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0:40 Brazil TV. Peace be upon you, and 1:09 Allah's mercy and blessings, brothers 1:11 and sisters. 1:11 And peace be upon you, and Allah's 1:13 mercy and blessings. 1:14 All praise and gratitude to Allah for 1:17 His grace, guidance, and blessings, 1:19 allowing us to gather here in the 1:21 Health Space on Silaturahim Radio for a 1:24 united Islam. Hopefully, this program 1:28 will help us better maintain our 1:30 physical and spiritual well-being, so 1:32 we may become useful and beneficial 1:35 servants of Allah. Being healthy in 1:37 body and soul is like that, isn't it? 1:40 Also, we send our prayers and greetings 1:44 to our beloved Prophet Muhammad, may 1:47 Allah's peace and blessings be upon him 1:51 , with the hope that we will be with 1:54 him in the times we long for in the 1:57 hereafter. 1:59 Amen. For this afternoon, the Health 2:05 Space welcomes a doctor who has been 2:09 here before, Doctor Suci, specifically 2:14 Tri Pratiwi Suci, an OB-GYN, and she is 2:19 already here with us, let's say hello. 2:25 Peace be upon you, and Allah's mercy 2:26 and blessings. 2:27 Peace be upon you too, Nuning. Peace be 2:29 upon you. And peace be upon you to all 2:33 the dear listeners of RSIL who are 2:36 loyal and never seem to leave 2:38 Silaturahim Radio. 2:41 Amen. God willing, yes. I don't know 2:44 how it happened that we ended up 2:45 matching like this. Okay, specifically 2:49 today, as shown in the flyer, we are 2:51 talking about infertility. 2:54 Right, 2:55 it is like that 2:55 yes. Okay, so that we can know for sure 3:00 if it is something we are currently 3:04 facing, or for those of you who aren't 3:08 yet, you still need to be aware. Let's 3:12 listen. Please, Doctor. 3:13 Very well. Peace be upon you, and 3:15 Allah's mercy and blessings. Well, we 3:18 meet again this afternoon here in the 3:22 Health Space on Silaturahim Radio. This 3:28 afternoon, I will be discussing—well, 3:31 not just discussing, but sharing 3:34 knowledge about infertility. What is 3:38 infertility? Like that. When we hear 3:40 infertility, there must be the opposite 3:42 , which is fertility. Fertility is the 3:48 ability or ease of a woman to conceive 3:54 and have a baby, giving birth to a 3:59 living child within her marriage. 4:05 Meanwhile, infertility is the opposite. 4:09 So, infertility is when a woman has 4:14 never been pregnant and given birth to 4:19 a living baby from her womb after 12 4:24 months of marriage. So, even if someone 4:31 has been pregnant but suffered a 4:33 miscarriage, we still categorize that 4:35 as infertility. So, this condition is 4:44 starting to be found more frequently in 4:46 Indonesia. In the first 3 months of 4:52 marriage, 25%of couples will conceive. 5:01 Then, in the next 6 months, about 63%of 5:08 pregnancies will occur. Then, within 12 5:12 months, about 80%will achieve pregnancy 5:18 . And within 18 months, 90%will be 5:24 pregnant. Overall, roughly only 5 to 10 5:33 %are truly infertile. So, it is 5:38 difficult to conceive. Infertility: if 5:42 an infertile couple comes in, they are 5:46 viewed as a single unit. So, if only 5:52 one of them comes, usually it's just 5:55 the wife who comes to see me. Well, I 6:01 usually feel a bit reluctant to examine 6:06 them because, to achieve pregnancy, it 6:11 cannot be done by the wife alone. To 6:17 make the effort to get pregnant. 6:21 Because to get pregnant, the husband's 6:24 role is very significant, even if that 6:28 role is just contributing his sperm. So 6:33 , 50%of infertility cases are indeed 6:37 caused by the woman. Why is that? 6:42 Because a woman's reproductive organs 6:44 are quite complex. Meanwhile, men 6:48 account for 45%. So, it's almost the 6:51 same. And 5%of the causes are unknown. 7:00 Maybe we can show the anatomy...Now, 7:03 this sperm analysis has...It just looks 7:06 like fluid, and people always ask, " 7:09 Doctor, it comes out, right?" Yes, it 7:15 does come out, but what we need to look 7:20 at is the quality of that sperm 7:25 analysis. Because what we look at, 7:29 first, is the volume of the semen 7:32 produced in one ejaculation. Because 7:35 there are specific numbers for all of 7:36 that. Then, how many sperm are inside 7:40 that fluid? How many are moving, how 7:45 many are dead, and what is the shape of 7:48 the sperm? Now, those all affect male 7:54 fertility. If the results are normal, 8:00 meaning normozoospermia, then we 8:05 proceed to examine the woman. It is 8:10 true that the one who gets pregnant is 8:12 the woman. But she can only get 8:14 pregnant because there is sperm. So, if 8:17 there is no sperm, pregnancy is not 8:19 possible. So, don't be surprised if the 8:22 sperm results show what is called 8:24 azoospermia. That means there is 8:27 absolutely no sperm in the semen fluid. 