The good work of nurses in the fields of gynecology and assisted reproduction favors the success of treatments"

Care for women requires specific knowledge and attention. It is the result of a great deal of care and attention given with generosity and professionalism by different professional categories. Therefore, it requires the acquisition of special knowledge that is different from that of the rest of the population, and it is necessary to rely on professionals trained in these specific areas. A similar situation occurs in the field of Assisted Reproduction, since having specific knowledge will help professionals, but, above all, it will help patients. 

This Advanced master’s degree aims to meet the needs of nurses specialized in these fields of care. Therefore, specific care in the field of gynecology, such as gynecological diseases, changes in the growth and aging of women, as well as the study of infertility in women, to learn to identify the most important factors involved in it and to know the most relevant and frequent pathologies that affect women with infertility. 

There is a growing demand for nurses to have knowledge of this population in order to provide the best attention to ensure quality care adapted to new research. For this reason, this program aims to help professionals train in this field and care for their patients with the utmost scientific and professional rigor. 

Throughout this program, the student will learn all of the current approaches to the different challenges posed by their profession. A high-level step up that will become a process of improvement, not only on a professional level, but also on a personal level. 

This challenge is one of TECH social commitments: to help highly qualified professionals specialize and develop their personal, social and work skills during the course of their studies. 

We will not only take you through the theoretical knowledge we offer, but we will show you another way of studying and learning that is more organic, simpler and more efficient. We will work to keep you motivated and to create a passion for learning within you, and we will push you to think and develop critical thinking. 

The high demand for nursing professionals in the areas of gynecology and assisted reproduction favors this type of training" 

This Advanced master’s degree in Gynecological and Assisted Reproductive Nursing contains the most complete and up-to-date scientific program on the market. Its most notable features are:

• The latest technology in e-learning software
• Intensely visual teaching system, supported by graphic and schematic contents that are easy to assimilate and understand
• The development of practical case studies presented by practising experts 
• State-of-the-art interactive video systems 
• Teaching supported by telepractice 
• Continuous updating and recycling systems 
• Self-regulated learning: full compatibility with other occupations 
• Practical exercises for self-assessment and learning verification 
• Support groups and educational synergies: Questions to the expert, discussion forums and knowledge 
• 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 training has ended

A high level of scientific training, supported by advanced technological development and the teaching experience of the best professionals"

Our teaching staff is made up of working professionals. This way we ensure that we provide you with the up-to-date training you are expecting. A multidisciplinary team of trained and experienced professionals in different environments who will develop the theoretical knowledge in an efficient way, but above all, they will put the practical knowledge derived from their own experience at the service of the program. 

This mastery of the subject is complemented by the effectiveness of the methodological design of this Advanced master’s degree, which has been developed by a multidisciplinary team of e-learning experts and integrates the latest advances in educational technology. This way, you will be able to study with a range of easy-to-use and versatile multimedia tools that will give you the necessary skills you need for your specialization. 

The design of this program is based on Problem-Based Learning, an approach that views learning as a highly 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 facing the scenario you are studying at that moment. A concept that will allow students to integrate and memorize what they have learnt in a more realistic and permanent way. 

A deep and comprehensive dive into strategies and approaches in Gynecological and Assisted Reproductive Nursing "

We have the best teaching methodology and a multitude of simulated cases that will help you train in real situations"

The contents of this program have been developed by the different teachers of this Advanced master’s degree, 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. The content of this program enables you to learn all aspects of the different disciplines involved in this field. A complete and well-structured program will take you to the highest standards of quality and success. 

Through a very well structured program, you will be able to access the most advanced knowledge of the moment in Gynecological and Assisted Reproductive Nursing " 

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. Mechanism of Action
1.2.4.4. Estrogens
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. Pre-Menopause
1.3.4.2. Menopause
1.3.4.3. Post-Menopause 

1.4. Ovogenesis (Folliculogenesis and Ovulation). Meiosis: From the Oogonia to the MII Oocyte. Types of Follicles and their Relation to Ovogenesis. Follicular Dynamics. Ovarian Recruitment and Ovulation. Oocyte MII: Markers of Oocyte Quality. 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-Testis 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: Mesoderm Formation

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. Puberty, Menstruation and the Climacteric Period

2.1. Pathology of Puberty

2.1.1. Precocious Puberty 
2.1.2. Delayed Puberty

2.2. Menstrual Disorders

2.2.1. Hypothalamic Amenorrhea
2.2.2. Hypophyseal Type of Amenorrhea
2.2.3. Hyperprolactinemia

2.3. Uterine Amenorrhea

2.3.1. Protocol 
2.3.2. Diagnosis

2.4. Functional Uterine Bleeding

2.4.1. Ovulatory Bleeding
2.4.2. Anovulatory Bleeding
2.4.3. Bleeding from Extragenital Causes

2.5. Climacteric Pathology

2.5.1. Treatment of Climacteric Pathology: HRT
2.5.2. Hormone Replacement Therapy and Gynecological Cancer
2.5.3. Complementary or Alternative Measures in Menopause
2.5.4. Phytoestrogens

