Infertility, Contraception, Abortion

Question 1

Infertility

diagnosis
goals

Answer 1

• Diagnosis after 1yr of unprotected intercourse when woman is <35yrs or after 6mths of unprotected intercourse when woman is >35yrs
• 4 goals when providing care:
  > provide couple w/ accurate info
  > assist in identifying the cause
  > provide emotional support
  > guide & educate abt forms of treatment

Question 2

Factors Associated with Female Infertility

Answer 2

• 40% of infertility issues caused by female-specific issues
• Assessment of female infertility
  > ovarian factors
  > tubal & peritoneal factors
  > uterine factors
  > vaginal-cervical factors

Question 3

Assessment of Female Infertility

Answer 3

• Test or examination
  > evaluation of anatomy
  > detection of ovulation
  > hormone analysis: a common evaluation of ovarian reserve is measurement of the FSH lvls on 3rd day of peroid
  > ultrasonography
  > endometrial biopsy
  > hysterosalpingography
  > laparoscopy

Question 4

Assessment of Male Infertility

Answer 4

• Hormonal factors
• Testicular factors
• Factors associated w/ sperm transport
• Idiopathic male infertility
• 40% infertility attributed to male facotrs

Question 5

Care Management of Male Fertility

Answer 5

• Assessment of male infertility
  > semen analysis: basic test of male fertility
  > hormone analysis
  > scrotal ultrasound: transrectal U/S evaluates ejaculatory ducts, vas deferens, and seminal vesicles

Question 6

Plan of Care and Implementation of Infertility

Answer 6

• Psychosocial considerations
  > major life stressor
  > exhibit greiving behaviors
• Nonmedical treatments
  > herbal alternative methods
• Medical therapy
• Surgical therapies
  > assisted reproductive therapies (ART)
• Fertility treatments are more successful in producing a live birth for women <35yrs

Question 7

Reproductive Alternatives

Answer 7

• Surogacy
• Adoption
• Cryopreservation of human embryos
• Moral and ethical dilemmas may exist for ARTs
  > preimplantation genetic diagnosis

Question 8

Contraception

Answer 8

• Intentional prevention of pregnancy
• Birth control is the device or practice to dcr the risk of conceiving
• Family planning is the conscious decision on when to conceive or avoid pregnancy
• May still be at risk for pregnancy
• Nearly half of all US pregnancies are unplanned

Question 9

Coitus Interruptus

Answer 9

• Withdrawal
• 27% failure rate

Question 10

Fertility Awareness Methods (FAMs)

Answer 10

• Rely on avoidance of intercourse during fertile peroids
• Failure rate for 1st yr use is 24%
• FAMs combine charting menstrual cycle w/ abstinence or other contraceptive methods
  > natural family planning (peroid abstinence)
  > calendar rhythm method
  > standard days method
  > basal body temp method
  > cervical mucus ovulation-detection method
  > symptothermal method
  > predictore test kits for ovulation
  > twoday method
  > breast-feeding

Question 11

Spermicides

barrier method

Answer 11

• Frequent use of N-9 or the use of N-9 during anal intercourse may incr HIV transmission and lesions
• 29% failure rate in 1st yr when used alone

Question 12

Condoms

barrier method
male
sti protection

Answer 12

• Non-spermicidal latex condoms provide barrier against STIs & HIV
• Polyurethane = thinner & stronger
• Latex perfect use better to prevent pregnancy

Question 13

Vaginal Sheath

barrier method
sti protection

Answer 13

• Can be noisy
• Cannot use concurrently w/ male condoms
• 21% failure rate 1st yr

Question 14

Diaphragm

barrier method

Answer 14

• Mechanical (device shape) and chemical barrier (holds spermicide against cervix)
• Poor choice for those w/ poor vaginal muscle tone

Question 15

Cervical Cap

barrier method

Answer 15

• Effectiveness less than that of diaphragm
• Contraindicated for those w/ abn pap test results

