Infertilitas

Dr. Frizar Irmansyah SpOG (K)

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 hamil
selama 12 bulan pernikahan.
Infertilitas sekunder, pernah hamil, namun
kemudian tidak terjadi kehamilan lagi.
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/ hamil 2,3 2,8 bulan
Makin lama pasangan itu kawin tanpa kehamilan,
makin turun kejadian kehamilannya.
Major Causes


What Increases the Risks?
Age
Stress
Poor diet
Smoking
Alcohol
STDs
Overweight
Underweight
Caffeine intake
Too much exercise

The Age Factor
20% of women in the United States have
their first child after age 35.
About one third of couples over age 35 have
fertility problems.
Age decreases the womans ability to
conceive by:
Ability of a womans ovaries to release eggs
Increased miscarriages



The Age Factor
A woman's fertility
naturally starts to decline
in her late 20's.
After age 35 a woman's
fertility decreases rapidly.
A woman is born with all
the eggs she'll have, and
with time, the supply
diminishes.
The remaining eggs also
age along with the rest of
the body.
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
Physical Obstructions
Endometriosis
Pelvic Inflammatory Disease
Uterine Fibroids
Pelvic Adhesions
Ovarian Failure

Endometriosis
Occurs when the uterine
tissue implants and
grows outside of the
uterus, affecting the
function of the ovaries,
uterus and fallopian
tubes.
Scar tissue can block the
fallopian tubes and
prevent the egg from
entering the uterus.
There is a 25-35% rate
of infertility in moderate
to severe cases of
Endometriosis
PID
Pelvic inflammatory disease (PID) is a spectrum
of infections of the female genital tract that
includes endometritis, salpingitis, tuboovarian
abscess, and peritonitis.
Uterine Fibroids and Pelvic Adhesions
Fibroids are benign
tumors in the wall of the
uterus
May cause infertility by
blocking the fallopian
tubes
Pelvic adhesions are
bands of scar tissue that
bind organs after pelvic
infection, appendicitis, or
abdominal or pelvic
surgery
This scar tissue formation
may impair fertility.
Ovarian failure
Ovarian failure can be a consequence of
medical treatments, or the complete
failure of the ovaries to develop or contain
eggs in the first place (Turner's
Syndrome).
Ovarian failure can also occur as a result
of treatments such as chemotherapy and
pelvic radiotherapy for cancers in other
body areas. These therapies destroy eggs
in the ovary.

Hormonal Obstructions
Ovulation disorders
Elevated prolactin
Polycystic ovary syndrome
Early menopause
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
Treatment
Infertility can be treated with medicine,
surgery, artificial insemination or assisted
reproductive technology.
Stimulate ovulation with fertility drugs
About two-thirds of couples who are treated
for infertility are able to have a baby.
In most cases, infertility is treated with
drugs or surgery.
Masalah Uterus
Sinekia, mioma, polip, kelainan bawaan rahim
Pemeriksaan : Histerosalpingografi
Biopsi endometrium
Histeroskopi
Masalah Tuba
25-50 % penyebab infertilitas.
Penyebab : infeksi, endometriosis
Pemeriksaan :
Pertubasi/hidrotubasi/HSG/laparaskopi
Masalah Ovarium
Penilaian ovulasi :
1. suhu basal badan
2. sitologi vagina
3. spinbarkeit
4. biopsi endometrium
5. analisa hormonal
PCOS
Polycystic ovary
syndrome
(PCOS)
Produces too
much androgen
hormone (male
hormones)
Causes an
irregular or no
menstrual cycle

First visit
Have both come to all visits!!
Get a complete history
Sexual history!!
Educate!!
Manly Questions
Infertility duration
Prior fertility in relationship(s)
Medical & surgical history
Meds (anabolic steroids, cancer
chemotherapy, sulfasalazine, nitrofurantoin)
Alcohol, drugs, pot
Occupational exposures
Sexual dysfunction
Tight fitting underwear/pants
Previous testing
Womanly Questions
Infertility duration
Detailed menstrual history
Prior pregnancies
Fertility in other relationships
IUDs, OCPs, Depo
Frequency of intercourse/sexual dysfunction

Womanly Questions
Gynecologic history (PID, endometriosis,
fibroids, cervical dysplasia)
DES exposure
Medical and surgical history
Medications
Previous tests and therapy

DRUGS
Cause hyperprolactinemia:
l Neuroleptic, antidepressant, and
hypotensive drugs and drugs for
gastrointestinal symptoms
Recreational drugs such as marijuana
and cocaine
Spontaneous galactorrhoea must be
ascertained and further investigated for
suspected hyperprolactinemia
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
Treatment
Education
BBTs/menstrual calendar
Clomiphene
Pergonal
Artificial insemination
IVF

Environmental changes
Vitamins
Baggy shorts
Sex not every niteevery other
Diet changes
Stop smoking
TESTS
Thyroid
Midcycle progesterone level &/or luteal phase
progesterone level
FSH/ LH
Cortisol
Hystersalpingogram
Laporoscopy
Postcoital Test

Coping with Infertility
Consider other
options
Adoption, donor sperm
or egg
Talk about your
feelings
To each other
Support groups
Counseling services
Coping with Infertility
Acupuncture
Practice relaxation
Stay in touch with
loved ones
Assisted reproductive technology
(ART)
In vitro fertilization (IVF)
Most effective
Recommended when both
fallopian tubes are
blocked
ART works best when
the woman has a
healthy uterus, responds
well to fertility drugs,
and ovulates naturally or
uses donor eggs.

Complications
Multiple pregnancy
Ovarian hyperstimulation syndrome
(OHSS)
Ovaries may enlarge and cause pain and
bloating
Higher risk in PCOS women
Bleeding or infection
Low birth weight
Birth defects
Terimakasih