Copyright © 2016 by Elsevier Inc. All rights reserved. Chapter 9 Infertility Copyright © 2016 by Elsevier Inc. All rights reserved.

Learning Objectives List common causes of infertility. Discuss the psychosocial impact of infertility. Identify common diagnoses and treatments for infertility. Identify reproductive alternatives for infertile couples. Examine the various ethical and legal considerations of assisted reproductive therapies for infertility.

Incidence Affects about 15% of reproductive-age couples Subfertility: prolonged time to conceive Sterility: inability to conceive Increases with age, particularly women older than 35 years Diagnosis and treatment of infertility require physical, emotional, and financial investment.

Factors Associated with Infertility Female infertility causes Hormonal and ovulatory factors Tubal and peritoneal factors Uterine factors Developmental anomalies Endometritis Vaginal-cervical factors

Factors Associated with Infertility (Cont.) Male infertility causes Can be caused by structural and hormonal disorders Undescended testes Hypospadias Varicocele (varicose vein of the scrotum) Low testosterone levels Azoospermia: no sperm cells produced Oligospermia: few sperm cells produced Substance abuse

Infertility Care Management Assessment of female infertility Diagnostic tests Detection of ovulation Hormone analysis Ultrasonography Hysterosalpingography Hysteroscopy Laparoscopy

Diagnostic Tests: Female Infertility

Infertility Care Management Assessment of male infertility Semen analysis Ultrasonography Other tests

Infertility Care Management (Cont.) Plan of care and interventions Psychosocial Major life stressor; can disrupt relationships Nonmedical Diet, habit changes; weight loss Complementary and alternative measures Medical Correcting pre-existing factors Ovarian stimulation

Infertility Care Management (Cont.) Assisted reproductive therapy (ART): fertility treatments in which both eggs and sperm are handled Intrauterine insemination (IUI) In vitro fertilization–embryo transfer (IVF-ET) Intracytoplasmic sperm injection (ICSI) Assisted hatching Preimplantation genetic diagnosis Gamete intrafallopian transfer (GIFT)

Infertility Care Management (Cont.) Assisted reproductive therapies Zygote intrafallopian transfer (ZIFT) Oocyte donation Embryo donation Surrogate mothers/embryo hosts Therapeutic donor insemination (TDI) Adoption Success rates and costs of ART Risks of ART Cryopreservation

Key Points Infertility is the inability to conceive and carry a child to term gestation when the couple has chosen to do so. Infertility affects approximately 15% of otherwise healthy adults. Infertility increases as the woman ages, especially after age 40 years.

Key Points (Cont.) In the United States, about 20% of infertility cases are unexplained; of that 80% in which causative factors are known, about 40% are related to female causes, 40% are related to male causes, and 20% are attributable to both male and female causes. Common etiologic factors of infertility include decreased sperm production, ovulation disorders, tubal occlusion, and endometriosis. Obesity or smoking in either partner is receiving increasing attention as a cause of infertility.

Key Points (Cont.) The investigation of infertility is conducted systematically and simultaneously for male and female partners. The couple’s relationship dynamics, sexuality, and ability to cope with the psychologic and emotional effects of diagnostic procedures and treatment of infertility must be considered in the plan of care. Ongoing support is recommended.

Key Points (Cont.) Most infertility cases are treated with conventional medical and surgical therapies. Reproductive alternatives for family building include ovarian stimulation, followed by IUI, IVF-ET, GIFT, or ZIFT, oocyte donation, embryo donation, TDI, gestational or surrogate motherhood, and adoption.

Question A nurse is providing instruction to a couple undergoing zygote intrafallopian transfer (ZIFT). The nurse is aware that instruction has been effective when the woman states: “My egg will be fertilized and then placed into my uterus.” “My husband’s sperm will be inserted into my uterus.” “My husband’s sperm and my egg will be placed into my fallopian tube.” “A fertilized egg will be placed into my fallopian tube.” ANS: D Feedback A Incorrect: This procedure is known as in vitro fertilization (IVF). B Incorrect: This procedure is known as artificial insemination (AI). C Incorrect: This is the description for the procedure known as gamete intrafallopian transfer (GIFT). D Correct: A fertilized egg that is placed into the fallopian tube is known as ZIFT.