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"Latar belakang: Vitrifikasi folikel pre-antral menjadi pilihan dalam upaya preservasi fungsi reproduksi karena dapat menurunkan risiko mikrometastasis sel kanker akibat transplantasi korteks ovarium serta tidak dipengaruhi oleh perfusi jaringan. Tujuan: Memperoleh upaya preservasi fungsi ovarium yang efektif dengan penilaian apoptosis folikel pre-antral. Tempat: Departemen Obstetri Ginekologi Fakultas Kedokteran Universitas Indonesia - RS Dr. Cipto Mangunkusumo dan RS Fatmawati Jakarta. Metode: Studi ini merupakan penelitian eksperimental untuk menilai apoptosis folikel pre-antral pasca vitrifikasi. Folikel pre-antral segar merupakan kelompok kontrol. Hasil: Korteks ovarium didapatkan dari 6 enam pasien kanker serviks dan kanker payudara berumur 30-37 tahun yang menjalani operasi ooforektomi. Tidak terdapat perbedaan morfologi folikel primordial, folikel primer dan folikel sekunder dari korteks ovarium segar dan korteks ovarium pasca vitrifikasi. Dari 6 sampel korteks ovariumSeratus enam puluh satu berhasil di-isolasi 161 folikel pre-antral berhasil di-isolasi dengan 70 % di antaranya merupakan folikel sekunder. Tidak tampak perbedaan morfologi folikel pre-antral berdasarkan kriteria membran basalis, sel granulosa, zona pelusida dan oosit. Rerata ekspresi mRNAgen FasL folikel pre-antral segar adalah 0,43 ± 0,20 dibandingkan 0,51 ± 0,20 pada folikel pre-antral pasca vitrifikasi (nilai p = 0,22). Rerata ekspresi mRNAgen kaspase-3 folikel pre-antral segar adalah 0,56 ± 0,49 dibandingkan 0,27 ± 0,21 pada folikel pre-antral pasca vitrifikasi (nilai p = 0,233). Satu folikel sekunder dari korteks ovarium segar berhasil tumbuh menjadi folikel antral lanjut pada hari ke-6 kultur. Simpulan: Vitrifikasi folikel pre-antral terbukti tidak menyebabkan perubahan morfologi folikel dan peningkatan ekspresi gen mRNA FasL dan kaspase-3. Untuk membuktikan pengaruh vitrifikasi terhadap kesintasan folikel pre-antral pasca dalam kultur diperlukan penelitian lanjutan.

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Background: Pre-antral follicle vitrification should be considered as fertility preservation method because it lowers the risk of cancer micrometastasis of ovarian tissue transplantation and is not disturbed by ovarian tissue perfusion.

Objectives: To obtain the effective method of ovarian function preservation with pre-antral follicle apoptosis assessment.

Setting: Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital and Fatmawati Hospital Jakarta.

Method: This is an experimental study about apoptosis in pre-antral follicles after vitrification. Fresh pre-antral follicles served as a control group.

Results: Ovaries from six women between 30‒37 years of age who underwent oophorectomy due to cervical cancer or breast cancer were examined. There was no significant difference between primordial, primary and secondary follicles morphology from fresh and warmed-vitrified ovaries based on basal membrane, granulosa cells, zona pellucida and oocytes. From 6 six ovarian cortex, 161 pre- antral follicles were isolated and 70 % of them is secondary follicle. There was no significant difference between the morphology of isolated pre-antral follicles from fresh and warmed-vitrified ovaries. The mean FasL mRNA expression on the fresh isolated pre-antral follicles was 0.43±0.20 versus 0.51±0.20 on the warmed-vitrified group (p=0.22). The mean caspase-3 mRNA expression on the fresh isolated pre-antral follicles was 0.56±0.49 versus 0.27±0.21 on the warmed- vitrified group (=0.233). One secondary follicle grew and developed to an antral follicle within 6 days of culture.

