Latar belakang: Endometriosis merupakan penyakit yang sering ditemukan melatarbelakangi infertilitas pada seorang wanita. Untuk meningkatkan angka kehamilan, pada kasus-kasus endometriosis yang diterapi program bayi tabung (IVF) dilakukan seleksi embrio. Penelitian ini ingin membuktikan efektifitas penilaian seleksi embrio terhadap keberhasilan kehamilan di sebuah rumah sakit di Jakarta.
Metode: Penelitian ini adalah sebuah studi epidemiologi klinik dengan rancangan potong-lintang pada pasien-pasien endometriosis yang datang pada kurun waktu 2007-2009 di sebuah rumah sakit di Jakarta. Pasien didiagnosis endometriosis menggunakan laparoskopi. Seleksi embrio dilakukan dengan metode penilaian morfologi dan jumlah sel. Data demografi, pemeriksaan laboratorium sampai kepada kehamilan diambil dari rekam medik untuk dianalisis lebih lanjut.
Hasil: Sebanyak 72 subjek mengikuti program IVF dalam kurun waktu penelitian ini yang datanya berhasil diambil. Ada satu kasus yang di-drop out karena oosit tidak matur. Sementara yang mengalami pembuahan ada 65 orang, dimana dua tidak dilakukan transfer embrio. Diantara mereka yang dilakukan transfer embrio, terjadi 26 kehamilan (36,1%). Pada kasus endometriosis berat, kehamilan terjadi pada kualitas embrio excellent (50%) dan good-moderate (16,7%). Tetapi peluang tidak hamil yang ditemukan juga sama yaitu 50% pada kasus endometriosis berat. Pada kasus endometriosis ringan-sedang, peluang kehamilan bila embrio excellent adalah 39% dibandingkan good-moderate (25%). Bila dibandingkan dengan jumlah embrio yang ditransfer, maka probabilitas kehamilan meningkat 50% apabila ditransfer 3 embrio dibandingkan 1 atau 2 embrio.
Kesimpulan: Penelitian ini menunjukkan bahwa kualitas embrio dan jumlah embrio transfer berperan meningkatkan peluang kehamilan pada pasien-pasien IVF. Namun karena dibandingkan peluang tidak hamil yang tidak berbeda bermakna, diperlukan marker lain yang lebih sensitif untuk menilai kualitas embrio transfer.
AbstractBackground: Endometriosis is the most common condition underlying infertility in women. To increase the rate of pregnancy in women with endometriosis, embryo selection is performed during in vitro fertilization. This study aims to prove the effectiveness of embryo selection on the rate of pregnancy in a hospital in Jakarta.
Methods: This is a cross sectional clinical epidemiology study, performed on endometriosis patients who visited the hospital between 2007 ? 2009. Patients were diagnosed with endometriosis using the laparoscopy technique. Embryo selection was performed by assessing the morphology and cell count.
Results: We were able to collect data from 72 subjects who underwent IVF during this research period. One subject was dropped out of the program due to immaturity of the oocyte. Successful fertilization was achieved for 65 subjects, but two of them did not undergo embryo transfer. Out of all the subjects undergoing embryo transfer, 26 subjects successfully became pregnant (36.1%). In severe endometriosis cases, pregnancy was achieved with excellent quality embryos (50%) and good-moderate quality embryos (16.7%); but the probability of failure to become pregnant was found to be the same (50%). In mild-moderate endometriosis cases, the probability of pregnancy with excellent quality embryos was 39% compared to 25% chance with good-moderate quality embryos. Regarding the number of embryos that were transferred, we have found that the probability of pregnancy was 50% higher when 3 embryos were transferred, compared to 1 or 2 transferred embryos.
Conclusion: This study shows that embryo quality and the number of transferred embryos are relevant to increase the probability of pregnancy in patients undergoing IVF. But because the probability of not achieving pregnancy is not significantly different, we need to find another marker that is more sensitive to assess the quality of embryo transfer.
