Laboratory Info No. 3/201


Controlled ovarian stimulation (COS), so far the most optimum strategy for in vitro fertilization (IVF), remains in debate. Analysis of ovarian supply is an important issue in infertility and IVF. Ovarian supply analysis includes analysis of serologic and ultrasonographic (USG) marker analysis such as antral follicle count (AFC) and ovary volume. Serologic markers include follicle stimulating hormone (FSH), estrogen and inhibin B, but these markers are limited in terms of its ability to estimate ovarian response due to dependency to menstrual cycle (2.3).

Inter and intra-cycle variability comparison shows anti-mullerian hormone (AMH) better than AFC. The high variability in AFC is due to AFC's own reproducibility and standardization, intra and inter-observer variations, and short follicle count time as follicles keep developing and its size changing through time. It is thus recommended that the AFC count to take is within the size range of 2-10 mm as this range is better in terms of stability than 2-5 mm range (2). AMH serum is currently the new promising marker of ovarian functions. AMH belongs to the transforming growth factor (TGF) β. AMH is secreted by the growing preantral follicle and granulose cells on the antral small follicle, while atretic follicle and theca cells do not secrete AMH (3).



Chronic hepatitis B virus (HBV) infection is a "silent disease" and is often undiagnosed. Approximately one third of patients with chronic HBV infection will suffer from long-term consequences such as cirrhosis, end-stage liver disease or hepatocellular cancer (1). According to WHO's data, it is estimated that in 2011 there are 100 million hepatitis B carrier patients, with more than 5.6% of the population is residing in Southeast Asia region. Each year, more than 300,000 of these hepatitis B patients die, primarily due to the effects of chronic hepatitis B infection such as cirrhosis and hepatocellular cancer (2). Chronic HBV infection is a dynamic condition affected by the interaction among the virus, hepatocytes, and the host's immune system. The development of chronic HBV infection can be divided into several phases, i.e. immune tolerant phase, immune clearance phase, immune control phase and immune escape phase (3). Laboratory analysis is important to conduct in order to identify the phase of hepatitis B infection. By identifying the phase of infection, the correct timing to initiate therapy can be determined, allowing achievement of the therapy's ultimate goal. Therapy is recommended to give on chronic HBV patients in immune clearance phase and reactivation phase, which is indicated by the increase of HBV DNA and ALT, or as shown by biopsy result (3).

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