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"Sindrom ovarium polikistik (SOPK) merupakan kelainan reproduksi yang ditandai dengan anovulasi, menstruasi tidak teratur, dan hirsutisme yang seringkali menyebabkan infertilitas. Meski etiologinya belum sepenuhnya dipahami, namun telah diketahui bahwa sebagian besar wanita dengan SOPK mengalami obesitas dengan prevalensi mencapai 40—80%. Obesitas merupakan kelebihan akumulasi lemak tubuh yang dicirikan dengan hipertrofi. Salah satu gen yang diduga terkait dengan obesitas adalah gen fat mass and obesity associated (FTO). Gen FTO menyebabkan peningkatkan nilai BMI. Penelitian ini bertujuan untuk mengetahui perbedaan ekspresi mRNA gen FTO dan korelasinya dengan BMI pada wanita SOPK dan normal dengan obesitas dan non-obesitas. Jaringan darah digunakan sebagai sumber mRNA yang diambil pada 30 wanita non obesitas, 30 wanita normal obesitas, 30 wanita SOPK non-obesitas, dan 30 wanita SOPK obesitas. Kuantitas ekspresi mRNA gen FTO ditentukan dengan menggunakan quantitative real-time PCR. Hasil penelitian menunjukkan terdapat perbedaan ekspresi mRNA gen FTO pada kelompok wanita SOPK dan normal dengan obesitas, serta tidak terdapat korelasi antara ekspresi mRNA gen FTO dengan BMI. Gen FTO merupakan gen yang bertanggung jawab terhadap obesitas akan tetapi tidak memiliki keterkaitan dengan sindrom ovarium polikistik, serta tidak memiliki korelasi dengan BMI

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Polycystic ovary syndrome (PCOS) is a reproductive disorder characterized by anovulation, irregular menstruation, and hirsutism which often causes infertility. Although the etiology is not fully understood, it is well known that most women with PCOS are obese with a prevalence of 40-80%. Obesity is an excess of body fat accumulation which is characterized by hypertrophy. Fat mass and obesity associated gene (FTO) is known to correlate with obesity. The study found that FTO gene causes an increase in the BMI. This reserach aim to determine the differences in FTO mRNA gene expression and its correlation with BMI in normal and PCOS woman with obesity and lean. This study used blood tissue as a source of mRNA taken in 30 normal lean woman, 30 normal obese women, 30 PCOS lean women, and 30 PCOS obese women. The quantity of FTO mRNA gene expression was determined using quantitative real-time PCR. The result shows that there is differences in FTO mRNA gene expression in PCOS and normal woman with obesity dan non-obesity. FTO mRNA expression in PCOS and normal obesity woman is higher than those in the PCOS and normal lean women, and there is no correlation between FTO gene mRNA expression and BMI. Thus, the FTO gene is a gene responsible for obesity but has no association with polycystic ovary syndrome, and does not have a correlation with BMI. "

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Latar belakang: Suplementasi mikronutrien untuk wanita pada masa prakonsepsi, khususnya zinc dan kalsium, terbukti penting untuk maturasi oosit dan ovulasi. Namun, peran zinc dalam mempromosikan kualitas oosit dan potensi perkembangannya belum diketahui secara jelas. GDF9, anggota superfamili TGF b yang disekresikan dari oosit selama proses folikulogenesis, terbukti dapat menjadi biomarker maturasi nuklear oosit dan kualitas embrio. Tujuan: Studi potong lintang ini bertujuan untuk mengetahui apakah ada hubungan antara kadar zinc dan kalsium dalam serum dan cairan folikel dengan ekspresi GDF9 terhadap maturasi oosit. Selain itu, penelitian ini juga bertujuan untuk mengetahui apakah kadar zinc dan kalsium dalam serum dapat mewakili kadar zinc dan kalsium dalam cairan folikel. Metode: Studi ini dilakukan pada 25 subjek penelitian yang menjalani program fertilisasi in vitro di Poliklinik Yasmin RSUPN Cipto Mangunkusumo (RSCM) Kencana. Darah vena sebanyak 6 cc diambil pada hari ovum pick up (OPU) dan kemudian dianalisis di laboratorium untuk mengetahui kadar zinc, kalsium, dan protein GDF9. Cairan intrafolikuler dan sel granulosa juga akan diambil dan diperiksa kadar zinc dan kalsium dari cairan intrafolikuler serta ekspresi mRNA GDF9 dari sel granulosa. Hasil:  Dari 25 subjek penelitian, 12 subjek (48%) di antaranya dikategorikan ke dalam kelompok angka maturasi oosit baik (berdasarkan indikator oosit matur dari konsensus Vienna) serta 13 (52%) sisanya dikategorikan ke dalam kelompok angka maturasi oosit buruk. Dari uji korelasi antara kadar zinc dan kalsium dalam serum dengan cairan folikel, kadar zinc folikel terbukti berkorelasi secara signifikan dengan kadar zinc serum (p = 0,019). Kadar GDF9 serum juga terbukti berkorelasi secara signifikan dengan ekspresi GDF9 (p = 0,047). Tidak didapatkan korelasi yang bermakna antara kadar zinc dan kalsium serum dengan kadar GDF9 serum serta ekspresi mRNA GDF9 dari sel granulosa terhadap angka maturasi oosit (p > 0,05). Kesimpulan: Kadar GDF9 serum dapat menjadi pengganti biomarker untuk kualitas oosit. Tidak didapatkan hubungan antara kadar zinc dan kalsium dalam serum atau cairan folikel terhadap kadar GDF9 serum atau ekspresi mRNA GDF9 dari sel granulosa terhadap angka maturasi oosit.