Conclusion: It was shown that vitrification did not affect pre-antral follicles morphology and mRNA expression of FasL and caspase-3 on isolated pre-antral follicles and ovarian cortex. Further studies are required to establish whether vitrification affect in vitro culture of pre-antral follicles"

"ABSTRAKAdverse pregnancy outcome (APO) adalah kondisi patologis kehamilan yang berperan dalam morbiditas dan mortalitas maternal dan perinatal, antara lain preeklamsia (PE)/ eklamsia, keguguran berulang, kematian janin dalam kandungan, dan pertumbuhan janin terhambat (PJT). Penelitian ini bertujuan mengetahui peran resistensi arteri uterina, kadar Annexin-V, sTNF-R2, dan sFlt-1 pada serum wanita hamil trimester II sebagai prediktor PE dan PJT.Penelitian ini dilakukan menggunakan desain potong lintang, kohort dan nested case control di RS.Fatmawati dan Puskesmas Kecamatan Cilandak, Jakarta Selatan. Subjek penelitian adalah ibu hamil 22?24 minggu yang datang ke poliklinik antenatal care. Dilakukan pemeriksaan doppler velosimetri arteri uterina. Bila tinggi/takik dikategorikan sebagai kasus dan bila normal sebagai kontrol. Pada seluruh subjek penelitian dilakukan pemeriksaan Annexin-V, sTNF-R2 dan sFlt-1. Seluruh subjek diikuti secara prospektif sampai dengan timbul gejala PE atau PJT.Dari 96 subjek, 47 kasus dan 49 kontrol, lima subjek (5,2 %) dengan manifestasi APO, terdiri dari 3 subjek mengalami Preeklamsia (PE) dan Pertumbuhan Janin Terhambat (PJT), 2 subjek hanya mengalami Pertumbuhan Janin Terhambat (PJT). Seluruhnya terjadi pada kelompok kasus (10,6 %), dengan risiko relatif kejadian APO 11,46 (95 % IK: 0,65?201,66).Nilai titik potong kadar Annexin-V serum pada APO ≤ 0,84 ng/mL dengan nilai sensitivitas 80% dan spesifisitas 61,50%. Nilai titik potong kadar sTNF-R2 serum pada APO ≤ 236,93 ng/mL dengan nilai sensitivitas 60,00% dan spesifisitas 53,80%. Titik potong kadar sFlt-1 serum pada APO ≥ 1331,66 pg/mL dengan nilai sensitivitas 40,00% dan spesifisitas 75,80 %.Di buat model prediksi, menggunakan variabel paritas, usia maternal dan kadar annexin-V < 0,84 ng/mL. Resistensi arteri uterina yang tinggi di usia kehamilan 22?24 minggu meningkatkan peluang terjadinya APO 11,46 kali

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ABSTRACTAdverse pregnancy outcomes (APO) is a group of pathological conditions of pregnancy which play a role in morbidity and/or mortality maternal/perinatal. Included in this complications are preeclampsia (PE)/eclampsia, recurrent miscarriage, fetal death in utero, and Fetal Growth Restriction (FGR). The objective of this study was to determine the role of resistance of the uterine artery by doppler velocymetry examination, the serum levels of annexin-V, sTNF-R2, and sFlt-1 in the 22?24 weeks of pregnancy as a predictor of PE and FGR.This study was conducted at Fatmawati Hospital and Cilandak Subdistrict Health Center, South of Jakarta. Subjects of the study was a 22?24 weeks pregnant women who came to the antenatal care clinic. Doppler velocymetry examination of uterine artery was conducted, subjects with high resistance categorized as cases, while when normal, categorized as a control. To all of the subjects, measurement of serum Annexin-V, sTNF-R2 and sFlt-1 was carry out.Out of 96 subjects, 47 were cases and 49 were controls. Five (5.2 % ) subjects with APO, consisting of three subjects had PE and FGR, two subjects experienced only FGR. All of APO found in the case group (10.6%), with relative risk was 11.46 (95% CI: 0.65?201.66), with p = 0.096. If the notch was seen, the relative risk of APO was 6.44 (95% CI: 0.78?53.20), with p = 0.04.The cut-off point of serum Annexin V in subject with APO was ≤ 0.84 ng / mL with a sensitivity of 80% and specificity of 61.50%. The cut-off point serum levels of TNF-R2 in subject with APO was ≤ 236.93 ng/mL, with a 60.00% sensitivity and specificity of 53.80%. The cut-off point serum levels of sFlt-1 in subject with APO was ≥1331.66 pg/mL with a 40.00% sensitivity and specificity of 75.80%.Prediction model has been made, using variabel maternal age, parity and the serum level of Annexin V. High uterine artery resistance at 22?24 weeks gestational age increases the chances of APO 11.46 times"

