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All Journal Majalah Kedokteran Bandung Jurnal Promkes: The Indonesian Journal of Health Promotion and Health Education Majalah Obstetri dan Ginekologi The Indonesian Biomedical Journal Universa Medicina Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia) eJournal Kedokteran Indonesia Jurnal Kedokteran Meditek
Achmad Kemal Harzif
Obstetric And Gynecology Department, Faculty Of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National General Hospital, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Anti-Müllerian Hormone Levels as Predictor of In Vitro Fertilization Outcomes Mila Maidarti; Prini Diandara Garinasih; Aprilia Asthasari Siregar; Gita Pratama; Achmad Kemal Harzif; Kanadi Sumapraja; Budi Wiweko
eJournal Kedokteran Indonesia Vol 9, No. 2 - Agustus 2021
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (328.455 KB) | DOI: 10.23886/ejki.9.43.87

Abstract

A decrease in serum anti-müllerian hormone (AMH) concentration suggests the reduction of antral follicle number. AMH serum level was correlated with ovarian stimulation outcomes, oocyte quantity and quality, embryo quality and in vitro fertilization (IVF) outcomes. However, the use of AMH to predict pregnancy rates in IVF is still debatable. This study aimed to determine the role of AMH in predicting ovarian response and pregnancy rates in IVF programs. This was a retrospective cohort study involving patients who underwent a short protocol of ovarian stimulation for IVF at the Yasmin clinic, dr Cipto Mangunkusumo General Hospital. from March 2013 to March 2021. A total of 1,527 out of 3,880 IVF cycles were included. Poor ovarian response was determined as a collection of fewer than four oocytes following ovarian stimulation. The data was then analyzed using the Mann Whitney test if the data distribution was not normal or the unpaired t-test if the data distribution was normal. Median AMH levels were higher in the normal (2.5(0.01-32)) compared to poor responder (0.68(0.01-6.86)) group (p<0.05; Mann Whitney). Serum AMH level and age had predictive value for pregnancy rate (p<0.05; Mann Whitney). Keywords: AMH, ovarian response, pregnancy rate, IVF.   Kadar Hormon Anti-Müllerian sebagai Prediktor Luaran Fertilisasi in Vitro Abstrak Penurunan konsentrasi serum hormon anti-müllerian (HAM) menunjukkan penurunan jumlah folikel antral. HAM serum berkorelasi dengan luaran stimulasi ovarium kuantitas dan kualitas oosit serta kualitas embrio dan luaran fertilisasi in vitro (FIV). Namun, penggunaan HAM untuk memprediksi angka kehamilan dengan stimulasi ovarium pada FIV masih diperdebatkan. Tujuan penelitian ini untuk mengetahui peran serum HAM dalam memprediksi respons ovarium dan laju kehamilan pada program FIV. Penelitian ini adalah studi kohort retrospektif yang melibatkan pasien yang menjalani protokol singkat stimulasi ovarium pada program FIV di klinik Yasmin rumah sakit dr Cipto Mangunkusumo.dari bulan Maret 2013 sampai Maret 2021. Sebanyak 1.527 dari 3880 siklus IVF dimasukkan ke dalam penelitian. Dikatakan perespon buruk apabila diperoleh kurang dari empat oosit setelah stimulasi ovarium. Data kemudian dianalisis dengan menggunakan uji Mann Whitney bila sebaran data tidak normal atau uji t tidak berpasangan bila sebaran data normal. Median kadar HAM lebih tinggi pada kelompok perespons baik (2.5 (0.01-32)) dibandingkan perespons buruk (0.68 (0.01-6.86)) (p<0,05; Mann Whitney). Kadar HAM serum dan usia memiliki nilai prediktif terhadap angka kehamilan (p<0,05; Mann Whitney). Kata kunci: hormon anti-Müllerian, respons ovarium, angka kehamilan, FIV.
Evaluation of Estradiol and Pro-Inflammatory Marker Level with VAS Score After Progestin Therapy in Endometriosis Patients Muthalib, Aidrus; Sumapraja, Kanadi; Harzif, Achmad Kemal; Maidarti, Mila
Indonesian Journal of Obstetrics and Gynecology Volume 12 No. 4 October 2024
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v12i4.2531