8:30 And that 8:31 actually happens. Now, what do we need 8:35 to look at regarding the woman? We look 8:38 at the condition of her vagina. Is 8:40 there an infection in there? How is the 8:44 cervix? Is there a tumor on the cervix, 8:48 what we call a polyp? Is there an 8:51 infection in the cervix, and then 8:53 inside the uterus itself, is there a 8:56 tumor or not? Then the fallopian tubes, 9:01 the egg ducts, are there any infections 9:03 or swelling? Then the fimbriae 9:07 themselves, whether the fallopian tubes 9:10 are blocked or not, and how the eggs 9:13 are. So, there is so much we have to 9:17 examine, so usually the wives say, " 9:22 It's okay, Doc.""I'll get checked, and 9:23 my husband can come later." I tell them 9:25 that's the wrong way around. So, if you 9:28 come with your husband, the sperm 9:30 analysis should be done first. Then we 9:34 examine the wife; we examine whatever 9:36 we can check at that moment. Well, only 9:41 after the sperm test results are in, 9:43 will we conduct further examinations. 9:47 Now, indeed, to check whether these 9:53 reproductive organs are healthy or not 9:57 depends on the woman's age. So, if the 10:02 woman is between 20 and 30 years old 10:06 when she gets married, we can wait 12 10:10 months. He he. 10:12 If she doesn't get pregnant after 12 10:13 months, then we do an examination. But 10:17 if the woman is over 30, it would be 10:20 better to act quickly. For example, if 10:24 she doesn't get pregnant in 2 or 3 10:26 months, immediately go get checked. Now 10:30 , if it's a second marriage, well, 10:33 that's another story. So, the approach 10:38 taken is indeed different. There are 10:43 many causes of infertility. It can be 10:47 caused by infections, it can be caused 10:50 by tumors or organ abnormalities, it 10:55 can also be caused by, well, having no 10:58 identifiable cause. So the cause is 11:00 unknown, they just don't get pregnant. 11:02 Like that. Perhaps that is the outline, 11:06 Ms. Nuning. 11:08 Please go ahead. I think it's better if 11:11 we discuss 11:12 as we go along, okay? As we go, please 11:15 feel free to ask questions via our 11:17 WhatsApp as usual at 0811999 720. But 11:26 recently, brothers and sisters, that 11:28 number can also be used for phone calls 11:31 , you know. So, you can call the WA 11:35 number, it will be answered, and you 11:37 just speak. No need to call the Rasil 11:41 landline, you can stick with that WA 11:43 number. Alright, meanwhile, let's see 11:47 if anyone has asked a question for Dr. 11:49 Suci. Um, oh yes, this one has no name. 11:55 If endometriosis is detected, Doc. What 12:00 is the percentage chance of getting 12:02 pregnant? Thank you very much. 12:04 Assalamu'alaikum. Oh, okay. 12:06 It has no name, right, Ms. Nuning? 12:09 Wa'alaikumussalam warahmatullahi 12:11 wabarakatuh. Indeed, regarding 12:15 endometriosis, out of 100 infertile 12:18 women, 75%suffer from endometriosis. 12:23 Hmm. 12:24 So, this endometriosis can be treated 12:27 depending on where the endometriosis is 12:30 located. So, maybe I will tell a little 12:33 bit about endometriosis, okay, Ms. 12:34 Nuning? Is that okay? 12:35 Yes. 12:37 So, endometriosis is, actually, the 12:40 endometrium is normal tissue if it 12:42 lines the inner layer of the uterine 12:46 cavity. But if the cells of that tissue 12:51 grow outside the uterine cavity, that 12:54 is what is called endometriosis. For 12:58 example, if it grows on the ovary, it 13:00 will become an endometriotic cyst. If 13:04 it grows on the wall of, what is it 13:06 called? The uterus, 13:09 it becomes endometriotic spots, or on 13:11 the pelvic wall it becomes 13:13 endometriotic spots. If it grows in the 13:17 wall of, um, the uterine muscle, it is 13:21 called adenomyosis. So each of these 13:26 has an impact on pregnancy. Hence, 13:31 infertility. 13:32 Yes. 13:33 If it is in the form of a cyst, we 13:38 remove it completely like that. We can 13:43 remove it entirely. Don't forget, 13:46 endometriosis is a very stubborn 13:49 disease, Ms. 13:50 Oh my. 13:51 So if we treat it 13:53 he 13:54 within 6 months to a year and they 13:56 don't get pregnant, it comes back. 13:59 Okay. 14:00 That's it. So like I said, it’s 14:02 stubborn. And it is highly dependent on 14:06 female estrogen hormones. 14:08 He. 14:09 Whereas women of childbearing age have 14:12 incredibly high estrogen. like that. So 14:16 if we take action for women who want to 14:20 get pregnant, we will try our best, 14:24 once we’ve taken action to treat the 14:28 endometriosis, to ensure the woman 14:31 becomes pregnant within 1 year. 14:36 That’s how it is, Miss. 14:37 Okay. 14:38 Yeah. 14:39 Alright. Then there is also a question 14:44 here. Oh, regarding sperm, this is from 14:48 Mr. Budi, right. The sperm count is low 14:53 , Doc. Does it need to be increased by 14:56 consuming certain foods? Just curious. 15:00 Yes. 15:00 Okay. 15:01 Alright. The sperm count how low is it? 15:09 Because normal sperm per cc of 15:13 ejaculation is 15 million to around 250 15:19 million. 15:20 Yeah. 15:21 Now, if it's still in that range, it 15:22 doesn't need to be increased. 15:25 Okay. 15:25 Now, what needs to be looked at instead 15:30 is the motility, the movement of the 15:35 sperm. So if the sperm's movement, when 15:40 checked, just spins in place, 15:43 He. 15:44 It's impossible for it to fertilize. 