Introduction
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http://www.youtube.com/watch?v=qjSZ
f43yf7k
Women’s health
Fertility and Infertility
Developed by
D. Ann Currie , R.N., M.S.N.
2012
Fertility
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Menstrual cycle
Ovulation
Cervical mucous
Uterine structure
Hormones
Fallopian tubes
Menstrual Cycle
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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
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Mature ovum comes out of the follicle
Cervical Mucus
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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
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Normal shape and myometrium
Placement of fertilizated ovum for
successful implantation
Unicornate
Septate
Bicornate
Uterine Types
Hormones
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Estrogen
Progesterone
FSH-Follicle stimulating hormone
LH-Lutenizing hormone
Fallopian Tubes
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Patent
for sperm to reach ovum
for fertilized ovum to reach uterus
Male Component
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SpermMorphology-50% must have normal
shape
Count->20 million per ml.
Motility-50% must have normal motion
patterns
Testosterone
Erection
Infertility
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Primary infertility- the individual has
never conceived
Secondary infertility- the individual was
able to get pregnant but now can not
conceive.
Female component
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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
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Antibodies in vaginal or cervical mucus
against sperm
Scarring or blockade of fallopian tubes
Smoking
Other
Male Components of infertility
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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
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Mumps during teen years or adulthood
Developmental factors
Common Diagnostic Studies
with Infertility
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FemaleBasal Body Temperature(BBT)
Serum Hormone Testing
Postcoital Exam
Endometrial biopsy
Hysterosalpingogram
Laparoscopy
BBT
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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
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FSH
LH
Postcoital Exam
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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
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Consistency of cervical mucus.
Endometrial Biopsy
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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
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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
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Under general or epidural anesthesia
used to visualize the structures in the
pelvis or to do surgical procedures
Male diagnostic studies for
infertility
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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
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Many couples will experience
Shame
Guilt
Blame
Stages of Grief
Marital difficulties
The nurse should
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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
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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 txsurgeries, medications, and maybe
assigned reproductive technologies.
Hormonal therapy
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Used for induction of ovulation
for therapy
for preparation for in vitro fertilization
Medications
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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
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Fertinex
HCG
Risks of ovulation induction- multiple
births, ovarian hyperstimulation enlarged ovaries,abdominal
distention,pain,and occasionally ovarian
cysts
Sperm washing
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For intrauterine insemination
Artificial insemination
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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)
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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
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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
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Education
Support
Resource
Advocate
QUESTIONS
Thank You
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http://www.youtube.com/watch?v=STn
oSnWOLwA