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Background:  Micronutrient supplementation for women during preconception, especially zinc and calcium, is critical for oocyte maturation and ovulation. However, the role of Zinc in promoting quality of oocytes has not yet been elucidated. GDF9, one of oocyte sereting factor, has been proven to be a biomarker of maturation of nuclear oocyte and quality of embryo. Aim: to investigate any relationship between zinc and calcium levels in serum and follicular fluid and GDF9 expression towards maturation of oocytes. In addition, this study also aimed to determine whether zinc and calcium levels in serum could represent zinc and calcium levels in follicular fluid. Method: This cross-sectional study was conducted on 25 subjects who underwent IVF programs at the Yasmin Policlinic, RSCM Kencana. Six mililiters of venous blood was taken on the day of the ovum pick up (OPU) and then analyzed in the laboratory to determine the levels of zinc, calcium, and protein GDF9. In addition to venous blood, intrafollicular fluid and granulosa cells will also be taken and examined zinc and calcium levels from intrafollicular fluid and GDF9 mRNA expression from granulosa cells. Result: 12 (48%) out of 25 subjects were categorized into high oocyte maturation rate (based on Vienna consensus on oocyte maturation rate), and the other 13 (52%) were categorized into low oocyte maturation rate. Follicular zinc levels were significantly correlated with serum zinc levels (p = 0,019). Serum GDF9 levels were also significantly correlated with expressions of GDF9 mRNA (p = 0,047). No significant correlation was found between serum levels of zinc and calcium and serum GDF9 levels or GDF9 mRNA expression towards maturation of oocytes (p > 0,05). Conclusion: Serum GDF9 might substitute for follicular GDF9 as a biomarker of oocyte quality. There is no relationship between serum or follicular zinc/calcium levels and serum GDF9 levels or GDF9 mRNA expression from granulosa cells towards oocyte maturation rates.

 

 

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"ABSTRAKTesis ini membahas kadar Anti Mullerian Hormone (AMH) sebagai salah satu prediktor cadangan ovarium dalam infertilitas. Tujuan penelitian adalah membandingkan kadar AMH perempuan berusia 40 tahun ke atas yang dapat hamil dengan perempuan berusia 40 taun ke atas yang mengalami infertilitas. Selain itu, melalui penelitian ini diharapkan juga diperoleh suatu nilai kadar AMH yang dapat digunakan untuk prediktor terjadinya kehamilan pada perempuan 40 tahun ke atas. Penelitian ini merupakan suatu studi potong lintang. Dari hasil studi ini, didapatkan bahwa tidak ada perbedaan signifikan kadar AMH pada perempuan usia 40 tahun ke atas yang mengalami kehamilan spontan dan dengan infertilitas. Di samping itu, penelitian ini belum bisa membuktikan peran kadar AMH untuk memprediksi terjadinya kehamilan pada perempuan usia 40 tahun ke atas.

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ABSTRACTThis thesis discusses the levels of Anti Mullerian Hormone (AMH) as a predictor of ovarian reserve in infertility. The research objective was to compare the levels of AMH women aged 40 years and over who can get pregnant naturally and in women aged 40 and over who are experiencing infertility. In addition, through this study is expected to also expect to have a value of AMH levels to be used for predictors of pregnancy in women 40 years and over. This study is a cross-sectional study. From the results of this study. From the results of this study, it was found that there was no significant difference in the levels of AMH in women aged 40 years and over who experienced spontaneous pregnancy and infertility. In addition, this study can’t prove a role for AMH levels predict the occurrence of pregnancy in women aged 40 years and over."

