Devi Arine Kusumawardani, S.Keb., M.

Kes
 TOPIK BAHASAN
1 Definisi infertilitas

2 Epidemiologi infertilitas

3 Jenis infertilitas

4 Etiologi infertilitas

5 Penatalaksanaan infertilitas

6 Dampak fisik infertilitas

7 Dampak mental infertilitas

8 Dampak sosial infertilitas

 What is INFERTILITY ? ……..

Pasangan A Pasangan B Pasangan C

• Usia istri 27 th • Usia istri 28 th • Usia istri 36 th
• Usia suami 28 th • Usia suami 37 th • Usia suami 37 th
• Usia pernikahan : 10 • Usia pernikahan : 1 tahun • Usia pernikahan : 6 bulan
bulan 2 bulan • Intercourse : 3-4
• Intercourse : 3-4 • Intercourse : 2-3 x/minggu, tanpa KB
x/minggu, tanpa KB x/minggu, tanpa KB
 So infertility is ……

• “ A disease of the • Infertility is defined as the

WHO, 2012

Anwar S. & Anwar A., 2012

reproductive system defined inability to conceive naturally
by the failure to achieve a after one year of regular
clinical pregnancy after 12 unprotected intercourse.
months or more of regular
unprotected sexual
intercourse.”
American College of Obstetricians and Gynecologists (ACOG, 2017)

A couple should consider having an infertility evaluation if any of the following apply to the
couple:

Woman has not become pregnant Woman older than age 35 years
after 1 year of having regular and have not become pregnant
sexual intercourse without the use after trying for 6 months without
of birth control using birth control

Woman’s menstrual cycle is not Woman and husband have a

regular known fertility problem
 Epidemiology of Infertility

Source: Nordqvist C. 2018. Infertility in Men and Women. Medical News Today. https://www.medicalnewstoday.com/articles/165748.php.
 Epidemiology of Infertility

Prevalence of primary infertility among women who seek a child, in 2010. Infertility
prevalence is indexed on the female partner; age-standardized prevalence among women
aged 20–44 y

Source: Mascarenhas M.N, Flaxman S.R, Boerma T, Vanderpoel S, Stevens G.A, 2012. National, Regional, and Global Trends in Infertility Prevalence Since
1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 9(12):e1001356.
 Epidemiology of Infertility

Prevalence of secondary infertility among women who have had a live birth and seek
another, in 2010. Infertility prevalence is indexed on the female partner; age-standardized
prevalence among women aged 20–44 y

Source: Mascarenhas M.N, Flaxman S.R, Boerma T, Vanderpoel S, Stevens G.A, 2012. National, Regional, and Global Trends in Infertility Prevalence Since
1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 9(12):e1001356.
 Types of infertility

• A delay for a couple • A delay for a couple

Primary infertility

Secondary infertility
who have had no who have conceived
previous pregnancies previously, although the
pregnancy may not
have been successful
(miscarriage & ectopic
pregnancy)

Source: Taylor A. Extent of the problem. ABC of subfertility. 2003;327(7412):434-436.

What causes infertility ? ………

Etiology of infertility

19%
33%
Female factors
15%
Male factors
Unexplained
33% Combined

Source: Deyhoul N, Mohamaddoost T, Hosseini M. 2017. Infertility-Related Risk Factors: A Systematic Review. International Journal of Women’s Health and
Reproduction Sciences 5(1): 24-29
Causes of Male Infertility

Source: Deyhoul N, Mohamaddoost T, Hosseini M. 2017. Infertility-Related Risk Factors: A Systematic Review. International Journal of Women’s Health and
 Causes of Male Infertility

Source: Jose-Miller A.B, Boyden J.W, Frey K.A. 2007. Infertility. American Academy of Family Physicians. 75(6): 849-856
 Causes of Male Infertility

Source: Jose-Miller A.B, Boyden J.W, Frey K.A. 2007. Infertility. American Academy of Family Physicians. 75(6): 849-856
 Causes of Male Infertility

• Oligozoospermia (reduced number of sperma)

• Asthenozoospermia (reduce sperm motility)
• Necrozoospermia (reduced sperm vitality)
• Teratozoospermia (abnormal sperm morphology)
• Combination

Source: Jose-Miller A.B, Boyden J.W, Frey K.A. 2007. Infertility. American Academy of Family Physicians. 75(6): 849-856
Risk Factors of Male Infertility
Genetic causes

• Chromosomal abnormalities are associated with infertility: deletion,

inversion, mutation, aneuploidy, and translocation.
• Translocation  exhibit reproductive dysfunction  oligospermia

