Study on Treatment of Polycystic Ovarian Syndrome with Infertility by Combined Therapy of Chinese Herbal Medicine and Compound Cyproterone Acetate

Objective: To evaluate the effect of combined therapy of Chinese herbal medicine and compound cyproterone acetate (CPA) in treating non-obesity polycystic ovarian syndrome (PCOS) and to explore its mechanism in improving withdrawal ovulation. Methods: Eighty-six patients of non-obesity P-COS, typed as Shen-deficiency with blood stasis Syndrome or Shen-deficiency with Phlegm-Dampness Syndrome by Syndrome Differentiation in traditional Chines medicine, were randomly divided into three groups: (1) The TCM group (n = 26) was treated with Chinese drugs for 6 menstrual cycles; (2) The western medicine (WM) group (n=30) was treated with 1 tablet of CPA for 21 days, with the treatment beginning from the 5th day of menstruation. The treatment was given for 3 menstrual cycles by repetitious medication, which stopped and restarted on the 5th day of withdrawal bleeding. Then the ovulation promoting therapy was applied by using clomifene citrate and human chorionic gonadotropin (CC/hCG) for 3 menstrual cycles; (3) The TCM-WM group (n=30) was treated with the medications used for the above two groups. The menstrual cycle, the volume and duration of the menstruation, as well as the improvement of acne and pilosis [Ferriman-Gallway (F-G) scoring] were observed after 3 cycles ended. Moreover, condition of ovulation was monitored by B-ultrasonography at the 4th- 6th cycle and status of pregnancy was observed. Results: Compared with before treatment, the blood level of luteinizing hormone (LH) and testosterone (T) in all 3 groups after treatment significantly decreased (P<0. 05), with its ratio to follicle-stimulating hormone (LH/FSH) recovered to normal, but without markedly change in levels of FSH, estradiol (E2) and prolactin (PRL). The menstrual cycle in most patients got regular and acne significantly alleviated (P<0. 05), and the improvement of infrequent menstruation and acne was better in the WM group and the TCM-WM group than that in the TCM group, but pilosis showed no significant improvement in all three groups. The periodical ovulation rate in the TCM-WM group (73. 1%) and the WM group (68. 3%) was significantly higher than that in the TCM group (40%). The pregnancy rate in the TCM-WM group (53. 8%) was significantly higher than that in the other two groups (26.1% and 25% respectively, all P<0.05). Conclusion: Using combined therapy of TCM and composite CPA followed by o-vulation promoting agents of TCM and WM to treat patients of non-obesity PCOS could relieve the clinical symptoms, improve the abnormal blood level of sex hormones and significantly elevate the pregnancy rate.

Assessing and treating insulin resistance in women with polycystic ovarian syndrome

Polycystic ovarian syndrome(PCOS) is a highly prevalent hormonal and metabolic disorder among reproductive aged women worldwide.Women with PCOS have widely varying phenotypes and seek medical care for differing reasons.In addition to concern for menstrual cycle function,ovulation,hirsutism and acne,many PCOS women have abnormal glucose metabolism.While diabetes mellitus and impaired glucose tolerance are easily diagnosed,the diagnosis of and concern for insulin resistance as a precursor disorder is underappreciated.Insulin resistance may be the first important marker of metabolic disease in PCOS women at risk for metabolic syndrome and coronary artery disease.

Meta analysis of infertility due to polycystic ovarian syndrome treated by kidney-tonifying and blood-activating therapy

Objective:To explore the Meta-analysis of polycystic ovary syndrome-induced infertility by tonifying kidney and activating blood circulation.Methods:Chinese keywords or subject words such as"kidney-tonifying and Blood-Activating Therapy","polycystic ovary syndrome","infertility"were searched in CNKI,Wanfang and Weipu databases,and English keywords such as"Kidney-tonifying and Blood-Activating Therapy","Stein-Leventhal syndrome","Infertility"were searched in Pubmed database for a period of 2.From 2000 to 2019,Meta-analysis was carried out with Review Manager 5.0.Results:Thirteen randomized controlled literatures were screened out,and the control group was treated with routine western medicine and the treatment group was treated with Kidney-tonifying and Blood-activating therapy.All of them included literatures mentioned grouping method,but no blind method was mentioned,and the literature quality was generally low.Meta-analysis of the effective rate showed that Z=3.69(P=0.0002<0.001),95%CI(1.77,6.42),indicating that the effective rate in the treatment group was higher than that in the control group.Meta-analysis of the cycle ovulation rate showed that Z=2.19(P=0.03<0.05),95%CI(1.08,4.35),indicating that the cycle ovulation rate in the treatment group was higher than that in the control group.Meta-analysis of pregnancy rate showed that:Z=7.07(P<0.00001),95%CI(2.27,4.24),indicating that the pregnancy rate in the treatment group was higher than that in the control group;bias analysis found that the literature was distributed on both sides of the dotted line,most of which were biased.Meta-analysis of the incidence of LUFS showed that Z=3.25(P=0.001<0.05),95%CI(0.02,0.38),indicating that the incidence of LUFS in the treatment group was lower than that in the control group.Meta-analysis of serum E2 level after treatment showed that Z=4.41(P<0.0001),95%CI(11.01,28.64),indicating that the serum E2 level in treatment group was higher than that in control group after treatment.Conclusion:Meta-analysis shows that the method of tonifying kidney and activating blood circulation has a significant effect on infertility caused by polycystic ovary syndrome.It can improve the level of sex hormones,improve the efficiency,cycle ovulation rate and pregnancy rate,and reduce the incidence of LUFS.However,the quality of the included literature is not high,which needs to be further included in high-quality literature to confirm.

