Care of Couple

with Problems of
INFERTILITY
(Female)
Definitions
• INFERTILITY – inability to conceive a child or sustain a
pregnancy to birth

• SUBFERTILITY – it exist when a pregnancy has not

occurred after at least 1 year of engaging in
unprotected coitus (Hamilton, 2012)
Types of Subfertility

1. PRIMARY - no previous conception

2. SECONDARY -   w/ previous viable pregnancy but

the couple is unable to conceive at present
Definitions
• STERILITY
– w/ absolute factor preventing reproduction

– inability to conceive because of a known

condition, such as the absence of a uterus
(Pillitteri, 2014)
 FEMALE INFERTILITY FACTORS:
1. ANOVULATION – absence of ovulation
– Genetic abnormality
• TURNER’S SYNDROME – hypogonadism
- no ovaries to produce ova
 FEMALE INFERTILITY FACTORS:
1. ANOVULATION – absence of ovulation
– Hormonal imbalance
• HYPOTHYROIDISM
 FEMALE INFERTILITY FACTORS:
1. ANOVULATION – absence of ovulation
– Ovarian tumors
 FEMALE INFERTILITY FACTORS:
1. ANOVULATION – absence of ovulation
– Stress
• Decreased body weight

• POLYCYSTIC OVARY SYNDROME

 FEMALE INFERTILITY FACTORS:
1. ANOVULATION – absence of ovulation
– Stress
• POLYCYSTIC OVARY SYNDROME – is associated with the
metabolic syndrome :
– A waist circumference of 35” or above in women
– A fasting blood glucose >100 mg/dL
– Serum triglycerides >150 mg/dL
– Blood pressure of >135/85 mmHg
– High-density lipoprotein cholesterol <50mg/dL
 FEMALE INFERTILITY FACTORS:
1. ANOVULATION – absence of ovulation
– Chronic or excessive exposure to x-rays or
radioactive substances
– General ill health
– Poor diet
 FEMALE INFERTILITY FACTORS:
2. TUBAL TRANSPORT PROBLEMS
– PELVIC INFLAMMATORY DISEASE - infection of the
pelvic organ:
• Uterus
• Fallopian tubes
• Ovaries
• Supporting structures
 FEMALE INFERTILITY FACTORS:
3. UTERINE PROBLEMS
– Rare causes of infertility:
• TUMORS
 FEMALE INFERTILITY FACTORS:
3. UTERINE PROBLEMS
– Rare causes of infertility:
• Congenitally deformed uterine cavity
– Poor secretion of estrogen or progesterone from
the ovary
• ENDOMETRIOSIS
 FEMALE INFERTILITY FACTORS:
4. CERVICAL PROBLEMS
– Thick cervical mucus
– Stenotic cervical os or obstruction of the os by a
polyp
 FEMALE INFERTILITY FACTORS:
4. CERVICAL PROBLEMS
– Cervical conization (cervical surgery)
 FEMALE INFERTILITY FACTORS:
5. VAGINAL PROBLEMS
– Infection of the vagina
– Sperm-immobilizing or sperm-agglutinating
antibodies
 Unexplained Subfertility
• No known cause for
subfertility
 FERTILITY
ASSESSMENT
 PHYSICAL ASSESSMENT
  WOMAN
• As a rule:
–  if a woman is YOUNGER than 35 years
of age
• have an evaluation after 1 year of
subfertility
– OLDER than 35 years
• Have an evaluation after 6 months of
subfertility
 PHYSICAL ASSESSMENT
  WOMAN
• breast and thyroid examination – to rule out
current illness
• maturity and good pituitary function
• anatomic disorders and infection (through
pelvic examination – Paps test)
 FERTILITY TESTING
OVULATION MONITORING
 Basal Body Temperature Recording
• nurse instructs the woman in the technique
of recording BBT on a special form
 FERTILITY TESTING
OVULATION MONITORING
 Basal Body Temperature Recording
– at time of ovulation, basal temperature
can be seen to dip slightly (about 0.5oF)
– rises to a level no higher than normal
body temperature and remains at that
level until 3 or 4 days before the next
menstrual flow
 FERTILITY TESTING
OVULATION DETERMINATION BY TEST STRIP
• Detects the LH surge, allowing you to
accurately predict when you will ovulate.
• A positive result on an ovulation test means
that the woman will most likely become fertile
over the next three days - with peak fertility at
36 hours following the LH surge.
 FERTILITY TESTING
OVULATION DETERMINATION BY TEST STRIP
• Advantageous for women with irregular work
or daily activity schedules:
– Working the night shift
– Arising at varying times in the morning
 FERTILITY TESTING
OVULATION DETERMINATION BY TEST STRIP
• Test of whether she has adequate FSH to
stimulate egg growth
• Woman’s result is available in 30 minutes, the
man in 90 minutes
• Not a test for her time of ovulation
• Do not use the test at the midpoint of
menstrual cycle
 FERTILITY TESTING
TUBAL PATENCY
Sonohysterography
• inspect the uterus for abnormalities:
– Septal deviation
– Presence of myoma
• Done at any time
during the menstrual
cycle (minimally
invasive technique)
 FERTILITY TESTING
TUBAL PATENCY
Hysterosalpingography
• Scheduled immediately
after a menstrual flow
• Contraindicated:
– if infection of the vagina,
cervix, or uterus is present
 ADVANCED SURGICAL PROCEDURES
UTERINE ENDOMETRIAL BIOPSY
• Used to reveal an endometrial problem such
as luteal phase defect.
• Done 2 or 3 days before
an expected menstrual
flow (day 25 or 26 of a
typical 28-day
menstrual cycle)
 ADVANCED SURGICAL PROCEDURES
HYSTEROSCOPY
• Evaluate uterine adhesions or other
abnormalities that were discovered on
hysterosalpingogram.
 ADVANCED SURGICAL PROCEDURES
LAPAROSCOPY
• Scheduled during the follicular phase of a
menstrual period
• To examine the position and status of fallopian
tubes and ovaries
 NURSING DIAGNOSES

