Name: Cortez, Gwen Julia P.

Date: February 19, 2023

Salalila, Tristan Clarenz S.
Section: NU - 201
A client in a fertility clinic complains of the inability to maintain an erection but he
wants to have a child to her second wife. He is 48-year-old who is taking Amlodipine
regularly.
1. How would erectile dysfunction affect the ability to have children? (2pts)
Answer: Erectile dysfunction causes difficulties in conceiving a child as the male
partner has trouble maintaining an erection during coitus to ejaculate. As a result,
the couple would have very low chances in conceiving a child which could also
discourage couples from further engaging in sexual activity (Sissons, 2022).
An erection occurs when the blood vessels of the corpus cavernosa relax
and open up, allowing the rush of blood through the arteries and gets trapped
under high pressure within the chambers of the penis (Cleveland Clinic, 2023). It
is often caused by sexual arousal, often sensory and mental stimulation, as
nerves from the penis send messages to the brain and local nerves and return
impulses which cause the muscles of the corpus cavernosa to relax and permit
blood flow. The blood then creates pressure in the chambers of the penis
allowing it to expand and create an erection. The tunica albuginea helps to trap
the blood in the corpora cavernosa which sustains the erection and only when
the muscles in the penis start to contract, will the erection cease.
Ejaculation is triggered by sexual stimulation and friction which is
controlled by the central nervous system that has two phases. The first phase is
when the vas deferens contract and squeeze the sperm toward the base of the
penis and the prostate gland and seminal vesicles release secretions to form
semen. It is at this phase that ejaculation is inevitable and cannot be stopped.
The second phase shows the muscles at the base of the penis contracting every
0.8 seconds to force semen out of the penis.
Male clients who have problems with erection and/or ejaculation have a
decreased chance in conceiving a child because of this reproductive problem. If
one of these reflexes is affected, it significantly affects the procreative ability of
the male client to produce offspring.
2. What are the possible causes of erectile dysfunction? (2pts)
Answer: Erectile dysfunction may root from physical, psychological, and lifestyle
causes.
The common physical and lifestyle causes of erectile causes include heart
disease, clogged blood vessels (atherosclerosis), cerebrovascular accident, high
cholesterol, hypertension, diabetes, obesity, metabolic syndrome involving
increased blood pressure, insulin levels, body fat around the waist and high

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 cholesterol, Parkinson’s disease, multiple sclerosis, certain prescription
medications, tobacco use, Peyronie’s disease or the development of scar tissue
inside the penis, alcoholism and other forms of substance abuse, sleep
disorders, treatments for prostate cancer or enlarged prostate, surgeries or
injuries that affect the pelvic area or spinal cord, and low testosterone.
The psychological factors that can cause erectile dysfunction are
depression, anxiety or other mental health conditions, stress, and relationship
problems due to stress, poor communication, or other concerns.
The aforementioned physical, psychological, and lifestyle causes can also
contribute as risk factors to erectile dysfunction, with symptoms manifesting as
delayed erections and trouble maintaining one. Because the client is taking
Amlodipine, which is a medication used to treat high blood pressure, he may
have been diagnosed with hypertension which is contributing to his reproductive
condition.
3. What possible assisted reproduction techniques can you recommend for the
couple with this kind of problem? (2pts)
Answer: The couple can be recommended to undergo Artificial Insemination or
Intrauterine Insemination wherein semen collected from the male is transferred to
the uterus by the cervix immediately before anticipated ovulation. This procedure
is recommended especially for male clients who suffer from erectile dysfunction
or who undergo cancer treatment and are planning to store their sperm in sperm
banks for future purposes.
Another possible assisted reproductive treatment for the couple is in-vitro
fertilization (IVF). Although this procedure is highly recommended for women
who do not have intact fallopian tubes or have undergone salpingectomy, it may
also be a possible solution to their problem. This process involves the harvesting
of the woman’s egg cells and fertilizing them in a laboratory dish with the male’s
healthy sperm cells. If an embryo has successfully formed, it is then inserted into
the uterus using a catheter.
A couple sought consultation in a fertility clinic. They have been married for the
past 5 years and have not conceived yet. The doctor advised the mother to undergo a
sonohysterosalpingogram.
1. Discuss the procedure briefly. What are the organs to be assessed in this
procedure? How will you prepare the mother? (3pts)
Answer: A sonohysterosalpingogram (SHG) is a diagnostic imaging procedure
that examines the uterus and fallopian tubes using ultrasound and saline
solution. According to John Hopkins Medicine (n.d.), it is a newer, non-radiologic
method with outcomes similar to those of an hysterosalpingogram (HSG) for
assessing the fallopian tubes and shape of the uterus.

