Procedure You are a fertility specialist at

Procedure You are a fertility specialist at HASPI Fertility Center. Couples have been referred to you for why the couple may be experiencing fertility problems. The problem may be only male, only female, both, or neither. Complete the case plan for the couple to diagnose and develop a treatment plan. Table 1. Normal Hormone Levels Table 2. Normal Semen Analysis Hormone Female Hormone Levels Male Hormone Levels Total Volume 2.0 ml Progesterone 2-25 ng/ml < 1.0 ng/ml Sperm Concentration 20 million/ml Luteinizing hormone 5 - 25 IU/L 2 - 4 IU/L Motility 50% + Prolactin 2 - 29 ng/ml 2 - 18 ng/ml Forward Progression (0-4) 3 or 4 Testosterone 15 - 70 ng/dl 300 - 1000 ng/dl Normal Morphology 30% + Estradiol 15 - 350 pg/ml 10 - 40 pg/ml Total Sperm Count 40 million + Follicle stimulating hormone 4.7 - 21.4 mIU/ml 1.5 - 12.5 mIU/ml Total Motile Sperm 20 million + Total Functional Sperm 6 million + A Note on the Measurement Units Hormones are measured by the amount of that hormone found in the blood. Therefore the units for hormone amount are written in grams per liter, or g/L. Since the quantities are very small, smaller weight measurements are often used, for example mg/ml. A few of the measurements used include: 1 liter(L) = 10 deciliters(dl) = 1,000 milliliters(ml) 1 gram(g) = 1,000 milligrams(mg) = 1 billion nanograms(ng) = 1 trillion picograms(pg) 1 International unit(IU) = 1,000 milli-international units(mIU) *IU and mIU are only used in medicine and are standard medical measurements of that hormone Reproductive Case History A 55-year-old postmenopausal, retired school teacher, with a family history of breast cancer in her mother and sister, noticed a painless hard lump in the upper-outer quadrant of the right breast. A history and physical exam were followed by a mammogram that identified a 1cm lump in the right breast. She chose a breast conserving treatment consisting of localized surgery called a lumpectomy to remove what turned out to be an adenocarcinoma of the breast, followed by removal of some of the axillary lymph nodes. She was started on Tamoxifen, a drug that acts as an anti-estrogen toward breast cancers, but has estrogenic effects on certain other tissues such as the endometrium. This individual has two daughters, ages 35 and 37 who were strongly encouraged to have yearly physicals and mammograms by their mother's doctor, and to perform monthly self-breast exams. 1. What is the function of lymph nodes? 2. What problem could develop in the arm as a result of removing the axillary lymph nodes? 3. what changes would you expect in the lining of the uterus if Tamoxifen has estrogenic effects on the endometrium? 4. What role do progesterones have on the uterus in the normal menstrual cycle? 5. What is BRCA 1 and 2? 6. Why might genetic counseling be of value for this family? SCIENCE HEALTH SCIENCE NURSING HITM 1244

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