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"Latar belakang: Vitrifikasi folikel pre-antral menjadi pilihan dalam upaya preservasi fungsi reproduksi karena dapat menurunkan risiko mikrometastasis sel kanker akibat transplantasi korteks ovarium serta tidak dipengaruhi oleh perfusi jaringan. Tujuan: Memperoleh upaya preservasi fungsi ovarium yang efektif dengan penilaian apoptosis folikel pre-antral. Tempat: Departemen Obstetri Ginekologi Fakultas Kedokteran Universitas Indonesia - RS Dr. Cipto Mangunkusumo dan RS Fatmawati Jakarta. Metode: Studi ini merupakan penelitian eksperimental untuk menilai apoptosis folikel pre-antral pasca vitrifikasi. Folikel pre-antral segar merupakan kelompok kontrol. Hasil: Korteks ovarium didapatkan dari 6 enam pasien kanker serviks dan kanker payudara berumur 30-37 tahun yang menjalani operasi ooforektomi. Tidak terdapat perbedaan morfologi folikel primordial, folikel primer dan folikel sekunder dari korteks ovarium segar dan korteks ovarium pasca vitrifikasi. Dari 6 sampel korteks ovariumSeratus enam puluh satu berhasil di-isolasi 161 folikel pre-antral berhasil di-isolasi dengan 70 % di antaranya merupakan folikel sekunder. Tidak tampak perbedaan morfologi folikel pre-antral berdasarkan kriteria membran basalis, sel granulosa, zona pelusida dan oosit. Rerata ekspresi mRNAgen FasL folikel pre-antral segar adalah 0,43 ± 0,20 dibandingkan 0,51 ± 0,20 pada folikel pre-antral pasca vitrifikasi (nilai p = 0,22). Rerata ekspresi mRNAgen kaspase-3 folikel pre-antral segar adalah 0,56 ± 0,49 dibandingkan 0,27 ± 0,21 pada folikel pre-antral pasca vitrifikasi (nilai p = 0,233). Satu folikel sekunder dari korteks ovarium segar berhasil tumbuh menjadi folikel antral lanjut pada hari ke-6 kultur. Simpulan: Vitrifikasi folikel pre-antral terbukti tidak menyebabkan perubahan morfologi folikel dan peningkatan ekspresi gen mRNA FasL dan kaspase-3. Untuk membuktikan pengaruh vitrifikasi terhadap kesintasan folikel pre-antral pasca dalam kultur diperlukan penelitian lanjutan.

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Background: Pre-antral follicle vitrification should be considered as fertility preservation method because it lowers the risk of cancer micrometastasis of ovarian tissue transplantation and is not disturbed by ovarian tissue perfusion.

Objectives: To obtain the effective method of ovarian function preservation with pre-antral follicle apoptosis assessment.

Setting: Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital and Fatmawati Hospital Jakarta.

Method: This is an experimental study about apoptosis in pre-antral follicles after vitrification. Fresh pre-antral follicles served as a control group.

Results: Ovaries from six women between 30‒37 years of age who underwent oophorectomy due to cervical cancer or breast cancer were examined. There was no significant difference between primordial, primary and secondary follicles morphology from fresh and warmed-vitrified ovaries based on basal membrane, granulosa cells, zona pellucida and oocytes. From 6 six ovarian cortex, 161 pre- antral follicles were isolated and 70 % of them is secondary follicle. There was no significant difference between the morphology of isolated pre-antral follicles from fresh and warmed-vitrified ovaries. The mean FasL mRNA expression on the fresh isolated pre-antral follicles was 0.43±0.20 versus 0.51±0.20 on the warmed-vitrified group (p=0.22). The mean caspase-3 mRNA expression on the fresh isolated pre-antral follicles was 0.56±0.49 versus 0.27±0.21 on the warmed- vitrified group (=0.233). One secondary follicle grew and developed to an antral follicle within 6 days of culture.

Conclusion: It was shown that vitrification did not affect pre-antral follicles morphology and mRNA expression of FasL and caspase-3 on isolated pre-antral follicles and ovarian cortex. Further studies are required to establish whether vitrification affect in vitro culture of pre-antral follicles"

