Chapter 7 Infertility, Contraception, and Abortion

Chapter 7 Infertility, Contraception, and Abortion

Infertility Incidence Affects about 10% to 15% of reproductive-age population Subfertility: prolonged time to conceive Sterility: inability to conceive Increases with age of woman, particularly in women 40 years and older Diagnosis and treatment of infertility require physical, emotional, and financial investment 2

Infertility cont d Factors associated with infertility Female infertility Ovarian factors Tubal and peritoneal factors Uterine factors Vaginal-cervical factors Isoimmunization Other factors 3

Fig. 7-1. Abnormal uterus. A, Complete bicornuate uterus with vagina divided by a septum. B, Complete bicornuate uterus with normal vagina. C, Partial bicornuate uterus with normal vagina. D, Unicornuate uterus. 4

Infertility cont d Factors associated with infertility Male infertility Can be caused by structural and hormonal disorders Undescended testes Hypospadias Varicocele (varicose vein of the scrotum) Low testosterone levels Substance abuse Other factors 5

Nursing Care Management Assessment of female Diagnostic tests Evaluation of the anatomy Detection of ovulation Hormone analysis Ultrasonography Endometrial biopsy Hysterosalpingography Laparoscopy 6

Fig. 7-2. Hysterosalpingography. Note that the contrast medium flows through the intrauterine cannula and out through the uterine tubes. 7

Fig. 7-3. Laparoscopy. 8

Nursing Care Management cont d Assessment of male Semen analysis Hormone analysis Scrotal ultrasound Assessment of couple Postcoital test 9

Nursing Care Management cont d Plan of care and implementation Psychosocial Nonmedical Herbal alternative methods Medical Surgical Assisted reproductive therapies 10

Nursing Care Management cont d 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 adoption or hosting 11

Fig. 7-4. Gamete intrafallopian transfer (GIFT). A, Through laparoscopy a ripe follicle is located, and fluid containing the egg is removed. B, The sperm and egg are placed separately in the uterine tube, where fertilization occurs. 12

Nursing Care Management cont d Reproductive alternatives Adoption Surrogate motherhood Preimplantation genetic diagnosis 13

Contraception 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 14

Nursing Care Management 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 The safety of a method depends on a woman s medical history 15

Contraception cont d Methods 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 16

Contraception cont d Methods FAMs Natural family planning (period abstinence) Calendar rhythm method Standard days method Basal body temperature method Cervical mucus ovulation-detection method 17

Contraception cont d Methods FAMs Symptothermal method Predictor test for ovulation TwoDay method Lactation amenorrhea method 18

Unn. Fig. 7-2. Cervical Mucus Characteristics 19

Contraception cont d Barrier methods Spermicides Condoms, male (STI protection) Vaginal sheath (STI protection) Diaphragm Fit of diaphragm Toxic shock syndrome Cervical cap Fit of cervical cap Contraceptive sponge 20

Fig. 7-11. Spermicides. 21

Fig. 7-12. A, Mechanical barriers. Clockwise from top: female condom, cervical cap, diaphragm, types of male condoms, vaginal ring (hormonal) (center). B, Contraceptive sponge. 22

Unn. Fig. 7-4. Squatting 23

Unn. Fig. 7-5. Leg-Up Method 24

Unn. Fig. 7-6. Chair Method 25

Unn. Fig. 7-7. Reclining 26

Unn. Fig. 7-8. Preparation of Diaphragm 27

Unn. Fig. 7-9. Insertion of Diaphragm 28

Unn. Fig. 7-10. Diaphragm Insertion 29

Unn. Fig. 7-11. Diaphragm Insertion 30

Unn. Fig. 7-12. Diaphragm Insertion 31

Unn. Fig. 7-13. Diaphragm Insertion 32

Unn. Fig. 7-14. Cervical Cap Insertion 33

Unn. Fig. 7-15. Cervical Cap Insertion 34

Unn. Fig. 7-16. Cervical Cap Insertion 35

Contraception cont d Hormonal methods Combined estrogen-progestin contraceptives (COCs) Oral contraceptives and side effects Transdermal contraceptive system Vaginal ring 36

Contraception cont d Hormonal methods Progestin-only contraceptives Oral progestins (minipill) Injectable progestins Implantable progestins (Norplant) 37

Contraception cont d Emergency contraception Used within 72 hours of unprotected intercourse Three methods available in the United States High doses of estrogen or COCs Two days of levonorgestrel Insertion of the copper intrauterine device (IUD) 38

Contraception cont d IUD Small, T-shaped device inserted into the uterine cavity Medicated IUDs loaded with either copper or progestational agent IUD offers no protection against STIs or HIV 39

Fig. 7-14. Intrauterine devices. A, Copper T380A. B, Levonorgestrel-releasing intrauterine device. 40

Contraception cont d Sterilization Female Tubal occlusion Tubal reconstruction Male (vasectomy) Tubal reconstruction (reanastomosis) 41

Fig. 7-15. Sterilization. A, Uterine tubes ligated and severed (tubal ligation). B, Sperm duct ligated and severed (vasectomy). 42

Fig. 7-16. Use of minilaparotomy to gain access to uterine tubes for occlusion procedures. Tenaculum is used to lift uterus upward (arrow) toward incision. 43

Abortion Purposeful interruption of pregnancy before 20 weeks of gestation Elective Therapeutic Contributing factors Legal and moral issues 44

Abortion cont d First-trimester abortion Surgical (aspiration) abortion Methotrexate and misoprostol Mifepristone and misoprostol Second-trimester abortion Dilation and evacuation Prostaglandins Hypertonic and uterotonic agents 45

Key Points Infertility: inability to conceive and carry a fetus to term gestation Infertility affects about 10% to 15% of otherwise healthy adults Infertility increases in women older than 35 years In the United States about one third of infertility causes are related to female causes, one third are related to male causes, 20% of causes are unexplained 46

Key Points cont d Common etiologic factors include decreased sperm production, ovulation disorders, tubal occlusion, and endometriosis Reproductive alternatives include: IVFET, GIFT, ZIFT, oocyte donation, embryo donation, TDI, surrogate motherhood, and adoption Contraceptive methods with various effectiveness rates, advantages, and disadvantages are available 47

Key Points cont d Women and their partners should choose the contraceptive method(s) best suited to them Effective contraceptives are available through both prescription and nonprescription sources Concurrent use of spermicides and latex condoms provides protection against STIs Tubal ligations and vasectomies are permanent sterilization methods 48

Key Points cont d Induced abortion performed in the first trimester is safer and less complex Most common complications of induced abortion include infection, retained products of conception, and excessive vaginal bleeding 49