Assisted Reproductive Nursing

Acquire the necessary skills and competencies to work in nursing in the best Assisted Reproduction Units with a highly intensive academic Professional Master’s Degree”

This Professional Master’s Degree will take the student through several key aspects: anatomy of human reproduction, neuroendocrinology of reproduction, ovogenesis and spermatogenesis and other fundamental aspects. 

Throughout the Professional Master’s Degree, the approach to the study of infertility in women will start from the basics. By means of the clinical history, the nursing student will begin by identifying the most important factors involved and will learn about the most relevant and frequent pathologies that affect women with infertility. Special emphasis will be placed on all those basic tests necessary for the initiation and continuation of treatment, finding out the fundamental role of the nursing service: assistance, management and education.

In addition, we will study the different techniques performed in the AR Laboratory, aimed at achieving pregnancy in patients with fertility problems both female and male, the characteristics of the surgical area and the work in it and the intervention of the nursing staff in preoperative, intraoperative and postoperative moments. 

The final part of the Professional Master’s Degree will qualify students in the transcendental legal field of assisted reproduction, which will provide students with the ability to resolve multiple legal issues, both in questions related to legality, in the uses and limits of assisted reproduction techniques, as well as in any doubts about the use and approach of informed consents. 

And of course, this very complete Professional Master’s Degree will place special emphasis on the need for collaborative and close work in Assisted Reproduction with the coordinated intervention of the areas of medicine, nursing and embryology. 

With this Professional Master’s Degree, you will be able to combine high-intensity education with your personal and professional life, achieving your goals in a simple and real way”

This Professional Master’s Degree in Assisted Reproductive Nursing offers the characteristics of a course of high scientific, teaching and technological level. These are some of its most notable features: 

• 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 are permanently available, even after the program

A Professional Master’s Degree that will enable you to work in the field of Assisted Reproduction Nursing, with the solvency of a high-level 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 targeted capacitive update it intends. A multidisciplinary team of professionals trained and experienced in different environments, who will cover the theoretical knowledge in an efficient way, but, above all, will put the practical knowledge derived from their own experience: one of the differential qualities of this course. 

This mastery of the subject is complemented by the effectiveness of the methodological design of this Professional Master’s Degree in Assisted Reproductive Nursing. Developed by a multidisciplinary team of experts, 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 education.  

The design of this program is based on Problem-Based Learning: an approach that conceives learning as an eminently practical process. To achieve this remotely, we will use telepractice: With the help of an innovative interactive video system, and Learning from an Expert you will be able to acquire the knowledge as if you were actually dealing with the scenario you are learning about. A concept that will allow you to integrate and fix learning in a more realistic and permanent way. 

A program created and directed by professional experts in Assisted Reproduction that make this Professional Master’s Degree a unique opportunity for professional growth"

The learning in this Professional Master’s Degree is developed through the most performed didactic methods in online teaching to guarantee that your efforts produce the best results possible"

The content on this Professional Master’s Degree has been developed by the different experts on program with a clear purpose: to ensure our students acquire each and every one of the skills required to become true experts in the 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

Module 5. Assisted Reproduction Consultation and Donor Bank

5.1. Importance of the Nurse in the Assisted Reproduction Clinic 

5.1.1. Nursing Consultation. An Emerging Requirement
5.1.1. Areas of Work: Assistance, Management and Education
5.1.3. The Integral Continuum of Care

5.2. Assistance Area. Follow-Up Consultation

5.2.1. Patient Care in Stimulation Cycles
5.2.2. Folliculometry
5.2.3. Cytology

5.3. Blood Tests for Fertility Study. Programming, Interpretation and Extraction

5.3.1. Hypophyseal Hormones or Gonadotropins

5.3.1.1. FSH
5.3.1.2. LH
5.3.1.3. Prolactin
5.3.1.4. TSH

5.3.2. Ovarian Hormones

5.3.2.1. Estradiol
5.3.2.2. Progesterone
5.3.2.3. Antimullerian (HAM) 

5.3.3. Other Hormones

5.3.3.1. Free Triiodothyronine (T3)
5.3.3.2. Free Thyroxine (T4)
5.3.3.3. Total Testosterone (T)
5.3.3.4. Inhibin B

5.3.4. Implantation Failure Study. Interpretation and Extraction

5.3.4.1. Definition
5.3.4.2. Immunological Profile
5.3.4.3. Thrombophilias
5.3.4.4. Endometrial Biopsy
5.3.4.5. Endocervical and Vaginal Culture

