Infertilitas

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Information about Infertilitas

Published on October 22, 2008

Author: ajiandi

Source: slideshare.net

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Infertil

Copyright http://www.ilmukedokteran.net Infertility Problem Gunawan Dwi Prayitno Copyright http://www.ilmukedokteran.net

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

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

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

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

Copyright http://www.ilmukedokteran.net Anamnesis -Menstrual Cycle 28 d + 3d Eumenorhea Polimenorhea oligomenorhea 25 31 Copyright http://www.ilmukedokteran.net

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

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

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

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

Copyright http://www.ilmukedokteran.net ASA, Abnormal semen analysis Copyright http://www.ilmukedokteran.net

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

Copyright http://www.ilmukedokteran.net Tubal Patency (HSG, Hysterosalpingo-contrast-USG, Laparaskopy-kromotubation) Copyright http://www.ilmukedokteran.net

Copyright http://www.ilmukedokteran.net Screening Clamydial and Antibiotic Profilactic before Uterine instrumentation Copyright http://www.ilmukedokteran.net

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

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

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

Copyright http://www.ilmukedokteran.net Ovulation detection - Mid Luteal Progesteron - USG monitoring Copyright http://www.ilmukedokteran.net

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

Copyright http://www.ilmukedokteran.net Frequency and Timing of Sexual Intercourse Copyright http://www.ilmukedokteran.net

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

Copyright http://www.ilmukedokteran.net Obesity and Weight loss Copyright http://www.ilmukedokteran.net

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

Copyright http://www.ilmukedokteran.net Folic Acid Supplementation Copyright http://www.ilmukedokteran.net

Copyright http://www.ilmukedokteran.net Male Factor Management Medical Management (Hypogonadotrophic hypogonadism, idiopatic, ASA, Leucocytes in semen) Copyright http://www.ilmukedokteran.net

Copyright http://www.ilmukedokteran.net Obstuctive azoospermia Varicocele Copyright http://www.ilmukedokteran.net

Copyright http://www.ilmukedokteran.net Ovulation Induction 1. Antiestrogen : CC or Tamoxifen Copyright http://www.ilmukedokteran.net

Copyright http://www.ilmukedokteran.net 2. Insulin Sensitizer : Metformin Copyright http://www.ilmukedokteran.net

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

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

Copyright http://www.ilmukedokteran.net Management of Endometriosis Ovarian Suppresion Surgical Ablation Copyright http://www.ilmukedokteran.net

Copyright http://www.ilmukedokteran.net Non Paten Tubes : Microsurgery and Laparascopic tubal surgery Copyright http://www.ilmukedokteran.net

Copyright http://www.ilmukedokteran.net Intra Uterine Insemination Copyright http://www.ilmukedokteran.net

Copyright http://www.ilmukedokteran.net Take home baby : IVF Copyright http://www.ilmukedokteran.net

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

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

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