5.1.Simpulan
1. Terdapat perbedaan ekspresi MMP-9 terkait dengan reseptivitas endometrium pada penderita endometriosis dibandingkan pasien normal, dimana ekspresi MMP-9 pada penderita endometriosis lebih tinggi dan bermakna secara statistik dengan nilai p < 0,05.
2. Terdapat perbedaan ekspresi IGF-1 terkait dengan reseptivitas endometrium pada penderita endometriosis dibandingkan pasien normal, dimana ekspresi IGF-1 pada penderita endometriosis lebih tinggi dan bermakna secara statistik dengan nilai p < 0,05..
Pada pemeriksaan defek reseptivitas endometrium endometriosis, Ekspresi IGF-1 dan MMP-9 perlu mendapat perhatian. Penderita endometriosis mengalami gangguan reseptivitas endometrium khususnya pada saat invasi yang disebabkan peningkatan ekspresi IGF-1 dan MMP-9.
5,2. Saran
1. Perlu dikembangkan penelitian lebih lanjut untuk pemanfaatan IGF-1 dan MMP-9 bukan hanya sebagai marker untuk mengetahui tingkat reseptivitas endometrium penderita endometriosis melalui pemeriksaan IHC, namun juga bisa digunakan sebagai terapi, bagi pasien endometriosis yang mengalami gangguan reseptivitas endometrium.
2. Penanganan endometriosis dimasa mendatang berupa targeting terapi berdasarkan hasil pemeriksaan marker ekspresi IGF-1 dan MMP-9 untuk menurunkan angka kegagalan implantasi embrio akibat imbalance ekspresi MMP-9 ataupun IGF-1.
3. Bagi klinisi pemeriksaan reseptivitas endometrium sebelum tindakan transfer embrio dalam program reproduksi berbantu sangat penting dilakukan sehingga defek reseptivitas endometrium dapat terdeteksi dini. Karena deteksi dini gangguan reseptivitas endometrium diharapkan dapat menurunkan angka kegagalan implantasi dengan melakukan penangan sesegera mungkin.
Daftar Pustaka
Bulun, S. E. (2009). Endometriosis. The New England Journal of Medicine, 360(3), 268–
79. http://doi.org/10.1056/NEJMra0804690
Cavagna, M., & Mantese, J. C. (2003). Biomarkers of endometrial receptivity--a review. Placenta, 24 Suppl B, S39–S47.
Cha, J., Sun, X., & Dey, S. K. (2012). Mechanisms of implantation: strategies for suc-cessful pregnancy. Nature Medicine, 18(12), 1754–67.
Chen, S. L., Wu, F. R., Luo, C., Chen, X., Shi, X. Y., Zheng, H. Y. & Ni, Y. P. (2010) Combined analysis of endometrial thickness and pattern in predicting outcome of in vitro fertilization and embryo transfer: a retrospective cohort study. Reprod Biol Endocrinol,8:30.
Daniel Shapiro, 2014. Examining the evidence: progesterone supplementation during fresh and frozen embryo transfer Reproductive BioMedicine Online 29: 4–14 Data Sekunder RSUD Dr Moewardi, Pusat Rekam medis RSDM, 2014.
De Joliniere JB, Ayoubi JMB, Gianaroli L, Dubuisson JB, Gogusev J, Feki A, (2014). Endometriosis : a new cellular and molecular genetic approach for understanding the pathogenesis and evolutivity. Maternity and Surgical Department of Gynecology HFR Fribourg Switzerland
Diaz, I.Navarro J, Blasco, L., Simon, C., Pellicer, A. & Remohi, J. (2000) Impact of stage III-IV endometriosis on recipients of sibling oocytes: matched case-kontrol study. Fertil Steril, 74(1): 31-4
F. Dominguez, et al, 2005. Embryonic implantation and leukocyte transendothelial mi-gration: different processes with similar players? FASEB J. 19, 1056–1060
Ghazal, S., McKinnon, B., Zhou, J., Mueller, M., Men, Yang, Taylor, H. S. (2015). H19 lncRNA alters stromal cell growth via IGF signaling in the endometrium of women
with endometriosis. EMBO Molecular Medicine, 7(8), 996–1003. http://doi.org/10.15252/emmm.201505245
Gipson, I., K., Blalock, T., Tisdale, A., Spurr-Michaud, S., Allcorn, S., StavreusEvers, & Gemzell, K. (2008) MUC16 is lost from the uterodome(pinopode) sur -face of the receptive human endometrium: in vitro evidence that MUC16 is bar-rier to trophoblast adherence. Biol Reprod, 78 (1): 134-42
Kang Shan, et al, 2006. Polymorphisms in the promoter regions of the matrix metallopro-teinases-7, -9 and the risk of endometriosis and adenomyosis inChina. Molecular Human Reproduction Vol.12, No.1 pp. 35–39.
