Luaran Transfer Embrio Simpan Beku pada Pasien Endometriosis Pasca Operasi dan Non Endometriosis yang Menjalani IVF di Klinik Permata Hati RSUP Dr. Sardjito

Background: Endometriosis is a chronic condition that is influenced by the hormone estrogen which affects women of childbearing age, and is associated with pelvic pain and infertility. In Vitro Fertilization (IVF) is currently the most efficient assisted reproductive technology and its high success rate is often done for infertility therapy in women associated with endometriosisObjective: The aim of this study is to determine whether postoperative endometriosis affected pregnancy outcomes in patients underwent frozen embryo transfer in IVF / ICSI programs.Method: This Research is done with a retrospective cohort design. The data was taken from medical records, research subjects who met the inclusion and exclusion criteria. The research data was collected, processed and analyzed using SPSS 23. Univariate, bivariate and multivariate data analysis was carried out to determine the effect between variablesResult: There were 458 research subjects in this study. Endometriosis patients were 119 subjects (26%). 57 subjects were categorized as minimum-mild endometriosis (47.9%) and moderate-severe subjects as many as 62 subjects (52.1%). The biochemical pregnancy rate (36.31%) and clinical pregnancy (29.4%) in patients with endometriosis was slightly higher than in non-endometriosis. But statistically it did not affect success rate of achieving biochemical (p = 0.428; RR 0.89; 95% CI: 0.71-1.24) and clinical pregnancy (p = 0.535; RR 0.883; 95% CI: 0.63- 1.22). The rate of miscarriage in postoperative endometriosis patients was higher than non-endometriosis patients (88.6% vs 80.7%) but was not statistically significant (p = 0.294; RR 1.69; 95% CI: 0.61-4.67) . Biochemical and clinical pregnancies were significantly affected by age, infertility, endometrial thickness, embryo age and embryo quality. The incidence of miscarriage was affected by the ovarian stimulation protocol.Conclusion: Endometriosis post operative statistically has no effect on pregnancy outcomes in the IVF / ICSI cycle with frozen embryo transfer compared with another cause of infertility .Keywords:Endometriosis, In Vitro Fertilization, Clinical pregnancy, biochemical pregnancy, miscarriag

Comparison of postthawing sperm motility recovery between cryopreserved with and without cryoprotective agent using 4 different cryopreservationmethods

Frozen-thawed human spermatozoa are routinely used for many assisted reproduction program.However, cryopreserved spermatozoa was reported to yield lower pregnancy rates compared tofresh semen in both intra uterine inseminations and in vitro fertilization/intracytoplasmic sperminjection (IVF/ICSI) due to the reduction of sperm motility and viability induced by cryopreservationprocedures. This study was aimed to evaluate the influence of cryoprotective agent (CPA) andcryopreservation methods on human sperm motility. This was a quasi experimental study. Thirtyseven normozoospermic semen samples collected in Permata Hati Infertility Clinics of Dr. SardjitoGeneral Hospital, Yogyakarta were recruited. Four different cryopreservation methods were appliedusing and without CPA (TEST-yolk buffer). In simple two steps freezing, cryostraw were graduallyfrozen from 8 to -4°C. In simple graduated freezing, cryostraus were directly frozen at -4°C. Invapor phase freezing method, the samples in cryostraw were placed 1 cm above liquid nitrogen.In the last method, the samples were directly submerged into liquid nitrogen. Thawing wasconducted by incubation at 37°C for 5 minutes. The sperm motility recovery after cryopreservationin the 4 different cryopreservation methods was evaluated and analyzed by analysis of variance(ANOVA). The fresh sperm motility before cryopreservation was 52.9 ± 4.50%. The recovery ofmotile sperms was 17.00 ± 7.83%, 20.96 ± 5.81%, 15.06 ± 8.55% and 15.68 ± 8.3%, whenusing CPA and 5.63 ± 4.63%, 5.47 ± 3.95%, 4.45 ± 4.46% and 6.08 ± 5.06% when withoutCPA following direct plunge to liquid nitrogen freezing, vapor liquid nitrogen freezing, simplegraduated freezing and simple 2-steps freezing, respectively. Among methods using CPA, thevapor phase method resulted in highest sperm motility recovery. In methods without CPA, nosignificant difference of sperm motility recovery was observed among the 4 differentcryopreservation methods. In conclusion, the use of CPA for cryopreservation improves spermmotility recovery

