dr. Risman Felix Kaban, SpOG dr. Indra Gunasti Munthe, SpOG (K)

KORELASI ANTARA ALIRAN DARAH CORPUS LUTEUM 

DENGAN KONSENTRASI SERUM PROGESTERON 

PADA WANITA INFERTIL 

TESIS 

OLEH : 

BOY RIVAI PANDAPOTAN SIREGAR 

DEPARTEMEN OBSTETRI DAN GINEKOLOGI 

FAKULTAS KEDOKTERAN UNIVERSITAS SUMATERA UTARA 

RUMAH SAKIT UMUM PUSAT H. ADAM MALIK 

MEDAN 

2011 

Universitas Sumatera Utara

PENELITIAN INI DIBAWAH BIMBINGAN TIM-5 

PEMBIMBING: dr. Binarwan Halim, SpOG (K) 

dr. Muhammad Rusda, SpOG (K) 

PENYANGGAH : dr. Risman Felix Kaban, SpOG 

dr. Indra Gunasti Munthe, SpOG (K) 

Prof. dr. M. Fauzie Sahil, SpOG (K) 

Diajukan untuk melengkapi tugas-tugas 

dan memenuhi salah satu syarat untuk 

mencapai keahlian dalam bidang Obstetri dan Ginekologi 


LEMBAR HALAMAN PENGESAHAN 

Penelitian ini telah disetujui oleh Tim 5 ( Lima ) 

PEMBIMBING : 

Dr. Binarwan Halim, SpOG (K) …………………… 

Pembimbing I ....…. MEI 2011 

Dr. Muhammad Rusda, SpOG (K) …………………… 

Pembimbing II .…… MEI 2011 

PENYANGGAH : 

Dr. Risman Felix Kaban, SpOG .…………………… 


Divisi Feto Maternal ……. MEI 2011 

Dr. Indra Gunasti Munthe,SpOG (K) ……………………. 

Divisi Fertilisasi, Endokrinologi .…… MEI 2011 

& Reproduksi 

Prof. Dr. M. Fauzie Sahil, SpOG (K) ……………………. 

Divisi Onko- Ginekologi ……. MEI 2011 


“ Ya Allah ya Tuhan kami, … bagi-Mu lah segala pujipujian, 

pujian sepenuh langit, pujian sepenuh bumi 

dan sepenuh apapun yang Engkau kehendaki 

setelah itu …“ 

( H.R. Muslim ) 

Kupersembahkan untuk yang Terkasih dan Tercinta 

Kedua orangtua-ku, 

Drs.H.Amir Hood Siregar, Apt, MHA 

Dan 

(Almh.) Hj. Yunidar Anas 


KATA PENGANTAR 

Dengan nama Allah Yang Maha Pengasih Lagi Maha Penyayang, 

Segala Puji dan Syukur saya panjatkan ke hadirat Allah Subhanahu Wata’ala, Tuhan Yang Maha 

Kuasa, berkat Rahmat,Ridho dan Karunia-Nya lah penulisan tesis ini dapat diselesaikan dengan 

baik. 

Tesis ini disusun untuk melengkapi tugas-tugas dan memenuhi salah satu syarat untuk 

memperoleh keahlian dalam bidang Obstetri dan Ginekologi. Sebagai manusia biasa, saya 

menyadari bahwa tesis saya ini masih banyak kekurangannya dan masih jauh dari sempurna, 

namun demikian besar harapan saya kiranya tulisan sederhana ini dapat bermanfaat dalam 

menambah perbendaharaan bacaan khususnya tentang : 

“ KORELASI ANTARA ALIRAN DARAH CORPUS LUTEUM DENGAN 

KONSENTRASI SERUM PROGESTERON PADA WANITA INFERTIL ” 

Dengan selesainya laporan penelitian ini, perkenankanlah saya menyampaikan rasa terima kasih 

dan penghargaan yang setinggi-tingginya kepada yang terhormat : 

1. Rektor Universitas Sumatera Utara Prof.Dr.dr.Syahril Pasaribu, DTM&H, MSc (CTM), 

SpA(K) dan Dekan Fakultas Kedokteran Universitas Sumatera Utara, Prof.dr.Gontar 

Alamsyah Siregar, SpPD (K-GEH) yang telah memberikan kesempatan kepada saya untuk 

mengikuti Program Pendidikan Dokter Spesialis di Fakultas Kedokteran USU Medan. 

2. Prof.dr.Delfi Lutan, MSc, SpOG(K), Ketua Departemen Obstetri dan Ginekologi FK-USU 

Medan ; dan dr. M. Fidel Ganis Siregar, SpOG, Sekretaris Departemen Obstetri dan 

Ginekologi FK-USU Medan 

3. dr Henry Salim Siregar, SpOG(K), Ketua Program Studi Pendidikan Dokter Spesialis 

Obstetri dan Ginekologi FK-USU Medan ; dr. M. Rhiza Z. Tala, SpOG(K), Sekretaris 

Program Studi Pendidikan Dokter Spesialis Obstetri dan Ginekologi FK-USU Medan 

4. Prof. dr. R. Haryono Roeshadi, SpOG(K), selaku Kepala Bagian Obstetri dan Ginekologi 

pada saat saya diterima untuk mengikuti pendidikan spesialis di Departemen Obstetri dan 


Ginekologi FK-USU Medan ; Prof. M. Jusuf Hanafiah, SpOG(K) ; Prof. dr. Hamonangan 

Hutapea, SpOG(K) ; Prof. DR. dr. M. Thamrin Tanjung, SpOG(K) ; Prof. dr. Djafar Siddik, 

SpOG(K) ; Prof. dr. T.M. Hanafiah, SpOG(K) ; Prof. dr. Budi R. Hadibroto, SpOG(K) ; 

Prof. dr. Daulat H. Sibuea, SpOG(K) dan Prof. dr. M. Fauzie Sahil, SpOG(K) yang telah 

bersama-sama berkenan menerima saya untuk mengikuti Program Pendidikan Dokter 

Spesialis di Departemen Obstetri dan Ginekologi di FK-USU Medan. 

5. dr. Binarwan Halim, SpOG(K) yang telah memberikan idenya yang cemerlang kepada saya 

untuk melakukan penelitian ini dan sekaligus sebagai Pembimbing Utama Tesis saya 

,bersama-sama dengan dr. Muhammad Rusda, SpOG(K) yang juga sebagai pembimbing 

tesis saya, yang telah dengan sabar meluangkan waktu dan pikiran yang sangat berharga dan 

juga sebagai nara sumber untuk membimbing, mengkoreksi, dan melengkapi penulisan dan 

penyusunan tesis ini hingga dapat diselesaikan dengan baik. 

6. dr. Risman Felix Kaban, SpOG ; dr.Indra Gunasti Munthe, SpOG(K) ; dan Prof. dr. M. 

Fauzie Sahil, SpOG(K), sebagai penyanggah tesis saya, yang juga merupakan nara sumber 

yang telah dengan penuh kesabaran meluangkan waktu yang sangat berharga untuk 

membimbing, memeriksa, dan melengkapi penulisan tesis ini hingga dapat diselesaikan 

dengan baik. 

7. Dr Ichwanul Adenin, SpOG(K), selaku Ketua Divisi Fertilisasi dan Endokrinologi 

Reproduksi atas kesempatan yang diberikan kepada saya untuk dapat melakukan penelitian 

di Bidang Fertilisasi dan Endokrinologi Reproduksi di Departemen Obstetri dan Ginekologi 

FK-USU . 

8. Ucapan Terimakasih yang tak terhingga kepada dr. Binarwan Halim, SpOG(K) beserta 

seluruh Staff ,Paramedis dan Karyawan / ti “Halim Fertility Center” Medan yang telah 

mengizinkan saya dan banyak sekali memberikan bantuan kepada saya, selama saya 

melakukan penelitian di “Halim Fertility Center” Medan. Semoga Tuhan membalas 

kebaikan anda semua. 


9. Kepada dr. Surya Dharma, MPH, Drs.Abdul Jalil Amri,M.Kes dan dr.Arlinda Sari 

Wahyuni,M.Kes, sebagai pembimbing statistik Tesis saya ,yang telah dengan penuh 

kesabaran meluangkan waktu dan pikiran untuk membimbing dan membantu saya dalam 

penyelesaian uji statistik tesis ini. 

10. dr.Yusuf R Surbakti, SpOG(K), selaku pembimbing Referat Fetomaternal saya yang 

berjudul ”Penatalaksanaan Thrombo Emboli Vena dalam Kehamilan” ; Kepada dr. 

Syamsul Arifin Nasution, SpOG(K) selaku pembimbing Referat Fertilitasi, Endokrinologi 

dan Reproduksi saya yang berjudul ”Penggunaan Selective Progesterone Receptor 

Modulator pada Pengobatan Endometriosis dan Myoma Uteri” dan kepada dr. John S. 

Khoman, SpOG(K) selaku pembimbing Referat Onko-Ginekologi saya yang berjudul 

”Pseudomyxoma Peritonei”. Terimakasih atas bimbingan dan arahan yang diberikan 

kepada saya , selama saya menyelesaikan referat referat saya tersebut. 

