NURSING

CARE OF THE FAMILY HAVING § Anticipatory grieving related to failure

DIFFICULTY CONCEIVING A CHILD to conceive or sustain a pregnancy.
§ Powerlessness related to repeated
(DEAN GASCO) unsuccessful attempts at achieving
INFERTILITY conception.
§ Hopelessness related to perception of
- Is a term used to describe the inability no viable alternatives to usual
to conceive a child or sustain a conception.
pregnancy to a birth.
IMPLEMENTATION
- A couple is said to be infertile if they Ø Fertility testing can be costly for a
have not become pregnant after at couple because not all health insurance
least 1 year of unprotected sex.
programs provide reimbursement for
- Lesbian, gay, bisexual, or transgender these procedures.
(LGBT) have a child through an assisted
§ The patient rearranges work
fertility method. plans to manage the schedule
- When a couple first begins fertility
of fertility testing by 1 month’s
counseling, they usually have fears and time.
anxieties not only about their ability to
conceive but also about what an OUTCOME:
identified problem will mean to their
future lifestyle and family. § The couple verbalizes they understand
their individual subfertility problem
- Subfertility screening and counseling
can be both an emotionally difficult and after preliminary testing.
§ The couple demonstrates a high level of
a physically demanding process.
- Subfertility investigation usually has self-esteem after fertility studies, even
in the face of disappointing study
three assessments.
1. Semen analysis outcomes.
2. Ovulation monitoring SUBFERTILITY
3. Tubal patency
Ø Primary subfertility
NURSING DIAGNOSIS Ø Secondary subfertility

§ Fear related to possible outcome of
subfertility studies. - Is the inability to conceive because of a
known condition, such as the absence
§ Situational low self-esteem related to
the apparent inability to conceive. of a uterus, difficulty conceiving than
those who space coitus every other day.
§ Anxiety related to what the process of
fertility testing will entail. - This is because too-frequently coitus
§ Deficient knowledge related to can lower a man’s sperm count to a
level below optimal fertility, age is
measures to promote fertility.
related to subfertility.

annesacro 🌷
 - Women who are using oral, injectable History taking for History taking for
or implanted hormones for men should include: women should
contraceptive may have difficulty. include:
• His general • General health
health
- Determine the ovulation.
• A typical 24-hr • Nutrition
- Men need sperm recovery time after
food intake,
ejaculation. including
- Male-superior position is the best alternative
position for coitus to achieve
conception.
- Male should try to deep penetration so • He had a • Past
congenital reproductive
ejaculation places sperm as close as
health tract problems
possible to the cervix.
problem,
- Woman should remain on her back pospadias or
with knees drawn up for at least 20 cryptorchidism
minutes after ejaculation to help • He ever had • Past history of a
sperm remain near the cervix. radiation to his childhood
- Don’t use douching lubricants before or testes because cancer treated
of childhood with radiation
after intercourse so vaginal pH is
cancer, x-ray, that might have
unaltered.
operation such reduce ovarian
- Eat a diet high in slowly digested as surgical function or any
carbohydrates, low in saturated or trans repair of a exposure to
fats, and moderate in protein. hernia or occupational
- Maintain a body weight that results in a torsion of the hazards.
body mass index between 18.5 and 24.9 testes.

- Exercise about 30 mins. per day to help
keep blood glucose and insulin levels
• Operation such • Abdominal or
stabilized. as surgical pelvic operation
- A woman is younger than 35 years of repair of a
age, suggested she have an evaluation hernia or
after 1 year of subfertility. torsion of the
- A woman who is older than 35 years, testes
should be seen after 6 months, • Current illness • Overall health,
emphasizing
strategies such as IVE, as well as endocrine
common alternatives to natural problems
childbearing such as adoption, are also galactorrhea
limited by age. (breast nipple
secretions),
thyroid
dysfunction

