An evaluation of methods for the test of tubal patency in female infertility

ＡｎｅｖａｌｕａｔｉｏｎｏｆｍｅｔｈｏｄｓｆｏｒｔｈｅｔｅｓｔｏｆｔｕｂａｌｐａｔｅｎｃｙｉｎｆｅｍａｌｅｉｎｆｅｒｔｉｌｉｔｙＨｅＦａｎｇｆａｎｇ（何方方），ＸｕＬｉｎｇ（徐苓），ＧｅＱｉｎｓｈｅｎｇ（葛秦生）Ａｎｅｖａｌｕａｔｉｏｎｏｆｍｅｔｈｏ...

Oligospermia due to partial maturation arrest responds to low dose estrogen-testosterone combination therapy resulting in live-birth: a case report

A man having severe oligospermia, due to partial maturation arrest at spermatid stage, was given low dose estrogen-testosterone combination therapy for three months. His sperm count increased enormously, following which his wife conceived and delivered a healthy baby at term.

Prevalence and Factors Associated with Female Sexual Dysfunction in Beijing, China

Background： Female sexual dysfunction （FSD） is a highly prevalent and often underestimated problem. However, large-scale, population-based epidemiological surveys of FSD are scarce in China. The present study was conducted to evaluate the prevalence and the potential risk factors of FSD across a selection of social groups in Beijing, China, based on the Female Sexual Function Index （FSFI）. Methods： A cross-sectional study based on the multiple-stage cluster sampling was performed with adult women throughout the Dongcbeng and Shunyi districts of Beijing. The Chinese version of FSFI was used, as well as questions on demographic characteristics, the disease-related context, and social relationships. Results： A total of 6000 consecutive women entered this study, with an actual response from 5024 women, corresponding to a response rate of 83.7%. A total of 4697 （78.3%） questionnaires were effective. The prevalence of adult FSD in Beijing was 2973 （63.3%） using a score of 26.55 as the boundary value, whereas the total mean FSFI score was 23.92 ~ 6.37. However, 1423 （30.3%） women did not seek help. By multivariate logistic regression analysis, the possible potential risk factors included age （odds ratio [OR] = 1.051 ）, dissatisfaction with the spouse＇s sexual ability （OR = 3.520）, poor marital affection （OR = 2.087）, spouse sexual difficulties （OR = 1.720）, dissatisfaction with married life （OR = 1.476）, living in a rural area （OR = 1.292）, chronic pelvic pain （OR = 1.261）, chronic disease （OR = 1.534）, previous pelvic surgery （OR = 1.605）, vaginal delivery （OR = 2.285）, lower education （OR = 3.449） and postmenopausal （OR = 3.183）. Conclusions： As suggested by the FSFI scores, female sexual problems are highly prevalent in Beijing. Dissatisfaction with the spouse＇s sexual ability, poor marital affection, sexual difficulties of the spouse, dissatisfaction with the marriage, rural life, CPP, and postmenopausal were conceivable risk factors for FSD in Beijing women.

Nearly-complete labial adhesions diagnosed with repetitive cystitis in postmenopausal women:A case report

BACKGROUND Nearly-complete labial adhesions diagnosed with repetitive cystitis in postmenopausal women:A case report CASE SUMMARY The case of an 83-year-old woman who presented with dysuria,urination disorders,recurrent cystitis,and bacteriuria and was admitted to a private hospital after 1 mo of antibiotic treatment without improvement of her symptoms.Upon examination,labial adhesions were observed with nearly-complete labial fusion with a pinpoint opening.Bacteriuria was detected in urine analysis,and the urine culture test was positive for Escherichia coli.Therefore,a parenteral antibiotic(Fosfomycin)and topical estrogen cream were administered.However,since the adhesion did not separate after 2 wk of treatment,surgical correction was performed.First,adhesiolysis was conducted with a blunt instrument.Then,hysteroscopy and cystoscopy were performed.Hysteroscopic findings showed no abnormalities of the endometrium and endocervix,and the cystoscopic results were also normal.Finally,labiaplasty was completed to prevent adhesion recurrence.One month after the surgery,the discomfort while urinating was eliminated and the adhesion did not recur.CONCLUSION Labial adhesions in postmenopausal women cannot be successfully treated with estrogen creams,and surgical treatment should be considered.

