Ch. 2 Infertility

*Infertility Assessments* *Female* Age greater than ___ yrs may affect fertility.

35

*Infertility Assessments* *Female* Duration of infertility=

> 1yr w/o conception

*INFERTILITY DIAGNOSTIC PROCEDURES* Evaluates hypothalamic-pituitary-ovarian axis to include serum prolactin, FSH, LH, estradiol, progesterone, & thyroid hormones. A) Hormone analysis B) Endometrial biopsy

A

*Infertility Assessments* *Female* Atypical secondary sexual characteristic such as abnormal body fat distribution or hair growth, which is indicative of an endocrine disorder= A) Medical History B) Obstetric History C) Sexual History D) Gynecologic History

A

*INFERTILITY DIAGNOSTIC PROCEDURES* In 40% of couples who are infertile, inability to conceive is due to ______ infertility. A) male B) female

A *SEMEN ANALYSIS is the 1st test because it is less expensive & less invasive compared w/ female infertility testing. It may need to be repeated.

A nurse in a clinic is caring for a group of female clients who are being evaluated for infertility. Which of the following clients should the nurse anticipate the provider will refer to a genetic counselor? A. A client whose sister has alopecia B. A client whose partner has von Willebrand disease C. A client who has an allergy to sulfa D. A client who had rubella 3 months ago

A. INCORRECT: Alopecia is a nonhereditary disorder and does not warrant referral to a genetic counselor. B. CORRECT: Von Willebrand disease is an genetic bleeding disorder and warrants a client being referred to a genetic counselor. C. INCORRECT: Allergy to sulfa is a nonhereditary condition and does not warrant referral to a genetic counselor. D. INCORRECT: A recent episode of rubella in a non-pregnant female does not warrant a referral to a genetic counselor.

A nurse in an infertility clinic is providing care to a couple who has been unable to conceive for 18 months. Which of the following data should be included in the assessment? (Select all that apply.) A. Occupation B. Menstrual history C. Childhood infectious diseases D. History of falls E. Recent blood transfusions

A. CORRECT: Occupational hazards may include exposure to teratogenic substances in the workplace, such as radiation, chemicals, herbicides, and pesticides. B. CORRECT: Menstrual history can identify hormone-related patterns, such as anovulation, pituitary disorders, and endometriosis. C. CORRECT: Childhood infectious diseases may identify the male partner having had the mumps. D. INCORRECT: A history of falls is not a consideration in the assessment. E. INCORRECT: A recent blood transfusion is not a consideration in the assessment.

A nurse in a clinic is caring for a client who is to be seen by the provider for a postoperative appointment following a salpingectomy due to an ectopic pregnancy. Which of the following statements by the client requires clarification? A. "It is good to know that I won't have a tubal pregnancy in the future." B. "The doctor said that this surgery can affect my ability to get pregnant again." C. "I understand that one of my fallopian tubes had to be removed." D. "Ovulation can still occur because my ovaries were not affected."

A. CORRECT: The risk of recurrence of an ectopic pregnancy is increased following an ectopic pregnancy. B. INCORRECT: Infertility can occur as a result of an ectopic pregnancy. C. INCORRECT: A salpingectomy involves the removal of a fallopian tube. D. INCORRECT: A salpingectomy does not involve the removal of the ovaries.

A nurse in an infertility clinic is caring for a client and her partner. The client asks about the assessments and diagnostic procedures that are done to determine whether infertility can be identified. What is an appropriate response by the nurse? Use the ATI Active Learning Template: Systems Disorder to complete this item to include the following sections: A. Description of Disorder/Disease Process: Define infertility. B. Assessments: Describe at least three. C. Diagnostic Procedures: Describe at least three.

A. Description of Disorder/Disease Process ● Inability to conceive despite engaging in unprotected sexual intercourse for a prolonged period of time or at least 12 months B. Assessments ● Age ● Weight ● Duration of infertility ● Medical history ● Surgical history ● Obstetric history ● Gynecologic history ● Occupational/environmental exposure risk C. Diagnostic Procedures ● Semen analysis ● Pelvic examination ● Hormone analysis ● Endometrial biopsy ● Postcoital test ● Ultrasonography ● Hysterosalpingography ● Hysteroscopy ● Laparoscopy

A nurse is caring for a couple who is being evaluated for infertility. Which of the following statements by the nurse indicates understanding of the infertility assessment process? A. "You will need to see a genetic counselor as part of the assessment." B. "It is usually the woman who is 'having trouble,' so the man doesn't have to be involved." C. "The man is the easiest to assess, and the provider will usually begin there." D. "Think about adopting first because there are many babies that need good homes."

