2.1 DEFINITION OF INFERTILITY :
Infertility is defined as a failure to conceive within one or more year of regular unprotected coitus.
2.2 TYPES OF INFETILITY:
1. PRIMARY INFERTILITY:
SECONDARY INFERTILITY
2.3 CAUSES OF INFERTILITY :
• MALE FACTORS :
DEFECTIVE SPERMATOGENESIS
SECONDARY INFERTILITY
2.3 CAUSES OF INFERTILITY :
• MALE FACTORS :
DEFECTIVE SPERMATOGENESIS
Infection
Gonadotropin suppression
Endocrine factors
Immunological factors
Tubal and peritoneal factors
UTERINE FACTORS CERVICAL FACTORS
VAGINAL FACTORS
COMBINED FACTORS
DIAGNOSTIC PROCEDURES
FOR FEMALE
HISTORY
EXAMINATIONS
DIAGNOSTIC EVALUATION:
1. CERVICAL MUCUS STUDY
2. HORMONAL ESTIMATION
3. ENDOMETRIAL BIOPSY
4. SONOGRAPHY
5. LAPROSCOPY
6. INSUFFLATION TEST (Rubin’s test)
2.5 RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT :
ASSISTED REPRODUCTIVE TECHNIQUES (ART)
“ASSISTED REPRODUCTIVE TECHNIQUES INVOLVING DIRECT RETRIEVAL OF OOCYTE FROM OVARY, MANIPULATION OF GAMETS AND EMBROYOS OUTSIDE BODY FOR PURPOSE OF ESTABLISHING PREGNANCY”.
TYPES OF ART :
1. IUI (Intrauterine insemination)
2. IVF-ET(In vitro fertilization & embryo transfer)
3. ZIFT(Zygote intra fallopian transfer)
4. ICSI (Intra cytoplasmic sperm injection) (TESA, PESA, MESA)
5. EMBRYO OR OOCYTE DONATION
6. GESTATIONAL CARRIER
7. SURROGACY
2.6 ROLE OF NURSE IN MANAGEMENT OF
INFERTILITY :
] ASSESSMENT :
- Assessment of the infertile couple is the initial stage of infertility management. The nurse is often the first contact the infertile couple make during their visit for treatment. The nurses role during this stage is to educate the couple about each test or investigation. The nurse plays a vital role in alleviating the fear and anxiety about the various diagnostic procedure.
2] TREATMENT :
- The nurse plays the link between the doctor and the couple and should always be available to the couple for their assistance, guidance and support before, during and after the infertility treatment.
- Numerous ethical issues are associated with infertility treatments and the couple undergoing treatment need appropriate counselling and discussion.
-The goal of the nurse helping the infertile couple is to assist them through the treatment cycle as smoothly as possible.
3] EDUCATION :
- The role of a nurse in educating the patients includes education about the basic male and female anatomy and physiology and how the drugs act on their body, including possible side effects. This may be offered under various setting such as
• Face to face on an individual basis.
• In a group situation,
• Fertility nurses should also educate the couple about the self-administer medications.
• Proper knowledge of administration of these medicines and storage conditions for medications, as well as the possible side affects, should be imparted to the couple undergoing treatment.
4] PSYCHOLOGICAL SUPPORT :
-A couple undergoing infertility treatments are usually under stress due to variety of reasons.
9. OBJECTIVES AND NEED FOR INFERTILITY
CONCELLING
• INFORMED CONCENT.
• TO HELP THE COUPLE, OFFER COPING STRATEGIES, OFFER
PREPARATION FOR PROCEDURES AND FACILITATE DECISION
MAKING.
• TO HELP THE PATIENT ACHIEVE BETTER QUALITY OF LIFE.
• PSYCHOSOCIAL CARE FOR PATIENTS WHO EXPERIENCE
DISTRESS.
10. QUALIFICATION OF COUNCELLER
• A GRADUATE DEGREE IN A MENTAL HEALTH PROFESSION.
• LICENSE TO PRACTICE.
• TRAINING IN THE MEDICAL AND PSYCHOLOGICAL ASPECTS
OF INFERTILITY.
• CLINICAL EXPERIENCE.
• CONTINUING EDUCATION.
11. PATIENT CENTRE CARE
AND COUNSELING
PATIENT CENTRE CARE CAN BE IN THE FOLLOWING WAY:
IVF-GROUP DISCUSSION BY STAFF.
THIRD PARTY REPRODUCTION FOR BOTH DONOR AND RECIPIENT PRIVAE
COUNSELOR SESSION.
THERAPEUTIC COUNSELING, CRISIS COUNSELING ASSESSMENT AND FOLLOW
UP CAN BE OFF SITE.
14. ADVANTAGES OF INFERTILITY COUNSELING
• HELPS TO DEAL WITH THE EMOTIONAL STRESS.
• PROVIDE EXTRA SUPPORT.
• ALLOW TO THE PATIENT TO EXPLORE ALL OPTION FOR FAMILY
BUILDING.
• HELP THE COUPLES TO OVERCOMING DILEMMAS AND DECIDING THE
RIGHT FERTILITY TREATMENT.
