Value of Intrauterine Autologous Platelet-Rich Plasma Therapy on Endometrial Receptivity:A Literature Review

Endometrial receptivity is an important factor that influences embryo implantation.Thus,it is important to identify an applicable approach to improve endometrial receptivity in women undergoing assisted reproductive technology.Recently,growing evidence has indicated that intrauterine platelet-rich plasma(PRP)infusion is an effective method to obtain a satisfactory reproductive outcome by increasing endometrial thickness and improving endometrial receptivity.Therefore,the present review aims to outline the possible mechanisms of PRP on endometrial receptivity and summarize the present literature on the effects of PRP therapy in improving endometrial receptivity.

Impact of Luteinized Unruptured Follicles on Endometrial Receptivity

This study examined the impact of luteinized unruptured follicle （LUF） on endometrial receptivity. The menstrual cycle of 17 LUF patients （LUF group） and 13 ovulatory women （control group） was monitored by measuring LH level in urine and by ultrasonic examination. An endometrial biopsy at the sixth to tenth day after LH surge was taken in all the patients. The expressions of endometrial ER, PR and integrin ανβ3 were immunohistochemically determined. At the same time, the serum levels of E2 and P were detected by chemiluminescence. The results exhibited that （1） The mean serum P level in LUF group （7.32±2.56 ng/mL） was significantly lower than that in control group （11.17±3.17 ng/mL） （P0.01）. But there was no significant difference in the mean serum E2 levels between LUF group （179.35±81.60 pg/mL） and the control group （198.58±75.23 pg/mL） （P0.05）; （2） The mean expression intensities of ER, PR in endometrium of LUF group （183.86±2.43, 167.94±3.04） were significantly higher than those in control group （109.35±6.31, 105.98±4.07） （P0.01）; （3） The mean expression intensities of integrin ανβ3 in endomtrium of LUF patients （114.90±11.38） were significantly lower than those in control group （191.34±1.82） （P0.01）; （4） The change profile of integrin ανβ3 expression in the endometrium of LUF patients was in positive relation with serum P level （r=0.77, P0.01）, but bore no significant relationship with serum E2 level （r=0.01, P0.05）. It was concluded that the depression of serum P levels in LUF patients was closely related to the failure of the down-regulation of ER and PR, and the low expressions of integrin ανβ3 also suggested that the delayed implantation and the impaired endometrial receptivity had impact on embryonic implantation.

Network pharmacology-based prediction and verification of the mechanism for Bushen Chengyun granule on low endometrial receptivity

Objective:Bushen Chengyun granule(BCG)is an empirical treatment for female infertility(FI)caused by low endometrial receptivity(LER)involving a poorly understood mechanism.In this study,network pharmacology was used to explore the potential therapeutic mechanism of BCG on FI caused by LER.Methods:The corresponding herb targets were obtained by conducting a search in the Traditional Chinese Medicine Systems Pharmacology Database and PubMed-reported literature.Disease targets were obtained from the following databases:Comparative Toxicogenomics Database,Human Phenotype Ontology,and Therapeutic Target Database.Treatments for LER using BCG have used target matching(BCG e LER target).Then,the predicted targets were uploaded to the Search Tool for the Retrieval of Interacting Genes/Proteins database for gene ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway analyses.Furthermore,triptorelin acetate for injection t menotrophin t chorionic gonadotropin for injection were used to establish a mouse model of blastocyst implantation disorder and to evaluate the in vivo effect of BCG on blastocyst implantation.Results:Overall,156 bioactive chemical components and 1092 targets of BCG were identified.The results indicated that 482 biological processes(FDR<0.01)and 15 pathways(FDR<0.01)related to BCG participated in the complex treatment effects and were associated with the endocrine system,inflammatory responses,metabolism,apoptosis,ovulatory performance,and angiogenesis.Moreover,16 hub nodes of BCG including estrogen receptor(ESR1),estrogen receptor beta(ESR2),progesterone receptor,et al,were recognized as potential treatment targets and might help clarify the underlying therapeutic mechanisms of BCG for female infertility.BCG significantly increased the protein expressions of estrogen receptors and progesterone receptors.Conclusions:These findings reveal the potential therapeutic mechanism of BCG for female infertility involves low endometrial receptivity,which should be evaluated further.

