proceeding book
TRANSCRIPT
PROCEEDING BOOK
The 3rd Congress of Asian Society for Fertility Preservation
in conjunction with
The 4th Beinnieal Meeting of Indonesian Association for In Vitro Fertilization 2021
Theme:
“Advancement in Assisted Reproductive Technology and Fertility Preservation
; Ethics, Patient Expectations and Beyond.”
Published by:
Obstetrics and Gynecology Department, Faculty of Medicine
Udayana University, Bali
All Right Reserved
No Part of This Publication May Be Reproduce Without Written Permission of The Publisher
iii
INTRODUCTION
The scientific theme of 3rd Congress of Asian Society for Fertility Preservation in
Conjunction with 4th Biennial Meeting of Indonesian Association for In Vitro Fertilization 2021
is Advancement of Assisted Reproductive Technology and Fertility Preservation; Ethics, Patient
Expectations and Beyond.”
This conference will deliver all advancements in assisted reproductive technology as well
as fertility preservation to improve the quality of health services in daily practices. We also expect
to trigger and stimulate the readiness in facing the infertility problem in Indonesia and all around
the world. Many outstanding speakers will contribute in this conference to enhance our
knowledge and new insight about assisted reproductive technology including fertility
preservation.
The publication of papers in the form of proceedings will also be carried out. For that we
express our gratitude and high appreciation to all parties who have contributed in taking their
time and thoughts for the publication of this proceeding, we always hope for suggestions and
criticism for the publication of this proceeding.
Denpasar, September 2021
Editor Team
iv
Content
Introduction ............................................................................................................................................................. iii
Content ..................................................................................................................................................................... iv
Oral Persentatio
MORPHOKINETIC ANALYSIS AS A PREDICTOR OF BLASTOCYST SCORE ON DAYS 5 OR DAY 6
USING A TIME-LAPSE MONITORING SYSTEM
Budi Wiweko, Rini Widyastuti, Risa Djuniarti, Diar Trie Dinanty, Deka Putri Gunarwati, Syifa Ghifrani, Muharam Natadisastra, Gita Pratama, Yassin Yanuar, Aida Riyanti, Shanty Olivia Jasirwan, Kanadi Sumapraja, Upik Anggraheni, and Moh. Luky Satria ................................................................................................................ 1
THE IMPACT OF OOCYTE MORPHOLOGY ON ICSI OUTCOME: FERTILIZATION, CLEAVAGE,
AND EMBRYO COMPETENCE RATE
Deka Putri Gunarwati, Rini Widyastuti, Risa Djuniarti, Diar Trie Dinanty, Syifa Ghifrani, Budi Wiweko,
Muharam Natadisastra, Gita Pratama, Yassin Yanuar, Aida Riyanti, Shanty Olivia Jasirwan, Kanadi Sumapraja,
Upik Anggraheni, and Moh. Luky Satria ................................................................................................................. 4
THE EFFECT OF AUTOLOGOUS PLATELET RICH PLASMA (PRP) ADMINISTRATION ON
INTEGRIN β3 EXPRESSION AND LEUKEMIA INHIBITORY FACTOR (LIF) LEVELS ON
ENDOMETRIAL DAMAGE IN WISTAR RATS
Made Angga Diningrat, Ida Bagus Putra Adnyana, and Anak Agung Ngurah Anantasika ..................................... 6
OOCYTE MORPHOLOGY DERIVED OF IVF PATIENTS DIAGNOSED WITH ENDOMETRIOSIS
COMPARE TO TUBAL FACTOR AT RSUP DR SARDJITO INFERTILITY CLINIC
Meydita Fauzia PI, Diany Suyaningtyas, and Vicky Nuri7
RELATIONSHIP BETWEEN ANXIETY (DASS21) AND THE QUALITY OF LIFE (FERTIQOL) IN
INFERTILE WOMEN WHO UNDERGO IN VITRO FERTILIZATION
Dian Tjahyadi, Bayu Irsyad, and Santi Andayani .................................................................................................... 8
MOLECULAR PROFILE OF SPERMATOZOA AND PREGNANCY RATE AFTER IUI WITH
DIFFERENCES SPERM UP TEMPERATURE
Uki Retno Budihastuti, Eriana Melinawati, Mulyoto Pangestu, Teguh Prakosa, Affi Angelia Ratnasari, and
Abida Zuhra Jatiningtyas .......................................................................................................................................... 9
FERTILITY RESULTS AND PREGNANCY OUTCOMES AFTER IN VITRO FERTILIZATION (IVF)
IN PATIENTS WITH GYNECOLOGICAL MALIGNANCY : A SYSTEMATIC REVIEW
Supak Silawani, Muhammad Ary Zucha, and Addin Trirahmanto .......................................................................... 10 SMALLER OVARIAN TISSUE SIZE CONTRIBUTES TO LESS FOLLICULAR BURN-OUT AFTER
TRANSPLANTATION: A STUDY ON CHORIONIC ALLANTOIC MEMBRANE (CAM)
Sarrah Ayuandari, Kuky Cahya Hamurajib, Diah Kartina, Shofwal Widad, and Agung Dewanto .......................... 11
EXPRESSION OF KISSPEPTIN AND LEUKEMIA INHIBITORY FACTOR mRNA GENES IN
ENDOMETRIUM INVITRO FERTILIZATION PATIENTS
Arie A Polim, Nining Handayani, Nusratuddin Abdullah, Mohammad Hatta, Rosdiana Natzir, Soegiharto
Soebianto, Nuraeni Jusuf, Caroline Hutomo, Aryando Pradana, and Reini Rambey ............................................... 13
v
POSTER
SEX SELECTION
Putra Adnyana IB ..................................................................................................................................................... 15
OVARIAN STIMULATION IN INTRAUTERINE INSEMINATION
Anom Suardika ........................................................................................................................................................ 16
GENITAL TUBERCULOSIS, INFERTILITY, AND SUCCESSFUL CONCEPTION AFTER
ASSISTED REPRODUCTIVE TECHNOLOGY TREATMENT-A CASE REPORT
Dian Tjahyadi, Kevin Dominique Tjandraprawira, and Tono Djuwantono ............................................................. 17
ATTITUDES OF INFERTILE PATIENTS/COUPLES WHO UNDERWENT IVF PROGRAM
TOWARDS SURPLUS EMBRYOS: A SCOPING REVIEW
I Gusti Agung Ngurah Agung Sentosa, Sarrah Ayuandari, and Agung Dewanto .................................................. 18 PRIMARY AMENORRHEA RELATED TO MOSAIC TURNER SYNDROME
WITH 45 X/ 46, XY MOSAICISM
Ni Luh Wita Astari W and Ida Bagus Putra Adnyana ............................................................................................. 20
LABIAL SYNECHIAE IN PATIENTS WITH TURNER SYNDROME, A CASE REPORT Arif Tantri Hartoyo, Nuring Pangastuti, and Shofal Widad .................................................................................... 22 FACTORS THAT INFLUENCE THE SUCCESS RATE OF INTRAUTERINE INSEMINATION (IUI) CLOMIPHENE CITRATE AND GONADOTROPHINE PROTOCOL IN BALI ROYAL GENERAL HOSPITAL, DENPASAR, BALI Made Angga Diningrat, Anom Suardika, and IB Putra Adnyana ........................................................................... 23 The Effect of Phyllantus Niruri Extract on Sperm Quality Experimental Study on Male Wistar Rats Given Formalin Exposure
Meidona Nurul Milla and Dian Novitasari.............................................................................................................. 24 PUBERTY DELAY IN CHILDREN AS A SCREENING FOR TURNER SYNDROME: A RARE CASE REPORT Anggia Mayangsari W, Darma Syanty, and Trika Irianta ....................................................................................... 25 COMPARISON OF PERI-MENOPAUSAL AND POST-MENOPAUSAL LIPID PROFILE BASED ON BODY MASS INDEX Yuliati, A. Mardiah Tahir, Nasrudin A.M, Isharyah Sunarno, Eddy Hartono, and Umar Malinta ......................... 26 SUCCESSFUL MANAGEMENT OF ABDOMINAL PREGNANCY
Maike Irwan, Made Suyasa Jaya, and Ida Bagus Putra Adnyana ........................................................................... 27
MC CUNE-ALBRIGHT SYNDROME: A CASE REPORT Astra Budiati Nusrat, Sriwijaya, Masita Fujiko, and Ratna Dewi Artati ................................................................ 28 DAY THREE VS DAY FIVE EMBRYO TRANSFER
Jaqueline Sudiman, Putu Gita Garbhini, Anom Suardika, AAN Anantasika, I Made Darmayasa, Nono Tondohusodo and IB Putra Adnyana ...................................................................................................................... 29
DIFFERENCES IN SPERM DAMAGE TO TEMPERATURE CHANGES IN PREPARATION Uki Retno Budihastuti, Eriana Melinawati, Mulyoto Pangestu, and Alfi Marita Tristiarti. .................................... 30 ENDOMETRIOSIS OF THE RECTUS ABDOMINIS MUSCLES AFTER CESAREAN SECTION: A CASE REPORT
Sebastianus Tannur, Eddy Hartono and Fatmawaty Madya ............................................................................................ 31 PRECOCIOUS PUBERTY Anom Suardika and Made Angga Diningrat. .......................................................................................................... 32
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MAYER-ROKITANSKY-KÜSTER-HAUSER SYNDROME: A CASE REPORT Ines Kurniaty Hartono, Anom Suardika, I Gusti Putu Mayun Mayura, and Endang Sri Widiyanti ................................. 33 FERTILIZATION RATES AND QUALITY OF EMBRYOS ARE NOT INFLUENCED BY PRE-WASH TOTAL MOTILE SPERM COUNT IN MODIFIED CONVENTIONAL IVF WITH HYPERCONCENTRATED SPERM Seso S Suyono, Dicky M Rizal, and Nandia Septiyorini. ....................................................................................... 34
ORAL PRESENTATION
1
MORPHOKINETIC ANALYSIS AS A PREDICTOR OF BLASTOCYST SCORE ON DAYS
5 OR DAY 6 USING A TIME-LAPSE MONITORING SYSTEM
Budi Wiweko, Rini Widyastuti, Risa Djuniarti, Diar Trie Dinanty, Deka Putri
Gunarwati, Syifa Ghifrani, Muharam Natadisastra, Gita Pratama, Yassin Yanuar, Aida
Riyanti, Shanty Olivia Jasirwan, Kanadi Sumapraja, Upik Anggraheni, Moh. Luky
Satria
Rumah Sakit Pondok Indah
IVF Centre
Abstract
The advanced, comprehensive, and non-invasive assessment of blastocysts for embryos
transfer and freezing are critical to improving the pregnancy rate during ART procedure. Time- lapse
morphokinetics is an alternative tool for embryo evaluation that can be used in conjunction with
morphology parameters. The goal of this study is to observe how morphokinetic analysis can be used
to predict blastocyst quality on D5 and D6. The data was collected from 92 blastocysts of couples
undergoing ICSI treatment at the RSPI IVF Centre between February-Juni 2021. The morphokinetics
were recorded in Esco MIRI® TL using the annotation procedure for 6-7 days after ICSI. The
blastocyst classified into three categories: excellent, good and moderate according to Gardner criteria.
