DR.dr.

TINNY RASJAD INDRA SpPK (K)

Hormones synthesized by :
Testis testosterone
Ovary progesterone and estradiol
Pituitary follicle stimulating hormone (FSH)
luteinizing hormone (LH)
Hypothalamus gonadottropin releasing hormone
(GnRH)
Placenta human chorionic gonadotropin
(hCG)
estrogens
progesterone
 Hormon disintesis oleh:
Testis testosteron
Ovarium progesteron dan estradiol
Hipofisis follicle stimulating hormone
(FSH)
luteinizing hormone (LH)
Hipotalamus gonadottropin releasing
hormone (GnRH)
Plasenta human chorionic gonadotropin
(HCG)
estrogen
progesteron
 Regulation of
reproduction
in male

LH Luteinizing hormone
FSH Follicle-stimulating
hormone
GnRH Gonadotropin
-releasing hormone
 Hypothalamus secretes GnRH binds to specific cell
membrane receptor on gonadotroph in the anterior
pituitary synthetize and secrete LH and FSH
FSH induces Sertoli cells to synthetize and secrete
androgen-binding protein maintains high testosterone
concentration.
LH induces Leydig cells to synthesize and secrete
testosterone
Testosterone is required for normal spermatogenesis and
normal male growth, some transported to hypothalamus
and anterior pituitary where it has a negative feedback
effect.
 Hipotalamus mengeluarkan GnRH mengikat
reseptor membran sel tertentu pada gonadotroph di
hipofisis anterior synthetize dan mensekresi LH
dan FSH
FSH menginduksi sel Sertoli untuk synthetize dan
mensekresikan protein pengikat androgen
mempertahankan konsentrasi testosteron tinggi.
LH menginduksi sel-sel Leydig untuk mensintesis
dan mensekresi testosteron
Testosteron diperlukan untuk spermatogenesis
normal dan pertumbuhan laki-laki normal, beberapa
diangkut ke hipotalamus dan hipofisis anterior di
mana ia memiliki efek -feedback negatif.
Regulation of
reproduction
in female
 Hypothalamus secretes GnRH binds to specific
cell membrane receptor on gonadotroph in the
anterior pituitary synthesize and secrete LH and
FSH
Regulatory process in female is cyclic menstrual
cycle pituitary, ovarian and uterine changes
occur during 28 days
FSH regulating follicular phase of the ovarian cycle
Growing follicle produces estradiol restores
endometrium proliferative phase
 Hipotalamus mengeluarkan GnRH mengikat
reseptor membran sel tertentu pada
gonadotroph di hipofisis anterior
mensintesis dan mensekresi LH dan FSH
Proses regulasi pada wanita adalah siklik
siklus menstruasi hipofisis, ovarium dan
rahim perubahan terjadi selama 28 hari
FSH mengatur fase folikuler dari siklus ovarium
Tumbuh folikel menghasilkan estradiol
mengembalikan fase proliferative
endometrium
 Estradiol has a negative-feed back on hypothalamus
and anterior pituitary
Near the end of the follicular phase, feed back
effect of estradiol switches to positive surge in
GnRH, FSH and LH secretion ovulation
Estradiol production drops
Disrupted follicle differentiate into corpus luteum
(luteal phase of the ovarian cycle) synthesize
and secrete estradiol and progesterone cause
development of endometrium (secretory phase of
endometrium)
 Estradiol memiliki negatif-umpan balik pada
hipotalamus dan hipofisis anterior
Menjelang akhir fase folikuler, umpan balik efek
switch estradiol ke positif lonjakan GnRH,
FSH dan LH sekresi ovulasi
tetes produksi estradiol
Terganggu folikel berdiferensiasi menjadi
korpus luteum (fase luteal dari siklus ovarium)
mensintesis dan mensekresi
estradiol dan progesteron penyebab
perkembangan endometrium (fase sekresi dari
endometrium)
Infertile cycle :
