Validity of The Fertility Quality of Life (FertiQol) Questionnaire in Indonesian Infertile Women

<p><strong>Introduction</strong></p><p>Infertility in Indonesia has an estimated prevalence as high as 22.3%, with the nature of the problem and its treatment could be devastating, it could affect quality of life and vice versa influence successful of the treatment. The Fertility Quality of Life (FertiQol) Questionnaire was specifically designed for infertility couples and has been demonstrated to have good properties. Studies in several countries has showed consistency in validity and reliability of the questionnaire. Precedently there has been no published study about Fertiqol in Indonesia, this preliminary study is to measure validity and reliability of FertiQol questionnaire among Indonesian infertility women.</p><p><br /> <strong>Material &amp; Methods</strong></p><p>This is a cross-sectional study, a written Fertiqol Questionnaire Indonesian version (www.Fertiqol.org) were distribute to Infertility clinic in Cipto Mangunkusumo General Hospital, total of 129 women completed the questionnaire. Statistical analysis used SPSS version 23.0. The questionnaire were tested for validity with Pearson’s correlation with two tailed and Cronbach α coefficient for reliability.<br /> <strong></strong></p><p><strong>Results</strong></p><p>FertiQol were completed by 129 women with infertility problem. The mean of total FertiQol score was 70.49±11.44, score for emotional, mind/body, relational, environment and tolerability was respectively 63.79±18.86; 66.05±18.22; 75.19.±15.11; 68.99±18.63; 75.64±16.55; 66.23±19.17. Reliability of Fertiqol was high (Cronbach a &gt; 0.70) with every item of questionnaires was valid ( r&gt; 0.1729).<br /> <strong></strong></p><p><strong>Conclusion</strong></p><p>This study showed that FertiQol Indonesian version are valid and reliable in measured quality of life among infertility women in Indonesia.</p>

The cut off of Ferriman Gallwey score for PCOS in Asia and the degree of hyperandrogenism indicator

<p><strong>Objective:</strong> To determine the distribution of the Ferriman–Gallwey score in Asia and to study any association between hirsutism and endocrine markers, and also to find the cut off of F-G score. </p><p><strong>Background: </strong>Hirsutism is the most widely used clinical diagnostic criterion for hyperandrogenism, it is present in approximately 70% of PCOS women. Using the Ferriman- Gallwey (F-G) scoring systems for evaluation of hirsutism, the degrees of hyperandrogenism from different regions are distinct and have different cut off.</p><p><strong>Material and methods: </strong>A descriptive cross-sectional study was carried out at Dr. Cipto Mangunkusumo General Hospital Jakarta in 2015. Reproductive age women who commits with PCOS criteria were included in the study. Clinical data was taken by interview, physical examination and US examination. Patient’s blood was taken for FTI, and testosterone.</p><p><strong>Results: </strong>The data indicated that 32.4% PCOS woman shows clinical signs of hyperandrogenism, with the minimum score of hirsutism 2 and based on laboratory findings 34.3% subjects show high FTI and testosterone level. However not all patient with high androgen level have a high score of hirsutism. </p><p><strong>Conclusion:</strong> Clinical and laboratory finding of hyperandrogenism have a correlation to determine the score of Ferriman–Gallwey (F-G). The cut off is lower than European and west countries.</p>

Expression of CA-125 Level And Neutrophil to Lymphocyte Ratio In Infected And Non-infected Endometrioma

<p>Implantation and growth of endometriosis was determined by immune cell. There were several immunologic cells that promoting implantation and cell proliferation such as macrophages, Natural killer, lymphocyte and monocyte. Infected endometrioma was associated in women with revised American Society for Reproductive Medicine (ASRM) stage III-IV. Neutrophil lymphocyte ratio (NLR) was a simple systemic inflammation response markers. The sensitivity and spesificity CA-125 in predicting endometrioma was very low but it had been used to monitor the progress of endometriosis. Therefore, measuring mean in leucocyte, NLR, PLR and CA-125 level in infected endometrioma was necessary. </p>

Characteristic of Poor Responder Patients and the success rate of biochemical pregnancy in the administration of adjuvant recombinant Luteinizing Hormones in Yasmin Clinic, Jakarta

