PATOLOGI KLINIK pada

INFERTILITAS &
SISTEM REPRODUKSI
DR. RAHMA TRILIANA, S.KED., M.KES., PHD
S1-FARMASI
8 NOVEMBER 2023
 THINGS TO REMEMBER
❑ Embryogenesis of Male & Female Genitourinary
system
❑ Genetic of primary and secondary sex appearance
❑ Anatomy & Histology of Male & Female Reproductive
system
❑ Physiology of Male & Female Reproductive system
(Spermatogenesis, erection & ejaculation, Ovulation,
menstruation, pregancy etc)
ANATOMY of MALE UG
ANATOMY of FEMALE UG
MALE & FEMALE GAMETOGENESIS
SPERMIOGENESIS
MALE &
FEMALE
HORMONE
REGULATION
STAGES OF REPRODUCTIVE
SYSTEM
SEX SPECIFIC HORMONAL LEVEL
THROUGHOUT LIFE
 TESTOSTERONE LEVELS THROUGHOUT LIFE

Testosterone regulates spermatogenesis, male sexual appearance & libido

HORMONAL REGULATION
of SPERMATOGENESIS
PATH of SPERM / EJACULATION
FERTILIZATION
HORMONES DURING PREGNANCY
INFERTILITY
‘Infertility is the inability of a sexually active, non-
contracepting couple to achieve spontaneous
pregnancy in one year.’

(WHO, 1995)
 RISK FACTORS
❑ Age (female > 35 y.o, male > 55 y.o)
❑ Urogenital tract infections
❑ Genetic abnormalities
❑ Immunological factors (autoimmune diseases)
❑ Lifestyle factors (obesity, smoking, drugs, anabolic
steroids, lack of exercise)
❑ Endocrine disturbances/imbalances → periods
irregularities, defect in oogenesis &/ spermatogenesis
 RISK FACTORS Continued
❑ Congenital factors (abnormalities of the reproductive tract
e.g cryptorchidism (M), Uterus Bicornua (F), testicular /
ovarial dysgenesis )
❑ Acquired urogenital abnormalities (obstructions, torsion,
tumour, infections)
❑ Systemic diseases (diabetes, renal and liver insufficiency,
cancer, hemochromatosis)
❑ Exogenous factors (medications, toxins, irradiation)
❑ Increased scrotal temperature (M/e.g. due to varicocele)
❑ Idiopathic (40–50% of cases)
 Clinical Pathology Exam In
Reproductive System
1. Anamnesis / History outline & Physical examination →
M/F
2. Hormonal Evaluation → reproductive is determine by
hormonal factors (male & female)
3. Sperm Analyses (M), Vulvo-Vaginal Preparat (VVP)
Analyses (F)
4. Microbiology examination & culture of seminal fluid and
or vaginal discharge
5. Imaging evaluation → Radiology
6. Genetic Testing → PCR, FISH, Karyotyping
7. Other testings
 History Outline
1) Infertility History
◦ Age of partners, length of time the couple has been attempting to conceive,
Contraceptive methods/duration, Previous pregnancy (current partner/other
partner), Previous treatments, Treatments/evaluations of female partner
2) Sexual History
◦ Potency, libido, lubricant use, Ejaculation, timed intercourse, frequency of
masturbation
3) Childhood and Development
◦ Cryptorchidism, hernia, testicular trauma, Testicular torsion, infection (e.g., mumps),
Sexual development, puberty onset
4) Personal History
◦ Systemic diseases (diabetes, cirrhosis, hypertension), Sexually transmitted diseases,
tuberculosis, viral infection
5)Previous Surgeries History Outline Continued
• M: Orchidopexy, orchiectomy (testicular cancer, torsion), scrotal/inguinal
surgery, bladder neck surgery, transurethral resection of the prostate
• F: Histerctomy, ovariectomy, etc
• M/F : Retroperitoneal, pelvic & perineal surgery.
6)Gonadotoxin/drugs exposure
• Pesticides, alcohol, cocaine, marijuana abuse, Medication (chemotherapy
agents, cimetidine, sulfasalazine, nitrofurantoin, allopurinol, colchicine,
thiazide, b– and a–blockers, calcium blockers, finasteride), Organic
solvents, heavy metals, Anabolic steroids, tobacco use, High temperatures,
electromagnetic energy, Radiation (therapeutic, nuclear power plant
workers), etc.
7) Family History
• Cystic fibrosis, endocrine diseases, Infertility in the family
8) Current Health Status
• Respiratory infection, anosmia, Galactorrhea, visual disturbances, Obesity
 HORMONAL INVESTIGATION
❑ Purpose of exam
▪ Detect Endocrine Malfunctions
▪ Distinguish obstructive & nonobstructive
azoospermia (M) & defect of menstrual cycle (F)
❑ Hormonal screening test
▪ FSH & LH (M/F)
▪ Testosterone (M)
▪ Estrogen & Progesteron (F)
▪ GnRH/Inhibin (M/F) ➔ rarely done
 SPERM ANALYSES
◦ PURPOSE
◦ Functional test of male reproductive system
◦ Evaluation of testicular and non testicular defect
◦ Assess quality and quantity of sperm
◦ Asses the functions of male accessory glands
◦ Determine complications of other diseases
which affect male reproductive system (i.e.
Hernia, post vasectomy, torsio testis, etc)
 REFERENCE
LIMITS USE FOR
NORMAL
SEMEN
ANALYSES
◦ Sperm (Count, morphology,
vitality, motility) → reflects
testicular functions & Tract
patency
◦ Fluid (non cellular
components) → volume,
quality and components of
non cellular properties of
semen → reflects activity and
production of accessory
glands
 TERMINOLOGY

