Chapter 9: infertility
A male client has been diagnosed with subfertility. Which instructions by the nurse are the most appropriate? Select all that apply. "Include antioxidants in your diet." "Use lubricant during intercourse." "Take baths in hot water regularly." "Avoid keeping your cell phone on your belt." "Wear loose, comfortable pants."
Subfertile men should be advised to eat a diet rich in antioxidants like vitamins E and C. Cell phones placed at the belt or hip may decrease sperm quality and should be avoided. Wearing loose, comfortable pants may improve sperm count. Hot baths and saunas create high scrotal temperatures, which decrease spermatogenesis. Therefore, hot baths should be avoided. Lubricants should not be used during intercourse, because they may diminish sperm motility and quality. (A,D,E)
***A nursing student is reviewing information relative to cultural beliefs about infertility. Which statement if made by a client would require intervention? "I want to consult my rabbi before going any further with an infertility work up." "I will not be able to use IVF therapies, because it is against my Roman Catholic religion as." "I have to take full responsibility for my failure to conceive." "I may consider having infertility treatments but I have to talk this over with my husband first."
In certain cultures, women are viewed as being responsible for all fertility problems; the fact that this statement acknowledges complete guilt would require the nursing student to intervene in order to provide compassion and decrease psychologic stress of the client. Individuals may want to discuss infertility treatments with their spiritual leaders regardless of which religion they are members of, and as such no intervention is required. Members of certain religions such as Roman Catholics may not be able to utilize IVF therapy as a result of their religious affiliation. "I may consider having infertility treatments but I have to talk this over with my husband first" is an expected statement, because both the female and male partner should discuss and explore available fertility options. (C)
A 25-year-old client has been unable to conceive after being diagnosed with chlamydia. What infertility treatment would help the client conceive? In vitro fertilization therapy (IVF) Menotropin (Pergonal) therapy Zygote intrafallopian transfer (ZIFT) Gamete intrafallopian transfer (GIFT)
Infection caused by Chlamydia causes tubal damage, resulting in impaired fertility. Because the client's fallopian tubes are damaged, in vitro fertilization (IVF) will be the most suitable infertility treatment option for the client. With in vitro fertilization (IVF), ova are removed surgically from the client, fertilized outside the uterus, and reintroduced into the uterus. This method uses a special tube, which passes through the cervix to the uterus, completely bypassing the fallopian tubes. Menotropin (Pergonal) therapy is suggested if the client is experiencing ovarian dysfunction. Zygote intrafallopian transfer involves introducing the in vitro-fertilized ovum into the uterine tube at the zygote stage. However, this may not be possible if the fallopian tubes are blocked. Gamete intrafallopian transfer is the transfer of ova into the client's fallopian tube for fertilization. Gamete intrafallopian transfer would be inappropriate in a client with blocked fallopian tubes. (A)
***Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with a number of legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issues would need to be addressed by an infertile couple before treatment? Select all that apply. Risk of multiple gestation Whether or how to disclose the facts of conception to offspring Freezing embryos for later use Financial ability to cover the cost of treatment Stress management techniques and couple counseling
Multiple gestation is indeed a risk of treatment of which the couple needs to be aware. To minimize the chance of multiple gestation, generally only three or fewer embryos are transferred. The couple should be informed that there may be a need for multifetal reduction. Nurses can provide anticipatory guidance on this matter. Depending on the therapy chosen, there may be a need for donor oocytes, sperm, embryos, or a surrogate mother. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer want the embryos at a future time. Stress management techniques and couple counseling should be addressed before treatment. Although the method of payment is important, obtaining this information is not the nurse's responsibility. It is also of note that 14 states have mandated some form of insurance to assist couples with coverage for infertility. (A,B,C,E)
A client who had stimulated ovulation is given hormonal therapy to maintain the uterine lining. The client, however, has a spontaneous abortion while resting at home. What could be the probable reason for the spontaneous abortion? The client was administered exogenous estrogen as the main therapy. The client was administered exogenous estrogen as adjunct therapy. The client was administered exogenous progesterone as the main therapy. The client was administered exogenous progesterone as adjunct therapy
Progesterone is a hormone released by the ovaries. Progesterone plays a vital role in the implantation of the fertilized egg and in the maintenance of the pregnancy. Exogenous progesterone, when administered alone, cannot maintain the uterine lining, and, because of this, may result in abortion. In the case of stimulated ovulation, exogenous progesterone is effective in maintaining the uterine lining only if used as adjunct therapy. Exogenous estrogen is used to treat menopausal symptoms and osteopeorosis. It is unrelated to the maintenance of the uterine lining in stimulated ovulation. Therefore, exogenous estrogen is not beneficial as either the main therapy or as adjunct therapy. (C)
The nurse is teaching the nursing student about semen analysis. Which statement by the student indicates the need for further teaching? "The client should be instructed to masturbate to obtain the semen sample." "A cold environment or low temperature is suitable for storing the semen sample." "The test must be performed within 2 hours of collecting the semen sample." "A spermicide-free plastic sheath must be used to collect the semen sample."
