Knowledge, attitudes, and behaviors of practitioners supporting cancer patients in fertility preservation in DKI Jakarta: A crosssectional study

Background: More than 135,000 people aged under 45 yr are diagnosed with cancer annually in Indonesia. Good detection and management of cancer increase the quality of life. Objective: To determine the knowledge, attitudes, and behaviors of practitioners supporting cancer patients in fertility preservation. Materials and Methods: This cross-sectional study was conducted in 18 type D government hospitals and Dr. Cipto Mangunkusumo Hospital, in Jakarta, Indonesia, between January 2018 and August 2019. This study involved practitioners providing care to cancer patients. Data were described descriptively. Results: Most of the general practitioners, specialists, and subspecialists who participated in this study were aged 26-30 yr (65.4%), 31-35 yr (70.4%), and 31-40 yr (53.0%), respectively. The fertility treatment most known by general practitioners was in vitro fertilization with embryo cryopreservation (12.1%); for specialists it was sperm cryopreservation (24.5%). Meanwhile, subspecialists knew most about in vitro fertilization with embryo cryopreservation and sperm cryopreservation using a GnRH agonist (such as leuprolide injection) pre-cancer treatment (13%). A positive attitude towards fertility preservation as an important priority for cancer patients was shown in 72.0% of general practitioners, 73.3% of specialists, and 100% of subspecialists. General practitioners mostly referred patients to fertility specialists (44.4%). Many specialists (54.9%) and subspecialists (67%) discussed the possible impact of the patient’s condition and / or treatment on fertility. Conclusion: The knowledge of and practices related to fertility preservation differed among general practitioners, specialists, and subspecialists. However, positive attitudes among them were similar. Key words: Knowledge, Attitude, Practice, Doctor, Fertility preservation

Expression of CA-125 Level And Neutrophil to Lymphocyte Ratio In Infected And Non-infected Endometrioma

Implantation and growth of endometriosis was determined by immune cell. There were several immunologic cells that promoting implantation and cell proliferation such as macrophages, Natural killer, lymphocyte and monocyte. Infected endometrioma was associated in women with revised American Society for Reproductive Medicine (ASRM) stage III-IV. Neutrophil lymphocyte ratio (NLR) was a simple systemic inflammation response markers. The sensitivity and spesificity CA-125 in predicting endometrioma was very low but it had been used to monitor the progress of endometriosis. Therefore, measuring mean in leucocyte, NLR, PLR and CA-125 level in infected endometrioma was necessary.

Knowledge, attitude, intention, and religion aspect toward fertility preservation among obstetrics and gynecology residents in Indonesia: A cross-sectional study

Background: The lack of knowledge from healthcare providers regarding fertility preservation will certainly affect the patient’s knowledge, attitude, behavior, and also perspective. Obstetrics and Gynecology (OB/GYN) residents may most likely be the first line professionals to integrate fertility preservation technologies into their practice which plays an important task in giving an understanding of the relationship between age and fertility for patients. Objective: This study aims to assess OB/GYN resident knowledge and beliefs regarding age-related fertility decline, intentions, and religion aspect toward fertility preservation. Materials and Methods: A cross-sectional study was conducted on 92 Indonesian OB/GYN residents at the Cipto Mangunkusomo Hospital between November and December 2017. Data were collected using a questionnaire which had four sections, knowledge, attitude, intention, and religion aspect toward fertility preservation. Results: The majority of participants believed that an OB/GYN should encourage discussions about potential childbearing desires (96.74%) and age-related fertility decline (94.57%) with patients, of which 79.34% believed that these discussions should be part of a woman’s annual health examination. Cancer patients are likely to undergo oocyte cryopreservation than people who choose career as priority. From the religion aspect, fertility preservation options such as sperm, oocyte, embryo, and ovarian cortex cryopreservation were accepted by most residents with varied religions, while oocyte and sperm donor methods were unacceptable (48% and 57%, respectively) because of the belief that oocyte/sperm should only be given to legitimate partners, but many still do not know that oocyte and sperm donor were prohibited by all religions. Conclusion: Age-related fertility decline and frozen egg storage should be discussed during annual woman wellness examinations by OB/GYN specialists. Key words: Knowledge, Attitude, Intention, Fertility preservation

Combination of electroacupuncture and pharmacological treatment improves insulin resistance in women with polycystic ovary syndrome: Double-blind randomized clinical trial

Background: Acupuncture is a nonpharmacological treatment which has been known to improve ovulatory function in polycystic ovary syndrome (PCOS) women. Acupuncture modulates the somatic and autonomic nervous systems, which regulate endocrine and metabolic functions to impact ovulatory functions. Objective: To investigate the effectiveness of electroacupuncture (EA) and pharmacological combination therapy on improving insulin resistance in women with PCOS. Materials and Methods: This double-blind, randomized clinical trial was performed on 44 participants from March to September 2018 at Cipto Mangunkusumo National hospital, Jakarta, Indonesia. Participants were randomly allocated to treatment (true EA + medication) and control group (sham EA + medication) in a 1:1 ratio using a web-based computer random-number generator. Randomization was carried out by an independent project manager. Both groups received 12 sessions of acupuncture therapy and metformin as pharmacological therapy. Results: This study showed a significant decrease in the Homeostatic Model Assessment for Insulin Resistance index in the true EA + medication group before and after therapy (p = 0.014). Conclusions: The combination of EA and pharmacological therapy effectively improves insulin sensitivity in women with PCOS. Key words: Acupuncture, PCOS, Insulin resistance, HOMA-IR