Defining the role of bariatric surgery in polycystic ovarian syndrome patients

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women.To meet PCOS criteria,women must have a combination of hyperandrogenism,anovulation and ultrasound findings.Almost 10% of all reproductive age women worldwide show signs of PCOS.Although women often seek care for gynecological or body image concerns,many PCOS women are at risk for metabolic syndrome (MS).Many of the metabolic consequences are overlooked and un-dertreated by physicians because these patients tend to be young,reproductive age women.MS and obesity coexist commonly with PCOS.These young women are predisposed to glucose abnormalities and ulti-mately diabetes mellitus,dyslipidemia and eventually cardiovascular disease.Bariatric surgery can be an ef-fective means of weight loss in PCOS women.Surgical techniques have become safer and less invasive over time and have been found to be effective in achieving significant weight loss.Surgical options have also in-creased,giving patients more choices.Bariatric surgery may prevent or reverse metabolic syndrome.Bariatric surgery may also have reproductive benefits in PCOS patients.Although bariatric surgery has historically been performed in older,reproductive aged women,it has recently gained favor in adolescents as well.This is of particular importance due to the prevalence of both PCOS and MS in adolescents.Treatment of PCOS and MS certainly requires a combination of medical therapy,psychological support and lifestyle modifications.These treatments are difficult and often frustrating for pa-tients and physicians.Bariatric surgery can be effective in achieving significant weight loss,restoration of the hypothalamic pituitary axis,reduction of cardiovascular risk and even in improving pregnancy outcomes.Ulti-mately,bariatric surgery should be considered part of the treatment in PCOS women,especially in those with MS.

Endocrine Indices of PCOS in Women with Polycystic Ovaries but without Diagnostic Features of PCOS: A Study of an Infertility Clinic Population

Background: The presence of polycystic ovarian morphology (PCO) without the other characteristics of the polycystic ovarian syndrome (PCOS) is insufficient for the diagnosis of PCOS and there is little justification for follow up in endocrine clinics for women with PCO morphology alone. A few studies have been reported regarding the endocrine features of asymptomatic women with PCO with conflicting data about endocrine profiling. The aim of this study was to assess whether women with PCO, but who have no symptoms of PCOS differ, endocrinologically, from women with normal ovaries.?Methods: We analysed the results of ultrasound and endocrine investigations in 576 consecutive women who attended the infertility clinic between 1993 and 1995 at the Reproductive Medicine Unit of St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK. Results: Three hundred and twenty eight women had PCO and 248 had normal ovaries. Among the 328 women with PCO, 169 (51.5%) had PCOS according to Rotterdam criteria. The remaining women with PCO had no symptoms of the syndrome (n = 159);they had a history of regular menses, had proven ovulatory cycles and had neither clinical nor biochemical evidence of hyperandrogenism. However, these women had higher timed LH [median (IQR) 5.3 (4.2) IU/l vs 4.8 (3.4) IU/l, respectively;p = 0.044] and testosterone [2.0 (0.8) nmol/l vs 1.8 (0.8), respectively;p = 0.009] compared with women with normal ovaries (although by definition within the normal range). There was no difference in BMI or FSH between the two groups. Among the 169 women with PCOS, 45.0% (n = 76) were anovulatory without hyperandrogenism, 34.3% (n = 58) fulfilled the NIH criteria and 20.7% (n = 35) were ovulatory with hyperandrogenism. The proportion of hyperandrogenism among anovulatory women with PCO is 43.3% (58 out of 134).?Conclusions: Women with PCO, but no symptoms of the syndrome, differ endocrinologically compared with women with normal ovaries: they had higher timed LH and testosterone (although by definition within the normal range). These data suggest that despite the lack of symptoms of PCOS, women presenting to an infertility clinic with PCO represent a milder phenotype of those with overt PCOS, but fall on the same spectrum.