• Fear related to possible outcome of

subfertility studies
• Situational low self-esteem related to the
apparent inability to conceive
• Anxiety related to what the process of fertility
testing will entail
• Deficient knowledge related to measures to
promote fertility
 NURSING DIAGNOSES

• Anticipatory grieving related to failure to

conceive or sustain a pregnancy
• Powerlessness related to repeated
unsuccessful attempts at achieving conception
• Hopelessness related to perception of no
viable alternatives to usual conception
 PLANNING

• The couple will:

– Show interest in procedures by asking questions
and demonstrating interest in fertility testing
– Discuss options they need to follow for fertility
testing
– Accurately describe situations and manifest
adequate self-esteem
 PLANNING

• The couple will:

– States they feel well equipped to manage stress
following fertility assessment.

– List appropriate persons or groups to use as

support people.
 IMPLEMENTATION

• Correction of underlying problem

– HORMONE THERAPY
• For disturbance in ovulation, administer:
 IMPLEMENTATION

• Correction of underlying
problem
– HORMONE THERAPY
• to increase mucus production
during days 5 to 10 of her cycle

• If with luteal phase defect:

– begun on the third day of the
temperature
rise and continued for next 6 weeks or
until a
menstrual flow begins
 IMPLEMENTATION

• Correction of underlying problem

– SURGERY
 IMPLEMENTATION

• Correction of underlying problem

– SURGERY
• Tubal insufficiency from inflammation:
– Diathermy
– Steroid administration
– hysterosalpingography
– Canalization
– Surgical repair (microsurgery)
 IMPLEMENTATION

•  Assisted Reproductive Techniques

– THERAPEUTIC INSEMINATION
• Intracervical insemination - sperm is instilled into the
cervix
• Intrauterine insemination - directly into the uterus
• Therapeutic insemination by husband - husband’s sperm
• Therapeutic insemination by donor or therapeutic donor
insemination - donor sperm
 IMPLEMENTATION

•  Assisted Reproductive Techniques

– THERAPEUTIC INSEMINATION
 IMPLEMENTATION

•  Assisted Reproductive Techniques

– THERAPEUTIC INSEMINATION
• Sperm can be cryopreserved (frozen) in a sperm bank
before radiation or chemotherapy and then used for
insemination afterward
– Disadvantage:  tends to have slower motility than unfrozen
specimen
– Advantage:  no increase in incidence of congenital
anomalies in children conceived
 it can be used even after years of storage
 IMPLEMENTATION

•  Assisted Reproductive Techniques

– IN VITRO FERTILIZATION
• Use when:
– Woman has blocked or damaged fallopian tubes
– Man has oligospermia or a very low sperm count
– Absence of cervical mucus prevents sperm from traveling to or
entering the cervix
– Antisperm antibodies cause immobilization of sperm
– Couples with unexplained subfertility of long duration
 IMPLEMENTATION

•  Assisted Reproductive Techniques

– IN VITRO FERTILIZATION
 IMPLEMENTATION

•  Assisted Reproductive Techniques

– GAMETE INTRAFALLOPIAN TRANSFER (GIFT)
 IMPLEMENTATION

•  Assisted Reproductive Techniques

– ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT)
 IMPLEMENTATION

•  Assisted Reproductive
Techniques
– SURROGATE EMBRYO TRANSFER
The process involves the use of an
oocyte that has been donated by
a friend or relative or provided by
an anonymous donor.
• Menstrual cycles of the donor and
recipient are synchronized by
administration of gonadotropic
hormones
 IMPLEMENTATION

•  Assisted Reproductive Techniques

– PREIMPLANTATION GENETIC DIAGNOSIS
After the oocytes are fertilized in IVF and ZIFT
procedures, the DNA of both sperm and oocytes
can be examined for specific genetic abnormalities
or specific genes such as Down’s syndrome or
hemophilia.
 IMPLEMENTATION

•  Alternatives to childbirth
– SURROGATE MOTHERS
A woman who agrees to carry
a pregnancy to term for a
subfertile couple.

Often friends or family

members who assume the
role out of friendship or
compassion.
 IMPLEMENTATION

•  Alternatives to childbirth
– ADOPTION
 IMPLEMENTATION

•  Alternatives to childbirth
– CHILD-FREE LIVING