INTRA UTERINE INSEMINATION ON ANTI MULLERIAN HORMONE RESERVE LEVELS AS A MARKER OF OVARIAN RESERVE
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Objective Recently fertility problem in Indonesia is increasing. According to a report from the Ministry of Health of Indonesia in 2010, approximately 12% couples in reproductive age have fertility problems. Intra Uterine Insemination (IUI) is commonly provided to treat the infertility problem before IVF program. Ovarian reserve is a term used to estimate the success of ovarian stimulation in ART. To understand how AMH works as an indicator of ovarian reserve, it is important to understand about how the eggs are stored in the ovary. Design Observational study with case control. Materials and Methods Case control study was done to evaluate the effectiveness of clomifen citrate (CC) alone compared with clomifen citrate (CC) + human menopausal gonadotropine (Hmg) on AMH levels during ovarian stimulation in IUI program. 40 patients undergoing IUI, divided into 20 subjects in each group This study was conducted retrospectively by analyzing the data taken from medical record at Asri Medical Center, Universitas Muhammadiyah Yogyakarta from 2015-2016. AMH levels measured in pre-and post-ovarian stimulation taken on the day of HCG evaluation in every group. Results 40 patients were eligible for study. Twenty patients undergoing IUI with CC and 20 patients with CC combine with hMG. The mean age of patients was 30,3±5 years, the mean duration of infertility 2,1±3,7 years. The mean BMl 20,9±5,4 kg/ml, AMH level pre-stimulation in group CC alone was 3,5 ng/ml and group of CC + hMG was 4,2 ng/ml. Total dosage of FSH in both group 3747,5±1086,2 IV/day. The mean duration of ovarian stimulation was 9±3 days. In subjects with CC alone, 12 patients (60%) had AMH level decreased, while in group of CC+hMG 11 patients (55%) had AMH level decreased, statistically was not significant (p=0,387). AMH levels pre-stimulation in group CC only=median 4,8 ng/ml (range 2,2-5,7),post-stimulation=median 4,0 ng/ml (range 2,4-5,6). AMH levels pre-stimulation in group CC+hMG median 3,3 ng/ml (range 1,7-5,2), post-stimulation median 4,0 (range 2,4-5,4).