Potential use of durian fruit(Durio zibenthinus Linn) as an adjunct to treat infertility in polycystic ovarian syndrome

Infertility due to polycystic ovarian syndrome （PCOS） is a worldwide problem that is increasing at alarming rates. Insulin resistance, the prime factor of PCOS, induces comorbid metabolic syndrome as well. Durian （Durio zibenthinus Linn）, a fruit of Southeast Asia, is used as a natural supplement in healthy diets. This paper is a short literature review that examines the fruit＇s effects against various components of metabolic syndrome and its fertility-enhancing properties in PCOS. Various published literature was reviewed to learn of the anti-inflammatory, anti-oxidant, anti-obesity, anticholesterol, and antihypoglycaemic nature of the fruit. The literature search was done using PubMed, Google Scholar and library databases. The keywords used were polycystic ovarian syndrome, infertility, metabolic syndrome and Durian zibenthinus Linn. Reviewed studies showed that the fruit is effective against various components of metabolic syndrome, but the mechanisms of action against anovulation and menstrual disturbances in PCOS have yet to be studied. The traditional use of durian as a fertility-enhancing agent needs to be validated scientifically by isolating its various components and ascertaining its fertility enhancing properties.

The progress and prospect of assessment measures of uterine cavity function for infertility patients

Objective:To explore the progress and prospect of evaluation methods for infertility patients.Methods:From September 2017 to December 2020,199 cases of infertility patients who have accepted mini-hysteroscopy examination in the Department of Gynecological Endocrinology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University.The patients who had primary ovary insufficiency,tubal infertility were excluded;patients with hysteroscopy contradiction,such as acute or sub-acute vaginal tract inflammation,endometrium lesion or endometrium carcinoma,severe cardiovascular,liver or kidney insufficiency were excluded.40 patients were excluded and 15 patients lost follow up,144 patients were eventually included in the analysis.The patient’s age,body mass index,infertility etiology,preoperative and postoperative stimulate ovulation cycle,pregnancy state and pregnancy time were recorded.The effect of mini-hysteroscopy on ovulation induction cycle was analyzed in pregnant patients.Results:The average age of 144 patients was 32.10±4.67 years old.96(66.67%)patients were found to have intrauterine abnormalities,while 48(33.33%)patients were found to have normal intrauterine cavity.48 cases of pregnancy,accounting for 33.33%;the median and interquartile ranges[M(Q1,Q3)]of ovulation induction cycles before and after surgery were respectively[3(0,5)],[2(1,3)],the difference was statistically significant(P<0.05).Among the 48 pregnant patients,32 of them had no structural lesions in hysteroscopy,the ovulation induction cycle of these patients before and after hysteroscopy were respectively[5(0,9)],[1(0,3)],the difference was statistically significant(P<0.05).Conclusion:Uterine cavity evaluation is important for the assessments of fertility.As an advanced diagnosis instrument,mini-hysteroscopy can not only timely detect the intrauterine abnormalities of patients,hut also with great application value in shorten the ovulation cycle in infertility patients and increase the pregnancy rate.

血清氧化低密度脂蛋白与多囊卵巢综合征不孕患者临床妊娠结局的相关性研究

目的分析血清氧化低密度脂蛋白(ox-LDL)与多囊卵巢综合征(PCOS)不孕患者临床妊娠结局的关系。方法采用前瞻性队列研究方法连续收集2020年1月至2021年12月承德市中心医院诊治的155例PCOS不孕患者作为研究对象。记录患者的妊娠成功率,记录患者入组时临床资料及基线性激素指标、胰岛素抵抗相关指标、血清ox-LDL水平。根据血清ox-LDL水平分为高水平组(n=85)和低水平组(n=70)。分析血清ox-LDL与PCOS不孕患者临床妊娠结局的相关性。结果155例PCOS不孕患者中有34例成功妊娠,临床妊娠率为21.94%。高水平组临床妊娠成功率低于低水平组,稳态模型胰岛素抵抗指数(HOMA-IR)高于低水平组,差异具有统计学意义(P<0.05)。Logistic回归分析显示,PCOS不孕患者血清ox-LDL、HOMA-IR和甘油三酯(TG)表达上调是导致PCOS不孕患者临床妊娠失败的危险因素(P<0.05)。Pearson相关性检验显示,血清ox-LDL水平与PCOS不孕患者HOMA-IR和TG呈正相关(r>0,P<0.05)。受试者工作特征(ROC)曲线显示,血清ox-LDL水平预测PCOS不孕患者临床妊娠结局的曲线下面积(AUC)为0.806;当血清ox-LDL临界值达498.09μg/L时,患者发生临床妊娠失败风险较高。结论PCOS不孕患者临床妊娠结局与血清ox-LDL升高有关,早期检测有助于预测临床妊娠失败的风险,其可作为辅助预测指标。

