infertility jt edit
TRANSCRIPT
InfertilityPresented by: Ritchie, A., Savalle, O., Shammo, A., Szwast, L.,
Tomljenovic, J., & Walk, J.
Oakland University
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(Mayo Clinic, 2014)
Facts About InfertilityWhat is it: Infertility is when you cannot get pregnant after having
unprotected, regular sex for six months to one year, depending on your age
Causes: Infertility may be due to single cause in either you or your partner, or a combination of factors that may prevent a pregnancy from occurring or continuing
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MALE FEMALE
Abnormal sperm production or function Ovulation disorders
Problems with the delivery of sperm Uterine or cervical abnormalities
Overexposure to certain chemicals and toxins Fallopian tube damage or blockage
Damage related to cancer Endometriosis & primary ovarian insufficiency
Pelvic adhesions
Symptoms: The main symptom of infertility is not getting pregnant. May not have any other symptoms
Risk factors: Tobacco/Alcohol use; age; exercise issues; obesity; anorexia
How to diagnose:
(Mayo Clinic, 2014)
Facts About Infertility
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MALE FEMALE
Semen analysis Ovulation testing
Hormone testing Hysterosalpingography
Ultrasound Hormone testing
Genetic testing Genetic testing
Biopsy Imaging testing
Blood tests
Is it common? Yes. About 6% of married women 15-44 years of age in the United States are unable to get pregnant after one year of unprotected sex
Also, about 12% of women 15-44 years of age in the US have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status (impaired fecundity)
Number of women ages 15-44 with impaired fertility/fecundity: 6.7 million (10.9%)
Number of married women ages 15-44 that are infertile (unable to get pregnant after at least 12 consecutive months of unprotected sex with husband): 1.5 million (6.0%)
Number of women ages 15-44 who have ever used infertility services: 7.4 million
Why is it important: It is a common problem that can create a multitude of other issues within a family (Domino Effect)
(Center for Disease Control and Prevention, 2016; Roberson, 2015)
Prevalence and Incidences of Infertility
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Dependent on: Cause, infertile length, age, partner’s age, and personal preferences
Unfortunately, some causes of infertility can’t be corrected. However, a woman may still become pregnant with assisted reproductive technology (ART). These infertility treatments involve significant financial, physical, psychological, and time commitment
Assisted reproductive technology (ART) fast facts: Each year thousands of babies are born in the US as a result of ART. The success rate of ART is lower after age 35
Multiple types of ART: In vitro fertilization (IVF)
Zygote intrafallopian transfer (ZIFT)
Gamete intrafallopian transfer (GIFT)
Intracytoplasmic sperm injection (ICSI)
(Mayo Clinic, 2014; Center for Disease Control and Prevention, 2016)
Treatment Options
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Nutrition
Weight loss
Scrotal temperature
Water-soluble lubricants
Condoms to lower female antisperm antibodies
(Lowdermilk, Perry, Cashion, & Alden, 2012)
Treatment Options - Lifestyle Changes
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Ovulation medications help women, especially those that do not have a regular menstrual cycle, by stimulating ovulation and multiple egg release. This increases the opportunities for fertilization
Clomiphene citrate
Letrozole (aromatase inhibitor)
Gonadotropins; follicle-stimulating hormone (FSH), luteinizing hormone (LH), human menopausal gonadotropin (hMG), human chorionic gonadotropin (hCG), & gonadotropin-releasing hormone (GnRH)
Metformin (insulin sensitizing drug) (American Society for Reproductive Medicine, 2014)
Treatment Options - Medical
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Laparoscopic surgery can be performed to remove scar tissue or cysts from ovaries, which may be the cause of infertility.