Semen samples should not be kept in a cold environment or at low temperatures, because it reduces the sperm motility. For collecting the semen sample, the patient should be instructed to masturbate, because it stimulates the impulse. For an accurate estimation of sperm count, the test should be performed within 2 hours after collecting the semen sample. This helps to prevent deterioration of the sample. To keep the sperm alive, semen samples should be collected in plastic sheaths that are free from any spermicidal agent. (B)
A client is diagnosed with adhesions in the uterine lining. Which assisted reproductive therapy may be beneficial to the client? Assisted hatching technique Use of a surrogate mother Gamete intrafallopian transfer In vitro fertilization-embryo transfer
Surrogate motherhood is a process by which a woman is inseminated with semen from an infertile woman's husband and then carries the fetus until birth. This method is suggested for a patient with uterine adhesions who cannot become a gestational carrier (embryo host) due to an impaired uterus. Assisted hatching is used to improve the implantation rate in women with previously unsuccessful in vitro fertilization (IFV) attempts. Gamete intrafallopian transfer is indicated for tubal disease or blockage, endometriosis, and severe male infertility. In gamete intrafallopian transfer, the retrieved oocytes are fertilized with washed motile sperms in a catheter, and are transferred into the uterine tube. IVF-ET is indicated for endometriosis. This method involves fertilizing the woman's egg with sperm in the laboratory and then transferring it to her uterus after normal embryo development. (B)
After checking the laboratory report of a client, the nurse reports to the primary health care provider findings that the client has developed insulin resistance and anovulation. What should the nurse expect to be prescribed for the client? Danazol (Danocrine) and glipizide (Glucotrol) Bromocriptine (Parlodel) and glyburide (Diabeta) Progesterone (Prometrium) and acarbose (Precose) Clomiphene (Clomid) and metformin (Glucophage)
The client has anovulation and insulin resistance. Therefore, the primary health care provider may prescribe a combination of clomiphene to promote ovulation and metformin to control blood sugar levels. Clomiphene increases pituitary production and increases the production of follicle-stimulating hormone. Insulin resistance causes hyperinsulinemia, which is a feature of polycystic ovary syndrome. This causes anovulation and leads to infertility in the client. Danazol (Danocrine) is used for the treatment of endometriosis. Glipizide (Glucatrol) and glyburide (Diabeta) are oral hypoglycemic agents but do not work on clients with insulin resistance. Bromocriptine (Parlodel) is used for clients who have excess prolactin. Progesterone (Prometrium) is used for the treatment of endometriosis. Acarbose (Precose) works on carbohydrates in the gastrointestinal tract to treat diabetes mellitus. (D)
A 25-year-old client complains that she has not had her period for 2 months following the discontinuation of oral contraceptives. What instruction does the nurse expect from the primary health care provider? Administer tricyclic antidepressants to the client. Suggest a diet rich in animal protein to the client. Administer phenothiazine (Compazine) to the client. Do not administer menstruation-inducing medication to the client for the next 4 months.