Module 3. Gynecological Infectious Pathology and Sexually Transmitted Diseases

3.1. Sexually Transmitted Infections

3.1.1. Etiology
3.1.2. Epidemiology

3.2. Infectious Processes of the Reproductive System

3.2.1. Etiology
3.2.2. Classification
3.2.3. Treatment

3.3. Vulvovaginitis

3.3.1. Description
3.3.2. Treatment

3.4. Vaginal Candidiasis

3.4.1. Description
3.4.2. Treatment

3.5. Bacterial Vaginosis

3.5.1. Description
3.5.2. Treatment

3.6. Vaginal Trichomoniasis

3.6.1. Description
3.6.2. Treatment

3.7. Syphilis

3.7.1. Description
3.7.2. Treatment

3.8. Chancroid

3.8.1. Description
3.8.2. Treatment

3.9. Lymphogranuloma Venereum

3.9.1. Description
3.9.2. Treatment

3.10. Herpes Simplex

3.10.1. Description
3.10.2. Treatment

3.11. Infections that Cause Urethritis and Cervicitis

3.11.1. Description
3.11.2. Treatment

3.12. Condyloma Acuminata

3.12.1. Description
3.12.2. Treatment

3.13. Molluscum Contagiosum

3.13.1. Description
3.13.2. Treatment

3.14. Scabies

3.14.1. Description
3.14.2. Treatment

3.15. Pediculosis Pubis

3.15.1. Description
3.15.2. Treatment

3.16. HIV

3.16.1. Description
3.16.2. Treatment

3.17. Pelvic Inflammatory Disease

3.17.1. Description
3.17.2. Treatment

3.18. Papillomavirus Infection

3.18.1. Description
3.18.2. Treatment

Module 4. Care for Women with Gynecological Problems

4.1. Pelvic Pain

4.1.1. Dysmenorrhea
4.1.2. Premenstrual Syndrome, Endometriosis and Others
4.1.3. Nursing Care

4.2. Genital Apparatus Malformations

4.2.1. Vulvar Malformations
4.2.2. Vaginal Malformations
4.2.3. Cervical Malformations
4.2.4. Uterine Body Malformations
4.2.5. Ovarian Malformations
4.2.6. Lower Urinary Organ Malformations: Urogenital Fistulas
4.2.7. Female Genital Mutilation
4.2.8. Breast Malformations

4.3. Benign Tumors

4.3.1. Benign Vulvar Tumors
4.3.2. Benign Vaginal Tumors
4.3.3. Benign Ovarian Tumors

4.4. Benign Gynecological Pathology

4.4.1. Benign Cervical Pathology
4.4.2. Benign Uterine and Endometrial Body Pathology
4.4.3. Benign Fallopian Tube Pathology

4.5. Genital Static Disorders

4.5.1. Uterine Prolapse
4.5.2. Cystocele
4.5.3. Rectocele
4.5.4. Enterocele

4.6. Vulvovaginoperineal Tears and Rectovaginal Fistulas
4.7. Vulvovaginal Pathology

4.7.1. Vulvovaginitis
4.7.2. Bartholinitis
4.7.3. Vulvar Lichen Sclerosis
4.7.4. Paget’s Disease
4.7.5. Vulvar and Vaginal Cancer

4.8. Cervical Pathology

4.8.1. Cervicitis
4.8.2. Polyps
4.8.3. Cervical Cancer

4.9. Uterine Pathology

4.9.1. Uterine Myoma
4.9.2. Endometrial Cancer

4.10. Adnexal Pathology

4.10.1. Pelvic Inflammatory Disease (PID)
4.10.2. Polycystic Ovary Syndrome (PCOS)
4.10.3. Endometriosis
4.10.4. Ovarian Carcinoma
4.10.5. Ovarian Carcinoma

Module 5. Care for Women with Gynecological Oncology Problems

5.1. Early Diagnosis of Breast and Gynecological Cancer

5.1.1. Early Diagnosis and Population Screening Programs
5.1.2. Identification of Groups at Risk

5.2. Epidemiology of Breast and Gynecological Cancer

5.2.1. Examinations and Diagnostic Tests

5.3. Gynecological and Breast Cancer

5.3.1. Description
5.3.2. Treatment

5.4. Vulvar Cancer

5.4.1. Description
5.4.2. Treatment

5.5. Cervical Cancer

5.5.1. Description 
5.5.2. Treatment

5.6. Endometrial Cancer

5.6.1. Description
5.6.2. Treatment

5.7. Uterine Sarcomas

5.7.1. Description 
5.7.2. Treatment

5.8. Ovarian Cancer

5.8.1. Description
5.8.2. Treatment

5.9. Breast Cancer

5.9.1. Description
5.9.2. Treatment

5.10. Psychological Aspects of Gynecological Cancer

5.10.1. Nursing Care
5.10.2. Palliative Care and Pain Management

Module 6. Gynecological Surgery

6.1. Gynecological Surgical Intervention

6.1.1. Gynecological Surgery
6.1.2. Breast Surgery

6.2. Hospitalized Gynecological Patient

6.2.1. Preoperative Care
6.2.2. Postoperative Care
6.2.3. Complications

6.3. Anesthesia in Gynecology

6.3.1. Description of the Different Techniques
6.3.2. Nursing Care 

6.4. Endoscopic Surgery (Laparoscopy)

6.4.1. Description
6.4.2. Action Protocol

6.5. Endoscopic Surgery (Hysteroscopy)

6.5.1. Description
6.5.2. Action Protocol

6.6. Tubal Ligation

6.6.1. Description
6.6.2. Action Protocol

6.7. Robotic Surgery Applied to Gynecology

6.7.1. Description
6.7.2. Nursing Care

Module 7. Breast Pathology

7.1. Clinical and Instrumental Examination in Breast Pathology

7.1.1. Different Examination Methods
7.1.2. Types of Diagnostic Methods

7.2. Benign Breast Pathology

7.2.1. Abnormalities
7.2.2. Anomalies
7.2.3. Mastodynia
7.2.4. Inflammatory Process
7.2.5. Benign Tumor Pathology

7.3. Breast Cancer

7.3.1. Epidemiology and Risk Factors
7.3.2. Primary Prevention: Early Diagnosis. Non-Palpable Lesions
7.3.3. Clinic and Development
7.3.4. TNM Classification
7.3.5. Biology of Breast Carcinoma (Markers)

