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Infertility Problem


   Gunawan Dwi Prayitno




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  Introduction
Definition :
Infertility is Failure to conceive after
regular u...
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       Infertility Causes
In RSPAD-Gatot Soebroto Jakarta

         FAKTOR PEN...
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       Requisite for Succesful
       pregnancy
   Oosit : ovulation ?, Oosit
...
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    Anamnesis

•  Age
• History of Thyroid
              - Hypothyroid
       ...
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Anamnesis
-Menstrual Cycle




                                                  ...
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Physical Examination




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The Level of Evidence
Level   Evidence
1a      Systematic review and meta-anal...
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The Grade of Evidence
Recommendation
Grade          Strenght of evidence
A     ...
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Semen Analysis




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ASA, Abnormal semen analysis




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 Definition Relating to Sperm
 Quality
Term                         Definition
...
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Tubal Patency (HSG,
Hysterosalpingo-contrast-USG,
Laparaskopy-kromotubation)




...
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Screening Clamydial and Antibiotic Profilactic
before Uterine instrumentation

...
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The Thyroid function

  -   There is no value in women with a
      regular men...
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Basal FSH & Estradiol (Day 2 – 3)


- Patients Ages ≥ 35 years
- Ovarian Reserv...
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Ovarian Reserve
 FSH > 10 m IU/mL Decreased ovarian reserve
     > 15 m IU/mL ...
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Ovulation detection

-   Mid Luteal Progesteron
-   USG monitoring




       ...
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Treatment

  Copyright http://www.ilmukedokteran.net
Copyright http://www.ilmukedokteran.net


Frequency and Timing of Sexual
Intercourse




        Copyright http://www.ilmu...
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Stop Smoking




      Copyright http://www.ilmukedokteran.net
Copyright http://www.ilmukedokteran.net




Obesity and Weight loss




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Scrotal Temperatur




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Folic Acid
Supplementation




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Copyright http://www.ilmukedokteran.net




    Male Factor Management

Medical Management
(Hypogonadotrophic hypogonadism...
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Obstuctive azoospermia




Varicocele




             Copyright http://www.il...
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   Ovulation Induction

1. Antiestrogen : CC or Tamoxifen




               C...
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2. Insulin Sensitizer : Metformin




         Copyright http://www.ilmukedokt...
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3. Gonadotrophin : FSH, hMG,
CC+IUI




         Copyright http://www.ilmukedo...
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Hyperprolaktinemia :
Bromokriptin




          Copyright http://www.ilmukedok...
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Management of Endometriosis
Ovarian Suppresion




Surgical Ablation




     ...
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Non Paten Tubes : Microsurgery
and Laparascopic tubal surgery




        Copyr...
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Intra Uterine Insemination




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Take home baby : IVF




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Summary

   Sperm transport, egg transport,
    physiology fertilisation, and...
Copyright http://www.ilmukedokteran.net




Thank You




Copyright http://www.ilmukedokteran.net
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Infertilitas

