Samsulhadi. Dept. of Obstetric & Gynecology, Fac. of Medicine Airlangga University. Dr. Soetomo Hospital Surabaya 26 MEI 2012
Samsulhadi. Dept. of Obstetric & Gynecology, Fac. of Medicine Airlangga University. Dr. Soetomo Hospital Surabaya 26 MEI 2012
Samsulhadi. Dept. of Obstetric & Gynecology, Fac. of Medicine Airlangga University. Dr. Soetomo Hospital Surabaya 26 MEI 2012
SAMSULHADI
KLINIK FERTILITAS GRAHA AMERTA
DIVISI FERTILITAS & ENDOKRINOLOGI REPRODUKSI
DEPARTEMEN / SMF OBSTETRI & GINEKOLOGI
FK UNAIR, RSUD DR SOETOMO SURABAYA
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
KESUBURAN MENURUN
1 Tahun
PRIMER / Tahun ke . . . ?
Bulan Madu
SEKUNDER
UMUM ORGAN
REPRODUKSI
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
UMUR - KESUBURAN
% Fertilitas maksimum ISTRI Angka Kejadian
Abortus (%)
% Fertilitas maksimum
50
SUAMI
100
Angka kejadian Abortus (%)
80 40
60 30
Istri
40 20
20 10
0 0
20-24 25-29 30-34 35-39 40-44
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
FAKTOR INFERTILITAS – LAMA KAWIN
LAMA INFERTILITAS – KEHAMILAN KUMULATIF
Lama Perawatan ( bl.) 6 12 18 24
Lama Infertilitas (th) (%) (%) (%) (%)
1–2 20 50 60 > 60
2–3 10 > 20 60 -
3–5 - 10 20 40
>5 - 10 10 10
Cedars Marcele. Infertility : Practical Pathways in Obstetrics & Gynecology. Mc Graw Hill. San Fransisco, 2005. p : 305 - 320
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
INFERTILITAS – LAMA KAWIN
CUMULATIVE RATES OF CONCEPTION RELATED TO DURATION OF INFERTILITY
90
80
70
60
50
40
% of couples
30
20
10
0
6 12 18 24
Months after initial clinic v isit
1 – 2 years 2 – 3 years
3 – 5 years > 5 years
Duration of Infertility
Cedars Marcele. Infertility : Practical Pathways in Obstetrics & Gynecology. Mc Graw Hill. San Fransisco, 2005. p : 305 - 320
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
FREKUENSI SANGGAMA
1 BULAN
1 TELUR
1 HARI
OV
35
10 - 21
F 14
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
FREKUENSI SANGGAMA
Ov.
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
GAYA HIDUP - KESUBURAN
MODERN
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
GEMUK / OBESITAS
BB (Kg) LINGKAR
BMI :
TB ( m) 2 PERUT
25 – 30 Kg / m2 : GEMUK / OBES.
Berat • WANITA > 80 cm
> 30 Kg / m2 : • PRIA > 90 cm
Gemuk / Obes.
BMI IDEAL : 20 – 25 Kg / m2
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
OBESITAS - KESUBURAN
WANITA OBES 43 % LEBIH SULIT
UNTUK HAMIL
PENURUNAN BB 10 %
KESUBURAN NAIK 40 %
DIATASI
• POLA MAKAN
• OLAH RAGA *
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
ROKOK - KESUBURAN *
• 60 % perokok wanita Infertil
• < 20 rokok / hari kesuburan tinggal 75%, > 20 / hari
tinggal 57 %
2. Rokok – Bayi Tabung
- Dosis Gonadotropin * Risiko abortus & KET
- Angka Kehmilan * Cacat ( Syndronme Down)
3. Kualitas Sperma
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
LINGKUNGAN - KESUBURAN
MEKANISMENYA ?
