Infertility in Assisted Reproductive Nursing

Get up to date on Infertility nursing and become qualified to work in the best Assisted Reproduction units"

This Postgraduate Diploma will take the student through several key aspects of Assisted Reproduction: anatomy of human reproduction, neuroendocrinology of reproduction, ovogenesis and spermatogenesis and other fundamental aspects.

Throughout the Postgraduate Diploma the student will approach the study of infertility in women from the most basic aspects. Through clinical history, the nursing student will begin by identifying the most important factors involved in it and will learn about the most relevant and frequent pathologies that affect women with infertility and will learn how to perform all the tests and protocols corresponding to their activity.

This program will also explore the field of male infertility, with a broad and specific tour through all aspects of these disorders. This specialization is extremely necessary since nurses are involved in many of the processes related to infertility. The nursing staff may be in charge of performing seminograms, sample analysis and processing, semen freezing, seminal cleaning or even managing the male donor bank. 

Another aspect of study of this Postgraduate Diploma is the relationship between genetics and immunology and assisted reproduction. The importance of karyotyping in assisted reproduction consultation will also be discussed. 

We will review more complex and novel techniques, such as CGH arrays, which are used in preimplantation genetic diagnosis. The key concepts of immunology will also be reviewed, and we will talk about the ever-changing immune system of women and the cell populations that compose it in order to develop the possible problems that can appear when there are autoimmune or alloimmune factors that compromise fertility. The main treatments that can be carried out in these cases will also be discussed. Finally, two specific cases will be discussed, endometriosis and Chlamydia trachomatis infection, which are closely related to inflammation and the immune system. 

With this Postgraduate Diploma you will be able to combine a high intensity specialization with your professional and personal life, achieving your goals in a simple and real way"

This Postgraduate Diploma in Infertility in Assisted Reproductive Nursing contains the most complete and up-to-date scientific program on the market. The most important features include: 

• The latest technology in online teaching software
• A highly visual teaching system, supported by graphic and schematic contents that are easy to assimilate and understand
• Practical cases presented by practising experts
• State-of-the-art interactive video systems
• Teaching supported by telepractice
• Continuous updating and recycling systems
• Autonomous learning: full compatibility with other occupations
• Practical exercises for self-evaluation and learning verification
• Support groups and educational synergies: questions to the expert, debate and knowledge forums
• Communication with the teacher and individual reflection work
• Content that is accessible from any fixed or portable device with an Internet connection
• Supplementary documentation databases that are permanently available, even after the program

A very specific specialization that will update you on the latest advances in the field of Infertility in Assisted Reproductive Nursing, with the solvency of a high-quality professional".

Our teaching staff is made up of professionals from different fields related to this specialty. In this way, TECH ensures that it delivers the educational update objective it is aiming for. A multidisciplinary team of professionals specialized and experienced in different environments, who will develop the theoretical knowledge efficiently, but, above all, will put at the service of the program the practical knowledge derived from their own experience: one of the differential qualities of this specialization.

This mastery of the subject matter is complemented by the effectiveness of the methodological design of this program in Assisted Reproduction in Nursing. Developed by a multidisciplinary team of Postgraduate Diploma, it integrates the latest advances in educational technology. In this way, you will be able to study with a range of comfortable and versatile multimedia tools that will give you the operability you need in your training. 

The design of this program is based on Problem-Based Learning: an approach that conceives learning as a highly practical process. To achieve this remotely, TECH will use telepractice:  with the help of an innovative interactive video system, and Learning from an Expert, the student will be able to acquire the knowledge as if he/she were facing the very cases being studied. A concept that will allow students to integrate and memorize what they have learnt in a more realistic and permanent way.

This Postgraduate Diploma is supported by the best educational platform and the best online resources to guarantee that your efforts will have the best possible results"

Our innovative telepractice concept will give you the opportunity to learn through an immersive experience: "Learning from an Expert". A system of recognized effectiveness for the integration of knowledge"

The contents of this Postgraduate Diploma have been developed by the different experts of this program, with a clear purpose: to ensure that our students acquire each and every one of the necessary skills to become true experts in this field. 

A complete and well-structured program that will take you to the highest standards of quality and success. 

