Chapter 26, Infertility

What is the goal of preconception counseling? 1 To help evaluate a couple's risk for birth defects 2 For couples to develop a more intimate connection 3 To give couples freedom to explore the option of adoption 4 For infertile couples to meet couples who overcame infertility

1 The goal of preconception counseling is to help evaluate a couple's risk for birth defects or autosomal recessive disorders in order to help reduce their risk for bearing a child with an anomaly. Preconception counseling does not aim to help couples develop a more intimate connection. The counseling is not intended for exploration of adoption as an alternative to pregnancy. Preconception counseling does not involve introducing infertile couples to couples who overcame infertility.

The nurse is assessing a patient who is planning to conceive. While reviewing the patient's laboratory reports, the nurse notices a decrease in hypothalamic hormone levels. What should the nurse interpret from this? 1 The patient will not be able to successfully produce any ova. 2 The patient demonstrates impairment in fallopian factors. 3 The patient has an increased risk of fetal congenital anomalies. 4 The patient has a family history of fetal hemorrhagic disorders.

1 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.

What action can the nurse take to best reduce a couple's sense of isolation when dealing with infertility? 1 Refer the couple to support groups. 2 Provide the couple with relaxation techniques. 3 Encourage the couple to avoid activities that involve infants. 4 Teach the couple how to manage stress with different techniques.

1 The nurse should refer the couple to support groups to help reduce their sense of isolation. Relaxation techniques are helpful for increasing the couple's sense of control, but not for reducing isolation. Encouraging the couple to avoid activities that involve infants is part of promoting a positive self-image. Teaching the couple how to manage stress is part of increasing the couple's sense of control.

Which techniques will a nurse include in the assessment of an infertile couple? Select all that apply. 1 Evaluating commitment to treatment 2 Asking the couple about support systems 3 Assisting communication between partners 4 Planning for one of three expected outcomes 5 Encouraging the couple to accept their feelings

1,2 As part of the assessment of the infertile couple, the nurse will evaluate the couple's commitment to treatment and ask about their support systems. Assisting with communication between partners is part of nursing intervention, not assessment. Planning for expected outcomes is part of the planning stage, not assessment. Encouraging partners to accept their feelings is part of the intervention stage, not assessment.

The nurse is caring for a patient who is scheduled to undergo a hysterosalpingogram. What possible abnormalities can be detected through the procedure? 1 Presence of infection 2 Blockage in the fallopian tubes 3 Decrease in ovarian reserve 4 Abnormal endometrial tissue

2 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.

Which test is performed first when considering potential causes of infertility in a male patient? 1 Ultrasound 2 Semen analysis 3 Hormone assay 4 Testicular biopsy

2 A semen analysis test is performed first because it is noninvasive, easy, and inexpensive. An ultrasound is noninvasive, but it is not usually the first diagnostic test performed. A hormone assay is likely to be performed next. A testicular biopsy is invasive and is therefore not a first option for diagnostic testing.

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? 1 Male and female are the same age, 35. 2 Both partners have had children in their past marriage. 3 There is a history of endocrine problems. 4 There is a history of hypertension

3 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.

Which potential side effects does the nurse discuss with a patient receiving clomiphene citrate (Clomid)? Select all that apply. 1 Headache 2 Vaginal bleeding 3 Breast tenderness 4 Nausea and vomiting 5 Abdominal discomfort

3,4,5 Breast tenderness, nausea and vomiting, and abdominal discomfort are the side effects of clomiphene citrate (Clomid). It is an ovulation-inducing drug and is also used in the treatment of luteal phase inadequacy. Headache and vaginal bleeding are not reported with clomiphene citrate (Clomid); these signs and symptoms may occur with the subcutaneous administration of Ganirelix acetate (Ganirelix).

The nurse is reviewing the hormonal reports of a female patient at the time of ovulation. The nurse finds that the levels of estrogen and luteinizing hormone are high and the prostaglandin levels are low. What does the nurse interpret from the report? 1 The patient's ovulatory cycle is normal. 2 The patient's ovarian follicles are not maturing. 3 The patient's ovum has not entered the fallopian tube. 4 The patient's ovum is not getting released from the follicles.

