Anti Mullerian Hormone Serum Level Indicates Ovarian Response in Controlled Ovarian Hyperstimulation of IVF Cycles

Objective: To evaluate the clinical value of Anti Mullerian Hormone serum (AMH) level as one of ovarian response indicator in controlled ovarian hyperstimulation in IVF cycles. Method: This cohort-prospective study was conducted in Dr. Cipto Mangunkusumo General Hospital. The subjects of this study were infertile couples who underwent controlled ovarian hyperstimulation in IVF cycles. The measurement of FSH level, estradiol level, AMH level, and antral follicles count was done in the beginning of IVF cycles. The cycles were divided into two groups, good responder group and poor responder group. Good responder group had three or more mature oocytes, while the poor responder group had two or less mature oocytes. Statistical analysis was done using T-Test and Receiver Operator Characteristic area under curve (ROCAUC) to measure the predictive value of AMH, FSH, estradiol, age, and antral follicle count as ovarian response predictors. Results and Discussion: From 92 IVF cycles, there were 15 poor responder cycles (16.3%) and 77 good responder cycles. AMH serum level was 3.75 ± 2.77 μg/ml in good responder cycles and 1.04 ± 1.39 μg/ml in poor responder cycles (p < 0.0001). AMH serum level was more superior than other ovarian response predictors (AUC 0.846) with cut-off value of 1.40 μg/ml. AMH serum level ≥ 1.40 μg/ml had good predictive value as ovarian reserve or ovarian reserve parameter with 81% sensitivity and 87% specificity. Conclusion: AMH serum level was more superior ovarian reserve and ovarian response predictor compared to other parameters. [Indones J Obstet Gynecol 2010; 34-3: 114-8] Keywords: anti-Mullerian hormone, ovarian reserve, ovarian respons

Predictive Factors For Three Pronuclear Zygote In Ivf Cycle

Introduction: Preimplantation Genetic Testing is one of the methods to screen genetic defects in embryos created through In Vitro Fertilization. In developing country this technique is still new and expensive method. Thus, knowing several factors in predicting the occurrence of three-pronuclear zygote can help much.Method: 472 cycles in 449 subjects who underwent controlled ovarian hyperstimulation in IVF cycles between January 2013 and August 2014 were included in the study. Categorical variables were compared using Chi Square test and continuous variables were analyzed using Independent t-test, and statistically significant was considered when p &lt; 0.05. Multivariate logistic regression analysis was performed in order to correlate clinical variables and the occurrence of three-pronuclear zygote (3pn). Results: There were 38 3pn was identified in this study (8.05%). No correlation was found between age of the women, number of mature follicles, which are less than six with the incidence of 3pn. However, level of Anti Mullerian Hormones (AMH) found to be the strongest predictor with the incidence of 3PN (p &lt; 0,01, RR 2.5, CI95% 1,55; 4.16).Conclusion: level of AMH is known to be strong predictor of thee pronuclear zygote after IVF cycle

Not only embryo quality but also Endometrial Thickness Contributes to IVF outcome: a retrospective study of all IVF cycles in Yasmin Clinic, Jakarta, Indonesia

Objective: To study the endometrial thickness and embryo quality during In Vitro Fertilization (IVF) cycles in predicting IVF outcome. Methods: This retrospective study involved 206 infertile patients undergoing 218 IVF cycles in Yasmin Clinic, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia. All IVF cycles were performed from January 2005 until May 2009. The outcome of this study is the clinical pregnancy following IVF cycles. The endometrial thickness was measured on the day of human chorionic gonadotrophin (hCG) administration. The number of embryos that developed ≥ 8 cells on cleavage II represented as the embryo quality. Results: There were 51 among 218 cycles (23.4%) resulted in pregnancy. The endometrial thickness on day of hCG administration was significantly higher in pregnant group compared to non-pregnant group (11.49±1.97 mm versus 10.13±1.93mm;

Predictive Factors for Pregnancy in IVF: An Analysis of 348 Cycles

Objective: To determine predictive factors for pregnancy after IVF. Method: The subject of this study were three hundred and forty eight IVF cycles in 266 couples who underwent controlled ovarian hyperstimulation in IVF cycles between January 2005 and March 2010. Categorical variables were compared using Chi Square test and continuous variables were analyzed using Independent t-test, p < 0.05 was considered statistically significant. Multivariate logistic regression analysis was done to test correlations between clinical variables and the occurrence of pregnancy. Results: The women’s age significantly influenced pregnancy rate since women under 35 years old has the best chance for pregnancy (56.4%). Endometrial thickness on the day of hCG administration also significantly influenced pregnancy in IVF (p < 0.001) because 64.1% of pregnancy occurred if endometrial thickness ≥ 10.95 mm. Serum FSH on 3rd day of period that can predict ovarian reserve also has significance on pregnancy. On the other hand, 61.5% pregnancy occurred if more than 6 mature oocytes were retrieved (p < 0.001). Among 92 patients of 348 cycles we found strong correlation between AMH level with number of mature oocytes retrieved (p < 0.001; r 0.659). Logistic regression done revealed the couple with best chance of pregnancy can be described as follows: women with endometrial thickness ≥ 10.95 mm, number of mature oocytes > 6 and age under 35 years old. Conclusion: This study enabled the characterization of many prognostic factors for pregnancy. [Indones J Obstet Gynecol 2010; 34-4: 180-4] Keywords: in vitro fertilization, clinical pregnancy, age, mature oocytes, endometrial thicknes