11. dr. Einil Rizar, SpOG(K), selaku Bapak Angkat saya ,selama saya menjalani masa 

pendidikan di Departemen Obstetri dan Ginekologi FK-USU, yang telah banyak 

mengayomi, membimbing dan memberikan nasehat-nasehat yang bermanfaat kepada saya 

dalam menghadapi masa-masa sulit selama masa pendidikan. 

12. Seluruh Staf Pengajar di Departemen Obstetri dan Ginekologi FK-USU Medan / RSUP 

H.Adam Malik / RSUD Dr.Pirngadi Medan, yang secara langsung telah banyak 

membimbing dan mendidik saya sejak awal hingga akhir pendidikan. 

13. Kepada Sekretariat Bersama Fakultas Kedokteran se-Indonesia (CHS) dan Kepala Dinas 

Kesehatan Propinsi Sumatera Utara, atas izin yang telah diberikan kepada saya untuk 

mengikuti Program Pendidikan Dokter Spesialis Obstetri dan Ginekologi di Fakultas 

Kedokteran Universitas Sumatera Utara Medan. 


14. Direktur RSUP. H. Adam Malik Medan ; dan Ketua SMF Kebidanan dan Penyakit 

Kandungan RSUP H.Adam Malik , beserta seluruh staf ,para Bidan dan seluruh paramedis 

yang telah memberikan kesempatan dan sarana serta bantuan kepada saya untuk bekerja 

selama mengikuti pendidikan dan selama saya bertugas di SMF Kebidanan dan Penyakit 

Kandungan RSUP H.Adam Malik Medan. 

15. Direktur RSUD Dr. Pirngadi Medan ; dan Ketua SMF Kebidanan dan Penyakit Kandungan 

RSUD Dr.Pirngadi Medan dr. Rushakim Lubis, SpOG beserta seluruh staff-nya ,para Bidan 

dan seluruh paramedis yang telah memberikan kesempatan dan sarana serta bantuan kepada 

saya untuk bekerja selama mengikuti pendidikan dan selama saya bertugas di SMF 

Kebidanan dan Penyakit Kandungan di RSUD Dr.Pirngadi Medan. 

16. Direktur RS. PTPN 2 Tembakau Deli Medan ;dan Kepala SMF Kebidanan dan Penyakit 

Kandungan RS PTPN 2 Tembakau Deli Medan dr. Sofian Abdul Ilah, SpOG dan juga dr. 

Nazaruddin Jaffar, SpOG(K) ; beserta staf ,para Bidan dan Paramedis yang telah 

memberikan kesempatan dan sarana kepada saya dan membantu saya selama bertugas di 

Rumah Sakit tersebut. 

17. Direktur RS Haji Mina Medan ;dan Kepala SMF Kebidanan dan Penyakit Kandungan RS 

Haji Mina Medan ,dr Muslich Peranginangin, SpOG beserta seluruh staff ,para Bidan dan 

seluruh paramedis yang telah memberikan kesempatan dan sarana serta membantu saya 

untuk bekerja selama bertugas di Rumah Sakit tersebut. 

18. Direktur RS Sundari Medan dan Kepala SMF Kebidanan dan Penyakit Kandungan RS 

Sundari Medan dr Muhammad. Haidir, SpOG beserta staff, dan Ibu Hj.Sundari,Amkeb 

beserta para Bidan dan seluruh paramedis yang telah memberikan kesempatan dan sarana 

kepada saya untuk bekerja selama bertugas di Rumah Sakit tersebut. 

19. Ka. RUMKIT Tk. II KesDam II / Bukit Barisan ” Puteri Hijau” ; dan Kepala SMF 

Kebidanan dan Penyakit Kandungan di RUMKIT Tk.II KesDam II / Bukit Barisan Mayor 

CKM dr Gunawan Rusuldi, SpOG beserta seluruh staff, para Bidan dan seluruh paramedis 


di RUMKIT Tk.II KesDam II / Bukit Barisan ”Puteri Hijau” yang telah memberikan 

kesempatan dan sarana serta bantuan kepada saya untuk bekerja selama bertugas di Rumah 

Sakit tersebut. 

20. Distrik Manager PTPN 3 Distrik Pamela dan Manager RS PTPN 3 Sri Pamela, Tebing 

Tinggi, dan Kepala SMF Kebidanan dan Penyakit Kandungan RS PTPN 3 Sri Pamela, 

Tebing Tinggi, beserta seluruh staf,para Bidan dan seluruh paramedis yang telah 

memberikan kesempatan kerja ,memberikan bantuan sarana dan bantuan moril selama saya 

bertugas di rumah sakit tersebut. 

21. Dinas Kesehatan Kota Tebing Tinggi ,IDI dan POGI Kota Tebing Tinggi atas bantuan dan 

perlindungan kepada saya selama saya bertugas di Tebing Tinggi. Khusus kepada dr.Budi 

Santoso, SpOG ,dr.Rosnaliza Harahap, SpOG dan dr.Maria Novita Adelina Pardede, SpOG 

,saya menghaturkan banyak terimakasih atas bantuan dan bimbingan selama saya bertugas 

di Tebing Tinggi. Semoga Tuhan membalas kebaikan anda. 

22. Ketua Departemen Anestesiologi dan Reanimasi FK USU / RSUP H.Adam Malik Medan 

beserta seluruh staff, atas kesempatan dan bimbingan yang telah diberikan selama saya 

bertugas di Departemen tersebut. 

23. Ketua Departemen Patologi Anatomi FK-USU beserta seluruh staf, atas kesempatan dan 

bimbingan yang telah diberikan selama saya bertugas di Departemen tersebut. 

24. Kepada senior-senior saya, Terimakasih banyak atas segala bimbingan, bantuan dan 

dukungannya yang telah diberikan kepada saya selama ini. Semoga Allah SWT membalas 

budi baik yang saya terima dari mereka selama ini. 

25. Teman-teman seangkatan saya: dr. Muhammad Jusuf Rachmatsyah, SpOG; dr. Teuku 

Jeffrey Abdillah, SpOG; dr.Sri Jauharah Laily, SpOG; dr. Made Surya Kumara, SpOG; dr. 

Muhammmad Rizki Yaznil, SpOG; dan dr. Yuri Andriansyah, Terima kasih untuk 

kebersamaan dan kerjasama kita selama pendidikan ini. 


26. Kepada yunior-yunior saya, saya menyampaikan sedalam-dalam terima kasih dan rasa 

syukur alhamdulillah atas segala dukungan dan bantuan yang diberikan selama ini serta 

kebersamaan kita selama pendidikan. Semoga kebersamaan dan kerjasama kita tetap 

terpelihara dan Allah SWT melindungi kita semua. 

27. Kepada yang tersayang ,tim Jaga ku. Tiada saat yang paling indah selain di waktu jaga kita 

bersama selama ini. Rasa Syukur dan Terimakasih yang sebesar-besarnya atas bantuan dan 

kerjasama yang kompak diantara kita selama ini. Semoga kebersamaan dan kekompakan 

kita tetap terpelihara, dan kita semua senantiasa dalam lindungan Allah SWT. 

28. Seluruh teman sejawat PPDS yang tidak dapat saya sebutkan satu persatu, terima kasih atas 

kebersamaan, dorongan semangat dan doa yang telah diberikan . 

29. Seluruh Teman Sejawat Dokter Muda, para Bidan, seluruh Paramedis, serta para pasien di 

Departemen Obstetri dan Ginekologi FK USU / RSUP. H. Adam Malik – RSU. Dr. Pirngadi 

Medan dan RS Jejaring yang daripadanya saya banyak memperoleh pengetahuan baru, 

terima kasih atas kerja sama dan saling pengertian yang baik, yang diberikan kepada saya 

selama ini ,sehingga saya dapat sampai pada akhir program pendidikan ini. 

30. Para karyawan / karyawati yang banyak membantu saya selama menjalani masa pendidikan 

di Departemen Obstetri dan Ginekologi FK-USU, Ibu Asnawati Hasibuan, Ibu Sosmalawati 

Harahap, Ibu Nur Asmawati, Ibu Zubaedah, Ibu Jas, Ibu Nurmawan, Mimi Rahmi ,Rifda 

Astuti, Winta, Yus Sari Asih. Terimakasih atas bantuan dan kerjasamanya selama saya 

menjalani pendidikan di Departemen Obstetri dan Ginekologi FK-USU / RSUP H.Adam 

Malik / RSU Dr. Pirngadi Medan. 

Sembah sujud, setinggi-tinggi hormat dan sedalam-dalam terima kasih yang tidak terhingga dari 

lubuk hati sanubari yang paling dalam ,saya sampaikan kepada kedua Orang Tua saya yang saya 

cintai dan saya sayangi, Ayahanda Drs.H.Amir Hood Siregar, Apt, MHA dan Ibunda (Almh.) 

