Chapter 5

Infertility, Contraception, and Abortion

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Incidence Affects about 10% to 15% of reproductive-age

couples Four goals when providing care:

• Provide the couple with accurate information• Assist in identifying the cause of infertility• Provide emotional support• Guide and educate about forms of treatment

Infertility

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Assessment of female infertility Ovarian factors Tubal and peritoneal factors Uterine factors Vaginal-cervical factors Other factors

Factors Associated with Infertility

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Assessment of male infertility Hormonal factors Testicular factors Factors associated with sperm transport Idiopathic male infertility

Factors Associated with Infertility (Cont.)

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Assessment of female infertility Test or examination

• Evaluation of the anatomy• Detection of ovulation• Hormone analysis• Ultrasonography• Endometrial biopsy• Hysterosalpingography• Laparoscopy

Care Management

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Assessment of male infertility Semen analysis Hormone analysis Scrotal ultrasound

Care Management (Cont.)

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Plan of care and implementation Psychosocial considerations Nonmedical treatments

• Herbal alternative methods

Medical therapy Surgical therapies

• Assisted reproductive therapies (ART)

Care Management (Cont.)

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Assisted reproductive therapies In vitro fertilization–embryo transfer (IVF-ET) Gamete intrafallopian transfer (GIFT) Zygote intrafallopian transfer (ZIFT) Ovum transfer (oocyte donation) Therapeutic donor insemination (TDI) Embryo hosting Assisted embryo hatching

Care Management (Cont.)

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Reproductive alternatives Surrogacy Preimplantation genetic diagnosis Adoption Cryopreservation of human embryos

Care Management (Cont.)

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Intentional prevention of pregnancy Birth control is the device or practice to

decrease the risk of conceiving Family planning is the conscious decision on

when to conceive or avoid pregnancy May still be at risk for pregnancy Nearly half of all U.S. pregnancies are

unplanned

Contraception

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A multidisciplinary approach to assist the woman in choosing an appropriate contraceptive method

Ideally the method should be safe, readily available, economical, acceptable, and simple to use

Contraceptive choice must meet personal, social, cultural, and interpersonal needs

Care Management

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Coitus interruptus (withdrawal) Fertility awareness methods (FAMs)

Rely on avoidance of intercourse during fertile periods FAMs combine charting menstrual cycle with

abstinence or other contraceptive methods Natural family planning (period abstinence) Calendar rhythm method

Methods of Contraception

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FAMs Standard days method Basal body temperature method Cervical mucus ovulation-detection method Symptothermal method Predictor test kits for ovulation TwoDay method Breast-feeding

Methods of Contraception (Cont.)

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Barrier methods Spermicides Condoms, male (STI protection) Vaginal sheath (STI protection) Diaphragm Cervical cap Contraceptive sponge

Methods of Contraception (Cont.)

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Hormonal methods Combined estrogen-progestin contraceptives (COCs)

• Oral contraceptives and side effects• Transdermal contraceptive system• Vaginal ring

Methods of Contraception (Cont.)

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Hormonal methods Progestin-only contraceptives

• Oral progestins (minipill)• Injectable progestins• Implantable progestins (Norplant)

Methods of Contraception (Cont.)

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Emergency contraception Used within 72 hours of unprotected intercourse Five methods available in the United States

• High doses of estrogen or COCs (three options)• Two days of levonorgestrel• Insertion of the copper intrauterine device (IUD)

Methods of Contraception (Cont.)

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IUD Small, T-shaped device wrapped in copper inserted

into the uterine cavity Medicated intrauterine system loaded with

progestational agent (Mirena) IUD offers no protection against STIs or HIV

Methods of Contraception (Cont.)

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Sterilization Female

• Tubal occlusion• Tubal reconstruction

Male (vasectomy)• Tubal reconstruction (reanastomosis)

Methods of Contraception (Cont.)

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Purposeful interruption of pregnancy before 20 weeks of gestation Elective Therapeutic

Contributing factors Legal and moral issues

Roe v. Wade 1973

Abortion

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First-trimester abortion Surgical (aspiration) abortion Medical abortion

• Methotrexate and misoprostol• Mifepristone and misoprostol

Second-trimester abortion Dilation and evacuation Cervical preparation with prostaglandins Emotional considerations

Abortion (Cont.)

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Induced abortion performed in the first trimester is safest and less complex

Common complications: Infection Retained products of conception Excessive vaginal bleeding

Abortion (Cont.)

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A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. The nurse’s most appropriate response is:

“This is a legitimate concern. Would you like to discuss this further before your treatment begins?”

“No one has ever had more than triplets with Clomid.” “Ovulation will be monitored with ultrasound so this will

not happen.” “Ten percent is a very low risk, so you don’t need to

worry too much.”

Question

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