Infertility Nursing - Omnia Education

More documents

Recommendations

Info

tHE OMnia cME JOURnal tm | sEPtEMBER 2011 15. Pinborg, a. iVF/icsi twin pregnancy: risks and prevention. Hum Reprod Update 2005:11: 575-93. 16. gardner dK, surrey E, Minjarez d, leitz a, stevens J and schoolcraft WB. single blastocyst transfer: a prospective randomized trial. Fertil&Steril. 2004; 81,551–555. 17. Hunault cc, Eijkemans MJc, Pieters MHEc, teVelde ER, Habbema JdF, et al. a prediction model for selecting patients undergoing in vitro fertilization for elective single embryo transfer. Fertil&Steril. 2002; 77(4):725-732. 18. scotland, g., Mcnamee, P., Peddie, V. and Bhattacharya, s. safety versus success in elective single embryo transfer: women’s preferences for outcomes of in vitro fertilisation. BJOG: Inter J of Obstet & Gyn. 2007; 114: 977–983. 19. thurin a, Hausken J, Hillensjo t, Jablowska B, et al. Elective single embryo transfer: the value of cryopreservation. N Engl J Med; 2004; 351:2392- 2402. 20. templeton, a. avoiding multiple pregnancies in aRt: replace as many embryos as you like-one at a time. Hum. Reprod. 2000; 15: 1662. 21. Ryan gl, sparks aEt, sipe cs, et. al. a mandatory single blastocyst transfer policy with educational campaign in a United states iVF program reduces multiple gestation rates without sacrificing pregnancy rates. Fert & Steril. 2007; 88(2):354-360. 22. Veleva Z, Karinen P, tomas c, tapanainen Js, & Martikainen H. Elective single emryo transfer with cryopreservation improves the outcome and diminishes the costs of iVF/icsi. Hum Reprod. 2009; 1(1):1-8. 23. scott Rt,tao X,taylor d,Ferry KM,treff nR. a prospective randomized controlled trial demonstrating significantly increased clinical pregnancy rates following 24 chromosome aneuploidy screening: biopsy and analysis on day 5 with fresh transfer. Fertil & Steril 2011. 94(4): s2. 24. Findlay i. Pre-implantation genetic diagnosis. Br. Med. Bull. 2000; 56(3):672-690. 25. Harper Jc, Bui tH. Pre-implantation genetic diagnosis. Best Prac & Res Clin Obstet Gyn. 2002; 16(5):659-670. 26. stern JE, cedars Mi, Jain t, et al. assisted reproductive technology practice patterns and the impact on embryos transferred guidelines in the Us. Fertil & Steril. 2007 aug; 88(2): 275-82. 27. schoolcraft WB, Fraquoli E, stevens J, et al. clinical application of comprehensive chromosomal screening at the blastocyst stage. Fertil & Steril. 2010; 94(5):1700-6. 28. 2010, december 22. single Embryo Beat double Embryo transfer in iVF study. Health Day News. http://www.drugs.com/news/single-embryo-beatdouble-embryo-transfer-ivf-study-28537.html.
The Patient and Multiple Births: Blessing or Burden To many infertile couples, the idyllic image of double strollers and an instantly complete family may sound too good to be true. However, the reality of conceiving, carrying, delivering, and raising multiples is often drastically different than the image held strongly in the minds of many hopeful patients. the very real risks of carrying multiples are to be conveyed honestly, clearly, and compassionately. the occurrence of multiples has drastically increased since the advancement of fertility technology, and a real assessment of our approach to this subject is necessary. 1 assisted reproductive technology (aRt) increases a woman’s chance of conception by hyperstimulating her ovaries, ensuring close contact between egg and sperm via ovulation induction with timed intercourse, intrauterine insemination (iUi), or in vitro fertilization (iVF) with subsequent embryo transfer (Et). Frozen embryo transfers (FEt) are another means to conception, with lower success rates, compared to its fresh counterpart. Patients pursuing these avenues of conception have likely faced over a year of struggle with infertility. their emotional investment and physical burden often leave them in a state of desiring twins, triplets, or higherorder pregnancies in order to achieve a complete family in one cycle. Recently, a few studies have highlighted the great disconnect between dream and reality, exhibiting that some infertile couples view a multiple fetal pregnancy as the ideal outcome. 2 this poses a great risk not only to the health of the mother and expected children, but also to the expectations of parenthood held by the infertile couple, as a unit. While there are some cases where twins, triplets, and even higher-order pregnancies can be successfully carried to their respective term dates, and may experience a complication-free delivery and neonatal period, the risk is often too great to take. 3 in order to preserve the health and wellness of both patient and child(ren) while honoring their unique wishes as a family, it is important to follow a simple yet effective protocol: hold an honest conversation to further understand the patients’ perspectives, educate them on the very real risks and complications of carrying multiples, and collaborate to create a treatment plan that is both safe and realistic. taking into consideration the great emotional and physical burdens experienced by the infertile patient, it is not too surprising that they may view multiples as a blessing. if the patient is uneducated with respect to the very real risk and burden associated with twin, triplet, and higher-order pregnancy, they will likely request a more aggressive and risky protocol than may be necessary. in the case of conception and successful live births of a multiples pregnancy, an uneducated patient may not have the proper support system in place for the challenging neonatal and postpartum periods. as practitioners, it is our responsibility to fulfill our roles as educators, caretakers, and advocates, in order to protect our patients and their expanding families. The Allure of Multiples after what may have been years of trying to conceive, financial sacrifice, and emotional struggles such as, “… distress, loss of control, stigmatization, author Margaret Marnell, fnp Family Nurse Practitioner CNY Fertility Center syracuse, ny peer reviewers Adrienne Kramer, rn, rnc Senior Nurse Coordinator Reproductive Medical Associates of New Jersey morristown, nj Eric S. Surrey, md, facog Medical Director Colorado Center for Reproductive Medicine lone tree, co medical editor Erem Latif, ms, medical physiology Medical Editor chantilly, va and a disruption in the developmental trajectory of adulthood,” 4 the idea of achieving a complete family in one cycle is going to appear ideal. never having to worry about attempting to conceive again, ensuring a full house, and sense of completion, are just a few benefits of having multiples in the eyes of the infertile patient. Regardless of the risks involved, the idea of a bustling home after years of feeling empty is a challenging emotion to overcome. abandoning the known and unknown risks of multiples, many couples are choosing to pursue aggressive treatments, sometimes even with the hope of conceiving twins or triplets. a recent study revealed that many women pursuing in vitro fertilization (iVF) would prefer to deliver a child with severe disabilities, as sometimes associated with double or multiple embryo transfer, than experience an unsuccessful cycle resulting in no child. 5 Understanding the magnitude of grief, loss, and struggle associated with infertility is critical 12
Page 1 and 2: the Omniacme journaltm special edit
Page 3 and 4: Beyond Clomiphene - What’s Next?
Page 5 and 6: centers may perform 2 iUis once at
Page 7 and 8: conclusion Beyond clomid, infertili
Page 9 and 10: higher order multiples, twin gestat
Page 11: considered normal only if it has 2
Page 15 and 16: even spiritual support opportunitie
Page 17 and 18: POst-tEst instructions for credit P
Page 19 and 20: Receive up to 15 Credit Hours ! 5 R

Infertility Nursing - Omnia Education

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?