EFFECT OF MIFEPRISTONE (RU486)ON MARKERS OF ENDOMETRIAL RECEPTIVITY

Objective To study the effect of single and low dose of RU486 on endometrial receptivity of healthy women. Methods A total of 5 healthy women were followed for one control and one treatment cycle. In the treatment cycle, a dose of 10 mg RU486 was administered on day luteinizing hormone (LH)-2. In both the control and treatment cycle, an endometrial biopsy was obtained on LH+7. These biopsies were assessed by immunohistochemical analysis to find the difference in expression of integrins and progesterone receptor (PR) between the control and treatment cycle. Results The treatment with RU486 increased the expression of α 1 and α 4 subunits of integrin in glandular epithelial cells, but did not influence β 3 subunit. Moreover, the normal down regulation of PR in epitherial cell nuclei was inhibited by 10 mg RU486. Conclusion Single dose of 10 mg RU486 impairs the establishment of endometrial receptivity on time.

Study of Endometrial Receptivity during Implantation in Implantation Dysfunction Mouse

Objective To establish the mice model of implantation dysfunction and to study the endometrial receptivity during implantation in implantation dysfunction mouse. Methods Sexually mature female virgin, Kunming mice were randomly assigned to the control group and the model group postcoitally. The model mice at 9 ： 00 AM on d 4 of pregnancy（d 4） were injected subcutaneously with mifepristone. All animals were sacrificed at 9 ：00 PM on d 4 and their uterine horns were examined for the presence of implanted embryos. Histopathology of uterine endometrium was observed by light-microscope. The endometrial expressions of estrogen receptor （ER） and progesterone receptor （PR） assessed by immunnohistochemical SP method. The endometrial expressions of ER mRNA and PR mRNA were assessed by semi-quantitative reverse transcriptase polymerase chain reaction （RT-PCR）. Results Compared with control group, implantation rates and average embryo num- ber significently decreased in model group, the development of endometrium was inhibited. In model group, absorbency and area rate of ER and PR in the gland and stroma were lower than those in control group （P〈0.05）. Expressions of ER mRNA and PR mRNA in model uterus were significantly lower than those in the control. Conclusion The endometrial receptivity and implantation decreased in mifepristoneinduced implantation dysfunction mouse.

A meta-analysis on the improvement of endometrial receptivity of PCOS by Bushen recipe combined with Clomiphene

Objective: To systematically evaluate the efficacy and safety of Bushen Recipe combined with clomiphene compared with clomiphene in improving endometrial receptivity of polycystic ovary syndrome. Methods: The time limit is from the establishment of the database to January 2, 2020. A randomized controlled trial was conducted to compare the effects of Bushen Recipe combined with clomiphene and clomiphene on the endometrial receptivity of polycystic ovary syndrome (PCOS). Meta analysis was performed with RevMan5.3 software. Results: A total of 13 RCTS were included, with a total of 797 PCOS patients. The results of this meta-analysis show: there were statistically significant differences in the improvement of endometrial thickness [WMD=1.62,95%CI(1.22, 2.01), P <0.00001], endometrial type[RR=1.51,95%CI(1.28, 1.78), P <0.00001], uterine artery pulse index(PI) [WMD=-0.18,95%CI(-0.27, -0.09) , P <0.0001], uterine artery resistance index(RI)[WMD=-0.08,95%CI(-0.11, -0.05) , P <0.00001], pregnancy rate [RR=2.18,95%CI(1.55, 3.05), P <0.00001], TCM syndrome score[WMD=-6.97,95%CI(-8.97, -4.97) , P <0.00001], effective rate [RR=1.25, 95%CI (1.13, 1.37), P < 0.00001]. Conclusion: Compared with clomiphene alone, Bushen Recipe combined with clomiphene can effectively increase the thickness of endometrium and improve the type of endometrium, promote the blood perfusion of endometrium, improve the pregnancy rate, improve the clinical symptoms, reduce the TCM syndrome score, improve the total efficiency of treatment, with high clinical application value.

