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Objective: This study examines the effectiveness of combined laparoscopic cystectomy and leuprolide acetate therapy on AMH level and AFC profile in endometriosis.

This study is a randomized controlled clinical trial with open label form. The subjects were divided into control and therapy groups, with the therapy group receiving leuprolide acetate injection following laparoscopic cystectomy. In both groups, the AMH levels and AFC were examined prior to the surgery and six weeks after before they were compared.

There were significant pre-post differences of AMH levels(p = 0.000) and AFC (p = 0.000) in the therapy group but not in the control group. In the therapy group, the mean increases of AMH level and AFC were 0.94 (95% CI: 0.63-1.25) and 9.53 (95% CI: 6.83-12.24), respectively. Linear regression model found that AFC level prior to intervention was a significant predictor of endometriosis ASRM grade (p = 0.001) with an R-value of 0.633, suggesting strong correlation.

The combined therapy of laparoscopic cystectomy and leuprolide acetate injection for endometriosis provided better outcome concerning ovarian reserve, as opposed to the therapy with laparoscopic cystectomy alone. Peran Kombinasi Laparoskopi Kistektomi dan Terapi Leuprolide Asetat Terhadap Kadar Hormon Anti-Mullerian dan Profil Jumlah Folikel Antral pada Penderita Endometriosis Abstrak Tujuan:Studi ini bertujuan menguji keefektifan kombinasi kistektomi laparoskopi dan terapi leuprolide acetate terhadap kadar AMH dan profil AFC pasien endometriosis. Metode: Penelitian ini merupakan uji klinis terkontrol acak dengan bentuk open label. Subjek dibagi menjadi kelompok kontrol dan terapi, dengan kelompok terapi menerima injeksi leuprolide acetate setelah kistektomi laparoskopi. Pada kedua kelompok, kadar AMH dan AFC diperiksa sebelum pembedahan dan enam minggu setelahnya sebelum kemudian dibandingkan. Hasil: Terdapat perbedaan bermakna kadar AMH (p = 0,000) dan AFC (p = 0,000) sebelum dan sesudah pada kelompok terapi tetapi tidak pada kelompok kontrol. Pada kelompok terapi, rata-rata peningkatan kadar AMH dan AFC adalah masing-masing 0,94 (95% CI: 0,63-1,25) dan 9,53 (95% CI: 6,83-12,24). Model regresi linier menemukan bahwa kadar AFC sebelum intervensi merupakan prediktor signifikan derajat endometriosis sesuai ASRM (p = 0,001) dengan nilai R sebesar 0,633 yang menunjukkan korelasi yang kuat. Kesimpulan: Terapi kombinasi kistektomi laparoskopi dan injeksi leuprolide acetate untuk endometriosis memberikan hasil yang lebih baik terhadap cadangan ovarium, dibandingkan dengan terapi dengan kistektomi laparoskopi saja. Kata kunci: endometriosis; leuprolide acetate; kistektomi; hormon anti-mullerian; jumlah folikel antral

Full Text: PDFReferences Speroff L, Glass RH, Kase NG. Clinical gynecologic endocrinology and infertility. 6th ed. Philladelphia: Lippincott Williams & Wilkins; 1999. Ferrero S, Remorgida V, Venturini PL, Bizzarri N. Endometriosis: The effects of dienogest. BMJ Clin Evid. 2015; 0802: 1-8. Bellelis P, Dias JR, Podgaec S, Gonzales M, Baracat EC, Abrao MS. Epidemiological and clinical aspects of pelvic endometriosis–a case series. Rev Assoc Med Bras. 2010; 56(4): 467-71. HIFERI Indonesia. Panduan nasional pelayanan kedokteran: Konsensus nyeri endometriosis. Perkumpulan Obstetri dan Ginekologi Indonesia; 2013. Verma S. Evidence linked treatment for endometriosis associated infertility. Apollo medicine. 2012; 9(3): 184-92. Adnyana P. Endometriosis: Masalah klinis dan penanganannya, subbagian fertilitas dan endokrinologi reproduksi, makalah pertemuan ilmiah tahunan. Bali: Bagian Obstetri dan Ginekologi FKUNUD/RS Sanglah; 2005. Bhat RG, Dhulked S, Ramachandran A, Bhaktha A, Vasudeva A, Kumar P, Rao ACK. Laparoscopic cystectomy of endometrioma: Good surgical technique does not adversely affect ovarian reserve. J Hum Reprod Sci. 2014; 7(2):125-9. Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Corton MM. Williams gynecology. Chapter 10 : Endometriosis. California: McGraw-Hill; 2010 Depalo R, Jayakrishan K, Garruti G, Totaro I, Panzarino M, Giorgino F, et al. GnRH agonist versus GnRH antagonist in in vitro fertilization and embryo transfer. Reprod Bio Endocrinol. 2012; 10:26. Yadav A, Patel S. A review article on ovarian cystectomy in endometriomas by laparoscopy. Int J Reprod Contracept Obstet Gynecol. 2017; 6(11): 4754-8. Busacca M, Somigliana E, Bianchi S, De Marinis S, Calia C, Candiani M, et al. Post-operative GnRH analogue treatment after conservative surgery for symptomatic endometriosis stage III-IV: A randomized controlled trial. Hum Reprod. 2001; 16(11): 2399-402. Oral E, Demir B, Inceboz U. Endometriosis and ovarian reserve. Womens Health (Lond). 2015; 11(5): 671-5. Ergun B, Ozsurmeli M, Dundar O, Comba C, Kuru O, Bodur S. Changes in markers of ovarian reserve following laparoscopic ovarian cystectomy. J Minim Invasive Gynecol. 2015;22:997-1003. Cagnacci A, Bellafronte M, Xholli A, Palma F, Carbone MM, Di Carlo C, et al. Impact of laparoscopic cystectomy of endometriotic and non-endometriotic cysts on ovarian volume, antral follicle count, and ovarian doppler velocimetry. Gynecol Endocrinol. 2016; 32(4):298-301. Ding Y, Yuan Y, Ding J, Chen Y, Zhang X, Hua K. Comprehensive assessment of the impact of laparoscopic ovarian cystectomy on ovarian reserve. J Minim Invasive Gynecol. 2015; 22(7):1252-9. Salihoglu KN, Dilbaz B, Cirik DA, Ozelci R, Ozkaya E, Mollamahmutoglu L. The short-term impact of laparoscopic cystectomy on ovarian reserve tests in bilateral and unilateral endometiotic and non-endometriotic cysts. J Minim Invasive Gynecol. 2016; 23(5):719-25. Georgievska J, Sapunov S, Cekovska S, Vasilevska K. Ovarian reserve after laparoscopic treatment of unilateral ovarian endometrioma. Acta Inform Med. 2014; 22(6): 371-3 Goodman LR, Goldberg JM, Flyckt RL, Gupta M, Harwalker J, Falcone T. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol. 2016; 215(5): 589.e1-6. Vignali M, Mabrouk M, Ciocca E, Alabiso G, di Prun AB, Gentilini D, Busacca M. Surgical excision of ovarian endometriomas: Does it truly impair ovarian reserve? Long term anti-Mullerian hormone (AMH) changes after surgery. J Obstet Gynaecol Res. 2015; 41(11): 1773-8. DOI: http://dx.doi.org/10.24198/obgynia.v6i3.519 Refbacks - There are currently no refbacks. This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.