1. Ast Prof. University of Washington
Issues in Infertility
Mary Ann Draye, ARNP, MPH
Ast Prof. University of Washington
School of Nursing

2. Day
10, 12, 14, 16

3. Infertility: Definition
Failure to conceive after 12 mos. of regular intercourse; Unable to carry pregnancy to live birth (pregnancy wastage)
Primary- Never conceived
Secondary- Prev conception; subsequently unable to conceive
Unexplained- No abnormalities discovered

4. Infertility : Prevalence
8-15% couples, USA= 1:5 couples
2.1 million couples
1/3 F in their 30’s
9.3 million women using infertility services
Rates double in F 35 yrs+
Pg loss >30% in F in 40’s

5. Decline in U.S. Fertility
Changing Female roles
Postponement of marriage
Delay of childbearing
Contraception/ abortion
Environmental concerns
Environmental hazards

6. Infertility: Etiology
Male 40%
Female 40%
Combined 20%
Unexplained 15% of couples

7. Infertility: Female Factors
Ovulatory dysfunction
Tubal disease
Advanced age
Endometriosis
Cervical abnl
Unexplained
Chronic disease
Environment
Sexual practices

8. Infertility: Male Factors
Abnl semen analysis
Varicocele
Obstruction
Infections
Hormonal abnl
Exposures- toxic, Δ
Trauma
Drugs
Smoking esp THC
Sexual practices

9. Male Factors: Semen Analysis
Nl Values
Volume > 2-5ml
Count > 40 million/ml
Below 10= poor, 20 or > may be OK if motility and morphology nl
Motility >50%
Morphology > 30-60% nl
WBC < 1million/ml
pH 7-8
SPA > 10
Spermatogenesis =

10. Infertility: History Onset Perception/ Knowledge Occupation
Medications
Past Health Hx
ROS
Sexual Hx
Amt of disruption/ crisis
Stage
Support

11. Infertility: Physical
Complete
Pelvic
Genital/ DRE in M Varicocele 40% L > R
Lab
Cervical/ vaginal / GU specimens
Pap
Semen analysis

12. Infertility: Common Responses
Shock
Denial
Anger/ frustration
Guilt
Grief…chronic sorrow
Depression/ anxiety
Decreased self esteem
Isolation
Exhaustion

13. Infertility: NP Role Initial assessment Referral Empathy/ support
Empowerment
-Information
-Resources
-Self esteem
-Anticipatory guidance
~procedures
~logistics
Prevention

14. Assisted Reproductive Technologies (ART)
Artificial Insemination (AI)
Partner/ known donor
Unknown donor
In Vitro Fertilization (IVF)
Gamete Intra Fallopian Transfer (GIFT)
Zygote Intra Fallopian Transfer (ZIFT)

15. Access to ART Services Access defined= 60 min. travel time Over-served
Northeast % population has access
Underserved
Alaska, MT, WY, W Va

16. Infertility: Ethical Issues
Patient
Potential Child
Provider
Resources
Health care
Society

17. Infertility: Resources
Nat’l Resolve Organization
Am Society for Reproductive Medicine
Resolve of Washington State
PO Box 31231
Seattle, Wa 98103
(206)

18. Am Society for Reproductive Medicine www.asrm.org
Technical Bulletins
E.g. Smoking and infertility
Endometriosis and infertility
Practice Guidelines
E.g. Limits on numbers of embryos to transfer
Minimal Standards