Majority of the world have strong cultural beliefs that children increase the well-being of parents, and especially women, and these beliefs have bolstered norm about the desirability of having children. Parenthood changes lives in both positive and negative ways, many of them unexpected by the parents themselves. Having a child deepens joy, strengthens social ties with family and friends (Gallagher and Gerstel 2001; Umberson and Gove 1989), and creates new roles for adults that carry rights, responsibilities, and a sense of adulthood (Sieber 1974; Hoffman and Manis 1979).
People who were raised in a positive home environment with a stable family want to create impactful life each other. They want to create a family that is full of joy and love where they can be affectionate towards their children.
Infertility is a multidimensional problem with social, economic and cultural implications, which can take threatening proportions in countries with strong demographic problems. Infertility is a medical condition that can cause psychological, physical, mental, spiritual, and medical detriments to the patient.
Cause of infertility vary: 1 in 3 infertile women have problem with the female reproductive system, 1 in 3 infertile men have a problem with the male reproductive system, and 1 in 3 couples have a problem that affects both of them or an undetermined issue. The unique quality of this medical condition involves affecting both the patient and the patient’s partner as a couple.
Infertility is a common disease. At least 10% of women deal with infertility of some kind. The chances of being infertile increases as a woman age. The World Health Organization (WHO) performed a large multinational study to determine gender distribution and infertility etiologies.
Infertility happens when cannot conceiving after 12 months of regular sexual intercourse without use of birth control. It may be that one partner cannot contribute to conception, or that a woman is unable to carry a pregnancy to full term. In 37% of infertile couples, female infertility was the cause; in 35% of couples, both male and female causes were identified; in 8% there was male factor infertility.
Sign of Potential Infertility in Women
In women, changes in the menstrual cycle and ovulation may be a symptom of a disease related infertility. The symptoms are:
- Abnormal periods. Bleeding is heavier or lighter than usual
- Irregular periods. The number of days in between each period varies each month
- No periods. You have never had a period, or periods suddenly stop
- Painful periods, back pain, pelvic pain, and cramping may happen.
The causes of female infertility
There are many possible causes of infertility. However, it can be difficult to pinpoint the exact cause, and some couples have “unexplained” infertility. Some possible causes of female factor infertility can include:
- Problems with the uterus: This includes polyps, fibroids, septum or adhesions inside the cavity of the uterus. Polyps and fibroids can form on their own at any time, whereas other abnormalities (like a septum) are present at birth.
- Problems with the fallopian tubes: The most common cause of “tubal factor” infertility is pelvic inflammatory disease, usually cased by chlamydia and gonorrhea.
- Problems with ovulation: There are many reasons why a woman may not ovulate (release an egg) regularly. Hormonal imbalances, thyroid conditions, severe stress and pituitary tumors are all examples of things that affect ovulation.
- Problems with egg number and quality: Women are born with all the eggs they will ever have, and this supply can “run out” early before menopause. In addition, some eggs will have the wrong number of chromosomes and cannot fertilize or grow into a healthy fetus.
Who is at risk for female infertility?
Many factors can increase a woman’s risk of female infertility. General health conditions, genetic (inherited) traits, lifestyle choices and age can all contribute to female infertility. Specific factors can include:
- Age
- Hormone issue that prevents ovulation
- Abnormal menstrual cycle
- Obesity or being underweight
- Endometriosis
- Structural problems (problems with the fallopian tubes, uterus or ovaries)
- Autoimmune disorders (lupus, rheumatoid arthritis, Hashimoto’s disease, thyroid gland conditions).
- Polycystic Ovary Syndrome (PCOS)
How does age impact female infertility?
As a woman ages, her chances of becoming pregnant decreases. Age is becoming a more common factor in female infertility because many couples are waiting to the have children until their 30s or 40s. Women over age 35 have a higher risk of having fertility issues. The reasons for this include:
- Overall number of eggs is lower
- More eggs have an abnormal number of chromosomes
- An increased risk of other health conditions.