Hubungan peningkatan kadar progesteron pada saat pengambilan oosit terhadap keberhasilan Fertilisasi In Vitro

Latar belakang:Fertilisasi In Vitro (FIV) semakin banyak digunakan dalam penanganan infertilitas di Indonesia. Banyak penelitian yang mempelajari pengaruh peningkatan kadar progesteron saat pengambilan oosit dalam keberhasilan FIV, namun hasil yang diperoleh masih bersifat kontroversi.Tujuan: Mengetahui hubungan peningkatan kadar hormon progesteron saat pengambilan oosit dengan keberhasilan FIV.Metode: Penelitian ini menggunakan metode kohort retrospektif melibatkan 210 siklus FIV dari Januari 2014 sampai Desember 2016. Subyek penelitian dibagi menjadi dua kelompok berdasarkan kadar progesteron saat pengambilan oosit. Kelompok pertama dengan kadar progesteron 0,05). Pada analisis bivariat, terdapat peningkatan signifikan dari kadar estradiol pasca stimulasi dan jumlah folikel (RR 2,00 IK 1,57-2,55, p<0,0001 dan RR 1,86, IK 1,47-2,36, p<0,0001);  jumlah oosit (RR 1,99, IK 1,61-2,48, p<0,0001), dan jumlah embrio (RR 1,99 IK 1,62-2,43; p<0,0001) pada kelompok dengan kadar progesteron tinggi. Dari analisis multivariat, peningkatan jumlah oosit merupakan satu – satunya faktor yang secara signifikan meningkatkan rasio kehamilan pada FIV (RR 3,36 IK 1,04-10,87; p<0,05).Kesimpulan:Pada penelitian ini tidak terdapat perbedaan signifikan rasio kehamilan pada FIV dengan peningkatan kadar hormon progesteron pada pengambilan oosit. Jumlah oosit yang dipanen secara signifikan meningkatkan keberhasilan kehamilan pada FIV, dan jumlah oosit juga signifikan meningkat pada kelompok dengan kadar progesteron tinggi.Kata kunci: progesteron; oosit; Fertilisasi In Vitr

PERBANDINGAN FRAGMENTASI DNA FOLIKEL PRIMER JARINGAN KORTEKS OVARIUM FRESH NON TRANSPLAN, FRESH TRANSPLAN, VITRIFIKASI NON TRANSPLAN DAN VITRIFIKASI TRANSPLAN PADA MODEL BINATANG

