MCN 12.1: (Nursing Care of Subfertile Couple) PART 1

tuberculosis; sinusitis

Chronic infection from _____ or recurrent _____, lower a sperm count.

hypospadias

Congenital health problem in males

• Fear related to possible outcome of subfertility outcomes • Anxiety related to what the process of fertility testing will entail • Situational low self-esteem related to apparent inability to conceive • Knowledge deficiency related to measures to promote fertility • Grief related to failure to conceive or sustain a pregnancy • Powerlessness related to repeated unsuccessful attempts at achieving conception • Hopelessness related to perception of no viable alternative to usual conception

Nursing Diagnosis

galactorrhea

breastmilk secretions

pelvic sonogram

may be performed to rule out ovarian, tubal, or uterine structural disorder.

Clomid

may overstimulate the ovary causing multiple ova to come to maturity, and possibly resulting in multiply

Spermatozoa

must be produced and maintained at a temperature slightly lower than body temperature to be fully motile.

sperm motility

Qualitative or quantitative changes in seminal fluid, which prevent —-

1. Good quality and number of sperm available 2. Ova (egg) available 3. Is it possible for the sperm and egg to meet?

Questions in Fertility Testing

Fertility testing 1 months' time

can be costly for a couple not all health insurance programs provide reimbursement for these procedure The patient rearrange work plans to manage the sched of fertility testing by _______

Pelvic sonogram

can be used to confirm cysts are present on the ovaries

sperm count

the number of sperm in a single ejaculation or in a millimeter of semen

Anovulation

- absence of ovulation or release of ova from ovary) - most common cause of female subfertility

- Rubella titer; - a serologic test for syphilis - HIV evaluation - thyroid uptake determination; - assay history of galactorrhea - a serum prolactin will be obtained, - A pelvic sonogram may be performed

Additional Test for Females

- urinalysis - CBC; blood typing with RH Factor - Serologic test for syphilis the presence HIV; - Erythrocyte sedimentation rate (an increased rateprotein-bound iodine a test for thyroid function), - cholesterol level - and follicle-stimulating hormone and luteinizing hormone

Additional tests for males

A blood test and analysis can determine whether adequate levels of FSH & LH are present.

Analysis of Pituitary Hormones

- Cryptorchidism - Varicocele or varicosity

Congenital Abnormalities that could lower sperm count

- Psychological problems, - cerebrovascular accident, - diabetes, - Parkinson disease, - Use of antihypertensive agents.

Erectile Dysfunction may occur from

use of hot tubs or saunas

Frequent ________ may also lower sperm counts.

6 months; IVF

If a woman is older than 35 years, she should be seen after _______. Strategies such as _____ as well as common alternatives to natural childbearing such as adoption, are also limited by age.

Premature ejaculation - Ejaculation

another factor that interfere with proper deposition of sperm.

autoimmunity

it immobilizes sperm

50%

percent of sperm that are motile

- Diathermy or steroid administration - Canalization of fallopian tubes

therapies for lack of tubal patency

Clomid or Femara

used to stimulate ovulation -ovarian follicular growth of FSH and LH and administration of human chorionic gonadotropin to produce ovulation.

- tumors - endometriosis

uterine concerns may include these

lead Apron

wear a — to protect your babies during xrays

arterial plaques

— could interfere with pelvic blood flow

Steep Trendelenburg position

(which bring the reproductive organs down out of the pelvis) position for laparoscopy

Ovulation Determination by Test Strip

- Various brands of commercial kits are available for assessing the upsurge of LH that occurs just before ovulation and can be used in place of BBT monitoring. - a person dips the test strip to a midmorning urine specimen and then compares it with the kit for colour change.

1 year of UNPROTECTED SEX

A couple is infertile if they have NOT become pregnant after at least

basal body temperature (BBT), 4 months.

A method of ovulation testing and the least costly way is to determine ovulation pattern where she is asked ask her record her ____ for least ____.