A. INCORRECT: A referral to a genetic counselor occurs if there is a reason to suspect birth defects or other physiological concerns. It is not included in all infertility assessment processes. B. INCORRECT: The cause of infertility is almost evenly divided between men and women. C. CORRECT: A sperm analysis is one of the first steps in the infertility assessment process and can identify a cause of infertility in a less-invasive and less-costly manner. D. INCORRECT: Adoption is an option for the infertile couple after identifying a possible cause for the infertility.

*INFERTILITY ASSESSMENT* *Female* Past episodes of spontaneous abortions are considered= A) Medical History B) Obstetric History C) Sexual History D) Gynecologic History

B

*INFERTILITY DIAGNOSTIC PROCEDURES* Assesses for uterine or vaginal anomolies A) Hysterosalpingography B) Pelvic exam

B

Common factors associated with infertility?

Decreased sperm production Endometriosis Ovulation disorders Tubal occlusions

*INFERTILITY DIAGNOSTIC PROCEDURES* Hysterosalpingography

Dye is used to assess the patency of the fallopian tubes. *Assess for history of allergies to iodine & seafood. *outpatient procedure

People that may need genetic counseling include...

History of birth defects Sickle cell trait or Sickle cell anemia > 35

*INFERTILITY ASSESSMENT* *Female* What needs to be included in a sexual history?

Intercourse frequency # of partners across the lifespan History of STI's

*INFERTILITY ASSESSMENT* *MALE* What is included in a male infertility assessment?

Mumps during adolescence? Substance use (alcohol, cigarettes, heroin, marijuana) Exposure to hazardous teratogenic materials in home or work environment.

*GENETIC COUNSELING*

Provide and clarify information pertaining to the risk of or the occurrence of genetic disorders within a family preceding, during, and following a genetic counseling session. ● Assist in the construction of family medical histories of several generations. ● Provide emotional support. Client responses vary and include denial, anger, grief, guilt, and self-blame. ● Make referrals to support groups and provide follow-up.

*INFERTILITY DIAGNOSTIC PROCEDURES* T or F Laparoscopy is a procedure where gas insufflation under general anesthesia is used to observe internal organs.

TRUE

*INFERTILITY ASSESSMENT* *Female* Why do we need an occupational/environmental exposure risk assessment?

To see if there is any exposure to hazardous teratogenic materials in the home or at a place of employment.

*Infertility Assessments* *Female* Is a surgical history part of the infertility assessment?

Yes, particularly pelvic & abdominal procedures.

*INFERTILITY DIAGNOSTIC PROCEDURES* Postcoital test=

evaluates coital technique & mucus secretions

Infertility=

an inability to conceive despite engaging in unprotected sexual intercourse for a prolonged period of time or at least 12 months.

*INFERTILITY DIAGNOSTIC PROCEDURES* Hysteroscopy is a radiographic procedure used to...

exam the uterus for signs of defect, distortion, or scar tissue that may impair successful impregnation.

*INFERTILITY ASSESSMENT* *Female* What do we need to know about the clients weight?

overweight or underweight

*Genetic Counseling* Can a prenatal assessment of genetic disorders (amniocentesis) pose a potential risk to the fetus?

yes

*INFERTILITY DIAGNOSTIC PROCEDURES* Can an ultrasound be performed to visualize female reproductive organs?

yes

Is an allergy to seafood a contraindication to the dye used in hysterosalpingography?

yes

*Nursing interventions for infertility*

● Encourage couples to express and discuss their feelings and recognize infertility as a major life stressor. Assist the couple to consider options, and provide education to assist in decision-making. ● Explain role of genetic counselor, reproductive specialist, geneticist, and pharmacist in providing psychosocial and medical care. ● Monitor for adverse effects associated with medications to treat female and male infertility. ● Advise that the use of medications to treat female infertility may increase the risk of multiple births by more than 25%. ● Provide information regarding assisted reproductive therapies (in vitro fertilization and embryo transfer, intrafallopian gamete transfer, surrogate parenting, and reproductive alternatives such as adoption). ● Make referrals to grief and infertility support groups.

*COMPLICATIONS* Ectopic Pregnancy

◯ Ovum may implant in the fallopian tubes or abdominal cavity due to the presence of endometrial tissue. ◯ As ovum increases in size, fallopian tube may rupture, and extensive bleeding occurs, resulting in surgical removal of the damaged tube. ◯ If ectopic pregnancy is identified prior to rupture of the tube, surgical removal of the products of conception may be performed, or methotrexate (Rheumatrex) is prescribed to dissolve the pregnancy. ◯ Client faces increased risk of recurrence of an ectopic pregnancy and infertility.

Partners who experience infertility may experience stress related to:

◯ Physical inability to conceive ◯ Expense ◯ Effect on the couple's relationship ◯ Lack of family support Infertility assessments, diagnostic procedures, and genetic counseling may be undertaken.