Hj. Yunidar Anas, tiada kata terindah yang dapat saya ucapkan melainkan rasa syukur dan 

terimakasih saya kepada Allah SWT yang tidak terhingga, karena telah menitipkan saya kepada 


orangtua yang telah membesarkan, membimbing, mendoakan, serta mendidik saya dengan penuh 

kasih sayang dari sejak saya kecil hingga saat ini, memberi contoh yang baik dalam menjalani 

hidup ,serta memberikan motivasi dan semangat serta dukungan kepada saya selama saya 

mengikuti pendidikan ini. Semoga Allah SWT melindungi kita semua. 

Kepada abangku tersayang Rachmad Saleh Siregar, ST ; dan kakak iparku Rika Yulisa 

Rachmad Saleh, S.IP, M.HRD Science ( Hons.) dan adikku tersayang Fifi Savitri Siregar, 

B.Comp Science ( Hons,), M.M .Dan juga kepada ibunda Siti Rodiah, S.E .Terima kasih atas 

dorongan semangat serta doa yang diberikan kepada saya ,sehingga saya dapat menyelesaikan 

program pendidikan ini. Tanpa pengorbanan, doa, dorongan ,semangat dan dukungan dari kalian 

semua, tidak mungkin tugas tugas ini semua dapat saya selesaikan. 

Kepada yang terhormat, Om dr.H.Sjahrial Refli Anas, MHA dan Tante Hj. Getrina Fezienty 

Sjahrial. Terimakasih yang sebesar-besarnya atas dukungan, bantuan, doa dan semangat yang 

diberikan kepada saya selama ini.Tiada kata terindah selain ungkapan rasa syukur dan 

terimakasih yang teramat dalam atas bantuan Om dan Tante selama saya menjalani masa 

pendidikan ini. Semoga Allah SWT membalas kebaikan Om dan Tante. 

Akhirnya kepada seluruh keluarga besar saya, Keluarga besar Alm.Bokar Siregar glr Sutan 

Pandapotan Muda dan Keluarga besar Anas Sofyan glr Datuak Rajo Sutan, serta seluruh handai 

taulan semua yang tidak dapat saya sebutkan namanya satu persatu, baik secara langsung 

maupun tidak langsung, yang telah banyak memberikan bantuan,doa dan dukungan, baik moril 

maupun materiil, saya ucapkan banyak terima kasih. 

Semoga Allah Subhanahu wa Ta’ala senantiasa melimpahkan rahmah dan barokah-Nya kepada 

kita sekalian. Amin 

Medan, Mei 2011 

dr. BOY RIVAI PANDAPOTAN SIREGAR 


KORELASI ANTARA ALIRAN DARAH CORPUS LUTEUM DENGAN KONSENTRASI SERUM 

PROGESTERON PADA WANITA INFERTIL 

Siregar B R P, Halim B, Rusda M 

Departemen / SMF Obstetri dan Ginekologi 

Fakultas Kedokteran Universitas Sumatera Utara / RSUP H. Adam Malik / 

Unit/Sub-Divisi Teknologi Reproduksi Bayi Tabung, Divisi FER,Dept Obgyn FK-USU 

”Halim Fertility Centre” Medan 

--------------------------------------------------------------------------------------------------------------------------------- 

ABSTRAK 

Tujuan : Tujuan penelitian ini adalah untuk mengetahui Adakah Korelasi yang signifikan antara Aliran darah 

Corpus Luteum dengan Konsentrasi serum Progesteron pada Fase Luteal wanita infertil.Dan untuk menilai 

parameter manakah dari Aliran Darah Corpus Luteum yang menjadi Prediktor terbaik untuk menegakkan diagnosa 

Defek Fase Luteal sebagai parameter diagnostik alternatif selain melalui penilaian Kadar Serum Progesteron 

Rancangan Penelitian : Penelitian ini merupakan suatu penelitian survei analitik dengan menggunakan rancangan 

potong lintang (cross sectional study),dilaksanakan di Unit / Sub-Divisi Teknologi Reproduksi Bayi Tabung, Divisi 

FER, Dept Obgin ,FK-USU “Halim Fertility Centre”, Medan,berlangsung dimulai dari 1 November 2010 sampai 

dengan 30 April 2011. Sampel penelitian adalah semua wanita infertil yang merupakan wanita usia reproduksi ( 15 – 

45 tahun ) yang yang dilakukan dengan Consecutive Sampling diseleksi menurut kriteria inklusi dan eksklusi yang 

datang memeriksakan diri ,kemudian yang memenuhi kriteria inklusi dan bersedia ikut serta,diambil sebagai sampel 

penelitian. Dengan rumus Korelasi Pearson (r = 0.433) dari liteartur, didapatkan sebanyak 41 sampel. Data – data 

yang dikumpulkan dibuat dalam Tabulasi Induk, diolah secara komputerisasi dengan menggunakan SPSS versi 

19.0. Data disajikan dengan nilai Rata-rata ± Standar Deviasi . Data disajikan dalam bentuk Grafik Scattered Dot. 

Untuk melihat hubungan signifikansi antar variabel dilakukan dengan analisis korelasi Pearson dan dinyatakan 

bermakna jika nilai p < 0.05, dan dengan menggunakan nilai r untuk melihat kuatnya hubungan antar variabel 

penelitian. Hubungan akan semakin kuat jika mendekati nilai +1 atau -1Arah korelasi dinyatakan positif (+) jika 

ditemukan variabel yang satu berbanding lurus dengan variabel yang lainnya dan negatif (-) jika ditemukan variabel 

yang satu berbanding terbalik dengan variabel yang lainnya 

Material dan Metode Penelitian : Tiap responden yang memenuhi kriteria inklusi masing masing diberikan Chart 

Suhu Basal Badan untuk dicatat suhu basal badannya pada pagi hari setiap hari selama 28 hari. Hari ke 14 

diperkirakan merupakan suhu terendah selama siklus, dan dinyatakan sebagai hari ovulasi. Setelah ovulasi, 

terbentuk Corpus Luteum yang memproduksi Progesteron. Puncak fase Luteal yaitu 7 hari setelah ovulasi. Pada hari 

ke 21 pasien diminta datang untuk dilakukan pemeriksaan konsentrasi serum progesteron,dan selanjutnya dilakukan 

USG Power Doppler Transvaginal untuk menilai Aliran darah Corpus Luteum (PSV,EDV,PI,RI,Volume Corpus 

Luteum), kemudian data dikumpulkan sampai 41 sampel terpenuhi dan ditabulasi, lalu dilakukan Uji Korelasi 

Pearson. 

Hasil Penelitian : Dengan uji korelasi Pearson, secara statistik ditemukan hubungan yang bermakna antara kadar 

serum Progesterone dan Peak Systolic Velocity (PSV) pada Corpus Luteum dengan nilai p=0.000 (p

dengan nilai r = 0.002. Diperoleh nilai cut off point dari Pulsatility Index (PI) sebagai alat diagnostik yang paling 

baik nilai AUC-nya (AUC=70,1%) dibandingkan dengan variabel-variabel prediktor (alat diagnostik ) lainnya 

pada defek fase luteal adalah 1,085 dengan sensitivitas 73,3 % dan spesifisitas 66,7 %. 

Kesimpulan : Ada korelasi yang bermakna antara Peak Systolic Velocity (PSV) Aliran Darah Corpus Luteum 

dengan Konsentrasi Serum Progesteron dan ditemukan hubungan korelasi positif dengan Kekuatan Korelasi sedang. 

Ada korelasi yang bermakna antara End Diastolic Velocity (EDV) Aliran Darah Corpus Luteum dengan Konsentrasi 

Serum Progesteron dan ditemukan hubungan korelasi positif dengan Kekuatan Korelasi kuat. Ada korelasi yang 

bermakna antara Pulsatility Index Aliran Darah Corpus Luteum dengan Konsentrasi Serum Progesteron dan 

ditemukan hubungan korelasi negatif dengan Kekuatan Korelasi lemah .Ada korelasi yang bermakna antara 

Resistance Index Aliran Darah Corpus Luteum dengan Konsentrasi Serum Progesteron dan ditemukan hubungan 

Korelasi negatif dengan Kekuatan Korelasi sedang. Ada Korelasi yang tidak bermakna antara Volume Corpus 

Luteum (mm 3 ) dengan Konsentrasi Serum Progesteron dan ditemukan hubungan korelasi positif dengan kekuatan 

Korelasi sangat lemah Diperoleh nilai Pulsatility Index (PI) sebagai nilai untuk alat diagnostik yang paling baik , 

dimana nilai AUC-nya (AUC=70,1%) dibandingkan dengan variabel-variabel prediktor (alat diagnostik ) lainnya 

pada defek fase luteal ,dengan nilai cut-off point nya adalah 1,085 dengan sensitivitas 73,3 % dan spesifisitas 66,7 

%. 

Kata Kunci : Suhu Basal Badan, Volume Corpus Luteum, Peak Systolic Velocity, End Diastolic Velocity, 

Pulsatility Index, Resistance Index, Konsentrasi serum Progesteron,Defek Fase Luteal. 


