Pengaruh kadar Follicle Stimulating Hormone (FSH) basal terhadap keberhasilan stimulasi ovarium pada fertilisasi invitro metode Short Protocol

RETNOWATI, Sulistiari, Prof.dr. H. Mochamad Anwar, M.Med.Sc.,SpOG(K)

2005 | Tesis | PPDS I Obstetri dan Ginekologi

Latar belakang: FSH basal yang tinggi menunjukkan cadangan ovarium yang rendah, dan menggambarkan kuantitas folikel yang tersedia untuk distimulasi pada fertilisasi invitro (FIV). Sehingga FSH basal dapat membantu prediksi keberhasilan stimulasi ovarium Tujuan penelitian: untuk menilai hubungan antara kadar hormon FSH basal dengan keberhasilan stimulasi ovarium pada FIV dengan metode superovulasi short protocol. Desain penelitian: Analisis kohort retrospektif Bahan dan cara: Data populasi pasien yang menjalani program FIV dengan metode stimulasi short protocol diambil dari rekam medis klinik Permata Hati, RS dr Sarjito Yogyakarta dalam kurun waktu Januari 2000-Desember 2005. Pasien menjalani pemeriksaan kadar FSH basal pada hari ke 2 sampai 5 menstruasi. Terdapat dua kelompok penelitian berdasarkan kadar FSH basal kelompok A dengan FSH basal <10mIU/mL dan kelompok B dengan kadar FSH basal ≥10mIU/mL. Kedua kelompok penelitian mendapatkan protokol superovulasi dengan metode short protocol. Luaran yang dinilai berupa keberhasilan stimulasi ovarium, disebut berhasil apabila menghasilkan folikel ukuran ≥16 mm sejumlah ≥3 buah, atau kadar puncak estradiol > 500pg/mL. Analisis statistik yang digunakan adalah Chi-square test, Fischer’s exact test, ROC dan regresi logistik biner. Hasil : Dalam periode 5 tahun terdapat 75 siklus short protocol, 53 siklus dengan kadar FSH basal <10mIU/mL dan 22 siklus dengan FSH basal ≥10mIU/mL. Kelompok dengan kadar FSH basal <10mIU/mL memberikan keberhasilan stimulasi ovarium yang lebih tinggi (RR 1,43 CI 95% (1,02-2,05)). Dengan kurva ROC dapat ditentukan FSH basal 9,32mIU/mL mempunyai sensitivitas 76,9% dan spesivitas 70% dalam prediksi kegagalan stimulasi ovarium. FSH basal <9,32mIU/mL memberikan keberhasilan stimulasi ovarium yang lebih tinggi (RR 1,47 CI 95% (1,09-1,99)), Kesimpulan: FSH basal kurang dari 10mIU/mL meningkatkan keberhasilan stimulasi ovarium, meningkatan jumlah folikel, dan kadar puncak E2 yang dihasilkan pada stimulasi ovarium metode short protocol.

Backgrounds: Higher basal FSH level indicate decreased ovarian reserve and are good predictors of the eggs quantity which can be induced to grow during in vitro fertilization (IVF). Objectives: To assess the correlation between basal FSH levels with the success rates of ovarian response in short protocol stimulation Study design: Hystorical cohort. Materials and Method: Data of patients cycles underwent short protocol for in vitro fertilization were taken from hospital medical record of Permata Hati Clinics, Dr Sarjito Hospital, Jogjakarta since January 2000 until December 2005. Basal FSH level examination performed in the second until fifth day of menstrual cycle. There are two study groups with basal FSH levels 10mIU/mL as cutoff point. Study group A for population with basal FSH level <10mIU/mL and study group B for population with basal FSH level ≥10mIU/mL The main outcome was the success rates of ovarian response during stimulation. Good ovarian response would produce ≥3 follicles size ≥16 mm, or the peak of estradiol level >500 pg/mL. Chi-square test, Fischer’s exact test, ROC curve and binary logistic regression were used for statistical analysis. Results: There were 75 cycles in a 5-years study, 53 cycles with basal FSH levels <10mIU/mL and 22 cycles with basal FSH level ≥ 10mIU/mL. Higher success rate found in the study group with basal FSH level <10mIU/mL (RR 1,43 CI 95% (1,02-2,05)). ROC curve can determine basal FSH levels cut off point, with cut off value 9,32mIU/mL had sensitivity 76,9% dan specifity 70%. Group with basal FSH level <9,32 mIU/mL had higher success rate (RR 1,47 CI 95% (1,09-1,99)) Conclusion: Basal FSH <10mIU/mL increased the number of follicle and peak of estradiol produced, and also increased the success rate during ovarian stimulation using short protocol methode.

Kata Kunci : Fertilisasi In Vitro,FSH Basal,Short Protocol, in vitro fertilization, basal FSH, poor responders, short protocol