Female Factor Infertility (Nursing)

by Jacquelyn McMillian-Bohler

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    00:01 So for today, we're going to talk about infertility.

    00:05 Now, infertility is defined differently depending on one's age.

    00:10 If someone is under the age of 35, the definition of infertility is an inability to conceive after 12 months of unprotected intercourse.

    00:20 If you're over the age of 35, however, the time changes.

    00:24 It's an inability to conceive after only six months of unprotected intercourse.

    00:30 Now, the reason for that difference is pretty simple.

    00:32 If you're over the age of 35, your chances of not being able to conceive are going to go up.

    00:37 So we don't want to wait that extra six months before we intervene.

    00:41 Now, there's also a thing called primary infertility.

    00:45 Primary infertility refers to an inability or difficulty in conceiving when someone's never been pregnant before.

    00:53 Secondary infertility, on the other hand, happens when someone was previously able to achieve a pregnancy, and now they're having challenges and difficulty.

    01:03 Fecundity, really just refers to an ability to achieve a live birth at all.

    01:08 So those are our definitions.

    01:10 Make sure you have them in your head.

    01:12 First, we're going to talk about female factor infertility.

    01:16 I make one small side note here that when we discuss female factor and male factor infertility, we're talking about sex assigned at birth.

    01:26 When you take someone's history, a female client who comes in for an assessment for infertility, there are several areas you want to make sure that you assess.

    01:34 First of all, knowing what their medical and surgical history may have been.

    01:38 So do they have diabetes or chronic hypertension? Or have they had surgery? Some sort of operation? Not necessarily on their reproductive system, but anywhere because that can have ramifications for fertility.

    01:51 We also want to talk about their sexual history.

    01:53 Are they engaged in intercourse? I know that seems sort of illogical that someone would expect to be pregnant, if they're not having intercourse.

    02:01 But we do have to have that conversation.

    02:03 How often and with whom? We also want to know a bit about their GYN history, or gynecologic history.

    02:09 Had they had a series of infections? Or have they been treated for abnormalities of the cervix or the uterus? That's really important when we're talking about infertility.

    02:19 Also their OB history. Have they been pregnant before? Have they had a series of losses? That's really important for assessing, why someone may or may not be having trouble getting pregnant at this point.

    02:31 And finally, what's been their history with infertility in general? So is this something they've been working on for a month, two months, six months, two years, eight years? All of that matters.

    02:43 Now, we also want to think about the environment, where do they live, work, and play? So sometimes at work, we're exposed to certain environmental toxins that may impact fertility.

    02:53 And sometimes, what we do in our off time can expose us to the same chemicals and toxins.

    02:59 So make sure that you assess the environment.

    03:03 We also want to think about other habits someone may have in terms of substance use.

    03:07 So there's been a lot of changes in laws about, what's acceptable and what's not? But we have to know that recreational drug use can definitely impact our ability to produce sperm or to achieve fertility.

    03:20 We also want to think about weight.

    03:22 So being overweight or underweight can absolutely affect especially for the female their ability to ovulate.

    03:29 So we need to talk about that.

    03:31 And then we need to do a physical assessment.

    03:34 So our next few slides, we're going to visit what's included in that physical assessment? Let's talk about the assessment for female factor infertility We'll always begin with a pelvic exam.

    03:47 This allows us to palpate the uterus and note any structural anomalies.

    03:52 We will also need to evaluate the hormones.

    03:55 So I don't just mean estrogen and progesterone.

    03:58 We also need to check FSH and LH, and maybe a thyroid because any abnormality here can affect ovulation, which affects fertility.

    04:08 We may also need to do a post coital test.

    04:11 Now this test is a little more complicated.

    04:13 It involves being exposed to sperm, and then testing the vaginal environment afterwards.

    04:19 We're looking to see if the sperm are still alive after they're exposed to cervical mucus.

    04:24 We may also do an ultrasound to give us a better idea of the shape of the uterus.

    04:29 There's some things we're not going to be able to feel on a pelvic exam.

    04:33 We may also do a hysterosalpingogram and for this we'll do an ultrasound and actually shoot fluid through the fallopian tubes to see if they're actually open.

    04:43 So in order for the sperm and egg to get together, the highway has to be clear.

    04:49 A hysteroscopy may be performed in order to really see what's going on in the inside of the uterus.

    04:55 So we can see the endometrium.

    04:57 There may be polyps or other tumors that would affect implantation.

    05:01 And finally, a laparoscopy will allow providers to actually see what's going on in the abdominal cavity.

    05:08 So we can see again, if there are tumors or other structural blockages that can impact fertility.

    05:15 Now, looking at an entire graphic of all the causes of infertility, there are a couple of things we want to take note of.

    05:22 First is the most common cause.

    05:24 And you can see here that 25% of female factor infertility is caused by ovulatory disorders.

    05:31 So in this particular situation, someone is not ovulating regularly or maybe at all, and that's why they're unable to conceive.

    05:39 The second most common reason is endometriosis.

    05:42 So if you'll remember, endometriosis is caused by retrograde bleeding, which means that instead of the menses coming out through the cervix, it's going out through the tubes.

    05:51 So it gets mixed in with the peritoneum, and so you'll have scar tissue that actually will grab on to the tubes and pull it in lots of different directions.