"[ABSTRAKLatar Belakang: Endometriosis diperkirakan ditemukan pada 2-22% wanita usia reproduksi yang asimptomatik, sedangkan pada wanita yang mengalami dismenore, prevalensinya meningkat menjadi 40-60%. Terapi yang ada saat ini adalah terapi medikamentosa, terapi pembedahan, atau gabungan dari keduanya. Namun belum ada yang dapat berhasil menghilangkan penyakit ini. Hal ini dibuktikan dengan angka kekambuhan endometriosis yang cukup tinggi, yaitu 33,3-40,3%. Pada penderita endometriosis, terjadi proses inflamasi akibat adanya stress oksidatif yang berasal dari perdarahan siklik. Pada perdarahan siklik ini didapatkan heme dan besi yang merupakan suatu oksidan. Beratnya stress oksidatif yang terjadi dapat dilihat dari kadar malondialdehida dalam darah karena radikal bebas yang merupakan bagian dari ROS akan mengubah asam lemak jenuh menjadi aldehid dan malondialdehida (MDA). Telah diketahui bahwa kadar MDA pada jaringan endometriosis lebih tinggi secara bermakna dibandingkan dengan endometrium eutopik. Kurkumin diketahui mempunyai efek antiinflamasi, antioksidan, dan imunomodulator. Efek antioksidan dari kurkumin bekerja dengan cara mengurangi jumlah radikal bebas yang beredar.Tujuan: Menilai pengaruh pemberian kurkumin terhadap stress oksidatif pada penderita endometriosis.Metode: Penelitian ini merupakan suatu penelitian uji klinis acak tersamar ganda dengan kontrol pasien yang mendapat kapsul plasebo selama periode Desember 2014 ? Mei 2015. Pengambilan sampel dilakukan dengan consecutive sampling.Hasil: Sejumlah 12 subjek dari kelompok kurkumin diberikan perlakuan dengan 1x100 mg kurkumin selama 2 bulan, sedangkan 12 subjek pada kelompok kontrol diberikan kapsul plasebo selama 2 bulan, setelah sebelumnya diambil MDA pre perlakuan. Satu pasien dari kelompok kurkumin dan 2 dari kelompok kontrol drop-out karena tidak kembali pada akhir bulan kedua untuk pengambilan MDA pasca perlakuan. Rerata awal kadar MDA subjek kelompok plasebo adalah 0,39 ± 0,39 nmol/ml dengan rerata kadar MDA di akhir intervensi 0,32 ± 0,14 nmol/ml. Penurunan tersebut tidak bermakna berdasarkan uji statistik dengan nilai p=0,80. Rerata awal (baseline) kadar MDA subjek dengan suplementasi kurkumin adalah 0,33 ± 0,21 nmol/ml dengan rerata kadar MDA pasca intervensi berkurang menjadi 0,31 ± 0,13 nmol/ml. Secara statistik penurunan kadar MDA pasca suplementasi kurkumin tidak bermakna (p=0,84). Tidak didapatkan perbedaan bermakna kadar MDA awal antar kedua kelompok (p=0,56). Demikian juga pada kadar MDA akhir intervensi dan perubahan (delta) kadar MDA antar kedua kelompok setelah intervensi, tidak dijumpai berbedaan bermakna secara statistik dengan p=0,85 dan p=0,81, berturut-turutKesimpulan: Tidak terdapat penurunan kadar MDA yang bermakna pada subjek dengan suplementasi kurkumin maupun plasebo.

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ABSTRACTBackground: Endometriosis is estimated to be found in 2-22% asymptomatic reproductive women, while women with dysmenorrhea, the prevalence increased to 40-60%. Current management is medical therapy, surgical therapy, or a combination of both. But no one has been able to successfully eliminate this disease. This is proven by endometriosis recurrence rate is high enough, ranging from 33.3 to 40.3%. In endometriosis, inflammatory process occurs as a result of oxidative stress originating from cyclic bleeding. At this cyclic bleeding obtained heme and iron which is an oxidant. Free radicals that are part of the ROS (reactive oxygen species) will change the saturated fatty acids to aldehydes and malondialdehydes (MDA), so oxidative stress that occurs can be seen from plasma malondialdehyde levels. In recent study, MDA levels in endometriosis tissue was significantly higher than the eutopic endometrium. Curcumin is known to have anti-inflammatory, antioxidant and immunomodulatory effects. Antioxidant effects of curcumin works by reducing the amount of circulating free radicals.Objective: Assess the effect of curcumin on oxidative stress in endometriosis patientsMethods: This study is a randomized double-blind clinical trial with control groups receiving placebo capsules for the period December 2014 - May 2015. Sampling was conducted by consecutive sampling.Results: Twelve subjects of the treatment group was given curcumin 1x100 mg, while 12 subjects in the control group was given placebo capsules for 2 months. Peripheral blood was taken for MDA levels pre treatment. One patient from curcumin group and 2 from the control group dropped out because they do not come at the end of treatment for MDA measurement. The mean initial MDA level of placebo group was 0.39 ± 0.39 nmol / ml with a mean MDA levels at the end of the intervention 0.32 ± 0.14 nmol / ml. The decrease was not statistically significants with p = 0.80. The mean initial MDA levels of curcumin group was 0.33 ± 0.21 nmol / ml with a mean at the end of intervention was 0.31 ± 0.13 nmol / ml. The decrease was not statistically significants with p = 0.84. There were no significant differences between the initial MDA levels both groups (p = 0.56). Likewise, at MDA levels post intervention and delta between the MDA pre and post intervention on both groups, found no statistically significant with p = 0.85 and p = 0.81, respectively.Conclusions: There was no significant decrease in MDA levels in subjects with curcumin supplementation or placebo., Background: Endometriosis is estimated to be found in 2-22% asymptomatic reproductivewomen, while women with dysmenorrhea, the prevalence increased to 40-60%. Currentmanagement is medical therapy, surgical therapy, or a combination of both. But no one hasbeen able to successfully eliminate this disease. This is proven by endometriosis recurrencerate is high enough, ranging from 33.3 to 40.3%. In endometriosis, inflammatory processoccurs as a result of oxidative stress originating from cyclic bleeding. At this cyclic bleedingobtained heme and iron which is an oxidant. Free radicals that are part of the ROS (reactiveoxygen species) will change the saturated fatty acids to aldehydes and malondialdehydes(MDA), so oxidative stress that occurs can be seen from plasma malondialdehyde levels. Inrecent study, MDA levels in endometriosis tissue was significantly higher than the eutopic endometrium. Curcumin is known to have anti-inflammatory, antioxidant and immunomodulatory effects. Antioxidant effects of curcumin works by reducing the amountof circulating free radicals.Objective: Assess the effect of curcumin on oxidative stress in endometriosis patientsMethods: This study is a randomized double-blind clinical trial with control groups receivingplacebo capsules for the period December 2014 - May 2015. Sampling was conducted byconsecutive sampling.Results: Twelve subjects of the treatment group was given curcumin 1x100 mg, while 12subjects in the control group was given placebo capsules for 2 months. Peripheral blood wastaken for MDA levels pre treatment. One patient from curcumin group and 2 from the controlgroup dropped out because they do not come at the end of treatment for MDA measurement.The mean initial MDA level of placebo group was 0.39 ± 0.39 nmol / ml with a mean MDAlevels at the end of the intervention 0.32 ± 0.14 nmol / ml. The decrease was not statisticallysignificants with p = 0.80. The mean initial MDA levels of curcumin group was 0.33 ± 0.21nmol / ml with a mean at the end of intervention was 0.31 ± 0.13 nmol / ml. The decreasewas not statistically significants with p = 0.84. There were no significant differences betweenthe initial MDA levels both groups (p = 0.56). Likewise, at MDA levels post intervention anddelta between the MDA pre and post intervention on both groups, found no statisticallysignificant with p = 0.85 and p = 0.81, respectively.Conclusions: There was no significant decrease in MDA levels in subjects with curcumin supplementation or placebo.]"