吴作君从气血水火辨治多囊卵巢综合征致不孕症经验

吴作君认为多囊卵巢综合征发病与气血水火关系失衡,脏腑功能失调相关,与肾、肝、脾关系密切。治疗上,从肾调水火,育卵促排;从肝脾调气血,养膜助孕。在针对多囊卵巢综合征合并症治疗上,以活化清疏为总则,认为活即理血,化即治水,清即平火,疏即调气,将利湿祛浊、滋阴清热、疏肝行气、益气活血、温阳化痰等治法综合应用于合并症治疗中。并结合临床验案对吴作君治疗多囊卵巢综合征致不孕症的诊疗思路及用药经验进行介绍。

血清SFRP5水平、LH/FSH比值联合卵巢超声对多囊卵巢综合征不孕患者的诊断价值

目的探讨血清分泌型卷曲相关蛋白5(SFRP5)、黄体生成素/卵泡刺激素(LH/FSH)比值联合卵巢超声对多囊卵巢综合征(PCOS)不孕患者的诊断价值。方法将2022年1月至2023年6月于武汉市中医医院超声诊断科就诊的135例PCOS伴不孕患者设为不孕组,另选取同期进行孕前检查的130例健康者为对照组。彩色多普勒超声检查获取卵泡数、最大卵泡直径、卵巢血流搏动指数(PI)和阻力指数(RI);Pearson/Spearman相关性分析法分析血清SFRP5水平、LH/FSH比值与超声参数的相关性;受试者工作特征(ROC)曲线分析血清SFRP5水平、LH/FSH比值联合卵巢超声对PCOS不孕的诊断价值。结果与对照组比较,不孕组血清SFRP5水平[(13.68±3.25)ng/ml vs.(17.50±3.42)ng/ml]、最大卵泡直径[(8.67±1.75)mm vs.(11.83±2.88)mm]、PI[(0.82±0.14)vs.(0.98±0.20)]和RI[(0.56±0.11)vs.(0.65±0.13)]均显著降低(P<0.05),LH/FSH比值[(2.13±0.45)vs.(1.49±0.31)]、稳态模型胰岛素抵抗指数(HOMA-IR)[(2.94±0.53)vs.(2.36±0.42)]和卵泡数[(15.31±4.26)vs.(9.52±2.19)]均显著升高(P<0.05);血清SFRP5水平与卵泡数呈负相关(P<0.05),与最大卵泡直径、PI、RI呈正相关(P<0.05);血清LH/FSH比值与卵泡数呈正相关(P<0.05),与最大卵泡直径、PI、RI呈负相关(P<0.05);血清SFRP5水平、最大卵泡直径、PI和RI均是PCOS患者发生不孕的独立保护因素(OR分别为0.724、0.713、0.731、0.741,P<0.05),LH/FSH比值、HOMA-IR和卵泡数均是PCOS患者发生不孕的独立危险因素(OR分别为1.349、1.436、1.352,P<0.05);血清SFRP5水平、LH/FSH比值、卵泡数、最大卵泡直径、PI、RI诊断PCOS不孕的AUC分别为0.819、0.855、0.786、0.755、0.834和0.813,且6个指标联合诊断PCOS不孕的AUC为0.952(P<0.05)。结论PCOS不孕患者血清SFRP5水平降低、LH/FSH比值升高,二者联合卵巢超声参数对PCOS不孕具有较高的诊断价值。

小柴胡汤治疗不孕症的研究进展

小柴胡汤是《伤寒论》中著名方剂,具有和解少阳、疏肝解郁、调和气血等功效,可以用来治疗外感、内伤杂病、妇人病等疾病,疗效良好。中医学认为不孕症的病机与肾精亏虚、肝气郁结等因素有关,针对“肝气郁结”这一病机,结合张机“但见一证便是,不必悉具”之宗旨,小柴胡汤常被临床用于治疗不孕症及其相关疾病。

