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Chapter 12
Special Reproductive Concerns: Infertility and Genetics
Resource Library
Prentice Hall Nursing Medialink DVD-ROM
Audio Glossary
NCLEX Review
Activity: Ovulation
Video: Through the Eyes of a Nurse—The First Trimester
Companion Website
Additional NCLEX Review
Case Study: Infertility
Care Plan Activity: Infertile Couple
Applications: Infertility Testing; In Vitro Fertilization
CriticalThinking
Learning Objective 1
Identify the components of fertility.
Concepts for Lecture
1. The components of fertility that are essential for the female partner include: favorable cervical
mucous, clear passage between the cervix and the fallopian tubes, patent fallopian tubes with
normal motility, ovulation and the release of the ova, no obstruction between the ovary and the
fallopian tube, favorable endometrial environment for implantation, and adequate reproductive
hormones.
2. The components of fertility that are essential for the male partner include: normal semen
analysis, unobstructed genital tract, normal genital tract secretions, and ejaculated spermatozoa
deposited at the cervix.
Learning Objective 2
Describe the elements of the preliminary investigation of infertility.
Concepts for Lecture
1. Both partners will undergo a thorough history and physical examination as well as several
tests to identify cause of infertility. The woman’s ovulatory function and the structure and
function of the cervix, uterus, fallopian tubes, and ovaries will be assessed. In the male, a semen
analysis for sperm quality, quantity, and motility is the most important assessment.
Learning Objective 3
Summarize the indications for the tests and associated treatments, including assisted reproductive
technologies, that are done in an infertility work-up.
Concepts for Lecture
1. If a woman has ovulatory problems, the diagnostic tests that are most appropriate would be
BBT, hormonal assessments (including FSH, LH, progesterone, TSH, and androgen levels), an
endometrial biopsy to assess endometrial receptivity, and a transvaginal ultrasound to monitor
follicles. Pharmacologic treatment to induce or improve ovulation and donor oocytes would be
instituted. If the woman has cervical problems, the diagnostic test that is most appropriate is
cervical mucous analysis. This problem would best be treated by therapeutic insemination (THI),
in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). The woman with problems
involving the uterine structures or tubal patency would benefit most from assessment techniques
including hysterosalpingography, hysteroscopy, and laparoscopy. The most appropriate
treatments may include in vitro fertilization, gamete intrafallopian transfer, donor oocytes, and in
vitro fertilization using a gestational carrier. If infertility is related to a semen problem, analysis
of the quality and quantity of the semen would be most appropriate, and treatment may include
therapeutic insemination, in vitro fertilization, gamete intrafallopian transfer, and
micromanipulation techniques.
Learning Objective 4
Summarize the physiologic and psychologic effects of infertility.
Concepts for Lecture
1. Infertility often taxes a couple’s financial, physical, and emotional resources. Their marriage
may be stressed and their relationship affected by the intrusiveness of the testing. They may
experience guilt, frustration, anger, or shame. They may experience loss of control, feelings of
reduced competency and defectiveness, loss of status and ambiguity as a couple, a sense of social
stigma, stress on the marital and sexual relationship, and a strained relationship with healthcare
providers.
Learning Objective 5
Describe the nurse’s roles as counselor, educator, and advocate during infertility evaluation and
treatment.
Concepts for Lecture
1. The nurse’s role in caring for couples with infertility is that of a counselor, educator, and
advocate. The nurse counsels the couple about treatment options and provides education about
the treatment. Additionally, the nurse counsels them to help give them control and negotiate the
treatment process.
Learning Objective 6
Discuss the indications for preconceptual genetic counseling and prenatal testing.
Concepts for Lecture
1. Indications for preconceptual genetic counseling and prenatal testing may include: women age
35 or over, couples with a chromosomal abnormality, a family history of known or suspected
Mendelian genetic disorders, couples with a previous child with a chromosomal abnormality,
couples in which either partner or a previous child is affected by (or in which both partners are
carriers for) a diagnosable metabolic disorder, a family history of birth defects and/or mental
retardation, ethnic groups at increased risk for specific disorders, couples with a history of two or
more first trimester spontaneous abortions, women with an abnormal MSAFP, and women with a
teratogenic risk secondary to an exposure or maternal health condition.
Learning Objective 7
Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sexlinked) recessive disorders.
Concepts for Lecture
1. Multiple generations are affected by autosomal dominant disorders, with affected individuals
having a 50% chance of passing on the abnormal gene to each of their children. Males and
females are equally affected, and fathers can pass on the abnormal gene to their sons.
2. An individual may have an autosomal recessive disorder passed to them through clinically
normal parents who are carriers of the gene. Each carrier has a 25% chance of passing on the
abnormal gene to a child. There is a 25% chance with each pregnancy that there will be an
affected child. There is a 50% chance that an unaffected child will be a carrier. Males and
females are equally affected. Males cannot pass on the abnormal gene in an X-linked recessive
disorder because it is carried on the X chromosome. A carrier mother has a 50% chance of
passing the abnormal gene to each of her sons who will become affected. She also has a 50%
chance of passing the abnormal gene to each of her daughters who will become affected.
Affected fathers will pass on the gene to all of their daughters.
Learning Objective 8
Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic
disorders.
Concepts for Lecture
1. Prenatal diagnostic procedures that may be done to assess the fetus for genetic disorders
include: ultrasound at 18 to 20 weeks, amniocentesis, chorionic villus sampling (CVS), and
maternal serum AFP (MSAFP). Postnatal diagnostic procedures include: a detailed family
history, a thorough physical examination including dermatoglyphic analysis, and laboratory
analysis (including chromosome analysis, enzyme assay for inborn errors of metabolism, DNA
studies, and antibody titers for infectious teratogens).
Learning Objective 9
Explore the emotional impact on a couple undergoing genetic testing or coping with the birth of
a baby with a genetic disorder, and explain the nurse’s role in supporting the family undergoing
genetic counseling.
Concepts for Lecture
1. The emotional impact on a couple undergoing genetic testing involves their decision to have
the child affected with a genetic disorder or to abort. If abortion is not an option, couples may not
choose to have genetic testing; however, other couples may choose to have the testing in order to
prepare themselves for the birth of a child with special needs. The nurse should prepare the
family for genetic counseling and act as a resource person and an advocate for the family.