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Julianto Witjaksono
Ultrasonografi sebagai prediktor diagnosis reseptivitas endometrium pada masa jendela implantasi embrio perempuan infertil sindrom ovarium polikistik = Ultrasound as diagnostic predictor for endometrial receptivity assessment during embryo implantation window period in infertile female with polycystic ovary syndrome
"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.
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."
Depok: Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Disertasi Membership  Universitas Indonesia Library
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Andhika Ardi Perdana
Peran Perubahan Gaya Hidup melalui Perubahan Pola Diet terhadap Reseptivitas Endometrium Perempuan Infertil dan Obesitas dengan Sindrom Ovarium Polikistik = Role of Lifestyle Modification trough Dietary Changes to Endometrial Receptivity on Infertility Women and Obesity with Polycystic Ovarian Syndrome.
"Latar Belakang: Sindrom ovarium polikistik dan obesitas memperlihatkan dampak pada kemampuan endometrium untuk menerima hasil konsepsi. Penggunaan Ultrasonografi Doppler memiliki peran penting dalam pemeriksaan reseptivitas endometrium karena efisiensi dan prosedur non-traumatis. Tujuan dari penelitian ini adalah untuk menyelidiki efek modifikasi gaya hidup pada penerimaan endometrium wanita obesitas dengan sindrom ovarium polikistik menggunakan ultrasonografi.
Metode: Penelitian observasional ini dilakukan di Rumah Sakit Umum Cipto Mangunkusumo Jakarta, Indonesia dari Agustus 2019 hingga Mei 2020. Total 32 subjek yang berpartisipasi dalam penelitian ini pada awalnya. Karena kasus loss to follow up, subjek akhir dikurangi menjadi 14 orang. Subyek pertama dievaluasi dengan USG trans-vaginal untuk melihat gambar endometrium, kemudian disarankan untuk mendapatkan konseling gizi oleh ahli gizi klinis dan kemudian ditindaklanjuti selama 6 bulan menggunakan ultrasonografi trans-vaginal.
Hasil: Sebanyak 19 subjek menerima konseling gizi oleh spesialis Gizi Klinis. Tapi kemudian, hanya 14 subjek yang dievaluasi dengan Ultrasonografi. Ada beberapa hasil yang signifikan antara sebelum dan sesudah perawatan beberapa subjek seperti kalori, berat badan, indeks massa tubuh, lingkar pinggang (p<0,05) dan jenis zona vaskular, volume endometrium, indeks aliran vaskular dalam endometrium (p<0,05).
Kesimpulan: Belum didapatkan korelasi yang signifikan antara perubahan antropometri dan asupan kalori harian dengan perubahan Zona Vaskular endometrium disebabkan tingginya angka loss to follow-up dan belum tekontrolnya asupan kalori harian dari setiap subjek.
Background: Polycystic Ovarian Syndrome and obesity have shown an impact on endometrium ability to accept the results conception. The use of a Doppler Ultrasonography has an important role in the examination of endometrial receptivity due to efficiency and non traumatic procedure. The aim of this study is to investigate the effect of lifestyle modification on endometrial receptivity of obese women with polycystic Ovarian Syndrome using ultrasonography.
Methods: This observational study was conducted at Cipto Mangunkusumo General Hospital Jakarta, Indonesia from August 2019 to May 2020. From a total of 32 subjects were participated in this study. Due to loss of follow up case, the final subject was decrease into 14 person. The subjects were firstly evaluated with the trans-vaginal ultrasound to see the picture of the endometrium, then advised to get nutrition counseling by Clinical nutritionist and then followed up for 6 months using trans- vaginal ultrasonography.
Results: A total 19 subjects were received nutrition counseling by Clinical Nutritionist. But then, only 14 subjects were evaluated by Ultrasonography. There were several significant results between before and after treatment of some subjects such as calories, body weight, body mass index, waist circumference (p<0,05) and type of the vascular zone, endometrium volume, vascular flow index in endometrium (p<0,05). In this study, no significant results have been found on the correlation between dietary changes and changes of endometrial receptivity.
Conclusion: No significant correlation has been found between changes in antropometrics and daily calorie intake with changes in endometrial vascular zones due to high loss to follow-up rates and uncontrolled daily caloric intake for each subject."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tesis Membership  Universitas Indonesia Library
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Nurhuda
Progesteron sebagai penentu jendela implantasi berdasarkan penilaian petanda reseptivitas endometrium (HOXA10, integrin aVB3 dan Pinopod) macaca nemestrina pasca pemberian hiperstimulasi ovarium terkendali = Progesterone as determinant of window implantation based on evaluated marker of receptivity of macaca nemestrina endometrium after controlled ovrian hyperstimulation
"ABSTRAK
Latar belakang. Prosedur stimulasi ovarium terkendali pada program FIV berdampak buruk terhadap reseptivitas endometrium. Efek buruk tersebut terjadi karena perubahan kadar hormon yang tidak fisiologis. Laporan penelitian menunjukkan bahwa keberhasilan hamil pada program FIV hanya sekitar 30%.
Tujuan penelitian. Menilai dampak pemberian stimulator ovarium terhadap ekspresi petanda reseptivitas endometrium periode implantasi.
