Tesis

Efektivitas amnion bilayer terhadap ekspresi gen HOXA 10, LIF dan VEGF untuk regenerasi endometrium pada kasus sindrom Asherman derajat ringan - sedang = Effectiveness of amnion bilayer on HOXA 10, LIF and VEGF for endometrial regeneration in mild to moderate Asherman syndrome cases.

Latar belakang: Sindrom Asherman menjadi salah satu penyebab umum gangguan regenerasi endometrium dan penipisan endometrium, yang ditandai dengan perlengketan intrauterin yang menyebabkan kelainan menstruasi, infertilitas, dan keguguran berulang. Mengingat keadaan ini, maka peneliti mencoba meneliti menggunakan selaput amnion aselular yang disterilisasi secara kimiawi menggunakan peracetic acid (PAA) dan diberi lapisan growth factor, menjadi amnion bilayer, sebagai womb patch. Objektif: Penelitian ini bertujuan untuk menilai efektivitas terapi menggunakan amnion bilayer sebagai inovasi regeneratif untuk meningkatkan ketebalan, struktur histologis, serta ekspresi gen reseptivitas HOXA10 dan LIF, serta angiogenesis melalui marker VEGF endometrium pasien dengan sindrom Asherman derajat ringan hingga sedang. Metode: Penelitian dengan desain kuasi eksperimental, melibatkan 12 pasien yang dilakukan pemasangan amnion bilayer pada hari ke -10-13 haid selama 7 hari sesaat setelah dilakukan histeroskopi adesiolisis, dengan evaluasi sebelum dan sesudah intervensi melalui pemeriksaan ultrasonografi, histologi H&E, dan analisis ekspresi gen menggunakan qPCR. Data dianalisis dengan uji Wilcoxon dan uji normalitas ShapiroWilk, serta statistik deskriptif. Hasil: Menunjukkan peningkatan signifikan pada ketebalan endometrium, serta peningkatan ekspresi HOXA 10, LIF dan VEGF yang signifikan. Gambaran histologis menunjukkan adanya perbaikan struktur jaringan endometrium. Tidak ditemukan komplikasi rejeksi maupun infeksi pada penelitian ini. Kesimpulan: Penggunaan amnion bilayer berpotensi meningkatkan ketebalan dan fungsi endometrium pada pasien sindrom Asherman, memperbaiki ekspresi biomarker reseptivitas dan angiogenesis serta dapat menjadi alternatif terapi regeneratif yang aman dan efektif dalam penanganan endometrium tipis dan infertilitas.
Kata kunci: Amnion bilayer, Sindrom Asherman, HOXA10, LIF, VEGF


Background: Asherman syndrome is one of the common causes of endometrial regeneration disorders and endometrial thinning, and is characterized by intrauterine adhesions that cause menstrual disorders, infertility, and recurrent miscarriage. Based on these conditions, researchers tried to study using acellular amnion membranes that were chemically sterilized using peracetic acid (PAA) and given a growth factor layer, becoming amnion bilayer, as a womb patch. Objective: This study aims to assess the effectiveness of therapy using amnion bilayer as a regenerative innovation to increase endometrial thickness, histological structure, and expression of HOXA10 and LIF receptivity genes, as well as angiogenesis through VEGF markers in patients with mild to moderate Asherman syndrome. Methods: Quasi experimental study, involving 12 patients who underwent amnion bilayer on the 10th – 13 th day of the menstrual cycle for 7 days, which previously underwent laparoscopic adhesiolysis while AB therapy was subsequently performed. Evaluation was conducted before and after intervention through ultrasonography, H&E histology, and gene expression analysis using qPCR. Data were analyzed using the Wilcoxon test and the Shapiro-Wilk normality test, as well as descriptive statistics. Results: Significant increase in endometrial thickness, as well as a significant increase in HOXA 10, LIF and VEGF expression. Histological images showed improvements in endometrial tissue structure. No complications of rejection or infection were found in this study. Conclusion: The use of amnion bilayer has the potential to increase endometrial thickness and function in patients with Asherman syndrome, improve the expression of receptivity and angiogenesis biomarkers and can be an alternative safe and effective regenerative therapy in the treatment of thin endometrium and infertility.
Keywords: Amnion bilayer, Asherman syndrome, HOXA10, LIF, VEGF