5.3.5. Serologies. Interpretation and Extraction

5.3.5.1. Introduction and Necessity
5.3.5.2. HBV
5.3.5.3. HCV
5.3.5.4. HIV
5.3.5.5. Syphilis (RPR)
5.3.5.6. Rubella
5.3.5.7. Toxoplasmosis

5.3.6. Karyotypes

5.4. Patient Education Area

5.4.1. Effective Communication
5.4.2. Basic Hygienic-Dietetic Measures. Importance of BMI
5.4.3. Self-Administration of Medications

5.5. Management Area

5.5.1. Medical History
5.5.2. Informed Consents
5.5.3. Gamete Request

5.5.3.1. Male Gamete Petition
5.5.3.2. Female Gamete Petition

5.5.4. Transfer of Genetic Material

5.6. Patient Follow-up after BHCG Result

5.6.1. Introduction Interpretation of the Result
5.6.2. First Consultation after BHCG Result

5.6.2.1. Negative Result
5.6.2.2. Positive Result

5.6.3. Food Education for Pregnant Women
5.6.4. Follow-Up of the Pregnant Woman. Medication and Ultrasound Monitoring Discharge
5.6.5. Obstetrical Control after Delivery

5.7. Donor Bank

5.7.1. Donor Requirements. Testing and Compatibility. Importance of Blood Type
5.7.2. Limits on the Number of Stimulations and/or Donations
5.7.3. Limit on the Number of Pregnancies
5.7.4. International Donations
5.7.5. Anonymity
5.7.6. Financial Compensation
5.7.7. Donor Registration
5.7.8. Additional Tests

5.8. Frequently Asked Questions
5.9. Conclusions

Module 6. Pharmacology

6.1. Folliculogenesis Inducer: Clomiphene Citrate

6.1.1. Introduction
6.1.2. Definition
6.1.3. Action Mechanism
6.1.4. Administration and Use
6.1.5. Side Effects
6.1.6. Advantages and Disadvantages
6.1.7. Results

6.2. Induction of Folliculogenesis with Gonadotropins

6.2.1. Introduction and Indications
6.2.2. Types

6.2.2.1. Follicle Stimulants
6.2.2.2. Corpus Luteum Stimulants

6.2.3. Stimulation with Increasing or Decreasing Doses
6.2.4. Treatment Results
6.2.5. Complications
6.2.6. Instruction in Self-Administration

6.3. Ovulation Inducers

6.3.1. Human Chorionic Gonadotropin (hCG) and Recombinant Chorionic Gonadotropin
6.3.2. Human Menopausal Gonadotropin (hMG)
6.3.3. Recombinant Follicle Stimulating Hormone (FSH)
6.3.4. Recombinant Luteinizing Hormone (LH)
6.3.5. GnRH Agonists

6.4. Other Hormonal Treatments

6.4.1. Hypothalamic Gonadotropin-Releasing Hormone (GnRH)

6.4.1.1. Introduction
6.4.1.2. Action Mechanism
6.4.1.3. Administration Guideline
6.4.1.4. Complications

6.4.2. Aromatase Inhibitors

6.4.2.1. Definition and Use
6.4.2.2. Mechanism of Action and Mode of Use
6.4.2.3. Administration Guideline
6.4.2.4. Types
6.4.2.5. Advantages and Disadvantages

6.5. Use of Gonadotropin Analogues in Assisted Reproduction

6.5.1. Agonists

6.5.1.1. Introduction and Main Agonists
6.5.1.2. Origin, Chemical Structure and Pharmacodynamic Properties
6.5.1.3. Pharmacokinetics and Method of Administration
6.5.1.4. Effectiveness

6.5.2. Antagonists

6.5.2.1. Types and Mechanism of Action
6.5.2.2. Form of Administration
6.5.2.3. Pharmacokinetics and Pharmacodynamics

6.6. Other Coadjuvant Pharmaceutical Products Used in Assisted Reproduction

6.6.1. Insulin-Sensitizing Drugs: Metformin
6.6.2. Corticoids
6.6.3. Folic Acid
6.6.4. Estrogens and Progesterone
6.6.5. Oral Contraceptives

6.7. Pharmacological Support of the Luteal Phase in In Vitro Fertilization

6.7.1. Introduction
6.7.2. Ways to Treat Luteal Phase Deficit

6.7.2.1. Luteal Support with hCG
6.7.2.2. Luteal Phase Supplementation with Progesterone
6.7.2.3. Luteal Phase Supplementation with Estrogen
6.7.2.4. Luteal Phase Maintenance with GnRH Agonists