The results indicated a significant difference in the tEB (blastocyst expanded) time obtained from
excellent and good blastocyst compared to moderate blastocyst at D5 (113.09 h vs 116.14 hours,
p0<.05). On the other hand, no parameter differs significantly in D6. Furthermore, there was a
significant difference in tB and teB between excellent and good blastocyst in D5 compared to D6
(106.68 h vs 120.47 h; 113.09 h vs 136.99 h, p0<05, respectively). Interestingly, for the moderate
blastocyst obtained from D5 and D6 showed a significantly diffeterent in t3 (28.82 h vs 36.21 h), t6
(44.33 h vs 52.90 h), t7 (48.90 h vs 58.74 h), tCom (70.06
h vs 84.26 h), tM (84.06 h vs 97.76 h), tSB (97.69 h vs 111. 62), tB 107.27 h vs 123.84 h) and tEB
(116.13 h vs 139.81 h) (P< 0.05). It can be concluded that tB and tEB are the most crucial parameters
in determining blastocyst score. Moderate blastocysts can be detected at early cleavage duration during
all development stages.
Keyword: blastocyst, annotation, scoring
2
Table 1. The duration required to completed each cleavage stage of D5 excellent and good
blastocysts compared to moderate.
Esco MIRI® TL annotation Blastocyst score
Excelent and good (h) Moderate (h)
tPNf 22.18±4.99 22.70±3.11
t2 25.08±5.09 25.30±2.80
t3 33.20±6.71 28.82±5.99
t4 36.91±5.94 33.06±5.34
t5 46.41±9.33 37.51±8.27
t6 50.51±9.18 44.33±8.81
t7 53.86±8.56 48.90±5.01
t8 57.53±11.66 55.75±9.63
tCom (2 cell fussion) 75.59±70.06 70.06±10.27
tM (morula) 86.15±11.57 84.06±9.36
tSB (early blastocyst) 98.01± 8.74 97.69±5.45
tB (blastocyst) 106.68±9.39 107.27±5.60
tEB (expand blasocyst) 113.09±2.43a 116.14±2.61b
Data presented in average ± SD. a,b values followed by different superscript in the same raw
showed a significant difference (p<0.05)
Table 2. The duration required to complete each cleavage stage from D6 excellent and
good blastocysts compared to moderate.
Esco MIRI® TL annotation
Blastocyst score
Excelent and good (h) Moderate (h)
tPNf 22.27±4.42 23.80±3.45
t2 25.28±5.03 27.67±3.70
t3 31.64±5.95 36.21±4.52
t4 36.56±5.54 39.54±7.77
t5 48.29±10.88 44.33±8.81
t6 50.80±11.71 52.90±8.37
t7 54.86±11.52 58.74±8.85
t8 58.67±10.39 64.59±11.43
tCom (2 cell fussion) 79.43±15.25 84.26±6.25
tM (morula) 94.43±12.13 97.76±9.78
tSB (early blastocyst) 107.29±12.26 111.62±9.55
tB (blastocyst) 120.47±12.18 123.84±9.31 tEB (expand blasocyst) 136.99±5.43 139.81±4.50
Data presented in average ±SD. a,b values followed by different superscrip in the same raw showed a significant difference (p<0.05)
3
Table 3. The duration required to complete each cleavage stage from excellent and
good blastocysts obtained from D5 and D6
Esco MIRI® TL annotation Blastocyst
D5 (h) D6 (h)
tPNf 22.18±4.99 22.27±4.42
t2 25.08±5.09 25.28±5.03
t3 33.20±6.71 31.64±5.95
t4 36.91±5.94 36.56±5.54
t5 46.41±9.33 48.29±10.88
t6 50.51±9.18 50.80±11.71
t7 53.86±8.56 54.86±11.52
t8 57.53±11.66 58.67±10.39
tCom (2 cell fussion) 75.59±70.06 79.43±15.25
tM (morula) 86.15±11.57 94.43±12.13
tSB (early blastocyst) 98.01± 8.74 107.29±12.26
tB (blastocyst) 106.68±9.39a 120.47±12.18b
tEB (expand blasocyst) 113.09±8.43a 136.99±5.43b
Data presented in average ±SD. a,b values followed by different superscrip in the same
raw showed a significant difference (p<0.05)
Table 4. The duration required to complete each cleavage stage from moderate blastocysts
obtained from D5 and D6
Esco MIRI® TL annotation Blastocyst
D5 (h) D6 (h)
tPNf 22.70±3.11 23.80±3.45
t2 25.29±2.80 27.67±3.70
t3 28.82±5.99a 36.21±4.52b
t4 33.06±5.34 39.54±7.77
t5 37.53±8.39 44.33±8.81
t6 44.33±8.80a 52.90±8.37b
t7 48.90±5.01a 58.74±8.85b
t8 55.75±9.63 64.59±11.43
tCom (2 cell fussion) 70.06±10.28a 84.26±6.25b
tM (morula) 84.06±9.36a 97.76±9.78b
tSB (early blastocyst) 97.69±5.45a 111.62±9.55b
tB (blastocyst) 107.27±5.60a 123.84±9.31b
tEB (expand blasocyst) 116.13±2.61a 139.81±4.50b
4
THE IMPACT OF OOCYTE MORPHOLOGY ON ICSI OUTCOME:
FERTILIZATION, CLEAVAGE, AND EMBRYO COMPETENCE RATE
Deka Putri Gunarwati, Rini Widyastuti, Risa Djuniarti, Diar Trie Dinanty, Syifa Ghifrani, Budi
Wiweko, Muharam Natadisastra, Gita Pratama, Yassin Yanuar, Aida Riyanti, Shanty Olivia
Jasirwan, Kanadi Sumapraja, Upik Anggraheni, Moh. Luky Satria
Rumah Sakit Pondok Indah IVF Centre
ABSTRACT
The morphology of the oocyte is known to be related to the success rate of ICSI (Intracytoplasmic
Sperm Injection). Oocyte morphological abnormalities are frequently observed in human oocytes
and may be useful as predictors of ICSI outcome. However, it is unclear which of these
characteristics has the greatest influence on fertilization, cleavage, and embryo competence rate. The
study's goal is to identify the morphology of the oocytes to the ICSI outcome. Twenty cases collected
from 241 oocytes obtained from 23-39 years old patient underwent ICSI using normozoospermia at
RS Pondok Indah IVF Centre were observed. For ovarian stimulation using antagonist protocol with
rFSH for 10-11 stimulation days an triggering with rHcG 36 hour before oocyte pick up. ICSI was
performed 2-4 hours after oocytes retrieval. Oocytes were classified into five groups based on their
morphological appearances: normal (A), cytoplasm abnormality including SER; Bull's eye;
granulation (B), polar body fragmentation (C), wide PVS (perivitelline space) (D), and combination
of abnormal morphology (E). The fertilization rate, cleavage rate, and presence of a good or excellent
embryo competence rate on day 3 or day 5/6 were statistically analyzed. The results showed that the
fertilization rate obtained from oocytes with abnormal polar bodies was significantly lower compared
to controls, oocytes with abnormal cytoplasm, wide perivitelline space, and combine abnormality (45
% vs more than 70%, p<0.05). Interestingly, none of the oocytes with wide PVS resulted a good or an
excellent embryos in D3 or D5/D6, whereas the other abnormality still obtained more than 40%. It
can be concluded that the morphology of the oocytes had a significant impact on the ICSI outcome,
particularly the fertilization rate and the number of good or excellent embryos on D3 or D5/D6.
