Universitas Sumatera Utara

KORELASI ANTARA ALIRAN DARAH CORPUS LUTEUM DENGAN KONSENTRASI SERUM PROGESTERON PADA WANITA INFERTIL Siregar B R P, Halim B, Rusda M Departemen / SMF Obstetri dan Ginekologi Fakultas Kedokteran Universitas Sumatera Utara / RSUP H. Adam Malik / Unit/Sub-Divisi Teknologi Reproduksi Bayi Tabung, Divisi FER,Dept Obgyn FK-USU ”Halim Fertility Centre” Medan --------------------------------------------------------------------------------------------------------------------------------ABSTRAK Tujuan : Tujuan penelitian ini adalah untuk mengetahui Adakah Korelasi yang signifikan antara Aliran darah Corpus Luteum dengan Konsentrasi serum Progesteron pada Fase Luteal wanita infertil.Dan untuk menilai parameter manakah dari Aliran Darah Corpus Luteum yang menjadi Prediktor terbaik untuk menegakkan diagnosa Defek Fase Luteal sebagai parameter diagnostik alternatif selain melalui penilaian Kadar Serum Progesteron Rancangan Penelitian : Penelitian ini merupakan suatu penelitian survei analitik dengan menggunakan rancangan potong lintang (cross sectional study),dilaksanakan di Unit / Sub-Divisi Teknologi Reproduksi Bayi Tabung, Divisi FER, Dept Obgin ,FK-USU “Halim Fertility Centre”, Medan,berlangsung dimulai dari 1 November 2010 sampai dengan 30 April 2011. Sampel penelitian adalah semua wanita infertil yang merupakan wanita usia reproduksi ( 15 – 45 tahun ) yang yang dilakukan dengan Consecutive Sampling diseleksi menurut kriteria inklusi dan eksklusi yang datang memeriksakan diri ,kemudian yang memenuhi kriteria inklusi dan bersedia ikut serta,diambil sebagai sampel penelitian. Dengan rumus Korelasi Pearson (r = 0.433) dari liteartur, didapatkan sebanyak 41 sampel. Data – data yang dikumpulkan dibuat dalam Tabulasi Induk, diolah secara komputerisasi dengan menggunakan SPSS versi 19.0. Data disajikan dengan nilai Rata-rata ± Standar Deviasi . Data disajikan dalam bentuk Grafik Scattered Dot. Untuk melihat hubungan signifikansi antar variabel dilakukan dengan analisis korelasi Pearson dan dinyatakan bermakna jika nilai p < 0.05, dan dengan menggunakan nilai r untuk melihat kuatnya hubungan antar variabel penelitian. Hubungan akan semakin kuat jika mendekati nilai +1 atau -1Arah korelasi dinyatakan positif (+) jika ditemukan variabel yang satu berbanding lurus dengan variabel yang lainnya dan negatif (-) jika ditemukan variabel yang satu berbanding terbalik dengan variabel yang lainnya Material dan Metode Penelitian : Tiap responden yang memenuhi kriteria inklusi masing masing diberikan Chart Suhu Basal Badan untuk dicatat suhu basal badannya pada pagi hari setiap hari selama 28 hari. Hari ke 14 diperkirakan merupakan suhu terendah selama siklus, dan dinyatakan sebagai hari ovulasi. Setelah ovulasi, terbentuk Corpus Luteum yang memproduksi Progesteron. Puncak fase Luteal yaitu 7 hari setelah ovulasi. Pada hari ke 21 pasien diminta datang untuk dilakukan pemeriksaan konsentrasi serum progesteron,dan selanjutnya dilakukan USG Power Doppler Transvaginal untuk menilai Aliran darah Corpus Luteum (PSV,EDV,PI,RI,Volume Corpus Luteum), kemudian data dikumpulkan sampai 41 sampel terpenuhi dan ditabulasi, lalu dilakukan Uji Korelasi Pearson. Hasil Penelitian : Dengan uji korelasi Pearson, secara statistik ditemukan hubungan yang bermakna antara kadar serum Progesterone dan Peak Systolic Velocity (PSV) pada Corpus Luteum dengan nilai p=0.000 (p<0.05) dan ditemukan hubungan korelasi positif dengan kekuatan kuat dengan nilai r = 0.567. Ditemukan hubungan yang bermakna antara kadar serum Progesterone dan End Diastolic Velocity (EDV) pada Corpus Luteum dengan nilai p=0.000 (p<0.05) dan ditemukan hubungan korelasi positif dengan kekuatan kuat dengan nilai r = 0.604 Ditemukan hubungan yang bermakna antara kadar serum Progesteron (ng/ml) dan Pulsatility Index pada Corpus Luteum dengan nilai p = 0.032 (p<0.05) dan ditemukan hubungan korelasi negatif dengan kekuatan lemah dengan nilai r = -0.332. Ditemukan hubungan yang bermakna antara kadar serum Progesteron dan Resistance Index pada Corpus Luteum dengan nilai p = 0.002 ( p < 0.05 ); dan ditemukan hubungan korelasi negatif dengan kekuatan sedang dengan nilai r = - 0.463. Ditemukan hubungan yang tidak bermakna antara kadar serum Progesteron dan Volume Corpus Luteum (mm3) dengan nilai p = 0.992 ( p > 0.05 ) dan ditemukan hubungan korelasi positif dengan kekuatan sangat lemah