"[ABSTRAKLatar Belakang: Kualitas hidup dan fertilitas merupakan isu yang ingin ditangani pada kasus amenorhea primer, dan kedua masalah ini menjadi alasan utama pasien mencari pengobatan. Penundaan diagnosis dan tatalaksana dapat mempengaruhi masa depan jangka panjang pasien. Walaupun prevalensi amenorhea primer sangat jarang (<0.1%), belum didapatkan data di senter pelayanan rawat jalan poliklinik Endokrinologi-Reproduksi RSCM. Tujuan: Meneliti karakteristik pasien amenorhea primer yang ditemui di poliklinik endokrinologi RSCM selama tahun 2014. Metode: Telaah retrospektif rekam medik dengan desain studi deskriptif kategorik terhadap pasien amenore primer yang berobat jalan di poliklinik imunoendokrinologi-reproduksi RSCM selama tahun 2014. Hasil dan simpulan: Terdapat 57 subyek penelitian. Selama 1 tahun terdapat 74% kasus baru dan 26% kasus lama, mayoritas kasus rujukan (79%) dengan karakteristik: Usia pada awal kontrol 22 ± 5.9 tahun. Keluhan utama yang tersering ditemukan adalah belum menstruasi (91.2%). Keluhan penyerta lain berupa gangguan pertumbuhan seks sekunder (8.7%). Sebanyak 93% tidak memiliki riwayat operasi dan obatan. Setengah populasi (50%) pasien tidak pernah mengalami perdarahan haid. Indeks massa tubuh pasien sebesar 20.77±3.5 kg/m2. Sebanyak 22.8% pasien amenore primer berperawakan kecil, serta 56.14% pasien amenore primer tidak memiliki pertumbuhan seks sekunder. Sebanyak 98.3% pasien tanpa hirsutisme, pembesaran tiroid, galaktore atau massa inguinal. Sebanyak 68.5 % dengan genitalia eksterna normal. Sebanyak 56.2% pasien dengan hipoplasi uterus, dan 49.1% dengan hipoplasi ovarium. Amenore primer hipergonadotropin-hipogonadisme adalah profil lab yang tersering ditemukan (33.33%). Dari gambaran kariotipe tersering 38% adalah 46XX. Etiologi dasar pada yang tersering adalah disgenesis gonad (36.8%), diikuti kelainan pembentukan duktus muller (28.07%) dan kelainan sentral (15.79%). Tatalaksana yang dilakukan terhadap kasus amenore primer berupa, induksi haid 42.1% dengan terapi hormonal. Pasien yang mendapat terapi hormonal, 24.56% mengalami perdarahan sela; Pada 28% mengalami perubahan klasifikasi Tanner. Operasi penyesuaian jender dilakukan pada 5 kasus (11%).