The client has been experiencing amenorrhea, or the absence of menstrual periods in women of reproductive age, which is common immediately following the discontinuation of oral contraceptives. Most women resume menstruation within 6 months of the discontinuation of oral contraceptives. Therefore, the primary health care provider would not consider prescribing any menstruation-inducing medication for another 4 months. Tricyclic antidepressants; are unrelated to a woman's menstrual cycle; hence, they should be avoided. A diet rich in animal protein is associated with early menopause, so it should be avoided. Phenothiazine (Compazine) should not be prescribed, because it may cause increased prolactin levels which may lead to amenorrhea. (D)
The nurse is assessing a couple for infertility problems. After reviewing the client's history and laboratory results, the nurse finds that the client is being treated with clomiphene (Milophene). However, there has not been an increase in the sperm count. What else could be added to the prescription that would help the client to increase the sperm count? Bromocriptine (Parlodel) Progesterone (Prometrium) Depot medroxyprogesterone acetate (DMPA) Intracytoplasmic sperm injection (ICSI)
The client may require intracytoplasmic sperm injection (ICSI). This treatment is preferred for treating clients who have a low sperm count or reduced spermatogenesis. In this process, one sperm cell is selected and injected directly into the egg to achieve fertilization. Bromocriptine (Parlodel) is used to reduce excess prolactin levels. Progesterone (Prometrium) is used for the treatment of endometriosis. Progestin (DMPA) injections are used to impair fertility by inhibiting ovulation. These medications are not prescribed for infertility problems in males. (D)
The nurse is caring for a client who is pregnant as a surrogate mother. Which condition would the biologic mother have to need to use a gestational surrogate? Ovarian failure Tubal blockage Early menopause Uterine myoma
The client who carries a fetus for another couple is referred to as a surrogate mother. In conditions like uterine myomas, the fertilized ova cannot be impregnated in the uterus of the biologic mother. Therefore, the couple would need a surrogate mother to carry the fetus. A female with ovarian failure can still carry the fetus after in vitro fertilization of the donor oocyte. The genetic investment from the male parent can possibly be observed in the embryo when the oocyte is donated and fertilized with the father's sperm. In conditions like tubal blockage, a woman can carry the fetus after it is fertilized in vitro. Genetic investment is possible from both parents for the embryo. Early menopause is the condition in which a woman may require a donor oocyte to conceive and can still carry the embryo in her own uterus. (D)
What is the significance of the clomiphene citrate challenge test (CCCT)? To assess if the fallopian tubes are open and patent To assess for the presence of uterine abnormalities To assess the amount of progesterone production To assess follicle-stimulating hormone (FSH) levels
The clomiphene citrate challenge test (CCCT) is used to assess follicle-stimulating hormone (FSH) levels. In this test, 100 mg of clomiphene (Clomid) are administered to the patient from day 3 to day 10 of the menstrual cycle. Follicle-stimulating hormone (FSH) levels are assessed on the 3rd day and the 10th day after clomiphene (Clomid) is administered. FSH levels greater than 20 indicate that the pregnancy will not occur with the woman's own eggs. FSH levels less than 15 suggest an adequate ovarian reserve in the patient. Patency in the fallopian tubes is assessed by hysterosalpingogram, hysterosalpingo-contrast sonography, and chlamydia immunoglobulin G antibodies. Uterine abnormalities are assessed by hysterosalpingogram and hysterosalpingo-contrast sonography. Progesterone production is assessed by the serum progesterone test. (D)
The nurse is assessing a client who is planning to conceive. While reviewing the client's laboratory reports, the nurse notices a decrease in hypothalamic hormone levels. What should the nurse interpret from this? The client will not be able to successfully produce any ova. The client demonstrates impairment in fallopian factors. The client has an increased risk of fetal congenital anomalies. The client has a family history of fetal hemorrhagic disorders.
The hypothalamus secretes thyrotropin-releasing hormones, corticotrophin-releasing hormones, gonadotropin-releasing hormones, and growth hormones. Among these, gonadotropin-releasing hormones (GnRH) and thyrotropin-releasing hormones play an important role during pregnancy. The hormones stimulate the gonads to produce ova in females and sperm in males. Therefore, low hypothalamic hormones indicate that the formation of ova is affected in the patient. Impaired fallopian factors cannot be interpreted based on the low hypothalamic hormones, because they require further evaluation. Congenital anomalies and hemorrhagic disorders are caused by genetic abnormalities in the fetus. They are not influenced by maternal hormone levels. (A)
***A 36-year-old client is taking ovulation-inducing drugs to conceive after having had one child previously. The client says, "I've been using ovulation-inducing drugs for a month now and still haven't ovulated." How does the nurse respond? A. "You're likely too old to ovulate." B. "When did you have your last menstrual cycle?" C. "You may be sterile and unable to conceive naturally." D. "Continue using the medication a while longer."
