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Running head: INFERTILITY: CAUSES AND TREATMENTS
Infertility: Causes and Treatments
Rachel Krogstie
Methodist University
NUR 4040
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INFERTILITY: CAUSES AND TREATMENTS
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Abstract
Infertility is a significant health care issue all over the world. It is often thought of a first world
problem, but this is only because infertility is often expensive to treat and taboo in some cultures.
Jean Watson, a nursing theorist, developed a theoretical framework to carry out nursing care
called the Theory of Human Caring. This theoretical framework is often successfully used in the
treatment and counseling of infertile couples. Couples going through the various treatments for
infertility can experience a myriad of emotions, thus making Watson’s theory a great supplement
to the treatment regimen. The many treatment option include education, surgical interventions,
gamete intra-fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), and in-vitro
fertilization (IVF). Education of the anatomy of the reproductive systems is crucial before
considering treatments that are more advanced because this education alone may help the couple
conceive. The invasive procedures are between 15%-30% effective depending on the patient and
timing of the intervention.
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Infertility: Causes and Treatments
While often thought of as a problem affecting older couples, or those with extensive
medical history, infertility is prevalent in the general population (Bell, 2013). Infertility is a
pervasive, destructive, and significant health problem that affects 10 to 15% of couples of
reproductive age (Özkan, Okumuş, Buldukoğlu, & Watson, 2013). In a recent review, it was
stated that in developing countries 1 in 4 married women of reproductive age is infertile (Özkan,
Okumuş, Buldukoğlu, & Watson, 2013), while 4% to 17% of couples in industrialized countries
experience an involuntary absence of conception lasting at least 12 months (Bushnik, Cook,
Hughes, & Tough, 2012). Infertility strikes couples from every socio-economic class, race, and
creed; it does not discriminate. The goal of this paper is to shed light on the etiology, treatment,
and emotional impact on couples suffering with infertility.
Theoretical Framework - Watson’s Theory of Human Caring
Jean Watson developed the Human Caring Theory between 1975 and 1979 (Özkan,
Okumuş, Buldukoğlu, & Watson, 2013). Watson stated “the individual–nurse relationship
increases the individual’s self-healing capacity, develops a high level of consciousness in the
individual, and the individual emerges with harmony of mind-body-soul” (Özkan, Okumuş,
Buldukoğlu, & Watson, 2013). Watson also viewed the nursing process as “caregiving between
people and regarded the patient as an agent of change” (Özkan, Okumuş, Buldukoğlu, & Watson,
2013).
Watson’s Human Caring Theory has been widely used in the treatment of infertility
(Özkan, Okumuş, Buldukoğlu, & Watson, 2013). This is partly due to the caritas processes, or
caring occasions, that she uses to explain her philosophy (Özkan, Okumuş, Buldukoğlu, &
Watson, 2013). Human Caring Theory processes applicable to supporting couples with infertility
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include: instill faith and hope and honor others, be sensitive to self and others by nurturing
individual beliefs and practices, promote and accept positive and negative feelings as you
authentically listen to another’s story, and open to mystery and allow miracles to enter (Özkan,
Okumuş, Buldukoğlu, & Watson, 2013).These processes, if they are incorporated by the nurse,
can help couples progress through the ups and downs of the infertility process.
Discussion
The causes of infertility are varied with factors specific to the males, females, both, or
unknown (Quallich, 2010). One third of infertility cases are male factors, such as sperm
antibodies or sperm transport (Quallich, 2010). Another third are female factors, such as ovulary
or tubal deformities (Kendall, 2008). The last third are either both male and female factors, or
unexplained (Porche, 2006b; Kendall, 2008).
Physiology and Etiology of Male Infertility
Causative factors of male infertility are generally classified into five categories:
endocrine, spermatogenesis, sperm antibodies, sperm transport, and disorders of intercourse
(Porche, 2006a). Lastly, an estimated 10% to 20% of infertile couples have unexplained
infertility that may be associated with idiopathic causes (Porche, 2006a). Endocrine factors are
either hypothalamic or pituitary diseases such as luteinizing hormone deficiency or the use of
exogenous hormones. (Porche, 2006a). These disorders can easily be tested for by drawing
blood.
Spermatogenesis factors can be genetic, acquired, and idiopathic. Some genetic
abnormalities associated with male infertility consist of chromosomal disorders such as
Klinefelter syndrome, the most common sex chromosome abnormality seen in infertile men
(Porche, 2006a; Quallich, 2010). Acquired spermatogenesis factors can be caused by
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gonadotoxins, such as chemicals, medications, and nicotine; systemic illness or infection, such as
orchitis, renal or hepatic diseases, or sickle cell disease; vascular abnormalities, such as
varicocele; and heat exposure (Porche, 2006a). Welding, military service, mechanics, and,
agriculture have been associated with lower sperm counts and lower pregnancy rates (Porche,
2006a). Most of these causes are treatable or preventable.
The last two male factor processes are less easily treated. Sperm agglutination, caused by
sperm antibodies, is associated with impaired sperm motility, impairment of binding to ovum,
and impaired penetration of cervical mucus (Porche, 2006a). Sperm transport causative factors
are either congenital, such as an absence of the vas deferens, or acquired, like those associated
with infections or surgical procedures (Porche, 2006a).
Physiology and Etiology of Female Infertility
Basic factors responsible for the majority of female infertility cases are tubal or
peritoneal factors, and ovulatory factors (Akhter & Jebunnaher, 2012). Tubal/peritoneal factors
include endometriosis, pelvic inflammatory disease, or a tubal occlusion (Akhter & Jebunnaher,
2012). Endometriosis leads to distorted anatomy and adhesions that cause problems with
implantation of the embryo (Akhter & Jebunnaher, 2012). Pelvic inflammatory disease is usually
caused by chlamydia or other sexually transmitted infections (Akhter & Jebunnaher, 2012).
