So now let's talk about
How do we hopefully
make things better?
So I want to start with
Because this is important,
and it's a treatment factor that
can make all the difference.
We want to start with
Now imagine that if your whole life is
centered around the idea of having a family
and making lots of babies, and then you
find out that that's not going to happen,
there's a lot of disappointment
that may come with that, or shame.
So as nurses,
we need to be in a place
where we can offer psychological
support to the family,
whether they achieve a
pregnancy, or they do not.
We also want to make sure again,
that we're talking about nutrition,
and trying to get this couple in the
most healthy state that we possibly can.
The healthier the body is,
the more likely all of the hormones
and everything else will function
to the best of their ability.
Exercise may be important as
it as a weight control method,
but also in terms of just
being psychologically healthy
and reducing stress.
Now, we can think about some other
alternative medicine therapies
that also work for the
treatment of infertility.
So things like acupuncture and
herbal remedies should be discussed.
Now, these are treatments.
And so we want to make sure
our clients feel comfortable
in describing all the
things that they're doing.
Be sure to ask and be supportive
when your clients answer.
More specific treatment for
female factor infertility
is going to first include correction
of the hormonal imbalance.
So remember, we talked about
drawing labs for FSH and LH
and progesterone and estrogen.
We want to make sure that
those are in alignment
with producing a
normal ovulatory cycle.
If we correct that,
sometimes that's all that needs to be done
in order to get someone
on the path to fertility.
We may need surgical correction
of anatomic abnormalities.
So think about that
septate in the uterus.
Sometimes, if that's the reason,
we can go in and cut that septation out,
and then the client is able
to achieve her pregnancy.
Maybe you remember these 3.
Hysteroscopy and Laparoscopy.
They were under the section for
diagnosing female factor infertility.
They can also be treatments.
So imagine in the
Hysterosalpingogram, for example,
if we're shooting fluid through
the tube to see if they're open,
and by shooting the fluid through,
we actually open the tube,
then that can reverse
We could also do in
As we look inside
the uterine cavity,
we may see polyps or some sort of
tumor that can be quickly removed,
and that can make it possible
for implantation to occur,
Or the Laparoscopy if they're plaques
of endometriosis that are noted
and those are removed, that can take away
the structural issues that may be there.
Now let's talk about
the female client.
We want to induce ovulation, especially
for someone who has sub ovulatory cycles,
that means they're not ovulating
normally, or maybe not at all.
We can use 2 medications
called clomiphene citrate
and letrozole as a way
to stimulate that cycle.
I'll talk to you more about the
clomiphene citrate in just a bit.
We can also treat some of
the other underlying causes.
So insulin resistance can cause
anovulatory cycles as well.
Metformin may help
to reduce that.
And if you remember Metformin,
from any discussion about diabetes,
And finally, Progesterone.
Now in a normal menstrual
cycle, and in pregnancy,
Progesterone's role is to
stabilize the endometrium.
So in the case that infertility is caused
by an inability to sustain a pregnancy,
Progesterone may be needed and
can reverse the infertility.
Let's talk about the
Clomid cycle in detail.
We begin with a baseline ultrasound
to take a look at the ovaries
to make sure that the follicles are
looking normal and the ovaries are okay.
We can also take a quick peek
at the lining of the uterus
to make sure that the
endometrium looks normal.
Then we begin the treatment with Clomid,
these are pills that are taken daily.
Then as a Clomid begins to
work, we monitor the follicles.
So we're looking for development
of the O-site within the follicle.
Once we notice there's the
development of a primary O-site,
then a trigger shot is given.
So if you remember from our
discussion of the menstrual cycle,
LH is going to trigger ovulation
and that's what we want.
We want the O-site to
erupt from the ovary.
The LH shot is what's
going to do that.
Then we want to have
So we'll encourage
the couple to do that.
Or if artificial insemination
is going to be the way,
then this is when
that will be done.
Then we'll monitor progesterone
levels to make sure
that the lining of the uterus is
stable in case there is a conception.
We wait 2 weeks.
And then we have a pregnancy
test, which hopefully is positive.
Now I want to make one note.
It's important to understand that because
we are really stimulating the ovary
to try to get 1 egg to ripen,
it's very possible we
could get 2 or 3 or 4.
So we have to make sure that
when we're prescribing Clomid,
and this is what the
provider would do
that we are monitoring
so we don't stimulate someone
who has 3 or 4 eggs ready to go.
Because that's how we end up with 4, 5, 6,
or eight babies as in the case of Octomom.
If this cycle does not work,
the client will have a period,
and then we can begin
the cycle again.
So in some cases,
the issue is not hormonal,
and we've got to get the egg
and sperm closer together.
And in this case, we may use
assisted reproductive technologies
in order to
So I want to share a
few of those with you.
The first one is called AI
or Artificial Insemination.
And in this case,
the sperm is collected externally,
and then introduced
into either the vagina
or all the way into
the uterine cavity
to make it easier for the
sperm and egg to get together.
This can be done through
So what that means is that
instead of this being the partner,
this could be someone
either the female knows,
or perhaps from a donor bank
where sperm is supplied.
Sometimes we have to offer more
assistance to the conception process.
So we remove the O-site from the female
body and actually place it in a petri dish,
and we add the sperm to the dish and
allow conception to happen there.
Now, if there are barriers to the egg
and sperm getting together in the dish,
we can actually take the sperm and
directly inject it into the O-site,
and then transfer.
Now often, we need to let the
cells divide further in the dish
before we transfer that entire
blastocyst back into the female body.
And that's called a GIFT,
a gamete intrafallopian transfer.
So it's further along
into the process.
Now, donor eggs can be used
if they don't have to come
from the person who's
going to carry the baby.
And we can also
use a donor embryo,
so that could be a sperm and an egg
from an entirely different couple.
Let's talk about a couple of
other special situations in ART.
So sometimes the couple is able to
donate the in sperm, but not the egg.
So we'll utilize a third party who
is willing to donate their egg.
We can also have a situation
where we have a surrogant
who is able to
carry the pregnancy,
but the couple donates
both the egg and the sperm.
Even in the cases where
a conceptus happens,
there can still be
The first one being
an ectopic pregnancy,
especially in the cases of
artificial insemination or IVF.
Ectopic pregnancies are
definitely a possibility.
There can also be
So if we do ovulation induction,
we talked about that with Clomid,
but any of our other strategies
can also increase our
chances of multiples.
And finally, we can still
have genetic abnormalities
or other complications that may
lead to spontaneous abortion.
So remember, when we think
about psychological support,
this may be something that
continues even after pregnancy.
So let's take a few minutes
and really think about
what the nursing
responsibility should be
for clients that are
First, we really need to assess the
psychological impact of infertility.
If you can imagine setting
your whole life on the idea
that you're going to
have lots of children
and then finding out that
it's not working out that way.
We need to be there and be
able to offer that support.
We need to make sure that we
explore all the social drivers
that may impact that
client and that couple.
So exploring their support
system outside of the office.
Do they have family or friends or
therapist to help them work through things?
I also want to
call your attention
to taking care of same sex
or transgender couples.
Every couple that comes in seeking
assistance with reproduction
is not truly infertile.
However, they absolutely should be offered
the same care and respect as everyone else.
We may need to recognize that
same sex or transgender couples
may need extra care,
really to address the societal biases
that unfortunately are in place.
And we want to consider the
fact that they may need support,
whether they're able
to achieve a pregnancy
or if they decide
to stop treatment.