Corpus luteum regress estradiol and progesterone
synthesis and secretion decrease endometrium shed
during menstruation
Hypothalamic and anterior pituitary negative feed back
decrease FSH and LH are synthesized and secreted
again to begin another cycle
siklus subur:
Korpus luteum kemunduran estradiol dan sintesis
progesteron dan penurunan sekresi gudang
endometrium saat menstruasi
Hipotalamus dan hipofisis anterior negatif feed back
penurunan FSH dan LH disintesis dan disekresi lagi
untuk memulai siklus lain
 9 days after fertilization implantation trophoblasts
synthesize hCG (human chorio gonadotropin, a LH like
hormone) are found in maternal blood
hCG prevents corpus luteum from regression estradiol
and progesterone synthesis continues maintain
uterine endometrium throughout pregnancy
 9 hari setelah pembuahan implantasi
trofoblas mensintesis hCG (gonadotropin
chorio manusia, sebuah LH seperti hormon)
yang ditemukan dalam darah ibu
hCG mencegah korpus luteum dari regresi
estradiol dan sintesis progesteron terus
mempertahankan endometrium rahim selama
kehamilan
 Benign Prostatic Hypertrophy
Prostate Cancer
Infertility
Male
Female
Endometriosis
Pelvic Inflammatory Disease
Ovarian Cysts
Cancer : breast, cervix, uterine
 Jinak prostat hipertrofi
Kanker prostat
infertilitas
Pria
Wanita
endometriosis
Penyakit inflamasi panggul
Kista ovarium
Kanker: payudara, leher rahim, rahim
 Common in older men; varies from mild to
severe
Change is actually hyperplasia of prostate
Nodules form around urethra
Result of imbalance between estrogen and testosterone
No connection w/ prostate cancer
Rectal exams reveals enlarged gland
Incomplete emptying of bladder leads to
infections
Continued obstruction leads to distended
bladder, dilated ureters, renal damage
If significant, surgery required
Lab test : PSA (Prostat Specific antigen) normal/
increase 4 10 ng/ml (in 20% patients)
 Umum pada pria yang lebih tua; bervariasi dari ringan
sampai berat
Perubahan sebenarnya hiperplasia prostat
Nodul bentuk sekitar uretra
Hasil ketidakseimbangan antara estrogen dan testosteron
Tidak ada koneksi w kanker / prostat
ujian dubur mengungkapkan kelenjar membesar
pengosongan lengkap dari kandung kemih menyebabkan
infeksi
obstruksi terus mengarah ke buncit kandung kemih,
ureter melebar, kerusakan ginjal
Jika signifikan, operasi diperlukan
Uji Lab: PSA (Prostat Specific Antigen) yang normal /
meningkat 4 - 10 ng / ml (pada pasien 20%)
 Cause not determined
Genetic, environmental, hormonal factors
Common in North American and northern Europe
Incidence higher in black population than white
Genetic factor?
Testosterone receptors found on cancer cells
Penyebab tidak ditentukan
Genetik, lingkungan, faktor hormonal
Umum di Amerika Utara dan Eropa Utara
Insidensi lebih tinggi pada penduduk kulit hitam dari
putih
Faktor genetik?
reseptor testosteron yang ditemukan pada sel-sel
kanker
 Hard nodule in periphery of gland
Detected by rectal exam
No early urethral obstruction
b/c of location
As tumor develops, some obstruction occurs
Hesitancy, decreased stream, urinary frequency, bladder
infection
Keras nodul di pinggiran kelenjar
Terdeteksi oleh pemeriksaan dubur
Tidak ada awal obstruksi uretra
b / c dari lokasi
Sebagai tumor berkembang, beberapa obstruksi terjadi
aliran keraguan, menurun, frekuensi kencing, infeksi
kandung kemih
 2 helpful serum markers
Prostate-specfic Antigen (PSA) > 10-40 ng/ml
Useful screening tool for early detection