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Infertilitas

  1. 1. Copyright http://www.ilmukedokteran.net Infertility Problem Gunawan Dwi Prayitno Copyright http://www.ilmukedokteran.net
  2. 2. Copyright http://www.ilmukedokteran.net Introduction Definition : Infertility is Failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology Clasification : - Primary - Secondary Copyright http://www.ilmukedokteran.net
  3. 3. Copyright http://www.ilmukedokteran.net Infertility Causes In RSPAD-Gatot Soebroto Jakarta FAKTOR PENYEBAB INFERTILITAS PENYEBAB FAKTOR ISTRI TUBA OVARIUM FAKTOR ISTRI UTERUS & 49 51 SERVIKS FAKTOR SUAMI HORMONAL ENDOMETRIO SIS IMUNOL/INFE KSI Copyright http://www.ilmukedokteran.net
  4. 4. Copyright http://www.ilmukedokteran.net Requisite for Succesful pregnancy  Oosit : ovulation ?, Oosit Quality(≈ age)  Sperm : Concentration, motility, morphology  Sperm & oosit transport, fertilization, and implantation. : Psychology, organic, and immunologic compatible.  Endometrial reseptivity Copyright http://www.ilmukedokteran.net
  5. 5. Copyright http://www.ilmukedokteran.net Anamnesis • Age • History of Thyroid - Hypothyroid - Hyperthyroid - Family / Diabetes mellitus history → Resistensi insulin PCOS • Complain : Dismenorhea ? PID, Endometriosis • Intercourse Frequency : 2-3 x/w • Intercourse Problem : Impotensi / Frigyd • Smoking, alcohol, drug abuse Copyright http://www.ilmukedokteran.net
  6. 6. Copyright http://www.ilmukedokteran.net Anamnesis -Menstrual Cycle 28 d + 3d Eumenorhea Polimenorhea oligomenorhea 25 31 Copyright http://www.ilmukedokteran.net
  7. 7. Copyright http://www.ilmukedokteran.net Physical Examination Copyright http://www.ilmukedokteran.net
  8. 8. Copyright http://www.ilmukedokteran.net The Level of Evidence Level Evidence 1a Systematic review and meta-analysis of randomised controlled trials 1b At least one randomised controlled study without randomisation 2a At least one well-designed controlled study without randomisation 2b At least one other type of well-designed quasi- experimental study 3 Well-designed non-experimental descriptive studies, such as comparative studies, correlation studies or case studies 4 Expert committee report or opinions and/ or clinical experienceof respected authoritis Copyright http://www.ilmukedokteran.net
  9. 9. Copyright http://www.ilmukedokteran.net The Grade of Evidence Recommendation Grade Strenght of evidence A Directly based on level 1 evidence B Directly based on level 2 evidence or extrapolated recommendation from level 1 evidence C Directly based on level 3 evidence or extrapolated recommendation from either level 1 or 2 evidence D Directly based on level 4 evidence or extrapolated recommendation from either level 1, 2 or 3 evidence Good practice The view of the Guideline Development Group Poin (GPP) NICE Technology Recommendation taken from a NICE Technology Appraisal Appraisal Copyright http://www.ilmukedokteran.net
  10. 10. Copyright http://www.ilmukedokteran.net Semen Analysis Copyright http://www.ilmukedokteran.net
  11. 11. Copyright http://www.ilmukedokteran.net ASA, Abnormal semen analysis Copyright http://www.ilmukedokteran.net
  12. 12. Copyright http://www.ilmukedokteran.net Definition Relating to Sperm Quality Term Definition Normozoospermia Normal ejaculate ~ WHO reference values Oligozoospermia Sperm concentration less than WHO reference values Asthenozoospermia Sperm motility less than WHO reference values Teratozoospermia Sperm morphology less than WHO reference values Oligoasthenoteratozoospe Signifies disturbance of all 3 or 2 variables rmia Azoospermia No spermatozoa in the ejaculate Aspermia No ejaculate Cryptozoospermia Few spermatozoa recovered after centrifugation RCOG 2004 Copyright http://www.ilmukedokteran.net
  13. 13. Copyright http://www.ilmukedokteran.net Tubal Patency (HSG, Hysterosalpingo-contrast-USG, Laparaskopy-kromotubation) Copyright http://www.ilmukedokteran.net
  14. 14. Copyright http://www.ilmukedokteran.net Screening Clamydial and Antibiotic Profilactic before Uterine instrumentation Copyright http://www.ilmukedokteran.net
  15. 15. Copyright http://www.ilmukedokteran.net The Thyroid function - There is no value in women with a regular menstrual Cycle RCOG B 200 • Hypothyroid : High TSH → Oligomenorhea - amenorhea Copyright http://www.ilmukedokteran.net
  16. 16. Copyright http://www.ilmukedokteran.net Basal FSH & Estradiol (Day 2 – 3) - Patients Ages ≥ 35 years - Ovarian Reserve : ( decreased negative feed back from ovaries ) Copyright http://www.ilmukedokteran.net
  17. 17. Copyright http://www.ilmukedokteran.net Ovarian Reserve FSH > 10 m IU/mL Decreased ovarian reserve > 15 m IU/mL Diminished ovarian reserve E-2 > 70 pg/mL (High FSH  Premature follicel developed) Copyright http://www.ilmukedokteran.net
  18. 18. Copyright http://www.ilmukedokteran.net Ovulation detection - Mid Luteal Progesteron - USG monitoring Copyright http://www.ilmukedokteran.net
  19. 19. Copyright http://www.ilmukedokteran.net Treatment Copyright http://www.ilmukedokteran.net
  20. 20. Copyright http://www.ilmukedokteran.net Frequency and Timing of Sexual Intercourse Copyright http://www.ilmukedokteran.net
  21. 21. Copyright http://www.ilmukedokteran.net Stop Smoking Copyright http://www.ilmukedokteran.net
  22. 22. Copyright http://www.ilmukedokteran.net Obesity and Weight loss Copyright http://www.ilmukedokteran.net
  23. 23. Copyright http://www.ilmukedokteran.net Scrotal Temperatur Copyright http://www.ilmukedokteran.net
  24. 24. Copyright http://www.ilmukedokteran.net Folic Acid Supplementation Copyright http://www.ilmukedokteran.net
  25. 25. Copyright http://www.ilmukedokteran.net Male Factor Management Medical Management (Hypogonadotrophic hypogonadism, idiopatic, ASA, Leucocytes in semen) Copyright http://www.ilmukedokteran.net
  26. 26. Copyright http://www.ilmukedokteran.net Obstuctive azoospermia Varicocele Copyright http://www.ilmukedokteran.net
  27. 27. Copyright http://www.ilmukedokteran.net Ovulation Induction 1. Antiestrogen : CC or Tamoxifen Copyright http://www.ilmukedokteran.net
  28. 28. Copyright http://www.ilmukedokteran.net 2. Insulin Sensitizer : Metformin Copyright http://www.ilmukedokteran.net
  29. 29. Copyright http://www.ilmukedokteran.net 3. Gonadotrophin : FSH, hMG, CC+IUI Copyright http://www.ilmukedokteran.net
  30. 30. Copyright http://www.ilmukedokteran.net Hyperprolaktinemia : Bromokriptin Copyright http://www.ilmukedokteran.net
  31. 31. Copyright http://www.ilmukedokteran.net Management of Endometriosis Ovarian Suppresion Surgical Ablation Copyright http://www.ilmukedokteran.net
  32. 32. Copyright http://www.ilmukedokteran.net Non Paten Tubes : Microsurgery and Laparascopic tubal surgery Copyright http://www.ilmukedokteran.net
  33. 33. Copyright http://www.ilmukedokteran.net Intra Uterine Insemination Copyright http://www.ilmukedokteran.net
  34. 34. Copyright http://www.ilmukedokteran.net Take home baby : IVF Copyright http://www.ilmukedokteran.net
  35. 35. Copyright http://www.ilmukedokteran.net Summary  Sperm transport, egg transport, physiology fertilisation, and physiology of implantation  important to pregnancy outcome Copyright http://www.ilmukedokteran.net
  36. 36. Copyright http://www.ilmukedokteran.net Thank You Copyright http://www.ilmukedokteran.net

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