Tesis

Profil Ultrasonografi Doppler sebagai Prediktor Reseptifitas Endometrium pada Perempuan Usia Reproduksi Normal Dibandingkan Pemeriksaan Histologis Penanggalan Endometrium = Doppler Ultrasonography Profile as A Predictor of Endometrial Receptivity in Normal Reproductive Age Women Compared To Histological Endometrial Dating.

Latar Belakang: Reseptifitas endometrium merupakan salah satu faktor yang berpengaruh dalam fertilitas. Namun, sejak enam dekade lalu, reseptifitas endometrium dinilai menggunakan prosedur invasif guna mendapatkan sampel histologis endometrium. Perlu dilakukan penelitian menggunakan pemeriksaan lain yang bersifat non-invasif seperti USG Doppler guna memprediksi reseptivitas endometrium pada populasi perempuan usia reproduksi normal. Tujuan: Mengetahui profil USG Doppler sebagai prediktor reseptivitas endometrium dibandingkan pemeriksaan histologis penanggalan endometrium. Metode: Penelitian potong lintang dilakukan pada perempuan usia 20-35 tahun dengan pola menstruasi reguler, telah memiliki minimal 1 anak, dan tidak memiliki gangguan ginekologis sebelumnya. Kriteria ekskluasi adalah subjek dengan kelainan anatomi uterus, gangguan pembentukan darah, infeksi intrauterin, atau menolak mengikuti penelitian. Dilakukan pemeriksaan pada haid hari ke-12 hingga 14 untuk memastikan ovulasi serta pemeriksaan pada hari ke-5 hingga 7 pasca ovulasi untuk menilai reseptivitas endometrium. Seluruh subjek diperiksa menggunakan USG Doppler dan biopsi endometrium. Dilakukan analisis kesesuaian antara USG Doppler dan biopsi endometrium. Subjek dikategorikan dalam kelompok in-phase atau out-phase tergantung dari kesesuaian biopsi endometrium terhadap penanggalan berdasarkan siklus menstruasi subjek sesuai kriteria Noyes. Hasil: Didapatkan 11 subjek (8 in-phase dan 3 out-phase) dalam penelitian ini. Dibandingkan kelompok out-phase, pada kelompok in-phase dtemukan ketebalan endometrium (12,36 mm v.s. 11,3 mm) dan volume endometrium (3,84 cm 3 v.s. 2,91 cm 3 ) yang lebih tinggi, serta proporsi pola endometrium 3 lapis (87,5% v.s. 33,3%) dan zona vaskularisasi lebih baik. Namun belum didapatkan perbedaan yang bermakna secara statistik antar kelompok pada semua parameter (p > 0,05). Ditemukan pula parameter vaskularisasi yang rendah pada semua subjek penelitian. Tidak ditemukan kesesuaian antara USG Doppler dan biopsi endometrium (nilai Kappa 0,154 , p = 0,338). Simpulan: Ditemukan ketebalan endometrium dan volume endometrium yang lebih tinggi, serta proporsi pola endometrium 3 lapis dan zona vaskularisasi lebih baik pada subjek inphase. Tidak didapatkan kesesuaian antara USG Doppler dan biopsi endometrium.
Kata Kunci: Reseptivitas endometrium, penanggalan endometrium Noyes, USG Doppler, infertilitas.


Background: Endometrial receptivity is one of the factors that influence fertility. However, since six decades ago, endometrial receptivity was assessed using invasive procedures to obtain histological samples of the endometrium. It is necessary to conduct research using other non-invasive tests such as Doppler ultrasound to predict endometrial receptivity in a population of women of normal reproductive age. Objective: To determine the profile of Doppler ultrasound as a predictor of endometrial receptivity compared to histological examination of endometrial dating. Methods: A cross-sectional study was conducted on women aged 20-35 years with regular menstrual patterns, had at least 1 child, and had no previous gynecological disorders. The exclusion criteria were subjects with uterine anatomic abnormalities, impaired blood formation, intrauterine infection, or refusal to participate in the study. An examination was performed on the 12 Title th to 14 th day of menstruation to confirm ovulation and an examination on the 5 th to 7 th post-ovulation day to assess endometrial receptivity. All subjects were examined using Doppler ultrasound and endometrial biopsy. An analysis of the concordance between Doppler ultrasound and endometrial biopsy was performed. Subjects were categorized in in-phase or out-phase groups depending on the suitability of the endometrial biopsy against dating based on the subject's menstrual cycle according to Noyes criteria. Results: There were 11 subjects (8 in-phase and 3 out-phase) in this study. Compared to the out-phase group, the in-phase group found a higher endometrial thickness (12.36 mm vs 11.3 mm) and endometrial volume (3.84 cm 3 vs 2.91 cm 3 ), as well as the proportion of 3- layered endometrial pattern (87.5% vs 33.3%) and better vascularity zone. However, there was no statistically significant difference between groups in all parameters (p > 0.05). We also found low vascularity parameters in all study subjects. No concordance was found between Doppler ultrasound and endometrial biopsy (Kapa value 0.154, p = 0.338). Conclusion: Higher endometrial thickness and endometrial volume, as well as the proportion of 3-layer endometrial pattern and better vascularized zone were observed in inphase subjects. There was no concordance between Doppler ultrasound and endometrial biopsy.
Keywords: Endometrial receptivity, Noyes endometrial dating, Doppler ultrasound, infertility.