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Latar belakang: Suplementasi mikronutrien untuk wanita pada masa prakonsepsi, khususnya zinc dan kalsium, terbukti penting untuk maturasi oosit dan ovulasi. Namun, peran zinc dalam mempromosikan kualitas oosit dan potensi perkembangannya belum diketahui secara jelas. GDF9, anggota superfamili TGF b yang disekresikan dari oosit selama proses folikulogenesis, terbukti dapat menjadi biomarker maturasi nuklear oosit dan kualitas embrio. Tujuan: Studi potong lintang ini bertujuan untuk mengetahui apakah ada hubungan antara kadar zinc dan kalsium dalam serum dan cairan folikel dengan ekspresi GDF9 terhadap maturasi oosit. Selain itu, penelitian ini juga bertujuan untuk mengetahui apakah kadar zinc dan kalsium dalam serum dapat mewakili kadar zinc dan kalsium dalam cairan folikel. Metode: Studi ini dilakukan pada 25 subjek penelitian yang menjalani program fertilisasi in vitro di Poliklinik Yasmin RSUPN Cipto Mangunkusumo (RSCM) Kencana. Darah vena sebanyak 6 cc diambil pada hari ovum pick up (OPU) dan kemudian dianalisis di laboratorium untuk mengetahui kadar zinc, kalsium, dan protein GDF9. Cairan intrafolikuler dan sel granulosa juga akan diambil dan diperiksa kadar zinc dan kalsium dari cairan intrafolikuler serta ekspresi mRNA GDF9 dari sel granulosa. Hasil:  Dari 25 subjek penelitian, 12 subjek (48%) di antaranya dikategorikan ke dalam kelompok angka maturasi oosit baik (berdasarkan indikator oosit matur dari konsensus Vienna) serta 13 (52%) sisanya dikategorikan ke dalam kelompok angka maturasi oosit buruk. Dari uji korelasi antara kadar zinc dan kalsium dalam serum dengan cairan folikel, kadar zinc folikel terbukti berkorelasi secara signifikan dengan kadar zinc serum (p = 0,019). Kadar GDF9 serum juga terbukti berkorelasi secara signifikan dengan ekspresi GDF9 (p = 0,047). Tidak didapatkan korelasi yang bermakna antara kadar zinc dan kalsium serum dengan kadar GDF9 serum serta ekspresi mRNA GDF9 dari sel granulosa terhadap angka maturasi oosit (p > 0,05). Kesimpulan: Kadar GDF9 serum dapat menjadi pengganti biomarker untuk kualitas oosit. Tidak didapatkan hubungan antara kadar zinc dan kalsium dalam serum atau cairan folikel terhadap kadar GDF9 serum atau ekspresi mRNA GDF9 dari sel granulosa terhadap angka maturasi oosit.

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Background:  Micronutrient supplementation for women during preconception, especially zinc and calcium, is critical for oocyte maturation and ovulation. However, the role of Zinc in promoting quality of oocytes has not yet been elucidated. GDF9, one of oocyte sereting factor, has been proven to be a biomarker of maturation of nuclear oocyte and quality of embryo. Aim: to investigate any relationship between zinc and calcium levels in serum and follicular fluid and GDF9 expression towards maturation of oocytes. In addition, this study also aimed to determine whether zinc and calcium levels in serum could represent zinc and calcium levels in follicular fluid. Method: This cross-sectional study was conducted on 25 subjects who underwent IVF programs at the Yasmin Policlinic, RSCM Kencana. Six mililiters of venous blood was taken on the day of the ovum pick up (OPU) and then analyzed in the laboratory to determine the levels of zinc, calcium, and protein GDF9. In addition to venous blood, intrafollicular fluid and granulosa cells will also be taken and examined zinc and calcium levels from intrafollicular fluid and GDF9 mRNA expression from granulosa cells. Result: 12 (48%) out of 25 subjects were categorized into high oocyte maturation rate (based on Vienna consensus on oocyte maturation rate), and the other 13 (52%) were categorized into low oocyte maturation rate. Follicular zinc levels were significantly correlated with serum zinc levels (p = 0,019). Serum GDF9 levels were also significantly correlated with expressions of GDF9 mRNA (p = 0,047). No significant correlation was found between serum levels of zinc and calcium and serum GDF9 levels or GDF9 mRNA expression towards maturation of oocytes (p > 0,05). Conclusion: Serum GDF9 might substitute for follicular GDF9 as a biomarker of oocyte quality. There is no relationship between serum or follicular zinc/calcium levels and serum GDF9 levels or GDF9 mRNA expression from granulosa cells towards oocyte maturation rates.

