Path Analysis on the Biopsychosocial Determinants of Infertility among Reproductive Aged Women in Surakarta, Central Java

Luthfia Zauma, Uki Retno Budhiastuti, Eti Poncorini Pamungkasari


Background:  Infertility is a multidimensional prob­­lem. This problem occurs not only because of health problems related to anatomic factors such as problems in the fallopian tubes, ovaries, and endo­­­metrium, but also there are more factors such as physiological, genetic, and environmental fac­tors. The purpose of this study was to analyze the factors that influence the incidence of infer­tility in women.

Subjects and Method: A case control study was conducted at the Gynecology Obstetrics Poly­clinic and Sekar Fertility Clinic, Dr. Moewardi hos­pital, Surakarta, Central Java, from October to November 2019. A sample of 200 women rep­ro­­ductive age was selected by fixed disease samp­ling. The dependent variable was infertility. The inde­pen­dent variables were age, body mass index (BMI), physical activity, endo­metriosis, family his­tory, exposure to cigarette smoke, and stress. The data were obtained from medical record and question­naire. The data were analyzed by path analysis run on Stata 13.

Results: Infertility in women was directly increased with age 35 years (b= 1.20; 95% CI= 0.18 to 2.22; p= 0.021), BMI <18 or ≥25 (b= 2.93; 95% CI= 1.95 to 3.91; p<0.001), high phy­sical activity (b= 1.30; 95% CI= 0.28 to 2.33; p= 0.013), endometriosis (b= 1.17; 95% CI= 0.20 to 2.13; p= 0.018), exposure to cigarette smoke (b= 1.19; 95% CI= 0.20 to 2.23; p= 0.023), and severe stress (b= 1.18; 95% CI= 0.27 to 2.08; p= 0.011). In­fer­­tility in women was indirectly increased with age, physical activity, and family history of infer­tile.

Conclusion: Infertility in women is directly in­creas­ed with age 35 years, BMI <18 or ≥25, high phy­sical activity, endometriosis, exposure to ciga­ret­­­te smoke, and severe stress. Infertility in women is indirectly increased with age, physical acti­vity, and family history of infertile.

Keywords: female infertility, risk factors, path analy­sis

Correspondence: Luthfia Zauma. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia, 57126. Mobile: 0813379 77377.

Journal of Maternal and Child Health (2020), 5(2): 173-181

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Cai J, Liu L, Zhang J, Qiu H, Jiang X, Li P, Sha A, Ren J(2017). Low body mass index compromises live birth rate in fresh transfer in vitro fertilization cycles: a retrospective study in a chinese population. Fertil Steril, 107: 422–429. doi: 10.1016/j.fertnstert.2016.10.029 [Crossref] [PubMed] [Google Scholar]

Dechanet C, Anahory T, Mathieu-Daude JC, Reyftmann L, Hamamah S, Hedon B, Deechaud H (2011). Effects of cigarette smoking onreproduction. Hum Reprod Update 17:76–95. doi: 10.1093/humupd/dmq033 [Crossref] [PubMed] [Google Scholar]

Farquhar C, Bhattacharya S, Repping S, Mastenbroek S, Kamath M, Marjoribanks J, Boivin J (2019). Female subfertility. Lancet, 5(7). 1–21. doi: 10.1038/s41572-018-0058-8 [Crossref] [PubMed] [Google Scholar]

Gudmundsdottir SL, Flanders WD, Augestad LB (2011). A longitudinal study of physical activity and menstrualcycle characteristics in healthy noerwegian women–The nortronderlag health study. NorskEpidemiol. 20(2): 163-71. doi: 10.5324/nje.v20i2.1337 [Crossref] [Google Scholar]

Hajela S, Prasad S, Kumaran A, Kumar Y (2016). Stres and infertility: a review. Int J Reprod Contracept Obstet Gynecol, 940–943. doi: 10.18203/2320-1770.ijrcog20160846 [Crossref] [Google Scholar]

Indarwati I, Budihastuti UR, Dewi YLR (2017). Analysis of factors influencing female infertility. J Matern Child Health, 02(02): 150–161. doi: 10.26911/thejmch.2017.02.02.06 [Crossref] [Google Scholar]

Oboni JB, Vidal PM, Bastardot F, Vollenweider P, Waeber G (2016). Impact of Smoking on Fertility and Age of Menopause: A Population-Based Assessment. BMJ Open 6(11): 1–9. doi: 10.1136/bmjopen-2016-012015 [Crossref] [PubMed] [Google Scholar]

Oktarina A, Abadi A, Bachsin R (2014). Faktor-faktor yang memengaruhi infertilitas pada wanita di klinik fertilitas endokrinologi reproduksi (Factors affecting infertility in women in reproductive endocrinology fertility clinics). 46(4): 295–300. [Website]

Prescott J, Farland LV, Tobias DK, Gaskins AJ, Spiegelman D, Chavarro JE, RichEdwards JW, Barbieri RL, Missmer SA (2016). A prospective cohort study of endometriosis and subsequent risk of infertility. Hum Reprod, 31:1475–82. doi: 10.1093/humrep/dew085 [Crossref] [PubMed] [Google Scholar]

Retiyansa Y, Indarto D, Murti B (2019). Path analysis on the associations between infertility, stres, and depression among women in surakarta, Central Java. J Matern Child Health, 4(4): 260–266. doi: 10.26911/thejmch.2019.04.04.05 [Crossref] [Google Scholar]

Sanlier N, Yorusun TO (2018). The relationship between infertility and nutrition. J Nutr Health Sci, 5(2): 207. doi: 10.15744/2393-9060.5.207 [Crossref] [Google Scholar]

Rizki S (2017). Gambaran identitas diri pada pasangan infertile di RSUD Dr. Moewardi (The description of self-identity in infertile couples in Dr. Moewardi). Universitas Muhammadiyah Surakarta. [Website]

Setiyono, Awik, Prasetyo B, Maramis M (2015). Pengaruh tingkat stres dan kadar kortisol dengan jumlah folikel dominan pada penderita infertilitas yang menjalani fertilisasi invitro (Effect of stress levels and cortisol levels with the number of dominant follicles in infertility patients undergoing vitro fertilization). Majalah Obstetri Ginekologi 23(3): 128. [Google Scholar]

Tanbo, Tom, Fedorcsak P (2017). Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta Obstet Gynecol Scand 96(6): 659–67. doi: 10.1111/aogs.13082 [Crossref] [PubMed] [Google Scholar]


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