<p><strong>Introduction:</strong> Management for poor response patients is still a challenge for clinician engaged in Assisted Reproductive Technology. Various protocols have been proposed to improve the outcome for patients, though no RCT can provide the evidence based of success rate of one protocol among others.</p><p><strong>Objective:</strong> Our purpose is to find the basic data of poor responder patients in Yasmin Clinic, Jakarta and to assess the IVF cycle outcome after the addition of recombinant Luteinizing Hormones.</p><p><strong>Material and methods:</strong> This is a cohort retrospective study taken from medical records of IVF patients at Yasmin Clinic, Cipto Mangunkusumo Hospital between January 2012 to January 2015.</p><p><strong>Result :</strong> Two hundreds and eighty-one poor response patients were selected for ART during January 2012 to January 2015, were divided into four main group. Control group received gonadotrophin protocol, while group II received additional recombinant Luteinizing hormones (rLH), Group III received additional Growth hormones (GH) and Group IV received additional rLH and GH both.</p><p><strong>Discussion:</strong> Our study demonstrated the follicle count, the oocyte count and the cleavage rate were statistically significant difference between control group and LH group. Where the oocyte count and follicle count were significantly higher, but the cleavage rate with LH showed negative correlation compare with control group.</p><strong>Conclusion : </strong>In this study we found that with adjuvant therapy with <em>recombinant Luteinizing Hormones, </em>produced higher follicles count and oocyte count.

Knowledge and Attitude in Indonesian Patients and Parents of Patient with Turner Syndrome towards Fertility Treatment

<p>The objective of the study was to prospectively determine the knowledge and attitude in Indonesian girls and parents of patients diagnosed with Turner Syndrome (TS) towards future fertility treatment possibility. Data collected from in-depth interviews with 20 TS patients or parents. The first group was composed of 16 patients selected from Indonesian Turner Syndrome Society and 4 patients from dr. Cipto Mangunkusumo National Hospital Jakarta. All participants were stratified by characteristics, physical appearance, hormonal therapy and TS knowledge and attitude towards future fertility treatment possibility.</p><p> </p><p class="ng-scope">More than half of the TS patients belong to the support grup have better knowledge than the patients in the non support group. This study showed that 31.25% patients from support group and 25% patients from non support group believed that TS patients still have normal social life, but still concern about TS fertility (support group 87% and non support group 100%). Most of them (support group 93.75% and non support group 100%) agree to have possible fertility treatment, but 31.25% of them insisted on lower cost of hormonal treatment and medication. The greatest barriers for accepting fertility preservation by the parents and TS patients were lack of information (41.2%), fear of complication (22.1%) and lower cost for hormonal treatment (15.3%).</p><p class="ng-scope">The challenges of counseling and fertility treatment for TS patients in Indonesia are the time pressure diagnosis and the possible fertility treatment and lack of knowledge about TS fertility condition by pediatric endocrinologist, fertility experts and parents; therefore a team consisting of pediatric endocrinologist, infertility specialists and support group is recommended in these setting.</p>

Corifollitropin Alfa: One Shot Injection for IVF

<p>Controlled ovarian stimulation (COS) has been recognized as a painstaking process for many people. It involves the maintenance of extended control over endogenous reproductive hormones and continuous dosing with exogenous hormones via abdominal injection<span style="font-size: 8.33333px;">.</span></p>

Estradiol Serum Levels in Menopausal Women With and Without Vasomotor Syndrome in Medan

<p>Vasomotor syndrome is the most commonly complained syndrome in menopause women. The main mechanism is the decrease in estrogen which causes increasing of body's core temperature and overactivity of the parasympathetic nervous system. Estradiol is the most abdudant and most potent estrogen derivate that works in major receptors throughout the body. This study aimed to determine difference of estradiol serum levels between women with and without vasomotor syndromes and among the symptoms severity. This study was conducted in 50 menopausal women in the Department of Obstetrics and Gynecology H. Adam Malik Hospital, Medan, Indonesia. Vasomotor symptoms was assessed by interview using three options of answers. Estradiol serum was analyezed using chemiluminescent principle in Prodia Laboratory. Data were tabulated and analyzed by SPSS. This study showed significant difference of mean estradiol serum levels between women with and without vasomotor syndromes (17.5 and 47.5 pg/ml, respectively; p=0.0001). Women with mild vasomotor syndromes had higher estradiol serum levels (23.9-29 pg/ml) than those with moderate (12-19.7 pg/ml) and severe (11.8 pg/ml) degree of syndromes. By using estradiol level as a marker, the presence vasomotor symptoms even its severeity should have been predicted earlier. Therefore, women can prepare to overcome those debilitating symptoms. Further and larger reseach is needed to make this study applicable in all clinical settings.</p>

In Vitro Fertilization Outcome After Intracytoplasmic Sperm Injection with Fresh and with Frozen-Thawed Epididymal Spermatozoa

