Assessment of the Health Care Environment

1. Assessment of the Health Care Environment • Failure of the fertility doctors to regulate themselves • Couples only have one thing on their minds, having a baby • Doctors give into the parents wishes even though there could be severe consequences • Fertility clinics give statistics of how many live births they have achieved but that doesn’t include how many preterm births or deaths after birth due to prematurity (Van Voorhis, 2007) (Paul-Simon, 2011)

2. Inferences & Implications • Fertility clinics need regulations on how many embryos can be transferred in one cycle of IVF • Pre genetic screening needs to also be regulated and used to look for fatal genetic disorders not just gender selection • Fertilizing more eggs than a couple plans on using. Each harvest egg has a 60-70% chance of being fertilized (Goldworth, 1999) • What to do with the extra embryos • Talk with couples about selective reduction in the case of multiples beyond twins.

3. American society of reproduction medicine There are guidelines for embryo transfer for physicians but they are only guidelines not regulations • A limit of 2 embryos implanted for women aged <35 years. • A limit of 3 embryos implanted for women aged 35 to 37 years. • A limit of 4 embryos implanted for women aged 38 to 40 years old. • A limit of 5 embryos for women aged > 40 years. (American Society of Reproductive Medicine, 2009)

4. Points of view-patients • Couples just want to have a baby. • They will do anything to get pregnant. • Couples don’t believe that anything bad will happen, they will have a healthy, perfect baby.

5. Points of view-nurses • Couples may make decisions that the nurse does not agree with on a personal level. • Nurse may feel the couple is “playing God” when dealing with pre-genetic screening. • Nurse may feel that the couple does not totally understand what they are consenting to.

6. Quality & Safety • Assess level of patient's decisional conflict and provide access to resources • Describe strategies to empower patients or families in all aspects of the health care process • Value seeing health care situations “through patients' eyes” (QSEN, 2012)

7. ANA Standards • Standard 5a- Coordination of Care • Provides leadership in the coordination of multidisciplinary health care. • Standard 6-Evaluation • Synthesizes the results of the evaluation to determine the impact of the plan on the patient and family. • Standard 12 Ethics • Informs patient of the risks, benefits, and outcomes of healthcare regimens. • Standard 13—Research • Formally disseminates research findings. (ANA, 2004)

8. Nursing Considerations • Knowledge of current practices and research • Knowledge of additional resources for couples and families going through IVF • Advocate for families • There is a need for families to understand the underlying condition when there is a pre-genetic diagnosis. (Gallo, Knafl, & Angst, 2009)

9. Conclusion • IVF is a very common procedure but needs to be better regulated to keep both the woman and the unborn baby(ies) safe. • As nurses we need to be knowledgeable and compassionate with couples going through IVF. • Thank you for watching and I hope you enjoyed my presentation.

10. References American Society of Reproductive Medicine. (2009). Guidelines on number of embryos transferred. Fertility and Sterility. 92(5):1518-1519. doi:10.1016/j.fertnstert.2009.08.059 American Nurses Association. (2004). Nursing scope and standards of practice. Silver Springs, MD: Nursebooks.org. Baruch, S., Kaufman, D., Hudson, K. (2008). Genetic testing of embryos: Practices and perspectives of US in vitro fertilization clinics. Fertility and Sterility. 89(5):1053-1058. doi: 10.1016/j.fertnstert.2007.05.048 Gallo, A., Knafl, K., Angst, D. (2009). Information management in families who have a child with a genetic condition. Journal of Pediatric Nursing. 24(3):194-204 doi: 10.1016/j.pedn.2008.07.010 Goldworth, A. (1999). The ethics of in vitro fertilization. Pediatrics in Review. (20)28-31. doi:10.1542/pir.20-8-e28 Lachman, V. (2006). Applied ethics in nursing. New York, NY: Springer Publishing Companies, Inc. Medicine Net. (2012).Infertility. Retrieved October 3, 2012 fromhttp://www.medicinenet.com/infertility/page7.htm

11. References Cont. Moyers, S. (2012). ART and embryo donation: A short story. Retrieved October 3, 2012 from http://www.fertilityauthority.com/blogger/swmoyers/2012/4/05/art-and-embryo-donation-short-history Nursing Theories. (2012). Jean Watson’s philosophy of nursing. Retrieved October 6, 2012 from http://currentnursing.com/nursing_theory/Watson.html Paul-Simon, A. (2011). Infertility and multiples. Newborn & Infant Nursing Reviews. 11(4):180-184. doi: 10.1053/j.nainr.2011.09.007 Peach, E., Hopkin, R. (2007). Advances in prenatal genetic testing: Current options, benefits, and limitations. Newborn & Infant Nursing Reviews. 7(4):205-210. doi: 10.1053/j.nainr.2007.09.012 Pfister, H., Bohm, G. (2008). The multiplicity of emotions: A framework of emotions in decision making. Judgment and Decision Making. 3(1):5-17. QSEN. (2012). Competency KSAs. Retrieved from http://www.qsen.org/ksas_prelicensure.php Van Voorhis, B. (2007). In vitro fertilization. The New England Journal of Medicine. 356:379-386. doi:10.1056/NEJMcp065743