OB Infertility

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Author:
julianne.elizabeth
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284312
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OB Infertility
Updated:
2014-09-29 09:52:38
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lccc nursing ob infertility
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For Siegmunds Exam 1
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  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
  2. What are the female risk factors for infertility?
    • Autoimmune disorders
    • diabetes
    • Eating disorders/poor nutrition
    • Excessive alcohol use
    • Excessive Exercise
    • Obesity
    • Older Age
    • STI
  3. What are the male risk factors for infertility?
    • Environmental pollutants
    • Heavy use of alcohol, marijuana, cocaine
    • Impotence
    • Older Age
    • Smoking
    • STI
  4. What are the male causative factors for infertility?
    • Endocrine: diseases or tumors or pituitary or hypothalamus, low levels of LH or FSH
    • Spermatogensis: factors that affect sperm development, such as drugs (calcium channel blockers, chemotherapy, nicotine), infection, illness, heat exposure, pesticides, and radiation to pelvis
    • Sperm antibodies: immune response that causes decreases sperm motility (r/t vasectomy or testicle trauma)
    • Sperm Transport disorder of anatomy
    • Disorders of intercourse
  5. What are the female causative factors for infertility?
    • Ovulatory dysfunction: ovulatory dysfunction or inconsistent ovulation
    • Tubal/pelvis Pathology: 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
  6. How is infertility diagnosed in women?
    • Initial screening by GYN (with PMH & Assessments):
    • -STIs
    • -Hormonal Levels-¬†FSH, FH, progesterone, prolactin, TSH, Androgens
    • Assessments of ovulatory dysfunction
    • -Basal body temp
    • -Ovarian reserve testing
    • Endometrial biopsy: performed at the end of the menstrual cycle to assess for the response to hormonal signals
    • Laparoscopy: fluro injection to determine if there are tubal blockages or abnormalities
  7. What hormones are assessed in female infertility?
    • FSH & LH: evaluates ovarian function and determines potential for success with ovarian stimulation medication
    • Progesterone: evaluates ovulation and corpus luteum function
    • Prolactin: high levels can cause anovulation
    • TSH: hypothyroidism may cause menstrual irregularities
    • Androgens (Such as in polycystuc ovary syndrome): excess can lead to oligomenorrhea, anovulation, & amenorrhea
  8. 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
  9. How is infertility diagnosed in men?
    • Initial screening by a urologist
    • Sperm analysis:
    • -volume >2ml
    • -pH 7-8
    • -count >20 mil
    • -motility >50% forward progression
    • -normal sperm >30%
  10. How is male infertility treated?
    • Treatment for endocrine factors
    • Treatment for abnormal sperm count
    • -Stress reduction
    • -improved nutrition
    • -eliminate tobacco
    • -eliminate drugs that effect spermatogenesis
    • Treatment of sperm antibodies with corticosteroids
    • Treat Infections
    • Repair variocele, inguinal hernias blocking ejaculation
    • Treatment of intercourse disorders, such as hypospadius
  11. How is female infertility treated?
    • Lifestyle changes for anovulation
    • -stress reduction
    • -improved nutrition
    • -eliminate tobacco
    • -eliminate drugs that affect oogenesis
    • Treatment for tubal abnormalities
    • Treat uterine fibroids
    • Antibiotics to treat cervical infections
    • Medications to stimulate ovulation
  12. Which medications promote follicular maturation?
    • Clomiphene citrata
    • Menotropins
  13. Which medications stimulate ovulation?
    • hCG
    • Choriogonadotropin alfa
  14. Which medications prevent premature ovulation in women receiving medications to stimulate follicular maturation?
    • Ganirelix
    • Cetrirelix
  15. 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
  16. How does Menotropins work?
    • Also known as Human menopausal gonotropin (hMG)
    • Acts directly on ovaries to induce maturation in follicles
  17. 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
  18. 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
  19. What medications are used for endometriosis?
    • leuprolide/nafarelin
    • Reduces symptoms, but does not increase feritlity
  20. What medications are used for Polycystic Ovary Syndrome?
    • Insulin sensitizing agents helps to lower insulin by allowing it to work
    • -metformin, rosiglitazone
    • -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
  21. Name 6 assisted fertility technologies and how they work
    • INSEMINATION: 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
  22. What are other treatment options for infertility?
    • IVF with donor eggs/sperm
    • Gestational carrier (surrogate mother)
    • Adoption
    • Tubal reversal
  23. 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
    • Social Isolation
    • Self Esteem Issues
    • Ethical concerns, such as what to do with surplus embryos
  24. 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

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