Infertility PDF

1/9/24, 2:49 AM Realizeit for Student Infertility The desire to have children can be powerful and widespread for many women, but for many, that desire can also be unfulfilled. Infertility is defined as the inability to conceive a child after 1 year of regular sexual intercourse unprotected by cont...

1/9/24, 2:49 AM Realizeit for Student Infertility The desire to have children can be powerful and widespread for many women, but for many, that desire can also be unfulfilled. Infertility is defined as the inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception (RESOLVE, 2019). Secondary infertility is the inability to conceive after a previous pregnancy. Many people take the ability to conceive and produce a child for granted, but infertility affects more than 7.4 million Americans, or up to 15% of the reproductive-age population, according to the American Society for Reproductive Medicine (ASRM, 2019). Infertility is a widespread problem that has an emotional, social, and economic impact on couples. Although male infertility contributes to more than half of all causes, infertility typically remains a woman’s social burden. It affects relationships, leads to tension and anger between partners, and can result in severe sexual dysfunction and breakdown of the relationship. Nurses must recognize infertility and understand its causes and treatment options so they can help women and couples understand the possibilities as well as the limitations of current therapies. Nurses have a central role in supporting women and couples through these stressful treatments. Women and couples will frequently confide in a nurse and can gain great benefit from a sympathetic and sensible discussion. Women wish to be treated with respect and dignity and given appropriate information and support. Cultural Considerations Infertility is not only a physiologic problem, but it is one that can initiate a life crisis that is experienced with psychological, familial, social, and cultural consequences. Cross-culturally, the expectation for couples to reproduce is an accepted norm and the inability to conceive may be considered a violation of this cultural norm. In this context, infertility represents a crisis for the woman and/or the couple. The manner in which different cultures, ethnic groups, and religious groups perceive and manage infertility may be very different. For example, many African Americans believe that assisted reproductive techniques are unnatural and that they remove the spiritual or divine nature of creation from conception. For this reason, they may seek spiritual rather than medical assistance when trying to conceive. Those belonging to Hispanic cultures may believe that children validate the marriage, so families are often large. Like African Americans, Hispanic individuals are often spiritual and may consider infertility a test of faith, leading them to seek spiritual counseling. Disappointing one’s spouse can often be of concern to African American women, while avoiding the stigmatization of infertility can be a top concern to Asian American women. African American and Asian American alike may find themselves living with partner tensions, criticism from relatives, and stigmatization from the community (Hess et al., 2018). Religion often influences cultural factors and for this reason, may also be considered when pursuing treatment for infertility. In the Orthodox Jewish religion, procreation is considered to be a “mitzvah,” a https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 1/5 1/9/24, 2:49 AM Realizeit for Student religious good deed. However, Orthodox Jews do accept the use of contraceptives to prevent conception when it is not desired. Conservative and Reform Jews put no restrictions on contraception and a lesser demand on procreation. Roman Catholics have a restrictive view of the use of assisted reproductive technologies since in their view, procreation cannot be separated from the relationship between parents. Thus, God wants human life to begin through the “conjugal act” and not artificially. Most religious teachings speak to the significance of procreation, so infertility can impact the self and relational identities of the couple wishing to become parents. Therefore, infertility presents a risk for both a crisis of identity and of faith (Klitzman, 2018). Nurses must be cognizant of the client’s cultural and religious background and how it may dictate which, if any, reproductive treatment options are chosen. Nurses need to include this awareness in their counseling of infertile couples. Etiology and Risk Factors Reproduction requires the interaction of the female and the male reproductive tracts, which involves (1) the release of a normal preovulatory oocyte; (2) the production of adequate spermatozoa; (3) the normal transport of the gametes to the ampullary portion of the fallopian tube (where fertilization takes place); and (4) the subsequent transport of the cleaving embryo into the endometrial cavity for implantation and development (Webster et al., 2018). Therapeutic Management As noted earlier, the main causes of infertility are female-factor (e.g., anovulation, tubal damage, endometriosis, ovarian failure), male-factor (e.g., low or absent numbers of motile sperm in the ejaculate, erectile dysfunction), or unexplained (Dunne, 2018). The test results are presented to the couple and different treatment options are suggested. The majority of infertility cases are treated with drugs or surgery. Treatment options include lifestyle changes, such as weight loss and smoking cessation; taking clomiphene to promote ovulation; hormone injections to promote ovulation; intrauterine insemination; and IVF. Various ovulation-enhancement drugs and timed intercourse might be used for the woman with ovulation problems. The woman should understand a drug’s benefits and side effects before consenting to take it. Depending on the type of drug used and the dosage, some women may experience multiple pregnancies. If the woman’s reproductive organs are damaged, surgery can be done to repair them. Nursing Assessment Infertile couples may be under tremendous pressure and often keep the problem a secret, considering it to be personal. Couples and women are often beset by feelings of inadequacy and guilt, and many are subject to pressures from both family and friends. As the problem becomes more chronic, they may begin to blame one another, with consequent marital discord. Seeking help is often a difficult step, and it may take a lot of courage to discuss something about which they feel https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 