The role of the expanded function nurse in fertility preservation

Abstract

The women's health care nurse practitioner has a unique opportunity to provide care to women in all stages of the reproductive life span. The care and guidance provided can affect general gynecologic health and the patient's ability to conceive. Crucial decisions about contraception and life-style choices have a far-reaching impact on reproductive potential. Women must be made aware of the issues surrounding these topics so they can make appropriate choices. The nurse practitioner, in the role of primary care provider, can assist women in this decision making process.

PIP: The role of the nurse needs to be expanded to include protection of women's reproductive potential. Nursing has adjusted to the change in medical care through assistance in regaining of health in acute and extended care facilities, in health maintenance, and in acting as primary care providers in providing information on prevention. Infertility increases with age. The impact of contraceptive choices on fertility is reviewed for barrier contraception, oral contraception, IUDs, sterilization, and new contraceptive methods. At different stages in the life cycle there are methods of contraception that are more appropriate than others. The environmental effects on fertility are noted for diethylstilbestrol (DES), which may result in cell carcinoma and changes in the cervical ectropion, uterine, and tubal anomalies; these effects in turn may lead to decreased fertility or fetal loss. DES may also affect male fertility. Chemicals in the workplace such as lead, ionizing radiation, ethylene oxide, and dibromochloropropane are Federally regulated because of deleterious effects on reproduction. Other metals and chemicals that may affect fertility are indicated. The prevention of sexually transmitted diseases has a significant impact on preservation of fertility. Life style choices and counseling at early stages of disease are important considerations. Women who smoke have an earlier menopause, have reduced estrogen levels, and increased vaginal bleeding. Infant mortality is higher among women who smoke. Fetal alcohol syndrome is known, but alcohol's effect on fertility is not well documented. Adolescent drug use may lead to later dysfunction. Marijuana use in adults has been related to decreased levels of follicle stimulating hormone, luteinizing hormone, and prolactin, which appears to be reversible in adults. Exposure to high levels of heat is related to male infertility (sperm quality and number); increased scrotal temperature may be caused by febrile illness, varicocele, hot tub usage, and tight jockey shorts. Fertility impairment may be related to a previous medical or surgical intervention. Options are available for organ preservation rather than outright removal. General health conditions related to infertility are identified. The nurse practitioner as a preconception counselor may screen for potential infertility and collect a routine history and physical examination including testing.