(WebMD, 2014c)
Treatment Options - Laparoscopy
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During ovulation, sperm is inserted directly into the woman’s uterus
(WebMD, 2014b)
Treatment Options - Intrauterine Insemination
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Collected sperm and mature eggs are placed in a dish together for fertilization to occur. Then about one to three fertilized eggs get inserted into the uterus
(WebMD, 2014a)
Treatment Options - In Vitro Fertilization
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Cultural lag / religious perspectiveInvention and implementation of new technology
occur before cultural acceptance of that technology (e.g. church rejection of ART)
Spiritual characterConception degraded from an intimate act to purely
mechanical
Multiple pregnanciesImplantation of multiple embryos increase the
potential for perinatal mortality(Shreffler, Johnson, & Scheuble, 2010)
Ethical Dilemmas of ART
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Embryo selection process and genetic screening Fertilization outside the maternal body allows the selection and modification of desired
traits
Access of treatmentsLack of standardized regulation of cost, quality, and extent of treatment creates unequal
opportunities
Insurance coverage varies widely from state to state - Michigan state has no infertility insurance mandate
(Chatzinikolaou, 2010)
Ethical Dilemmas of ART
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About 5% of couples living in the 1st world countries experience primary infertility (inability to have any children) or secondary infertility (inability to conceive or carry a pregnancy to term following the birth of one or more children
Research confirmed that the majority of infertility cases can be attributed to a physiological cause in the man or woman
About one-third of the time a physiological problem is identified in the woman, one-third of the time in the man, and about one-tenth of the time in both partners
In approximately 10 to 20% of cases, the basis of infertility cannot be determined
(John Hopkins Medicine, 2016)
Infertility
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Counseling: focused on increasing coping strategies. Research suggests that addressing psychological factors such as depression, anxiety, and stress prior to fertility treatment may lead to a more successful outcome when undergoing fertility assistance to conceive
Group counseling has been demonstrated to be more beneficial to couples than individual counseling because the couples can discuss their issues as a group
Psychotherapy: interpersonal therapy and cognitive behavioral therapy combined has shown to be helpful in providing relief to infertility patients suffering with mild to moderate depression
Interpersonal Therapy: The goal of such therapy is tailored towards education on how to strengthen relationships and/or techniques to resolve conflicts with others
Cognitive Therapy: This form of therapy identifies and tries to change unhealthy patterns of thought or behavior.
(Cousineau & Domar, 2007; Yuit Wah Wong & Ser Hua Tan, 2012)
Therapies to Address the Negative Impacts of Infertility
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Relaxation Techniques: Experts recommend various relaxation techniques to address the significant amount of stress infertility has on males and females
Examples of this therapy include - mindful meditation, deep breathing, guided imagery, and yoga to promote stress management
(Cousineau & Domar, 2007)
Therapies to Address the Negative Impacts of Infertility
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Psychological interventions emphasizing stress management and coping-skills training are proving to have beneficial effects for fertility patients. Still further research is needed to truly understand the correlation between distress and fertility outcome, as well as effective psychosocial interventions
(Klock, 2011)
Psychological Intervention
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A recent qualitative study, the first of its kind, explored the needs of infertile couples
A close overview of the research findings provided the following insight:A need for support and assistance is among infertile couples’ main demands, so that they
can cope with the stress caused by infertility
This need encompasses four categories:Infertility and social support
Infertility and financial support
Infertility and spiritual support
Infertility and information support (Jafarzadeh-Kenarsari, Ghahari, Habibi, & Zargham-Boroujeni, 2015)
Couples Support Requirement
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Studies show in addition to treatment and medical needs, infertile couples are also faced with challenges in emotional, psychological, communicative, cognitive, spiritual and economic aspects that can affect various areas of their lives and lead to new found concerns/problems and demands
Address infertile couples needs and expectations in conjunction with their fertility treatments through patient-centered approaches and couple-based interventions can improve their quality of life and treatment results, and can also relieve negative psychosocial consequences associated with failed fertility
(Jafarzadeh-Kenarsari et al., 2015)
Couples Support Requirement
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Research has found that many women have insufficient education on fertility
Some lack the appropriate information in regards to their menstrual cycle dates
Nurses need to educate women about fertility as soon as the women identify they have difficulties with conceiving