7.4. Breast Cancer Treatments

7.4.1. Types of Treatment
7.4.2. Nursing Care

7.5. Monitoring and Management of the Breast Cancer Patient

7.5.1. Care Control
7.5.2. Health Education
7.5.3. Nursing Care

Module 8. Urinary Incontinence (UI)

8.1. Epidemiology of Urinary Incontinence

8.1.1. Prevalence
8.1.2. Incidence

8.2. Types of Urinary Incontinence

8.2.1. Concept
8.2.2. Classification

8.3. Nursing Assessment in Urinary Incontinence

8.3.1. Nursing Care Process
8.3.2. Nursing Care

8.4. Nursing Diagnostics in Urinary Incontinence

8.4.1. Examination Methods
8.4.2. Diagnostic Techniques

8.5. Treatment of Urinary Incontinence

8.5.1. Non-Surgical Treatment
8.5.2. Surgical Management

8.6. Prevention and Management of Urinary Incontinence in Women

8.6.1. Health Education

Module 9. Gynecological and Obstetrical Emergencies

9.1. Gynecological Abdominal Pain

9.1.1. Concept
9.1.2. Nursing Care

9.2. Genital Tract Trauma and Wounds

9.2.1. Types
9.2.2. Nursing Care

9.3. Sexual Assault

9.3.1. Concept
9.3.2. Diagnosis
9.3.3. Nursing Care

9.4. Gynecological Hemorrhage

9.4.1. Classification
9.4.2. Nursing Care

9.5. Threat of Preterm Labor

9.5.1. Concept
9.5.2. Treatment
9.5.3. Nursing Care

9.6. Hypertensive States of Pregnancy

9.6.1. Classification
9.6.2. Treatment
9.6.3. Nursing Care

9.7. Obstetric Hemorrhage

9.7.1.1st Trimester Hemorrhage
9.7.2. 2nd Trimester Hemorrhage
9.7.3. Postpartum Hemorrhage

 Module 10. Study of Infertility in Women 

10.1. Initial Study

10.1.1. Introduction
10.1.2. Basis of the Study According to Factors
10.1.3. Medical History
10.1.4. Physical Exploration
10.1.5. Basic Infertility Studies
10.1.6. Complementary Studies According to Altered Factor

10.2. Ovarian Factor

10.2.1. Age

10.2.1.1. Age and Ovarian Reserve
10.2.1.2. Early Ovarian Failure
10.2.1.3. Studies to Assess Ovarian Reserve

10.2.1.3.1. AMH
10.2.1.3.2. RFA
10.2.1.3.3. Other Hormones

10.2.2. Anovulation

10.2.2.1. What Is Anovulation?
10.2.2.2. Clinical Manifestations
10.2.2.3. Importance of the Luteal Phase
10.2.2.4. Causes

10.2.2.4.1. Polycystic Ovary Syndrome
10.2.2.4.2. Most Frequent Hormonal Disorders
10.2.2.4.3. Other Causes

10.2.2.5. Studies to Assess Ovulation

10.2.2.5.1. Gynecological Hormonal Profile
10.2.2.5.2. Other Hormones

10.2.2.5.2.1. Thyroid Hormones
10.2.2.5.2.2. Prolactin
10.2.2.4.2.3. Androgens

10.2.2.5.3. Luteal Phase Progesterone

10.3. Uterine and Tubal Factor

10.3.1. Uterus

10.3.1.1. Uterus and Endometrium
10.3.1.2. Müllerian Malformations
10.3.1.3. Myomas and Polyps
10.3.1.4. Asherman’s Syndrome
10.3.1.5. Uterine Factor and Implantation Failure
10.3.1.6. Uterine Factor and Recurrent Pregnancy Loss

10.3.2. Fallopian Tubes

10.3.2.1. Tubal Obstruction

10.3.2.1.1. Pathology
10.3.2.1.2. Surgical
10.3.2.1.3. Endometriosis
10.3.2.1.4. Others

10.3.3. Research

10.3.3.1. 2D and 3D Ultrasound
10.3.3.2. Hysteroscopy and Others

10.3.3.2.1. Hysteroscopy
10.3.3.2.2. Hysterosalpingography
10.3.3.2.3. Hysterosonography
10.3.3.2.4. Hysterolaparoscopy
10.3.3.2.5. MRI

10.4. Infectious Factor

10.4.1. Infections and Infertility
10.4.2. Most Frequent Infections
10.4.3. Pelvic Inflammatory Disease
10.4.4. Hydrosalpinx
10.4.5. Research

10.4.5.1. Crops and Specialty Crops
10.4.5.2. PCR and Others

10.5. Genetic Factor

10.5.1. Genetics Today
10.5.2. Most Frequent Genetic Disorders

10.5.2.1. Turner Syndrome
10.5.2.2. Fragile X Syndrome
10.5.2.3. Hereditary Thrombophilias
10.5.2.4. Other Mutations

10.5.3. Screening Studies

10.6. Immunological Factor

10.6.1. The Immune System and Fertility
10.6.2. Main Disorders

10.6.2.1. Antiphospholipid Antibody Syndrome
10.6.2.2. Systemic Lupus Erythematosus (SLE)
10.6.2.3. Others

10.6.3. Key Immunological Tests

10.7. Endometriosis

10.7.1. Endometriosis Today
10.7.2. Implications in Fertility
10.7.3. The Patient with Endometriosis
10.7.4. Clinical and Laboratory Study