脐周八穴埋线对肥胖型多囊卵巢综合征不孕症患者IVF-ET治疗结局的影响

目的:探讨脐周八穴埋线治疗对肥胖型多囊卵巢综合征(PCOS)不孕症患者体外受精-胚胎移植(IVF-ET)结局的影响。方法:将90例肥胖型PCOS不孕症患者按随机数字表法分为观察组和对照组各45例。对照组患者接受IVF-ET治疗,观察组患者以脐周八穴埋线联合IVF-ET治疗,检测治疗前、后患者抑制素B(INHB)、黄体生成素(LH)、睾酮(T)、卵泡刺激素(FSH)、视黄醇结合蛋白4(RBP-4)、白脂素(Asprosin)、瘦素(LEP)、脂联素(APN)、白细胞介素-17(IL-17)、胆固醇(TC)、甘油三酯(TG)水平,以及卵巢基质血流动力学指标舒张末期流速(EDV)、收缩期最大流速(PSV)、阻力指数(RI),记录患者促性腺激素(Gn)使用剂量、获取卵泡个数、MⅡ卵率、受精率、优质胚胎率、临床妊娠率、流产率。结果:治疗后,两组患者INHB、T、LH、TC、TG、Asprosin、RBP-4、LEP、IL-17水平较治疗前降低,FSH、APN水平较治疗前升高(P<0.05),且观察组INHB、T、LH、TC、TG、Asprosin、RBP-4、LEP、IL-17水平较对照组低,FSH、APN水平较对照组高(P<0.05);治疗后,两组EDV、RI水平均降低,PSV水平升高(P<0.05),且观察组EDV、RI水平较对照组低,PSV水平较对照组高(P<0.05);观察组Gn使用剂量少于对照组(P<0.05),获取卵泡个数多于对照组(P<0.05),受精率、MⅡ卵率、临床妊娠率高于对照组(P<0.05)。结论:脐周八穴埋线治疗肥胖型PCOS不孕症行IVF-ET患者,可改善患者性激素指标,调节卵巢储备功能与基质血流动力学,改善糖脂代谢与胰岛素敏感性,抑制机体炎症,有利于获取卵泡,改善妊娠结局。

来曲唑联合甲泼尼龙治疗克罗米芬抵抗的多囊卵巢综合征不孕患者的临床观察

目的探讨来曲唑联合甲泼尼龙对克罗米芬抵抗的多囊卵巢综合征不孕患者临床结局、卵巢储备功能、血清性激素和安全性的影响。方法回顾性分析青岛市中心医院妇科2021年2月至2022年1月收治的78例克罗米芬抵抗的多囊卵巢综合征不孕患者的临床资料,根据治疗方法不同分为对照组(42例)和观察组(36例)。对照组患者在月经周期第5~9天口服来曲唑5 mg/d,顿服,并采用阴道B超监测子宫内膜和卵泡发育情况、以戊酸雌二醇纠正子宫内膜厚度、以绒促性素诱发排卵等措施促进受孕。观察组患者在对照组治疗基础上,于自然月经或者撤退性出血第3天开始口服甲泼尼龙,4 mg/d,顿服。2组均治疗6个月经周期。比较2组患者排卵和1年内妊娠情况,血清性激素[雌二醇(E2)、黄体生成素(LH)、卵泡刺激素(FSH)、睾酮]、抗米勒管激素(AMH)水平,排卵指标(卵泡生长时间、排卵数量和优势卵泡数量)以及不良反应发生情况。结果治疗后,观察组患者的生化妊娠率(72.22%)和临床妊娠率(47.22%)均显著高于对照组(47.62%、19.05%),血清E2、LH、FSH、睾酮和AMH水平均显著低于对照组,卵泡生长时间显著短于对照组,排卵数量和优势卵泡数量均显著多于对照组(P<0.05)。观察组和对照组患者的排卵率(94.44%vs.83.33%)和不良反应总发生率(8.33%vs.9.52%)比较,差异均无统计学意义(P>0.05)。结论来曲唑联合甲泼尼龙相比单用来曲唑能够显著提高克罗米芬抵抗的多囊卵巢综合征不孕患者的妊娠率,调节其性激素水平,改善其卵巢储备功能,且安全性良好。

经阴道超声血流参数联合血清抗苗勒管激素对多囊卵巢综合征不孕症体外受精-胚胎移植妊娠失败的预测价值

目的探讨经阴道超声血流参数联合血清抗苗勒管激素(AMH)对多囊卵巢综合征(PCOS)不孕症体外受精-胚胎移植(IVF-ET)妊娠失败的预测价值。方法选取行IVF-ET的173例PCOS不孕症患者为研究对象,其中脱落12例。根据胚胎移植后第28天阴道B超结果将161例患者分为妊娠失败组(n=96)与妊娠成功组(n=65)。比较2组阻力指数(RI)、搏动指数(PI)、收缩与舒张末期最大血流速度比值(S/D)和血清AMH水平。采用多因素Logistic回归分析法分析PCOS不孕症IVF-ET妊娠失败的影响因素。绘制受试者工作特征(ROC)曲线,分析RI、PI、S/D、血清AMH水平单独及联合评估对PCOS不孕症患者IVF-ET妊娠失败的预测价值。结果妊娠失败组血清AMH水平低于妊娠成功组,血流RI、PI、S/D高于妊娠成功组,差异有统计学意义(P<0.001)。RI(OR=4.688,95%CI:2.878~6.498)、PI(OR=4.332,95%CI:2.277~6.387)、S/D(OR=3.773,95%CI:1.856~5.691)、月经第3天黄体生成素(LH)/促卵泡生成素(FSH)值(OR=2.998,95%CI:1.236~4.760)高是PCOS不孕症IVF-ET妊娠失败的危险因素(P<0.05);月经第3天FSH水平高(OR=0.579,95%CI:0.416~0.806)、血清AMH水平高(OR=0.722,95%CI:0.533~0.911)及人绒毛膜促性腺激素(hCG)日子宫内膜厚(OR=0.632,95%CI:0.421~0.843)是PCOS不孕症IVF-ET妊娠失败的保护因素(P<0.05)。RI、PI、S/D联合血清AMH水平预测PCOS不孕症IVF-ET妊娠失败的灵敏度、特异度、曲线下面积(AUC)分别为95.83%、80.00%、0.933。结论超声血流参数联合AMH对PCOS不孕症IVF-ET妊娠失败具有较好的预测价值。