annesacro 🌷
 • Job or lifestyle • Female Ø Erythrocyte sedimentation rate (an
involves sitting circumcision increased rate)
all day • History of Ø Protein-bound iodine a test for thyroid
• Frequency of contraceptive function),
coitus, use
Ø Cholesterol level (arterial plaques could
masturbation, • Past pregnancies
coital position interfere with pelvic blood flow), and
miscarriages or
used, failure to abortion Ø Follicle-stimulating hormone, luteinizing
achieve • Detect ovulation hormone
ejaculation through such Ø Rubella titer a serologic test for syphilis
symptoms Ø HIV evaluation,
breast Ø Thyroid uptake determination;
tenderness
galactorrhea prolactin levels reduce the
midcycle
secretion.
“wetness”
• Use of douches Ø A pelvic sonogram may be performed to
or intravaginal rule out ovarian, tubal, or uterine
• Menstrual structural disorder.
history,
including age of FACTORS THAT CAUSE MALE SUBFERTILITY
menarche
frequently of • Disturbance in spermatogenesis
menstrual • Inadequate production of FSH and LH in
periods; the pituitary which stimulates the
production of sperm.
• Obstruction in the seminiferous tubules
PHYSICAL ASSESSMENT:
• Qualitative or quantitative changes fluid,
Ø Absence of a vas deferens descended which prevent sperm motility
testes or a varicocele (a collection of • Development of autoimmunity, which
fluid thyroid examination, secondary immobilizes sperm
sex characteristics) • Problems in ejaculation or deposition
Ø Pap smear test • Chronic or excessive exposure to x-rays or
Ø Anatomic disorders and radioactive substances
Ø Infection • General ill health, poor diet

FERTILITY TESTING: LIMITED SPERM COUNT

1. Good quality and numbers Sperm count minimum sperm

2. Ova (egg) available
§ 50% of sperm that are motile
Ø Semen analysis tubal patency § 30% that are normal in shape
assessment include urinalysis complete spermatozoa must be produced and
blood, blood typing, including Rh factor; maintained at a temperature slightly
Ø A serologic test for syphilis for the lower than body temperature to be the
presence HIV; testes, in which sperm are produced

annesacro 🌷
 and stored, are suspended in the scrotal microscope within 1 hour of
sac away from body heat. ejaculation.
§ Chronic infection from tuberculosis or Ø After 2 or 3 months and 30 to 90 days
recurrent sinusitis, lower a sperm is needed for new sperm to reach
count. Working at a desk job or driving maturity.
a great deal every day.
SPERM PENETRATION ASSAY AND ANTISPERM
§ Frequently use of hot tubs or saunas
may also lower sperm counts. ASSAY AND ANTIBODY TESTING
§ Maintaining an ideal body weight, Ø Abstain from coitus for 7 to 10 days at a
excessive weight may alter testosterone time to increase the ligation of a
production and sperm production varicocele, such as avoiding recreational
§ Cryptorchidism (undescended testes marijuana use
varicocele or varicosity) Ø Wearing looser clothing
Ø Avoiding long periods of sitting
OTHER CONDITIONS THAT MAY INHIBIT SPERM Ø Avoiding prolonged hot baths, may also
help reduce scrotal heat and increase
PRODUCTION INCLUDE:
the sperm count
• Past trauma to the testes.
OBSTRUCTION OR IMPAIRED SPERM MOTILITY
• Surgery on or near the testicles.
• Endocrine imbalances, thyroid Ø Mumps orchitis (testicular inflammation
pancreas, or pituitary glands and scarring due to the mumps virus,
• Drugs use or excessive alcohol use epididymis and infections gonorrhea)
• Environment factors, such as exposure Ø Adhesions from and occlusion
to x-rays or radioactive substances Ø Congenital stricture of a spermatic duct
hypertrophy of the prostate gland
Ø Pressure from the enlarged gland,
ANALYSIS TO PITUITARY HORMONES
vasectomies develop an autoimmune
Semen Analysis: reaction or form antibodies that
immobilize their own sperm.
Ø 1.4 to 1.7 ml of semen Ø Scarring after an infection, could also
Ø 33 to 46 million spermatozoa develop an autoimmune reaction that
immobilizes sperm the same way.
§ Sexually abstinence of 2-4 days prior to Ø Anomalies of the hypospadias ventral
the analysis surface of the penis, epispadias
(urethral opening on the dorsal
1. Patient ejaculates by masturbation into surface), cause sperm to be deposited
a clean dry, specimen jar or a special too far from the sexual partner’s cervix
condom. to allow optimal cervical penetration
2. Number of sperm in the specimen are Ø Sperm transport disorders are
counted and then examined under a suspected when FSH and hormones,