15:47 Oh. 15:47 Because when sperm is released into the 15:50 vagina during intercourse, 15:52 he 15:53 it has to travel, like I mentioned 15:55 earlier. Now, it has to move quickly, 15:58 enter the womb, pass through the cervix 16:01 , get into the uterus, pass through the 16:03 fallopian tubes, until it reaches the 16:06 end of the tube to meet the egg there. 16:10 So even if the number is very high, if 16:14 the motility is zero or very low, it 16:18 cannot fertilize either. So, according 16:24 to WHO figures, only 1%progressive 16:28 motility is needed, Miss. 16:33 Not that much. 16:34 He 16:34 like that. So 16:35 with that quality. But 16:37 Yes. So if it is really, really low, 16:43 that's an indication because sperm 16:47 cannot be increased. cannot be 16:52 increased. So if the factory produces 16:56 only a little, that's how it will be. 17:01 Like that. It's quite difficult for us 17:04 to manipulate sperm. So for azoospermia 17:08 or oligospermia, 17:10 he 17:11 with what is it called? Very, very low 17:15 motility. He 17:16 the indication is sometimes it can be 17:20 done with insemination, 17:23 or it could also be IVF. 17:27 There are solutions now, yes. 17:29 there is assisted technology. But to 17:33 increase the amount 17:37 that seems quite difficult, Miss. 17:39 Yeah. There is a note from Mrs. Juni. 17:44 But earlier someone said my husband 17:48 once experienced low sperm count too. 17:52 Do you know? Eating venison turned out 17:55 to help. Oh, venison, maybe it's a 17:58 coincidence or maybe 18:01 it's possible the motility became good. 18:04 So what can be helped is the motility. 18:07 Yeah. So, even though, because actually 18:10 at the time of pregnancy, what is 18:12 needed is only one out of those 18:14 millions. 18:16 Yeah. 18:17 Only one, miss, 18:19 that is needed to fertilize the egg. 18:22 Only the best one. 18:25 Like that. So if the count is, for 18:28 example, what is it? 10 million. 18:31 Yeah. 18:32 Then these 10 million all have good 18:34 movement, right? Good. So it cannot be 18:36 used for fertilization. 18:38 Yeah. Yeah. 18:39 Like that. 18:40 Yes. 18:40 Yeah. 18:41 Alright, let's go to Mrs. Juni in 18:44 Ciputat. Peace be upon you, Dr. Suci. 18:47 And peace be upon you too. 18:50 I am 65 years old. I only had a child 18:54 at the age of 30 after 3 years of 18:56 marriage. My complaint is extreme pain 18:59 during menstruation. It turns out my 19:03 daughter experiences the same thing. A 19:06 gynecologist once said that one should 19:08 be suspicious if there is extreme pain 19:10 during menstruation. What is wrong, 19:14 Doctor? Why does it affect fertility? 19:18 Thank you. Yes. Now I have one child 19:21 and that child has one grandchild who 19:24 is only 8 years old. Yes. 19:27 Yeah. 19:28 Yeah. Alright. Mrs. Yuni who is in 19:31 Ciputat, right? 19:32 Ciputat. So, it's like this, Ma'am. 19:37 Pain during menstruation, from a 19:40 gynecologist's perspective, the most 19:43 suspected cause is endometriosis. 19:48 Because it is very characteristic that 19:50 the pain occurs during menstruation. 19:53 Once that period passes, you're free, 19:55 there's no more pain. It will disappear 19:59 during pregnancy. Then it will not be 20:05 felt for about 5 years after giving 20:08 birth. After that, the pain starts to 20:13 be felt again and will truly disappear 20:16 during menopause. Because during 20:19 menopause, the hormone estrogen is 20:22 relatively very low. So, you have to 20:26 check if there is endometriosis, Mrs. 20:31 Yuni. Because indeed, usually if the 20:34 mother has endometriosis, the daughter 20:36 also tends to have it too. Yeah. And 20:40 this endometriosis can be treated, 20:42 although it is temporary, yes. So, to 20:44 prepare for pregnancy, we usually treat 20:46 it first. After it is calm, we try for 20:51 pregnancy. After that, if you are 20:54 pregnant, it is usually safe for 5 20:56 years after giving birth. That's how it 20:58 is, Mrs. Yuni. Maybe you can, you know, 21:04 understand this, Ma'am. 21:08 Yeah. But thank God, there is already a 21:09 grandchild. 21:10 Yes. Thank God. So, endometriosis is 21:13 indeed a disease that, as I said 21:16 earlier, is stubborn. And it doesn't 21:20 have a strict rule that if you have 21:22 endometriosis, it's definitely hard to 21:25 have children. No, miss. 21:27 Yeah. 21:28 So there are some who have 21:29 endometriosis and just get pregnant 21:31 easily. Yeah. 21:32 Yeah. So, usually, when we suspect 21:34 endometriosis in someone trying to 21:36 conceive, we say, "No need for birth 21:38 control, Ma'am. Just try for pregnancy. 21:40 Try until you have as many children as 21:41 you want, then use birth control." Yeah 21:43 . 21:43 Because after giving birth, the 21:45 endometriosis will be calm. 21:47 Yes. 21:48 So that the infertility, uh, I mean, 21:50 the fertility is still good. 21:52 So it depends on the condition. If the 21:55 purpose of birth control is to space 21:57 out pregnancies, that's fine. But 21:59 that’s if you don’t have 22:00 endometriosis. It's better to try for 22:03 it first. 