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With Indonesia’s growing population of over 240 million, you’d think that fertility is not an issue in Indonesia. But the sad fact is that there are still couples that wish to have their own babies, but experience challenges in reaching that goal due to infertility issues. With Indonesia’s economy enjoying a considerable boom, many couples that have deferred their initial plans of starting a family are now working toward that goal.

A common response for those who can afford it is to fly off to Singapore, Malaysia, Australia or elsewhere for infertility diagnosis and treatments. Airline tickets, medical check-ups, and hotel costs pile up to result in a small fortune being paid for the medical checkups and infertility treatments. With all the financial stress that incurs (barring medical issues) it’s bound to contribute to infertility just because of the stress of having checkups in a distant location within a medical system that may be unfamiliar, conducted in a language that may not be your first language.

Fortunately, infertility diagnosis and treatments are now available in Jakarta, serving Indonesian and expatriate couples who wish to start or grow their families.

What is infertility?

Infertility is usually defined as not being able to get pregnant after one year of well-timed and unprotected sexual intercourse. Unprotected here refers to not using birth control devices/methods. A broader view of infertility includes not being able to carry a pregnancy to term. Infertility affects about 6.1 million Americans, or 10 percent of the reproductive age population, according to the American Society for Reproductive Medicine. Statistics for Indonesian couples are not readily available.

Who is infertile?

Statistics vary, but roughly one-third of the cases of infertility are female factor (ovulation disorders, tubal issues, etc.), one-third of the cases are male factor (poor sperm motility or mobility, lack of sperm, erectile dysfunction, etc.), and one-third are caused by a combination of male and female factors, or the cause is unknown. There is also a condition known as secondary infertility, where pregnancy has previously been achieved without difficulty and now a subsequent pregnancy is not achieved easily.

What is female infertility?

Infertility in women may be due to problems with ovulation, barriers to egg and sperm meeting, barriers to implantation, poor hormonal support of the conceptus, immune system irregularities or any combination of the above. Testing is done to help determine which of these factors may be involved and how to proceed with treatment.

Emotional ramifications of infertility

For some, receiving a label of "infertility" is a relief. The problems were not all in their head and diagnosing the actual medical problem is the first step to finding the solution. For others, being labeled "infertile" is simply painful. For both groups, and all those in between, finding emotional support may be important. Some fertility clinics require counseling for couples undergoing the treatment of infertility.

Top causes of female infertility

Fertility can be caused by complicated medical conditions. Here are the most common causes of female factor infertility:

• Structural issues

These account for about 15% of female factors. Mechanical issues usually refer to issues with the anatomy of the woman. It may be a blockage in the fallopian tube, a fibroid in the uterus, or a problem with the opening of the cervix.
Some of these factors may be caused by previous medications or surgeries, like DES exposure when the woman was a fetus herself, or a surgery that would disrupt the stability of the cervix. Some of these causes may be treated with surgical intervention while others may need other forms of specialized treatment.

• Mechanical issues

Some 25-40% of women will have fertility problems due to mechanical issues, such as scar tissue that block the fallopian tubes or the uterus. This can also be caused by pelvic inflammatory disease (PID) or endometriosis.

• Ovulatory issues

As many as 30% of all causes of female factor infertility are due to issues with ovulation. This may entail complete ovarian failure due to hormonal issues, etc. It could be merely a problem with the timing or detection of ovulation. These irregularities are usually evaluated and treated with medications to help restore ovarian function.

• Multiple or unknown factors

It is possible that a woman will have multiple factors involved in her cause of infertility. This is why prompt medical evaluation by a qualified practitioner is always important. Remember, about 10% of women will have unknown causes of infertility.

How does age affect your fertility?

As we get older fertility decreases in both men and women. Most of us know that once a woman reaches menopause, it is impossible for her to get pregnant without the assistance of fertility treatments. It is not, however, just the lack of eggs in the ovary at menopause which contributes to decreasing female fertility. Other changes occur in women over time, including:

• The quality of the eggs in the ovaries decline with age.
• The ability of an egg to become fertilized may also decrease over time, lowering the odds of conception. This can be caused by more years in which older women have had a chance to acquire pelvic infections, uterine fibroids or polyps, or other conditions that impair fertility.
• There are fewer eggs with time (referred to as ovarian reserve)
• Over time, changes in hormones can cause difficulties with ovulation
• Miscarriage rates increase with age
• As you age, general health problems like high blood pressure and diabetes can affect your ability to get pregnant, stay pregnant or have a healthy pregnancy.

When should I see a doctor?

If you are under 35 and have no other health problems that affect your fertility, you should be having well-timed, unprotected intercourse for a period of one year before contacting a fertility specialist (also known as a reproductive endocrinologist). If you are over 35 or have known medical issues, the general recommendation is to seek evaluation by a specialist, if you fail to become pregnant after six months of well-timed and unprotected intercourse.

In vitro fertilization (IVF)

In vitro fertilization (IVF) is carried out by encouraging your body to produce multiple eggs through the use of fertility drugs which cause a controlled ovarian hyperstimulation. These eggs are then removed and combined with semen in a Petri dish or individually inseminated with intracytoplasmic sperm injection (ICSI). The fertilized eggs are then returned to the uterus a couple of days later, with the hope that they will implant in the uterine wall. There are times when this is done without the use of medications, during what is called a natural cycle.

Whatever may be causing your fertility issues, a visit to a fertility specialist is your best hope for ensuring pregnancy.

Other interesting articles on infertility:
Infertility Issues: Tips for Getting Pregnant
Top 10 Infertility Myths

Other medical clinics/centers that offer infertility consultations/treatments:

Rumah Sakit Asri
Jl. Duren Tiga
South Jakarta

RS Ibu dan Anak Kemang Medical Care
Kemang

RS Ibu dan Anak Brawijaya
Cipete

Jasmine Clinic
RS Harapan Kita

RS Siloam Gleneagles
Surabaya

RS Dr Sutomo IVF Clinic
Surabaya

If you have medical-related questions about living in Indonesia to ask of medical professionals, see Ask the Experts.

We trust this information will assist you in making correct choices regarding your health and welfare. However, it is not intended to be a substitute for personalized advice from your medical advisor.

Our thanks to Dr. Ivan R. Sini, SpOG for contributing this article. Dr. Sini holds practice in Morula IVF Jakarta, one of the major IVF clinics located at Bunda International Clinic in Menteng. Morula IVF Jakarta provides a comprehensive medical solution for couples seeking to start a family.

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