Infertility, Contraception, and Abortion PPT

What percentage of reproductive-age couples are affected by infertility?

About 12% of reproductive-age couples.

What are the four main goals when providing care to infertile couples?

• Provide accurate information

• Assist in identifying the cause of infertility

• Offer emotional support

• Guide and educate about treatment options

What are the major causes of female infertility?

• Ovarian factors (ovulation disorders, anovulation)

• Tubal or peritoneal factors (blockage, scarring)

• Uterine factors (fibroids, congenital anomalies)

• Vaginal–cervical factors (infection, abnormal mucus)

• Other factors (age, endocrine disorders)

What are the major causes of male infertility?

• Hormonal factors (low testosterone, pituitary disorders)

• Testicular factors (infection, trauma, varicocele)

• Sperm transport issues (blockages or poor motility)

• Idiopathic (unknown cause)

What diagnostic tests are used to assess female infertility?

• Evaluation of anatomy

• Ovulation detection (basal temperature, LH kits)

• Hormone analysis

• Ultrasonography

• Endometrial biopsy

• Hysterosalpingography (HSG)

• Laparoscopy

What diagnostic tests are used to assess male infertility?

• Semen analysis (first and most important test)

• Hormone analysis

• Scrotal ultrasound

What are some psychosocial considerations for couples experiencing infertility?

• Emotional distress and depression

• Relationship strain

• Financial stress due to costly treatments

• Need for counseling and support groups

What are some nonmedical treatments for infertility?

• Herbal or natural therapies

• Lifestyle modifications (healthy diet, stop smoking/drugs)

• Stress reduction and relaxation techniques

What are common medical therapies for infertility?

• Fertility drugs (e.g., Clomiphene citrate) to induce ovulation

• Hormone therapy to correct imbalances

• Treatment of infections or underlying conditions

What are common surgical therapies used to treat infertility?

• Correction of tubal obstruction

• Removal of fibroids or endometriosis

• Assisted reproductive therapies (ART)

What is ART (Assisted Reproductive Therapy)?

A collection of procedures that handle eggs and sperm outside the body to help achieve pregnancy.

What are examples of assisted reproductive therapies (ART)?

• In vitro fertilization–embryo transfer (IVF-ET)

• Gamete intrafallopian transfer (GIFT)

• Zygote intrafallopian transfer (ZIFT)

• Ovum transfer (oocyte donation)

• Therapeutic donor insemination (TDI)

• Embryo hosting (surrogacy)

• Assisted embryo hatching

What are reproductive alternatives for couples with infertility?

• Surrogacy

• Preimplantation genetic diagnosis (PGD)

• Adoption

• Cryopreservation of embryos

What is preimplantation genetic diagnosis (PGD) used for?

To identify genetic defects in embryos before implantation to prevent transmission of inherited disorders.

What is cryopreservation of embryos?

Freezing and storing embryos for future use in IVF or other fertility procedures.

What role does the nurse play in infertility care?

• Provide emotional support

• Educate about options and treatments

• Coordinate care among specialists

• Advocate for patient autonomy and informed decision-making

What is the definition of contraception?

The intentional prevention of pregnancy through devices, drugs, or behavioral practices.

What is the difference between contraception, birth control, and family planning?

• Contraception: Intentional prevention of pregnancy.

• Birth control: Device or practice used to decrease the risk of conceiving.

• Family planning: Conscious decision on when to conceive or avoid pregnancy.

What percentage of U.S. pregnancies are unplanned?

Nearly 50% (half of all pregnancies).

What is the nurse’s role in contraception counseling?

• Provide accurate information on available options.

• Use a multidisciplinary approach to support the patient.

• Ensure the method is safe, affordable, effective, and culturally acceptable.

• Respect personal, social, and religious beliefs.

What are the major categories of contraceptive methods?

• Behavioral methods (abstinence, withdrawal, fertility awareness)

• Barrier methods (condoms, diaphragm, cervical cap, sponge)

• Hormonal methods (oral, patch, ring, injection, implant)

• Intrauterine devices (IUDs)

• Emergency contraception

• Permanent methods (tubal ligation, vasectomy)

What is coitus interruptus (withdrawal)?

Withdrawal of the penis before ejaculation.

• Least reliable method due to pre-ejaculate sperm.

• No STI protection.

What are fertility awareness methods (FAMs)?

• Rely on avoiding intercourse during fertile periods.

• Combine menstrual cycle tracking with abstinence or barriers.

• Examples:

  • Standard days method

  • Basal body temperature method

  • Cervical mucus method

  • Symptothermal method

  • Ovulation predictor kits

  • Two-Day method

  • Breastfeeding (lactational amenorrhea)

What are disadvantages of fertility awareness methods?

