Does Lifestyle Affect Dysmenorrhea Intensity? A Cross-Sectional Study: Apakah Gaya Hidup Mempengaruhi Intensitas Dismenore? Sebuah Studi Cross-Sectional

Objective : To determine whether or not there is a relationship between lifestyle and dysmenorrhea intensity in FKIK Atma Jaya students. Methods : This research is a cross sectional analytic descriptive study with a minimum sample size of 196 students of the FKIK Atma Jaya class 2017-2019. The degree of pain was assessed using the Verbal Multidimensional Scoring System pain scale. Frequency of fast food consumption were assessed with Food Frequency Questionnaire. Frequency of physical activity were assessed with International Physical Activity Questionnaire. The datas were analyzed using the Kolmogorov-Smirnov normality test, the Mann-Whitney U test, and the Kruskal-Wallis test. Results : The highest percentage of menstrual pain was at grade 1 (painful menstruation; rarely disturbed activity; no systemic symptoms; rarely required analgesics) for the VMSS scale (46.3%). The percentage of fast food consumption in this study was 86.1%. The highest percentage of physical activity in the category of moderate physical activity was 56.2%. The results of this study indicates a significant relationship between consumption of fast food and the intensity of dysmenorrhea with p = 0.017. There were no significant relationship between physical activity and the intensity of dysmenorrhea with p = 0.225 Conclusion : Consumption of fast food were related to the intensity of dysmenorrhea, whereas physical activity was not related with the intensity of dysmenorrhea. Keywords : dysmenorrhea, , fast food consumption, lifestyle, physical activity   Abstrak Tujuan : Untuk mengetahui ada tidaknya hubungan gaya hidup dengan intensitas dismenore pada mahasiswa FKIK Atma Jaya. Metode : Penelitian ini merupakan penelitian deskriptif analitik cross sectional dengan jumlah sampel minimal 196 mahasiswa FKIK Atma Jaya angkatan 2017-2019. Derajat nyeri dinilai dengan menggunakan skala nyeri Verbal Multidimensional Scoring System. Frekuensi konsumsi makanan cepat saji dinilai dengan Food Frequency Questionnaire. Frekuensi aktivitas fisik dinilai dengan International Physical Activity Questionnaire. Data dianalisis menggunakan uji normalitas Kolmogorov-Smirnov, uji Mann-Whitney U, dan uji Kruskal-Wallis. Hasil : Persentase nyeri haid tertinggi pada derajat 1 (nyeri haid; aktivitas jarang terganggu; tidak ada gejala sistemik; jarang memerlukan analgesik) untuk skala VMSS (46,3%). Persentase konsumsi fast food dalam penelitian ini adalah 86,1%. Persentase aktivitas fisik tertinggi pada kategori aktivitas fisik sedang adalah 56,2%. Hasil penelitian ini menunjukkan adanya hubungan yang signifikan antara konsumsi fast food dengan intensitas dismenore dengan p = 0,017. Tidak ada hubungan yang bermakna antara aktivitas fisik dengan intensitas dismenore dengan p=0,225 Kesimpulan : Konsumsi fast food berhubungan dengan intensitas dismenore, sedangkan aktivitas fisik tidak berhubungan dengan intensitas dismenore. Kata kunci : aktivitas fisik, dismenore, gaya hidup, konsumsi fast food     &nbsp

The outcome of gynecologic cancer patients with Covid-19 infection: A systematic review and meta-analysis