Abstract

Objectives: To compare estradiol levels and proinflammatory biomarkers (IL-6, IL-1B, and COX-2) in endometriosis patients with pain and without pain after progestin therapy. Methods: This observational cross-sectional study involved 47 endometriosis patients undergoing three months of progestin therapy at RSUPN Cipto Mangunkusumo from March to June 2024. Serum levels of COX-2, IL-6, IL-1B, and estradiol will be measured using ELISA and Microplate Enzyme Immunoassay, with pain status assessed to determine associations between biomarkers and pain presence. Results: A significant difference in COX-2 levels between patients with pain and those without, with higher levels in the pain group [1.845 (1.24-10.26) vs 1.55 (0.32-3.07), p = 0.004]. A significant positive correlation was found between IL-1Beta and IL-6 (r = 0.471, p = 0.001). COX-2 levels also exhibited a weak but statistically significant positive correlation with VAS scores (r = 0.360, p = 0.013). Conclusion: There is a difference in inflammatory markers IL-6, IL-1 Beta and COX-2 in endometriosis patients with progestin therapy who experience pain and painlessness. Keywords: endometriosis, estradiol, proinflammation, progestin therapy.
Effects of autologous platelet-rich plasma in promoting endometrial thickness on patients with thin endometrium following IVF Pratama, Gita; Agustina, Elizabeth; Yanfaunnas, Atika Mahira; Maidarti, Mila; Harzif, Achmad Kemal; Muharam, R.; Wiweko, Budi
Majalah Obstetri & Ginekologi Vol. 32 No. 3 (2024): December
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V32I32024.174-180

Abstract

HIGHLIGHTS It was observed that autologous PRP substantially increased endometrial thickness in individuals experiencing infertility linked to a thin endometrium. The elevated clinical pregnancy rate emphasizes the favorable effectiveness of autologous PRP in addressing issues related to a thin endometrium in IVF programs.   ABSTRACT Objective: The objective of this research was to investigate the impact of autologous platelet-rich plasma (PRP) in enhancing endometrial thickness among individuals experiencing infertility associated with a thin endometrium. Materials and Methods: Nine individuals with a thin endometrium who participated in an in vitro fertilization (IVF) program were enrolled in the study. This study was carried out in Yasmin Clinic, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Patients underwent a hormone replacement protocol involving the preparation of the endometrium with estradiol valerate. Treatment with PRP was initiated when the endometrial thickness was less than 7 mm. Autologous PRP was infused into the uterine cavity between the 10th and 12th days after administering estradiol valerate, and the assessment of endometrial thickness was conducted using ultrasound 48 hours later. A second administration of PRP was provided in cases where the endometrial thickness was below 7 mm. Frozen-thawed embryo transfer (FET) was performed if the endometrium reached adequate thickness (minimum 7 mm). Results: Seven of nine patients had adequate endometrial thickness followed by FET. Endometrial thickness was improved in 8 from 9 patients (88.8%). Five patients were improved at the first autologous PRP infusion (62.5%) and three patients (37.5%) at the second PRP infusion. The implantation rate was 33.3-100%, clinical pregnancy was 100%, and ongoing pregnancy rate was 83.3%. Conclusion: The use of autologous platelet-rich plasma (PRP) successfully stimulates endometrial development in individuals with a thin endometrium during frozen-thawed embryo transfer.
Comparison of natural versus artificial cycles for endometrial preparation prior to frozen embryo transfer Tyagitha, Galuh Anindya; Nuryanto, Kartiwa Hadi; Pratama, Gita; Maidarti, Mila; Harzif, Achmad Kemal; Sumapraja, Kanadi; Lestari, Silvia Werdhy; Ampri, Irfan Arieqal Hatta; Talya, Natasha; Yanfaunas, Atika Mahira
Universa Medicina Vol. 43 No. 3 (2024)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2024.v43.304-312

Abstract

BackgroundThe endometrial preparation phase preceding embryo transfer assumes pivotal significance in achieving optimal endometrial receptivity and ensuring the success of pregnancy. The natural cycle (NC) and artificial cycle (AC) are the preferred methods for many in vitro fertilization (IVF) specialists. The objective of this study was to compare the difference between NC and AC in women undergoing frozen-thawed embryo transfer (FET) after IVF. MethodsA cross-sectional study was conducted involving 150 adult women who underwent FET with a single autologous blastocyst stage embryo in a 5-year period (2014-2019). Bivariate analysis was conducted to discern implantation and pregnancy rates associated with NC and AC for endometrial preparation. Multiple logistic regression was used to assess the association between endometrial preparation and clinical outcomes while adjusting for potential confounders. ResultsOf the 150 subjects meeting study criteria, 19 underwent NC, while 131 underwent AC for endometrial preparation. Natural cycle exhibited a higher biochemical pregnancy rates compared to AC (89.5% vs. 53.4%; p=0.003). Artificial cycle is a significant determinant for biochemical pregnancy rates compared to NC (aOR: 0.132;95% CI: 0.028 – 0.623; p=0.010) ConclusionIn women undergoing FET, NC resulted in higher biochemical pregnancy rates compared to AC. However, clinical pregnancy rates and ongoing pregnancies rates did not exhibit significant disparities between NC and AC. Future studies will hopefully further illuminate which protocol is most suitable for the individual patient. Further multi-center randomized clinical trials are needed to confirm the relationship between biochemical pregnancy rates and NC.
Current Trends in Contraceptive Use and Fertility Concerns Among Women of Reproductive Age in Indonesia Muharam Natadisastra, Raden; Christopher Yo, Edward; Nurdya Irzanti, Alisha; Sumapraja, Kanadi; Kemal Harzif, Achmad; Pratama, Gita; Maidarti, Mila; Hari Kurniawan, Riyan; Wiweko, Budi; Hestiantoro, Andon
Indonesian Journal of Obstetrics and Gynecology Volume 13. No. 1 January 2025
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v13i1.2508

