Pengaruh Endometriosis dan Tatalaksana Pembedahan terhadap Cadangan Sel Telur: Literature Review
Review
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Abstract
Endometriosis merupakan kelainan ginekologi inflamasi kronis yang menyerang 10–15% wanita usia reproduksi dan berisiko menurunkan cadangan sel telur (ovarian reserve) sehingga memicu infertilitas. Penulisan literature review ini bertujuan untuk meninjau bukti klinis, mekanisme patofisiologi, serta dampak pembedahan terhadap cadangan sel telur guna memberikan rekomendasi tatalaksana berbasis bukti. Tinjauan pustaka dilakukan dengan menganalisis studi klinis, kohort, dan meta-analisis terkait parameter cadangan sel telur (Anti-Müllerian Hormone [AMH], Antral Follicle Count [AFC], dan Follicle-Stimulating Hormone [FSH]) dari basis data PubMed, Google Scholar, Scopus, dan Cochrane Library (periode 2001–2026). Hasil penelusuran menunjukkan bahwa pasien dengan endometrioma, endometriosis superfisial, maupun Deep Infiltrating Endometriosis (DIE) memiliki kadar AMH baseline yang signifikan lebih rendah akibat inflamasi kronis, stres oksidatif, dan fenomena follicular burn-out. Kondisi ini diperparah secara iatrogenik oleh tindakan kistektomi laparoskopik yang menyebabkan penurunan AMH menetap hingga 54,2% pada bulan 9–18 pasca-bedah, terutama pada kasus kistektomi bilateral (mencapai 57%), kista >7 cm, serta penggunaan hemostasis energi bipolar. Terjadi pula diskrepansi di mana AMH menurun drastis sedangkan AFC relatif stabil, menandakan AMH lebih sensitif mendeteksi deplesi iatrogenik. Kesimpulannya, endometriosis dan tindakan pembedahan sama-sama berkontribusi terhadap penurunan cadangan sel telur. Tatalaksana pasien usia reproduksi yang menginginkan fertilitas harus dipersonalisasi dengan menerapkan teknik bedah ovarian-sparing, mempertimbangkan In Vitro Fertilization (IVF) langsung, serta melakukan pemeriksaan rutin AMH/AFC dan konseling pra-operasi mengenai risiko iatrogenik.
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- last seen: 2026-11-15T06:03:07.880986+00:00
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