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2.1.

Infertilitas
2.1.1. Definisi Infertilitas
Bahasa Indonesia

Kalimat asli
Infertility (clinical definition): a disease of the
reproductive system defined by the failure to achieve a
clinical pregnancy after 12 months or more of regular
unprotected sexual intercourse.

Infertility is a disease. The duration of the failure to


conceive should be twelve or more months before an
investigation is undertaken unless medical history and
physical findings dictate earlier evaluation and treatment.
Infertility is defined as the failure to conceive after one
year of attempting pregnancy.

Primary infertility refers to individuals who have


never established a pregnancy.

Secondary infertility refers to individuals who


have conceived previously (including
miscarriages) but are currently unable to establish
a subsequent pregnancy.

Fecundability, or the monthly probability


of pregnancy, is about 20% among fertile
couples. The cumulative probability of
pregnancy after 1 year approaches 85%.
Fekunditas untuk pasnganag normal
adalash sekitar 20-25%, sementara pada

Sumber
The International Committee
for Monitoring Assisted
Reproductive Technology
(ICMART) and the World
Health Organization (WHO)
Revised Glossary on ART
Terminology, 2009
American Society for
Reproductive Medicine
Practice Committee
Dikutip dari
The Boston IVF Handbook of
Infertility
BENSON & PERNOLLS
handbook of OBSTETRICS &
GYNECOLOGY

NMS Obstetrics and


Gynecology, 6th
Edition

NMS Obstetrics and


Gynecology, 6th
Edition
Manual inseminasi
intra teri, anwar

pasangan infertil fekunditas hanya sekitar


1-3 %
2.1.2.

Penyebab infertilitas
Bahasa Indonesia

Kalimat asli
Infertility can result from disorders in both partners
(40%), in the female partner alone (25-30%) or in the
male partner alone (20%). No detectable reason for
infertility is found in 10-15% of couples. (Thonneau et
al. 1991, ESHRE Capri Workshop 1996.)
The main causes of infertility are ovulation disorders
(20-32%), tubal damage (14-26%) and endometriosis (46%). There is no female reason for infertility in 26-30%
of couples and decreased semen quality is found in 2442% of male partners. (Hull et al. 1985, Thonneau et al.
1991, Schmidt et al. 1995.)
Terdapat 5 faktor penyebab infertilitas yang
mendasar, yaitu faktor pasangan pria, faktor
servikal, disfungsi ovulasi, adanya masalah pada
rahim atau organ pelvis pasangan wanita ataupun
keduanya, dan penyebab yang tidak dapat
dijelaskan.6

Sumber

INTRAUTERINE
INSEMINATION (IUI)
TREATMENT IN
SUBFERTILITY
SINIKKA NUOJUAHUTTUNEN
INTRAUTERINE
INSEMINATION (IUI)
TREATMENT IN
SUBFERTILITY
SINIKKA NUOJUAHUTTUNEN
Johns Hopkins Manual
of Gynecology and
Obstetrics, The, 3rd
Edition

The causes of infertility may be classified as male-coital


factors
(40%), cervical (5%10%), uterine-tubal (30%), ovulatory
factors
(15%20%), and peritoneal or pelvic factors (40%). A few
genetic
causes (e.g., primary amenorrhea) are recognized.

BENSON & PERNOLLS


handbook of OBSTETRICS &
GYNECOLOGY

MALE-COITAL FACTORS

BENSON & PERNOLLS


handbook of OBSTETRICS &
GYNECOLOGY

Male factors include abnormal spermatogenesis,


abnormal motility, anatomic disorders, endocrine
disorders, and sexual dysfunction. The anatomic
abnormalities possibly responsible are congenital
absence of the vas deferens, obstruction of the vas
deferens, and congenital abnormalities of the ejaculatory
system.
Abnormal spermatogenesis may occur as the result of
mumps orchitis, chromosomal abnormalities,
cryptorchidism, chemical or radiation exposure, or
varicocele. Abnormal motility is seen with absent cilia
(Kartageners syndrome), varicocele, and antibody
formation.
The male factor endocrine disorders include thyroid
disorders, adrenal hyperplasia, exogenous androgens,
hypothalamic dysfunction (Kallmanns syndrome),
pituitary failure (tumor, radiation, surgery), and
hyperprolactinemia (tumor, drug-induced). An elevated
FSH commonly indicates parenchymal testicular

damage, since inhibin, produced by the Sertoli cells, is


the primary feedback control of FSH secretion.

