温针灸对优质冻融胚胎移植失败者宫腔血流灌注的影响

Effect of warming acupuncture on uterine blood perfusion in patients with failed high-quality freeze-thawed embryo transfer

目的:观察温针灸对优质冻融胚胎移植(FET)失败者宫腔血流灌注的影响,探讨温针灸提高再次移植临床妊娠率的作用机制。方法:将72例优质FET失败患者随机分为观察组和对照组,各36例。观察组月经干净后开始行温针灸治疗,腹部穴位选取气海、关元、中极、曲骨等,腰骶部穴位选取肾俞、命门、腰阳关等,每次50 min,每天1次,4 d后休息1 d,休息后继续治疗至排卵期停止;对照组月经干净后连续口服暖宫孕子胶囊,每次3粒,每天3次,至排卵期停止。两组均1个月经周期治疗10d,1个月经周期为一疗程,共治疗3个月经周期。观察两组患者治疗前后子宫动脉搏动指数(PI)、内膜厚度、内膜类型、宫腔血流灌注情况、宫腔血流恢复充足所需治疗时间、种植窗期子宫内膜容受性(ER)比例及临床妊娠率。结果:治疗后,两组内膜厚度明显增加(P<0.05)、PI明显降低(P<0.05),观察组PI低于对照组(P<0.05);治疗后,两组患者a型、A型内膜比例明显升高(P<0.05),观察组均高于对照组(P<0.05);治疗后,两组宫腔血流灌注充足比例均明显增加(P<0.05),观察组高于对照组[83.3%(30/36)vs69.4%(25/36),P<0.05];治疗后,两组种植窗期优质ER比例明显升高(P<0.05),观察组高于对照组[72.2%(26/36)vs 50.0%(18/36),P<0.05];观察组宫腔血流恢复充足所需治疗时间短于对照组(P<0.05),临床妊娠率高于对照组[47.2%(17/36)vs33.3%(12/36),P<0.05]。结论:温针灸可增强优质冻融胚胎移植失败者宫腔血流灌注,提高子宫内膜容受性,从而提高再次移植临床妊娠率。

Objective To observe the effect of warming acupuncture on uterine blood perfusion in the patients with failed high-quality freeze-thawed embryo transfer(FET) and explore its effect mechanism on the improvement of clinical pregnancy rate after re-tranfer. Methods A total of 72 patients of failed high-quality FET were randomized into an observation group and a control group, 36 cases in each one. In the observation group, after the menstrual period ended, warming acupuncture started at the acupoints located on the abdomen, e.g. Qihai(CV 6), Guanyuan(CV 4), Zhongji(CV 3) and Qugu(CV 2) and those on the lumbar sacral region, e.g. Shenshu(BL 23), Mingmen(GV 4) and Yaoyangguan(GV 3), 50 min in each treatment, once daily, at the interval of 1 day after 4-day treatment. The treatment was discontinued till the patients were at the ovulatory stage. In the control group, nuangong yunzi capsules were taken orally and continuously after the end of menstrual period, 3 capsules each time, three times a day and stopped at the ovulatory stage. The treatment of one menstrual cycle was taken as one course and the treatment for 3 menstrual cycles was required. Before and after treatment, the uterine artery pulsation index(PI), endometrial thickness, endometrial type, uterine blood perfusion, the recovery time of sufficient uterine blood flow, the endomentrial receptivity(ER) during the implantation window period and the clinical pregnancy rate were observed in the two groups. Results After treatment, the endometrial thickness was increased and PI decreased obviously in the two groups(P<0.05) and PI in the observation group was lower than that in the control group(P<0.05). After treatment, the proportion of type a and type A of endometrium was increased markedly in the two groups(P<0.05) and the proportion in the observation group was higher than the control group(P<0.05). After treatment, the case proportion of sufficient uterine blood flow was increased obviously in the two groups(P<0.05) and the value in the observation group was higher than the control group [83.3% (30/36) vs 69.4%(25/36), P<0.05]. After treatment, the proportion of ER during the implantation window period was increased remarkably in the two groups(P<0.05) and the value in the observation group was higher than the control group [72.2%(26/36) vs 50.0%(18/36), P<0.05]. The recovery time of sufficient uterine blood flow in the observation group was shorter than the control group(P<0.05) and the clinical pregnancy rate was higher than the control group [47.2%(17/36) vs33.3%(12/36), P<0.05]. Conclusion Warming acupuncture enhances uterine blood perfusion and improves uterine endometrial receptivity so that the clinical pregnancy rate is increased after re-transfer in the patients with failed high-quality freeze-thawed embryo transfer.