Background: Cancer is a comorbidity that leads to progressive worsening of coronavirus disease 2019 (Covid-19) with increased mortality. This is a systematic review and meta-analysis to yield evidence of adverse outcomes of Covid-19 in gynecologic cancer. Methods: Searches through PubMed, Google Scholar, ScienceDirect, and medRxiv to find articles on the outcome of gynecologic cancer with Covid-19 (24 July 2021–19 February 2022). The Newcastle-Ottawa Scale tool was used to evaluate the quality of included studies. Pooled odds ratio (OR), 95% confidence interval (CI) and random-effects model were presented. Results: We accepted 51 studies (a total of 1991 gynecologic cancer patients with Covid-19). Covid-19 infection cases were lower in gynecologic cancer vs hematologic cancer (OR 0.71, CI 0.56-0.90, p 0.005). Severe Covid-19 infection and death were lower in gynecologic cancer vs lung and hematologic cancer (OR 0.36, CI 0.16-0.80, p 0.01), (OR 0.52, CI 0.44-0.62, p <0.0001), (OR 0.26, CI 0.10-0.67 p 0.005), (OR 0.63, CI 0.47-0.83, p 0.001) respectively. Increased Covid death was seen in gynecologic cancer vs population with breast cancer, non- Covid cancer, and non-cancer Covid (OR 1.50, CI 1.20-1.88, p 0.0004), (OR 11.83, CI 8.20-17.07, p <0.0001), (OR 2.98, CI 2.23-3.98, p <0.0001) respectively. Conclusion: Gynecologic cancer has higher Covid-19 adverse outcomes compared to non-cancer, breast cancer, non-metastatic, and Covid-19 negative population. Gynecologic cancer has fewer Covid-19 adverse outcomes compared to other cancer types, lung cancer, and hematologic cancer. These findings may aid health policies and services during the ongoing global pandemic. PROSPERO Registration: CRD42021256557 (22/05/21) Keywords COVID-19, Critical care outcome, Female genital neoplasms, Hospitalization, Morbidity, Mortalit

Machine Learning Approach to Predict Clinical Pregnancy Potential in Women Undergoing IVF Program

Objective: Hidden knowledge could be discovered within a large practical data of in vitro fertilization (IVF) practice. In this study, Machine learning–based data mining techniques were utilized to construct a reliable prediction model for clinical pregnancy in IVF. Study Design: A retrospective cohort multicenter study involving 4.570 IVF cycles. All patients underwent fresh embryo transfer at either the cleavage or blastocyst stage between January 2015 and December 2019. The experiment focused on utilizing tree-based classifiers to generate and compare the most effective prediction model that could predict a clinical pregnancy through clinical data. Additionally, each classifier is optimized via a genetic algorithm technique, along with the selection of variables. Results: Both the decision tree and random forest showed similar performance that was much better than the gradient boost. The two superior classifiers achieved a balanced accuracy of roughly 0.62. Additionally, each prediction model was shown to work optimally with different combinations of variables, with some variables being consistently included, such as female age, and some consistently excluded, which provides an insight into the relationship between the variables and each prediction model. Conclusion: Machine learning algorithm remains effective for the purpose of data mining and knowledge extraction in IVF clinical datasets through which a relatively reliable prediction system for clinical pregnancy could be constructed, provided the available data is sufficient. Keywords: In Vitro Fertilization; Prediction Model; Decision Tree; Machine Learning; Artificial Intelligenc

The origin and possible mechanism of embryonic cell‑free DNA release in spent embryo culture media: a review

The presence of cell-free DNA in spent embryo culture media (SECM) has unveiled its possible utilization for embryonic ploidy determination, opening new frontiers for the development of a non-invasive pre-implantation genetic screening tech- nique. While a growing number of studies have shown a high concordance between genetic screening using cell-free DNA (cfDNA) and trophectoderm (TE), the mechanism pertaining to the release of cfDNA in SECM is largely unknown. This review aims to evaluate research evidence on the origin and possible mechanisms for the liberations of embryonic DNA in SECM, including findings on the self-correction abilities of embryos which might contribute to the presence of cfDNA. Several databases including EMBASE, PUBMED, and SCOPUS were used to retrieve original articles, reviews, and opinion papers. The keywords used for the search were related to the origins and release mechanism of cfDNA. cfDNA in SECM originates from embryonic cells and, at some levels, non-embryonic cells such as maternal DNA and exogenous foreign DNA. The apoptotic pathway has been demonstrated to eliminate aneuploid cells in developing mosaic embryos which might culminate to the release of cfDNA in SECM. Nonetheless, there is a recognized need for exploring other pathways such as cross-talk molecules called extracellular vesicles (EVs) made of small, round bi-layer membranes. During in vitro develop- ment, embryos physiologically and actively expel EVs containing not only protein and microRNA but also embryonic DNA, hence, potentially releasing cfDNA of embryonic origin into SECM through EVs. Keywords Apoptosis · Cell-free DNA · In vitro fertilization · Spent embryo culture media · niPGT-

Clinical Pregnancy Is Not Associated with Sperm Quality in POSEIDON Group 1 and 2 Patients