Male Infertility
To conceive a child, a man’s sperm must combine with a woman’s egg. The testiscles make and store sperm, and the most common issues that lead to infertility in men are problems that affect how the testicles work. Other problems are hormone imbalances or blockages in the male reproductive organs. In about 50% of cases, the cause of male infertility cannot be determined.
A complete lack of sperm occurs in about 10% to 15% of men who are infertile. A hormone imbalance or blockage of sperm movement can cause a lack of sperm. In some cases of infertility, a man produces less sperm than normal. The most common cause of this condition is varicocele, an enlarged vein in the testicle. Varicocele is present in about 40% of men with infertility problems.
Common Signs of Infertility in Men
1. Changes in Sexual Desire
2. Pain or Swelling; Small and Firm Testicles
3. Problems Maintaining Erection
4. Issues with Ejaculation
5. Sperm Disorders
Sperm may be immature, abnormally shaped, or unable to swim. In some cases, you may not have enough sperm or you may not make any sperm. This problem may be caused by many different conditions, including:
- Infections or inflammatory conditions. One example is infection with the mumps virus after puberty
- Hormone or pituitary gland problems
- Immune problems in which you make antibodies against your own sperm
- Environmental and lifestyle factors. These include tobacco use, heavy alcohol use, use of drugs or steroids, or exposure to toxins
- Genetic diseases, such as cystic fibrosis or hemochromatosis
Homocysteine is an amino acid not supplied by the diet that can be converted into cysteine or recycled into cysteine recycled into methionine, an essential amino acid, with the aid of specific B vitamins. Homocysteine levels is vary between men and women, with normal range typically between 5 to 15 micromol/L.
When homocysteine levels are greater than normal limits, it signifies a disruption in the metabolism of homocysteine. Elevated levels of homocysteine have been associated with increased cardiovascular, cerebrovascular, and thromboembolic disease by causing endothelial layer injury, promoting inflammation, and increasing oxidative stress. Elevated total homocysteine levels in the third trisemester of pregnancy may cause subtle damage to the vasculature of the placenta, which can limit oxygen to the fetus and may have a direct effect on the brain structure of the fetus and thus increase the risk of developing schizophrenia.
Homocysteine values have been found to be elevated significantly in patients with unexplained infertility. The study gives an indication that infertility and recurrent pregnancy loss are a part of continuum of hyperhomocysteine induced adverse effects on female reproductive system.
Vitamin B9 is an essential nutrient that occurs as folate. It serves many important functions in your body. For example, it plays a crucial role in cell growth and DNA formation. Low levels of vitamin B9 are associated with an increased risk of several health conditions, including:
- Elevated homocysteine: High homocysteine levels have been associated with and increased risk of heart disease and stroke
- Birth defects: Low folate levels in pregnant women have been linked to birth abnormalities, such as neural tube defects.
- Cancer risk: Poor levels of folate are also linked to increased cancer risk.
What is Folate?
Folate is the naturally occurring form of vitamin B9. Its name is derived from the Latin word “folium”, which means leaf. In fact, leafy vegetables are among the best dietary sources of folate. The active form of vitamin B9 is a type of folate known as levomefolic acid or 5-methyltetrahydrofolate (5-MTHF). In your digestive system, most dietary folate is converted into 5-MTHF before entering your bloodstream.
Folic acid is a synthetic form of vitamin B9 and used in supplements and added to processed food products, such as flour and breakfast cereals. Unlike folate, not all of the folic acid you consume is converted into the active form of vitamin B9 (5-MTHF) in your digestive system. Instead, it needs to be converted in your liver or other tissues. Yet, this process is slow and inefficient in some people. After taking a folic acid supplement, it takes time for your body to convert all it to 5-MTHF. Even a small dose, such as 200 to 400 mcg per day may not be completely metabolized until the next dose is taken. As a result, unmetabolized folic acid is commonly detected in people’s bloodstreams, even in the fasted state and high levels of unmetabolized folic acid have been associated with several health problems. Several studies indicate that chronically elevated levels of unmetabolized folic acid may be adverse health effects, including increased cancer risk.
