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"Tujuan tulisan ini adalah mendiskusikan tatalaksana terkini pengobatan endometriosis dengan penekanan pada peran laparoskopi operatif dan pengobatan medikamatosa. Ketepatan mendiagnosis endometriosis tanpa Laparoskopi sangat lemah, dengan positif palsu 44 % dan negatif palsu 19 %. Tersangka endometriosis yang didiagnosis tanpa laparoskopi akan ditemukan 81 % secara laparoskopi, sisanya 19 % bukan endometriosis. Disimpulkan bahwa laparoskopi sangat dibutuhkan untitk mendiagnosis dan mengobati endometriosis. Pengobalun medikamentosa efektifdalam hal merendahkan progresifitas endometriosis. (MedJ Indones 2006; 15:121-4)

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The objective of this paper is to discuss the current guidelines for treatment of endometriosis, emphasis on the role of laparoscopic surgery and medical treatment. The accuracy of diagnosis ofendometriosis without laparoscopy is very low, as a false negative rate of 19 % and a false positive rate of 44 %, when a diagnosis was made pre iaparoscopy, 81 % had the diagnosis can confirmed on laparoscopy, while 19 % did not have endometriosis. It is concluded that laparoscopy is required for evaluation ami treatment of endometriosis. Medical therapy is effective in reducing progression of endometriosis score. (MedJ Indones 2006; 15:121-4)"

"Endometriosis merupakan penyakit ginekologi yang ditandai dengan pertumbuhan jaringan mirip endometrium di luar rongga uterus. Inflamasi kronik pada endometriosis memiliki peranan penting dalam memfasilitasi perkembangan kista endometriosis. Penelitian ini bertujuan untuk menganalisis efektivitas oktil galat dalam menurunkan inflamasi pada tikus Wistar model endometriosis. Sejumlah 30 ekor tikus wistar betina dibagi secara acak ke dalam tiga kelompok. Kelompok pertama dan kedua direkayasa membentuk jaringan endometriosis, sedangkan kelompok ketiga dilaparatomi sebagai kelompok kontrol negatif. Setelah dua bulan, dilakukan laparatomi kedua pada kelompok satu dan dua untuk mengevaluasi pembentukan jaringan endometriosis. Induksi oktil galat diberikan pada kelompok pertama selama satu bulan. Seluruh tikus kemudian dieuthanasia dan jaringan endometriosis kelompok pertama dan kedua, serta jaringan endometrium kelompok ketiga, diambil untuk dianalisis. Pengukuran kadar sitokin TNF-α dan IL-10 dilakukan menggunakan Luminex Multiplex Assay, sedangkan kadar COX-2 dan PGE₂ diukur menggunakan metode ELISA. Analisis beda proporsi menunjukkan bahwa pemberian oktil galat pada kelompok pertama tidak memberikan perubahan kadar TNF-α kategori tinggi yang signifikan, sedangkan kadar COX-2, PGE₂, dan IL-10 kategori tinggi teramati mengalami penurunan signifikan sebesar 22,3%, 55,6%, dan 44,5%, dibandingkan dengan kelompok kedua (p<0,05). Oktil galat diketahui efektif dalam menurunkan mediator inflamasi COX-2 dan PGE₂, serta anti-inflamasi IL-10, yang memicu perbaikan gejala klinis berupa regresi ukuran kista endometriosis.

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Endometriosis is a gynecological disease, characterized by the growth of endometrial-like tissue outside the uterine cavity. Chronic inflammation in endometriosis has an important role in facilitating the development of endometriosis cysts. The present study aimed to analyze the anti inflammatory effect of octyl gallate in endometriosis Wistar rat model. 30 female Wistar rats were divided randomly into three groups. Endometriosis induction was performed in the first and second group, while a sham operation was performed in the third group. Two months later, a second laparotomy was performed in the first and second groups to evaluate endometriosis tissue formation. Octyl gallate was administered via oral gavage to the first group for one month. All rats were sacrificed and endometriosis tissue samples were collected for further analysis. TNF-α and IL-10 levels were measured using Luminex Multiplex Assay, while COX-2 and PGE₂ levels were measured using the ELISA method. The administration of octyl gallate in the first group did not significantly effect TNF-α levels, whereas the high category of COX-2, PGE₂, and IL-10 levels were observed to experience a significant decrease up to 22.3%, 55.6%, and 44.5% compared to the second group (p<0.05). In conclusion, octyl gallate was able to supress the inflammatory mediators, COX-2 and PGE₂, along the anti-inflammatory mediators IL-10, which induced the regression of endometriosis cysts size as an improvement of clinical symptoms."