"Sindrom Ovarium Polikistik (SOPK) saat ini merupakan salah satu kelainan dengan keberhasilan kehamilan terendah di antara berbagai penyebab infertilitas. Penelitian ini bertujuan untuk menilai ultrasonografi (USG) sebagai prediktor diagnosis reseptivitas endometrium perempuan infertil Sindrom Ovarium Polikistik. Penelitian ini merupakan studi diagnostik observasional dengan disain potong lintang. Tiga puluh empat perempuan usia reproduksi (32,5 ± 3,8 tahun), mengalami infertilitas primer 4,9 ± 3,1 tahun dengan siklus anovulasi mendapat klomifen sitrat 100 mg perhari H2?6; perkembangan folikel dan ovulasi dikonfirmasi dengan pemeriksaan ultrasonografi (USG) H12?17. Pemeriksaan USG yang diikuti biopsi endometrium dan hormon progesteron dilakukan pada H19?21 atau pasca ovulasi H+5?+7. USG digunakan untuk menilai Zona Vaskularisasi menurut kriteria Sonai, Volume Endometrium menurut kriteria Zollner, dan Indeks Vaskularisasi-Arus Darah menurut kriteria Wu. Biopsi endometrium dinilai berdasarkan penanggalan histopatologis menurut kriteria Noyes, dan pemeriksaan imunohistokimia VEGF dan VEGFR-1 dengan penilaian secara H-Score. Kadar VEGF serum diperiksa dengan metode Elisa. Analisis statistik menggunakan uji chi-square, uji-t dan nilai ROC. Dihasilkan titik potong komposit endometrium sebagai baku emas reseptivitas endometrium berdasarkan pemeriksaan penanggalan histopatologis endometrium. Pemeriksaan USG berdasarkan pemeriksaan komposit endometrium ini akhirnya menghasilkan baku emas USG penetapan reseptivitas endometrium. Pemeriksaan USG H19?21 menunjukkan rerata tebal endometrium 10,47 ± 1,85 mm, Volume Endometrium 3,70 ± 1,31 ml, Indeks Vaskularisasi?Arus Darah Indeks Vaskularisasi?Arus Darah 0,08 (0,00-3,21) dan Zona Vaskularisasi di lapis 1,2,3 dan 4 masing-masing 14,7%, 41,2%, 35,3% dan 8,8%. Pemeriksaan histopatologis endometrium mendapatkan 58,8% in-phase dan 41,2% out-phase. Pemeriksaan VEGF endometrium mendapatkan ekspresi tertinggi di endotel (2,34 ± 0,26), kemudian di epitel luminal (2,23 ± 0,37), sel stroma (2,1±1,9), terendah di epitel kelenjar (2,00 ± 0,68). VEGFR-1 endometrium tertinggi di epitel kelenjar (2,85 ± 0,30), diikuti di epitel luminal (2,83 ± 0,54), endotel (2,70 ± 0,42) dan terendah di sel stroma (2,58 ± 0,42). Secara statistik, ditemukan hubungan bermakna antara Zona Vaskularisasi dengan VEGF sel stroma (p = 0,018), Volume Endometrium dengan VEGF endotel (p = 0,000), epitel luminal (p = 0,029) dan total sel (0,043) serta Penanggalan Histologis Endometrium dengan VEGFR-1 sel stroma (p = 0,009). Penetapan reseptivitas endometrium hasil penilaian Komposit USG berdasarkan baku emas komposit endometrium adalah ditemukannya Zona Vaskularisasi lapis 3?4, Volume Endometrium ≥ 3,090 ml dan Indeks Vaskularisasi-Arus Darah ≥ 0,253 yang menunjukkan spesifisitas 77,4%. Ultrasonografi dapat digunakan sebagai prediktor diagnosis reseptivitas endometrium masa jendela implantasi embrio perempuan infertil SOPK.