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ABSTRACTBackground : Quality of life and fertility are the two main issues to be handled in cases of primary amenorhea, as they become the main reasons for patients to seek medical care. Delay in diagnosis and treatment may affect the patient in the long term. Prevalence of primary amenorrhea is very rare (<0.1%) and there is minimal data on our reproductive endocrinology clinic at RSCM. Aim: To study the characteristics of primary amenorrhea patients at the reproductive endocrinology outpatient clinic during 2014. Methods: retrospective medical record review with cathegorical descriptive study to patients at reproductive-imunoendocrinology outpatient clinic during 2014. Results and conclusion: There were 57 study subjects. During 1 year there wer e74% new cases and 26% old cases with majority of referred casess(79%) with characteristics as such. Age at first control was 22 ± 5.9 years old. The most frequent chief complaint were no menstruation (91.2%). Other frequent complaint were disorder of secondary sex characteristics (8.7%). As much as 93% did not have history of surgery nor medication. Half of the cases (50%) never had menstruation. Body mass index mean was 20.77±3.5 kg/m2. As much as 22.8% patients were short-statured with 56.14% with no signs of secondary sex characteristics growth. Mostly (99.3%) patients had no hirsutism, thyroid enlargement nor inguinal. Normal external genitalia was found at 68.5% cases. 56.2% patient had uterus hipoplasia, and 49.1% with hipoplasia of the ovaries. Most often laboratory profile found was hypergonadotropin-hypogonadism (33.3%). Most frequent karyotpe were 46XX (38%). Most frequent etiology of primary amenorrhe in this study is gonadal dygenesis (36.8%) and mullerian dysgenesis/agenesis, and central disorders (15.79%). Most frequent etiology found was gonadal dysgenesis (36.8%), mullerian dysgenesis (28.07%) and central disorder (15.79%). Hormonal therapy was the most frequent treatment (42.1%). on patient with hormones, 24.6% had breakthrough bleeding, 28% had Tanner stage changes, and 11% had gender change. ;Background : Quality of life and fertility are the two main issues to be handled in cases of primary amenorhea, as they become the main reasons for patients to seek medical care. Delay in diagnosis and treatment may affect the patient in the long term. Prevalence of primary amenorrhea is very rare (<0.1%) and there is minimal data on our reproductive endocrinology clinic at RSCM. Aim: To study the characteristics of primary amenorrhea patients at the reproductive endocrinology outpatient clinic during 2014. Methods: retrospective medical record review with cathegorical descriptive study to patients at reproductive-imunoendocrinology outpatient clinic during 2014. Results and conclusion: There were 57 study subjects. During 1 year there wer e74% new cases and 26% old cases with majority of referred casess(79%) with characteristics as such. Age at first control was 22 ± 5.9 years old. The most frequent chief complaint were no menstruation (91.2%). Other frequent complaint were disorder of secondary sex characteristics (8.7%). As much as 93% did not have history of surgery nor medication. Half of the cases (50%) never had menstruation. Body mass index mean was 20.77±3.5 kg/m2. As much as 22.8% patients were short-statured with 56.14% with no signs of secondary sex characteristics growth. Mostly (99.3%) patients had no hirsutism, thyroid enlargement nor inguinal. Normal external genitalia was found at 68.5% cases. 56.2% patient had uterus hipoplasia, and 49.1% with hipoplasia of the ovaries. Most often laboratory profile found was hypergonadotropin-hypogonadism (33.3%). Most frequent karyotpe were 46XX (38%). Most frequent etiology of primary amenorrhe in this study is gonadal dygenesis (36.8%) and mullerian dysgenesis/agenesis, and central disorders (15.79%). Most frequent etiology found was gonadal dysgenesis (36.8%), mullerian dysgenesis (28.07%) and central disorder (15.79%). Hormonal therapy was the most frequent treatment (42.1%). on patient with hormones, 24.6% had breakthrough bleeding, 28% had Tanner stage changes, and 11% had gender change. , Background : Quality of life and fertility are the two main issues to be handled in cases of primary amenorhea, as they become the main reasons for patients to seek medical care. Delay in diagnosis and treatment may affect the patient in the long term. Prevalence of primary amenorrhea is very rare (<0.1%) and there is minimal data on our reproductive endocrinology clinic at RSCM. Aim: To study the characteristics of primary amenorrhea patients at the reproductive endocrinology outpatient clinic during 2014. Methods: retrospective medical record review with cathegorical descriptive study to patients at reproductive-imunoendocrinology outpatient clinic during 2014. Results and conclusion: There were 57 study subjects. During 1 year there wer e74% new cases and 26% old cases with majority of referred casess(79%) with characteristics as such. Age at first control was 22 ± 5.9 years old. The most frequent chief complaint were no menstruation (91.2%). Other frequent complaint were disorder of secondary sex characteristics (8.7%). As much as 93% did not have history of surgery nor medication. Half of the cases (50%) never had menstruation. Body mass index mean was 20.77±3.5 kg/m2. As much as 22.8% patients were short-statured with 56.14% with no signs of secondary sex characteristics growth. Mostly (99.3%) patients had no hirsutism, thyroid enlargement nor inguinal. Normal external genitalia was found at 68.5% cases. 56.2% patient had uterus hipoplasia, and 49.1% with hipoplasia of the ovaries. Most often laboratory profile found was hypergonadotropin-hypogonadism (33.3%). Most frequent karyotpe were 46XX (38%). Most frequent etiology of primary amenorrhe in this study is gonadal dygenesis (36.8%) and mullerian dysgenesis/agenesis, and central disorders (15.79%). Most frequent etiology found was gonadal dysgenesis (36.8%), mullerian dysgenesis (28.07%) and central disorder (15.79%). Hormonal therapy was the most frequent treatment (42.1%). on patient with hormones, 24.6% had breakthrough bleeding, 28% had Tanner stage changes, and 11% had gender change. ]"