Universitas Sumatera Utara

dengan nilai r = 0.002. Diperoleh nilai cut off point dari Pulsatility Index (PI) sebagai alat diagnostik yang paling baik nilai AUC-nya (AUC=70,1%) dibandingkan dengan variabel-variabel prediktor (alat diagnostik ) lainnya pada defek fase luteal adalah 1,085 dengan sensitivitas 73,3 % dan spesifisitas 66,7 %. Kesimpulan : Ada korelasi yang bermakna antara Peak Systolic Velocity (PSV) Aliran Darah Corpus Luteum dengan Konsentrasi Serum Progesteron dan ditemukan hubungan korelasi positif dengan Kekuatan Korelasi sedang. Ada korelasi yang bermakna antara End Diastolic Velocity (EDV) Aliran Darah Corpus Luteum dengan Konsentrasi Serum Progesteron dan ditemukan hubungan korelasi positif dengan Kekuatan Korelasi kuat. Ada korelasi yang bermakna antara Pulsatility Index Aliran Darah Corpus Luteum dengan Konsentrasi Serum Progesteron dan ditemukan hubungan korelasi negatif dengan Kekuatan Korelasi lemah .Ada korelasi yang bermakna antara Resistance Index Aliran Darah Corpus Luteum dengan Konsentrasi Serum Progesteron dan ditemukan hubungan Korelasi negatif dengan Kekuatan Korelasi sedang. Ada Korelasi yang tidak bermakna antara Volume Corpus Luteum (mm3) dengan Konsentrasi Serum Progesteron dan ditemukan hubungan korelasi positif dengan kekuatan Korelasi sangat lemah Diperoleh nilai Pulsatility Index (PI) sebagai nilai untuk alat diagnostik yang paling baik , dimana nilai AUC-nya (AUC=70,1%) dibandingkan dengan variabel-variabel prediktor (alat diagnostik ) lainnya pada defek fase luteal ,dengan nilai cut-off point nya adalah 1,085 dengan sensitivitas 73,3 % dan spesifisitas 66,7 %. Kata Kunci : Suhu Basal Badan, Volume Corpus Luteum, Peak Systolic Velocity, End Diastolic Velocity, Pulsatility Index, Resistance Index, Konsentrasi serum Progesteron,Defek Fase Luteal.


