Budi Wiweko

Current opinion on use of luteinizing hormone supplementation in assisted reproduction therapy: an Asian perspective

LH and FSH have complementary functions in ensuring optimal oocyte maturation and ovulation. In women undergoing assisted reproduction technology protocols with gonadotrophin-releasing hormone analogues, LH and FSH concentrations are reduced. While FSH use in assisted reproduction technology is well established, there is no published consensus on the need for exogenous LH in Asian patients. Having reviewed the concept of the LH therapeutic window and differences between recombinant human LH (r-HLH) and human menopausal gonadotrophin, a consensus was reached on which patient subgroups may benefit from LH supplementation. Adjuvant r-HLH gives clinicians precise control over the dose of LH bioactivity administered to target the therapeutic window. The use of r-HLH is recommended in women with poor response in a previous cycle or suboptimal follicular progression in a current cycle by day 6-8 of stimulation. r-HLH should also be considered in women at risk of suboptimal response, specifically age > 35 years. Other risk markers that suggest the need for LH supplementation, which include baseline/day-6 serum LH and anti-Müllerian hormone concentrations, antral follicle count and LH polymorphisms require further research and verification. For measurement of LH response adequacy, the monitoring of follicular progression, oestradiol concentrations and endometrial thickness is recommended.

Indonesian infertility patients’ health seeking behaviour and patterns of access to biomedical infertility care: an interviewer administered survey conducted in three clinics

BackgroundIndonesia has high levels of biological need for infertility treatment, great sociological and psychological demand for children, and yet existing infertility services are underutilized. Access to adequate comprehensive reproductive health services, including infertility care, is a basic reproductive right regardless of the economic circumstances in which individuals are born into. Thus, identifying and implementing strategies to improve access to assisted reproductive technology (ART) in Indonesia is imperative. The principle objectives of this article are to improve our understanding of infertility patients’ patterns of health seeking behaviour and their patterns of access to infertility treatment in Indonesia, in order to highlight the possibilities for improving access.MethodsAn interviewer-administered survey was conducted with 212 female infertility patients recruited through three Indonesian infertility clinics between July and September 2011. Participants were self-selected and data was subject to descriptive statistical analysis.ResultsPatients identified a number of barriers to access, including: low confidence in infertility treatment and high rates of switching between providers due to perceived treatment failure; the number and location of clinics; the lack of a well established referral system; the cost of treatment; and patients also experienced fear of receiving a diagnosis of sterility, of vaginal examinations and of embarrassment. Women’s age of marriage and the timing of their initial presentation to gynaecologists were not found to be barriers to timely access to infertility care.ConclusionsThe findings based on the responses of 212 female infertility patients indicated four key areas of opportunity for improving access to infertility care. Firstly, greater patient education about the nature and progression of infertility care was required among this group of women. Secondly, increased resources in terms of the number and distribution of infertility clinics would reduce the substantial travel required to access infertility care. Thirdly, improvements in the financial accessibility of infertility care would have promoted ease of access to care in this sample. Finally, the expansion of poorly developed referral systems would also have enhanced the efficiency with which this group of patients were able to access appropriate care.

Predictive value of sperm deoxyribonucleic acid (DNA) fragmentation index in male infertility

