Professional Documents
Culture Documents
12/08/21 1
DEFINISI
Tanpa perlindungan
kontrasepsi
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DEFINISI
Infertil primer
– Istri belum berhasil hamil dg CO teratur
dan dihadapkan pd kemungkinan
kehamilan selama 12 bln berturut-turut
Infertil sekunder
– Istri pernah hamil …………idem
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WHO (2000) MEMPERKIRAKAN ASIA
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Amerika
AmerikaSerikat
Serikat Indonesia
Indonesia7%7%pasutri
pasutri
10-15%
10-15%pasutri
pasutri mengalami
mengalamimasalah
masalah
mengalami
mengalamimasalah
masalah dengan
denganfertilitasnya
fertilitasnya
dengan
denganfertilitasnya
fertilitasnya
* GLOBALISASI
* KESEMPATAN KERJA
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Fecundability (conception rate)
Normal : 20-25% of couples will
conceive/cycle
50% should conceive after 3-4mos
95% should conceive after 1 yr
Bila usia 38 th + riw infertil 3 th 2%
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Komponen Dasar Fertilitas pd
Perempuan
Vagina Imun respon
Mukus Cx normal normal
– Sperma
Siklus ovulatoar
– Hsl konsepsi
Patensi Cx – Ov
– Fetal survival
Uterus Status kes,gizi &
Hormonal biokimiawi adekuat
memelihara
kehamilan
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FISIOLOGI TUBA FALOPII
FISIOLOGI
Ovum Picked - Up
Transport Gamet & Embrio
Tempat Fertilisasi
Tempat Pertumbuhan Dini Embrio
SYARAT
• Fimbriae Baik
• Patent
• Bebas Perlekatan
• Otot Tuba Baik
• 12/08/21
Villi / Cilia Baik 10
KANTUNG KENCING
RAHIM
RONGGA RAHIM
VAGINA
MULUT RAHIM
KANTUNG TELOR
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SALURAN TELOR
PINTU
DEPO MAKANAN
SARINGAN
MULUT RAHIM
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TEMPAT
TUMBUH
JANIN
RAHIM
RONGGA RAHIM
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MENANGKAP SEL TELUR
TRANSPORTASI SPERMA
DAN EMBRIO
RAHIM
PERTUMBUHAN DINI
EMBRIO
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SALURAN TELOR
Komponen Dasar Fertilitas pd Pria
Sperma normal
– Motilitas, struktur biologi, fungsi & jumlah
Analisa sperma normal :
– Volume : 2 – 5 ml
– Jumlah sperma >20 juta/ml
– Motilitas pada 6-8 jam : >40 %
– Bentuk sperma yang abnormal : < 20 %
– Kandungan kadar fruktosa : 120 -450 mikrog/ml. 1
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Komponen Dasar Fertilitas pd Pria
Traktus reproduksi tdk ada
obstruksi
Sekresi normal
Kemampuan ejakulasi dan deposit
sperma di Cx
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JUMLAH GERAK BENTUK
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Major Causes
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Etiologi Infertil pd Perempuan
Unexplained 10%
Cervical/mucus 2-3%
Endometrial/uterine 2-3%
Pelvic/peritoneal 5-10%
Tubal 30-50%
Central (CNS) 40%
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Etiologi lain
PID
Cx conization/cautery
Smoking
DES exposure
IUD
Endometriosis
PCOF
Usia stl 30 th fecundity me ↓
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Etiologi Infertil (Tidak berovulasi)
Tdp pd 40 % perempuan
Primary of premature ovarian failure
PCOS
Hypotyroidism
Tumor hipofise
Laktasi
Adesi periovarial
Endometriosis
Medisinalis
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Polycystic Ovarian Syndrome
Oligomenorrhea/amenorrhea and
hyperandrogenism
Prevalence: 5%.
Clinical evidence: hirsutism, acne, obesity
Lab evidence: elevated testosterone,
elevated DHEA-S.
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Hypothalamic Anovulation
Low levels of GnRH, low of normal
levels of FSH/ LH, low levels of
endogenous estrogen.
Associated factors: low BMI (< 20),
high-intensity exercise, extreme
diets, stress.
Treatment: lifestyle modification.
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Hyperprolactinemia
Causes: pituitary adenoma, psych meds.
Test for: pregnancy, thyroid disease.
Imaging: MRI for macro vs microadenoma
Treament: Bromocriptine (dopamine
agonist). After correction, 80% of women
will ovulate, 80% will get pregnant.
Discontinue treatment once pregnancy
established.
