2. References:  SDL refer to year one anatomy and physiology notes for female and male reproductive systems.  Papalia, D.E.,. & Feldman, R.D. (2012) Experience Human Development.12t h Edition, McGraw Hill. New York.  Google images  Crisp, J.C. & Taylor, C.T. (2013) Potter and Perry’s fundamentals of nursing, 3 rd edition Mosby.  Course Book of readings

3. Female internal reproductive system: Key terms: -pelvis, -

4. -uterus, fundus, cervix, endometrium, fallopian tubes (ampulla ) ovary, vagina.

5. Male reproductive system: Testes, seminiferous tubules (contain sperm cells), ducts and glands, vas deferens

6.  Female reproductive cycles: two cycles simultaneously 1. Ovarian cycle -immature follicles mature under the influence of FSH and LH until ovulation occurs. -luteal phase ( ovum leaves the follicle and corpus luteum develops

7. 2. Menstrual cycle: -menstrual phase (days 1-5) -proliferate phase (days 6-14) -estrogen peaks prior to ovulation, -cervical mucus at ovulation is clear, thin, slippery and favourable to sperm. At ovulation, body-temperature drops, then rises sharply and remains elevated.

8. - secretory phase (days 15-26) oestrogen drops sharply and progesterone dominates. -ischemic phase (days 27-28) both oestrogen and progesterone levels drop.

11. Pre conceptual / pre pregnancy health -aims of pre pregnancy care and advice 1. the woman conceives. 2. the mother and fetus remain healthy after conception to reduce adverse factors for the newborn. 3. reduce the factors which may cause pre maturity, low birth weight and congenital abnormality.

12. Physical aspects female: -weight / height -nutritional status: well balanced diet -folic acid (MOH recommends 0.8 mg daily from 4 weeks before conception to 12 weeks after

13. Screening -blood test :haemoglobin, rh factor, rubella, antibodies, hep B, vdrl, Aids, pap smear, -dental examination -contraception

14. Life style aspects -good nutrition: increased iron intake / protein / vitamins & minerals WHY? -sleep and rest -exercise: remain fit to cope with the demands of pregnancy and labour

15. -smoking tobacco -coffee / tea in excess -alcohol -drugs: prescription -drugs of abuse -work: occupational hazards -environmental aspects eg radiation…. ………..attention to avoid teratogens

16. Existing medical condition -how a pregnancy may affect the condition ? e.g. heart disease, asthma, diabetes, std and -how the condition may affect the pregnancy? Existing family conditions

17. Genetic counselling Enables couples who have a concern about passing on particular hereditary diseases, disabilities or congenital abnormalities to their prospective children, to discuss their concerns and gain information so as to be able to make an informed decision about their reproduction.

18. “What are our chances of having a child with….?” -genetic services in New Zealand are free but available in Auckland and Wellington centres (0800 476 123)

19.  Essential components of fertility

20. Essential components of fertility (female): 1. -vaginal secretions and cervical mucus must be favourable to sperm 2. -clear passage from the uterus to the fallopian tubes. 3. -fallopian tubes are patent and have normal peristaltic movement.

21. 4. - ovaries produce and release ova. 5. -endometrium must be favourable for embedding of the blastocyst. 6. -adequate hormones must be present (progesterone, leutenising hormone, follicle stimulating hormone oestrogen).

22. Essential components of fertility cont. (male). 1. -testes must produce spermatozoa of normal quality, quantity and motility. 2. -clear tubes 3. -secretions must be normal 4. -sperm need to be deposited in the female genital tract to reach the cervix.

23. Fertility awareness (natural family planning) -all based on an understanding of the changes that occur throughout the ovulatory cycle. -initial counselling, recording of events and co-operation of partners essential.

24. 1. Calendar method: -based on the principle that ovulation occurs approx. 14 days (plus or minus 2 days) before the first day of the woman’s next period.

25.  2. Cervical mucus method or Billings method. -involves the assessment of changes in the cervical mucus that occur during the menstrual cycle. -changes are due to oestrogen and progesterone, at the time of ovulation oestrogen-dominant mucus is more stretchable, (called spinbarkeit)

26. - leuteal phase, cervical mucus is thick, traps sperm more effectively -advised to abstain from sexual intercourse from the time she notices mucus is becoming clear, and more elastic to avoid pregnancy and vice versa.

27.  Basal Body temperature -the temperature drops slightly just before ovulation, rises sharply just after and stays higher for several days after ovulation. -taking the temperature before rising in the morning and documenting will show (over time ) a woman’s cycle and make predictions more accurate.

28. Infertility

29. -defined as a lack of conception despite unprotected sexual intercourse for at least 12 months. -1 in 5 couples in New Zealand experience infertility

30. -causes: -35% attributed to female -35% + to male -15% to both -15% unknown

31. Infertility may have profound emotional, and psychological impact on both the affected couples and on society. -diagnosis increased in 25-44 year old age group.

32. Management of infertility is a specialist area -expensive, time consuming, emotionally demanding, physically demanding. -variety of “therapies” (hormonal therapies, new birth technologies including AID, IVF, GIFT, ICI, -support groups: Fertility New Zealand

33.  Summary  Prospective parents may take lifestyle changes to increase the chances of having a healthy baby.  A good understanding of the physiology of reproduction can increase the likelihood of becoming pregnant and help individual s understand how different methods of contraception work.