The nurse should inquire about the client's last menstrual cycle as a way to begin exploring the details of the woman's menstrual cycle in the past month. Age 36 is not too old for a woman to ovulate. Generally, women enter the menopausal stage at the average age of 51. However, some women may enter menopause early. In the case of early menopause, the ovaries do not respond to ovulation-inducing drugs. Aging reduces the ability to conceive by reducing the functions of the ovaries. However, an ovulation-inducing drug stimulates the ovulation cycle. The scenario indicates that the client has conceived once previously, which indicates that the client is not sterile. Instructing the client to continue using the medication without explaining the reason may be nontherapeutic. (B)
Semen analysis is a common diagnostic procedure related to infertility. In instructing a male client regarding this test, the nurse would tell him to do what? Ejaculate into a sterile container Obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days Transport specimen with container packed in ice Ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation
An ejaculated sample should be obtained after a period of abstinence to get the best results. The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the laboratory within 2 hours of ejaculation. (B)
A client is diagnosed with polycystic ovaries following laparoscopy. The client is diagnosed to have anovulation. What strategies included in the treatment would help the client conceive? Select all that apply. Diet plan rich in antioxidants Herbal therapy of ginseng Thyroid-stimulating hormone (Synthroid) daily Clomiphene (Clomid) and metformin (Glucophage) Clomiphene (Clomid) and dexamethasone (Decadron)
Anovulation, excess androgenic hormones, and insulin resistance are the most common symptoms of polycystic ovarian syndrome. Clomiphene (Clomid) is a selective estrogen receptor modulator, which is used as an ovarian stimulant. Insulin sensitizers like metformin (Glucophage) and dexamethasone (Decadron) potentiate the effects of clomiphene (Clomid) when given to women with anovulation and polycystic ovarian syndrome. Antioxidants like vitamins E and C and herbal medications like ginseng are beneficial in cases of male infertility. Thyroid-stimulating hormone (Synthroid) is useful to treat hypothyroidism and is not associated with polycystic ovarian disease. (D,E)
A 35-year-old client with one child does not respond to ovulation-inducing drugs. On assessing the client's medical history, the nurse suspects early menopause. What could be the reason for the nurse's suspicion? The client has taken methyldopa. The client had a cranial injury. The client had a major surgery. The client had undergone chemotherapy.
Cancer treatments like chemotherapy or radiotherapy may reduce or completely halt ovarian function. Methyldopa is used to reduce blood pressure to normal levels. Methyldopa may cause hyperprolactinemia as a side effect. However, it does not cause early menopause. Cranial injury and surgeries are physical stressors, which may result in increased prolactin levels. However, the conditions are unrelated to early menopause. (D)
The nurse is teaching about infertility. A student nurse asks about the viability of sperm in the female reproductive tract. Which statement made by the nurse is accurate? The sperm remain viable for about 24 hours in the female reproductive system. The sperm remain viable for about 48 hours in the female reproductive system. The sperm remain viable for about 72 hours in the female reproductive system. The sperm remain viable for about 96 hours in the female reproductive system.
Sperm remain viable in the female reproductive tract for 48 hours. However, most of them remain potent for 24 hours. The sperm will degenerate after 48 hours and are eliminated from the female reproductive tract. Because the sperm contain food reserves for only 48 hours, they cannot be viable after 72 or 96 hours. (B)
The nurse is assessing a 36-year-old client who is planning for a second pregnancy. After reviewing the client's medical record, the nurse provides information about the egg donation process to the client. What would be the reason for providing this information to the client? The client suffers from reduced fecundity. The client has age-related infertility. The client has congenital disorders. The client has premature ovarian failure.
Estrogen levels are reduced in a 36-year-old patient. This causes age-related infertility due to reduced production of ova (eggs) from the ovaries. Because of this condition, the nurse can assist the patient by informing her about fertilization treatments like egg donation. Fecundity means the ability to reproduce. Because the client has already had a pregnancy, the client does not have reduced fecundity. If the client has congenital abnormalities, then the nurse could suggest surrogate motherhood or adoption. Premature ovarian failure is observed in women who are below 30, not 36-year-olds. (B)
A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the woman in which herbal preparations to avoid while trying to conceive? "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." "Herbs have no bearing on fertility."
Herbs that a woman should avoid while trying to conceive include licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Nettle leaf, dong quai, and vitamin E promote fertility. Vitamin E, calcium, and magnesium may promote fertility and conception. (B)
The nurse reviews the medical reports of a client and finds that the client has a low sperm count. What should the nurse understand about the client? The client has retrograde ejaculation. The client has azoospermia. The client has erectile dysfunction. The client has an attack of mumps.