Question 16

Contraceptive Sponge

barrier method

Answer 16

• Failure rate higher than diaphragm
• Sponge impregnated w/ N-9

Question 17

Combined Estrogen-Progestin Contraceptives (COCs)

hormonal method

Answer 17

• Oral contraceptives & side effects
  > ovulation inhibited
  > overall therapeutic effectiveness is 99-100%
  > contraindications: clotting disorders, liver disease, breast cx, pregnancy, smoking & >35yrs old, HTN, diabetes, & migraines w/ aura
• Transdermal contraceptive system (patch)
• Vaginal ring (NuvaRing)

Question 18

Progestin-Only Contraceptives

hormonal method

Answer 18

• Inhibit ovulation, thicken cervical mucus, alter tubal cilia, thin endometrium
• Less contraindications due to lack of estrogen
• Oral progestins (minipill)
  > taken every day at same time
• Injectable progestins
  > 4x/yr
• Implantable progestins (Norplant)
  > minor surgical procedure

Question 19

Emergency Contraception (EC)

Answer 19

• Used w/in 72hrs of unprotected intercourse
• 5 methods available in US
  > high doses of estrogen or COCs (2 options)
  > 2 days of Levonorgestrel
  > insertion of copper intrauterine device (IUD)
• Given before ovulation, inhibits follicular development
• Contraceptive counseling should be provided to women when requesting EC
  > discuss behavior modification

Question 20

Intrauterine Devices (IUDs)

Answer 20

• Small, t-shaped device wrapped in copper inserted into uterine cavity
  > approved for 10yrs of use
  > non-hormonal
  > copper creates volatile intrauterine envir’t
• Medicated intrauterine system loaded w/ progestational agent (Mirena)
  > approved for 5-7yrs of use
  > non-estrogen delivery system
  > FDA approved for menorraghia & contraception

Question 21

Sterilization

Answer 21

• Strict regulations in all states for informed consent w/ these procedures
  > if federal funds are used (Medicaid), pt must be 21yrs old
• Female:
  > tubal occlusion
  > tubal ligation
• Male:
  > vasectomy

Question 22

Sterilization Reversal

Answer 22

• Costly
• Female:
  > tubal reconstruction
  > incrd risk of ectopic pregnancy
• Male:
  > tubal reconstruction (Reanastomosis)

Question 23

Abortion

Answer 23

• Purposeful interruption of pregnancy before 20wks of gestation
• Elective: requested
• Therapeutic: for reasons of fetal or maternal health

Question 24

Abortion - Contributing Factors

Answer 24

• Preservation of life of the mother
• Genetic disorders of fetus
• Rape or incest
• Pregnant woman’s request
• Legal & moral issues (Roe v. Wade 1973)
• Association of women’s health & neonatal nurses (AWHONN) supports a nurse’s right to choose to participate in abortion procedures in keeping w/ his/her beliefs

Question 25

1st Trimester Abortion

Answer 25

• Induced abortion performed in 1st trimest is safest & less complex
• Surgical (aspiration) abortion
  > ideally 8-12wks from last menstrual period
• Medical abortion
  > Methotrexate (oral or IM) and Misoprostol (follows 3-7 days after methotrexate and placed vaginally)
  > Mifepristone (can be taken up to 7wks from last menstruation) and Misoprostol (taken orally 48hrs after Mifepristone)

Question 26

2nd Trimester Abortion

Answer 26

• Dilation and Evacuation
  > typically performed 13-16wks gestation
• Cervical preparation w/ prostagladins
• Emotional considerations
  > guilt
  > anxiety
  > emotional distress typically greater in 2nd trimester abortions

Question 27

Abortion Complications

Answer 27

• Common Complications:
  > infection
  > retained products of conception
  > excessive vaginal bleeding

Question 28

Nursing Education on Abortion Complications

women should report these

Answer 28

• Fever greater than 100.4
• Chills
• Bleeding more than one peripad/hour or heavy bleeding for >3days
• Foul-smelling vaginal discharge
• Severe abd pain, cramping, or backache
• Abd tenderness w/ applied pressure