Key word: oocytes, morphology, abnormalities, ICSI, embryos
5
Table 1. The comparison of ICSI outcome between normal and abnormal oocyte morphology
Stage Normal
Oocytes
(%)
Type abnormal morphology (%)
Cytoplasm
Polar
Body
Perivitelline
Space
Com
bine
Retrieved MII Oocyte for ICSI
63a 14b 5b 2c 10b
Fertilized oocytes 75a 79a 45b 100a 72a
Cleavaged embryos 89a 92a 100a 75a 83a
Good or excellent
embryos on D3/D5 46a 44a 40a 0b 59a
Data presented as percentage observed from 241 oocytes. Value in the same raw with different
superscripts (a,b) differ significantly at p < 0.05
6
THE EFFECT OF AUTOLOGOUS PLATELET RICH PLASMA (PRP) ADMINISTRATION
ON INTEGRIN β3 EXPRESSION AND LEUKEMIA INHIBITORY FACTOR (LIF) LEVELS
ON ENDOMETRIAL DAMAGE IN WISTAR RATS
Made Angga Diningrat1, Ida Bagus Putra Adnyana 2, Anak Agung Ngurah Anantasika 2 1Obstetrics and Gynecology Departement, Sanglah General Hospital/Udayana University, Denpasar,
Indonesia 2Division of Reproductive Endocrinology and Infertility, Obstetrics and Gynecology
Departement, Sanglah General Hospital/ Udayanan University, Denpasar, Indonesia
ABSTRACT
Background: Endometrial receptivity is strongly correlated with endometrial damage which is thought
to be related to the role of adhesion and inflammatory molecules, especially integrin 3 and leukemia
inhibitory factor (LIF). These two molecules are expected to work optimally in the administration of
autologous platelet-rich plasma (APRP) to the damaged endometrium. APRP administration in
damaged endometrium will be able to repair and increase endometrial receptivity. The purpose of this
study was to determine the effect of APRP administration on rat endometrial damage on endometrial
receptivity through the expression of 3 integrins and LIF levels in the Animal unit in Biomedical
Laboratory, Udayana University, Denpasar period December 2019 – February 2020.
Methods: The randomized posttest only controlled group design experimental study used female rats
of the Wistar/C strain as experimental animals.
Results: In the period December 2019 – February 2020, 40 rats were divided into 2 groups, namely 20
as the treatment group with PRP administration and 20 as control after previously receiving Intra
Uterine ethanol. There was no significant difference between the bodyweight of rats from the treatment
group and the control group at the start of the study (p = 0.519) and at the end of the study (p = 0.704).
The mean expression (H-score) of Integrin 3 in the endometrial epithelium in the treatment group (3.68
± 0.49) was higher than in the control group (1.54 ± 0.52). There was a significant difference in the
expression of 3 integrins between the treatment and control groups (p<0.05) wherein in the treatment
group, all 20 mice (100%) had strong-very strong 3 integrin expression and no rats had weak and very
strong 3 integrin expression. medium. In contrast, in the control group, 18 mice (90%) had weak and
moderate 3 integrin expression and only 2 mice (10%) had strong-very strong expression. The mean
LIF levels in the treatment group (356.79±25.43 ng/ml) were higher than the control group (151.12
±11.59 ng/ml). This shows that the addition of APRP to endometrial damage by ethanol significantly
caused higher endometrial LIF levels in rats than without APRP administration (p<0.05).
Conclusion: The administration of APRP to damaged endometrial will cause a significant increase of
integrin 3 expression and LIF levels compared to the control group.
Keywords: integrin 3, LIF, autologous PRP
7
OOCYTE MORPHOLOGY DERIVED OF IVF PATIENTS DIAGNOSED WITH
ENDOMETRIOSIS COMPARE TO TUBAL FACTOR AT RSUP DR SARDJITO
INFERTILITY CLINIC
Meydita Fauzia PI (1), Diany Suyaningtyas (2), Vicky Nuri (2)
1. PPDS1 Obstetri Ginekologi FKKMK UGM
2. IKR RSUP Dr Sardjito
ABSTRACT
Background: Endometriosis is an estrogen-dependent chronic inflammatory condition, affects
women in reproductive period causing infertility. The mechanism of endometriosis related
infertility is still largely unknown. Endometriosis affect ovarian site thus folliculogenesis altered.
Sonographic and histologic data has been shown to decrease number of follicles and produce
more atretic follicles. Oocyte retrieved from endometriosis women are more likely show
morphology alteration.
Aim: This study is presenting an update on current morphological data that directly relate to the
effect of endometriosis on oocyte quality.
Method: A retrospective analytic study of patients administered for IVF program in 2018 to 2021
at RSUP Dr Sardjito.
Results: a total of 183 patients (76 diagnosed with endometriosis, 107 with tubal factor)
administered IVF program during 2018 until 2021. There were no significant different between
group endometriosis vs tubal factor in term of age (p=0.702), AMH (p=0.841), and dose of FSH
in IU (p=0.128). Further data of number follicles punctured (p=0.075), Oocyte Cumulus
Complex/OCC retrieved (p=0.291), Metaphase II oocyte (p=0.347), Metaphase I oocyte
(p=0.801), Germinal Vesicle oocyte (p=0.765), fertilization observed by 2 pronucleus appearance
(p=0.432), no significant differences are found. However, oocyte morphology were differ
between two group: dark cytoplasm (p=0.014), dark thick zona pellucida (p=0.09), fragmented
Polar Body (p=0.026), while oocyte lysis after ICSI procedure were no differ for both group
(p=0.310).
Conclusion: From this study we concluded that oocyte morphology derived of endometriosis
patients shown inferior quality compare to those patients with tubal factor.
Keywords: Endometriosis, Oocyte Morphology, IVF (In Vitro Fertilization)
8
RELATIONSHIP BETWEEN ANXIETY (DASS21) AND THE QUALITY OF LIFE
(FERTIQOL) IN INFERTILE WOMEN WHO UNDERGO IN VITRO
FERTILIZATION
Dian Tjahyadi1, Bayu Irsyad1, Santi Andayani2
1Department of Obstetrics and Gynecology Faculty of Medicine Padjadjaran University 2Department of Psychiatry Faculty of Medicine Padjadjaran University
Hasan Sadikin Hospital Bandung
ABSTRACT
Infertility can be a serious physical and mental health problem and has consequences for
various aspects that affect social, cultural, emotional, physical and financial problems. In vitro
fertilization (IVF) is one of the assisted reproductive technology (ART) programs which have
several phase, a long-time treatment and need more patience. These infertility-related factors can
be a stressor for the patient herself. Anxiety is a normal and adaptive response to conditions of
helplessness or frustration due to physical needs such as infertility. The greater the level of
anxiety the patient is thought to have a lower level of quality of life.
This is an observational analytic research with cross-sectional design. This research was
perform in Aster Clinic Hasan Sadikin Hospital and Bandung Fertility Center Limijati Hospital
during February until April 2020. The analysis was carried out based on the measurement results
of the variables studied, i.e anxiety using DASS21 scale and quality of life using FertiQol with
27 subjects and 30 controls. Statistical analysis used to determine the condition of anxiety and
the condition of quality of life is the Chi square test and the Mann-Whitney test, while the
relationship between anxiety and quality of life in the main subject using the Spearman
correlation test
The results of the analysis on the subject and control groups are as follows with each average
scores: anxiety (6.2 vs 0.7; p<0.001), mind-body (79.6 vs 98.9; p<0.001), emotional (68.6 vs
98.5, p <0.001), relational (83.2 vs 95.7; p<0.001), social (77.6 vs 97.6; p<0.001), and core
quality of life levels (core FertiQol) (77.3 vs 97.7; p<0.001). Through the Spearman correlation
test the results obtained between anxiety and total core FertiQol (r -0.479; p <0.05)
The results showed significant differences in anxiety conditions and quality of life conditions
(p <0.05) between groups of patients undergoing IVF and control programs. From these two
conditions, we also found a significant relationship between anxiety conditions and quality of life
in the group of patients undergoing IVF, that the higher the anxiety level, the lower the quality
of life.