6.7.3. Controversies
6.7.4. Conclusions

6.8. Complications of Ovarian Stimulation: Ovarian Hyperstimulation Syndrome (OHSS)

6.8.1. Introduction
6.8.2. Pathophysiology
6.8.3. Symptomatology and Classification
6.8.4. Prevention
6.8.5. Treatment

6.9. Commercial Presentations in Fertility Treatments

6.9.1. Ovitrelle®, Elenva®, Ovaleap®, Porgoveris®, Bemfola®, Monopur®, Gonal®, Puregon®, Fostipur®, HMG-Lepori®, Decapeptyl®, Cetrecide®, Orgaluntan®

6.10. Anesthetic Management in Assisted Reproduction

6.10.1. Introduction
6.10.2. Local Anesthesia
6.10.3. Opioids
6.10.4. Benzodiazepines
6.10.5. Inhalation and Intravenous General Anesthesia: Nitrous Oxide, Halogenated and Propofol
6.10.6. Localized Anesthesia
6.10.7. Conclusions

Module 7. Assisted Reproduction Techniques

7.1. Artificial Insemination

7.1.1. Definition
7.1.2. Types
7.1.3. Indications
7.1.4. Requirements
7.1.5. Procedure
7.1.6. IVF/ICSI Results and Pregnancy Probability
7.1.7. Definition and Differences
7.1.8. IVF/ICSI Indications
7.1.9. Requirements
7.1.10. Advantages and Disadvantages
7.1.11. Probability of Pregnancy
7.1.12. Procedure

7.1.12.1. Oocyte Puncture
7.1.12.2. Oocyte Evaluation
7.1.12.3. Oocyte Insemination (IVF/ICSI)

7.1.12.3.1. Other Insemination Techniques: IMSI, PICSI, ICSI+MACS, Use of Polarized Light

7.1.12.4. Evaluation of Fertilization
7.1.12.5. Embryo Culture

7.1.12.5.1. Types
7.1.12.5.2. Cultivation Systems
7.1.12.5.3. Time-Lapse Culture Equipment 

7.1.13. Possible Risks

7.2. Preimplantation Genetic Test (PGT)

7.2.1. Definition
7.2.2. Types
7.2.3. Indications
7.2.4. Procedure
7.2.5. Advantages and Disadvantages

7.3. Embryo Transfer

7.3.1. Definition
7.3.2. Embryo Quality and Selection

7.3.2.1. Transfer Day
7.3.2.2. Number of Embryos to Be Transferred

7.3.3. Assisted Eclosion
7.3.4. Procedure

7.4. Freezing and Vitrification

7.4.1. Differences
7.4.2. Sperm Freezing

7.4.2.1. Definition

7.4.3. Egg Vitrification

7.4.3.1. Definition
7.4.3.2. Procedure
7.4.3.3. Devitrification
7.4.3.4. Advantages: Preservation and Donation

7.4.4. Embryo Vitrification

7.4.4.1. Definition
7.4.4.2. Indications
7.4.4.3. Vitrification Day
7.4.4.4. Procedure
7.4.4.5. Devitrification
7.4.4.6. Advantages

7.4.5. Fertility Preservation (Experimental)

7.4.5.1. Ovarian Tissue
7.4.5.2. Testicular Tissue

7.5. Donation

7.5.1. Definition
7.5.2. Types of Donation

7.5.2.1. Egg Donation (OVODONATION)

7.5.2.1.1. Definition
7.5.2.1.2. Indications
7.5.2.1.3. Types of Ovodonation
7.5.2.1.4. Procedure

7.5.2.1.4.1. Donor Ovarian Puncture
7.5.2.1.4.2. Recipient Endometrial Preparation

7.5.2.2. Egg bank: Storage System
7.5.2.3. Advantages and Disadvantages
7.5.2.4. Sperm Donation

7.5.2.4.1. Procedure

7.5.2.5. Embryo Donation

7.5.2.5.1. Definition
7.5.2.5.2. Indications
7.5.2.5.3. Procedure
7.5.2.5.4. Advantages

7.5.2.6. Double Donation

7.5.2.6.1. Definition
7.5.2.6.2. Indications
7.5.2.6.3. Procedure

7.6. ROPA Method

7.6.1. Definition
7.6.2. Indications
7.6.3. Procedure
7.6.4. Legal Requirements

7.7. Traceability

7.7.1. Definition
7.7.2. Materials 
7.7.3. Samples
7.7.4. Double Check
7.7.5. Technological Traceability Systems (Witness, Gidget)

7.8. Biovigilance
7.9. Other techniques

7.9.1. Endometrial Receptivity Test (ERA)
7.9.2.  Study of the Vaginal Microbiome

Module 8. The Operating Room and the Assisted Reproduction Laboratory

8.1. The Surgical Unit

8.1.1. Surgical Area Zones
8.1.2. Surgical Clothing
8.1.3. Role of Nurses in the Assisted Reproduction Unit
8.1.4. Waste Management and Environmental Control