Kang, Y.-J., Lees, M., Matthews, L. C., Kimber, S. J., Forbes, K., & Aplin, J. D. (2015). MiR-145 suppresses embryo-epithelial juxtacrine communication at implantation by modulating maternal IGF1R. Journal of Cell Science, 128(4), 804–14. http://doi.org/10.1242/jcs.164004
Kao, l., C., Germeyer, A., Tulac, S., Lobo, S., Yang., J., P., Taylor, R., N., Osteen, K, Lessey. (2003) Expresion profiling of endometrium from women with endo -metriosis reveals candidate genes for disease-based implantation failure and in-fertility. Endocrinology, 144(7):2870-81
Kennedy,S., Bergqvist, A., Chapron, C., D’Hooghe, T., Dunselman, G., Greb, R.,
Hummelshoj, L., Prentice, A. & Saridogan, E. (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod, 20 (10): 2698-704.
Kresno SB, (2010) Imunologi: Diagnosis dan prosedur Laboratorium, Badan Pen -erbit fkultas Kedokteran Universitas Indonesia edisi 5: 118-119
Lee KY, DeMayo FJ, Lee KY, DeMayo FJ. 2004. Animal models of implantation. Re-production ; 128(6): 679–95.
Lessey, B. A. (2011). Assessment of endometrial receptivity. Fertility and Sterility, 96(3), 522–9. http://doi.org/10.1016/j.fertnstert.2011.07.1095
between matrix metalloproteinase-9 and endometriosis, 8(10), 13399–13404. Macer, M. L., & Taylor, H. S. (2012). Endometriosis and Infertility. A Review of the
Pathogenesis and Treatment of Endometriosis-associated Infertility. Obstetrics and Gynecology Clinics of North America.
Mahajan, N. (2015). Endometrial receptivity array: Clinical application. Journal of Hu-man Reproductive Sciences, 8(3), 121–9. http://doi.org/10.4103/0974-1208.165153 Maia-Filho, V. Rocha, Ferreira, F. P., Bonetti, T. C., Serafini,, & Motta, E. L. (2015).
Matrix metalloproteinases 2 and 9 and e-cadherin expression in the endometrium during the implantation window of infertile women before in vitro fertilization treat-ment. Reprod Sci,22(4),416-422.
Merritt M, Strickler H, Einsten M, Yang H, Sherman M, Wentzensen N, Brouwer-Visser J, Jose Cossio M, Whitney KD, Yu H, Gunter M, Huang G. (2015). Insulin/ IGF and hormone axes in human endometrium and associations with endometrial cancer risk factor. Cancer Causes Kontrol, 27:737-748.
Oepomo Tedja D, 2012 Endometriosis, UNS PRESS. (2): 7-29
Pijnenborg R, L Vercruysse, M Hanssens, 2006 The uterine spiral arteries in human pregnancy: facts and controversies,Placenta, Elsevier Department of Obstetrics & Gynaecology, Universitair Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven, B3000 Leuven, Belgium Pages 939–958
Qiu, L., Wang, S., Lang, J. H., Shen, K., Huang, H. F., Pan, L. Y., … al., et. (2013). The
occurrence of endometriosis with ovarian carcinomas is not purely coincidental.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 170(1), 225–228. http://doi.org/10.1016/j.ejogrb.2013.06.015
Quinn, C. E. & Casper, R. F. (2009) Pinopodes: a questionable role in endometrial receptivity. Hum Reprod Update, 15 (2): 229-36.
Endometrial receptivity and human embryo implantation. American Journal of Reproductive Immunology, 66(SUPPL. 1), 23–30. http://doi.org/10.1111/j.1600-0897.2011.01048.x
Ruan, Y. C., Chen, H., & Chan, H. C. (2014). Ion channels in the endometrium: regulation of endometrial receptivity and embryo implantation. Human Reproduction Update, 20(4), 517–29. http://doi.org/10.1093/humupd/dmu006
Rita Silva de Cassia, Moura K, Junior C, Gurillo L. (2016). Estrogen signalling in the proliferative endometrium: Implication in endometriosis. Rev Assoc Med Bras 2016; 62(1):72-77.
Rutanen, E. M. (2000). Insulin-like growth factors and insulin-like growth factor binding proteins in the endometrium. Effect of intrauterine levonorgestrel delivery. Human Reproduction (Oxford, England), 15 Suppl 3, 173–81. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11041233
Singh M, Chaudry P, Asselin E, (2011). Bridging endometrial receptivity and implantation: network of hormones, cytokines, and growth factors. Journal of Endocrinology, 210, 5-14.
Weiss A , Shlomit Goldman and Eliezer Shalev, 2007 The matrix metalloproteinases (MMPS) in the decidua and fetal membranes, Frontiers in Bioscience 12, 649-659. Zhang, A., Xu, B., Sun, Y., Lu, X., Niu, Z., Chen,Xu, C. (2012). The effect of human
cumulus cells on the maturation and developmental potential of immature oocytes in ICSI cycles. Journal of Assisted Reproduction and Genetics, 29(4), 313–319. http://doi.org/10.1007/s10815-012-9712-3.
Zhang, S, et al. Physiological and molecular determinants of embryo implanttion. Molecular Aspects of Medicine (2013), http: //dx.doi.org/ 10. 1016/j. mam. 2012. 12.011.