DAFTAR ISI

PEMBIMBING PENELITIAN………………………………………………………………. i LEMBAR PENGESAHAN PENELITIAN…………………………………………………..ii KATA PENGANTAR………………………………………………………………………...iv ABSTRAK TESIS……………………………………………………………………………xiii DAFTAR ISI……………………………………………………………………………….…xv DAFTAR GAMBAR………………………………………………………………………....xix DAFTAR TABEL…………………………………………………………………………….xx DAFTAR GRAFIK…………………………………………………………………………..xxi DAFTAR SKEMA…………………………………………………………………………. .xxii DAFTAR SINGKATAN………………………………………………………………….....xxiii DAFTAR LAMPIRAN…………………………………………………………………...….xxv

BAB I PENDAHULUAN I.1 LATAR BELAKANG...........................................................................................................1 I.2 RUMUSAN MASALAH……………………………………………………. .....................7 I.3 TUJUAN PENELITIAN .......................................................................................................7 I.3.1 TUJUAN UMUM……………………………………………………………………..7 I.3.2 TUJUAN KHUSUS.......................................................................................................7 I.4 HIPOTESIS PENELITIAN...................................................................................................8 I.5 MANFAAT PENELITIAN ..................................................................................................8

BAB II TINJAUAN KEPUSTAKAAN II.1 CORPUS LUTEUM.............................................................................................................9


II.2 TUMBUH KEMBANG CORPUS LUTEUM .....................................................................9 II.3 PATHWAY STEROIDOGENIK LUTEAL .....................................................................10 II.4 REGULASI FUNGSI LUTEAL ........................................................................................12 II.5 ANGIOGENESIS CORPUS LUTEUM ............................................................................13 II.5.1 PENDAHULUAN......................................................................................................13

II.5.2 FAKTOR-FAKTOR YANG MEMPENGARUHI ANGIOGENESIS CORPUS LUTEUM...................................................................................................14 II.5.2.1 PERUBAHAN DALAM JUMLAH PERISIT ..............................................14 II.5.2.2 STABILISASI PEMBULUH DARAH.........................................................15 II.5.3 FAKTOR ANGIOGENIK..........................................................................................15 II.5.3.1 FAKTOR PERTUMBUHAN ENDOTELIAL ................................................15 II.5.3.2 ANGIOPOEITIN..............................................................................................15 II.5.4 REGULASI MOLEKULER ANGIOGENESIS CORPUS LUTEUM ......................17 II.5.5 ANGIOGENESIS DAN FUNGSI LUTEAL .............................................................18 II.6 DETEKSI ALIRAN DARAH LUTEAL PADA CORPUS LUTEUM .............................19 II.7 PENILAIAN ANGIOGENESIS CORPUS LUTEUM ......................................................19 II.7.1 VOLUME CORPUS LUTEUM.................................................................................20 II.7.2 PEAK SYSTOLIC VELOCITY (PSV) DAN EDV (END DIASTOLIC VELOCITY) ALIRAN DARAH CORPUS LUTEUM ...........20 II.7.3 INDEKS PULSATILITAS (PI=PULSATILITY INDEX) ........................................20 II.7.4 INDEKS RESISTENSI (RI= RESISTANCE INDEX) .............................................21 II.8 KONSENTRASI SERUM PROGESTERON....................................................................22 II.8.1 PERAN PROGESTERON PADA SUMBU HIPOTHALAMUS-HIPOFISIS..........22 II.8.2 PERAN PROGESTERON DALAM SISTEM REPRODUKSI ................................24


II.8.3 DEFEK FASE LUTEAL............................................................................................25 II.9 PENENTUAN DEFISIENSI SEKRESI PROGESTERON OLEH CORPUS LUTEUM PADA FASE LUTEAL .....................................................................................................25 II.9.1 SAAT OVULASI DAN PEMBENTUKAN CORPUS LUTEUM ............................25 II.9.2 PENGUKURAN SUHU BASAL BADAN (BBT=BASAL BODY TEMPERATURE).................................................................26 II.9.3 PENENTUAN PANJANG FASE LUTEAL .............................................................28 II.9.4 PEMERIKSAAN KONSENTRASI SERUM PROGESTERON FASE LUTEAL...28 II.9.5 PEMANTAUAN DENGAN ULTRASONOGRAFI.................................................29 II.9.6 BIOPSI ENDOMETRIUM ........................................................................................29 II.10 HUBUNGAN ALIRAN DARAH CORPUS LUTEUM DENGAN KONSENTRASI SERUM PROGESTERON .................................................................30 II.10.1 HUBUNGAN PEAK SYSTOLIC VELOCITY (PSV) DENGAN KONSENTRASI SERUM PROGESTERON PADA FASE MID-LUTEAL .........31 II.10.2 HUBUNGAN END DIASTOLIC VELOCITY (EDV) DENGAN KONSENTRASI SERUM PROGESTERON PADA FASE MID-LUTEAL .........32 II.10.3 HUBUNGAN PULSATILITY INDEX (PI) DENGAN KONSENTRASI SERUM PROGESTERON PADA FASE MID-LUTEAL ......................................33 II.10.4 HUBUNGAN RESISTANCE INDEX (RI) DENGAN KONSENTRASI SERUM PROGESTERON.......................................................................................34 II.10.5 HUBUNGAN VOLUME CORPUS LUTEUM DENGAN KONSENTRASI SERUM PROGESTERON.......................................................................................36