Low sperm volume may occur when spermatic fluid is ejaculated backward into the bladder, which is referred to as retrograde ejaculation. Azoospermia refers to complete loss of sperm cell production. The client does not have azoospermia, because the scenario indicates a low sperm count. A low sperm count does not indicate erectile dysfunction. Mumps would result in permanent damage to the testes after adolescence, which results in complete loss of sperm cell production. (A)
***A woman undergoing evaluation of infertility states, "At least when we're through with all of these tests and we will know what is wrong." What is the nurse's best response? "I know the test will identify what is wrong." "I'm sure that once you finish these tests, your problem will be resolved." "Even with diagnostic testing, infertility remains unexplained in about 20% of couples." "After you've identified your problem, you may want to look at the option of adoption."
Problems with infertility must be approached realistically. Nurses should not make judgments or give false reassurance. Providing accurate information to the couple is the best response. The nurse should not make statements indicating that problems will be resolved, because this gives a false impression. The tests are not always definitive, so the nurse should not give false reassurance. The nurse should not offer her opinion but instead should state the facts. (C)
A worried client says, "I had my first child two years ago, and I've been trying get pregnant again for the past six months." Which medical term does the nurse use to describe the client's condition? Sterility Primary infertility Idiopathic infertility Secondary infertility
Secondary infertility is infertility seen in any client who has ever had a pregnancy, regardless of the outcome of that pregnancy. Sterility is the inability of the client to conceive. Primary infertility is infertility seen in clients who have never been pregnant. Idiopathic infertility is unexplained infertility. (D)
A client approaches the primary health care provider due to ovulation problems. The nurse instructs the client to return for a visit 7 days before the menstrual cycle. What is the reason for these instructions? To assess the levels of progesterone in the client To determine the thickness of the uterine lining To evaluate the viscosity of the cervical mucus To assess the follicle-stimulating hormone (FSH) level
Serum progesterone levels are tested seven days before the onset of the next estimated menstrual cycle. This test would help identify the progesterone levels in the client. It helps to assess the corpus luteum and midluteal-phase progesterone levels, because progesterone plays a role in ovulation and the menstrual cycle. The uterine cavity is observed by using an x-ray film during a hysterosalpingogram. This test does not need to be conducted at a particular time. The viscosity of the cervical mucus is assessed to determine if it is conducive for the penetration of the sperm. This can be checked at any point in time. Follicle-stimulating hormone (FSH) levels are determined on day 3 of menstruation to determine ovarian reserve. (A)
The nurse is assessing a client with menstrual cycle irregularity. While speaking with the client, the nurse learns the client is an athlete. What should the nurse suggest to the client to promote a regular menstrual cycle? Undergo aromatherapy treatments Increase intake of food and water Perform aerobic exercise regularly No strenuous exercise for 5 months
An athletic woman who exercises vigorously can develop irregular menstrual cycles. Therefore, the nurse should instruct the client to increase food and water intake. This would increase the client's body mass index and possibly restart regular menstrual cycles. Aromatherapy and aerobic exercises are nonpharmaceutical ways to improve pregnancy rates. These would not be immediate approaches for clients facing irregular menstrual cycles. The nurse should not suggest changing exercise regimens or discourage physical exercise. (B)
Which tests are used to identify tubal patency? Select all that apply. Urine predictor test Hysterosalpingogram Clomiphene citrate challenge test Hysterosalpingography Chlamydia immunoglobulin G antibodies
Hysterosalpingogram, hysterosalpingography, and chlamydia immunoglobulin G antibodies are used to identify tubal patency. The urine predictor test is used to detect the timing of lutein hormone surge before ovulation. The clomiphene citrate challenge test is used to check the level of follicle-stimulating hormone (FSH). (B,D,E)
Following a discussion about assisted reproductive therapy (ART), the nurse asks a student nurse questions about in vitro fertilization (IVF). Which statement by the student nurse indicates the need for further explanation? "IVF is commonly indicated for treating endometriosis." "In IVF, the ova are fertilized with the sperm in the lab." "In IVF, the ova are aseptically removed from the ovaries." "The fertilized embryo is placed into the fallopian tube."
