infertility

what is infertility

reduced availability to conceive

unable to conceive after 1 year

inability to carry

primary: never been able to conceive

secondary: could before but now can’t

male contributing factors

inability to initiate pregnancy in a fertile female

40%

causes:
abnormalities in sperm
abnormal erections
abnormal ejaculation
abnormalities of seminal fluid

screening and diagnostic tests for males

health history and physical

semen analysis

endocrine tests; hormones

US: see structures

testicular biopsy; cancer

sperm penetration assay: show ability of sperm to fertilize egg

female contributing factors

40% impaired ovulation (irregular, abnormal, or at all)

25% multiple factors

causes:
disorders of ovulation
abnormalities of fallopian tubes
abnormalities of cervix

screening and diagnostic tests for females

health history and physical

hormone evaluations

ovulation prediction

US; see structures

hysterosalpingogram: dye to see structures

therapies

timing intercourse

medications: bromocritptine, cetrorelix, clomiphene citrate, letrazole

hormone therapy: hCG, FSH, LH, progesterone, hMG

adjunctive therapy: metformin; induces ovulation

erectile agents: sildenafil, tadalafil

clomiphene citrate (Clomid)

female infertility is present when estrogen levels are normal, including PCOS

ovulation induction/estrogen receptor modulator; increases risk of multiple babies

increases release of FSH and LH

adverse reactions: ovarian enlargement, n/v, breast tenderness, HA, pelvic pain

serious reactions: thromboembolism, ovarian hyperstimulation, multiple gestations, visual disturbances

letrazole

female infertility where estrogen levels are normal

estrogen/androgen antagonist

generates FSH

adverse reactions: hot flashes, flushing, HA, dizziness, arthralgia (joint pain), asthenia (lack of energy), fatigue, weight gain, constipation

serious: anaphylaxis, skin reactions, HTN, thromboembolism, stroke, MI

nsg considerations for clomiphene citrate and letrozole

obtain history

rule out pregnancy

pt education

other therapies

laparoscopy or laparotomy: treatment of obstructions, adhesions

laser surgery procedures: reduce adhesions

correct varicocele: ligation or embolizing the dilated vein; can improve sperm quanitiy or quality

surgical techniques to correct obstruction of fallopian tubes or males tubal structures

transcervical balloon tuboplasty: unblock fallopian tubes

therapeutic insemination

IUI

donor or patients

inject semen into uterus

egg donation

surrogate

assisted reproductive technologies

IVF: in vitro fertilization

GIFT (gamete intrafallopian transfer) or ZIFT (zygote intrafallopian transfer)

outpatient

progesterone given post procedure to promote implantation

success rates vary

preimplantation genetic testing: allows for informed decisions doesn’t rule out every possible abnormality

nsg in times of infertility

assessment:

where are they in their infertility journey

how does this affect their relationship

do they have adequate support systems

culture/religion that affects this process

stress management techniques