9

Chapter 09: Infertility
Lowdermilk: Maternity & Women’s Health Care, 11th Edition
MULTIPLE CHOICE
1. Which test is performed around the time of ovulation to diagnose the basis of infertility?
a. Hysterosalpingogram
b. Ultrasonography
c. Laparoscopy
d. Follicle-stimulating hormone (FSH) level
ANS: B
Ultrasonography is performed around the time of ovulation to assess pelvic structures for
abnormalities, to verify follicular development, and to assess the thickness of the
endometrium. A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid
flushing a potentially fertilized ovum out through a uterine tube into the peritoneal cavity.
Laparoscopy is usually scheduled early in the menstrual cycle. Hormone analysis is performed
to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles
are absent or irregular.
DIF: Cognitive Level: Understand REF: p. 201 TOP: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity
2. An infertility specialist prescribes clomiphene citrate (Clomid, Serophene) for a woman

experiencing infertility. She is very concerned about the risk of multiple pregnancies. What is
the nurse’s most appropriate response?
a. “This is a legitimate concern. Would you like to discuss further the chances of
multiple pregnancies before your treatment begins?”
b. “No one has ever had more than triplets with Clomid.”
c. “Ovulation will be monitored with ultrasound to ensure that multiple pregnancies
will not happen.”
d. “Ten percent is a very low risk, so you don’t need to worry too much.”
ANS: A
The incidence of multiple pregnancies with the use of these medications is higher than 25%.
The client’s concern is legitimate and should be discussed so that she can make an informed
decision. Stating that no one has ever had more than triplets with Clomid is inaccurate and
negates the client’s concerns. Ultrasound cannot ensure that a multiple pregnancy will not
occur, and 10% is inaccurate. Furthermore, the client’s concern is discredited with a statement
such as, “…don’t worry.”
DIF: Cognitive Level: Apply REF: p. 208 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
3. A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to
the difficulty he and his wife are having getting pregnant. Which guidance should the nurse
provide?
a. “Your sperm count seems to be okay in the first semen analysis.”
b. “Only marijuana cigarettes affect sperm count.”
c. “Although smoking has no effect on sperm count, it can give you lung cancer.”
d. “Smoking can reduce the quality of your sperm.”
ANS: D
Cigarette smoking has detrimental effects on sperm and has been associated with abnormal
sperm, a decreased number of sperm, and chromosomal damage. The nurse may suggest a
smoking cessation program to increase the fertility of the male partner. Sperm counts vary
from day to day and are dependent on emotional and physical status and sexual activity.
Therefore, a single analysis may be inconclusive. A minimum of two analyses must be
performed several weeks apart to assess male fertility. Marijuana use may depress the number
and motility of sperm. Smoking is indeed a causative agent for lung cancer.
DIF: Cognitive Level: Apply REF: p. 199 TOP: Nursing Process: Diagnosis
4. A couple comes in for an infertility workup, having attempted to achieve pregnancy for 2
years. The woman, 37 years of age, has always had irregular menstrual cycles but is otherwise
healthy. The man has fathered two children from a previous marriage and had a vasectomy
reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be
clumped together. What additional testing is needed?
a. Testicular biopsy
b. Antisperm antibodies
c. FSH level
d. Examination for testicular infection
ANS: C
This scenario does not indicate that the woman has had any testing related to her irregular
menstrual cycles. Hormone analysis is performed to assess endocrine function of the
hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.
Determining the blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol,
progesterone, and thyroid hormones may be necessary to diagnose the cause of the woman’s
irregular menstrual cycles. A testicular biopsy is indicated only in cases of azoospermia (no
sperm cells) or severe oligospermia (low number of sperm cells). Although unlikely to be the
case because the husband has already produced children, antisperm antibodies may be
produced by the man against his own sperm. Examination for testicular infection would be
performed before semen analysis. Furthermore, infection would affect spermatogenesis.
DIF: Cognitive Level: Analyze REF: p. 201 TOP: Nursing Process: Diagnosis
5. A couple is attempting to cope with an infertility problem. They want to know what they can
do to preserve their emotional equilibrium. What is the nurse’s most appropriate response?
a. “Tell your friends and family so that they can help you.”
b. “Talk only to other friends who are infertile, because only they can help.”
c. “Get involved with a support group. I’ll give you some names.”
d. “Start adoption proceedings immediately, because adopting an infant can be very
difficult.”
ANS: C
Venting negative feelings may unburden the couple. A support group may provide a safe
haven for the couple to share their experiences and gain insight from others’ experiences.
Although talking about their feelings may unburden them of negative feelings, infertility can
be a major stressor that affects the couple’s relationships with family and friends. Limiting
their interactions to other infertile couples may be a beginning point for addressing
psychosocial needs. However, depending on where the other couple is in their own recovery
process, limiting their interactions may not be of assistance to them. Telling the couple to start
adoption proceedings immediately is not supportive of the psychosocial needs of this couple
and may be detrimental to their well-being.
DIF: Cognitive Level: Apply REF: p. 204