The Role of Dominant Follicular Diameter and LH in Predicting Ovulation in Cycle with Clomiphene Citrate

Objective: To improve diagnostic method to predict ovulation in cycle with clomiphene citrate. Method: This diagnostic research was done in RSUPN Dr. Cipto Mangunkusumo between January 2011 - October 2011 with 31 women who taking CC 50 mg/day and 30 women with normal cycle. Result: Affecting with ovulation in the two groups, it was found that in groups with CC, the follicle diameter is 24.33 ± 3.87 mm with LH 14.21 ± 7.95 IU/l, meanwhile in normal group, follicular diameter is 17.62 ± 3.45 mm with LH 14.42 ± 5.91 IU/l. Cut-off point for follicular diameter simultaneously with ovulation determined by ROC curve was found in 24.33mm (AUC 0.67, sensitivity 0.64, specificity 0.56), meanwhile the cut-off for LH is 14.40 IU/l (AUC 0.61, sensitivity 0.57, specificity 0.43). Conclusion: In group with CC, ovulation occurred in bigger follicular diameter than normal cycle, while LH does not different significantly. [Indones J Obstet Gynecol 2011; 35-3: 128-9] Keywords: clomiphene citrate, follicular diameter, luteinizing hormon

Relation between CYP17 Polymorphism and Hyperandrogenemia in Polycystic Ovarian Syndrome

Objectives: To find 5-untranslated region polymorphism of CYP17 gene and its connection with hyperandrogenemia in polycystic ovarian syndrome. Methods: A cross sectional descriptive study with consecutive random sampling method. Body mass index, ovarian morphology by ultrasonography, fasting insulin level, fasting blood glucose level, 17-hydroxyprogesterone level, total testosterone level, serum hormone binding globulin level, and CYP17 gene polymorphism in 45 subject with PCOs and 45 control subject who attend Yasmin clinic of Cipto Mangunkusumo General Hospital with menstruation problems were measured. CYP17 gene polymorphism was evaluated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method with MspA1 restriction enzyme. Results: In PCOs group, the genotype distribution were; 11.1% subject with genotype CC, 71.1% subject with genotype TC and 17.8% subject was wild type TT. In non PCOs group, the genotype distribution for CC, TC and TT respectively were 13.3%, 46.7% and 40%. There was significant difference between both group in distribution of TC and TT genotype, with p value 0.013. Frequencies of allele c and allele t in PCOs group were 47% and 53%. In non PCOs group, frequency of allele c and t were 37% and 63%. There were tendency for higher frequency of allele c in the PCOs group but the difference was not statistically significant. Median FAI value for genotype CC homozygote, TC heterozygote and TT homozygote in PCOs group respectively were; 6.82 (6.07 - 8.23); 5.59 (0.25 -21.45) and 4.74 (3.48 - 8.88). There was tendency for increase FAI value in PCOs group corresponds to variant allele, but the result was not statistically different. Conclusion: There were higher proportion of CC homozygote and TC heterozygote genotype in PCOs patient with tendency of increasing FAI value. [Indones J Obstet Gynecol 2011; 35-1: 3-7] Keyword: polycystic ovarian syndrome, free androgen index, CYP17 polymorphis

Fertility Preservation: Save Our Hope for the Future It’s Time to Rethink...

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THE EFFECTS OF CURCUMIN ADMINISTRATION ON EXPRESSION PATTERNS OF VEGF AND COX-2 IN FERTILE ENDOMETRIUM: A RANDOMISED CLINICAL TRIAL

Objective: Curcumin (diferuloylmethane) is a a compound isolated from turmeric with biological activities, including antifertility. Curcumin inhibits COX-2 expression in granulosa cells of ovarian follicles and disrupts vascular endothelial growth factor (VEGF) derived angiogenesis in the endometrium, reducing endometrial receptivity. The purpose of this study was to examine the effects of curcumin on COX-2 and VEGF expression in endometrium of fertile women. Methods: A prospective double-blind placebo-controlled clinical trial was conducted in a group of fertile women with regular menstrual cycles, aged between 20-30 y, married, and with children. Subjects were divided into a group receiving daily 800 mg encapsulated curcumin. Curcumin orally for ten days, starting on the third day of the first menstrual day, and a control group. Endometrial biopsy was performed using a microcuret and immunohistochemistry was used to assess VEGF and COX-2 expression. The results were analysed using an independent sample t-test. Results: In the curcumin-treated group, VEGF expression was significantly lower than the control group (p&lt;0.05), and COX-2 expression was higher but not significantly so (p&gt;0.05). Conclusion: The curcumin causes VEGF expression in endometrium is lower and negatively affects the growth of endometrial stromal cells