In the IVF process, the embryo is not transferred into the fallopian tubes but directly placed in the endometrial lining of the uterus. IVF is indicated in females with endometriosis or tubal blockage. The eggs, aseptically collected from the ovaries, are fertilized with sperm under laboratory conditions until the embryo is formed. The embryo is then transferred into the uterus for further development. (D)
***The nurse is assessing a 37-year-old client with secondary infertility. While reviewing the client's laboratory reports, the nurse finds that the patient has a reduced ovarian reserve. Which laboratory report would the nurse have reviewed? Thyroxine hormone levels Prolactin hormone levels Follicle-stimulating hormone levels Human chorionic gonadotropin levels
Ovarian reserve refers to the number of viable ova that remain in the ovaries. To assess the ovarian reserve of the client, the nurse should check the levels of follicle-stimulating hormones on the third day of menstruation. Thyroxine levels indicate the presence of thyroid dysfunction. Though prolactin levels also contribute to anovulation, the follicle-stimulating hormone (FSH) level is considered the primary assessment standard for determining ovarian reserve. Human chorionic gonadotropin hormone levels are used in determining if a client is pregnant, because they are elevated during pregnancy. (C)
A couple arrives for their first appointment at an infertility center. A noninvasive test done during initial diagnostic testing is called what? Hysterosalpingogram Endometrial biopsy Semen analysis Laparoscopy
Semen analysis is the basic test for male infertility. Radiographic film examination allows visualization of the uterine cavity after instillation of radiopaque contrast medium through the cervix. The endometrial biopsy is an invasive procedure. A small cannula is introduced into the uterus and a portion of the endometrium is removed for histologic examination. Laparoscopy is useful in order to view the pelvic structures intraperitoneally. This is an invasive procedure. (C)
What laboratory finding would indicate that the nurse should inform the client about egg donation? The follicle-stimulating hormone (FSH) level is high. The follicle-stimulating hormone (FSH) level is low. The progesterone level is low. The progesterone level is high.
The follicle-stimulating hormone (FSH) levels of the client would be assessed to determine ovarian reserves. If FSH levels are greater than 20, this indicates that a pregnancy will not occur with the client's own eggs. Therefore, the nurse should counsel the client regarding egg donation to achieve pregnancy. If FSH levels are 8, then it indicates that the client has adequate ovarian reserve and does not need egg donation. Progesterone levels do not have much effect on the production of ova, so the nurse need not inform the client about egg donation. (A)
What factors should the nurse assess in the client with anovoluation? Select all that apply. Endometriosis Vaginal infections Thyroid disorders Pituitary gland disorders Pancreatic gland disorders
Thyroid disorders and pituitary gland disorders are the primary factors causing anovulation. Abnormal activity of these glands could restrict the formation of ova. Endometriosis is the condition that affects peritoneal factors. This condition does not affect the formation of ova, nor does it restrict it. Vaginal infections are treated with medications and have no relation to the ovaries or their functioning. The pancreas secretes insulin and glucagon, which are not related to ovarian activity either. (C,D)
An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). The nurse instructs her that this medication is administered in what form? A. Intranasal spray B. Vaginal suppository C. Intramuscular injection D. Tablet
Urofollitropin is given by intramuscular injection; the dosage may vary. Intranasal spray is not the appropriate route for urofollitropin. Vaginal suppository is not the correct route for urofollitropin. Urofollitropin cannot be given by tablet; it is given only by IM injection. (C)
The nurse instructs a student nurse to administer depot medroxyprogesterone acetate (DMPA) to a client. What precaution should be taken by the student nurse to ensure safe administration of the drug? Do not: massage the site after the administration. administer the injection at the deltoid muscle. administer the injection subcutaneously. aspirate a blood return prior to the injection.
Depot medroxyprogesterone acetate (DMPA) should be absorbed in the body slowly. Therefore, the nurse should not massage the site of administration after administering DMPA to the client. Massaging the site can hasten the absorption of the drug and shorten the period of effectiveness of the drug. The nurse can administer the injection into the deltoid muscle , because it is a preferable site for injection. The nurse can administer the injection subcutaneously, because this route is acceptable for this injection. Most medications must be aspirated prior to injection. The only drugs that should not be aspirated are anticoagulants and insulin. (A)
***A client who has undergone several failed attempts at in vitro fertilization discusses her feelings with the nurse. If the client says that her inability to conceive does not affect her worth as a human being, what behavioral characteristic is the client showing? Guilt Denial Depression Acceptance
When a client realizes that unworthiness and impaired fertility are unrelated, the client shows acceptance (resolution). Guilt may cause the client to express feelings of responsibility for having somehow caused the infertility. The client might say, "It can't happen to me!" if in denial. The client may express hopelessness or feelings of worthlessness if suffering from infertility-related depression. (D)
