Women’s health Fertility and Infertility

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

Women’s health Fertility and Infertility