Prostatic acid phosphatase (PAP)

elevated when metastatic cancer present

Ultrasound and biopsy confirms

2 spidol serum bermanfaat
Prostat-specfic Antigen (PSA)> 10-40 ng / ml
alat screening yang berguna untuk deteksi dini
fosfatase asam prostat (PAP)
ditinggikan hadir kanker ketika metastatik
USG dan menegaskan biopsi
 Surgery and radiation
Risk of impotence or incontinence
When tumor androgen sensitive:
orchiectomy (removal of testes) or
Antitestosterone drug therapy
5 yr survival rate is 85-90%
Bedah dan radiasi
Risiko impotensi atau inkontinensia
Ketika tumor androgen sensitif:
orchiectomy (pengangkatan testis) atau
terapi obat Antitestosterone
tingkat kelangsungan hidup 5 tahun adalah 85-90%
 The main reproduction problem a couple visits their
physician is INFERTILITY
Masalah reproduksi utama pasangan mengunjungi
dokter mereka adalah INFERTILITAS

Definition : inability to conceive after 12

months of unprotected sexual intercourse.
Definisi: ketidakmampuan untuk hamil setelah 12
bulan hubungan seksual tanpa kondom.
 Plays a role in 1/3 of infertile couples.
Causes of male infertility :
Primary hypogonadism (30 40%)
Disorders of sperm transport (10 20%)
Secondary hypogonadism (2%)
Unknown etiology (50%)
Isolated impaired spermatogenesis :
Y chromosome microdeletions and substitutions
Viral orchitis,Tuberculosis,STDs
Radiation,Chemotherapeutic agent
Environmental toxins
Prolonged elevation of testicular temperature
 Berperan dalam 1/3 dari pasangan infertil.
Penyebab infertilitas laki-laki:
hipogonadisme primer (30 - 40%)
Gangguan transportasi sperma (10 - 20%)
hipogonadisme sekunder (2%)
Diketahui etiologi (50%)
Terisolasi gangguan spermatogenesis:
Y mikrodelesi kromosom dan substitusi
Viral orkitis, Tuberkulosis, PMS
Radiasi, agen kemoterapi
racun lingkungan
Berkepanjangan peningkatan suhu testis
 Can be solely male, solely female, or both
Considered infertile after one year of
unprotected intercourse fails to produce a
pregnancy
Male problems include
Changes is sperm or semen
Hormonal abnormalities
Pituitary disorders or testicular problems
Physical obstruction of sperm passageways
Congenital or scar tissue from injury
Semen analysis
Assess specific characteristics
Number, motility, normality
 Dapat semata-mata laki-laki, hanya perempuan,
atau keduanya
subur dipertimbangkan setelah satu tahun hubungan
seks tanpa kondom gagal menghasilkan kehamilan
masalah laki-laki termasuk
Perubahan adalah sperma atau air mani
kelainan hormonal
gangguan hipofisis atau masalah testis
kerusakan fisik dari lorong sperma
Bawaan atau jaringan parut dari cedera
analisis air mani
Menilai karakteristik tertentu
Jumlah, motilitas, normalitas
Clinical features :
Evidence of hypogonadism may be present
Testicular size and consistency may be abnormal,
varicocele may be apparent on palpation
Key diagnostic test : semen analysis sperm
counts <13 million/mL, motility : <32%, and <9%
normal morphology subfertility.
If the sperm count is low on repeated exam , or if
there is clinical evidence of hypogonadism,
hormone level should be measured.
 Gambaran klinis:
Bukti hipogonadisme dapat hadir
Ukuran testis dan konsistensi mungkin
abnormal, varikokel dapat terlihat pada
palpasi
Key tes diagnostik: analisis semen jumlah
sperma <13 juta / mL, motilitas: <32%, dan
<9% yang normal morfologi subfertility.
Jika jumlah sperma rendah pada ujian ulang,
atau jika ada bukti klinis hipogonadisme,
tingkat hormon harus diukur.
 NORMAL VALUE IN SEMEN ANALYSIS