Health service needs of women with reproductive tract infections in selected areas of China

OBJECTIVE: To provide insight into the psychosocial factors underlying the utilisation of health services by women with reproductive tract infection (RTI) symptoms. METHODS: A cross-sectional study, adopting Aday and Andersen' s Social Behaviour Model, was conducted between 1998 and 1999 in Chinese Hebei province and Beijing. A total of 864 eligible married women (age 21 to 60 years) were face to face interviewed. RESULTS: The percentage of self-reported symptoms of RTIs in urban and rural women was 35.6 and 46.8, respectively; the proportion of women with RTIs who utilised health services was 27.5% and 26.7%, respectively. Compared to urban women, rural women had less knowledge on RTIs and more traditional beliefs, and were more satisfied with local health services. The results of logistic regression analysis showed that the common factor influencing health service utilisation in women with RTIs was current experience of RTIs. Knowledge about self-medication, perceived social stigma attached to RTIs, prior experience of RTIs, family income and perceived severity of RTIs were also predictors of utilisation of health services in rural women with RTIs. Satisfaction with health providers, information received from health providers, prior experience of RTIs, occupation and medical care coverage were predictors of utilisation of health services in urban women with RTIs. CONCLUSION: The prevalence of RTIs is high, but the rate of seeking health services is low. There is a great need for emphasizing culturally acceptable reproductive health education in different places to improve women' s ability for self-care. Regular medical check-ups for women are also important. It is necessary to improve the quality of health service, complete the reform of health insurance and alleviate women' s social stigma related to RTIs, giving women social and moral support.

News Release

The Cleveland Clinic Foundation is inviting appli-cations from persons interested in advanced training inareas of male or female infertility and sexual function.The training is designed for residents, clinicians, ARTpersonnel and scientists with background and interest inthe field of Reproductive Medicine, Andrology, andSexual Dysfunction. Selected candidates will get an op-portunity to:

腹腔镜手术对子宫内膜异位症不孕患者血清多项指标的影响

目的：观察腹腔镜手术（ LPS ）对子宫内膜异位症（ EMS ）不孕患者血清基质金属蛋白酶－9（MMP－9）、金属蛋白酶抑制因子－1（TIMP－1）和白细胞介素－2（IL－2）、白细胞介素－10（IL－10）的影响。方法选择2012年8月至2013年8月接受手术的EMS患者80例，根据手术方式的不同分为观察组（接受LPS手术治疗）和对照组（接受开腹手术治疗），每组各40例。观察两组治疗前后血清MMP－9、TIMP－1、MMP－9／TIMP－1和IL－2、IL－10、IL－2／IL－10的变化及术后6个月的受孕情况。结果观察组术后 MMP－9水平[（51．21±24．01）μg／L]比治疗前[（261．88±190．11）μg／L]明显下降，且观察组比对照组下降更明显；观察组TIMP－1水平[（45．88±11．02）μg／L]比对照组[（25．32±6．67）μg／L]明显上升（t＝4．846，P＜0．05）；观察组MMP－9／TIMP－1较对照组明显降低，差异有统计学意义（t＝3．636，P＜0．05）；两组治疗后IL－2、IL－10、IL－2／IL－10差异均有统计学意义（t＝4．228、4．415、3．396，均P＜0．05）；观察组受孕率65．0％、流产率7．7％，均优于对照组的30．0％、33．3％（χ^2＝9．825、4．060，均P＜0．05）。结论 LPS是一种治疗EMS的有效方法，可提高血清TIMP－1和IL－2水平，降低MMP9和IL－10水平；改善免疫指标，提高患者的生育能力。

Heyan Kuntai capsule versus dehydroepiandrosterone in treating Chinese patients with infertility caused by diminished ovarian reserve： a multicenter, randomized controlled trial

