3.INFRTpak alvarino

8/17/2019 3.INFRTpak alvarino

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DIAGNOSIS DAN

PENANGANANINFERTILITAS

PADA PRIAALVARINOSIE UROLOGI

LAB ILMU BEDAH

FK. Univ. ANDALAS

42


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PENDAHULUAN• 10 – 15% pasutri ,hub.seksual normal

tanpa kontrasepsi,belum hamil InfertilitiPrimer.

• Faktor Infertiliti pasangan :• Female 1/3

• Male 1/3

• Both 1/3


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REPRODUKSI PRIAHYPOTHALAMUS-PITUITARY-

GONADAL AXIS ( HPG

!MBRYO PH!NOTYP!

S!XUAL MATURATION!NDO"RIN! T!STI"ULAR

FUN"TION

te#to#te$o%e

!XO"RIN! T!STI"ULAR FUN"T

ION

#&e$mato'e%e##


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PRIA


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TESTIS

• !NDO"RIN! – L!YDIG "!LL T!STOST!RON) *+ (FR!!

– IN"R!AS!D L!,!L OF !STROG!N THYROIDD!"R!AS!D SHBG.

– ANDROG!N) GH) OB!SITY D!"R!AS!D SHBG A"TI,! ANDROG!N

FRA"TION

• !XO"RIN! –

S!RTOLI "!LL G!RM "!LL GROTH • INI!IN " #$I&IN


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SPERMATOGENESIS

SPERMATOGONIA

SPERMATOZOA

13 STAGES

74 DAYS


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• PR! T!STI"ULAR 0• HIPOTALAMUS

• !%o2$%o&at• Se4al 5#64%7to%

HIPOFISIS

. Mal'%a%75)$aato% )o&e$ato%

. H&e$&$ola2t%ema)hemo2$omato##

• T!STI"ULAR 0• UDT• "HROMOSOMAL ABNORMALITY• INF!"TION• M!DI"ATION• IN8URY• ,ARI"O"!L! *9-:9+

• POST T!STI"ULAR 0• "ONG!NITAL OBSTRU"TION 0 "YSTI" FIBROSIS• A";UIR!D OBSTRU"TION 0 ,AS!"TOMY• FUN"TIONAL OBSTRU"TION 0 N!UROG!NI"

• IDIOPATHI" :9+

ETIOLO

GI


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DISORD!RS OF SP!RM FUN"TION AND MOTILITY•Immotle "la S5%$ome•Mat4$ato% e6e7t#

•Imm4%olo'7 %6e$tlt5•I%6e7to%

DISORD!RS OF SP!RM D!LI,!RY / "OITUS•!$e7tle 5#64%7to%

•H5&o#&aa

ETIOLO

GI


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H#to$5 o6 %6e$tlt5 Me7al h5#to$5 Go%aoto%DURATION

PRIOR PR!GNAN"I!S

PR!S!NT PARTN!R

PR!,IOUS TR!ATM!NT

!,ALUATION TR!ATM!NT OFIF!

S5#tem7 Ill%e## ( .e) DM

M4lt&le #7le$o##

P$e


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PEMERIKSAAN FISIK

• Pemeriksaan genital eksterna : estis,epi2i23mis, &as 2eferens,

4arioele,genital keil.

• 6arakteristik seks sekun2er 7 pen3ebaran

rambut ketiak,pubis 2an ba2an tumbuh

besar.

• abnormal 7 g3neomastia,

anosmia86allmann9,galaktore,ggnlap.penglihatan.


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PEMERIKSAAN AWALU$%al5##

Seme% a%al5#e#• peiment ere obtaine2 orretl3 ;;;• #bstinene /, 8 > eeks < months 9• Normal result, 4ar3 i2el3

Ho$mo%al e


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KARAKTERISTIK SPERMA

NORMAL• &olume 1,5 = 5 ml

• $on A >0 million@ml, total

A 50 million

• *otile A 50%

• *otile gra2e A>

• normal morpholog3 A


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HORMONE PROFILE"ONDITION T FSH LH PRL

N-'*#( N( N( N( N(

PRIMARYT!STIS FAILUR! (- N(@ N(

H5&o'o%aot$o&h7-h5&o'o%a#m (- (- (- N(

P)'P'-(#$IN)*I# (- (-@N((- I

#N'-)N ')I#N$) N(


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•emen leuko3te anal3sis

• #ntisperm antibo23 test•$omputeriCe2 assiste2 semen anal3ses 8$##9•3poosmoti selling test•perm penetration assa3•perm=er4ial *uus interation

•'- 8reati4e oD3gen speies9•)N)I$ )(+#I-N

•$hromosomal stu23•$3sti fibrosis mutation testing• hromosome miro2eletion anal3sis

•'a2iologis : usg, 4enograph3, '+, $@*'I pel4i•!iopsi estis " &asograph3•FN# mapping of testis•emen ulture

PEMERIKSAAN

TAMBAHAN

KLASIFIKASI


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KLASIFIKASI

INFERTILITI PRIA')##!() $#+)