补肾活血方治疗PCOS合并不孕的妊娠结局及对性激素、卵巢功能改善的作用

目的:探讨补肾活血方治疗多囊卵巢综合征(PCOS)不孕效果及对患者性激素水平、卵巢功能改善作用。方法:选取2021年1月-2023年10月本院收治的PCOS不孕患者120例,分为观察组和对照组各60例。对照组口服枸橼酸盐氯米芬片治疗,观察组口服补肾活血方治疗,两组疗程均为3个月经周期,观察两组治疗后子宫内膜容受性、卵泡发育情况、性激素水平、排卵率及妊娠结局。结果:治疗后观察组排卵率(93.3%)、妊娠率(55.0%)高于对照组(80.0%、33.3%),自然流产率(3.3%)低于对照组(16.7%);子宫内膜厚度(9.36±0.77 mm)高于对照组(8.42±0.59 mm),子宫动脉搏动指数(2.02±0.21)、子宫动脉阻力指数(0.59±0.08)低于对照组(2.31±0.26、0.71±0.11),最大卵泡直径(2.23±0.42 cm)、优势卵泡数(2.68±0.51个)均高于对照组(1.92±0.40 cm、2.23±0.42个),卵泡数(19.85±3.98个)少于对照组(24.28±4.06个),血清卵泡刺激素(3.77±0.86 U/L)、黄体生成素(8.11±2.21 U/L)、睾酮(0.51±0.07 ng/ml)水平均低于对照组(4.61±0.79 U/L、9.95±2.61 U/L、0.64±0.14 ng/ml),孕酮(0.89±0.09 nmol/L)水平高于对照组(0.72±0.04 nmol/L)(均P<0.05)。结论:补肾活血方有助于改善PCOS患者子宫内膜容受性,促进卵泡正常发育,纠正性激素紊乱,提高排卵率,改善妊娠结局,有较好的临床疗效。

西罗莫司在生殖领域的研究进展

西罗莫司作为常用的免疫抑制剂,现广泛用于预防器官移植受者发生免疫排斥反应。随着医学研究的不断发展,已证明西罗莫司在女性生殖过程中具有免疫调节作用。西罗莫司通过抑制哺乳动物雷帕霉素靶蛋白发挥免疫调节功能,可能会改善合并反复种植失败、复发性流产、子宫内膜异位症、慢性子宫内膜炎及多囊卵巢综合征等生殖系统疾病患者的生殖免疫状态。西罗莫司还可预防辅助生殖治疗过程中卵巢过度刺激综合征的发生,提高母胎界面免疫状态异常患者的胚胎种植率和临床妊娠率,实现更好的妊娠结局。综述西罗莫司在女性生殖相关疾病中的作用机制、研究现状及安全性。