Metodologi penelitian. Sebanyak 16 ekor Macaca nemestrina dibagi menjadi 4 kelompok: 1 kelompok kontrol dan 3 kelompok perlakuan, berupa pemberian stimulator ovarium dosis 30-70 IU selama 10-12 hari sampai diperoleh puncak sekresi estradiol pada fase folikuler akhir dan dilanjutkan dengan pemberian hCG dosis 3200 IU. Nekropsi jaringan uterus dilakukan hari ke 8-9 setelah puncak sekresi estradiol. Parameter yang dinilai adalah kadar hormon estradiol, progesteron dan ekspresi protein HOXA10, integrin αvβ3 pinopod endometrium dan hubungan hormon steroid dengan ekspresi petanda reseptivitas endometrium.
Hasil dan pembahasan. Berdasarkan uji Anova, variasi dosis stimulator ovarium antara 30-70 IU tidak menunjukkan perbedaan bermakna kadar estradiol, progesteron serta ekspresi protein HOXA10 dan integrin αvβ3 antara kelompok kontrol dengan perlakuan (p > 0,05). Berdasarkan Uji korelasi Pearson terdapat hubungan bermakna antara kadar progesteron dengan ekspresi protein HOXA10 dan integrin αvβ3 terutama pada daerah fungsional endometrium ( p < 0,05), sedangkan dengan hormon estradiol tidak terdapat perbedaan yang bermakna (P>0.05). Perkembangan pinopod yang menunjukkan periode jendela implantasi (tahap perkembangan maksimal) diperoleh pada rasio progesteron/estrogen antara 0,20 ? 0,49 dan periode regresi yaitu pada rasio 0,26 ? 7,34.
Kesimpulan.Variasi dosis stimulator ovarium 30-70 IU tidak mempengaruhi sekresi hormon estrogen, progesteron dan ekspresi petanda reseptivitas endometrium. Berdasarkan uji regresi Pearson terdapat hubungan bermakna antara hormon progesteron fase folikuler akhir dan fase luteal dengan ekspresi petanda reseptivitas endometrium. Lonjakan estradiol fase folikuler akhir tidak berpengaruh terhadap ekspresi petanda reseptivitas endometrium. Rasio progesteron/estradiol antara 0,20-0,49 menunjukan periode jendela implantasi, sedangkan rasio 0,26 ? 7,34 menunjukkan bahwa perkembangan pinopod mengalami regresi.
ABSTRACT
Background.Controlled ovarian stimulation procedure on FIV program adversely affect endometrial receptivity. The adverse effects occur due to non physiological changes in hormone levels. Research reports showed that pregnant success rate of FIV program were only around 30%.
Research objective.To assess the impact of ovarian stimulator on the expression of endometrial receptivity markers of implantation period.
Research methodology.Total of 16 Macaca nemestrinawere divided into four groups, one control group and three treatment groups, ie giving a dose of 30-70 IU ovarian stimulator for 10-12 days to obtain peak estradiol secretion at the end of follicular phase and continued with a dose of 3200 IU of hCG administration. Uterine tissue necropsy was performed 8-9 days after the peak secretion of estradiol. The parameters assessed were levels of the hormones estradiol, progsterone and expression of proteins HOXA10, integrin αvβ3 pinopod endometrium and steroid hormone relationship with the expression of markers of endometrial receptivity.
Results and discussion. Based on analysis of variance (anova), ovarian stimulator dose variation between 30-70 IU showed no significant difference levels of estradiol, progesterone and protein expression of integrin αvβ3 HOXA10 and the control group with treatment (p> 0.05). Based on Pearson correlation test there is a significant correlation between the levels of progesterone with HOXA10 protein expression and integrin αvβ3 especially in the area of functional endometrium (p <0.05), whereas the hormone estradiol no significant difference (P> 0.05). Pinopod development which indicates implantation window period (maximum developmental stage) was obtained in the ratio of progesterone/estrogen between .20 to 0.49 and regression period is the ratio of 0.26 to 7.34.