10.8. Implantation Failure and Recurrent Abortion

10.8.1. Failure of Implantation

10.8.1.1. Definition
10.8.1.2. Main Causes
10.8.1.3. Study

10.8.2. Recurrent Miscarriage

10.8.2.1. Definition
10.8.2.2. Main Causes
10.8.2.3. Study

10.9. Special Considerations

10.9.1. Cervical Factor

10.9.1.1. Importance of Cervical Physiology

10.9.2. Postcoital Test

10.9.2.1. Sexology
10.9.2.2. Vaginismus

10.9.3. Psychological Causes
10.9.4. Infertility of Unknown Origin

10.9.4.1. Definition
10.9.4.2. What Should Be Done?

10.9.5. Comprehensive Approach

10.10. Conclusions

Module 11. Study of Male Infertility

11.1. Initial Study

11.1.1. Objectives
11.1.2. When Should It Be Done?
11.1.3. Minimum Evaluation
11.1.4. Optimal Evaluation
11.1.5. Medical History
11.1.6. Physical Exploration

11.2. Complementary Evaluations

11.2.1. Sperm Function Tests
11.2.2. Hormonal Determinations
11.2.3. Ultrasound and Scrotal Doppler Ultrasound
11.2.4. Transrectal Ultrasound
11.2.5. Bacteriological Study of Semen
11.2.6. Post-Orgasm Urinalysis

11.3. Genetic Studies

11.3.1. Karyotype
11.3.2. Y Chromosome Microdeletions
11.3.3. CFTR Mutations
11.3.4. Meiotic Chromosome Studies
11.3.5. FISH of Spermatozoa

11.4. Seminogram

11.4.1. Basic Considerations
11.4.2. Proper Sample Handling
11.4.3. Sample Collection

11.4.3.1. Preparation
11.4.3.2. Collection for Diagnosis
11.4.3.3. Collection for Use in Assisted Reproduction
11.4.3.4. Collection for Microbiological Analysis
11.4.3.5. Home Collection
11.4.3.6. Collection with Preservative

11.4.4. Initial Macroscopic Examination

11.4.4.1. Liquefaction
11.4.4.2. Viscosity
11.4.4.3. Appearance
11.4.4.4. Volume
11.4.4.5. PH

11.4.5. Initial Microscopic Examination

11.4.5.1. How to Obtain a Representative Sample
11.4.5.2. Sample Quantity
11.4.5.3. Aggregation
11.4.5.4. Agglutination
11.4.5.5. Presence of Cellular Elements Other than Spermatozoa

11.4.6. Motility
11.4.7. Vitality
11.4.8. Concentration
11.4.9. Counting of Cells Other than Sperm Cells
11.4.10. Sperm Morphology
11.4.11. Presence of Leukocytes in Semen
11.4.12. Antispermatozoa Antibodies Test
11.4.13. Automated Analysis

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

11.5.1. Washing
11.5.2. Swim-up
11.5.3. Density Gradients

11.6. Sperm Freezing

11.6.1. Indications
11.6.2. Cryoprotectors
11.6.3. Semen Freezing Techniques
11.6.4. Storage Containers

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

11.7.1. Hepatitis B
11.7.2. HIV
11.7.3. Hepatitis C
11.7.4. General Considerations

11.8. Sperm Donation

11.8.1. General Aspects
11.8.2. Indications
11.8.3. Sperm Donor Considerations
11.8.4. Recommended Tests
11.8.5. Anonymity
11.8.6. Choosing the Right Donor
11.8.7. Risk
11.8.8. Cessation of Donation

11.9. Complementary Sperm Selection Techniques

11.9.1. MACS (Magnetically Marked Cell Sorting)

11.9.1.1. Biological Basis of the Technique
11.9.1.2. Indications
11.9.1.3. Advantages and Disadvantages

11.9.2. IMSI (Intracytoplasmic Injection of Morphologically Selected Spermatozoa)

11.9.2.1. Procedure
11.9.2.2. Indications
11.9.2.3. Advantages and Disadvantages

11.9.3. Selection Based on Binding to Hyaluronic Acid

11.9.3.1. Procedure
11.9.3.2. Indications
11.9.3.3. Advantages and Disadvantages

11.10. Oral Therapy: Use of Antioxidants

11.10.1. Antioxidant Concept
11.10.2. Reactive Oxygen Species (ROS)
11.10.3. Factors Leading to Increased ROS in Semen
11.10.4. Damage Caused by Increased ROS in Spermatozoa
11.10.5. Antioxidant System in Semen

11.10.5.1. Enzymatic Antioxidants
11.10.5.2. Superoxide Dismutase
11.10.5.3. Catalase
11.10.5.4. Nitric Oxide Synthase
11.10.5.5. Glutathione S-Transferase
11.10.5.6. Peroxiredoxin
11.10.5.7. Thioredoxins
11.10.5.8. Glutathione Peroxidase

11.10.6. Exogenous Supplementation

11.10.6.1. Omega 3 Fatty Acids
11.10.6.2. Vitamin C
11.10.6.3. Coenzyme Q10
11.10.6.4. L-Carnitine
11.10.6.5. Vitamin E
11.10.6.6. Selenium
11.10.6.7. Zinc
11.10.6.8. Folic Acid
11.10.6.9. L-Arginine

