Chapter 7

Infertility, Contraception,
and Abortion

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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

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Infertilitycontd

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.

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Infertilitycontd

Factors associated with infertility

Male infertility
Can be caused by structural and hormonal disorders

Undescended testes
Hypospadias
Varicocele (varicose vein of the scrotum)
Low testosterone levels

Substance abuse
Other factors

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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.

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Nursing Care Managementcontd

Assessment of male

Semen analysis
Hormone analysis
Scrotal ultrasound

Assessment of couple

Postcoital test

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Nursing Care Managementcontd

Plan of care and implementation

Psychosocial
Nonmedical
Herbal alternative methods
Medical
Surgical
Assisted reproductive therapies

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Nursing Care Managementcontd

Assisted reproductive therapies

In vitro fertilization-embryo transfer (IVF-ET)

Gamete intrafallopian transfer (GIFT)
Zygote intrafallopian transfer (ZIFT)
Ovum transfer (oocyte donation)
Therapeutic donor insemination (TDI)
Embryo adoption or hosting

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Fig. 7-4. Gamete intrafallopian transfer (GIFT). A, Through laparoscopy a ripe follicle is located,
and fluid containing the egg is removed. B, The sperm and egg are placed separately in the
uterine tube, where fertilization occurs.
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Nursing Care Managementcontd

Reproductive alternatives

Adoption
Surrogate motherhood
Preimplantation genetic diagnosis

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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

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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
womans medical history

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Contraceptioncontd

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

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Contraceptioncontd

Methods

FAMs
Natural family planning (period abstinence)
Calendar rhythm method
Standard days method
Basal body temperature method
Cervical mucus ovulation-detection method

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Contraceptioncontd

Methods

FAMs
Symptothermal method
Predictor test for ovulation
TwoDay method
Lactation amenorrhea method

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Unn. Fig. 7-2. Cervical Mucus Characteristics

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Contraceptioncontd

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

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Contraceptioncontd

Hormonal methods

Combined estrogen-progestin contraceptives

(COCs)
Oral contraceptives and side effects
Transdermal contraceptive system
Vaginal ring

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Contraceptioncontd

Hormonal methods

Progestin-only contraceptives
Oral progestins (minipill)
Injectable progestins
Implantable progestins (Norplant)

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Contraceptioncontd

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)

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Contraceptioncontd

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.
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Contraceptioncontd

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.
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Abortion

Purposeful interruption of pregnancy

before 20 weeks of gestation

Elective
Therapeutic

Contributing factors
Legal and moral issues

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Abortioncontd

First-trimester abortion

Surgical (aspiration) abortion

Methotrexate and misoprostol
Mifepristone and misoprostol

Second-trimester abortion

Dilation and evacuation

Prostaglandins
Hypertonic and uterotonic agents

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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
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Key Pointscontd

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
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Key Pointscontd

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

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Key Pointscontd

Induced abortion performed in the first

trimester is safer and less complex
Most common complications of induced
abortion include infection, retained products
of conception, and excessive vaginal
bleeding

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