Dr. Kardi Suteja, SpU

Infertility in newly married couples is a very disturbing specter. Imagine if an old couple never produced any offspring, their lives in society would often become material for gossip. In the past, in a very patrilineal and feudal area, the absence of a child in a married couple often became the reason for the husband to remarry, even though the next marriage might not necessarily produce offspring. Infertility or infertility in married couples today is not a fixed price. Many cases of infertility can be cured. But in all honesty, the existing science and technology still cannot provide solutions for all cases of infertility.

Infertility in married couples or infertility is defined as the inability to produce a pregnancy after one year of unprotected marital relations. The couple did not use contraception, both husband and wife. The couple regularly hold normal conjugal relations not separated by geographical location. Infertility occurs in almost 15% of married couples. Roughly 40% of cases of infertility are caused by abnormalities in men and 40% of cases are caused by abnormalities in women, and the rest by both. It’s important to evaluate both husband and wife in parallel. However, it is very efficient to evaluate the husband first, especially in conditions of significant infertility risk. Evaluation in men can be fast, economical, and non-invasive.

History is very important

A history of infertility in the husband is a very important sign. A careful interview can reveal the length of infertility, the presence or absence of pregnancy in the past (with a previous partner), or the difficulty of conception (meeting between sperm with the ovum). Sexual relations must be known in detail. Most men (80%) do not know exactly when their relationship with their wife results in pregnancy. By knowing the frequency and time of intercourse can clarify the habits of sexual life.

Equally important, we must know the history of growth from childhood, puberty to adulthood. Are there any abnormalities in the testes, are there any abnormalities in the development of puberty, early-onset, normal or late? Are there any abnormalities in the hormone, for example, an enlargement of breasts in men.

A history of previous operations related to fertility must not go unnoticed. History of surgery in the pelvic area, groin and genitals associated with sperm ducts should be sought. Don’t forget the history of poisoning at work or in an environment that may disturb fertility. Where do you work? Do you work in an area with high radioactive radiation? In areas exposed to heat or chemicals? Also, listing bad habits can be useful. For example, smoking, or drinking alcohol.

Can Heal or Not?

Infertility disorders can be classified into three based on whether they can be cured or not. First, the causes of infertility that can be cured among other things: varicocele (dilation of spermatic veins), sperm duct obstruction, testicular and sperm duct infections, ejaculatory disorders, hormonal disorders, immunological disorders, sexual disorders (decreased libido, erectile dysfunction).

Secondly, potential causes of infertility to be cured, namely cryptokismus (failure of the testicles to descend into the testicles bag), vascular agenesis (non-growth of blood vessels), poisoning in fertility organs, and which really encourages unknown causes of infertility (idiopathic) still potentially curable.

Lastly, causes that cannot or cannot be cured to date, namely absent testes, non-growth of germ cells (sperm-producing), primary testicular failure, chromosomal abnormalities or syndrome of inability to move sperm.

For married couples who have met infertile criteria, of course, they can find out which causes failure to get offspring. Nearly 50% of infertile couples due to causes can be cured by men. Only 30% are truly incurable and the rests are still potential to be cured.

Varicocele

The most common cause of infertility in men is varicocele or dilation of the veins from the direction of the testes. This dilation can occur due to poor blood vessel valves or no valves at all in the spermatic veins. Poor combination of valves, and the length of the left spermatic vein cause almost 90% of the varicoceles to be on the left side. Only 40% found varicocele on both sides.

The incidence of varicoceles in the general male population is 10-15%, while infertile men are found in varicoceles between 21-41%. Nearly 50% of men with varicocele suffer from decreased sperm quality and vice versa many men are still fertile and can produce offspring.

There are several theories as to why varicoceles can cause infertility. Some include an increase in temperature in the testes due to non-smooth back blood flow, or a lack of oxygen in the testicular cells due to reverse blood flow or the presence of toxic substances against testicular cells due to backflow from the adrenal glands or kidneys. Of the three theories to date none of them can be proven.

But it is clear that the act of binding to spermatic veins in varicoceles (varicocelectomy) has shown to increase sperm quality by up to two-thirds and the occurrence of pregnancy is doubled. Widely performing varicocelectomy by urologists is an internationally accepted procedure for male infertility.

Being a married couple is a sacred opportunity to share the joys, and sorrows together. Infertility is the responsibility of both parties. A parallel examination between husband and wife will provide the best solution in overcoming the problem of infertility.

Dr. Kardi Suteja, SpU is a specialist in urological surgery at Karsuneka Clinic Denpasar and several private hospitals in Bali.