3.infrtpak alvarino
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DIAGNOSIS DAN
PENANGANANINFERTILITAS
PADA PRIAALVARINOSIE UROLOGI
LAB ILMU BEDAH
FK. Univ. ANDALAS
42
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PENDAHULUAN• 10 – 15% pasutri ,hub.seksual normal
tanpa kontrasepsi,belum hamil InfertilitiPrimer.
• Faktor Infertiliti pasangan :• Female 1/3
• Male 1/3
• Both 1/3
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REPRODUKSI PRIAHYPOTHALAMUS-PITUITARY-
GONADAL AXIS ( HPG
!MBRYO PH!NOTYP!
S!XUAL MATURATION!NDO"RIN! T!STI"ULAR
FUN"TION
te#to#te$o%e
!XO"RIN! T!STI"ULAR FUN"T
ION
#&e$mato'e%e##
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PRIA
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TESTIS
• !NDO"RIN! – L!YDIG "!LL T!STOST!RON) *+ (FR!!
– IN"R!AS!D L!,!L OF !STROG!N THYROIDD!"R!AS!D SHBG.
– ANDROG!N) GH) OB!SITY D!"R!AS!D SHBG A"TI,! ANDROG!N
FRA"TION
• !XO"RIN! –
S!RTOLI "!LL G!RM "!LL GROTH • INI!IN " #$I&IN
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SPERMATOGENESIS
SPERMATOGONIA
SPERMATOZOA
13 STAGES
74 DAYS
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• PR! T!STI"ULAR 0• HIPOTALAMUS
• !%o2$%o&at• Se4al 5#64%7to%
HIPOFISIS
. Mal'%a%75)$aato% )o&e$ato%
. H&e$&$ola2t%ema)hemo2$omato##
• T!STI"ULAR 0• UDT• "HROMOSOMAL ABNORMALITY• INF!"TION• M!DI"ATION• IN8URY• ,ARI"O"!L! *9-:9+
• POST T!STI"ULAR 0• "ONG!NITAL OBSTRU"TION 0 "YSTI" FIBROSIS• A";UIR!D OBSTRU"TION 0 ,AS!"TOMY• FUN"TIONAL OBSTRU"TION 0 N!UROG!NI"
• IDIOPATHI" :9+
ETIOLO
GI
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DISORD!RS OF SP!RM FUN"TION AND MOTILITY•Immotle "la S5%$ome•Mat4$ato% e6e7t#
•Imm4%olo'7 %6e$tlt5•I%6e7to%
DISORD!RS OF SP!RM D!LI,!RY / "OITUS•!$e7tle 5#64%7to%
•H5&o#&aa
ETIOLO
GI
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H#to$5 o6 %6e$tlt5 Me7al h5#to$5 Go%aoto%DURATION
PRIOR PR!GNAN"I!S
PR!S!NT PARTN!R
PR!,IOUS TR!ATM!NT
!,ALUATION TR!ATM!NT OFIF!
S5#tem7 Ill%e## ( .e) DM
M4lt&le #7le$o##
P$e
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PEMERIKSAAN FISIK
• Pemeriksaan genital eksterna : estis,epi2i23mis, &as 2eferens,
4arioele,genital keil.
• 6arakteristik seks sekun2er 7 pen3ebaran
rambut ketiak,pubis 2an ba2an tumbuh
besar.
• abnormal 7 g3neomastia,
anosmia86allmann9,galaktore,ggnlap.penglihatan.
