ABSTRACT
The case is a 38-year-old obese woman with complications such as idiopathic thrombocytopenic purpura, thyroid dysfunction, endometriosis, and uterine myoma. She had a wide variety of medical histories and had a long history of infertility treatment, and received various treatments. She has also undergone laparotomy for uterine myoma after the start of infertility treatment. We treated her with Kampo medicine for multiple complaints that appeared during infertility treatment. She received a combination therapy of tokishakuyakusan and shokenchuto, and after about 3 months, her symptoms improved and she became pregnant. In addition, bukuryoin and ryokankyomishingeninto, which were additionally used for hyperemesis gravidarum and cough during pregnancy, were also effective. The course of the pregnancy was uneventful and she gave birth to a girl at term. The girl is growing and developing normally without asphyxia, malformations, etc. It was suggested that it is necessary to pay attention not only to blood stasis and renal deficiency but also to spleen deficiency and consumptive disorder in Kampo medicine treatment for infertility and recurrent miscarriage.
ABSTRACT
We aimed to clarify the significance of using Kampo therapy centered on kamishoyosan and tokishakuyakusan together with general infertility treatment. The subjects were 41 women who visited a Kampo outpatient clinic for infertility and received general infertility treatment with Kampo therapy (Kampo group). The control group was 781 women who received only general infertility treatment at the same time (non-Kampo group). In comparing both groups, we conducted a retrospective survey on the pregnancy rate by cycle and the pregnancy rate by prescription. The pregnancy rate in the first cycle was 24.4% in the Kampo group and 8.5% in the non-Kampo group, and the pregnancy rate was higher in the Kampo group (P = 0.003). There was no difference in pregnancy rates after the second cycle. The pregnancy rate by prescription was 26.7% for kamishoyosan, 22.2% for tokishakuyakusan, and 8.5% for the non-Kampo group. In the comparison between the first cycle pregnant group and the non-pregnant group, the qi counter flow score was clearly higher in the first cycle pregnant group (P = 0.012). It is suggested that combined use of Kampo therapy including kamishoyosan and tokishakuyakusan may be effective from an early stage. Meanwhile, if pregnancy does not occur even after the combined use of Kamp therapy, it would be an opportunity to consider stepping up as Western medical therapy.
ABSTRACT
A endometriose consiste no alojamento de tecidos endometriais em certas regiões que ficam fora do útero. O número de casos dessa patologia é cada vez maior e é capaz de influenciar a fertilidade feminina. Os sinais e sintomas da patologia foram considerados no estudo, além de fatores biopsicossociais que envolvem as mulheres. Esse trabalho foi baseado em uma revisão bibliográfica a partir de uma seleção de artigos que relatam sobre endometriose e sobre a relação dessa enfermidade com infertilidade na população feminina. A partir da revisão de literatura, essa patologia pode causar modificação quimiotática e anatômica no aparelho de reprodução das mulheres, causando assim a infertilidade, dependendo do nível em que se encontra essa doença. Ademais, o tratamento dessa enfermidade, hormonal ou cirúrgico, é capaz de influenciar no processo saúde-doença da mulher, e ainda, possibilitar uma futura gravidez.
Endometriosis consists in endometrial tissues growth or adaptation outside of the uterus. The number of cases of this specific pathology has become more frequent and it may be capable influencing female fertility. Biopsychosocial factors as well as signs and symptoms that involve women are considered in this study. This work was based on a bibliographical review of selected articlesthat referred to endometriosis and its relationship with infertility in the female sex. According to this review, this pathology causes chemotactic and anatomic modification in the uterus, and consequently, infertility which depends on how advanced the disease is. Furthermore, the treatment of the disease, hormonal therapy or surgery, can influence the health-disease process as well as enable a future pregnancy.
Subject(s)
Endometriosis , Infertility , Pain , Health-Disease Process , Endometriosis/drug therapyABSTRACT
La Inseminación Intrauterina (IIU) es un procedimiento utilizado para el tratamiento de la infertilidad. En la actualidad las dos principales indicaciones para la IIU son el factor masculino leve y la infertilidad de causa desconocida. Los resultados obtenidos de la medicina basa en evidencias recomiendan que la IIU se realice en ciclos estimulados, en los cuales se gatille la ovulación con Gonadotropina Coriónica humana (hCG) y se suplemente la fase lútea con progesterona. Igualmente, se recomienda una monitorización ecográfica del crecimiento folicular y la realización de dos inseminaciones por cada ciclo de tratamiento. Para realizar la IIU se requiere de la indemnidad anatómica de los genitales internos de la mujer y de una separación espermática > 1,0 - 1,5 millones de espermatozoides conmotilidad progresiva. Las evidencias muestran que las mejores probabilidades de embarazo se producen cuando la mujer es menor de 35 años y la infertilidad es menor a cinco años. Nuestra tasa global de embarazo por ciclo con IIU en parejas infértiles es de 14,1 por ciento. Por otro lado, la tasa cumulativa de embarazo con IIU no recomienda realizar más de 4 a 6 ciclos de tratamiento, ya que las posibilidades de éxito después de ese tiempo son mínimas.
Intrauterine insemination (IUI) is procedure used for the treatment of infertility. At present, there are two principal indications for IUI: mild male factor and unexplained infertility. Results obtained through evidence based medicine, recommend IUI to be performed in stimulated cycles, triggering ovulation with human Chorionic Gonadotrophin (hCG) and giving a luteal phase supplementation with Progesterone. Ultrasound monitoring of the follicular growth and two inseminations per treatment cycle, are also recommended. In order to perform an IUI, a normal woman internal genital tract and a sperm count > 1,0 - 1,5 million with progressive motility after sperm preparation, are required. Evidence suggests that pregnancy is more likely in women less than 35 years and with infertility of 5 years, at the most. Our overall pregnancy rate per cycle with IUI in infertile couples is 14.1 percent. On the other hand, the cumulative pregnancy rate with IUI does not recommend performing more than 4 to 6 treatment cycles, since the probability of success after that is minimal.
Subject(s)
Humans , Female , Infertility, Female/therapy , Insemination, Artificial/methods , Cost-Benefit AnalysisABSTRACT
The treatment of infertile women with polycystic ovary syndrome (PCOS) has not yet been established. Before any intervention is initiated, lifestyle modification with diet and exercise leading to weight loss should be emphasized in overweight women. The recommended first-line treatment for ovulation induction remains clomiphene citrate. If clomiphene citrate use fails to result in ovulation or pregnancy, the recommended second-line intervention is exogenous gonadotropins. The use of exogenous gonadotropins is related to an increased risk for multiple pregnancies, and, therefore, intense ovarian response monitoring is required. Laparoscopic ovarian surgery is an alternative to gonadotropin therapy because this surgery is as effective as gonadotropin in pregnancy rate or live birth rate. However, the surgery may require additional ovulation induction drug and should be performed by well-trained surgeon, its use solely to induce ovulation is unwarranted. Recommended third-line treatment is in vitro fertilization (IVF). IVF reduces the risk of multiple pregnancies by using single-embryo transfer in women with PCOS. The use of metformin alone as first-line infertility therapy or in combination with clomiphene is surrounded by controversies. Aromatase inhibitors appear to be as effective as clomiphene citrate for induction of ovulation, but the drug is currently not approved for treatment of infertility. Further studies should demonstrate the efficacy and long term safety.