VOLUME 2 5 mL
VISCOSITY Pours in droplets
pH 7.2 8.0
SEMEN > 20 million/mL
CONCENTRATION
SPERM COUNT > 40 million/ejaculate
MOTILITY > 50% in 1 hour
QUALITY > 2 or a, b, c, according to sperm motility
grading
MORPHOLOGY 14% normal forms (strict criteria)
>30% normal forms (routine criteria)
ROUND CELLS < 1 million/mL
 Sexual abstinence 3 4 days before specimen
collection
When performing fertility testing, 2 3 test
performed with 2 weeks intervals
Provide warm sterile glass or plastic container
Inform the patient not to void into the container
Avoid collecting semen in condom spermaticide
Semen collected at home should be send
immediately in room temperature within 1 hr
Record the time specimen collected and receipt
 pantang seksual 3 - 4 hari sebelum pengambilan
spesimen
Ketika melakukan tes kesuburan, 2-3 pengujian
dilakukan dengan interval 2 minggu
Menyediakan kaca steril hangat atau wadah plastik
Menginformasikan pasien tidak membatalkan ke
dalam wadah
Hindari mengumpulkan semen di kondom
spermaticide
Semen dikumpulkan di rumah harus mengirimkan
segera di suhu kamar dalam waktu 1 jam
Mencatat waktu spesimen dikumpulkan dan
penerimaan
Examination :
Appearance greyish white, translucent, with
specific odor
Liquefaction a fresh specimen liquify
within 30 60 min after collection. Failure to
liquify indicates deficient in prostatic
enzyme
Volume : 2 5 mL decreased volume
associated with infertility
Viscosity : refers to the consintency of the
fluid increased viscosity and incomplete
liquefaction will impede sperm motility
 pemeriksaan:
Penampilan putih keabuan, tembus, dengan bau
spesifik
Pencairan spesimen segar mencairkan dalam
30 - 60 menit setelah pengumpulan. Kegagalan
untuk mencairkan menunjukkan kekurangan
enzim prostatic
Volume: 2 - 5 mL menurun volume yang
berhubungan dengan infertilitas
Viskositas: mengacu pada consintency cairan
meningkat viskositas dan pencairan tidak
lengkap akan menghambat motilitas sperma
 pH : alkaline, 7.2 8.0.
Increased pH indicative of infection.
Decreased pH increased production of prostatic fluid
Sperm count
Normal count >20 million/mL or >40 million/ ejaculate
(only developed sperm should be counted)
!0 20 million/mL considered borderline
Round cells : undeveloped sperm / WBC
> 1 million/mL leukocytes indicates infection of
reproductive organ that leads to infertility perform
aerobic and anaerobic culture
 pH: basa, 7,2-8,0.
Peningkatan pH indikasi infeksi.
Penurunan pH peningkatan produksi cairan
prostat
Jumlah sperma
hitungan normal> 20 juta / mL atau> 40 juta /
ejakulasi (sperma hanya dikembangkan harus
dihitung)
! 0-20000000 / mL dianggap batas
sel-sel bulat: berkembang sperma / WBC
> 1 juta / mL leukosit menunjukkan infeksi
organ reproduksi yang mengarah ke infertilitas
melakukan budaya aerobik dan anaerobik
 Spermatides >1 million/mL indicates
spermatogenesis disruption usually caused
by viral infection, exposure to toxic
chemicals, and genetic disorders
Sperm motility
Capability of sperm cells to move forward is
criticial for fertility. Motility is evaluated by
both speed and direction. A minimum
motility of 50% with 20% rating after 1hour is
considered normal
 Spermatides> 1 juta / mL menunjukkan
gangguan spermatogenesis biasanya
disebabkan oleh infeksi virus, paparan bahan
kimia beracun, dan kelainan genetik
sperma motilitas
Kemampuan sel sperma untuk bergerak
maju adalah criticial untuk kesuburan.
Motilitas dievaluasi oleh kecepatan dan arah.
Sebuah motilitas minimal 50% dengan rating
20% setelah 1 jam dianggap normal
 SPERM MOTILITY GRADING