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PEMERIKSAAN AWALU$%al5##
Seme% a%al5#e#• peiment ere obtaine2 orretl3 ;;;• #bstinene /, 8 > eeks < months 9• Normal result, 4ar3 i2el3
Ho$mo%al e
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KARAKTERISTIK SPERMA
NORMAL• &olume 1,5 = 5 ml
• $on A >0 million@ml, total
A 50 million
• *otile A 50%
• *otile gra2e A>
• normal morpholog3 A
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HORMONE PROFILE"ONDITION T FSH LH PRL
N-'*#( N( N( N( N(
PRIMARYT!STIS FAILUR! (- N(@ N(
H5&o'o%aot$o&h7-h5&o'o%a#m (- (- (- N(
P)'P'-(#$IN)*I# (- (-@N((- I
#N'-)N ')I#N$) N(
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•emen leuko3te anal3sis
• #ntisperm antibo23 test•$omputeriCe2 assiste2 semen anal3ses 8$##9•3poosmoti selling test•perm penetration assa3•perm=er4ial *uus interation
•'- 8reati4e oD3gen speies9•)N)I$ )(+#I-N
•$hromosomal stu23•$3sti fibrosis mutation testing• hromosome miro2eletion anal3sis
•'a2iologis : usg, 4enograph3, '+, $@*'I pel4i•!iopsi estis " &asograph3•FN# mapping of testis•emen ulture
PEMERIKSAAN
TAMBAHAN
KLASIFIKASI
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KLASIFIKASI
INFERTILITI PRIA')##!() $#+)
• &arioele
• -bstrution
• Infetion
• )Eaulator33sfuntion
• 3pogona2otropi=3pogona2ism
• ImmunologiProblem
• )retilel 3sfuntion
• 3perprolatinemia
P-)NI#((')##!()
• I2iopathi
• $r3ptorhi2ism• &asal #genesis
+N')##!()
• !ilateral #norhia
• erminal $ell= #plasia
• Primar3 estiular=
Failure
• $hromosomal=
#nomalies
• Immotile $ilia=
3n2rome
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PENATALAKSANAAN
HISTORY
PHYSICAL
SEMEN ANALYSIS
HORMONES
ADJUNCTIVE
TEST
SURGICALTHERAPY
NON
SURGICAL
TREATMENT
ASSISTEDREPRODUCTIVE
TECHNIUE
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No% S4$'7al T$eatme%t
SP!"IFI" TH!RAPY
HYPOGONADOTROPHI"-HYPOGONADISM
• IN$I)N$) 7 (-
• #$G+I') @ $-N)NI#( 86#((*#NNI N'-*)9
• +) - )$')#) P'-+$I-N -F n'• #-$I#) I -)' $-N #N-*#( : #N-*I#,
)#FN), $()F P#(#), ')N#( #N-*#(I)
• #$G+I') : PI+I#' +*-'@'#+*#, I-(#)
-N#-'-PIN )FI$I)N$, #N#!-(I$ )'-I +).
• I#N-I$ ) : $ @ *'I '+() -+ +*-'
• )'#P : h$ 1500= eeks,
then h* =J times eekl3
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No% S4$'7al T$eatme%t
SP!"IFI" TH!RAPY
HYP!RPROLA"TIN!MIA
• IN$I)N$) 7 (-
• P)'P'-(#$IN)*I# N) F))!#$6 - n',
INI!I-' )FF)$ on ( !ININ to ()I INF)'I(I,
)')$I() F+N$I-N
• )I-(- : IP-P)#( +*-', P-'-I*, (I&)'
I)#), '+ 8PhenothiaCine, ri3li #nti2epresant, some
antih3pertensi4e9
• I#N-I$ ) : $@*'I '+() -+ +*-'
• )'#P :
– "AUSAL o$
– BROMO"RIPTIN! *) -C) m' *-: TIM!S DAILY
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No% S4$'7al T$eatme%t
SP!"IFI" TH!RAPY
ISOLAT!D T!STOST!RON D!FI"I!N"Y
• P'I*#' P--N#I* 8 ()I $)(( F#I(+') 9 )$')#)
()&)( -F )-)'-N )$')#) (I!I- " )/+#( F+N$I-N
8 )')$I() F+N$I-N, et9
• IN$I)N$) 7 '#')• )'#P :
– )-)'-N )N#N#) @ P'-PI-N#) im
– g 1500 iu t.i.