• &arioele

• -bstrution

• Infetion

• )Eaulator33sfuntion

• 3pogona2otropi=3pogona2ism

• ImmunologiProblem

• )retilel 3sfuntion

• 3perprolatinemia

P-)NI#((')##!()

• I2iopathi

• $r3ptorhi2ism• &asal #genesis

+N')##!()

• !ilateral #norhia

• erminal $ell= #plasia

• Primar3 estiular=

Failure

• $hromosomal=

#nomalies

• Immotile $ilia=

3n2rome


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PENATALAKSANAAN

HISTORY

PHYSICAL

SEMEN ANALYSIS

HORMONES

ADJUNCTIVE

TEST

SURGICALTHERAPY

NON

SURGICAL

TREATMENT

ASSISTEDREPRODUCTIVE

TECHNIUE


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No% S4$'7al T$eatme%t

SP!"IFI" TH!RAPY

HYPOGONADOTROPHI"-HYPOGONADISM

• IN$I)N$) 7 (-

• #$G+I') @ $-N)NI#( 86#((*#NNI N'-*)9

• +) - )$')#) P'-+$I-N -F n'• #-$I#) I -)' $-N #N-*#( : #N-*I#,

)#FN), $()F P#(#), ')N#( #N-*#(I)

• #$G+I') : PI+I#' +*-'@'#+*#, I-(#)

-N#-'-PIN )FI$I)N$, #N#!-(I$ )'-I +).

• I#N-I$ ) : $ @ *'I '+() -+ +*-'

• )'#P : h$ 1500= eeks,

then h* =J times eekl3


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SP!"IFI" TH!RAPY

HYP!RPROLA"TIN!MIA

• IN$I)N$) 7 (-

• P)'P'-(#$IN)*I# N) F))!#$6 - n',

INI!I-' )FF)$ on ( !ININ to ()I INF)'I(I,

)')$I() F+N$I-N

• )I-(- : IP-P)#( +*-', P-'-I*, (I&)'

I)#), '+ 8PhenothiaCine, ri3li #nti2epresant, some

antih3pertensi4e9

• I#N-I$ ) : $@*'I '+() -+ +*-'

• )'#P :

– "AUSAL o$

– BROMO"RIPTIN! *) -C) m' *-: TIM!S DAILY


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SP!"IFI" TH!RAPY

ISOLAT!D T!STOST!RON D!FI"I!N"Y

• P'I*#' P--N#I* 8 ()I $)(( F#I(+') 9 )$')#)

()&)( -F )-)'-N )$')#) (I!I- " )/+#( F+N$I-N

8 )')$I() F+N$I-N, et9

• IN$I)N$) 7 '#')• )'#P :

– )-)'-N )N#N#) @ P'-PI-N#) im

– g 1500 iu t.i.

ISOLAT!D LH D!FI"I!N"Y / F!RTIL! !UNU"H SYNDROM!


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SP!"IFI" TH!RAPY

"ONG!NITAL ADR!NAL HYP!RPLASIA

• IN$I)N$) : '#')

• )FI$I)N$ -F #')N#( '-/(#)

)$')#) $-'I-( )$')I-N IN$')#) #$ IN$')#) #')N#( #N'-)NP'-+$I-N )$')#) nrh +PP'))P)'*#-)N)I.

• I#N-I$ ) : +rinar3 1=6)-)'-I or)'-)PI#N'-)'-N 8)#9

• )'#P : (+$-$-'I$-I ')P(#$)*)N.


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SP!"IFI" TH!RAPY

IMUNOLOGI" INF!RTILITY•

)&)N oral P')NI-N $#N )$')#) ##,

I '#')( +$$)F+(• ')#*)N -F $-I$) 7 #' I"SI

• 3 C+ MAL! INF!RTIL

G!NITAL TRA"T INF!"TION

• )F)$ of I

#!N-'*#( )*)N G+#(I ? >%

e4ere 8)nterobateriaeae, $hlam32ia, onorrhoeae9 )I

#'-P @ )PII*#( +$ -!'+$I-N

generate '- harm spermKs abilit3 to fertiliCe

• The$a&5 E A%tot7#

• Pe$##te%t O#t$47to% S4$'e$5


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SP!"IFI" TH!RAPY

R!TROGRAD! !8A"ULATION• )I-(- :

– ANATOMI", : !()' N)$6 +')' – N!UROG!NI", : PIN#( $-' INL+',

')'-P)'-N)#( +')', I#!)) *)(I+

– PHARMA"OLOGI" : N)+'-()PI$, 'I$$(I$ #NI)P')#N, #(P# !(-$6)', #NIP)')NI&) – IDIOPATHI"

• I#N-I$ ) : P- )L#$+(#) +'IN)• )'#P :

– #(P# #')N)'I$ #-NI 8)P)'IN),P)+-)P)'IN), I*IP'#*IN),P)N(P'-P#N-(#*IN)

– #' IN'#+)'IN) IN)*IN#I-N


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SP!"IFI" TH!RAPY

AN!8A"ULATION• IN$I)N$) : '#')

• )I-(- :