"Pendahuluan: Endometriosis merupakan penyakit yang secara klinis berhubungan dengan fertilitas dan memiliki beban ekonomi yang signifikan. Patogenesis endometriosis dan hubungannya dengan subfertilitas masih belum dipahami dengan jelas. Fertilisasi in Vitro (FIV) adalah terapi yang efektif untuk pasien dengan subfertilitas terkait endometriosis. Tingkat keberhasilan FIV di RSCM tidak dapat diperkirakan karena belum ada studi epidemiologi. Tujuan: Mengetahui angka kehamilan FIV pada pasien endometriosis di RSUPN dr. Cipto Mangunkusumo dan faktor-faktor yang mempengaruhinya.Metode: Penelitian ini menggunakan metode desain cross sectional. Sebanyak 225 pasien endometriosis dan blok tuba sebagai kontrol yang menjalani FIV di Klinik Yasmin Rumah Sakit Umum Nasional Dr. Cipto Mangunkusumo, Jakarta, pada periode Januari 2013 – Agustus 2021 disertakan dalam penelitian ini. Infertilitas karena faktor laki-laki diekslusi. Data demografi, dosis hormon rekombinan, durasi stimulasi, tingkat pembuahan, dan tingkat kehamilan yang diperoleh dari penelitian ini. Hasil: Angka kehamilan dibagi menjadi 3 jenis: biokimia, klinis, dan kehamilan berkelanjutan. Angka kehamilan pada pasien endometriosis lebih rendah dari faktor tuba, kehamilan biokimia (47,3% vs 52,7%, nilai p 0,375), kehamilan klinis (43,1% vs 56,9%, nilai p 0,215), dan kehamilan berkelanjutan (45,5% vs 54,5%) , nilai p 0,511). Kesimpulan: Penelitian kami menunjukkan bahwa angka kehamilan IVF pada pasien endometriosis lebih rendah daripada pasien dengan blok tuba, tetapi secara statistik tidak signifikan.

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Introduction: Endometriosis is a disease that is clinically related to fertility and has a significant economic burden. The pathogenesis of endometriosis and its relationship to subfertility is still not clearly understood. IVF is an effective therapy for patients with endometriosis-associated subfertility. The success rate of IVF in RSCM can’t be estimated because there is no epidemiological study. Objective: Knowing the pregnancy rate of IVF in endometriosis patients at the Yasmin Clinic, RSCM and the factors that influence it. Methods: This study was using cross sectional design. A total of 225 patients with endometriosis and tubal block as control who undergoing IVF at the Yasmin Clinic Dr. Cipto Mangunkusumo National General Hospital, Jakarta, in the period January 2013 – August 2021 were enrolled in this study.Infertility due to male factor were excluded. Demographic data, doses of recombinant hormone, duration of stimulation, fertilization rate, and pregnancy rate were obtained. Results: Pregnancy rate was divided into 3 types: biochemical, clinical, and ongoing pregnancy. Pregnancy rate in endometriosis patients were lower than tubal factor, biochemical pregnancy (47.3% vs 52.7%, p value 0.375), clinical pregnancy (43,1% vs 56.9%, p value 0.215), and ongoing pregnancy (45.5% vs 54.5%, p value 0.511). Conclusions: Our study demonstrated that pregnancy rate of IVF in endometriosis patient was lower than patient with tubal block, but statistically not significant. "