BAB III METODE PENELITIAN III.1 DESAIN PENELITIAN....................................................................................................39


III.2 TEMPAT DAN WAKTU PENELITIAN.........................................................................39 III.3 POPULASI DAN SAMPEL PENELITIAN III.3.1 POPULASI PENELITIAN .......................................................................................39 III.3.2 SAMPEL PENELITIAN...........................................................................................39 III.3.3 BESAR SAMPEL PENELITIAN.............................................................................40 III.3.4 KRITERIA SAMPEL III.3.4.1 KRITERIA INKLUSI .....................................................................................41 III.3.4.2 KRITERIA EKSKLUSI..................................................................................41 III.4 MATERIAL DAN METODE PENELITIAN III.4.1 MATERIAL ALAT PENELITIAN .........................................................................41 III.4.2 MATERIAL BAHAN PENELITIAN.......................................................................42 III.4.3 METODE/ CARA KERJA PENELITIAN ...............................................................42 III.5 ALUR PENELITIAN .......................................................................................................51 III.6 VARIABEL PENEITIAN ................................................................................................52 III.7 KERANGKA KONSEP PENELITIAN ...........................................................................52 III.8 BATASAN OPERASIONAL PENELITIAN...................................................................54 III.9 PENGOLAHAN DATA ...................................................................................................56 III.10 ETIKA PENELITIAN ....................................................................................................57

BAB IV HASIL PENELITIAN DAN PEMBAHASAN..........................................................59

BAB V KESIMPULAN DAN SARAN V.1 KESIMPULAN..................................................................................................................89 V.II SARAN .............................................................................................................................90


DAFTAR GAMBAR

Gambar 1 Penyebab infertilitas pada pasangan suami-istri ......................................................... 1 Gambar 2 Fase Proliferasi Endometrium / Fase Folikuler Ovarium ,Ovulasi dan Fase Sekresi Endometrium / Fase Luteal Ovarium Siklus Menstruasi Wanita ............................... 3 Gambar 3 Sel Theca Lutein dan Sel Granulosa Lutein.............................................................. 10 Gambar 4 Tumbuh Kembang Corpus Luteum........................................................................... 10 Gambar 5 Pathway Biosintesis Progesteron dalam Sel-sel Luteal ............................................ 11 Gambar 6 Siklus Hidup Corpus Luteum.................................................................................... 12 Gambar 7 Hipotesis Regulasi perubahan pembuluh darah oleh VEGF, Angiopoietin-1, dan Angiopoietin-2 selama perkembangan dan regresi Corpus Luteum .......................................16

Gambar 8 Mekanisme biomolekuler Angiogenesis dalam Corpus Luteum selama siklus Menstruasi dan pada Awal Kehamilan ...................................................................................18

Gambar 9 Hasil Scaning Aliran Darah (Angiogenesis) Corpus Luteum dalam Ovarium......... 21 Gambar 10Interpretasi Hasil Scanning Aliran Darah ( Angiogenesis ) Corpus Luteum Dalam Ovarium Pada USG Doppler Transvaginal ..................................................................... 22

Gambar 11Gambaran Mekanisme Hipothalamus Hipofisis Ovarium dalam Mempengaruhi Corpus Luteum Memproduksi Progesteron .............................................................. 23 Gambar 12Representasi Skematik perubahan vaskularisasi selama hidup Folikel tunggal yang diseleksi untuk menjadi matang dan ber-Ovulasi ..................................................... 25 Gambar 13Rekaman Suhu Basal Badan Ideal ............................................................................ 26 Gambar 14Contoh TABEL BBT ( BASAL BODY TEMPERATURE ) IDEAL ..................... 44 Gambar 15Ilustrasi Penggunaan Usg Doppler Transvaginal

