Women’s health Fertility and Infertility
Developed by D. Ann Currie , R.N., M.S.N.
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