Chapter 5 Infertility, Contraception, and Abortion All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Incidence  Affects about 10% to 15% of reproductive-age couples  Four goals when providing care: Provide the couple with accurate information Assist in identifying the cause of infertility Provide emotional support Guide and educate about forms of treatment Infertility 2 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Assessment of female infertility  Ovarian factors  Tubal and peritoneal factors  Uterine factors  Vaginal-cervical factors  Other factors Factors Associated with Infertility 3 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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 Assessment of male infertility  Hormonal factors  Testicular factors  Factors associated with sperm transport  Idiopathic male infertility Factors Associated with Infertility (Cont.) 5 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Assessment of female infertility  Test or examination Evaluation of the anatomy Detection of ovulation Hormone analysis Ultrasonography Endometrial biopsy Hysterosalpingography Laparoscopy Care Management 6 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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 Assessment of male infertility  Semen analysis  Hormone analysis  Scrotal ultrasound Care Management (Cont.) 8 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Plan of care and implementation  Psychosocial considerations  Nonmedical treatments Herbal alternative methods  Medical therapy  Surgical therapies Assisted reproductive therapies (ART) Care Management (Cont.) 9 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

10 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Assisted reproductive therapies  In vitro fertilization–embryo transfer (IVF-ET)  Gamete intrafallopian transfer (GIFT)  Zygote intrafallopian transfer (ZIFT)  Ovum transfer (oocyte donation)  Therapeutic donor insemination (TDI)  Embryo hosting  Assisted embryo hatching Care Management (Cont.) 11 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

12 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Reproductive alternatives  Surrogacy  Preimplantation genetic diagnosis  Adoption  Cryopreservation of human embryos Care Management (Cont.) 13 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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 Intentional prevention of pregnancy  Birth control is the device or practice to decrease the risk of conceiving  Family planning is the conscious decision on when to conceive or avoid pregnancy  May still be at risk for pregnancy  Nearly half of all U.S. pregnancies are unplanned Contraception 15 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 A multidisciplinary approach to assist the woman in choosing an appropriate contraceptive method  Ideally the method should be safe, readily available, economical, acceptable, and simple to use  Contraceptive choice must meet personal, social, cultural, and interpersonal needs Care Management 16 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

17 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Coitus interruptus (withdrawal)  Fertility awareness methods (FAMs)  Rely on avoidance of intercourse during fertile periods  FAMs combine charting menstrual cycle with abstinence or other contraceptive methods  Natural family planning (period abstinence)  Calendar rhythm method Methods of Contraception 18 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

19 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 FAMs  Standard days method  Basal body temperature method  Cervical mucus ovulation-detection method  Symptothermal method  Predictor test kits for ovulation  TwoDay method  Breast-feeding Methods of Contraception (Cont.) 20 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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 Barrier methods  Spermicides  Condoms, male (STI protection)  Vaginal sheath (STI protection)  Diaphragm  Cervical cap  Contraceptive sponge Methods of Contraception (Cont.) 24 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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 Hormonal methods  Combined estrogen-progestin contraceptives (COCs) Oral contraceptives and side effects Transdermal contraceptive system Vaginal ring Methods of Contraception (Cont.) 27 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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 Hormonal methods  Progestin-only contraceptives Oral progestins (minipill) Injectable progestins Implantable progestins (Norplant) Methods of Contraception (Cont.) 29 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Emergency contraception  Used within 72 hours of unprotected intercourse  Five methods available in the United States High doses of estrogen or COCs (three options) Two days of levonorgestrel Insertion of the copper intrauterine device (IUD) Methods of Contraception (Cont.) 30 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 IUD  Small, T-shaped device wrapped in copper inserted into the uterine cavity  Medicated intrauterine system loaded with progestational agent (Mirena)  IUD offers no protection against STIs or HIV Methods of Contraception (Cont.) 31 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

32 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Sterilization  Female Tubal occlusion Tubal reconstruction  Male (vasectomy) Tubal reconstruction (reanastomosis) Methods of Contraception (Cont.) 33 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

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 Purposeful interruption of pregnancy before 20 weeks of gestation  Elective  Therapeutic  Contributing factors  Legal and moral issues  Roe v. Wade 1973 Abortion 36 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 First-trimester abortion  Surgical (aspiration) abortion  Medical abortion Methotrexate and misoprostol Mifepristone and misoprostol  Second-trimester abortion  Dilation and evacuation  Cervical preparation with prostaglandins  Emotional considerations Abortion (Cont.) 37 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Induced abortion performed in the first trimester is safest and less complex  Common complications:  Infection  Retained products of conception  Excessive vaginal bleeding Abortion (Cont.) 38 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. The nurse’s most appropriate response is:  “This is a legitimate concern. Would you like to discuss this further before your treatment begins?”  “No one has ever had more than triplets with Clomid.”  “Ovulation will be monitored with ultrasound so this will not happen.”  “Ten percent is a very low risk, so you don’t need to worry too much.” Question 39 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.