• EXPLAINS ABOUT THE INFERTILITY MANAGEMENT AND SPECIFIC
TREATMENT.
15. • RECEIVING THE PATIENT AND FAMILY AND MAKE THEM ACCESSIBLE
AND COMFORTABLE FOR COUNSELING.
• FERTILITY NURSE SPECIALIST PROVIDE CARE FOR INDIVIDUALS AND
COUPLES BEFORE, DURING AND AFTER INFETRILITY TREATMENT.
• NURSE NEED TO OBTAIN HISTORY AS PRENATAL, FAMILY AND OTHER
RELEVANT HISTORY.
• NURSE HAS TO CONTACT PRIMARY PHYSICAL EXAMINATION AND
COLLECT OTHER RELEVANT INFORMATION REGARDING PATIENT.
• GIVE PSYCHOLOGICAL SUPPORT THROUGHOUT THE COUNSELING.
ROLE OF NURSE IN INFERTILITY COUNSELLING
16. CONT.....
• COLLECT OTHER INFORMATION ABOUT VARIOUS PRIOR TEST
REPORTS AND DOCUMENTS.
• THE NURSE HAS TO ENCOURAGE THE FAMILY AND PATIENT TO ASK
QUESTIONS ABOUT CONDITION AND DISEASE. ETC.
• PROVIDE ALL EXPLANATIONS ABOUT QUESTIONS.
• MAINTAIN PRIVACY AND CONFIDWNTIALITY OF ALL CASES.
• ENSURE FOLLOW UP AND SUPPORTIVE SERVICES TO INDIVIDUAL AND
FAMILY DURING COUNSELLING.
22. GAMETE INTRA FALLOPIAN TRANSFER
• GIFT IS SIMILAR TO IVF BUT THE DIFFERENCE IS THAT IN IVF
TECHNIQUE FERTILIZATION DONE IN VITRO & EMBRYO IS
TRANSFERED AND GIFT SPERM AND OOCYTE ARE MIXED IN VITRO &
FERTILZATION DONE IN VIVO.
23. ZYGOTE INTRA FALLOPIAN TRANSFER (ZIFT)
• EGG CELLS REMOVED AND FERTILIZED IN
LABORATORY AND ZYGOTE PLACED IN FALLOPIAN
TUBE FOLLOWING DAY 1 OF IVF.
25. EMBRYO OR OOCYTE DONATION
Ovum donation and IVF can help women
with successful pregnancy.
26. GESTATIONAL CARRIER SURROGACY
- A woman without a functional uterus can be a mother
with the help of ART.
- In this procedure of ART (IVF), a fertilized egg is placed
into the uterus of a surrogate but not into “intended
mother.”
27. ADOPTION PROCEDURE
In spite of excellent advances in the field of infertility
management, expectations are not always fulfil. Couple
must understand the fertility factors, cost and risk of
management. End point of management must be
realistically understood. Adoption is an alternative for
many couples.
28. Adoption means the process through which the adopted
children are permanently separated from their biological parents and
become the legitimate children of their adoptive parents with all the
rights, privileges and responsibilities that are attached to the
relationship.
29. WHO CAN ADOPT :
• Married couples undergoing treatment for infertility.
• Married couples having secondary infertility.
• Married couples voluntarily opting for adoption and
single person desiring to adopt.
30. ADOPTION ACT :
• The child can be legally placed with the parent(s) under
the HAMA/GAWA/JJ act2000. The prospective parents
should be informed about the different acts available
and the ramifications of each one. It would be left to
them to decide as to which act they would like to file
their petition under, provided they are eligible to do so
under the chosen act. As started above, the prospective
parents must be made to fully understand the status of
their adoption under each act.
31. FOLLOW UP:
Once an order has been issued, it should be followed by
regular follow up visits and postadoptation counselling by
the social worker till the child is adjusted in the new
environment. The follow up should preferably be for a
period of 1 yr at least or as directed by the court. Copies
of the follow up reports will be sent to the district social
welfare officer.
32. ROLE OF NURSE IN MANAGEMENT OF INFERTILITY
1] ASSESSMENT
2] TREATMENT
3] EDUCATION
4] PSYCHOLOGICAL SUPPORT
33. Conclusion
Fertility nursing is a relatively new specialty which offers a diverse
and challenging environment in which a nurse can work. The scope
of practice is continuing to expand to acomodate rapid
developments in reproductive science, along with societal pressures
and expectations which ensures exciting opportunities exist for
nurses interested in, and committed to, the care of couples facing
fertility issues.
34. REFERENCES
1.Annamma Jacob, “ A comprehensive textbook of midwifery &
gynecological nursing”, published by Jaypee, edition 3rd , page
no.716-724.
2.Kamini Rao, “textbook of midwifery and obstetrics for nurses”,
published by Elsevier, edition 1st , page no. 271-287.
3.Hiralal Konar, “DC Dutta’s textbook of gynecology ”,published by
Jaypee, edition 7th 2016, page no.186-208.
4.
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