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 During the procedure, the patient will be asked to empty her bladder first
then lie down with both knees bent and be awake. Then an ultrasound
transducer, which is a slim wand, will be placed inside the vagina, which is
covered with a disposable sheath and coated with a special gel. As the clinician
inserts the thin, flexible tube (catheter) into the cervix, a saline solution is sent
through the catheter into the uterus. The transducer simultaneously transmits
sound waves into the body through the gel. With that, the echoes from these
sound waves create a real-time image of the inside of the uterus that shows the
structure of the uterus. The saline solution aids the ultrasound in producing a
clearer, more detailed image.

In line with this, we can prepare the mother for this kind of procedure by
explaining the benefits of it, such as not requiring any exposure to radiation and
being done in a fertility doctor’s office to eliminate the need for an outpatient
hospital visit. This is to provide her with a sense of security and comfort. We can
also explain to her the reason for the test, which is to look for possible causes of
infertility including uterine fibroids, polyps, or tubal blockages. Also explain the
steps to her to be prepared, such as doing it in the week after her menstrual
period ends so that the test will be more accurate and it lowers the risk of
infection, taking analgesics to help prevent discomfort, and wearing underwear
with an absorbent pad on the day of the procedure since saline fluid will drain
from the uterus after the procedure. She would possibly be told to take an
antibiotic to prevent infection. Lastly, describe the symptoms that she would
expect after the procedure, like cramping, light spotting, and fluid leaking from
the vagina, which are all normal.

2. The doctor said: “You have a blocked tube” How would this condition lead to
infertility issues. (2pts)
Answer: According to the doctor's statement, "you have a blocked tube," it
indicates that the patient's fallopian tubes are blocked. With that, it will be
impossible for the sperm to reach the egg or for the fertilized egg to enter the
uterus. Knowing that the fallopian tube is the reproductive organ in a woman's
body that connects the ovaries and the uterus, how can this condition lead to
infertility issues? When a woman ovulates, her eggs leave the ovaries and enter
the fallopian tubes. The sperm travels from the vagina through the uterus to the
fallopian tubes, where it joins and fertilizes the egg. In order for pregnancy to
occur, the resulting embryo must move from the fallopian tubes to the uterus
once the egg has been fertilized. By interfering with the movement of the sperm
to the egg or the fertilized egg to the uterus, damaged or clogged fallopian tubes
can prevent a woman from becoming pregnant. According to Loma Linda
University (n.d.), a damaged or blocked fallopian tube is a common cause of
female infertility, and if it is not treated through surgery or tubal cannulation, the
woman will still be pregnant, but through in vitro fertilization (IVF). As a result, the
fallopian tube is important for conception since it allows both the sperm's
passage to the eggs and the fertilized egg's return to the uterus.

