FAKTOR SUAMI
- 35% oleh karena faktor sperma
- Gangguan; spermatogenesis & transfortasi:
Varikokel, prostatitis, Epididimitis, Orkhitis,
kelainan kongenital (Hipospadia, agenesis vas
deferens, klinefelters syndrome, Myotonic
distrophy), kelainan hipotalamus-hipofisa,
Autoimunitas, Impotensi dan yang tak diketahui
sebabnya.
FERTILITAS
1. Hormonal 3. Faktor Lain
a. Korteks a. Tuba
b. Hipotalamus b. Lendir serviks
c. Hipofisis c. Imunilogis
d. Ovarium d. Infeksi
e. Suami?
2. Anatomi
a. Uterus
b. Vagina
Pengobatan medis:
tidak begitu menggembirakan
a. Uterine activity 2 4 6 8 10 12
FSH
14 16 18 20 22 24 26 28
1- 4 : menstrual
phase
7-14: proliferative
Estrogen
phase walls thicken Progesterone
due to tissue and blood
2 4 6 8 10 12 14 16 18 20 22 24 26 28
about day 14
– Slight increase in
body temperature Follicular Phase Luteal Phase
– increase flow of
mucus
Estrogen
Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28
c. Hormone Activity
LH
FSH
1. Estrogen 2 4 6 8 10 12 14 16 18 20 22 24 26 28
- gradually increases
- prompts build-up of
uterine walls;
- stimulates pituitary to Follicular Phase Luteal Phase
produce FSH for
follicular development
Estrogen
2. Progesterone Progesterone
– gradually increases 2 4 6 8 10 12 14 16 18 20 22 24 26 28
– prepares uterus
B. Days 14 –20 LH
a. Uterine activity FSH
– Uterine walls continue 2 4 6 8 10 12 14 16 18 20 22 24 26 28
to build up due to
progesterone
b. Ovarian activity
Follicular Phase Luteal Phase
– old Graffian follicle
becomes corpus luteum,
secretes LH, keeps
progesterone up. Estrogen
Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28
c. Hormone Activity LH
estrogen – decreases
progesterone - highest FSH
2 4 6 8 10 12 14 16 18 20 22 24 26 28
levels for maintenance
uterine walls, blocks
FSH
luteinizing hormone - Follicular Phase Luteal Phase
high and maintains
levels of progesterone Estrogen
Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28
C. Days 20 - 28
LH
a. Uterine Activity –
– continued increase FSH
2 4 6 8 10 12 14 16 18 20 22 24 26 28
in proliferation until
day 28
– walls sloughed
away as tissue and Follicular Phase Luteal Phase
blood
b. Ovarian activity – Estrogen
– continued secretion Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28
of LH
3. Hormones LH
progesterone
FSH
begins to decrease 2 4 6 8 10 12 14 16 18 20 22 24 26 28
if no pregnancy
LH decreases as
Follicular Phase Luteal Phase
old corpus luteum
loses secretory
Estrogen
function Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28
Induksi Ovulasi
Clomiphene Citrate (CC) 50-150 mg
diberikan pada hari ke 5, 6, 7, 8, 9 dari
siklus menstruasi
hMG 2-3 Ampl/hari diberikan pada hari ke
5,6,7,8,9,10,11,12,13,14,15 dari siklus
menstruasi
FSH murni (Metrodin) 75 IU cara
pemberian sama dengan hMG
Assisted Reproductive
Technology (ART)
ttd: IVF (In Vitro Fertilization)
GIFT (Gamete Intro Fallopian Transfer)
ZIFT (Zygote Intro Fallopian Transfer)
penggunaan donor oosit
Cryopreserved embryo transfer
Indikasi: Tuba -/ rusak berat
Post sterilisasi tuba
Induksi ovulasi & Inseminasi: gagal
Kegagalan ovarium
Invertilitas akibat oocyt faktors
IN VITRO FERTILIZATION
Stimulasi ovarium dengan/tanpa supresi
sentral
Oocyt retreieval (pengambilan oosit)
Persiapan spermatozoa
Fertilisasi dan pembiakan embrio
Transfer embrio dan penanganan fase luteal
Saat inseminasi & transfer embrio