BackgroundRecently, damage to the sperm DNA has been studied as it is associated with reduced fertilization rates, embryo quality, and pregnancy rates, also higher rates of spontaneous miscarriage.ObjectiveTo develop a diagnostic method in predicting male infertility.Material and MethodsThe design of this study is cross-sectional. Data were retrieved from medical records of Yasmin IVF Clinic Dr. Cipto Mangunkusumo General Hospital and Daya Medika Infertility Clinic from January to December 2015. Subjects were selected by consecutive sampling and divided into two groups: infertile and fertile. Sperm deoxyribonucleic acid fragmentation index (DFI) was determined by sperm chromatin dispersion (SCD) method using Halosperm® Kit.ResultsThere were 114 subjects (36 fertile and 78 infertile) selected into this study. We found no significant difference in the age between both of groups. The median value of sperm DFI in infertile group was significantly higher, 29.95 (26.6–34.3)%, compared to 19.90 (15.6–24.4)% of the fertile group, with p < 0.001. Area Under Curve (AUC) of sperm DFI, 0.862 (95% CI 0.783, 0.941), was higher than concentration (AUC 0.744; 95% CI 0.657, 0.831), motility (AUC 0.668; 95% CI 0.572, 0.765), and morphology (AUC 0.718; 95% CI 0.697, 0.864) of the semen analysis. At the cut-off point of 26.1%, the sperm DFI had sensitivity of 80.8% (95% CI; 70.0, 88.5), specificity of 86.1% (95% CI; 69.7, 94.8), positive predictive value (PPV) of 92.6% (95% CI; 83.0, 97.3), negative predictive value (NPV) of 67.4% (95% CI; 51.9, 80.0), positive likelihood ratio (PLR) of 12.6 (95% CI; 5.4, 29.4), and negative likelihood ratio (NLR) of 0.48 (95% CI 0.31, 0.75). Sperm DFI of ≥26.1% had prevalence ratio of 2.84 (95% CI 1.86, 4.33) for the occurrence of male infertility.ConclusionThere was significant difference between the median value of sperm DFI of infertile men and fertile men. Compared to semen analysis, sperm DFI at cut-off point of 26.1% has a higher diagnostic value (AUC).RésuméObjectifDévelopper une méthode diagnostique e prédiction de l’infécondité masculine.Matériel et Méthodesil s’agit d’une étude transversale. Les données ont été extraites des dossiers médicaux de la Yasmin IVF Clinic Dr Cipto Mangunkusumo General Hospital et de la Daya.Medika Infertility Clinic, de janvier à décembre 2015. Les sujets ont été sélectionnés par échantillonnage consécutif et divisés en deux groupes : infécond et fécond. L’indice de fragmentation de l’acide désoxyribonucléique (DFI) a été déterminé par la méthode de la dispersion de la chromatine spermatozoïdaire (SCD) en utilisant le kit Halosperm™.RésultatsCent quatorze sujets ont été sélectionnés dans cette étude : 36 féconds et 78 inféconds. Aucune différence significative n’a été retrouvée pour l’âge entre les deux groupes. La valeur médiane du DFI spermatozoïdaire dans le groupe infécond était significativement plus élevée, 29.9% (IQ1-IQ3 = 26.6–34.3%), que celle du groupe fécond, 19,90% (15.6–24.4%; P < 0.001). L’aire sous la courbe (AUC) du DFI spermatozoïdaire, 0.862 (95% CI 0.783, 0.941), était plus grande que celle de la concentration (AUC 0.744; 95% CI 0.657, 0.831), mobilité (AUC 0.668; 95% CI 0.572, 0.765), et morphologie (AUC 0.718; 95% CI 0.697, 0.864) des spermatozoïdes retrouvées à l’analyse du sperme. Pour une valeur seuil de 26,1%, le DFI spermatozoïdaire a une sensibilité de 80.8% (95% CI; 70.0, 88.5%), une spécificité de 86.1% (95% CI; 69.7, 94.8%), une valeur prédictive positive (PPV) de 92.6% (95% CI; 83.0, 97.3%), une valeur prédictive négative (NPV) de 67,4% (95% CI; 51.9, 80.0%), un ratio de probabilité positive (PLR) de 12,6 (95% CI; 5.4, 29.4), et un ratio de probabilité négative (NLR) de 0.48 (95% CI 0.31, 0.75). Un DFI spermatozoïdaire ≥ 26,1% a un ratio de prévalence de 2,84 (95% CI 1.86, 4.33) pour la survenue d’une infécondité masculine.ConclusionLa valeur médiane du DFI spermatozoïdaire diffère significativement entre les féconds et les inféconds. Par comparaison aux paramètres spermatiques de l’analyse du sperme, un DFI spermatozoïdaire à une valeur seuil de 26,1% possède une plus grande valeur diagnostique (AUC).