Abstract

Abstract Background Family planning remains a key intervention in reducing maternal mortality and creating prosperous families. Assessing the unmet need for family planning allows insight into the progress of family planning programs. On the other hand, there has been much less attention given to the declining fertility rate in Indonesia. To address both the unmet need and declining fertility rate in Indonesia, this study aimed to investigate the most recent trends in contraceptive use in Indonesia as well as evaluate fertility concerns and access to reproductive healthcare service. Methods Women of reproductive age in Indonesia were asked to fill in an online questionnaire. They were asked about sociodemographic characteristics, marital status, pregnancy history, perception towards fertility, and access to healthcare service and information. Descriptive statistics and independent t-test were performed. Results Of 370 women, more than half (57.8%) had used some form of contraception. The most frequently used contraceptive method was natural family planning (30.3%), followed by condom (20%). Women with no prior sexual history, had never been pregnant before, and had not been married cared more about having a child in the future. Internet and social media represented the most popular information source for family planning. Conclusions Many Indonesian women still prefer traditional contraceptive methods over the more effective modern contraceptive methods. Numerous socio-cultural factors are likely to influence the behaviour of reproductive-age women regarding contraceptive use and childbearing in the future. More effort should be put into raising awareness about modern contraceptive methods and addressing fertility concerns. Keywords: contraception; fertility; family planning; awareness; reproduction
Knowledge, Attitude, and Perception Towards Condom Use among Female Sex Workers in North Jakarta: A Mixed-Method Study Harzif, Achmad Kemal; Surya, Raymond; Chiprion, Ariel Timy; Mutia, Heidi Dewi; Puspawardani, Aisyah Retno; Ummah, Nafi'atul; Nurbaeti, Putri; Sayogo, Atikah; Wiweko, Budi
Jurnal Promkes: The Indonesian Journal of Health Promotion and Health Education Vol. 13 No. 1 (2025): Jurnal Promkes: The Indonesian Journal of Health Promotion and Health Educatio
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jpk.V13.I1.2025.83-92

Abstract

Background: HIV/AIDS is a significant global health and social issue, particularly affecting sex workers, who are the second most common high-risk population. Efforts have been attempted to address the challenges, including promoting safer sex and increasing sex workers’ awareness of condom use to reduce sexually transmitted disease (STDs) transmission. Objectives: This study aimed to examine the knowledge, attitude, and perception among FSWs in North Jakarta towards condom use to prevent HIV. Method: Using a validated WHO questionnaire, this cross-sectional community-based study was conducted in pubs and lounges in North Jakarta among 182 FSWs. The questionnaire was translated forward and backward to ensure accuracy. The data were analyzed using SPSS Statistics for Windows and transcription in MS Word for qualitative data. Results: The reliability test for knowledge and attitude were 0.427 and 0.456, respectively. The study found that most participants (75%) had good knowledge about the benefits of condom use, and most agreed that condoms are suitable for casual or established relationships. However, due to cultural barriers in Indonesia, most subjects (68.1%) felt embarrassed about buying condoms.  Conclusion: The study found that FSWs possess a good knowledge and attitude regarding the utilization of condoms to avert STDs, particularly HIV/AIDS. Nonetheless, there is a need to enhance FSWs’ attitudes towards condom use and perceptions of health services, particularly those related to STDs, given their classification as a population at high risk.
Serial Kasus : Presentasi Klinis dan Tata Laksana Nodul Endometriosis Subkutan Franciska, Shelly; Harzif, Achmad Kemal; Lethulur, Shindie Dona Kezia
Jurnal Kedokteran Meditek Vol 31 No 2 (2025): MARCH
Publisher : Fakultas Kedokteran Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jkdoktmeditek.v31i2.3479

