1.

Fertilitas

Tidak hamil setelah 1 tahun berhungan seks tanpa birth control.

35th: setelah 6 bulan, 40th: sebelum 6 bl

Subfertil: 6 bl

2. Pemeriksaan
3. Gaya hidup dan factor lingkungan
a. Obesitas
 BMI

 In obese women, gonadotropin secretion is affected because of the increased

peripheral aromatization of androgens to estrogens. The insulin resistance and
hyperinsulinemia in obese women leads to hyperandrogenemia. The sex
hormone-binding globulin (SHBG), growth hormone (GH), and insulin-like growth
factor binding proteins (IGFBP) are decreased and leptin levels are increased.
Thus, the neuro-regulation of the hypothalamic-pituitary-gonadal (HPG) axis
deteriorates (2). These alterations may explain impaired ovulatory function and
so reproductive health.
Pada laki-laki, mempengaruhi jumlah, morfologi dan motilitas.
Sperm count:

 the concentration of spermatozoa should be at least 20 million per ml

 the total volume of semen should be at least 2ml
 the total number of spermatozoa in the ejaculate should be at least 40
million
 at least 75 per cent of the spermatozoa should be alive (it is normal
for up to 25 per cent to be dead)
 at least 30 per cent of the spermatozoa should be of normal shape and
form
 at least 25 per cent of the spermatozoa should be swimming with
rapid forward movement
 at least 50 per cent of the spermatozoa should be swimming forward,
even if only sluggishly.

Sperm Morfology:
 Motilitas

In a man with normal fertility, one ejaculate of semen may contain over
39 million sperm. Not all of those sperm, however, are expected to be
completely healthy.

When it comes to sperm motility, for an ejaculate sample to be considered

normal, at least 40 percent of the sperm should be motile, or moving. This
can include non-progressive movement.

b. Merokok

According to many studies on the subject, 10 or more cigarettes per day will
significantly harm your ability to conceive. This doesn't mean smoking fewer
cigarettes per day would not lead to lowered fertility. But it is clear that smoking 10
or more a day increases your risk of developing problems. Other studies have shown
that for each cigarette smoked per day, the longer it will take for the couple to get
pregnant.

Smoking is associated with the following fertility problems: menambah lama

konsepsi, menganggu siklus menstruasi, birth defect.

 Problems with the fallopian tubes, including blockages (preventing egg and sperm
from meeting) and an increased risk of ectopic pregnancy
 Cervical changes, specifically an increased risk of developing cervical cancer
 Damage to the eggs as they develop in the ovaries
 Increased risk of miscarriage, possibly due to damaged eggs, damage to the
developing fetus, or unfavorable changes in the uterine lining, which may make
healthy implantation of an embryo less likely.

c. Marijuana (buku)
Menginhibisi sekresi GnRH, menganggu fungsi ovary, meningkatkan resiko tubal
disease. Laki-laki: menggaungu spermatogenesis
 d. Alkohol (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504800/)
Wanita: Studies in humans and animal models have found alterations in ovulation and
menstrual cycle regularity with chronic/prolonged alcohol intake, though amount
consumed is often not specified. Schliep et al. found that acute alcohol use increased
estradiol, testosterone and LH levels, with greater increases seen in women who reported
recent binge drinking, though with no associated menstrual cycle dysfunction. While
acute alcohol consumption may have little or no associated effect on the menstrual cycle,
there does appear to be a negative effect on fertility treatment outcomes.
Pria: Alcohol consumption in men can also cause difficulties with fertility. Some studies
on long-term, heavy alcohol use have reported reduced gonadotropin release, testicular
atrophy, and decreased testosterone and sperm production [48]. Other studies of men
who drink heavily have documented increases in gonadotropins and estradiol,
independent of liver disease, with decreased testosterone as a consistent finding [49].
Alcoholism is also associated with liver dysfunction, which can result in hormonal
disturbances due to the inability to metabolize estrogens. A decrease in the quality of
semen parameters has also been consistently documented in heavy consumers of alcohol,
even with occasional azoospermia [50]. Furthermore, it has been well documented that
alcohol abuse and acute intoxication are associated with sexual dysfunction, including
issues with arousal and desire, as well as erectile and ejaculatory dysfunction, all of which
could lead to difficulties conceiving if men are unable to have effective intercourse
[48, 49, 51].
4. Efisiensi reproduksi normal
Peaks fertilitas bervariasi berdasarkan waktu ovulasi:
• Jika berdasarkan midcycle rise in basal body temperature (BBT), maka fertility peak 2
hari sebelum ovulasi, ovulasi biasanya terjadi 1 hari sebelum waktu yang diprediksikan.
• Jika waktu ovulasi diprediksi berdasarkan daily urine estrogen concentrations,
probabilitas terjadinya konsepsi meningkat saat 1 hari sebelum ovulasi atau pada hari
ovulasi (10%-33%).
• Daily urinary LH excretion dapat mendeteksi midcycle surge yang memicu ovulasi,
follicular collapse, dan pelepasan ovum, umumnya dalam 14-26 jam, dan hampir selalu
dalam waktu 48 jam.
Terlepas dari metode yang digunakan, semua penelitian menunjukkan bahwa
kesuburan menurun mendekati nol dalam 24 jam setelah ovulasi.
5. Penyebab infertilitas
A. Ovulatory dys:
a. PCOS: mens irregular
 b. Hyperprolactinemia
c. Hypothalamic dysfunction (eg, hypothalamic amenorrhea)
GnRH stop beberapa bln di produksi
B. Tubal and Pelvic Pathology
a. Endometriosis
 Tuba: Tuba blockage, Ovary: Cyst
b. Pelvic Adhesion

PID: STD-> chlamdya and gonorea

C. Men Infertility