"Tesis ini bertujuan untuk memperoleh upaya preservasi fungsi ovarium yang efektif dengan penilaian apoptosis sel granulosa. Vitrifikasi korteks ovarium menjadi pilihan dalam upaya mempertahankan fungsi reproduksi wanita penderita kanker karena dengan teknik ini dapat disimpan banyak folikel primordial, dilakukan kapan saja saat siklus haid tanpa penundaan terapi kanker dan dapat dilakukan untuk pasien prepubertas dan belum menikah. Penelitian vitrifikasi korteks ovarium masih terbatas pada hewan coba serta belum terdapat data yang menilai kejadian apoptosis sel granulosa pasca vitrifikasi korteks ovarium manusia yang dilihat dari ekspresi gen terkait apoptosis. Penelitian ini merupakan penelitian kuasi eksperimental yang dilaksanakan di Departemen Obstetri Ginekologi Fakultas Kedokteran Universitas Indonesia - RSUPN Dr. Cipto Mangunkusumo dan RS Fatmawati Jakarta dalam rentang waktu Maret 2012 hingga Mei 2015. Korteks ovarium didapatkan dari tiga belas pasien berusia 31-37 tahun yang menjalani ooforektomi atas indikasi ginekologis. Secara morfologi, folikel dari korteks ovarium segar tidak terdapat perbedaan dibandingkan dengan dari korteks ovarium pasca vitrifikasi. Rerata ekspresi protein Bax dari korteks ovarium segar yang dinilai dalam bentuk H-score adalah 1,66 ± 0,14 dibandingkan 1,68 ± 0,13 pada ovarium pasca vitrifikasi (p = 0,165). Sedangkan rerata ekspresi protein Bcl-2 dari korteks ovarium segar adalah 1,73 ± 0,10 dibandingkan 1,71 ± 0,10 pada ovarium pasca vitrifikasi (p = 0,068). Vitrifikasi korteks ovarium terbukti tidak menyebabkan peningkatan ekspresi gen Bax dan Bcl-2.

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The aim of this study was to obtain the effective method of ovarian function preservation with granulose cell apoptosis assessment. Ovarian tissue vitrification became a method for ovarian function preservation in women with cancer. This technique can be done anytime without delay on cancer therapy, in prepubertal and unmarried patient. It also can store many primordial follicles. Ovarian tissue vitrification study is still limited to animal test and there was no data about apoptosis assessment after ovarian vitrification in human ovary.

This is a quasi experimental study which was held in Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital and Fatmawati Hospital Jakarta from March 2012 to May 2015. Ovaries from thirteen women between 31-37 years of age who underwent oophorectomy with gynecological indication were examined.

There were no difference morphologically between follicles from fresh and warmed-vitrified ovaries. The mean protein Bax expression on the fresh ovaries which assessed in the form of H-score was 1,66 ± 0,14 compared to 1,68 ± 0,13 on the warmed-vitrified grup (p = 0,165). The mean protein Bcl-2 expression on the fresh ovaries which assessed in the form of H-score was 1,73 ± 0,10 compared to 1,71 ± 0,10 on the warmedvitrified grup (p = 0,068). As a conclusion, it was shown that vitrification did not affect Bax and Bcl-2 expression on human ovary."

"ABSTRAKPerubahan tingkat penanda epigenetik pada sperma memiliki dampak pada fertilisasi dan kontribusi sperma terhadap perkembangan embrio secara normal. Pada beberapa studi, perubahan metilasi pada DNA yang terdapat di dalam gen, memiliki kaitan dengan infertilitas dan keberhasilan teknologi reproduksi. Pemeriksaan Aniline Blue (AB) dan Toluidin Blue (TB) yang menganalisis maturitas dan kepadatan kromatin sperma ditentukan oleh ekspresi dari gen protamin. Namun sejauh ini, belum ada penelitian yang menganalisis tingkat maturitas dan kepadatan kromatin sperma sekaligus menilai status metilasi gen protamin 1 ini pada sperma pasien yang mengikuti program FIV dibandingkan dengan sperma pada laki-laki fertil normozoospermia dengan tingkat perkembangan zigot pada program FIV.Sampel penelitian ini berjumlah 60 orang, yang terdiri dari 30 sampel pasien yang mengikuti program FIV di Klinik Infertilitas Yasmin RSCM Kencana, dan 30 orang laki-laki fertil normozoospermia. Sampel ini diperiksa keadaan kromatin spermanya menggunakan pewarnaan AB dan TB, Data tingkat perkembangan zigot diperoleh dari data sekunder rekam medis Klinik Yasmin, kemudian analisis metilasi gen protamin 1 menggunakan MSP (Methylation Specific PCR) dan diukur pita yang terlihat secara semikuantitatif menggunakan ImageJ.Dari hasil penelitian diperoleh bahwa tingkat maturitas kromatin sperma pada ejakulat pasien FIV lebih rendah secara bermakna dibandingkan pada ejakulat laki-laki fertil normozoospermia. Maturitas kromatin sperma yang baik pada ejakulat pasien FIV memiliki arah korelasi positif yang tidak bermakna dengan tingkat perkembangan zigot, sedangkan pada tingkat kepadatan kromatin sebaliknya, dan memiliki korelasi bermakna pada kategori maturitas kromatin sperma yang tidak baik. Tingkat metilasi DNA gen protamin 1 pada pasien yang mengikuti program FIV lebih rendah bermakna dibandingkan dengan tingkat metilasi DNA gen protamin 1 pada ejakulat laki-laki fertil normozoospermia. Terdapat hubungan korelasi tidak bermakna dengan arah positif antara maturitas kromatin sperma dengan tingkat metilasi DNA gen protamin 1 namun pada kepadatan kromatin memiliki arah sebaliknya. Perubahan tingkat metilasi DNA pada gen Protamin 1 mempengaruhi perkembangan zigot pada program FIV namun tidak bermakna.

