Veritable evaluation and inspection of PCOS and its apropos medicaments

Polycystic Ovary Syndrome (PCOS) is a vastly familial, prevalent yet complicated endocrine disorder seen in 5 to 15% of premenopausal women. An estimated one in five ~ 20% Indian women suffer from PCOS. In India, PCOS is a tabooed disorder; If neglected, the condition can prove fatal. However, the past decade has seen the changing discourse in India. PCOS negatively affects reproduction, general health, sexual health, and quality of life. Genetic predisposition of hormonal and non-hormonal factors influence ovary functioning and are responsible for the onset of the syndrome. Hormonal imbalance, metabolic abnormality, and insulin resistance are characteristic features that significantly increase the risk of anovulatory infertility, type 2 diabetes, and cardiovascular diseases. The underlying cause of the path physiology of PCOS is still under the radar, but the derangement of the hypothalamic-pituitary-ovarian axis could be the sweeping reason for the same. PCOS management should address on healthy lifestyle with symptomatic medical therapy and psychological bearing with special emphasis on far reaching side effects and long-term metabolic consequences This review article gives a comprehensive overview of PCOS and the morbidities hooked up with it. It has a notable emphasis on the PCOS guidelines, diagnosis, non-pharmacological, and pharmacological treatments.

Effects of opium alkaloid, noscapine in RU486 induced experimental model of polycystic ovary syndrome

PCOS is a common endocrinopathy among premenopausal women, characterized by hyperandrogenism, anovulation, hirsutism. We evaluated credence of noscapine; in RU486 induced PCOS rat and compared with flutamide, a conventional drug. For 13 days, an oral dose of RU486 [20 mg/kg/day] was administered to Wistar rats exhibiting regular estrous cycle. Varying dosage of noscapine was given to PCOS rats and compared with rats administered flutamide. Cytology of estrous cycle and serum hormone levels (LH, FSH, PRL, estradiol, and testosterone) were measured. Histomorpho-metrical changes, events of apoptosis in theca and granulosa cells were observed using flow cytometry and the mode of cellular death was examined by TUNEL staining. Our findings suggested, normal folliculogenesis in PCOS rats, post noscapine administration (120 mg/kg) in 3-4 days with normal hormonal profile. Theca and granulosa cells undergo massive and marginal cellular degeneration respectively with no G2/M arrest. TUNEL staining confirms the granulosa cells in follicles are major cell type undergo apoptosis in RU486 administered rats. However, low apoptotic DNA fragmentations were found in theca cells. We conclude that the RU486 model is suitable for studies of the metabolic features of PCOS and noscapine appears to be promising therapeutic modality for amelioration of PCOS induced condition.

Effect of acupuncture on pregnancy outcomes of frozen embryo transfer in patients with anovulatory infertility / 中国针灸

OBJECTIVE@#To observe the effect of conventional ovulation induction protocol and acupuncture combined with conventional ovulation induction protocol on pregnancy outcomes of frozen embryo transfer (FET) in patients with anovulatory infertility.@*METHODS@#A total of 60 patients with anovulatory infertility were randomized into an observation group and a control group, 30 cases in each group. In the control group, conventional ovulation induction protocol was applied to prepare endometrium. On the basis of the control group, acupuncture was started on the 2nd day of menstrual cycle in the observation group，Baihui (GV 20), Mingmen (GV 4), Geshu (BL 17), Guanyuan (CV 4), Qihai (CV 6), etc. were selected, once every other day, until 1 day before transplantation. The clinical pregnancy rate, embryo implantation rate, endometrial morphology on HCG trigger day, ovulation rate and cycle cancellation rate were compared in the two groups. The endometrial thickness before treatment and on HCG trigger day, TCM symptom score before and after treatment were observed in the two groups.@*RESULTS@#In the observation group, the embryo implantation rate and clinical pregnancy rate were higher than the control group (P<0.05), endometrial thickness and endometrial morphology on HCG trigger day were superior to the control group (P<0.05). After treatment, the TCM symptom score in the observation group was decreased compared with before treatment (P<0.05), and the variation was greater than the control group (P<0.01).@*CONCLUSION@#On the basis of the conventional ovulation induction protocol, acupuncture could enhance the embryo implantation rate and clinical pregnancy rate of FET, improve the endometrial receptivity of patients with anovulatory infertility.