22:04 Yes. Just go for how many you want to 22:06 have. Then, afterwards, you can use 22:07 birth control. Here is a question that 22:10 might represent other friends as well. 22:12 I have been married for 4 years but 22:16 have never missed my period, never been 22:19 pregnant. I'm so confused. How many 22:24 times is the maximum for intercourse, 22:25 Doc, for a person to normally get 22:27 pregnant? It’s been 4 years. If we 22:29 only do it twice a month, how much 22:31 would that be? Okay, if there is an 22:34 explanation, thank you. Yes. 22:36 Yes. 22:36 Uh, alright. So, to get pregnant, the 22:40 means is indeed intercourse or having 22:44 sex. Coitus is the term, the medical 22:48 term is coitus, but the general term is 22:51 having sex. That is, uh, actually just 22:57 a means. But you have to get checked, 23:01 like before, whether the husband's 23:05 sperm is good, and then whether your 23:09 genitalia and reproductive organs are 23:13 also good. 4 years is not a short time. 23:17 Now, 23:18 Yeah. uh, in actually, within one year, 23:25 if you haven't become pregnant, you 23:28 should already be suspicious. 23:32 Especially if the intercourse is 23:35 regular, ideally 3 to 4 times a week. 23:41 If done every day, is it allowed? Yes, 23:44 it is. Five times a day, is that 23:45 allowed, Doc? It's allowed if it's for 23:48 pleasure, what wouldn't be allowed, 23:50 especially for a legitimate husband and 23:52 wife, so that's fine. However, to get 23:57 pregnant, it takes time to mature the 24:00 sperm. So if sperm is released every 24:06 day, eventually what comes out is young 24:08 , immature sperm that isn't capable of 24:11 fertilizing the egg. That's how it is. 24:15 So, ideally, it should be three, at 24:18 most four times a week. Uh, but don't 24:22 do those four times on Monday, Tuesday, 24:24 Wednesday, Thursday. Don't. So, skip 24:27 some days, you see. For example, Monday 24:30 , Tuesday, skip Wednesday, Thursday, 24:32 like that. What for? So that your 24:36 husband's sperm has time to mature. 24:41 Because if it's young sperm, it can't 24:42 fertilize, Ma'am. And then, uh, what do 24:47 you call it? If you have never, never 24:50 had a check-up, you should. Because 24:53 actually, the ideal time is 3 years, 24:55 Ma'am. Within 3 years if you aren't 24:57 pregnant, ideally you should have been 24:59 checked. If it's the fourth year, it's 25:02 a bit late for a check-up. That's how 25:04 it is. Like that, Ms. Nuning. 25:06 Yes. Hopefully, that answers the 25:09 question. This is from Mr. Idris. Peace 25:13 be upon you, Doc. Is being sterile a 25:15 disease or something else, and is it 25:18 hereditary to the next generation, 25:21 being sterile? Oh. 25:24 Uh, we call it infertility, Sir. So, 25:30 for infertility, we actually don't 25:32 define it as being sterile, as that 25:35 sounds like, well, being unable to 25:37 conceive at all. Well, being sterile 25:41 can actually happen to both women and 25:43 men. 25:44 Yes. 25:44 Exactly. So for men, what is called 25:47 sterile is azoospermia. So if there is 25:51 no sperm at all, then he is sterile. 25:53 Right. 25:54 Now, for women, what is called sterile 25:58 is if there are no egg cells, or if 26:01 there is no uterus, for example. That 26:04 is what we refer to as being sterile. 26:06 So, they truly cannot get pregnant. Now 26:10 , whereas if, uh, the husband has 26:12 azoospermia and has no sperm, but the 26:14 wife is perfectly fine, she can be made 26:17 pregnant by, uh, what do you call it? 26:21 Assisted by, uh, what? By means of IVF. 26:26 So, what is called azoospermia is when, 26:29 during ejaculation, only fluid comes 26:32 out, but there is no sperm. Right. 26:36 But if we, uh, have cases like that, 26:38 sometimes it's just the ducts that are 26:40 blocked, but the factory is actually 26:42 still producing sperm. Yes, like that. 26:48 The sperm can be taken directly from 26:51 the factory, then the best ones are 26:54 selected to fertilize an egg outside, 26:57 which is called IVF, like that. So 27:02 that is what is truly called sterile, 27:04 Sir. So if it is truly azoospermia 27:07 where there is absolutely no sperm, and 27:10 then there is also no sperm in the 27:12 factory, only then is it called truly 27:14 sterile. Now, for women, it is when 27:18 there are truly no eggs. Eggs that can 27:20 be fertilized are not there. 27:22 Like that. Only then do we call that 27:24 being sterile in women. That's how it 27:27 is, Miss. 27:27 Alright, let's go to Ibu Mufidah. Peace 27:32 be upon you, Doc. And peace be upon you 27:35 too. 27:36 The question is, what factors cause 27:38 premature ejaculation? Is there 27:42 something wrong with, uh, this disorder 27:46 for the condition in question, can it 27:50 be cured? Thank you. 27:53 Yes. 27:54 Alright, Ibu Mufidah. Ibu Mufidah, uh, 27:57 this is actually the realm of an 27:59 andrologist, but, uh, perhaps I can 28:03 help a little. Well, like this, Ibu 28:06 Mufidah. So, premature ejaculation is 28:09 actually, uh, before—so, as soon as 28:15 an erection happens, the sperm comes 28:18 out immediately, uh, that can be caused 28:22 by an illness, but most often it is 28:25 caused by psychological factors. Now, 28:30 for psychological ones, try, uh, to 28:36 have it checked first by an andrologist 28:38 or, uh, a urologist to see if there is 28:41 an organ abnormality. Right. 