Chapter 9 Infertility Copyright 2016 by Elsevier Inc

Learning Objectives List common causes of infertility. Discuss the psychosocial impact of infertility. Identify common diagnoses and treatments for infertility. Identify reproductive alternatives for infertile couples. Examine the various ethical and legal considerations of assisted reproductive therapies for infertility. Copyright © 2016 by Elsevier Inc. All rights reserved. 2

Incidence Affects about 15% of reproductive-age couples Ø Ø Subfertility: prolonged time to conceive Sterility: inability to conceive Increases with age, particularly women older than 35 years Diagnosis and treatment of infertility require physical, emotional, and financial investment. Copyright © 2016 by Elsevier Inc. All rights reserved. 3

Factors Associated with Infertility Female infertility causes Ø Ø Ø Hormonal and ovulatory factors Tubal and peritoneal factors Uterine factors Ø Vaginal-cervical factors • Developmental anomalies • Endometritis Copyright © 2016 by Elsevier Inc. All rights reserved. 4

Factors Associated with Infertility (Cont. ) Male infertility causes Ø Can be caused by structural and hormonal disorders • Undescended testes • Hypospadias • Varicocele (varicose vein of the scrotum) • Low testosterone levels • Azoospermia: no sperm cells produced • Oligospermia: few sperm cells produced • Substance abuse Copyright © 2016 by Elsevier Inc. All rights reserved. 5

Infertility Care Management Assessment of female infertility Ø Diagnostic tests • Detection of ovulation • Hormone analysis • Ultrasonography • Hysterosalpingography • Hysteroscopy • Laparoscopy Copyright © 2016 by Elsevier Inc. All rights reserved. 6

Diagnostic Tests: Female Infertility Copyright © 2016 by Elsevier Inc. All rights reserved. 7

Infertility Care Management Assessment of male infertility Ø Ø Ø Semen analysis Ultrasonography Other

Infertility Care Management (Cont. ) Plan of care and interventions Psychosocial • Major life stressor; can disrupt relationships Ø Nonmedical • Diet, habit changes; weight loss Ø Complementary and alternative measures Ø Medical • Correcting pre-existing factors • Ovarian stimulation Ø Copyright © 2016 by Elsevier Inc. All rights reserved. 9

Infertility Care Management (Cont. ) Assisted reproductive therapy (ART): fertility treatments in which both eggs and sperm are handled Ø Ø Ø Intrauterine insemination (IUI) In vitro fertilization–embryo transfer (IVF-ET) Intracytoplasmic sperm injection (ICSI) Assisted hatching Preimplantation genetic diagnosis Gamete intrafallopian transfer (GIFT) Copyright © 2016 by Elsevier Inc. All rights reserved. 10

Copyright © 2016 by Elsevier Inc. All rights reserved. 11

Infertility Care Management (Cont. ) Assisted reproductive therapies Ø Ø Ø Zygote intrafallopian transfer (ZIFT) Oocyte donation Embryo donation Surrogate mothers/embryo hosts Therapeutic donor insemination (TDI) Adoption Success rates and costs of ART Risks of ART Cryopreservation Copyright © 2016 by Elsevier Inc. All rights reserved. 12

Key Points Infertility is the inability to conceive and carry a child to term gestation when the couple has chosen to do so. Infertility affects approximately 15% of otherwise healthy adults. Infertility increases as the woman ages, especially after age 40 years. Copyright © 2016 by Elsevier Inc. All rights reserved. 13

Key Points (Cont. ) In the United States, about 20% of infertility cases are unexplained; of that 80% in which causative factors are known, about 40% are related to female causes, 40% are related to male causes, and 20% are attributable to both male and female causes. Common etiologic factors of infertility include decreased sperm production, ovulation disorders, tubal occlusion, and endometriosis. Obesity or smoking in either partner is receiving increasing attention as a cause of infertility. Copyright © 2016 by Elsevier Inc. All rights reserved. 14

Key Points (Cont. ) The investigation of infertility is conducted systematically and simultaneously for male and female partners. The couple’s relationship dynamics, sexuality, and ability to cope with the psychologic and emotional effects of diagnostic procedures and treatment of infertility must be considered in the plan of care. Ongoing support is recommended. Copyright © 2016 by Elsevier Inc. All rights reserved. 15

Key Points (Cont. ) Most infertility cases are treated with conventional medical and surgical therapies. Reproductive alternatives for family building include ovarian stimulation, followed by IUI, IVF-ET, GIFT, or ZIFT, oocyte donation, embryo donation, TDI, gestational or surrogate motherhood, and adoption. Copyright © 2016 by Elsevier Inc. All rights reserved. 16

Question 1. A nurse is providing instruction to a couple undergoing zygote intrafallopian transfer (ZIFT). The nurse is aware that instruction has been effective when the woman states: a. “My egg will be fertilized and then placed into my uterus. ” b. “My husband’s sperm will be inserted into my uterus. ” c. “My husband’s sperm and my egg will be placed into my fallopian tube. ” d. “A fertilized egg will be placed into my fallopian tube. ” Copyright © 2016 by Elsevier Inc. All rights reserved. 17