Environmental factors

• Heavy metals : lead (Pb), cadmium (Cd), mercury (Hg)  hypothalamic

pituitary axis disruption  spermatogenesis  semen quality
• Pesticides& polychlorinated hydrocarbon : Agriculture sector 
organophosphorus  sperm DNA damage
Free radicals (oxidative stress) : maturation, capacitation, acrosomal
reactions and fertilization

Source: Jose-Miller A.B, Boyden J.W, Frey K.A. 2007. Infertility. American Academy of Family Physicians. 75(6): 849-856
 Life Style on Male Infertility

• Normal sperm • Overweight men • Benzoapyrene

parameters were had reduced sperm (BaP) is a potent
observed at age ≥ concentration carcinogen in smoke
20-30 y • BMI > 25/30  sperm count and
• Reduction : >35 y testosterone level ↓

Age Obesity Smoking

• Spermatogenesis • Cocaine, • Radiofrequency

 sperm methamphetamine, electromagnetic
physiology  marijuana  radiation (RF-EMR)
impotence abnormal  damage Leydig
development of cell, semineferous
sperm tubules, sperm
Recreational Mobile
Alcohol
drugs phone

Source: Sharma A. 2017. Male Infertility: Evidence, Risk Factors, Causes, Diagnosis and Mangement in Human. Ann Clin Lab Res Vol.5(3): 188-198
Causes of Female Infertility

• Endocrine • Pelvic • Congenital

disorders (axis inflammatory anatomy and
hipotalamus- disease, infection fibroids :
hipofisis) • Scar tissue after • Bicornuate uterus
• Physical disorders surgery • Uterine fibroids
(obesity, anorexia • Sperm :
nervosa, exercise) vaginismus,
• Ovarian disorders dispareunia
(PCOS) • Cervix : trauma,
• Endometriosis surgery, anti-
sperm antibody
Detective Detective Detective
Ovulation Transport Implantation

Source: Jose-Miller A.B, Boyden J.W, Frey K.A. 2007. Infertility. American Academy of Family Physicians. 75(6): 849-856
Causes of Female Infertility

• An increased amount of testosterone and LH and decrease uptake of

glucose by muscle, fat and liver cells resulting in the production of
large amounts of insulin by the pancreas. Low FSH levels also hinder
the production of eggs from the ovarian follicles, and lead to form fluid-
filled ovarian cysts that eventually cover the whole ovaries and prevent
conception.

Source: Deyhoul N, Mohamaddoost T, Hosseini M. 2017. Infertility-Related Risk Factors: A Systematic Review. International Journal of Women’s Health and
 Follicle in Ovarium

• Follicle in ovarium has significant decrease in 35-37 years

• It can be reduced : history of surgery, radiation, endometriosis
Source: Deyhoul N, Mohamaddoost T, Hosseini M. 2017. Infertility-Related Risk Factors: A Systematic Review. International Journal of Women’s Health and
 Tubal factors

• If eggs or sperm are blocked

from the fallopian tube, then
fertilization can’t occur. The most
common cause of blockage or
damage is scar tissue.
• Hydrosalpinx : fallopian tube
that's blocked with a watery fluid.
This condition is typically caused
by a previous pelvic or sexually
transmitted infection,
endometriosis, or previous
surgery.

Source: Deyhoul N, Mohamaddoost T, Hosseini M. 2017. Infertility-Related Risk Factors: A Systematic Review. International Journal of Women’s Health and
 Uterine factors

Source: Deyhoul N, Mohamaddoost T, Hosseini M. 2017. Infertility-Related Risk Factors: A Systematic Review. International Journal of Women’s Health and
 Penatalaksanaan
Penatalaksanaan infertilitas tergantung dari beberapa faktor:
• Penyebab infertilitas
• Usia pasangan yang menginginkan kehamilan
• Durasi infertilitas terjadi
• Preferensi pribadi
• Kondisi kesehatan secara umum

TIME
FINANCIAL PHYSICAL
COMMITMENT
Penatalaksanaan

Fertility treatments for Fertility treatments for

men women

Reducing risk of
multiple pregnancies Assisted conception
Fertility treatments for men

Disfungsi ereksi : medikasi, pendekatan perilaku

Varicocele : operasi

Gangguan epididimis : operasi

Sumbatan duktus : ekstraksi sperma, injeksi ovum di lab

Fertility treatments for women

Manajemen disfungsi ovulasi : medikasi

Manajemen tuba fallopi, uterus, pelvic disease : operasi,

laparoskopi
 Reducing risk of multiple pregnancies

• Pemberian medikasi pada pasangan infertil dapat memicu terjadinya

kehamilan kembar (kembar, triplet)