OBJECTIVE: To evaluate the clinical efficacy and safety of Heyan Kuntai capsule(HYKT) in treating women with infertility caused by diminished ovarian reserve(DOR).METHODS: One hundred eight eligible patientsfrom three Chinese hospitals were randomly divided into an HYKT treatment group(n = 55) or a dehydroepiandrosterone(DHEA) treatment group(n =53). Patients in the HYKT group were treated orally with four 0.5 g HYKT three times a day; patients in the DHEA group were treated with one 25.0 mg DHEA capsule three times a day. All patients were treated for 3 months and followed up over a3-month period.RESULTS: Of 108 patients, 12 dropped out: six from the HYKT group, and six from the DHEA group. Eleven patients got pregnant during the treatment. Serum anti-Müllerian hormone levels and antral follicle counts increased significantly in both groups after treatment(P < 0.05) especially in the HYKT group(P < 0.05). Serum follicle stimulating hormone(FSH) levels and FSH/luteinizing hormone ratios decreased(P < 0.05) with no significant difference between the two groups. Estradiol levels in the HYKT group and DHEA-sulfate levels in the DHEA group both increased(P < 0.05). The spontaneous pregnancy rates were 12% and 11% in the HYKT and DHEA groups, respectively(not significant). During the follow-up period, 16 patients in the HYKT group underwent in vitro fertilization-embryo transfer(IVF-ET) and the number of retrieved oocytes was(5.1 ± 1.8). In DHEA group, 20 patients underwent IVF-ET and the number of retrieved oocyte was(4.2 ± 1.9)(not significant); clinical pregnancy rates were 38% in the HYKT group and 20%in DHEA group(not significant). No significant adverse reactions were observed.CONCLUSION: HYKT can improve the ovarian re-serve and hormone levels in patients with infertility caused by DOR. Pregnancy rates after HYKT treatment were similar to those of DHEA treatment.HYKT might be an alternative to the treatment of infertility caused by DOR.

Effects of Chinese herbs combined with in vitro fertilization and embryo transplantation on infertility:a clinical randomized controlled trial

OBJECTIVE： To assess the effects of using Chinese herbs in assisted reproductive technology. METHODS： Four hundred and thirty-three subjects aged less than 42 years with infertility due to Fallo- pian tube or male-related factors who were willing to undertake in vitro fertilization and embryo trans- plantation were randomly allocated to a Chinese herb intervention group （n=216） or a conventional treatment control group （n=217）. All subjects re- ceived one of four routine ultra-ovulation-promot- ing therapies at the Reproductive Center in the Third Hospital Affiliated to Beijing University ac- cording to their physician＇s assessments. The sub- jects in the intervention group received various Chi- nese herbs depending on their conventional treat- ment. Endometrial thickness, number of acquired eggs, and rates of normal fertility, high-quality em- bryos, biochemical and clinical pregnancy of sub- jects were assessed in both groups.RESULTS： The high-quality embryo rate of 51.9%, biochemical pregnancy rate of 51.0%, clinical preg- nancy rate of 44.2% and endometrial thickness of （10.84± 1.75） mm in the intervention group were all significantly higher than those in the control group [48.7%, 38.9%, 34.8%, and （10.52±1.50） mm, respec- tively; P〈O.05]. The normal fertility rate of 58.5% in the Chinese herb group was also significantly supe- rior to the 54.7% achieved in the control group （P〈 0.01）. There were no statistically significant differ- ences （P〉0.05） in the average number of acquired eggs within a single cycle, incidence of excessive stimulation of ovary, rates of embryo transplanta- tion or early abortion and birth of living babies be- tween the two groups. CONCLUSION： Our findings indicate that Chinese herbs increase endometrial thickness, improve the quality of fertility and embryo, and promote embry- onic nidation, thus enhancing the success rate of in vitro fertilization/intracytoplasmic sperm injec- tion-embryo transplantation cycle. Using Chinese herbs improves the outcomes and safety of assist- ed reproductive technologies.

Therapeutic efficacy of moxibustion plus medicine in the treatment of infertility due to polycystic ovary syndrome and its effect on serum immune inflammatory factors

