4.6: Summary
4.1 Fertility and Conception
Fertility is the ability to conceive a pregnancy. Many intricate processes must successfully occur to achieve conception. Couples with infertility may seek care from a reproductive endocrinologist who specializes in the treatment of infertility. Infertility can be caused by factors in either or both partners, though in many cases, a specific cause cannot be identified. Assessing a couple who presents with infertility involves looking at both partners and the three main factors that are essential for conception: the release of an egg, the presence of sperm, and a healthy environment for implantation. Though conception and pregnancy are largely physiologic events, the nurse must not neglect the important psychosocial factors that are associated with fertility and conception, including stress and societal pressures. Patient teaching is an essential function for the nurse caring for all patients considering conception.
4.2 Genetics
Humans typically have a total of 46 chromosomes organized in pairs: 22 pairs of autosomes (body chromosomes) and 1 pair of sex chromosomes (XX in people who are genetically female or XY in people who are genetically male). One set of chromosomes (22 autosomes and 1 sex chromosome) is inherited from each parent. Sometimes, an error in replication occurs, and an abnormal number of chromosomes results.
Genetic transmission between generations can lead to autosomal dominant inheritance disorders and autosomal recessive disorders. X-linked disorders disproportionately affect more males than females because males must inherit only one affected X chromosome to be affected.
Patients have many options for genetic screening, both prenatally and postnatally. Prenatal screening is done during pregnancy to determine the risk that the fetus has for aneuploidy, a neural tube defect, or another abnormality suggestive of a genetic disorder. Prenatal diagnostic testing includes chromosomal analysis. Postnatal testing, or the newborn screen, is done after the baby is born and consists of a capillary blood test. The hope is that early detection and treatment of these conditions improves the quality of life for newborns.
4.3 Causes of Infertility
Causes of infertility are multifactorial. Many causes of infertility in both persons assigned female at birth and those assigned male at birth are similar, such as medications, environmental toxins, hormones, and medical conditions. Treatments are available for many causes of infertility; yet not all causes of infertility are diagnosable or treatable. The nurse can be an excellent support to couples experiencing infertility by providing education, referrals, and emotional support.
4.4 Treating Infertility
When a patient or couple presents with difficulty in conceiving, the first step is a comprehensive assessment of both partners. Once the initial assessment has been completed, the provider will create a plan of care. Pharmacologic management of infertility, also known as ovulation induction or ovarian stimulation, is used in conjunction with many of the treatment options available for infertility. Medications are used to control the menstrual cycle and ovarian response to increase the odds of conception. IUI and IVF are procedures available for treatment of infertility. Like any medical procedure, infertility treatments do pose some risks. Educating patients about what to expect, what is normal, and what should be reported is a crucial function of all nurses practicing in this field. In addition, it is important to recognize signs and symptoms of potentially serious complications and how to manage them.