28:44 Now, if there is no organ abnormality, 28:47 the possibility is that the issue is 28:49 psychological. That's it. 28:52 That's how it is, Ma'am. So it must be 28:53 checked first whether there is an organ 28:55 abnormality or not. And if not, there 28:58 is likely something regarding their 29:00 mental state. That was the question 29:04 from Miss Retno. Peace be upon you, Doc 29:08 . 29:09 And peace be upon you too. 29:11 What usually causes infertility in men? 29:16 Right. So, uh, infertility in men 29:20 involves many, uh, male genital organs. 29:25 So it could be that the ducts did not 29:27 form properly. So there is something 29:29 called the vas deferens. So, the place 29:32 between, uh, the channel for sperm so 29:34 it can come out like that. Well, that 29:36 is not formed. That could be a reason. 29:38 Yeah. 29:39 Uh, then, uh, it could be due to a 29:42 varicocele. So, in the factory or the 29:46 storage area, there are varicose veins, 29:49 causing the temperature in that storage 29:52 area to be hotter than it should be, 29:55 hotter than normal, so the sperm there 29:58 end up dying. It could also be due to a 30:02 tumor in, what do you call it, the 30:04 testicles, yes. So, in the testicles, 30:07 there are varicose veins, or there is a 30:08 tumor, or there is an infection. 30:11 An infection of the, uh, what, sperm 30:14 emission duct, or, uh, a congenital 30:17 abnormality where there is no duct, all 30:20 of that can cause infertility in men, 30:22 like that. 30:25 Yes. Yeah. Men can prepare themselves. 30:30 So, yes. 30:31 At least when they are about to build a 30:35 household. 30:36 Correct. Uh, there is also trauma. 30:38 Trauma can also be trauma to the male 30:41 genitalia. 30:43 That can also cause infertility. 30:46 Uh, either severe trauma or mild trauma 30:49 . So, I once attended, uh, a lecture by 30:53 an andrologist at that time who shared 30:56 that 30:58 be careful for those who don't have 30:59 children yet, men who don't have 31:00 children yet, about cycling. So, that 31:04 is mild trauma but it's continuous, he 31:06 said. 31:06 Oh. 31:07 Now, I don't know if there is research 31:09 on it or not, but at that time I 31:10 followed what he said. 31:12 So don't go cycling too much, right. 31:15 Feel free to cycle. But just, I don't 31:17 know, how to manage this. 31:19 Okay. Yeah. Right. Still accompanied by 31:22 Dr. Suci, an OB-GYN specialist who is 31:25 talking about infertility this 31:27 afternoon. This is a question from 31:31 Mirna. It might also persuade others 31:34 who are listening. Doc, at home I have 31:37 some cats kept by my older sibling. 31:40 Yeah. 31:40 I heard a myth that it can cause 31:43 infertility. What about this? Because 31:46 the cats haven't been vaccinated. And 31:49 if it's related to their shedding fur, 31:51 for example, please explain, Doc. Can 31:54 cats cause people to experience 31:56 difficulty getting pregnant? I think it 31:59 needs an explanation. 32:00 Yes. 32:01 Yes. 32:02 Eh, so it's like this, uh, Mrs. Mirna, 32:04 or Miss Mirna, yes. Yeah. Miss Mirna, 32:08 uh, cats are, uh, one of the animals 32:12 that can spread toxoplasma. 32:17 Hmm. 32:19 Now, it's this toxoplasma that will, mm 32:23 , cause, uh, problems in pregnancy. 32:28 As well as for women who want to get 32:30 pregnant, like that. So, actually, it's 32:34 not the fur, but the feces. 32:37 Yeah. 32:38 Yeah. The cat's feces, like that. 32:42 Especially if these cats like to roam 32:44 everywhere, like that. 32:46 Yeah. So, it's not a house cat. 32:49 Not a house cat. If it's a house cat, 32:52 it's usually cared for, then, uh, given 32:54 what you call it? Vaccinated. Then it 32:58 gets, uh, the right food too, right. Uh 33:02 , it's clear what it eats. But if there 33:05 are many cats that are not cared for 33:08 properly, well, it is best, uh, for 33:11 mothers or women who are there who are 33:15 not yet married. 33:18 Yes, don't often hold them and kiss 33:20 them, like that. Because. 33:23 The fur, toxoplasma can attach itself 33:26 to the fur. So if you have already 33:30 contracted toxoplasmosis, it really 33:32 must be treated first. So usually for 33:35 women with infertility, we examine 33:38 everything. So that is included in an 33:41 infection. It is categorized as an 33:43 infection. So it is an infection-based 33:45 cause. 33:46 Alright. Moving on. Emm. Doctor, my 33:52 younger sister was given Danazol or 33:55 Danapol or something because she hasn't 33:58 gotten pregnant yet. Some say you could 34:03 get cancer if you keep taking it. How 34:07 can we minimize the risk so she doesn't 34:10 get exposed to cancer? 34:14 Look, regarding Danazol, why was it 34:16 prescribed in the first place? 34:18 Oh, there is a reason. Yes, it was 34:20 definitely prescribed for a reason by 34:22 the doctor who gave it to her. So, it 34:25 wasn't just given out of nowhere. So, 34:28 please ask why first. 