…………………………………..47

Gambar 16Aliran Darah ( Angiogenesis ) Corpus Luteum Di Dalam Ovarium Pada USG


Doppler Transvaginal………………………………………………………………49 Gambar 17Hasil Scanning Aliran Darah ( Angiogenesis ) Corpus Luteum Dalam Ovarium Pada USG Doppler Transvaginal…………………………………………50


DAFTAR TABEL

Tabel 2.1 Peran Progesteron untuk Implantasi dan Perkembangan Folikel ................................ 23 Tabel 4.1 Hubungan peak systolic velocity (PSV) aliran darah corpus luteum dengan konsentrasi serum progesteron.......................................................................................................59 Tabel 4.2 Hubungan end diastolic velocity (EDV) aliran darah corpus luteum dengan konsentrasi serum progesteron.......................................................................................................62 Tabel 4.3Hubungan pulsatility index (PI) alirandarah corpus luteum dengan konsentrasi serum progesteron..................................................................................................................63 Tabel 4.4Hubungan resistance index (RI) aliran darah corpus luteum dengan konsentrasi serum progesteron..................................................................................................................67 Tabel 4.5 Hubungan volume corpus luteum dengan konsentrasi serum progesteron....................69 Tabel 4.6.1 Sebaran subyek penelitian berdasarkan karakteristik umur…………………………72 Tabel 4.6.2 Sebaran subyek penelitian berdasarkan karakteristik BMI…………………………72 Tabel 4.6.3 Sebaran subyek penelitian berdasarkan karakteristik kadar serumProgesteron…….73 Tabel 4.7 Distribusi perbedaan rata – rata dari variabel-variabel prediktor terjadinya defek fase luteal yang dikategorikan berdasarkan kadar serum progesterone < 10 ng/ml dan >10ng/dl……74

Tabel 4.8 Hubungan variabel-variabel prediktor terhadap kadar serum progesteron pada subyek Penelitian……………………………………………………………………………..76 Tabel 4.9 Nilai Adjusted R Square dari variabel-variabel prediktor kadar serum Progesteron.………………………………………………………………………….77 Tabel 4.10 Nilai sensitivitas dan spesifisitas serta cut off point dari pemeriksaan Kadar Serum Progesteron pada defek fase luteal……………………………………………………..79 Tabel 4.10.1 Nilai sensitivitas dan spesifisitas serta cut off point dari pemeriksaan Pulsatility Index (PI) pada defek fase luteal……………………………………………………………………..85


DAFTAR GRAFIK

Grafik 1 Korelasi antar Peak Systolic Velocity (PSV) Aliran Darah Corpus Luteum dengan Konsentrasi Serum Progestereon……………………………………………………..60 Grafik 2 Korelasi antar End Diastolic Velocity (EDV) Aliran Darah Corpus Luteum dengan Konsentrasi Serum Progestereon……………………………………………………..63 Grafik 3 Korelasi antar Pulsatility Index (PI) Aliran Darah Corpus Luteum dengan Konsentrasi Serum Progestereon……………………………………………………..64 Grafik 4 Korelasi antar Resistance Index (RI) Aliran Darah Corpus Luteum dengan Konsentrasi Serum Progestereon……………………………………………………..67 Grafik 5 Korelasi antar Corpus Luteum dengan Konsentrasi Serum Progestereon…………...70 Grafik 6 Receiver Operating Characteristic (ROC) dari kadar serum progesterone pada defek fase luteal…………………………………………………………..…………….78

Grafik 7 Receiver Operating Characteristic (ROC) dari Peak Systolic Velocity (PSV) pada defek fase luteal…………………………………………………………………………81

Grafik 8 Receiver Operating Characteristic (ROC) dari End Diastolic Velocity (EDV) pada defek fase luteal……………………………………………………………………………82

Grafik 9 Receiver Operating Characteristic (ROC) dari Pulsatility Index (PI) pada defek fase Luteal……………………………………………………………………………………….,83

