Effects of Metformin Therapy on Anti-Mullerian Hormone (AMH) Levels in Polycystic Ovary Syndrome Patients with Insulin Resistance at Palembang

Anti-Mullerian Hormone is useful in examining folliculogenesis and ovarian abilities. Previous research found that follicular fluid and serum in PCOS women containing high AMH levels. As therapy in PCOS with insulin resistance, metformin, an insulin sensitizer agent can be given. The efficacy of metformin therapy in inducing ovulation is more due to the local action of metformin on the ovaries rather than the systemic improvements that result both metabolically and hormonally. We conducted this study to evaluate the levels of Anti-Mullerian Hormone (AMH) in women with polycystic ovarian syndrome (PCOS) with insulin resistance before and after metformin therapy. An analytic observational study with cross-sectional design. Seventy PCOS women with insulin resistance, taking metformin for 3 months, were enrolled in this study. Serum levels of AMH was assessed before and after treatment, and the difference between them was analyzed with student t-test. Diagnosis of PCOS is made based on Rotterdam criteria and insulin resistance by HOMA-IR calculation. This study was conducted at the Fertility and Reproductive Endocrinology Polyclinic of Dr. Mohammad Hoesin Palembang hospital and Imaya clinic. The mean age of PCOS patients with insulin resistance ranges from 25-30 years, with a mean age of 28.61±3.883. The mean AMH levels prior metformin therapy was 7.6957±0.6001 ng/ml; mean AMH after therapy was 7.5914±0.57678 ng/ml; and there are significant differences (p <0.001). The mean AMH levels in all patients were 0.10429. Based on body mass index (BMI), a total of 52 respondents (74.29%) met the criteria for obesity and 18 respondents (25.71%) nonobese. There is a relationship between AMH levels and the number of follicles (p <0.01), with an OR of 1.5. AMH levels decreased significantly after metformin therapy in PCOS patients with insulin resistance

Hubungan Polycystic Ovary Syndrome(PCOS)dengan Infertilitas di Praktik Swasta Dokter ObstetriGinekologi Palembang

Sindrom Ovarium Polikistik (SOPK) merupakan salah satu kelainan endokrin dan metabolik yang sering terjadi pada wanita usia reproduksi. SOPK merupakan kumpulan gejala dari amenorrhea, oligomenore, infertilitas, obesitas, hirsutisme, acne, alopesia, dan akantosis nigrikan. Dari seluruh perempuan usia reproduksi yang tersebar di dunia,  sebanyak 4-18% diantaranya mengalami SOPK. SOPK menyebabkan  5-10% wanita usia reproduktif menjadi infertilitas. Oleh karena itu, penelitian ini dilakukan untuk mengetahui hubungan antara SOPK dan infertilitas.Penelitian menggunakan metode observasional analitik dengan desain potong lintang. Sampel diambil dari data sekunder di Praktik Pribadi Dr. dr. Rizani Amran, SpOG(K) periode Agustus 2014-Juli 2017. Teknik pengambilan sampel menggunakan metode konsekutif. Data di analisis menggunakan uji Kai-kuadrat.Dari 249 orang (79,6%) SOPK, 77,8% amenorrhea/oligomenorrhea, 92,2% obesitas, 99% hirsutisme dan 89,6% infertilitas. Uji Kai-kuadrat menunjukkan nilai p = 0,000 (p-value <  5%) dan nilai PR = 8,572.Terdapat hubungan yang sangat bermakna antara SOPK dan infertilitas.Orang yang mengalami SOPK berisiko 8,572 kali lebih besar untuk mengalami infertilitas dari pada orang yang tidak mengalami SOPK

Serum Vascular Endothelial Growth Factor (VEGF) in DMPA Acceptors: Influence on Bleeding Occurrence

Objective: To analyze the relationship between levels of serum vascular endothelial growth factor (VEGF) and bleeding occurrence in depo medroxyprogesterone acetate (DMPA) acceptors. Method: We employed a cross‐sectional study on 70 DMPA acceptors with DMPA use of 3 to 6 months who presented for midwifery service in Palembang. Blood samples were obtained in order to assess levels of serum VEGF using ELISA (enzyme‐linked immunoabsorbent assay) method. Laboratory assessments were carried out in PRODIA laboratory in Jakarta. Result: We recruited 70 subjects into our study. After 3 to 6 months of using DMPA, as much as 26 subjects (37.1%) reported complaints of bleeding and 44 subjects (62.9%) reported no bleeding. The mean level of serum VEGF in DMPA acceptors with bleeding was 355 K 170 pg/ml, and 323 K 202 pg/ml in acceptors with no bleeding. We identified a significant association between duration of use and bleeding occurrence (p0.05). Conclusion: In our sample, we found an association between duration of DMPA use and presence of bleeding but VEGF levels was not found to be different in women experiencing abnormal uterine bleeding and those who did not. Keywords: bleeding, DMPA acceptor, serum VEG

