Luaran Transfer Embrio Simpan Beku pada Pasien Endometriosis Pasca Operasi dan Non Endometriosis yang Menjalani IVF di Klinik Permata Hati RSUP Dr. Sardjito

dr. Rina Fatmawati, dr. Shofwal Widad, SpOG(K); dr. Agung Dewanto., Ph. D , SpOG(K)

2019 | Tesis-Spesialis | OBSTETRI DAN GINEKOLOGI

Luaran Transfer Embrio Simpan Beku pada Pasien Endometriosis Pasca Operasi dan Non Endometriosis yang Menjalani IVF di Klinik Permata Hati RSUP Dr. Sardjito Rina Fatmawati, Shofwal Widad, Agung Dewanto Departemen Obstetri dan Ginekologi Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan Universitas Gadjah Mada RSUP Dr. Sardjito Yogyakarta Abstrak Latar Belakang: Endometriosis merupakan kondisi kronis yang dipengaruhi oleh hormon estrogen sehingga mempengaruhi wanita usia subur, dan berhubungan dengan nyeri panggul serta infertilitas. In Vitro Fertilization (IVF) saat ini merupakan teknologi reproduksi berbantu yang paling efisien dan tingkat keberhasilannya tinggi yang sering dilakukan untuk terapi infertilitas pada wanita yang berhubungan dengan endometriosis. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui apakah endometriosis pasca operasi mempegaruhi luaran kehamilan pasien yang menjalani transfer embrio simpan beku pada program bayi tabung (IVF/ICSI) Metode: Penelitian ini dengan desain kohort retrospektif. Data diambil dari rekam medis, subyek penelitian yang memenuhi kriteria inklusi dan eksklusi. Data penelitian dikumpulkan, diolah dan dianalisis dengan menggunakan SPSS 23. Dilakukan analisis data univariat, bivariat dan multivariat untuk mengetahui pengaruh antar variabel Hasil: Sampel pada penelitian ini berjumlah 458 subyek penelitian. Penderita endometriosis pasca operasi sebanyak 119 subyek (26%). Kategori endometriosis minimal-ringan 57 subyek (47,9%) dan sedang-berat sebanyak 62 subyek (52,1%). Angka kehamilan biokimiawi (36,31%) dan kehamilan klinis (29,4%) pada penderita endometriosis pasca operasi sedikit lebih tinggi dibandingkan pada non endometriosis. Namun secara statistik tidak mempengaruhi keberhasilan mencapai kehamilan biokimiawi (p =0,428; RR 0,89; CI 95%: 0,71-1,24) maupun kehamilan klinis (p= 0,535; RR 0,883; CI 95%: 0,63-1,22). Angka keguguran pada penderita endometriosis pasca operasi lebih tinggi daripada penderita non endometriosis (88,6%vs80,7%) namun tidak bermakna secara ststistik (p= 0,294; RR 1,69; CI 95%: 0,61-4,67) . Kehamilan biokimiawi dan kehamilan klinis dipengaruhi secara signifikan oleh usia, infertilitas, ketebalan endometrium, usia embrio dan kualitas embrio. Kejadian keguguran dipengaruhi oleh protokol stimulasi ovarium. Kesimpulan: Endometriosis pasca operasi secara statistik tidak berpengaruh terhadap luaran kehamilan pada siklus IVF/ICSI dengan transfer embrio simpan beku dibandingkan dengan penyebab infertilitas yang lain. Kata Kunci: Endometriosis, In Vitro Fertilization, Kehamilan Klinis, kehamilan biokimiawi, keguguran

Outcome of Frozen Embrio Transfer in Post Operative Endometriosis and Non-Endometriosis Patients Underwent IVF Programs in Klinik Permata Hati RSUP Dr. Sardjito Rina Fatmawati, Shofwal Widad, Agung Dewanto Department of Obstetrics dan Gynaecology Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada Dr. Sardjito Hospital of Yogyakarta Abstract Background: Endometriosis is a chronic condition that is influenced by the hormone estrogen which affects women of childbearing age, and is associated with pelvic pain and infertility. In Vitro Fertilization (IVF) is currently the most efficient assisted reproductive technology and its high success rate is often done for infertility therapy in women associated with endometriosis Objective: The aim of this study was to determine whether postoperative endometriosis affected pregnancy outcomes in patients underwent frozen embryo transfer in IVF / ICSI programs. Method: This Research was done with a retrospective cohort design. The data was taken from medical records, research subjects who met the inclusion and exclusion criteria. The research data was collected, processed and analyzed using SPSS 23. Univariate, bivariate and multivariate data analysis was carried out to determine the effect between variables Result: There were 458 research subjects in this study. Endometriosis patients were 119 subjects (26%). 57 subjects were categorized as minimum-mild endometriosis (47.9%) and moderate-severe subjects as many as 62 subjects (52.1%). The biochemical pregnancy rate (36.31%) and clinical pregnancy (29.4%) in patients with endometriosis was slightly higher than in non-endometriosis. But statistically it did not affect success rate of achieving biochemical (p = 0.428; RR 0.89; 95% CI: 0.71-1.24) and clinical pregnancy (p = 0.535; RR 0.883; 95% CI: 0.63- 1.22). The rate of miscarriage in postoperative endometriosis patients was higher than non-endometriosis patients (88.6% vs 80.7%) but was not statistically significant (p = 0.294; RR 1.69; 95% CI: 0.61-4.67) . Biochemical and clinical pregnancies were significantly affected by age, infertility, endometrial thickness, embryo age and embryo quality. The incidence of miscarriage was affected by the ovarian stimulation protocol. Conclusion: Endometriosis post operative statistically had no effect on pregnancy outcomes in the IVF / ICSI cycle with frozen embryo transfer compared with another cause of infertility . Keywords: Endometriosis, In Vitro Fertilization, Clinical pregnancy, biochemical pregnancy, miscarriage

Kata Kunci : Endometriosis, In Vitro Fertilization, Clinical Pregnancy, Biochemical Pregnancy, Miscarriage