OB Test 1 - Chapter 8

Two hormones responsible for ovulation

FSH and LH

A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about?

overstimulation of the ovary resulting in potential multiple births

Female Subfertility Factors

- Inadequate FSH or LH production (prevents ovulation from occurring) - Problems of ova transport through the fallopian tubes to the uterus - Uterine factors (displaced uterus) - Cervical and vaginal factors

A nurse is teaching a group of patients experiencing secondary subfertility. Which of the following would the nurse include as things that can negatively affect spermatogenesis? (Select all that apply.)

- Increased scrotal heat - Trauma to the testes - Drug use - Excessive alcohol use - X-ray exposure

Number 1 Cause of Subfertility

Anovulation - absence of ovulation

client asks the nurse, "What would be the best way to get pregnant." The nurse would incorporate which of the following in the response?

Conception is more likely when intercourse occurs within 72 hours of ovulation

Subfertility Assessment: Questions to ask the woman, the man, and both.

*Woman* - Past pregnancies, miscarriages, abortions, surgeries? - Menstrual history (*age* x *interval* (How many days go by before next period) x *duration*) - Current or past reproductive tract problems? - Any radiation to pelvis? (x-rays, occupation) - Use of douches or intravaginal medications? - How is her nutrition? (*folic acid*) - Can she detect when she's ovulation? (Basal body temp, mittelschmerz?) *Man* - Any radiation to testes? - Surgeries or treatments done? - Sexual practices? - Occupation (sitting, industrial exposure) - Play any recreational activities? (contact sports?) - Boxers or briefs? - Do they masturbate? *Both* - General health - AGE - Nutrition - Alcohol, drug, or tobacco use - Congenital problems of reproductive tract, past STDs or genital tract surgery - Current illnesses - Contraceptive history and pregnancies in previous relationships - Occupational/lifestyle hazards (do they work with pesticides? is the male a truck driver?)

The nurse is assessing a male client who is concerned about his ability to produce enough sperm to have a child. He tells the nurse, "I have had some issues in my younger years." What questions would be important for the nurse to ask this client? Select all that apply.

- "Do you use drugs or use alcohol excessively? - "Are you exposed to X-rays or other radioactive substances?" - "Have you ever had any type of trauma or surgery on or near your testicles?"

A woman calls into the ambulatory care center. She reports that her at-home ovulation predictor test strip results were "positive." She asks what this means. What should the nurse explain?

- "The kit has detected an increased presence of luteinizing hormone (LH) in the urine." - The kit has detected in the urine the hormone that surges prior to ovulation, indicating that the woman is approaching ovulation. Usually, a positive test will indicate that an ovum will be released within the next few days, indicating the most fertile period during the menstrual cycle. The kit does not test for presence of estrogen in the urine or the condition of the cervical mucous.

A nurse is assessing a man who, along with his partner, has been having trouble conceiving. When assessing the man, which area would the nurse most likely include as possibly affecting his fertility?

- A 24-hour food intake - History of a sexually transmitted disease - Testes exposed to radiation - A job that requires sitting all day

Infertile Couple

- A couple who has not become pregnant *after at least 1 year* of unprotected coitus - *"Subfertility"* used rather than "infertility"

A woman is using a basal body temperature (BBT) graph to monitor fertile periods. She calls to report that she did not see any temperature change during her past monthly cycle. To what does the nurse attribute this?

- A failure to ovulate - Rationale: The most likely reason is that the woman probably did not ovulate during this menstrual cycle. During a cycle when ovulation occurs, FSH and estrogen increase near the time of ovulation and progesterone surges within several days after ovulation (also see Fig. 8.1 in the text).

Hysterosalpingogram (HSG)

- A radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. - Given contrast and follow tubes - See if tubal blockage problem

A nurse is reviewing the medical record of several couples who have attempted to conceive but have been unsuccessful. Which couple would the nurse most likely identify as benefitting from in vitro fertiliziation (IVF)? Select all that apply.

- A woman who has blocked or damaged fallopian tubes - A man who has oligospermia - A woman who lacks cervical mucus - A couple with unexplained subfertility of long duration

Assisted Reproductive Technique

- AKA artificial insemination (term not used anymore) - Treatment to help achieve pregnancy - Alternative or intrauterine insemination - In vitro fertilization

If the patient is having a lot of trouble getting pregnant, what could be some options?

- Alternative insemination: instill sperm into the female reproductive tract - In vitro fertilization: union of sperm and ovum in the laboratory setting - Gamete intrafallopian transfer: egg and sperm placed in fallopian tube - Surrogate embryo transfer: donated oocyte - Adoption

What to include on the physical exam:

- Blood analysis - Sperm count for males - Pap smear for women - Breast and thyroid exam (hypothyroidism can contribute to infertility) - STD screening - Head to toe exam; assess for presence of secondary sex characteristics, any genital abnormalities

What to assess in a sperm analysis

- Count - Morphology (Normal shape? Curved tail?) - Motility (does it travel in a straight line?)

Male Subfertility Factors

- Disturbance in spermatogenesis - Inadequate FSH and LH production (causes a low sperm count) - Seminiferous tubule, duct, or vessel obstruction - Seminal fluid changes preventing sperm motility - Development of autoimmunity (possesses antibodies that kill sperm) - Ejaculation and erection problems

Clomiphene (Clomid)

- Estrogen modulator - Can treat infertility in women who have difficulties ovulating - 3 rounds (3 months; 1/mo) - Possibility of twins or triplets

In counseling a couple who have experienced subfertility for 14 months, which of the following true statement does the nurse base the initial information given to them?

- Fertility testing usually begins with ovulation monitoring in the woman. - Rationale: Ovulation monitoring in the woman and semen analysis in the man are usually the first steps taken in fertility testing because these are the least invasive of procedures and answers two of three basic questions related to subfertility (sperm quality and available ova). Transrectal and scrotal ultrasound and checking for tubal patency are more invasive procedures and are performed if these initial tests are negative.

Types of Fertility Testing

- Ovulation monitoring - Tubal patency - Uterine deformities - Vaginal and cervical problems - An inflamed fallopian tube due to scar tissue from PID can hinder the ovum

Nursing Dx & Outcomes r/t Subfertility

1.) Knowledge deficit related to fertility testing ~ Couple will understand the processes related to fertility testing. 2.) Anticipatory grieving related to failure to conceive or sustain a pregnancy ~ Couple will successfully resolve their grieving process (which may never happen - ambivalence).

Subfertility/infertility is said to exist when a couple has failed to achieve pregnancy after how many months of unprotected sexual intercourse?

12

A nurse is conducting a class for a group of couples about subfertility. When describing the causes of subfertility, which cause would the nurse include as being most common?

Anovulation

Sterility

Inability to conceive due to a *known* cause such as absence of a uterus

Ambivalence

Male or female become unsure if the pregnancy is even desired anymore

A client is being prepared for artificial insemination. Which finding is the most suggestive to determine if the client is ovulating?

change in the cervical mucus

A woman and her partner have been trying to conceive for over 2 years without success. Ultrasound imaging reveals scarring of her fallopian tubes, which appears to be the primary cause of subfertility. What is the most likely cause of the scarring?

pelvic inflammatory disease

A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests?

semen analysis, ovulation monitoring, and tubal patency assessment