ISOLAT!D LH D!FI"I!N"Y / F!RTIL! !UNU"H SYNDROM!
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No% S4$'7al T$eatme%t
SP!"IFI" TH!RAPY
"ONG!NITAL ADR!NAL HYP!RPLASIA
• IN$I)N$) : '#')
• )FI$I)N$ -F #')N#( '-/(#)
)$')#) $-'I-( )$')I-N IN$')#) #$ IN$')#) #')N#( #N'-)NP'-+$I-N )$')#) nrh +PP'))P)'*#-)N)I.
• I#N-I$ ) : +rinar3 1=6)-)'-I or)'-)PI#N'-)'-N 8)#9
• )'#P : (+$-$-'I$-I ')P(#$)*)N.
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No% S4$'7al T$eatme%t
SP!"IFI" TH!RAPY
IMUNOLOGI" INF!RTILITY•
)&)N oral P')NI-N $#N )$')#) ##,
I '#')( +$$)F+(• ')#*)N -F $-I$) 7 #' I"SI
• 3 C+ MAL! INF!RTIL
G!NITAL TRA"T INF!"TION
• )F)$ of I
#!N-'*#( )*)N G+#(I ? >%
e4ere 8)nterobateriaeae, $hlam32ia, onorrhoeae9 )I
#'-P @ )PII*#( +$ -!'+$I-N
generate '- harm spermKs abilit3 to fertiliCe
• The$a&5 E A%tot7#
• Pe$##te%t O#t$47to% S4$'e$5
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No% S4$'7al T$eatme%t
SP!"IFI" TH!RAPY
R!TROGRAD! !8A"ULATION• )I-(- :
– ANATOMI", : !()' N)$6 +')' – N!UROG!NI", : PIN#( $-' INL+',
')'-P)'-N)#( +')', I#!)) *)(I+
– PHARMA"OLOGI" : N)+'-()PI$, 'I$$(I$ #NI)P')#N, #(P# !(-$6)', #NIP)')NI&) – IDIOPATHI"
• I#N-I$ ) : P- )L#$+(#) +'IN)• )'#P :
– #(P# #')N)'I$ #-NI 8)P)'IN),P)+-)P)'IN), I*IP'#*IN),P)N(P'-P#N-(#*IN)
– #' IN'#+)'IN) IN)*IN#I-N
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No% S4$'7al T$eatme%t
SP!"IFI" TH!RAPY
AN!8A"ULATION• IN$I)N$) : '#')
• )I-(- :
– N!UROG!NI", : PIN#( $-' INL+',
')'-P)'-N)#( +')', I#!)) *)(I+,
'#N&)') *)(II, *+(IP() $()'-I
– PSY"HOG!NI" / IDIOPATHI"
• I#N-I$ ) : P- )L#$+(#) +'IN)
• )'#P : – R!"TAL PROB! !8A"ULATION
– P!NIL! ,IBRATORY STIMULATION
N S l T t t
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No% S4$'7al T$eatme%t
!MPIRI" TH!RAPY
• INI$#I-N : II-P#I$ -(I-P)'*I#
• '+ $#)-' F-' )*PI'$ )'#P:
– $(-*IP)N $I'#) – #*-/IF)N
– #N'-)N
– )-)'-N ')!-+N – #'-*##) INI!I-'
– -N#-'-PIN
– n'
– 6#((I6')IN
– P'-#(#NIN N)#) INI!I-'
– !'-*-$'IPIN)
– P)N-/IF((IN)
– #NI-/I#N – $#'NIIN).
N S l T t t
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No% S4$'7al T$eatme%t
!MPIRI" TH!RAPY
• N)I$, N-N)'-I#( #NI=)'-)N• !IN - )'-)N ')$)P-' $-*P)II&)( IN )
P-#(#*+, #N P-PI) !(-$6IN F)!#$6 #N IN$')#IN )$')I-N -F n', F, (
• -) 7 1>,5=50 mg@2, $-NIN+-+( F-' >5 2, I 5=2
') P)'I- eah *-N, F-' M *-N• F-((-=+P : )-)'-N ()&)( *+ !) IN N-'*#( (I*I.
