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Infertility

IncidenceCauses

Tests and TreatmentsPsychological Factors

Nurse’s Roles

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Causes of Infertility

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Infertility Preliminary Investigation

• Information about most fertile times for intercourse

• Explanation of basic infertility workup• Basic assessments

– Ovarian function– Cervical mucus adequacy– Semen analysis– Tubal patency– General condition of pelvic organs

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• If lack of ovarian function is suspected– Basal body temperature recording

– Hormonal assessments (FSH, LH, progesterone)

– Endometrial biopsy

– Transvaginal ultrasound

• If cervical problems are suspected– Ferning capacity of cervical mucus

– Spinnbarkeit – increase in mucus elasticity & viscosity

– Presence of antisperm antibodies

Indications for Tests and Treatments for Infertility

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Indications for Tests and Treatments for Infertility

• If tubal or uterine problems are suspected– Hysterosalpingography– Hysteroscopy– Laparoscopy

• If male’s fertility is suspected– Semen analysis– Screening for antisperm antibodies

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Treatments for Infertility

• Pharmacologic intervention– Ovulation-induction agents (Clomid, GnRH)– Human Menopausal Gonadotropins (Pergonal)– Bromocriptine (Parlodel)

• Therapeutic insemination– Indicated for low or abnormal sperm counts– Structural defects in the male reproductive tract

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Treatments for Infertility

• Indications for in vitro fertilization (IVF)– Infertility from tubal factors– Mucus abnormalities– Male infertility– Male & female immunologic infertility– Cervical factors

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Infertility Psychological Reactions

• Development of lack of spontaneity of sexual intercourse– Constant attention to temperature charts– Instructions about their sex life from an outsider

• Feelings of loss of control• Feelings of reduced competency• Loss of status and ambiguity as a couple -

infertility often becomes central focus for role identity

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Infertility Psychological Reactions

• Sense of social stigma– Feelings of guilt or shame

• Stress on marital and sexual relationship– Heighten feelings of frustration or anger

between partners

• Strained relationship with healthcare providers

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Nurse’s Roles in Infertility

• Counselor– Supports the couple as they make decisions– Provide comfort, sympathetic ear– Helps the couple to recognize feelings– Facilitates the free expressions of feelings– Facilitates partner communication– Nonjudgmental approach – Establish rapport - elicit relevant information from

couples

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Nurse’s Roles in Fertility

• Advocate– Helps the couple identify alternatives– Helps the couple to understand motives– Provides resources– Gives infertile couples a sense of control

• Educator– Provides accurate information– Gives extensive and repeated explanations– Ensures couples have written instructions– Helps them to understand the process

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NCLEX QuestionA client calls the fertility clinic to schedule a hysterosalpingogram. Which does the nurse instruct the patient to do?

a)Schedule the procedure on the 10th day of her ovarian cycle.

b)Avoid prostaglandin synthesis inhibitors 48 hours before the procedure.

c)Remain NPO for 8 hours prior to the procedure.

d)Schedule the procedure 4 days after ovulation.