Developing smart telehealth system in Indonesia: Progress and challenge

Indonesia is developing country with high population. There are more than 200 million residents living in the country. As a developing country, Indonesia has several health problems. First, Indonesia has a high value of mortality caused by heart and cardio vascular diseases. One of the major cause is the lack of medical checkup especially for heart monitoring. It is caused by limited number of medical instrumentation e.g. ECG in hospital and public health center. The supporting factor is the small number of cardiologist in Indonesia. There are 365 cardiologists across the country, which is a very small number compared to the 200 million of Indonesia population. Furthermore, they are not distributed evenly in all provinces, but only centered in Jakarta and other capital cities. Therefore, it is difficult for residents to get appropriate heart monitoring. Second, the mortality rate of mother and baby during delivery of the baby in Indonesia is also high. One way to solve this problem is to devise a system where the health clinics in rural areas can perform fetal biometry detection before consulting the results to the expert physicians from other areas. The proposed system will be equipped with algorithms for automatic fetal detection and biometry measurement. By the end of this development, we have several results, the first is a classifier to automatic heartbeat disease prediction with accuracy more than 95%, the second is compression method based on wavelet decompositon, and the third is detection and approximation a fetus in an ultrasound image with hit rate more than 93%.

Fetal head segmentation based on Gaussian elliptical path optimize by flower pollination algorithm and cuckoo search

Number of maternal and infant mortality in Indonesia is high. This problem can be minimized by monitoring the fetal condition via ultrasound image. In addition, Indonesia have small number of obstetrics and gynecology compare to number of its population. Moreover, it is centralized in urban areas, so it is hard to monitor the condition of every babies in Indonesia. In order to resolve this problem, we have built fetal head monitoring system. Part of the system is to segment the fetal head in ultrasound image. In this paper, we examine nature optimization such as bat algorithm, cuckoo search, and flower pollination algorithm for optimizing Gaussian elliptical path for automatic fetal head segmentation. Experiment results shows that nature optimization Based Gaussian elliptical path (DoGEII-FPA and DoGEII-CS) has a minimum error compared to Gaussian elliptical path (DoGEll) which is optimized by Nelder-Mead. Interestingly, DoGEll-FPA and DoGEll-CS perform well from DoGEll-NM in different image.

Automatic fetal organs segmentation using multilayer super pixel and image moment feature

Segmentation of fetal organs such as head, femur, and humérus on ultrasound image is one of the challenges in realization of automated system for fetal biometry measurements. Although many methods have been developed to overcome this problem, most of them are generally specific to one organ of the body alone. The research in this paper will focus on a machine learning method that has been available before: multilayer super pixel classification using random forest. The focus of this study is to improve the accuracy by exploring compactness parameter in the formation of super-pixels. In addition, we also add moment image features such as translation, rotation, and scale invariant to improve the segmentation performance. The experimental results showed that the difference in compactness parameters will provide different result for the accuracy, Fl-score, recall, and specificity. The addition of moment features can also improve the performance of image segmentation of fetal organs even though increase was not significant. Fetal head segmentation using proposed method has higher Fl-score and specificity, but lower accuracy and recall compared to previous methods. Whereas fetal femur and humérus segmentation using proposed method has higher accuracy, Fl-score, recall and specificity compared to previous method.