What is an MTHFR mutation?
Methylenetetrahydrofolate reductase (MTHF) is an enzyme that breaks down the amino acid homocysteine. The MTHFR gene that codes this enzyme has the potential to mutate, which can either interfere with the enzyme’s ability to function normally or completely inactivate it. People have two MTHFR genes, inheriting one from each of their parents. There are two common types, or variants of MTHFR mutations: C677T and A1298C. These gene mutations are relatively common.
Mutation in the MTHFR gene can affect the body’s ability to process amino acids, like homocysteine which can lead to some adverse health outcomes. Conditions that have associated with MTHFR gene mutations include:
- Hyperhomocysteinemia, which is the term for abnormally high levels of homocysteine in the blood or urine
- Ataxia, which is a neurological condition that affects coordination
- Peripheral neuropathy, which is a neurological condition that damage the nerves
- Microcephaly, which is a condition present at birth in which the head is smaller than usual
- Anemia, which means that there is a lack of healthy red blood cells in the body
- Cardiovascular diseases, such as blood clots, stroke, and heart attack
- Mental health conditions, such as depression
- Behaviour disorders, such as attention deficit hyperactivity disorder
Is Unmetabolized Folic Acid (UMFA) harmful?
Folic acid at the dosage above 200 mcg per day can increase unmetabolized folic acid in the plasma. As a result, unmetabolized folic acid is commonly detected in people’s bloodstreams. Several studies indicate that chronically elevated levels of unmetabolized folic acid may have adverse health effects, including increased cancer risk. So, the active form of Folate (as 5-MTHF) can use as the best choice for replace folic acid supplementation.
PT. SIMEX PHARMACEUTICAL INDONESIA as one of the pharmaceutical companies in Indonesia presents HY-FOLIC® products as supplement containing biologically active form of Folate (5-MTHF). HY-FOLIC® as active folate is not forming unmetabolized folic acid (UMFA) which is elevated in patients with folic acid. HY-FOLIC® has better absorption than folic acid; has sufficient dosage for therapy in pregnancy and infertility; and practical to be consumed. HY-FOLIC® has FDA, EFSA approval and HALAL certificate.
MaRgolis R., MyRskyla M. 2011. A Global Perspective on Happiness and Fertility. Popul Dev Rev. 2011; 37 (1): 29-56.
Servy EJ., Fournols LJ., et.al. 2018. MTHFR isoform carriers. 5-MTHF (5-methyl tetrahydrofolate) vs folic acid: a key to pregnancy outcome: a case series. Journal of Assisted Reproduction and Genetics.
Clement A., Menezo Y., et.al. 2019. 5-Methyltetrahydrofolate reduces blood homocysteine level significantly in C677T methyltetrahydrofolate reductase single-nucleotide polymorphism carriers consulting for infertility. Elsevier: Journal of Gynecology Obstetrics and Human Reproduction 49 (2020) 101622
https://my.clevelandclinic.org/health/diseases/16083-infertility-causes
https://www.healthline.com/health/pregnancy/signs-of-infertility#Common-Signs-of-Infertility-in-Men-
https://www.hopkinsmedicine.org/health/conditions-and-diseases/male-infertility
https://www.webmd.com/infertility-and-reproduction/guide/understanding-infertility-symptoms
https://my.clevelandclinic.org/health/diseases/17774-female-infertility
https://www.ncbi.nlm.nih.gov/books/NBK556033/
https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773
https://www.ncbi.nlm.nih.gov/books/NBK554408/
https://www.medicalnewstoday.com/articles/326181
https://www.healthline.com/nutrition/folic-acid-vs-folate#folic-acid-risks
https://www.invitra.com/en/female-sterility/
https://www.invitra.com/en/male-sterility/male-sterility-causes/