DAFTAR ISI 

PEMBIMBING PENELITIAN………………………………………………………………. i 

LEMBAR PENGESAHAN PENELITIAN…………………………………………………..ii 

KATA PENGANTAR………………………………………………………………………...iv 

ABSTRAK TESIS……………………………………………………………………………xiii 

DAFTAR ISI……………………………………………………………………………….…xv 

DAFTAR GAMBAR………………………………………………………………………....xix 

DAFTAR TABEL…………………………………………………………………………….xx 

DAFTAR GRAFIK…………………………………………………………………………..xxi 

DAFTAR SKEMA…………………………………………………………………………. .xxii 

DAFTAR SINGKATAN………………………………………………………………….....xxiii 

DAFTAR LAMPIRAN…………………………………………………………………...….xxv 

BAB I PENDAHULUAN 

I.1 LATAR BELAKANG...........................................................................................................1 

I.2 RUMUSAN MASALAH……………………………………………………. .....................7 

I.3 TUJUAN PENELITIAN .......................................................................................................7 

I.3.1 TUJUAN UMUM……………………………………………………………………..7 

I.3.2 TUJUAN KHUSUS.......................................................................................................7 

I.4 HIPOTESIS PENELITIAN...................................................................................................8 

I.5 MANFAAT PENELITIAN ..................................................................................................8 

BAB II TINJAUAN KEPUSTAKAAN 

II.1 CORPUS LUTEUM.............................................................................................................9 


II.2 TUMBUH KEMBANG CORPUS LUTEUM .....................................................................9 

II.3 PATHWAY STEROIDOGENIK LUTEAL .....................................................................10 

II.4 REGULASI FUNGSI LUTEAL ........................................................................................12 

II.5 ANGIOGENESIS CORPUS LUTEUM ............................................................................13 

II.5.1 PENDAHULUAN......................................................................................................13 

II.5.2 FAKTOR-FAKTOR YANG MEMPENGARUHI ANGIOGENESIS 

CORPUS LUTEUM...................................................................................................14 

II.5.2.1 PERUBAHAN DALAM JUMLAH PERISIT ..............................................14 

II.5.2.2 STABILISASI PEMBULUH DARAH.........................................................15 

II.5.3 FAKTOR ANGIOGENIK..........................................................................................15 

II.5.3.1 FAKTOR PERTUMBUHAN ENDOTELIAL ................................................15 

II.5.3.2 ANGIOPOEITIN..............................................................................................15 

II.5.4 REGULASI MOLEKULER ANGIOGENESIS CORPUS LUTEUM ......................17 

II.5.5 ANGIOGENESIS DAN FUNGSI LUTEAL .............................................................18 

II.6 DETEKSI ALIRAN DARAH LUTEAL PADA CORPUS LUTEUM .............................19 

II.7 PENILAIAN ANGIOGENESIS CORPUS LUTEUM......................................................19 

II.7.1 VOLUME CORPUS LUTEUM.................................................................................20 

II.7.2 PEAK SYSTOLIC VELOCITY (PSV) DAN EDV 

(END DIASTOLIC VELOCITY) ALIRAN DARAH CORPUS LUTEUM...........20 

II.7.3 INDEKS PULSATILITAS (PI=PULSATILITY INDEX)........................................20 

II.7.4 INDEKS RESISTENSI (RI= RESISTANCE INDEX) .............................................21 

II.8 KONSENTRASI SERUM PROGESTERON....................................................................22 

II.8.1 PERAN PROGESTERON PADA SUMBU HIPOTHALAMUS-HIPOFISIS..........22 

II.8.2 PERAN PROGESTERON DALAM SISTEM REPRODUKSI ................................24 


II.8.3 DEFEK FASE LUTEAL............................................................................................25 

II.9 PENENTUAN DEFISIENSI SEKRESI PROGESTERON OLEH CORPUS LUTEUM 

PADA FASE LUTEAL .....................................................................................................25 

II.9.1 SAAT OVULASI DAN PEMBENTUKAN CORPUS LUTEUM ............................25 

II.9.2 PENGUKURAN SUHU BASAL BADAN 

(BBT=BASAL BODY TEMPERATURE).................................................................26 

II.9.3 PENENTUAN PANJANG FASE LUTEAL .............................................................28 

II.9.4 PEMERIKSAAN KONSENTRASI SERUM PROGESTERON FASE LUTEAL...28 

II.9.5 PEMANTAUAN DENGAN ULTRASONOGRAFI.................................................29 

II.9.6 BIOPSI ENDOMETRIUM ........................................................................................29 

II.10 HUBUNGAN ALIRAN DARAH CORPUS LUTEUM DENGAN 

KONSENTRASI SERUM PROGESTERON .................................................................30 

II.10.1 HUBUNGAN PEAK SYSTOLIC VELOCITY (PSV) DENGAN 

KONSENTRASI SERUM PROGESTERON PADA FASE MID-LUTEAL .........31 

II.10.2 HUBUNGAN END DIASTOLIC VELOCITY (EDV) DENGAN 

KONSENTRASI SERUM PROGESTERON PADA FASE MID-LUTEAL .........32 

II.10.3 HUBUNGAN PULSATILITY INDEX (PI) DENGAN KONSENTRASI 

SERUM PROGESTERON PADA FASE MID-LUTEAL ......................................33 

II.10.4 HUBUNGAN RESISTANCE INDEX (RI) DENGAN KONSENTRASI 

SERUM PROGESTERON.......................................................................................34 

II.10.5 HUBUNGAN VOLUME CORPUS LUTEUM DENGAN KONSENTRASI 

SERUM PROGESTERON.......................................................................................36 

BAB III METODE PENELITIAN 

III.1 DESAIN PENELITIAN....................................................................................................39 


III.2 TEMPAT DAN WAKTU PENELITIAN.........................................................................39 

III.3 POPULASI DAN SAMPEL PENELITIAN 

III.3.1 POPULASI PENELITIAN .......................................................................................39 

III.3.2 SAMPEL PENELITIAN...........................................................................................39 

III.3.3 BESAR SAMPEL PENELITIAN.............................................................................40 

III.3.4 KRITERIA SAMPEL 

III.3.4.1 KRITERIA INKLUSI .....................................................................................41 

III.3.4.2 KRITERIA EKSKLUSI..................................................................................41 

III.4 MATERIAL DAN METODE PENELITIAN 

III.4.1 MATERIAL ALAT PENELITIAN .........................................................................41 

III.4.2 MATERIAL BAHAN PENELITIAN.......................................................................42 

III.4.3 METODE/ CARA KERJA PENELITIAN ...............................................................42 

III.5 ALUR PENELITIAN .......................................................................................................51 

III.6 VARIABEL PENEITIAN ................................................................................................52 

III.7 KERANGKA KONSEP PENELITIAN ...........................................................................52 

III.8 BATASAN OPERASIONAL PENELITIAN...................................................................54 

III.9 PENGOLAHAN DATA ...................................................................................................56 

III.10 ETIKA PENELITIAN ....................................................................................................57 

BAB IV HASIL PENELITIAN DAN PEMBAHASAN..........................................................59 

BAB V KESIMPULAN DAN SARAN 

V.1 KESIMPULAN..................................................................................................................89 

V.II SARAN .............................................................................................................................90 


DAFTAR GAMBAR 

Gambar 1 Penyebab infertilitas pada pasangan suami-istri ......................................................... 1 

Gambar 2 Fase Proliferasi Endometrium / Fase Folikuler Ovarium ,Ovulasi dan Fase Sekresi 

Endometrium / Fase Luteal Ovarium Siklus Menstruasi Wanita ............................... 3 

Gambar 3 Sel Theca Lutein dan Sel Granulosa Lutein.............................................................. 10 

Gambar 4 Tumbuh Kembang Corpus Luteum........................................................................... 10 

Gambar 5 Pathway Biosintesis Progesteron dalam Sel-sel Luteal ............................................ 11 

Gambar 6 Siklus Hidup Corpus Luteum.................................................................................... 12 

Gambar 7 Hipotesis Regulasi perubahan pembuluh darah oleh VEGF, Angiopoietin-1, dan 

Angiopoietin-2 selama perkembangan dan regresi Corpus Luteum .......................................16 

Gambar 8 Mekanisme biomolekuler Angiogenesis dalam Corpus Luteum selama siklus 

Menstruasi dan pada Awal Kehamilan ...................................................................................18 

Gambar 9 Hasil Scaning Aliran Darah (Angiogenesis) Corpus Luteum dalam Ovarium......... 21 

Gambar 10Interpretasi Hasil Scanning Aliran Darah ( Angiogenesis ) Corpus Luteum Dalam 

Ovarium Pada USG Doppler Transvaginal..................................................................... 22 

Gambar 11Gambaran Mekanisme Hipothalamus Hipofisis Ovarium dalam Mempengaruhi 

Corpus Luteum Memproduksi Progesteron.............................................................. 23 

Gambar 12Representasi Skematik perubahan vaskularisasi selama hidup Folikel tunggal yang 

diseleksi untuk menjadi matang dan ber-Ovulasi ..................................................... 25 

Gambar 13Rekaman Suhu Basal Badan Ideal ............................................................................ 26 

Gambar 14Contoh TABEL BBT ( BASAL BODY TEMPERATURE ) IDEAL..................... 44 