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Polycyctic ovary syndrome has been recognized as one of the lowest successful pregnancy rates in infertile women. This studi aimed to assess ultrasound as predictor of endometrial receptivity in PCOS infertile women.

Diagnostic observational study in cross sectional design was conducted. Thirty-four subjects suffered anovulatory cycles in a average 32,5 ± 3,8 years of age and primary infertility for 4,9 ± 3,1 years, receiving 100 mg/d clomiphene citrate therapy on D2?6 . Follicular development and ovulation were confirmed by tranasvaginal USG examination on D12?17 . Repeated USG procedures followed by endometrial biopsy and serum progesterone test were conducted on either D 19?21 or D+5?+7 post ovulatory. The use of USG was to assess Vascularization Zone by Sonai criteria, Endometrial Volume by Zollner criteria and Vascularization Flow Index (VFI) by Wu criteria. Endometrial biopsy was performed and dated, based on endometrial histological dating by Noyes citeria. Immunohistochemistry of VEGF and VEGFR-1 were done and counted by H-Score formula. VEGF serum was tested by Elisa method. Statistical analysis of Chi-squre test, student t-test and ROC value were used. Immunohistochemistry composite formation was based on histological dating of endometrium. Ultrasound composite based on immunohistochemistry composite was finally resulting the new cut-off of endometrial reseptivity. Ultrasound findings on D19?21 showed the average endometrial thickness 10,47± 1,85 mm, Endometrium Volume 3,70 ± 1,31 ml, Vascularization?Flow Index (VFI) 0,08 (0,00?3,21 ) and Vascularization Zone (ZV) of zone 1,2,3 and 4 were 14,7%, 41,2%, 35,3% and 8,8%. Endometrial dating was 58,8% in-phase and 41,2% out-phase. Endometrial VEGF staining showed the highest expression in endothel (2,34 ± 0,26), followed by luminal epithelium (2,23 ± 0,37), stromal cells (2,1 ± 1,9) and the lowest in glandular epithelial (2,00 ± 0,68); meanwhile the highest VEGFR-1 expression was seen in glandular epithelial (2,85 ± 0,30), followed by luminal epithelial (2,83 ± 0,54), endothelial (2,70 ± 0,42) and the lowest at the stromal cells (2,58 ± 0,42). Statistically, ZV was correlated to the VEGF stromal cells (p = 0,018) and Endometrial Volume was correlated to VEGF endothelial (p = 0,000) and VEGF luminal epithelium (p = 0,029) and VEGF total cells (p = 0,043); meanwhile Histological Dating of Endometrium was correlated to VEGFR-1 stromal cells (p = 0,009). Endometrial receptivity predictor determined by Ultrasound Composite based on immunohistochemistry composite was Vascularization Zone of layer 3?4, Endometrial Volume of ≥ 3,090 ml and endometrial VFI of 0,253 with a specificity of 77,4%. Ultrasound was the useful tools for diagnostic predictor of endometrial receptivity diagnosis during the implantation windows period of PCOS infertile female."