Pestisida,
Solvent (dipakai pada
industri dry cleaning)
Thinner
Logam berat (cadmium,
mercury)
Gas anestesi
Radiasi dosis besar
dalam jangka panjang
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
OBAT-OBATAN - KESUBURAN
NSAIDs ( Obat sakit kepala, nyeri haid,
arthritis) pada masa subur
mengganggu ovulasi
UMUM ORGAN
REPRODUKSI
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
MENGAPA KESUBURAN
Saluran Telur
Miometrium
Rahim
Endometrium
Indung Telur
Mulut
Rahim
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
TELUR 1 BULAN
1 BIJI
1 HARI
IMPLANTASI
6 – 7 Hari
PEMBUAHAN Pasca Ovulasi
Sperma : + 2 x 24 jam
di servik
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
FAKTOR (ORGAN) INFERTILITAS
F. Sal. Telur
(35%)
F. Telur
(15%)
Pasutri Istri
F. Sperma
Fritz Marc A and Speroff Leon. Clinical Gynecologic
Endocrinology and Infertility. Ed. VIII TH. Lippincott Williams & (40%)
Wilknis Philadelphia (2011)
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
HAID NORMAL
FSH LH
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
HAID TERATUR
FAKTOR
> 90%
OVULASI & HAID
OVULASI
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
NORMAL MENSTRUATION
FLOW (VOLUME) 30 - 80 ml
3-7 OV S
28
14 14
OV
24
10 14
OV
35
21 14
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
GANGGUAN SEL TELUR - SOPK
GEJALA KLINIK :
Siklus Haid
Pertumbuhan
rambut sex
Jerawat
Obesitas
PEMERIKSAAN
PENUNJANG :
- USG Pervaginam
- Hormon
- dsb.
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
Ultrasonograf
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
OV
35
21 14
F
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
USG : MONITORING PERTUMBUHAN FOLIKEL
ENDOMETRIUM FOLIKEL MASAK SOPK
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
MONITORING FOLIKEL
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
FAKTOR (ORGAN) INFERTILITAS
F. Sal. Telur
(35%)
F. Telur
(15%)
Pasutri Istri
F. Sperma
Fritz Marc A and Speroff Leon. Clinical Gynecologic
Endocrinology and Infertility. Ed. VIII TH. Lippincott Williams & (40%)
Wilknis Philadelphia (2011)
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
SEBAB FAKTOR TUBA ?
ENDOMETRIOSIS INFEKSI
• Tuba Buntu
• Perlekatan
• Tuba / Ovarium rusak
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
PATOGENESIS - ENDOMETRIOSIS
(1690 Daniel Shroen)
• Pop. Umum : + 10%
• Infertilitas : + 50%
Pertumbuhan Selanjutnya
dipacu oleh E
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
ENDOMETRIOSIS BERAT - INFERTILITAS
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
USG KISTA ENDOMETRIOSIS
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
SEBAB FAKTOR TUBA ?
ENDOMETRIOSIS INFEKSI
• Tuba Buntu
• Perlekatan
• Tuba / Ovarium rusak
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
INFEKSI KANDUNGAN
- KESUBURAN
• Penjalaran infeksi organ
sekitar kandungan
• TBC
• PHS (Ganti –ganti partner)
AWAS !!!
CHLAMIDIA
Saluran Telur :
TRACHOMATIS
• Dinding Rusak
• Fimbriae / Ujung Sal. Telur rusak
• Buntu
• Perlekatan
FUNGSI TERGANGGU
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
INFEKSI PANGGUL - INFERTILITAS
JUMLAH PAPARAN RISIKO FAKTOR
INF. PANGGUL SALURAN TELUR
Episode Rate of
of PID Tubal Infertility ( % )
I 12
II 23
III 54
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
BAGAIMANA MENGETAHUI FUNGSI SALURAN TELUR ?
Perlekatan
Dinding baik
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
BAGAIMANA MENGETAHUI FAKTOR SAL. TELUR ?
SYARAT FUNGSI SAL. TIUP FOTO TEROPONG /
TELUR HSG / SIS LAPAROSKOPI
Lubang / Patent + + +
Fimbria Baik - - +
Otot Tuba baik - ? +
Tidak ada - - +
perlekatan
Patologi Lain :
Endometriosis, - + +
Kista, Mioma, dll
Perbaikan - - +
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
SALURAN TELUR
DIAGNOSIS
HSG
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
NORMAL
HSG LAP. DX
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
Video LAP Dx NORMAL
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
ENDOMETRIOSIS RINGAN
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
KISTA COKLAT
Video Lap Op. Kistektomi
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
PERLEKATAN
RINGAN BERAT
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
HIDROSALPING
LAP. DX HSG
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
PERAN LAPAROSKOPI – INFERTILITAS
1. DIAGNOSIS
2. KOREKSI KELAINAN
A. MELEPASKAN PERLEKATAN
B. KISTEKTOMI / MIOMEKTOMI
C. MEMPERBAIKI SALURAN TELUR
D. ABLASI ENDOMETRIOSIS
E. LAPARASCOPIC OVARIAN DRILLING
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
Ovarian Drilling
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
APAKAH HISTEROSKOPI ?
