Infertility (Exam 1) Flashcards
How would infertility be described?
A failure to achieve a successful pregnancy after 12 MONTHS or more of regular, unprotected intercourse
What is Primary and Secondary Infertility?
Primary (no prior pregnancies + fetility defintion)
Secondary (couples who have been unable to conceive after ONE OR MORE successful pregnancies or who cannot sustain a pregnancy
What are the essential components of FEMALE infertility?
Favorable cervical mucus
Clear passage between cervix & uterus
Patent tubes w/ normal motility
Ovulation & release of Ova
No obstruction between ovary & tubes
Endometrial preparation
Any disruption in the process of conception may cause infertility
What are the essential components of MALE infertility?
Normal semen analysis
Unobstructed genital tract
Normal genital tract secretions
Ejaculate deposited @ the uterus
Any disruption in the process of conception may cause infertility
What is retrograde ejaculation?
Occurs when the sphinter that closes off the bladder doesn’t work properly and the semen back up into the bladder during ejaculation. The male can still have an orgasm
What does the primary assessment include?
Comprehensive history and physical exam
When are couples referred for evaluation?
One year of failure to conceive (without any other underlying causes)
6 months of failure to conceive for High risk pts.
What are examples of High risk patients?
Over 35
genetic Conditions (turner’s or down syndrome)
fertility lowering disease (endometriosis, PCOS)
What is the 1st diagnostic exam preformed 1st?
Semen Analyis (least invasive)
What are the types of tests used to determine inferility?
Basal body temperature (least expensive)
Serum testing
Hysterosalpingography (HSG)– Radiopaque dye is used to visualize fallopian tube patency; Flushes debris or adhesion (what it is thought to do); Assess for iodine/seafood allergy
Sperm Penetration Assay (PSA)— Assess for anti-sperm antibodies, enzyme defect
What does the nurse assess for couples to determine infertility?
Assess sexual hx (together and separately)
Genetic screening
Post-coital mucus examination (Sims-Huhner Test)
Time is critical (before ovulation, 8-12hrs after intercourse); No intercourse for 3 days before test; Examines sperm and cervical mucus interaction
What are the treatment modalities available for the infertile couple and the nursing role?
EDUCATION (changes in lifestyle, sexual techniques, timing of sexual intercourse)
MEDS
Clomiphene citrate (Clomid) 1st-line treatment which induce ovulation starting with the lowest dose
Letrozole (Femara) blocks conversion of estrogen, increasing FSH and GnRH
Oral Hypoglycemia Agents (Metformin) supports ovulation by managing hyperinsulinemia; PCOS
What are examples of Assisted Reproductive Techniques (ART)?
Intrauterine Insemination (IUI) which places prepared sperm @ cervical OS or into uterus; Donor insemination (DI) may be used (Used for chromosomal concerns)
Indications: seminal deficiencies; anatomic defects; ejaculatory dysfunction, cervical stenosis, poor cervical mucus; Surrogate Mother may be used
In-Vitro Fertilization-Embryo Transfer (IVF-EF)— Eggs are collected and fertilized in a lab with sperm then transferred to uterus
Donor oocytes and embryos may be used (Requires egg retrieval procedure; EXPENSIVE
In-Vitro Fertilization (IVF)— Fertilization in the fallopian tube
Examples:
Gamete intrafallopian transfer (GIFT)- Oocytes retrieved then combined w/ sperm and transferred immediately to fallopian tubes
Zygote intrafallopian transfer (ZIFT)
Combines IVF and GIFT; Zygote transferred to fallopian tube for transport into uterus
What is the psychological impact of being infertile on the couple and appropriate nursing considerations?
What is the nurse’s role?
What should the nurse provide when dealing with this patient population?
Stress r/t inability to conceive, expense (ART), Relationship changes, lack of family support
Grief (if ART is unsuccessful or unable to conceive)
Threat to gender identity and sexuality
Feelings of inferiority, guilt, failure, isolation
Depression and martial discord
NURSE’S ROLE
The nurse should teach about fetility awareness behaviors
Provide comfort to by offering a sympathetic ear, a nonjudgmental approach, and appropriate information and instructions throughout the diagnostic and therapeutic process
