Treatment for Infertility (Nursing)

by Jacquelyn McMillian-Bohler

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    00:01 So now let's talk about treating infertility.

    00:04 How do we hopefully make things better? So I want to start with non-pharmacological strategies.

    00:10 Because this is important, and it's a treatment factor that can make all the difference.

    00:15 We want to start with psychological support.

    00:18 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.

    00:32 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.

    00:41 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.

    00:49 The healthier the body is, the more likely all of the hormones and everything else will function to the best of their ability.

    00:56 Exercise may be important as it as a weight control method, but also in terms of just being psychologically healthy and reducing stress.

    01:05 Now, we can think about some other alternative medicine therapies that also work for the treatment of infertility.

    01:11 So things like acupuncture and herbal remedies should be discussed.

    01:16 Now, these are treatments.

    01:18 And so we want to make sure our clients feel comfortable in describing all the things that they're doing.

    01:23 Be sure to ask and be supportive when your clients answer.

    01:28 More specific treatment for female factor infertility is going to first include correction of the hormonal imbalance.

    01:34 So remember, we talked about drawing labs for FSH and LH and progesterone and estrogen.

    01:41 We want to make sure that those are in alignment with producing a normal ovulatory cycle.

    01:47 If we correct that, sometimes that's all that needs to be done in order to get someone on the path to fertility.

    01:53 We may need surgical correction of anatomic abnormalities.

    01:57 So think about that septate in the uterus.

    02:00 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.

    02:07 Maybe you remember these 3.

    02:10 Hysterosalpingogram, Hysteroscopy and Laparoscopy.

    02:15 They were under the section for diagnosing female factor infertility.

    02:19 They can also be treatments.

    02:21 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 the infertility.

    02:35 We could also do in the Hysteroscopy.

    02:37 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, thereby resolving the infertility.

    02:51 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.

    03:01 Now let's talk about pharmacologic strategies specifically for the female client.

    03:07 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.

    03:17 We can use 2 medications called clomiphene citrate and letrozole as a way to stimulate that cycle.

    03:24 I'll talk to you more about the clomiphene citrate in just a bit.

    03:27 We can also treat some of the other underlying causes.

    03:31 So insulin resistance can cause anovulatory cycles as well.

    03:35 Metformin may help to reduce that.

    03:37 And if you remember Metformin, from any discussion about diabetes, you'll understand that correlation.

    03:44 And finally, Progesterone.

    03:46 Now in a normal menstrual cycle, and in pregnancy, Progesterone's role is to stabilize the endometrium.

    03:52 So in the case that infertility is caused by an inability to sustain a pregnancy, Progesterone may be needed and can reverse the infertility.

    04:03 Let's talk about the Clomid cycle in detail.

    04:06 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.

    04:14 We can also take a quick peek at the lining of the uterus to make sure that the endometrium looks normal.

    04:20 Then we begin the treatment with Clomid, these are pills that are taken daily.

    04:25 Then as a Clomid begins to work, we monitor the follicles.

    04:29 So we're looking for development of the O-site within the follicle.

    04:34 Once we notice there's the development of a primary O-site, then a trigger shot is given.

    04:40 So if you remember from our discussion of the menstrual cycle, LH is going to trigger ovulation and that's what we want.

    04:47 We want the O-site to erupt from the ovary.

    04:51 The LH shot is what's going to do that.

    04:53 Then we want to have regular intercourse.

    04:56 So we'll encourage the couple to do that.

    04:58 Or if artificial insemination is going to be the way, then this is when that will be done.

    05:03 Then we'll monitor progesterone levels to make sure that the lining of the uterus is stable in case there is a conception.

    05:10 We wait 2 weeks.

    05:12 And then we have a pregnancy test, which hopefully is positive.

    05:16 Now I want to make one note.

    05:19 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.

    05:36 So we have to make sure that when we're prescribing Clomid, and this is what the provider would do that we are monitoring those follicles, so we don't stimulate someone who has 3 or 4 eggs ready to go.

    05:48 Because that's how we end up with 4, 5, 6, or eight babies as in the case of Octomom.

    05:55 If this cycle does not work, the client will have a period, and then we can begin the cycle again.

    06:03 So in some cases, the issue is not hormonal, and we've got to get the egg and sperm closer together.

    06:09 And in this case, we may use assisted reproductive technologies in order to accomplish fertility.

    06:16 So I want to share a few of those with you.

    06:18 The first one is called AI or Artificial Insemination.

    06:22 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.

    06:33 This can be done through intrauterine insemination, or therapeutic donor insemination.

    06:39 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.

    06:51 Sometimes we have to offer more assistance to the conception process.

    06:55 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.

    07:04 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.

    07:15 Now often, we need to let the cells divide further in the dish before we transfer that entire blastocyst back into the female body.

    07:24 And that's called a GIFT, a gamete intrafallopian transfer.

    07:29 So it's further along into the process.

    07:32 Now, donor eggs can be used if they don't have to come from the person who's going to carry the baby.

    07:38 And we can also use a donor embryo, so that could be a sperm and an egg from an entirely different couple.

    07:45 Let's talk about a couple of other special situations in ART.

    07:49 So sometimes the couple is able to donate the in sperm, but not the egg.

    07:54 So we'll utilize a third party who is willing to donate their egg.

    07:58 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.

    08:08 Even in the cases where a conceptus happens, there can still be potential complications.

    08:15 The first one being an ectopic pregnancy, especially in the cases of artificial insemination or IVF.

    08:21 Ectopic pregnancies are definitely a possibility.

    08:25 There can also be multiple gestation.

    08:27 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.

    08:35 And finally, we can still have genetic abnormalities or other complications that may lead to spontaneous abortion.

    08:43 So remember, when we think about psychological support, this may be something that continues even after pregnancy.

    08:52 So let's take a few minutes and really think about what the nursing responsibility should be for clients that are experiencing infertility.

    09:00 First, we really need to assess the psychological impact of infertility.

    09:05 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.

    09:14 We need to be there and be able to offer that support.

    09:18 We need to make sure that we explore all the social drivers that may impact that client and that couple.

    09:24 So exploring their support system outside of the office.

    09:27 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.

    09:37 Every couple that comes in seeking assistance with reproduction is not truly infertile.

    09:43 However, they absolutely should be offered the same care and respect as everyone else.

    09:49 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.

    10:01 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.

    About the Lecture

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

    Included Quiz Questions

    1. Metformin decreases insulin resistance which can cause anovulatory cycles
    2. Conception occurs when a woman has lower blood sugar
    3. Creating an optimal uterine environment for pregnancy is an off-label use for Metformin
    4. Metformin in conjunction with Letrozole work synergistically to promote fertility
    1. After a primary oocyte develops
    2. Directly after the Clomid gets administered
    3. After the couple has regular intercourse
    4. Before the woman's last menstrual cycle ends
    1. Intracytoplasmic sperm injection
    2. In vitro fertilization
    3. Gamete intrafallopian transfer
    4. Conception
    1. Surrogacy
    2. Gestational carrier
    3. Artificial insemination
    4. Therapeutic donor insemination
    1. Multiple gestation
    2. Ectopic pregnancy
    3. Spontaneous abortion
    4. Hemorrhage

    Author of lecture Treatment for Infertility (Nursing)

     Jacquelyn McMillian-Bohler

    Jacquelyn McMillian-Bohler

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