PERBANDINGAN RESPON STIMULASI OVARIUM TERKENDALI DENGAN PROTOKOL PANJANG ANTARA PASIEN ENDOMETRIOSIS PASCA TERAPI GnRH AGONIS 3-6 BULAN DAN TANPA GnRH AGONIS SEBELUM FERTILISASI IN VITRO

Nurmianda, dr. Shofwal Widad, SpOG(K)

2013 | Tesis | S2 Ilmu Kebidanan dan Penyakit Kandungan

Latar belakang: Pemberian GnRH agonis pada endometriosis dapat meningkatkan apoptosis dan menghambat proliferasi sel endometrium eutopik. Bagaimana efektifitas pemberian GnRH agonis selama 3-6 bulan sebelum FIV pada endometriosis perlu dikaji lebih lanjut. Tujuan: Untuk mengetahui efektifitas pemberian GnRH agonis 3-6 bulan sebelum FIV terhadap luaran jumlah oosit matang, dosis total gonadotropin dan lama stimulasi ovarium dengan stimulasi protokol panjang. Desain penelitian: Penelitian ini mengunakan rancangan kohort retrospektif observasional. Jumlah populasi pada penelitian ini sebanyak 60 pasien diklinik permata hati RS Dr. Sardjito mulai tahun 2003 sampai tahun 2011. Hasil: Sebanyak 60 subyek dari 60 pasangan yang menjalani fertilisasi in vitro diikutkan dalam penelitian sesuai dengan kriteria inklusi dan eksklusi. Lama stimulasi ovarium pasca terapi supresi lama stimulasi ≥10 hari sebanyak 10 subyek (33,3%) sedangkan kelompok tanpa terapi supresi, lama stimulasi ≥10 hari sebanyak 7 subyek (23,3%). Jumlah dosis total gonadotropin (≥40 ampul) selama stimulasi pada kelompok tanpa terapi supresi 3 subyek (10%) dan pasca terapi supresi 5 subyek (16,6%). Lima puluh enam subyek (93,3%) dengan jumlah oosit tinggi (≥3 oosit) dan 4 subyek (6,7%) dengan jumlah oosit yang rendah. Stadium endometriosis minimal-ringan (I-II) sebanyak 27 subyek (45%), stadium sedang-berat (III-IV) sebanyak 33 subyek (55%). Kelompok pasca terapi supresi GnRH agonis sebelum FIV secara klinis memberikan risiko 1,07 kali meningkatkan jumlah oosit matang bila dibandingkan dengan kelompok tanpa terapi supresi. Kesimpulan: Jumlah oosit matang dan jumlah dosis total gonadotropin lebih tinggi pada pasca terapi supresi dibandingkan tanpa terapi. Lama stimulasi ovarium lebih memanjang pada pasca terapi dibandingkan tanpa terapi.

Background: Administration of GnRH agonist on endometriosis can increased apoptosis and inhibit proliferation of endometrial cells eutopik. How the effectiveness of GnRH agonist for 3-6 months prior to FIV in endometriosis needs tobe studied further. Objective: To determine the effectiveness of GnRH agonists for 3-6 months before FIV output number of mature oocytes, total dose and duration of gonadotropin stimulation with a long protocol stimulation. Methods: This study uses a retrospective observational cohort design. Total population in this study were 60 patients from Klinik Permata Hati Dr RS Sardjito from 2003 to 2011 Results: Total of 60 subjecs of 60 couples undergoing in vitro fertilization were included in the study according to inclusion and exclusion criteria. Ovarian stimulation long after stimulation suppression therapy ≥ 10 days of 10 subjecs (33.3%), length of stimulation <10 days of 20 subjecs (66.7%), whereas those without suppression therapy, the stimulation of long ≥ 10 days and 7 subjecs (23, 3%) and longer stimulation of <10 days of 23 subjecs (76.7%). Number of total gonadotropin dose (≥ 40 pack) during stimulation without suppressive therapy in group 3 subjecs (10%) and after 5 subjecs of therapy (16.6% ). Fifty-six subjecs (93.3%) with a high number of oocytes (≥ 3 oocytes) and 4 subjecs (6.7%) by the number of oocytes is low (<3 oocytes). Minimal-mild endometriosis stage (I-II) 27 subjecs (45%), moderate-severe stage (III-IV) 33 subjecs (55%). Group after ovarian suppression therapy prior to clinical FIV give 1.07 times the chance of increasing the number of oocytes than in those without suppression therapy. Conclusion: The number of mature oocytes and the number of total gonadotropin dose was higher in the post-suppression therapy compared with no therapy. Long ovarian stimulation is more elongated in the post-treatment group compared with no therapy.

Kata Kunci : Respon stimulasi ovarium terkendali, jumlah oosit, stimulasi ovarium protokol panjang, fertilisasi in vitro, endometriosis, GnRH agonis.