• Require consistent daily tracking.

• Stress, illness, or medication can alter cycles.

• Higher failure rate with irregular periods.

What are examples of barrier methods of contraception?

• Spermicides

• Male condom (STI protection)

• Female condom (vaginal sheath) (STI protection)

• Diaphragm

• Cervical cap

• Contraceptive sponge

What are key teaching points for barrier methods?

• Use with spermicide for increased effectiveness.

• Must remain in place 6 hours after intercourse (for diaphragm/cap).

• Clean and dry between uses.

• Do not use oil-based lubricants with latex condoms.

• Female condoms can be inserted up to 8 hours before sex.

What are types of combined estrogen-progestin contraceptives (COCs)?

• Oral contraceptives (pills)

• Transdermal patch

• Vaginal ring (NuvaRing)

What are types of progestin-only contraceptives?

• Oral progestin (mini-pill)

• Injectable (Depo-Provera)

• Implantable (Nexplanon/Norplant)

What are the routes and duration for hormonal methods?

• Oral pills: 24 hours (daily)

• Patch: 7 days

• Vaginal ring: 3 weeks

• Depo injection: Every 3 months

• Implant: Up to 3 years

• IUD (progestin): Up to 1 year

What are the major contraindications to hormonal contraceptives?

• History of DVT or blood clots

• Uncontrolled hypertension

• Liver disease

• Smoking (especially age >35)

• Breast cancer

What is the ACHES mnemonic for warning signs of hormonal contraceptive complications?

• A – Abdominal pain → Liver or gallbladder issue

• C – Chest pain or SOB → Pulmonary embolism or clot

• H – Headache → Stroke or hypertension

• E – Eye problems → Retinal thrombosis or vascular issue

• S – Severe leg pain → DVT or thrombus

When should emergency contraception be used?

Within 72 hours of unprotected intercourse (most effective the sooner it’s taken).

What are the five types of emergency contraception available in the U.S.?

• High doses of estrogen or COCs (3 options)

• Levonorgestrel (Plan B, Next Choice) – 1.5 mg total dose

• Ulipristal (Ella) – 30 mg antiprogesterone pill

• Combined estrogen-progestin (Yuzpe regimen)

• Copper IUD insertion within 120 hours (5 days)

What is the difference between Plan B and Ella?

• Plan B One-Step: Progestin-only (levonorgestrel), OTC, most effective within 72 hours.

• Ella (Ulipristal): Antiprogestin prescription pill, effective up to 5 days after sex.

How does the Copper IUD work as emergency contraception?

• Causes a hostile uterine environment, preventing fertilization or implantation.

• Can remain in place for ongoing contraception after insertion.

What should nurses teach patients about emergency contraception?

• It does not terminate an existing pregnancy.

• Can cause temporary nausea, spotting, or irregular period.

• Should not be used as regular contraception.

✅ NCLEX/Exam Key Points:

• ACHES = immediate provider notification.

• COCs contraindicated in smokers >35 and history of clots.

• Depo-Provera → weight gain, bone loss (limit >2 years).

• IUD → check string monthly; report pain, fever, or abnormal bleeding.

• Plan B → take ASAP within 72 hours; Ella effective up to 5 days.

• Barrier methods are the only methods that protect against STIs.

What is an intrauterine device (IUD)?

• A small, T-shaped device inserted into the uterus to prevent pregnancy.

• Works by creating a hostile uterine environment that prevents fertilization or implantation.

What are the two main types of IUDs?

• Copper IUD (Paragard) – wrapped in copper; non-hormonal.

• Hormonal IUD (Mirena, Liletta, etc.) – releases levonorgestrel, a progestin.

How long is each IUD effective?

• Copper IUD: Up to 10 years.

• Hormonal IUD: Typically 3–5 years, depending on brand.

What are advantages of IUDs?

• Long-term and reversible.

• Low maintenance once inserted.

• High effectiveness rate (>99%).

What are disadvantages or limitations of IUDs?

• No protection against STIs or HIV.

• Possible cramping, spotting, or heavier periods initially.

• Must be inserted and removed by a healthcare provider.

What should patients be taught about IUD strings?

• Check string monthly after menses to ensure placement.

• If the string is missing, shorter, or longer, contact provider immediately — IUD may have shifted or expelled.

What is the mnemonic for IUD complications and what does it stand for?

PAINS

• P – Period late, abnormal spotting/bleeding

• A – Abdominal pain or pain with intercourse

• I – Infection exposure, abnormal discharge

• N – Not feeling well, fever, or chills

• S – String missing, shorter, or longer

(Indicates possible expulsion, infection, or perforation.)

What is sterilization?