<p><strong>Introduction</strong></p><p>Testicular epididymal sperm aspiration (TESA) is one of the method to retrieve sperm from the testes in men with azoospermia. The aim of the study is to compare the In vitro fertilization (IVF) outcome of intracytoplasmic sperm injection (ICSI)-ET cycles with fresh testicular epididymal spermatozoa obtained on the same day with oocyte retrieval and with frozen-thawed testicular epididymal spermatozoa.</p><p><strong>Material &amp; Methods</strong></p><p>A retrospective comparative analysis of patients who underwent fresh TESA and frozen-thawed TESA in ICSI-ET cycles from January 2012 to December 2014 in Halim Fertility Center was done. Fresh testicular epididymal sperm aspiration (fresh TESA) was performed on the same day with oocyte retrieval in 28 cycles and the frozen-thawed testicular epididymal sperm aspiration (frozen-thawed TESA) was used in 30 cycles. </p><p><strong>Results</strong></p><p>The two groups were comparable in terms of the ages of male and female patients, etiology of infertility and duration of infertility. Fertilization rates in fresh TESA group were 53,5% and in frozen-thawed TESA group, fertilization rates were 50%. There was no statistically significant difference between the groups. Clinical pregnancy rates in fresh TESA group were 35,7% and in frozen-thawed TESA group, clinical pregnancy rates were 26,7% and statistically there was no significant difference between the groups.</p><p><strong>Conclusion</strong></p>There is no significant difference in the in vitro fertilization outcome of intracytoplasmic sperm injection (ICSI)-ET cycles between fresh TESA and frozen-thawed TESA .

Comparative Study Between Mock Embryo Transfer Prior To The Treatment Cycle and Real Embryo Transfer In In Vitro Fertilization

<p><strong>Introduction</strong><strong></strong></p><p>A trial or mock embryo transfer (ET) may influence pregnancy rates and it performed prior to ET allows the clinician to assess the uterine cavity and the utero-cervical angle. The aim of this study is to compare the consistency of the type of ET in mock ET with real ET.</p><p><strong>Material &amp; Methods</strong></p><p>A retrospective comparative analysis of patients who underwent in vitro fertilization or ICSI cycle from January 2014 to December 2014 in Halim Fertility Center was done. The type of transfer was divided into two groups: ‘easy’ or ‘difficult’. An easy ET was defined as a transfer that occurred without the use of manipulation or other instrumentation and difficult ET was considered when additional instrumentation was required.</p><p><strong>Results</strong></p><p>From the study, 103 patients who underwent Mock-ET, we found 58 patients (56.3%) with easy ET and 45 patients (43.7%) with difficult ET, which with hard catheter ET in 17 patients (16.5%), with osfander assistance in 20 patients (19.4%) and with stylet in 8 patients (7,8%). 58 patients with Easy Mock ET group were entirely easy real ET (100%) and 45 patients with difficult Mock ET group also entirely were difficult real ET (100%). The Statistical analysis shows no significant difference between the mock ET and real ET groups (p&gt;0,05). In easy real ET, clinical pregnancy rates were 32.8% and in difficult real ET, clinical pregnancy rates were 26.7% with no significant difference between the groups (p&gt;0,05).</p><p><strong>Conclusion:</strong></p><p>Mock ET prior to the treatment cycle is consistent with real ET.</p>

Correlation between Follicular Fluid’s Androgen Level and Fertilization Rate in Poor Responder Patients Undergone IVF: A Prospective Cohort Done in Yasmin IVF Clinic, Jakarta, Indonesia

<p><strong>Introduction </strong>Androstenedione (A4), testosterone (T), and dehidroepiandrosterone (DHEA) are known to be involved in folliculogenesis and follicular maturity. Lower follicular androgen levels in poor responder due to malfunctioned granulosa and theca cells and decreased inhibin B production will decrease FSH and LH. However, androgenic follicular fluid might also induce follicular atresia, decreased oocytes viability, thus affecting fertilization. The aim of current study is to find the correlation between intra-follicular androgen levels and fertilization rate, specifically in poor responder whom contributed in 84% cancelled cycle.</p><p><strong>Material and Methods </strong>This prospective cohort study was done at Yasmin IVF Clinic, Jakarta, Indonesia, in January 2014-March 2015. Infertile women undergone IVF were asked to participate, grouped into poor responder and other, and the androgen levels in the follicular fluid of each consenting patients were measured.</p><p class="DecimalAligned"><strong>Results </strong>From total 62 patients, aged 23-47 years old (37.6±5,068), there were 21 poor responders, whereas the other 41 patients with other indication. In poor responder group, levels of androstenedione, testosterone, and DHEA were 50.8 – 272.3 (103.5 ± 59.9), 383.2 – 1747.9 (1114.4 ± 373.2), 11.3 – 454.8 (151.3 ± 96.8), whereas in other group the androgen levels were 44.3 – 326.8 (95.1 ± 61.2), 414.1 – 1463.7 (976.9 ± 258.4), 44.6 – 265.8 (132.7 ± 61.3) with the correlation with fertilization rate 0.609, 0.095, and 0.361 respectively.</p><p class="DecimalAligned"> </p><p><strong>Conclusion </strong>Correlation between follicular androgen levels and fertilization rate found to be not significantly different. The low number of subjects might cause this result, as well as the presence of bias, e.g.male factor and endometriosis might also affect fertilization. A multi-center study with larger sample size added with thorough analysis is needed to reconfirm current data.</p>