– N!UROG!NI", : PIN#( $-' INL+',

')'-P)'-N)#( +')', I#!)) *)(I+,

'#N&)') *)(II, *+(IP() $()'-I

– PSY"HOG!NI" / IDIOPATHI"

• I#N-I$ ) : P- )L#$+(#) +'IN)

• )'#P : – R!"TAL PROB! !8A"ULATION

– P!NIL! ,IBRATORY STIMULATION

N S l T t t


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!MPIRI" TH!RAPY

• INI$#I-N : II-P#I$ -(I-P)'*I#

• '+ $#)-' F-' )*PI'$ )'#P:

– $(-*IP)N $I'#) – #*-/IF)N

– #N'-)N

– )-)'-N ')!-+N – #'-*##) INI!I-'

– -N#-'-PIN

– n'

– 6#((I6')IN

– P'-#(#NIN N)#) INI!I-'

– !'-*-$'IPIN)

– P)N-/IF((IN)

– #NI-/I#N – $#'NIIN).

N S l T t t


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!MPIRI" TH!RAPY

• N)I$, N-N)'-I#( #NI=)'-)N• !IN - )'-)N ')$)P-' $-*P)II&)( IN )

P-#(#*+, #N P-PI) !(-$6IN F)!#$6 #N IN$')#IN )$')I-N -F n', F, (

• -) 7 1>,5=50 mg@2, $-NIN+-+( F-' >5 2, I 5=2

') P)'I- eah *-N, F-' M *-N• F-((-=+P : )-)'-N ()&)( *+ !) IN N-'*#( (I*I.

F')G+)N )*)N #N#().

• I) )FF)$ : N)$-*#I#, N#+)#, IIN), &I+#($-*P(#IN, #(()'I$ )'*#II

• ')+( : >=5H%

• #*-/IF)N : -'6 IN *#NN)' # $(-*IP)N, !+ I() )'-)NI$ )FF)$

• -) 7 10=15 mg@ I$) 2

CLOMIPHEN CITRATE

N S l T t t


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!MPIRI" TH!RAPY

• R!"!NT STUDI!S D!MONSTRAT!D AN IN"R!AS!D

OF ROS % IDIOPATHI" SUBF!RTILITY

• ROS IN"LUD! E HYDROXYL RADI"AL (OH)

SUP!ROXID! ANION (O*) HYDROG!N P!ROXID!

(H*O*• ROS DAMAG! SP!RM LIPID M!MBRAN!

• ,ITAMIN ! :99-1*99 4 /D IMPRO,!D "APA"ITY FOR

SP!RM-OO"YT! FUSION IN-,ITRO• GLUTHATION 99 m'/

ANTIOXIDANT

PEMBEDAHAN


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PEMBEDAHAN• &arioeletom3

• &aso4asostom3, )pi2i23mo4asostom3,+' of )Eaulator3 2ut

• #blation of Pituitar3 #2enoma

PROPILAKSISPEMBEDAHAN• -rh32opeD3

• -peration for estiular orsion• )letroeEaulation


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REPRODUCTIVE

TECHNIQUESIf neither urger3 nor me2ial therap3 is apropriate # logial treatment, tehniue atempt too4erome the problems of re2ue2 sperm motilit3

an2 number is ARTS&e$m Do%ato% 0

usban2 or -thers

Te7h%4e o6 #&e$m et$a7to% 0)Eaulate

*)#))

INTRAUTERINE


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INTRAUTERINE

INSEMINATION• P(#$)*)N -F # P)(()

)L#$+(#) IIN +)'+

• INI$#I-N 7

• ! P# $)'&I$#( F#$-'• I*+N-(-I$ INF)'I(I

• (- P)'* G+#(I

• *)$#NI$#( P'-!()* -F P)'* )(I&)'


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IVF & ICSI

• )/$)(()N )$, ! P# *-)'#)- )&)') F-'* -F *#() INF)'I(I

• I&F 7 500.000=5.000.000 *-I() P)'*# #N ) #') F)'I(I) IN P)'II)

• I$I 7 1 &I#!() P)'* INL)$) IN-$-P(#*I$ #')#


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ICSI

MALE


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METHODE• )#!(I)

– $-N-*

– P)'$+#N)-+ -$$(+I-N – '#II-N#( )$-* – N-N=$#(P)( )$-*

• '))#'$ – ormonal : PI((K, INL)$#!() – Non=hormonal – &aine – imunologi

MALECONTRACEPTIVE


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VASECTOMY

• *IN-' +'I$#( P'-$)+')• $+IN @ -$$(+I-N -F

)F)')N

• *IN-' $-*P(I$$#I-N• N- $#N) IN )/+#( F+N$I-N


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VASECTOMY

• P')P#'#I-N :• #&) #N # ) $'-+*

• !'IN # P#I' -F I FIIN

+N)')#' -' #()I$ +PP-'• #&-I #NII*F(#*#-' '+

8 I!+P'-F)N, #PI'IN !)F-') +')'

PROCEDURE


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PROCEDURE

CO C O


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COMPLICATION

• #)*#-*)• ')$#N#(I#I-N

• ##

• P)'* '#N+(-*#

3.INFRTpak alvarino

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