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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?
- Autoimmune disorders
- Eating disorders/poor nutrition
- Excessive alcohol use
- Excessive Exercise
- Older Age
What are the male risk factors for infertility?
- Environmental pollutants
- Heavy use of alcohol, marijuana, cocaine
- Older Age
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
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
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
- 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
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
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
- Sperm analysis:
- -volume >2ml
- -pH 7-8
- -count >20 mil
- -motility >50% forward progression
- -normal sperm >30%
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
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
Which medications promote follicular maturation?
- Clomiphene citrata
Which medications stimulate ovulation?
- Choriogonadotropin alfa
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
- -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
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
What are other treatment options for infertility?
- IVF with donor eggs/sperm
- Gestational carrier (surrogate mother)
- Tubal reversal
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
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