Rhizoma Drynariae Improves Endometrial Receptivity in a Mus Model of Dysfunctional Embryo Implantation

Background: Rhizoma drynariae is a traditional Chinese medicine used in orthopedics and traumatology, but its effect on endometrial receptivity remains unknown. Aims and Objectives: To observe effect of Rhizoma drynariae and its main components on endometrial receptivity in a mus model of dysfunctional embryo implantation. Materials and Methods: Mus models were established by the Gn RHa+HMG+HCG method. Normal mus receiving saline were used as controls and the remaining six groups were: model receiving saline, progynova, aspirin, Rhizoma drynariae, osteopractic total flavone, and naringin. Pinopodes in uterine endometrium were examined by scanning electron microscopy. Stem cell factor(SCF) m RNA expressions was determined by real-time RT-PCR, and estrogen receptor α(ERα), progesterone receptor(PR) by immunohistochemistry. Results: In the model group, surface morphology of endometrium was heterogeneous, without obvious pinopodes. In the Rhizoma drynaria and progynova groups, pinopodes were abundant. Compared with the blank group, model group had lower levels of SCF(-47%), ERα(-63%) and PR(-50%)(all P<0.05). In comparison, Rhizoma drynariae group had higher levels of SCF(+73%), ERα(+118%) and PR(+101%)(all P<0.01). The individual main components of Rhizoma drynariae had variable efficacy. Conclusion: Rhizoma drynariae could improve endometrial receptivity of mouse models of dysfunctional embryo implantation as shown by increased numbers of pinopodes and higher levers of SCF, ERα, PR compared with the model group.

Intrauterine hyperglycemia impairs endometrial receptivity via up-regulating SGK1 in diabetes

Diabetes is a complex metabolic disorder which can adversely affect reproductive function. SGK1 is found to be up-regulated in multiple tissues of diabetic patients. However, the effects of diabetes on endometrial SGK1 expression and endometrial receptivity remain unknown. In this study, we established a streptozotocin-induced diabetic mouse model and observed reduced implantation sites, retarded development of pinopodes, increased SGK1, and aberrant expression of LIF and MUC1 in the endometrial epithelium. We injected the uterine lumen of normal mice with high-glucose solution and cultured endometrial cells in high-glucose medium to mimic intrauterine hyperglycemia. Both studies provided compelling evidence that hyperglycemia could lead to diminished embryo implantation and dysregulated SGK1, LIF and MUC1. Additionally, through over-expression of SGK1 in vivo and in vitro, we found that enhanced SGK1 also decreased LIF expression, increased MUC1 expression, and attenuated embryo implantation rate. We further identified that hyperglycemia-activated SMAD2/3 might be responsible for the enhancement of SGK1 and verified directly the interaction between SMAD3 and corresponding SMAD binding elements within SGK1 promoter. Taken together, our study confirmed the association between diabetes-related hyperglycemia and endometrial receptivity defects. Hyperglycemia-induced SGK1 has a tremendous role in this pathological process, rendering it as an attractive therapeutic target for diabetes-related reproductive disorders.

Assessment of Uterine Receptivity by Endometrial and Subendometrial Blood Flows Measured by Vaginal Color Doppler Ultrasound in Women Undergoing IVF Treatment

Objective To evaluate endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound as a predicator of endometrial receptivity in women undergoing IVF treatment. Methods A total of 119 infertile patients undergoing the first IVF/ICSI-ET cycle were recruited. Three groups were divided according to a color Doppler ultrasound examination performed on the day of hCG injection. Group A, endometrial and subendometrial blood flows were 2 branches and below; group B, endometrial and subendometrial blood flows were between 3 and 4 branches; group C, endometrial and subendometrial blood flows were 5 branches and above. Patients were transferred 1-3 embryos each. Demographic data, ovarian responses, endometrial thickness, PI, RI, development of embryo and IVF result among groups were compared. Results Demographic data, ovarian responses, endometrial thickness, PI, RI and development of embryo among groups have no significant difference. The pregnancy rate of group A was significantly lower than that of group B （P〈0.05） and group C （P〈0.01）. The implantation rate of group A was significantly lower than than of group C （P〈0.01）. There was no significant difference of the rate of pregnancy and implantation between group B and group C （P〉0.05）. Conclusion Endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound is a good predicator of pregnancy during IVF treatment. A good endometrial and subendometrial blood flows is benefit for the result of IVF.