7 to 10

Abstain from coitus for _______ days at a time to increase the count before having Semen penetration assay and Antisperm assay and Antibody testing

o Genetic abnormal o Turner syndrome o Hormonal imbalance o Hypothyroidism o Pituitary-ovarian o Ovarian tumors, o Polycystic Ovary Syndrome o X-rays or radioactive substances o General ill health o Poor diet and stress

Anovulation may occur from

down then rises, 1, higher

At ovulation, BBT goes (down then rises, up and down) about ____ degree (higher, lower) than preovulation temps and stays at that level till 3 or 4 days before next menstrual flow.

spermatic duct; prostate gland

Congenital stricture of a ______ and hypertrophy of the ______ may occlude sperm transport

10% , pituitary hormones

Decreased body weight or a body fat ratio of less than _____ as may occurs in female athletes such as competitive runners can reduce _____ such as FSH and LH and halt ovulation

breast tenderness midcycle "wetness" mittleschmerz

Detect ovulation through such symptoms _______ or lower abdominal pain also known as _____.

slowly digested carbohydrate foods, fiber-rich vegetables, easily digested carbohydrates, increase, gestational diabetes

Eating slowly digested ____ (brown rice, pasta, dark bread, beans) and ____ (asparagus, broccoli) rather than ____ (white bread, cereals) can not only (increase, decrease) fertility by keeping insulin levels balanced but also may prevent ____ when a woman becomes pregnant.

carbohydrate foods; fiber-rich vegetables easily digested carbohydrates; insulin; gestational diabetes

Eating slowly digested____________(brown rice, pasta, dark bread, beans) and __________ (asparagus, broccoli) rather than ____________ (white bread, cereals) can not only increase fertility by keeping ______ levels balanced but also may prevent _________ when a woman becomes pregnant.

30 minutes, walking, mild aerobics

Exercising ____ per day by ___ or doing ____ helps to regulate blood glucose levels and increase fertility, complementing healthy eating habits

30 minutes

Exercising ________ per day by walking or doing mild aerobics helps to regulate blood glucose levels and increase fertility, complementing healthy eating habits

• Limited production of FHS or LH, which interfere with ova growth. • Anovulation (faulty or inadequate expulsion of ova) • Problems of ova transport through the fallopian tubes to the uterus. • Uterine factors, such as tumors or poor endometrial development • Cervical and vaginal factors, which immobilize spermatozoa • Poor nutrition

FACTORS THAT CAUSE FEMALE SUBFERTILITY

• Disturbance in spermatogenesis • Inadequate production of FSH and LH in the pituitary • Obstruction in the seminiferous tubules, ducts, or vessels •Qualitative or quantitative changes in seminal fluid • Chronic or excessive exposure to X-rays or radioactive substances • Problems in ejaculation or deposition • Development of autoimmunity

Factors that cause male subfertility

18.5 and 24.9

Ideal BMI for fertility is

surgery; intrauterine insemination; immune response and antibody production

If Sperm are not able to pass through the vas deference because of obstruction, ____ to relieve the obstruction is costly. extract sperm from appoint above the blockage and inject it to the vagina or uterus via ____ Administration of corticosteroids to a woman have some effect in decreasing sperm immobilization because it reduces her ______

after 1 year of subfertility

If a woman is younger than 35 years of age, s she should have an evaluation

corpus luteum, ovulation

If ovulation monitoring result is elevated, it implies a ____ has formed or ____ has occurred.

▪ breast and thyroid examination, secondary sex characteristics. ▪ Pap smear test. ▪ Anatomic disorders ▪ Infection

In physical assessment, in females check the

▪ Absence of a vas deferens or the presence of undescended testes ▪ Varicocele ▪ Hydrocele

In physical assessment, in males check the

special BBT or tympanic thermometer

In the BBT method, daily temperature is taken each morning before anything else using a ____ this is plotted on a monthly graph.

