Walden University IVF Pregnancy Discussion

Respond to at least two of your colleagues’ posts (from a different group) on two different days and provide additional insight that might be useful and appropriate for the issue addressed. Use your learning resources and/or evidence from the literature to support your position.

This week’s discussion focuses on case studies found in the resources section of the course. I chose the first case study which describes Gloria Smart who is a 55-year-old female following for gynecological care. This patient has a past medical history that includes a cardiac stent at age 50 and has mild hypertension managed on Zocor, Plavix and Lisinopril. She has a surgical history of tonsillectomy and bunion surgery. The patient is not married but does have a partner, doesn’t use tobacco or recreational drugs and has an occasional glass of wine. This post-menopausal patient presents to the clinic at 12 weeks pregnant following IVF and donor egg to be comanaged with maternal-fetal medicine. In this discussion you will find an explanation of differential diagnosis, treatment plan, resources for best practice guidelines and discussion of ethical dilemmas.

Differential diagnosis

Differential diagnosis helps the provider set the scene by looking at all the symptoms to help determine the most appropriate diagnosis for a patient. The primary diagnosis I chose for this case was Post-menopausal infertility. In post-menopausal women stop making oocytes and this patient wants to get pregnant so she must rely on donated oocytes to go through the IVF process (Nottingham-Jones et al., 2020). This patient went through two cycles and became pregnant and made it 12 weeks along before having an abruption and losing the baby. Another differential diagnosis I chose was Hypertension. The patient had chronic hypertension managed with medication prior to pregnancy which then escalated during pregnancy with HELLP syndrome sending her to the hospital where she then lost the baby. The patient suffered a pregnancy loss so I would also consider depression as another differential diagnosis. Women can often experience high levels of posttraumatic stress, anxiety and depression following a pregnancy loss (Farren et al., 2020).

Treatment Plan

The Society for Maternal Fetal Medicine has recommended guidelines for treatment of those who are going or who have gone through IVF. According to the Society for Maternal Fetal Medicine it is recommended that the patient receive genetic counseling and testing. If the patient determines they want to proceed with IVF again the patient will need to consult with Maternal Fetal Medicine and it is recommended a patient wait 3-6 months (Media, n.d.). The patient will also need to have a depression screening such as the Edinburgh Postnatal Depression Scale. According to The American College of Obstetricians and Gynecologist (2018) there is evidence that screening alone can have clinical benefits. If needed the patient can then be referred on to a mental health care provider to provide additional benefit. Finally remembering the patients cardiac history, I would ensure that the patient is taking her Zocor, Plavix and Lisinopril as well as monitoring her blood pressures and following up with her cardiologist.

Ethical Issues

           Many women are waiting until the 3rd or 4th decade of life before determining they want to become pregnant. This later maternal age can impact some risks as well as ethical dilemmas. One of the overall ethical concerns for IVF with advanced maternal age is with the procedure itself. The idea looks at the IVF procedure taking place to fertilize eggs when it is augmenting the bodies natural process (Harrison et al., 2020). Another ethical concern is that IVF can give the idea of false hope or the ability to delay conception and the women will get pregnant when they want, however IVF is very costly and considered to have a low success rate (Harrison, 2020).


           A patient determining to get pregnant later in life is a possibility, however it comes along with its own set of concerns. Advanced maternal age increases the likelihood of complications that can impact the pregnancy. Advanced maternal age, particularly post-menopausal age in addition brings along ethical questions and dilemmas. As a provider it is important to educate the patient and present all options by providing so the patient fully comprehends and is able to make an informed decision. In conclusion, this discussion covered the first learning lesson of a advanced maternal age women seeking IVF who lost a baby, looked at the differential diagnosis, treatment plan and ethical issues.