Conclusion. Variations ovarian stimulator dose of 30-70 IU did not affect the secretion of the hormone estrogen, progesterone and endometrial receptivity marker expression. Based on Pearson regression test there was a significant relationship between the hormone progesterone late follicular phase and the luteal phase endometrial receptivity marker expression. While the surge in late follicular phase estradiol had no effect on the expression of markers of endometrial receptivity. Progesterone/estadiol ratio between 0.20 to 0.49 indicates implantation window period, while the ratio of 0.26 to 7.34 indicates that the development pinopod regresses."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
D1969
UI - Disertasi Membership  Universitas Indonesia Library
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Mutiara Naninda
Analisis Metode Penentuan Konsepsi dan Pengaruh Induksi Hidroksiurea-Adrenalin terhadap Jumlah Implantasi Tikus Betina Model Gangguan Reseptivitas Endometrium = Analysis of Conception Determination Methods and Effect of Hydroxyurea-Adrenaline Induction on Implantation Number of Female Rats Model Impaired Endometrial Receptivity
"Gangguan reseptivitas endometrium berpotensi mengakibatkan infertilitas pada wanita. Oleh karena itu, dibutuhkan hewan model yang dapat menggambarkan patofisiologi untuk meningkatkan pemahaman terkait gangguan ini. Penelitian mengenai pembentukan hewan model infertilitas dengan gangguan reseptivitas endometrium masih sangat terbatas. Konfirmasi dan validasi dibutuhkan untuk mengevaluasi reliabilitas hewan model. Penelitian ini bertujuan untuk menganalisis metode penentuan konsepsi dan pengaruh pemberian hidroksiurea dan adrenalin serta mengonfirmasi terbentuknya hewan model gangguan reseptivitas endometrium yang mengalami penurunan fertilitas melalui analisis parameter jumlah implantasi. Sebanyak 18 ekor tikus Wistar betina dibagi menjadi 3 kelompok, yaitu kelompok kontrol normal (pembawa CMC Na 0,5%), model (hidroksiurea 450mg/kgBB dan adrenalin 0,3mg/kgBB), dan kontrol positif (hidroksiurea 450mg/kgBB, adrenalin 0,3mg/kgBB, dan progesteron 50mg/manusia). Perlakuan dilakukan selama 10 hari, kemudian tikus betina dipasangkan dengan tikus jantan dan dikorbankan pada hari ke-8 kehamilan. Dalam penelitian ini, waktu yang dibutuhkan untuk terjadinya konsepsi cukup lama. Metode pemeriksaan sumbat vagina dan pengamatan sitologi vagina digunakan untuk mendeteksi konsepsi serta dibandingkan ketepatannya. Jumlah implantasi diukur dengan menghitung tonjolan blastosit pada uterus. Jumlah implantasi dievaluasi secara statistik dan tidak ditemukan perbedaan bermakna antara kelompok kontrol normal, model, dan kontrol positif (ANOVA p > 0,05). Sumbat vagina hanya teramati pada 1 ekor tikus, sementara spermatozoa teramati pada seluruh apusan vagina tikus. Berdasarkan hasil penelitian ini, metode sitologi vagina lebih dapat diandalkan daripada sumbat vagina untuk mendeteksi terjadinya konsepsi dan induksi hidroksiurea dan adrenalin mungkin tidak memengaruhi jumlah implantasi.
Impaired endometrial receptivity can cause infertility in women. Therefore, animal models are needed to improve understanding of the pathophysiology of this disorder. Research about animal models of infertility with impaired endometrial receptivity is still minimal. Confirmation and validation are required for the reliability of the animal model findings. This study aims to analyze the method of conception determination and the effect of hydroxyurea and adrenaline and to ensure the formation of an animal model of impaired endometrial receptivity through implantation parameters. Total of 18 female Wistar rats were divided into 3 groups; normal control, model (hydroxyurea 450mg/kgBW and adrenaline 0.3mg/kgBW), and positive control (hydroxyurea 450mg/kgBW, adrenaline 0.3 mg/kgBW, and progesterone 50 mg/human). Treatment was given for ten days, then female rats were paired with male rats and sacrificed on the 8th day of gestation. In this study, the time required for conception to occur is quite long. Vaginal plug and vaginal cytology observations were used to detect conception and compared for accuracy. The number of implantations was measured by counting the blastocyst protrusion in the uterus. The number of implantations was evaluated statistically, and no significant difference was found between the normal control, model, and positive control group ( ANOVA p>0.05). Vaginal plugs were observed only in one rat, while spermatozoa were observed in all vaginal smears. In conclusion, vaginal cytology method is more reliable than vaginal plugs for detecting the occurrence of conception and induction of hydroxyurea-adrenaline may not affect the number of implantations."
Fakultas Farmasi Universitas Indonesia, 2021
S70500
UI - Dokumentasi  Universitas Indonesia Library
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Deniswari Rahayu
Hubungan hiperandrogenisme dan profil antropometri dengan skor disfungsi seksual pada sindrom ovarium polikistik dengan infertilitas = Association of hyperandrogenism and anthropometric profiles with sexual dysfunction in infertile Indonesian women with polycystic ovarian syndrome
"Latar belakang: Hiperandrogen merupakan fenotip yang seingkali ditemukan pada SOPK memiliki peran terhadap perubahan tampilan fisik (hirsutisme dan obesitas) juga infertilitas. Kondisi ini dilaporkan dapat menyebabkan gangguan citra tubuh, kecemasan hingga depresi sehingga juga dapat berkontribusi terhadap kejadian disfungsi seksual. Gangguan fungsi seksual pada wanita seringkali tidak dilaporkan. Sebagai langkah awal, dengan mengetahui hubungan perubahan fisik akibat hiperandrogen dan obesitas terhadap disfungsi seksual, maka diharapkan penatalaksanaan infertilitas pada kasus SOPK dapat dilakukan lebih komprehensif.
Tujuan: Mengetahui hubungan antara hiperandrogenisme, profil antropometri (IMT dan rasio pinggang-pinggul), dan disfungsi seksual pada wanita infertil Indonesia dengan SOPK.
