针刺联合克龄蒙治疗体外受精-胚胎移植患者卵巢低反应的疗效观察

Acupuncture combined with medication improves endocrine hormone levels and ovarian reserve function in poor ovarian response patients undergoing in vitro fertilization-embryo transplantation

目的:观察针刺联合克龄蒙治疗体外受精-胚胎移植患者卵巢低反应(POR)的临床疗效,并分析其作用机制。方法:选择在山东省青州市中医院行体外受精-胚胎移植(IVF-ET)中出现POR的患者100例,在进入第2个IVF-ET周期前,按随机数字表法分为对照组、克龄蒙组、针刺组及联合组,每组25例。克龄蒙组于月经第3天开始口服克龄蒙,每日1片,21 d后停药,针刺组于月经第8~15天(卵泡期)采用针刺治疗,联合组口服克龄蒙配合针刺治疗。3个治疗组均治疗3个月经周期,对照组未做特殊处理。观察4组治疗前后的卵巢储备功能指标促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)、抗苗勒管激素(AMH)、窦卵泡数(AFC)的变化,并于治疗第1、2周期监测促性腺激素(Gn)用量、Gn使用天数、扳机日E2值、获卵数、优质胚胎数等指标的变化。结果:与治疗前比较,克龄蒙组、针刺组及联合组治疗后FSH、LH及E2含量下降(P<0.05),AMH、AFC上升(P<0.05)。治疗后,与对照组比较,克龄蒙组、针刺组、联合组患者的FSH、LH及E2含量下降(P<0.05),AMH、AFC上升(P<0.05);与克龄蒙组比较,联合组LH含量降低(P<0. 05);与针刺组比较,联合组FSH、LH及E2含量降低(P<0. 05),AFC上升(P<0.05)。治疗2个周期后,与治疗第1周期的助孕指标比较,克龄蒙组的扳机日E2含量上升(P<0.05);针刺组患者的Gn使用天数减少、扳机日E2含量上升(P<0. 05);联合组患者的Gn用量减少、Gn使用天数减少、扳机日E2含量上升、优质胚胎数增加(P<0. 05)。治疗第2周期后,与克龄蒙组比较,联合组Gn用量减少、Gn使用天数减少、扳机日E2含量升高、优质胚胎数增加(P<0. 05);与针刺组比较,联合组Gn用量减少、扳机日E2含量升高(P<0. 05)。结论:针刺疗法联合克龄蒙治疗可以改善POR患者的内分泌激素水平,在一定程度上提高了患者的卵巢储备水平,营造有利于助孕的卵巢环境。

Objective To observe the clinical effect of acupuncture plus medication in the treatment of poor ovarian response(POR)patients and to explore its mechanisms in assisting pregnancy.Methods A total of 100 volunteer POR women undergoing in vitro fertilization-embryo transplantation(IVF-ET)were recruited in the present study.On the 1 stcycle of IVF-ET,these POR women received microstimulation of ovulation program(oral administration of Clomiphene,muscular injection of Menotrophin,Chorionic Gonadotrophin triggering,etc.).Before receiving the 2 ndperiod of IVF-ET,these patients were equally and randomly divided into control,medication(Climen,composed of estradiol valerate and cyproterone acetate),acupuncture and acupuncture+medication(combined treatment) groups according to the random number table.Patients of the medication group were asked to orally take Climen(1 tablet/d for 21 days)beginning from the 3 rdday of the menstruation,which was repeated for 3 menstrual cycles.Patients of the acupuncture group received manual acupuncture stimulation of Guanyuan(CV4),and bilateral Taixi(KI3),Sanyinjiao(SP6)of and Taichong(LR3)from day 8 to 15 of menstruation(follicular phase),once daily for 3 menstrual cycles.On the 2 ndday of menstruation of the 1 stand 2 ndIVF-ET cycle,the ovarian reserve function was detected,including measurement of serum follicle-stimulating hormone(FSH),luteinizing hormone(LH),and estradiol(E2)contents by using radioimmunoassay,and serum anti-mullerian hormone(AMH)level by using ELISA,and the antral follicles count(AFC)of the ovaries by using a color Doppler ultrasonic diagnosis apparatus.At the end of ovulation induction,the assisted pregnancy indexes and outcomes were detected,including administration of dosage and days of gonadotropin(Gn),the diameter of dominant oocyte,level of E2 on the trigger day,the numbers of ultrasound-guided-retrieved oocyte and the cultivated highquality embryo(grade 1 and 2).Results After the treatment,the contents of serum FSH,LH and E2 in the medication,acupuncture and combined treatment groups were significantly reduced(P<0.05),and the content of serum AMH and ovary AFC in the medication,acupuncture and combined treatment groups were obviously increased(P<0.05)in comparison with their own pre-treatment(P<0.05).Compared with the control group,the levels of FSH,LH and E2 contents were notably decreased,and the AMH content and AFC significantly increased in the medication,acupuncture and combined treatment groups(P<0.05).Comparison among the three treatment groups showed that the levels of FSH,LH and E2 were notably lower in the combined treatment group than in the acupuncture group(P<0.05),and the AFC was markedly more in the combined treatment group than in the acupuncture group(P<0.05),and LH content was also significantly lower in the combined treatment group than in the medication group(P<0.05).Regarding the pregnancy-assistant indexes and outcomes,the dosage of Gn in the combined treatment group and the number of Gn administration days in the acupuncture and combined treatment groups were significantly fewer(P<0.05),serum E2 levels on the trigger day in the medication,acupuncture and combined treatment groups,and the high-quality embryo number in the combined treatment group were considerably higher in comparison with their own levels of the 1 stIVF-ET cycle in each group(P<0.05).Comparison among the three groups showed that the dosage and number of administration days of Gn in the combined treatment group were fewer than those in the medication group(P<0.05),and the dosage of Gn in the combined treatment group were significantly lower than that in the acupuncture group(P<0.05),E2 content of the combined treatment group was markedly higher than that of the medication and acupuncture groups(P<0.05).The highquality embryo number in the combined treatment group was obviously larger than that of the medication group(P<0.05).No significant differences were found between the 2 ndand 1 stIVF-ET cycles in the number of the obtained oocyte,between the acupuncture and medication groups in the E2 content at the trigger day,and the numbers of Gn administration days and the high-quality embryo(P>0.05).Conclusion Acupuncture combined with medication improves the level of endocrinal hormones and ovarian reservation function in POR women undergoing IVF-ET,benefiting the ovary environment of pregnancy.