annesacro 🌷
 which stimulate the production of ANOVULATION
sperm.
1. Genetic abnormal
Ø Sperm are not able to pass through the
vas deferens because of obstruction, 2. Turner syndrome
3. Hormonal imbalance
surgery to relieve the obstruction,
administration of corticosteriods to a 4. Hypothyroidism
5. Pituitary-ovarian
woman effect in decreasing sperm
immobilization because it reduces her 6. Ovarian tumors, polycystic ovary
syndrome produce anovulation due to
immune response and antibody
production. feedback stimulation on the pituitary.
7. X-rays or radioactive substances
ERECTILE DYSFUNCTION 8. General ill health, poor diet, and stress
9. Poor diet
Ø Logical problems, cerebrovascular 10. Stress nutrition body weight, and
accident, diabetes, Parkinson disease,
exercise are they all influence the blood
antihypertensive, pattern baldness 11. Glucose/insulin balance, when either
PREMATURE EJACULATION glucose or insulin levels are too high,
they can disrupt the production of FSH
Ø Ejaculation is another factor that may and LH, leading to ovulation failure
interfere with psychological or sexual 12. Vitamin D may also be instrumental in
counseling, Phosphodiesterase, maintaining pituitary hormone levels
inhibitor, such as sildenafil (Viagra) or
tadalafil (Cialis) Ø Eating slowly digested carbohydrate
foods (brown rice, pasta, dark bread,
The factor that cause subfertility in women are
beans) and fiber-rich vegetables
analogous to those causing subfertility in men:
(asparagus, broccoli) rather than easily
§ Limited production of FSH or LH, which digested carbohydrates foods can not
interfere with ova growth. only increase fertility by keeping insulin
§ Anovulation (faulty or inadequate levels balanced but also may prevent
expulsion of ova) gestational diabetes when a woman
§ Problems of ova transport through the becomes pregnant.
fallopian tubes to the uterus Ø Exercising 30 minutes per day by
§ Uterine factors, such as tumors or poor walking or doing mild aerobics helps to
endometrial development regulate blood glucose levels and
§ Cervical and vaginal factors, which increase fertility, complementing
immobilizes spermatozoa healthy eating habits
§ Poor nutrition increased body weight, Ø Decreased body weight or a body fat
and lack ratio of less than 10% as may occurs in
female athletes such as competitive
runners can reduce pituitary hormones
such as FSH and LH and halt ovulation

annesacro 🌷
 Ø Polycystic ovary syndrome, a condition Therapy for Anovulation
in which the ovaries produce excess
Ø Administration of GnRH is a possibility
testosterone, thus lowering FSH and LH
levels, which then causes irregular and (this will stimulate the pituitary to
secrete more FSH and LH)
unpredictable menstrual cycles.
Ø Polycystic ovary syndrome is associated Ø Therapy (clomid) or (femara), ovarian
follicular growth of FSH and LH human
with metabolic syndrome
Ø Waist circumference of 35 in. or more chorionic gonadotropin (Parlodel), to
reduce prolactin levels and allow for for
in women
Ø Fasting blood glucose over 100 mg/dl the rise of pituitary gonadotropins
Ø Serum triglycerides over 150 mg/dl causing multiple ova to come to
maturity, and possibly resulting in
Ø Blood pressure over 135/85 mmHg
Ø High-density lipoprotein cholesterol multiplying births.

over 50 mg/dl
Ø Development of hirsutism 2. Tubal Transport Problems
Ø A. Scarring has developed in the
TESTING FOR ANOVULATION fallopian tubes, caused by chronic
salpingitis raptured appendix or from
Ovulation Monitoring
abdominal surgery infection left
Ø Measure the woman’s serum adhesion formation.
progesterone level during the luteal Ø B. Pelvic inflammatory disease (PID)
phase of her menstrual cycle this is organs the uterus, fallopian tubes,
elevated, implies a corpus luteum has ovaries and their supporting structures.
formed or ovulation has occurred Ø Sexually transmitted disease chlamydia,
Ø Record her basal body temperature or gonorrhea lead to stricture of the
(BBT) for at least 4 months fallopian.
Ø Eating or drinking using a special BBT or Ø There is a higher incident of PID if there
tympanic thermometer is multiple sexual partners.

Action
1. Ovulation Determination by Test Strip
Ø Various brands of commercial kits are Ø Estrogen agonist commonly used to
available for assessing the upsurge of stimulate the ovary binds to estrogen
LH that occurs just before ovulation and receptors, decreasing the number of
can be used in place of BBT monitoring. available estrogen receptors, which
Ø Fasting-glucose testosterone, and falsely signals the hypothalamus to
estrogen levels are analyzed. increase follicle-stimulating hormone
Ø A pelvic sonogram can be used to and luteinizing hormone secretion.
confirm cysts are present on the
Dosage
ovaries.
Ø 50 mg/day orally for 5 days fifty day of
the cycle 100 mg/day for 5 days stated

annesacro 🌷
 as early as 30 days after the initial procedure must be scheduled
course of therapy immediately.

