Question

This 41-year-old client presented to the office in March of 2014 with infertility. She had a height of 5’6” and a weight of 131 lb, putting her at a healthy BMI of 21.1. She presented with a diagnosis of infertility, PCOS, irregular menstrual cycles that were anovulatory (based on laboratory work and menstrual charting using basal body temperature), ovarian cysts, fatigue and depression (from previous clomiphene use), and breast pain. She slept an average of 8 hours per night, was gluten- and dairy-free, and had a family history of cancer and diabetes. She and her husband had been trying to conceive for 8 years. She had a history of a single miscarriage.

1. What would be the education acceptable to provide this client

2. What presenting health conditions should be a concern

3. How can we differentiate between fertility and Infertility

Answer 1

1. Education for the client:

* Educate the client regarding infertility and it causes

* Instruct the client to have healthy diet. Include green leafy vegetables, cereals, lentils , whole grains, fish , dried fruits and nuts etc for proper ovulation.

* Instruct client and her husband , not to smoke as smoking reduces the fertility .

* stay physically active with regular exercise.

* Encourage to have physical intercourse atleast 3 to 4 times a week to increase the chance of pregnancy.

* Drink more water on the fertile days, it may increase the quality of cervical fluid by helping the kidney to excete out more waste.

* Avoid alcohol and caffeine. caffeine constricts the blood vessels, there by reducing the uterine blood supply.

* practice relaxation and stress management techniques.

* lying down for few minutes after sex can retain more sperms in uterus.

* strictly take any medications as per physician's order only.

* Keep a menstrual cycle calendar to know the fertile days.

* Explain about different infertility treatments available, if needed.eg: Intrauterine insemination, In vitro fertilization.

2. Health conditions of concern:

The client is having many health conditions that negatively affect the chance of consumption:

* PCOS

Polycystic ovary Syndrome : A syndrome characterised by Polycystic ovaries , menstrual disturbance and high levels of androgens. It may affect ovulation and increases the chance of infertility.

* Irregular menstrual cycle with anovulation: During a menstrual cycle, ovaries are not able to release oocyte or ovum. This condition is called Anovulation. If there is no ovum, then no fertilization.

* Ovarian cyst: Cysts , within or surface of the ovaries. Cyst is a fluid filled or solid sac or pockets.

* Depression and fatigue :Depression is a Mental illness characterised by depressive cognitions such as helplessness, hopelessness, worthlessness , negative self image or low self esteem and suicidal ideations ( in severe depression). Fatigue and depression in the client are associated with medication side effects .

* miscarriage : The spontaneous natural termination of pregnancy. Previous miscarriages may increase the chance of infertility in woman.

3: Fertility and Infertility

Fertility is the natural capacity to produce offspring. ( In demographical data: Fertility is the aveage number of births per woman within a population)

Infertility is the inability to conceive children. The most common cause of infertility in woman is the problems with ovulation or Anovulation. There are two types of infertility: Primary and secondary. After one year of unprotected sex , if the couple are not able to conceive, then it is called primary infertility. Second infertility refers to the inability of the couple to be pregnant now, but previously they are able to get pregnant, atleast once.