4 A woman who is ovulating would have high levels of estrogen, luteinizing hormone, and prostaglandins. If the level of prostaglandins is low, the graafian follicle will not release the ovum and the cycle becomes anovulatory. The patient's ovulatory cycle is not normal. Maturation of ovarian follicles is brought about by follicle stimulating hormone. Once the ovum is released from the follicle, it directly enters into the fallopian tubes. Prostaglandins play no role in this process.

A worried patient says, "I had my first child 2 years ago, and I've been trying get pregnant again for the past 6 months." Which medical term does the nurse use to describe the patient's condition? 1 Sterility 2 Primary infertility 3 Idiopathic infertility 4 Secondary infertility

4 Secondary infertility is infertility seen in any patient who has ever had a pregnancy, regardless of the outcome of that pregnancy. Sterility is the inability of the patient to conceive. Primary infertility is infertility seen in patients who have never been pregnant. Idiopathic infertility is unexplained infertility.

Approximately how many births each year result from use of assisted reproductive technology (ART)? 1 1% 2 7% 3 15% 4 33%

1 More than 1% of births each year result from use of ART. The proportion has not yet reached 7%, 15%, or 33% of yearly births.

A semen analysis shows that a male patient has azoospermia. What does the nurse understand about this patient's condition? 1 The patient has difficulty ejaculating semen. 2 The patient does not have sperm in his semen. 3 The patient has an abnormality of the seminal fluid. 4 The patient has increased levels of sperm in his semen.

2 Azoospermia means that sperm is absent in the semen. It does not denote difficulty ejaculating semen. Azoospermia is not an abnormality of the seminal fluid, and it does not mean that the patient has increased levels of sperm in the semen.

Which medication can be prescribed for a patient with excessive prolactin levels? 1 Clomiphene (Clomid) 2 Bromocriptine (Parlodel) 3 Leuprolide acetate (Lupron) 4 Ganirelix acetate (Antagon)

2 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.

Why is semen analysis often the first test used when diagnosing the cause of infertility? 1 It is the most accurate test. 2 It is noninvasive. 3 It takes less than 1 week. 4 It tests for all male issues that cause most infertility problems.

2 Semen analysis is often the first test to be conducted because it is noninvasive as well as easy and inexpensive. It is not the most accurate test and it takes longer than 1 week to perform. Male factor infertility cases are only one-third of all infertility cases.

Which medication is prescribed to correct excess prolactin secretion? 1 Letrozole (Femara) 2 Nafarelin (Synarel) 3 Bromocriptine (Parlodel) 4 Clomiphene citrate (Clomid)

3 Bromocriptine (Parlodel) is used to correct excess prolactin secretion by the anterior pituitary. Letrozole (Femara) is used to induce ovulation. Nafarelin (Synarel) stimulates the release of follicle-stimulating hormone and luteinizing hormone. Clomiphene citrate (Clomid) is used to induce ovulation.

What is the extent of infertility in the United States? 1 Out of every 10 couples, one is able to conceive and sustain a pregnancy. 2 Of couples trying to get pregnant or sustain a pregnancy, 50% cannot. 3 One in eight couples has trouble getting pregnant or sustaining a pregnancy. 4 There are 100 couples every year who are unable to get pregnant or sustain a pregnancy.

3 One in eight couples in the United States has trouble getting pregnant or sustaining a pregnancy. One out of every 10 couples being able to conceive and sustain a pregnancy is too low an estimate of successful pregnancies in the United States. Less than 50% of couples have trouble getting pregnant or sustaining a pregnancy. More than 100 couples every year are unable to get pregnant or sustain a pregnancy.

While reviewing a patient's chart, the nurse finds that the patient has been prescribed Metformin (Glucophage). What does the nurse understand about this patient? 1 The patient has endometriosis. 2 The patient has low testosterone. 3 The patient has no sperm in the semen. 4 The patient has polycystic ovary syndrome.