ArcPSO: Ellipse detection method using particle swarm optimization and arc combination

In this paper we present a technique for ellipse detection in digital images based on swarm intelligence algorithm and arc segment combination. The proposed method is then used as embryo quality scoring assessment during the first 24-48 hours since its morphological structure can be approximated by ellipse. The idea of the proposed algorithm are based on combining possible arcs for the ellipse shaped objects and try to find the best combinations using Particle Swarm Optimization technique to find the actual ellipse. The process involves detecting line segments in the image and then followed by arc segment extraction from lines to get potential elliptical arcs. The detection process is then guided by Particle Swarm Optimization (PSO) by utilizing the calculation of the fitness function from the arc segment that had been detected previously. The measurement results of proposed method are then compared with manual measurements. The experiment results were conducted on both synthetic data and real embryo images. Experiment results showed that the proposed method is better than several ellipse detection methods such as RHT, IRHT, and PSORHT to detect ellipses on the image. Another advantage of our proposed algorithm compared to the Hough Transform variants is that it can be used for multiple ellipse detection.

Ovarian tissue vitrification as a method for fertility preservation: A study of follicle number and morphology after vitrification

Purpose: The aim was to evaluate the effects of ovarian cortex vitrification on follicle number and morphology. Materials and Methods: We excised approximately 5 mm of ovarian tissue from one ovary of each of 10 reproductive aged women who underwent surgery for the removal of benign ovarian tumors. A cryoprotectant agent containing 7.5% dimethylsulphoxide and 7.5% ethylene glycol was added to the ovarian cortex. Post-vitrification ovarian cortex was placed in a Cryotissue device and frozen in liquid nitrogen. We evaluated the shape and number of the follicles as well as the granulosa cell layers. The quality of the follicles was evaluated based on the morphological integrity of the oocytes, granulosa cells, and basal membranes as determined by hematoxylin and eosin staining. Results: The median age of the patients was 33 years (range: 28-40 years). The mean number of follicles per patient was 17 ± 7. After thawing, 59 primordial follicles (35.3%), 45 (26.9%) primary follicles and 6 (3.5%) secondary follicles were retrieved. The remaining follicles (34.1%) were atretic. There was a significant relationship between number of follicles and age ( P = 0.012, r = −0751). No differences were found in the morphology of the granulosa cells, stroma or collagen in both groups. The number of primordial follicles, primary follicles, secondary follicles, and follicular atresia were not significantly different before and after vitrification. Conclusion: In our study, vitrification does not cause significant changes to the morphology and number of follicles.

Automatic detection of embryo using Particle Swarm Optimization based Hough Transform

In-Vitro Fertilization (IVF) is a procedure to obtain embryo by inseminating oocyte and sperm outside human body. Several embryos are produced at the end of this procedure and it remains a problem to select the most appropriate embryo to be implanted into uterus. Many strategies have been proposed for selection of the embryo. The latest is time-lapse microscopy which monitors the embryo development continuously. An automatic method using computer to detect and locate the position of the embryo is thus needed. In this paper, an approach based on a modification of Hough Transform using Particle Swarm Optimization (PSO) is proposed to approximate the embryo as a circle. Each PSO particle represents a circle in the parameter space and mainly used to reduce the computational complexity of Hough Transform. Experiment result showed that the proposed method is able to detect the position of the embryo accurately. The result from this method can be used to extract criteria for embryo transfer purpose.

Indonesian kalkulator of oocytes (IKO): A smart application to determine our biological age

Background: The use of smartphones and its associated application provides new opportunities for physicians. In current situations, there are still few applications are designed in the field of infertility and Assisted Reproductive Technologies (ART). A study conducted on 1616 subjects proved that AMH (Anti-Mullerian Hormone) could be used to predict a woman’s biological age earlier than Follicle-Stimulating Hormone (FSH) and Antral Follicle Count (AFC). In this study, we describe the AMH nomogram that has been developed into a mobile application as “Indonesian Kalculator of Oocytes” (IKO). The software required to create IKO application was the Android 4.0.3 Ice Cream Sandwich and Java Application Development. The hardware specification that needed to develop the IKO apps were a 4.0-inch screen, 512 MB RAM (random-access memory), and CPU (central processing unit) with dual core 1.2 Ghz. The application is built using the Android SDK (Software Development Kit) and Java Application Development. In this app...