INDEX

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Maternal Age, Abortion and Aneuploidy

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Assessment of the Quality of Internet-Based Health Information in the Indonesian Language about Polycystic Ovarian Syndrome: Kajian Kualitas Informasi Kesehatan Berbasis Internet Berbahasa Indonesia tentang Sindrom Ovarium Polikistik

Objectives: To investigate health information quality about PCOS on the internet in Indonesian language.Methods: Top website from two separate search engines (Google and Bing) was collected using the keyword of “sindrom ovarium polikistik” (polycystic ovarian syndrome). Analysis of health information quality on those websites was performed.Results: Sixty-nine websites were included for analysis. The majority of those websites have good information quality in terms of content accuracy and website credibility. There was no difference in quality between the two search engines. The website was found at the top two pages in each search engine to have better quality than the later pages (p=0.02). The educational website had better quality (p=0.05). The website made by healthcare organizations had better quality (p=0.04). The non-commercial website had better information quality (p=0.01).Conclusion: Criteria affecting health information quality on the internet were as follows: found at the top two pages on a search engine; educational website; made by healthcare organization; and non-commercial purpose.Keywords: health information quality, Indonesian language, internet-based, polycystic ovarian syndrome Abstrak Tujuan: Untuk melakukan kajian kualitas informasi kesehatan tentang PCOS di internet dalam Bahasa Indonesia.Metode: Situs web teratas dari dua mesin pencari terpisah (Google dan Bing) dikumpulkan dengan menggunakan kata kunci “sindrom ovarium polikistik”. Analisis kualitas informasi kesehatan pada situs-situs tersebut telah dilakukan.Hasil: Enam puluh sembilan situs web dimasukkan untuk analisis. Mayoritas situs web tersebut memiliki kualitas informasi yang baik dalam hal akurasi konten dan kredibilitas situs web. Tidak ada perbedaan kualitas antara kedua mesin pencari tersebut. Situs web ini ditemukan pada dua halaman teratas di setiap mesin pencari memiliki kualitas yang lebih baik daripada halaman-halaman selanjutnya (p = 0,02). Kualitas situs web berbasis pendidikan menunjukkan hasil lebih baik (p = 0,05). Kualitas website yang dibuat oleh organisasi kesehatan menunjukkan hasil lebih baik (p = 0,04). Situs web non-komersial memiliki kualitas informasi yang lebih baik (p = 0,01).Kesimpulan: Kriteria yang mempengaruhi kualitas informasi kesehatan di internet adalah sebagai berikut: ditemukan pada dua halaman teratas pada mesin pencari; situs web berbasis pendidikan; dibuat oleh organisasi kesehatan; dan tujuan non-komersial.Kata kunci : bahasa indonesia, berbasis internet, kualitas informasi kesehatan, sindrom ovarium polikistik

Internet Based Infertility Information in Bahasa Indonesia Quality Survey

Objective: To assess the quality of websites providing information on infertility and its management in Bahasa. Methods: Differences between website types and affiliates were assessed for the credibility, accuracy and ease of navigation using predefined criteria. We used Google search engine with the keyword "infertilitas" and we assessed 50 websites in Bahasa that relates with infertility. Results: The content credibility for most of the sites has adequate score with range of score 60 to 80 for 68% sites. Content accuracy for most of the sites have scores more than 60, with 24% or 12 sites with scores 60 to 80 and 44% or 22 sites have scores above 80. The ease of navigation for most of the sites, 47 sites or 94% has scores more than 60. Conclusion: The quality of internet based infertility information in Bahasa is adequate for category credibility, accuracy and ease of navigation. [Indones J Obstet Gynecol 2018; 6-1: 28-33] Keywords: bahasa, infertility, information, internet, qualit

The Prevalence and Risk Factors of Constipation in Pregnancy

Objective: To estimate the prevalence of constipation in pregnancy and correlation between gestational age, dietary fiber intake, water comsumption, and physical activity.   Methods: This study used cross-sectional design with samples of 174 healthy pregnant women undergoing antenatal care at Obstetrics and Gynecology Outpatient Clinic RSCM during August - October 2016. Data were collected using questionnaire. Diagnosis of constipation was based on ROME III criteria, dietary fiber is measured using Food Frequency Questionnaire (FFQ), and physical activity was measured using International Physical Activity Questionnaire (IPAQ). Chi-square and Fisher’s exact test were conducted to evaluate the association between variables.   Results: The prevalence of constipation in pregnant women observed in this study was 13.2% (95% CI 8.3-18.1). The most frequent complaints included straining, incomplete evacuation, and anorectal obstruction. Dietary fiber intake was low in 81.03% subject. with average dietary fiber intake of 18.97 gram/day. There was no significant association between constipation and gestational age (OR 4.36, 95%CI 0.51-37.48 for second trimester and OR 2.04, 95%CI 0.25-16.7 for third trimester), dietary fiber intake (OR 0.82, 95%CI 0.28-2.39), water consumption (OR 1.38, 95%CI 0.56-3.41), and physical activity (OR 1.167, 95%CI 0.28-4.87).   Conclusion: Prevalence of constipation in pregnant women is 13.2%. There is no significant correlation between gestational age, dietary fiber intake, water consumption, and physical activity.   Keywords: constipation, pregnant woman, ROME II