4 The nurse understands metformin (Glucophage) is prescribed as adjunctive treatment to women who have polycystic ovary syndrome as a result of an ovulation induction. This medication is not used for endometriosis, raising testosterone, or aiding sperm production

A female patient who recently started the assisted reproductive technology (ART) process reports that she no longer gets her period. How does the nurse respond? 1 By notifying the health care provider immediately 2 By telling the patient to stop taking her ovulation induction medications 3 By having the patient take a pregnancy test to see if she is already pregnant 4 By explaining that this is a normal finding because of the supplemental progesterone

4 With ART, the patient will not have a menstrual period even if she is not pregnant because supplemental progesterone is given to promote implantation and support early pregnancy. The patient's lack of a period is a normal finding. The nurse does not have to notify the health care provider immediately, as this is not an emergency or abnormal finding. The nurse should not tell the patient to stop taking her ovulation induction medications. The nurse does not need to have the patient take a pregnancy test.

What is true of intrauterine insemination (IUI)? 1 Donor sperm is always used. 2 IUI adds antibodies into the sperm. 3 A laser is used to correct blockages of the uterus. 4 The sperm can be placed directly into the uterus.

4 With IUI, the sperm can be placed directly into the uterus, bypassing the cervical mucus and reducing some immunologic incompatibilities. Sperm can come from donation or from the woman's partner. Antibodies are removed, not added, with the IUI process. IUI does not involve the use of a laser and is not intended to remove or correct blockages.

What is the role of a surrogate mother? 1 Supplying her uterus to carry out a pregnancy 2 Providing the couple with counseling on becoming a parent 3 Donating her oocytes to be inseminated into another woman 4 Guiding couples through the process of infertility treatments

1 A surrogate mother supplies her uterus to carry out a pregnancy. A surrogate mother does not provide counseling, donate her oocytes, or guide couples through infertility treatments.

A 25-year-old patient has been unable to conceive after being diagnosed with chlamydia. What infertility treatment would help the patient conceive? 1 In vitro fertilization therapy (IVF) 2 Menotropin (Pergonal) therapy 3 Zygote intrafallopian transfer (ZIFT) 4 Gamete intrafallopian transfer (GIFT)

1 Infection caused by Chlamydia causes tubal damage, resulting in impaired fertility. Because the patient's fallopian tubes are damaged, IVF will be the most suitable infertility treatment option for the patient. With IVF, ova are removed surgically from the patient, 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 patient 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 patient's fallopian tube for fertilization. Gamete intrafallopian transfer would be inappropriate in a patient with blocked fallopian tubes.

A man and a woman who have not achieved a successful pregnancy are scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed? 1 Semen analysis 2 Testicular biopsy 3 Endometrial biopsy 4 Hysterosalpingogram

1 Semen analysis is usually the first test to be performed because it is the least costly and noninvasive. A testicular biopsy is an invasive examination using a local anesthetic. Endometrial biopsy determines whether the endometrium is responding to ovarian stimulation. A hysterosalpingogram uses contrast media to evaluate the structure and patency of the uterus and tubes.

Which finding from a semen analysis indicates a possible cause of infertility? 1 A pH of 7.7 2 Viability less than 35% live 3 Concentration less than 22 million/mL 4 Motility greater than 62% with normal forms

2 The finding of viability of less than 35% live indicates an abnormal result, as the threshold for a normal finding is at least 50% live. Viability of less than 35% live indicates a low live sperm count. A pH of 7.7 is average. A concentration less than 22 million/mL is not a cause for concern, as concentration greater than 20 million/mL is normal. A motility greater than 62% with normal forms is normal.

Which information will the nurse include in teaching a patient about a new prescription for clomiphene citrate (Clomid)? 1 Irritability and mood swings can be common. 2 The medication can cause mental alertness and hyperactivity. 3 Abdominal distention and pain in the pelvis are normal findings. 4 The patient should continue taking the medication if she becomes pregnant.

2 The nurse will inform the patient that irritability and mood swings are a common side effect of the medication. The medication can cause drowsiness, not mental alertness. Abdominal distention and pain in the pelvis are not normal and should be reported immediately. The patient should stop taking the medication if she suspects that she is pregnant.