Serum Vitamin D Levels, Visual Analog Scale Dysmenorrhea Score, and Endometriosis ASRM Classification: a Relationship Study

Objective: To assess the correlation between vitamin D levels, dysmenorrhea intensity measured by the visual analogue scale (VAS), and the stage of endometriosis determined by the American Society of Reproductive Medicine (ASRM) grading score. Methods: A cross-sectional study was conducted involving 37 women diagnosed with suspected endometriosis who met the inclusion and exclusion criteria. The aim was to determine the correlation between vitamin D levels, dysmenorrhea VAS scores, and the ASRM endometriosis stage at RSUP Dr. Mohammad Hoesin Palembang from November 2021 to April 2022. Bivariate analysis was employed to assess correlation, utilizing Pearson's correlation test and the Spearman Rank correlation test as an alternative method. Results: There was a significant positive correlation between vitamin D levels and the VAS score for dysmenorrhea (r = 0.678; p = 0.000) and a very strong positive correlation between vitamin D levels and the degree of endometriosis (r = 0.774; p = 0.000) based on Spearman Rho's correlation test. Conclusion: There is a significant relationship between vitamin D levels with the VAS score of dysmenorrhea and the degree of endometriosis ASRM. Keywords: american society of reproductive medicine, endometriosis, visual analogue scale, vitamin

A Randomized FiveYear Comparative Study of Two LevonorgestrelReleasing Implant Systems: Norplant® Capsules and Jadena® Rods

Objective: To provide a randomized comparison between Jadena® and Norplant® in terms of efficacy and acceptability among Indonesian women. Method: This study was a phase IV, open label, randomized, multicenter study throughout Indonesia. Subjects were Indonesian adult women who were randomized to receive Jadena® or Norplant® as their contraceptive method. The subjects were recruited from 6 large cities in Indonesia, such as Medan, Palembang, Jakarta, Semarang, Surabaya, and Makassar. Result: Of 600 subjects, 301 women getting to Jadena® and 299 women to Norplant® were enrolled between August 1998 and February 1999. The mean age was 29.8 (SD 5.3) years old, ranging from 18 to 40 years old. We did not find the pregnancy during the study. Non-pregnancy probability at the end of one year was similar between Jadena® (0.920 (SD 0.016)) and Norplant® users (0.916 (SD 0.084)). The continuation rates of Jadena® at one and three-year were 95.3% and 66.8%; whereas, the continuation rates of Norplant® was 94.3% at year-1 and 70.2% at year-3. Conclusion: The new two rod levonorgestrel subdermal system (Jadena®) showed similar efficacy with the old six capsule levonorgestrel subdermal system (Norplant®) in term of birth control. Both implant systems also have similar tolerability profile. Jadena® is easier to insert and remove than Norplant®. Keywords: birth control, efficacy, implan

Abnormal Uterine Bleeding in Adolescent

Abnormal uterine bleeding (AUB) is defined as the abnormal bleeding from the uterine corpus in term of duration, volume, frequency and/or regularity. This condition occurs in 37% of adolescents and may affect the quality of life and increased hospitalization. Etiology is divided into structural and non-structural causes, known as PALM-COEIN. The most common etiology in adolescents is anovulatory menstruation due to immature hypothalamus-hypophysis axis. Diagnostic evaluation should include investigation in the etiology of AUB, anemia signs, and hemodynamic status. Treatment of AUB consists of hormonal and non-hormonal therapy. Therapy in adolescent is given based on the severity of bleeding, grading of anemia, and hemodynamic stability. Follow-up is required after therapy. Understanding AUB in adolescents can help clinicians deliver appropriate and comprehensive treatment. This review was aimed to explain about definition, epidemiology, etiology, pathophysiology, diagnosis, and treatment of abnormal uterine bleeding in adolescent

A multicentred phase III comparative study between single-implant containing 3-ketodesogestrel (Implanon^®) and implants containing levonorgestrel (Norplant^®) II. Vaginal bleeding patterns

<span>[no abstract available]</span

A multicentred phase III comparatiye study between single-implant containing 3-ketodesogestrel (Implanon^®) and implants containing levonorgestrel (Norplant^®) I. Effïcacy, acceptability and safety (three-year results)

[no abstract available