Infertilitas

5/25/2018 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

Infertilitas

Documents

infertilitas primer

exercise5252018 infertilitas

infertilitas sekunder

age factor

pelvic adhesionsfibroids

bulan pertama

bulan pernikahan

womans ovaries