Grafik 10 Receiver Operating Characteristic (ROC) dari Resistance Index (RI) pada defek fase luteal………………………………………………………………………….…………87


DAFTAR SKEMA

Skema 1. KERANGKA TEORI PENELITIAN .......................................................................38 Skema 2. ALUR PENELITIAN ...............................................................................................51 Skema 3. KERANGKA KONSEP PENELITIAN…………………………………………..52


DAFTAR SINGKATAN

α-SMA

α Smooth Muscle Actin

Ang 1

Angiopoeitin 1

Ang 2

Angiopoeitin 2

HSD

Hydroxysteroid Dehydrogenase

BBT

Basal Body Temperature

CL

Corpus Luteum

COS

Controlled Ovarian Stimulation

CTGF

Connective Tissue Growth Factor

EDTA

Ethylene Diamine Tetraacetic Acid

EDV

End Diastolic Velocity

FER

fertilitas endokrinologi

FSH

Follicle Stimulating Hormone

GH

Growth Hormone

GnRH

Gonadotrophin Releasing Hormone

hCG

human Chorionic Gonadothropin


HDL

High Density Lipoproteinm

IGF-I

Insulin Like Growth Factor I

IVF

In Vitro Fertilization

LDL

Low Density Lipoprotein

LH

Luteinizing Hormone

LLC

Large Luteal Cells

LPD

Luteal Phase Defect

mRNA

messenger ribo nucleic acid

OHSS

Over Hyper Stimulation Syndrome

PCOS

Poly Cistic Ovarium Syndrome

PGE2

Prostaglandin E2

PGI 2

Prostaglandin I2

PI

Pulsatility Index

PIBF

progesteron induced blocking factor

PSV

Peak Systolic Velocity

RI

Resistance Index

ROC

Receiver Operating Characteristic Curve

SLC

Small Luteal Cells


StAR

Steroidogenic acute regulatory protein

USG

Ultasonography

VEGF

Vascular Endotelial Growth Factor


DAFTAR LAMPIRAN

Lampiran 1. LEMBAR INFORMASI PASIEN………………………………………………….. Lampiran 2. LEMBAR PERSETUJUAN PASIEN……………………………………………… Lampiran 3. KUESIONER PESERTA PENELITIAN………………………………………….. Lampiran 4. PERSETUJUAN DAN PENGESAHAN KOMITE ETIK PENELITIAN……….. Lampiran 5. TABEL INDUK PESERTA PENELITIAN………………………………………..


CORRELATION BETWEEN CORPUS LUTEUM BLOOD FLOW AND PROGESTERONE SERUM CONCENTRATION IN INFERTILE WOMEN Boy Rivai Pandapotan Siregar, Binarwan Halim, Muhammad Rusda Departement of Obstetrics and Gynecology Medical School, University of Sumatera Utara / H. Adam Malik General Hospital / Sub-Division of Reproduction Technology of IVF, Division of FER,Dept of Obgyn, Medical School-USU ”Halim Fertility Centre” Medan ABSTRACT Objective : The purpose of this study is to assess wether any significant correlation between corpus luteum blood flow and progesterone serum concentration on lutheal phase in infertile women. And to determine which parameter of corpus luteum blood flow would be the best predictor to diagnose the lutheal phase defect, as an alternative diagnostic parameter beside the Progesteron Serum Level. Study Design : This was an analytic survey study research with cross sectional study design, which performed in Sub-Division of Reproduction Technology of IVF, Division of FER, Obgyn Departement ,Medical School-USU “Halim Fertility Centre”, Medan, since November 1st 2010 until April 30th 2011. The samples of this study were obtained of all infertile women of reproductive age (15 - 45 years old) which collected by Consecutive Sampling, who is being selected according to inclusion and exclusion criteria which came to pursue medical check up, then fulfilled the inclusion criterias and willing to participate on this research. By Correlation Pearson Formula (r = 0.433) from literature, 41 samples were obtained to participate. The 41 samples data which completely collected , composed in a master of tabulation, then computerized by using Computer Statistic Program. Data presented on average values (Mean)± standard deviation. The presented data described in a scattered Dot graph form. To assess the significance of the relationship between the two variables were used Pearson correlation analysis and expressed significant if p value <0.05 and by using the r value to described the strength of the relationship between the two variables of this study. The relationship would be stronger if closer to the value of +1 or-1. The correlation would be positive (+) if found that one variable is directly proportional to the other variable and would be negative (-) if found that one variable varies inversely with the other variable. Material and Method: Each respondent who fulfilled the inclusion criteria are given respectively a Basal Body Temperature Chart to record their basal body temperature in the morning every day for 28 days recorded. Day 14 has been estimated as the lowest temperature during the menstrual cycle, and declared as the day of ovulation. After ovulation, corpus luteum would be formed and developed then started to produces progesterone. Peak of the luteal phase has been estimated on 7 days after ovulation. On day 21 patients were