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
FAKTOR (ORGAN) INFERTILITAS
F. Sal. Telur
(35%)
F. Telur
(15%)
Pasutri Istri
F. Sperma
Fritz Marc A and Speroff Leon. Clinical Gynecologic
Endocrinology and Infertility. Ed. VIII TH. Lippincott Williams & (40%)
Wilknis Philadelphia (2011)
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
F. SPERMA - INFERTILITAS
NILAI NORMAL
PARAMETER
MAYOR Tradisi- WHO 2010 KETERANGAN
onal
OLIGO SPERMIA
• Konsentrasi > 20 > 15 jt./
jt./ ml ml
• Motilitas > 50 % > 40 % ASTHENOSPERMIA
(a + b)
Epidedemis
> 15 % > 4 % TERATOZOOSPERMIA
• Morfologi
Normal
* Fritz Marc A, Speroff leon,. Clinical Gynecology Endocrinology and Infertility , ed. VIIIth Lipincot William Wilkins,
Philladelphia, 2011,
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
BAGAIMANA FERTILISASI
BILA ADA KELAINAN SPERMA BERAT ?
Depends on :
IUI or IVF
Female factors ?
20 50 15
Sperm recovery ?
IVF or IUI or ICSI IVF history ?
Female factor ?
10 25 10
Sperm recovery ?
ICSI or IVF IVF history ?
5 10 5
ICSI
Concentration Motility Morphology
(mill./ml) a + b (%) normal (%)
Hinting et al, 1997
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
INFERTILITAS
Komplek
Sosial Medis
1. Arti Anak 1. Multi Disiplin
2. Dana – Waktu 2. SDM Terampil & Sarana
3. Pendidikan / Pengertian 3. Penyebaran Fasilitas
SOLUSI
1.Penanganan Komprehensif, tergantung F. Penyebab
2.Terarah & terencana
3.Rujukan
4.PKB - KIE Pasutri 56
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
TAHAPAN PENANGANAN PASUTRI INFERTIL
Dipercepat 35 Tahun
Bayi
Tabung
Obat Penyubur
Peningkatan Kesuburan
Suntik / Inseminasi
Obat Penyubur
oral /
Pengobatan Inseminasi
Sederhana
Koreksi Faktor
Infertilitas
Identifikasi
Faktor Infertil
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
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
PENGERTIAN
INSEMINASI BAYI TABUNG
CUCI
SARING
CUCI
SARING
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
KAPAN DILAKUKAN ?
INSEMINASI BAYI TABUNG
INDIKASI :
INDIKASI :
1.Endometriosis ringan 1.Kelainan
2.Gangguan ovulasi - F. Infertilitas Berat/Ganda
- umur istri lanjut
3.Kel. Sperma ringan
4.Unexplained Infertility 2. Gagal Pengobatan
3. Unexplained Infertility.
Kontra Indikasi :
1.Infeksi Kandungan
2.Penyakit ibu berat
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
INSEMINASI
SELEKSI PROSES
FASE LUTEAL
PENUNJANG
INSEMINASI
OVARIUM
SYARAT MONITOR. CUCI /
SARING
KONTRA PEMASAK-
INDIKASI AN TELUR
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
INSEMINASI – STIMULASI OVARIUM
– MONITORING - PEMASAKAN TELUR
USG *
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
36
jam
Penunjang Fase Luteal
1. Obat Minum > 18 mm
Inseminasi
(KS)
2. Minum + Suntik CUCI
Suntik (FSH) Masak SARING
3. Suntik (FSH) Telur
LH Urine
- 16
*
Maksimum 3 telur masak
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
Bagaimana
hasil inseminasi Dook…..
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
ANGKA KEHAMILAN INSEMINASI
100
80
80
60
% Keberhasilan
60
Kehamilan (%)
40
40
20
20
Siebel Machelle M., Infertility : A Comprehensive Text, 2 nd Ed. Appleton & Lance.
Stamford. Connecticut 1997
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
KAPAN DILAKUKAN ?