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
6. The nurse working with clients who have infertility concerns should be aware of the use of
leuprolide acetate (Lupron) as a gonadotropin-releasing hormone (GnRH) agonist. For which
condition would this medication be prescribed?
a. Anovulatory cycles
b. Uterine fibroids
c. Polycystic ovary disease (PCOD)
d. Luteal phase inadequacy
ANS: B
Leuprolide acetate is used to treat endometriosis and uterine fibroids. Anovulatory cycles are
treated with Clomid, Serophene, Pergonal, or Profasi, all of which stimulate ovulation
induction. Metrodin is used to treat PCOD. Progesterone is used to treat luteal phase
inadequacy.
DIF: Cognitive Level: Remember REF: p. 206

TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
7. Which condition would be inappropriate to treat with exogenous progesterone (human

chorionic gonadotropin)?
a. Thyroid dysfunction
b. Recent miscarriage
c. PCOD
d. Oocyte retrieval
ANS: A
Synthroid is administered for anovulation associated with hypothyroidism. For women with
polycystic ovulation syndrome or a history of miscarriage, oocyte retrieval may have
insufficient progesterone and require exogenous progesterone until placental production is
sufficient.
DIF: Cognitive Level: Remember REF: p. 205 TOP: Nursing Process: Diagnosis
8. In vitro fertilization–embryo transfer (IVF-ET) is a common approach for women with

blocked fallopian tubes or with unexplained infertility and for men with very low sperm
counts. A husband and wife have arrived for their preprocedural interview. Which explanation
regarding the procedure is most accurate?
a. “The procedure begins with collecting eggs from your wife’s ovaries.”
b. “A donor embryo will be transferred into your wife’s uterus.”
c. “Donor sperm will be used to inseminate your wife.”
d. “Don’t worry about the technical stuff; that’s what we are here for.”
ANS: A
A woman’s eggs are collected from her ovaries, fertilized in the laboratory with the partner’s
sperm, and transferred to her uterus after normal embryonic development has occurred.
Transferring a donor embryo to the woman’s uterus describes the procedure for a donor
embryo. Inseminating the woman with donor sperm describes therapeutic donor insemination.
Telling the client not to worry discredits the client’s need for teaching and is not the most
appropriate response.
9. With regard to the assessment of female, male, or couple infertility, the nurse should be aware
of which important information?
a. The couple’s religious, cultural, and ethnic backgrounds provide emotional clutter
that does not affect the clinical scientific diagnosis.
b. The investigation will take several months and can be very costly.
c. The woman is assessed first; if she is not the problem, then the male partner is
analyzed.
d. Semen analysis is for men; the postcoital test is for women.
ANS: B
Fertility assessment and diagnosis take time, money, and commitment from the couple.
Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an
effect on diagnosis and assessment. Both partners are systematically and simultaneously
assessed, first as individuals and then as a couple. Semen analysis is for men; however, the
postcoital test is for the couple.

