Infertility, Contraception, and Abortion

Infertility

Education and Support

Unable to keep preganacy after 12months of unprotecected sexfor less than 35

6 months for over 35

Factors Associated With Female Infertility

• Ovarian factors
• Tubal and peritoneal factors
• Uterine factors
• Vaginal-cervical factors
• Fibroids, surgery

Hysterosalpingogram- dye injected

Endometrial biopsy

Assessment of male infertility

Inguinal hernias

Vasectomy- typically permanent

• Hormonal factors
• Testicular factors
• Factors associated with sperm transport- Exercise/Nutrition
• Idiopathic male infertility

Assessment of female infertility

Lifestyle change - stress, meds

Infection- antibiotics

Assisted reproductive therapies

Nursing role- Emotional support #1

-Find resources to help emotionally, financially

-Counsel

-Support

Clomiphene Citrate

Stimulated ovaries, hot flashes, breast pain, insomnia (NORMAL)

Report vision changes

Chance of multiple pregnancy

Contraception page 3 ATI

Education #1

Fertility knowledge FAM-Monitor 24% failure rate

Withdrawal- 22% failure rate, doesn’t prevent STI

Abstinence- 0% failure rate

period 7-9

No breastfeeding, yes menese’

breastfeeding not contraceptive- still ovulate

Barriers

Male and Female condoms

20% failure rate

Higher rate with spermicide

Sponge- left after intercourse for 6 hr

Cervical cap- PCP determines fit, left for 6 hr, must be refitted after delivery, 29% failure rate after birth

Diaphragm

fitted

refitted after weight change 12% failure rate,

left after 6 hr,

increase yeast infection risk & toxic shock syndrome

COC

9% failure rate

Contraindicated if DVT, Emboli, HTN, heart disease

Ot age 35 over if smoking

Patch

9% failure

Similar to PO contraceptive

Patch no effective in larger women

Mini pill

Taken at same time everyday

6% failure

#1 weight gain

irregular bleeding

Nausea/Mood change

Injectable Progestin

3% failure rate

may cause weight gain

headache, mood, breast tenderness

Doesn’t prevent STI

Emergency contraceptive

72-120 hr

OTC over 17

Younger than 17- prescription

Heavy or light bleeding

Diarrhea/fatigue

IUD/IUC

0.2-0.8% failure

During lactation

Lasts 1-10 yr

Cont in women with PID within past 3 months

Doesn’t protect against STI

Sterilization

• Female- general anesthesia
• Tubal occlusion
• Tubal reconstruction
• Male (vasectomy)- tubes post test #1, follow up
• Tubal reconstruction (reanastomosis)

Both difficult to reverse

Abortion

• Purposeful interruption of pregnancy before
20 weeks of gestation
• Elective
• Therapeutic

• Miscarriage

• Common complications:
• Infection
• Retained products of conception
• Excessive vaginal bleeding

EDUCATION