Midlife women's health.

The purpose of developing midlife women's health programs is to enhance the overall physical and mental health of the woman and to promote health habits necessary to ensure a healthy and active older woman. To design these programs, the demographic characteristics and health habits of women must first be examined. Innovative approaches are greatly needed as factors such as accessibility and cost are considered.

Endometriosis.

Endometriosis is a common disease associated with pelvic pain and infertility. The etiology and physiology are poorly understood, often frustrating clinicians and patient. Treatment may be medical or surgical, or a combination of these. Nursing care involves education of couples about endometriosis and its physical and psychological implications.

Pregnancy after infertility.

The perinatal nurse has an opportunity to provide specialized nursing care to couples who have achieved pregnancy after infertility. The emotional aspects of infertility and their relationship to the prenatal and early postpartum period are explored.

Selection of superior stimulation protocols for follicular development in a program for in vitro fertilization.

Classification of stimulated controlled follicular development cycles in programs for in vitro fertilization by the likelihood of culminating in a pregnancy would allow for increased efficacy in patient management and the distribution of care provider services. Analysis of human menopausal gonadotropin stimulations by the estradiol (E2) patterns identified trends suggesting superiority of one pattern, but no statistically significant difference was identified. Similarly, trends were identified in the Norfolk data for the height and pattern of E2 response, but no statistical significance was identified. While these observations may become significant with larger numbers, until that time, criteria for altering patient management based on the rise of follicular phase E2 levels should be reconsidered.

Antiestrogenic effect of clomiphene citrate: correlation with serum estradiol concentrations.

The antiestrogenic effect of clomiphene citrate (CC) on cervical mucus was evaluated in women receiving 150 mg CC daily for 5 days. Daily cervical mucus scores and serum estradiol (E2) concentrations were determined in control (n = 25) and CC (n = 24) cycles. E2 concentrations were significantly higher in the CC-treated women (mean +/- standard error of the mean, 1254 +/- 102 pg/ml versus 337 +/- 18 pg/ml, P less than 0.0001). Despite supraphysiologic E2 concentrations, however, cervical mucus scores were significantly reduced in the CC-treated group (P less than 0.01). These data indicate that CC exerts a direct suppressive effect on cervical mucus despite markedly increased E2 concentrations.

Outcome of progesterone treatment of luteal phase inadequacy.

Diagnosis, choice of therapy, and pregnancy outcome were analyzed in 79 women evaluated for luteal phase inadequacy. Criteria for the diagnosis were established, and groups at risk for luteal inadequacy were identified. Treatment choices, tailored to the suspected cause, included progesterone suppositories in 54 women, with 23 pregnancies and 19 deliveries; clomiphene citrate in 6 women, with 2 pregnancies and deliveries; and combined treatment in 7 women, with 5 pregnancies and 4 deliveries. Eight women received no treatment, including three who underwent endometrial biopsy in the cycle of conception and who subsequently delivered. These data suggest that careful diagnosis and the proper choice of treatment are important, and that progesterone supplementation may result in improved pregnancy outcome for patients with infertility and pregnancy wastage who have luteal phase inadequacy.

Combined screening laparoscopy and timed follicle aspiration for human in vitro fertilization.

Twenty-seven patients underwent ultrasonographic and clinical monitoring of a spontaneous cycle so that human chorionic gonadotropin administration could be timed in an attempt to schedule the screening laparoscopy at the optimal time for oocyte aspiration. Inadequate ovarian access was encountered in only 2 of 26 laparoscopies. Seven patients had ovulated by the time of scheduled laparoscopy. Nine mature, seven immature, and three postovulatory oocytes were obtained, and seven embryo transfers were accomplished. The number of eggs obtained per laparoscopy was 0.73. The attempt to control the time of ovulation was unpredictable, few mature oocytes were obtained, and the procedure offered little ultimate benefit to the patient.

In vitro fertilization and embryo transfer.

In vitro fertilization is one of the newest approaches to infertility. Opportunities for nurses in IVF involve teaching couples about physiology, providing technical assistance and care, and counseling about the medical and emotional aspects of the program. Many times the nurse serves as the primary support person for couples and as their advocate with other team members.