 

 

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"Latar Belakang: Growth Differentiation Factor 9 (GDF9) adalah salah satu anggota dari superfamili TGF-β yang merupakan salah satu oocyte-secreted factor (OSF). GDF9 memainkan peran penting dalam folikulogenesis ovarium, kompetensi perkembangan oosit, serta sebagai molekul esensial yang mengontrol berbagai proses sel granulosa dan laju ovulasi. GDF9 merupakan OSF yang memainkan peran penting dalam menjaga fertilitas wanita. Penelitian ini bertujuan untuk mengetahui apakah ekspresi GDF9 berkorelasi dengan kualitas oosit dan laju fertilisasi pada pasien fertilisasi in vitro.Tujuan: Mengetahui korelasi ekspresi GDF-9 dengan kualitas oosit dan laju fertilisasi pada pasien Fertilisasi In VitroMetode: Penelitian ini adalah penelitian potong lintang yang dilaksanakan di Klinik Yasmin, Rumah Sakit dr. Cipto Mangunkusumo, Jakarta sejak bulan Juli 2019 sampai bulan Juli 2020. Terdapat 26 wanita berusia 25-40 tahun pasien Fertilisasi In Vitro tanpa penyakit endometriosis maupun Sindrom Ovarium Polikistik yang menjadi subjek penelitian ini. Cairan folikel pasien diambil, kemudian dilakukan pengukuran ekspresi gen GDF9. Setelah itu, dilakukan evaluasi pada data ekspresi gen GDF9 serta diuji korelasinya dengan kualitas oosit dan laju fertilisasi pasien menggunakan aplikasi SPSS.Hasil: Sebanyak 26 pasien IVF berpartisipasi dalam penelitian ini. Median jumlah ekspresi gen GDF9 adalah sebanyak 2.47 x 10-5 ng/μl dengan median kualitas oosit dan laju fertilisasi pasien IVF sebesar 3.00 dan 0.60. Berdasarkan hasil uji korelasi, terdapat korelasi negatif antara ekspresi GDF9 terhadap laju fertilisasi dengan kekuatan korelasi sedang (r = -0.443, p = 0.012). Sementara, ditemukan korelasi tidak bermakna antara ekspresi GDF9 terhadap kualitas oosit (r = -0.306, p = 0.064).Kesimpulan: Terdapat korelasi negatif dengan kekuatan korelasi sedang antara ekspresi GDF9 dengan laju fertilisasi, sementara hubungan ekspresi GDF-9 dengan kualitas oosit memiliki korelasi tidak bermakna.

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Background: Growth Differentiation Factor 9 (GDF9) is a member of the TGF-β superfamily which is one of the oocyte-secreted factor (OSF). GDF9 plays an important role in ovarian folliculogenesis, the competence of oocyte development, as well as an essential molecule that controls various granulosa cells process and the rate of ovulation. GDF9 is an OSF which plays an important role in maintaining female fertility. This study is conducted to see the correlation between the expression of GDF9 gene with the oocyte quality and the fertilization rate in the IVF patients.

Aim: To find out the correlation between the expression of GDF9 with the oocyte quality and the rate of fertilization of IVF Patients

Methods: This study is a cross-sectional study which was conducted at Klinik Yasmin dr. Cipto Mangunkusumo General Hospital, Jakarta since July 2019 to July 2020. 26 IVF patients aged 25-40 years without the conditions of endometriosis or Polycystic Ovary Syndrome (PCOS) participated in this study. Follicular fluids are taken from the patients and the GDF9 gene expression were measured. The data were then evaluated for its correlation with the oocyte quality and the fertilization rate using the SPSS application.