Possible adverse effects D. Transvaginal Hydrolaparoscopy

Ø Abdominal discomfort distention, Ø With the instillation of a paracervical

bloating, nausea, vomiting, breast local anesthetic block followed by
tenderness, vasomotor flushing, ovarian introduction a hysteroscope into an
enlargement, ovarian overstimulation, incision just behind the cervix through
multiple births, visual disturbances the cu-de-sac
Ø 200 ml of normal saline is then
Nursing Implication introduced to move tubal patency view
§ Pelvic examination exiting the fimbrial end of the tubes
§ Review medication scheduling
Therapy for lack of tubal patency
§ Timing intercourse with ovulation
§ 24 hour urine samples Ø Diathermy or steroid administration
§ Report any bloating, stomach pain, may be helpful to reduce adhesions.
blurred vision, unusual bleeding Ø Canalization of the fallopian tubes and
plastic surgical repair (microsurgery) are
Testing for Tubal Patency other possible treatment
Ø Ultrasound or x-ray imaging and direct
visualization by a hysteroscope of 3. Uterine Concerns
fallopian tubes are all effective methods A. Tumors such as fibromas (leiomyomas)
used to determine the patency of may be a rare cause of subfertility if
fallopian tubes they block the entrance of the fallopian
tubes into the uterus or limit the
B. Sonohysterosalpingogram endometriosis poor secretion of
estrogen or progesterone are more
Ø Ultrasound contrast agent introduced
common uterine reasons for subfertility
into the uterus through a narrow
as these (overproduction or
catheter inserted into the uterine cervix
underproduction)
o Contraindicated if infection of

the vagina
B. Endometriosis- refer to the
o Causing momentary painful
implantation of uterine endometrium,
uterine cramping
or nodules, that have spread from the
C. Hysterosalpingogram interior of the uterus to locations
outside the uterus
Ø Hysterosalpingogram radiopaque o can cause tubal obstruction
contrast medium is used fallopian tubes o growths on the ovaries can
are revealed by x-ray. displace fallopian tubes away
Ø Because an x-ray is used, which might from the ovaries preventing the
be harmful to a growing pregnancy, the entrance of ova into the tubes

annesacro 🌷
 o peritoneal macrophages, which the abdominal wall outward and to
are drawn to nodules of offer better visualization
endometrium, can destroy
sperm Therapy for uterine Concerns

Ø Progesterone vaginal suppositories

Testing for Uterine Concerns Hysteroscopy
begun on the third day of a woman's
Ø Hysteroscopy is visual inspection of the temperature rise and continued for the
uterus through the insertion of a next 6 weeks
hysteroscope vagina, cervix, and into Ø Myoma (fibroid tumor) intrauterine
the uterus evaluate: adhesions interfering with fertility, a
o Uterine adhesions myomectomy, intrauterine device (IUD)
o Malformations, or other may be inserted to prevent the uterine
o Abnormalities such as fibroid sides from touching and forming new
tumors or polyps adhesions

Uterine Endometrial Biopsy
VAGINAL AND CERVICAL CONCERNS
Ø Used to reveal an endometrial problem,
such as a luteal phase defect 1. Cervical mucus may be too thick to
Ø Resembles a corkscrew suggests allow spermatozoa to penetrate the
ovulation has occurred it is done 2 or 3 cervix
days before an expected menstrual flow 2. Infection or inflammation of the cervix
Ø After a paracervical block and a screen (erosion) can also cause cervical mucus
for chlamydia, thin probe and biopsy to thicken so much that spermatozoa
forceps are introduced through the cannot penetrate it easily or survive in it
cervix 3. Infection of the vagina can cause the pH
Ø A woman may experience mild-to- of vaginal secretion to become acidotic,
moderate discomfort from thus limiting or destroying the morality
maneuvering the instruments. of spermatozoa.
4. Prescribed low-dose estrogen therapy
Laparoscopy
toincrease mucus production
Ø Laparoscopy is the introduction of a (Premarin). Vaginal infections such as
thin, hollow, lighted tube (a fiber optic trichomoniais and moniliasis tend to
telescope or laparoscope) through a recur, antibiotic therapy (Flagyl) for a
small incision in the abdomen, just Trichomonas teratogenic
under the umbilicus, to examine the 5. Unexplained Subfertility
position and state of the fallopian tubes
Assisted Reproductive Techniques
and ovaries
Ø Steep Trendelenburg position (which Ø Discontinuing smoking or recreational
bring the reproductive organs down out drug behaviors, ingesting a diet high in
of the pelvis). Carbon dioxide is usually protein, and having a BMI within a
introduced into the abdomen to move normal range of 18.5 to 24.9.