GRADE WHO CRITERIA

4.0 a Rapid, straight motility
3.0 b Slower speed, some lateral
movements
2.0 c Slow forward progression,
noticeable lateral movement

1.0 d No forward progression

0 e No movement
 Sperm morphology
Evaluation of head, neck piece, mid piece
and tail and their size, acrosomal cap and
vacuolization
The head represents the sperm cell itself
with its enzyme-containing acrosomal cap
Find abnormal heads : double head, giant
head, pin head, tapered head and
constricted head
Abnormal tail : coiled, bend, doubled
Long neck piece backward bending head
 sperma morfologi
Evaluasi kepala, leher bagian, pertengahan
bagian dan ekor dan ukuran, topi akrosom dan
vakuolisasi
Kepala merupakan sel sperma itu sendiri
dengan itu tutup akrosom mengandung enzim
Cari kepala tidak normal: kepala ganda,
kepala raksasa, kepala pin, kepala meruncing dan
kepala terbatas
Abnormal ekor: melingkar, tikungan, dua kali
lipat
Panjang leher bagian kepala belakang
membungkuk
 ADDITIONAL TEST FOR ABNORMAL SPERM ANALYSIS
Abnormal Result Possible Abnormality Test
Decreased motility Viability Eosin-nigrosin stain
with normal count
Decreased count Lack of seminal vesicle Fructose level
support medium
Decreased motility Male antisperm Mixed agglutination
with clumping antibodies reaction
Immunobead tests
(Sperm agglutination
with male serum)
Normal analysis with Female antisperm Sperm agglutination
continued infertility antibodies with female
serum/cervical mucosa
Etiology :
Primary hypogonadism testicular failure

Secondary hypogonadism hypothalamic-

pituitary defects
etiologi:
hipogonadisme primer kegagalan testis
hipogonadisme sekunder cacat
hipotalamus-hipofisis
Diagnose :
Testosterone level
Gonadotropin levels (LH and FSH) are

Etiology :
Klinefelters syndrome most common
Acquired primary testicular failure results from viral
orchitis, trauma, cryptorchidism, radiation damage,
systemic diseases (amyloidosis, Hodgkins disease, sickle
cell disease).
Toxins marijuana, alcohol, heroin, lead,
antineoplastic, and chemotheurapeutic agents.
Ketoconazole blocked testosterone synthetis.
Competitive inhibition by spironolactone and
cimetidine.
 mendiagnosa:
Tingkat testosteron
tingkat gonadotropin (LH dan FSH) yang
etiologi:
Sindrom Klinefelter paling umum
Mengakuisisi kegagalan testis primer hasil dari
orchitis virus, trauma, kriptorkismus, kerusakan
radiasi, penyakit sistemik (amiloidosis, penyakit
Hodgkin, penyakit sel sabit).
Racun ganja, alkohol, heroin, memimpin,
antineoplastik, dan agen chemotheurapeutic.
Ketokonazol diblokir testosteron synthetis.
penghambatan kompetitif dengan spironolactone dan
simetidin.
Diagnose :
Testosterone levels low
Gonadotropin levels low (hypogonadotropic
hypogonadism)

Etiology :
Kallmanns syndrome : impairment of
synthesis/release GnRH (gonadotropin releasing
hormone) LH, FSH with/without anosmia
Cushings syndrome, adrenal hypoplasia- congenita,
hemochromatosis, hyperprolactinemia
 mendiagnosa:
kadar testosteron rendah
kadar gonadotropin rendah (hipogonadisme
hipogonadisme)