CERVICAL FACTORS
Cervical factors of female infertility may be congenital
(DES exposure, mullerian duct abnormality) or acquired
(infection, surgical treatment).

UTERINE-TUBAL FACTORS
Uterine-tubal factors are most commonly structural
abnormalities
(e.g., DES exposure, myoma, failure of normal fusion of
the reproductive tract, infections, previous ectopic
pregnancy).

OVULATORY FACTORS
Ovulatory factors involve CNS function, metabolic
disease, or peripheral defects. CNS defects include
chronic hyperandrogenemic anovulation,
hyperprolactinemia (empty sella, tumor, or
druginduced), hypothalamic insufficiency (including
Kallmanns syndrome), and pituitary insufficiency
(trauma, tumor, or congenital). Metabolic diseases
causing ovulatory factor defects are thyroid disease,
liver disease, renal disease, obesity, and androgen
excess (adrenal or neoplastic). Peripheral defects may
be gonadal dysgenesis, premature ovarian failure,
ovarian tumor, or ovarian resistance.

PERITONEAL OR PELVIC FACTORS


The two most common pelvic or peritoneal factors are
endometriosis and sequelae or infection (e.g.,
appendicitis, pelvic inflammatory disease). Laparoscopy
in women with unexplained infertility will reveal
previously unsuspected pathology in at least 30% of
patients. Endometriosis exerts a greater pejorative effect
on fertility than can be explained on the basis of physical
alterations.

2.1.3.

Angka Kejadian Infertilitas


Bahasa Indonesia

Kalimat asli

Data dari
Family

Sumber

National Survey of Fertility, Family Planning, and


Growth
(2002) Reproductive Health of U.S.

menunjukkan bahwa dari 7,4 % Women: Data From the 2002


pasangan yang menikah, dimana National Survey of Family
Growth
pasangan wanitanya masih berada
pada usia reproduktif (15 44
tahun),
tidak
mendapatkan
kehamilan
setelah
12
bulan
melakukan senggama teratur tanpa
kontrasepsi
Due to population growth, however, the
absolute number of couples affected by
infertility increased from 42.0 million (39.6
million, 44.8 million) in 1990 to 48.5
million (45.0 million, 52.6 million) in 2010.

National, Regional, and Global


Trends in Infertility Prevalence
Since 1990: A Systematic
Analysis of 277 Health Surveys

The number of infertile couples throughout the


world has been approximated at 60-80 million
(ESHRE Capri Workshop 1996). The reported
lifetime prevalences of infertility (having
experienced a period of infertility at some stage
of reproductive life) vary greatly, which is
assumed to result partly from varying
definitions and measurements of infertility. In
industrialised countries the prevalence ranges
from 10 to 33%. (Schmidt & Munster 1995,
Sundby & Schei 1996, Chandra & Stephen
1998.) In a Finnish population based study the
lifetime prevalence of infertility was 14%
(Notkola 1995). In developed countries, 3-7%
of the female population who are at the end of
reproductive age, are childless because of
infertility (Schmidt & Munster 1995, ESHRE
Capri Workshop 1996, Sundby & Schei 1996,
Buckett & Bentik 1997, Wulff et al. 1997).

INTRAUTERINE
INSEMINATION (IUI)
TREATMENT IN
SUBFERTILITY
SINIKKA NUOJUAHUTTUNEN

The current evidence indicates a 9%


prevalence of infertility (of 12
months) with 56% of couples

International estimates
of infertility prevalence
and

seeking medical care. These


estimates are lower than those
typically cited and are remarkably
similar between more and less
developed countries.

treatment-seeking:
potential need and
demand for
infertility medical care
Jacky Boivin1,4, Laura
Bunting1, John
A.Collins2 and Karl
G.Nygren3