A permanent method of contraception achieved by surgically interrupting reproductive pathways.

What are the types of female sterilization procedures?

• Tubal occlusion: Fallopian tubes are sealed or blocked (e.g., tied, cut, banded, or cauterized).

• Tubal reconstruction (reanastomosis): Surgical reversal of sterilization, not always successful.

What is male sterilization called, and how is it performed?

• Vasectomy – Vas deferens are cut and sealed to prevent sperm transport.

• Sperm is still produced but cannot leave the body.

• Requires confirmation of sperm absence (azoospermia) after ~20 ejaculations or 3 months.

What are key nursing considerations for sterilization?

• Must be considered permanent.

• No protection against STIs.

• Provide emotional support and confirm understanding of permanency.

• Teach to use alternative contraception until procedure effectiveness is confirmed.

What is the definition of abortion?

• Purposeful interruption of pregnancy before 20 weeks of gestation.

• Can be elective (patient choice) or therapeutic (for medical reasons such as maternal or fetal health).

What are the types of abortion based on trimester?

First-trimester:

• Surgical (aspiration) abortion

• Medical abortion:

  • Methotrexate + Misoprostol, or

  • Mifepristone + Misoprostol

Second-trimester:

• Dilation and evacuation (D&E)

• Cervical preparation with prostaglandins

• Requires emotional and psychological support

Which type of abortion is safest and least complex?

Induced abortion in the first trimester.

What are common complications of abortion?

• Infection

• Retained products of conception

• Excessive vaginal bleeding

• Emotional distress or guilt

What U.S. Supreme Court case legalized abortion and when?

Roe v. Wade (1973) – legalized abortion nationwide, though access and regulation vary by state.

What are nursing responsibilities when caring for a patient undergoing abortion?

• Provide nonjudgmental, compassionate care.

• Respect patient’s beliefs and autonomy.

• Offer emotional support and counseling resources.

• Monitor for complications post-procedure.

⚡ NCLEX Key Points

• IUDs: Use PAINS mnemonic for warning signs.

• Copper IUD: May cause heavier periods; used for emergency contraception within 5 days.

• Hormonal IUD: Lighter periods; may cause amenorrhea.

• Vasectomy: Not immediately effective — confirm sperm absence.

• Tubal ligation: Permanent, irreversible contraception.

• Abortion: Watch for bleeding, infection, and emotional needs; provide unbiased care.

• First-trimester abortion is safest.

The nurse is educating a couple who has been trying to conceive for 12 months without success. Which statement by the nurse best explains infertility?
A. “Infertility means the woman cannot get pregnant.”
B. “Infertility is the inability to conceive after one year of unprotected intercourse.”
C. “Infertility occurs only in women over 35 years old.”
D. “Infertility always requires in vitro fertilization.”

B
Rationale: Infertility is defined as failure to conceive after 12 months of unprotected intercourse (6 months if over age 35).

Which nursing action is most important when caring for a couple experiencing infertility?
A. Emphasize medical treatment options first
B. Provide emotional support and education on all available options
C. Focus only on the female partner’s fertility
D. Recommend herbal remedies before testing

B
Rationale: Emotional support and accurate information are essential for couples dealing with infertility.

A male patient’s semen analysis reveals a low sperm count. Which other diagnostic test should the nurse anticipate?
A. Hysterosalpingogram
B. Endometrial biopsy
C. Hormone analysis
D. Cervical mucus test

C
Rationale: Hormone analysis is used to assess male infertility, especially testosterone and gonadotropin levels.

A client taking combined oral contraceptives reports chest pain and shortness of breath. Which action should the nurse take first?
A. Reassure the client this is a common side effect
B. Instruct to stop the pills and contact the provider
C. Schedule an appointment in 3 days
D. Advise to continue the pills and rest

B
Rationale: Chest pain and SOB indicate possible pulmonary embolism — part of ACHES warning signs.

The nurse teaches a patient about the ACHES warning signs for oral contraceptives. Which symptom indicates the need to contact the provider immediately?
A. Mild nausea after taking the pill
B. Spotting between periods
C. Severe leg pain
D. Acne

C
Rationale: Severe leg pain may indicate a DVT (the “S” in ACHES).

Which contraceptive method provides protection against STIs?
A. Oral contraceptives
B. Diaphragm
C. Condom
D. IUD

C
Rationale: Only barrier methods such as condoms protect against sexually transmitted infections.

The nurse instructs a client taking Depo-Provera. Which statement indicates correct understanding?
A. “I need to get this injection every month.”
B. “I should increase my calcium intake while using this method.”
C. “This method protects me from STIs.”
D. “It’s safe to use while breastfeeding.”