Metode: Penelitian menggunakan metode potong lintang (cross sectional). Subjek merupakan 71 wanita infertil dengan SOPK di Klinik Yasmin, Rumah Sakit Umum Dr. Cipto Mangunkusumo, Jakarta, Indonesia yang berobat pada Desember 2021 – Desember 2022. Hiperandrogenisme biokimiawi dinilai dengan kadar androgen bebas dan rasio LH/FSH sedangkan hiperandrogenisme klinis dinilai menggunakan skor Ferriman-Gallwey dimodifikasi. Profil antropometri dinilai menggunakan IMT dan rasio pinggang-pinggul. Kami menggunakan kuesioner FSFI untuk mengevaluasi disfungsi seksual dan kuesioner HAM-A untuk menilai kecemasan.
Hasil: Sebanyak 53,3% subjek mengalami disfungsi seksual, namun tidak ditemukan hubungan yang signifikan secara statistik antara hirsutisme, profil antropometri, dan skor disfungsi seksual pada wanita infertil dengan SOPK (p >0,05). Analisis skor keseluruhan domain FSFI menunjukkan bahwa lubrikasi dan kepuasan lebih rendah pada pasien obesitas (p=0,02 dan p=0,03), tetapi ini tidak berkontribusi pada skor disfungsi seksual secara keseluruhan. Selain itu, subjek yang mengalami disfungsi seksual memiliki skor kecemasan yang lebih tinggi (p<0,005), dengan analisis korelasi menunjukkan bahwa skor FG memiliki korelasi positif yang signifikan terhadap kecemasan.
Kesimpulan: Hirsutisme dan profil antropometri tidak terkait dengan disfungsi seksual pada wanita infertil Indonesia dengan SOPK. Namun, hirsutisme dapat berperan dalam menyebabkan kecemasan pada wanita Indonesia dengan SOPK. Penelitian kolaboratif dan kualitatif diperlukan selanjutnya karena fungsi seksual wanita adalah subjek yang kompleks.
Background: Hyperandrogenism, a phenotype often found in PCOS, plays a role in physical changes (hirsutism and obesity) as well as infertility. This condition is reported to contribute to body image disturbances, anxiety, and even depression, thereby potentially contributing to the occurrence of sexual dysfunction and impacting infertility conditions. Sexual dysfunction in women is often underreported, leading to a lack of in-depth evaluation by clinicians. As a preliminary step, by understanding the relationship between physical changes due to hyperandrogenism and obesity with sexual dysfunction, it is hoped that the management of infertility in PCOS cases in Indonesia can be more comprehensive.
Objective: To evaluate the relationship between hiperandrogenism, anthropometric profile (BMI and waist to hip ratio), and sexual dysfunction in infertile Indonesian women with PCOS.
Methods: A cross-sectional study was conducted from December 2021 to December 2022 on 71 infertile women with PCOS at Yasmin Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. Biochemical hyperandrogenism was assessed through free androgen levels and the LH/FSH ratio, while clinical hyperandrogenism was evaluated using the modified Ferriman-Gallwey score. The anthropometric profile was assessed using BMI and waist-to-hip ratio. We utilized the FSFI questionnaire to evaluate sexual dysfunction and the HAM-A questionnaire to assess anxiety.
Results: In this study, it was discovered that 53.3% of subjects experienced sexual dysfunction. However, there was no statistically significant relationship between hirsutism, anthropometric profile, and sexual dysfunction score in infertile women with PCOS (p >0.05). Analysis of the overall FSFI domain score revealed that lubrication and satisfaction were lower in patients with obesity (p=0.02 and p=0.03), but this did not contribute to an overall sexual dysfunction score. Also, we found that subjects who experienced sexual dysfunction had a higher anxiety score (p<0.005), with correlation analysis showing that FG scores have a significant positive correlation with anxiety.
Conclusions: Hirsutism and anthropometric profile are not associated with sexual dysfunction in infertile Indonnesian women with PCOS. However, hirsutism could play a role in causing anxiety in Indonesian PCOS women. Additional qualitative and collaborative investigation is required as female sexual function is a intricate subject."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
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Rachmat Dediat Kapnosa Hasani
Korelasi antara komposisi lemak tubuh dengan kadar prokalsitonin sebagai penanda biokimiawi inflamasi kronis derajat rendah pada sindrom ovarium polikistik = Correlation between body fat composition and procalcitonin as low grade chronic inflammation marker in polycystic ovary syndrome
"Latar Belakang: Sindrom ovarium polikistik merupakan kelainan endokrin dan metabolik terbanyak yang dialami oleh wanita usia reproduksi. Penyebab dari SOPK diketahui multifaktorial, namun faktor lemak memiliki peranan penting dalam perjalanan penyakit. Pada pasien SOPK ditemukan akumulasi lemak dilokasi tertentu. Komposisi lemak tubuh dapat menyebabkan proses inflamasi klinis derajat rendah yang berperan dalam terjadinya resistensi insulin pada pasien SOPK. Pengukuran komposisi lemak tubuh berdasarkan indeks massa tubuh kurang spesifik. Persentase lemak tubuh diperkirakan lebih spesifik dalam menggambarkan komposisi lemak tubuh dan memiliki korelasi dengan proses inflamasi kronis derajat rendah yang gambarkan oleh peningkatan prokalsitonin darah pasien dengan SOPK.