A comprehensive teaching program, structured in well-developed teaching units, oriented towards learning that is compatible with your personal and professional life" 

Module 1. Anatomy and Physiology of Reproduction

1.1 Anatomy of the Female Reproductive Organs

1.1.1. Introduction
1.1.2. External Female Genitalia

1.1.2.1. Vulva
1.1.2.2. Mons Pubis
1.1.2.3. Labia Majora
1.1.2.4. Labia Minora
1.1.2.5. Vaginal Vestibule
1.1.2.6. Clitoris
1.1.2.7. Vestibular Bulbs

1.1.3. Internal Female Genitalia

1.1.3.1. Vagina. 1.1.3.2. Uterus
1.1.3.3. Fallopian Tube
1.1.3.4. Ovaries

1.2. Endocrinology of the Female Reproductive System

1.2.1. Introduction
1.2.2. The Hypothalamus

1.2.2.1. GnRH

1.2.3. Pituitary Gland

1.2.3.1. FSH and LH

1.2.4. Steroid Hormones

1.2.4.1. Introduction
1.2.4.2. Synthesis
1.2.4.3. Action Mechanism
1.2.4.4. Estrogen
1.2.4.5. Androgens
1.2.4.6. Progestogens

1.2.5. External Modulation: Endorphins and Melatonin
1.2.6. GnRH Pulses: Brain-Ovarian Relationship
1.2.7. GnRH Agonists and Antagonists

1.3. Menstrual Cycle

1.3.1. Menstrual Cycle
1.3.2. Biochemical Indicators of the Menstrual Cycle

1.3.2.1. Hormones in Basal State
1.3.2.2. Ovulation
1.3.2.3. Evaluation of Ovarian Reserve. Antimüllerian Hormone

1.3.3. Ultrasound Indicators of the Menstrual Cycle

1.3.3.1. Follicle Count
1.3.3.2. Endometrial Ultrasound

1.3.4. End of the Reproductive Age

1.3.4.1. Premenopause
1.3.4.2. Menopause
1.3.4.3. Post-menopause 

1.4. Ovogenesis (Folliculogenesis and Ovulation)

1.4.1. Meiosis. From the Oogonia to the MII Oocyte
1.4.2. Types of Follicles and their Relation to Ovogenesis: Follicular Dynamics
1.4.3. Ovarian Recruitment and Ovulation
1.4.4. Oocyte MII: Markers of Oocyte Quality
1.4.5. In Vitro Oocyte Maturation

1.5. Anatomy of the Male Reproductive Organs

1.5.1. External Male Genitalia

1.5.1.1. Testicles
1.5.1.2. Penis
1.5.1.3. Epididymis
1.5.1.4. Vas Deferens

1.5.2. Internal Male Genitalia

1.5.2.1. Seminal Vesicles
1.5.2.2. Ejaculatory Duct
1.5.2.3. Prostate
1.5.2.4. Urethra
1.5.2.5. Bulbourethral Glands

1.6. Endocrinology of the Male Reproductive System

1.6.1. Testicular Function Regulation
1.6.2. Androgen Biosynthesis
1.6.3. Inhibins and Activins
1.6.4. Prolactin
1.6.5. Prostaglandins
1.6.6. Estrogens
1.6.7. Other Factors

1.7. Spermatogenesis

1.7.1. Meiosis
1.7.2. Differences between Ovogenesis and Spermatogenesis
1.7.3. The Seminiferous Tubule

1.7.3.1. Hormones Involved
1.7.3.2. Cell Types

1.7.4. The Blood-Tissue Barrier
1.7.5. Endocrine and Paracrine Control

1.8. Fertilization

1.8.1. Gamete Transport
1.8.2. Gametic Maturation
1.8.3. Gamete Interaction

1.9. Embryonic Development

1.9.1. Zygote Formation
1.9.2. First Divisions
1.9.3. Blastocyst Formation and Implantation
1.9.4. Gastrulation: Formation of Mesoderm

1.9.4.1. Notochord Formation
1.9.4.2. Establishment of Body Axes
1.9.4.3. Setting Cellular Destinations
1.9.4.4. Trophoblast Growth

1.9.5. Embryonic Period or Organogenesis Period

1.9.5.1. Ectoderm
1.9.5.2. Mesoderm 
1.9.5.3. Endoderm 

1.10. Effect of Age on the Male and Female Reproductive System

1.10.1. Female Reproductive System
1.10.2. Male Reproductive system

Module 2. Study of Infertility in Women 

2.1. Initial Study

2.1.1. Introduction
2.1.2. Basis of the Study by Factors
2.1.3. Medical History
2.1.4. Physical Exploration
2.1.5. Basic Infertility Studies
2.1.6. Complementary Studies According to Altered Factor