8.2. Follicular Puncture for Oocyte Collection

8.2.1. Definition
8.2.2. Features
8.2.3. Procedure and Material Required
8.2.4. Nursing Activities: Intraoperative
8.2.5. Nursing Activities: Post-Operative
8.2.6. Discharge Recommendations
8.2.7. Complications

8.3. Embryo Transfer

8.3.1. Definition
8.3.2. Features
8.3.3. Procedure and Material Required
8.3.4. Endometrial Preparation: Estrogen and Progesterone
8.3.5. Nursing Role during Embryo Transfer
8.3.6. Nursing Role after Embryo Transfer
8.3.7. Discharge Instructions
8.3.8. Complications

8.4. Sperm Collection in Patients with Azoospermia (Testicular Biopsy)

8.4.1. Sperm Introduction and Recovery
8.4.2. Methods

8.4.2.1. MESA
8.4.2.2. PESA
8.4.2.3. TESE 
8.4.2.4. TESE 
8.4.2.5. TEFNA

8.4.3. Conclusions

8.5. Surgical Treatments for Infertility

8.5.1. Laparoscopy in Infertility

8.5.1.1. Objectives
8.5.1.2. Techniques and Instrumentation
8.5.1.3. Indications

8.5.2. Hysteroscopy

8.5.2.1. Introduction
8.5.2.2. Diagnostic Techniques
8.5.2.3. Hysteroscopic Distention Devices
8.5.2.4. Operative Technique 

8.6. The Laboratory as a Clean Room: Definition
8.7. Laboratory Structure

8.7.1. Andrology Laboratory
8.7.2. Embryology Laboratory
8.7.3. Cryobiology Laboratory
8.7.4. PGD Laboratory

8.8. Laboratory Conditions

8.8.1. Design
8.8.2. Pressure
8.8.3. Gas Control (CO2, O2, N2)
8.8.4. Temperature Control
8.8.5. Air Control (VOC's)
8.8.6. Lighting

8.9. Cleaning, Maintenance and Safety

8.9.1. Personnel Clothing and Hygiene
8.9.2. Laboratory Cleaning
8.9.3. Biosafety
8.9.4. Quality Control

8.10. Laboratory Equipment

8.10.1. Bells
8.10.2. Incubators
8.10.3. Microinjectors
8.10.4. Refrigerators
8.10.5. Nitrogen Tanks
8.10.6. Time-Lapse Equipment
8.10.7. Control of Equipment, Breakdowns and Repairs

8.11. Laboratory Working Times

Module 9. Psychological Support and Special Situations in Assisted Reproduction

9.1. Psychology of Human Reproduction

9.1.1. Reproductive Physiology
9.1.2. Human Sexuality: Functional and Dysfunctional
9.1.3. Definition of Sterility/Infertility
9.1.4. Infertile Couple Support

9.2. Assisted Human Reproduction Psychology

9.2.1. Beliefs about Assisted Reproduction
9.2.2. Psychological, Emotional, Behavioral, Cognitive and Emotional Aspects of Assisted Reproduction
9.2.3. Psychological Aspects of Genetic Studies
9.2.4. Psychological and Emotional Repercussions of Reproductive Treatments
9.2.5. Awaiting Results
9.2.6. Families Resulting from Assisted Reproduction

9.2.6.1. Family Types and Emotional Nursing Support

9.3. Recurrent Gestational Loss

9.3.1. Causes 

9.3.1.1. Stress

9.3.2. Social, Cultural and Religious Beliefs
9.3.3. Possible Reactions to Repeat Abortion
9.3.4. Psychological, Cognitive-Behavioral Repercussions of Abortion
9.3.5. Psychosomatic Repeat Miscarriage
9.3.6. Intervention in Repeat Abortions
9.3.7. Indication for Psychotherapy: Nursing Support in Psychotherapy

9.4. Psychosocial Approach in Gamete Donation

9.4.1. Interviewing Gamete Donor Candidates

9.4.1.1. Qualitative Assessment
9.4.1.2. Quantitative Valuation
9.4.1.3. Behavioral Assessment 
9.4.1.4. Psycho-Technical Evaluation

9.4.2. Gamete Donation Candidate Evaluation Report

9.4.2.1. Re-Evaluation

9.4.3. Gamete Recipient Families

9.4.3.1. Myths and Beliefs about Gamete Donation
9.4.3.2. Frequently Asked Questions
9.4.3.3. Disclosure of Origins According to Family Models