11.10.7 Conclusions

Module 12. Genetics and Immunology of Reproduction

12.1. Basic Cytogenetics: The Importance of Karyotyping

12.1.1. DNA and its Structure

12.1.1.1. Genes
12.1.1.2. Chromosomes

12.1.2. The Karyotype
12.1.3. Uses of Karyotyping: Prenatal Diagnosis

12.1.3.1. Amniocentesis
12.1.3.2. Chorionic Villus Biopsy
12.1.3.3. Abortion Analysis
12.1.3.4. Meiosis Studies

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

12.2.1. FISH
12.2.2. CGH Arrays
12.2.3. Massive Sequencing

12.3. Origin and Etiology of Chromosomal Abnormalities

12.3.1. Introduction
12.3.2. Classification According to Origin

12.3.2.1. Numeric
12.3.2.2. Structural
12.3.2.3. Mosaicism

12.3.3. Classification According to Etiology

12.3.3.1. Autosomal
12.3.3.2. Sexual
12.3.3.3. Polyploidy and Haploidy

12.4. Genetic Disorders in the Infertile Couple

12.4.1. Genetic Disorders in Women

12.4.1.1. Hypothalamic Origin
12.4.1.2. Pituitary Origin
12.4.1.3. Ovarian Origin

12.4.1.3.1. Chromosomal Disorders

12.4.1.3.1.1. Total X Chromosome Deletion: Turner Syndrome
12.4.1.3.1.2. Partial X Chromosome Deletion
12.4.1.3.1.3. X Chromosome and Autosome Translocations
12.4.1.3.1.4. Others

12.4.1.4. Monogenic Disorders

12.4.1.4.1. Fragile X

12.4.1.5. Fragile X Syndrome

12.4.2. Genetic Disorders in Men

12.4.2.1. Numerical Alterations: Klineffelter’s Syndrome
12.4.2.2. Robertsonian Translocations
12.4.2.3. CFTR Mutation
12.4.2.4. Y Chromosome Microdeletions

12.5. Pre-Implantation Genetic Diagnosis (PGT): Pre-Implantation Genetic Testing)

12.5.1. Introduction
12.5.2. Embryo Biopsy
12.5.3. Indications
12.5.4. Genetic Diagnosis for Monogenic Diseases (PGT-M)

12.5.4.1. Carrier Studies

12.5.5. Genetic Diagnosis for Structural Abnormalities

12.5.5.1. Numerical (Aneuploidies; PGT-A)
12.5.5.2. Structural (PGT-SR)

12.5.6. Combined Genetic Diagnosis
12.5.7. Limitations
12.5.8. Mosaic Embryos as a Special Case
12.5.9. Non-Invasive Pre-Implantational Genetic Diagnosis

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

12.6.1. Mitochondrial DNA
12.6.2. Mitochondrial Diseases
12.6.3. Donor Cytoplasmic Transfer

12.7. Epigenetics

12.7.1. General Concepts
12.7.2. Epigenetic Modifications
12.7.3. Genetic Imprinting

12.8. Genetic Studies in Donors

12.8.1. Recommendations
12.8.2. Carrier Matching
12.8.3. Carrier Panels

12.9. The Immunological Factor in Assisted Reproduction

12.9.1. General Aspects
12.9.2. The Immune System in Women in Constant Change
12.9.3. Immune Cell Population in the Female Reproductive System

12.9.3.1. Regulation of T-Lymphocyte Populations
12.9.3.2. Cytokines
12.9.3.3. Female Hormones

12.9.4. Infertility of Autoimmune Origin

12.9.4.1. Antiphospholipid Syndrome
12.9.4.2. Antithyroid Antibodies
12.9.4.3. Antinuclear Antibodies
12.9.4.4. Anti-Ovarian and Anti-FSH Antibodies
12.9.4.5. Antispermatozoa Antibodies

12.9.5. Alloimmune Infertility, the Contribution of the Fetus

12.9.5.1. The Embryo as an Antigen
12.9.5.2. Implantation Failure of Euploid Embryos

12.9.5.2.1. NK Cells
12.9.5.2.2. T-Helpers
12.9.5.2.3. Autoantibodies

12.9.6. The Role of Sperm and Spermatozoa

12.9.6.1. T-Lymphocyte Regulation
12.9.6.2. Seminal Fluid and Dendritic Cells
12.9.6.3. Clinical Relevance

12.10. Immunotherapy and Special Situations 

12.10.1. Introduction
12.10.2. Aspirin and Heparin
12.10.3. Corticosteroids
12.10.4. Antibiotic Therapy
12.10.5. Colony Growth Factors
12.10.6. Intravenous Fat Emulsions
12.10.7. Intravenous Immunoglobulins
12.10.8. Adalimumab
12.10.9. Peripheral Mononuclear Cells
12.10.10. Seminal Plasma
12.10.11. Antibody-Free Semen Preparations
12.10.12. Tacrolimus
12.10.13. Risks and Benefits
12.10.14. Conclusions
12.10.15. Special Situations: Endometriosis
12.10.16. Special Situations: Chlamydia Trachomatis Infection

Module 13. Assisted Reproduction Consultation and Donor Bank

13.1. Importance of the Nurse in the Assisted Reproduction Clinic

13.1.1. Nursing Consultation: An Emerging Requirement
13.1.2. Areas of Work: Care, Management and Education
13.1.3. The Integral Continuum of Care

