Laporan Kasus

Keberhasilan Program IVF pada Infertilitas Primer dengan PCOS post Ovarian Drilling
disertai Severeoligoasthenoteratozospermia pada Suami

The success of the IVF Program on Primary Infertility with PCOS post Ovarian Drilling with
Severeoligoasthenoteratozospermia in Husband

Djanas Dovy

Division of Fertility, Endocrinology and Reproduction

Departement of Obstetrics and Gynecology
Faculty of Medicine Universitas Andalas
Dr. M. Djamil Central General Hospital
Padang

Abstract
Objective: Report a case of The success of the IVF Program on Primary Infertility with PCOS post
Ovarian Drilling with Severeoligoasthenoteratozospermia in Husband.
Method: Case report
Background : Polycystic ovary syndrome (PCOS) is a common, complex reproductive endocrinopathy
characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries one of the most
common causes of anovulatory infertility, with an estimated prevalence of 4–7% worldwide.1,2 There
are several treatment options for PCOS related anovulatory infertility. First line of treatment is usually
clomiphene citrate, but when it fails to result in conception, gonadotrophins or laparoscopic ovarian
drilling (LOD) may be used as a second line treatment.3 Finally, a high-complexity reproduction
treatment (in vitro fertilization or intracytoplasmic sperm injection) is the third-line treatment and is
recommended when the previous interventions fail. 4
Case: Reported case, female, 28 years old with diagnose of primary infertility with PCOS post ovarian drilling
accompanied by severeoligoasthenoteratozospermia in husband. Patient has been known to have PCOS since
2015 with irregular menstrual complaint, every 3 months, 5-6 days duration, menstrual pain (+), 2 years
married, patients has not been pregnant altough with 2x regular intercourse weekly. The physical appearance,
like obesity, acne and hirsutism is not dominant. The results of her husband sperm analysis who diagnosed with
varicocele are severeoligoastenoteratozospermia (4m, 0% + 5%, 1%) and has not undergone surgery. After
failure of 2 cycles ovulation induced, ovarian drilling was performed in February 2017. Then, the patient
prepared an IVF program. Ovum Pick Up (OPU) was performed in April 2017 followed by Intra Cytoplasmic
Sperm Injection (ICSI) and embryo development, obtained 7 good embryos and 1 moderate embryo, performed
Freezing Embryo Transfer (FET) on July 27, 2017, 1 good embryo. Patient was pregnant on August 7, 2017 with
test pack (+), b-HCG 447,2 and gestational sac from USG according to biometry 4-5 weeks. Strictly
Observation of pregnancy to term done.
Conclusion: Management of PCOS by ovarian drilling in cases of conservative failure, provides a good
prognosis for successful of IVF program altough it is accompanied by
severeoligoasthenoteratozospermia in the husband.
Keywords: Infertility, PCOS, LOD, IVF.

Abstrak
Tujuan: Melaporkan kasus keberhasilan program IVF pada infertilitas primer dengan PCOS post
ovarian drilling disertai severeoligoasthenoteratozospermia pada suami
Metode: Laporan kasus
Latar Belakang : Sindrom ovarium polikistik (PCOS) adalah endokrinopati reproduksi yang umum dan
kompleks yang ditandai dengan mesntruasi tidak teratur, hiperandrogenisme dan ovarium polikistik. PCOS
penyebab infertilitas paling umum yang disebabkan anovulasi, dengan perkiraan prevalensi 4-7% di seluruh
dunia.1,2 Ada beberapa pilihan pengobatan untuk infertilitas anovulasi pada PCOS. Pengobatan lini pertama
biasanya dengan klomifen sitrat, namun bila gagal, gonadotrofin atau ovarium drilling perlaparoskopi (LOD)
dapat digunakan sebagai pengobatan lini kedua.3 Terakhir, teknologi reproduksi berbantu (fertilisasi in vitro
(IVF) atau intracytoplasmic injeksi sperma (ICSI)) adalah pengobatan lini ketiga dan direkomendasikan saat
intervensi sebelumnya gagal.4
Kasus: Dilaporkan kasus, perempuan, 28 tahun dengan diagnosis infertilitas primer dengan PCOS post
ovarian drilling disertai severeoligoasthenoteratozospermia pada suami. Pasien sudah dikenal
menderita PCOS sejak tahun 2015 dengan keluhan haid tidak teratur setiap 3 bulan, lamanya 5-6 hari,
nyeri haid (+), pasien 2 tahun menikah belum pernah hamil dengan hubungan seksual 2x seminggu
teratur. Tampilan fisik obesitas, akne dan hirsutisme tidak dominan. Hasil analisa sperma suami yang
didiagnosis varikokel adalah severeoligoastenoteratozospermia (4juta,0%+5%,1%) dan belum
menjalani tindakan bedah. Setelah 2 siklus induksi ovulasi tidak berhasil, dilakukan ovarian drilling
perlaparaskopi pada Februari 2017. Kemudian pasien disiapkan program IVF. Ovum Pick Up (OPU)
dilakukan pada April 2017 dilanjutkan Intra Cytoplasmic Sperm Injection (ICSI) dan perkembangan
embrio, didapatkan 7 embrio good dan 1 embrio moderate, dilakukan Freezing Embryo Transfer (FET)
pada 27 Juli 2017 1 embrio good. Pasien dinyatakan hamil pada tanggal 7 Agustus 2017 dengan test
pack (+), b-HCG 447,2 dan tampak gestasional sac sesuai biometri 4-5 minggu. Dilakukan pengawasan
ketat terhadap kehamilan hingga aterm.
Kesimpulan: Penatalaksanaan PCOS dengan ovarian drilling pada kasus gagal konservatif,
memberikan prognosis yang baik pada keberhasilan program IVF setelahnya walaupun disertai dengan
disertai severeoligoasthenoteratozospermia pada suami.
Kata kunci: Infertilitas, PCOS, LOD, IVF.

Correspodence: Dovy Djanas :

dovy.dj86@gmail.com