Objective:To explore the effects and related mechanism of heat-sensitive moxibustion plus clomifene citrate capsules for infertility due to polycystic ovary syndrome(PCOS).Methods:A total of 70 patients were randomized into a control group and an observation group by the random number table method,with 35 cases in each group.The control group was treated with clomifene citrate capsules,while the observation group was treated with heat-sensitive moxibustion on the basis of the medications in the control group.The treatment course lasted for 6 menstrual cycles.The endometrial thickness and ovarian volume of the patients were measured before and after treatment.The levels of serum sex hormones,tumor necrosis factor-α(TNF-α)and nuclear factor-κB(NF-κB)were detected.Follow-up was performed for 1 year after treatment,and the pregnancy rate was recorded.Results:After treatment,the endometrium of the patients in both groups was significantly thickened,the ovarian volume was significantly reduced,and the intra-group differences were statistically significant(all P<0.05).The endometrium thickness and ovarian volume in the observation group were significantly different from those in the control group(both P<0.05).After treatment,the levels of serum testostrn(T)and luteinizing hormone(LH)in both groups decreased significantly,the level of estradiol(E2)increased obviously,and the intra-group differences were statistically significant(all P<0.05).The levels of serum T and LH in the observation group were lower than those in the control group,and the E2 level in the observation group was higher than that in the control group,and the between-group differences were statistically significant(all P<0.05).After treatment,the levels of serum TNF-αand NF-κB of the patients in both groups decreased,and the intra-group differences were statistically significant(all P<0.05).The levels of serum TNF-αand NF-κB in the observation group were significantly lower than those in the control group(both P<0.05).After 1-year follow-up,the pregnancy rate was 20.0%in the control group,versus 51.5%in the observation group.The pregnancy rate in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:The treatment of heat-sensitive moxibustion plus clomifene citrate capsules can increase the endometrium thickness,reduce the ovarian volume,improve the status of serum sex hormone disorders,and increase the conception rate in patients with infertility due to PCOS,which may be related to the adjustment of the levels of immune inflammatory factors such as serum TNF-αand NF-κB.

Effect of Acupuncture on Infertility Due to Luteal Phase Defect

Objective：To observe the effect of acupuncture for infertility due to luteal phase defect （LPD）.Method：Fifty cases were randomized into an acupuncture group （30 cases） and a medication （Clomiphene） group （20 cases）.High phase score （HPS） was adopted to evaluate the luteal function before and after treatments,coupled with observation on the changes of E 2,progesterone （P）,follicles and endometrium.Results：The total effective rate in the acupuncture group was 93.4%,versus 70.0% in the medication group,showing a significant difference （P〈0.05）.Conclusion：Both acupuncture and Clomiphene can substantially improve the luteal function;however,acupuncture can get a better effect in improving the endometrium and a lower miscarriage rate than Clomiphene.

Therapeutic Effect Observation on Combined Acupuncture and Medication for Ovulation

Objective：To observe the curative effect of acupuncture plus medicine in treating ovulatory dysfunctional infertility.Method：All 36 cases with anovulatory infertility were randomly allocated into a control group （19 cases） and an observation group （17 cases）.The cases in the control group were treated with 50 mg of oral administration Clomiphene once a day for 5 d,and 50 menstrual cycles were observed.The cases in the observation group were treated with combined acupuncture and the same medication as those in the control group and 45 menstrual cycles were observed.During the treatment sessions,the follicular development,ovulation,thickness of the endometrium,cervical mucus and pelvic fluid were observed and recorded.Results：The cases in the observation group showed significantly higher ovulation and pregnancy rates,along with thickening of the endometrium.In addition,no luteinized unruptured follicle syndrome （LUFS） occurred in the observation group.Conclusion：Acupuncture coupled with oral administration Clomiphene can obtain higher ovulation and conception rates than oral Clomiphene alone.

Acupuncture-moxibustion Treatment for Polycystic Ovary Infertility:A Report of 20 Cases

The incidence rate of polycystic ovary syndrome （PCOS） is about 5%-10% in the women of childbearing age and accounts for 30%-60% in the patients with anovulatory infertility. From 2005 to 2008, I treated 20 cases of polycystic ovary infertility by acupuncture-moxibustion plus acupressure along the meridians. Now, the report is given as follows.

Clinical Study on Combined Acupuncture with Chinese Medicine for Infertility Due to Hydrosalpinx

Objective：To observe the clinical effect of combined electroacupuncture with Chinese medicine for infertility due to hydrosalpinx.Methods：A total of 114 cases were randomly allocated into 3 groups,an observation group of 38 cases treated by combined electroacupuncture with oral administration of Chinese medicine and medicinal fumigation,a combined acupuncture and Chinese medicine group of 38 cases treated by electroacupuncture and oral administration of Chinese medicine,and a Chinese medicine group of 38 cases treated by oral administration of Chinese medicine and medicinal fumigation.The cases were treated for 1-3 sessions.After each session of treatment,conduct ultrasound examination after menstruation to observe the condition of hydrosalpinx,and continue with next session for those with hydrosalpinx retention.Results：The therapeutic efficacy of the observation group was significantly different from that of the combined acupuncture with Chinese medicine group and the Chinese medicine group （P0.05）.Conclusion：Combined acupuncture with Chinese medicine can obtain obvious effect in treating hydrosalpinx.