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
10. The nurse is having her first meeting with a couple experiencing infertility. The nurse has
formulated the nursing diagnosis, “Deficient knowledge, related to lack of understanding of
the reproductive process with regard to conception.” Which nursing intervention does not
apply to this diagnosis?
a. Assess the current level of factors promoting conception.
b. Provide information regarding conception in a supportive manner.
c. Evaluate the couple’s support system.
d. Identify and describe the basic infertility tests.
ANS: C
Evaluating the couple’s support system would be a nursing action more suitable to the
diagnosis, “Ineffective individual coping, related to the ability to conceive.”
DIF: Cognitive Level: Analyze REF: p. 203 TOP: Nursing Process: Diagnosis
11. Male fertility declines slowly after age 40 years; however, no cessation of sperm production
analogous to menopause in women occurs in men. What condition is not associated with
advanced paternal age?
a. Autosomal dominant disorder
b. Schizophrenia
c. Autism spectrum disorder
d. Down syndrome
ANS: D
Paternal age older than 40 years is associated with an increased risk for autosomal dominant
disorder, schizophrenia, and autism spectrum disorder in their offspring. Although Down
syndrome can occur in any pregnancy, it is often associated with advanced maternal age.
DIF: Cognitive Level: Understand REF: p. 199

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
12. A woman inquires about herbal alternative methods for improving fertility. Which statement
by the nurse is most appropriate when informing the client on which herbal preparations may
improve ovulation induction therapy?
a. “You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get
pregnant.”
b. “You may want to try black cohosh or phytoestrogens.”
c. “You should take vitamins E and C, selenium, and zinc.”
d. “Herbs have no bearing on fertility.”
ANS: B
Ovulation therapy may have better outcomes when supplemented by black cohosh,
progesterone, or plant estrogens. Antioxidant vitamins E and C, selenium, zinc, coenzyme 10,
and ginseng have been shown to improve male fertility. Although most herbal remedies have
not been clinically proven, many women find them helpful. They should be prescribed by a
health care provider who has knowledge of herbalism.
13. To provide adequate care, the nurse should be cognitive of which important information
regarding infertility?
a. Is perceived differently by women and men.
b. Has a relatively stable prevalence among the overall population and throughout a
woman’s potential reproductive years.
c. Is more likely the result of a physical flaw in the woman than in her male partner.
d. Is the same thing as sterility.
ANS: A
Women tend to be more stressed about infertility tests and to place more importance on
having children. The prevalence of infertility is stable among the overall population, but it
increases with a woman’s age, especially after age 40 years. Of cases with an identifiable
cause, approximately 40% are related to female factors, 40% to male factors, and 20% to both
partners. Sterility is the inability to conceive. Infertility or subfertility is a state of requiring a
prolonged time to conceive.
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
14. Although remarkable developments have occurred in reproductive medicine, assisted

reproductive therapies are associated with numerous legal and ethical issues. Nurses can
provide accurate information about the risks and benefits of treatment alternatives to enable
couples to make informed decisions about their choice of treatment. Which concern is
unnecessary for the nurse to address before treatment?
a. Risks of multiple gestation
b. Whether or how to disclose the facts of conception to offspring
c. Freezing embryos for later use
d. Financial ability to cover the cost of treatment
ANS: D
Although the method of payment is important, obtaining this information is not the
responsibility of the nurse. Many states have mandated some form of insurance to assist
couples with coverage for infertility. Multiple gestation is a risk of treatment of which the
couple needs to be aware. To minimize the chance of multiple gestation, generally only three
or fewer embryos are transferred. The couple should be informed that multifetal reduction
may be needed. Nurses can provide anticipatory guidance on this matter. Depending on the
therapy chosen, donor oocytes, sperm, embryos, or a surrogate mother may be needed.
Couples who have excess embryos frozen for later transfer must be fully informed before
consenting to the procedure. A decision must be made regarding the disposal of embryos in
the event of death or divorce or if the couple no longer wants the embryos at a future time.

TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
15. Which statement regarding gamete intrafallopian transfer (GIFT) is most accurate?
a. Semen is collected after laparoscopy.
b. Women must have two normal fallopian tubes.
c. Ovulation spontaneously occurs.
d. Ova and sperm are transferred to one tube.
ANS: D
Similar to in vitro fertilization (IVF), GIFT requires the woman to have at least one normal
tube. Ovulation is induced, and the oocytes are aspirated during laparoscopy. Semen is
collected before laparoscopy. The ova and sperm are then transferred to one uterine tube,
permitting natural fertilization and cleavage.
DIF: Cognitive Level: Remember REF: p. 207

16. Significant advances have been made with most reproductive technologies. Which
improvement has resulted in increased success related to preimplantation genetic diagnosis?
a. Embryos are transferred at the cleavage stage.
b. Embryos are transferred at the blastocyst stage.
c. More than two embryos can be transferred at a time.
d. Two cells are removed from each embryo.
ANS: B
Preimplantation genetic diagnosis can be performed on a single cell removed from each
embryo after 3 to 4 days. With the availability of extended culture mediums, embryos are
transferred at the blastocyst stage (day 5), which increases the chance of a live birth,
compared with the older practice of transferring embryos at the cleavage stage (day 3). No
more than two embryos should be transferred at a time.

17. An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she
will take purified FSH (Metrodin). The nurse instructs her that this medication is administered
in the form of what?
a. Intranasal spray
b. Vaginal suppository
c. Intramuscular (IM) injection
d. Tablet
ANS: C
Metrodin is only administered by IM injection, and the dose may vary. An intranasal spray or
a vaginal suppository are not appropriate routes for Metrodin, nor can Metrodin be given by
mouth in tablet form.
DIF: Cognitive Level: Comprehend REF: p. 206

TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
18. A couple arrives for their first appointment at an infertility center. Which of the following is a
noninvasive test performed during the initial diagnostic phase of testing?
a. Hysterosalpingogram
b. Endometrial biopsy
c. Sperm analysis
d. Laparoscopy
ANS: C
Sperm analysis is the basic noninvasive test performed during initial diagnostic phase of
testing for male infertility. Radiographic film examination allows visualization of the uterine
cavity after the instillation of a radiopaque contrast medium through the cervix. The
endometrial biopsy is an invasive procedure, during which a small cannula is introduced into
the uterus and a portion of the endometrium is removed for histologic examination.
Laparoscopy is useful to view the pelvic structures intraperitoneally and is an invasive
procedure.
DIF: Cognitive Level: Comprehend REF: pp. 202-203 TOP: Nursing Process: Planning
MULTIPLE RESPONSE
1. Many factors, male and female, contribute to normal fertility. Approximately 40% of cases of
infertility are related to the female partner. Which factors are possible causes for female
infertility? (Select all that apply.)
a. Congenital or developmental
b. Hormonal or ovulatory
c. Tubal or peritoneal
d. Uterine
e. Emotional or psychologic
ANS: A, B, C, D
Female infertility can be attributed to alterations in any one of these systems along with
possible vaginal-cervical factors. Although the diagnosis and treatment of infertility require
considerable emotional investment and may cause psychologic stress, these are not considered
factors associated with infertility. Feelings connected with infertility are many and complex.
Resolve is an organization that provides support, advocacy, and education for both clients and
health care providers.
DIF: Cognitive Level: Remember REF: pp. 197-199

TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
2. A probable cause for increasing infertility is the societal delay in pregnancy until later in life.
What are the natural reasons for the decrease in female fertility? (Select all that apply.)
a.Ovulation dysfunction
b.Endocrine dysfunction
c.Organ damage from toxins
d.Endometriosis
e.Tubal infections
ANS: A, C, D, E
All of these factors may result in a cumulative effect, decreasing fertility in women. Male
infertility is more often caused by unfavorable sperm production attributable to endocrine
dysfunction or cumulative metabolic disease.
DIF: Cognitive Level: Comprehend REF: p. 197