etiologi:
Sindrom Kallmann ini: gangguan sintesis /
release GnRH (gonadotropin releasing hormone)
LH, FSH dengan / tanpa anosmia
Sindrom Cushing, adrenal congenita
hypoplasia-, hemochromatosis,
hiperprolaktinemia
 History focus on developmental stages such as
puberty and growth
Physical examination should focus on secondary sex
characteristics : hair growth in the face, axilla,
chest, pubic region, gynaecomastia, testicular
volume, prostate, height and body proportion.
The presence of varicocele
Morning total testosterone levels <6.93 nmol/L
(<200 ng/dL), in association with symptoms,
suggests testosterone deficiency.
 Sejarah fokus pada tahap perkembangan
seperti pubertas dan pertumbuhan
Pemeriksaan fisik harus fokus pada
karakteristik seks sekunder: pertumbuhan
rambut di wajah, ketiak, dada, daerah
kemaluan, ginekomastia, volume testis,
prostat, tinggi dan tubuh proporsional.
Kehadiran varikokel
Pagi kadar testosteron total <6,93 nmol / L
(<200 ng / dL), berkaitan dengan gejala,
defisiensi testosteron.
 Levels between 6.93 nmol/L and 12.13
nmol/L must be repeated and a free
testosterone levels should be measured.
Levels of LH and FSH can be used to
differentiate between primary and secondary
hypogonadism.
Measurement of prolactin level and MRI scan
of the hypothalamic-pituitary region should
be considered in secondary hypogonadism
 Tingkat antara 6,93 nmol / L dan 12,13
nmol / L harus diulang dan kadar testosteron
bebas harus diukur.
Tingkat LH dan FSH dapat digunakan untuk
membedakan antara hipogonadisme primer
dan sekunder.
Pengukuran tingkat prolaktin dan MRI scan
daerah hipotalamus-hipofisis harus
dipertimbangkan dalam hipogonadisme
sekunder
 FSH
OESTROGENE OESTRIO
GRAAFIAN
S L
LH FOLLICLES
OVULATION PROGESTERON
OESTROGENES
CORPUS
LUTEUM

