Infertility

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Infertility

• Incidence
• Causes
• Tests and Treatments
• Psychological Factors
• Nurses 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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Indications for Tests and Treatments for
Infertility

• 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

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Indications for Tests and Treatments for
Infertility

• If tubal or uterine problems are suspected
• Hysterosalpingography
• Hysteroscopy
• Laparoscopy
• If males 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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Nurses 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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Nurses 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 Question

• A client calls the fertility clinic to schedule a
  hysterosalpingogram. Which does the nurse
  instruct the patient to do?
• Schedule the procedure on the 10th day of her
  ovarian cycle.
• Avoid prostaglandin synthesis inhibitors 48 hours
  before the procedure.
• Remain NPO for 8 hours prior to the procedure.
• Schedule the procedure 4 days after ovulation.