Ear Acupuncture Anesthesia for In Vitro Fertilization and Embryo Transfer Egg Retrieval

Objective：To observe the anesthesia effect of ear acupuncture for in vitro fertilization-embryo transfer （IVF-ET） egg retrieval.Method：All of 160 IVF-ET cases were allocated into a treatment group （120 cases） and a control group （40 cases）.Ear acupuncture and Pethidine Hydrochloride （Dolantin） were employed respectively to alleviate pain.After that,the anesthesia effects in two groups were compared.Results：There were no significant differences in anesthesia effect and retrieved eggs between the treatment group and the control group （P〉0.05）.Conclusion：Ear acupuncture can obtain similar effects as Pethidine Hydrochloride;however,it is safer and more effective.

Acupuncture Treatment for 26 Cases of Polycystic Ovary Syndrome

Polycystic ovary syndrome （PCOS） is a commonly encountered disease in fertile women, clinically manifested by polymorphous comprehensive symptoms such as irregular menstruation, infertility, polytrichosis and obesity, and manifested by high levels of androgen, and no ovulation constantly shown by monophasic basal body temperature （BBT）. The therapeutic methods are medication for promoting ovulation and surgery, but, even certain therapeutic effect can be achieved, there is certain side effect and high cost. The author had treated 26 cases of PCOS by acupuncture. Now, the report is given in the following.

Clinical Observations on Electroacupuncture-induced Ovulation in Patients with Luteinized Unruptured Follicle Syndrome

Objective： To investigate the curative effect of electroacupuncture on luteinized unruptured follicle syndrome（LUFS） and its mechanism, Methods： Sixty LUFS patients were randomly allocated to treatment （electroacupuncture） group and control （hCG） group. The follicular condition and ovarian arterial flow under color Doppler ultrasonogaphy and a change in reproductive endocrine level were observed in the patients before and after treatments. The ovulation rates and pregnancy rates were compared between the two groups, and the mechanism was investigated. Results： Both ovulation rate and pregnancy rate were significantly higher in the treatment group than in the control group （P〈0.01）. There was a significant difference in the improvement in ovarian arterial flow between the treatment and control groups （P〈0.01）. The improvement in endocrine level was significantly more marked in the treatment group than in the control group（P〈0.01）. Conclusion： Electroacupuncture has a good effect on luteinized unrupture follicle syndrome. Its mechanism may be related to the improvement in ovarian arterial blood supply and the regulation of endocrine level.

Treatment of Tubal Infertility Mainly by Acupoint-injection in 64 Cases

Sixty-four patients with tubal infertility were treated with a complex therapy of injection on Zigong （Ex-CA 1） and Ciliao （BL 32） and acupuncture on Qichong （ST 30）, Guilai （ST 29）,Chongmen （SP 12） and Dahe （KI 12）, and ginger-partitioned moxibustion on the lower abdomen. As a result, 31 cases were cured, 20 cases got marked effectiveness, 8 cases improved and 5 cases failed,and the total effective rate was 92.2%.

Treatment of Tubal Inflammatory Obstruction Mainly by Thunder-fire Moxibustion： A Report of 54 Cases

moxibustion of the lower cases got an Fifty-four patients with tubal inflammatory were treated by thunder-fire at Shenque （CV 8）, Guanyuan （CV 4） and Zhongji （CV 3） and the bilateral areas abdomen. As a result, 14 cases got cured, 19 cases were got a marked effect, 16 effect, 5 cases got no effect, the total effective rate was 90.7%.

Therapeutic Efficacy Observation on Electroacupuncture for Ovulatory Dysfunctional Infertility

Objective：To observe the clinical effect of electroacupuncture for ovulatory dysfunctional infertility by ovulation stimulation.Methods：A total of 65 patients were randomly allocated into a treatment group （38 cases） and a control group （27 cases）.Acupuncture plus electric stimulation was employed in the treatment group,whereas oral Clomifene Citrate Tablets in the control group,50 mg per day.Results：After six months （2 sessions） of treatment,the cure rate in the treatment group was 76.3%,versus 48.1% in the control group,showing a significant difference between the two groups （P〈0.05）.Conclusion：Electroacupuncture can obtain better cure rate than oral Clomifene Citrate Tablets for infertility via ovulation stimulation.