Infertility Contraception Chapter 1 2 NURS 250 Voice Over

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Chapter 1 & 2 Pamela Dennis RNC-OB msn:

Chapter 1 & 2 Pamela Dennis RNC-OB msn Infertility, Contraception, and Abortion

Key Points :

Key Points Women and their partners should choose the contraceptive method(s) best suited to them Effective contraceptives are available through both prescription and nonprescription sources Concurrent use of spermicides and latex condoms provides protection against STIs Tubal ligations and vasectomies are permanent sterilization methods

Infertility :

Infertility Incidence Affects about 10% to 15% of reproductive-age population Subfertility: prolonged time to conceive Sterility: inability to conceive Increases with age of woman, particularly in women 40 years and older Diagnosis and treatment of infertility require physical, emotional, and financial investment

Infertility—cont’d :

Infertility—cont’d Factors associated with infertility Female infertility Ovarian factors Tubal and peritoneal factors Uterine factors Vaginal-cervical factors Isoimmunization Other factors

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Fig. 7-1. Abnormal uterus. A, Complete bicornuate uterus with vagina divided by a septum. B, Complete bicornuate uterus with normal vagina. C, Partial bicornuate uterus with normal vagina. D, Unicornuate uterus.

Nursing Care Management :

Nursing Care Management Assessment of female Diagnostic tests Evaluation of the anatomy Detection of ovulation Hormone analysis Ultrasonography Endometrial biopsy Hysterosalpingography Laparoscopy

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Fig. 7-2. Hysterosalpingography. Note that the contrast medium flows through the intrauterine cannula and out through the uterine tubes.

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Fig. 7-3. Laparoscopy.

Nursing Care Management—cont’d :

Nursing Care Management—cont’d Assessment of male Semen analysis Hormone analysis Scrotal ultrasound Assessment of couple Postcoital test

Nursing Care Management—cont’d :

Nursing Care Management—cont’d Plan of care and implementation Psychosocial Nonmedical Herbal alternative methods Medical Surgical Assisted reproductive therapies

Contraception :

Contraception 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

Nursing Care Management :

Nursing Care Management 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 The safety of a method depends on a woman’s medical history

Contraception—cont’d :

Contraception—cont’d Methods 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

Contraception—cont’d :

Contraception—cont’d Methods FAMs Natural family planning (period abstinence) Calendar rhythm method Standard days method Basal body temperature method Cervical mucus ovulation-detection method

Contraception—cont’d :

Contraception—cont’d Methods FAMs Symptothermal method Predictor test for ovulation TwoDay method Lactation amenorrhea method

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Unn. Fig. 7-2. Cervical Mucus Characteristics

Contraception—cont’d :

Contraception—cont’d Barrier methods Spermicides Condoms, male (STI protection) Vaginal sheath (STI protection) Diaphragm Fit of diaphragm Toxic shock syndrome Cervical cap Fit of cervical cap Contraceptive sponge

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Fig. 7-11. Spermicides.

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Fig. 7-12. A, Mechanical barriers. Clockwise from top: female condom, cervical cap, diaphragm, types of male condoms, vaginal ring (hormonal) (center). B, Contraceptive sponge.

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Unn. Fig. 7-4. Squatting

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Unn. Fig. 7-5. Leg-Up Method

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Unn. Fig. 7-6. Chair Method

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Unn. Fig. 7-7. Reclining

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Unn. Fig. 7-8. Preparation of Diaphragm

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Unn. Fig. 7-9. Insertion of Diaphragm

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Unn. Fig. 7-10. Diaphragm Insertion

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Unn. Fig. 7-11. Diaphragm Insertion

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Unn. Fig. 7-12. Diaphragm Insertion

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Unn. Fig. 7-13. Diaphragm Insertion

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Unn. Fig. 7-14. Cervical Cap Insertion

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Unn. Fig. 7-15. Cervical Cap Insertion

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Unn. Fig. 7-16. Cervical Cap Insertion

Contraception—cont’d :

Contraception—cont’d Hormonal methods Combined estrogen-progestin contraceptives (COCs) Oral contraceptives and side effects Transdermal contraceptive system Vaginal ring

Contraception—cont’d :

Contraception—cont’d Hormonal methods Progestin-only contraceptives Oral progestins (minipill) Injectable progestins Implantable progestins (Norplant)

Contraception—cont’d :

Contraception—cont’d Emergency contraception Used within 72 hours of unprotected intercourse Three methods available in the United States High doses of estrogen or COCs Two days of levonorgestrel Insertion of the copper intrauterine device (IUD)

Contraception—cont’d :

Contraception—cont’d IUD Small, T-shaped device inserted into the uterine cavity Medicated IUDs loaded with either copper or progestational agent IUD offers no protection against STIs or HIV

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Fig. 7-14. Intrauterine devices. A, Copper T380A. B, Levonorgestrel-releasing intrauterine device.

Contraception—cont’d :

Contraception—cont’d Sterilization Female Tubal occlusion Tubal reconstruction Male (vasectomy) Tubal reconstruction (reanastomosis)

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Fig. 7-15. Sterilization. A, Uterine tubes ligated and severed (tubal ligation). B, Sperm duct ligated and severed (vasectomy).

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Fig. 7-16. Use of minilaparotomy to gain access to uterine tubes for occlusion procedures. Tenaculum is used to lift uterus upward (arrow) toward incision.

Key Points :

Key Points Infertility: inability to conceive and carry a fetus to term gestation Infertility affects about 10% to 15% of otherwise healthy adults Infertility increases in women older than 35 years In the United States about one third of infertility causes are related to female causes, one third are related to male causes, 20% of causes are unexplained

Key Points—cont’d :

Key Points—cont’d Common etiologic factors include decreased sperm production, ovulation disorders, tubal occlusion, and endometriosis Reproductive alternatives include: IVF­ET, GIFT, ZIFT, oocyte donation, embryo donation, TDI, surrogate motherhood, and adoption Contraceptive methods with various effectiveness rates, advantages, and disadvantages are available