Influence of internet, mobile phone use, and sociodemographic factors on women’s knowledge and attitude towards contraception in Indonesia

Objective Rapid population growth has been a problem in Indonesia for several decades. One of the reasons for this phenomenon is limited knowledge of reproductive health and proper contraception methods. The use of mobile phones and the internet has made it easier to access health information. This study aimed to determine the influence of the internet, mobile phone use, and sociodemographic factors on Indonesian women’s knowledge of and attitudes toward contraception. Methods The present study used secondary data from the 2017 Indonesian Health and Demographics Survey. Altogether, 49,627 women participated in this study. Descriptive statistics were performed, and bivariate analysis using the chi- squared test was performed to measure the association between variables. Results Knowledge about the ovulation cycle and contraception was positively associated with mobile phone ownership, frequent internet use, higher wealth index, reading printed media, listening to the radio, watching the television, higher educational level, and older age. The use and intention of contraception were positively associated with lower wealth index, watching television at least once a week, primary-secondary educational level, rural residence, and older age. Thus, acquisition of knowledge does not necessarily translate into implementation of contraceptive methods, since there might be certain digital and social barriers. Conclusion Access to the internet and mobile phones as well as certain sociodemographic factors have contributed to an increase in women’s knowledge about contraception, but not necessarily in their knowledge regarding the use of contraception. Keywords: Contraception; Reproductive health; Internet; Women; Indonesi

Influence of internet, mobile phone use, and sociodemographic factors on women’s knowledge and attitude towards contraception in Indonesia

Objective Rapid population growth has been a problem in Indonesia for several decades. One of the reasons for this phenomenon is limited knowledge of reproductive health and proper contraception methods. The use of mobile phones and the internet has made it easier to access health information. This study aimed to determine the influence of the internet, mobile phone use, and sociodemographic factors on Indonesian women’s knowledge of and attitudes toward contraception. Methods The present study used secondary data from the 2017 Indonesian Health and Demographics Survey. Altogether, 49,627 women participated in this study. Descriptive statistics were performed, and bivariate analysis using the chi-squared test was performed to measure the association between variables. Results Knowledge about the ovulation cycle and contraception was positively associated with mobile phone ownership, frequent internet use, higher wealth index, reading printed media, listening to the radio, watching the television, higher educational level, and older age. The use and intention of contraception were positively associated with lower wealth index, watching television at least once a week, primary-secondary educational level, rural residence, and older age. Thus, acquisition of knowledge does not necessarily translate into implementation of contraceptive methods, since there might be certain digital and social barriers. Conclusion Access to the internet and mobile phones as well as certain sociodemographic factors have contributed to an increase in women’s knowledge about contraception, but not necessarily in their knowledge regarding the use of contraception

Trans-arterial embolization of acquired uterine arteriovenous malformation after Cesarean section: A case series

Background: Acquired uterine arteriovenous malformation (AVM) is a rare condition due to traumatic episodes in cesarean section. The patient can suffer from life-threatening hemorrhage or recurrent vaginal bleeding. Establishing this diagnosis is difficult, often misdiagnosed due to lack of information and number of cases. Trans-Arterial Embolization (TAE) procedure is rarely performed in our center. All of the cases were found with history of massive bleeding and diagnosed lately after recurrent bleeding history. Even though promising, one of our cases failed to be managed with TAE. It is important to diagnose early symptoms of AVM in order to prevent the life-threatening event. Case presentation: In this case series, four cases of AVMs after cesarean procedures will be reviewed. One could be diagnosed in less than a month but the other three took several months. The symptom of vaginal bleeding might occur a few weeks after the procedure is done, and most patients need transfusion and hospitalization. Three out of four patients were initially sent to the hospital in order to recover from shock condition, and one patient was sent for a diagnostic procedure. AVMs diagnostic was established with ultrasound with or without angiography. Three of our cases were succeeded by performing TAE procedure without further severe vaginal bleeding. One case failed to be treated with embolization and had to proceed with hysterectomy. Conclusion: AVM should be considered early-on in patient with abnormal uterine bleeding and history of cesarean section. Embolization is still the first-choice treatment of AVMs, otherwise, definitive treatment is hysterectomy in a patient without fertility need, or impossible to perform TAE. Key words: Trans-arterial embolization, Acquired uterine arteriovenous malformation, Cesarean section

Correlation of anti-Müllerian hormone levels with metabolic syndrome events in polycystic ovary syndrome: A cross-sectional study

