Anda di halaman 1dari 4

DAFTAR ISI

BAB I PENDAHULUAN ............................................................................ 1


BAB II INDIKASI IVF ................................................................................. 3
2.1 Indikasi IVF ........................................................................................................ 3
2.1.1 Indikasi Infertilitas Faktor Tuba ....................................................................... 4
2.1.2 Indikasi Endometriosis ..................................................................................... 6
2.1.3 Indikasi Infertilitas Faktor Laki-laki ................................................................ 7
2.1.4 Indikasi Disfungsi Ovulasi .............................................................................. 8
2.1.5 Indikasi Unexplained Infertility ....................................................................... 8
2.1.6 Indikasi Lain untuk IVF .................................................................................. 9

BAB III GONADOTROPIN DAN PROTOKOL PADA IVF ........................ 10


3.1 Gonadotropin pada IVF ....................................................................................... 10
3.2 Protokol pada IVF .............................................................................................. 12
3.2.1 IVF Siklus Natural ........................................................................................... 12
3.2.2 Protokol Stimulasi Dengan Clomifen Sitrat .................................................... 13
3.2.3 Protokol Stimulasi Ringan/minimal ................................................................ 13
3.2.4 Protokol GnRH Agonis ................................................................................... 14
3.2.5 Protokol GnRH Antagonis ............................................................................... 17

BAB IV STIMULASI OVARIUM TERKENDALI PADA IVF .................... 20


4.1 Individualized Controlled Ovarian Stimulation (iCOS) ..................................... 20
4.2 Penatalaksanaan Pasien Poor responder ............................................................. 24
4.2.1 Protokol pada pasien poor responder ............................................................... 24
4.2.2 Strategi alternatif pada poor responder ............................................................ 26

i
4.2 Menentukan Dosis Awal Stimulasi .................................................................... 29
4.3 Pemantauan Stimulasi Ovarium Terkendali ....................................................... 31

BAB V TRIGGER OVULASI, OVUM PICK UP DAN TRANSFER EMBRIO ..... 37


5.1 Trigger Ovulasi ................................................................................................... 37
5.2 Ovum Pick Up (OPU) ......................................................................................... 40
5.3 Transfer Embrio ................................................................................................... 40

BAB VI PENUNJANG FASE LUTEAL ................................................................. 42


BAB VII IN VITRO ACTIVATION ........................................................................ 46
BAB VIII SIMPULAN ............................................................................................. 48
DAFTAR PUSTAKA ............................................................................................... 49

ii
DAFTAR TABEL
Tabel 1 Pemilihan protokol berdasarkan jenis responder .......................................... 23
Tabel 2 Model prediksi yang menggabungkan lebih dari satu pemeriksaan
cadangan ovarium untuk dosis FSH............................................................. 30

DAFTAR GAMBAR
Gambar 1 Tingkat reproduksi berbantu yang dibutuhkan untuk konsepsi
berdasarkan jumlah sperma motil total .................................................... 8
Gambar 2 Protokol stimulasi minimal ....................................................................... 14
Gambar 3 Protokol GnRH agonis .............................................................................. 15
Gambar 4 long protocol GnRH agonis ...................................................................... 16
Gambar 5 Protokol OC microdose GnRH agonist flare ............................................ 17
Gambar 6 Protokol GnRH antagonis ......................................................................... 19
Gambar 7 Nomogram dosis untuk dosis awal FSH berdasarkan umur dan kadar
hormon AMH serum yang dibuat oleh La Marca, dkk ............................. 30
Gambar 8 Nomogram dosis untuk dosis awal FSH berdasarkan umur, kadar hormon
AMH dan FSH yang dibuat oleh La Marca, dkk ...................................... 31
Gambar 9 Langkah-langkah in vitro activation pada pasien POI .............................. 47

iii
DAFTAR SINGKATAN

ART : Assisted reproduction technology


AMH : Anti mullerian hormone
AFC : Antral follicle count
BMI : Body mass index
ESHRE : The European Society of Human Reproduction and Embryology
FSH : Follicle stimulating hormone
hCG : Human chorionic gonadotropin
hMG : Human menopause gonadotropin
HSG : Hysterosalpingography
GnRH : Gonadotropin releasing hormone
ICSI : Intra cytoplasmic sperm injection
IUI : intrauterine insemination
IVA : In Vitro activation
IVF : Invitro Fertilization
LH : Luteinizing hormone
OHSS : Ovarian hyperstimulation syndrome
OPU : Ovum pick up
POR : Poor ovarian Response
POI : Primary ovarian insufficiency
PGD : Preimplantation Genetic Diagnosis
RCOG : Royal collage of obstetricians and Gynecologists
SOPK : Sindrome ovarium polikistik
USG : Ultrasonography

iv