Key words: anxiety, quality of life, infertility
9
MOLECULAR PROFILE OF SPERMATOZOA AND PREGNANCY RATE
AFTER IUI WITH DIFFERENCES SPERM UP TEMPERATURE
Uki Retno Budihastuti 1),3), Eriana Melinawati 1),3), Mulyoto Pangestu 2), Teguh
Prakosa 1),3), Affi
Angelia Ratnasari 1),3), Abida Zuhra Jatiningtyas 3)
1) Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sebelas Maret,
Surakarta, Jawa Tengah, Indonesia 2) Department of Obstetrics and Gynecology, School of Clinical Sciences at Monash Health,
Monash University, Clayton, Australia 3) Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
ABSTRACT
Background and Aims: Sperm preparation is an important steps in supporting the successful
intrauterine insemination (IUI). This study investigates the effects of different temperature in
sperm preparation during swim-up on total motile sperm count (TMSC), sperm DNA
fragmentation index (DFI), and pregnancy rate.
Methods: This study recruited 15 male patients who visited the Sekar Fertility Clinic, Dr.
Moewardi General Hospital from April to Juni 2021. All patients signed their informed
consent. All collected samples were divided into 1 ml for sperm preparation at 27°C (Group
A) and 37°C (Group B). Differences in the average of DFI and TMSC in both groups were
analyzed with the Wilcoxon test and p<0.05. Observation were made on sperm quality and DFI
after swim-up and pregnancy rate after IUI. Pregnancy was indicated by hCG serum
confirmed with ultrasound.
Results: The mean TMSC in group A was 12.28±8.84x106 lower than the group B TMSC
mean (14.52±11.31x106; p=0.140). Group A had a DFI TMSC mean of 16.94±9.36%, also
lower than group B 17.34±12.36%, with a significance of 0.820. Both temperatures 27°C and
temperature 37°C have similiar pregnancy rate 13% after IUI.
Conclusions: Sperm using swim-up at 27°C lowers DFI and TMSC in infertile males, but not
significant (p<0.01) compared to 37°C. Preparation at 27°C and 37°C provide similiar
pregnancy rate after IUI.
Keywords: molecular profile; temperature; spermatozoa; intrauterine insemination.
10
FERTILITY RESULTS AND PREGNANCY OUTCOMES AFTER IN VITRO
FERTILIZATION (IVF) IN PATIENTS WITH GYNECOLOGICAL MALIGNANCY :
A SYSTEMATIC REVIEW
Supak Silawani, Muhammad Ary Zucha, Addin Trirahmanto
Department of Obstetrics and Gynecology, Universitas Gadjah Mada
Background and Aims
More than fifty percent patients with gynecological malignancy are diagnosed during
reproductive years. Standard treatment for these cancers may effect on female reproductive. The
in vitro fertilization (IVF) as the therapy of choice in infertility requires strong evidence of
efficacy (pregnancy rate and live birth rate) in patients with ginecologycal malignancy.
This study aims to review pregnancy rate and live birth rate in patient with gynecological
malignancy and IVF as infertility treatment.
Methods
We searched Pubmed database from 2011-2021 to acquired qualified studies, then identified and
extracted data from these studies to review the fertility rate and live birth rate.
Results
A total 194 gynecological malignancy patients (ovarian carcinoma, endometrial carcinoma, and
cervical carcinoma) were included in this review. The pregnancy rate of patients attempting
pregnancy with IVF and live birth rate were 46.6% (55/118) and 35.6% (42/118). The pregnancy
rate of patient without IVF (natural pregnancy or others infertility treatment) and live birth rate
were 28.5 % (22/76) and 26.3 % (20/76).
Conclusions
This study showed an acceptable cumulative pregnancy rate and live birth rate after the IVF in
patients with gynecological malignancy.
11
SMALLER OVARIAN TISSUE SIZE CONTRIBUTES TO LESS FOLLICULAR
BURN-OUT AFTER TRANSPLANTATION: A STUDY ON CHORIONIC ALLANTOIC
MEMBRANE (CAM)
Sarrah Ayuandari1, Kuky Cahya Hamurajib1, Diah Kartina1, Shofwal Widad1,
Agung Dewanto1 1Division of fertility and reproductive endocrinology, Department of Obstetrics and
Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah
Mada, Yogyakarta
Background: Ovarian tissue cryopreservation and transplantation method should be optimized
before being applied in human samples and clinical settings. The size of transplanted tissue plays
a major role on follicular burn-out which then affects post-transplantation survival.
Methods: Ovarian tissue samples from goat (Capra hircus) were divided into pre transplantation
group and post-transplantation group on CAM of 8-day-old fertilized eggs. Each group then were
cut into 2.5x2.5x1 mm; 5x5x1 mm and 10x10x1 mm and analysed for number of follicles,
vascularization and PTEN protein expressions.
Results: Thirty-six total ovarian tissue strips were divided into pre-transplantation and post-
transplantation samples. In 10x10x1 mm samples, the total number of primordial follicles in the
post- transplantation samples (9.71 ± 2.56) was significantly lower compared to the pre-
transplantation samples (15.27± 5.52, P <0,05). As for vascularization, the total number of
vessels in 2.5x2.5x1 mm transplantation samples was significantly higher compared to the pre-
transplantation samples (9.54 ± 3.2; 15.46 ± 1.85; P <0,05). Meanwhile, PTEN protein
expressions in the 10x10x1 mm transplantation samples (6.63 ± 3.36) were significantly lower
than the pre-transplantation samples (11.80 ± 0.42; P
<0,05).
Conclusions: Ovarian tissue samples with the size 2.5x2.5x1 mm, has been shown to be the
most vascularized, with fewer expressions of PTEN. Therefore it also had the least decrease of
total follicle numbers post-transplantation on CAM media compared to the other sample sizes,
showing a less follicular burn-out compared to bigger tissue size group.
Keywords: fertility preservation, ovarian tissue transplantation, follicular burn-out, CAM,
vascularization, PTEN.
12
253
POSTER
15
SEX SELECTION
Putra Adnyana IB
Departmen Obstetrics & Gynecology, Fakultas Kedokteran Universitas Udayana/ RSUP
Sanglah Denpasar, Bali
ABSTRACT
Sex selection, the antenatal procedure of selecting the desired sex of the fetus, is one of the
most controversial topics in bioethics. Sex selection was categorized into medical and non-
medical. For medical purposes, sex selection is used to prevent sexually related diseases. While
the non-medical goal is to fulfill the wishes of parents in having a certain gender. Some
communities prefer the male sex because it is related to inheritance, therefore sex selection
may have advantages for women living in societies that do not prioritize gender. Indonesia
legalizes sex selection for second and subsequent children. Regulations regarding sex-assisted
reproduction in Indonesia have been regulated in Government Regulation Number 61 of 2014
concerning Reproductive Health. To address ethical issues regarding gender selection in non-
medical matters, a law may be enacted to completely prohibit the practice of non-medical sex
selection. In addition, guidelines from health authorities are needed so that clinics can practice
self-regulation.
Keywords: Sex selection, Gender
16
OVARIAN STIMULATION IN INTRAUTERINE INSEMINATION
Anom Suardika
Abstract
Intrauterine Insemination (IUI) is a widely used treatment option for infertility. IUI is a process
of placing washed spermatozoa into the uterine cavity. IUI may be done with or without ovarian
stimulation. Study shows that IUI with ovarian stimulation was superior to IUI without
stimulation. Only when ovarian stimulation is ineffective and not possible or not available, IUI
in the natural cycle is recommended. Ovarian stimulation may be done using clomiphene
citrate, aromatase inhibitor, and gonadotropins. Clomiphene citrate (CC) is an inexpensive and
widely available drug, which is effective in inducing one to three mature eggs for fertilization.
When CC does not produce a satisfactory ovarian response, the option of using letrozole and
low-dose gonadotropins alone or in combination with CC. Letrozole, which is an aromatase
inhibitor (AI), is effective when CC has failed. Each ovarian stimulation methods had its
challenge and limitation. Therefor better understanding on each regiment will bring better
outcome in IUI procedure. This paper discuss the use IUI as a basic infertility treatment in
technology-limited settings. We focused on IUI with various ovarian stimulation,
requirements, timing and luteal support after the procedure.
