leukocytes suggests infection
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8
Q

explain the process of ovulation

A
  • GnRH from the hypothalamus causes the release of FSH and LH from the pituitary
  • FSH: stimulates maturation of follicles in the ovary
  • as the follicles mature, the ovary secretes estrogen to thicken the endometrium
  • about 24-36 hours before ovulation, LH increases which stimulates final maturation of one ovum from its follicle
    • the other follicles regress
    • the collapsed follicle from where the ovum was released (corpus luteum) produces progestone and estrogen which prepares the endometrium for implantation
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9
Q

name the 3 contributing factors in women that contriubte to infertility

A
  • disorders of ovulation
  • abnormalities of the fallopian tubes
  • abnormalities of the cervix
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10
Q

explain how disorders of ovulation may result in infertility

A
  • ovulation can be disrupted by:
    • dysfuntion in the hypothalamus or pituitary that alters secretion of GnRH, FSH, and LH
    • failure of ovaries to respond to FSH and LH sitmulation which prevents maturation and release of an ovum
  • these 2 dysfunctions can be caused by:
    • cranial tumors
    • stress
    • obesity
    • anorexia
    • systemic dz
    • abnormalities of the ovaries: PCOS, early menopause
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11
Q

explain how abnormalities of the fallopian tubes contribute to infertility

A
  • tubal obstruction may occur from scarring and adhesions after reproductice tract infections, like chlamydia, gonorheea, PID
    • need prompt tx if these infections occur
  • endometriosis (uterine lining tissue outside uterine cavity): may cause tubal adhesions, painful periods, painful intercourse
  • congenital abnormalities of the fallopian tubes
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12
Q

tubal obstruction

A
  • tubal obstruction may occur if adhesions develop after pelvic surgery, ruptured appendix, peritonitis, or ovarian cysts
  • may develop from scarring and adhesions after infections
  • conditions that cause obstruction may interfere with normal motility in fallopian tube:
    • poor movement of fibriae may prevent pickup of ovum after ovulation
    • abnormal action of cilin in tube prevents movement of ovum toward uterus
      • can all prevent fertilization or lead to ectopic pregnancy
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13
Q

explain how abnormalities in the cervix contribute to infertility

A
  • low estrogen prevents development of clear, thin, slippery mucus (spinnbarkeit) that helps sperm pass into the uterus
    • should be released to days before ovulation
    • w/o this mucus, anovulation occurs (mentrual cycle w/o ovulation)
    • prevents normal capacitation of sperm and movement of the sperm into uterus
  • polyps or scarring from past surgical procedures such as cauterization may obstruct the woman’s cervix
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14
Q

list the 6 factors that contribute to repeated pregnancy loss

A
  • abnormalities of fetal chromosomes
  • abnormalities of cervix or uterus
  • endocrine abnormalities
  • immunologic factors
  • environmental agents
  • infections
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15
Q

explain how abnormalities of the fetal chromosomes contributes to repeated pregnancy loss

A
  • errors in fetal chromosomes may result in spontaneous abortion–>usually in the 1st trimester
    • these abnormalities often severely disrupt development, and the fetus cannot survive until birth
    • maternal age assoc chromosomes also inc spontaneous abortinos
  • most abnormalities are sporadic
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16
Q

explain how abnormalities in the cervix or uterus can contribute to repeated pregnancy loss

A
  • multiple types of congenital malformations: prevent normal implantation of the fertilized ovum or normal prenatal growth of the placenta/fetus
  • women who are exposed prenatally to DES which was prescribed to pregnant women through the ealry 1970s are more likely to have uterine malformations or an incompetent cervix (will not remain closed)
    • if have an incompetent cervix, premature cervical dilation often occurs in the 2nd trimester, so unable to carry to term
  • uterine myomas (benign tumor) and adhesions can cause fetal losses b/c they alter the blood suppy to the developing fetus or cause uterine irritability
18
Q

explain how endocrine abnormalities contribute to repeated pregnancy loss

A
  • inadequate progesterone secretion by the corpus luteum prevents normal thickening of the endometrium for implantation
  • hypo & hyperthyroidism may be assoc with recurrent pregnancy loss
  • poorly controlled DM: b/c it effects blood glucose levels and vascular system
19
Q

explain how immunologic factors may cause repeated pregnancy loss

A
  • embryo has antigens different from those of the mother and ordinarily would be rejected like any other foreign tissue
    • but, the mom’s body normally blocks this rejection response
    • BUT, some women’s body’s reject the baby as foreign tissue–>spontaneous abortion
  • autoimmune dz, like lupus: cause thrombosis or damage in placental blood vessels, exacerbation of symptoms of autoimmune dz, fetal heart block, nonreassuring fetal status
20
Q

explain how environmental agents may contribute to repeated pregnancy loss

A
  • amount of exposure often relates to pregnancy outcome
  • established toxins:
    • radiation
    • alcohol & tobacco
    • accutane
    • mercury
    • pesticides
    • lead
    • anesthetic agents
21
Q

preconception counseling

A
  • helps the couple evaluate their risk for birth defects and reduce their risk of bearing a child with birth defects
  • thorough hx and physical of borth members of the couple may identify inc risk for having a child with a genetic defect
  • can help the woman understand the importance of an adequate diet before conception and also helps her avoid teratogens
22
Q