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 3. What are the possible assisted reproductive techniques appropriate for the
couple? Justify your answer (2pts)
Answer: The possible assisted reproductive techniques appropriate for the
couple are the following:
➢ In Vitro Fertilization (IVF) - Considering the couple’s situation since the
fallopian tube is blocked, it is impossible for the sperm to reach the egg or
for the fertilized egg to enter the uterus. Through this course of treatment
the egg will be manually combined with the sperm outside the body in a
lab for fertilization. Whereas, a few days after fertilization, the fertilized egg
(known as the embryo), is implanted inside the uterus then pregnancy
occurs when this embryo implants itself in the uterine wall. Moreover, IVF
is chosen by people for a number of reasons, such as infertility issues or
when one couple has a pre-existing health condition (Cleveland Clinic,
n.d.). Therefore, it is one of the most effective assisted reproductive
technologies (ARTs) out there.
➢ Intrauterine Insemination (IUI) - As the patient has a blocked tube, there is
a chance that only one fallopian tube is open. This treatment involves
injecting sperm straight into the uterus using a tiny catheter in order to
increase the amount of healthy sperm that reaches the fallopian tubes
when the woman is most fertile. According to John Hopkins Medicine
(n.d.), IUI is a popular course of treatment since it is a less intrusive, more
affordable option to in vitro fertilization (IVF), and it may be easily
performed in a clinic.
➢ Gamete Intrafallopian Transfer (GIFT) - This is utilized for infertile couples
who want to avoid fertilization outside the human body due to religious
beliefs or for infertile women who are ovulating but have blocked fallopian
tubes. It is similar to the IVF procedure. Moreover, it makes use of
numerous eggs extracted from the ovaries. The intended sperm and eggs
are put into a catheter. Laparoscopy, a surgical procedure, is then used to
inject the gametes (eggs and sperm) into the fallopian tubes, where
general anesthesia will be used by the doctor. According to ReUnite (n.d.),
for couples with healthy sperm and fallopian tubes but unexplained
infertility, GIFT is effective. Therefore, compared to IVF, GIFT has a
greater success rate.
➢ Zygote Intrafallopian Transfer (ZIFT) - With this procedure, it will only be
performed if there is one healthy fallopian tube so that it can be carried out
because it is not a viable option if fallopian tubes are damaged or blocked.
According to the Texas Fertility Center (n.d.), ZIFT starts just like the IVF
procedure. Prior to collecting the eggs, the ovaries are first stimulated to
generate more eggs using fertility medications. The eggs are then
fertilized in an IVF laboratory. The resemblance to the IVF process ends
here. The fertilized eggs are laparoscopically transferred to the fallopian
tubes by the ZIFT procedure, where they travel to the uterus for natural

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 implantation. Therefore, the presence of implantation will be verified by a
pregnancy test.

References

Cleveland Clinic. (2023). Erection & ejaculation: How does it work? Cleveland Clinic.
https://my.clevelandclinic.org/health/articles/10036-erection-ejaculation-how-it-oc
curs

Cleveland Clinic. (n.d.). IVF (In Vitro Fertilization).

https://my.clevelandclinic.org/health/treatments/22457-ivf\

John Hopkins Medicine. (n.d.). Intrauterine Insemination (IUI) Treatment.

https://www.hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/fertility-c
enter/infertility-services/intrauterine-insemination.html

John Hopkins Medicine. (n.d.). Sonohysterography.

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sonohyste
rography

Loma Linda University. (n.d.). Infertility Caused By Damaged or Blocked Fallopian

Tubes.
https://lomalindafertility.com/infertility/women/blocked-fallopian-tubes/#:~:text=Da
maged%20or%20blocked%20fallopian%20tubes%20is%20a%20common%20ca
use%20of,ectopic%20pregnancy%20or%20tubal%20ligation.

ReUnite. (n.d.). GIFT vs IVF: Which Fertility Treatment Is Right For You?
https://reuniterx.com/fertility-articles/gift-vs-ivf-which-fertility-treatment-is-right-for-
you/#:~:text=Both%20GIFT%20and%20IVF%20are,higher%20success%20rate
%20than%20IVF.

Sissons, B. (2022, December 22). Trying to conceive with ed: Tips, outlook, and more.
Medical News Today.
https://www.medicalnewstoday.com/articles/how-to-conceive-when-husband-has-
erectile-dysfunction#:~:text=According%20to%20a%202022%20review,has%20s
ex%2C%20negatively%20affecting%20fertility.

Texas Fertility Center. (n.d.). Zygote Intrafallopian Transfer.

https://www.fertility-texas.com/in-vitro-fertilization-ivf/zygote-intrafallopian-transfer

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