通元针法联合补肾活血膏方治疗肾虚血瘀型多囊卵巢综合征所致不孕症的疗效观察及机制探讨

【目的】观察在促排卵基础上应用通元针法联合补肾活血膏方治疗肾虚血瘀型多囊卵巢综合征(PCOS)所致不孕症患者的临床疗效,探索提高患者妊娠成功率的方法及可能的疗效机制。【方法】将120例肾虚血瘀型PCOS所致不孕症患者随机分为西药组、膏方组、针灸组和联合组4组,每组各30例。所有患者均给予来曲唑片促排卵治疗,在此基础上,西药组不加用其他干预措施,膏方组给予补肾活血膏方治疗,针灸组给予通元针法治疗,联合组给予通元针法联合补肾活血膏方治疗,共治疗6个月经周期。观察各组患者治疗前后中医证候积分及血清抗缪勒氏管激素(AMH)、促卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)、泌乳素(PRL)和睾酮(T)水平的变化情况,观察各组患者的卵泡发育情况、子宫内膜厚度及子宫内膜类型,计算排卵率和妊娠率,评价各组患者的中医证候疗效、临床综合疗效和安全性。【结果】(1)中医证候疗效方面,联合组的总有效率为83.33%(25/30),西药组为43.33%(13/30),膏方组为66.67%(20/30),针灸组为50.00%(15/30),组间比较,联合组的中医证候疗效明显优于其他3组(P<0.01)。(2)临床综合疗效方面,联合组的总有效率为83.33%(25/30),西药组为46.67%(14/30),膏方组为60.00%(18/30),针灸组为70.00%(21/30),组间比较,联合组的临床综合疗效明显优于其他3组(P<0.05)。(3)中医证候积分方面,治疗后,各组患者的中医证候积分均较治疗前明显下降(P<0.01),且联合组的下降幅度明显优于其他3组(P<0.05)。(4)性激素方面,治疗后,各组患者的血清AMH、LH、T水平均较治疗前明显下降(P<0.05或P<0.01),而血清FSH、E2、PRL水平均较治疗前无明显下降(P>0.05);治疗后组间比较,联合组对血清AMH、LH、T水平的下降幅度均明显优于其他3组(P<0.05)。(5)卵泡发育方面,联合组对卵泡发育情况包括优势成熟卵泡数量、排卵期最大卵泡直径、卵泡期天数的改善作用均明显优于其他3组(P<0.05)。(6)排卵期子宫内膜厚度及子宫内膜类型方面,联合组的子宫内膜明显厚于其他3组(P<0.05),A型子宫内膜所占比例明显高于其他3组(P<0.05)。(7)排卵率和妊娠率方面,联合组的排卵率和妊娠率均明显高于其他3组,差异均有统计学意义(P<0.05)。(8)安全性方面,研究过程中,各组患者均无明显不良反应发生,且患者的血常规、肝功能、肾功能等安全性指标均无明显异常变化。【结论】在促排卵基础上应用通元针法联合补肾活血膏方治疗肾虚血瘀型PCOS所致不孕症患者具有明显优势,可有效调节患者的性激素水平,改善患者的卵巢功能,提高患者的妊娠成功率,可为中西医结合治疗PCOS所致不孕症开辟新的途径。

PCOS不孕症患者糖脂代谢变化及其与子宫内膜容受性的关系

目的探讨多囊卵巢综合征(PCOS)不孕症患者糖脂代谢变化及其与子宫内膜容受性的关系。方法选取2021年3月至2022年10月商丘市妇幼保健院接收的136例PCOS不孕症患者作为疾病组,同时选取在商丘市妇幼保健院体检并明确因男性因素不孕的健康女性136例作为健康组。检测两组糖脂代谢指标[空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)]和子宫螺旋动脉搏动指数(PI)、阻力指数(RI)及子宫内膜厚度(Em)并比较。采用Pearson法分析PCOS不孕症患者糖脂代谢变化与子宫螺旋动脉PI、RI、Em的相关性。另根据疾病组患者子宫内膜容受性将其分为子宫内膜容受性良好组和不良组,比较两组患者糖脂代谢变化,并采用多因素logistic回归分析PCOS不孕症患者糖脂代谢变化对子宫内膜容受性的影响。结果疾病组FBG、FINS、TC、TG、LDL-C、HOMA-IR和子宫螺旋动脉PI、RI均高于健康组(P<0.05),HDL-C水平和Em均低于健康组(P<0.05);Pearson分析结果显示,PCOS不孕症患者FBG、FINS、TC、TG、LDL-C、HOMA-IR与PI、RI均呈正相关(P<0.05),与Em呈负相关(P<0.05);HDL-C水平与PI、RI均呈负相关(P<0.05),与Em呈正相关(P<0.05);子宫内膜容受性不良组FBG、FINS、TC、TG、LDL-C、HOMA-IR和子宫螺旋动脉PI、RI均高于良好组(P<0.05),HDL-C水平和Em均低于良好组(P<0.05);多因素logistic回归分析结果显示FBG、FINS、HOMA-IR、TC、TG、LDL-C、HDL-C均是PCOS不孕症患者子宫内膜容受性不良的影响因素(P<0.05)。结论PCOS不孕症患者FBG、FINS、TC、TG、LDL-C水平和HOMA-IR均升高,HDL-C水平降低,且均与子宫螺旋动脉PI、RI、Em相关联,糖脂代谢紊乱是PCOS不孕症患者子宫内膜容受性不良的影响因素。

