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.

Prevalence of Polycystic Ovary Syndrome in Nigerian Women with Infertility: A Prospective Study of the Three Assessment Criteria

Background: Polycystic ovarian syndrome (PCOS) is a frequent diagnosis in oligomenorrheic and infertile Nigerian women. However, to date there is a paucity of data on the prevalence of PCOS in Nigerian women. The objective of this study was to investigate the prevalence of PCOS in a cross-section of women attending Infertility Clinics in Benin City, Nigeria using the three assessment criteria namely: the 1990 National Institutes of Health (NIH), the 2003 Rotterdam and 2006 Androgen Excess Society (AES) criteria. Method: Four hundred and twenty-one consecutive infertile premenopausal women aged 18 - 45 years were recruited and evaluated with a proforma that elicited information about their maternal and reproductive health history. Blood samples were analyzed for hormone levels using standard immunoassay procedures, while trans-vaginal ultrasound scan was carried out to determine the presence of ultrasonic features of PCOS. The control group comprised of eumenorrheics (n = 180). Results: An estimated prevalence of biochemical hyperandrogenism (BHA) was as high as 20.9% (88 women), while 3.6% (15 women) presented with clinical hyperandrogenism (CHA). Also the prevalence of polycystic ovaries (PCO) was 13.8%. The prevalence of PCOS based on NIH, Rotterdam and AES criteria was 16.9% (71 women), 27.6% (116 women) and 20.7% (87 women) respectively. However, women with PCOS were significantly younger and had higher total testosterone levels (p = 0.001) when compared to controls. Conclusion: The prevalence of PCOS is as high in the population under study as in other prevalence studies. The hormonal investigations were clinically useful in assessing the prevalence rates. However, the recruitment criteria, together with the regional and racial factors may have contributed to the estimates obtained, and the high incidence of biochemical hyperandrogenism in this region.

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.

Infertility and ovarian failure in celiac disease

Unexplained infertility in females may be a devastating event for the reproductive-aged female.However,infertility may be due to ovarian failure associated with celiac disease,an immune-mediated disorder that may have few or no symptoms and can be successfully treated.In some prospective serologically-based studies,over 4% of infertile females may prove to have celiac disease.Serological screening for celiac disease is relatively inexpensive and involves testing for antibodiesto tissue transglutaminase.If positive,a small intestinal biopsy should be done to confirm the diagnosis.The initial treatment for this disorder is a gluten-free diet.To date,a number of reports have indicated that this treatment for celiac disease may result in successful pregnancy,in spite of prolonged periods of infertility.Celiac disease,when untreated,may also lead to several adverse events following pregnancy including increased risk of recurrent abortions,low birthweight and impaired fetal growth.Recent molecular and pathological studies from different laboratories suggest that altered placental function may be due to binding to cells in the trophoblast by tissue transglutaminase antibodies impairing embryo implantation and leading to failure of early pregnancy or retarded intrauterine growth.

Integrative techniques using acupuncture,Chinese herbal medicine,diet,and supplements for polycystic ovary syndrome:a case report

Patients with a diagnosis of polycystic ovary syndrome （PCOS） are on the rise. About 4%-12% of women are currently estimated to have this condition. It is hypothesized that PCOS appears in women who have long-standing insulin resistance （1R）, which leads to high androgen and testosterone levels; this ultimately disrupts their menstrual cycles. Some researchers attribute IR to genetic factors, although there have been only minute changes in the human genome in the past 20 000 years. However, even with a stable gene pool, genes can be turned on and offby the environment, food and air quality and toxin exposure.

补肾化痰汤对多囊卵巢综合征不孕患者卵巢功能及性激素水平的影响

目的观察补肾化痰汤对多囊卵巢综合征(PCOS)不孕患者卵巢功能及性激素水平的影响。方法本研究为随机对照试验。选取陕西省中医医院2023年9月至2024年6月收治的PCOS不孕患者114例,按随机数字表法分研究组与对照组各57例。研究组年龄(27.91±3.15)岁;体重指数(BMI)(25.47±2.59)kg/m^(2);不孕时间(3.57±0.62)年;初潮年龄(13.86±1.15)岁。对照组年龄(28.14±3.25)岁;BMI(25.88±2.64)kg/m^(2);不孕时间(3.45±0.71)年;初潮年龄(14.03±1.06)岁。对照组口服氯米芬,50 mg/次,1次/d,月经周期第5天开始服用,连服5 d。研究组加用补肾化痰汤(200 ml药汁分早晚两次服下,每日一剂),月经结束后第1天连续服用至下次月经。两组均连续治疗3个月经周期。治疗后评估两组疗效;治疗前后,比较两组中医证候积分、卵巢功能[卵巢体积、卵泡数量、抗米勒管激素(AMH)、子宫内膜厚度]、性激素[促黄体生成素(LH)、睾酮(T)、雌二醇(E2)、促卵泡生成素(FSH)];统计两组不良反应发生情况。采用t检验、χ^(2)检验进行统计学分析。结果研究组总有效率高于对照组[91.23%(52/57)比75.44%(43/57)](P<0.05)。治疗后,两组各项中医证候积分均下降,且研究组低于对照组(均P<0.05)。治疗后,两组卵巢体积、卵泡个数、AMH均下降,且研究组[(10.53±2.46)cm^(3)、(6.71±0.95)个、(7.13±2.08)μg/L]低于对照组[(13.94±3.02)cm^(3)、(9.03±1.02)个、(9.05±4.33)μg/L];两组子宫内膜厚度均上升,且研究组[(9.83±0.64)mm]高于对照组[(9.05±0.62)mm](均P<0.05)。治疗后,两组LH、T均下降,且研究组[(6.24±1.79)mIU/ml、(1.42±0.29)nmol/L]低于对照组[(9.05±2.16)mIU/ml、(1.93±0.34)nmol/L];E2均上升,且研究组[(182.16±15.98)ng/L]高于对照组[(166.72±14.03)ng/L](均P<0.05);两组FSH无显著变化(均P>0.05)。两组不良反应总发生率差异无统计学意义(P>0.05)。结论补肾化痰汤对PCOS不孕患者疗效较佳,可有效减轻患者症状,改善卵巢功能及性激素紊乱,且安全性较高。