    06:01 So it makes it very difficult for there to be fertilization.

    06:05 And then there's 10%, that's completely unexplained.

    06:08 So for some clients, they will never know the reason for their infertility.

    06:13 Let's talk about the hormonal and ovulatory factors in a bit more detail.

    06:18 So developmental anomalies can absolutely affect fertility for the female client.

    06:24 So thinking about an abnormally formed ovary, or maybe the oocytes or the eggs that are formed inside the ovary are impaired in some way, and this may happen long before pregnancy is desired.

    06:36 The female client can also experience what we call anovulatory cycles.

    06:40 As the name suggests, ovulation does not occur.

    06:44 There may be issues with the pituitary or the hypothalamus that can affect ovulation.

    06:50 There can be a situation where a client is experiencing congenital adrenal hyperplasia.

    06:55 And this is an abnormality in terms of the adrenal glands.

    06:59 And this can definitely impact fertility.

    07:02 Premature ovarian failure can also lead to anovulatory cycles.

    07:07 Polycystic ovarian syndrome can lead again to anovulatory cycles.

    07:13 Increased prolactin can actually suppress GnRH, gonadotropin releasing hormone, which as we know begins the whole menstrual cycle at all.

    07:24 So if any of these factors are off, we will not have ovulation, and without ovulation, fertility is impossible.

    07:33 Now, let's look at some of the structural issues that the female might experience that could impact fertility.

    07:40 Any type of infectious process in the lining of the endometrium can make implantation difficult or impossible.

    07:48 Tumors inside the uterus or in the fallopian tubes, again can affect the passage of the sperm and the egg.

    07:55 So if they're not able to get together, we can't have fertilization.

    07:59 Adhesions inside the endometrium can make it very difficult for implantation to occur.

    08:05 But it can also be a barrier for sperm to get out to the egg in the first place.

    08:11 Again, endometriosis.

    08:13 So think about what this causes that scar tissue is like sticky fingers, and if it causes the tubes to be torturous, then it will be very difficult for the egg even if it's fertilized to make its way back to the endometrium.

    08:27 And finally, inflammation.

    08:29 So infection does not always cause inflammation.

    08:33 When we think about the uterine walls, if they're endometrial or myometrial tumors that can also affect implantation.

    08:42 When we think about the uterine walls, if they're endometrial or myometrial tumors that can affect implantation.

    08:50 And again, not making pregnancy impossible, but being able to sustain a pregnancy very, very difficult.

    08:57 There may also be developmental anomalies.

    09:00 So you can see in this graphic, we have what looks like a septation in the middle of the uterus.

    09:05 So that actually almost two uteri here, in this picture.

    09:08 So this can affect spatial issues, this can affect implantation.

    09:13 Either way, this makes fertility very difficult.

    09:17 And finally, Asherman syndrome.

    09:19 So, Asherman syndrome results after a procedure, such as a dilation and curettage where the lining of the uterus is scraped, and scar tissue is left behind.

    09:29 If there scar tissue in the endometrial lining, then it's impossible for implantation to occur.

    09:36 If that scarring is low enough, it can actually cover the cervix, and in that case, menstrual blood flow will be impeded.

    09:46 Not just the endometrial lining is important to consider when we talk about factors in the uterus.

    09:51 We also have to think about the cervix and the mucus that's produced by the cervix.

    09:56 If it's thick, dry or sticky, then that will be impede sperm transport.

    10:02 So the sperm can't even make it through the cervix to get to the egg.

    10:06 Also, if the environment is particularly acidic, that may be inhospitable to sperm.

    10:12 We also have to think about inflammatory cells.

    10:15 Again, creating a situation that's not a warm and fuzzy for the sperm to get through.

    10:20 And finally, there can actually be antisperm antibodies.

    10:24 So that goes in step further.

    10:26 And they actually attack the sperm when they come.

    10:29 This is why the post coital test might be particularly helpful.

    About the Lecture

    The lecture Female Factor Infertility (Nursing) by Jacquelyn McMillian-Bohler is from the course Infertility (Nursing).

    Included Quiz Questions

    1. A 37-year-old woman who has not been able to conceive after eight months of unprotected intercourse, who has two living children
    2. A 31-year-old woman who has not been able to conceive after nine months of unprotected intercourse, who has two living children
    3. A 38-year-old woman who has not been able to conceive after eight months of unprotected intercourse, who has never been successfully pregnant
    4. A 21-year-old woman who has not been able to conceive after 14 months of unprotected intercourse, who has never been successfully pregnant
    1. The workplace may expose the client to toxins that will affect their fertility
    2. The nurse should ensure the client is financially prepared for a child before addressing their fertility
    3. The workplace may not have adequate maternity leave for the client to support a child
    4. The nurse does not have to ask about the client's workplace when performing a fertility assessment
    1. Hysterosalpingogram
    2. Pelvic exam
    3. Postcoital test (PCT)
    4. Ultrasound
    1. Ovulatory disorders
    2. Endometriosis
    3. Unexplained causes
    4. Pelvic adhesions
    1. Wet, thin, and runny
    2. Thick, dry, or sticky
    3. Wet, thin, and sticky
    4. Thick, wet, and runny

    Author of lecture Female Factor Infertility (Nursing)

     Jacquelyn McMillian-Bohler

    Jacquelyn McMillian-Bohler

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