asked to come and pursue the progesterone serum concentration examination, and then performed ultrasound Transvaginal Power Doppler to assess corpus luteum blood flow (PSV, EDV, PI, RI, Volume Corpus Lutem). Each patient which completely examined were recorde on a medical record ,then the Medical Record data collected until completely 41 samples ,and the data were tabulated , then the tabulated data were examined on Pearson correlation test. Results : By Pearson correlation test, statistically significant correlation was found between serum level of Progesterone (ng/ml) and Peak Systolic Velocity (PSV) of the corpus luteum (cm/s) with p = 0.000 (p <0.05) and was found a positive correlation with the strength value was moderate with r = 0,567. Was found a significant correlation between serum level of Progesterone (ng/ml) and End Diastolic Velocity (EDV) of the corpus luteum (cm/s) with p = 0.000 (p <0.05) and was found a positive correlation with the strength value was strong with r = 0,604. Was found a significant correlation between serum level of progesterone ( ng / ml) and Pulsatility Index of the Corpus Luteum with p = 0.032 (p <0.05) and found a negative correlation with the strength value was weak with r = -0.332. Was found a significant correlation between serum level of progesterone (ng/ml) and Resistance Index of the corpus luteum with p = 0.002 (p <0.05), and found a negative correlation with the strength value was moderate with r = 0.463. Was found no significant relationship between serum level of progesterone (ng/ml) and the volume of Corpus Luteum (mm3) with p = 0.992 (p> 0.05), and found a positive correlation with the strength value was very weak with r = 0.002. Retrieved the Pulsatility Index (PI) as the best diagnostic tool in this study. AUC value (AUC = 70.1%) which compared to other predictor variables (diagnostic tools) to predict the luteal phase defect ,with cut off point value was 1.085 with a sensitivity of 73, 3% and a specificity of 66.7%. Conclusion : There is significant correlation between the Peak Systolic Velocity (PSV) of Corpus luteum blood flow (cm/s) and Progesterone serum concentration (ng/ml) and found a positive correlation with the strength value was moderate. There is significant correlation between the End Diastolic Velocity (EDV) of Corpus Luteum blood flow (cm/s) and Progesterone serum concentration (ng/ml) and found a positive correlation with the strength value was strong. There is significant correlation between the Pulsatility Index of Corpus Luteum blood flow and Progesterone Serum Concentration (ng/ml) and found a negative correlation with the strength value was weak. There is significant correlation between the Resistance Index of Corpus Luteum blood flow and Progesterone Serum Concentrations (ng/ml) and found negative correlation with the strength value was moderate. There was no significant correlation between the volume of Corpus Luteum (mm3) and Progesterone Serum Concentrations and found a positive correlation with the strength value was very weak. Retrieved the Pulsatility Index (PI) as the best diagnostic tool in this study. AUC value (AUC = 70.1%) which compared to other predictor variables (diagnostic tools) to predict the luteal phase defect ,with cut off point value was 1.085 with a sensitivity of 73, 3% and a specificity of 66.7%.


Key Words : Body Basal Temperature, Corpus Luteum Volume, Peak Systolic Velocity, End Diastolic Velocity, Pulsatility Index, Resistance Index, Progesteron Serum Concentration, Luteal Phase Defect.


Universitas Sumatera Utara

Recommend Documents