Synonym/acronym: Infertility screen.
To evaluate testicular fertility and identify causes of infertility such as congenital defects, cancer, and torsion.
SpecimenSerum (1 mL) collected in a red-top tube.
|Result||Sperm Bound by Immunobead (%)|
Normally sperm develop in the seminiferous tubules of the testes separated from circulating blood by the blood-testes barrier. Any situation that disrupts this barrier can expose sperm to detection by immune response cells in the blood and subsequent antibody formation against the sperm. Antisperm antibodies attach to the head, midpiece, or tail of the sperm, impairing motility and ability to penetrate the cervical mucosa. The antibodies can also cause clumping of sperm, which may be noted on a semen analysis. A major cause of infertility in men is blocked efferent testicular ducts. Reabsorption of sperm from the blocked ducts may also result in development of sperm antibodies. Another more specific and sophisticated method than measurement of circulating antibodies is the immunobead sperm antibody test used to identify antibodies directly attached to the sperm. Semen and cervical mucus can also be tested for antisperm antibodies.
This procedure is contraindicated for
- Evaluation of infertility
Conditions that affect the integrity of the blood-testes barrier can result in antibody formation.
- Blocked testicular efferent duct (related to absorption of sperm by blocked vas deferens)
- Congenital absence of the vas deferens (related to absorption of sperm by blocked vas deferens)
- Cryptorchidism (related to disruption in the integrity of the blood-testes barrier)
- Infection (orchitis, prostatitis) (related to disruption in the integrity of the blood-testes barrier)
- Inguinal hernia repair prior to puberty (related to disruption in the integrity of the blood-testes barrier)
- Testicular biopsy (related to disruption in the integrity of the blood-testes barrier)
- Testicular cancer (related to disruption in the integrity of the blood-testes barrier)
- Testicular torsion (related to disruption in the integrity of the blood-testes barrier)
- Varicocele (related to disruption in the integrity of the blood-testes barrier)
- Vasectomy (related to absorption of sperm by blocked vas deferens)
- Vasectomy reversal (related to interaction between sperm and autoantibodies developed after vasectomy)
- The patient should not ejaculate for 3 to 4 days before specimen collection if semen will be evaluated; results may be affected if specimens are collected within 48 hr of ejaculating or after no ejaculation for longer than 5 days.
- Sperm antibodies have been detected in pregnant women and in women with primary infertility.
Nursing Implications and Procedure
Potential nursing problems
|Problem||Signs and Symptoms||Interventions|
|Sexuality (Related to altered sexual activity; diminished intimacy; testicular disease)||Decreased sexual satisfaction; diminished sexual function; ongoing infertility||Discuss the possibility of sperm banking for future fertility needs; suggest counseling for patient and family and provide contact information; facilitate a discussion of realistic changes to sexual intimacy associated with testicular disease; provide a relaxed atmosphere to discuss sexuality concerns; provide contact information for a support group|
|Self-esteem (Related to altered view of self secondary to altered ability to participate in sexual intimacy; infertility; altered body image)||Verbalizes feelings that express being a failure as a man; dissatisfaction with present state of intimacy with significant other||Monitor for negative self-statements; assess for withdrawal; monitor for real or perceived rejection of others; encourage verbalization of self-worth; encourage a discussion of perceived changes in family role; monitor for anxiety; recommend personal and family counseling; facilitate support group participation|
|Fear (Related to prognosis secondary to diagnosis (cancer); infertility; permanently altered sexual function; risk of death; loss of control; ineffective coping; unfamiliar therapeutic regime; unknown)||Expression of fear; preoccupation with fear; increased tension; increased blood pressure; increased heart rate; vomiting; diarrhea; nausea; fatigue; weakness; insomnia; shortness of breath; increased respiratory rate; withdrawal; panic attacks||Discuss the concepts of watchful waiting, surgical intervention, radiation therapy, chemotherapy, in relation to diagnosis; access social services; provide specific and culturally appropriate education; assist the patient and family to recognize effective coping strategies; assist the patient to acknowledge fear; provide a safe environment to decrease fear; explore cultural influences that may enhance fear; utilize therapeutic touch as appropriate to decrease fear; collaborate with social services to address specific medical problems associated with fear|
|Pain (Related to spermatic cord twisting; disease process (cancer); infection)||Sudden testicular pain; swollen tender testicle; nausea; bloody semen; visually one testicle is higher than the other; testicular lumps; achy discomfort in the lower abdomen; self-report of pain; crying; moaning; sleeplessness; restlessness; emotional symptoms of distress; agitation; facial grimace; irritability; diaphoresis; altered blood pressure and heart rate; nausea; vomiting||Assess pain characteristics, testicular, low abdomen; identify pain modalities that have relieved pain in the past; administer prescribed pain medication; monitor and trend vital signs; recommend use of nonpharmacologic pain management modalities, imagery, distraction, music, relaxation; provide education on postoperative pain management|
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Patient Teaching: Inform the patient this test can assist in the evaluation of infertility and provide guidance through assistive reproductive techniques.
- Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
- Obtain a history of the patient’s reproductive system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
- Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
- Review the procedure with the patient. Inform the patient that blood specimen collection takes approximately 5 to 10 min and that additional specimens may be required. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Note that there are no food, fluid, or medication restrictions unless by medical direction.
- Potential complications: N/A
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
- Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
- Timing of specimen collection is an important instruction to follow in order to obtain accurate results if semen will be evaluated. The testing facility should be contacted for specific instructions that the patient will need to follow for specimen collection and direct, timely submission to the testing facility.
- Promptly transport the specimen to the laboratory for processing and analysis.
- Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
- Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Educate the patient regarding access to counseling services. Provide a supportive, nonjudgmental environment when assisting a patient through the process of fertility testing.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
- Answer any questions or address any concerns voiced by the patient or family.
- Educate the patient regarding access to counseling services, as appropriate.
Expected Patient Outcomes
- States understanding of therapeutic options as described by HCP
- States understanding that infertility may be permanent
- Actively participates in a support group to address fertility concerns
- Describes postoperative symptoms of infection that should be reported to the HCP
- Complies with recommendation to attend support group
- Complies with the recommendation to attend personal and family counseling in relation to changes in intimacy and fertility.
- Related tests include HCG, LH, progesterone, semen analysis, testosterone, and US scrotal.
- See the Reproductive System tables at the end of the book for related tests by body system.