"Latar Belakang: Endometriosis menjadi penyakit dengan teka-teki yang memerlukan penyelesaian. Prevalensinya bervariasi dengan rentang yang luas. 0,7-44% pada populasi umum. 26,5% pada kelompok 40-44 tahun, namun 52,7% pada usia 18-29 tahun. Ilmu, tehnologi dan penelitian yang ada belum menghasilkan terapi terkini menurunkan prevalensinya. Anti inflamasi non-steroid terapi non-hormonal penghilang nyeri mempunyai efek samping pada pemakaian jangka panjang, terapi hormonal mempengaruhi siklus menstruasi dan fertilitas. Modalitas terapi perlu dikembangkan mengatasi endometriosis. Peroxisome Proliferator Activated Receptor gamma merupakan faktor transkripsi terikat pada membran nukleus sebagai anti inflamasi potensial. Aktivasi PPAR gamma oleh ligan menghambat faktor transkripsi nuclear factor-κB menurunkan ekspresi gen sitokin inflamasi, menurunkan TNF α, menginduksi sekresi IL-8 menghambat proliferasi sel. Agonis selektif PPARγ diharapkan menjadi pilihan terapi non-hormonal jangka panjang endometriosis masa mendatang. Belum ada penelitian mengevaluasi ekpresi PPARγ pada jaringan endometrium endometriosis dan tidak endometriosis. Tujuan: Penelitian ini membandingkan ekpresi mRNA PPARγ endometrium subjek endometriosis dan tidak endometriosis.Metode: Penelitian potong lintang pada Desember 2016-Oktober 2017 di Kamar Operasi RS Ciptomangunkusumo. Dua puluh lima pasien endometriosis yang menjalani laparoskopi atau laparotomi yang memenuhi syarat penelitian direkrut consecutive sampling diperiksa tampilan PPAR Gamma pada dinding endometrium endometriosis dan tidak endometriosis; jaringan endometriosis dari dinding kista endometriosis. Ekspresi PPAR Gamma diperiksa menggunakan two step real time PCR. Penelitian ini disetujui oleh Komite Etik dan Penelitian tahun 2016. Hasil: Ekspresi PPARγ endometrium subjek endometriosis dan tidak endometriosis tidak berbeda bermakna (p 0,58). Ekspresi mRNA PPARγ jaringan endometrium dan endometriosis subjek endometriosis tidak berbeda bermakna (p 0,89). Ekspresi PPARγ jaringan endometriosis dan endometrium subjek tidak endometriosis tidak berbeda bermakna (p 0,68). Kesimpulan: Penilaian ekspresi mRNA PPARγ belum dapat digunakan sebagai dasar target terapi endometriosis. Penelitian lanjutan memisahkan jaringan epitel dan stromanya dapat dilakukan untuk membuktikan peran PPARγ pada patogenesis endometriosis.

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Background: Endometriosis becomes a disease with a puzzle that requires completion. Prevalence varies with wide ranges. 0.7-44% in the general population. 26.5% in the 40 to 44 years group, but 52.7% at the age of 18-29 years. Existing science and research have not resulted in current therapy reducing its prevalence. Non-steroidal antiinflammatory non-hormonal pain relief therapy has side effects on long-term use, hormonal therapy affects the menstrual cycle and fertility. Therapeutic modalities need to be developed to overcome endometriosis. Peroxisome Proliferator Activated Receptor gamma is a transcription factor bound to the nuclear membrane as a potential anti-inflammatory. Activation of gamma PPAR by ligand inhibits nuclear factor-κB transcription factor decreases expression of inflammatory cytokine gene, decreases TNF α, inducing IL-8 secretion inhibiting cell proliferation. PPAR sel-selective agonists are expected to be the preferred long-term non-hormonal therapy of future endometriosis. Objective: This study compared PPAR expression in endometriosis and endometrial subjects of endometriosis and not endometriosis.Method: Cross-sectional study in December 2016-October 2017 at Operation Room of RS Ciptomangunkusumo. Twenty-five endometriosis patients undergoing laparoscopy or laparotomy who qualified for the study were recruited consecutive sampling examined PPAR Gamma display on the endometrial wall of endometriosis and not endometriosis; endometriosis of the cervical wall of endometriosis. The PPARγ expression was examined using two step real time PCR. The study was approved by the Ethics and Research Committee of 2016. Result: The PPAR expression of the endometrium of endometriosis and nonendometriosis did not differ significantly (p 0.58). Expression of PPAR gamma endometrial and endometriosis tissue subject of endometriosis was not significantly different (p 0.89). PPAR expression of endometriosis and endometrial tissue of the subjects not endometriosis was not significantly different (p 0.68). Conclusion: PPAR expressivity assessment has not been used as a target for endometriosis therapy. Further studies separating epithelial tissue and stroma can be performed to prove the role of PPARγ in the pathogenesis of endometriosis."

