Infertility and Nurse Practitioner Role

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.