2.2. Ovarian Factor

2.2.1. Age

2.2.1.1. Age and Ovarian Reserve
2.2.1.2. Early Ovarian Failure
2.2.1.3. Studies to Assess Ovarian Reserve

2.2.1.3.1. AMH
2.2.1.3.2. RFA
2.2.1.3.3. Other Hormones

2.2.2. Anovulation

2.2.2.1. What is Anovulation?
2.2.2.2. Clinical Manifestations
2.2.2.3. Importance of the Luteal Phase
2.2.2.4. Causes

2.2.2.4.1. Polycystic Ovarian Syndrome
2.2.2.4.2. Most Frequent Hormonal Disorders
2.2.2.4.3. Other Causes

2.2.2.5. Studies to Assess Ovulation

2.2.2.5.1. Gynecological Hormonal Profile 
2.2.2.5.2. Other Hormones

2.2.2.5.2.1. Thyroid Hormones
2.2.2.5.2.2. Prolactin
2.2.2.4.2.3. Androgens

2.2.2.5.3. Luteal Phase Progesterone

2.3. Uterine and Tubal Factor

2.3.1. Uterus

2.3.1.1. Uterus and Endometrium
2.3.1.2. Müllerian Malformations
2.3.1.3. Myomas and Polyps
2.3.1.4. Asherman's Syndrome
2.3.1.5. Uterine Factor and Implantation Failure
2.3.1.6. Uterine Factor and Recurrent Abortion

2.3.2. Fallopian Tubes

2.3.2.1. Tubal Obstruction

2.3.2.1.1. Pathology
2.3.2.1.2. Surgical
2.3.2.1.3. Endometriosis
2.3.2.1.4. Others

2.3.3. Studies

2.3.3.1. 2D and 3D Ultrasound Echography
2.3.3.2. Hysteroscopy and Others

2.3.3.2.1. Hysteroscopy
2.3.3.2.2. Hysterosalpingography
2.3.3.2.3. Hysterosonography
2.3.3.2.4. Hysterolaparoscopy
2.3.3.2.5. MRI

2.4. Infectious Factor

2.4.1. Infections and Infertility
2.4.2. Most Frequent Infections
2.4.3. Pelvic Inflammatory Disease
2.4.4. Hydrosalpinx
2.4.5. Studies

2.4.5.1. Crops and Specialty Crops
2.4.5.2. PCR and Others

2.5. Genetic Factor

2.5.1. Genetics Today
2.5.2. Most Frequent Genetics Disorders

2.5.2.1. Turner Syndrome
2.5.2.2. Fragile X Syndrome
2.5.2.3. Hereditary Thrombophilias
2.5.2.4. Other Mutations

2.5.3. Screening Studies

2.6. Immunological Factor

2.6.1. Immune System and Fertility
2.6.2. Main Disorders

2.6.2.1. Antiphospholipid Antibody Syndrome
2.6.2.2. Systemic Lupus Erythematosus (SLE)
2.6.2.3. Others

2.6.3. Key Immunological Tests

2.7. Endometriosis

2.7.1. Endometriosis Today
2.7.2. Implications in Fertility
2.7.3. The Patient with Endometriosis
2.7.4. Clinical and Laboratory Study

2.8. Implantation Failure and Recurrent Abortion

2.8.1. Failure of Implantation

2.8.1.1. Definition
2.8.1.2. Main Causes
2.8.1.3. Study

2.8.2. Recurrent Abortion

2.8.2.1. Definition
2.8.2.2. Main Causes
2.8.2.3. Study

2.9. Special considerations

2.9.1. Cervical Factor

2.9.1.1. Importance of Cervical Physiology

2.9.2. Postcoital Test

2.9.2.1. Sexology
2.9.2.2. Vaginismus

2.9.3. Psychological Causes
2.9.4. Infertility of Unknown Origin

2.9.4.1. Definition
2.9.4.2. What Should Be Done?

2.9.5. Integral Approach

2.10. Conclusions

Module 3. Study of Male Infertility

3.1. Initial Study

3.1.1. Objectives
3.1.2. When Should it be Done?
3.1.3. Minimum Evaluation
3.1.4. Optimal Evaluation 
3.1.5. Medical History
3.1.6. Physical Exploration

3.2. Complementary Explorations

3.2.1. Sperm Function Tests
3.2.2. Hormonal Determinations
3.2.3. Ultrasonography and Scrotal Doppler Ultrasonography
3.2.4. Transrectal Ultrasound
3.2.5. Bacteriological Study of Semen
3.2.6. Post-Orgasm Urinalysis

3.3. Genetic Studies

3.3.1. Karyotype
3.3.2. Microdeletions Yq
3.3.3. CFTR Mutations
3.3.4. Meiotic Chromosome Studies
3.3.5. FISH of Spermatozoa

