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The American Pregnancy Association points out, “Infertility is a condition that affects approximately 1 out of every 6 couples” (“Female Infertility”, 2019). Infertility is a global public health issue that silently affects more people that the average person assumes. Because this issue is not openly talked about, many people are unaware about the topic and it becomes stigmatized. In this paper, the pathophysiology, population affected, current ideas treatment measures, nursing care, other possible consideration regarding this health topic, and any emerged research available over infertility will be explored.
The pathophysiology of infertility is very complex and includes a multitude of routes upon what could go wrong in the process of conception. What is infertility? In general, infertility diagnosis is given to a couple that has been unsuccessful to conceive over the course of one full year. This includes miscarriages and stillbirths. Infertility is assessed in a thorough physical exam that includes a medical history regarding potential factors that could contribute to infertility (National Institute of Child Health and Human Development, 2019). Typically a medical and family background, occupational and lifestyle history, physical examination, and laboratory testing are also done. This condition does affect both the men and female population, both physically and mentally. As Medline Plus explains, “ About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause can be found” (“Infertility”, 2019). First let’s start with conceiving in a normal fertile couples compared to where it could go wrong. In general, problems can arise from both female problems, male problems, or a combination. The fundamental steps for a female is hormones, oogenesis, implantation, and then the potential for pregnancy. The essentials steps for a male include hormones, spermatogenesis, (maintaining an) erection, and lastly ejaculation. The most common causes for infertility is age, ovulation, and issues with the fallopian tubes, uterus, or spermatogenesis. Issues with hormones, which leads to an concerns with ovulation in females, can come from other disorders in the body such as anorexia and bulimia. Tumors and cyst in both male and females can cause an issue and block center organs from undertaking their job in conceiving. Another issue is excess weight or more commonly underweight, which can also lead to thyroid gland issues. Lastly, another classic problem in woman that can cause infertility is a damaged or not functioned uterus. This can be a result from pelvis inflammatory disease (PID), polycystic ovary syndrome (PCOS), polyps in uterus, and endometriosis (U.S. Department of Health & Human Services, 2019).
When faced with the situation of infertility there are several directions patient can navigate to try and treat the condition. The route infertility specialist typically take first, depending on what the issue is, is treating with drugs. Pharmacology dealing with infertility is like any other pharmaceutical class, it is changing and evolving constantly. However, there have been a some select drugs that have been a constant go-to medication for a good amount of time. The fist drug currently being used for treatment is Clomid. The classification of this is drug a non-steroidal fertility medication. Clomid works by stimulating the pituitary gland to release its hormones to stimulate ovulation such as luteinizing hormone. The type of clients that this medication works for is clients who have the predisposing medical conditions that prevent natural ovulation such as PID, PCOS, and endometriosis. A known side effect to be aware of when dealing with this drug is to know that Clomid has a reputation for causing multiples or twins (Multum, 2019). The main infertility drug is Bravelle. Bravelle is a pure form of the follicle- stimulating hormone (FSH). FSH is vital to conception as it aids in developing the eggs that are constructed in the ovaries and later join with the sperm to eventually form a zygote. “Bravelle is used together with other medicines to treat infertility in women with FSH deficiency. This medicine is also used to help the ovaries produce multiple eggs for use in ‘in-vitro’ fertilization” (Multum, 2018). The last drug that is used frequently is Crinone. The classification of this drug is a progestin. The type of clients that are prescribed this medication is those woman that are deficient in the adequate amount of progesterone in their body. Progesterone is a hormone produced by the adrenal glands that aids fertility by helping your body maintain the pregnancy by making modifications in the lining of the uterus. By changing the lining in the uterus, it makes the zygote attachment to the uterus easing in those beginning stages (Multum, 2019).