Use of biological and chemical molecules in regulating embryo implantation and endometrial receptivity

This review summarizes the drugs and chemicals that may modulate embryo implantation.Non-hormonal molecules,including aspirin,improved endometrial blood flow,while low molecular weight heparin,vitamin E,sildenafil,and atosiban modulated the expression of endometrial genes.Hormonal factors,including human chorionic gonadotropin and growth hormones,can regulate the expression of endometrial receptivity markers.Other immunomodulatory molecules,including granulocyte colony-stimulating factor,peripheral blood mononuclear cells,autologous platelet-rich plasma,and intralipid and intravenous immunoglobulins,may improve implantation rate by modulating endometrial immune functions.Medicinal extracts of the Chinese herbs Paeonia lactiflora and Perilla frutescens increased the expression of leukemia inhibitory factors in endometrial epithelial cells.Recently,the use of the commercially available Library of Pharmacologically Active Compounds with a high-throughput screening method has provided an approach to screen for compounds that may potentially enhance or suppress embryo implantation.Whether these biomedical findings translate into clinical effects that enhance or suppress embryo implantation requires further investigation.

Effect of Acupuncture on Endometrial Blood Flow in Women Undergoing in vitro Fertilization Embryo Transfer: A Single Blind, Randomized Controlled Trial

Objective: To evaluate the effect of manual acupuncture on endometrial blood flow parameters by three-dimensional(3D) power Doppler ultrasound in women undergoing in vitro fertilization embryo transfer(IVF-ET). Methods: Seventy patients undergoing IVF-ET were equally randomized into traditional or sham acupuncture treatment group for totally 4 days(from the day of oocyte aspiration to the day of embryo transfer) of treatment by random envelope method at the Reproductive Medicine Center and Outpatient Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology from January 2013 to December 2015. Patients in the traditional acupuncture group accepted traditional acupuncture methods with manual acupuncture, and Zhongji(CV3), Qihai(CV 6), Sanyinjiao(SP6), Taichong(LR 3), Tianshu(ST 25), Guilai(ST 29) and Zusanli(ST 36) were chosen. Patients at the sham acupuncture group accepted shallow acupuncture methods at 4 non-meridian points at each shoulder and upper arm. Outcome measures included endometrial ultrasonic indices such as vascularization index(VI), flow index(FI) and vascularization flow index(VFI), endometrial thickness and volume, subendometrial VI(sVI), subendometrial FI(sFI), subendometrial VFI(sVFI), implantation rate, clinical pregnancy rate, abortion rate, live birth rate and number of live births. Results: Finally, 34 patients in the traditional acupuncture group and 35 in the sham acupuncture group completed this trial. VI, FI and VFI of the traditional acupuncture group were significantly higher than those in the sham acupuncture group(P<0.05). No significant differences were found in endometrial thickness, endometrial volume, sVI, sFI, sVFI, implantation rate, clinical pregnancy rate, abortion rate, live birth rate and number of live births(P>0.05). Conclusions: Manual acupuncture performed after oocyte aspiration and before transplantation improved the endometrial blood flow parametersVI, RI and VFI in women who underwent IVF-ET, instead of sVI, sFI and sVFI. Therefore, acupuncture might be beneficial in women undergoing IVF-ET by increasing endometrial blood flow and endometrial receptivity.(Registration No. ChiCTR2100053354)

Association of Controlled Ovarian Hyperstimulation Treatment with Down-regulation of Key Regulators Involved in Embryonic Implantation in Mice