Keywords: Clomiphene citrate, Infertility, IUI, Intrauterine insemination, Letrozole
17
GENITAL TUBERCULOSIS, INFERTILITY AND SUCCESSFUL CONCEPTION
AFTER ASSISTED REPRODUCTIVE TECHNOLOGY TREATMENT – A CASE
REPORT
Dian Tjahyadi1, Kevin Dominique Tjandraprawira1, Tono Djuwantono1 1Department of Obstetrics and Gynaecology, Universitas Padjadjaran, Indonesia
Background and Aims
Genital tuberculosis (TB) is an underdiagnosed complication of tuberculosis. It most often
manifests silently and only discovered during infertility workup. Due to the extensive damage
and adhesions, genital TB often requires artificial reproductive technology (ART) to provide
them a chance of conception. We present a report of 2 patients having undergone laparoscopy
during which genital TB was discovered and successfully conceiving after ART treatment.
Case Discussion
A 23-year old P0A0 presented to our clinic having complained of a right abdominal mass of 2
months. There had been vaginal discharge for the preceding 2 months. The other patient was a
31-year old P1A0 having complained of inability to conceive and dyspareunia (?). Both
patients then underwent operative laparoscopy. During laparoscopy, there were extensive
adhesions, areas of caseous necrosis and in the first patient, signs of endometriosis. They were
both diagnosed with tuberculous salpingitis. An infertility workup ensued and they were
advised to undergo in vitro fertilisation.
The first patient underwent successful ovum pick up (OPU) and she conceived after her first
embryo transfer during which 2 excellent-grade embryos were transferred. She gave birth at
term to a healthy male newborn.
The second patient underwent successful OPU but her embryo transfer failed. She then
underwent frozen embryo transfer after which she successfully conceived. She gave birth at
term to a healthy female newborn.
Conclusion
The above cases underline the wide-ranging yet silent manifestations of TB. Infertility remains
the most frequent manifestation of genital TB and many will require ART to successfully
conceive. Extra vigilance for one’s reproductive function is warranted for TB patients.
18
ATTITUDES OF INFERTILE PATIENTS/COUPLES WHO UNDERWENT IVF
PROGRAM TOWARDS SURPLUS EMBRYOS: A SCOPING REVIEW
I Gusti Agung Ngurah Agung Sentosa1, Sarrah Ayuandari2, Agung Dewanto3
1Department of Obstetrics and Gynaecology, Faculty of Medicine, Ganesha University of
Education, Bali, Indonesia* 2Department of Obstetrics and Gynaecology Division of Reproductive Endocrinology
Fertility, Faculty of Medicine, Public Health and Nursing, University of Gadjah Mada,
Yogyakarta, Indonesia 3Department of Obstetrics and Gynaecology Division of Reproductive Endocrinology
Fertility, Faculty of Medicine, Public Health and Nursing, University of Gadjah Mada,
Yogyakarta, Indonesia
*Corresponding Author E-mail:[email protected]
Abstract
Background: Currently, the IVF program has demonstrated its success in achieving
pregnancy. However, such success can lead to surplus embryos in one cycle of the IVF
program. In addition, parents who have undergone IVF programs and feel they have a sufficient
number of children but still have frozen embryos can also cause surplus embryos. Therefore,
surplus embryos can be a problem that has an impact on ethical dilemmas. On the other hand,
the attitude of couples towards surplus embryos has been varied. This studies will extract data
and analize their attitude.
Objective: This study aimed to determine the attitudes of patients or infertile couples towards
surplus embryos.
Method: This scoping review was performed using PRISMA extension for Scoping Reviews
(PRISMA-ScR). Studies which reported qualitative and/or quantitative data from any country
was considered into the review. Inclusion criteria was the studies that assess the attitude of
patients or infertile couples who have surplus embryos. We conducted the study selection and
application of inclusion/exclusion criteria in accordance with PRISMA-ScR
approach. Systematic searches were conducted on 7 databases: PubMed, ScienceDirect,
EBSCO, Scopus, the Cochrane Library, Sage Journals and Google Scholar from April 2011 to
April 2021 using keywords: attitude, infertile patients/couples and surplus embryo/embryo
disposition/ embryo left over.
Result: This scoping review yielded 4196 research journals, and after the elimination of
duplication, we obtained 2729 research journals. Afterwards, the selection process continued
to decide on 246 research journals which met eligibility criteria. A total of 37 research articles
were selected for analysis. Most of these articles used analytical and qualitative descriptive
studies of the attitudes of infertile patients/couples toward surplus frozen embryos. The
research article came from 14 countries, mostly from the United States (n=8), then Belgium
(n=5) and the other studies were from Portugal (n=3), Canada (n=3), Japan (n=3), China (n=3),
Sweden (n=2), India (n=2), Australia (n=2), Israel (n=2), Mexico (n=1), France (n=1), Italy
(n=1), and Iran (n=1). This review was focused on the attitudes of the patients or infertile
couples towards surplus embryos. Their attitudes included the donation the surplus embryo for
19
both research and reproductive purposes, the continuation on keeping the frozen embryos and
the disposal of surplus embryos.
Conclusion: Most of the infertile patients would donate their surplus embryos for research and
reproductive purposes. The arguments behind this decision were their will to take part on the
scientific development, the positive point of view toward research, the trust on health system
and the desire to help other infertile couples. Meanwhile, the couples who wanted to keep the
frozen embryos thought the sense of parenthood towards the embryos and the desire to save
embryos for subsequent reproductive efforts. While the reasons for couples who wanted to
dispose the embryos were: lack of information/explanation received, negative perception of
research, storage cost and a sufficient number of children.
Keywords: Attitude; Infertile Patients/Couples; Surplus Embryo
20
PRIMARY AMENORRHEA RELATED TO MOSAIC TURNER SYNDROME
WITH 45 X/ 46, XY MOSAICISM
Ni Luh Wita Astari W1, Ida Bagus Putra Adnyana2
1 Resident of Department of Obstetrics and Gynecology, Faculty of Medicine, Udayana
University Sanglah General Hospital, Denpasar, Bali 2Obstetrician and Gynecologist, Fertility, Endocrinology and Reproduction
Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Udayana
University Sanglah General Hospital, Denpasar, Bali
ABSTRACT
Background
Primary amenorrhea is defined as the absence of menstruation at 15 years of age in the presence
of normal growth and secondary sexual characteristics.1 Epidemiologically, this disorder may
rarely occurs in <1% of women which could be caused by chromosome abnormalities such as
Turner Syndrome.2 Mosaic Turner syndrome is one of challenging types of Turner Syndrome.
Consequently, the earlier detection and management could give a better outcome. This case
report will present a 15-year-old young woman presenting with primary amenorrhea with the
result of chromosome 45X/46, XY Mosaic Turner.
Case report
We presented a young female, aged 15 years with complaints of no menstruation, breast growth
and pubic hair is also absent. The patient's parents also complained that their child's height was
below the average for his age. The patient had no acne and a loud voice, but positive hirsutisms.
External genitalia looks like a girl. The patient's breast and pubic hair development was Tanner
2. On immunological examination revealed increasing levels of FSH 45.64 mIU/mL and LH
13.18 mIU/ml while testosterone was 2.83 ng/dl. Chromosomal analysis with G-Banding of 40
cells studied showed mos 45,X(23)/46,XY so that it could be diagnosed with primary
amenorrhea ec Turner syndrome with mosaic type 45,X/46,XY. Combined oral contraceptive
is an option for treat this patient whereas her height has increased to 145 cm and has been
having monthly menstrual period.
Discussion
Primary amenorrhea can be caused by genetic or anatomical abnormalities. Examination of the
type of primary amenorrhea and supporting examinations such as ultrasound, serum or urine
hCG, measurement of hyperandrogen conditions (FSH, TSH, and PRL) are the first step that
can be done. After that, when the FSH results increase, the next step is to check the karyotype.3
From the results of the standard karyotype (i.e., chromosome analysis of 30 peripheral
lymphocytes) an abnormality with Turner syndrome was found in which a combination of
monosomy X and normal cells was found (45, X / 46, XY) -Mosaic Turner syndrome. Patients
with a Y chromosome have a 12% risk of gonadoblastoma should be referred for further
hormonal testing, imaging studies to decide whether a laparoscopic removal of testicular tissue
21
(ie, gonadectomy) is necessary.4 Given the complexity and multisystem abnormalities of
Turner syndrome, coordinate multidisciplinary management and directly manage risk factors
and complications such as fertility for those who wish to conceive on their own very necessary
in handling this case.5
Keywords: Primary Amenorrhea, Turner Syndrome, Mosaic Turner Syndrome
22
LABIAL SYNECHIAE IN PATIENTS WITH TURNER SYNDROME, A CASE
REPORT
Arif Tantri Hartoyo1, Nuring Pangastuti2, Shofal Widad3
1Resident of Obstetrics and Gynaecology Department of Obstetric & Gynaecology, Faculty
of Medicine, Public Health and Nursing, Universitas Gadjah Mada/RSUP Dr. Sardjito,
Yogyakarta
2Staff of Urogynaecology Division and Reconstruction Surgery, Obstetric & Gynaecology,
Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/RSUP Dr.
