Infertilitas
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Infertilitas
Dr. Frizar Irmansyah SpOG (K)
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Definisi
Fertilitas, kemampuan seorang istri menjadi
hamil dan melahirkan anak hidup oleh
suami yg mampu menghamilinya.
Infertilitas,pasangan,1 th,hubungan sex
teratur tanpa kontrasepsi, anak hidup.
Infertilitas primer, belum pernah hamilselama 12 bulan pernikahan.
Infertilitas sekunder, pernah hamil, namun
kemudian tidak terjadi kehamilan lagi.
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Kans untuk hamil
1 bulan pertama : 32,7%
3 bulan : 57%
6 bulan : 72,1 %
12 bulan : 85,4 %
24 bulan : 93,4 %
Waktu rata-rata u/ hamil2,32,8 bulan
Makin lama pasangan itu kawin tanpa kehamilan,
makin turun kejadian kehamilannya.
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Major Causes
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What Increases the Risks?
Age Stress
Poor diet
Smoking Alcohol
STDs
Overweight Underweight
Caffeine intake
Too much exercise
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The Age Factor
20% of women in the United States havetheir first child after age 35.
About one third of couples over age 35 havefertility problems.
Age decreases the womans ability to
conceive by: Ability of a womans ovaries to release eggs
Increased miscarriages
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The Age Factor
A woman's fertilitynaturally starts to declinein her late 20's.
After age 35 a woman's
fertility decreases rapidly. A woman is born with all
the eggs she'll have, andwith time, the supplydiminishes.
The remaining eggs alsoage along with the rest ofthe body.
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Common Causes of Infertility (female)
Severe endometriosis
Pelvic Inflammatory Disease (PID)
Ovulation disorders
Elevated prolactin
Polycystic ovary syndrome (PCOS)
Early menopause
Benign uterine fibroids
Pelvic adhesions
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Physical Obstructions
Endometriosis
Pelvic Inflammatory Disease
Uterine Fibroids
Pelvic Adhesions
Ovarian Failure
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Endometriosis
Occurs when the uterinetissue implants andgrows outside of theuterus, affecting thefunction of the ovaries,
uterus and fallopiantubes.
Scar tissue can block thefallopian tubes and
prevent the egg fromentering the uterus. There is a 25-35% rate
of infertility in moderateto severe cases ofEndometriosis
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PID
Pelvic inflammatory disease (PID) is a spectrumof infections of the female genital tract that
includes endometritis, salpingitis, tuboovarian
abscess, and peritonitis.
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Uterine Fibroids and Pelvic Adhesions
Fibroids are benigntumors in the wall of theuterus
May cause infertility byblocking the fallopian
tubes Pelvic adhesions are
bands of scar tissue thatbind organs after pelvic
infection, appendicitis, orabdominal or pelvicsurgery
This scar tissue formationmay impair fertility.
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Ovarian failure
Ovarian failure can be a consequence ofmedical treatments, or the completefailure of the ovaries to develop or contain
eggs in the first place (Turner'sSyndrome).
Ovarian failure can also occur as a resultof treatments such as chemotherapy and
pelvic radiotherapy for cancers in otherbody areas. These therapies destroy eggsin the ovary.
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Hormonal Obstructions
Ovulation disorders
Elevated prolactin
Polycystic ovary syndrome
Early menopause
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Masalah vagina
Sumbatan / peradangan
Cth : vaginismus, dispareuni
Masalah Serviks
- Sumbatan kanalis servikalis
- Lendir serviks yg abnormal
- Malposisi serviks
Cth : polip, stenosis, sinekia, peradangan
Penilaian : uji pasca sanggama
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Treatment
Infertility can be treated with medicine,surgery, artificial insemination or assistedreproductive technology.
Stimulate ovulation with fertility drugs
About two-thirds of couples who are treatedfor infertility are able to have a baby.
In most cases, infertility is treated withdrugs or surgery.
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Masalah Uterus
Sinekia, mioma, polip, kelainan bawaan rahim
Pemeriksaan : Histerosalpingografi
Biopsi endometrium
HisteroskopiMasalah Tuba
25-50 % penyebab infertilitas.
Penyebab : infeksi, endometriosisPemeriksaan :
Pertubasi/hidrotubasi/HSG/laparaskopi
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Masalah Ovarium
Penilaian ovulasi :
1. suhu basal badan
2. sitologi vagina3. spinbarkeit
4. biopsi endometrium
5. analisa hormonal
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PCOS
Polycystic ovary
syndrome
(PCOS)
Produces toomuch androgen
hormone (male
hormones)
Causes anirregular or no
menstrual cycle
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First visit
Have both come to all visits!!
Get a complete history
Sexual history!!
Educate!!
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Manly Questions
Infertility duration
Prior fertility in relationship(s)
Medical & surgical history
Meds (anabolic steroids, cancerchemotherapy, sulfasalazine, nitrofurantoin)
Alcohol, drugs, pot
Occupational exposures
Sexual dysfunction
Tight fitting underwear/pants
Previous testing
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Womanly Questions
Infertility duration
Detailed menstrual history
Prior pregnancies
Fertility in other relationships
IUDs, OCPs, Depo
Frequency of intercourse/sexual dysfunction
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Womanly Questions
Gynecologic history (PID, endometriosis,
fibroids, cervical dysplasia)
DES exposure Medical and surgical history
Medications
Previous tests and therapy
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DRUGS
Cause hyperprolactinemia:
l Neuroleptic, antidepressant, and
hypotensive drugs and drugs forgastrointestinal symptoms
Recreational drugs such as marijuanaand cocaine
Spontaneous galactorrhoea must beascertained and further investigated forsuspected hyperprolactinemia
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Ways to Battle Infertility
Regular exercise
Avoid alcohol, tobacco, and narcotics
Limit caffeine No more than 250 mg per day
Limit medications
Eat a balanced diet
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Treatment
Education
BBTs/menstrual calendar
Clomiphene Pergonal
Artificial insemination
IVF
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Environmental changes
Vitamins
Baggy shorts
Sex not every niteevery other Diet changes
Stop smoking
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TESTS
Thyroid
Midcycle progesterone level &/or luteal phase
progesterone level
FSH/ LH
Cortisol
Hystersalpingogram
Laporoscopy
Postcoital Test
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Coping with Infertility
Consider other
options
Adoption, donor sperm
or egg Talk about your
feelings
To each other
Support groups
Counseling services
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Coping with Infertility
Acupuncture
Practice relaxation Stay in touch with
loved ones
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Assisted reproductive technology(ART)
In vitro fertilization (IVF) Most effective
Recommended when bothfallopian tubes are
blocked ART works best when
the woman has ahealthy uterus, responds
well to fertility drugs,and ovulates naturally oruses donor eggs.
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Complications
Multiple pregnancy
Ovarian hyperstimulation syndrome(OHSS)
Ovaries may enlarge and cause pain andbloating
Higher risk in PCOS women
Bleeding or infection
Low birth weight
Birth defects
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Terimakasih
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