The debate exists whether or not gonadotropin-releasing hormone（GnRH） analogs used in controlled ovarian hyperstimulation（COH） impair endometrial receptivity.Homeobox A11（Hoxa11）,Meis homeobox 1（Meis1）,cadherin 1（Cdh1）,and catenin beta 1（Ctnnb1） are well known to be involved in successful implantation.In this study,the endometrial expression of Hoxa11,Meis1,Cdh1,and Ctnnb1 during the peri-implantation period was investigated in an in vitro fertilization（IVF） mouse model by real-time RT-PCR and Western blot to evaluate the relationship between Hoxa11,Meis1,Cdh1,and Ctnnb1 expression and the impact of the COH on endometrial receptivity.The mimic COH protocols included GnRH agonist plus human menopausal gonadotropin（HMG）（GnRH agonist group）,GnRH antagonist plus HMG（GnRH antagonist group）,and HMG alone（HMG group）.The expression levels of Hoxa11,Meis1,Cdh1,and Ctnnb1 mRNA and protein were decreased in all of the COH groups.The expression levels of Hoxa11 and Ctnnb1 were the lowest in the GnRH agonist group,and those of Meis1 and Cdh1 were lower in the GnRH analog groups than the HMG group.There were positive correlations between the expression of Hoxa11 and Ctnnb1,as well as the expression of Meis1 and Cdh1 among all the groups.In conclusion,the COH protocols,particularly with GnRH analogs,suppressed Hoxa11,Meis1,Ctnnb1 and Cdh1 expression,in mouse endometrium during the peri-implantation period.Our data reveal a novel molecular mechanism by which the COH protocols might impair endometrial receptivity.

Activation of Uterine Smad3 Pathway Is Crucial for Embryo Implantation

Embryo implantation is a complicated physiological process tightly regulated by multiple biological molecules including growth factors.Transforming growth factor-betas(TGF-βs)and their most specific signal transduction factors,Smads,are expressed in the endometrium during the window of implantation.Recent researches indicated that Smad dependent TGF-β signaling may play an important role in the process of embryo implantation.In this study,we measured the expression of TGF-β1,TGF-β receptor type I(TpRI),Smad3 and p-Smad3 in the endometrium of mice and observed their elevation on day 4,5 and 6 of pseudopregnancy.Then we administrated a specific Smad3 inhibitor(Sis3)into the uterine cavity of mice on day 3 of pregnancy.The results showed a reduction in insulin-like growth factor-1(IGFBP-1)expression and the decreased number of implanted embryo after the administration.In addition,Sis3 was found to reduce the IGFBP-1 secretion in decidualized endometrial stromal cells.Taken all together,our findings demonstrated that TGF-β/Smad3 signaling is involved in the process of embryo implantation.

The expression of Hoxa10 and its regulation by sex steroids andHB-EGF at the time of implantation in the human endometrium

Objective:The aim of this study was to determine the expression of Hoxa 10 in endometrium during the menstrual cycle and their response to sex steroids and HB-EGF.Methods:Forty endometrial samples from regularly cycling women were studied.The endometrial epithelial(EEC)and stromal(ESC)cells isolated by collagenase Ⅰ digestion and mechanical dissociation was cultured from every sample.The endometrial stromal cells(ESC)were incubated with 17-beta estradiol(10-8mol/L),medroxyprogesterone acetate(MPA)(10-6mol/L),RU486(10-8mol/L)or HB-EGF(10ng/ml)for 48 hours respectively.The expression of Hoxa10 mRNA was demonstrated by reverse transcription-polymerase chain reaction(RT-PCR).Result:Hoxa10 showed a regulated cycle phase-dependent expression pattern in stromal cells and epithelial cells.Hoxa10 expression dramatically increased during the midsecretory phase of the menstrual cycle,at the time of implantation.The expression of Hoxa10 in cultured endometrial stromal cells was stimulated by estrogen,progesterone and HB-EGF.Conclusion:The cycle phase-specific expression of Hoxa10 and up-regulated by sex steroids and HB-EGF suggests a tight regulation and establishing conditions necessary for implantation.