3.4. Seminogram

3.4.1. Basic Considerations
3.4.2. Proper Sample Handling
3.4.3. Sample Collection

3.4.3.1. Preparation
3.4.3.2. Collection for Diagnosis
3.4.3.3. Collection for Use in Assisted Reproduction
3.4.3.4. Collection for Microbiological Analysis
3.4.3.5. Home Collection
3.4.3.6. Collection with Preservative

3.4.4. Initial Macroscopic Examination

3.4.4.1. Liquefaction
3.4.4.2. Viscosity
3.4.4.3. Appearance
3.4.4.4. Volume
3.4.4.5. PH

3.4.5. Initial Microscopic Examination

3.4.5.1. How to Get a Representative Sample?
3.4.5.2. Sample Quantity
3.4.5.3. Aggregation
3.4.5.4. Agglutination
3.4.5.5. Presence of Cellular Elements Other than Spermatozoa

3.4.6. Motility
3.4.7. Vitality
3.4.8. Concentration
3.4.9. Counting of Cells Other than Sperm Cells
3.4.10. Sperm Morphology
3.4.11. Presence of Leukocytes in Semen
3.4.12. Antispermatozoa Antibodies Test
3.4.13. Automated Analysis

3.5. Analysis and Processing of Samples for Assisted Reproduction Techniques (ART)

3.5.1. Washing
3.5.2. Swim-up
3.5.3. Density Gradients

3.6. Sperm Freezing

3.6.1. Indications
3.6.2. Cryoprotection
3.6.3. Semen Freezing Techniques
3.6.4. Storage Containers

3.7. Semen Washing for HIV, Hepatitis B and Hepatitis C Seropositive Males

3.7.1. Hepatitis B
3.7.2. HIV
3.7.3. Hepatitis C
3.7.4. General Considerations

3.8. Sperm Donation

3.8.1. General Aspects
3.8.2. Indications
3.8.3. Sperm Donor Considerations
3.8.4. Recommended Tests
3.8.5. Anonymity
3.8.6. Choosing the Right Donor
3.8.7. Risks
3.8.8. Cessation of Donation

3.9. Complementary Sperm Selection Techniques

3.9.1. MACS (Magnetically Marked Cell Sorting)

3.9.1.1. Biological Basis of the Technique
3.9.1.2. Indications
3.9.1.3. Advantages and Disadvantages

3.9.2. IMSI (Intracytoplasmic Injection of Morphologically Selected Spermatozoa)

3.9.2.1. Procedure
3.9.2.2. Indications
3.9.2.3. Advantages and Disadvantages

3.9.3. Selection Based on Binding to Hyaluronic Acid

3.9.3.1. Procedure
3.9.3.2. Indications
3.9.3.3. Advantages and Disadvantages

3.10. Oral Therapy Use of Antioxidants

3.10.1. Antioxidant Concept
3.10.2. Reactive Oxygen Species (ROS)
3.10.3. Factors Leading to Increased ROS in Semen
3.10.4. Damage Caused by Increased ROS in Spermatozoa
3.10.5. Antioxidant System in Semen

3.10.5.1. Enzymatic Antioxidants
3.10.5.2. Superoxide Dismutase
3.10.5.3. Catalase
3.10.5.4. Nitric Oxide Synthase
3.10.5.5. Glutathione S-Transferase
3.10.5.6. Peroxiredoxin
3.10.5.7. Thioredoxins
3.10.5.8. Glutathione Peroxidase

3.10.6. Exogenous Supplementation

3.10.6.1. Omega 3 Fatty Acids
3.10.6.2. Vitamin C
3.10.6.3. Coenzyme Q10
3.10.6.4. L-Carnitine
3.10.6.5. Vitamin E
3.10.6.6. Selenium
3.10.6.7. Zinc
3.10.6.8. Folic Acid
3.10.6.9. L-Arginine