Effect of therapies for kidney-tonifying and blood-activating in treatment of anovulatory infertility in eugenics / 中国中药杂志

In the context of the new era, paying attention to maternal and child health and advocating prenatal and postnatal care can effectively improve the quality of the birth population. Traditional Chinese medicine has a long history of prenatal and postnatal healthcare with rich content, which is the theoretical basis of modern related services. With the social development and the improvement of people's awareness of prenatal and postnatal healthcare, people have gradually shifted the focus of prenatal and postnatal healthcare to the peri-pregnancy stage at present, namely that couples of childbearing age are guided to prepare for pregnancy under the premise of solving their basic diseases. Infertility is a common and refractory disease for women of childbearing age. Ovulation disorder is one of its common pathological mechanisms. Traditional Chinese medicine believes that kidney deficiency is the main cause and pa-thogenesis of anovulation infertility and blood stasis is an important factor throughout the disease course. In clinical practice, therapies for invigorating kidney and activating blood are safe and reliable to treat anovulatory infertility mainly by adjusting the hypothalamus-pituitary-ovarian axis, improving ovarian function, uterine environment and gamete quality and increasing endometrial volume. Under the guidance of the thought of prenatal and postnatal healthcare, the authors tried to explore the effect of therapies for kidney-tonifying and blood-activating in the treatment of anovulatory infertility in eugenics, with the purpose of providing ideas and basis for subsequent relevant clinical studies and contributing to prenatal and postnatal healthcare services.

Examples of Professor MA Kun's treatment of infertility caused by hyperprolactinemia with kidney deficiency and blood stasis / 中国中药杂志

Hyperprolactinemia(HPRL) is one of the diseases leading to anovulatory infertility, which is a refractory gynecological disease and seriously affects female reproductive function. Professor MA Kun has summarized his experience in clinical and scientific studies for many years. And believes that kidney deficiency is the pathogenesis of HPRL and blood stasis is the dominant pathological manifestation of HPRL and can promote the progress of the disease. In view of this, Professor MA Kun took the therapy of kidney-tonifying and blood-activating as the principle for treating anovulatory infertility caused by HPRL, with soothing the liver and promoting Qi as adjuvant therapies. She has also summarized and refined the prescriptions for tonifying kidney and inducing ovulation, which have a remarkable clinical efficacy.

Advantages of integrated Chinese and western medicine in diagnosis and treatment of anovulatory infertility due to kidney deficiency and blood stasis / 中国中药杂志

Under the guidance of the theory of "kidney governing reproduction", this study demonstrated the mechanism of six types of ovulatory infertility caused by kidney deficiency and blood stasis, including anovulatory bleeding, polycystic ovary syndrome, hyperprolactinemia, luteinized unruptured follicle syndrome, luteal phase deficiency, and primary ovarian insufficiency. A series of studies have confirmed that integrated Chinese and western medicine can increase the responsiveness of the ovaries to gonadotropins and improve ovarian function by regulating the effects of estradiol(E_2), prolactin(PRL), and reducing follicle-stimulating hormone(FSH), luteinizing hormone(LH), progestin(P), and testosterone(T). It can also improve ovulation rate and pregnancy success rate by promoting follicle development, discharging, and synchronizing endometrial growth. This study illustrated the diagnosis and treatment of ovulatory infertility caused by kidney deficiency and blood stasis with integrated traditional Chinese and Western medicine in the "disease-syndrome-symptom" research mode, and highlighted the traditional Chinese medicine(TCM) idea of differentiating diseases based on syndromes and unique advantages of the combination of disease differentiation and syndrome differentiation, and interpreted TCM principle of "treating different diseases with the same method".

Lomiphene citrate versus letrozole as first line ovulation induction drug in infertile anovulatory polycystic ovarian syndrome women: a prospective randomized controlled trial