Latar Belakang: Kriopreservasi jaringan ovarium merupakan salah satu pendekatan cara mempertahankan fertilitas pada wanita yang diprediksi mengalami kegagalan ovarium prematur sebagai konsekuensi dari kemoterapi, radioterapi atau kelainan genetik. Kriopreservasi dengan vitrifikasi menjadi fokus investigasi meskipun masih terdapat kontroversi terhadap hasil akhirnya, karena belum ada protokol optimal untuk vitrifikasi serta data vitrifikasi jaringan ovarium manusia masih terbatas dan berlainan hasil Tujuan: Mengevaluasi metode vitrifikasi modifikasi Suzuki pada folikel primer jaringan korteks ovarium Metode: Metode penelitian ini menggunakan uji eksperimental jenis one shot case study dengan menggunakan 28 jaringan korteks ovarium kambing (Capra aegagrus hircus) yang terbagi dalam 4 perlakuan yaitu jaringan korteks ovarium fresh non transplan, jaringan fresh ditransplantasikan ke CAM (chorioallantoic membrane) ayam, jaringan di vitrifikasi non transplan dan jaringan di vitrifikasi yang ditransplantasikan ke CAM. Penilaian fragmentasi DNA folikel primer pada setiap grup dilakukan dengan metode TUNEL (TdT-mediated dUTP-biotin nick end labeling) yang dilakukan di laboratorium fisiologi Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan Universitas Gadjah Mada Yogyakarta. Analisis statistik data penelitian dilakukan dengan uji ANOVA.Hasil: Fragmentasi DNA pada folikel primer grup fresh non transplan : 17,39 %, fresh transplan : 12,5 %, vitrifikasi non transplan : 17,39 % dan vitrifikasi transplan 7,4 %. Uji komparasi 4 grup didapatkan p = 0.782 (p&lt;0.05).Kesimpulan: Tidak terdapat perbedaan signifikan fragmentasi DNA folikel primer jaringan korteks ovarium antara fresh non transplan, fresh transplan, vitrifikasi non transplan dan vitrifikasi transplan yang menunjukkan metode vitrifikasi modifikasi Suzuki dapat mempertahankan folikel dari fragmentasi DNA

Perbandingan hasil stimulasi ovarium dengan kombinasi klomifen sitrat gonadotropin dan klomifen sitrat pada inseminasi intra uteri

Background: Infertile couple with the cause of unexplained infertility and male factor can follow intrauterine insemination (IUI) program as a cheap and easy method for infertility therapy. Ovarian stimulation by combination of clomiphene citrate and gonadotropin and also clomiphene citrate alone was done as a superovulation mode to get higher number of mature follicle to gain higher pregnancy rate. Objective : To compare the amount of mature follicles and  endometrial thickness as an outcome of ovarian stimulation between combination drug of clomiphene citrate and gonadotrophin with clomiphene citrate alone.Methods: Observational retrospective cohort. Subject is one cycle intrauterine insemination stimulated either by combination CC gonadotrophin or CC alone, eligible in inclusion criteria and exclusion criteria. Statistic test used was independent t-test, chi-square and logistic regression.Location of study: Infertility Clinic of  Permata Hati, dr. Sardjito Hospital, Yogyakarta.Result: A total of 142 cycle from 98 couples followed IUI and stimulated by combination CC gonadotrophin (n=72) or CC alone (n=70). Multiple mature follicle number was different and statistically significant 77% vs 54%, RR 1,433 (IK95% 1,118-1,836), p=0,005, while endometrial thickness > 7mm was more frequent in combination group but not statistically different with percentage 81,9% vs 74,3%, RR 1,103 (CI95% 0,926-1,315), p=0,367.Conclusion: Ovarian stimulation by combination CC gonadotropin resulting of more multiple mature follicle number while  good endometrial thickness was more in combination group but not statistically significant.Keywords: ovarian stimulation, clomiphene citrate, gonadotrophin, multifollicular, endometrial thicknes

Indications and Complications of Obstetrical Hysterectomy: Sardjito Hospital Experience