Background: Various endocrine disorders have been reported in women of reproductive age, 10% of which is affected by polycystic ovary syndrome (PCOS). Objective: This study aimed to evaluate the correlation of anti-Müllerian hormone (AMH) levels with the metabolic syndrome in patients with PCOS. Materials and Methods: This cross-sectional study employed a consecutive sampling method using medical records from January 2013 to December 2017 at Dr. Cipto Mangunkusumo General Hospital polyclinic and Yasmin in vitro fertilization Clinic (Kencana), Jakarta, Indonesia. The primary outcome of the study was the AMH levels as independent variable correlated with metabolic syndrome. The secondary outcome was also the AMH levels correlated with each PCOS phenotype. The tertiary outcome was each PCOS phenotype as independent variable correlated with metabolic syndrome. Results: Women with phenotype 1 of PCOS had a median AMH level of 13.92 (range: 3.88-34.06) ng/ml. 21% patients had metabolic syndrome, with a median AMH level 7.65 (3.77-20.20) ng/ml, higher than the women without metabolic syndrome (p = 0.38). The most frequent phenotype in women with PCOS was phenotype 4, oligo- or anovulation and polycystic ovary morphology (OA/PCOM) in 41.3%. The most frequent phenotype in women with metabolic syndrome was phenotype 1, OA + PCOM + hyperandrogenism in 56.5%. Conclusion: All PCOS phenotypes exhibited significant correlations with the AMH level. Phenotype 1 (OA + PCOM + hyperandrogenism) was associated with the highest AMH level and was significantly associated with metabolic syndrome. Key words: Anti-Müllerian hormone, Metabolic syndrome, Polycystic ovary syndrome

Analysis of factors associated with ovarian reserve in a group of poor responders to in vitro fertilization: A cross-sectional study

Background: Poor ovarian reserve and a high rate of pregnancy failure associated with low quality and quantity of oocytes are observed in poor responders to in vitro fertilization. Objective: To assess the effect of age, body mass index (BMI), endometriosis, and history of ovarian surgery on ovarian reserve in a group of poor responders. Materials and Methods: In this cross-sectional study 749 women who referred to Yasmin Clinic of Dr Cipto Mangunkusumo National General Hospital from January 2013 to June 2017 were enrolled. Two definitions of poor responders and Poseidon criteria and consecutive sampling techniques were used. Participants were divided into good and poor responder groups based on the ovarian reserve test; participant with oocyte ≤ 3 was classified as a poor responder. Based on this, 188 participants with nine (4-47) oocytes were included in the poor responder group. While good responder comprised of two (0-3) oocytes. Results: Age and anti-Mullerian hormone level (AMH) were significantly associated with ovarian reserve in the poor-responder group (p < 0.001). However, in multivariate analyses, age was the only significant predictor of ovarian response in the poor responder group (p = 0.004). While endometriosis was the significant predictor of Poseidon groups 1 and 4, surgical history was the significant predictor of Poseidon groups 2 and 3. Meanwhile, an increase in BMI decreased the risk of classification under Poseidon group 3. Conclusion: Age, AMH, BMI, endometriosis, and history of ovarian surgery affected the risk of classification of the Poseidon group. Key words: Ovarian reserve, Poseidon, In vitro fertilization

Correlation between luteinizing hormone receptor gene expression in human granulosa cells with oocyte quality in poor responder patients undergoing in vitro fertilization: A cross-sectional study [version 1; peer review: 2 approved, 1 approved with reservations]

Background: This study was performed to evaluate the role of luteinizing hormone (LH) and granulosa cell LH receptor (LH-R) in poor responder patients who underwent controlled ovarian stimulation. Expression levels of LH-R mRNA in granulosa cells was investigated and compared with oocyte morphology, oocyte maturity and fertilization rate.  Methods: Granulosa cells were obtained from 30 patients who underwent in vitro fertilization (IVF) at Dr. Cipto Mangunkusumo Hospital, Jakarta. The patients were divided into two groups: group I (n=10) poor responders; and group II (n=20) non-poor responders. After the extraction of total RNA from granulosa cells, semi-quantitative RT-PCR was performed and the amount of LH-R mRNA was quantified. The relative values were calculated as the ratio of LH-R mRNA and actin beta mRNA. Statistical analysis was performed using Mann-Whitney test and Spearman correlation.  Results: The relative value of LH-R mRNA was higher in group I compared with group II (27.37[0.00-28939.37] vs 0.00[0.00-7196.12]). Oocyte maturity (r=0.267) and morphology (r=0.267) in group I consistently showed a positive correlation with LH-R mRNA; in group II a negative correlation with LH-R mRNA was shown for oocyte maturity (r= -0.552) and morphology (r= -0.164). Group I had a positive correlation between LH-R expression with fertilization rate (r=0.430), and group II showed a negative correlation (r=-0.340).  Conclusions: The expression of LH-R mRNA has a positive correlation with oocyte quality in poor responder patients and a negative correlation in non-poor responders. Our study suggests an optimal expression of LH- R mRNA in granulosa cells during controlled ovarian stimulation to obtain good quality oocytes