A patient has recently completed her first course of clomiphene citrate (Clomid) at 50 mg by mouth daily for 5 days. The nurse observes in the medical record that ovulation did not occur during the first course. Which statement made by the patient requires correction? 1 "I am stopping the medicine until my next course begins." 2 "I am going to continue taking 50 mg each day for the second course." 3 "I am going to take an increased dose of the medicine for the second course." 4 "I am going to take the medicine on days 3 through 7 of my menstrual cycle."

2 The statement about taking the same 50 mg each day for the second course requires correction because the patient does not understand that the dose will be increased since she did not ovulate during the first course. It is normal for the patient to stop taking the medicine until the next course begins. It is normal to take an increased dose of medicine for the next course. It is normal that the medicine is taken on days 3 through 7 of the menstrual cycle.

What is the likely effect of low prostaglandin (PG) levels on the patient's menstrual cycle? 1 The endometrium in the uterus fails to form. 2 Peak levels of progesterone are not attained in the luteal phase. 3 The ovum remains entrapped in the graafian follicle. 4 Ovum growth is inhibited in the proliferative phas

3 PGs are oxygenated fatty acids and are classified as hormones. PGs may play a key role in ovulation. Hence, low levels of prostaglandins result in entrapment of the ovum within the graafian follicle and interference with ovulation. The levels of progesterone peak during the luteal phase after ovulation. Prostaglandins don't affect the formation of endometrium in the uterus. Prostaglandins influence the release of the ovum but don't have direct influence on the growth of the ovum. The growth of the ovum is facilitated by follicle-stimulating hormone (FSH).

A male patient is preparing to receive an endocrine test for infertility. What information will the nurse include when educating this patient? 1 Leydig cells produce sperm. 2 Sperm is produced by luteinizing hormone (LH). 3 Luteinizing hormone (LH) stimulates testosterone. 4 Follicle-stimulating hormone (FSH) stimulates the Leydig cells.

3 LH stimulates testosterone; this is information the nurse will include in teaching the patient before the endocrine test. Leydig cells produce testosterone, not sperm. Sperm is produced by Sertoli cells, not by LH. The FSH stimulates Sertoli cells of the testes to produce sperm.

The nurse knows that which factors can affect the amount and impair the function of sperm? Select all that apply. 1 Renal failure 2 Lead poisoning 3 Minimal alcohol intake 4 Chronic exposure to heat 5 Hypothermia

1,2,4 Factors that can affect the amount and impair the function of sperm include acute or chronic illness, such as renal failure, lead poisoning, and chronic exposure to heat. Minimal alcohol intake and hypothermia are not factors.

Which interventions is the nurse most likely to employ in helping an infertile couple maintain positive self-image? Select all that apply. 1 Reinforcing positive attitudes and self-evaluations 2 Exploring other avenues that make the couple feel good about themselves 3 Encouraging the couple to attend activities that involve infants or children 4 Encouraging the couple to maintain activities and hobbies that they enjoy 5 Telling the couple to distance themselves from people while they take time to conceive

1,2,4 To help the infertile couple maintain a positive self-image, the nurse will most likely focus on reinforcing positive attitudes and self-evaluations, suggesting the couple explore other things that make them feel good about themselves, and encouraging them to maintain activities and hobbies that they enjoy. The nurse will not encourage the couple to attend activities that involve infants or children, as seeing children while they address their infertility may cause undue stress. The nurse will not support the couple distancing themselves from people, as this could create isolation.

A female patient who has recently been prescribed clomiphene citrate (Clomid) has questions regarding the appropriate dosage of the medication. What does the nurse teach the patient about using this medication? 1 "There are three total courses of medication to be taken, and each course increases by 100 mg per day." 2 "The first course and the second course are taken for 10 days each at a dose of 250 mg daily, and a third course is required if ovulation does not occur." 3 "The first course is 100 mg and is taken for 3 to 7 days; the second course involves the same dose as the first course." 4 "The first course is taken for 5 days, and dosage for the second course can be increased and taken for 5 more days if ovulation did not occur with the first course."

4 The nurse should explain that the first course is taken for 5 days, and the second course is taken another 5 days, but that the dose will be increased if ovulation did not occur with the first course. There are not three courses that increase by 100 mg per day, the first and second courses are not taken for 10 days each, and the first course is not taken for 3 to 7 days.