This study is aimed at establishing the effects of varying sperm quality on IVF-ICSI/IMSI outcomes in unexpected poor ovarian responder subjects of POSEIDON groups 1 and 2. In the present study, 1,263 couples with female partners who fulfilled the POSEIDON group 1 and 2 criteria were recruited. All couples underwent ICSI or IMSI at Morula IVF Jakarta Clinic, Indonesia. Patients were subsequently classified into six groups, according to semen conditions of the respective male partners: (1) normozoospermic, (2) teratozoospermia, (3) oligoasthenoteratozoospermia (OAT), (4) asthenozoospermia, (5) severe OAT, and (6) cryptozoospermia. Laboratory and clinical outcomes of the IVF-ICSI/IMSI program were then evaluated. Early and late embryonic development parameters including the number of fertilization, cleavage and blastocyst stages, and blastocyst quality differed significantly among the different sperm quality groups (p < 0:05). No difference was observed in the number of embryo transfers and clinical pregnancy among the studied groups (p > 0:05). Our study has demonstrated the effect of sperm quality on embryo development at the early and later stages; however, the clinical pregnancy was not impaired in the unexpected poor responders of POSEIDON groups 1 and 2

CC-Human Menopausal Gonadotropin Combined with Growth Hormone in Mini-stimulation Protocol could Improve Clinical Outcome in Poor Ovarian Responders

Objective: To investigate the role of CC-highly purified Human Menopausal Gonadotropin (hpHMG) and Growth Hormone (GH) in mini-stimulation protocol to improve outcome in poor ovarian responders (POR). Method: All patients were given clomiphene citrate 150 mg from day 3 to day 7 of menstrual cycle followed by 150 IU hpHMG daily from day 8 until ovulation trigger. Two groups were observed where one group received GH and the other arm did not. In the GH group, 8 IU of GH were given from day 1 of stimulation until stimulation was stopped. GnRH antagonist was used to suppress ovulation. Result: Among 51 eligible women, 29 patients with GH and 22 patients without GH, no difference was observed in the number of oocytes retrieved (2.21 versus 2.64) and the number of embryos transferred (1.24 versus 1.68) in the GH group versus the group without GH, respectively. Total clinical pregnancy rate was 17.6%. No significant difference in pregnancy and ongoing pregnancy rate in both groups (17.2% versus 18.2%) and (13.8% versus 13.6%), respectively. In patients older than 40 years old, GH showed a 4-fold likelihood in producing top quality embryos (44.8% vs 13.6%, OR=3.6, p=0.05). Conclusion: CC-HMG regimen in mini-stimulation protocol is an effective option in poor responders. Additional GH in ministimulation program provided a higher number of top quality embryos in women older than 40 years old, although there were no difference in clinical or ongoing pregnancy rate. Keywords: CC-HMG, growth hormone, IVF, mini-stimulation protocol, poor ovarian responder

Association between estradiol levels and clinical outcomes of IVF cycles with single blastocyst embryo transfer

Objective: To determine the correlation of different serum estradiol levels on the trigger day with the clinical and laboratory outcomes of in-vitro fertilization (IVF) cycles comprising a single fresh topquality blastocyst transfer. Methods: This was a retrospective observational study performed in Morula IVF Clinic Jakarta. Five hundred forty-two women were recruited and grouped according to their serum estradiol levels on the trigger day of follicular maturation as follows: <2 000 pg/mL, 2 000-2 999 pg/mL, 3 000-3 999 pg/mL, and ≥4 000 pg/mL. Clinical pregnancy and miscarriage rates were evaluated as the primary outcomes and embryology laboratory results as the secondary outcomes which consisted of the number of retrieved, mature, and fertilized oocytes, the total sum of derived embryos, and top-quality embryos at cleavage and blastocyst stage. Results: Clinical pregnancy and miscarriage rates did not differ among the groups (P>0.05). Nonetheless, the study demonstrated a positive correlation of the serum estradiol levels with the overall laboratory outcomes including the number of retrieved, mature, and fertilized oocytes, the total sum of derived embryos, and top-quality embryos at cleavage and blastocyst stage (P<0.001). The subject group with estradiol level of ≥4 000 pg/mL was superior to the other groups in its respective median number of retrieved, mature, fertilized oocytes, total derived embryos, and top-quality cleavageand blastocyst-stage embryos. Conclusions: Although an apparent positive correlation is observed between estradiol levels and laboratory outcomes, serum estradiol level on hCG trigger day is not associated with the clinical outcomes of IVF. KEYWORDS: In-vitro fertilization; Estradiol; IVF outcomes; Single blastocyst transfe