Extreme (<5mil/mL), Polizoospermia (> 250mil/mL)

Necrozoospermia

❑ Hyperspermia (ejaculate > 6 mL )

❑ Hypospermia (ejaculate < 1 mL)
 GENETIC TESTING
>> Detect fertility disorders with genetic origin.
Screening :
◦ Extensive family history, karyotype & analyses of Y chromosome

Detect
◦ Chromosomal abnormalities
◦ Number e.g Klinefelter’s syndrome (47, XXY)
◦ Translocations
◦ Deletions
◦ Gene mutation
◦ Hormone abnormalities due to genetic disorder/mutations
 MICROBIOLOGICAL
ASSESSMENT
When WBC (+) in semen or vaginal discharge:
◦ Urinary tract infections (UTI)
◦ Sexually transmitted diseases (STDs).
◦ Chronic infection of the reproductive system
◦ Genital infections (external or internal properties)
◦ Male accessory gland infections (MAGI)

Common cause
◦ Male → Neisseria gonorrhea, Chlamydia trachomatis
◦ Female → Trichomonas vaginalis, Pseudomonas aeruginosa
 IMAGING & BIOPSY
-Ultrasonography (Colour Doppler ultrasound )
- Transrectal ultrasonography (M/F)
- Trans vaginal ultrasonography, Histerosalpingography → test of tubal patency
& uterine structure (F)
-MRI
-CT Scan
-Biopsy of the reproductive systems
- Fine Needle Aspiration biopsy / FNAB & Pap Smears
- TESE/TESA: Testicular Sperm Extraction/Aspiration
- MESA: Micro-Epididymal Sperm Aspiration
- PESA: Percutaneous Epididymal Sperm Aspiration
- Endometrial Biopsy
- Open biopsy or Close biopsy (laparoscopy)
 ADDITIONAL TESTS
Testing for antibody coating of spermatozoa
◦ Mixed antiglobulin reaction (MAR) test
◦ Direct or Indirect immunobead test
Immunocytochemical staining with CD45
◦ Flowcytometry, immunophenotyping
Interactions between spermatozoa and cervical mucous
◦ In-vivo post coital test
◦ In-vitro simplified slide test, Capillary tube test
◦ Cervical mucous analyses
Biochemical analyses of assessor sex organ function
◦ Measurement of Zinc, Fructose, Neutral alpha-glucosidase, ROS in seminal fluid,
Positive myeloperoxidase staining/ENDTZ test
Ovulation testing & Ovarian Reserve testing
◦ To test ovulation and ovum production
 THANK YOU
Q? FOR
PAYING
ATTENTION