- You should respond to your peers by extending, refuting/correcting, or adding additional nuance to their posts.
- All replies must be constructive and use literature where possible.
Ferlanda Pierrelus.
Female Patient Cases 2
A diagnosis of infertility is not made until after a couple has sought conception for 12 months; hence, the examination does not begin until this time period has passed. Women over the age of 35 or who have medical issues that may impede fertility should be evaluated earlier (Schuiling & Likis, 2022), which is the case of Ms. R.T.
Infertility evaluation begins with a detailed history and physical examination. Gynecologists frequently conduct a limited assessment of male partners (e.g., getting pertinent history and ordering semen tests) and then send men to a urologist or other male reproduction expert if additional evaluation is required. Diagnostic tests for infertility are most beneficial and cost-effective when performed logically ( Shuilling et al., 2022). To begin, the practitioner must collect an accurate and complete history from R.T. and her partner. This history will help determine which diagnostic tests to perform, the urgency with which they should be performed, and when R.T should return for a follow-up visit. R.T. and her lover should ideally be interviewed separately and then together to ensure a thorough review.
The most fundamental and straightforward diagnostic tests that should be conducted at an initial evaluation are documentation of ovulation detection and semen analysis from the male partner or donor. Laboratory testing, sonohysterosalpingography, hysterosalpingography, a transvaginal ultrasound, hysteroscopy, laparoscopy, postcoital testing, endometrial biopsy, and sperm penetration assay may be necessary. The history should inform the clinician’s judgment regarding which tests are required and avoid wasting time and money. Generally, evaluations progress from the least invasive to the most invasive testing. If a woman is menstruating, it is ideal to schedule the infertility evaluation around her menstrual cycle. Numerous tests can be performed within the same month without interfering with her capacity to conceive ( Schuilling et al., 2022). Serum tests are typically used to diagnose infertility and guide treatment. The hypothalamus, pituitary gland, thyroid gland, and ovaries all release-critical hormones during conception; Thyroid-stimulating hormone (TSH), free thyroxine (T4), and prolactin levels are frequently checked at the initial exam, as women can have silent thyroid illness or hyperprolactinemia (Dunphy, Winland-Brown, Porter, & Thomas, 2019).
The differential diagnosis of infertility consists of the following:
- N80.9 – Endometriosis, unspecified
- N85.6 – Asherman’s syndrome
- D25.9 – Leiomyoma of the uterus, unspecified
Infertility treatments are typically cause-specific. Occasionally, treatments are broad in scope because infertility cannot be discovered (unexplained infertility). Treatment approaches in these cases involve a slew of complex considerations about risks and benefits. Typically, the least invasive and least expensive treatment option is offered first. If this is ineffective, more intrusive and costly procedures are used to treat the patient. Throughout the therapy process, therapists must consider the woman’s and her partner’s physical and emotional health, financial resources, and overall well-being ( Schuilling et al., 2022).
Clomiphene citrate, which is suggested for anovulatory or unexplained infertility, is the first-line medicine for ovulation induction in women who do not have polycystic ovarian syndrome (PCOS) ( Schuilling et al., 2022).
Letrozole is now the first-line medicine for inducing ovulation in women with PCOS. Letrozole is also used as a backup medication for women who cannot conceive with clomiphene citrate ( Schuilling et al., 2022).
For some women, education about how to time intercourse with ovulation is required to boost conception rates. Additionally, the infertility evaluation is an excellent moment to recommend health-promoting behaviors. Among the behaviors that may promote fertility mainly include achieving a BMI of 20 to 25 if the woman is underweight or overweight, quitting smoking for both couples, and lowering alcohol and caffeine consumption (to four or fewer drinks per week and less than 250 mg per day, respectively) (Schuilling et al., 2022).
Pelvic inflammatory disease (PID) is characterized as an infection-related inflammation of the upper vaginal tract in women. The uterus, fallopian tubes, and ovaries are all affected by the condition. It is often an ascending infection that begins in the lower genital tract and spreads upward. A sexually transmitted infection most frequently causes PID. If left untreated for an extended time, it can result in consequences such as ectopic pregnancy, infertility, chronic pelvic pain, and tubo-ovarian abscess (Dunphy, Winland-Brown, Porter, & Thomas, 2019).
References
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (Eds.). (2019). Primary care: The art and science of advanced practice nursing (5th ed.).
Schuiling, K. D. & Likis, F. E. (2022). Gynecologic Health Care with an Introduction to Prenatal and Postpartum Care (4th Ed).
0 comments