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