Card Set Information
lccc nursing ob infertility
For Siegmunds Exam 1
What is the definition of infertility and what are the general causes?
Inability to conceive and maintain a pregnancy after one year of active attempt at pregnancy (after 6mo if the woman is older than 35 y/o)
The cause can be identified in about 80% of couples, with one third of cases related to the female, one third related to the male, and one third related to both
What are the female risk factors for infertility?
Eating disorders/poor nutrition
Excessive alcohol use
What are the male risk factors for infertility?
Heavy use of alcohol, marijuana, cocaine
What are the male causative factors for infertility?
: diseases or tumors or pituitary or hypothalamus, low levels of LH or FSH
: factors that affect sperm development, such as drugs (calcium channel blockers, chemotherapy, nicotine), infection, illness, heat exposure, pesticides, and radiation to pelvis
: immune response that causes decreases sperm motility (r/t vasectomy or testicle trauma)
Sperm Transport disorder of anatomy
Disorders of intercourse
What are the female causative factors for infertility?
: ovulatory dysfunction or inconsistent ovulation
: damage to fallopian tubs often related to PID, uterine fibroids
Cervical mucus factor
: cervical injury, infection, interferes with ability of sperm to survive or enter uterus
How is infertility diagnosed in women?
Initial screening by GYN (with PMH & Assessments):
-Hormonal Levels- FSH, FH, progesterone, prolactin, TSH, Androgens
Assessments of ovulatory dysfunction
-Basal body temp
-Ovarian reserve testing
: performed at the end of the menstrual cycle to assess for the response to hormonal signals
: fluro injection to determine if there are tubal blockages or abnormalities
What hormones are assessed in female infertility?
FSH & LH
: evaluates ovarian function and determines potential for success with ovarian stimulation medication
: evaluates ovulation and corpus luteum function
: high levels can cause anovulation
: hypothyroidism may cause menstrual irregularities
Androgens (Such as in polycystuc ovary syndrome)
: excess can lead to oligomenorrhea, anovulation, & amenorrhea
How is basal body temperature assessed?
This is a basic test for ovulatory function
Identifies follicular and luteal phase
Measure the BBT daily before rising from bed
Estrogen increases as ovulation nears and the peak of estrogen causes slight drop in BBT followed by a rise in BBT
Surge of LH causes a sustained rise in BBT
May use a standard thermometer calibrated in tenths of a degree
May also use a BBT thermom that only reads 96-100F
If there is no temp change during the cycle, there is no ovulation
How is infertility diagnosed in men?
Initial screening by a urologist
-count >20 mil
-motility >50% forward progression
-normal sperm >30%
How is male infertility treated?
Treatment for endocrine factors
Treatment for abnormal sperm count
-eliminate drugs that effect spermatogenesis
Treatment of sperm antibodies with corticosteroids
Repair variocele, inguinal hernias blocking ejaculation
Treatment of intercourse disorders, such as hypospadius
How is female infertility treated?
Lifestyle changes for anovulation
-eliminate drugs that affect oogenesis
Treatment for tubal abnormalities
Treat uterine fibroids
Antibiotics to treat cervical infections
Medications to stimulate ovulation
Which medications promote follicular maturation?
Which medications stimulate ovulation?
Which medications prevent premature ovulation in women receiving medications to stimulate follicular maturation?
How does Clomiphene citrata work and what does it require?
Induces ovulation by increasing secretion of FSH & LH
This requires normal ovaries, normal prolactin, intact pituitary gland
This is usually the first line of therapy
How does Menotropins work?
Also known as Human menopausal gonotropin (hMG)
Acts directly on ovaries to induce maturation in follicles
How does hCG work and when is it used?
This is used in 3 different scenarios:
1. Used to promote follicular maturation and ovulation in women with ovulatory failure
2. Used to induce ovulation in combination with a medication
3. Used in combination with clominphene when clomiphene along failed to induce ovulation
What medications are used for hyperprolactinemia?
Cabergoline & Bromocriptine
Treats hyperprolactinemia which may inhibit production of FSH & FH
Restores normal menstrual cycles
Cabergoline better tolerated than bromocriptine
What medications are used for endometriosis?
Reduces symptoms, but does not increase feritlity
What medications are used for Polycystic Ovary Syndrome?
Insulin sensitizing agents helps to lower insulin by allowing it to work
-may induce ovulation in anovulatory women with hyperinsulinemia due to PCOS
Piglitazone and spironolactone
are used to reduce symptoms, but not used for women attempting pregnancy due to harmful effects on unborn infant
Name 6 assisted fertility technologies and how they work
: sperm placed into the cervix or uterus and the sperm may be from a partner or donor
TESTICULAR SPERM ASPIRATION
: sperm is aspirated directly from the testicles and then the sperm is injected into the egg
IN VITRO FERTILIZATION (IVF)
: fertilization in laboratory and then fertilized egg is inserted into the uterus
GAMETE INTRAFALLOPIAN TRANSFER (GIFT)
: eggs are retrieved from ovaries and placed directly into a catheter with live sperm, then deposited into the fallopian tubes
ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT)
: fertilized egg is placed into the fallopian tube
EMBRYO TRANSFER (ET)
: growing embryo is placed into the uterys
What are other treatment options for infertility?
IVF with donor eggs/sperm
Gestational carrier (surrogate mother)
What are some emotional implications for infertility?
Roller coaster ride ea month r/t anticipated pregnancy
Situational crisis for the couple
Stress, anxiety & depression
Strain b/t partners
Self Esteem Issues
Ethical concerns, such as what to do with surplus embryos
What is the critical component of nursing care for infertility?
The experience of infertility effects the individual as well as the couple's emotional well being
Nurse's awareness of how fertility affects all aspects of the individual and of the couple's relationship will enhance the effectiveness of the nursing care provided to these couples or individuals