Setelah mengikuti kuliah faham 1/2

Faham hormon2: FSH, LH, E2,

Testosteron
human Chorionic Gonadotropin
(hCG) Graviditas mola
LH surge Progesteron
Menopause
Analisa Sperma, Indikasi Infert. Vasekt
pregnancy hormon juga Tumor marker
Prinsip TK
Sampel: urin atau darah
Cara pemeriksaan TK
Ketelitian/accuracy TK
Waktu periksa TK
Arti TK negatif
Arti TK positif
TK positif palsu
TK negatif palsu 2
 The female reproductive Cycle 1/2
What happens at the pituitary

Hypothalamus

Over most of cycle

Negative feedback
GnRH
Positive feedback
On days 12 to 14

Anterior Pituitary

FSH/LH

Ovary

Estrogen
And
Progesterone

Uterus 3
The female reproductive Cycle
What happens to the hormones

4
Siklus Haid

5
Fertilization and Implantation

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Setelah mengikuti kuliah faham 2/2

Hypothalamic-pituitary-ovarian
axis
Perubahan hormon pada waktu
subur (ovulasi)
Kehamilan ektopik
Mola
Menopos: FSH,LH,E2
Cardiovascular Lipid Changes
Osteoporosis

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Reproductive aging
1-2
million follicles at birth, only
approximately 1,000 by
menopause
Most follicular loss due to
atresia, not ovulation
Atresia accelerates at around age
37
Age-relateduterine changes also
contribute to decreased fertility

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Decline in fertility
Fertility
wanes starting at about age 37,
before perimenopause signs occur
By age 45, risk of spontaneous
miscarriage increases to 50%
Fertility-enhancing techniques available
Natural
pregnancy still possible until
menopause is reached

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HORMONAL REGULATION SYSTEM
HYPOTHALAMUS:-
GONADOTROPIN RELEASING
HORMONE [GnRH].
PITUITARY:-LUTEINIZING
HORMONE [LH]
FOLLICLE STIMULATING
HORMONE [FSH]

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Female Reproductive Hormons
Estrogen, Estrone (E1) and Estradiol (E2),
serum
Estrogens involved development &
maintenance phenotype, germ cell
maturation & pregnancy. E2 mainly produced
primarily in ovaries & testes by aromatization
of testosteron
Measurements E2: assessment reproductive
function in infertilty, oligo-amenorrhea,
menopause status. Male:10-40 pg/ml
Premenopausal: 15-350 pg/ml **
Postmenopausal: < 10 pg/ml
HCG:Selectively produced by
syncytiotrophoblast, normal titre 20 to 30
mIU /ml
menopause:
E2 FSH LH ,
PERUBAHAN CARDIOVASCULAR LIPIDS.
osteoporosis
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 Hormones of Placenta

The placenta forms large quantities

of human chorionic
gonadotropin/hCG, estrogen,
progesterone and human
chorionic somatomammotropin,
which are all essential to a normal
pregnancy
Diagnosis of the early pregnancy

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 Home Pregnancy Test Kits

Measure Urinary human

Chorionic gonadotropin
(hCG) levels.
Can detect urinary hCG as
low as 25IU
Maximum Sensitivity: 1 to
4 days post MMP
Reason for use
Detects pregnancy at very
early stage
Earlier prenatal care 13
 How the Test Works

First
introduced in 1976
Hemagglutination inhibition
Earliest Sensitivity 4 days post-MMP
Mostrecent methods
Use monoclonal antibodies
Much more sensitive ~ day of
MMP
Accuracy quoted >98%
Various Formats: test stick, test
well, test solution, colored line
Time involved and # of Steps
vary
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Latex Agglutination

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Home Pregnancy Test Kits

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 Home Pregnancy Test Kits

2nd hCG-specific
antibodies
1st hCG specific
Sample window antibodies
Antibody against
Antibody to hCG

