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Information about Infertilitas

Published on October 22, 2008

Author: ajiandi




Copyright Infertility Problem Gunawan Dwi Prayitno Copyright

Copyright 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


Copyright 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

Copyright 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

Copyright Anamnesis -Menstrual Cycle 28 d + 3d Eumenorhea Polimenorhea oligomenorhea 25 31 Copyright

Copyright Physical Examination Copyright

Copyright 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

Copyright 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

Copyright Semen Analysis Copyright

Copyright ASA, Abnormal semen analysis Copyright

Copyright 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

Copyright Tubal Patency (HSG, Hysterosalpingo-contrast-USG, Laparaskopy-kromotubation) Copyright

Copyright Screening Clamydial and Antibiotic Profilactic before Uterine instrumentation Copyright

Copyright The Thyroid function - There is no value in women with a regular menstrual Cycle RCOG B 200 • Hypothyroid : High TSH → Oligomenorhea - amenorhea Copyright

Copyright Basal FSH & Estradiol (Day 2 – 3) - Patients Ages ≥ 35 years - Ovarian Reserve : ( decreased negative feed back from ovaries ) Copyright

Copyright 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

Copyright Ovulation detection - Mid Luteal Progesteron - USG monitoring Copyright

Copyright Treatment Copyright

Copyright Frequency and Timing of Sexual Intercourse Copyright

Copyright Stop Smoking Copyright

Copyright Obesity and Weight loss Copyright

Copyright Scrotal Temperatur Copyright

Copyright Folic Acid Supplementation Copyright

Copyright Male Factor Management Medical Management (Hypogonadotrophic hypogonadism, idiopatic, ASA, Leucocytes in semen) Copyright

Copyright Obstuctive azoospermia Varicocele Copyright

Copyright Ovulation Induction 1. Antiestrogen : CC or Tamoxifen Copyright

Copyright 2. Insulin Sensitizer : Metformin Copyright

Copyright 3. Gonadotrophin : FSH, hMG, CC+IUI Copyright

Copyright Hyperprolaktinemia : Bromokriptin Copyright

Copyright Management of Endometriosis Ovarian Suppresion Surgical Ablation Copyright

Copyright Non Paten Tubes : Microsurgery and Laparascopic tubal surgery Copyright

Copyright Intra Uterine Insemination Copyright

Copyright Take home baby : IVF Copyright

Copyright Summary  Sperm transport, egg transport, physiology fertilisation, and physiology of implantation  important to pregnancy outcome Copyright

Copyright Thank You Copyright

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