2/5 1/9/24, 2:49 AM Realizeit for Student embarrassed or upset. The nurse working in this specialty setting must be aware of the conflict and problems couples experience and must be sensitive to their needs. A full medical history should be taken from both partners, along with a physical examination. The data needed for the infertility evaluation are sensitive and of a personal nature, so the nurse must use professional interviewing skills. Infertility has numerous causes and contributing factors, so it is important to use the process of elimination, determining what problems do not exist to better comprehend the problems that may exist. At the first visit, a plan of investigation is outlined and a complete health history is taken. This first visit forces many couples to confront the reality that a desired pregnancy may not occur naturally. At a minimum, women should have evidence of ovulation and tubal patency and the male should have a normal semen analysis for conception to be successful (ACOG, 2019). Alleviate some of the anxiety associated with diagnostic testing by explaining the timing and reasons for each test. Laboratory and Diagnostic Testing The diagnostic procedures that should be done during an infertility workup should be guided by the couple’s history. They generally proceed from less to more invasive tests. HOME OVULATION PREDICTOR KITS Home ovulation predictor kits contain monoclonal antibodies specific for LH and use an enzymelinked immunosorbent assay (ELISA) test to determine the amount of LH present in the urine. A significant color change from baseline indicates the LH surge and presumably the most fertile day of the month for the woman. CLOMIPHENE CITRATE CHALLENGE TEST The clomiphene citrate challenge test is used to assess a woman’s ovarian reserve (ability of her eggs to become fertilized). FSH levels are drawn on cycle day 3 and on cycle day 10 after the woman has taken 100 mg clomiphene citrate on cycle days 5 through 9. If the FSH level is greater than 15, the result is considered abnormal and the likelihood of conception with her own eggs is low (Knaus et al., 2018). The diagnostic procedures that should be done during an infertility workup should be guided by the couple's history. They generally proceed from less to more invasive tests. HYSTEROSALPINGOGRAPHY Hysterosalpingography (HSG) is the gold standard in assessing patency (being open and unobstructed) of the fallopian tubes. Fallopian tube obstruction is among the most common causes https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 3/5 1/9/24, 2:49 AM Realizeit for Student of female factor infertility. Ultrasonography and magnetic resonance imaging (MRI) are used in this assessment. In hysterosalpingography, 3 to 10 mL of an opaque oil-based contrast medium is slowly injected through a catheter into the endocervical canal so that the uterus and tubes can be visualized during fluoroscopy and radiography. If the fallopian tubes are patent, the dye will ascend upward to distend the uterus and the tubes and will spill out into the peritoneal cavity (Fig. 4.4) (ACOG, 2019). LAPAROSCOPY A laparoscopy is usually performed early in the menstrual cycle. It is not part of the routine infertility evaluation. It is used when abnormalities are found on the ultrasound or the hysterosalpingogram or when endometriosis is suspected. Because of the added risks of surgery, the need for anesthesia, and operative costs, it is only used when clearly indicated. During the procedure, an endoscope is inserted through a small incision in the anterior abdominal wall. Visualization of the peritoneal cavity in an infertile woman may reveal endometriosis, pelvic adhesions, tubal occlusion, fibroids, or polycystic ovaries (Sahu & Modi, 2018). FIGURE 4.4 Insertion of a dye for a hysterosalpingogram. The contrast dye outlines the uterus and fallopian tubes on an x-ray to demonstrate patency. Nursing Management Nurses play an important role in the care of infertile couples. They are pivotal educators about preventive health care. A number of potentially modifiable risk factors are associated with the development of impaired fertility in women, and women need to be aware of these risks to institute change. The nurse is most effective when they offer care and treatment in a professional manner and regards the couple as valued and respected individuals. The nurse must be respectful of and mindful https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 4/5 1/9/24, 2:49 AM Realizeit for Student that many women may seek spiritual help for their infertility issues in addition to traditional medical modalities. In a recent study, a couple’s level of spirituality was positively associated with their own quality of life and helped reduce infertility-related stress (Casu et al., 2018). The nurse’s focus must encompass the whole person, not just the results of the various infertility studies. There is no absolute way to prevent infertility per se because so many factors are involved in conception. Nurses can be instrumental in educating men and women about the factors that contribute to infertility. The nurse can also outline the risks and benefits of treatments so that the couple can make an informed decision. As couples struggle with infertility, they frequently turn to nurses for empathy, counseling, and support. By understanding the struggles and lived experiences of women and couples experiencing infertility, the nurse can tailor their approach to better meet the couple’s needs so that the pregnancy and birth experience of these women are healing, transformative, and positive. With advances in genetics and reproductive medicine also come a myriad of ethical, social, and cultural issues that will affect the couple’s decisions. With this in mind, provide an opportunity for the couple to make informed decisions in a nondirective, nonjudgmental environment. It is important to encourage couples to remain optimistic throughout investigation and treatment. Through the use of advocacy and anticipatory guidance, assist and support couples through the diagnosis and treatment of infertility (Jordan et al., 2019). Finances and insurance coverage often dictate the choice of treatment. Help couples decipher their insurance coverage and help them weigh the costs of various procedures by explaining what each will provide in terms of their infertility problems. Assisting them in making a priority list of diagnostic tests and potential treatment options will help the couple plan their financial strategy. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 5/5