Infertility

Inability to conceiving a child or sustain a pregnancy and delivery of the baby

FSH and LH

Inadequate production of — and — in the pituitary which stimulates the production of sperm.

acidotic

Infection of the vagina can cause the pH of vaginal secretion to become ____, thus limiting or destroying the morality of spermatozoa.

gonorrhoea

Infections such as ____ adhesions may occlude sperm transport

Ovulation

It is important to determine this if you are trying to conceive

assisted fertility method

LGBT couples have a child through

testosterone production and sperm production

Maintaining an ideal body weight. excessive weight may alter ______

superior position

Male _________ is the best for coitus to achieve conception

deep penetration; cervix

Male should try for ________ to ejaculation places sperm as close as possible to _____

sperm recovery

Men need _______ after ejaculation

33 million to 46 million sperm per ml

Minimum sperm count is _____ of seminal fluid

continuing to try to conceive, assisted reproductive techniques, adoption, childfree life, adoption, childfree life

No known cause for subfertility can be discovered. Offer active support to help find alternative solutions like ___, use ___, ___, or ___.

1 hour of ejaculation

Number of sperm in the specimen is counted and then examined under a microscope within

- Pelvic examination - Review medication scheduling - Timing intercourse with ovulation - 24 hour urine samples - Report any bloating, stomach pain blurred vision, unusual bleeding

Nursing Implication for tubal transport problems

- Mumps orchitis - Epididymitis - infections - Congenital stricture of spermatic duct - Pressure from enlarged gland - Vasectomies - Scarring after infection

OBSTRUCTION OR IMPARED SPERM MOTILITY are caused by the following

• Past trauma to the testes. • "Surgery" on or near the testicles• Endocrine imbalances, thyroid, pancreas, or pituitary glands • Drug use or excessive alcohol use • Environment factors, such as exposure to X-rays or radioactive substances

OTHER CONDITIONS THAT MAY INHIBIT SPERM

spermatozoa

Obstruction in the seminiferous tubules, ducts, or vessels which prevents the movement of —

Mumps Orchitis

One cause of obstruction due to the mumps virus and is known as testicular inflammation and scarring

- The couple verbalizes they understand their individual subfertility probs after preliminary testing -The couple demonstrates a high level of self- esteem after fertility studies even in the face of disappointing study outcomes. - Women who are using oral, injectable, or implanted hormones for contraceptives may have difficulty conceiving

Outcomes of Nursing a Subfertile Couple

occupational hazards

Past history of a childhood cancer treated with radiation that might have reduced ovarian function or any exposure to —

specimen jar or a special condom

Patient ejaculates by masturbation into a clean dry, ______

- 35 in. or more - 100 mg/dl - 150 mg/dl - 135/85 mmHg - 50 - Hirsutism

Polycystic ovarian syndrome (PCOS) is diagnosed in pt with: - Waist circumference of ____ in women - Fasting blood glucose over ____. - Serum triglycerides over ____. - Blood pressure over ____. - High-density lipoprotein cholesterol over ____. - Development of ____.

Pressure from the enlarged gland may occlude sperm transport,

Pressure from the enlarged ____ may occlude sperm transport,

Endometriosis

Refers to the implantation of the uterine endometrium, or nodules, that have spread from the interior of the uterus to locations outside the uterus can cause tubal obstruction; growths on the ovaries can displace fallopian tubes away from the ovaries preventing the entrance of ova into the tubes. Peritoneal macrophages, which are drawn to nodules of endometrium, can destroy sperm

a) Determine ovulation b) Men need sperm recovery after ejaculation c) Male superior position is the best for coitus to achieve conception d) Male should try for deep penetration to ejaculation places sperm as close as possible to cervix e) Woman should remain on her back with knees drawn up at least 20 minutes after ejaculation to help sperm remain near cervix f) Woman shouldn't use douching lubricants so vaginal pH is unaltered g) Eating slowly digested carbohydrate foods (brown rice, pasta, dark bread, beans) and fiber-rich vegetables (asparagus, broccoli) rather than easily digested carbohydrates (white bread, cereals) can not only increase fertility by keeping insulin levels balanced but also may prevent gestational diabetes when a woman becomes pregnant. h) Exercising 30 minutes per day by walking or doing mild aerobics helps to regulate blood glucose levels and increase fertility, complementing healthy eating habits

SUGGESTIONS TO HELP CONCEPTION

1.4 to 1.7 ml; 33 to 46

Semen analysis _______ ml of semen should contain a minimum of ________ million spermatozoa