34:31 Because Danazol is actually one of the 34:34 medications that can be used for 34:36 endometriosis. Does your sister have 34:41 endometriosis? So it is being treated 34:44 with Danazol. Well, that needs to be 34:47 asked further, Miss. 34:49 Okay. So, regarding the issue of 34:52 whether it will cause cancer or not? 34:55 The answer is not available right now. 34:58 Yeah. Because there is an indication 35:00 for it. Why was it given? 35:01 Why was it given? 35:02 Like that. 35:03 Then, what was the next question? From 35:13 Miss or Mrs. Miftah here. 35:16 Assalamu'alaikum, Doctor. 35:17 Wa'alaikumussalam. 35:19 Excuse me, can masturbation cause 35:21 infertility in men in the future? If I 35:25 may know, what are the causes of 35:27 infertility in men? 35:29 Okay. I actually already explained that 35:32 earlier. 35:33 So, there are various causes for 35:36 infertility in men. There's infection. 35:40 The infection could be in the ducts, it 35:43 could be in the, what do you call it? 35:45 The sperm factory, or in the sperm 35:48 storage area, or in the sperm ducts. 35:51 It could also be due to a tumor. A 35:54 tumor in the factory, a tumor in the 35:57 storage area, or a tumor in the, excuse 36:01 me, the sperm exit path. 36:04 It could also be due to chronic 36:06 illnesses. For example, what? Diabetes, 36:09 or what? High blood sugar, yes. 36:11 Yeah. 36:12 It could also be due to, what's it 36:14 called? Medications consumed for a long 36:16 time. Well, then it could also be 36:23 congenital, meaning the ducts are 36:26 missing, the sperm ducts are absent, or 36:29 the factory is not producing. So, that 36:34 is something congenital. And there is 36:38 another, what do you call it, 36:44 psychological factors that can also 36:48 make a man become, what? Infertile. So, 36:52 sterile. 36:53 Yeah. 36:53 So, that's it, Ma'am, so it's worth 36:57 noting as well. Now, it seems from what 37:01 I've discussed, masturbation is not 37:03 included in those causes, Miss. 37:06 So it is safe. 37:07 It is safe, but it seems like it's not 37:09 allowed. 37:11 From another perspective. 37:12 Correct, from another perspective. 37:13 Correct. Yeah. 37:14 Okay. This is from Surya. It's been the 37:18 women asking questions so far. This is 37:19 Surya. Uh, peace be upon you, Doc. 37:22 And peace be upon you too. I heard one 37:24 of the reasons why women find it hard 37:28 to get pregnant is blocked fallopian 37:32 tubes. What kind of condition is that, 37:34 Doc? What are the symptoms? 37:36 Yeah. 37:36 Okay, 37:37 yes. So, the fallopian tube is, uh, 37:41 well, for Mrs. Miftah. Right, Mrs. 37:44 Miftah, yes. 37:45 Yeah. 37:45 Yeah. If Mrs. Miftah saw the TV, if you 37:49 look at the TV, there was an image 37:51 shown. The fallopian tube is the part 37:55 on the left and right, left and right 37:57 of the uterus, the big one is the 37:59 uterus, the ones that look like strings 38:01 on the sides. Those are the tubes. They 38:04 can get infected. They can get infected 38:07 , or they might not have formed at 38:10 birth. Also, there could be a tumor 38:13 there. That's the cause. So, if it's 38:17 blocked due to an infection, it's 38:19 because of the infection, and if it's 38:22 blocked because there's a tumor inside, 38:24 or a tumor outside pressing on it 38:27 heh 38:28 we must treat it if the tumor is from 38:31 the outside. But if the tumor is inside 38:34 , since the tube is very small. So, 38:37 yeah, we look at how big it is first. 38:41 Then, if it was never formed, there's 38:44 nothing we can do. So, the tube, in 38:49 common terms, is the oviduct. That duct 38:56 is the path for sperm to meet the egg 39:02 at the end of the oviduct. Because that 39:08 egg won't enter the uterus unless it's 39:12 in the form of an embryo. Exactly. So 39:16 the egg stays still, waiting to be 39:18 picked up by the sperm. So the sperm 39:21 must come 39:22 proactively, yes 39:23 to fertilize it, then become an embryo, 39:25 only then will the egg go into the 39:27 uterus. If not, then no. 39:29 Yes. 39:30 So the blockage can be caused by 39:32 infections, tumors, or it might not 39:34 have formed at all. 39:35 That was the question from Mas Surya, 39:38 as I said, the only man who has asked 39:40 so far. 39:41 For Ms. Miftah, that's already done. 39:44 Now I'll move to the next question. 39:48 This one is also from a man, Mas Hamam. 39:53 Doc, I'm 27 years old and married. I 39:57 have a history of inguinal hernia, 39:59 right? 40:01 Yeah. 40:01 I've been married for 2 years. I want 40:05 to read the rest but the phone is 40:07 ringing. Maybe you can help, Mas Anis. 40:15 Don't pick it up or it will cut off. 40:18 Okay, let me continue. 40:23 It cut off, right? Okay, proceed. This 40:26 is for the one who has been married for 40:29 2 years. 40:32 Can the hernia I have affect my ability 40:36 to have children? Because until now, I 40:41 don't have any children yet. Please 40:44 help. Oh, there's a call coming in. 40:46 Let's take the call first, Mas Hamam. 40:48 Let's postpone the answer. Hello. 40:52 Peace be upon you. 40:52 Hello. Peace be upon you. And peace be 40:54 upon you too. 40:55 And peace be upon you too. Who is this? 40:56 Where are you calling from? 40:58 This is Fajar from Kemayoran, Miss. 41:01 Okay, go ahead, Fajar. 