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ABSTRACT

The changes of epigenetic marker level of sperm have an impact on fertilization and contribution sperm to the normally embryo development. In some studies, DNA methylation changes in genes, linked to infertility and the success of assisted reproductive technology. The assay of Aniline Blue (AB) and Toluidine Blue (TB) which analyzed maturity and integrity of sperm chromatin was determined by the expression of protamine gene. Up till now, there has not been any study to analyze the maturity level and integrity of sperm chromatin level, and methylation status of protamine 1 genes on the FIV patients sperm compared to sperm in normozoospermia fertile male with the level of zygote development in the IVF program.

Samples used in this study were ejaculate from patients who take IVF program at Yasmin Infertility Clinic, RSCM Kencana, and 30 normozoospermia fertile male as control. These samples were assayed the sperm chromatin using AB and TB staining. The data of zygote development level were obtained from secondary data of medical records of Yasmin Infertility Clinic, and the methylation level of protamine 1 gene were done MSP (methylation Specific PCR) and its band measured using ImageJ semi quantitatively.

The result showed that the level of sperm chromatin maturity of ejaculate IVF patients was significantly lower compared to normozoospermia fertile male. The maturity and chromatin integrity level of sperm in the ejaculate IVF patients with have weak correlation with the level of zygote development and significant in the bad category of sperm chromatin maturity. The DNA methylation level of protamine 1 gene in patients under when the IVF program was significantly lower compared to normozoospermia fertile male. There was not significantly with positif correlation between maturity chromatin of sperm with the DNA methylation of protamine 1 gene and the chromatin integrity was different. The changes of DNA methylation of Protamine 1 gene affects the level of zygote development in IVF program not significantly.Aniline Blue."

"TUJUAN: Mengetahui efek metformin atau DLBS3233 terhadap kadar AMH. LATAR BELAKANG: SOPK merupakan sindrom yang diketahui berkaitan dengan resistensi insulin dalam patofisiologi dan peranan AMH dalam patogenesis. Maka salah satu bagian dari tatalaksana SOPK adalah dengan pemberian insulin sensitizing agent ISA. ISA yang telah banyak digunakan yaitu metformin yang terbukti dalam memperbaiki siklus haid, namun obat ini juga menimbulkan efek samping seperti keluhan gastrointestinal yang cukup berat. Sehingga perkembangan obat herbal seperti fraksi bioaktif DLBS3233 memberikan harapan akan ISA yang efektif, namun memiliki efek samping minimal. Peranan ISA dalam efek perubahan AMH masih kontroversial, dan hanya ditemui penelitian yang meneliti metformin. DESAIN DAN METODE: Penelitian ini menggunakan desain uji klinis acak tersamar ganda yang berlangsung pada bulan Maret 2013 hingga Juni 2015 di klinik Yasmin, RSCM Kencana dan RS Hasan Sadikin, Bandung. Subjek penelitian akan mendapatkan metformin sebanyak 2x750mg atau DLBS3233 1x100mg per hari selama enam bulan. Evaluasi kadar AMH akan dilakukan sebanyak dua kali, sebelum dan sesudah pengobatan. HASIL: Sebanyak 20 subjek mendapati metformin dan 18 subjek mendapati DLBS3233. Rerata kadar AMH sebelum pengobatan didapati 9,30 5,06 ng/mL dan 11,27 6,47 ng/mL. Pasca pengobatan, didapati penurunan kadar AMH yang signifikan sebesar 1,52 0,07 p < 0,001. Penurunan kadar AMH didapati lebih tinggi pada grup metformin bila dibandingkan dengan DLBS3233 ? AMH = 1,83 ng/mL vs 1,15 ng/mL. Namun, metformin menimbulkan efek samping yang lebih signifikan dibandingkan DLBS3233 p=0,01. Sebanyak 7 pasien 18,42 hamil selama penelitian ini. Namun efek samping pengobatan jauh dirasakan oleh subjek yang mendapatkan metformin dibandingkan DLBS3233 p=0,01. KESIMPULAN: Baik metformin atau fraksi bioaktif DLBS3233 dapat menurunkan kadar AMH, dan DLBS3233 merupakan pilihan terapi SOPK dengan efek samping yang minimal.

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OBJECTIVE: To determine the effect of metformin and DLBS3233 on serum AMH level.

BACKGROUND: PCOS is known to be associated with insulin resistance in the pathophysiology and Anti Mullerian Hormone AMH in the pathogenesis. Thus, one of management of PCOS is to give insulin sensitizing agent ISA. Type of ISA which has been widely used is metformin which proven to improve menstrual cycle, but this medication cause major side effect such as gastrointestinal problems. So, the development of herbal medicine such as Bioactive Fraction DLBS3233, offer effective medicine, with minimal side effects. To date, the role of ISA to effects the changes in AMH still controversial, and studies only examine the effect of metformin to the level of AMH.

