Definisi dan etiologi

Infertilitas

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Definisi
Primer : Kegagalan pasangan suami istri untuk hamil, setelah senggama teratur tanpa kontrasepsi selama satu tahun (<35th) (>35th) 6 bulan Sekunder : Kegagalan pasangan suami istri untuk hamil yang sebelumnya pernah hamil

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WANITA

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Female Infertility
Ovulation Disorders:
Aging Diminished ovarian reserve Endocrine disorder Polycystic ovary syndrome (PCOS) Premature ovarian failure

Tubal Factors:

To Investigate Tubal Obstruction: History of pelvic inflammatory disease (PID) Tubal Surgery Previous ectopic pregnancy Salpingectomy

Uterine/Cervical Factors:

Congenital uterine anomaly Fibroids Poor cervical mucus quantity/quality Infection

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Uterine Types

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Female Factors Hypothalamus

Pituitary

Follopian tube Uterine ovary Cervix Extra-genital tract

Thyroid

oocyte

Adrenal

Fig.1sperm

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Gangguan vagina dan serviks

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Kelainan uterus (rahim)

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Kerusakan Saluran Telur

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Kegagalan ovulasi

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Endometriosis

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PRIA

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Male infertility

Causes 1. PRE-TESTICULAR CAUSES OF INFERTILITY a. Hypothalamic disease Isolated gonadotropin deficiency (Kallmann's syndrome) Isolated LH deficiency ("Fertile eunuch") Isolated FSH deficiency Congenital hypogonadrotropic syndromes

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b. Pituitary disease Pituitary insufficiency (tumors, infiltrative processes, operation, radiation) Hyperprolactinemia Hemochromatosis Exogenous hormones (estrogen-androgen excess, glucocorticoid excess, hyper and hypothyroidism).

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2. TESTICULAR CAUSES OF INFERTILITY a. Chromosomal abnormalities: Klinefelter's syndrome (XXY, karayotype), XX disorder (sex reversal syndrome), XYY syndrome Noonan's syndrome (male Turner's syndrome) Myotonic dystrophy- Bilateral anorchia (vanishing testes syndrome) Sertoli-cell-only syndrome (germinal cell aplasia)

b. c. d.

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e. f. g. h.

i. j. k.

Gonadotoxins (drugs, radiation) Orchitis Trauma Systemic disease (renal failure, hepatic disease, sickle cell disease) Defective androgen synthesis or action Cryptorchidism Varicocele

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3. POST-TESTICULAR CAUSES OF INFERTILITY

a. Disorders of sperm transport

Congenital disorders Acquired disorders Functional disorders b. Disorders of sperm motility or function Congenital defects of the sperm tail Maturation defects Immunologic disorders Infection 3. Sexual dysfunction

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Causes of male infertility

Impaired production or function of sperm Impaired shape or movement of sperm Low sperm concentration Varicocele Undescended testicle Testosterone deficiency (male hypogonadism) Genetic defects Infections
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Causes of male infertility

Impaired delivery of sperm Sexual issues Retrograde ejaculation Blockage of epididymis or ejaculatory ducts No semen (ejaculate) Hypospadia Anti sperm antibodies Cystic fibrosis

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Causes of male infertility

General health and lifestyle Emotional stress Malnutrition Obesity Cancer and its treatment Alcohol and drugs Age Other medical conditions
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Causes of male infertility

Environmental exposure Pesticides and other chemicals Overheating the testicles Substance abuse Tobacco smoking

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Causes of female infertility

Fallopian tube damage or blockage Endometriosis Ovulation disorders Hyperprolactinemi a Polycystic ovary syndrome (PCOS) Early menopause Uterine fibroids Pelvic adhesions

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Causes of female infertility

Medications Thyroid problems Cancer and its treatment Caffeine intake Other medical conditions

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Risk factors
Age Tobacco smoking Alcohol use Being overweight Too much exercise Caffeine intake

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