Infertility is a condition where it is difficult to get offspring in a husband and wife who are married & have regular intercourse without family planning for 1 year. It's best, regardless of the age of the couple, if you've been married for one year, don't use birth control and have regular sex, but haven't gotten pregnant yet, immediately consult a specialist.
Age factor is the most influential factor on fertility. Over 35 years, female fertility begins to decline. When coupled with co-morbidities and other factors above, it will be more difficult to have children. In women over 35 years of age with infertility, it is recommended to see a specialist sooner if they have been married for 6 months but have not become pregnant. Apart from age, what can have an effect is the presence of comorbidities, such as endometriosis, PCO (Polycystic Ovary Disease), obstruction of the fallopian tubes, ovulation problems or sperm problems. It could also be a problem with egg reserves & genetic or chromosomal abnormalities.
Frequently asked questions about infertility
- Been married for a long time, but don't have children yet. It has been examined, the results stated that they were both healthy and had no problems. But still can't get pregnant.
Answer : Even though they have gone through various examinations with no abnormal results, a natural pregnancy still cannot be achieved. There is something called unexplained infertility or unexplained infertility. The incidence is about 10% of all cases of infertility. This happens because infertility is a complex issue. There is an "x" factor that can have an effect, such as immunology, while there is no standard test for it until now.
What to do : This problem can be overcome through assisted reproductive technology, such as insemination and IVF. It should be noted, the new couple will be declared to have unexplained infertility if they have undergone a thorough examination. Many couples only consult an obstetrician and undergo an ultrasound examination which gives normal results, then conclude that they are normal. In fact, there are still other tests that have not been done and need to be done, such as HSG, Sperm Analysis & Hormone Profile.
- Had delayed pregnancy for several years with a contraceptive method. When you're ready to have children, but you can't get pregnant.
Answer : Couples who do not have children are encouraged to use the contraceptive pill method. So, the fertile period can quickly return after the use of the pill is stopped. The injectable birth control method, especially the 3-month injection, can have a prolonged effect. While spiral contraception or IUD often causes vaginal discharge and infection, especially for patients who are negligent or have never been controlled. The biggest risk is cervical infection which spreads and causes infection in the oviducts, so that the oviducts become blocked and eventually infertility occurs.
What to do : Ideally, couples are expected not to delay pregnancy, because over time and age, diseases that did not exist before can appear. Meanwhile, if there is already a disease but it is not known, such as endometriosis, the process is more progressive, the impact can lead to infertility. With increasing age exposure to pollutants and free radicals also increases, so that it can reduce the quality of germ cells (eggs and sperm cells) and complicate pregnancy. Make sure to live a healthy lifestyle, such as not smoking, keeping cell phones away from areas near the genitals, and not putting your laptop on your lap while working because it can reduce the quality of germ cells.
- We didn't feel there was a problem getting pregnant, because we had been pregnant several times, but always had miscarriages.
Answer : Actually, miscarriage is a reflection of a poor quality pregnancy and is also a problem of infertility. Because most of the causes of miscarriage in the first trimester of pregnancy (under 12 weeks) are gene or chromosomal abnormalities caused by poor germ cell quality. The fetus cannot survive and develop because its quality is not good. Miscarriage can be in the form of fetal death or blighted ovum (there is a pregnant sac but does not contain a fetus) or a pregnancy that does not develop. Chances of recurrence can be up to 5-10%.
What to do : If there is only one miscarriage, we only need to improve the quality of the germ cells, by avoiding pollutants and taking supplements such as vitamins C, E & antioxidants for 3 months. However, if a miscarriage has occurred 2 or more times (recurrent miscarriage), a more detailed and targeted investigation is needed by an expert in the field of fertility. The causes can be APS disease or Anti Phospholipid Syndrime, reproductive tract disorders, chromosomal abnormalities, or genetics, immunological disorders, and blood clotting factor abnormalities.
- Is it true, if it's hard to get pregnant, there must be something wrong with the woman? Because men are never in trouble.
Answer : Many couples think that failure to have children is solely the responsibility of the woman, even though 30% of the causes of infertility are sperm disorders. This number is quite large and is often found as the only cause of difficulty getting pregnant. Therefore, sperm analysis must be carried out as one of the basic examinations for infertility problems. Sperm abnormalities can be related to the concentration, shape, and speed of movement. With age, sperm quality can decrease and this is also affected by exposure to pollutants or free radicals in the surrounding environment. Sperm quality cannot be assessed macroscopically. For example, it is not necessarily thick semen with lots of sperm. Men/women who are able to conceive with their first partner may not be successful with their second partner, depending on the quality of the sperm at that time, their age, and whether there are immunological factors, eg anti-sperm antibodies.
What to do : Examination of sperm disorders is very simple and easier to do than HSG and other examinations for women. This examination should be carried out by trained laboratory personnel and carried out using a microscope. Sperm quality can change after 1 year, therefore, it is best if this test is repeated after one year.
- When you have your first child, it's easy. But when I wanted to have a second child, it was very difficult to get pregnant.
Answer : This condition is referred to as secondary infertility, the same as primary infertility, only in this case, suspected uterine anatomic abnormalities can be ruled out. What could be the main cause is age and exposure to pollutants and free radicals, which reduce the quality of germ cells.
What to do : Examinations are the same as those with primary infertility problems, namely HSG examination, sperm analysis and ovulation analysis as well as examination of the reproductive hormone profile, adapted to each case.
Actions that Need to be Taken
1. Initial consultation, including:
- Anamnesis / Questions and answers with a fertility specialist, who asked about the length of marriage, frequency of intercourse, difficulties during intercourse, menstrual pain problems or irregular menstrual cycles, vaginal discharge, medical history and past surgeries.
- Gynecological examination with Transvaginal Ultrasound for evaluation: Condition of the uterus & mouth of the uterus from myomas / cysts, thickness of the inner wall of the uterus, the number of egg cells in both ovaries.
2. Basic Examination
Consisting of an HSG (Hysterosalpingography) examination to see if there is any blockage in the fallopian tubes & sperm analysis to see sperm abnormalities. Examination of the reproductive hormone profile can be postponed if the results of the anamnesis show regular & normal menstrual cycles (28 - 35 days). Evaluation of ovulation can be done with serial transvaginal ultrasound examinations, which begin on the 11th day after the first day of menstruation. The 21st menstruation is carried out by checking the levels of the hormone progesterone from the blood. In women over 35 years of age or having had cyst surgery, it is necessary to check the egg reserve to evaluate how many eggs can still be stimulated. This includes checking FSH & AMH hormone levels.
3. Action
If a natural pregnancy has been tried but it doesn't work, the specialist will help you with a pregnancy program that suits your problem. For example with ovulation induction (stimulation of the ovaries to help raise eggs), followed by IUI (Intra Uterine Insemination or Intrauterine Insemination) or IVF (In Vitro Fertilization or IVF). The decision to do IUI or IVF is taken by a doctor who is an expert in the field of fertility, as well as existing egg reserves. It is better for the couple to get counseling about the procedure to be carried out in detail, so that they get an overview as well as mentally prepare.
Article written by dr. Caroline Tirtajasa, Sp.OG (K) (Obstetric Obstetrician, Fertility & Reproductive Hormones, Laparoscopic Surgeon at EMC Pulomas Hospital).