Infertility

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Author:
Prittyrick
ID:
282589
Filename:
Infertility
Updated:
2014-09-11 21:48:03
Tags:
matper
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Description:
quick lecture
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  1. Description
    Inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception

    emotional/financial burden

    Primary infertility- trying to get pregnant for the 1st time

    Secondary infertility- trying to get pregnant after u had a children. having difficult (men and women)
  2. Concerns
    • Physical inability to conciece
    • feelings of inadequacy and guilt
    • expense
    • effects on the couple relationship
    • lack of family support

    • Cultural aspect
    • ability to conceive a child is a norm
    • treatment is effected by culture/religion
  3. Risk Factors for infertility
    • Female
    • - weight
    • - hormonal imbalance
    • - tubal blockage
    • - stress
    • - smoking
    • - hx of STI
    • - older women 
    • - multi miscarriage
    • - radiation tech

    • Men
    • - toxic waste/radiation
    • - work enviroment
    • - genitial to hot tubs
    • - smoking
    • - mumps in adolescents
    • - undecedant testes
    • - tight whites
    • - long distance cycling
  4. Nursing Assessment
    Female
    You need to do a complete health history of both of parties

    • Female
    • age, how long have she been trying, medical hx, surgical hx, OB hx, sexual hx, occupation, weight
  5. Nursing Assessment
    Males
    • mumps, substance use, occupational/enviromental risk
    • timing and frequency of coitus- too much sex
    • sperm antibodies-auto-antibodies interfere with spermatogenesis
    • exposure to cold enviroments
  6. Diagnostic/procedural assessment
    female
    • assess ovulation
    • clomiphene citrate challenge test - drug for fertility- to test how many mature ovum
    • basal body temp- check temp everyday at same time..at ovulation bbt will go up. call hunny home quick
    • progesterone assay testing- this needs to go up- maintain the pregnancy
    • endometrial biopsy
    • cervical mucous- can be a hostile enviroment for the sperm- ovulation it is very thin
    • post coital test- have intercourse and see how much sperm survived getting into the cervix
    • ultrasound- to check for block tubes/her anatomy
    • tubal patency test
    • hysteroscopy- look at tube
    • laparoscopy
  7. Dx/procedure assessment
    Male
    semen analysis

    • volume
    • viscosity
    • % normal v abnormal
    • number > 20 ml
    • viability
    • sperm shape
    • motility- can they swim
  8. Infertility Management
    • we want to correct the underlying problem
    • increase sperm count and motility
    • reducing the presence of infection
    • hormone therapy
    • surgery
  9. Treatment
    • If pt has what issue which treatment would you give (hint)
    • Medications
    • Lupron- puts u into chemical menopause- stops having cycle
    • the purpose of this is when u come off this med all levels should go up (ovulate more)

    clonid/pergonal- so u can develop more eggs (deficient in eggs

    Artificial Insemination- male having issue with swimming so u would u this to put the s

    IVF in vitro fert.- the need to help the egg and the sperm become fertilized (test tube). once the egg is fertilized they wait a day or and then implant in the uterus- problem with the fallopian tube

    Gamete intrafallopian tube transfer (GIFT)- female has to have at least one working ovary and tube- similar to IVF mix egg and sperm and place in the tube

    Intracytoplasmic sperm injection- one sperm and put it into the egg (use this with IVF) (males)

    Donor oocytes or sperm 

    preimplantation genetic dx- look at the egg (IVF) to make sure it would be stable to see if it is not a genetic issue

    • gestational carrier surrogacy 
    • adoption
    • table p124
  10. Nursing Intervention
    • Education, support
    • have couple to discuss feelings
    • monitor adverse effects associated with meds to treat female/male infertility
    • advise that fertility meds may increase the risk of multiple births by 25%
    • provide info on procedures and treatment
    • make referrals to grief and infertility groups
  11. Endometriosis p118
    one of the reason for infertility
    • Etiology
    • endometrial tissues are located outside of the their normal site, the uterine cavity
    •  (background- the lining of ur uterus endometrial thickens when u are ovulating waiting for pregnancy to occur. when it doesnt happen- u shed lining and u have ur menses) 
    • sometime this sneaks out into ur abd cavity (tissue). estrogen and progesterone increase...this does the same thing and u get ur period and u have all that mess in there.

    • Commonly found on ur ovaries, fallopian tubes, surface of the uterus, bowels, rectvaginal septum, pelvic organs
    • They treat this with lupron
    • laproscopy

    risk factor is age, short menstrual cycle, start period early, high fat, few pregnancy

    sometimes pregnancy cleans this out. 
  12. Clinical Manifestations
    • Infertility (30%-40% with endometrosis are infertile)
    • pain before and during menstrual period
    • pain during and after sex
    • painful urination
    • depression
    • fatigue
    • painful bowel movements
    • chronic pelvic pain
    • pelvic adhension- bowel can actually stick to something else
    • irregular or more frequent menses
    • premenstrual vaginal spotting
  13. Therapeutic Management endometriosis
    Goals of therapy is to suppress levels of estrogen and progesterone- lupron

    surgical of ablation- hysterectomy

    medication therapy- like birth control bc some make u not have ur period. 
  14. Physical exam and dx test
    vaginal exam- the uterosacral ligaments, the posterior uterus, or posterior cul-de-sac 

    pelvic or transvaginal ultrasound

    laparoscopy- to see if u have adhension- they may scrape it all down so woman can try to get pregnant

    tissue biospy

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