Tujuan: Penelitian ini bertujuan untuk mengetahui korelasi komposisi lemak tubuh terhadap kadar prokalsitonin sebagai penanda biokimiawi inflamasi kronis derajat rendah.
Metode: Penelitian dilakukan dengan desain penelitian potong lintang (cross sectional), di klinik Yasmin RSUPN Dr.Cipto Mangunkusumo dan Laboratorium Terpadu FKUI selama tahun 2014-2015. Pasien yang sudah terdiagnosis SOPK berdasarkan kriteria Rotterdam 2003, dilakukan pemeriksaan indeks massa tubuh, persentase lemak tubuh dengan menggunakan metode bioelectrical impedance analysis dan pemeriksaan prokalsitonin darah. Dilakukan uji korelasi antara indeks massa tubuh dan persentase lemak tubuh terhadap kadar prokalsitonin darah pasien.
Hasil: Dari total 32 subyek penelitian, didapatkan peningkatan komposisi lemak tubuh dengan rerata indeks massa tubuh 29,09±5,11 kg/m2 dan komposisi lemak tubuh 39,38±9,04 %. Pada uji korelasi didapatkan peningkatan indeks massa berkorelasi positif terhadap kadar prokalsitonin namun tidak bermakna secara statistik (r =0,27; p =0,131). Persentase lemak tubuh didapatkan berkorelasi positif bermakna secara statistik dengan kadar prokalsitonin (r=0,35; p=0,048).
Kesimpulan: Terdapat peningkatan rerata komposisi lemak tubuh pada pasien dengan sindrom ovarium polikistik. Persentase lemak tubuh memiliki korelasi yang lebih baik dibandingkan dengan indeks massa tubuh terhadap kadar prokalsitonin darah sebagai penanda biokimia inflamasi kronis derajat rendah pada pasien.
Background: Polycystic ovary syndrome (PCOS) is the most common metabolic and endocrine problems in reproductive ages women. PCOS has multifactorial cause, but body fat was known to has significant role in disease course. Patient with PCOS known to have body fat accumulation in some body location. Body fat composition can cause low grade chronic inflamation which can cause insulin resistence. Measuring body fat composition with body mass index is not an ideal method. Body fat percentage should be more specific in measuring body fat composition and should have better corelation than body mass index to procalcitonin as low grade chronic inflamation marker.
Purpose: The purpose of this research is to identify corelation between body fat composition and procalcitonin as low grade chronic inflamation in PCOS.
Method: The study was conducted with a cross sectional study design, in Yasmin Clinic, RSUPN Dr.Cipto Mangunkusomo and Integrated Laboratory of Medical Faculty University of Indonesia during 2014-2015. Patients who have been diagnosed with PCOS based on the criteria of Rotterdam, 2003, was examined the body mass index, body fat percentage using bioelectrical impedance analysis and blood procalcitonin level. We measure the correlation between body mass index and body fat percentage to procalcitonin levels of the patient's blood.
Result: From a total of 32 subjects of the study, we found an increase in body fat composition with a mean body mass index 29.09 ± 5.11 kg/m2 and body fat composition 39.38 ± 9.04%. From correlation test, we found that body mass index was positively correlated to the levels of procalcitonin but not statistically significant (r = 0.27; p = 0.131). Body fat percentage has significant positive corellation to procalcitonin levels (r = 0.35; p = 0.048).
Conclutions: There is an increase in the average composition of body fat in patients with polycystic ovary syndrome. Body fat percentage has a better correlation than the body mass index on blood levels of procalcitonin."
Depok: Fakultas Kedokteran Universitas Indonesia, 2018
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Ivan Ginanjar Sunarya
Survei Persepsi dan Sikap Pasien Sindrom Ovarium Polikistik (SOPK) Terhadap Gangguan Haid dan Gangguan Kesuburan = Survey of Perceptions and Attitudes of Polycystic Ovary Syndrome (PCOS) Patients Against Menstrual and Fertility Problems
"Sindrom ovarium polikistik (SOPK) merupakan suatu kelainan endokrin yang sering dijumpai pada perempuan usia repoduksi. Masalah yang sering dijumpai adalah gangguan haid dan gangguan kesuburan. Persepsi dan sikap pasien dapat berbeda-beda. Kurangnya informasi, latar belakang pendidikan, dan sumber informasi juga dapat berdampak pada persepsi dan sikap pasien. Akan tetapi, data mengenai gambaran persepsi dan sikap pada pasien SOPK masih sulit diperoleh karena penelitian-penelitian dalam hal tersebut masih belum ada di Indonesia. Oleh karena itu, dengan penelitian ini diharapkan dapat diperoleh gambaran mengenai persepsi dan sikap terhadap gangguan haid dan gangguan kesuburan pada pasien SOPK, sehingga dapat meningkatkan kualitas pasien yang nantinya berdampak pada persepsi dan sikapnya dalam manajemen tatalaksana terapeutik SOPK. Dilakukan studi potong lintang pada 241 subyek penelitian yang diperoleh melalui akun media sosial Instagram “pcosfighterindonesia’. Dilakukan pengumpulan sejumlah variable data seperti usia, IMT, pendidikan terakhir, riwayat penyakit, sumber informasi, serta persepsi dan sikap subyek penelitian. Diperoleh data bahwa mayoritas subyek penelitian memiliki persepsi baik, mengenai definisi dan penyebab SOPK, mengenai gangguan haid dan gangguan kesuburan pada SOPK, dan juga mengenai tatalaksana SOPK. Mayoritas subyek penelitian juga memiliki sikap baik, dan juga terdapat kesesuaian kuat antara persepsi dan sikap subyek penelitian mengenai SOPK dan juga mengenai gangguan haid dan kesuburan yang terjadi pada SOPK.