41:04 Yes, ma'am. Um, well, Doc, I want to 41:08 ask, if a man takes medication that's 41:11 said to make him last longer, Doc, does 41:13 it have any negative side effects, Doc? 41:18 Um, my friend uses, uh, what is it, 41:20 potency drugs like that to last longer? 41:23 Either the topical or oral ones, but 41:26 eventually he feels that thing of his, 41:28 his penis, starts to feel bad, Doc. 41:31 It's like it's numb. Could that be 41:33 because of, uh, frequently taking 41:34 things like that, Doc? 41:36 Yes. 41:36 Thank you, Doc. Assalamualaikum. 41:38 Waalaikumsalam. 41:39 Waalaikumsalam warahmatullahi 41:40 wabarakatuh. 41:41 Yes, please go ahead. 41:42 So, uh, what is it? The penis itself 41:47 consists of muscles, blood vessels, and 41:52 nerves, you see. So if it stays erect 41:57 for a long time, eventually 42:00 the nerves become numb. 42:03 Because, uh, let's just imagine a 42:06 muscle that is constantly in a state of 42:09 , what? contraction, like that. A 42:12 muscle that is constantly in a state of 42:13 contraction. Well, that, uh, the 42:16 sensitivity of the nerves will decrease 42:20 . So, I really don't know what's in 42:24 those drugs, but it's better to just go 42:28 natural. 42:30 Yes. 42:31 Just naturally, because, uh, what is it 42:34 ? The most important thing is actually, 42:39 uh, what? The quality of the sexual 42:41 intercourse. Right? The quality of the 42:44 sexual intercourse. 42:45 So, uh, maybe gentlemen need to learn 42:49 what good quality sexual intercourse is 42:54 really like. So sometimes, uh, I don't 42:59 know, why do you have to use those 43:02 supplements earlier 43:03 just to last longer. What if it's too 43:05 long, you know? Maybe instead of being 43:09 better, it just gets, uh, what, tired, 43:12 right, because 43:13 uh, muscles have their, uh, limits, you 43:16 know, muscles have their limits 43:19 and they cannot be forced constantly 43:22 like that. There is a time for 43:25 contraction and a time for relaxation, 43:27 you see. 43:28 Yes. So, just keep it natural, okay? 43:31 Yes, that is my advice. 43:33 Right. I hope that answers your 43:35 question. Let's return to the question 43:37 from Mas Hamam earlier. 43:38 Yes, correct. It was inguinal hernia, 43:40 right, Mas Hamam? Its effect on 43:43 infertility. 43:44 Correct. Uh, it depends. So, a hernia 43:47 is the, uh, protrusion of, uh if it's 43:54 inguinal, usually the intestine and its 43:57 contents enter a cavity where they 44:00 shouldn't be. 44:01 Heh. 44:02 So, near the groin there is an inguinal 44:06 canal, so to speak. That inguinal canal 44:10 , it just comes out here, right? Now, 44:14 it can actually affect it if it's on 44:17 both sides, left and right. 44:19 If it's on the left and right. So if 44:21 the inguinal hernia is on both sides. 44:25 So if it's on both sides, it can affect 44:28 it if it's already large and reaches 44:30 the, uh, the testicles, ma'am. He he. 44:33 Well, if it reaches that point, it can 44:35 have an effect. But if it's only on one 44:37 side, surely the other side is still 44:38 fine. 44:39 Yes. 44:39 Exactly. Hernia can be bilateral, both 44:42 left and right. Uh-huh. 44:43 It can be just unilateral, on one side 44:45 only. So if it's only on one side, well 44:48 , what do you call it? The other one is 44:51 still fine. But, uh, personally, I 44:54 would say a hernia is not something 44:58 that should be kept or delayed. 45:02 in its treatment. Because, actually, 45:04 the treatment is quite easy. 45:06 Uh-huh. So, go to a surgeon as soon as 45:08 you see it; don't wait until it becomes 45:11 what's called an incarcerated hernia. 45:15 So, the organs that enter that hole can 45:18 no longer go back up. So it gets 45:21 trapped inside and then becomes 45:23 extremely painful. If it gets to that 45:26 point, the surgery will be much bigger; 45:29 if, for example, the intestine gets in 45:31 there, it might have to be removed. So 45:33 my advice to Mr. Hamam, to Mas Hamam, 45:37 is to go to a surgeon immediately 45:40 because, uh, today's surgery is easy, 45:43 much easier. So, don't wait for further 45:47 symptoms to appear. Because once an 45:50 illness is known, treat it immediately, 45:53 so, God willing, the rest won't be 45:56 affected. That's how it is. Alright, 45:59 the next question is from Mbak Nia. 46:02 Doctor, Mbak Nuning, may I ask? 46:06 Go ahead. 46:07 Can a woman's or man's infertility be 46:10 caused by thoughts from the husband's 46:14 family and my own family? Asking, "Are 46:18 you pregnant yet?" Because of this, we 46:22 feel, you know, the effect. That is 46:27 absolutely true. 46:28 Uh-huh. Very true. So, 46:30 uh, like this. Because for couples who 46:34 are always asked when they will be 46:37 pregnant, it's as if in their heads, uh 46:39 , it's ingrained that if they have 46:44 intercourse, they must conceive. 46:45 Like that. Uh-huh. 46:47 Now, that will make them feel, uh, 46:50 uncomfortable 46:52 in having intercourse, 46:53 and that can even make the sperm 46:55 quality become poor. Why does sperm 46:58 quality drop? Sometimes it will disrupt 47:01 , uh, what do you call it? Their 47:04 intimacy will also be disturbed, like 47:06 that. Uh-huh. 47:08 So for example, if you've been married 47:10 a year and aren't pregnant yet, you get 47:13 asked every time you meet the family. 