"Tujuan tulisan ini adalah mendiskusikan tatalaksana teknisi pengobatan endometriosis, dengan penekanan pada peran laparoskopi operatif dan pengobatan medikamatosa"

"Pendahuluan : Infertilitas merupakan salah satu gejala pada endometriosis dengan prevalensi mencapai 40-50%. Endometriosis memiliki dampak merugikan terhadap kualitas oosit, sementara sampai saat ini belum ada biomarker baik dari serum ataupun cairan folikel yang dapat dijadikan acuan penilaian kualitas oosit untuk dapat digunakan pada pasien endometriosis yang menjalani fertilisasi in vitro (FIV). Telah ditemukan bahwa pada serum pasien endometriosis terjadi perubahan ekspresi microRNA dimana miRNA-125b memiliki peningkatan yang paling signifikan dengan sensitifitas dan spesifisitas yang paling tinggi. Pada cairan folikel, miRNA-125b berperan saat transisi fase folikular-luteal dengan mempengaruhi ekspresi leukemia inhibitory factor (LIF). LIF diketahui dapat menginduksi sel kumulus yang kemudian mempengaruhi maturasi oosit.Tujuan: Tujuan penelitian ini adalah untuk mencari apakah terdapat hubungan antara miRNA-125b serta LIF dengan kualitas oosit pada pasien infertil dengan endometriosis.Desain: Studi Analitik korelatif dengan desain potong lintang.Material dan Metode: Sampel penelitian didapatkan dari 31 pasien infertil dengan endometriosis yang menjalankan program FIV di Klinik Yasmin RSCM Kencana, dan Klinik Melati RSAB Harapan Kita. Sesaat sebelum petik ovum, sebanyak 5cc sampel darah dari setiap pasien akan diambil untuk penilaian ekspresi miRNA-125b. Pada saat petik ovum, sebanyak 10cc dari total cairan dari folikel yang didapat akan diambil untuk penilaian ekspresi miRNA-125b dan kadar LIF. Oosit yang didapat dinilai oleh embriolog. Pemeriksaan ekspresi miRNA dilakukan dengan RT-PCR, dan kadar LIF menggunakan metode sandwich ELISA.Hasil:Terdapat korelasi negatif antara miRNA-125b serum dengan LIF cairan folikel (p=0,042; r=-0,34). Tidak terdapat korelasi antara miRNA-125b serum dengan miRNA-125b cairan folikel. Tidak terdapat korelasi antara miRNA-125b cairan folikel dengan LIF cairan folikel. Tidak terdapat korelasi antara miRNA-125b serum, miRNA-125b cairan folikel, dan LIF cairan folikel dengan kualitas oosit. Terdapat hubungan yang bermakna antara kadar ekspresi miRNA-125b cairan folikel dengan angka kehamilan biokimia.Kesimpulan: Terdapat ekspresi miRNA-125b pada serum dan cairan folikel pada pasien endometriosis, namun miRNA-125b belum dapat dijadikan sebagai parameter yang kuat untuk pemeriksaan kualitas oosit pada pasien endometriosis yang menjalani FIV.

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Introduction : Infertility is one of the symptoms in endometriosis with prevalence reaching 40-50%. Endometriosis is known to have detrimental effect on oocyte quality, yet until now there is no biomarker derived from either serum, or even follicular fluid, which can be used as reference for oocyte quality assessment in endometriosis patients going through in vitro fertilization (IVF) procedures. Changes of some microRNAs expression has been found in serum of endometriosis patients, with miRNA-125b showing the most significant increase with the highest sensitivy and specificity. In follicular fluid, miRNA-125b play role during follicular-lutheal phase transition by targeting the expression of Leukemia Inhibitory Factor (LIF). LIF has been studied to have the ability to induce cumulus cell expansion which in turn will affect the oocytes maturation.

Purpose: The purpose of this study is to observe the correlation between miRNA-125b, LIF, and oocyte quality in infertile patient with endometriosis.

Design: this is a cross-sectional study with correlation analysis method.

Materials and Methods: in this study, samples were collected from 31 infertile women with endometriosis undergoing in vitro fertilization procedure at Yasmin Clinic of Dr. Cipto Mangunkusumo Hospital, and Melati Clinic of Harapan Kita Mother and Child Hospital. Shortly prior to ovum pick up (OPU) procedure, 5cc of blood sample from each patients was collected, and 10 cc of total follicular fluid was obtained during OPU. Harvested oocytes during the procedure were assessed and scored by embryologist. MiRNA-125b expressions from serum and follicular fluid samples were analyzed using RT-PCR, and LIF levels were analized using ELISA sandwich method.