Abstract

Introduction: Subcutaneous endometriosis is a rare condition with endometrial tissue localized outside the pelvis and often mimics general endometriosis. The novelty of this study is an in-depth understanding of the specific risk factors associated with subcutaneous endometriosis after cesarean section and how optimal therapeutic approaches can provide better outcomes in patients with a history of endometriosis. This study aims to explore the clinical presentation, outcomes, and managerial approaches to this condition, as well as provide evidencebased recommendations for its management. Case Illustration: This study involved seven patients at Cipto Mangunkusumo Hospital (January 2022–December 2024). Data collected included demographics, age, BMI, initial symptoms, time of symptom onset, history of cesarean section, history of endometriosis, complications, nodule size, therapeutic approaches, and clinical outcomes. Discussion: Of the seven patients, three underwent one cesarean section, two underwent two operations, and two underwent more than two cesarean sections. A history of diffuse adenomyosis was found in three patients. Subcutaneous nodules located mainly in the cesarean scar, had highly variable sizes and caused significant pain (VAS 5–6). Dienogest therapy was given to three patients and significantly reduced pain. Conclusion:Subcutaneous endometriosis is often associated with a history of abdominal surgery, especially cesarean section. Extrapelvic location can be mistaken for keloid or fibroma, which hinders timely diagnosis. The novelty of this study lies in emphasizing the importance of multidisciplinary collaboration in the management of subcutaneous endometriosis, especially involving plastic surgeons to improve aesthetic results and prevent recurrence. Treatment involving hormonal therapy or surgery, based on the size and location of the nodule, is essential for optimal results.
Prevalence, Severity, and Self-Medication for Dysmenorrhea among Female Adolescents in Indonesia Zulimartin, Handika; Harzif, Achmad Kemal; Shadrina, Amalia; Harahap, Juliana Sari; Tanjung, Anton; Muharam, R.
Majalah Kedokteran Bandung Vol 57, No 2 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Dysmenorrhea, commonly referred to as menstrual pain, is a prevalent condition affecting many reproductive-aged women, particularly female adolescents, with varying degrees of intensity. Dysmenorrhea affects 64.5% of female adolescents in Indonesia, with the highest prevalence rates found in West Java (98.8%) and Jakarta (87.5%). Over the years, various therapy modalities have been developed for treating this condition based on its pathophysiology. However, in Indonesia, a country renowned for its rich natural resources and medicinal herbs, there is a prevailing belief in the efficacy of traditional medicine. Female adolescents in Indonesia are often engaged in self-medication practices, combining traditional medicine with nonsteroidal anti-inflammatory drugs (NSAIDs). This study aimed to analyze the prevalence, severity, and self- medication practices for dysmenorrhea among female adolescents in Indonesia. The study was conducted from January to December 2020 using an online survey that included questions about menstrual pain, family history, and the use of traditional medicine and NSAIDs. This study comprised 362 participants recruited through convenience sampling. Results showed that 92.5% of participants experienced dysmenorrhea with varying degrees of pain. A total of 216 (59.9%) female adolescents experienced frequent dysmenorrhea, while 118 (32.6%) reported experiencing this condition every menstrual cycle. Of all participants, 33.1% used traditional medicine as a treatment option, and 16.9% used NSAIDs. According to the self-reported visual analog scale (VAS), the use of natural remedies, such as traditional medicine, was associated with lower pain levels, suggesting their potential benefits in healthcare services for dysmenorrhea.
Long COVID in vaccinated women with Polycystic Ovary Syndrome: A retrospective cohort pilot study Muharam, R; Bagastoro, Aswan; Faradina, Anindita Abigail; Yo, Edward Christopher; Irzanti, Alisha Nurdya; Sumapraja, Kanadi; Harzif, Achmad Kemal; Pratama, Gita; Maidarti, Mila; Silvana, Vita; Wiweko, Budi; Hestiantoro, Andon
Majalah Obstetri & Ginekologi Vol. 33 No. 2 (2025): August
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V33I22025.89-96