13.2. Care Area. Follow-Up Consultation

13.2.1. Patient Care in Stimulation Cycles
13.2.2. Folliculometry
13.2.3. Cytology

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

13.3.1. Hypophyseal Hormones or Gonadotropins

13.3.1.1. FSH
13.3.1.2. LH
13.3.1.3. Prolactin
13.3.1.4. TSH

13.3.2. Ovarian Hormones

13.3.2.1. Estradiol
13.3.2.2. Progesterone
13.3.2.3. Antimullerian (HAM) 

13.3.3. Other Hormones

13.3.3.1. Free Triiodothyronine (T3)
13.3.3.2. Free Thyroxine (T4)
13.3.3.3. Total Testosterone (T)
13.3.3.4. Inhibin B

13.3.4. Implantation Failure Study: Interpretation and Extraction

13.3.4.1. Definition
13.3.4.2. Immunological Profile
13.3.4.3. Thrombophilias
13.3.4.4. Endometrial Biopsy
13.3.4.5. Endocervical and Vaginal Culture

13.3.5. Serologies: Interpretation and Extraction

13.3.5.1. Introduction and Necessity
13.3.5.2. HBV
13.3.5.3. HCV
13.3.5.4. HIV
13.3.5.5. Syphilis (RPR)
13.3.5.6. Rubella
13.3.5.7. Toxoplasmosis

13.3.6. Karyotypes

13.4. Patient Education Area

13.4.1. Effective Communication
13.4.2. Basic Hygienic–Dietary Measures: Importance of BMI
13.4.3. Self-Administration of Medications

13.5. Management Area

13.5.1. Medical History
13.5.3. Gamete Request

13.5.3.1. Male Gamete Petition
13.5.3.2. Female Gamete Petition

13.5.4. Transfer of Genetic Material

13.6. Patient Follow-Up after BHCG Result

13.6.1. Introduction: Interpretation of the Result
13.6.2. First Consultation after BHCG Result

13.6.2.1. Negative Result
13.6.2.2. Positive Result

13.6.3. Food Education for Pregnant Women
13.6.4. Monitoring of Pregnant Women: Medication and Ultrasound Monitoring. Release
13.6.5. Obstetrical Control after Delivery

13.7. Donor Bank

13.7.1. Donor Requirements: Testing and Compatibility. Importance of Blood Type
13.7.2. Limits on the Number of Stimulations and/or Donations
13.7.3. Limit on the Number of Pregnancies
13.7.4. International Donations
13.7.5. Anonymity
13.7.6. Financial Compensation
13.7.7. Donor Registration
13.7.8. Additional Tests

13.8. Frequently Asked Questions
13.9. Conclusions

Module 14. Pharmacology

14.1. Folliculogenesis Inducer: Clomiphene Citrate

14.1.1. Introduction
14.1.2. Definition
14.1.3. Mechanism of Action
14.1.4. Administration and Use
14.1.5. Side Effects:
14.1.6. Advantages and Disadvantages
14.1.7. Results

14.2. Induction of Folliculogenesis with Gonadotropins

14.2.1. Introduction and Indications
14.2.2. Types

14.2.2.1. Follicle Stimulants
14.2.2.2. Corpus Luteum Stimulants

14.2.3. Stimulation with Increasing or Decreasing Doses
14.2.4. Treatment Results
14.2.5. Complications
14.2.6. Instruction in Self-Administration

14.3. Ovulation Inducers

14.3.1. Human Chorionic Gonadotropin (HCG) and Recombinant Chorionic Gonadotropin
14.3.2. Human Menopausal Gonadotropin (HMG)
14.3.3. Recombinant Follicle Stimulating Hormone (FSH)
14.3.4. Recombinant Luteinizing Hormone (LH)
14.3.5. GnRH Agonists

14.4. Other Hormonal Treatments

14.4.1. Hypothalamic Gonadotropin-Releasing Hormone (GnRH)

14.4.1.1. Introduction
14.4.1.2. Mechanism of Action
14.4.1.3. Administration Guideline
14.4.1.4. Complications

14.4.2. Aromatase Inhibitors

14.4.2.1. Definition and Uses
14.4.2.2. Mechanism of Action and Mode of Use
14.4.2.3. Administration Guideline
14.4.2.4. Types
14.4.2.5. Advantages and Disadvantages

14.5. Use of Gonadotropin Analogs in Assisted Reproduction

14.5.1. Agonists

14.5.1.1. Introduction and Main Agonists
14.5.1.2. Origin, Chemical Structure and Pharmacodynamic Properties
14.5.1.3. Pharmacokinetics and Method of Administration
14.5.1.4. Effectiveness

14.5.2. Antagonists

14.5.2.1. Types and Mechanism of Action
14.5.2.2. Form of Administration
14.5.2.3. Pharmacokinetics and Pharmacodynamics

14.6. Other Coadjuvant Pharmaceutical Products Used in Assisted Reproduction

14.6.1. Insulin-Sensitizing Drugs: Metformin
14.6.2. Corticoids
14.6.3. Folic Acid
14.6.4. Estrogens and Progesterone
14.6.5. Oral Contraceptives

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

14.7.1. Introduction
14.7.2. Ways to Treat Luteal Phase Deficit

14.7.2.1. Luteal Support with hCG
14.7.2.2. Luteal Phase Supplementation with Progesterone
14.7.2.3. Luteal Phase Supplementation with Estrogens
14.7.2.4. Luteal Phase Maintenance with GnRH Agonists

14.7.3. Controversies
14.7.4. Conclusion

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

14.8.1. Introduction
14.8.2. Pathophysiology
14.8.3. Symptomatology and Classification
14.8.4. Prevention
14.8.5. Treatment

14.9. Commercial Presentations in Fertility Treatments

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

14.10. Anesthetic Management in Assisted Reproduction

14.10.1. Introduction
14.10.2. Local Anesthesia
14.10.3. Opioids
14.10.4. Benzodiazepines
14.10.5. Inhalation and Intravenous General Anesthesia: Nitrous Oxide, Halogenated and Propofol
14.10.6. Regional Anesthesia
14.10.7. Conclusions

