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FERTILITY AND INFERTILITY

THE PURPOSE OF REPRODUCTION

STUDENTS WORKSHEET

Contributors :

Nurul Hidayati, dr., M.Sc

Hermawan Wibisono, dr., Sp.OG

Fakultas KedokteranUniversitas Brawijaya

2014

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Ferlitility and Infertility :

The Purpose of Reproduction

Introduction

One organ system by which humans reproduce and bear live offspring is humanreproductive system. Humans continue their futue generation life allowing delivere of

hereditary traits from one generation to the next through mechanism called reproduction. This

process requires a mutual interdependent cooperation between male and female reproductive

system to be fertile. Conversely, any problems occur during the process may cause inability to

produce offspring. Talking about human growth population, human reproduction concern to

two disticnt condition leading to (very active) fertile or infertile states. Both sides have crucial

implication in a human life personally or in a public area. Hence, a doctor should be able to

identify various clinical conditions underlying problems of being infertile and is required to

promote management of family planning. Emphasis would be placed on covering problems of

infertility and family planning management. Some other materials relevant to the concern areinvited to build comprehensive understanding of the issue. It is recommended that students

revisite material available on blocks of Life Cycle and Endocrine System.

Learning objectives

- Identify problems of (very active) fertility and infertility viewed in biological and social

aspects

- Understand various clinical problems as the pathophysiology of being infertile for both male

and female reproductive system

- Identify the social factors influencing health reproduction

-

Promote family planning management

Level of competency : 1, 2, 3B

Conceptual Framework

Human reproductive system works on some requirements and mechanisms. Provided

that the organ system of male and female are present and normally structured with functions

properly, to be fertile subsequent process must occur, including (1) the release of ovum or egg

at a specific time in the reproductive cycle in a process called ovulation, (2) an

internalfertilization of the ovum by spermatozoa, orsperm cells, (3) transport of the fertilized

ovum to theuterus,or womb, (4) implantation of the blastocyst, the early embryo developed

from the fertilized ovum, in the wall of the uterus, (5) formation of aplacenta and maintenance

of the unborn child during the entire period of pregnancy. Any problems occur on both

structure and function of the reproductive system from both female and male may result in fail

to conceive a baby, a condition called infertility. The underlying mechanism disturbing the

reproduction process may come from various clinical problems such as endometriosis,

policystic ovary, infection, smoking etc. Students are recommended to identify many diseases

of reproductive system with condition leading to infertility problems by applying SKDI list of

reproductive diseases according to level of mastery to be a general practitioner.

http://global.britannica.com/EBchecked/topic/205305/fertilizationhttp://global.britannica.com/EBchecked/topic/559354/spermhttp://global.britannica.com/EBchecked/topic/620603/uterushttp://global.britannica.com/EBchecked/topic/462525/placentahttp://global.britannica.com/EBchecked/topic/462525/placentahttp://global.britannica.com/EBchecked/topic/620603/uterushttp://global.britannica.com/EBchecked/topic/559354/spermhttp://global.britannica.com/EBchecked/topic/205305/fertilization

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come alone again. Srikandis husband believed that he would not have problem of

being sterile as he had a big family whereas Srikandi was the only child in her family. As

Srikandi live with her parents in law, she felt underpressure without the present of baby

in her small family. She would do anything to have a baby to defend her long-life

marriage. Srikandi might need your help with such explanation about her current

condition. You could help her by answering the following guidance of explanation :

a. Do you think Srikandi is suffering of primary or secondary infertility ? give

confidential reasons for your preference answer

b. What do you think about chance of Srikandi to bear offspring? give confidential

reasons for your preference answer. How about her husband ?

c. How to confirm that someone is suffering of infertility ?

d. Lists some possible causes influencing both male and female infertility, specific

female causes and specific male causes for the infertility ! and, in context of Srikandi

case, which causes might present ?

e.

If Srikandi insist to do any effort to have her own baby, what would stages ofmedical intervention she should take ? explain in details

f. What are the consequences of infertility to the health status and well being of

mother, couples, family and society

g. What are the social determinants that influences the burden of infertility problem to

the well being of mother, couples, family and society

h. What would you suggest as the intervention strategy to control the social impact

(explain by identifying the health problem, risk factor, contributing risk factor; goal,

objective, sub objective, strategy and target population in each)

2.

A lot of kids a lot of luckOne other beautiful woman, Nawangwulan was a 27-year old breastfeeding

mother came to your private clinic while bringing her 6-month old cute baby. Applying

an exclusive breastfeeding with requency of at least 9 times a day to her baby,

Nawangwulan was still not confident whether the breastfeeding would prevent her to

get pregnant. Marrying Arjuna, her husband, about last ten years, Nawangwulan had

already gave him five children including the baby. Although her husband, would be

happy having many kids, Nawangwulan felt tired in passing all the process. She was very

busy in taking care all the children. She asked your help to find any contraception

intervention suitable to her current condition.

a.

In selecting the most suitable contraception, what condition of Nawangwulanshould be considered ?

b. According to your above answer, why should we consider it? What clinical

implication might occur for inappropriate selection of contraception ?

c. What the specific feature of contraception required to select the most appropriate

one for Nawangwulan ?

d. List examples of the recommended contraception for Nawangwulan !

e. What are the social determinant (behavior, husband, and acceptance) that need to

be considered when choosing the right contraception method

f. Explain the public health program related to this problems

g.

Provide a communication steps for this case.

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3. Ways to be infertile

In group of three person, you are assigned to complete task 3 to identify various

problems leading to infertility. The question sheet is available to your tutor