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。

尤昭玲教授基于“生殖链”假说运用“生殖五论”治疗妇科生殖疾病的经验

宫腔粘连、多囊卵巢综合征、子宫内膜异位症、不孕症等生殖疾病是影响女性生殖健康的重点、难点问题。全国名中医尤昭玲创新性提出“生殖链-生殖链终端-终端效应”临证假说,凝练出以“时空论”为核心的“生殖五论”,指导妇科疾病的诊断、治疗和管理。围绕“生殖链-生殖链终端-终端效应”临证假说,提出胞宫-内环-外环3条病邪侵袭路径,构成妇科疾病的多元化病因,将生殖链假说融入妇科生殖疾病的认知、诊疗、评估、评价、管理各个环节中。重视生殖链终端结局,总结出以“时空论”为核心的生殖五论,分别应用“巢宫论”“卵膜论”“冰山论”“纳胎论”指导卵巢-子宫疾病、卵泡-子宫内膜疾病、巢衰-泡竭疾病、妊娠疾病的诊断与治疗。对于生殖疾病,关注“巢-泡-宫-膜-带-管-腔”7个部位,综合运用“调泡三部曲”“调泡八法”“调膜十法”等方法指导临床处方用药。评估管理时,结合疾病特点,将生殖疾病分为中医全病程管理、中医全生命周期管理两类,分类管理,维系女性生殖健康、孕育安全。

司美格鲁肽联合地屈孕酮对多囊卵巢综合征不孕症患者性激素水平和卵巢功能的影响

目的探讨司美格鲁肽联合地屈孕酮对多囊卵巢综合征(PCOS)不孕症患者性激素水平和卵巢功能的影响。方法回顾性分析2022年5月至2023年5月诊治的PCOS不孕症患者100例的临床资料。按治疗方法分为观察组和对照组,每组50例。对照组给予地屈孕酮治疗,观察组在对照组基础上加用司美格鲁肽。评估2组治疗前后性激素水平、卵巢功能、月经周期及体质量管理指标。结果观察组治疗有效率[94.00%(47/50)]显著高于对照组[80.00%(40/50)],差异有统计学意义(P<0.05)。治疗后,观察组黄体生成素/促卵泡激素比值、卵巢体积、睾酮水平、体质量指数和腰臀比均低于对照组,卵泡数少于对照组,月经周期短于对照组,雌二醇水平高于对照组,子宫内膜厚度大于对照组(P<0.05)。结论司美格鲁肽联合地屈孕酮可有效改善PCOS不孕症患者的性激素水平、卵巢功能及体质量指标。

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。

超声联合AMH对PCOS不孕患者卵巢储备功能的评估价值

目的:探究彩色多普勒超声检查联合血清抗苗勒氏管激素(AMH)对多囊卵巢综合征(PCOS)不孕患者卵巢储备功能的评估价值。方法:回顾性选取2021年1月-2024年3月本院就诊的PCOS不孕患者82例,根据卵巢储备功能情况分为正常组和异常组。两组均接受阴道超声检查,观察卵巢体积(OV)、卵泡计数(AFC),采用化学发光法测定血清AMH和雌二醇(E_(2))水平,采用受试者工作特征(ROC)曲线分析超声指标和血清指标对卵巢储备功能的评估价值,采用多因素logistic回归分析患者卵巢储备功能影响因素。结果:卵巢储备功能异常43例(52.4%)纳入异常组,余患者39例纳入正常组。正常组年龄、体质指数(BMI)、流产次数和盆腔手术史均少于异常组,运动频率高于异常组,OV、AFC和AMH水平高于异常组(均P<0.05),E_(2)水平与异常组无差异(P>0.05)。ROC曲线分析,OV、AFC、AMH联合检测评估PCOS不孕患者卵巢储备功能异常效能提高,其曲线下面积为0.877,评估灵敏度达97.4%。多因素logistic回归分析,年龄大、BMI高、流产次数多、盆腔手术史均是PCOS不孕患者卵巢储备功能异常的影响因素,每周运动频率≥2次/周为保护因素(均P<0.05)。结论:超声检查联合血清AMH水平对PCOS不孕患者卵巢储备功能评估价值较好,年龄大、BMI高、流产次数多、盆腔手术史均能影响患者卵巢储备功能。

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。