A client diagnosed with endometriosis expresses the desire to conceive. Which reproductive therapy would help the client to conceive? Gestational carrier Assisted hatching technique Intrauterine insemination technique In vitro fertilization-embryo transfer
Endometriosis is inflammatory peritoneal damage caused by endometrial tissue that migrates from the uterus and implants on the pelvic organs or connective tissue. In vitro fertilization-embryo transfer (IVF-ET) is often indicated for endometriosis. Therefore, the primary health care provider would suggest IVF-ET. IVF-ET involves the implantation of a laboratory-developed embryo into the uterus. A client with endometriosis would not need a gestational carrie, because the uterus can still hold a fetus to term. Assisted hatching is used to improve the implantation rate in women with previously unsuccessful IVF attempts. Intrauterine insemination is an indication for male subfertility and cervical factors. (D)
The nurse is caring for a client who is scheduled to undergo a hysterosalpingogram. What possible abnormalities can be detected through the procedure? Presence of infection Blockage in the fallopian tubes Decrease in ovarian reserve Abnormal endometrial tissue
A hysterosalpingogram is an x-ray film on which the uterus and fallopian tubes can be visualized for abnormalities. The procedure can help to determine if the fallopian tubes are blocked. Presence of infection cannot be assessed with a hysterosalpingogram. Abnormalities in endometrial tissue are found when endometrial tissue implants itself outside the uterus and is observed by doing an ultrasound. Diagnostic laparoscopy may be indicated for this condition. (B)
Which of the following could affect female fertility? Select all that apply. Partner relationship status Financial history A clinical diagnosis of anemia. Bicornate uterus Uterine abnormality Cephalopelvic disproportion (CPD)
A diagnosis of anemia can affect a woman's fertility status. The presence of a uterine abnormality can affect a woman's fertility status. The presence of CPD relates to whether or not a woman can successfully deliver a baby vaginally based on obtained pelvic measurements. Partner relationship status, although important to one's well-being, does not typically affect female fertility. Financial history is not a factor in determining female fertility. (C,D,E)
***Which of the following, if found in both the male and female of a couple, could present an issue with regard to the couple's fertility? Male and female are the same age, 35. Both partners have had children in their past marriage. History of endocrine problems. History of hypertension.
A history of endocrine problems should be investigated further, because it may have an effect on the couple's fertility. Age is a relative factor, and because the recorded age is 35, it does not in itself present a significant fertility factor unless there are additional factors. The fact that both the man and woman have already had children is a favorable sign of fertility. Although hypertension is a relevant clinical finding, it may not have a direct bearing on the couple's fertility. (C)
The nurse is counseling a client who has had multiple miscarriages. The nurse explains to the client that she has developed endometriosis. In which category would this be placed as a cause of infertility? Tubal factors Ovarian factors Uterine factors Cervical factors
A series of steps are required for successful conception. Interference in any one of the steps may result in infertility. Tubal factors would be the cause of this client's infertility. The fertilized embryo was unable to reach the uterus by passing through the fallopian tubes because of the client's endometriosis. Ovarian factors that cause infertility impair the process of production of healthy oocytes during the menstruation cycle. A successfully formed fertilized embryo signifies that oocytes are healthy. This client does not have uterine factors that cause infertility, because the client is able to successfully conceive. Uterine factors may affect the process of implantation and nourishment of the embryo in the uterus. The fertilized egg is unable to reach the uterus. Any change in the anatomy of the cervix that affects the movement of the sperm into the uterus indicates a cervical factor. In this client, the embryo was fertilized. This indicates that the sperm were able to pass through the uterus and fertilize the egg. Therefore it is not a cervical factor. (A)
The nurse is caring for a client who is taking ganirelix acetate (Antagon) to treat infertility. Which adverse effects associated with the use of ganirelix acetate may be found in this client? Select all that apply. Headaches Depression Nosebleeds Abdominal pain Vaginal bleeding
Ganirelix acetate (Antagon) is a gonadotropin-releasing hormone (GnRH) antagonist. It is used for the treatment of infertility and controls ovarian stimulation. It suppresses the release of gonadotropin, which in turn affects prostaglandin levels. Due to this effect, the drug may cause adverse effects like headaches, abdominal pain, and vaginal bleeding. Depression is an adverse effect of human chorionic gonadotropin. Nosebleeds are an adverse effect of nafarelin acetate (Synarel). Therefore, depression and nosebleeds are not associated with ganirelix acetate (Antagon). (A,D,E)