Results: Abour 26 IVF patients were participated in this study. The median amount of GDF9 gene expression was 2.47 x 10-5 ng/μl. The median of the oocyte quality and the fertilization rate was 3.00 and 0.60. According to the correlation test, there is a negative correlation between the expression of GDF9 gene and the fertilization rate with a moderate statistical correlation (r = -0.443, p = 0.012). Meanwhile, the expression of GDF9 gene has no significance correlation with the oocyte quality (r = -0.306, p = 0.064).

Conclusion: This study showed a negative correlation between the expression of GDF9 gene and the fertilizatio rate, while the relation between the GDF9 expression and the occyte quality has no significance correlation."

"Prevalensi infertilitas di Indonesia yang meningkat tiap tahunnya juga memperbesar kebutuhan pasangan infertil terhadap program fertilisasi in vitro (FIV). Diketahui oosit mempunyai peranan penting dalam keberhasilan FIV. Namun pada pelaksanaannya, oosit yang didapat saat tindakan petik oosit mempunyai maturitas yang tidak sama. Dari beberapa penelitian didapatkan stimulasi ovarium terkendali (SOT) dapat meningkatkan apoptosis sel granulosa dan reactive oxygen species (ROS) yang dapat memberikan efek negatif pada maturasi oosit. Penelitian ini bertujuan untuk mengetahui pengaruh elektroakupunktur terhadap maturasi oosit, laju fertilisasi, kadar GDF9 dan BMP15 pada program FIV. Uji klinis acak tersamar ganda dengan kontrol dilakukan terhadap 24 subjek yang menjalani program FIV. Subjek dialokasikan secara acak ke dalam kelompok elektroakupunktur (n=12), dan kelompok elektroakupunktur sham (n=12). Penilaian maturasi oosit dan laju fertilisasi dilakukan secara mikroskopis oleh embriolog, sedangkan pemeriksaan kadar ekspresi mRNA GDF9 dan BMP15 oleh analis lab. Hasil penelitian menunjukkan terdapat perbedaan bermakna maturasi oosit antara kelompok elektroakupunktur dengan elektroakupunktur sham (p=0,02); laju fertilisasi (p=0,03). Tidak didapatkan perbedaan bermakna kadar GDF9 (p=0,34) dan BMP15 (p=0,47) antara kelompok elektroakupunktur dengan elektroakupunktur sham . Kesimpulan penelitian ini adalah elektroakupunktur dapat meningatkan maturasi oosit dan laju fertilisasi pada program FIV.

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Increasing prevalence of infertility in Indonesia every year also increases the need for infertile couples in the in vitro fertilization program (FIV). It is known that oocytes have an important role in the success of FIV. But in its implementation, oocytes obtained during oocyte retrieval have unequal maturity. From several studies it was found that controlled ovarian stimulation (COS) can increase the apoptosis of granulosa cells and reactive oxygen species (ROS) which can have a negative effect on oocyte maturation. This study aims to determine the effect of electroacupuncture on oocyte maturation, fertilization rate, levels of GDF9 and BMP15 in the FIV program. A double blind randomized clinical trial with controls was conducted on 24 subjects who underwent the FIV program. Subjects were randomly allocated to the electroacupuncture group (n = 12), and the electroacupuncture sham group (n = 12). The assessment of oocyte maturation and the rate of fertilization were carried out microscopically by the embryologist, while the examination of the levels of GDF9 and BMP15 mRNA by lab analysts. The results showed that there were significant differences in oocyte maturation between the electroacupuncture group and electroacupuncture sham (p = 0.02); fertilization rate (p = 0.03). There were no significant difference in GDF9 levels (p = 0.34) and BMP15 levels (p = 0.47) between the electroacupuncture group and sham electroacupuncture. The conclusion of this study is electroacupuncture can enhance oocyte maturation and fertilization rate in the FIV program."