OB Infertility

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  1. What is the definition of infertility and what are the general causes?
    • Inability to conceive and maintain a pregnancy after one year of active attempt at pregnancy (after 6mo if the woman is older than 35 y/o)
    • The cause can be identified in about 80% of couples, with one third of cases related to the female, one third related to the male, and one third related to both
  2. What are the female risk factors for infertility?
    • Autoimmune disorders
    • diabetes
    • Eating disorders/poor nutrition
    • Excessive alcohol use
    • Excessive Exercise
    • Obesity
    • Older Age
    • STI
  3. What are the male risk factors for infertility?
    • Environmental pollutants
    • Heavy use of alcohol, marijuana, cocaine
    • Impotence
    • Older Age
    • Smoking
    • STI
  4. What are the male causative factors for infertility?
    • Endocrine: diseases or tumors or pituitary or hypothalamus, low levels of LH or FSH
    • Spermatogensis: factors that affect sperm development, such as drugs (calcium channel blockers, chemotherapy, nicotine), infection, illness, heat exposure, pesticides, and radiation to pelvis
    • Sperm antibodies: immune response that causes decreases sperm motility (r/t vasectomy or testicle trauma)
    • Sperm Transport disorder of anatomy
    • Disorders of intercourse
  5. What are the female causative factors for infertility?
    • Ovulatory dysfunction: ovulatory dysfunction or inconsistent ovulation
    • Tubal/pelvis Pathology: damage to fallopian tubs often related to PID, uterine fibroids
    • Cervical mucus factor: cervical injury, infection, interferes with ability of sperm to survive or enter uterus
  6. How is infertility diagnosed in women?
    • Initial screening by GYN (with PMH & Assessments):
    • -STIs
    • -Hormonal Levels-¬†FSH, FH, progesterone, prolactin, TSH, Androgens
    • Assessments of ovulatory dysfunction
    • -Basal body temp
    • -Ovarian reserve testing
    • Endometrial biopsy: performed at the end of the menstrual cycle to assess for the response to hormonal signals
    • Laparoscopy: fluro injection to determine if there are tubal blockages or abnormalities
  7. What hormones are assessed in female infertility?
    • FSH & LH: evaluates ovarian function and determines potential for success with ovarian stimulation medication
    • Progesterone: evaluates ovulation and corpus luteum function
    • Prolactin: high levels can cause anovulation
    • TSH: hypothyroidism may cause menstrual irregularities
    • Androgens (Such as in polycystuc ovary syndrome): excess can lead to oligomenorrhea, anovulation, & amenorrhea
  8. How is basal body temperature assessed?
    • This is a basic test for ovulatory function
    • Identifies follicular and luteal phase
    • Measure the BBT daily before rising from bed
    • Estrogen increases as ovulation nears and the peak of estrogen causes slight drop in BBT followed by a rise in BBT
    • Surge of LH causes a sustained rise in BBT
    • May use a standard thermometer calibrated in tenths of a degree
    • May also use a BBT thermom that only reads 96-100F
    • If there is no temp change during the cycle, there is no ovulation
  9. How is infertility diagnosed in men?
    • Initial screening by a urologist
    • Sperm analysis:
    • -volume >2ml
    • -pH 7-8
    • -count >20 mil
    • -motility >50% forward progression
    • -normal sperm >30%
  10. How is male infertility treated?
    • Treatment for endocrine factors
    • Treatment for abnormal sperm count
    • -Stress reduction
    • -improved nutrition
    • -eliminate tobacco
    • -eliminate drugs that effect spermatogenesis
    • Treatment of sperm antibodies with corticosteroids
    • Treat Infections
    • Repair variocele, inguinal hernias blocking ejaculation
    • Treatment of intercourse disorders, such as hypospadius
  11. How is female infertility treated?
    • Lifestyle changes for anovulation
    • -stress reduction
    • -improved nutrition
    • -eliminate tobacco
    • -eliminate drugs that affect oogenesis
    • Treatment for tubal abnormalities
    • Treat uterine fibroids
    • Antibiotics to treat cervical infections
    • Medications to stimulate ovulation
  12. Which medications promote follicular maturation?
    • Clomiphene citrata
    • Menotropins
  13. Which medications stimulate ovulation?
    • hCG
    • Choriogonadotropin alfa
  14. Which medications prevent premature ovulation in women receiving medications to stimulate follicular maturation?
    • Ganirelix
    • Cetrirelix
  15. How does Clomiphene citrata work and what does it require?
    • Induces ovulation by increasing secretion of FSH & LH
    • This requires normal ovaries, normal prolactin, intact pituitary gland
    • This is usually the first line of therapy
  16. How does Menotropins work?
    • Also known as Human menopausal gonotropin (hMG)
    • Acts directly on ovaries to induce maturation in follicles
  17. How does hCG work and when is it used?
    • This is used in 3 different scenarios:
    • 1. Used to promote follicular maturation and ovulation in women with ovulatory failure
    • 2. Used to induce ovulation in combination with a medication
    • 3. Used in combination with clominphene when clomiphene along failed to induce ovulation
  18. What medications are used for hyperprolactinemia?
    • Cabergoline & Bromocriptine
    • Treats hyperprolactinemia which may inhibit production of FSH & FH
    • Restores normal menstrual cycles
    • Cabergoline better tolerated than bromocriptine
  19. What medications are used for endometriosis?
    • leuprolide/nafarelin
    • Reduces symptoms, but does not increase feritlity
  20. What medications are used for Polycystic Ovary Syndrome?
    • Insulin sensitizing agents helps to lower insulin by allowing it to work
    • -metformin, rosiglitazone
    • -may induce ovulation in anovulatory women with hyperinsulinemia due to PCOS
    • Piglitazone and spironolactone are used to reduce symptoms, but not used for women attempting pregnancy due to harmful effects on unborn infant
  21. Name 6 assisted fertility technologies and how they work
    • INSEMINATION: sperm placed into the cervix or uterus and the sperm may be from a partner or donor
    • TESTICULAR SPERM ASPIRATION: sperm is aspirated directly from the testicles and then the sperm is injected into the egg
    • IN VITRO FERTILIZATION (IVF): fertilization in laboratory and then fertilized egg is inserted into the uterus
    • GAMETE INTRAFALLOPIAN TRANSFER (GIFT): eggs are retrieved from ovaries and placed directly into a catheter with live sperm, then deposited into the fallopian tubes
    • ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT): fertilized egg is placed into the fallopian tube
    • EMBRYO TRANSFER (ET): growing embryo is placed into the uterys
  22. What are other treatment options for infertility?
    • IVF with donor eggs/sperm
    • Gestational carrier (surrogate mother)
    • Adoption
    • Tubal reversal
  23. What are some emotional implications for infertility?
    • Roller coaster ride ea month r/t anticipated pregnancy
    • Situational crisis for the couple
    • Stress, anxiety & depression
    • Strain b/t partners
    • Social Isolation
    • Self Esteem Issues
    • Ethical concerns, such as what to do with surplus embryos
  24. What is the critical component of nursing care for infertility?
    • The experience of infertility effects the individual as well as the couple's emotional well being
    • Nurse's awareness of how fertility affects all aspects of the individual and of the couple's relationship will enhance the effectiveness of the nursing care provided to these couples or individuals
Card Set
OB Infertility
For Siegmunds Exam 1
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