While the list of medications could go on and on, there are other current considerations for treatment. The main category of options includes a natural approach, traditional and over-the-counter methods, and infertility procedures. The first step doctors recommend is the natural approach. This is typically done within the first year of actively trying before couples are even considered ‘infertile’. This includes the craton method which is tracking ovulation through fertility awareness, diet, exercise, acupuncture, massage therapy, and Chinese therapy. Traditional and over-the-counter methods are next in line. The American Pregnancy Association has a resource guide in which they give a detailed explanation about the different tools. The first is a urine based ovulation test. It predicts your peak ovulation time so couples can plan the optimum time of intercourse. A more advanced ovulation prediction is an electronic fertility monitor. It works swapping the patients saliva or cervical mucus and tracing the electrolyte level changes. Supplement wise, the top selling is FertilAid. It is a concoction of prenatal vitamins and minerals all aiding to help trying-to-conceive woman help balance hormone levels and endorse regularity of cycles. Another interesting tool is a lubricant called Pre-Seed. Unlike most other lubricants that may not foster a safe atmosphere for sperm, Pre-Seed claims to not harm the sperm giving couples a higher chance of it connecting with the egg (American Pregnancy Association, n.d.). The last group of treatments are the infertility procedures. Some are test, some correct issues that are preventing conceptions while some others aide in conception. These include a wedge resection for polycystic ovaries, removal of polyps, dilation and curettage (D&C), endometrial receptivity analysis (ERA), in vitro fertilization (IVF), and zygote intrafallopian transfer (ZIFT). It is also noteworthy to mention some other alternatives. The healthcare workers will also mention adoption, fostering, surrogacy, embryo adoption, and donor eggs or sperm to infertile couples. While infertility can be a discouraging diagnosis, there are many options for clients to explore which gives patients hope.
Working with patients diagnosed with infertility takes a special kind of nurse. Just as some a made for pediatric oncology, some are made for working with fertility care. This population that is affected has specific nursing interventions that is used to reach a specific goal and outcome. The first type of interventions include the nurse acting as an educator. Mostly including increasing awareness of efforts to decrease possibility of infertility. Included is preventing sexually transmitted diseases (STD’s), avoid illicit drugs and abuse of alcohol, stay in overall good health, having regular checkups with a gynecologist, and being mindful of the effects of hormonal birth control. Not that birth control causes infertility as its stigmatized but rather it masking certain preexisting conditions that cause infertility. The second types of interventions are ones that typically occur in the hospital or outpatient setting side. Nurses can perform blood draws, help with ultrasounds, assist with surgery, and most importantly act as moral support. Nurses act as a liaison through the whole process. Like a bridge between the patients and doctors.
Nurses also can work within the emerging research side of things. Two specific studies have recently been done that have surprised that general population. The first one being over the older male population. Rutgers University has concluded that just as older woman’s age increased risk of infertility and complications, so does males. The study concluded that men 45 and older indeed do have a ‘biological clock’ which decreased fertility. The decline in testosterone over the years with aging results in “sperm degradation and poorer semen quality” (Rutgers University, 2019). Additionally, it puts their companions at a greater risk for gestational diabetes, preterm birth complications, and preeclampsia. Another interesting study is in correlation with aspirin and infertility. The US Department of Health and Human Services claim that taking aspirin has an advantage for procreation measures. In short it increased blood flow which in turn reduced risk for adverse events dealing with pregnancy. The increased blood flow during conception also increased overall placental health. EAGeR states aspirin, “ provide(s) an advantage for reproductive measures, including conception, implantation of the fertilized egg, early reproductive loss, late fetal death, and low birth weight, among others” (Schisterman, 2018). New information like these two case studies are constantly being done to help understand infertility as much as possible.
While the stigma of infertility can often make victims feel alone, they are not. Infertility is quite prevalent and it’s a global health issue that merits to be recognized. The pathophysiology, population affected, current ideas treatment measures, nursing care, other possible consideration regarding this health topic, and any emerged research available over infertility is quite complex but important nonetheless. As Margaret Thatcher encourages, “You may have to fight a battle more than once to win it”.
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