"Pendahuluan: Angka keberhasilan FIV di Indonesia sekitar 32-35%. Salah satu penyebab pencapaian yang rendah ini adalah mutu oosit yang dinilai secara mi­kros­kopik pada saat panen oosit. Dari sekian banyak faktor yang berperan dalam pembentukan oosit matang bermutu baik diduga yang paling menentukan per­olehan oosit ma­tang, jumlah fertilisasi, dan jumlah embrio yang dipindahkan ke ute­rus pada FIV adalah AMH, inhibin-B, IGF-2 dan nisbahnya. Bahan dan metoda: Kajian analitik potong-lintang pengukuran berulang dilaku­kan pada bu­lan September 2013-Agustus 2014 di Rumah Sakit Anak dan Bunda Harapan Kita, Jakarta. Sebanyak 38 pasien berumur 26-42 tahun yang mengikuti program FIV diukur kadar AMH, inhibin-B, IGF-2 saat basal, pencetus, panen oosit dalam serum dan dalam zalir folikel. Analisis regresi linear digunakan untuk memperoleh faktor penduga jumlah perolehan oosit matang, jumlah fertilisasi, dan jumlah embrio yang dipindahkan.Hasil: Parameter penduga perolehan oosit matang adalah inhibin-B serum panen oosit dan folikel antral basal (FAB) total. Parameter penduga jumlah fertilisasi adalah FAB to­tal, nisbah inhibin-B pencetus terhadap inhibin-B basal, dan nisbah IGF-2 pen­cetus terhadap inhibin-B pencetus. Parameter penduga jumlah embrio yang dipin­dahkan adalah FAB total, inhibin-B panen oosit, dan nisbah inhibin-B panen oosit terhadap inhi­bin-B pencetus.Pada analisis bivariat area under curve (AUC) terbesar (77,4%) ditemukan pada titik-potong in­hi­bin-B serum panen oosit. Kadar inhibin-B panen oosit yang lebih tinggi dari 131,16 ng/ mL adalah akurat untuk menetapkan kematangan oosit de­ngan ke­pe­­kaan (sensiti­vitas) 84% dan kekhasan (spesifisitas) 69,2%.Simpulan: Inhibin-B serum saat panen oosit berhubungan dengan pembentukan oo­sit matang dan normal sehingga dapat dijadikan parameter penduga perolehan oosit ma­tang dan jum­lah em­brio yang terbentuk. Ditemukan parameter-parameter baru, yaitu (1) nisbah inhibin-B pen­ce­tus terhadap inhibin-B basal serum, dan nisbah IGF-2 pen­cetus terhadap in­hibin-B pencetus serum untuk menduga jumlah fertili­sasi; (2) nisbah inhibin-B pa­nen terhadap inhibin-B pen­­cetus serum untuk menduga jumlah em­brio yang dipindahkan ke uterus pada FIV.

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Background: The success rate of IVF in Indonesia was 30-35%. This low rate was caused by the microscopically evaluated oocyte quality that was obtained by ovum pick-up (OPU). The determinatively contributing factors for the formation of good quality mature oocytes, which are considered to be used as predictive parameter for mature oocytes recovery, number of fertilization, and number transferrable embryos in IVF, are AMH, inhibin-B, IGF-2, and their ratios. Therefore, the study to determine the correlation of those factors with the formation of ferti­li­zable mature oocyte in IVF program is necessary.

Materials and methods: An analytic cross-sectional repeated measurements study was conducted from September 2013 until August 2014 at Harapan Kita Mother and Chil­d Hospital, Jakarta. There were 38 patients aged between 26-42 years who par­ticipated in the IVF program; all of them underwent measurement for serum AMH, inhibin-B, and IGF-2 levels at basal, trigger, and OPU times. Predictive parameters for the number of mature oocytes, fertilizable oocytes, number of embryos transferred were analysed using linear regression.

Results: Predictive parameter for the number of mature oocytes are inhibin-B at OPU and total basal antral follicle (BAF) count. Predictive factors for the number of fertili­za­tion are total BAF count, the ratio of inhibin-B at triggering to inhibin-B at basal ti­mes. Predic­ti­ve factors for the number of embryos transferred are total BAF, inhibin-B at OPU, and the ratio of inhibin-B at OPU to inhibin-B at triggering time.

Using bivariate analysis, at the largest area under the curve (AUC) which was as high as 77.4%, the cut-off point of serum inhibin-B at OPU was found. The serum inhibin-B level at OPU higher than 131.16 ng/mL is accurate for determining the oocyte ma­turity (84% sensitivity and 69.2% spe­cificity).

Conclusions: Serum inhibin-B at OPU correlates with the formation of both mature and normal oocytes, thus it can be used as a predictor for the number of mature oo­cytes recovered and the number of embryos transferred. New parameters are found, those are: (1) the ratio of inhibin-B at triggering to inhi­bin-B in serum at basal times; and the ratio of IGF-2 at triggering to inhibin-B in serum at triggering times to pre­dict the number of fer­tilization; (2) the ratio of inhibin-B at OPU to inhibin-B in se­rum at triggering times to pre­dict the number of embryos transferred."