PITUITARY Gn-RH UTERUS

HYPOTHALAMUS hCG
 LH FSH Oestradiol- Progesteron
(u/L) (u/L) 17 (nmol/L)
(pmol/L)
Children 13 13 40 120 <6
Menstruating adults
Follicular phase 1 - 10 16 40 600 <6
Mid-cycle peak 8 60 4 15 500 1600 4 10
Luteal phase 2 14 15 280 1000 > 20
Post menopause > 15 > 20 < 150 <6
 The pituitary hormone : luteinizing hormone
(LH), follicle stimulating hormone (FSH),
stimulate ovarian follicular development and
result in ovulation at about day 14 of the 28-day
menstrual cycle.
Hormon hipofisis: luteinizing hormone (LH),
hormon perangsang folikel (FSH), merangsang
perkembangan folikel ovarium dan menghasilkan
ovulasi pada sekitar hari ke-14 dari siklus
menstruasi 28 hari.
 Associated w/ hormonal imbalances
Result from altered function of hypothalamus, anterior
pituitary, or ovaries
Typically after long use of birth control pill
Structural abnormalities
Small or bicornuate uterus
Obstruction of fallopian tubes
Scar tissue or endometriosis
Access of viable sperm
Change in vaginal pH
Due to infection or douches
Excessively thick cervical mucus
Development of antibodies in female to particular sperm
Smoking by male or female
 Terkait w / ketidakseimbangan hormonal
Hasil dari fungsi berubah dari hipotalamus, hipofisis
anterior, atau ovarium
Biasanya setelah digunakan panjang pil KB
kelainan struktural
uterus kecil atau bikornu
Obstruksi saluran tuba
Jaringan parut atau endometriosis
Akses sperma yang layak
Perubahan pH vagina
Karena infeksi atau douche
Berlebihan tebal lendir serviks
Pengembangan antibodi pada wanita untuk sperma tertentu
Merokok dengan laki-laki atau perempuan
 Broad range of tests avail
General health status checked 1st
Pelvic examinations, ultrasound, CT scans check
for structural abnormalities
Tubal insufflation (gas/pressure measurement) or
hysterosalpingogram (X-ray w/ contrast material)
used to check tubes
Blood tests throughout cycle to check hormone
levels
 berbagai tes berhasil
Status kesehatan umum diperiksa 1
pemeriksaan panggul, USG, CT scan cek
untuk kelainan struktural
insuflasi tuba (/ pengukuran tekanan gas)
atau hysterosalpingogram (X-ray w / bahan
kontras) digunakan untuk memeriksa tabung
Tes darah ke seluruh siklus untuk memeriksa
kadar hormon
 Due to primary (gonadal)
secondary (pituitary)
Karena - primer (gonad)
- Sekunder (hipofisis)
Basal tests
Preliminary investigation :
Plasma / urine [estriol]
Total urinary estrogens
Low value confirm gonadal failure but do not
diferentiate the ovarial / pituitary site
To confirm the site, need to measure plasma
[FSH],
[LH], urinary excretion of [FSH] and [LH],
plasma
prolactin, [oestradiol-17] and progesterone
 tes basal
penyelidikan awal:
Plasma / urine [estriol]
Jumlah estrogen kemih
nilai rendah mengkonfirmasi kegagalan gonad
tapi tidak
diferentiate situs ovarial / hipofisis
Untuk mengkonfirmasi situs, perlu untuk
mengukur plasma [FSH],
[LH], ekskresi [FSH] dan [LH], plasma
prolaktin, [estradiol-17] dan progesteron
Gonadal failure due to gonads disease
The ovaries fail to respond to endogenous
gonadotrophin no progesteron nor
oestrogens produced lack of feed back
inhibition to pituitary and hypothalamus
plasma [LH] and [FSH]
kegagalan gonad karena penyakit gonad
Ovarium gagal menanggapi gonadotropin
endogen tidak ada progesteron atau
estrogen diproduksi kurangnya umpan balik
penghambatan ke hipofisis dan hipotalamus
plasma [LH] dan [FSH]
Gonadal failure due to non gonadal causes
Primary causes : hypothalamic or pituitary or
both
Plasma [LH] and [FSH] are low or normal-low
while plasma oestradiol-17 and
progesterone are low
In Stein-Leventhal syndrome (polycystic
ovary) primary pathological abnormality
lies in the hypothalamus / pituitary. Plasma
[LH] and [tertosterone] , plasma
[oestrogens]
 kegagalan gonad karena penyebab non gonad
penyebab utama: hipotalamus atau hipofisis
atau keduanya
Plasma [LH] dan [FSH] yang rendah atau
normal-rendah, sementara plasma estradiol-
17 dan progesteron rendah
Pada sindrom Stein-Leventhal (polycystic
ovary) kelainan patologis utama terletak
di hipotalamus / hipofisis. Plasma [LH] dan
[tertosterone] , plasma [estrogen]
 Hyperprolactinemia happens in 20% of
women with secondary amenorrhoe and
ovulatory failure.
Some have galactorrhoea
Hiperprolaktinemia terjadi di 20% dari wanita
dengan amenore sekunder dan kegagalan
ovulasi. Beberapa memiliki galaktorea
1. Plasma [progesterone] or 24 hr urinary pregnandiol
