Infertility and Nurse Practitioner Role

Questions and Answers

What is the definition of infertility in women under 35 years old?

Able to conceive despite irregular vaginal intercourse with sperm producing partner for 6 months

Able to conceive despite irregular vaginal intercourse with sperm producing partner for 12 months

Unable to conceive despite regular vaginal intercourse with sperm producing partner for 6 months

Unable to conceive despite regular vaginal intercourse with sperm producing partner for 12 months (correct)

What percentage of infertility cases are caused by female factors?

50%

30%

55% (correct)

40%

What is a common cause of tubal and pelvic pathology leading to infertility?

Polycystic Ovary Syndrome (PCOS)

Pelvic Inflammatory Disease (PID) (correct)

Asherman syndrome

Endometriosis

What is a type of infertility characterized by one or more prior pregnancies?

Secondary infertility Signup and view all the answers

What is a cause of ovulatory dysfunction leading to infertility?

All of the above Signup and view all the answers

At what age do women typically undergo immediate intervention for infertility?

40 years old Signup and view all the answers

What is the minimum number of cycles required for ovulation detection?

3 cycles Signup and view all the answers

What is the expected increase in basal body temperature after ovulation?

Greater than 0.4°C Signup and view all the answers

What is the fertile window in relation to ovulation?

5 days before ovulation and 1 day after ovulation Signup and view all the answers

How long should a patient abstain from ejaculating before a semen analysis?

2-5 days Signup and view all the answers

How many serum lab tests are mentioned in the content based on H and P?

5 Signup and view all the answers

What is the purpose of conducting semen analysis early in infertility analysis?

To spare women from more invasive diagnostic testing Signup and view all the answers

What is a significant male factor that can contribute to infertility due to gonadal disorders?

Klinefelter syndrome Signup and view all the answers

Which of the following conditions could lead to a congenital absence of the vas deferens?

Cystic fibrosis Signup and view all the answers

What is a psychological factor that may contribute to combined infertility disorders?

Anxiety and depression Signup and view all the answers

Which history component is important to consider for understanding female infertility?

Diet and exercise Signup and view all the answers

Which symptom is specifically associated with male patients in a review of systems for infertility?

Impotence Signup and view all the answers

Which diagnostic procedure is likely to give insights into male factor infertility?

Semen analysis Signup and view all the answers

What is a common treatment approach for addressing anti-sperm antibodies?

Intrauterine insemination Signup and view all the answers

Which of the following factors may contribute to decreased sperm motility due to environmental exposure?

Occupational hazards like heavy metals Signup and view all the answers

Study Notes

Infertility Overview

Infertility is defined as the inability to conceive despite regular intercourse with a sperm-producing partner.
Criteria for infertility diagnosis vary by age:
- Under 35 years: 12 months of trying
- Over 35 years: 6 months of trying
- Women over 40 should seek immediate intervention due to limited time for conception.
Types of infertility include:
- Primary infertility: No prior pregnancies
- Secondary infertility: One or more previous pregnancies

Etiology - Female Factors

Female factors account for 55% of infertility cases.

Ovulatory Dysfunction

Contributes to 20-40% of female infertility.
Ovulation signs include monthly menses and symptoms like breast tenderness and bloating.
Causes include:
- Abnormal BMI, eating disorders, stress, hormonal imbalances (e.g., PCOS), pituitary tumors, thyroid issues, and hyperprolactinemia.
Medications like hormones, antidepressants, antipsychotics, corticosteroids, and chemotherapeutics can disrupt ovulation.

Tubal and Pelvic Pathology

Causes 30-40% of infertility cases.
Common issues include:
- Pelvic inflammatory disease (most frequent cause of tubal infertility).
- Ectopic pregnancy, endometriosis, Asherman syndrome (uterine scarring), and fibroids.

Etiology - Male Factors

Male factors contribute 30-40% of infertility.
Gonadal disorders include chromosomal abnormalities like Klinefelter syndrome, cryptorchidism, varicoceles, infections, and environmental impacts.
Conditions affecting sperm transport include congenital absence of the vas deferens or acquired obstruction.
Other contributing factors may include hypothalamic-pituitary disorders and idiopathic causes.

Combined Factors

Anti-sperm antibodies hinder sperm survival in cervical mucus, affecting motility.
Infertility may result from concurrent disorders and psychological stress.
In some cases, the cause remains unexplained.

Comprehensive History

A thorough medical and gynecological history is crucial, including:
- Previous treatments like chemotherapy or radiation, STIs, and fertility outcomes in past relationships.
- Gynecological details: menstrual history, surgeries, contraceptive use, and cervical cancer screenings.
- Family history of reproductive health issues, birth defects, and developmental delays.
- Social history detailing environmental exposures and substance use.

Physical Examination

Full physical assessment required, including:
- Vital signs: BMI, blood pressure, heart rate.
- Examination of skin, hair, nails, thyroid, and pelvic area.

Diagnostic Testing

Ovulation Detection: Must track for a minimum of three cycles.
- Basal body temperature (BBT) monitoring to identify ovulation (rise of >0.4°F expected).
- Over-the-counter urine tests for LH to predict ovulation (which occurs within 24-36 hours of surge).
- The fertile window extends from five days before to one day after ovulation.
Semen Analysis:
- Initial and cost-effective test; requires abstinence from ejaculation for 2-5 days prior.
- Tests should occur within one hour of collection, with at least two tests conducted a month apart.
Additional screenings include STI testing, cervical cancer screening, and serum labs based on health history and physical exams (e.g., TSH, progesterone levels, hormone excess indicators).
Imaging:
- Antral follicle count for assessing ovarian reserve.

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Description

This quiz covers the definition and types of infertility, including primary and secondary infertility, as well as female factors that contribute to infertility. It is designed for nurse practitioners and other healthcare professionals.