Question

L.B. and her husband, come to the clinic, saying they want to become pregnant. L.B. is 29 years old and a self-employed photographer. J.B. is 31 years old and a dispatcher with a local oil and gas company. They have been married for 4 years and have been trying to become pregnant for just over 2 years. L.B. has not been pregnant previously; J.B. says he has never gotten a girl pregnant “that he knows of.” 1. Is this couple infertile? Defend your response. 2. What type of infertility does the couple have, primary or secondary? 3. What are the common causes of male infertility? 4. What are the common causes of female infertility? 5. Describe the reproductive and sexual history you need to obtain from the couple. 6. In addition to performing a general physical examination, what lab tests do you expect the provider to order? Chart View General Assessment L.B. J.B. 29 years old 31 years old BMI 26.1 BMI 27.4 Reproductive structures normal Slightly irregular menses with a cycle of 28-35 days No problems with erection or ejaculation Nonsmoker; nondrinker Nonsmoker; drinks 1-2 alcoholic beverages weekly Both report their spouse has been their only sexual partner for the past 6 years. They engage in intercourse an average of 2 to 3 times per week and deny any sexual problems. L.B. had been using oral contraceptive pills for about 4 years prior to their attempting to conceive. She says her menses were regular before using the oral contraceptives, but once she stopped using them, regular menses did not resume. Both deny any history of the urinary tract and sexually transmitted infections. Their general physical assessments are remarkable except for their BMIs. Neither engages in any regular physical exercise. The provider orders an ultrasound for L.B. and lab testing for both. L.B. is to begin performing basal body temperature (BBT) charting in conjunction with using an ovulation kit. 7. J.B. needs a semen analysis. What instructions will give you him about specimen collection? Select all that apply. a. Keep the container in an insulated bag with ice. b. Bring the specimen to the office within 8 hours. c. Place the specimen in a clean container for transport. d. He can collect the specimen in a sterile, nonlubricated condom. e. He should not have sex or ejaculate for 2 to 5 days before the procedure. 8. What information is obtained from a semen analysis? 9. The provider orders follicle-stimulating hormone (FSH), estradiol, and progesterone levels for L.B.; a luteinizing hormone (LH) level for J.B.; and TSH levels for both. When will you schedule these tests? 10. What is the purpose of BBT charting? 11. What teaching will you provide L.B. on how to perform BBT charting? 12. Outline the teaching you will provide L.B. on how to use an ovulation kit. 13. Because lifestyle and sexual practices can affect fertility, what do you encourage the couple to do to enhance their ability to conceive? Select all that apply. a. Relax in a hot tub daily before going to bed. b. Avoid the use of artificial lubricants during sex. c. Have them drink alcohol before sex to help relax. d. Eat a healthy diet with plenty of fruits and vegetables. e. Use strategies that are usually helpful in reducing stress. f. Engage in moderate exercise for 30 minutes, 3 to 4 times per week. 14. As you are finishing the appointment, L.B. begins to cry out and says, “I can’t believe this is happening to us when all of my friends are just popping out babies.” How do you respond? Chart View (Fill in the empty boxes with the appropriate information) Laboratory Results L.B. Normal Results J.B. Normal Results Color of Vacutainer Used to Obtain Sample Progesterone low Testosterone normal Estradiol normal LH normal FSH normal TSH normal Seminal parameters normal Pelvic ultrasound normal J.B.’s semen analysis reveals no apparent problem. L.B. appears to be ovulating normally. BBT charting captures a change in temperature, and ovulation testing reveals an LH surge. The provider suspects L.B. may have a luteal phase defect because her progesterone levels are low after ovulation. The provider decides to order a hysterosalpingogram (HSG) for L.B. 15. How will you describe an HSG to the couple? 16. You tell L.B. that it is important for her to call the office when her menstrual cycle starts so the HSG can be scheduled between days 7 and 20 of her cycle. It is important they abstain from sex between the first day of her cycle until after the test. L.B. asks why. What do you tell her? The HSG was normal, with no blockage to the fallopian tubes. The provider speaks with the couple about starting L.B. on clomiphene (Clomid) and progesterone vaginal suppositories, starting 2 days after ovulation. 17. What is the expected outcome associated with each of these medications? 18. You determine that L.B. understands your teaching about clomiphene therapy when she says: (Select all that apply.) a. “I do not need to use the LH testing kits anymore.” b. “There is a higher risk of my having twins, or more.” c. “I will take this medicine orally for 5 days each month.” d. “I may experience some flushing and breast tenderness.” e. “My husband will need to learn to give me daily injections.” On the fourth round of clomiphene, L.B. and J.B. were successful in becoming pregnant. She delivered an 8 pound, 7-ounce (3827 grams) baby boy vaginally at 38 weeks after having induced labor because of mild preeclampsia.

Answer 1

1.The couple is having infertility problem because any couple who is in sexual relationship without use of any contraception for twelve months is considered infertile .

2.The couple is experiencing primary infertility problem because this couple has not conceived previously .

3.The common cause of male infertility are

• Any disorder related to sperm production ,ejaculation problems ,sperm defects
• Diabetes ,cryptochidism, endocrine problems ,varicocele,torsion ,etc.,
• Infection
• Genetic or hereditary
• Smoking
• Exposure to metals
• Hot tub baths frequently
• Medication like steroids
• Lifestyle factors like stress
• Use of radiation prone devices in close contact with reproductive area

4.The common causes of female infertility are

• Hormonal imbalance
• Structural abnormality which occurs in the reproductive system
• Any major obstetric surgery
• Stress
• Diet ,lack of exercise
• Medical condition
• Problem associated with menstrual cycle, ovulation ,implantation etc.,
• Congenital or hereditary problems