NCM 109 – MATERNAL LEC

2ND SEMESTER | MIDTERMS

TOPIC 2: INFERTILITY/SUBFERTILITY

INFERTILITY /SUBFERTILITY - Condition that occurs when adhesions

or scaring bind adjacent organs together
Infertility – inability to conceive a child or sustain a
pregnancy to birth. CAUSES OF SUBFERTILITY
 a couple is infertile if they do not become In Males:
pregnant after at least 1 year of unprotected  Disturbance in spermatogenesis
sex or the woman keeps having  Inadequate production of FSH and LH in the
miscarriages. pituitary
 Obstruction in seminiferous tubules, ducts,
Subfertility – most often used today or vessels
 delay in conceiving  Development of autoimmunity
 possibility of conceiving naturally exists, but  Problems in ejaculation
it takes longer than average  excessive exposure to X-rays or radioactive
 can be related to age substances, stress
In Females
TYPES OF INFERTILITY  Limited production of FHS or LH
1. Primary Infertility - there have been no  Anovulation
previous conceptions  Problems of ova transport
2. Secondary Infertility - there has been a  Uterine tumors
previous viable pregnancy but there is
 Cervical Vaginal Factors
inability to conceive at present
 Poor nutrition
3. Sterility - inability to conceive because of
known condition (e.g., absence of uterus)
SIGNS AND SYMPTOMS OF INFERTILITY AND
SUBFERTILITY
CAUSES OF INFERTILITY
1. Abnormal Menstruation
- Cause of infertility is multifactorial
2. No Menstruation
3. Irregular Menstruation
1. Severe Endometriosis
4. Painful Menstruation
- cells of endometrium grow outside the
5. Skin Changes
uterus.
6. Dark Hair Growth
2. Pelvic Inflammatory Disease
7. Loss or Thinning of Hair
- Inflammation of reproductive organs of a
8. Weight Gain
woman.
3. Ovulation Disorders
DIAGNOSTIC PROCEDURES
- Most common cause of infertility.
1. Semen Analysis
- Inability of a woman to produce egg
- a.k.a sperm count or male fertility test -
cells during menstruation.
measures the amount and quality of a
4. Elevated Prolactin
man's semen and sperm
- a.k.a Prolactinoma
- lab test that evaluates sperm count,
- excess prolactin can cause production
motility, morphology and more
of breastmilk in men and women who
2. Ovulation Monitoring Assessment
are not pregnant.
- helps identify the most fertile days each
5. Polycystic Ovarian Syndrome
month
- Women with PCOS may not ovulate.
requires monitoring to distinguish
They have high levels of androgen, and
normal and abnormal ovarian cycles
have many small cysts on the ovaries.
3. Tubal Patency Assessment
6. Benign Uterine Fibroids
- it starts with a normal ultrasound (using
- Tumors arising from smooth muscle
a vaginal probe) to assess your uterus,
tissues within the uterus.
- ovaries and pelvis.
7. Pelvic Adhesions
- to determine if the fallopian tubes are
open and free of disease. It is commonly
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NCM 109 – MATERNAL LEC
2ND SEMESTER | MIDTERMS

TOPIC 2: INFERTILITY/SUBFERTILITY

done in women with an infertility

diagnosis.
HEALTH TEACHINGS
MEDICAL MANAGEMENT 1. Maintenance of body weight
1. Clomiphene Citrate – stimulate the growth 2. Avoid fertility impairing medications
of an ovarian follicle containing an egg 3. Avoid smoking and alcohol
2. Letrozole – helpful aid to induce an egg to 4. Psychological support
develop and be released in women 5. Stay informed
3. Gonadotropins – stimulate the ovary directly 6. Stay physically active to maintain fitness
to produce multiple eggs
4. Bromocriptine – used when ovulation
problems are caused by excess production
of prolactin by the pituitary gland

SURGICAL MANAGEMENT
1. Hysteroscopy – can be used diagnostically -
find the cause of abdominal bleeding
2. Laparoscopy – minimally invasive surgery -
Uses a system containing a small camera
and operating instruments to see the
reproductive organs
3. Tubal Surgeries – removal of tubes or
blockage in the tubes close to the uterus -
Can improve the chances of pregnancy with
IVF

NURSING MANAGEMENT
1. Assess hormone levels and whether a
woman is ovulating
2. Provide the couple with accurate
information about human reproduction,
infertility treatments, and prognosis for
pregnancy
3. Identify and treat possible causes of
infertility

NURSING DIAGNOSIS
1. Anticipatory grieving related to failure to
conceive or sustain a pregnancy
2. Deficient knowledge related to measures to
promote fertility
3. Powerlessness related to repeated
unsuccessful attempts at achieving
conception
4. Fear related to possible outcome of infertility
studies
5. Anxiety related to what the process of
fertility testing will entail
6. Hopelessness related to perception of no
viable alternatives to usual perceptions
7. Situational low self-esteem related to the
apparent inability to conceive
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