Abstract

HIGHLIGHTS Among women with PCOS, many still reported persistent long COVID symptoms such as hair loss and fatigue. COVID-19 vaccination does not exacerbate symptoms of PCOS, which further emphasizes the importance of completing COVID-19 doses for women with PCOS to avoid long COVID sequelae.   ABSTRACT Objective: Long COVID, or the persistence of symptoms after acute COVID-19 illness, can affect individuals with pre-existing health conditions such as polycystic ovary syndrome (PCOS). Long COVID and PCOS may share overlapping pathogenesis which potentially exacerbate one another. The aim of this study was to evaluate the symptoms of long COVID in women with PCOS who have been vaccinated and investigate whether COVID-19 vaccination or infection worsened PCOS symptoms. Materials and Methods: We carried out a retrospective cohort study on 44 women with PCOS who have been vaccinated and previously diagnosed with COVID-19. Questionnaires were distributed to find out the effect of COVID infection and vaccines in these women, as well as the symptoms of long COVID-19. Results: Of all participants, 28 women (70%) continued to report persistent long COVID symptoms, with the highest number of complaints being fatigue and hair loss. The results, using Mann-Whitney test, showed that there was no difference in PCOS symptoms before and after COVID-19 vaccination (p = 0.520) or after COVID-19 infections (p = 0.241). Although this study revealed a substantial prevalence of long COVID symptoms among women with PCOS, an encouraging finding emerged: neither the administration of COVID-19 vaccination nor prior infection with COVID-19 had a significant impact on PCOS-associated symptoms. Conclusion: This study further underscores the importance of vaccination for all individuals, including women with a history of PCOS. Furthermore, the purpose of COVID-19 vaccination is to mitigate symptom severity, thus potentially diminishing the occurrence of long-term COVID-19 symptoms in future cases.
Triglyceride-Glucose Index as A Crucial Marker for Polycystic Ovary Syndrome Women with Insulin Resistance Hestiantoro, Andon; Saraswati, Jaya; Prasetya, David Eka; Sandra, Ferry; Muharam, Raden; Pratama, Gita; Harzif, Achmad Kemal
The Indonesian Biomedical Journal Vol 16, No 1 (2024)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v16i1.2639

Abstract

BACKGROUND: Insulin resistance (IR) is considered as the main driver of polycystic ovary syndrome (PCOS) pathogenesis. In PCOS condition, IR is frequently related to glucose, anthropometric profile, lipid profile, and hormone profile parameters. However, not all PCOS phenotype show IR. Therefore, this study was conducted to determine the association the parameters mentioned above in PCOS subjects with and without IR.METHODS: Fifty PCOS women with IR and 26 PCOS women without IR were recruited. All subjects underwent physical examination for measurement of weight, waist circumference (WC), and body mass index (BMI). Ferriman Gallwey Score (FGS) was used to evaluate hirsutism. Blood sample was taken from each subject for measurement of fasting glucose, postprandial glucose, fasting insulin, low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, triglyceride (TG), sex hormone binding globulin (SHBG), thyroid-stimulating hormone (TSH), luteinizing hormone (LH), follicle stimulating hormone (FSH), and prolactin. Homeostatic model assessment for IR (HOMA-IR), TG-glucose index (TyGI), and free testosterone index (FTI) were then calculated.RESULTS: From all the parameters examined, only fasting insulin (p<0.001), HOMA-IR (p<0.001), SHBG (p=0.012), TG (p<0.001), and TyGI (p=0.008) that show significant differences between PCOS subjects with and without IR. After multivariate analysis, TyGI was found to have strong association with IR occurrence in PCOS subjects (p=0.005) with an odd ratio of 5.26 (1.65–16.74).CONCLUSION: TyGI appears to have a significant association with the IR occurrence in PCOS subjects. Hence, it can be suggested that TyGI could be an important marker for PCOS women with IR.KEYWORDS: insulin resistance, lipid metabolism, polycystic ovary syndrome, triglyceride-glucose index
Co-Authors Agustina, Elizabeth Ampri, Irfan Arieqal Hatta Andon Hestiantoro Aprilia Asthasari Siregar Bagastoro, Aswan Budi Wiweko Chiprion, Ariel Timy Christopher Yo, Edward Faradina, Anindita Abigail Ferry Sandra Franciska, Shelly Gita Pratama Harahap, Juliana Sari Hari Kurniawan, Riyan Irzanti, Alisha Nurdya Kanadi Sumapradja Kartiwa Hadi Nuryanto Lestari, Silvia Werdhy Lethulur, Shindie Dona Kezia Mila Maidarti Muharam Natadisastra, Raden Muharam, R Muharam, Raden Muthalib, Aidrus Mutia, Heidi Dewi Nurbaeti, Putri Nurdya Irzanti, Alisha Prasetya, David Eka Prini Diandara Garinasih Puspawardani, Aisyah Retno R. Muharam Raymond Surya Saraswati, Jaya Sayogo, Atikah Shadrina, Amalia Silvana, Vita Talya, Natasha Tanjung, Anton Tyagitha, Galuh Anindya Ummah, Nafi'atul Yanfaunas, Atika Mahira Yanfaunnas, Atika Mahira Yo, Edward Christopher Zulimartin, Handika