INSEMINASI BAYI TABUNG
INDIKASI :
INDIKASI :
1.Endometriosis ringan 1.Kelainan
2.Gangguan ovulasi - F. Infertilitas Berat/Ganda
- umur istri lanjut
3.Kel. Sperma ringan
4.Unexplained Infertility 2. Gagal Pengobatan
3. Unexplained Infertility.
Kontra Indikasi :
1.Infeksi Kandungan
2.Penyakit ibu berat
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
BAYI TABUNG
SELEKSI PROSES
TANAM EMBRIO
PEMBUAHAN
FASE LUTEAL
PENUNJANG
OVARIUM Telur
SYARAT MONITOR. Cuci
Sperma
KONTRA PEMASAK-
INDIKASI AN TELUR
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
GnRHa / GnRH antag
BAYI TABUNG
Gonadotropin
Masturbasi hCG / P
Endogen
& Cuci sperma
USG
Penunjang Fase Luteal
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
36
jam
Transfer Embrio
Transfer Embrio
1. Obat Minum • > 3 Fol.
Panen Telur
(KS) > 18 mm
2. Minum +
Suntik (FSH) Suntik AZOOSPERMI
Masak
3. Suntik (FSH)
Telur
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
V
36
jam
Transfer Embrio
Transfer Embrio
1. Obat Minum • > 3 Fol.
I
Panen Telur
(KS) > 18 mm
2. Minum +
Suntik (FSH) II
Suntik
Masak
3. Suntik (FSH)
Telur
IV
ICSI III Pembuahan 1 hr. 2 hr.
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
Kehamilan terjadi pada “ Kesempatan”
yang sangat “ kebetulan”
(Karena Kehendak Allah semata)
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
APAKAH BAYI TABUNG
PASTI BERHASIL DOK … ?
SAYA PUNYA
DUIT
BUANYUUUAAK …. ?
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
KEBERHASILAN MENDAPATKAN
BUAH HATI DIPERLUKAN…
KOMUNIKASI
• RENCANA PENGOBATAN
• PENYULUHAN
• KERJASAMA
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
BAGAIMANA MENILAI
KESUBURAN PASANGAN
BERDASARKAN
FAKTOR RISIKO / GEJALA KILINIK
YANG ADA
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
SKOR INFERTILITAS
SKOR 1 2 3
Umur Istri * < 30 30 - 35 > 35
Lama Kawin / Lama Infertilitas 1-2 >2 > 3
PROGRESIF TIDAK
STATIS
(ADA FAKTOR WAKTU)
MENGHINDARI RUJUKAN
TERLAMBAT
78
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
SAN INFERTILITAS
K A
N G KELAINAN ORGAN
RI UMUM
• Umur Istri *
• Lama Infert. * TELUR SAL. TELUR SPERMA
• Frek. Koitus
• Emosi ** ANALISA SP.
• Gaya hidup HAID Foto HSG / SIS LAPAROSKOPI
B A
Riwayat Analisa Sperma Umur < 30 Th. atau Umur > 30 Th.
Disfungsi Seksual (2- 3 x dan Atau dan
pemeriksaan) Lama Infertilitas / Lama Infertilitas /
Kawin 1 - 2 Tahun Kawin > 2 Tahun
Normal
Ada Kelainan
C
Siklus Haid Tidak Teratur Siklus Haid Teratur dan
Dan atau Risiko Faktor Tuba &
Terdapat risiko Peritoneum
Faktor Tuba & Peritoneum
1. KESPRO REMAJA
2. KIE
3. KB
Hindari UNWANTED Pregnancy
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
KAMI SIAP MEMBANTU MELENGKAPI
KEBAHAGIAAN ANDA
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
SAMSULHADI. DEPT. OF OBSTETRIC & GYNECOLOGY, FAC. OF MEDICINE AIRLANGGA UNIVERSITY. DR. SOETOMO HOSPITAL SURABAYA 26
ART IN INFERTILITY
MANAGEMENT INFERTILITY MANAGEMENT
FEMALE MALE
Age > 37 Years
Sperm An.
and or OVULATORY FACTOR TUBAL FACTORS
Multiple Factors Normal Abnormal
of Infertility
• Age > 30 yrs • Age < 30 yrs
Irregular Cycles Regular
(WHO) cycles • Infertility • Infertility
duration > 3 yrs duration < 3 yrs Tx Tx