Background: The present study was design to compare letrozole (5 mg) and clomiphene citrate (100 mg) as first line ovulation induction drug in infertile anovulatory polycystic ovarian syndrome (PCOS) women.Methods: This prospective randomized clinical trial included 60 cases of PCOS with anovulatory infertility. The first group comprised of 30 patients who received 5 mg letrozole daily and the second group received 100 mg clomiphene citrate daily for 5 days starting on day 2-5 of menses. Both the groups were followed by ultrasound for follicle monitoring, ovulation and endometrial thickness. When dominant follicle reaches a diameter of more than or equal to 18mm and endometrial thickness ≥7.5 mm, human chorionic gonadotrophin (hCG) 5,000 IU was given intramuscularly and timed intercourse was advised. Main outcome measures were occurrence of ovulation, endometrial thickness and pregnancy rates.Results: The mean age, body mass index, and number of cases of primary and secondary infertility in both the groups showed no statistically significant difference. Multi-follicular development during induction was statistically significantly greater in the clomiphene group (1.27±1.11 versus 2.03±1.65; p=0.041). Ovulation occurred in 24 subjects (80%) in letrozole group and 18 subjects (60%) in the clomiphene group, with a statistically significant difference between the two groups (p=0.024). Pregnancy occurred in 16 subjects (53.33%) in letrozole group and 7 subjects (23.33%) in clomiphene group, which shows statistically significant difference between the two groups (p=0.048).Conclusions: Though number of developing follicles was found statistically significant with clomiphene citrate but ovulation rate and pregnancy rate were higher with letrozole group. Therefore, letrozole is a safe and better alternative for ovulation induction in patients of anovulatory PCOS, and it may be considered as a first line treatment for ovulation induction in these patients.

Comparative evaluation of different cost effective ovulation induction drugs and their effect on follicular growth, endometrial thickness and pregnancy outcome

Background: Ovulatory dysfunction is a common cause of female infertility, occurring in up to 20 - 30% of infertile women. The most commonly prescribed ovulation drugs are clomiphene citrate (CC), tamoxifen, aromatase inhibitors (such as letrozole) and gonadotropins. Objective of the study was to evaluate the efficacy of clomiphene citrate, letrozole and tamoxifen for ovulation induction in anovulatory infertility.Methods: Randomized open label interventional clinical trial. Patients were randomized to 3 drug groups. After baseline investigations, they were subjected to ovulation induction and then USG monitoring of follicular growth and ovulation. The primary outcome measured was occurrence of conception. Secondary outcome was effect on endometrial thickness and ovulation rate.Results: In the study, letrozole group showed 100% mono-follicular response. Mid cycle endometrial thickness in about 17% of cases in CC group is ≤8 mm. But all the cases in tamoxifen and letrozole group have ET >8 mm. This difference is statistically significant. The ovulation and conception rates are highest in letrozole group but the difference was not statistically significant.Conclusions: Letrozole produces higher mid cycle endometrial thickness, 100% mono follicular development than clomiphene and tamoxifen. This difference is found to be statistically significant. Ovulation rate and conception rate is highest in letrozole group. But there is no statistically significant difference among the three drugs.

Association of age and body mass index with response to clomiphene citrate or letrozole as treatment for anovulatory infertility in a sample of Filipino women

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Clomiphene citrate is used as the first line drug for anovulatory infertility treatment. When a woman fails to ovulate using clomiphene at maximum dose, letrozole is used as a second line drug.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine association between a patient's age and body mass index (BMI) and their response to clomiphene citrate or letrozole in the treatment of anovulation-related infertility.</p><p style="text-align: justify;"><strong>MATERIALS AND METHODS:</strong> The authors reviewed 147 patient records from January 2011 to August 2016 and investigated the age, BMI and response of patients when given clomiphene or letrozole for ovulation induction.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Ninety-nine (99) patients received clomiphene citrate while the other 118 patients received letrozole. Those who responded positively to clomiphene were at least 35 years old (72.2%) or had above normal BMI (61.5%). Patients who responded positively to letrozole were at least 35 years old (95%) and were categorized with above normal BMI (82.9%). The authors found that patients who are older than 35 years of age are more likely to respond to letrozole compared to younger patients.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This study found no significant association between BMI and response to either Letrozole or Clomiphene. Patients who are more than 35 years old are more likely to respond to letrozole, compared to younger patients. </p>

Treatment of anovulatory infertility by tonifying kidney and promoting blood circulation / 中国中药杂志

Infertility is a common disease in women of childbearing age and is also a refractory disease. Anovulatory dysfunction is one of the main causes of female infertility, and the incidence of anovulatory infertility has been increasing year by year. Traditional Chinese medicine has unique advantages and definite curative effect on the treatment of this disease. Kidney deficiency is the basic pathogenesis and blood stasis is an important factor that has been through. Flexible of tonifying the kidney and promoting blood circulation treatment of anovulatory infertility in clinic, has achieved remarkable curative effect. Kidney deficiency and blood stasis is a common form of gynecological disease. After years of clinical practice, we also found that patients with anovulatory infertility were more common with kidney deficiency and blood stasis. The kidneys and blood are not isolated from each other, but interact and influence each other. Kidney deficiency and blood stasis interact as both cause and effect, they have very close relationship. To achieve the purpose of urinary Tiangui, Chongren, ovulation and pregnancy miscarriage by tonifying the kidney and promoting blood circulation.