3.10.7. Conclusions

Module 4. Genetics and Immunology of Reproduction

4.1. Basic Cytogenetics: The Importance of Karyotyping

4.1.1. DNA and its Structure

4.1.1.1. Genes
4.1.1.2. Chromosomes

4.1.2. The Karyotype
4.1.3. Uses of Karyotyping: Prenatal Diagnosis

4.1.3.1. Amniocentesis
4.1.3.2. Chorionic Villus Biopsy
4.1.3.3. Abortion Analysis
4.1.3.4. Meiosis Studies

4.2. The New Era of Diagnostics: Molecular Cytogenetics and Massive Sequencing

4.2.1. FISH
4.2.2. CGH Arrays
4.2.3. Massive Sequencing

4.3. Origin and Etiology of Chromosomal Abnormalities

4.3.1. Introduction
4.3.2. Classification According to Origin

4.3.2.1. Numeric
4.3.2.2. Structural
4.3.2.3. Mosaicism

4.3.3. Classification According to Etiology

4.3.3.1. Autosomal
4.3.3.2. Sexual
4.3.3.3. Polyploidy and Haploidy

4.4. Genetic Disorders in the Infertile Couple

4.4.1. Genetic Disorders in Women

4.4.1.1. Hypothalamic Origin
4.4.1.2. Pituitary Origin
4.4.1.3. Ovarian Origin

4.4.1.3.1. Chromosomal Alterations

4.4.1.3.1.1. Total Deletion of the X Chromosome: Turner’s Syndrome
4.4.1.3.1.2. Partial Deletion of the X Chromosome
4.4.1.3.1.3. X Chromosome Translocations and Autosomes
4.4.1.3.1.4. Others

4.4.1.4. Monogenic Alterations

4.4.1.4.1. X-Fragile

4.4.1.5. Hereditary Thrombophilias

4.4.2. Genetic Disorders in Men

4.4.2.1. Numerical Alterations: Klineffelter’s Syndrome
4.4.2.2. Robertsonian Translocations
4.4.2.3. CFTR Mutation
4.4.2.4. Microdeletions in the Y Chromosome

4.5. Preimplantation Genetic Diagnosis (PGT): Preimplantation Genetic Testing)

4.5.1. Introduction
4.5.2. Embryo Biopsy
4.5.3. Indications
4.5.4. Genetic Diagnosis for Monogenic Diseases (PGT-M)

4.5.4.1. Carrier Studies

4.5.5. Genetic Diagnosis for Structural Abnormalities

4.5.5.1. Numerical (Aneuploidies; PGT-A)
4.5.5.2. Structural (PGT-SR)

4.5.6. Combined Genetic Diagnosis
4.5.7. Limitations
4.5.8. Mosaic Embryos as a Special Case
4.5.9. Non-Invasive Pre-implantational Genetic Diagnosis

4.6. Babies with Three Genetic Progenitors, Nuclear Transfer in Mitochondrial Diseases

4.6.1. Mitochondrial DNA
4.6.2. Mitochondrial Diseases
4.6.3. Donor Cytoplasmic Transfer

4.7. Epigenetics

4.7.1. General Concepts
4.7.2. Epigenetic Modifications
4.7.3. Genetic Imprinting

4.8. Genetic Studies in Donors

4.8.1. Recommendations
4.8.2. Carrier Matching
4.8.3. Carrier Panels

4.9. The Immunological Factor in Assisted Reproduction

4.9.1. General Aspects
4.9.2. The Immune System in Women in Constant Change
4.9.3. Immune Cell Population in the Female Reproductive System

4.9.3.1. Regulation of T-lymphocyte Populations
4.9.3.2. Cytokines
4.9.3.3. Female Hormones

4.9.4. Infertility of Autoimmune Origin

4.9.4.1. Antiphospholipid Syndrome
4.9.4.2. Antithyroid Antibodies
4.9.4.3. Anti -Nuclear Antibodies
4.9.4.4. Anti-Ovarian and Anti-FSH Antibodies
4.9.4.5. Anti-Sperm Antibodies

4.9.5. Infertility of Alloimmune Origin, the Contribution of the Fetus

4.9.5.1. The Embryo as Antigen
4.9.5.2. Implantation Failure of Euploid Embryos

4.9.5.2.1. NK Cells
4.9.5.2.2. T-Helpers
4.9.5.2.3. Autoantibodies

4.9.6. The Role of Sperm and Spermatozoa

4.9.6.1. T-Lymphocyte Regulation
4.9.6.2. Seminal Fluid and Dendritic Cells
4.9.6.3. Clinical Relevance

4.10. Immunotherapy and Special Situations

4.10.1. Introduction
4.10.2. Aspirin and Heparin
4.10.3. Corticosteroids
4.10.4. Antibiotic Therapy
4.10.5. Colony Growth Factors
4.10.6. Intravenous Fat Emulsions
4.10.7. Intravenous Immunoglobulins
4.10.8. Adalimumab
4.10.9. Peripheral Mononuclear Cells
4.10.10. Seminal Plasma
4.10.11. Antibody-Free Semen Preparations
4.10.12. Tacrolimus
4.10.13. Risks and benefits
4.10.14. Conclusions
4.10.15. Special Situations: Endometriosis
4.10.16. Special Situations - Chlamydia Trachomatis Infection

A very complete teaching program, structured in complete and specific teaching units, in a learning process that is totally compatible with your personal and professional life"