Gambar 15Ilustrasi Penggunaan Usg Doppler Transvaginal …………………………………..47 

Gambar 16Aliran Darah ( Angiogenesis ) Corpus Luteum Di Dalam Ovarium Pada USG 


Doppler Transvaginal………………………………………………………………49 

Gambar 17Hasil Scanning Aliran Darah ( Angiogenesis ) Corpus Luteum Dalam 

Ovarium Pada USG Doppler Transvaginal…………………………………………50 


DAFTAR TABEL 

Tabel 2.1 Peran Progesteron untuk Implantasi dan Perkembangan Folikel ................................ 23 

Tabel 4.1 Hubungan peak systolic velocity (PSV) aliran darah corpus luteum dengan konsentrasi 

serum progesteron.......................................................................................................59 

Tabel 4.2 Hubungan end diastolic velocity (EDV) aliran darah corpus luteum dengan konsentrasi 

serum progesteron.......................................................................................................62 

Tabel 4.3Hubungan pulsatility index (PI) alirandarah corpus luteum dengan konsentrasi serum 

progesteron..................................................................................................................63 

Tabel 4.4Hubungan resistance index (RI) aliran darah corpus luteum dengan konsentrasi serum 

progesteron..................................................................................................................67 

Tabel 4.5 Hubungan volume corpus luteum dengan konsentrasi serum progesteron....................69 

Tabel 4.6.1 Sebaran subyek penelitian berdasarkan karakteristik umur…………………………72 

Tabel 4.6.2 Sebaran subyek penelitian berdasarkan karakteristik BMI…………………………72 

Tabel 4.6.3 Sebaran subyek penelitian berdasarkan karakteristik kadar serumProgesteron…….73 

Tabel 4.7 Distribusi perbedaan rata – rata dari variabel-variabel prediktor terjadinya defek fase luteal 

yang dikategorikan berdasarkan kadar serum progesterone < 10 ng/ml dan >10ng/dl……74 

Tabel 4.8 Hubungan variabel-variabel prediktor terhadap kadar serum progesteron pada subyek 

Penelitian……………………………………………………………………………..76 

Tabel 4.9 Nilai Adjusted R Square dari variabel-variabel prediktor kadar serum 

Progesteron.………………………………………………………………………….77 

Tabel 4.10 Nilai sensitivitas dan spesifisitas serta cut off point dari pemeriksaan Kadar Serum 

Progesteron pada defek fase luteal……………………………………………………..79 

Tabel 4.10.1 Nilai sensitivitas dan spesifisitas serta cut off point dari pemeriksaan Pulsatility Index (PI) 

pada defek fase luteal……………………………………………………………………..85 


DAFTAR GRAFIK 

Grafik 1 Korelasi antar Peak Systolic Velocity (PSV) Aliran Darah Corpus Luteum dengan 

Konsentrasi Serum Progestereon……………………………………………………..60 

Grafik 2 Korelasi antar End Diastolic Velocity (EDV) Aliran Darah Corpus Luteum dengan 


Grafik 3 Korelasi antar Pulsatility Index (PI) Aliran Darah Corpus Luteum dengan 


Grafik 4 Korelasi antar Resistance Index (RI) Aliran Darah Corpus Luteum dengan 


Grafik 5 Korelasi antar Corpus Luteum dengan Konsentrasi Serum Progestereon…………...70 

Grafik 6 Receiver Operating Characteristic (ROC) dari kadar serum progesterone pada 

defek fase luteal…………………………………………………………..…………….78 

Grafik 7 Receiver Operating Characteristic (ROC) dari Peak Systolic Velocity (PSV) pada 

defek fase luteal…………………………………………………………………………81 

Grafik 8 Receiver Operating Characteristic (ROC) dari End Diastolic Velocity (EDV) pada 

defek fase luteal……………………………………………………………………………82 

Grafik 9 Receiver Operating Characteristic (ROC) dari Pulsatility Index (PI) pada defek fase 

Luteal……………………………………………………………………………………….,83 

Grafik 10 Receiver Operating Characteristic (ROC) dari Resistance Index (RI) pada defek 

fase luteal………………………………………………………………………….…………87 


DAFTAR SKEMA 

Skema 1. KERANGKA TEORI PENELITIAN .......................................................................38 

Skema 2. ALUR PENELITIAN ...............................................................................................51 

Skema 3. KERANGKA KONSEP PENELITIAN…………………………………………..52 


α-SMA α Smooth Muscle Actin 

Ang 1 Angiopoeitin 1 

Ang 2 Angiopoeitin 2 

DAFTAR SINGKATAN 

HSD Hydroxysteroid Dehydrogenase 

BBT Basal Body Temperature 

CL Corpus Luteum 

COS Controlled Ovarian Stimulation 

CTGF Connective Tissue Growth Factor 

EDTA Ethylene Diamine Tetraacetic Acid 

EDV End Diastolic Velocity 

FER fertilitas endokrinologi 

FSH Follicle Stimulating Hormone 

GH Growth Hormone 

GnRH Gonadotrophin Releasing Hormone 

hCG human Chorionic Gonadothropin 


HDL High Density Lipoproteinm 

IGF-I Insulin Like Growth Factor I 

IVF In Vitro Fertilization 

LDL Low Density Lipoprotein 

LH Luteinizing Hormone 

LLC Large Luteal Cells 

LPD Luteal Phase Defect 

mRNA messenger ribo nucleic acid 

OHSS Over Hyper Stimulation Syndrome 

PCOS Poly Cistic Ovarium Syndrome 

PGE2 Prostaglandin E2 

PGI 2 Prostaglandin I2 

PI Pulsatility Index 

PIBF progesteron induced blocking factor 

PSV Peak Systolic Velocity 

RI Resistance Index 

ROC Receiver Operating Characteristic Curve 

SLC Small Luteal Cells 


StAR Steroidogenic acute regulatory protein 

USG Ultasonography 

VEGF Vascular Endotelial Growth Factor 


DAFTAR LAMPIRAN 

Lampiran 1. LEMBAR INFORMASI PASIEN………………………………………………….. 

Lampiran 2. LEMBAR PERSETUJUAN PASIEN……………………………………………… 

Lampiran 3. KUESIONER PESERTA PENELITIAN………………………………………….. 

Lampiran 4. PERSETUJUAN DAN PENGESAHAN KOMITE ETIK PENELITIAN……….. 

Lampiran 5. TABEL INDUK PESERTA PENELITIAN……………………………………….. 


CORRELATION BETWEEN CORPUS LUTEUM BLOOD FLOW AND 

PROGESTERONE SERUM CONCENTRATION IN INFERTILE WOMEN 

Boy Rivai Pandapotan Siregar, Binarwan Halim, Muhammad Rusda 

Departement of Obstetrics and Gynecology 

Medical School, University of Sumatera Utara / H. Adam Malik General Hospital / 

Sub-Division of Reproduction Technology of IVF, Division of FER,Dept of Obgyn, Medical 

School-USU 


ABSTRACT 

Objective : The purpose of this study is to assess wether any significant correlation between 

corpus luteum blood flow and progesterone serum concentration on lutheal phase in infertile 

women. And to determine which parameter of corpus luteum blood flow would be the best 

predictor to diagnose the lutheal phase defect, as an alternative diagnostic parameter beside the 

Progesteron Serum Level. 

Study Design : This was an analytic survey study research with cross sectional study design, 

which performed in Sub-Division of Reproduction Technology of IVF, Division of FER, Obgyn 

Departement ,Medical School-USU “Halim Fertility Centre”, Medan, since November 1 st 2010 

until April 30 th 2011. The samples of this study were obtained of all infertile women of 

reproductive age (15 - 45 years old) which collected by Consecutive Sampling, who is being 

selected according to inclusion and exclusion criteria which came to pursue medical check up, 

then fulfilled the inclusion criterias and willing to participate on this research. By Correlation 

Pearson Formula (r = 0.433) from literature, 41 samples were obtained to participate. The 41 

samples data which completely collected , composed in a master of tabulation, then 

computerized by using Computer Statistic Program. Data presented on average 

values (Mean)± standard deviation. The presented data described in a scattered Dot graph form. 

To assess the significance of the relationship between the two variables were used Pearson 

correlation analysis and expressed significant if p value

asked to come and pursue the progesterone serum concentration examination, and then 

performed ultrasound Transvaginal Power Doppler to assess corpus luteum blood flow (PSV, 

EDV, PI, RI, Volume Corpus Lutem). Each patient which completely examined were recorde on 

a medical record ,then the Medical Record data collected until completely 41 samples ,and the 

data were tabulated , then the tabulated data were examined on Pearson correlation test. 

Results : By Pearson correlation test, statistically significant correlation was found between 

serum level of Progesterone (ng/ml) and Peak Systolic Velocity (PSV) of the corpus luteum 

(cm/s) with p = 0.000 (p

Key Words : Body Basal Temperature, Corpus Luteum Volume, Peak Systolic Velocity, End 

Diastolic Velocity, Pulsatility Index, Resistance Index, Progesteron Serum Concentration, Luteal 

Phase Defect. 