Latar Belakang: Histerektomi obstetri adalah operasi besar dan tetap merupakan salah satu bencana di bidang obstetri. Tindakan ini jarang dilakukan, namun merupakan operasi penyelamatan hidup dalam kasus perdarahan obstetrik yang sulit ditangani. Hal itu terkait dengan peningkatan morbiditas dan mortalitas ibu.Tujuan: Untuk menentukan indikasi dan komplikasi histerektomi obstetri di RSUP Dr. Sardjito. Metode: Penelitian ini menggunakan metode penelitian retrospektif kasus histerektomi obstetrik di RSUP Dr. Sardjito pada Januari 2012 hingga April 2015.Hasil dan Pembahasan: Selama masa studi, 30 histerektomi obstetri dilakukan. Delapan puluh persen kasus merupakan kasus rujukan. Rata-rata usia 32,47 tahun dengan standar deviasi 5,91. Atonia uteri merupakan indikasi yang paling umum (40%), diikuti oleh dehisensi uterus segmen bawah (33,3%), ruptur uteri (16,7%) dan plasenta akreta (10%). Tipe histerektomi yang dilakukan adalah histerektomi supra servikal sebesar 46,7%, histerektomi abdominal total 33,3%, dan histerektomi sesar 6%. Komorbiditas intraoperatif yang paling umum adalah kehilangan darah masif (93,3%). Disseminated Intravascular Coagulation (DIC) menyebabkan 30% dari komorbiditas pasca operasi. Kematian ibu mencapai 20%.Kesimpulan: Indikasi histerektomi obstetri ialah atonia uteri, dehisensi uterus segmen bawah, ruptur uterus, dan plasenta akreta. Komplikasi intraoperatif yang paling sering terjadi ialah kehilangan darah. DIC merupakan komplikasi paska operatif terbanyak dan penyebab utama kematian.Kata Kunci: Histerektomi obstetrik, atonia uteri, dehisensi uterus segmen bawah, ruptur uteri

Pengaruh Pendidikan Kesehatan Tentang Menopause Terhadap Perubahan Kualitas Hidup Perempuan Klimakterik

Physical and psychological changes that happen at the climacterium period would influence the quality of life in climacteric women. Therefore, the adaptation process is needed to overcome problems and changes during this period so that the quality of life of climacteric women could be increased. Lack of knowledge and access to information are major challenger that were faced by menopause women. One of efforts that can be done to improve their knowledge is through health education. This study aimed to identify the influence of health education about menopause towards the quality of live changes in climacteric women. The study used quasi experiment design with pretest and posttest nonequivalent control group. The location of this study was in Gamping Kidul Ambarketawang Village in December 2013 to April 2014. The total population is 271 people. Sample consisted of 44 people in the intervention group and 44 people in the control group. The intervention group received 4 times health education and small group discussion, as well as once relaxation and Yoga. Participants in control group received a booklet about menopause, signs and symptoms, nutrition during menopause period, and management of menopause. The quality of life was measured using WHOQOL-BREF. Analysis used paired t-test, independent samples t-test with α = 0.05. The mean scores of quality of life for intervention group were 51.0 (pretest) and 66.5 (posttest). The paired t-test showed that there was a significant difference of quality of life score before and after health education in the intervention group (t =14,436, p=0,001). However, there was no significant difference of quality of life in the control group (t=1,059, p= 0,0295). Based on this results, it can be concluded that health education program about menopause can increase quality of life of climacteric women

Evaluasi Clinical Pathway Seksio Sesarea: Keefektifan Penggunaan Antibiotika Injeksi Cefotaxime 2 Gram dalam 24 Jam untuk Mencegah Terjadinya Infeksi Luka Operasi

Background: The usage of prophylactic antibiotics in Dr. Sardjito Hospital, Yogyakarta, is still diverse. Previously, prophylactic antibiotics that were given would be in a form of multidose and or multidrug regimen. Recently, a clinical pathway for c-section had been set up to uniform the antibiotics given. Cefotaime 2g, given intravenously, in 24 hours is the antibiotic of choice. Unfortunately, there was no data about the effetiveness of cefotaime that can be used as a basis of clinical pathway. Objective: Comparing the incidence of surgical site infection (SSI) between cefotaime 2g,/24 hours (clinical pathway or CP) with previous regimen of prophylactic antibiotics (non-clinical pathway or nonCP) and also identify the risk factors.Method: This is a retrospective cohort study with 129 subjects, divided into two groups. The CP group consists of 63 subjects, while non-CP group consists of 66 subjects. The surgical site infection was observed in the day 3 and day 10 aer C-section. Multivariat analysis was used to determine the risk factors of SSI.Result and Discussion: SSI incidence in the CP group at day 3 was higher compared to non-CP group, but it was not statistically significant (OR 4,73 95% CI 0,52 43,04), eukocytosis (>17000/mcl) was the independent risk factor for SSI (OR 7,54 95% CI 1,25 45,39).Conclusion: SSI incidence between two groups was not statistically significant but was clinically significant. The presence of leukocytosis is becoming the risk factor for SSI.Keywords: prophylactic antibiotic, c-section, cesarean section, surgical site infecti

