Clinical efficacy of acupuncture combined with Chinese herbal medication for recurrent implantation failure infertility of kidney deficiency and blood stasis and its effects on serum p38MAPK and JAK/STAT protein expression / 中国针灸

OBJECTIVES@#To observe the effects of acupuncture combined with Chinese herbal medication on pregnancy outcomes in patients with recurrent implantation failure (RIF) infertility of kidney deficiency and blood stasis, and to explore its effects on the protein expression of serum p38MAPK and JAK/STAT.@*METHODS@#Sixty-two patients with RIF infertility of kidney deficiency and blood stasis who were scheduled for artificial cycle frozen-thawed embryo transfer were randomly divided into an observation group (31 cases, 4 cases dropped out) and a control group (31 cases, 3 cases were eliminated). The patients in the control group were treated with conventional artificial cycle frozen-thawed embryo transfer. On the basis of the control group, the patients in the observation group were treated with acupuncture combined with Chinese herbal medication. Acupuncture was applied at Baihui (GV 20), Guanyuan (CV 4) and bilateral Neiguan (PC 6), Zigong (EX-CA 1), Guilai (ST 29), Zusanli (ST 36), Taichong (LR 3), Shenshu (BL 23), Ciliao (BL 32), with each session lasting for 30 minutes, once every other day. Chinese herbal medication was administered to Bushen Huoxue (tonifing the kidney and activating blood circulation) decoction, with one dose per day, starting from the 3rd to 5th day of the menstrual cycle and continuing until 1 day before embryo transfer. Clinical pregnancy rate, embryo implantation rate, live birth rate, and biochemical pregnancy rate were compared between the two groups. TCM symptom score, platelet count (PLT), and plasma D-dimer level were assessed before treatment and 1 day before embryo transfer. Western blot method was used to detect the expression of serum P38MAPK, JAK, and STAT proteins before treatment and 1 day before embryo transfer.@*RESULTS@#In the observation group, the clinical pregnancy rate, embryo implantation rate, and live birth rate were higher (P<0.05), while the biochemical pregnancy rate was lower (P<0.05) than those in the control group. One day before embryo transfer, both groups showed a decrease in TCM symptom scores, PLT, and plasma D-dimer levels compared to those before treatment (P<0.05), and the observation group had lower TCM symptom scores and plasma D-dimer levels than the control group (P<0.05). One day before embryo transfer, the expression levels of serum p38MAPK, JAK, and STAT proteins in both groups were lower than those before treatment (P<0.05), and the observation group had lower serum p38MAPK protein expression than the control group (P<0.05).@*CONCLUSIONS@#Acupuncture combined with Chinese herbal medication can improve the clinical pregnancy rate, embryo implantation rate, live birth rate, and reduce the biochemical pregnancy rate in RIF infertility patients of kidney deficiency and blood stasis. Its mechanism of action may be related to down-regulating plasma D-dimer level and protein expression of serum p38MAPK.

The application of mechanical stimulation to the endometrium in the frozen thawed embryo transfer of hormone replacement therapy / 中国医师进修杂志

Objective To analyze the mechanical stimulation to the endometrium on the clinical pregnancy rate and embryo implantation rate in the frozen thawed embryo transfer of hormone replacement therapy.Methods There were 193 patients undergoing the frozen thawed embryo transfer of hormone replacement therapy.According to the endometrial condition on the second or third day of the menstrual cycle,they were divided into three groups.Group A,54 patients whose endometrial thickness was no less than 0.6 cm or abnormal endometrium were operated the mechanical stimulation.Group B,55 patients whose endometrial thickness was no less than 0.6 cm or abnormal endometrial were not operated the mechanical stimulation.Group C,84 patients whose endometrial thickness was less than 0.6 cm and normal endometrium.Each group was divided into blastomere transplantation and blastula transplantation.Group A was 23,31 patients,group B was 24,31 patients,group C was 39,45 patients.The age,number of embryo,level of estradiol when injecting chorionic gonadotrophin,clinical pregnancy rate and embryo implantation rate were compared.Results (1) The clinical feature of blastula transplantation.The age,number of embryo,embryo implantation rate among three groups had no significant difference (P ＞ 0.05).The clinical pregnancy rate in group A and group C was significantly higher than that in group B [73.91％ (17/23),69.23％ (27/39)vs.37.50％(9/24)] (P ＜ 0.05),and there was no significant difference between group A and group C (P ＞ 0.05).The level of estradiol when injecting chorionic gonadotrophin in group C was significantly higher than that in group B [(841.56 ± 802.73) μ g/L vs.(293.34 ± 69.14) μ g/L] (P ＜ 0.05).There was no significant difference between group A and group B,group A and group C (P ＞0.05).(2)The clinical feature of blastomere transplantation.The age,number of embryo,level of estradiol when injecting chorionic gonadotrophin,embryo implantation rate and clinical pregnancy rate among three groups had no significant difference (P ＞ 0.05).Conclusions Mechanical stimulation to the endometrium can significantly improve the clinical pregnancy rate of blastula transplantation.It has no improvement for embryo implantation rate and clinical pregnancy rate of blastomere transplantation.