Effects of controlled superovulation on the expression of HOXA10,integrin αvβ3 and LIF in mice during peri-implantation

Objective:To observe the expression of endometrial homologous box gene A10(HOXA10),Integrinαvβ3 and leukemia suppressor factor(LIF)in peri-implantation mice,and to investigate the effect of controlled superovulation(COH)on endometrial receptivity in mice.Methods:After COH model preparation and blastocyst transplantation,kunming pure-bred mature mice were randomly divided into natural blastocyst+natural pseudocyst group,COH blastocyst+natural pseudocyst group,natural blastocyst+COH pseudocyst group,and COH blastocyst+COH pseudocyst group.The pregnancy rate and average number of beds in each group were observed on day 6 of conception.Western blot and RT-PCR were used to detect the expression of HOXA10,Integrinααvβ3,LIF protein and mRNA in the endometria of mice on day 5 of conception.Results:The pregnancy rate and average number of beds in the COH group were lower than those in the natural receptor group.The expression of HOXA10,Integrinααvβ3 and LIF in endometrium was significantly lower than that of the natural receptor mice(P<0.01).Conclusion:Superovulation drugs down-regulate the expression of HOXA10,Integrinαvβ3 and LIF in endometrium during the implantation window,reduce endometrial receptivity,and lead to low clinical pregnancy rate.

Role of microRNAs in embryo–endometrial interactions:biological functions and clinical applications

The human endometrium and embryo both produce microRNAs(miRNAs),which are involved in various physiological activities.Accumulating evident suggested that endometrial miRNAs are regulated by steroid hormones that modulate endometrial functions,whereas embryo-derived miRNAs play vital roles in maternal–embryo communication.The aberrant expression of endometriumor embryo-derived miRNAs can cause early pregnancy and gestational disorders,including repeated implantation failure,recurrent miscarriage,and pathological conditions such as endometriosis.miRNAs are,therefore,ideal candidates for conducting clinicopathological tests.Potential diagnostic and prognostic tests using miRNAs are under development;however,the therapeutic applications of miRNAs in regulating gestational disorders require further investigation.

Endometrial MicroRNA Signature during the Window of Implantation Changed in Patients with Repeated Implantation Failure

Background： At present, a diagnostic tool with high specificity for impaired endometrial receptivity, which may lead to implantation failure, remains to be developed. We aimed to assess the different endometrial microRNA （miRNA） signatures for impaired endometrial receptivity by microarray analysis. Methods： A total of 12 repeated implantation failure （RIF） patients and I0 infertile patients, who conceived and delivered after one embryo transfer attempt, were recruited as RIF and control groups, respectively. Endometrial specimens from the window of implantation （WOI） were collected from these two groups. MiRNA microarray was conducted on seven and five samples from the RIF and control groups, respectively. Comparative, functional, and network analyses were performed for the microarray results. Quantitative real-time polymerase chain reaction （PCR） was performed on other samples to validate the expression of specific miRNAs. Results： Compared with those in the control group, the expression levels of 105 miRNAs in the RIF group were found to be significantly up- or down-regulated （at least 2-fold） by microarray analysis. The most relevant miRNA functional sets of these dysregulated miRNAs were miR-30 family, human embryonic stern cell regulation, epithelial-mesenchymal transition, and miRNA tumor suppressors by tool for annotations ofmicroRNA analysis. Network regulatory analysis found 176 miRNA-mRNA interactions, and the top 3 core miRNAs were has-miR-4668-5p, has-miR-429, and has-miR-5088. Expression levels of the 18 selected miRNAs in new samples by real-time PCR were found to be regulated with the same trend, as the result ofmicroarray analysis. Conclusions： There is a significant different expression of certain miRNAs in the WOI endometrium for RIF patients. These miRNAs may contribute to impaired endometrial receptivity.