excretion about the 21st day of menstrual cycle + basal
temperature charts.
2. Plasma or urinary [oestrogens] low value confirms
gonadal failure primary/secondary
3. Plasma [FSH] = probably has primary ovarian
failure. If normal / low proceed to 4)
4. Plasma [prolactin] , confirm that she does not under
stress / consuming oral conraceptives to perform
thyroid function. If normal / low proceed to 5)
5. Dynamic tests. Using GnRH test, if subnormal due
to pituitary failure secondary to hypothalamus
disease.
 Plasma [progesteron] atau 24 jam ekskresi pregnandiol
kemih tentang hari ke-21 dari siklus menstruasi + grafik
suhu basal.
Plasma atau urin [estrogen] nilai rendah menegaskan
kegagalan gonad primer / sekunder
Plasma [FSH] = mungkin memiliki kegagalan ovarium
primer. Jika biasa / rendah dilanjutkan ke 4)
Plasma [prolaktin] , mengkonfirmasi bahwa dia tidak
di bawah tekanan / memakan conraceptives oral untuk
melakukan fungsi tiroid. Jika biasa / rendah
melanjutkan ke 5)
tes dinamis. Menggunakan uji GnRH, jika subnormal
karena kegagalan hipofisis sekunder untuk penyakit
hipotalamus.
 Synthetized by placental syncytiotrophoblast
Secreted into maternal circulation and excreted
in maternal urine in very early stage of
pregnancy
Urinary hCG output peaks about 7th 10th weeks
With LH like effect against corpus luteum to
maintain steroids production
hCG produced in other conditions, by
trophoblastic tumors in male / female
Male : testicular teratoma
Female : hydatidiform mole and choriocarcinoma
 Disintesis oleh sinsitiotrofoblas plasenta
Disekresi ke sirkulasi ibu dan diekskresi dalam urin
ibu dalam tahap sangat awal kehamilan
Kemih puncak keluaran hCG tentang 7 - minggu 10
Dengan LH seperti efek terhadap korpus luteum
untuk mempertahankan produksi steroid
hCG diproduksi dalam kondisi lain, oleh tumor
trofoblas di pria / wanita
Pria: teratoma testis
Perempuan: mola hidatidosa dan koriokarsinoma
 Endometriosis is typically seen during the
reproductive years;
occurs in roughly 610% of women.
Symptoms may depend on the site of active
endometriosis. Its main but not universal
symptom is pelvic pain in various
manifestations.
is a common finding in women with
infertility.
 Endometriosis biasanya terlihat selama
tahun-tahun reproduksi;
terjadi di sekitar 6-10% wanita.
Gejala mungkin tergantung pada situs
endometriosis aktif. Yang utama tetapi tidak
universal gejala adalah nyeri panggul dalam
berbagai manifestasi.
merupakan temuan umum pada wanita
dengan infertilitas.
 Endometriosis is a gynocological condition in
which cells from the lining of the
Uterus(endometrium) appear and flourish
outside the uterine cavity, most commonly
on the membrane which lines the abdominal
cavity, the peritoneum. The uterine cavity is
lined with endometrial cells, which are under
the influence of female hormone
 Endometriosis adalah suatu kondisi
gynocological di mana sel-sel dari lapisan
Rahim (endometrium) muncul dan
berkembang di luar rongga rahim, yang
paling umum pada membran yang melapisi
rongga perut, peritoneum. Rongga rahim
dilapisi dengan sel endometrium, yang
berada di bawah pengaruh hormon wanita
Signs and symptoms
Pelvic pain
dysmenorrhoe
Chronic pelvic pains
dyspareunia painful sex
dysuria urin
Tanda dan gejala
nyeri panggul
dysmenorrhoe
nyeri panggul kronis
dispareunia - seks menyakitkan
disuria - urin
 Endometriosis lesions react to hormonal
stimulation and may "bleed" at the time of
menstruation. The blood accumulates locally,
causes swelling, and triggers inflammatory
responses with the activation of cytokines. This
process may cause pain. Pain can also occur from
adhesions (internal scar tissue) binding internal
organs to each other, causing organ dislocation.
Fallopian tubes, ovaries, the uterus, the bowels,
and the bladder can be bound together in ways
that are painful on a daily basis, not just during
menstrual periods.[
 lesi endometriosis bereaksi terhadap rangsangan
hormon dan mungkin "berdarah" pada saat
menstruasi. darah terakumulasi secara lokal,
menyebabkan pembengkakan, dan memicu respon
inflamasi dengan aktivasi sitokin. Proses ini dapat
menyebabkan rasa sakit. Nyeri juga dapat terjadi
dari adhesi (jaringan parut internal) yang
mengikat organ satu sama lain, menyebabkan
dislokasi organ. tuba falopi, ovarium, rahim,
usus, dan kandung kemih dapat terikat bersama-
sama dengan cara yang menyakitkan setiap hari,
bukan hanya selama periode menstruasi. [
SELAMAT
BELAJAR