(Hampton, Mazza, & Newton, 2013)
Nursing Role
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Expressive Writing Intervention (EWI) Nurses can educate couples on EWI
This helps couples to indicate their emotions in writing
Research has found that couples that have used EWI have less anxiety in regards in regards to infertility
(Yuit Wah Wong, & Ser Hua Tan, 2012)
Nursing Interventions
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Infertility can be life altering and is a major cause of stress that affects cultures worldwide
The most common emotional symptoms accompanying infertility are anxiety and depression, however couples also frequently experience:
Generalized sadness
Stress
Feeling like a disgrace
Dealing with peers questioning about when they will have children
Loss of privacy
Loss of relationships
Emotionally, couples may experience infertility similar to the way they experience a loss, causing a similar overwhelming grief pattern
(Mosallanejad & Koolee, 2013; Onat & Beji, 2012; Tuzer et al., 2010)
The Emotional Effects
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Infertility often has negative effects on a couple’s marriage, sexual relationship, and self-esteem
Studies suggest that these effects are less severe when both partners equally want children and when they experience similar levels of stress when dealing with infertility
A partner may sometimes distance or detach themselves from the problem as a way of coping, leading to marital problems
Couples who feel that they are not filling their roles by reproducing are likely to experience depression
Emotional consequences of infertility increases with time or as the number of failed treatments increases, shown by an overall decline in marital content in the third year following treatments
(Tuzer et al., 2010)
The Emotional Effects
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Most studies reveal that women are typically more emotionally affected by infertility than men are
This is exhibited by increased display of health concerns, depression, and anxiety
A significant cause of anxiety that women experience is due to invasive procedures or negative bodily effects of interventions that men do not experience when seeking alternatives
Women may experience less severe depression when their partner is the cause of infertility, while the opposite tends to be true when the woman is infertile
(Tuzer et al., 2010)
The Emotional Effects
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There is a significant financial burden associated with trying to have children despite infertility
The United States is the most expensive country for treating infertility, potentially costing approximately 50% of a couple’s net income
The financial burden of treatments directly contributes to the couple’s stress
If treatments are not covered by insurance, they may be too costly, rendering treatment inaccessible
(Connolly, Hoorens, & Chambers, 2010; Tuzer et al., 2010)
The Financial Effects
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Direct Costs - costs needed to cover the price of treatmentConsults
Medications
Lab work
Radiology
Procedures etc.
Indirect Costs - costs to cover anything resulting from treatment
(Connolly et al., 2010)
The Financial Effects
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Treatments commonly cause a woman to become pregnant with multiples
Pregnancies resulting from medical interventions have an increased risk for poor health outcomes than those conceived without intervention
Both circumstances can result in unexpected increased costs associated with infertility
(Connolly et al., 2010)
The Financial Effects
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The stress of infertility can be physically manifested by:An inability to sleep
A significant change in appetite or diet
Smoking
Staying away from places where children may be
No longer having sex for pleasure
Negative career effects
(Onat & Bei, 2012)
The Physical Effects
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Couples may feel absolute exhaustion when dealing with infertility from the addition pressure caused by family and friends expecting the couple to have children
Without proper healthy coping methods, the psychological impact of the stress and depression that accompanies infertility may contribute to the inability of the couple to become pregnant
Stress and depression can make an individual more susceptible to illness
(Gulec, Hassan, Gunes, & Yenilmez,, 2011; Mosallanejad & Koolee, 2013)
The Physical Effects
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Infertility may cause feelings of meaningless
Studies have revealed that many people consider their spirituality to be a major part of their lives
Their spirituality may help them cope, or it may be a cause of additional stress and anxiety
The concept of handing their burden over to a higher power helps provide comfort to some couples dealing with infertility
(Mosallanejad & Koolee, 2013; Roudsari, Allan,& Smith, 2014)
Infertility & Spirituality
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What additional research is needed?
According to reports by the American Pregnancy Association, research in the area of male infertility is lacking. Often when the male is determined to solely be the cause of a couple’s inability to conceive, the case receives the blanket diagnosis of “unknown cause”.
Further research is needed to truly understand the correlation between distress and fertility outcome, as well as effective psychosocial interventions
30 (American Pregnancy Association, 2015; Klock, 2011)