Perbandingan respon ovarium terhadap stimulasi gonadotropin pada endometriosis pascaterapi bedah dan non endometriosis

WAHYUNI, Alfaina, Prof. dr. H. Moch. Anwar, M.Med.Sc, SpOG(K)

2009 | Tesis | S2 PPDS 1-Obstetri dan Ginekologi

Latar belakang. Hipotesis yang menjelaskan infertilitas pada endometriosis masih kontroversial dan banyak diteliti. Beberapa mekanisme dikemukakan, salah satunya adalah berkaitan dengan gangguan folikulogenesis dan steroidogenesis di ovarium. Apakah gangguan ini bisa diperbaiki dengan terapi bedah dan stimulasi ovarium masih perlu dikaji lebih lanjut. Tujuan. Membandingkan respon ovarium terhadap stimulasi gonadotropin antara pasien infertilitas endometriosis pascaterapi bedah dan pasien infertilitas non endometriosis. Bahan dan cara penelitian. Penelitian dilakukan dengan rancangan kohort retrospektif terhadap 53 pasien infertilitas endometriosis pascaterapi bedah dan 53 pasien infertilitas faktor tuba dan atau sperma yang menjalani stimulasi ovarium dalam program IVF di Klinik Permata Hati RS. Dr. Sardjito Yogyakarta dari tahun 2002 sampai Agustus 2008. Luaran penelitian respon ovarium berdasarkan kadar estradiol puncak maupun jumlah folikel matur. Respon ovarium baik jika kadar E2 puncak > 500 pg/ml atau jumlah folikel matur ≥3, sedangkan respon buruk bila kadar E2 puncak ≤ 500 pg/ml atau jumlah folikel matur <3. Analisis data dilakukan dengan uji statistik T test dan Chi Square. Analisis multivariat dilakukan dengan regresi logistik. Hasil. Karakteristik kedua kelompok penelitian sama, baik dari segi umur, BMI, lama infertilitas, FSH basal, E2 basal, jenis stimulasi dan kebutuhan gonadotropin. Pada kelompok endometriosis kadar E2 puncak lebih rendah (1394,58±832,4 vs 1841,76 ± 906,9 ; p<0,05), begitu juga dengan jumlah folikel matur (1,42±0,908 vs 2,7±2,04; p<0,05). Jumlah folikel <3 lebih tinggi pada endometriosis (88,7% vs 52,8%, RR 1,679;CI 95% 1,28-2,20), namun proporsi kadar E2 puncak ≤500 pg/ml tidak berbeda (5,7% vs 1,9%, RR 3,0; CI95% 0,32-27,93). Kelompok endometriosis mempunyai risiko lebih besar untuk mendapatkan respon buruk dibandingkan kelompok non endometriosis (OR 14,47; CI95% 4,98-40,68). Kesimpulan. Pada endometriosis pascaterapi bedah proporsi jumlah folikel >3 lebih tinggi dibandingkan non endometriosis namun proporsi kadar E2 puncak ≤500 pg/ml tidak berbeda.

Background. The hypothesis that endometriosis causes infertility remains controversial. Several mechanism have been proposed, one of them was abnormal follicular growth and endocrin ovarian abnormalities. Whether this abnormalities would be improved by surgical therapy and ovarian stimulation was still unclear. Objective. To compare the ovarian response to gonadotropins women with endometriosis-infertility who underwent surgical treatment to women without endometriosis- infertility. Material and methode. The study design was retrospective cohort. A total of 106 women who underwent ovarian stimulation and IVF and had laparoscopy to diagnose or and treament endometriosis, divided into 2 groups: 53 women with endometriosisinfertility and 53 women with tubal or male infertility. The main outcome were ovarian response based on peak E2 level and number of mature follicle (well response was peak E2 level > 500 pg/ml or number of follicle mature was ≥3. Poor response was peak E2 level ≤500 pg/ml or number of follicle mature was <3). The data were analysis by camparative statistic (T-tes and Chi Square) continued with multivariat analysis by logistic regression. Results. Patient age, BMI, periode of infertility, level estradiol base, the kind of ovarian stimulation protocol and gonadotropin requirement were similar. Lower peak E2 level (1394,58±832,4 vs 1841,76 ± 906,9 ; p<0,05) and lower number of mature follicle (1,42±0,908 vs 2,7±2,04; p<0,05) were found in women with endometriosis. Number of follicle mature <3 was higher in endometriosis (88,7% vs 52,8%, RR 1,679;CI 95% 1,28-2,20), however no differences was found in peak E2 level ≤ 500 pg/ml (5,7% vs 1,9%, RR 3,0; CI95% 0,32-27,93). Endometriosis have more risk to get poor response to gonadotropin (RR 14,47; CI95% 4,98-40,68). Conclusions. Women with endometriosis-infertility who have undergone surgery respond less well to gonadotropins based on number of follicle mature <3 than women with tubal and or male infertility, no differences was found in peak E2 level ≤ 500 pg/ml.

Kata Kunci : respon ovarium, jumlah folikel matur, kadar estradiol puncak, endometriosis, stimulasi ovarium, endometriosis, ovarian response, the number of mature follicle, peak estradiol level, ovarian stimulation