Module 15. Assisted Reproduction Techniques

15.1. Artificial Insemination

15.1.1. Definition
15.1.2. Types
15.1.3. Indications
15.1.4. Requirements
15.1.5. Procedure
15.1.6. IVF/ICSI Results and Pregnancy Probability
15.1.7. Definition and Differences
15.1.8. IVF/ICSI Indications
15.1.9. Requirements
15.1.10. Advantages and Disadvantages
15.1.11. Probability of Pregnancy
15.1.12. Procedure

15.1.12.1. Oocyte Puncture
15.1.12.2. Oocyte Evaluation
15.1.12.3. Oocyte Insemination (IVF/ICSI)

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

15.1.12.4. Evaluation of Fertilization
15.1.12.5. Embryo Culture

15.1.12.5.1. Types
15.1.12.5.2. Cultivation Systems
15.1.12.5.3. Time Lapse Culture Equipment 

15.1.13. Possible Risks

15.2. Preimplantation Genetic Testing (PGT)

15.2.1. Definition
15.2.2. Types
15.2.3. Indications
15.2.4. Procedure
15.2.5. Advantages and Disadvantages

15.3. Embryo Transfer

15.3.1. Definition
15.3.2. Embryo Quality and Selection

15.3.2.1. Transfer Day
15.3.2.2. Number of Embryos to Be Transferred

15.3.3. Assisted Eclosion
15.3.4. Procedure

15.4. Freezing and Vitrification

15.4.1. Differences
15.4.2. Sperm Freezing

15.4.2.1. Definition

15.4.3. Egg Vitrification

15.4.3.1. Definition
15.4.3.2. Procedure
15.4.3.3. Devitrification
15.4.3.4. Advantages: Preservation and Donation

15.4.4. Embryo Vitrification

15.4.4.1. Definition
15.4.4.2. Indications
15.4.4.3. Vitrification Day
15.4.4.4. Procedure
15.4.4.5. Devitrification
15.4.4.6. Advantages

15.4.5. Fertility Preservation (experimental)

15.4.5.1. Ovarian Tissue
15.4.5.2. Testicular Tissue

15.5. Donation

15.5.1. Definition
15.5.2. Types of Donation

15.5.2.1. Egg Donation

15.5.2.1.1. Definition
15.5.2.1.2. Indications
15.5.2.1.3. Types of Egg Donation
15.5.2.1.4. Procedure

15.5.2.1.4.1. Donor Ovarian Puncture
15.5.2.1.4.2. Recipient Endometrial Preparation

15.5.2.2. Egg Bank: Storage System
15.5.2.3. Advantages and Disadvantages
15.5.2.4. Sperm Donation

15.5.2.4.1. Procedure

15.5.2.3. Embryo Donation

15.5.2.3.1. Definition
15.5.2.3.2. Indications
15.5.2.3.3. Procedure
15.5.2.3.4. Advantages

15.5.2.4. Double Donation

15.5.2.4.1. Definition
15.5.2.4.2. Indications
15.5.2.4.3. Procedure

15.6. ROPA Method

15.6.1. Definition
15.6.2. Indications
15.6.3. Procedure
15.6.4. Legal Requirements

15.7. Traceability

15.7.1. Definition
15.7.2. Materials
15.7.3. Samples
15.7.4. Double Check
15.7.5. Technological Traceability Systems (Witness, Gidget)

15.8. Biovigilance
15.9. Other Techniques

15.9.1. Endometrial Receptivity Test (ERA)
15.9.2. Study of the Vaginal Microbiome

Module 16. The Operating Room and the Assisted Reproduction Laboratory

16.1. The Surgical Unit

16.1.1. Surgical Area Zones
16.1.2. Surgical Clothing
16.1.3. The Role of Nurses in the Assisted Reproduction Unit
16.1.4. Waste Management and Environmental Control

16.2. Follicular Puncture for Oocyte Collection

16.2.1. Definition
16.2.2. Features
16.2.3. Procedure and Material Required
16.2.4. Nursing Activities: Intraoperative
16.2.5. Nursing Activities: Postoperative
16.2.6. Discharge Recommendations
16.2.7. Complications

16.3. Embryo Transfer

16.3.1. Definition
16.3.2. Features
16.3.3. Procedure and Material Required
16.3.4. Endometrial Preparation: Estrogens and Progesterone
16.3.5. Nursing Role during Embryo Transfer
16.3.6. Nursing Role after Embryo Transfer
16.3.7. Discharge Instructions
16.3.8. Complications

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

16.4.1. Sperm Introduction and Recovery
16.4.2. Methods

16.4.2.1. MESA
16.4.2.2. PESA
16.4.2.3. TESE
16.4.2.4. TESE
16.4.2.5. TEFNA

16.4.3. Conclusion

16.5. Surgical Treatments for Infertility

16.5.1. Laparoscopy in Infertility

16.5.1.1. Objectives
16.5.1.2. Techniques and Instrumentation
16.5.1.3. Indications

16.5.2. Hysteroscopy

16.5.2.1. Introduction
16.5.2.2. Diagnostic Techniques
16.5.2.3. Hysteroscopic Distention Devices
16.5.2.4. Operative Technique

16.6. The Laboratory as a Clean Room: Definition
16.7. Laboratory Structure

16.7.1. Andrology Laboratory
16.7.2. Embryology Laboratory
16.7.3. Cryobiology Laboratory
16.7.4. PGD Laboratory

16.8. Laboratory Conditions

16.8.1. Design
16.8.2. Pressure
16.8.3. Gas Control (CO2, O2, N2)
16.8.4. Temperature Control
16.8.5. Air Control (VOCs)
16.8.6. Lighting