CORRELATION BETWEEN CORPUS LUTEUM BLOOD FLOW AND 

PROGESTERONE SERUM CONCENTRATION IN INFERTILE WOMEN 

Boy Rivai Pandapotan Siregar, Binarwan Halim, Muhammad Rusda 

Departement of Obstetrics and Gynecology 

Medical School, University of Sumatera Utara / H. Adam Malik General Hospital / 

Sub-Division of Reproduction Technology of IVF, Division of FER,Dept of Obgyn, Medical 

School-USU 


THESIS SUMMARY 

INTRODUCTION 

Infertility in the clinical sense is defined as an inability of one person or a couple to produce 

conception after one year of regular having sex without using protection, or a woman's inability 

to maintain pregnancy until term pregnancy. Forecast found in some literature suggests that the 

incidence of infertility in the United States the incidence ranges from 10-15%. From some 

literature, other causes of infertility incidence,such as: Male Factor 30-40%, Ovulation Disorders 

(Diminished Ovarian Reserve, Polycystic Ovaries, hyperprolactinemia, Dysfunction Thyroid) 

15%, 5-10% cervical mucus factor, Tuba adhesions 20%, 10% luteal phase defect, Unknown 

10%, Other (autoimmune diseases, tumors / Endocrine, Endometriosis) 1 

A woman's menstrual cycle is influenced by many hormones, In the first half of the menstrual 

cycle, GnRH in the hypothalamus induce the Anterior pituitary to release FSH. This FSH 

stimulates the maturation of follicles in the ovary (follicular phase), resulting in the synthesis of 

estrogen hormone in large quantities. The estrogen causes the proliferation of endometrium cells, 

known as Proliferation in the Endometrium or also known as the follicular phase in ovary. 

Proliferation phase lasts not fixed, can range from 7 to 21 days. This high estrogen signs the 

pituitary to release the LH. Estrogen in high quantity on mid-menstrual cycle causes ovulation. 

And then in the second half of Menstrual Cycle, corpus luteum formed then developed, to 

synthesize progesterone. Progesterone causes changes in the secretory of endometrium, known 

as Secretion phase in Endometrium which also known as luteal phase in the ovary. Luteal phase 

lasts 14 days and usually remains on the same length. 2,21,22 

Angiogenesis in the corpus luteum occurrs during the menstrual cycle and is functionally 

important for the maintenance of early pregnancy. After ovulation, as the luteinizing granulosa 

cell layer become thicker, the basement membrane that separates the granulosa cell layer from 

the theca cell layer breaks down. Blood vessels from the Theca interna invaded the cavity of the 

ruptured follicle and form a network that supplies neovascularization luteal cells. Corpus luteum 

being one of the most powerful organ in the body experiencing vascularization 3,4,5,6,7,8. Blood 


flow in the corpus luteum is important for the development itself and the maintenance of luteal 

function 3,4,5,6,7,8 

This neovascularization is essential for the delivery of luteal steroid to the general circulation, as 

well as for the provision of the circulating substrate, Low Density Lipoprotein,that is used by 

luteal cells in the biosynthesis of progesterone (Carr et al,1982). Therefore it is likely that blood 

flow to the ovary and to the corpus luteum, may be important in the regulation of the function of 

the Corpus Luteum. Blood flow to the ovary bearing Corpus Luteum increases three to seven 

fold during luteal phase and then decreases markedly as the Corpus Luteum regresses 

(Niswender et al, 1976). 3,4,5,6,7,8 If the corpus luteum does not produce progesterone in sufficient 

quantities and not on time, then the difficulty arises from multiple interactions of focus-focus on 

the reproductive cycle. 1 

Transvaginal colour Power Doppler ultrasound imaging- has been used to determine indices of 

echogenicity index and intrafollicular blood flow (Collins et al, 1991) and to evaluate serial 

indices of echogenicity, vascularity and blood flow throughout the life span of the corpus luteum 

(Bourne et al, 1996). Furthermore, color flow pulsed Doppler has been used to predict a luteal 

phase defect (Tinkannen, 1994: Glock and Brumsted, 1995). Previous studies using colour 

Power Doppler imaging have measured indices of blood flow in the Ovary and the corpus 

luteum. 3,10,11,14,15,16,17,18,19,20,21,24 

Changes in the Corpus luteum blood flow in the luteal phase and close relationship with luteal 

function are interesting topics to be discussed. Interestingly, luteal blood flow correlated 

significantly with progesterone serum concentration during mid-luteal phase, and luteal blood 

flow is significantly lower in women with luteal phase defect than women with normal luteal 

function, which indicates that the low blood flow to the corpus luteum associated with the 

incidence of luteal phase defect. 12,13 

Luteal phase defect is a state of recurrent post-ovulation deficiency to produce progesterone from 

the corpus luteum that result in infertility and recurrent miscarriage. In these circumstances, the 

corpus luteum is unable to produce an adequate progesterone, causing disturbances in the 

endometrium such as unsynchronized endometrium stroma and endometrial glands which builds 

the endometrium. Which in turn caused the disruption of implantation. So a woman is unable to 

maintain pregnancy until term pregnancy and resulted in the incidence of recurrent 

miscarriage. 1,2,15,20,21,22 

The literature estimates that 10% incidence of Luteal Phase Defect was found in the normal 

population in the United States. In Indonesia, the incidence of Luteal Phase Defect is 3-4% of all 

infertile women, and 5% in women with recurrent miscarriage. However, this reference is less 

accurate due to the lack of homogenous standardized criteria which used to evaluate and 

diagnose luteal phase defect. 1,2,15,20,21,22 


Many clinical trials have been performed to diagnose luteal phase defect and various 

combinations have been used to investigate this situation, including measurement of Basal Body 

Temperature Chart, endometrial biopsy, pelvic ultrasound to measure the pre-ovulatory follicle 

diameter pre-ovulation, serum progesterone levels of mid-luteal phase, luteal phase length. 

Growing discrepancy in the literature that when should we recommend the most optimal time in 

the menstrual cycle to obtain sampling to determine the luteal phase defect, varied from between 

1 to 2 days before the onset of the next menstrual period, up to 9 days after ovulation. However, 

the most optimal time is at Mid luteal phase, ie at 7 days after the LH surge or 7 days before 

onset of next menstruation. Categorized as luteal phase defect wether found Serum Progesterone 

Levels

This research is expected to gain more knowledge and understanding of the corpus luteum blood 

flow and its effect on the production of progesterone in the luteal phase of infertile women. 

Transvaginal colour Power Doppler Ultrasound imaging examination was able to help to 

diagnose blood flow of the corpus luteum in the luteal phase of infertile women and could be an 

alternative non-invasive diagnostic to diagnose the Luteal Phase Defect beside The examination 

of Progesterone serum concentration. 

MATERIAL AND METHODS 

This was an analytic survey study research with cross sectional study design, which performed in 

Sub-Division of Reproduction Technology of IVF, Division of FER, Obgyn Departement 

,Medical School-USU “Halim Fertility Centre”, Medan, since November 1 st 2010 until April 

30 th 2011. The samples of this study were obtained of all infertile women of reproductive age (15 

- 45 years old) which collected by Consecutive Sampling, who is being selected according to 

inclusion and exclusion criteria which came to pursue medical check up, then fulfilled the 

inclusion criterias and willing to participate on this research. 

Each respondent who fulfilled the inclusion criteria are given respectively a Basal Body 

Temperature Chart to record their basal body temperature in the morning every day for 28 days 

recorded. Day 14 has been estimated as the lowest temperature during the menstrual 

cycle, and declared as the day of ovulation. After ovulation, corpus luteum would be formed and 

developed then started to produces progesterone. Peak of the luteal phase has been estimated 

on 7 days after ovulation. On day 21 patients were asked to come and pursue the progesterone 

serum concentration examination, and then performed 

ultrasound Transvaginal Power Doppler to assess corpus luteum blood flow (PSV, EDV, PI, RI, 

Volume Corpus Lutem). Each patient which completely examined were recorde on a medical 

record ,then the Medical Record data collected until completely 41 samples ,and the data were 

tabulated , then the tabulated data were examined on Pearson correlation test. 

By Correlation Pearson Formula (r = 0.433) from literature, 41 samples were obtained to 

participate. The 41 samples data which completely collected , composed in a master of 

tabulation, then computerized by using Computer Statistic Program. Data presented on average 

values (Mean)± standard deviation. The presented data described in a scattered Dot graph form. 

To assess the significance of the relationship between the two variables were used Pearson 

correlation analysis and expressed significant if p value < 0.05 and by using the r 

value to described the strength of the relationship between the two variables of this study. The 

relationship would be stronger if closer to the value of +1 or-1. The correlation would be 

positive (+) if found that one variable is directly proportional to the other variable and would be 

negative (-) if found that one variable varies inversely with the other variable. 


RESULTS 

After 6 months duration of this study, from November 1 st , 2010 to April 30th, 2011, which 

performed at Sub-Division of Reproductive Technology IVF,Division of FER, Department of 

Obgyn FK-USU "Halim Fertility Centre" obtained 42 infertile women who admitted to 

performed examination, who fulfilled the inclusion criteria . 