Ovulatory factors can be menopause, ovarian cancer, anovulation, or polycystic ovary syndrome
(Akhter & Jebunnaher, 2012).
Along with these factors, environmental and lifestyle factors also cause problems with
infertility (Akhter & Jebunnaher, 2012). For example, a woman’s fertility is affected by her age;
thus, fertility peaks in the early and mid-twenties, after which it starts to decline, with this
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decline being accelerated after age thirty-five (Akhter & Jebunnaher, 2012). At 35, 94 out of 100
women will conceive; at 38, however, only 77 out of every 100 will do so (Akhter & Jebunnaher,
2012).
Lifestyle choices have a great impact on female infertility. Tobacco smoking is harmful
to the ovaries; nicotine and other harmful chemicals in cigarettes interfere with the body’s ability
to create estrogen (Akhter & Jebunnaher, 2012). Some damage is irreversible, but smoking
cessation can prevent further damage (Akhter & Jebunnaher, 2012). Twelve percent of all
infertility cases are a result of a woman being either underweight or overweight (Akhter &
Jebunnaher, 2012). Fat cells produce estrogen in addition to the primary sex organs (Ward &
Hisley, 2016). Too much body fat causes overproduction of estrogen and too little body fat
causes insufficient production of estrogen; both under and overweight women have irregular
cycles in which ovulation does not occur or is inadequate (Akhter & Jebunnaher, 2012).
Treatment Options
Treatment for infertility starts with simpler interventions and moves to more complicated
interventions as the need arises. A careful history should include when the couple concentrates
their efforts at conception. The first intervention would be education on reproductive systems
and how to improve chances of conceiving. There are couples who do not have a complete
understanding of the menstrual cycle, in that they do not take advantage of optimal timing for
intercourse (Quallich, 2010). Because healthy individuals are more successful at conceiving, the
education should also include nutrition, lifestyle choices, and exercise (Akhter & Jebunnaher,
2012). These minor and non-invasive interventions should be the first line of treatment of
infertility.
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More complex treatment options are assisted reproductive techniques or surgery
(Quallich, 2010). Surgery can be used to correct male anatomical abnormalities such as
varicocele or transurethral resection of the ejaculatory duct in males (Porche, 2006b), and tubal
occlusion or endometriosis in females (Akhter & Jebunnaher, 2012). Surgical procedures are
always risky in that they could cause more problems. Other treatment options for the extraction
of sperm are fine-needle aspiration and microdissection testicular sperm extraction (Porche,
2006b). These procedures are invasive, but highly successful at extracting the sperm.
Assisted reproduction is prescribed more than any other advanced intervention for female
factor infertility (Kendall, 2008). The main treatments used are gamete intra-fallopian transfer
(GIFT), zygote intra-fallopian transfer (ZIFT), and in-vitro fertilization (IVF) (Ward & Hisley,
2016; Kendall, 2008; Bushnik, Cook, Hughes, & Tough, 2012). GIFT is a form of artificial
insemination that laparoscopically harvests oocytes from the ovary and immediately combines
them with sperm (Ward & Hisley, 2016; Kendall, 2008). The sperm and oocytes are then
introduced back into the fallopian tubes, thus the fertilization takes place inside the body making
this form of conception more acceptable to certain religious groups (Ward & Hisley, 2016). ZIFT
is adapted from the GIFT procedure, the difference being the oocytes are fertilized outside the
body and placed in the distal end of the fallopian tubes (Ward & Hisley, 2016). GIFT and ZIFT
procedures have an average success rate of 25%-30% (Kendall, 2008). IVF takes it one-step
further by letting the fertilized oocytes develop for a few days and implanting the embryos
directly into the uterus (Kendall, 2008; Ward & Hisley, 2016). IVF has a highly variable success
rate depending on the patient and facility, but the average is 15%-30% (Kendall, 2008).
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Emotional Impact
Both men and women experience emotional difficulties that can contribute to infertility.
These include stress, anxiety, depression, loneliness, economic hardships, social stigmatization,
isolation, guilt, fear, loss of social status, desperation, and in some cases violence (Özkan,
Okumuş, Buldukoğlu, & Watson, 2013). In a society where women are called upon to not only
fulfill many roles, but also excel at them, infertility may make a woman feel as though she is
inherently broken. If she cannot contribute in such a profound way by bearing her own progeny,
she has failed (Özkan, Okumuş, Buldukoğlu, & Watson, 2013). Males can experience the same
anxiety; however, their anxiety focuses more on carrying on the family name and the threat to
masculinity (Dooley, Nolan, & Sarma, 2011). For both sexes, feelings of inadequacy can result
in conflict, sexual dysfunction, hostility, and guilt (Dooley, Nolan, & Sarma, 2011).The nurse
can use Watson’s caritas processes of being open to mysteries and allowing miracles to enter and
instilling faith and hope.
Conclusion
Couples undergoing treatment for infertility need caring and nonjudgmental care from all
healthcare providers. They need relationships based on trust, authentic listening, faith and hope
(Özkan, Okumuş, Buldukoğlu, & Watson, 2013). These needs fall into the caritas processes of
Watson’s Theory of Human Caring (Özkan, Okumuş, Buldukoğlu, & Watson, 2013). They
should be included into treatment regimen for infertility regardless of the cause.
While the causes of infertility are varied and complicated at times, most of the time,
infertility can be overcome with time and patience. Encouraging a woman with a history of
infertility to become an active participant in her pregnancy and birth can help her regain a sense
of control and stronger sense of self (Özkan, Okumuş, Buldukoğlu, & Watson, 2013). These
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women, and their partners, can then gain vindication through the successful birth of their child
(Bell, 2013).
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References
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