16.9. Cleaning, Maintenance and Safety

16.9.1. Personnel Clothing and Hygiene
16.9.2. Laboratory Cleaning
16.9.3. Biosecurity
16.9.4. Quality Controls

16.10. Laboratory Equipment

16.10.1. Bells
16.10.2. Incubators
16.10.3. Microinjectors
16.10.4. Refrigerators
16.10.5. Nitrogen Tanks
16.10.6. Time Lapse Equipment
16.10.7. Control of Equipment, Breakdowns and Repairs

16.11. Laboratory Working Times 

Module 17. Psychological Support and Special Situations in Assisted Reproduction

17.1. Psychology of Human Reproduction

17.1.1. Reproductive Physiology
17.1.2. Human Sexuality: Functional and Dysfunctional
17.1.3. Definition of Sterility/Infertility
17.1.4. Infertile Couple Support

17.2. Assisted Human Reproduction Psychology

17.2.1. Beliefs about Assisted Reproduction
17.2.2. Psychological, Emotional, Behavioral, Cognitive and Emotional Aspects of Assisted Reproduction
17.2.3. Psychological Aspects of Genetic Studies
17.2.4. Psychological and Emotional Repercussions of Reproductive Treatments
17.2.5. Awaiting Results
17.2.6. Families Resulting from Assisted Reproduction

17.2.6.1. Family Types and Emotional Nursing Support

17.3. Recurrent Gestational Loss

17.3.1. Causes

17.3.1.1. Stress

17.3.2. Social, Cultural and Religious Beliefs
17.3.3. Possible Reactions to Repeat Abortion
17.3.4. Psychological, Cognitive-Behavioral Repercussions of Abortion
17.3.5. Psychosomatic Repeat Miscarriage
17.3.6. Intervention in Repeat Abortions 
17.3.7. Indication for Psychotherapy: Nursing Support in Psychotherapy

17.4. Psychosocial Approach in Gamete Donation

17.4.1. Interviewing Gamete Donor Candidates

17.4.1.1. Qualitative Assessment
17.4.1.2. Quantitative Valuation
17.4.1.3. Behavioral Assessment
17.4.1.4. Psycho-Technical Evaluation

17.4.2. Gamete Donation Candidate Evaluation Report

17.4.2.1. Re-evaluation

17.4.3. Gamete Recipient Families

17.4.3.1. Myths and Beliefs about Gamete Donation
17.4.3.2. Frequently Asked Questions
17.4.3.3. Disclosure of Origins According to Family Models

7.5. Assisted Reproduction Nursing Consultation: Psychosocial Approach

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

17.5.2.1. Target Population Recruitment
17.5.2.2. Initial Interview: Reception, Information, Orientation, Referral to Other Professionals

17.5.3. Management of Communication with Assisted Reproductive Technologies Patients

17.5.3.1. Communicative Skills
17.5.3.2. Nurse-Patient Interpersonal Relationship
17.5.3.3. Emotional Patient Care in Assisted Reproduction

17.5.3.3.1. Detection of Emotional Problems in the Interview with the Patient
17.5.3.3.2. Intervention and Prevention Strategies
17.5.3.3.3. Support Groups

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

17.6. Special Situations

17.6.1. Reproductive Approach in the Oncology Patient

17.6.1.1. How Does Cancer Treatment Affect Fertility? 
17.6.1.2. When Is it Necessary to Preserve Fertility? 
17.6.1.3. Limits to Fertility Preservation

17.6.2. Fertility Preservation in Oncology Patients

17.6.2.1. Ovarian Stimulation for Fertility Preservation in Oncology Patient
17.6.2.2. Preservation Methods: 

17.6.2.2.1. Cryopreservation: Oocytes, Embryos and Ovarian Tissue
17.6.2.2.2. Hormone Therapy
17.6.2.2.3. Ovarian Transposition

17.6.3. Fertility Preservation in Oncology Patients

17.6.3.1. Preservation Methods 

17.6.3.1.1. Cryopreservation of Semen
17.6.3.1.2. Cryopreservation of Testicular Tissue
17.6.3.1.3. Hormone Therapy

17.6.4. Reproductive Approach and Preservation in Patients with Sex Change

17.7. Nutritional Advice in Assisted Reproduction

17.7.1. Nutrition and Infertility. Lifestyle

17.7.1.1. Obesity
17.7.1.2. Hormonal Problems

17.7.1.2.1. Hypothyroidism/Hyperthyroidism
17.7.1.2.2. Diabetes Mellitus
17.7.1.2.3. SOP
17.7.1.2.4. Endometriosis 

17.7.2. Recommended/Discouraged Foods Before and During Assisted Reproduction Treatment

17.7.2.1. Role of Vitamins
17.7.2.2. Role of Minerals

17.7.3. Myths and Truths About Feeding in Assisted Reproduction
17.7.4. Examples of Diet

17.8. Grief in Assisted Reproduction

17.8.1. Concept of Grief
17.8.2. Types of Grief in Assisted Reproduction

17.8.2.1. Infertility Grief
17.8.2.2. Mourning the Loss of the Invisible
17.8.2.3. Gestational Grief
17.8.2.4. Grief for Unsuccessful Implementations
17.8.2.5. Perinatal Grief

17.8.3. Therapeutic Advice for Overcoming Grief
17.8.4. Care Plan in the Grief Process

17.9. Assisted Reproduction Failure: New Alternatives

17.9.1. Adoptions
17.9.2. The Childless Family

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