47:16 Every time you see the family, you get 47:18 asked. Maybe sometime the family needs 47:20 a consultation, too, right? It is 47:23 absolutely true, Mbak Nia, that if that 47:26 causes stress for both, it can indeed 47:29 lead to difficulty in getting pregnant. 47:33 Not impossible, but difficult. Now, uh, 47:36 what do you call it? Irregular, or not 47:40 regular, intercourse. "Regular" means 47:42 like this, regular. I always have 47:43 patients who say their intercourse is 47:45 regular. "Regular, Doc, twice a week." 47:47 But it turns out the "twice a week" is 47:48 only on Saturday and Sunday. 47:50 Uh-huh. 47:51 Now, that also makes the, uh, chance of 47:54 a successful pregnancy go down. 47:57 There are fertile times, right, Doc? 47:59 How many days after a period is it 48:00 usually? 48:00 Yes. So, if you only have intercourse 48:02 during fertile periods, it’s still 48:04 hard to get pregnant, Miss. Because 48:06 sperm has an expiration date. 48:10 So, if sperm isn't released for 10 days 48:14 , it expires; many die, and many stop 48:17 moving. 48:18 The limit is 10 days, like that. 48:21 Don't let it go 10 days without being 48:23 used. 48:23 Use it. Yes. Don't let it be more than 48:25 that. If possible, once every 2 or 3 48:26 days. Yes. Exactly, Miss. Like the one 48:30 who asked earlier about having a 48:32 routine of 3 to 4 times. That, that is 48:36 the most ideal. 48:37 So 3 to 4 times means, as I said, have 48:39 intercourse today, wait 2 days, then do 48:42 it again. Because good sperm can live 48:46 up to 3 days inside the uterus. 48:50 So 48:51 whenever you are fertile, for women 48:53 it's only once a month, you know. Yeah. 48:56 And there's no need to look for it, 48:59 no need to wait for that one week. No 49:01 need to wait for it, Miss. Really, Miss 49:03 . 49:03 It just happens. 49:04 Because if you wait for it, ovulation 49:06 can happen in the morning. 49:07 Yeah. 49:08 It can be during the day or at night. 49:11 And if there is sperm waiting, as soon 49:14 as the egg appears, it is usually 49:16 fertilized immediately. 49:19 Yeah. 49:20 And what will that do? The success rate 49:23 for pregnancy is higher if you have 49:26 regular sexual intercourse. So, some 49:30 people say, "I've calculated it, Doc." 49:32 So when they are fertile, wow, they are 49:34 diligent. 49:35 But then when they aren't, they don't 49:36 do it 49:37 for a long time, and then only have 49:38 intercourse again during the next 49:40 fertile period. But the sperm that 49:42 hasn't been released for a long time, 49:44 its quality is poor, 49:47 like that. 49:48 Okay, we are at the end now. So for 49:51 those who tuned in late, you can watch 49:56 it on the Rasil YouTube channel, look 50:00 for "Rasil TV." Search there, and on 50:05 this final occasion, we will listen to 50:10 a summary of the discussion we had 50:14 earlier, which will be provided by Dr. 50:18 Suci. 50:19 Yeah. Alright. So, infertility is not 50:25 just a women's issue. So, an infertile 50:31 couple is a single unit, don't forget 50:35 that. So if you want to get pregnant, 50:38 come together, first of all. Then, the 50:42 cause of infertility, both in men and 50:45 women, can be because the organs are 50:47 not formed. That's a birth defect. 50:52 Second, because of infection. Third, 50:56 because of a tumor or something 50:58 blocking it. Then, the next one is 51:02 psychological. Next, if you have been 51:08 married for 1 year and still haven't 51:12 conceived, hurry to find out why. The 51:19 maximum, most ideal time is before it 51:22 exceeds 3 years. So, before 3 years, go 51:26 and see a doctor that you trust to ask 51:30 why you haven't gotten pregnant yet. 51:35 And for the family, please understand 51:39 that every couple definitely wants to 51:43 have children. There is no need to ask 51:48 whether they are pregnant or not. If 51:51 they are already pregnant, it will 51:53 surely be visible that the couple is 51:55 expecting. And finally, please take 51:59 care of both the female and male 52:03 reproductive organs. So, do not do 52:08 things that could damage these organs 52:13 before having children. God willing, if 52:20 it is His will, regardless of the 52:22 marriage age, if God says pregnant, God 52:25 willing, it will happen, Mbak Nuning. 52:29 Masyaallah. So, thank you Dr. Tri 52:33 Pratiwi Suci Spog for giving us 52:37 additional information regarding 52:40 infertility. A child is indeed a gift 52:45 from God, but the awareness to protect 52:48 our organs from harmful things must 52:51 still be optimized, right? 52:54 Alright, thank you once again to all 52:57 our friends, 52:59 brothers and sisters everywhere 53:02 watching this show who happen to not 53:05 yet have been blessed with the 53:08 opportunity to have a child. God 53:11 willing. We all pray that it will be 53:14 made easy by God. Billahi taufik wal 53:16 hidayah. Wasalamualaikum warahmatullah 53:19 wabarakatuh. 