Result: negative correlation was found between the expression of miRNA-125b serum and LIF follicular fluid (p=0,042; r=-0,34). No correlation was found between the expression of miRNA-125b in serum and in follicular fluid, as well as the expression of miRNA-125b in follicular fluid and LIF in follicular fluid. No correlation was found between the expression of miRNA-125b in serum, follicular fluid, also LIF in follicular fluid, with oocyte quality. Significant result was found between the expression of miRNA-125b in follicular fluid and biochemical pregnancy rate.

Conclusion: This study found miRNA-125 expression represented in serum and follicular fluid in endometriosis patient, but it still cannot be used as a strong parameter for assessing the oocyte quality in infertile women with endometriosis"

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"Pendahuluan: Endometriosis merupakan suatu kelainan jinak ginekologi yang dapat mengalami transformasi menjadi kanker. Stres oksidatif diduga berperan dalam perkembangan penyakit endometriosis. Gen supresor tumor ARID1A banyak ditemukan termutasi dan inaktif pada kanker ovarium yang berhubungan dengan endometriosis. Tujuan penelitian adalah untuk menganalisis peran stres oksidatif terhadap ekspresi gen supresor tumor ARID1A dalam transformasi endometriosis menjadi ganas. Metoda: Penelitian dimulai dengan 10 sampel jaringan kanker ovarium, 10 sampel endometriosis dan3 jaringan endometrium eutopik sebagai kontrol yang diisolasi mRNA dan proteinnya. Analisis ekspresi gen ARID1A pada tingkat mRNA dilakukan dengan pemeriksaan RT-qPCR dan pada tingkat protein dengan ELISA. Pada sel endometriosis dan kanker ovarium dilakukan analisis stres oksidatif dengan pemeriksaan aktivitas antioksidan MnSOD dan pemeriksaan kadar MDA sebagai salah bukti kerusakan salah satu komponen sel. Setelah itu dilakukan uji eksperimental pada kultur sel endometriosis dan endometrium eutopik sebagai kontrol. Kedua sel kultur diinduksi dengan H2O2 konsentrasi 0 nM, 100 nM, dan 1000 nM. Analisis dilakukan terhadap ketahanan hidup sel, kadar ROS dan ekspresi gen ARID1A pada tingkat mRNA dan protein. Hasil: Efek induksi H2O2 dalam menekan ekspresi gen ARID1A sel endometriosis dan sel endometrium eutopik pada tingkat mRNA dan protein, bermakna, meskipun pada kanker ovarium tidak bermakna pada penelitian ini. Kesimpulan: Stres oksidatif berperan dalam menekan ekspresi gen supresor tumor ARID1A ditingkat mRNA dan protein pada endometriosis.

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Introduction: Endometriosis as a gynecologic benign lesion, can transform itself into cancer. Oxidative stress is considered as an important factor in endometriosis development. Studies found that ARID1A as tumor suppressor gene, was frequently mutated and inactivated in endometriosis associated ovarian cancer. The aim of the study is to analyze the role of oxidative stress on ARID1A expresion in endometriosis malignant transformation.

Methods: This study started with ten samples of ovarian cancer, ten samples of endometriosis, and 3 samples of eutopic endometrioid tissues as control. They were analyzed for the expression of ARID1A by RT-qPCR and ELISA, then analyzed for the activity of MnSOD as antioxidant enzyme and level of malondialdehyde as one of the oxidative stress damage effect evidence on cell's components. The second part of the study was experimental study on cultured eutopic endometrial and endometriosis cells. They were induced by H2O2 of 0, 100, and 1000 nM concentration. Analysis of the expression of ARID1A by RTqPCR and ELISA, and the DCFH-DA for the level of Reactive oxygen species were done.

Result: The impact of the H2O2 induction in repressing ARID1A gene expression on the endometriosis as well on the eutopic endometrium cells are significant, but not on the ovarian cancer in this study.

Conclusion: Oxidative stress has a role in repressing the expression of ARID1A gene at the mRNA and protein levels on the endometriosis."