METHOD: Double blind randomized controlled trial was conducted in Yasmic Clinic, Cipto Mangunkusumo General Hospital, Kencana and Hasan Sadikin hospital, Bandung within March 2013 until June 2015. PCOS patient diagnosed using Rotterdam All participant get daily dose of metformin 2x750mg or DLBS3233 1x100mg for six months. Evaluation of serum AMH level was conducted twice prior therapy and after the completion of the therapy. Protocol analysis was carried out upon differences of AMH using SPSS 20.

RESULTS: 20 subjects received metformin, while 18 subject received DLBS3233. Level of AMH prior medication was known to be 9,30 5,06 ng mL and 11,27 6,47 ng mL. After six months of therapy, there is significant decrease of AMH level of 1,52 0,07 p 0,001. The decrease level of AMH was observed higher in metformin group compared to DLBS3233 AMH 1,83 ng mL vs 1,15 ng mL. However, metformin causing more side effects compared to DLBS3233 p 0,01. There are total of 7 subjects 18,42 pregnant during the studies.

CONCLUSION: There rsquo s a significant decrease of AMH level after administration of either metformin or DLBS3233. "

"ABSTRAKLatar Belakang: Nyeri panggul kronik merupakan suatu gejala yang dialami oleh perempuan terutama di usia reproduksi. Kondisi ini menggangu aktivitas harian dan menurunkan kualitas hidup hingga membuat penderita mengalami depresi. Prevalensi nyeri panggul kronis pada perempuan berkisar 3,8 ndash; 40 di seluruh dunia. Kondisi ini merupakan suatu entitas yang masih belum dipelajari dengan baik dan dapat menyebabkan morbiditas yang serius. Proses inflamasi juga berperan dalam mencipatakan rasa nyeri. Hs ndash; CRP merupakan sebuah penanda inflamasi yang nilainya meningkat pada saat terjadi reaksi tersebut.Tujuan: Penelitian ini bertujuan untuk mengetahui prevalensi dan berbagai aspek yang berhubungan dengan nyeri panggul kronik pada perempuan di RSUP Cipto Mangunkusumo.Metode: Penelitian dilakukan dengan desain potong lintang di poliklinik rawat jalan ginekologi dan laboratorium di RSCM selama Januari ndash; Maret 2016. Pasien yang mengeluh nyeri panggul lebih dari 6 bulan dilakukan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang dan pemeriksaan hs ndash; CRP serum. Dilakukan penghitungan prevalensi dan deskripsi karakteristik klinis dan diagnosis pasien. Kualitas hidup dan kadar hs ndash; CRP dibandingkan antara kelompok derajat nyeri ringan dan berat.Hasil: Didapatkan prevalensi sebesar 9,78 dari total pasien di poliklinik ginekologi RSCM. Ditemukan 96,9 kelainan ginekologi, 1 kelainan urologi, dan 2,1 kelainan muskulo-skeletal. Diagnosis tersering adalah endometriosis. Karakteristik klinis pasien yang ditemukan adalah 62,9 menderita lama nyeri selama 6 bulan ndash; 1 tahun dengan intensitas nyeri VAS 7 ndash; 10 sebanyak 51,5 . Kadar hs ndash; CRP serum sebesar 1,99 0,00 ndash; 404, 53 . Terjadi penurunan kualitas hidup dari domain fisik 56 38 - 81 ; domain psikologi 56 31 - 100 ; domain hubungan sosial 25 - 75 ; domain lingkungan 56 31 - 94 .Kesimpulan: Nyeri panggul kronik pada perempuan dijumpai pada usia reproduksi dengan penyebab tersering endometriosis. Nyeri tersebut menyebabkan penurunan kualitas hidup.

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ABSTRACT Background Chronic pelvic pain is a symptom which experienced by women, especially in the reproductive age. These condition interferes with daily activities and decreses quality of life from the patient who suffers it. The prevalences of chronic pelvic pain in women range from 3.8 to 40 worldwide. This condition is an entity that has not been studied well and can cause serious morbidity. Inflammatory process also plays a role in the creation of pain. Hs CRP is a marker of inflammation that increases in value in the event of such reactions.Purpose This study aimed to determine the prevalence and various aspects that associated with female chronic pelvic pain at Cipto Mangunkusumo hospital. Methods The study was conducted with a cross sectional design in gynecology outpatient polyclinic and laboratory at RSCM during January to March 2016. Patients who complain pelvic pain for more than 6 months. We take the history and was performed physical examination and investigations including hs CRP serum examination. We calculate the prevalence and describe the clinical characteristics and diagnosis of the patient. Quality of life and levels of hs CRP were compared between the group of mild and severe pain. Results The prevalence was 9.78 from the total patients in the RSCM gynecology outpatient clinic. We found 96.9 of gynecological disorders, 1 of urological disorders, and 2.1 of musculo skeletal disorders. The most common diagnosis is endometriosis. The Clinical characteristics of patients were found 62.9 suffer for 6 months 1 year with the intensity of pain VAS 7 10 as much as 51.5 . Levels of hs CRP serum was around 1.99 0.00 404, 53 . We found a decreased in the quality of life of the patient. The physical domain score was 56 38 81 the psychology domain score was 56 31 100 the domain of social relationships was 59 25 75 and the environmental domain score was 56 31 94 . Conclusion Endometriosis is the most common diagnosis in female chronic pelvic pain of reproductive age. The Pain causes a decreased in quality of life who suffer from it. "