Hubungan Kadar β-hCG 12 Hari Pasca Transfer Embryo dengan Luaran Kehamilan

Latar Belakang: Subfertilitas merupakan salah satu permasalahan yang sering ditemukan di era modern ini. Berbagai metode ditemukan dan digunakan untuk meningkatkan angka keberhasilan reproduksi pada perempuan. Teknologi reproduksi berbantu memiliki risiko terjadinya keguguran dan kehamilan ektopik. Kadar serum β-hCG 12 hari pasca transfer embryo memiliki peranan penting dalam prediksi luaran kehamilan.Tujuan: Untuk memprediksi luaran kehamilan, sensitivitas, spesifisitas serta nilai ambang kadar β-hCG 12 hari pasca transfer embryo.Metode: Penelitian menggunakan  rancangan penelitian observasional kohort retrospektif di Klinik Permata Hati RSUP. Dr. Sardjito Yogyakarta tahun 2012 – 2015. Subyek penelitian 130 subyek yang terbagi menjadi 65 subyek dengan kadar β-hCG  <76 IU/l dan 65 subyek ≥76 IU/l. Luaran kehamilan diklasifikasikan sebagai viabel (janin hidup pada usia kehamilan ≥ 22 minggu) dan non viabel ( kehamilan biokimia, ektopik, mola dan keguguran).Hasil dan Pembahasan: Median dan minimum kadar β-hCG pada kehamilan viabel 167 IU/l dan 44 IU/l,  dan 53 IU/l dan 16 IU/l pada kehamilan non viabel. Terdapat hubungan yang bermakna antara kadar serum β-hCG 12 hari pasca transfer embryo dengan luaran kehamilan. Kadar  β-hCG  ≥76 IU/l sebanyak 50 (76,9%) pada kehamilan viabel  dan sebanyak 15 (23,1%) subyek pada kehamilan non viabel.  Kadar β-hCG <76 IU/l sebanyak 7 (10,8%) pada kehamilan viabel dan 58 (89,2%) pada kehamilan non viabel (p=0,000). Kadar β-hCG terendah pada kehamilan ganda 300 IU/l.Kesimpulan: Kadar β-hCG 12 hari pasca transfer embryo bermakna secara statistik dalam membantu memprediksi luaran kehamilan viabel dengan cut-off point 71,5 IU/l, sensitivitas 89,1 % dan spesifitas 79,5 %. Nilai positive predictive value (PPV) adalah 76,9 %, dan nilai negative predictive value (NPV) adalah  89,2%.Kata kunci: Teknologi reproduksi berbantu, subfertilitas, kadar β-hCG, transfer embryo, luaran kehamilan.

HUBUNGAN KADAR ANTI MULLERIAN HORMONE (AMH) DENGAN KEBERHASILAN STIMULASI OVARIUM PADA FERTILISASI IN VITRO METODE PROTOKOL PANJANG

