Perbedaan Luaran Embrio pada IVF dengan Teknik Fresh Oosit dan Vitrifikasi Oosit

Abstract

Tujuan : Mengetahui perbedaan luaran embrio pada IVF dengan teknik fresh oocyte dan vitrifikasi oosit Metode : Penelitian ini merupakan penelitian analitik observasional dengan desain cohort prospective pada data sekunder berupa rekam medik pasien wanita yang telah menjalani fertilisasi in vitro (IVF) yang bertujuan untuk mengetahui perbedaan luaran embrio pada IVF dengan teknik fresh oocyte dan vitrifikasi oosit. Tempat penelitian dilakukan di Halim Fertility Center (HFC), Departemen Obstetri dan Ginekologi Fakultas Kedokteran Universitas Sumatera Utara Divisi Fertilisasi, Endokrinologi, dan Reproduksi, RSUP H. Adam Malik Medan pada periode Desember 2016 sampai dengan September 2017. Seluruh sampel adalah pasien yang menjalani IVF dengan fresh oocyte dan yang dilakukan vitrifikasi oosit terlebih dahulu. Data yang dikumpulkan ditabulasi menggunakan program perangkat lunak statistik. Data yang disajikan memiliki distribusi yang berbeda sehingga digunakan metode yang berbeda pada setiap variabel. Untuk menguji perbedaan mean variabel dengan data tidak berdistribusi normal dilakukan uji Mann Whitney dan Chi Square, sementara untuk data berdistribusi normal digunakan uji T-tidak berpasangan, dengan signifikansi p<0.005. Hasil : Dari 105 pasien, karakteristik sampel penelitian terdiri dari jumlah oosit, umur (tahun), BMI (kg/m2), kadar FSH, densitas sperma, dan motilitas sperma, dan tidak dijumpai adanya perbedaan mean pada tiap variabel, (p value > 0,005). Pada distribusi morfologi pada oosit vitrifikasi dijumpai fragmented polar body sebanyak 44,21%, 1 polar body sebanyak 18,94%, oosit granular dijumpai 20%, oosit SER tidak dijumpai, oosit oval 2,1% dan oosit PVS sebanyak 14,73%. Pada fresh oocyte dijumpai fragmented polar body sebanyak 43,47%, 1 polar body dijumpai 14,49%, oosit granular sebanyak 23,18%, oosit SER sebanyak 1,44%, oosit oval sebanyak 8,69% dan oosit PVS sebanyak 8,69%. Pada oocyte survive dijumpai adanya perbedaan antara uji mean kedua kelompok oosit vitrifikasi dan fresh oocyte, dengan p value <0,005, sementara untuk nilai fertilisasi dan embryo cleaved tidak dijumpai adanya perbedaan antara uji mean pada kedua kelompok. Mengenai kualitas embrio, pada grade 1 dijumpai adanya perbedaan yang bermakna dengan p value = 0,025, sementara pada grade 2 dan grade 3 tidak dijumpai adanya perbedaan. Untuk useable embryo tidak dijumpai adanya perbedaan dengan p value = 0,095. Kesimpulan : Tidak dijumpai adanya perbedaan yang bermakna pada luaran embrio IVF teknik fresh oocyte dengan vitrifikasi oosit.

Objective: To find the difference between embryo morphology in IVF between fresh oocyte and vitrified oocyte. Methods: This research was an observational analytic study with prospective cohort design on secondary data in the form of medical record of female patients that had undergone in vitro fertilization (IVF) that was aimed to know the difference of embryo outcome in IVF between fresh oocyte technique and vitrified oocyte. The study was conducted at Halim Fertility Center (HFC), Department of Obstetrics and Gynecology Faculty of Medicine, University of Sumatera Utara Division of Fertilization, Endocrinology, and Reproduction, H. Adam Malik General Hospital Medan from December 2016 to September 2017. All samples were patients who undergone IVF with fresh oocyte or vitrified oocyte first. The data is tabulated using a statistical software program. The data presented have different distributions so that different methods were used for each variable. To test the difference of the mean of variables with non-normal distributed data, the tests that used were Mann Whitney and Chi Square, while for normal distributed data it was used unpaired T-test, with significance p<0.005. Results: Of 105 patients, the characteristics of the study sample consisted of the number of oocytes, age (years), BMI (kg/m2), FSH levels, sperm density, and sperm motility, and no mean differences found in each variable (p value> 0.005). In morphological distribution of vitrified oocyte, it was found fragmented polar body as much as 44.21%, 1 polar body as much as 18.94%, granular oocyte was found 20%, SER oocyte was not found, oval oocyte was 2.1% and PVS oocyte was 14.73%. In fresh oocyte, it was found 43.47% fragmented polar body, 1 polar body was found 14.49%, granular oocyte as much as 23.18%, SER oocyte as much as 1.44%, oval oocyte as much as 8.69% and PVS oocyte as much as 8.69%. In oocyte survive, there was a difference between the test of the mean of both groups of vitrified oocyte and fresh oocyte, with p value <0.005, while for fertilization and embryo cleaved there was no difference between the mean test in both groups. About the embryo quality, in grade 1 group it was found a significant difference with p value = 0.025, while in grade 2 and grade 3 there were no difference found. For usable embryo, there was no difference with p value = 0.095. Conclusion: There was no significant difference in embryo morphology in IVF between fresh oocyte technique and vitrified oocyte.