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"Fully revised second edition providing providing trainees with the most recent advances in infertility. Includes two CD ROMs. Previous edition published in 2007."

"Latar Belakang: Sindrom Ovarium Polikistik (SOPK) menjadi penyebab 60-85% infertilitas pada wanita. Gangguan ovulasi pada SOPK diperbaiki dengan obatobatan yang menstimulasi ovarium seperti klomifen sitrat. Klomifen menstimulasi ovarium untuk memulai folikulogenesis hingga terjadi ovulasi. Pada 20-60% wanita SOPK tidak mengalami ovulasi setelah pemberian klomifen. Hal ini diduga karena tidak terjadi perkembangan folikel dominan akibat tingginya kadar AMH. AMH yang tinggi menyebabkan sensitivitas reseptor FSH terhadap stimulasi FSH berkurang. AMH memiliki peran negatif terhadap perkembangan folikel pada SOPK. Kadar AMH tertentu diduga dapat meramal keberhasilan stimulasi ovarium yang bermanfaat untuk menentukan terapi yang tepat. Tujuan: Mendapatkan titik potong kadar AMH sebagai peramal keberhasilan stimulasi ovarium dengan klomifen sitrat. Metode: Studi analitik dengan desain potong lintang selama periode Juni 2013 hingga April 2014 di Poliklinik Endokrinologi Ginekologi, RSCM, Jakarta. Hasil: Didapatkan 50 subjek SOPK yang diberikan klomifen sitrat 100 mg pada hari ke-2 hingga ke-5 haid kemudian dievaluasi folikel dominan > 16 mm pada hari ke-12 haid. Kemudian Subjek dibagi dua; kelompok responder (n=23) dan kelompok non-responder (n=27). Kadar AMH serum kedua kelompok dibandingkan. Terdapat perbedaan bermakna kadar AMH serum antara kedua kelompok (p 0,001). Pada kurva ROC didapatkan AUC Kadar AMH sebesar 0,75 (IK 95% 0,62 – 0,88). Titik potong AMH dalam menentukan keberhasilan stimulasi ovarium adalah 4,4 ng/ml dengan sensitifitas 35%, spesifisitas 86%. Pada analisa multivariat probabilitas keberhasilan stimulasi ovarium pada kadar AMH 4,4 ng/ml adalah 71%. Kesimpulan: Kadar AMH serum dapat digunakan sebagai parameter untuk meramal keberhasilan stimulasi ovarium dengan klomifen sitrat pada populasi SOPK.

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Background: About 60-85% women with infertility have PCOS. It is characterized by anovulation which is corrected by giving ovulatory medication. Clomiphene has become first line drug of ovarian stimulation. Since only 40-80 % women respond to clomiphene, many remains anovulatory. The cessation of follicle development may be influenced by high level of Anti Mullerian Hormone (AMH). It decreases sensitivity of FSH receptor within granulose cells. Studies reveal AMH has regulatory effect of follicle development. It is possible that certain level of AMH might predict the success of ovarian stimulation and therefore benefit women’s choice of treatment.

Objective: To obtain AMH cutoff level that can predict success of ovarian stimulation in PCOS receiving clomiphene.

Method: This is a cross sectional study conducted in Endocrinology Gynecology Clinic in RSCM during a period of June 2013 till April 2014.

Result: Fifty women were enrolled in this study. All subject received 100 mg of clomiphene and followed to acquire domminat follicle and then divided into two groups; responder (n=23) and non-responder (n=27). AMH serum level was obtained. We found statistical difference of AMH serum level between two groups (p 0,001). On ROC curve, the AUC of AMH was 0,75 (CI 95% 0,62-0,88). Cut off level of AMH used in this study was 4,4 ng/ml with sensitivity 35% and specificity 86%. This cut off level has 71% of ovulatory success prediction after entering it to the multivariate analysis.

Conclusion: The AMH serum level may be used as predictor of ovarian stimulation success in selected PCOS women receiving clomiphene."

"Intrauterine insemination and ovulation induction is effective first-line treatment for infertility in many straightforward cases and is preferred by many clinicians because they are less invasive than in-vitro fertilization and its variants. This is a comprehensive account of how to set up and run a successful IUI program. The book addresses the practical aspects of treatments that will produce optimum results in terms of pregnancy outcome and safety, as well as the pharmacological and physiological reasons for their use. Chapters on how to prevent complications of ovulation induction such as multiple births and ovarian hyperstimulation syndrome are included, as well as how to diagnose infertility in both sexes. Laboratory procedures for sperm preparation are described in detail. Worldwide resources for obtaining donor sperm and legal issues that surround the management of patients are included. This manual is of interest to reproductive medicine specialists, general practitioners and general obstetrician gynecologists."