Outcomes Comparison of In-Vitro Fertilization (IVF) between GnRH Agonist Trigger and hCG for Final Oocyte Maturation

Introduction: For decades, human chorionic gonadotropin (hCG) has been used for final oocyte maturation. It is proven to have highest life birth rate, comparing to gonadotropin releasing hormone (GnRH) agonist, but unfortunately it can increases the risk of developing ovarian hyper stimulation syndrome (OHSS). There is an ongoing debate over the optimal agent that can trigger final oocyte maturation in antagonist protocol, leading to higher IVF success rate without increasing the risk of OHSS.Objective: To compare IVF outcomes in patient using GnRH agonist trigger and hCG for final oocyte maturation.Method: A retrospective review of in vitro fertilization patient at Daya Medika Clinic and Yasmin Clinic.Result: 76 women were analyzed consist of 38 women using GnRH agonist and 38 women using hCG. We found no significant differences on biochemical pregnancy rate (24.00% and 20.51%) between two group, but there were significant differences on fertilization rate (67.72% and 61.32%),  cleavage rate (95.04% and 88.92%) and blastocyst rate (13.90% and 7.38%). There was one patient developed OHSS in hCG groupConclusion: GnRH agonists can be considered for use as a trigger final oocyte maturation in the antagonist protocol because some IVF outcomes data showed that GnRH agonists triggering were better than hCG without increasing the risk of OHS

Clinical Pregnancy Rate in in-Vitro Fertilization (IVF) among Endometrioma Patients Underwent Cystectomy Laparoscopy : Kejadian Kehamilan Klinis setelah Fertilisasi In Vitro pada Pasien Endometrioma Postsistektomi Laparoskopi

Abstract Objective: to discuss the clinical pregnancy rate and factors influencing fecundity among endometriosis women having cystectomy laparoscopically who underwent IVF. Methods: The search was conducted on Pubmed®, EBSCOhost®, and Proquest®, Cochrane Library®, ClinicalKey® using MeSH. Case : A 38-years woman, P0A0 come to the gynecology clinic with a chief complaint of primary infertility for eight years. The patient had undergone a bilateral endometrial cyst resected with laparoscopy and failed for two cycles of IVF. What is the clinical pregnancy rate of women that undergo IVF with a history of ovarian endometrioma cystectomy? Results:, There were six articles appropriate to the inclusion criteria and further appraised using the Centre for Evidence-Based Medicine, University of Oxford appraisal tools. The studies consisted of five prognostic studies and one meta-analysis. The studies were appraised for their validity, Importance, and Applicability. Conclusion: The pregnancy rate in patients undergoing IVF after ovarian cystectomy ranges from 14%-45.2%. A prudent consideration and carefulness during cystectomy surgery are essential for patients that wish to be fertile. Keywords: clinical pregnancy rate, endometrioma, in vitro fertilization, laparoscopy, ovarian cystectomy   Abstrak Tujuan:  Untuk menelaah tentang kemungkinan terjadinya kehamilan secara klinis pada perempuan yang menjalani IVF dengan riwayat laparoskopi sistektomi dan faktor-faktor yang mempengaruhi kesuburannya. Metode: Pencarian jurnal dilakukan dengan menggunakan search engine Pubmed®, EBSCOhost®, dan Proquest®, Cochrane Library®, ClinicalKey® menggunakan MeSH. Kasus: Perempuan P0A0 berusia 38 tahun datang ke poliklinik dengan keluhan utama infertilitas selama delapan tahun. Pasien memiliki riwayat kista endometrioma bilateral yang sudah di kistektomi dengan laparoskopi dan dua kali gagal menjalani siklus IVF. Berapa kemungkinan terjadinya kehamilan secara klinis pada perempuan yang menjalani IVF dengan riwayat kistektomi endometrioma? Hasil: Dari hasil pencarian didapatkan enam artikel jurnal yang sesuai dengan kriteria inklusi dan dianalisis lebih lanjut menggunakan telaah kritis Evideence-Based Medicine, University of Oxford. .Terdapat lima jurnal studi prognostic dan satu meta-analisis. Studi-studi tersebut akan ditelaah kritis lebih lanjut berdasarkan validitas, kepentingan, dan aplikabilitasnya Kesimpulan: Kemungkinan terjadinya kehamilan secara klinis pada pasien yang menjalani IVF setelah kistektomi endometrioma ovarium adalah 14%-45,2%. Pertimbangan yang bijaksana dan hati-hati diperlukan untuk melakukan operasi kistektomi pada pasien yang mengalami endometrioma dan ingin tetap subur. Kata kunci: endometrioma, fertilisasi in vitro, kehamilan klinis, kistektomi ovarium, laparoskop