9.5. Assisted Reproduction Nursing Consultation: Psychosocial Approach

9.5.1. Holistic Counseling and Treatment in Assisted Reproduction Nursing
9.5.2. Primary Health Care Role of the Infertile Couple

9.5.2.1. Target Population Recruitment
9.5.2.2. Initial Interview: Reception, Information, Orientation, Referral to Other Professionals

9.5.3. Management of Communication with Assisted Reproductive Technologies Patients

9.5.3.1. Communicative Skills
9.5.3.2. Nurse-Patient Interpersonal Relationship
9.5.3.3. Emotional Patient Care in Assisted Reproduction

9.5.3.3.1. Detection of Emotional Problems in the Interview with the Patient
9.5.3.3.2. Intervention and Prevention Strategies
9.5.3.3.3. Support Groups

9.5.4. Principal Nursing Diagnoses (NANDA), Interventions (NIC) and Outcomes (NOC) in the Emotional Process of Assisted Reproduction

9.6. Special Situations

9.6.1. Reproductive Approach in the Oncology Patient

9.6.1.1. How Does Cancer Treatment Affect Fertility? 
9.6.1.2. When is it Necessary to Preserve Fertility?
9.6.1.3. Limits to Fertility Preservation

9.6.2. Fertility Preservation in Oncology Patients

9.6.2.1. Ovarian Stimulation for Fertility Preservation in Oncology Patient
9.6.2.2. Preservation Methods

9.6.2.2.1. Cryopreservation: Oocytes, Embryos and Ovarian Tissue
9.6.2.2.2. Hormone Therapy
9.6.2.2.3. Ovarian Transposition

9.6.3. Fertility Preservation in Oncology Patients

9.6.3.1. Preservation Methods

9.6.3.1.1. Cryopreservation of Semen
9.6.3.1.2. Cryopreservation of Testicular Tissue
9.6.3.1.3. Hormone Therapy

9.6.4. Reproductive Approach and Preservation in Patients with Sex Change

9.7. Nutritional Advice in Assisted Reproduction

9.7.1. Nutrition and Infertility: Lifestyle

9.7.1.1. Obesity
9.7.1.2. Hormonal Problems

9.7.1.2.1. Hypothyroidism/Hyperthyroidism
9.7.1.2.2. Diabetes Mellitus
9.7.1.2.3. SOP
9.7.1.2.4. Endometriosis

9.7.2. Foods Recommended/Discouraged before and during Assisted Reproduction Treatment

9.7.2.1. Role of Vitamins
9.7.2.2. Role of Minerals

9.7.3. Myths and Truths About Feeding in Assisted Reproduction
9.7.4. Examples of Diet

9.8. Grief in Assisted Reproduction

9.8.1. Concept of Grief
9.8.2. Types of Grief in Assisted Reproduction  

9.8.2.1. Infertility Bereavement
9.8.2.2. Mourning the Loss of the Invisible
9.8.2.3. Gestational Bereavement
9.8.2.4. Duel for Unsuccessful Implementations
9.8.2.5. Perinatal Bereavement

9.8.3. Therapeutic Advice for Overcoming Grief
9.8.4. Care Plan in the Bereavement Process

9.9. Assisted Reproduction Failure: New Alternatives

9.9.1. Adoptions
9.9.2. The Childless Family

Module 10. Legal and Ethical Aspects in Assisted Reproduction 

10.1. Assisted Reproduction in Law

10.1.1. Introduction and Key Concepts to be Defined

10.2. Ethical and Legal Approach to Surrogacy

10.2.1. Ethical Debate For or Against: Breakdown of Points

10.3. Ethical Issues and Approaches

10.3.1. What are the Ethical Aspects to be Taken into Account in the Daily Practice of Infertility Treatments? 
10.3.2. Ethical Limits to Treatment
10.3.3. Advanced Maternal Age Under Debate
10.3.4. Religious and Cultural Tendencies of Users as Influencing Factors in Undergoing Assisted Reproductive Techniques
10.3.5. Embryo Donation and Destruction: Ethical and Legal Issues
10.3.6. Growth of Assisted Reproduction as a Private Business - Access for All? 

10.4. Research in Assisted Reproduction

10.4.1. Donation and Use of Human Gametes and Pre-embryos

10.4.1.1. Procurement of Cells of Embryonic Origin
10.4.1.2. Donation of Human Embryos and Fetuses
10.4.1.3. Donation Requirements

10.6.2. Genetic Analysis and Biological Samples
10.6.3. Biobanks

10.5. Mandatory European Guidelines

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