Introduction f43yf7k f43yf7k.

Introduction

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Women’s health Fertility and Infertility

Developed by D. Ann Currie , R.N., M.S.N.

2012

Fertility

Menstrual cycle Ovulation Cervical mucous Uterine structure Hormones Fallopian tubes

Menstrual Cycle

Follicular phase-days 1-14 of the cycle

Menstrual phase (Menses) Proliferative phase Luteal phase-days 15-28 of the cycle Secretory phase Ischemic phase

Ovulation

Mature ovum comes out of the follicle

Cervical Mucus

Becomes more plentiful,thinner,and more stretchy consistency, and forms columns during ovulation to facilitate the transport of the sperm into the uterus

Uterine Structure

Normal shape and myometrium Placement of fertilizated ovum for

successful implantation Unicornate Septate Bicornate

Uterine Types

Hormones

Estrogen Progesterone FSH-Follicle stimulating hormone LH-Lutenizing hormone

Fallopian Tubes

Patent for sperm to reach ovum for fertilized ovum to reach uterus

Male Component Sperm- Morphology-50% must have normal shape Count->20 million per ml. Motility-50% must have normal motion

patterns Testosterone Erection Ejaculation

Infertility

Primary infertility- the individual has never conceived

Secondary infertility- the individual was able to get pregnant but now can not conceive.

Female component Various factors Ovulation- failure to ovulate Body fat under 14% will result in

irregular menses,amenorrhea,or failure to ovulate

Decrease in pituitary hormones of FSH or LH will result in fail to ovulate

Structure of uterus - malformation of uterus

Female Components

Antibodies in vaginal or cervical mucus against sperm

Scarring or blockade of fallopian tubes

Smoking Other

Male Components of infertility

Sperm- lack of sperm, problems with shape, size,count, or motility

Lack of testosterone Unable to maintain erection Failure to ejaculate Scrotal temperature Drug use-ETOH,marijuana,cocaine,

smoking

Male Components

Mumps during teen years or adulthood

Developmental factors

Common Diagnostic Studies with Infertility

Female- Basal Body Temperature(BBT) Serum Hormone Testing Postcoital Exam Endometrial biopsy Hysterosalpingogram Laparoscopy

BBT

Temperature taken prior to arising from bed each morning

sudden dip in temperature prior to ovulation followed by a rise of 0.5 -1.0degrees F which indicates ovulation.

Fertility awareness includes BBT and cervical mucus changes to detect

ovulation

Serum Hormone Testing

FSH LH

Postcoital Exam Couples are instructed to have

intercourse 8-12 hours prior to the exam-1-2 days before ovulation

10ml syringe with catheter attached is used to collect a specimen of the secretions from the vagina

the secretion is examined for s/s of infection,number of active or nonmotile sperm,sperm-mucus interaction

Cont

Consistency of cervical mucus.

Endometrial Biopsy

Obtaining an endometrial tissue sample

lithotomy position or feet in stirrups paracervical block catheter into uterine to obtain

sample to check the luteal phase

Hysterosalingogram To detect uterine or tubal abnormalities Sedation or anesthesia iodine-based radio-opaque dye is

instilled through a catheter into the uterus and tubes to outline these structures and x-ray is taken

procedure should not be scheduled during menses or at time of ovulation

Laparoscopy

Under general or epidural anesthesia

used to visualize the structures in the pelvis or to do surgical procedures

Male diagnostic studies for infertility

Sperm analysis-client ejaculates into container

no ejaculation for several days prior to test

specimen must be tested within 1/2-1 hr after ejaculation.

Serum hormone testing Structural defects

Psychological Factors associated with infertility

Many couples will experience Shame Guilt Blame Stages of Grief Marital difficulties

The nurse should

Address the psychological factors discuss the couples feelings facilitate communication between

the couple provide information to the couple

on resources for coping and support groups and or professional counseling

Educational needs of the infertile couple The educational needs of the couple

with infertility problems is extensive. They will need to know about

test/exams- preparation for the test, what it is, how it is done,meaning of the results of the assessment or tests.

They will need to know about tx- surgeries, medications, and maybe assigned reproductive technologies.

Hormonal therapy

Used for induction of ovulation for therapy for preparation for in vitro

fertilization

Medications Used to achieve induction of ovulation in

cases of anovulatory menstrual cycles or to achieve multiple ova prior to in

vitro fertilization Clomiphene citrate( Clomid,Serophene) Pergonal Humegon Repronex

Medications

Fertinex HCG Risks of ovulation induction-

multiple births, ovarian hyperstimulation -enlarged ovaries,abdominal distention,pain,and occasionally ovarian cysts

Sperm washing

For intrauterine insemination

Artificial insemination

Sperm collected within after ejaculation is inserted via a catheter into the uterus/vagina

Donor sperm- identity of donor is confidential if sperm bank is used or the couple may know the donor

In vitro fertilization (IVF)

Multiple ova are harvested ova are then mixed with sperm in

petri dish up to 4 embryos are placed in uterus extra embryos can be frozen for

implantation at a later time. Hormone are used- FSH, progesterone

Other procedures

Gamete intrafallopian tranfser (GIFT)

Tubal embryo tranfser(TET) Zygote intrafallopian transfer(ZIFT) Micro-epididymal sperm

aspiration(MESA) Percutaneous epididymal sperm

aspiration (PESA)

Nurse’s Role with infertility

Education Support Resource Advocate

QUESTIONS

Thank You

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