Visceral Adipose Tissue was Associated with Increased Risk of Insulin Resistance in Lean Polycystic Ovarian Syndrome, Independent with Retinol Binding Protein-4: Jaringan Adiposa Viseral berkaitan dengan Peningkatan Risiko Resistensi Insulin pada Sindrom Ovarium Polikistik dengan Indeks Masa Tubuh Normal, Independen terhadap Retinol Binding Protein-4

Objective: To determine whether visceral adipose tissue or serum RBP-4 were related with the risk increment of insulin resistance in normal BMI PCOS patients. Methods: This was a cross-sectional study conducted in normal body mass index PCOS patients at Yasmin Clinic, RSCM, Jakarta from July 2014 until March 2015. Diagnosis of PCOS was established using Rotterrdam (2003) criteria. Insulin resistance was confirmed by using ratio of HOMA-IR >1.4. Results: Among 40 subjects, 20 subjects (50%) belong insulin resistance group. Serum RBP-4 level was higher in insulin resistance group (p=0.06). After ROC analysis was conducted, area under curve for of serum RBP-4 was 69.9% (CI 95% -3754.77 - (186.60-7696.14, p=0.061)). Cut-off level of serum RBP-4 was 23814.5 ng/mL yielded sensitivity and specificity to a level of 60% and 60%, respectively. After logistic regression were analyzed, visceral adipose tissue demonstrated substantial association with the risk increment of insulin resistance in normal BMI PCOS patients. Conclusions: Visceral adipose tissue demonstrated substantial association with the risk increment of insulin resistance in normal BMI PCOS patients, independent with serum RBP-4 levels. Key words: body mass index, diagnosis, insulin resistance, PCOS, retinol binding protein-4   Abstrak Tujuan: Untuk menentukan apakah jaringan adiposa viseral atau serum RBP-4 berhubungan dengan peningkatan risiko resistensi insulin pada Sindrom Ovarium Polikistik dengan indeks masa tubuh normal. Metode: Studi potong lintang dilakukan pada subjek SOPK dengan IMT normal di Klinik Yasmin, RSCM, Jakarta sejak Juli 2014 sampai dengan Maret 2015. Penegakan diagnosis SOPK dilakukan dengan kriteria Rotterdam (2003). Resistensi insulin dikonfirmasi dengan pemeriksaan rasio HOMA-IR > 1.4 Hasil: Diantara 40 subjek, sebanyak 20 subjek (50%) mengalami resistensi insulin. Kadar serum RBP-4 lebih tinggi pada kelompok resistensi insulin (p=0.06). Setelah dilakukan analisis Receiver Operating Curve (ROC), serum RBP-4 memiliki Area Under the Curve  (AUC) sebesar 69.9% (IK 95% -3754.77 - (186.60-7696.14, p=0,061)). Titik potong kadar serum RBP-4 adalah 23814.5 ng/mL dengan sensitivitas dan spesifisitas masing-masing 60% dan 60%. Setelah dilakukan analisis regresi logistik, jaringan adiposa viseral menunjukan asosiasi yang kuat dengan terjadinya resistensi insulin pada pasien SOPK dengan IMT normal. Kesimpulan: Jaringan adiposa viseral menunjukan asosiasi yang kuat dengan terjadinya resistensi insulin pada SOPK dengan IMT normal, independen terhadap kadar serum RBP-4. Kata kunci: diagnosis, indeks masa tubuh, resistensi insulin, retinol binding protein-4, SOP

Correlation between Follicular Fluid’s Androgen Level and Fertilization Rate in Poor Responder Patients Undergone IVF: A Prospective Cohort Done in Yasmin IVF Clinic, Jakarta, Indonesia