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 Home Pregnancy Test Kits

hCG

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 Home Pregnancy Test Kits

Positive Test
Negative Test

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 Patient Consultation

1) 1st AM voiding; > conc. of HCG

2) Run test immediately, or store
sample in refrig.
use within 24 hrs;
allow to come to room temp.
Follow timing and sequence of steps.
If negative, repeat in 7 days.
See MD regardless of result
If negative - may require
amenorrhea workup
If positive - will need prenatal
care follow-up.
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 Interpretation
Negative Result
HCG is not present at detectable
concentrations
Positive Result
Pregnancy
False Positives
Drugs: Antiparkinsonian,
anticonvulsants, phenothiazines.
Medical Conditions: Tumors, Recent
completed pregnancy or miscarriage.
False Negatives
Testing too early, Urine not at room
temp.

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 Accuracy
97% sensitivity
In 100 pregnant women
97 will be positive

3 false-negative.

95% specificity
In 100 non-pregnant women
95 will be negative

5 false-positives.

Accuracy similar to laboratory tests.

User and technique dependent.

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 hCG: -
Can be detected in pregnancy one day after
implantation, 8 days after ovulation and 9
days after LH surge .
Concentration rises exponentially until 9 to
10 weeks of gestation with a doubling time
of 1.3 to 2 days.
Reaches its peak of around 105 IU/ml after
60 to 90 days of gestation.
It decreases from this peak level to a
plateau value of 10,000 to 20,000 IU/ml,
which is maintained for the remainder of
the pregnancy.
HCG level comes to nonpregnant level of
less then 5mU/ml, 21 to 24 days after
delivery.
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HCG: - in Hydatidform Mole

Hydatidform mole is very much suggestive if:-

urine in dilution of 1 in 200 to 1 in 500 is
positive for HCG beyond 100 days of
gestation.
If HCG in urine in 24 hours is around 0.3 to
3 million IU during similar period of
amenorrhoea.
Molar pregnancy patients are more prone to
develop Choriocrcinoma: -
If excreting HCG > 100,000 IU/ in urine in 24
hours
If serum level of HCG is > 40,000 mIU/ml.

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 Predicting Ovulation

Pattern of Menstrual Cycle with Calendar

Cervical Mucous
BBT (Basal Body Temperature)
LH Surge

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Detecting Ovulation
Measures Urinary LH
Best indicator is
50% over mean
basal plasma LH
in urine
follows.
Ovulation
usually within
12-24 hours.
(Basal body temp
change follows
ovulation)

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 How the Test Works
LH increases sharply prior to Ovulation
LH Surge
Causes ovarian follicle rupture and
release of mature egg within in 1 to 2
days.
Occurs 8 to 12 hrs later in urine
~6 consecutive days of testing will
detect LH Surge in about 66% of
ovulating women
~10 consecutive days of testing
increase probability to 95%.
Intensity of color on test strip is
proportional to LH in Urine

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Ovulation Prediction Kits

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 is the permanent cessation of
menstruation resulting from loss of
ovarian follicular activity.
It can only be determined after 12
months' spontaneous amenorrhoea.
Mean age is 51 years.

menopause: E2

FSH LH ,

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occurs after bilateral oophorectomy with or
without hysterectomy.
Premature menopause may also be
radiation- or chemotherapy-induced, or
occur after hysterectomy with ovarian
conservation.

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 A premature menopause is one that
occurs before the age of 40 years.
Primary premature menopause may
occur at any age and present as
amenorrhoea. Not all women have acute
symptoms. FSH levels are elevated.
Spontaneous fertility may recur.

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Cardiovascular Lipid Changes
With approaching ovarian failure,
changes occur in the cardiovascular
lipid profile. Total cholesterol
increases, high-density lipoprotein
(HDL) cholesterol decreases and
low-density lipoprotein (LDL)
cholesterol increases.
Tes Lipid Profile

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PENDAPAT & SARAN

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