Table 4.1 . Correlation between Peak Systolic Velocity (PSV) of Corpus Luteum blood flow 

and progesterone serum concentration in the mid-luteal phase 

Peak Systolic Velocity 

(PSV) (cm/s) 

Serum Progesteron 

(ng/ml) 

*Pearson correlation test 

Mean SD P r 

12.75 7.30 0.000* 0.567* 

13.06 4.77 

The Average level of Progesterone serum concentration of the participants on this study is 13.06 

± 4.77 ng / ml with Average Peak Systolic Velocity (PSV) of the Corpus Luteum blood flow of 

the participants of this study is 12.75 ± 7.30 cm/s. By Pearson correlation test, found statistically 

significant correlation between Progesterone serum concentration and Peak Systolic Velocity 

(PSV) of the corpus luteum blood flow with p = 0.000 (p

= 0.567 

Graphic 1. Correlation between Peak Systolic Velocity (PSV) of Corpus Luteum blood flow 


From the scattered dot graph above described a positive correlation between the Progesterone 

serum concentration and Peak Systolic Velocity (PSV) of the corpus luteum blood flow with the 

strength value is moderate correlation r = 0.567. 


Table 4.2 Correlation between End Diastolic Velocity (EDV) of Corpus Luteum blood flow and 

progesterone serum concentration in the mid-luteal phase 

End Diastolic Velocity 

(EDV)(cm/s) 


(ng/ml) 


Mean SD p R 

4.54 3.95 0.000* 0.604* 

13.06 4.77 


± 4.77 ng / ml with Average End Diastolic Velocity (EDV) of the Corpus Luteum blood flow of 

the participants of this study is 4.54 ± 3.95 cm/s. By Pearson correlation test, found statistically 

significant correlation between Progesterone serum concentration and End Diastolic Velocity 

(EDV) of the corpus luteum blood flow with p = 0.000 (p

Graphic 2. Correlation between End Diastolic Velocity (EDV) of Corpus Luteum blood flow 



serum concentration and End Diastolic Velocity (EDV) of the corpus luteum blood flow with the 

strength value is Strong correlation r = 0.604. 

s 

. 

r = 0.604 


Table 4.3 Correlation between Pulsatility Index (PI) of Corpus Luteum blood flow and progesterone 

serum concentration in the mid-luteal phase 

Mean SD P r 

Pulsatility Index (PI) 1.12 0.51 0.032* - 0.332* 


(ng/ml) 


13.06 4.77 


± 4.77 ng / ml with Average Pulsatility Index (PI) of the Corpus Luteum blood flow of the 

participants of this study is 1.12 ± 0.51 cm/s. By Pearson correlation test, found statistically 

significant correlation between Progesterone serum concentration and Pulsatility Index (PI) of 

the corpus luteum blood flow with p = 0.032 (p

= ‐0.332 

Graphic 3. Correlation between Pulsatility Index (PI) of Corpus Luteum blood flow and 


From the scattered dot graph above described a negative correlation between the Progesterone 

serum concentration and Pulsatility Index (PI) of the corpus luteum blood flow with the strength 

value is Weak correlation r = - 0.332 


Table 4.4 Correlation between Resistance Index (RI) of Corpus Luteum blood flow and 


Mean SD P R 

Resistance Index (RI) 0.71 0.36 0.005* - 0.423* 


(ng/ml) 


13.07 4.77 


± 4.77 ng / ml with Average Resistance Index (RI) of the Corpus Luteum blood flow of the 

participants of this study is 0.71 ± 0.36 cm/s. By Pearson correlation test, found statistically 

significant correlation between Progesterone serum concentration and Resistance Index (RI) of 

the corpus luteum blood flow with p = - 0.005 (p

= ‐0.423 

Graphic 4. Correlation between Resistance Index (RI) of Corpus Luteum blood flow and 


From the scattered dot graph above described a negative correlation between the Progesterone 

serum concentration and Resistance Index (RI) of the corpus luteum blood flow with the strength 

value is Moderate correlation r = - 0.423 


Table 4.5 Correlation between Volume Corpus Luteum and progesterone serum 

concentration in the mid-luteal phase 

Volume corpus luteum 

(cm 3 ) 

Serum Progesterone 

(ng/ml) 


Mean SD P r 

7.13 4.48 0.992* 0.002* 

13.14 4.65 


± 4.77 ng / ml with Average Volume Corpus Luteum of the participants of this study is 7.13 ± 

4.48 cm/s. By Pearson correlation test, found no statistically significant correlation between 

Progesterone serum concentration and Volume corpus luteum with p = 0.992 and found a 

positive correlation between Progesterone serum concentration and Volume corpus luteum with 

the strength value is very weak, with r = 0.002. 


= 0.002 

Graphic 5. Correlation between Volume Corpus Luteum and progesterone serum concentration 

in the mid-luteal phase 


serum concentration and Volume corpus luteum with the strength value is very weak correlation 

r = 0.002 


DISCUSSION 

Corpus luteum becomes highly vascularized within a few days after ovulation so that, on a tissueto-weight 

basis, blood flow to the corpus luteum is among the greatest of any tissue in the body 

(Abdul-Karim and Bruce, 1973). This increased vascularity, in addition to providing a conduit for 

the delivery of luteal steroids to the general circulation, it also necessary for the provision of the 

cholesterol substrate in the form of Low Density Lipoprotein, for progesterone biosynthesis 

(Carr et al, 1982). Therefore, it seems likely that blood flow to the ovary and the corpus luteum 

may be important in regulating the function of the corpus luteum. 3 

Progesterone serum concentration peaked 6 to 8 days before the start of menstruation. The early 

luteal stage is characterized by the rapid proliferation of endothelial cells and invasion of 

capillaries from the cores of the luteal tissue infoldings, which contain connective tissue and 

blood vessels derived from the theca into the peripheral areas of the infoldings, which contain 

granulosa-derived luteal cells (Gaede et al. 1985). The mid-luteal stage is characterized by the 

formation of a dense microvascular network composed primarily of capillaries. The late luteal 

stage is characterized by the regression of the capillaries, a relative increase in connective tissue, 

an increased abundant of larger microvessels, and a regression and loss of luteal parenchymal 

cells (Azmi dan O’Shea, 1984; Jablonka Shariff dkk., 1993). 3 

In research of Bau and Bajo in Madrid, Spain in 2001, found the serum levels of progesterone 

was significantly lower in women with luteal phase defect than women with normal cycles. And 

the length of the luteal phase is found shorter in women with luteal phase defect than women 

with normal cycles. 16 

Kupesic and Kurjak Research in Zagreb, Croatia, 1996, found the average progesterone serum 

level was significantly lower in women with luteal phase defect compared to the control group ( 

p < 0.01 ). 9,25 

Correlation between Peak Systolic Velocity (PSV) of Corpus Luteum blood flow and 


Miyazaki et al, 1998, in Japan in their research, PSV found peaked at 8-6 days before the onset 

of the next menstrual period and declined until the late luteal phase. Serum concentrations of 

progesterone showed the same changes, increased from 12-16 days before the start of the next 

menstrual period and peaked at 6-8 days before onset of next menstruation. Although the PSV 

did not correlate with serum concentrations of progesterone in their study, but it showed the 

same pattern of changes in progesterone serum concentrations in accordance with a previous 

study conducted by Bourne et al., 1996. 3 

Bourne et al, 1996, showed a close relationship between the PSV of blood flow surrounding the 

Corpus luteum and Serum Concentration of progesterone in a spontaneous cycle. 3,13 


Niswender et al, 1976 showed that blood flow to the ovary and the number and size of luteal 

cells may be important in the regulation of progesterone production by the ovary. Blood flow to 

the ovary bearing corpus luteum increases three to sevenfold during the luteal phase and then 

decreases markedly as the corpus luteum regresses. 3,7,8 

Hong-Ning Xie et al, Japan. In 2001 revealed that the blood flow of intra-Ovarial clearly show 

maximum velocity and low resistance index in the mid-luteal phase in normal menstrual cycle, 

suggesting that the blood vessels of the corpus luteum has a minimum flow of Resistance Index 

because they are maximally dilated, so it is not optimal for vasomotor motion. The same pattern 

was found in luteal blood flow and progesterone levels during developing corpus luteum, 

indicating that the corpus luteum of adequate vascularization is a physiological need for adequate 

luteal function. This research indicates that the increase in luteal blood flow is the impact of 

vascular dilatation in early luteal phase. PSV was found positively correlated with serum 

concentrations of progesterone. This supports the concept that luteal blood flow velocity is a 

complementary parameter that describes the luteal function in infertility. 19 

Relationship between PSV of Corpus Luteum blood flow and luteal phase deficiency, Bau and 

Bajo ,Madrid, Spain in 2001, found that the PSV in mid-luteal phase of women with luteal 

phase defect is lower than PSV in women with normal cycles. And found a significant 

correlation between PSV and progesterone serum concentration in women with luteal phase 

defect ( r = 0,36 ). 16 

On this present study, found a significant correlation between the Peak Systolic Velocity (PSV) 

of Corpus luteum blood flow (cm/s) and Progesterone serum concentration (ng/ml) and found a 

positive correlation with the strength value was moderate. 