Sardjito, Yogyakarta
3Staff of Reproductive Endocrinology and Fertility, Obstetric & Gynaecology, Faculty of
Medicine, Public Health and Nursing, Universitas Gadjah Mada/RSUP Dr. Sardjito,
Yogyakarta
Abstract
Introduction: Turner syndrome is a chromosomal condition that affecting women caused by
haplo-insufficiency of some or all of the genes on the X chromosome. Labial synechiae is a
disorder of the female genitalia characterized by thin, membranous attachments of the labia.
Primary amenorrhea is defined as the absence of menstruation at the age of 14 years without
the growth or development of secondary sexual characteristics or the absence at the age of 16
years regardless of the presence of normal growth and development including secondary sexual
characteristics.
Case Presentation: A woman, P0A0 aged 26 years, was referred from Cilacap Hospital with
the chief complaint of not menstruating. Transabdominal ultrasound examination showed that
the VU was filled with sufficient volume, there was a building in the anterior vesica urinaria
uk 5.82 x 2.18 x 2.33 cm. Right and left ovaries were not visualized, ren bilateral (+). Trans
perineal ultrasound examination showed that the VU was filled enough, there was a hypoechoic
space between the bladder and rectum, 1.02x3.65 cm in size, the impression of vaginal space.
Ultrasound examination of the upper lower abdomen showed no abnormalities in the liver,
vesica fellea, spleen, pancreas, both kidneys, bladder and uterus, no para-aortic
lymphadenopathy was seen. Chromosomal examination revealed a 45X karyotype, BMD
examination revealed osteopenia. Preoperative diagnosis P0A0 26 years, labium adhesions
major and minor, primary amenorrhea due to Turner syndrome. Then the labium major and
minor incisions are made. Postoperative diagnosis P0A0 26 years, post-incision due to major
labium adhesions, primary amenorrhea due to Turner syndrome. HRT therapy with conjugated
estrogens 0.625 mg once daily was continued.
Conclusion: In the case of this patient with labial synechiae with Turner syndrome, major and
minor labial incisions were made and given hormone replacement therapy with conjugated
estrogens as much as 0.625 once a day and BMD evaluation was performed every 6 months.
Keywords: Synechiae labial, Turner syndrome, Urinary disorders, Primary amenorrhea
23
FACTORS THAT INFLUENCE THE SUCCESS RATE OF INTRAUTERINE
INSEMINATION (IUI) CLOMIPHENE CITRATE AND GONADOTROPHINE
PROTOCOL IN BALI ROYAL GENERAL HOSPITAL, DENPASAR, BALI
Made Angga Diningrat1, Anom Suardika2, IB Putra Adnyana3 1Reproductive Endocrinology and Infertility Fellowship, Obstetric and Gynecology
Department, Medical Faculty, Udayana University/ Sanglah General Hospital, Denpasar, Bali 2.Staff of Reproductive Endocrinology and Infertility Divison, Obstetric and Gynecology
Department, Medical Faculty, Udayana University/ Sanglah General Hospital, Denpasar, Bali
ABSTRACT
Objective: To determine the factors that influence the success rate of intrauterine insemination
(IUI) clomiphene citrate and gonadotropin protocols at Bali Royal General Hospital, Denpasar,
Bali.
Methods: This study is an observational study with a cross-sectional method involving 70
married couples who underwent intrauterine insemination (IUI) program with the clomiphene
citrate and gonadotropin protocol at the Bali Royal General Hospital, Denpasar, Bali during
the period 1 January until 31 December 2018. The data obtained from the medical record. The
variables studied included wife factors (age, endometrial thickness, number of preovulatory
follicles, diameter of preovulatory follicles) and husband factors (sperm count, sperm
concentration, sperm motility). The outcome assessed was the occurrence of pregnancy.
Results: The success rate of the intrauterine insemination (IUI) protocol for clomiphene citrate
and gonadotropins at the Bali Royal General Hospital, Denpasar, Bali was 17.1% (12/70 cases).
The factors that had a significant effect were the diameter of the preovulatory follicle (p=0.000)
and the number of pre-ovulatory follicles (p=0.011) The factors of wife's age, husband's age,
sperm count, sperm concentration, endometrial thickness, and sperm motility had no significant
effect (p> 0.05).
Conclusion: Factors of preovulatory follicle diameter and sperm motility were associated with
the success of the intrauterine insemination (IUI) protocol of clomiphene citrate and
gonadotropins at Bali Royal General Hospital, Denpasar, Bali.
Keywords: IUI, success rate, Bali Royal Hospital
24
The Effect of Phyllantus Niruri Extract on Sperm Quality
Experimental Study on Male Wistar Rats Given Formalin Exposure
Meidona Nurul Milla1, Dian Novitasari1
1. Department of Anatomy, Faculty of Medicine, UNISSULA, Semarang, Indonesia
Formalin is a liquid form of formaldehyde, that is widely used as an industrial
disinfectant, a preservative in funeral homes and medical labs. However the use of this
chemical agent that is sometimes abused as food preservatives. Some studies has shown that it
carried many negative effects on various body system. One of the system that is assumed to be
affected is the reproductive system. Metabolism process of formalin will produce formic acid
that later will form free radical substances that will disturb the sperm quality. Phyllanthus niruri
extract contains lignan and flavonoid that are known as antioxidants. These substances are
expected to overcome the negative effect of free radical agents produced by formalin. This
study is aimed to identify the effect of Phyllantus niruri extract on sperm quality of wistar rats
given oral formalin exposure.
This study is an experimental study with post test only randomized control group design.
Fifteen wistar rats were divided into 3 groups with 5 rats each. Group 1 was a control group
given formalin orally only , group 2 was given formalin orally and Phyllantus niruri extract
100 mg/kg BW, and group 3 was given formalin orally and Phyllantus niruri extract 300
mg/kgBW. The treatment was performed for 15 days. On day 16 the rats were terminated,
sperm sample were collected and sperm was analysed for the concentration, viability motility
and morphology
One way Anova test showed that there were no significant difference of sperm
concentration and viability among the study groups. While Kruskal Wallis test performed to
analyze the motility and morphology, showed there was significant difference on sperm
morphology, between the group 1 and 2. We can conclude that the administration of Phylantus
niruri extract had effect on sperm quality of wistar rats exposed to formalin orally.
Keyword: Formalin, Phyllantus niruri extract, Sperm Quality
25
PUBERTY DELAY IN CHILDREN AS A SCREENING FOR TURNER SYNDROME:
A RARE CASE REPORT
Anggia Mayangsari W 1*, dr. Darma Syanty, Sp.OG(K), M.Kes2, Dr. dr. Trika Irianta,
Sp.OG(K) 3
1Department of Obstetrics and Gynecology, Hasanuddin University, Makassar, Indonesia 2 Division of Fertility and Reproductive Endocrinology, Department of Obstetrics and
Gynecology, Hasanuddin University, Makassar, Indonesia 3 Division of Urogenicology, Department of Obstetrics and Gynecology, Hasanuddin
University, Makassar, Indonesia
Correspondence author: [email protected]
Abstract
Aim: Describe the clinical manifestations of Turner Syndrome in a 14-year-old patient.
Background: Turner syndrome is a genetic disorder caused by the loss of the X chromosome
in women, which causes the sufferer to be short and puberty delay. Turner syndrome cases
have psychosocial problems with higher rates of depression which lead decreased in quality of
life. Timing of diagnosis is a factor in psychosocial development among populations with the
syndrome. Case Description: A 14 year-old-girl was referred from the pediatric department
with complaints of no menstruation. On physical examination, there was a short stature,
webbed neck, shield chest, wide-spaced nipples, and no secondary genital growths in the breast
and pubic area. The bone age was in 10 years, which inconsistent for her chronological age and
no abnormalities on echocardography. Chromosomes analysis found the number of
chromosomes 45 with one X chromosome (monosomy X). Psychological results within normal
limits. Evaluation for comorbidities should also be conducted. Conclusion: Sindrom Turner is
diagnosed from clinical features. Radiologic and chromosome analysis should be performed in
order to investigate the presence of accompanying disorders. Early detection and appropriate
treatment of Turner syndrome can help minimize symptoms that arise both physically and
psychosocially. Clinical significance: The patient was diagnosed with turner syndrome from
clinical features, radiologic and chromosome analysis.