What is the procedure in which ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the woman's uterus? In vitro fertilization Tubal embryo transfer Therapeutic insemination Gamete intrafallopian transfer
In vitro fertilization is a procedure used to bypass blocked or absent fallopian tubes. Tubal embryo transfer places the conceptus into the fallopian tube. Therapeutic insemination uses the partner's sperm or that of a donor and places it directly into the woman. Gamete intrafallopian transfer involves placing the sperm and ova in the fallopian tube. (A)
A client is being treated for a defect in the luteal phase. The nurse instructs the patient to start taking a drug on the fifth day of menstruation and continue for the next 5 days. Which drug is prescribed for the patient? Progesterone (Camila) Clomiphene citrate (Clomid) Nafarelin acetate (Synarel) Metformin (Glucophage)
Clomiphene citrate (Clomid) is used to treat luteal phase defects and induce ovulation. This drug is administered on the fifth day of menstruation. The medication is continued for the next 5 days in order to induce ovulation. Progesterone (Camila), which is administered as a vaginal gel once per day, is used to increase the luteal phase of menstruation. If ovulation is induced by Camila, the drug is continued until after 10 to 12 weeks of pregnancy. Nafarelin acetate (Synarel) is a gonadotropin-releasing hormone (GnRH) agonist used to treat endometriosis and uterine fibroids. It is a nasal spray used for 6 months. Metformin (Glucophage) is an oral hypoglycemia agent and has no role in treatment of luteal phase defects. (B)
A 37-year-old client says, "I haven't been able to conceive after trying for 3 months." Upon evaluating the client's medical history, the nurse finds that the client has a history of endometriosis. What does the nurse tell the client? "Continue trying for another 3 months and come back for an evaluation." "Continue trying for another 6 months and come back for an evaluation." "Continue trying for another 9 months and come back for an evaluation." "Continue trying for another year and come back for an evaluation."
Generally, a client is instructed to come for an evaluation after trying to conceive for one year. However, clients over the age of 35, or with risk factors such as endometriosis, are instructed to come for an evaluation after trying for 6 months. Because the client has already been trying to conceive for 3 months, the nurse should ask the client to come for evaluation after 3 additional months. The nurse should not instruct the client to undergo evaluation after 6 or 9 additional months, because it would be too long for a 35-year-old client. Clients under the age of 35 are asked to come for evaluation if they do not conceive after trying for one year. (A)
Which medication can be prescribed for a client with excessive prolactin levels? Clomiphene (Clomid) Bromocriptine (Parlodel) Leuprolide acetate (Lupron) Ganirelix acetate (Antagon)
Increased prolactin levels cause anovulation. Therefore, bromocriptine (Parlodel) must be prescribed to reduce excessive prolactin levels. Clomiphene (Clomid) is prescribed for ovulation induction and for the treatment of luteal phase inadequacy. Leuprolide acetate (Lupron) is prescribed for the treatment of uterine fibroids. Ganirelix acetate (Antagon) is prescribed for infertility treatment. (B)
A client tested negative on a clomiphene citrate challenge test (CCCT). Which technique would be included in the treatment plan to assist reproduction in the client? Using donor sperm to inseminate the client Placing prepared sperm in the client's uterus at the time of ovulation Transferring retrieved oocytes into the uterine tube after fertilization Transferring embryos, formed by inseminating donated eggs, into the uterus
A clomiphene citrate challenge test (CCCT) is used to assess ovarian stimulation in the client. Negative results of a CCCT imply that the client has poor ovarian reserve. This indicates the need for donor eggs or oocytes. Therefore, the primary health care provider would suggest assisted reproductive technology (ART), in which embryos formed by inseminating donated eggs are transferred into the client's uterus. Placing prepared sperm in the uterus at ovulation is called intrauterine insemination. This method is used in cases of male subfertility, cervical factors, and vaginal factors. Injection of a selected sperm cell into the client's egg for fertilization is called intracytoplasmic sperm injection. It is indicated if the male partner is azoospermic or oligospermic, or if one of the partners has a genetic defect. Oocytes cannot be retrieved from a client who has poor or no ovarian reserve. Gamete intrafallopian transfer involves fertilizing retreived oocytes with washed motile sperm and transferring them into the uterine tube. (D)
Which method is used to determine the presence of varicoceles in the testes? Semen analysis Scrotal ultrasound Transrectal ultrasound Sperm penetration assay
A scrotal ultrasound is used to examine the testes for the presence of varicoceles. It is also used to identify abnormalities in the scrotum and/or the spermatic cord. Semen analysis is used to detect the ability of the sperm to fertilize an egg. Transrectal ultrasound is used to evaluate the ejaculatory ducts, seminal vesicles, and vas deferens. Sperm penetration assay is used to evaluate the ability of the sperm to penetrate an egg. (B)