Correlation between End Diastolic Velocity (EDV) of corpus luteum blood flow and 


Ottander et al., Sweden in 2004 showed that the End Diastolic Velocity (EDV) decreased 

significantly at the end-luteal phase than mid-luteal phase. It also found in the pattern of changes 

of PSV, where PSV showed a similar pattern of changes with the pattern of change of EDV. 10 

Relationship of EDV and luteal phase deficiency, Bau and Bajo in Madrid, Spain 2001, On this 

research found no difference between end diastolic blood flow velocity intra ovarial in women 

with luteal phase defect than women with normal ovulatoar cycle. 16 

On this present study, found a significant correlation between 

the End Diastolic Velocity (EDV) of corpus luteum blood flow (cm/s) and progesterone serum 

concentration (ng/ml) and found a positive correlation with the strength value was strong. 


Correlation between Pulsatility Index (PI) of corpus luteum blood flow with progesterone 

serum concentration in the mid-luteal phase 

Miyazaki et al. In Japan, 1998 in his research found that the Pulsatility Index (PI) of 

ovarian artery reaches its nadir in the mid-luteal phase (3-8 days prior to the next menstrual 

cycle). Progesterone serum concentration showed similar changes, increased from 12-16 days 

before the start of the next menstrual period and peaked on 6-8 days before onset of next 

menstruation. In this study, intra-luteal PI are found to be associated with serum progesterone. 

Progesterone peaked in mid-luteal phase (8-6 days before onset of next menstruation), while 

intra-luteal PI began to decreased in the early luteal phase (11-9 days before the start of the next 

menstrual period) and then increased until the beginning of the next menstrual period. The 

difference between the maximum period of progesterone serum concentrations with lowest PI 

period point showing the fact that the increase in circulating hormone is inversely proportional to 

the increase in corpus luteum of structural vascularization. 3 

Hata et al, 1990; Glock et al, 1995 suggest that the low PI values associated with lower RI. The 

blood supply to the ovary bearing corpus luteum increased during the luteal phase, especially in 

the mid-luteal phase in line with increased consumption of Low-Density Lipoprotein to the luteal 

cells to produce progesterone in the corpus luteum. 3 

Tinkanen et al., Finland, 1994 in her research found no significant difference in terms of intra- 

Ovarial Pulsatility Index (PI) with Progesterone Serum Levels. However, inadequate number of 

patients and insuficient methods used for evaluation of luteal function in this study, have become 

limitations in this study. 9 

On this present study, found a significant correlation between the Pulsatility Index of 

Corpus Luteum blood flow and Progesterone Serum Concentration (ng/ml) and found a 

negative correlation with the strength value was weak. 

Correlation between Resistance Index (RI) of Corpus Luteum blood flow and Progesterone 

serum concentration in the Mid-Luteal Phase 

In the study of Kupesic and Kurjak in Croatia in 1996, their research found the lowest RI value 

at the mid-luteal phase, which then increased to higher values in the late luteal phase. The 

average progesterone level was significantly lower (P

detected in the mid-luteal phase in line with the peak of corpus luteum Angiogenesis. Increased 

RI is shown in the late luteal phase as the regression of the corpus luteum. 3,14 

In the study of Tamura et al. in Japan in 2008, found that luteal RI in the mid-luteal phase in 

women with luteal phase defect increased significantly compared with women with normal luteal 

function. Luteal RI was significantly correlated with progesterone serum concentrations in the 

mid-luteal phase. In this study, shows that the luteal RI decreased during the early luteal phase 

and increased during the regression phase. Furthermore, this study showed high luteal RI and 

low progesterone serum levels are found during the luteal phase. In fact, angiogenesis is essential 

for corpus luteum development and maintenance of luteal function. These findings indicate that 

blood flow is an important factor to regulate luteal function. Therefore, showing that the luteal 

phase defect is caused by defective regulation of blood flow during mid-luteal luteal phase. 11 

Study by Takasaki et al. in Japan in 2009 that conducts research on the corpus luteum blood 

flow associated with luteal function found a significant negative correlation between corpus 

luteum RI with progesterone serum concentrations during mid-luteal phase. 17 

Relationship between RI and luteal phase defect, both previous studies and the study of Takasaki 

et al, Japan,2009 support that the luteal phase defect associated with the presence of high RI in 

corpus luteum because luteal RI in women with luteal phase defects during mid-luteal phase 

increased significantly compared to women with normal luteal function and corpus luteum RI 

negatively correlated with progesterone serum concentrations during the Mid-luteal phase on 

women with normal cycles. 17 

On this present study, found a significant correlation between the Resistance Index of 

Corpus Luteum blood flow and Progesterone Serum Concentrations (ng/ml) and found 

negative correlation with the strength value was moderate.. 

Correlation between the Volume of Corpus Luteum and Progesterone Serum Concentration in 

the Mid-Luteal Phase 

Miyazaki et al., 1998 in Japan showed the corpus luteum image with Doppler transvaginal 

ultrasound imaging during the luteal phase. Areas that seen increased vascularity in the time of 

periovulation to mid-luteal phase and declined until the next menstrual period. Volume of 

Corpus Luteum showed the same pattern as changes in Progesteron serum concentrations. 

Although the changes in volume corpus luteum is proportional to the change of Progesterone 

Serum Concentrations, but there is no significant correlation between the volume of the corpus 

luteum and Serum Concentrations of Progesterone. 3 

Jablonka Shariff et al., 1993 on their research found that the rapid growth of luteal 

vascularization is accompanied by a rapid increase in weight and size of the corpus luteum. 3 


Bruce and Moor, 1976;. Niswender et al, 1976 found the luteal phase blood flow increased 

dramatically in relation to the increase in corpus luteum tissue growth. 3,7,8 

Bourne et al, 1996 found a significant correlation between the size of the corpus luteum with 

progesterone production, shown in his research. 3,13 

Jokubkiene et al., Sweden 2006, in his study he found there was no significant relationship 

between volume corpus luteum on day-7 and progesterone level on day-7 after ovulation. The 

study found no correlation between serum progesterone levels with blood flow to the corpus 

luteum in the mid-luteal phase. Progestreron level is a description of the corpus luteum function, 

but blood flow does not depict progesterone production in the corpus luteum. Corpus luteum 

highest volume found in the early luteal phase and decreased significantly at the end of the luteal 

phase. 24 

Furthermore, the study of Singh et al 1997 found that the size of luteal cell increases during the 

formation of the corpus luteum and decreases during the regression of the corpus luteum. 3 

On this present study, found no significant correlation between the Volume of Corpus 

Luteum (mm3) and Progesterone Serum Concentration and found a positive correlation with 

the strength value was very weak. 

Retrieved the Pulsatility Index (PI) as the best diagnostic tool in this study. AUC value (AUC = 

70.1%) which compared to other predictor variables (diagnostic tools) to predict the luteal phase 

defect ,with cut off point value was 1.085 with a sensitivity of 73, 3% and a specificity of 66.7%. 


CONCLUSION 

Based on the purpose of this study, results and discussion of this study, it can be concluded that : 

There is significant correlation between the Peak Systolic Velocity (PSV) of Corpus luteum 

blood flow (cm/s) and Progesterone serum concentration (ng/ml) and found a positive 

correlation with the strength value was moderate. There is significant correlation between 

the End Diastolic Velocity (EDV) of Corpus Luteum blood flow (cm/s) and Progesterone serum 

concentration (ng/ml) and found a positive correlation with the strength value was strong. There 

is significant correlation between the Pulsatility Index of Corpus Luteum blood flow 

and Progesterone Serum Concentration (ng/ml) and found a negative correlation with the 

strength value was weak. There is significant correlation between the Resistance Index of 

Corpus Luteum blood flow and Progesterone Serum Concentrations (ng/ml) and found 

negative correlation with the strength value was moderate. There was no significant 

correlation between the volume of Corpus Luteum (mm3) and Progesterone Serum 

Concentrations and found a positive correlation with the strength value was very weak. Retrieved 

the Pulsatility Index (PI) as the best diagnostic tool in this study. AUC value (AUC = 70.1%) 

which compared to other predictor variables (diagnostic tools) to predict the luteal phase defect 

,with cut off point value was 1.085 with a sensitivity of 73, 3% and a specificity of 66.7%. 

RECOMMENDATION 

Based on the advantages of this study, it can be suggested: 

By Power Doppler Transvaginal Ultrasound can also reflected the Progesterone serum 

concentration, without having to perform progesterone serum examination through the laboratory 

findings. Therefore Power Doppler Transvaginal Ultrasound can be used as an alternative noninvasive 

diagnostic tool to diagnose Luteal Progesterone Deficiency in the Luteal Phase with 

Pulsatility Index as the best predictor for determining the existence of Luteal Phase Defect. 


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dr. Risman Felix Kaban, SpOG dr. Indra Gunasti Munthe, SpOG (K)

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