INFERTILITAS PRIA

DR. Dr. Rudi Yuwana

Definisi
Infertilitas adalah apabila
pasangan suami istri tidak dapat
hamil dan membuahkan suatu
kelahiran hidup setelah 1 tahun
mengadakan hubungan seksual
tanpa menggunakan cara-cara
proteksi untuk kehamilan, disebut
primary infertility

Apabila pasangan suami istri

telah subur sebelumnya, tetapi
mendapatkan anak lebih sedikit
daripada yang dikehendaki maka
disebut secondary infertility

Epidemiologi
Rata-rata 15% pasangan suami
istri adalah infertil
Kira-kira 60% dari pasangan yang
infertil ini, disebabkan oleh faktor
pria ( 20% hanya faktor pria, 40%
faktor pria dan wanita )

Hypothalamic-pituitary-gonadal
axis

Androgen action

Kapan pasangan infertil perlu di

evaluasi sebelum 1 tahun
Faktor pria
Kriptorkhismus,
Torsiotestis,
Infertilitas yang tidak dapat
diterangkan sebelumnya
Kemoterapi sebelumnya
Infeksi saluran kencing
Pernah operasi di daerah dasar
panggul

Kapan pasangan infertil perlu di

evaluasi sebelum 1 tahun
Faktor wanita
Umur lanjut (lebih 35 tahun)
Haid tidak teratur atau tidak pernah
haid
Infertilitas sebelumnya yang tidak
dapat diterangkan,
Infeksi dasar panggul
Pernah operasi di daerah dasar
panggul

Tujuan pemeriksaan infertilitas

Apakah ada kelainan-kelainan
yang masih bisa dikoreksi,
anatomis maupun fisiologis
Menentukan kasus yang tidak bisa
dikoreksi, tetapi masih bisa
dilakukan dengan teknologi
bantuan reproduksi (Assisted
Reproductive Technology = ART)

Kausa infertilitas pada pria

Treatable causes

Varicocele
Obstruction (acquired/congenital)
Infection
Ejaculatory dysfunction
Hypogonadotropic hypogonadism
Immunologic problems
Sexual dysfunction
hyperprolactinemia

Kausa infertilitas pada pria

Potentially treatable causes

Idiopathic
Cryptorchiidism
Vasal agenesis
Gonadotoxins (drugs, radiation)

Kausa infertilitas pada pria

Untreatable causes

Bilateral anorchia
Germinal cell aplasia
Primary testicular failure
Chromosomal anomalies
Immotile cilia syndrome

Infertility workup
I. Simple infertility workup
A. History
B. Physical examination
C. Semen analysis

1. Macroscopic examination
a.
b.
c.
d.

Appearance and odor

Coagulation, liquefication and viscosity
Volume
pH

Infertility workup
I. Simple infertility workup
A. History
B. Physical examination
C. Semen analysis

2. Microscopic examination
a.
b.
c.
d.
e.

Native specimen
Sperm count
Motility
Vitality
Morphology

Infertility workup
II. Extensive infertility workup
A. Fructose

1. Initial fructose
2. Fructose test
3. Fructolysis test

B. Citrate measurement
C. Hormone measurement
1.
2.
3.
4.
5.

Gonadotropins
Androgens
Estrogens
Thyroid function tests
HCG test

Infertility workup
II. Extensive infertility workup
D.
E.
F.
G.

Chromosomal analysis
Immunological test
Sperm DNA content
Exact analysis of motility (speed
etc.)
H. Time of sperm motility
I. Testicular biopsy
J. Vasogram

Semen analysis

Component of the infertility

history
Medical history

Fevers
Systemic illness-diabetes, cancer
Genetic diseases cystic fibrosis,
Klinefelter syndrome

Component of the infertility

history
Surgical history

Orchidopexy, crytorchidism
Herniorraphy
Trauma, torsion
Pelvic, bladder or retroperitoneal
surgery
Transurethral resection for
prostatism
Pubertal onset

Component of the infertility

history
Fertility history

Previous pregnancies (present and

with other partners)
Duration of infertility
Previous infertility treatments
Female evaluation

Component of the infertility

history
Sexual history

Erections
Timing and frequency
lubricants

Component of the infertility

history
Family history

Cryptorchidism
Midline defects (Kartagener
syndrome)
Hypospadias
Exposure to diethylstilbestrol
Other rare syndromes prune belly
etc.

Component of the infertility

history
Medication history
Nitrofurantoin
Cimetidine
Sulfasalazine
Spironolactone
Alpha blockers

Component of the infertility

history
Social history

Ethanol
Smoking/tobacco
Cocaine
Anabolic steroids

Component of the infertility

history
Occupational history

Exposure to ionizing radiation

Chronic heat exposure (saunas)
Aniline dyes
Pesticides
Heavy metals (lead)

Treatment
I. Surgical measures
A.
B.
C.
D.

Varicocelectomy
Vasovasostomy
Epididymovasostomy
Transurethral resection of
ejaculatory duct
E. Microsurgical epididymal sperm
aspiration (MESA)

Treatment
I. Surgical measures

F. Ablation of Pituitary Adenoma

G. Prophylactic surgical measures :
a. Orchidopexy
b. Operation for testicular torsion

H. Electroejaculation

Treatment
II. Medical measures
A.
B.
C.
D.
E.

Endocrine therapy
Therapy for immunologic infertility
Therapy for retrograde ejaculation
Treatment of infection
Empiric therapy

1. Antiestrogens
2. Historical therapies

New therapies : assisted

reproductive techniques
A. Semen processing
B. Intrauterine insemination ( IUI )
C. In Vitro Fertilization (IVF) or In
Vitro Fertilization/embryo
Transfer (IVF-ET)
D. Gamete Intrafallopian Tube
Transfer (GIFT)

New therapies : assisted

reproductive techniques
E. Micromanipulation

1. Zona drilling
2. Partial zona dissection (PZD)
3. Subzonal sperm insertion (SZI,
SUZI) or microinsemination sperm
transfer (MIST)
4. Microinjection of sperm into
ooplasm or intracytoplasmic sperm
injection (ICSI)

THANK YOU