HUBUNGAN KADAR ANTI MULLERIAN HORMONE (AMH)DENGAN KEBERHASILAN STIMULASI OVARIUM PADAFERTILISASI IN VITRO METODE PROTOKOL PANJANGRidho Permana, Shofwal Widad, M. LutfiABSTRACTBackground: Patient with decline oocyte number and quality assumed has lower Anti Mullerian hormone(AMH). AMH concentration which expressed by the granulosa cells of preantral and small antral folliclesindirectly determine the ovarian reserve. Therefore, AMH may be used as a marker of ovarian ageing andassociated with ovarian response in in vitro fertilization (IVF).Objective: To determine the effect of Anti Mullerian Hormone (AMH) on ovarian response in IVF longprotocol method.Method: This research is a retrospective cohort study in Permata Hati Fertility Clinic, IVF program-Dr.Sardjito Hospital, Yogyakarta, Indonesia. Seventy one cycle enrolled in an IVF program conducted fromJanuary 2011 through December 2013 at the Permata Hati Fertility Clinic.Result and Discussion: ROC curve were used to determine cut-off AMH. With cut-off point 2.59 ng/ml,subject divided into two groups (high AMH level: ≥2.59 ng/ml and low AMH level: <2.59 ng/ml). Totaldose gonadotropin was significantly different in two groups (p=0.02). High AMH and low AMH levelwere significantly associated with ovarian response (RR 2,05; CI 95% 1,32 – 2,20 ; p< 0,01). BesideAMH, multivariate analysis shows basal LH level (p=0,04; OR 7,22; CI 95% 1,09 – 47,87) and peritonealendometriosis (p=0,03; OR 7,80; IK 95% 1,15–52,81) were significantly influenced ovarian response in IVF.Conclusion: high AMH level influence ovarian response in IVF. Total dose gonadotropin on low AMH levelswas greater than high AMH level. In addition to AMH, ovarian response were influenced by basal LH leveland peritoneal endometriosis.Keywords: Anti Mullerian hormone (AMH), ovarian response, long protocol stimulation, in vitro fertilization(IVF).ABSTRAKLatar belakang: Pasien dengan penurunan jumlah dan kualitas oosit diduga mempunyai kadar AntiMullerian Hormone (AMH) lebih rendah. Konsentrasi Anti Mullerian Hormone (AMH) yang dihasilkanfolikel ovarium secara tidak langsung menggambarkan cadangan ovarium yang tersisa. Karenanya kadarAnti Mullerian Hormone (AMH) dapat digunakan sebagai prediktor yang akurat dari cadangan ovarium danrespons stimulasi ovarium pada fertilisasi in vitro.Tujuan: Untuk mengetahui pengaruh kadar Anti Mullerian Hormone (AMH) terhadap keberhasilanstimulasi ovarium pada fertilisasi in vitro pada metode protokol panjang.Metode: Penelitian ini menggunakan rancangan kohort retrospektif observasional.Hasil dan Pembahasan: Sebanyak 71 siklus dari 71 pasangan yang menjalani fertilisasi in vitro disertakandalam penelitian sesuai dengan kriteria inklusi dan eksklusi. Dengan cut off point AMH ditetapkan 2,59 ng/ml, maka subyek ini dibagi menjadi 2 kelompok yaitu ≥2,59 ng/ml sebagai kelompok AMH tinggi dan <2,59 ng/ml sebagai kelompok AMH rendah. Perbedaan bermakna antara dua kelompok ditemukan pada dosistotal gonadotropin (p=0,02).Terdapat perbedaan bermakna respons stimulasi ovarium antara AMH tinggidan AMH rendah (RR 2,05; IK 95% 1,32 – 2,20 ; p< 0,01). Kadar LH basal (p=0,04; OR 7,22; IK 95% 1,09 –47,87) dan endometriosis peritoneal (p=0,03; OR 7,80; IK 95% 1,15–52,81) juga mempengaruhi respons terhadap stimulasi ovarium.Kesimpulan : AMH tinggi mempengaruhi respons terhadap stimulasi ovarium. Dosis total gonadotropinpada AMH rendah dibutuhkan lebih banyak dibandingkan dengan AMH tinggi. Selain AMH, responsterhadap stimulasi ovarium juga dipengaruhi oleh kadar LH basal, dan endometriosis peritoneal.Kata kunci : kadar Anti Mullerian hormone (AMH), stimulasi ovarium protokol panjang, fertilisasi in vitro.Bagian Obstetri Ginekologi, Fakultas Kedokteran, Universitas Gadjah Mada Yogyakart