KUPAS TUNTAS

ATASI INFERTILITAS

KLINIK FERTILITAS GRAHA AMERTA

DIVISI FERTILITAS & ENDOKRINOLOGI REPRODUKSI
BAGIAN / SMF OBSTETRI & GINEKOLOGI
FK UNAIR, RSU DR SOETOMO
SURABAYA
 1 Tahun

Tahun ke . . . ?
Bulan Madu
 Organ Organ
Reprod. Wanita Reprod. Pria

Bagaimana
Kehamilan
Terjadi ?
FUNGSI REPRODUKSI
WANITA
(SIKLUS HAID)
 HAID NORMAL
3-8 OV S
28
14 14

OV
23
9 14

OV
37
23 14

KAPAN KEHAMILAN TERJADI ?

OV
37
23 14
F
 Terganggu Fungsi
Fungsi Terganggu
• Infeksi • Ovum Pick-Up
• Endometriosis • Transportasi • Sel Telur • Kel. Hipotalamus
• Kel. Bawaan • Pertumbuhan Pituitari
embrio • Hub. Umpan Balik
• Ovarium

Induksi Ovulasi

Terganggu Fungsi
• Tumor - Tempat embrio Fungsi Terganggu
• Infeksi Tumbuh • Pintu • Infeksi
• Gangguan - Memberi makan • Depo Makan • Kekebalan
Pertumbuhan • Reservoir • Polip
• Klep Biol. • Anatomi

Terganggu
SPERMA • Infeksi
• Kekebalan
• Hormonal
• Idiopati
 FAKTOR PENYEBAB INFERTILITAS

Sperma Tuba & Gangguan

TORCH
Peritoneum Ovulasi
• Umur ♀
I • H L
Lama Kawin
A A
P • Emosi
M H
A • Frek. Koitus
I I
• Obat-obatan DSB
L ACA R
• Peny. Lain Servik Uterus
PENATALAKSANAAN INFERTILITAS

DIAGNOSIS

PENGOBATAN
 SPERMA

DIAGNOSIS

ANALISA KEMAMPUAN
SPERMA SEKS

IDIOPATI INFEKSI

HORMONAL
LAIN-2 :
• VARIKOKEL KEKEBALAN
• DSB.
TRB Operasi

KUALITAS PENGOBATAN SUBUR

SPERMA

Obat-obatan
Parameter WHO 1999 WHO 2010

Volume 2 ml 1.5 ml

Concentration 20 million/ml 15 million/ml

Progressive 50% 32%

motility
Normal forms 14% 4%
 TUBA & PERITONEUM

DIAGNOSIS

HSG
 NORMAL

HSG LAP. DX
 HYDROSALPHINX
LAP. DX HSG
 PERLEKATAN
RINGAN BERAT
ENDOMETRIOSIS RINGAN
ENDOMETRIOSIS BERAT
 TUBA & PERITONEUM

Perlekatan
Operasi & Obat : 1 – 2 Th. Hamil 
Endometriosis

Bayi
Tabung
 GANGGUAN OVULASI
DIAGNOSIS
Ovulasi 
Obat
Siklus Haid

Temperatur Basal Cek Faktor lain

+ 6 Bulan
Vaginal USG

Hormon
Operasi
Ovulasi 
(Drilling)

Bayi
Tabung
Prof. Dr. H. Samsulhadi, SpOG (K). Seksi Fertilitas Endokrinologi Reproduksi, Bag / SMF Obstetri & Ginekologi RSU Dr. Soetomo / FK Unair Surabaya
 Faster 35 Years

IVF
Increasing Fecundability

hMG or
hMG-IUI
CC or
CC - IUI
Expectant
Management
Correct all
Fertility factors
Identify all
Fertility factors

Increasing intensiveness of resource utilization

Figure 20 – 16. Staircase approach to empirical infertility treatment/ For women over 35 years old, the first three steps in the algorithm
should be rapidly completed. In women less than 30 years old, more time can be spent on the first three steps in the staircase

Barbieri Robert L. : Female Infertility

In Yen and Jaffe’s Reproductive Endocrinology. Ed V Th Elsevier Saunders. Philadelphia.2004. P : 633- 668

SAMSULHADI. DEP. OF OBSTETRICAL & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA
 BAYI TABUNG

IIU FIV - ET

• Unexplained Inf. Indikasi • Severe Abnormality

• Ov. Factor • Failure of previous Treat.
• Mild Endometriosis • Unexplained Inf.
• Oligo zoopspermia
• Etc.

There is There is
• Sperm Syarat • Sperma
• Oocyte • Oosit
• Uterus • Uterus
Normal Tube

- Poor ov. Reserve - Poor ov. Reserve

- > 40 yrs of old Kontra
- > 40 yrs of old
- C.I. to be Pregn. Indikasi
- C.I. to be Pregn.
Indikasi
Syarat
PREPARASI hCG atau
Kontra Indikasi SPERM Progesterone P
R
E
Pemilihan INSEMI LUTEAL G
Pasien NASI SUPPORT N
A
N
Ovarium Induksi Ovulasi T
Reserve
Monitoring ?
hCG
Indikasi S P E R M A

Syarat AZOOSP OLIGO “N”

Kontra Indikasi ICSI

PESA / TESE

Seleksi O F Pemilihan E Luteal H

Pasien P E EmbrIo / T Supp. A
R M
U T blastocyst
I
I L
Ovarium GnRHa or GnRH L
Reserve I PGD
Antagonist S
Gonadotropin A
S
Monitoring I
hCG
 Umur
Faktor
( ♀)
Infertilitas
Program
Penanganan
Infertilitas
SOSIAL
EKONOMI &
PENDIDIKAN

SARANA RS

Prof. Dr. H. Samsulhadi, SpOG (K). Seksi Fertilitas Endokrinologi Reproduksi, Bag / SMF Obstetri & Ginekologi RSU Dr. Soetomo / FK Unair Surabaya
 EMOSI PENY. LAIN
TENAGA, SARANA
LAMA KAWIN
PRASARANA RS
UMUR WANITA
NAKES AHLI
PENDIDIKAN
PENATALAKSANAAN PERALATAN
KEUANGAN INFERTILITAS
OBAT-2 AN
AGAMA
ATURAN
BUDAYA /
LINGKUNGAN
TUBA &
SPERMA PERITONEUM OVULASI

FAKTOR INFERTILITAS