多囊卵巢综合征不孕女性血清胰岛素样生长因子结合蛋白-3、游离睾酮指数水平及与卵巢储备功能的关系

目的 分析多囊卵巢综合征(PCOS)不孕女性血清胰岛素样生长因子结合蛋白-3(IGFBP-3)、游离睾酮指数(FAI)水平及其与卵巢储备功能的关系。方法 回顾性分析青岛市第八人民医院收治的120例PCOS不孕女性(观察组)和42名健康体检女性(对照组)的临床资料。比较观察组和对照组研究对象血清IGFBP-3及FAI水平,并统计观察组患者卵巢储备功能情况,比较卵巢储备功能正常、卵巢储备功能低下患者的基线资料,分析PCOS不孕女性卵巢储备功能低下的影响因素,血清IGFBP-3、FAI水平与PCOS不孕女性卵巢储备功能的关系及其对PCOS不孕女性卵巢储备功能低下的预测效能。结果 与对照组比较,观察组患者血清IGFBP-3水平更低,FAI水平更高(P<0.05)。120例PCOS不孕女性中,38例存在卵巢储备功能低下。与卵巢储备功能正常患者比较,卵巢储备功能低下患者的盆腔炎发生率、婚姻不满意占比及FAI水平更高(P<0.05),血清IGFBP-3水平更低(P<0.05);多因素Logistic回归分析显示盆腔炎(95%CI:1.151~6.290)、婚姻满意程度(95%CI:1.033~4.952)、血清IGFBP-3水平(95%CI:0.040~0.286)及FAI水平(95%CI:10.024~185.807)是PCOS不孕女性的卵巢储备功能低下的影响因素(P<0.05)。Pearson分析显示血清IGFBP-3水平与卵巢储备功能呈正相关关系(r=0.513,P<0.05),FAI水平与卵巢储备功能呈负相关关系(r=-0.495,P<0.05)。ROC曲线分析血清IGFBP-3、FAI水平及两者联合预测PCOS不孕女性卵巢储备功能低下的AUC分别为0.786、0.845、0.912,且联合预测的AUC值更高(P<0.05)。结论 与正常人群比较,PCOS不孕女性血清IGFBP-3水平更低,与卵巢储备功能呈正相关关系;FAI水平更高,与卵巢储备功能呈负相关关系,即血清IGFBP-3水平越低,FAI水平越高,卵巢储备功能越低下,血清IGFBP-3联合FAI水平对卵巢储备功能低下具有较好的预测效能。

Analysis of acupoint-selection patterns in acupuncture-moxibustion treatment of polycystic ovarian syndrome based on data mining

Objective:To analyze the meridian and acupoint-selection patterns in acupuncture-moxibustion treatment of polycystic ovarian syndrome (PCOS) by data mining technique,for exploring acupoints that could be effective for PCOS and providing suggestion and reference in selecting acupoints for the acupuncture-moxibustion treatment of PCOS.Methods:Literatures related to the acupuncture-moxibustion treatment of PCOS published before April 2018 were collected.By a self-made data mining program developed using Microsoft Excel 2007,a database of acupuncture-moxibustion treatment of PCOS was then established.The correlation analysis was performed for the frequency of use of acupoints and acupoint groups.Cluster analysis was also conducted.Results:A total of 92 articles were recruited finally.Sanyinjiao (SP 6),Conception Vessel and chest-abdomen region ranked the top on the list of the most frequently used acupoints,meridians and regions,respectively.Correlation analysis showed that the acupoint group with the highest confidence was Sanyinjiao (SP 6) and Zusanli (ST 36),and the group with the highest support was Sanyinjiao (SP 6) and Guanyuan (CV 4).Cluster analysis revealed five effective clusters:Guanyuan (CV 4) and Sanyinjiao (SP 6);Zhongwan (CV 12) and Tianshu (ST 25);Zhongji (CV 3),Zusanli (ST 36) and Qihai (CV 6);Xuehai (SP 10),Shenshu (BL 23),Taichong (LR 3) and Guilai (ST 29);Ganshu (BL 18),Taixi (KI 3),Yinlingquan (SP 9) and Pishu (BL 20).Conclusion:According to the confidence and support report,Sanyinjiao (SP 6) and Zusanli (ST 36) or Sanyinjiao (SP 6) and Guanyuan (CV 4) are recommended in acupuncture-moxibustion treatment of PCOS,with adjunct points selected for different patterns,e.g.Zhongwan (CV 12) and Tianshu (ST 25) for tonifying spleen and expelling dampness;Zhongji (CV 3) and Qihai (CV 6) for supplementing qi and cultivating blood;Xuehai (SP 10),Shenshu (BL 23),Taichong (LR 3) and Guilai (ST 29) for tonifying kidney and dissolving stasis;Ganshu (BL 18),Taixi (KI 3),Yinlingquan (SP 9) and Pishu (BL 20) for tonifying kidney and spleen and regulating liver.