F')G+)N )*)N #N#().
• I) )FF)$ : N)$-*#I#, N#+)#, IIN), &I+#($-*P(#IN, #(()'I$ )'*#II
• ')+( : >=5H%
• #*-/IF)N : -'6 IN *#NN)' # $(-*IP)N, !+ I() )'-)NI$ )FF)$
• -) 7 10=15 mg@ I$) 2
CLOMIPHEN CITRATE
N S l T t t
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No% S4$'7al T$eatme%t
!MPIRI" TH!RAPY
• R!"!NT STUDI!S D!MONSTRAT!D AN IN"R!AS!D
OF ROS % IDIOPATHI" SUBF!RTILITY
• ROS IN"LUD! E HYDROXYL RADI"AL (OH)
SUP!ROXID! ANION (O*) HYDROG!N P!ROXID!
(H*O*• ROS DAMAG! SP!RM LIPID M!MBRAN!
• ,ITAMIN ! :99-1*99 4 /D IMPRO,!D "APA"ITY FOR
SP!RM-OO"YT! FUSION IN-,ITRO• GLUTHATION 99 m'/
ANTIOXIDANT
PEMBEDAHAN
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PEMBEDAHAN• &arioeletom3
• &aso4asostom3, )pi2i23mo4asostom3,+' of )Eaulator3 2ut
• #blation of Pituitar3 #2enoma
PROPILAKSISPEMBEDAHAN• -rh32opeD3
• -peration for estiular orsion• )letroeEaulation
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REPRODUCTIVE
TECHNIQUESIf neither urger3 nor me2ial therap3 is apropriate # logial treatment, tehniue atempt too4erome the problems of re2ue2 sperm motilit3
an2 number is ARTS&e$m Do%ato% 0
usban2 or -thers
Te7h%4e o6 #&e$m et$a7to% 0)Eaulate
*)#))
INTRAUTERINE
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INTRAUTERINE
INSEMINATION• P(#$)*)N -F # P)(()
)L#$+(#) IIN +)'+
• INI$#I-N 7
• ! P# $)'&I$#( F#$-'• I*+N-(-I$ INF)'I(I
• (- P)'* G+#(I
• *)$#NI$#( P'-!()* -F P)'* )(I&)'
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IVF & ICSI
• )/$)(()N )$, ! P# *-)'#)- )&)') F-'* -F *#() INF)'I(I
• I&F 7 500.000=5.000.000 *-I() P)'*# #N ) #') F)'I(I) IN P)'II)
• I$I 7 1 &I#!() P)'* INL)$) IN-$-P(#*I$ #')#
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ICSI
MALE
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METHODE• )#!(I)
– $-N-*
– P)'$+#N)-+ -$$(+I-N – '#II-N#( )$-* – N-N=$#(P)( )$-*
• '))#'$ – ormonal : PI((K, INL)$#!() – Non=hormonal – &aine – imunologi
MALECONTRACEPTIVE
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VASECTOMY
• *IN-' +'I$#( P'-$)+')• $+IN @ -$$(+I-N -F
)F)')N
• *IN-' $-*P(I$$#I-N• N- $#N) IN )/+#( F+N$I-N
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VASECTOMY
• P')P#'#I-N :• #&) #N # ) $'-+*
• !'IN # P#I' -F I FIIN
+N)')#' -' #()I$ +PP-'• #&-I #NII*F(#*#-' '+
8 I!+P'-F)N, #PI'IN !)F-') +')'
PROCEDURE
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PROCEDURE
CO C O
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COMPLICATION
• #)*#-*)• ')$#N#(I#I-N
• ##
• P)'* '#N+(-*#
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