2 to 4 days

Sexually abstinent _____ prior to the analysis

- Semen analysis - Ovulation monitoring - Tubal patency

Subfertility investigation (3 Assessments).

emotionally difficult ; physically demanding

Subfertility screening and counselling can be both an__________ and a _________ process

1) Pychological/ sexual counseling 2) Phosphodiesterase inhibitor 3) Dapoxetine

THERAPY FOR EJACULATOIN CONCERNS

low-dose estrogen therapy Conjugated estrogen (Premarin)

Testing and therapy for vaginal and cervical concerns If sperms does not appear to survive in vaginal secretions, pt may be prescribed ____ to increase mucus production during 5-10 days of the cycle.

- hysteroscopy - uterine endometrial biopsy - laparoscopy

Testing for uterine concerns

Hysterosalpingogram radiopaque contrast medium

The Hysterosalpingogram uses this medium

2 or 3 months; 30 to 90 days

The analysis is repeated ______ after months and _____ is needed for new sperm to reach maturity.

o avoiding recreational marijuana use, o wearing looser clothing, o avoiding long periods of sitting, o avoiding prolonged hot baths, may also help reduce scrotal heat and increase the sperm

Therapy for increasing sperm count and motility includes changes in lifestyle such as

1) Surgery 2) Exctraction and injecting of sperm to vagina 3) Administration of corticosteroids to a woman

Therapy for sperm transport Disorders

Progesterone vaginal suppositories, myomectomy, intrauterine device (IUD)

Therapy for uterine concerns: ____ begun on the 3rd day of a woman's temperature rise and continued for the next 6 weeks. Myoma (fibroid tumor) intrauterine adhesions interfering with fertility, a ___. ____ may be inserted to prevent the uterine sides from touching and forming new adhesions.

Stress, nutrition, body weight, and exercise

These four all influence the blood glucose/insulin balance. When glucose/insulin levels are too high, they can disrupt the production of FSH and LH, leading to ovulation failure.

Hysterosalpingogram

This requires a radiopaque contrast medium and is used in fallopian tubes where it is revealed by X-ray. Because an X-ray is used, which might be harmful to a growing pregnancy, the procedure must be scheduled immediately.

Uterine Endometrial Biopsy

Used to reveal an endometrial problem, such as a luteal phase defect; resembles a corkscrew suggests ovulation has occurred it is done 2 or 3 days before an expected menstrual flow. After a paracervical block and a screen for chlamydia, thin probe and biopsy forceps are through the cervix. woman may experience mild-to- moderate discomfort from maneuvering the instruments.

1. Cervical mucus may be too thick to allow spermatozoa to penetrate the cervix 2. Infection or inflammation of the cervix (erosion) can also cause cervical mucus to thicken so much that spermatozoa cannot penetrate it easily or survive in it

Vaginal and cervical concerns

fears and anxiety ability to conceive; future lifestyle and family

When a couple begins fertility counselling, they usually have __________. Not only about their ______________ but about what in identified problem will meant to their ________.

Alternative insemination

With the instillation of a paracervical local anesthetic block followed by introduction a hysteroscope into an incision just behind the cervix through the cul-de-sac 200 ml of normal saline is then introduced to move to move tubal patency view exiting the fimbrial end of the tubes

Transvaginal Hydrolaparoscopy

With the instillation of a paracervical local anesthetic block followed by introduction a hysteroscope into an incision just behind the cervix through the cul-de-sac, 200 ml of normal saline is then introduced to move to move tubal patency view exiting the fimbrial end of the tubes

back; 20 minutes

Woman should remain on her _____ with knees drawn up at least ______ after ejaculation to help sperm remain near cervix

vaginal pH

Woman shouldn't use douching lubricants so ______ is unaltered

PCOS, fasting-glucose, testosterone, estrogen levels

__ can be detected by examining the menstrual history but ___, ___, ___ are analyzed.

Vasectomies; autoimmune reaction

____ develop an autoimmune reaction or form antibodies that immobilize their own sperm. • Scarring after an infection, could also develop an _____ that immobilizes sperm.

