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					PATTERN OF INFERTILITY CASES WHO
 BE DONE LAPAROSCOPIC SURGERY
   BASED ON INFERTILITY SCORE
              (RISK FACTORS)
PRELIMINARY
  REPORT


                      SAMSULHADI

           DEPT. OF OBSTETRIC & GYNECOLOGY,
         FAC. OF MEDICINE AIRLANGGA UNIVERSITY.
                  DR. SOETOMO HOSPITAL
                        SURABAYA
       PATTERN OF INFERTILITY CASES
    WHO BE DONE LAPAROSCOPIC SURGERY
        BASED ON INFERTILITY SCORE
              (RISK FACTORS)

             To evaluate infertility cases based on
OBJECTIVE
             infertility score

             Infertility cases who be done
             laparoscopic surgery at fertility clinic
POPULATION   Graha Amerta, school of medicine
             Airlangga University Dr. Soetomo
             Hospital Surabaya during 2008 (1 year)

             Analytical observational, retrospective
METHODE
             study
BACKGROUND
                        Infertility
                            Is
                   Complicated Problems


                        NEEDED
                      Planned and
                     Comprehensive
                      Management

 Appropriate and                           Referral System
  Standardized
  Management                              • Net working
                          GOALS           • Infertility Score

                         IMPROVED

   INCREASED
                      SERVICES QUALITY
   OUTCOME
    INFERTILITY SCORE ARE :

• Based on risk of dominant infertility’s
  factors

• Used to simplify referral system.
  Infertility caused by multiple and
  complicated factors so must be handled by
  comprehensive management
                      INFERTILITY FACTORS
I                                                                                           P
N                             Ovulation     Tube &           Sperm                          R
F                                           Peritoneum                                      E
E
R                                                                                           G
        Factors :                                                     Treatment :
T                                                                                           N
I       --Age (wife)
           Age                                                        • Conventional
                                                                                            A
L       - Marital Duration /
        -Marital duration                                               and / surgery
          Length of Infertility
                                                                                            N
I        \infertility length
                                                                      • ART
T       - Life Style                                                                        C
Y       - Social Economic             Cervix             Uterus                             Y

Postcoital testing of cervical mucus
The routine use of postcoital testing of cervical mucus in the investigation of fertility
problems is not recommended because it has no predictive value on pregnancy rate.
                                                                                            A
Assessing Uterine abnormalities
Women should not be offered hysteroscopy on its own as part of the initial
investigation unless clinically indicated because the effectiveness of surgical
treatment of uterine abnormalities on improving pregnancy rates has not been
                                                                                            B
established.
           “SURABAYA” INFERTILITY SCORE
                  SCORE                       1                  2                      3
Wife Age (Year)                              < 30             30 - 35                 > 35
Marital duration /
                                             1- 2               >2                    > 3
Length of Infertility ( Year)
Menstrual Cycle                            Regular          Oligo / DUB           Amenorrhea
Pain (Pelvic) *                                               1 Type            > 2 Type of Pain
                                             Neg
                                                              of Pain           or Pelvic Mass
History of    **
                                             Neg            1 Time / IUD            > 2 Times
PID / Pelvic Surgery
Sperm Analysis
Consentration     : 20 million / ml        Normal          1 abnormality        > 2 abnormality
Motility ( a + b) : 50 %                    value       of major parameter     of major parameter
Normal Morphology : 30 %

    If there is ≥ 1 component of risk factor has higher value, the total score group belongs to the
    Higher risk group                             • IUD
                                          **                                     Score 6
*   - Dysmenorrhea                                • STD
    - Dyspareunia                                 • Pelvic Surgery                Score 7 - 12
    - Spontaneous pelvic pain
                                                                                 Score > 12
                  LENGTH OF INFERTILITY - WIFE’S AGE
                                N : 212
Wife’s age ( %)




                                            Age         x : 32.16 + 4.8
                                            Inf. Length x : 6.16 + 4.64
             INFERTILITY SCORE
             ( BASED ON RISK FACTORS )


                      N = 212
                                          72.1%
percentage




                                27.4 %

                 0.5 %
                Low risk    Middle risk   High risk
MIDDLE RISK - INFERTILITY RISK FACTORS
Risk factor (%)




N : 212
n : 58
HIGH RISK - INFERTILITY RISK FACTORS
 Risk factor (%)




N : 212
n : 153
     INFERTILITY SCORE – PREGNANCY RATE
Pregn




                                 n : 20   n : 56
N : 212
ancy
(%)




n : 77




          18.2

                   N : 212
                   n : 77
    INFERTILITY SCORE – PREGNANCY - TREATMENT
                      N : 14

                n:5                  n:9
Pregnancy (%)
1. MOST OF THE CASES WERE HIGH RISK GROUPS & THE DOMINANT

 RISK FACTORS WERE LENGTH OF INFERTILITY AND FOLLOWED BY

 WIFE’S AGE

2. HIGH RISKS GROUPS HAD LOWER PREGNANCY RATE

				
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posted:6/11/2011
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