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Etiologi Infertil
(Tubal/ Pelvic pathology)
Congenital May occur as
anomalies sequelae of
Tubal occlusion – PID
Evaluated by: – endometriosis
– hysterosalpingogram – abdominal/pelvic
surgery
– laparoscopy
– peritonitis
– hysteroscopy
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Etiologi Infertil (Mukus Cx)
Cervisitis
Respon imun thd sperma
Pemakaian lubrikasi or vag douche
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Etiologi Infertil (Blokade)
Cx Tuba Tuba or
– Polip motilitas abN
– Myoma – PID
– Adhesi – IUD
– Endometriosis – Neoplasma
– Adenomyosis – Salpingitis
– Endometritis – Ligasi tuba
– Cx stenosis – Endometriosis
– Anomali kongenital – KE
– Peritubal
adesion
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Etiologi Infertil cont
Obst Ov – Fimbrie
PID
Adesi Faktor Endometrium
Endometriosis tdk siap
– Anovulasi
– Defek fase luteal
– IUD
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Penyebab infertilitas pria
1. Gangguan produksi sperma
2. Gangguan fungsi sperma
3. Gangguan transportasi sperma
4. Idiopatik
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Penyebab infertilitas pria
BLOKADE
– Infeksi
– Tumor
– Anomali kongenital DEPOSIT SPERMA
– Vasektomi – Prematur ejakulasi
– Retrograde – Hyospadia
ejakulation – Retrograde ejakulation
– Ggn eurologi (spine)
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Evaluasi untuk Perempuan Ax
Infertility duration
Detailed menstrual history ovulasi
Prior pregnancies
Fertility in other relationships
IUD’s, OCP’s, Depo
Frequency of intercourse/sexual
dysfunction
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DETEKSI OVULASI
Riwayat Haid teratur
Biopsi endometrium fase skeretorik
LH test
BBT bifasik
Pemeriksaan hormonal : FSH , LH, P4 (hr
XXI), TSH, prolaktin
TVS hr XIV Folikel dominan Ø 18-22 mm
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USG OVARIUM
18 mm
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Evaluasi untuk Perempuan Ax
Gynecologic history (PID,
endometriosis, fibroids, cervical
dysplasia)
DES exposure
Medical and surgical history
Medications
Previous tests and therapy
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Evaluasi unt Pria Ax
Infertility duration
Prior fertility in relationship(s)
Medical & surgical history
Meds (anabolic steroids, cancer
chemotherapy, sulfasalazine,
nitrofurantoin)
Alcohol, drugs, pot
Occupational exposures
Sexual dysfunction
Tight fitting underwear/pants
Previous testing
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TES CADANGAN OVARIUM
Biofisik Biokimia
Ultrasound Kadar basal (folikuler awal):
2D atau 3D FSH, LH, E2
Volume ovarium Inhibin dan activin
Basal antral folikel (AFC) Antimullerian hormon (AMH)
Aliran darah stroma ovarium Tes stimulasi ovarium :
Dimensi uterus GnRH agonist stimulation test
Densitas folikel Human menopausal gonadotropin
(hMG test)
Clomiphene citrate challenge test
(CCCT)
FSH
PATHOLOGICAL CASES
• Post pelvic surgery
• Immun or genetic F.
• Etc.
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CADANGAN OVARIUM
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16-20 minggu kehamilan : 6-7 juta
Jumlah oosit
Saat lahir : 1-2 juta
Usia
Pubertas : 300.000.
Folikel antral adalah folikel kecil – kecil yang mempunyai ukuran 2-8 mm
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resting follicle 43
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MEMPRODUKSI
SEL TELUR
INDUNG TELOR
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INFERTILITY
FEMALE MALE
Normal • COH Tx /
Abnormal Op. Reconstructive 1,5 – 2 Y. • IUI Induction
Surgery (Tube F. N)
6 Months.
Op. Failed
IVF
Increasing Fecundability
hMG or
hMG-IUI
CC or
CC - IUI
Expectant
Management
Correct all
Fertility factors
Identify all
Fertility factors
Figure 20 – 16. Staircase approach to empirical infertility treatment/ For women over 35 years old, the first three steps in the algorithm
should be rapidly completed. In women less than 30 years old, more time can be spent on the first three steps in the staircase
1 – 2 TH 1 – 2 TH 1 – 2 TH
HAMIL -
HAMIL -
BAYI TABUNG
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HIDROSALPING & INFERTILITAS *
SALPINGECTOMI • FIMBRIOPLASTY
• SALPHINGOSTOMI
FIV – ET 1,5 – 2 TH
HAMIL
ANTISPERMA
KENTAL
POLIP
MULUT RAHIM
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SPERMA
OVUM
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RONGGA RAHIM
VAGINA
MULUT RAHIM
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INFEKSI
TUMOR
RAHIM
KETEBALAN
RAHIM TIPIS
RONGGA RAHIM
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INFEKSI
RAHIM
ENDOMETRIOSIS
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SALURAN TELOR
TUBOPLASTI
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Dx Tx
KISTE
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ADOPSI AKU
AE . . .
MARI MBAK
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Terima Kasih
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