EKSPRESI RESEPTIVITAS ENDOMETRIUM PADA POLIP ENDOMETRIUMPASIEN INFERTILITAS PRIMER KAJIAN POLIMORFISME PROGINS

CINDY RANI WIRASTI, Prof.dr.Djaswadi Dasuki,Sp.OG(K), MPH, Ph.D.; Dr. Med. dr. Indwiani Astuti.; dr. Ahmad Hamim Sadewa, Ph.D

2018 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Pendahuluan: Wanita dengan infertilitas primer tanpa gejala yang ditemukan polip endometrium pada pemeriksaan ginekologi dimasukan sebagai subjek penelitian. Efek polip endometrium terhadap perubahan reseptivitas endometrium dinilai dengan ekspresi pinopoda pada pertengahan fase luteal (hari ke 19-21). Polimorfisme PROGINS berhubungan dengan perubahan progesteron reseptor, yang akan meningkatkan risiko polip endometrium. Metode Penelitian: Penelitian Potong Lintang, di Klinik Permata Hati RSUP Sardjito dan Klinik Ginekologi RS Pluit Jakarta, Januari 2015 - Juli 2017. Cara kerja: Pada penelitian ini subjek diperiksa USG transvaginal, saline infusion histerosonografi, dan histeroskopi operatif terhadap jaringan polip. Jaringan polip diperiksa histopatologi, dan ekspresi pinopoda. Pemeriksaan polimorfisme PROGINS diperiksa dengan mengambil sampel darah . Hasil : Empat puluh satu orang subjek penelitian menjalani prosedur pemeriksaan rutin infertilitas, ditemukan polip endometrium, dan menjalani prosedur histeroskopi polipektomi. Jaringan polip diperiksa histopatologi dan ekspresi pinopoda. Hubungan bermakna ekspresi pinopoda dengan polip endometrium. Ekspresi pinopoda negatif pada 23,8%, terisolir 31%, beberapa 38%, berkelompok 3%. Hubungan bermakna polip endometrium terhadap polimorfisme PROGINS, T1T1 homozygot (92,1%); T1T2 heterozygot (7,9%) (p<0,05). Kesimpulan : Ekspresi pinopoda merupakan petanda reseptivitas endometrium yang dapat digunakan untuk prediksi keberhasilan implantasi embrio. Polimorfisme PROGINS dapat digunakan untuk menilai peningkatan risiko polip endometrium.

Introduction: Women with primary infertility eumenorea during infertility examination have endometrial polyps. Their effect on endometrial receptivity is assesed by pinopode expression at mid luteal phase (Day 19-21). Progesterone receptor gene polymorfism (PROGINS) seems have a correlation with impairment of endometrial growth. Method: Cross Sectional Study, Gynecology Jakarta Fertility Centre,from January 2015 - July 2017, primary infertility, eumenore woman, with endometrial polyp was recruited for this study. Intervention(s): In this study the patients undergoes transvaginal ultrasound (TVUS), saline infusion hysterosonography (SIS), hysteroscopy operatif. During hysteroscopy endometrial biopsy and operatif hysteroscopy for polypectomi was performed. Hysteroscopy procedures and endometrial biopsy was performed on day 19-21 (mid luteal phase) to evaluate the pinopoda expression and cytology examination of the polyp, along with blood sample collection for determined the PROGINS polimorfism. Result(s): Forty one patients was recruit in this study. Transvaginal ultrasound can not be used to determine uterine cavity pathology. Saline infusion hysterosonograph and hysteroscopy as a gold standart to evaluate uterine cavity. Polyp endometrial is significantly correlated with pinopode development. Pinopode expression negatif in 23,8%, isolated 31%, scattered 38%, clustered 3%. There is significant correlation on endometrial polyp and polymorphism PROGINS T1T1 homozygot (92,1%); T1T2 heterozygot (7,9%). Conclusion: Pinpode expression is a reliable marker for endometrial receptivity and PROGINS polymorphism can be used to determine increased risk of endometrial polyp.

Kata Kunci : Polip endometrium, ekspresi pinopoda, polimorfisme PROGINS, Endometrial Polyp, Pinopode expression, PROGINS polymorphism.