H&P to evaluate infertility

A
  • hx:
    • women’s menstrual pattern, age of onset, characteristics
    • any pregnancies, complications
    • contraceptive methods
    • previous fertility with other partners
    • pattern of intercourse in relation to the woman’s cycles
    • length of the time the couple has had intercourse w/o contraception
    • exposure to potential toxins
    • family hx of pregnancy losses
    • past surgical hx and infections
  • physical exam: includes endocrine disturbances, cranial tumors, chronic dz, structural reproductive defects, chronomosomal abnormalities
23
Q

diagnostic tests to evaluate infertility

A
  • ovulation monitoring
  • evaluation of cervical mucus
  • hormone evaluations
  • semen analysis
  • testicular biopsy
  • hysterosalpingogram (HSG): gentle injection of contrast into cervix while imaging pelvis to visualize passage of dye thru uterus and fallopian tubes
24
Q

medication therapies to facilitate pregnancy

A
  • hormones
    • progesterone and Clomiphene (Clomid) is often used to stimulate follicle development
    • hCG: to induce release of several ova
  • meds to improve semen quality, ovulation, prepare endometrium, and support pregnancy
  • meds to correct infection or endometriosis
  • erectile dysfunction medications
25
Q

complications of medications to facilitate fertility

A
  • superovulation: inc risk of multiple births due to ovulation induction by medication
  • ovarian hyperstimulation syndrome: involves marked ovarian enlargement with exudation of fluid and protein into the woman’s peritoneal and pleural cavites
26
Q

surgical procedures to facilitate pregnancy

A
  • endoscopy: to correct obstructions
  • laparotomy: to relieve pelvic adhesions or obstructions caused by endometriosis, infections
  • laser surgical techniques: may be used to reduce adhesions and are less likely to cause new adhesions
  • ligation or embolization of a dilated vein to correct varicocele: improve sperm quantity or quality
  • transcervical balloon tuboplasty: to unblock fallopian tubes
27
Q

therapeutic insemination

A
  • may use either partner or donor sperm
  • intrauterine insemination (IUI): sperm placed directly into uterus which bypasses cervical mucus and removes many antibodies that interfere with sperm motility
  • sperm is collected by masturbation
  • donors:
    • tested for diseases and genetic defects
    • before their sperm is used, it is held and frozen for 6 mos while the man receives more testing
    • inadvertent consanguinity can occur if too many donations from the same man are allowed
28
Q

egg donation

A
  • use of donor oocytes may be an option if a woman cannot produce ova b/c of premature ovarian failure, if a woman does not respond to ovarian stimulation, or if a woman’s ova are not successsfully fertilized despite normal sperm
  • egg donor is screened for genetic problems and diseases
29
Q

surrogate parenting

A
  • surrogate mother may be used if woman is infertile or cannot carry a fetus to live birth
    • may supply uterus only (gestational surrogate) and the couple supplies sperm and ovum
    • may supply ovum and be fertilized by male partner’s sperm–so genetic and gestational surrogate
  • not anonymous
  • custody of child has been an issue in many court cases
30
Q

in vitro fertilization (IVF)

A
  • can be done to bypass blocked or absent fallopian tubes, for male factor infertility, or for unexplained infertility
  • sperm and egg are fertilized outside the body, and after fertilization, embryo is implanted in the uterus
    • number of fertilized ova transferred to uterus is individualized, but usually 2-3
  • supplemental progesterone is given to the woman to promote implantation and support early pregnancy
31
Q

gamete intrafallopian transfer (GIFT)

A
  • woman must have at least one patent fallopian tube
  • ova and sperm are extracted and then introduced into the fallopian tube thru a laparoscope
  • progesterone is given to woman to prepare endometrium and support early pregnancy
32
Q

zygote intrafallopian transfer (ZIFT)

A
  • hybrid of IVF and GIFT
  • woman’s ova are fertilized outside the body, but the resulting fertilized ova are placed in fallopian tubes and enter the uterus naturally for implantation
  • must have at least 1 patent fallopian tube
33
Q

intracytoplasmic sperm injection (ICSI)

A
  • can be helpful if there is a male factor infertility
    • men who have obstructions to epididymis or absence of epididymis
  • sperm are retrieved from epididymus by aspiration of a single spermatozoon
    • sperm are then used to fertilize ova by intracytoplasmic sperm infection (ICSI)
34
Q

responses to infertility

A
  • many people assume they are fertile, so must take contraception until ready to have a child
  • growing awareness of a problem: months pass and not getting pregnant
  • seeking help for infertility
    • have to share intimate infomation, consider finances, committment to treatment
  • reactions during evaluation:
    • lots of decisions to make: social/cultural/religious values, difficult of treatment, probability of success, finances
    • psychological reactions: guilt that they “are the problem,” isolation from others, depression, stress on relationship
  • outcomes vary: success, loss, adoption
35
Q

perinatal loss

A
  • grief is emotional response to loss
  • mourning is the process of going thru the phases of grief until the loss is accepted
  • loss takes various forms:
    • loss of idealized experience
    • loss of expected characteristics of infant
    • loss of infant before birth, after birth, or knowing it will happen in the future
36
Q

how can a nurse assist with the grieving process of perinatal loss

A
  • acknowledge loss at any stage of development
  • recognize grief responses vary outwardly
  • promote bonding to help with acceptance
  • provide accurate information
  • show kindness and honestly
  • include the entire family
  • recognize conflicting feelings in concurrent death and surivival (multiple pregnancies)
37
Q

nursing interventions of perinatal loss

A
  • acknowledge the infant
    • address by name
    • present to parents with dignity
    • comment on the positive
    • provide mementos and photos
    • respect cultural practices
    • follow up with clergy, autopsy, geneticist, bereavement counseling as the family desires
38
Q

anticipatory grief

A
  • approaching care with the loss of an infant
    • involving family in infant’s care
    • providing privacy
    • answering questions
    • preparing family for inevitability of death
    • growing emphasis on hospital and palliative care for infants and their families

Women's Health Test IV (5 decks)

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