Endometrial Collagen Fibril Hyperplasia is Associated with Implantation Failure in Women Undergoing IVF-ET

Objective To analyse the effects of controlled ovarian hyperstimulation （ COH） on the endometrial expression of collagen fibril （CF） during the peri-implantation period in patients undergoing IVF, and its relation to endometrial receptivity （ER） in repeated implantation failure（RIF）. Methods Peripheral blood and endometrial biopsies were obtained from 45 infertile women on days 5, 7 or 9 after oocytes retrieval or ovulation in a stimulated cycle （SC） and natural cycle （NC） respectively. CF was assayed by transmission electron microscope and quantified by modified Masson dyeing. The outcome of subsequent embryo transfer（ET） was observed. Results Levels of both E2 and progesterone were higher in the peripheral blood in SC than in NC. Also the expression of CF in the stroma in each secretory phase was increased significantly in SC （P 〈O.05）. After embryo transferring, expression levels of CF in the pregnancy group dropped between the mid- and late-secretory phase, but no change in the non-pregnancy group. In the same term, all patients undergone endometrial curettage had higher pregnancy rate than those without. Conclusion Imbalance of production and degradation of endometrial CF in the secretory phase resulting from COH may be the cause of defective ER and implantation failure in some RIF patients. Endometrial curettage may improve implantation rate by inducing appropriate CF hyperplasia and degradation.

电针联合隔姜灸对多囊卵巢综合征不孕患者子宫内膜容受性的影响

Objective:To observe the effect of the combined therapy of electroacupuncture(EA) and ginger-isolated moxibustion on endometrial receptivity in the patients with polycystic ovarian syndrome(PCOS).Methods:A total of 70 subjects of PCOS were randomized into two groups,35 cases in each one.In the western medication group,letrozole and human chorionic gonadotropin(HCG) were administered.In the combined therapy group,on the base of the treatment as the western medication group,the artificial cycle therapy with EA and ginger-isolated moxibustion was provided.The treatment duration was 3 menstrual cycles in two groups.After treated for 3 menstrual cycles,the symptom score of traditional Chinese medicine(TCM),endometrial thickness,the number of ovulation cycle,endometrial morphology,bilateral uterine artery pulsatility index(PI),resistance index(RI),the sum of peak systolic velocity/end diastolic velocity(S/D) and pregnancy were compared in the patients between two groups.Results:(1) After treatment,the endometrial thickness was better(0.21 ± 0.13 vs 0.14 ± 0.08,P <0.01),TCM symptom score reducing range was larger(5.00 ± 2.24 vs 0.52 ± 1.66,P <0.01),the reducing degrees of bilateral uterine artery PI,RI and S/D sum were better(0.62 ± 0.26 vs 0.04 ± 0.15,0.08± 0.05 vs0.01±0.05,0.61±0.33 vs 0.07±0.17,0.11±0.05 vs 0.01 ± 0.05,4.80±1.14 vs 0.15 ± 0.89,all P <0.01) in the combined therapy group respectively as compared with the western medication group.After treatment,the number of ovulation cycle and the proportion of A+B type of endometrial morphological were higher in the combined therapy group(2.09 ± 0.78 vs 1.27 ± 0.84,87.5% vs 60.61%,P <0.01,P <0.05) as compared with the western medication group respectively.(2) The clinical pregnancy rate was56.25% in the combined therapy group,better than 30.30% in the western medication group(P <0.05).The early abortion rate was 10.53% in the combined therapy group,lower than 50.00% in the western medication group(P <0.05).Conclusion:The combined treatment of electroacupuncture and ginger-isolated moxibustion with western medication effectively improves endometrial receptivity,increases clinical pregnancy rate and reduces early abortion rate in the patients with PCOS.

Case of acupuncture combined with Chinese herbal medication in assistance of pregnancy after 11 failures of IVF-ET at advanced age

This paper reports one case of successful pregnancy in the assistance of acupuncture therapy for regulating menstruation and promoting pregnancy and the periodic intervention with Chinese herbal medicine in a 41-year-old patient with infertility.The patient suffered from 11 failures in the assisted reproductive technique during 3 years.This case suggests that the combined treatment with acupuncture for regulating menstruation and promoting pregnancy and the periodic intervention with Chinese herbal medicine increase the levels of follicle-stimulating hormone(FSH)and estradiol(E2),improve the oocyte quality and the uterine environment.This therapeutic method plays a positive auxiliary role in the whole process of in vitro fertilization and embryo transfer(IVF-ET)and it can be adopted as an intervention for patients with multiple assisted reproductive failures.