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Nursing Assessment of Individuals Presenting For Fertility Evaluation Print E-mail

PURPOSE: To outline the nursing management of patients/couples presenting for fertility evaluation

DIRECT ASSESSMENT ACTIVITIES

HISTORY:

  1. Demonstrate knowledge of the components of a comprehensive histor
  2. Elicit comprehensive medical and reproductive history including general medical, gynecologic/ andrologic, genetic, lifestyle and psychosocial (sexual/ mental health/ violence history, resources) information
  3. Clarify inconsistencies and omissions

PHYSICAL EXAMINATION:

  1. Demonstrate knowledge of the physical exams performed routinely and on an ad hoc basis
  2. Obtain consent and prepare the patient appropriately
  3. Provide assistance to MD/ Ultrasonographer or perform examinations observing Institutional/ Professional standards for aseptic technique, patient privacy
  4. Obtain height, Weight, BMI
LAB:
  1. Demonstrate knowledge of the lab investigations requested routinely and on an ad hoc basis, and knowledge of appropriate scheduling; Demonstrate knowledge of the range of normal values for routine investigations
  2. Record available lab results; report abnormal findings
  3. Evaluate need for repeat/ further testing; request lab tests as per clinic protocol and/ or specific MD order (see Appendix)

PATIENT TEACHING:

  1. Assess patient/ couple educational needs
  2. Apply concepts of adult learning to the patient/ couple teaching regarding completion of infertility investigations ordered by the physician; Review the requested investigations with the patient/couple including discussion of:
    * Test description / rationale for the test
    * Discomforts/ risks where applicable
    * Scheduling
    * Fees (refer for financial/insurance counselling as indicated)
  3. Address lifestyle choices including:
    * Diet & BMI
    * Vitamin supplement (e.g. folic acid),
    * Recreational drugs (e.g. alcohol, cigarettes, etc)
    * Exercise
    * Sexual health
  4. Provide educational materials outlining procedures/ investigations treatment and the diagnosis of infertility.
  5. Confirm understanding and invite questions from the patient/couple


COUNSELLING:

  1. Demonstrate knowledge of the psychosocial challenges/ issues accompanying infertility
  2. Describe the possible impact of an emotional and financial commitment to treatment.
  3. Identify individual/couple/ family strengths and resources.
  4. Assess and address patient/ couple concerns
  5. Assess the need for psychology referral; Encourage professional intervention for resolution of grief, conflict, altered self-image.

REFERRAL:

  1. Demonstrate knowledge of the appropriate local/ regional/ national (and including internet) resources.
  2. Identify relevant local and regional support programs (e.g. IAAC or other peer support) for individuals with related fertility issues and provide referral information to the patient/couple.
  3. Identify and inform the patient/couple regarding general and specialized (e.g. psychologist/ counsellor, nutritionist, smoking cessation, etc) resources as needed.

ADVOCACY:

  1. Assess the patient/couple concerns (in general, and related to testing).
  2. Present patient or nursing identified issues for discussion and evaluation at nursing, medical or team conferences.
  3. Participate in ongoing evaluation of the medical plan for testing of the patient/couple.
  4. Participate in team discussion of clinic policies regarding diagnostic testing.

TREATMENT COORDINATION:

  1. Demonstrate knowledge of Clinic/ Institutional policies and procedures
  2. Devise a plan of care based on Clinic/ Institutional procedures and nursing assessments
  3. Identify and plan next steps to be followed by patient/couple and by the clinic in order to pursue investigation; provide appropriate requisitions/ Consultation forms
  4. Identify potential problems and problem solve related to these
  5. Review timeline and expectation regarding the review appointment
  6. Provide continuation of care (eg phone contact info) where possible
  7. Confirm understanding and invite questions from the patient/couple

DOCUMENTATION:

  1. Record subjective and objective assessments.
  2. Document verbal information given to the patient/couple, nursing interventions, and dissemination of education materials
  3. Document patient/couple concerns/issues and their disposition, along with nursing assessment and plan to address these.

Accepted by NSIG Standard Committee on …………………………….

Revision Date: …………………………

Appendix 1a: INVESTIGATIONS DONE IN THE INVESTIGATION OF FEMALE FERTILITY

CONTENT: This list includes, but is not limited to, the assessment of the female patient in a Fertility Clinic setting. The physician may decide to include all, some, or add to these examples.

ASSESSMENTS:

a. Physical exam
b. Cultures:

  • General culture (+ sensitivity)
  • Chlamydia
  • Mycoplasma/ ureaplasma
  • Gonorrhea
  • Pap test

c. Endometrial biopsy

d. Imaging:

  • Pelvic ultrasound
  • Hysterosalpingogram (HSG)
  • Sonohysterogram

e. Hysteroscopy, Laparoscopy

f. Lab:

Endocrine
FSH, LH, E2, Progesterone
TSH, Thyroid Function, Prolactin, Testosterone, DHEAS
Serology HBsAg, HCV, HIV, Rubella, Varicella, VDRL, Anti HTLV 1-2, CMV IgG (+IgM)
Hematology CBC, Pt, PTT , Sickle Cell/ Thalassemia screen
Blood Group
Genetic Karyotype, CF, Thalassemia, Sickle Cell, Ashkenazi profile


g. Add’l. Investigations for Recurrent Pregnancy Loss may include:

Thyroid peroxidase antilbody
Circulating anticoagulant
Prothrombin G20210A mutation
Factor V Leiden
Anti cardiolipin Activated Protein C resistance
Protein C Protein S
Anticardiolipin antibody (IgG, IgM)
Lupus anticoagulant


Appendix 1b: INVESTIGATIONS DONE IN THE INVESTIGATION OF MALE FERTILITY

CONTENT: This list includes, but is not limited to, the assessment of the male patient in a Fertility Clinic setting. The physician may decide to include all, some, or add to these examples.


ASSESSMENTS:


a. Physical exam

b. Cultures:

  • Chlamydia
  • Gonorrhea

c. Lab:

Andrology Semen Analysis + MAR test
Endocrine FSH, LH, Free Testosterone, Total Testosterone, TSH, Prolactin
Serology HBsAg, HCV, HIV,

VDRL, Anti HTLV 1-2, CMV IgG (+IgM)

Hematology

 CBC, Pt, PTT , Sickle Cell/ Thalassemia screen
Blood Group
Genetic
Karyotype, CF, Thalassemia, Sickle Cell, Ashkenazi profile