3. Women who have undergone an oophorectomy, have ovarian failure, or a genetic defect may
be eligible to receive donor oocytes (eggs). Which statements regarding oocyte donation are
accurate? (Select all that apply.)
a. Donor is inseminated with semen from the parent.
b. Donor eggs are fertilized with the male partner’s sperm.
c. Donors are under 35 years of age.
d. Recipient undergoes hormonal stimulation.
e. Ovum is placed into a surrogate.
ANS: B, C, D
Oocyte donation is usually provided by healthy women under the age of 35 years, who are
recruited and paid to undergo ovarian stimulation and oocyte retrieval. The donor eggs are
fertilized in a laboratory with the male partner’s sperm. The woman undergoes hormonal
stimulation to allow the development of the uterine lining. Embryos are then transferred. A
donor that is inseminated with the male partner’s semen or receives the fertilized ovum and
then carries it to gestation is known as a surrogate mother.

4. Which procedure falls into the category of micromanipulation techniques of the follicle?
(Select all that apply.)
a. Intrauterine insemination
b. Preimplantation genetic diagnosis
c. Intracytoplasmic sperm injection (ISCI)
d. Assisted hatching
e. IVF-ET
ANS: C, D
ISCI makes it possible to achieve fertilization even with a few or poor quality sperm by
introducing sperm beneath the zone pellucid into the egg. Another micromanipulation
technique is assisted hatching. An infrared laser breaks through the thick or tough zone
pellucid, enabling the blastocyst to hatch.

MATCHING
Evaluation for infertility should be offered to couples who have failed to become pregnant
after 1 year of regular intercourse or after 6 months if the woman is older than 35 years.
Impaired fertility in women may be the result of numerous factors. Careful identification of
the cause of infertility assists in determining the correct treatment plan. The nurse who
chooses to work in the specialty of infertility must have an excellent understanding of these
factors and causes. Match each factor affecting female infertility with the likely cause.
a. Ovarian
b. Tubal or peritoneal factors
c. Uterine
d. Vaginal-cervical factors
e. Other factors
1. Endometrial or myometrial tumors

2. Anorexia
3. Isoimmunization
4. Thyroid dysfunction or obesity
5. Endometriosis
1. ANS: C DIF: Cognitive Level: Understand REF: pp. 197-199

NOT: Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia),
and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal
motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine
factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Asherman
syndrome. Vaginal-cervical factors include vaginal-cervical infections, inadequate cervical mucus, and
isoimmunization (development of sperm antibodies). Other factors may include nutritional
deficiencies, obesity, thyroid dysfunction, and idiopathic conditions.
2. ANS: A DIF: Cognitive Level: Understand REF: pp. 197-199
3. ANS: D DIF: Cognitive Level: Understand REF: pp. 197-199
4. ANS: E DIF: Cognitive Level: Understand REF: pp. 197-199
5. ANS: B DIF: Cognitive Level: Understand REF: pp. 197-199

9

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

9

Uploaded by

Copyright:

Available Formats

Chapter 09: Infertility

Lowdermilk: Maternity & Women’s Health Care, 11th Edition

2. An infertility specialist prescribes clomiphene citrate (Clomid, Serophene) for a woman

DIF: Cognitive Level: Apply REF: p. 204

DIF: Cognitive Level: Remember REF: p. 206

7. Which condition would be inappropriate to treat with exogenous progesterone (human

8. In vitro fertilization–embryo transfer (IVF-ET) is a common approach for women with

DIF: Cognitive Level: Apply REF: p. 199

DIF: Cognitive Level: Understand REF: p. 199

14. Although remarkable developments have occurred in reproductive medicine, assisted

DIF: Cognitive Level: Apply REF: p. 208

DIF: Cognitive Level: Remember REF: p. 207

DIF: Cognitive Level: Understand REF: p. 207

DIF: Cognitive Level: Comprehend REF: p. 206

DIF: Cognitive Level: Remember REF: pp. 197-199

DIF: Cognitive Level: Comprehend REF: p. 197

DIF: Cognitive Level: Understand REF: p. 207

DIF: Cognitive Level: Understand REF: p. 207

1. Endometrial or myometrial tumors

1. ANS: C DIF: Cognitive Level: Understand REF: pp. 197-199

You might also like