annesacro 🌷
Alternative insemination grown fertilized ova (now
zygotes) inserted into a
Ø Alternative or 1Ul in the Instillation of
woman's uterus, where, ideally,
sperm from a masturbatory sample into one or more of them will
the female reproductive tract by means
implant and grow.
of a cannula to aid conception at the
• Donor ovum, used for a woman
time of ovulation. Sperm can either be
who does not ovulate or who
instilled into the cervix (intracervical
carries a sex-linked disease she
insemination) or directly into the uterus
does not want to pass on her
(IU) at the time of predicted ovulation.
children. Ovarian radiation or
Donor insemination can be used genetic
ovaries removed before surgery
disorder does not want to Woman does
for ovarian
not have a male partner. Sperm can be
• 1 month 10th day of the
cryopreserved (frozen) in a sperm bank
menstrual woman is given an
before radiation or chemotherapy then
injection of needle is then
used for alternative insemination
introduced intravaginally
afterward, tends to have slower motility
guided by ultrasound oocyte is
than unfrozen specimens.
aspirated from its follicle, many
Ø Woman receives an injection of
as 3 to 12 can oocytes chosen
clomiphene (Clomid) month prior to the
are incubated for at least 8
insemination So follicle growth of ova is
hours to ensure viability.
stimulated and a day of ovulation can
• Sperm cells and oocytes are
be predicted
mixed and allowed to incubate
Ø Donor for alternative insemination are
in a growth medium. Genetic
volunteers who have no history of
analysis to reveal chromosomal
disease and no family history of
abnormalities or the potential
possible inheritable disorders.
sex can be completed
IN VITRO FERTILIZATION • Zona pellucida surrounding
discovered zygotes begin to
• In Vitro fertilization (IVF) is most often divide and grow 40 hours after
used for couples who have not been fertilization, multiple eggs were
able to conceive because chosen planted to ensure a
1. The woman has obstructed or damaged pregnancy resulted multiple
fallopian tubes. births 4 up to five embryos may
2. It is also used when the man has be transferred
oligospermia or a very low sperm
count. Absence of cervical mucus
prevents sperm from entering the

cervix or antisperm antibodies cause
immobilization of sperm.
• About 40 hours after
fertilization, the laboratory-

annesacro 🌷
GAMETE INTRAFALLOPIAN AND ZYGOTE SURROGATE MOTHERS
INTRAFALLOPIAN TRANSFER
ADOPTION
Ø Gamete intrafallopian transfer (GIFT)
procedures, ova are obtained from 1. Alternative for subfertile and LGBT
couples,
ovaries exactly as in IVF. Instead of
waiting for fertilization to occur in the 2. Those individuals who have genetic-
related health conditions
laboratory, both ova and sperm are
instilled, within a matter of hours, using 3. Health conditions what would make
pregnancy high risk.
a laparoscopic technique, the open end
of a patent fallopian tube. Fertilization CHILDREN-FREE LIVING
then occurs in the tube, zygote moves
to the uterus for implantation. Patent Ø Child-free living emerge as the option, a
fallopian tube by some couples because couple in the midst of fertility testing
conception fallopian tube and so is not may begin to reexamine their motives
cortradictory to their religious beliefs. for pursuing pregnancy and may decide
Ø Zygote intrafallopian transfer (ZIFT) egg pregnancy and parenting are not worth
is fertilized in the laboratory, fertilized the emotional or financial
egg is transferred by laparoscopic Ø Child-free living can be as having
technique into end of a waiting children be cause it allows a couple
fallopian more time to help other people and
contribute to society allows time for
SURROGATE EMBRYO TRANSFER both members to pursue careers. They
Ø Surrogate embryo transfer is an can travel more or have more time and
money to pursue hobbies or continue
assisted reproductive technique for a
woman who does not produce Ova their education.
Ø Oocyte is donated by a friend, relative
anonymous donor menstrual cycles of
the donor and recipient are
synchronized by administration of
gonadotropic hormones.
• The donor's ovum is removed
by a transvaginal, ultrasound-
guided procedures oocyte is
then fertilized in the laboratory
by the recipient woman's
partner's sperm (or donor
sperm) and placed in the
recipient woman's uterus
embryonic transfer.

annesacro 🌷