Clinical observation of endometrial prescription combined with TAM on FET of thin endometrial patients with kidney deficiency and blood stasis

Objective:To explore the best endometrial preparation scheme of freeze-thawed embryo transfer(FET)for patients with thin endometrium with kidney deficiency and blood stasis by comparing the clinical outcomes of three endometrial preparation schemes of estradiol valerate tablets Hormone Replacement(HRT),Tamoxifen(TAM)and Endometrial Prescription combined with TAM(EP-TAM group).Method:Retrospective analysis of 318 patients with thin endometrium with kidney deficiency and blood stasis who underwent FET in Changle People's Hospital of Shandong Province,Shandong Maternal and Child Health Hospital,and Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine from September 2018 to March 2023,including 101 patients in HRT group(estradiol valerate tablets);108 patients in TAM group;109 patients in EP-TAM group.The cycle cancellation rate,intimal thickness,clinical pregnancy rate,embryo implantation rate,early abortion rate and ectopic pregnancy rate were compared among the three groups.Result:Cycle cancellation rates of TAM group and EP-TAM group were significantly lower than HRT group(8.3%,9.2%vs 17.8%,P<0.05).The intimal thickness of TAM group[(8.11±0.36)mm]and EP-TAM group[(8.21±0.40)mm]was significantly thicker than HRT group[(7.11±0.43)mm](P<0.05).The clinical pregnancy rate and implantation rate of TAM group and EP-TAM group were higher than HRT group,the early abortion rate and ectopic pregnancy rate were lower than HRT group,and EP-TAM group was more significant(P<0.05).Conclusion:Patients with thin endometrium underwent FET can try Endometrium Prescription combined with TAM(EP-TAM)to prepare the endometrium.

A Comparative Study on the Effects of Vaginal Misoprostol and Vaginal Misoprostol Plus Estradiol on Labor Induction

Background:Cervical ripening is an important factor in predicting successful labor induction.In an unfavorable cervix,ripening should be done before induction.In this study,the effect of misoprostol and that of misoprostol plus estradiol on cervical ripening were compared.Methods:This randomized,double-blinded study included a total of 190 pregnant women who were identified for pregnancy termination due to maternal or fetal cause at 37 weeks with Bishop score of less than 4.The patients were assessed between April 2015 to April 2016 in two university hospitals at northeast Iran(Omol-Banin Hospital and Emam Reza Hospital,Mashhad).The patients who met the inclusion criteria were randomly assigned to two groups:the intervention group(Group A),who received 25 micrograms of vaginal misoprostol plus 50 micrograms of estradiol,and the control group(Group B),who received 25 micrograms of vaginal misoprostol only.Misoprostol was administered at 4-hour intervals until cervical ripening(Bishop score≥8)or upon initiation of active phase in both the groups.The maximum dosage of misoprostol was three doses,whereas estradiol was administered only once.Results:In this study,the main causes of pregnancy termination were ROM and post-term.There was no significant statistical difference in the Bishop score between the two groups(P=0.13).In addition,no significant difference was observed in the duration of time for cervical ripening(Bishop≥8)between the two groups(P=0.7).The duration between drug administration to the initiation of active phase and also from active phase to delivery showed no significant differences between the two groups(P=0.49 and 0.24,respectively).There was also no significant difference in the delivery route(operative vaginal delivery or Cesarean section)(P=0.2 and P=0.91,respectively).Conclusion:From this study,the use of misoprostol plus estradiol did not improve cervical ripening or decrease the induction time.Further studies are recommended to investigate complementary results.

温和灸联合西药治疗脾肾阳虚型卵巢早衰的临床研究

Objective To explore the clinical therapeutic effect on premature ovarian failure(POF)treated with the combination of mild moxibustion and western medication.Methods A total of 66 patients were divided into a control group and an observation group according to random number table,33 cases in each one.In the control group,the conventional western medication was administered.In the observation group,besides the treatment as the control group,mild moxibustion was supplemented at Guānyuán(关元CV4),Qìhăi(气海CV6),Píshū(脾俞BL20)(bilateral)and Shènshū(肾俞BL23)(bilateral).The duration of treatment was 3 menstrual cycles in either group.Before treatment and on the 9th day of menstruation after 3-menstrual cycle treatment,the number of antral follicles and ovarian volume were detected by color Doppler ultrasound respectively.Before treatment and on day 2 to 4 of menstruation after 3-menstrual cycle treatment,the levels of serum estrogen(E_(2)),follicle-stimulating hormone(FSH),interleukin-21(IL-21)and vascular endothelial growth factor(VEGF)were determined separately and the therapeutic effect was evaluated in two groups separately.Results The effective rate was 93.94%in the observation group and was 72.73%in the control group(P<0.05).After treatment,the number of antral follicles and ovarian volume were increased as compared with those before treatment in the patients of two groups(both P<0.05).After treatment,the number of antral follicles and ovarian volume in the observation group were higher than the control group(both P<0.05).After treatment,the levels of serum E_(2) and FSH were improved as compared with those before treatment in the two groups(both P<0.05).The levels of serum E_(2) and FSH in the observation group were better than the control group after treatment(both P<0.05).The levels of serum IL-21 and VEGF after treatment did not change obviously as compared with those before treatment in the control group(both P>0.05).But in the observation group,the levels of serum IL-21 and VEGF after treatment changed apparently as compared with those before treatment(both P<0.05)and the levels of these two indicators after treatment were better than the control group(both P<0.05).Conclusion The combined treatment of mild moxibustion with western medication achieves the definite therapeutic effect on POF and it increases the number of antral follicles and ovarian volume and regulates sex hormone level,which is probably related to the regulation of serum IL-21 and VEGF.