Keywords: Turner’s Sindrome, Puberty delay, Psycosocial Problem
26
COMPARISON OF PERI-MENOPAUSAL AND POST-MENOPAUSAL LIPID
PROFILE BASED ON BODY MASS INDEX
Yuliati1*, A. Mardiah Tahir2, Nasrudin A.M3, Isharyah Sunarno4, Eddy Hartono5, Umar
Malinta6
1,2,3,4,5,6Department of Obstetrics and Gynecology,
Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
*Corresponding author.
Email: [email protected]
Background and Aims: Menopause is a condition where women had not experienced
menstruation for 12 consecutive cycles. At the menopausal period, there is an alteration in
women's reproductive cycle because of estrogen decreased and lipid metabolism altered. This
study aims to compare the lipid profile in peri- and post-menopausal women with normal body
mass index (BMI) (18.9-24.9 kg/m2) and overweight (25-29.9 kg/m2).
Methods: This study was an observational study with a cross-sectional design underwent in
Tamalanrea Jaya Puskesmas, Makassar in 100 women aged between 40-55 years divided into
perimenopausal and postmenopausal group based on BMI. The study was conducted for 6
months. Measurement of total cholesterol (TC), high-density lipoprotein-cholesterol (HDL),
low-density lipoprotein (LDL), triglyceride (TG) by enzymatic colorimetric method.
Results: Our study revealed that serum levels of TC (p<0.018) and TG (p<0.048) were
significantly higher in post-menopausal group compared with the perimenopausal group for
normal BMI. No significant different lipid profile in perimenopausal group compared with
postmenopausal group with overweight (p>0.05).
Conclusions: There were significant differences in lipid profiles (total cholesterol and
triglycerides) between perimenopausal and postmenopausal in normoweight.
Keywords: Perimenopausal, postmenopausal, lipid profile, BMI, estrogen
27
Case Report
SUCCESSFUL MANAGEMENT OF ABDOMINAL PREGNANCY
Maike Irwan,1; Made Suyasa Jaya,2; Ida Bagus Putra Adnyana3
2.Departmen Obstetri dan Ginekologi, Universitas Udayana, RSUP Sanglah 3.Departmen Obstetri dan Ginekologi, Universitas Udayana, RSUP Sanglah
ABSTRACT
Abdominal pregnancy is a rare, life-threatening condition defined as pregnancy in the
peritoneal cavity exclusive of tubal, ovarian, or intraligamentary locations. It can be primarily
located in the peritoneal cavity or secondary to a ruptured ectopic pregnancy or tubal abortion.
We present two cases of abdominal pregnancy, one primary and another secondary, both
diagnosed and successfully managed in our institution. The first patient, a para 2 at 14 weeks
gestation, presented with abdominal pain, distension, and dizziness, which had started four
days prior. The initial radiological scan reported an intrauterine pregnancy with ascites, but a
bedside ultrasound revealed an empty uterus and a viable pregnancy located in the Pouch of
Douglas (POD). This was a secondary abdominal pregnancy managed successfully by
laparotomy. The second patient, a para 3 + 4 miscarriages with seven weeks amenorrhea was
admitted with an initial diagnosis of pregnancy of unknown location. She had a beta human
chorionic gonadotropin level of 14 444 mIU/mL. Diagnostic laparoscopy revealed a
hemoperitoneum, bulky uterus, normal looking right and left adnexa, and a dense irregular
bleeding tissue of around 3 × 4 cm firmly attached to the POD. The histopathology report of
the tissue retrieved from the POD confirmed products of conception. This case report supports
the importance of awareness and high clinical suspicion for such a life-threatening condition
to avoid maternal morbidity and mortality. To the best of our knowledge, no previous cases of
abdominal pregnancy have been reported in Bali to date.
Keywords: Pregnancy, Abdominal; Douglas’ Pouch; Hemoperitoneum; Chorionic
Gonadotropin, beta Subunit, Human; Ultrasound Imaging
28
MC CUNE-ALBRIGHT SYNDROME: A CASE REPORT
Astra Budiati Nusrat1*, Dr. dr. Sriwijaya, Sp.OG(K)1, Dr. dr. Hj. Masita Fujiko, Sp.OG(K)2,
dr. Ratna Dewi Artati, Sp.A(K), MARS3
1Department of Obstetrics and Gynecology, Hasanuddin University, Makassar, Indonesia 2 Division of Fertility and Reproductive Endocrinology, Department of Obstetrics and
Gynecology, Hasanuddin University, Makassar, Indonesia 3 Division of Endocrinology, Metabolism and Diabetes, Department of Pediatric, Hasanuddin
University, Makassar, Indonesia
Correspondence author: [email protected]
Abstract
Aim: To describe the clinical manifestations of McCune-Albright syndrome in a 3-year-old
patient.
Background: McCune-Albright syndrome (MAS) is a disease caused by a postzygotic somatic
mutation in the α subunit guanine nucleotide-binding protein gene (GNAS1). This syndrome
has a triad, brown discoloration of the skin (café-au-lait), bone dysplasia, and autonomic
hyperfunction of the endocrine system. The mortality and morbidity associated with MAS are
due to fractures, malignancies, endocrine disorders.
Case Description: A 3 year-old-girl was referred from the pediatric department with bleeding
from the birth canal that lasted approximately 2 months ago. On physical examination, a right-
sided thyroid mass, breast tanner 2, and pubis examination Tanner 1 was found. The skin
revealed unilateral hyperpigmentation of the right inguinal to the right upper thigh. The
estradiol level was high. The FSH, LH, and TSHS were low. On plain radiographs, there were
lytic and blastic lesions of the left femur. Bilateral ovarian cysts were found on ultrasound. The
bone age was in 5 years, which inconsistent with her chronological age. The patient also
received treatment from a pediatrician (vitamin D and calcium suplement). Follow-up
examination of the breast and the cyst will be done in 2 - 3 months. Evaluation for comorbidities
should also be conducted.
Conclusion: MAS is a rare disease. MAS is diagnosed from clinical features. Systematic
diagnosis and management are important for optimizing the prognosis of patients with MAS.
Clinical significance: The triad of MAS was found in the patient.
Keywords: McCune-Albright syndrome, café-au-lait, endocrine disorders
29
DAY THREE VS DAY FIVE EMBRYO TRANSFER
Jaqueline Sudiman1,2, Putu Gita Garbhini 3 , Anom Suardika2,3 , AAN Anantasika3 , I Made
Darmayasa2,3, Nono Tondohusodo2,3 and IB Putra Adnyana2,3
1Department of Anatomy, Faculty of Medicine, Udayana University, 2 Bali Royal IVF, BROS
Hospital, Denpasar, Bali, 3 Obstetrics and Gynaecology Department, Faculty of Medicine,
Udayana University, Jl Diponegoro, Denpasar, Bali
Abstract
Background and Aim: It has been reported that transfer of embryos on day five has been
associated with higher success rates, therefore our IVF clinics have started to extend embryo
culture until blastocyst stage. This research aimed to compare success rates and neonatal
outcomes of day three vs day five embryo transfers.
Methods: A total of 266 patients were included, all having undergone ICSI, with 221 patients
having undergone day three embryo transfers, and 45 patients having undergone day five
embryo transfers. Patients with more than five good quality embryos on day three were chosen
to prolong the culture of embryos into day five.
Results: There were no significant differences in patient characteristics, including basal
hormone LH, FSH, Prolactin and Estradiol. Moreover, there were also no significant
differences in total dosage of rFSH and duration of stimulation day. Final estradiol levels,
number of follicles, retrieved oocytes, matured oocytes, fertilized oocytes and number of
embryos were significantly higher in day five compared to day three embryo transfer groups.
However, there were no statistical differences in the number of embryos transferred in both
groups. Neither group showed any significant differences in clinical pregnancy, implantation,
multiple pregnancy or living birth rates. In day three embryo transfer group, two patients had
miscarriages and three patients had ectopic pregnancies. One patient had a miscarriage in day
five embryo transfer group. Looking at neonatal outcomes, there were no significant
differences in neonatal birth weight and length, head circumstances and APGAR score in either
singleton or twin group in day three and day five transfer groups. There were no differences in
gender between day three and day five transfer groups.
Conclusions: Transferring embryos at day five may not provide any additional benefit over
day three transfers to patients.
Keyword: day three embryo transfer, day five embryo transfer, implantation rate, live birth
rate, pregnancy rat
30
DIFFERENCES IN SPERM DAMAGE TO TEMPERATURE CHANGES IN
PREPARATION
Uki Retno Budihastuti, Eriana Melinawati, Mulyoto Pangestu, Alfi Marita
Tristiarti Obstetrics and Gynecology Department
Sebelas Maret University Surakarta
ABSTRACT
Background: Intrauterine insemination (IUI) has low pregnancy success of 5–13% per
cycle. The success of IUI is also influenced by the method of preparation and quality of
sperm. Temperature affects sperm quality. Sperm damage is known in the presence of DNA
fragmentation from spermatozoa.
