Dong Xiao-Lei, Ran Jiao-Kun, Zhang Hai-Jun, Chen Kai, Li Hong-Xia
Department of Obstetrics and Gynecology, Qingzhou Hospital of Traditional Chinese Medicine, Qingzhou 262500, Shandong Province, China.
Department of Pediatrics, Weifang Yidu Central Hospital, Qingzhou 262500, Shandong Province.
Zhen Ci Yan Jiu. 2019 Aug 25;44(8):599-604. doi: 10.13702/j.1000-0607.180779.
To observe the clinical effect of acupuncture plus medication in the treatment of poor ovarian response (POR) patients and to explore its mechanisms in assisting pregnancy.
A total of 100 volunteer POR women undergoing in vitro fertilization-embryo transplantation (IVF-ET) were recruited in the present study. On the 1 cycle of IVF-ET, these POR women received microstimulation of ovulation program (oral administration of Clomiphene, muscular injection of Menotrophin, Chorionic Gonadotrophin triggering, etc.). Before receiving the 2 period of IVF-ET, these patients were equally and randomly divided into control, medication (Climen, composed of estradiol valerate and cyproterone acetate), acupuncture and acupuncture+medication (combined treatment) groups according to the random number table. Patients of the medication group were asked to orally take Climen (1 tablet/d for 21 days) beginning from the 3 day of the menstruation, which was repeated for 3 menstrual cycles. Patients of the acupuncture group received manual acupuncture stimulation of Guanyuan (CV4), and bilateral Taixi (KI3), Sanyinjiao (SP6) of and Tai-chong (LR3) from day 8 to 15 of menstruation (follicular phase), once daily for 3 menstrual cycles. On the 2 day of menstruation of the 1 and 2 IVF-ET cycle, the ovarian reserve function was detected, including measurement of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E) contents by using radioimmunoassay, and serum anti-mullerian hormone (AMH) level by using ELISA, and the antral follicles count (AFC) of the ovaries by using a color Doppler ultrasonic diagnosis apparatus. At the end of ovulation induction, the assisted pregnancy indexes and outcomes were detected, including administration of dosage and days of gonadotropin (Gn), the diameter of dominant oocyte, level of E on the trigger day, the numbers of ultrasound-guided-retrieved oocyte and the cultivated high-quality embryo (grade 1 and 2).
After the treatment, the contents of serum FSH, LH and E in the medication, acupuncture and combined treatment groups were significantly reduced (<0.05), and the content of serum AMH and ovary AFC in the medication, acupuncture and combined treatment groups were obviously increased (<0.05) in comparison with their own pre-treatment (<0.05). Compared with the control group, the levels of FSH, LH and E contents were notably decreased, and the AMH content and AFC significantly increased in the medication, acupuncture and combined treatment groups (<0.05). Comparison among the three treatment groups showed that the levels of FSH, LH and E were notably lower in the combined treatment group than in the acupuncture group (<0.05), and the AFC was markedly more in the combined treatment group than in the acupuncture group (<0.05), and LH content was also significantly lower in the combined treatment group than in the medication group (<0.05). Regarding the pregnancy-assistant indexes and outcomes, the dosage of Gn in the combined treatment group and the number of Gn administration days in the acupuncture and combined treatment groups were significantly fewer (<0.05), serum E levels on the trigger day in the medication, acupuncture and combined treatment groups, and the high-quality embryo number in the combined treatment group were considerably higher in comparison with their own levels of the 1 IVF-ET cycle in each group (<0.05). Comparison among the three groups showed that the dosage and number of administration days of Gn in the combined treatment group were fewer than those in the medication group(<0.05), and the dosage of Gn in the combined treatment group were significantly lower than that in the acupuncture group (<0.05), E content of the combined treatment group was markedly higher than that of the medication and acupuncture groups (<0.05). The high-quality embryo number in the combined treatment group was obviously larger than that of the medication group (<0.05). No significant differences were found between the 2 and 1 IVF-ET cycles in the number of the obtained oocyte, between the acupuncture and medication groups in the E content at the trigger day, and the numbers of Gn administration days and the high-quality embryo (>0.05).
Acupuncture combined with medication improves the level of endocrinal hormones and ovarian reservation function in POR women undergoing IVF-ET, benefiting the ovary environment of pregnancy.
观察针刺联合药物治疗卵巢低反应（POR）患者的临床疗效，并探讨其辅助妊娠的机制。
本研究共招募100例接受体外受精-胚胎移植（IVF-ET）的POR志愿者。在IVF-ET的第1周期，这些POR女性接受微刺激排卵方案（口服克罗米芬、肌肉注射尿促性素、注射绒毛膜促性腺激素触发等）。在接受第2周期IVF-ET之前，根据随机数字表将这些患者等分为对照组、药物组（克龄蒙，由戊酸雌二醇和醋酸环丙孕酮组成）、针刺组和针刺+药物组（联合治疗组）。药物组患者从月经第3天开始口服克龄蒙（1片/天，共21天），重复3个月经周期。针刺组患者在月经第8至15天（卵泡期）接受针刺刺激关元（CV4）、双侧太溪（KI3）、三阴交（SP6）和太冲（LR3），每日1次，共3个月经周期。在第1和第2周期IVF-ET月经的第2天，检测卵巢储备功能，包括采用放射免疫法测定血清促卵泡生成素（FSH）、促黄体生成素（LH）和雌二醇（E）含量，采用酶联免疫吸附测定法测定血清抗苗勒管激素（AMH）水平，采用彩色多普勒超声诊断仪测定卵巢窦卵泡计数（AFC）。在促排卵结束时，检测辅助妊娠指标和结局，包括促性腺激素（Gn）的用药剂量和天数、优势卵泡直径、扳机日E水平、超声引导下取卵数和培养的优质胚胎（1级和2级）。
治疗后，药物组、针刺组和联合治疗组血清FSH、LH和E含量显著降低（<0.05），血清AMH含量和卵巢AFC与各自治疗前相比明显增加（<0.05）。与对照组相比，药物组、针刺组和联合治疗组FSH、LH和E含量明显降低，AMH含量和AFC显著增加（<0.05）。三组治疗组比较显示，联合治疗组FSH、LH和E水平明显低于针刺组（<0.05），联合治疗组AFC明显多于针刺组（<0.05），联合治疗组LH含量也明显低于药物组（<0.05）。关于辅助妊娠指标和结局，联合治疗组Gn用量以及针刺组和联合治疗组Gn用药天数明显减少（<0.05），药物组、针刺组和联合治疗组扳机日血清E水平以及联合治疗组优质胚胎数与各自第1周期IVF-ET时相比明显升高（<0.05）。三组比较显示，联合治疗组Gn用量和用药天数少于药物组（<0.05），联合治疗组Gn用量明显低于针刺组（<0.05），联合治疗组E含量明显高于药物组和针刺组（<0.05）。联合治疗组优质胚胎数明显多于药物组（<0.05）。在获得的卵母细胞数量方面，第2周期和第1周期IVF-ET之间、针刺组和药物组在扳机日E含量、Gn用药天数和优质胚胎数量方面未发现显著差异（>0.05）。
针刺联合药物可提高接受IVF-ET的POR女性的内分泌激素水平和卵巢储备功能，有利于妊娠的卵巢环境。