• Monitoring selama kehamilan dapat mengurangi risiko komplikasi

• Semakin banyak jumlah janin  semakin berisiko terjadi kelahiran

prematur
 Assisted Conception

Intra-uterine Insemination • Sperma sehat dikumpulkan & dimasukkan ke dalam uterus

(IUI) selama ovulasi

• Multiple ovum matang difertilisasi dgn sperma dalam cawan

In-Vitro Fertilization (IVF) gelas di laboratorium. Implantasi di uterus setelah hari ke
3/5

Zigote Intra-fallopian • ZIFT : Ovum yg telah difertilisasi secara langsung ditransfer

transfer & Gamete Intra- ke tuba fallopi
Fallopian Tubes • GIFT : Gabungan antara sperma dan ovum ditempatkan di
tuba fallopi dan fertilisasi terjadi disana
(ZIFT dan GIFT)
 Assisted Conception

Intracytoplasmic • 1 sperma sehat diinjeksi ke dalam ovum yang matang.

Digunakan saat ada masalah kualitas semen, oligospermia,
Sperm Injection (ICSI) IVF sebelumnya gagal

• Implantasi embrio dilakukan dengan membuka selaput luar

Assisted Hatching yang menyelimuti embrio  membantu embrio untuk lebih
mudah berimplantasi

Donor eggs and • Ketika ada gangguan kesehatan berat pada pasangan
sperms
 Alternatif lain ….

Gestasional • Surrogate pregnancy : jika uterus wanita tidak dapat

berfungsi dengan baik atau membahayakan kesehatan 
carrier pasangan memutuskan untuk meminjam rahim orang lain
sebagai tempat tumbuhnya embrio

Adoption • Pilihan bagi pasangan yang memiliki kegagalan multiple

unexplained IVF
Dampak Fisik Infertilitas
Dampak fisik yg dapat terjadi akibat infertilitas antara lain yaitu:
• Ovarian hyperstimulation syndrome (OHSS)
Ovarium dapat membengkak, mengeluarkan cairan berlebih, memproduksi
banyak folikel. Akibat medikasi untuk merangsang ovarium. Gejala :
kembung, sembelit, urin gelap, diare, mual, muntah.
• Kehamilan ektopik
Kehamilan yang berkembang di luar uterus, umumnya di tuba fallopi shg
dapat mengakibatkan tuba fallopi ruptur. Perlu dilakukan tindakan operasi
segera.

Source: Nordqvist C. 2018. Infertility in Men and Women. Medical News Today. https://www.medicalnewstoday.com/articles/165748.php.
Dampak Psikis Infertilitas

Dampak psikis yg dapat terjadi akibat infertilitas antara lain yaitu:

• Tingkat stress, depresi kecemasan yang meningkat

• Skor quality of life rendah selama masa treatment inferlitilitas
• Hubungan pernikahan yang terganggu (ketidakpuasan thdp pasangan)
• Rasa kesepian yang berlarut larut

Source:
Li Y, Zhang X, Shi M, Guo S, Wang L, 2019. Resilience acts as a moderator in the relationship between infertility-related stress and fertility quality of
life among women with infertility: a cross-sectional study. Health and Quality of Life Outcomes 17:38
Oti-Boadi M & Asante K.O. 2017. Psychological health and religious coping of Ghanaian women with infertility. BioPsychoSocial Medicine 11:20
Dampak Sosial Infertilitas
Dampak sosial yg dapat terjadi akibat infertilitas antara lain yaitu:

• Stigmatisasi di masyarakat  pelecehan verbal dan

Stigma kehilangan status sosial di masyarakat. Pengacuhan di
masyarakat terutama pada wanita (budaya patriarki)

• Tekanan sosial berat dari masyarakat (stigma) 

kekerasan fisik dan emosional dalam rumah tangga
Tekanan sosial
• Wanita dgn tingkat sosial ekonomi rendah lebih sering
dihadapkan dengan sosial stigma

Source:
Tabong P.T & Adongo P.B, 2013. Infertility and childlessness: a qualitative study of the experiences of infertile couples in Northern Ghana. BMC
Pregnancy and Childbirth 13:72
Dierick S, Rahbari L, Longman C, Jaiteh F, Coene G, 2018. ‘I am always crying on the inside’: a qualitative study on the implications of infertility on
women’s lives in urban Gambia. Reproductive Health (2018) 15:151