Introduction Androstenedione (A4), testosterone (T), and dehidroepiandrosterone (DHEA) are known to be involved in folliculogenesis and follicular maturity. Lower follicular androgen levels in poor responder due to malfunctioned granulosa and theca cells and decreased inhibin B production will decrease FSH and LH. However, androgenic follicular fluid might also induce follicular atresia, decreased oocytes viability, thus affecting fertilization. The aim of current study is to find the correlation between intra-follicular androgen levels and fertilization rate, specifically in poor responder whom contributed in 84% cancelled cycle.Material and Methods This prospective cohort study was done at Yasmin IVF Clinic, Jakarta, Indonesia, in January 2014-March 2015. Infertile women undergone IVF were asked to participate, grouped into poor responder and other, and the androgen levels in the follicular fluid of each consenting patients were measured.Results From total 62 patients, aged 23-47 years old (37.6±5,068), there were 21 poor responders, whereas the other 41 patients with other indication. In poor responder group, levels of androstenedione, testosterone, and DHEA were 50.8 – 272.3 (103.5 ± 59.9), 383.2 – 1747.9 (1114.4 ± 373.2), 11.3 – 454.8 (151.3 ± 96.8), whereas in other group the androgen levels were 44.3 – 326.8 (95.1 ± 61.2), 414.1 – 1463.7 (976.9 ± 258.4), 44.6 – 265.8 (132.7 ± 61.3) with the correlation with fertilization rate 0.609, 0.095, and 0.361 respectively. Conclusion Correlation between follicular androgen levels and fertilization rate found to be not significantly different. The low number of subjects might cause this result, as well as the presence of bias, e.g.male factor and endometriosis might also affect fertilization. A multi-center study with larger sample size added with thorough analysis is needed to reconfirm current data

Estradiol on Day Seven is a Good Predictor for Oocyte Maturation Rate in In Vitro Fertilization Program: Kadar estradiol hari ketujuh sebagai prediktor tingkat kematangan oosit pada program Fertilisasi In Vitro

Abstract Objective: to determine which factors influence the rate of oocyte maturation in In Vitro Fertilization (IVF) program. Methods: A retrospective cohort study was conducted using secondary data from IVF participants at the Yasmin Fertility Clinic, Dr. RSUP. Cipto Mangunkusumo, Jakarta, Indonesia during the period January 2019 to December 2020, as recorded in the InaRepromed archive. The variables analyzed were age, body mass index, and hormone levels on day 1, day 7, and day hCG, with oocyte maturation rate as the main outcome. Correlation test was performed between several variables and the level of oocyte maturation rate and followed by multivariate analysis to assess the factors that were closely related to oocyte maturation rate. Results: Data from 52 subjects were collected for the study. Positive correlation was observed between oocyte maturation rate and estradiol on day 7 (r = 0.229), while negative correlation was observed between oocyte maturation rate and progesterone/estradiol ratio on day 7 (r = -0.289) and luteinizing hormone on day 1 (r = -0.265). Multivariate analysis revealed that higher estradiol on day-7 was associated with better oocyte maturation rate (p = 0.047). Conclusion: Higher estradiol level on day 7 was associated with better oocyte maturation rate in IVF. Keywords: Assisted reproductive technology (ART), estradiol, in vitro fertilization (IVF), progesterone.   Abstrak Tujuan: untuk menentukan faktor-faktor yang mempengaruhi tingkat pematangan oosit dalam program Fertilisasi InVitro (FIV). Metode: Desain penelitian adalah kohort retrospektif, menggunakan data sekunder peserta bayi tabung Klinik Fertilitas Yasmin, RSUP Dr. Cipto Mangunkusumo, Jakarta, Indonesia selama periode Januari 2019 hingga Desember 2020, yang tercatat di dalam arsip InaRepromed. Variabel yang dianalisis adalah umur, indeks massa tubuh, dan kadar hormon pada hari ke-1, hari ke-7, dan hari ke-hCG, dengan tingkat maturasi oosit sebagai luaran utama. Dilakukan analisis korelasi antara beberapa variabel dengan tingkat maturasi oosit, dan dilanjutkan dengan analisis multivariat untuk menilai faktor-faktor yang berhubungan kuat dengan tingkat maturasi oosit. Hasil: Data dari 52 subjek dikumpulkan untuk penelitian ini. Dijumpai korelasi positif antara tingkat maturasi oosit dan estradiol pada hari ke 7 (r = 0,229), sedangkan korelasi negatif diamati pula antara tingkat maturasi oosit dan rasio progesteron/estradiol pada hari ke 7 (r = -0,289) dan hormon luteinisasi pada hari 1 (r = -0,265). Analisis multivariat mengungkapkan bahwa estradiol yang lebih tinggi pada hari ke-7 dikaitkan dengan tingkat maturasi oosit yang lebih baik (p = 0,047). Kesimpulan: Kadar estradiol yang lebih tinggi pada hari ke 7 dikaitkan dengan tingkat pematangan oosit yang lebih baik pada program FIV. Kata kunci : Teknologi reproduksi berbantu (TRB), estradiol, fertilisasi in vitro (IVF), progesteron