Not having children is often something that is feared by couples and can cause more serious problems in household harmony, because in addition to having an impact on economic conditions, it also has psychological problems for the couple themselves. The condition of having difficulty having children or often referred to as infertility is a commonly found condition around us and is caused by female, male, or both factors. Infertility may also be unknown what is becoming the cause, known by the term idiopathic infertility. Generally speaking, couples who experience infertility will undergo a long process of evaluation and treatment, where this process can be a physical and psychological burden for the couple. infertility. Increasing age greatly affects a woman's fertility, but in men, increasing age has not given a clear effect on fertility. Research in France reported that 65% of women aged 25 years will experience pregnancy in 6 months and cumulatively 85% of pregnancies will be obtained by the end of the first year. This means that if there are 100 couples trying to get pregnant, 40 couples will not get pregnant after six months, and 15 couples will still not get pregnant after a year. Couples aged 35 years or older have a 60% chance of getting pregnant in the first year and 85% in the second year. Approximately 15 percent still have not gotten pregnant after the 3rd year of marriage.
When does a married couple fall into the category Infertility?
If a couple who have had regular sexual intercourse without contraception for at least 12 months, but do not have children, this condition also known as primary infertility. Whereas Secondary infertility is a condition where a married couple who already have children cannot get pregnant again after one year of regular sexual intercourse without using contraception. In women over 35 years old, evaluation and treatment can be done after 6 months of marriage. Idiopathic infertility refers to infertile couples who have undergone standard examinations including ovulation tests, tubal patency, and semen analysis with normal results.
Primary infertility occurs in married couples in Indonesia in the highest age range at 20-24 years at 21.3%, then at 25-29 years at 16.8% and at 35-39 years at 8.2%.
FACTORS CAUSING INFERTILITY
A. General risk factors
- Lifestyle
Alcohol consumption disrupt cells Leydig by reducing synthesis testosterone and causes damage to the basal membrane. Excessive alcohol consumption can cause hypothalamic and pituitary dysfunction.
- Smoke
Cigarettes contain substances that are harmful to oocytes (causing oxidative damage to mitochondria), sperm (morphological damage), and embryos (causing miscarriage).
- Caffeine consumption
Excessive consumption of caffeine (tea, coffee, carbonated drinks) affects fertility.
- Weight
- Women with a body mass index (BMI) > 29 tend to take longer to get pregnant.
- The act of losing weight in women with a BMI > 29 and experiencing anovulation will increase the chance of getting pregnant.
- Efforts to increase body weight in women with a BMI < 19 and experiencing menstrual disorders will increase the chances of this occurring.
- Men with a BMI > 29 will experience disorders
- Sport
- Light to moderate exercise can increase fertility due to increased blood flow and fertility status.
- Heavy exercise can reduce fertility
- Sports > 5 hours/week, for example: cycling for men
- Sports > 3-5 hours/week, for example: aerobics for
- Stress
- Feelings of excessive anxiety, guilt, and depression are associated with infertility, but there has been no research to support this.
- Relaxation techniques can reduce stress and reduce the potential for
- A 2013 study conducted on women who failed to conceive found that their blood pressure and heart rate increased because stress can cause narrowing of blood flow to organs.
- Vitamin supplementation
- Excessive consumption of Vitamin A in men can cause congenital abnormalities including craniofacial, heart, thymus and central nervous system.
- Fatty acids such as EPA and DHA (fish oil) are recommended for infertility patients because they will suppress the activation of nuclear factor kappa B.
- Some antioxidants are known to improve sperm quality, including:
- Vit C can be used to improve semen quality
- Ubiquinone Q10 can improve sperm quality
- Selenium and glutathione can increase sperm motility
- Folic acid, Zinc and Vit B12
- The combination of folate and zinc increases sperm concentration and morphology
- Vitamin B12 (cobalamin) is important for
- Drugs
- Some types of drugs have side effects such as damaging testosterone and sperm production, as well as affecting normal sperm development.
- Herbal medicine
- Research in California found that taking even minimal amounts of herbal medicines is suspected of inhibiting fertilization, changing sperm genetic material, and reducing sperm viability.
- Work
- Some jobs involve exposure to substances that are harmful to both male and female fertility. At least 000 occupational physical and chemical substances have been identified, but the majority of their effects on fertility have not been identified. Substances that have been identified as affecting fertility include heat, X-ray radiation, metals and pesticides.
B. Risk factors for women
In general, the causes of infertility are divided into female factors and male factors as well as unexplained causes of infertility. Female factors can be divided into ovarian factors, tubal factors, uterine factors, pelvic adhesions, endometriosis, hyperprolactinemia and unexplained infertility.
Figure 1. Causes of infertility in women
- Ovarian Factors
Ovulation disorders are the most common disorders experienced by infertile women. Ovulation disorders that affect the menstrual cycle can occur primarily and secondarily.
- Tubal & Pelvic Factors
Endometriosis is the main cause of infertility in the tubes and pelvis. Endometriosis causes chronic inflammation and causes damage to the inner and middle layers of the tube structure. Then followed by infection in the tubes and pelvis which causes adhesions of the internal genitalia to the surrounding tissue.
- Uterine Factors
Uterine anatomical disorders, especially endometrium, are the most common cause of infertility in women. In addition, other causes are tumors such as uterine myomas, endocervical polyps, uterine and vaginal anatomical abnormalities, and infections.
- Unknown factors
10% of female infertility is caused by unknown factors where the anatomical and physiological structure of the reproductive organs is normal with normal hormonal parameters. Mostly associated with psychological factors.
C. Male Risk Factors
In general, male infertility is the same as female infertility in that the causes can be central or peripheral or both. The diagnosis of male infertility must be carried out carefully, including a thorough anamnesis, a thorough physical examination, supporting examinations that help and an accurate diagnosis are very much needed in managing male infertility. In addition to hormonal examination, physical examination of the scrotum is a very important examination in establish the cause of male infertility.
Varicocele and hydrocele are among the most common causes of male infertility. Varicoceles cause increased temperature and interfere with spermatogenesis. It is very important to perform a thorough examination of varicocele findings and undertake appropriate management with the urology team in treating varicocele.
Solving problem Infertility is a problem Which requires holistic and appropriate treatment. It is important to explore the general risk factors for infertility in each couple. Which starting with lifestyle, diet, rest patterns, exercise patterns and types, consumption of drugs before conducting in-depth investigations and specific infertility examinations of the internal reproductive organs and hormone profiles of infertile couples. If you experience these problems, do not hesitate to immediately consult your trusted doctor.
Article written by Dr. dr. Edo Rezaldy E., Sp.OG., Subsp. FER, SH, MH (Obstetrics and Gynecology Specialist Doctor, EMC Cikarang Hospital).