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DEFINITIONS
INFERTILITY
WHO: INABILITY TO CONCEIVE AFTER ONE YEAR OF
REGULAR UNPROTECTED INTERCOURSE.
AFS : INABILITY TO CONCEIVE AFTER ONE YEAR
OF REGULAR UNPROTECTED INTERCOURSE, (AGE 35 > 6
MONTH)
FECUNDITY
ABILITY WOMEN TO PREGNANT
STATISTICS
80-85% OF COUPLES WILL CONCEIVE WITHIN 1 YEAR OF
UNPROTECTED INTERCOURSE
90% WILL CONCEIVE WITHIN 2 YEARS OF UNPROTECTED
INTERCOURSE
ORIGIN:
causa percentase%
Faktor tuba , pelvik 35
Faktor laki-laki 35
Disfungsi ovulasi 15
idiopatik 10
lain-lain 5
INFERTILITY MANAGEMENT
COUPLE MANAGEMENT
FEMALE MALE
GYNECOLOGY ANDROLOGY
INSIDENCE
IDIOPATIC/UNEXPLAIN INFERTILITY
Tube and Pertoneal Factor
Ovulation Factor
Uterine Factor
Cervical Factor
- Environment Surgical A
- Freq. / Time Combination N
of Coitus ART C
Y
- Social
Economic Cervix Uterus
AGING AND REPRODUCTION IN WOMEN
60 30
40 20
20 10
0 0
20-24 25-29 30-34 35-39 40-44
Leon Speroff and Frits marc A. Clinical Gynecologic Endocrinology and Infertility. Ed. VII TH. Lippincott
Williams & Wilknis Philadelphia (2005) p : 1013 - 1056
INFERTILITY
COMPLICATED
OVULATION FACTORS 15 - 20 %
Genetic disorders
Hiperprolaktinemia
Tiroid disease
Stress
Weight Changes
Polycystic Ovary
SERVICAL FACTORS 2 - 5%
Anatomic disorders
Infection
UTERUS FACTORS 5 - 10 %
Anatomic disorders :
Congenital
Intrauterine adhesion
Myoma uteri
Endometrial polip
Hyperplasia of endometrium
EXAMINATION
HISTORY
PHYSICAL EXAMINATION
SPERM ANALYSIS
DETECTION OF OVULATION
POST COITAL TEST
USG
HSG
LAPAROSCOPY
BOTH COUPLES SHOULD BE PRESENT
AGE
PREVIOUS PREGNANCIES BY EACH PARTNER
VARICOCOELE
PELVIC MASSES
ABDOMINOPELVIC TENDERNESS
THYROID EXAM
PHYSICAL EXAM-FEMALE
CERVICAL AND UTERINE ABNORMALITIES
PHYSICAL EXAMINATION
Bodyweight, BMI
Thyroid Enlargment
Breast Secretions
Sign of Androgen Excess
Pelvic tenderness
Vaginal discharge
Uterine size, adnexal mass,
NORMAL SEMEN ANALYSIS
OVULATORY FACTORS
Menstrual history
Basal body temperature :
- Simple and in expensive method
- Biphasis patterns
Serum Progesterone
Urinary luteinizing hormone
Endometrial Biopsy
SOCIAL
ECONOMIC
HEALTH SERVICE
FACILITIES
MEDICATION
USING OVARIAN STIMULATION DRUGS (OVULATION INDUCTION):