Polycystic Ovary Syndrome (PCOS) is an endocrine disorder that is often found in women of reproductive age. Problems that are often encountered are menstrual and fertility. Patient perceptions and attitudes may vary. Lack of information, educational background, and sources of information can also have an impact on patient perceptions and attitudes. However, data regarding the description of perceptions and attitudes in PCOS patients is still difficult to obtain because studies in this topic do not yet exist in Indonesia. Therefore, with this study, it is hoped that an overview of the perceptions and attitudes towards menstrual disorders and fertility problems in PCOS patients can be obtained, so that it can improve the quality of patients which will have an impact on their perceptions and attitudes in the therapeutic management of PCOS.
A cross-sectional study was carried out on 241 research subjects obtained through the Instagram social media account "pcosfighterindonesia". Collecting a number of data variables such as age, BMI, recent education, medical history, information sources, and perceptions and attitudes of research subjects. Data was obtained that the majority of research subjects had good perceptions, regarding the definition and causes of PCOS, regarding menstrual disorders and fertility disorders in PCOS, and also regarding the management of PCOS. The majority of research subjects also had good attitudes, and there was also a strong agreement between perceptions and attitudes of research subjects regarding SOPK and also regarding menstrual disorders and fertility that occurred in PCOS."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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Indra
Hubungan hormon anti-mullerian serum dan resistensi insulin terhadap fenotip sindrom polikistik ovarium = The relationship between polycystic ovary syndrome phenotype and insulin resistance with serum anti-mullerian hormone amh level
"ABSTRAK
Latar Belakang: Sindroma ovarium polikistik (SOPK) merupakan kelainan
kompleks endokrin terbanyak pada usia reproduksi. Ketidakseimbangan hormon
merupakan salah satu temuan SOPK yang terkait dengan patofisiologinya.
Adanya perbedaan kejadian resistensi insulin mungkin terkait dengan perbedaan
karakteristik hormon pada pasien SOPK pada berbagai fenotipe, salah satunya
Hormon Anti-Mullerian (HAM).
Metode: Desain penelitian potong lintang (cross sectional), pengambilan subjek
dimulai dari identifikasi kelompok dengan SOPK menggunakan titik potong
HAM >4,45 ng/dl, lalu akan dikelompokkan menjadi empat kelompok sesuai
dengan fenotipnya berdasarkan kriteria Rotterdam 2003, di klinik Yasmin dan
Makmal Endokrinologi di bagian Obstetri dan Ginekologi RSUPN Dr.Cipto
Mangunkusumo selama tahun 2011 ?2014. Resistensi insulin dinilai
menggunakan homeostatic model assessment for insulin resistance (HOMA IR).
Hasil: Didapatkan 125 subjek SOPK dengan kadar HAM cenderung lebih tinggi
pada fenotipe 1 dan lebih rendah pada fenotipe 4 (p<0,05). Selain itu, ditemukan
perbedaan kadar LH dan rasio LH/FSH pada keempat fenotipe (p<0,05). Nilai
HOMA IR juga lebih tinggi pada fenotipe 1 (p<0,05). Berdasarkan analisis regresi
linear, didapatkan indeks massa tubuh dan HAM berkorelasi positif dengan nilai
HOMA IR (r=0,19 p=0,015 dan r=0,53 p<0,001, berturut-turut).
Kesimpulan: Terdapat korelasi positif kadar HAM terhadap nilai HOMA IR.
Pada keempat fenotipe SOPK didapatkan kadar HAM dan HOMA IR lebih tinggi
pada fenotipe 1 dan semakin rendah pada fenotipe 4. ABSTRACT Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder that is
the most complex in the reproductive age. Hormonal imbalance remains a part of
its pathophysiology. Insulin resistance might be linked with difference in
hormonal parameter across four phenotypes of PCOS, especillay in AMH level.
Method: The study design was cross-sectional (cross-sectional). Subject retrieval
starts from the identification of the group with PCOS (with cutt-off AMH serum
>4.45 ng/dl), and will be grouped into four groups according to their phenotype
based on the criteria of Rotterdam in 2003, in the clinic Yasmin and
Endocrinology Laboratory at the Obstetrics and Gynecology RSUPN Dr.Cipto
Mangunkusomo during 2011 -2014. Insulin resistance was counted using
homeostatic model assessment for insulin resistance (HOMA IR).
Result: A total of 125 PCOS patients were recruited with AMH serum
significantly higher among phenotype 1 and lower among phenotype 4 (p<0.05).
Besides, Lh serum and LH/FSH ratio were also different across four phenotypes
(p<0.05). The value of HOMA IR tend to be higher among phenotype 1 (p<0.05).
