Faktor prognosis keberhasilan terapi infertilitas endometriosis
NUGROHO, Rachmat, Prof.dr. H. Djaswadi Dasuki, MPH.,PhD.,SpOG(K)
2004 | Tesis | PPDS I Obstetri dan GinekologiLatar Belakang: Endometriosis berhubungan dengan infertilitas, penyebab infertilitas endometriosis adalah multifaktorial, tetapi patogenesis infertilitas pada endometriosis belum diketahui secara pasti dan sangat komplek. Inferttilitas endometriosis tidak tergantung stadium endometriosis, stadium minimal bisa menyebabkan infertilitas dan pada stadium berat bisa terjadi kehamilan atau infertilitas endometriosis tidak seiring dengan berat ringannya derajat endometriosis. Tujuan Penelitian: Mengetahui besar pengaruh Stadium endometriosis, ukuran folikel, tebal endometrium dan Uji mukosa servik terhadap keberhasilan terapi infertilitas endometriosis Rancangan penelitian: Case control Bahan dan Cara: Data diambil dari rekam medik klinik Permata Hati RS dr.Sardjito Yogyakarta dari januari tahun 2000 sampai februari 2004. Pasien dengan diagnosis infertilitas endometriosis yang memenuhi criteria inklusi dan ekslusi dibagi 2 kelompok yaitu hamil dan tidak hamil kemudian diiukuti ada tidaknya faktor prognosis (Stadium ringan endometriosis, ukuran folikel ≥ 14mm, tebal endometrium ≥6mm, dan Uji mukosa serviks ≥ 7) dari dua kelompok. Dilakukan analisa univariat, bivariat dan multivariat (regresi logistik berganda) dengan komputer. Hasil: Didapatkan 11 kasus kehamilan pada infertilitas endometriosis selama januari 2000 sampai februari 2004. Pada analisa bivariat didapatkan faktor prognosis yang secara statistik mempengaruhi keberhasilan terapi infertilitas endometriosis adalah ukuran folikel ≥ 14mm (OR = 12; CI 95% = 1,83-78,36; p = 0,004) dan tebal endometrium ≥ 6mm (OR = 12; CI 95% = 2,16-66,54; p= 0,002). Stadium endomtriosis secara klinis mempengaruhi keberhasilan terapi infertilitas endometriosis tetapi secara statistik tidak bermakna (OR = 3,7; CI 95% = 0,81-17,17; p = 0,08). Uji mukosa serviks baik secara klinis maupun statistik tidak mempengaruhi keberhasilan terapi infertilitas endometriosis (OR = 1,4; CI 95% = 0,36-8,42, p = 0,54). Dari analisis multivariat didapatkan tebal endometrium ≥ 6mm paling berpengaruh terhadap keberhasilan terrapin infertilitas endometriosis (p = 0,03). Kesimpulan: Ukuran folikel ≥ 14mm dan tebal endometrium ≥ 6mm mempengaruhi keberhasilan terapi infertilitas endometriosis. Stadium ringan endometriosis secara klinis mempengaruhi keberhasilan terapi infertilitas endometriosis. Uji mukosa serviks baik secara klinik maupun statistik tidak mempengaruhi keberhasilan terapi infertilitas endometriosis.
Background. Endometriosis is known cause of infertility, many factor that may contribute to infertility in patients with endometriosis. The degree of severity of the endometriosis has not been particulary helpful in predictory respon to therapy. There is poor correlation between the degree of infertility and severity of endometriosis. Women with severe endometriosis are not always more likely to have infertility than minimal endometriosis. Objective. To identify the influence of severity of endometriosis, the size of follicle, endometrial thicknes, and servical mucus examination as prognostic factor for the successful of endometriosis related infertility therapy. Design. Case Control Material and method. The study was conducted at Permata hati Sardjito Hospital Yogyakarta, from January 2000 to February 2004. Data was taken from hospital medical record. Patiens with diagnosis infertility of endometriosis and met the criteria were include. The prognostic factor were identified as well as of pregnancy group and not pregnancy group. Univariate, bivariate and multivareiate (binary logistic regression) were used for statistical analysis. All data were processed by computer. Result. Eleven pregnancys were found on endometriosis infertility patients in January 2000 to February 2004. Bivariate analysis show that prognostic factor those statistically significant increased pregnancy rate were size of follicle ≥ 14mm (OR = 12; CI 95% = 1,83-78,36; p = 0,004) and endometrial thicknes ≥ 6mm (OR = 12; CI 95% = 2,16-66,54; p = 0,002). Clinically, minimal endometriosis increased pregnancy rate but not statistically (OR = 3,7; CI 95% = 0,81-17,17, p = 0,08). Clinically and statistically, servical mucus examination not correlated pregnancy rate (OR = 1,4; CI 95% = 0,36-8,42; p = 0,54). The logistic regression analysis shows that endometrial thicknes ≥ 6mm and size of follicle ≥ 14mm are important prognostic factors contributing to pegnancy rate. Conclusion. Size of follicle ≥ 14mm and endometrial thicknes ≥ 6mm were the main prognostic factors for increased pregnancy rate. Minimal endometriosis although is not statistically significant but clinically it is.
Kata Kunci : Infertilitas Endometriosis,Hamil,Faktor Prognosis,Infertility-endometriosis-prognostic factor-pregnancy