Objective: Measuring differences in DNA fragmentation index and spermatozoa
morphology before and after preparation of swim up method at sperm preparation
temperatures of 27 oC and 37 oC.
Methods: Quasi-experiment laboratory test with pre and post-test control group design was
conducted at Sekar Fertility Clinic dr. Moewardi Hospital. Sperm infertile patients 20
samples performed sperm preparation swim up method with temperatures 27 oC and 37 oC.
Sperm DNA fragmentation was assessed using sperm Chromatin Dispersion test / SpermFunc
DNAf. There is a fragmentation of sperm DNA if it is found halo <30% of the volume of the
sperm head. Sperm morphological assessment based on WHO 2010. Data analysis using
Wilcoxon Test with 95% confidence interval and p <0.05.
Results: The DNA fragmentation index after sperm preparation using the swim-up method
at 27 °C was lower than 37 °C, 17.79 ± 10.88 versus 18.18 ± 12.95 but there was no
significant difference (p = 0.765). Sperm morphology after sperm preparation using the
swim-up method at a temperature of 27 °C was lower than that of 37 °C, 11.25 ± 5.15 versus
11.6 ± 5.34 but there was no significant difference (p = 0.626). DNA fragmentation index
and sperm morphology after sperm preparation were better than before preparation.
Conclusion: The swim-up method of sperm preparation can be done at room temperature
(27 oC) or 37 oC without any significant differences in the fragmentation index and sperm
morphology.
Keywords: DNA fragmentation, sperm, preparation, morphology
31
ENDOMETRIOSIS OF THE RECTUS ABDOMINIS MUSCLES AFTER CESAREAN
SECTION: A CASE REPORT
Sebastianus Tannur1*, Eddy Hartono1*, Fatmawaty Madya2*
1.Department of Obstetrics and Gynecology, Hasanuddin University, Makassar – Indonesia 2Division of Fertility and Reproductive Endocrinology, Department of Obstetrics and
Gynecology, Hasanuddin University, Makassar – Indonesia
correspondent: [email protected]
Abstract
Aim: Describe how to diagnose and management endometriosis of the rectus abdominis
muscle after cesarean section
Background: Endometriosis is a condition in which the endometrial glands grow outside the
uterus. It is quite rare to happen where endometriosis to be found in pelvic extra organ, which
one of the cases is endometriosis to be found on the abdomen wall.
Case Description: We are reporting 1 case of a 26 year old woman with endometriosis on the
rectus abdominis muscle 3 years after cesarean section. The patient came complaining lower
abdomen pain especially during menstruation period and there was a lump on the area of the
cesarean section. CT scan was performed in diagnosis. Wide excision surgery and
salphingoovorectomy were also done and followed with histopathology. From the treatment it
is known that there were tissue and stroma endometrium between muscle tissue, connective
tissue, and fat tissue. Abdomen wall endometriosis is often undiagnosed because of many
similar masses.Cesarean section is one of the important risk factors in the case of abdomen
wall endometriosis.
Conclusion: The proper handling on abdomen wall endometriosis is performing wide excision
to prevent recurrence.
Clinical significance: history of cesarean section and clinical manifestations was found in the
patient
32
PRECOCIOUS PUBERTY
Anom Suardika, Made Angga Diningrat
Fertility and Reproduction Endocrinology Division, Obstetric and Gynecology Departement
Sanglah General Hospital, Bali Royal Hospital, Denpasar, Bali
ABSTRACT
Introduction: Puberty that occurs at an earlier age than expected by normal standards. Puberty
occurring > 2.5 SD for mean age.
Case Report: a female, seven years old, with a diagnosis of precocious puberty. From the
clinical, it was obtained with menstrual complaints since 2017 at the age of five years, once for
two days. Currently the patient is menstruating, with two changes of sanitary napkins every
day accompanied by breast enlargement. Physical examination in this patient revealed tanner
II breast, tanner pubis I, hymen intact. Support shows LH hormone levels; FSH; Estradiol; 0.36
mIU/mL; 0.74 mIU/mL and 26 pg/mL. Investigations using transabdominal ultrasonography
(USG-TAS) showed sufficient solid content, uterus AF 4.36 x 1.83 cm, ET 0.32 cm, right ovary
1.63 x 1.57 cm, left ovary 1.44 x 0.81 cm and without free fluid. The patient was referred to
the Division of Pediatric Endocrinology for further management.
Conclusion: Precocious puberty is the development of secondary sexual characteristics before
the age of 8 years in girls and 9 years in boys. Precocious puberty is classified into two main
categories: central precocious puberty and peripheral precocious puberty. Treatment of
precocious puberty is according to the etiology so that management will follow the cause.
Keywords: Precocious puberty, Tanner
33
MAYER-ROKITANSKY-KÜSTER-HAUSER SYNDROME: A CASE REPORT
Ines Kurniaty Hartono, Anom Suardika, I Gusti Putu Mayun Mayura, Endang Sri
Widiyanti
Obstetrics and Gynecology Department, Sanglah Hospital/Faculty of Medicine Udayana
University, Bali
Abstract
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare disorder of congenital uterine
malformation characterized by aplasia of the uterus and the upper two-thirds of the vagina.
This disease may cause a significant decrease in quality of life. This article reviews the case
report of a a 21-year-old woman came with primary amenorrhoea and underdeveloped breasts.
External physical examination showed female sexual maturity consistent with Tanner stage 1.
Ultrasound examination and abdominal CT scan showed uterine hypoplasia and no ovaries.
There were no abnormalities of other organs in the abdomen. The laboratory test showed
testosterone levels <2.5ng/dL, FSH 0.16 mlU/ml, LH <0.5 mlU/ml, and 46 XX karyotypes.
The patient was given estrogen hormone replacement therapy to improve the patient's quality
of life by enlarging breasts, preventing osteoporosis, and reducing the risk of heart and vascular
disease. Our patient had MRKH syndrome type B/atypical-M4 characterized by uterine
hypoplasia and agenesis of bilateral ovaries.
Keywords: Amenorrhoea, mayer-rokitansky-kuster-hauser syndrome, ovarian ggenesis,
uterine hypoplasia
34
FERTILIZATION RATES AND QUALITY OF EMBRYOS ARE NOT INFLUENCED
BY PRE-WASH TOTAL MOTILE SPERM COUNT IN MODIFIED
CONVENTIONAL IVF WITH HYPERCONCENTRATED SPERM
Seso S Suyono2 Dicky M Rizal1,2, and Nandia Septiyorini1
1 Departement of Physiology, Faculty of Medicine, Public Health, and Nursing,
Universitas Gadjah Mada, Yogyakarta
2 Gladiool IVF Centre, Rumah Sakit Ibu dan Anak Gladiool, Magelang
Background
Although only been performed in less than 40% of all clinics over the world, conventional In
Vitro Fertilization (conventional IVF) still showed satisfactory results especially in normal
semen parameter or a very high concentration of spermatozoa. Our Clinic, Gladiool IVF, used
modified protocol of conventional IVF, inseminates hyperconcentrated sperms with oocytes
(150.000 sperms/oocyte). Pre-wash total motile sperm count (TMSC) showed better predictive
value than conventional WHO semen parameters for the outcomes of ICSI, but as far as we
know only few studies has studied the correlation of pre-wash TMSC and the outcomes of
conventional IVF.
Aims
This study aimed to evaluate the relationship between pre-wash TMSC, fertilization rates and
embryo quality among patients who underwent conventional IVF with hyperconcentrated
sperms in Gladiool IVF Centre, Magelang.
Methods
Fertilization rates and quality of embryos were analyzed in 195 embryos from 95 couples
undergoing conventional IVF cycle. The couples were allocated in 4 groups, according to
prewash TMSC: Group I (TMSC 0-5x106), Group II (TMSC 5-10x10
6), Group III (TMSC 10-
20x106) and Group IV (TMSC>20x10
6). We used modified conventional IVF protocol,
inseminated oocytes with hyperconcentrated sperms (150.000 sperms/oocyte). Fertilization
rates were evaluated 18 hours after insemination by the presence of two pronuclei (2PN).
Embryos were graded in Day 3, according to the shape, size and degree of fragmentation into
5 grades. Fertilization rates and quality of embryos were compared among TMSC groups.
Results
Data were analyzed in195 embryos from 95 couples. Our data show no significant differences
in female partner’s age among TMSC groups so it can be concluded that our current study
35
evaluated only male factor in IVF. There were no significant differences in fertilization rates
and quality of embryos among pre-wash TMSC groups.
Conclusion
Pre-wash total motile sperm count (TMSC) can’t be used as indicator for fertilization rates and
quality of embryos in conventional IVF with hyperconcentrated sperms.
Keywords: total motile sperm count, conventional IVF, hyperconcentrated sperm, embryo
quality
36
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Thanks’s For Support