"Latar Belakang: Endometriosis adalah terdapatnya jaringan (kelenjar dan stroma) abnormal mirip endometrium di luar uterus yang menyebabkan proses reaksi inflamasi kronis. Penderita endometriosis mengalami gangguan yang bersifat siklik dan terus menerus.Masalah lain adalah keterlambatan diagnosis. Laparoskopi adalah baku emas endometriosis, namun sulit untuk mengenali endometriosis pada stadium minimal dan ringan. Penanda atau biomarker sangat berguna untuk menghindari tindakan invasif yang tidak diperlukan, belum ada biomarker dapat memberikan gambaran secara jelas pada penggunaan klinis sehari-hari. Calprotectin adalah penanda dari inflamasi akut dan kronis yang diekspresikan pada granulosit terutama pada neutrofil, dan juga pada monosit, dan makrofag.25,26 belum ada penelitian yang meneliti hubungan calprotectin dengan penderita endometriosis. CRP merupakan marker inflamasi sistemik dan secara rutin digunakan sebagai penanda infeksi, inflamasi, atau kerusakan jaringan.30,31 Data mengenai kadar CRP perifer pada endometriosis jarang dan kontroversial.31Tujuan: Diketahui korelasi calprotectin dan hs-CRP serum sebagai penanda inflamasi kronis terhadap derajat endometriosis menurut klasifikasi rASRM, yaitu derajat minimal, ringan, sedang, dan beratMetode: Analisis observasional dengan desain potong lintang pada bulan Juli 2017-April 2018 di RSUPN Cipto Mangunkusumo Jakarta, RSUP Fatmawati dan RSUP Persahabatan, Jakarta. Empat puluh enam pasien endometriosis yang akan menjalani laparoskopi atau laparotomi yang memenuhi syarat penelitian direkrut consecutive sampling diperiksa kadar serum Calprotectin dan hs-CRP. Penelitian ini disetujui oleh Komite Etik dan Penelitian tahun 2017Hasil: Tidak adanya korelasi antara Calprotectin dengan derajat endometriosis (r=-0,16, p=0,278). Adanya korelasi positif lemah antara HsCRP dengan derajat endometriosis (r=0,29, p=0,050)Kesimpulan: Kadar Calprotectin serum tidak memiliki korelasi dengan derajat endometriosis. Kadar HsCRP serum memiliki korelasi positif lemah dengan derajat endometriosis, HsCRP dan Calprotectin serum tidak dapat membedakan derajat endometriosis

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Background: Endometriosis is defined as the presence of endometrial-like tissue (gland and stroma) outside the uterus, which induces a chronic inflammatory reaction. Patients with endometriosis experience cyclic and continuous symptoms. Another problem is delays in diagnosis. Laparoscopy is gold standart in endometriosis, but it is difficult to recognize endometriosis at minimal and mild stage. Biomarkers are very useful to avoid invasive procedure that are not needed, none of these have been clearly shown to be of clinical use. Calprotectin is a marker of acute and chronic inflammation which is expressed on granulocytes, especially in neutrophils, and also in monocytes, and macrophages. There have been no studies examining the relationship between calprotectin and endometriosis. CRP is a systemic inflammatory marker and it routinely used as a marker of infection, inflammation, or tissue damage. Data regarding the CRP level in peripheral blood of endometriosis patients are relatively scarce and controversial. Purpose: The purpose of this research is to identify correlation between calprotectin and hs-CRP as a marker of chronic inflammation with the degree of endometriosis according to the rASRM classification, which is minimal, mild, moderate, and severe. Method: Analysis observational with cross sectional study design in July 2017-April 2018 at Cipto Mangunkusumo General Hospital Jakarta, Fatmawati General Hospital and Persahabatan Hospital, Jakarta. Forty-six endometriosis patients undergoing laparoscopy or laparotomy who met the study requirements were recruited by consecutive sampling to be examined for serum levels of Calprotectin and hs-CRP. This study was approved by Ethics and Research Committee in 2017 Results: No correlation between Calprotectin and the degree of endometriosis (r=-0.16, p=0.278). There was a weak positive correlation between HsCRP and the degree of endometriosis (r=0.29, p=0.050). Conclusion: Calprotectin levels uncorrelated with the degree of endometriosis. HsCRP levels have a weak positive correlation with the degree of endometriosis, HsCRP dan Calprotectin cannot distinguish the degree of endometriosis"