Using multivariable linear regression analysis, body mass index and AMH serum
were positively correlated with HOMA IR (r=0.19 p=0.015 and r=0.53 p<0.001,
respectively).
Conclusion: There was a positive correlation between AMH serum and HOMA
IR value. The four PCOS phenotypes had significantly different value of HAM
serum and HOMA IR with phenotype 1 possed higher value among the others.
;Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder that is
the most complex in the reproductive age. Hormonal imbalance remains a part of
its pathophysiology. Insulin resistance might be linked with difference in
hormonal parameter across four phenotypes of PCOS, especillay in AMH level.
Method: The study design was cross-sectional (cross-sectional). Subject retrieval
starts from the identification of the group with PCOS (with cutt-off AMH serum
>4.45 ng/dl), and will be grouped into four groups according to their phenotype
based on the criteria of Rotterdam in 2003, in the clinic Yasmin and
Endocrinology Laboratory at the Obstetrics and Gynecology RSUPN Dr.Cipto
Mangunkusomo during 2011 -2014. Insulin resistance was counted using
homeostatic model assessment for insulin resistance (HOMA IR).
Result: A total of 125 PCOS patients were recruited with AMH serum
significantly higher among phenotype 1 and lower among phenotype 4 (p<0.05).
Besides, Lh serum and LH/FSH ratio were also different across four phenotypes
(p<0.05). The value of HOMA IR tend to be higher among phenotype 1 (p<0.05).
Using multivariable linear regression analysis, body mass index and AMH serum
were positively correlated with HOMA IR (r=0.19 p=0.015 and r=0.53 p<0.001,
respectively).
Conclusion: There was a positive correlation between AMH serum and HOMA
IR value. The four PCOS phenotypes had significantly different value of HAM
serum and HOMA IR with phenotype 1 possed higher value among the others.
;Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder that is
the most complex in the reproductive age. Hormonal imbalance remains a part of
its pathophysiology. Insulin resistance might be linked with difference in
hormonal parameter across four phenotypes of PCOS, especillay in AMH level.
Method: The study design was cross-sectional (cross-sectional). Subject retrieval
starts from the identification of the group with PCOS (with cutt-off AMH serum
>4.45 ng/dl), and will be grouped into four groups according to their phenotype
based on the criteria of Rotterdam in 2003, in the clinic Yasmin and
Endocrinology Laboratory at the Obstetrics and Gynecology RSUPN Dr.Cipto
Mangunkusomo during 2011 -2014. Insulin resistance was counted using
homeostatic model assessment for insulin resistance (HOMA IR).
Result: A total of 125 PCOS patients were recruited with AMH serum
significantly higher among phenotype 1 and lower among phenotype 4 (p<0.05).
Besides, Lh serum and LH/FSH ratio were also different across four phenotypes
(p<0.05). The value of HOMA IR tend to be higher among phenotype 1 (p<0.05).
Using multivariable linear regression analysis, body mass index and AMH serum
were positively correlated with HOMA IR (r=0.19 p=0.015 and r=0.53 p<0.001,
respectively).
Conclusion: There was a positive correlation between AMH serum and HOMA
IR value. The four PCOS phenotypes had significantly different value of HAM
serum and HOMA IR with phenotype 1 possed higher value among the others.
"
Fakultas Kedokteran Universitas Indonesia, 2015
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Rina Puspita
Studi eksplorasi mekanisme epigenetik pada steroidogenesis subjek sindrom ovarium polikistik. Fokus pada peran asam folat terhadap gen CYP19A1, HSD17B1 dan FSHR = Exploration tsudy epigenetic mechanism steroidogenesis polycystic ovary syndrome subject. Focus in folic acid in CYP19A1, HSD17B1 and FSHR gene / Rina Puspita
"ABSTRAK
Latar belakang: SOPK adalah gangguan endokrin yang hingga saat ini etiologinya masih belum jelas. Faktor epigenetik metilasi DNA, akhir-akhir ini mendapatkan perhatian dalam patogenesis SOPK. Gen HSD17B1 disebut sebagai "estrogenik" 17β-HSD karena mengkatalisasi langkah terakhir dalam biosintesis estrogen dengan secara istimewa mengurangi estrone, estrogen yang lemah untuk menghasilkan estrogen 17β-estradiol yang kuat. Kami berspekulasi cacat pada metilasi DNA mendorong deregulasi gen sehingga terjadi penurunan ekspresi mRNA HSD17B1, akhirnya menghasilkan estradiol yang tidak cukup pada pasien SOPK.
Metode: Kami mengumpulkan total 60 pasien wanita. MSP untuk analisis metilasi DNA, qPCR untuk analisis ekspresi mRNA.
Tujuan: Untuk menganlisis metilasi DNA pada kelompok pasien SOPKdan kelompok wanita sehat, ekspresi mRNA pada kelompok pasien SOPK dan kelompok wanita sehat, tingkat estradiol pada pasien SOPK dan kelompok wanita sehat, korelasi antara metilasi DNA dan ekspresi mRNA pada pasien SOPK, korelasi ekspresi mRNA pada pasien SOPKdan kadar serum estradiol.
