Soffin Arfian

RS PKU Muhammadiyah
Surakarta
FK UMS

Definition of infertility Is :
Any woman not being able to
get pregnant after at least one
year of Unprotected Intercourse.

80% to 90% couples conceive within

one year of their marriage.
Incidence : 10% to 15% of all couple
are infertile. Incidence varies among
different communities but generally
about 15% of couples need some
help to achieve pregnancy.

Infertility is a common condition

affecting one in six couples.
About 80 million couples are affected
world wide.
It is of two types:
1. Primary Infertility
2. Secondary Infertility

Pregnancy is a result of complex events

which includes ovulation that is release
of mature egg from the ovary.
Its transport through the fallopian
tubes.
Availability of healthy sperms that
fertilize the egg.
The fertilized egg must attaches itself to
uterus.

So infertility can result from problems

that interfere with any of these steps.
Infertility is not always womens
problem.
Causes of infertility may lie either in
male or female or in both.
Female Causes ( 40% ), Male causes
( 40% ), 20% is a combination of Male
& Female causes.

UNEXPLAINED ( 28% )
SPERM PROBLEM ( 21% )
OVULATORY PROBLEM ( 18 % )
TUBAL DAMAGE ( 14 % )
ENDOMETRIOSIS / CERVICAL MUCOUS
(9%)
COITAL PROBLEM ( 5 % )
OTHER ( 5 % )

OVULATORY:
- PCOs, Hypotalamic Amenorrhea, Luteal
Phase Deficiency
TUBAL / PERITONEAL :
- Hydrosalphinx, Tubal Obstruction,
Endometriosis, Adhesion
UTERINE :
-Synechiae, Fibroids, Anomalies
CERVICAL
-Mucous, Antisperm antibodies
OVARIAN RESERVE :
-Ovarian Failure

Abnormal spermatogenesis
Impaired sperm transport
Immunological and infective factor
Varicoceole
Normal spermatogenesis depends
upon adequate gonadotrophic
stimulation of testes, proper testicular
function and patent seminal duct.

Orchitis
Undescended testes
Past history of mumps
Chronic renal failure.
Chronic liver diseases
Malignancies
Uncontrol diabetes mellitus
Multiple scleroses
Exposure to radiations or Chemotherapy
Excessive exposure to heat.

First step in male investigation is

Semen analyses .
-. if this is normal then no other test
is needed.
-. If oligospermia or azoospermia is
found then patients are referred to
specialist fertility clinic for further
investigation.

Ejaculate Volume >2ml

Sperm Density: >20m/ml
Motility >50%
Morphology 15% normal
pH 7.5 8.5

At least one-half of male problems

can be treated.
Treatment in collaboration with
urologists and endocrinologist is
essential.
Treatment options are:
-Drug Therapy
- Surgery
- IUI / ART

Due to some autoimmune

phenomenon.
Anti-sperm antibodies maybe
present in cervical mucus which
neutralize sperms by clumping them
together and destroying their
membrane.
About 12-15% of unexplained
infertility in women is linked to ASA.

These include Large fibroids

distorting uterine cavity
Congenital abnormalities in shape of
uterus.
Leuteal phase insufficiency, due to
progestrone deficiency which causes
preparation of endometrium for
reception of fertilized ovum.

Age Stress
Poor diet
Smoking
Alcohol
STDs
Overweight/ Underweight
Caffeine intake
Too much exercise

PELVIC ULTRASOUND &

HYSTEROSALPINGOGRAM
Pelvic Ultrasound : A detailed ultrasound
is important diagnostic tool. It reveals
uterine abnormalities, uterine masses,
ovarian size, presence or absence of
follicles, diagnosing PCO.
LAPAROSCOPY: It is considered as
investigation of choice. It has advantage
of diagnosing tubal blockage and
simultaneously treating the pathology.

Treatment should be based on

documentation of abnormality leading to
infertility.
The first thing to offer a couple is
counseling and reassurance.
Because infertility treatment can be
physically uncomfortable, time
consuming, costly and without
guarantee of success.

Improve general health

Stop smoking
Limiting alcohol consumption
Obtaining standard Weight. Both over
weight and underweight can cause
sub fertility
Infections are treated with
appropriate antibiotics

A delicate balance of Estrogen,

Progesterone, FSH, LH is needed for
timely growth and release of egg
from the ovary.
Even slight irregularity in these
hormones can cause an ovulation.
Drugs used for induction of ovulation
are: Clomifen citrate ,HMGS, FSHr,
Dopamine Agonists

Clomiphene is a synthetic weak

estrogen.
It competes with endogenous
estrogen for estrogen binding sites in
the hypothalamus
Giving a negative feedback to
pitutiary gland which starts producing
large amounts of FSH which causes
growth and maturity of folical hence
ensuring ovulation.

HMGS are GlycoProtein Hormones

directly stimulates ovary
These drugs are prepared from urine of
menopausal women. They are used to
produce super ovulation in ART and in
certain cases where clomiphen citrate
fails to produce ovulation. Progesteron
support is given from 15 to 25th day.

FSH recombinant is more accepatable

now because it produce not from
human urine and ofcourse it is Halal.
It works directly to stimulate
folicullogenesis
All of stimulation ovulation procedure
needs luteal phase support because
usually lack of progesterone

Bromocriptin is Used when cause of

an ovulation is hyperprolactenemia

Anti sperm anti bodies are treated

with low dose coticosteroids.
Predinsolone 40 60 mg is used from
day 1 to 10 and than 20 mg for next
2 days. This therapy is given for 6 to
9 months.

IUI
IVF
ICCSI

Infertility should be evaluated for

couples after one year of trying
pregnant without contraception.
History and Physical examination
usually will help to identify the etiology.
If patients fail the initial therapies then
the proper referral should be made to a
reproductive specialist.

Optionof adoption is also offered to

infertile couples when all the
treatments are failed