B and D
Rationale: Depo-Provera can decrease bone density (needs calcium/vitamin D) and is safe for lactation.

The nurse teaches about emergency contraception. Which statement indicates understanding?
A. “Plan B must be taken within 72 hours of unprotected sex.”
B. “It will end a pregnancy if I’m already pregnant.”
C. “It’s as effective as regular birth control.”
D. “It protects me from STIs.”

A
Rationale: Plan B should be taken ASAP, within 72 hours, and does not terminate an existing pregnancy.

A client with an IUD reports fever, abdominal pain, and foul vaginal discharge. What is the nurse’s priority action?
A. Reassure the patient it is normal after insertion
B. Document findings and recheck in one week
C. Notify the healthcare provider immediately
D. Check if the string is visible

C
Rationale: Signs of infection or PID require immediate evaluation; IUD may need removal.

Which teaching point is appropriate for a patient with an IUD?
A. “You should check for your IUD string each month after your period.”
B. “The IUD protects against HIV.”
C. “You will need to replace the IUD every 6 months.”
D. “If the string feels longer, it means your IUD is working.”

A
Rationale: Monthly string checks confirm the IUD is still properly placed.

The nurse uses the mnemonic PAINS when teaching about IUD complications. What does the “S” represent?
A. Shortness of breath
B. Severe bleeding
C. String missing, shorter, or longer
D. Sharp abdominal pain

C
Rationale: “S” = String missing, shorter, or longer — may indicate displacement or expulsion

Which instruction should the nurse include when teaching about vasectomy?
A. “You’re sterile immediately after surgery.”
B. “You’ll need a sperm count follow-up to confirm sterility.”
C. “This method protects against STIs.”
D. “You’ll stop producing sperm entirely.”

B
Rationale: Vasectomy effectiveness must be confirmed with sperm analysis; sperm may remain for weeks.

Which teaching is appropriate for a client after tubal ligation?
A. “You will still menstruate after this procedure.”
B. “You will not ovulate anymore.”
C. “You will have increased risk for STIs.”
D. “You will go through menopause early.”

A
Rationale: Tubal ligation does not affect ovulation or hormone production; periods will continue normally.

Which describes a therapeutic abortion?
A. Termination of pregnancy for personal reasons
B. Termination of pregnancy for medical reasons
C. Spontaneous loss of pregnancy
D. Illegal termination of pregnancy

B
Rationale: A therapeutic abortion occurs when continuation endangers maternal health or fetus is nonviable.

Which combination of medications is used for medical abortion?
A. Methotrexate and misoprostol
B. Oxytocin and misoprostol
C. Clomiphene and progesterone
D. Estrogen and levonorgestrel

A
Rationale: Methotrexate and misoprostol (or mifepristone + misoprostol) are used for first-trimester abortion.

The nurse provides care to a patient after a dilation and evacuation (D&E). Which finding requires immediate intervention?
A. Mild cramping
B. Light vaginal bleeding
C. Fever and foul-smelling discharge
D. Emotional tearfulness

C
Rationale: Indicates infection — a major complication of abortion procedures.

The nurse explains that the safest and least complex abortion method occurs during which trimester?
A. First
B. Second
C. Third
D. Any trimester

A
Rationale: First-trimester abortions are safest, least invasive, and carry fewer complications.

Common complications of abortion include which of the following? (Select all that apply)
A. Infection
B. Retained products of conception
C. Excessive vaginal bleeding
D. Amenorrhea
E. Breast tenderness

A, B, C
Rationale: These are potential complications requiring follow-up and monitoring.

A client with a Mirena IUD reports sudden severe abdominal pain and fever. Which complication does the nurse suspect?
A. Normal cramping
B. Ectopic pregnancy or uterine perforation
C. Expected hormonal side effect
D. Expulsion of the IUD

B
Rationale: Sudden abdominal pain and fever may signal perforation or ectopic pregnancy — medical emergency.

A nurse is counseling a couple considering assisted reproductive therapy (ART). Which statement requires clarification?
A. “We might use donor sperm or eggs if needed.”
B. “IVF involves fertilizing the egg outside the body.”
C. “Once we use IVF, it guarantees pregnancy.”
D. “These treatments can be emotionally and financially stressful.”

C
Rationale: ART methods increase chances of conception but do not guarantee pregnancy.

✅ Exam Key Focus Areas

• Infertility = 12 months unprotected sex; provide support.

• COCs = know ACHES warning signs.

• Depo-Provera = bone loss + weight gain.

• IUD = PAINS mnemonic; no STI protection.

• Vasectomy = confirm with sperm count.

• Tubal ligation = permanent; periods continue.

• Abortion = safest in 1st trimester; infection risk.

• Maintain nonjudgmental, supportive communication.