Hasil: Metilasi gen HSD17B1 pada wanita SOPK adalah 42,64% dan kelompok yang sehat menunjukkan 53,80%, p = 0,160 tidak signifikansi antara kedua kelompok. Nilai ekspresi relatif gen HSD17B1 adalah 0,70 kali lebih rendah dibandingkan dengan kelompok wanita sehat, p = 0,003 signifikansi antara kedua kelompok. Estradiol rata-rata pada kelompok SOPK25,78 pg / ml dan kelompok wanita sehat adalah 36,74 pg / ml. Korelasi tingkat metilasi DNA versus ekspresi mRNA pada pasien SOPK, tidak signifikan p = 0,076. Korelasi antara ekspresi mRNA gen HSD17B1 dan kadar serum estradiol, signifikansi p = 0,020. ;Semakin terjadi penurunan ekspresi mRNA, semakin rendah kadar serum estradiol.
ABSTRACT
Background: PCOS is the most common endocrine disorder but its etiology remains unclear. Lately, epigenetic factors have gained considerable attention in the pathogenesis of PCOS, DNA methylation.  HSD17B1 is referred to as the "estrogenic" 17β-HSD because it catalyzes the final step in estrogen biosynthesis by preferentially reducing the weak estrogen estrone to yield the potent estrogen 17β-estradiol. We speculated defects in DNA methylation promote the deregulation of genes make decrease mRNA expression HSD17B1, finally produces not enough estradiol in PCOS patients.
Methods: We collected a total of 60 female patients. MSP for DNA methylation analysis, qPCR for mRNA expression analysis.
Aims: To investigate, DNA methylation in PCOS patients group and healthy women group, mRNA expression in PCOS patients group and healthy women group, estradiol level in PCOS patients and healthy women group, the correlation between DNA methylation and mRNA expression in PCOS patients, correlation mRNA expression in PCOS patients and estradiol serum level.
Results: Methylated of HSD17B1 gene in PCOS women was 42.64 % and a healthy group showed 53.80 %, p=0.160 not significances between the two groups.  The relative expression value of the HSD17B1 gene was 0.70 fold lower compare with a healthy women group, p=0.003 significance between the two groups. The average estradiol in the PCOS group 25.78 pg/ml and the healthy women group is 36.74 pg/ml. Correlation of DNA methylation level versus mRNA expression in PCOS patients, not significance p=0.076. Correlation between mRNA expression of the HSD17B1 gene and estradiol serum level, significance p=0.020. (More decrease mRNA expression, more lower estradiol serum level)."
2019
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Ayu Mulia Sundari
Studi ekspresi mRNA gen Vitamin D Receptor (VDR) pada wanita obesitas dan non-obesitas dengan sindrom ovarium polikistik dan normal = Study of Vitamin D Receptor (VDR) genes mRNA expression in obese and non-obese women with Polycystic Ovary Syndrome (PCOS) and normal
"Sindrom ovarium polikistik (SOPK) merupakan kelainan yang ditandai oleh hiperandrogenemia, ovarium disfungsi, dan polikistik ovarium yang dapat menyebabkan infertilitas. Meski etiologi pastinya belum diketahui, obesitas merupakan ciri khas umum pada SOPK di mana sekitar 40--80% wanita SOPK meningkatkan obesitas. Kej Vitamin D Receptor (VDR) terkait dengan SOPK melalui peradangan kronik tingkat rendah. Tujuan penelitian adalah mempelajari ekspresi mRNA gen VDR pada wanita obesitas dan non-obesitas dengan SOPK dan normal. Sampel darah dari 120 subjek dibagi menjadi empat kelompok, yaitu 30 normal non-obesitas (BMI <25), 30 normal non-obesitas (BMI> 25), SOPK non-obesitas (BMI <35), dan 30 SOPK obesitas (BMI> 25) kemudian dianalisis menggunakan kuantitatif Real-Time PCR (qPCR) dengan metode kurva standar. Hasil penelitian menunjukkan bukti mRNA gen VDR pada subjek obesitas dan SOPK secara signifikan lebih tinggi dibandingkan kedua kontrol. Hasil ini menunjukkan bahwa gen VDR terkait dengan obesitas dan SOPK.
Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandrogenemia, ovarian dysfunction, and polycystic ovaries that can cause infertility. Although the exact etiology is unknown, obesity is a hallmark common in PCOS where about 40-80% of PCOS increase obesity. Vitamin D Receptor (VDR) is associated with PCOS through low-level chronic inflammation. The aim of the study was to study the expression of VDR gene mRNA on obese and non-obese women with PCOS and normal. Blood samples from 120 subjects were divided into four groups, namely 30 normal non-obese (BMI <25), 30 normal non-obese (BMI> 25), non-obese PCOS (BMI <35), and 30 obese PCOS
(BMI> 25) was then analyzed using quantitative Real-Time PCR (qPCR) with the standard curve method. The results showed evidence of VDR gene mRNA in obese and PCOS subjects was significantly higher than the two controls. These results indicate that the VDR gene is associated with obesity and PCOS.
"
Depok: Fakultas Matematika dan Ilmu Pengetahuan Alam Universitas Indonesia, 2019
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