Infertility Nursing - Omnia Education

tHE OMnia cME JOURnal tm | sEPtEMBER 2011
to 15 days after retrieval (as a result of
the hcg if pregnancy occurs). the risk
of severe complications is about 4 to 12
times higher if pregnancy occurs, which
is why sometimes no embryo transfer is
performed to reduce the possibility of
this occurring. 9
Early signs and symptoms of OHss
include abdominal bloating, pelvic pain,
weight gain of 1-2 pounds, nausea and/
or vomiting, decreased urine output, and
shortness of breath. Patients who are
considered at risk need to be educated
on the signs and symptoms as well as
the potential severity of OHss. Patients
should be instructed to notify their nurse
or physician immediately with onset
of any of these signs and symptoms.
Patients at risk should be cautioned to
limit their activities and increase PO
fluids. Physicians, working with patients
at risk for OHss, should consider low
gonadotropin dose initially as well as
frequent monitoring and adjustment
of dosage during cycle if needed.
cancelation of the insemination is
sometimes the best prevention of OHss
as well multiple pregnancies. iVF patients
may benefit from having egg retrieval
and cryopreservation of embryos.
figure 1
Indication for Ovulation Induction or COH
WHO type I- anovulation
(Hypogonadotropic hypogonadism)
WHO type II - (hyperandrogenic-PCOS/
Oligomenorrheic)
unexplained infertility including
Endometriosis I & II (no iUi)
unexplained Infertility including
Endometriosis I & II (with iUi)
% Pregnant
(per cycle)
Total % Pregnant
after 4 cycles
29% 67%
18-19% 30-58%
7.7-8% 19%
17.1-18% 33%
Fluker et al. 1994
guzick et al. 1998 &1999
reassuring for patients
no increased risks
Miscarriage Rate: 20-25%, about equal
to the general population and is age
dependent.
Ectopic Pregnancy Rate: 2-5%, equal
to or slightly higher than the general
population.
congenital anomalies: the risk is equal
to the general population. 10
Ovarian cancer: “no convincing
association was found between use of
fertility drugs and risk of ovarian cancer.
Furthermore, no associations were found
between all four groups of fertility drugs
and number of cycles of use, length of
follow-up, or parity.” 11
results of ovulation induction/
controlled ovarian hyperstimulation
with gonadotropins
the results of Oi/cOH presented in
figure 1 are dependant upon many
factors including primary diagnosis,
the woman’s age, quality of sperm, and
quality of pelvic anatomy, as well as
other diagnoses that may be present.
the results presented below are from the
literature. they are listed to provide you
with an overall perspective regarding the
general effectiveness of this therapy.
in a retrospective review of over 450
treatment cycles, Fluker et al., examines
the cumulative pregnancy rates in cOH
cycles in WHO group i & WHO group
ii patients. 12 in another retrospective
analysis of 45 published reports, guzick
et al. suggests that empiric gonadotropin
therapy is an effective therapy for
unexplained infertility, especially when
combined with iUi. 13 guzick then showed
in a large randomized multicenter trial
that FsH combined with iUi yielded
higher cumulative pregnancy rates than
FsH alone. 14 it should be noted that
maternal age was a significant predictor
of conception in all of these studies. 12-14
Each patient should discuss their specific
case with their doctor in order to
determine their prognosis and potential
success rates.
assisted reproductive
technologies (art)
although, cOH/iUi results can be
promising, some patients may choose to
go directly to iVF following failed cc
treatment to optimize their outcome.
this has been demonstrated as a rational
and cost effective approach by Fastt—a
randomized clinical trial comparing two
groups of treatment regimens, one with
a “faster” approach. the first treatment
group has a more traditional approach of
following clomiphene/iUi treatment by
cOH/iUi before moving on to iVF which
is compared to a second more aggressive
approach of clomiphene/iUi followed
by moving directly on to iVF. the main
outcome measure was the time it took to
establish a pregnancy that led to a live
birth and cost-effectiveness. Reindollar et
al. results demonstrated an increased rate
of pregnancy observed in the accelerated
arm compared with the conventional arm. 15