1. What are some elements that you see in the write-up about Juan that you think might be contributing to his fertility/infertility? 2. What are some elements that you see in the write-up about Maria that you think might be contributing to her fertility/infertility? 3. When you meet with Juan and Maria what questions will you ask each of them about their diet and lifestyle? 4. Are there any strengths that you see in terms of social determinants of health for Juan and Maria? 5. Are there any lab values that you will seek from the medical record [this might be a stretch given what you know about lab values, but use your knowledge from NUFD113, from the text and from the readings]? 6. In your group, discuss any additional information that is relevant from the article you read for Class 3. Each person will be able to discuss at least one point from their assigned article. [This will be for discussion in class with the other members of your group. You don't need to write anything here. Each person will be able to write up key points for their articles in the Individual Answers section below] 7. From the information in the case description and reviewing the journal articles that your group members found (see #9 below), identify at least 5 potential areas to prioritize in your discussion with Juan and Maria. Why did your group choose these areas? 8. What additional information should be included in this case when it is revised for next semester? How would it enhance your understanding of the case? Juan and Maria have been trying to conceive for their first pregnancy for over a year. Six months ago they had a miscarriage after week 5 of the pregnancy. It was a hard time for them as a couple, but after talking with Maria's OBGYN team (physician and nurse practitioner) they have decided to try to become pregnant again. The medical team has a nutrition professional working in the office, so Juan and Maria have made an appointment to talk with you to learn about diet/nutrition and environmental issues that they should consider when they try to become pregnant again. Juan – age 28 ht: 5'8" wt: 185 lb. Employment: For the last 3 years he has been working as a groundskeeper at a local golf course. Before that he was part of a landscape team. Work has been stressful the last few months as the management has changed and he has been asked to work extra shifts, for a total of about 55-60 hours per week. Most evenings he comes home and has 3 beers to unwind. On Saturday nights and Sunday he and Maria get together with family and friends where he usually has 4 -5 beers or several cocktails along with delicious home cooked food. Juan is one of 4 siblings, who have two children each. He is the last in his family to have children and there has been some pressure from his parents and grandparents. He avoids shellfish because Maria is allergic. He also limits his dairy intake due to lactose intolerance. His weight has been stable, and probably has increased about 5 lb since the miscarriage. Maria – age 22 ht: 5'4" wt: 140 lb. Knowing that she wanted to become pregnant Maria lost about 30 pounds. She tried to eat more vegetables and fruit and used fiber powder daily. Maria is in her last semester at Sac State as a Psychology major and is finishing a capstone course with a total of 18 credits. She hopes to apply to grad school and has been taking a GRE study course in addition to her Psychology classes. She was diagnosed with Polycystic Ovarian Syndrome four years ago after she reported to her physician that her periods were irregular and she had some facial hair. She was thrilled to become pregnant as she and Juan have been trying. And then very sad for the miscarriage a few months ago. In addition to being allergic to shellfish Maria is allergic to citrus and peanuts. With so many classes Maria drinks the equivalent of 3 Venti coffees with steamed 2% fat milk from Starbucks every day so that she can stay awake to complete her school work. Maria is close with her family of origin and sees them every weekend.