PRIMARY; SECONDARY

_____ if person had never been able to achieve an erection. _____ if they can achieve ejaculation in the past but now is having difficulty.

Testes; scrotal sac

_____, in which sperm are produced and stored, are suspended in the _____ away from body heat

Hydrocele

a collection of fluid in the tunica vaginales of the scrotum

Polycystic ovarian syndrome (PCOS)

a condition in which the ovaries produce excess testosterone, thus lowering FHS and LH levels, which then causes irregular and unpredictable menstrual cycles. associated with Metabolic syndrome which is associated with increased cardiac disease

thyroid function

an increased rateprotein-bound iodine a test for

Exposure to radiation Operation

due to childhood cancer, x-ray, such as surgical repair of hernia or torsion of testes.

Varicocele

enlargement of testicular vein

Ovulation monitoring

fastest way to investigate if ovulation is occurring, this Measure the woman's serum progesterone level during the luteal phase of her menstrual cycle.

Administration of GnRH

how is testing for anovulation performed? this will stimulate the pituitary to secrete more FSH and LH)

Erectile Dysfunction

impotence or inability to achieve erection

Secondary Infertility

inability to conceive after a previous successful pregnancy got pregnant or was able deliver a baby but was unable to conceive

24hr food intake

include alternative therapy like herbs.Whether he drinks alcohol or use drugs

prolactin

increased — levels reduce the secretion of pituitary hormone

Laparoscopy

is the introduction of a thin, hollow, lighted tube (a fiber optic telescope or laparoscope) through a small incision in the abdomen, just under the umbilicus, to examine the position and state of the fallopian tubes and ovaries. Carbon dioxide is usually introduced into the abdomen to move the abdominal wall outward and to offer better visualization.

Hysteroscopy

is visual inspection of the uterus through the insertion of a hysteroscope vagina, cervix, and into the uterus evaluate: uterine adhesions, malformations, or other abnormalities such as fibroid tumors or polyps

30%

percent that are normal in shape.

Primary Infertility

refers to no previous history of either partner conceiving or impregnating never been pregnant nor delivered a baby.

tubal transport

scaring has developed in the fallopian tubes, caused by chronic salpingit it interfers. Ruptured appendix or from abdominal surgery, infection, adhesion formation in the fallopian tubes

Dapoxetine

short acting selective serotonin reuptake inhibitor, treatment especially for premature ejejaculationshows good result after 1 hour before coitus.

fat deposits

sperm cells are produced in the walls of the seminiferous tubules, they can be obstructed by —

Tumors

such as fibromas (leiomyomas) may be a rare cause of subfertility if they block the entrance of the fallopian tubes into the uterus or limit the endometriosis poor secretion of estrogen or progesterone are more common uterine reasons for subfertility these (overproduction or underproduction)

- Canalization of the fallopian tubes - plastic surgical repair (microsurgery)

therapies for lack of tubal patency are other possible treatment

Diathermy or steroid administration

therapies for lack of tubal patency be helpful to reduce adhesions.

125,000,000 ; 4 - 5 cc; 500,000,000 ; 1

there should be _______ sperm cells per cc of ejaculate per ejaculate, there, is ________, multiplied it by 125, 000,000 is around ________ per ejaculation and with this count, only __sperm cell is able to penetrate the egg cell

vitamin D

this may also be instrumental in maintaining pituitary hormone levels

Parlodel

to reduce prolactin levels and allow for the rise of pituitary gonadotropins.

Cryptorchidism Varicocele or varicosity

undescended testes enlargement of the spermatic vein, increase temperature and congestion within the testes which slow and disrupt spermatogenesis.

Sonohysterosalpingogram

• ultrasound contrast agent introduced into the uterus through a narrow catheter inserted into the uterine cervix • Contraindicated if infection of the vagina • Causing momentary painful uterine cramping

Semen penetration assay and Antisperm assay and Antibody testing

▪ Abstain from coitus for 7 to 10 days at a time to increase the count. ▪ the Ligation of a varicocele,