Herb-partitioned moxibustion on navel for anovulatory infertility:a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the efficacy differences between herb-partitioned moxibustion on navel and clomiphene for anovulatory infertility.</p><p><b>METHODS</b>With double-blind double-dummy randomized control method, a total of 40 patients with anovulatory infertility were randomly divided into a moxibustion group and a clomiphene group, 20 cases in each one. Blinding was conducted on both patients and doctors. The patients in the moxibustion group were treated with herb-partitioned moxibustion on navel and oral administration of clomiphene placebo, while the patients in the clomiphene group were treated with placebo-partitioned moxibustion on navel and oral administration of clomiphene. The herb-partitioned moxibustion and placebo-partitioned moxibustion were given at the end of menstruation, 1.5 hours per treatment, once a week, and no treatment was given during menstruation. The oral administration of clomiphene and clomiphene placebo were given from 5 days into menstruation, 50 mg, once a day, for consecutive 5 days. One menstrual cycle was taken as one treatment course, and 3 treatment courses were conducted. After 3 treatment courses, the endometrial thickness (ET), maximum follicular diameter (MFD), ovulation rate (OR) and effective rate (ER) were evaluated between the two groups.</p><p><b>RESULTS</b>(1) Compared before treatment, ET was significantly increased after treatment in the two groups (both<0.05); after treatment, the ET in the moxibustion group was higher than that in the clomiphene group (<0.05). (2) After treatment, MFD was significantly increased in the moxibustion group (<0.05) and insignificantly increased in the clomiphene group (>0.05); the MFD in the moxibustion group was higher than that in the clomiphene group (<0.05). (3) The OR was 75.0% (15/20) and 65.0% (13/20) in the two groups respectively, which were not significantly different (>0.05). (4) The total ER in the moxibustion group was 95.0% (19/20), which was superior to 70.0% (14/20) in the clomiphene group (<0.05).</p><p><b>CONCLUSIONS</b>The clinical efficacy of herb-partitioned moxibustion at navel on anovulatory infertility was superior to that of clomiphene, but their effects on OR was similar.</p>

Randomized Controlled Study of Disease-syndrome Combination Therapy for Anovulatory Infertility / 广州中医药大学学报

Objective To investigate the clinical effectiveness of disease-syndrome combination therapy for anovulatory infertility through randomized controlled trial, thus to provide high-level evidence-based medical reference for the diagnosis and treatment of WHO typeⅡovulation disorder infertility. Methods Eighty-six patients with WHO typeⅡovulation disorder infertility were randomized into treatment group and control group , 43 cases in each group. Both groups were given the treatment for correcting endocrinic disorder if necessary. Additionally, by following the principle of combination of disease differentiation and syndrome differentiation , Zhuyun Recipe 1, Zhuyun Recipe 2, and Zhuyun Recipe 3 were separately given orally to the patients with kidney-yang deficiency (WHO type Ⅱ ovulation disorder without PCOS), patients with liver-kidney insufficiency(WHO typeⅡovulation disorder complicated with hyperandrogenitic lean-PCOS),and patients with kidney-deficiency complicated with phl egm-dampness (WHO type Ⅱ ovulation disorder complicated with insulin-resistant obesity-PCOS) in the treatment group respectively. The patients in the control group was given oral use of the first-rate ovulation induction drug Clomiphene. The treatment covered 3 menstruation cycles. Ovulation rate,pregnancy rate and alive fetus rate were used as the indicators for evaluating the effectiveness,and the safety was also monitored. Results(1)Of the 86 cases,5 cases dropped out(loss to follow-up or being excluded),with the drop-out rate being 6%. Of the 5 drop-out cases,3 were from the control group,and 2 were from the treatment group. (2)Ovulation rate of the treatment group was 70.7%,and that of the control group was 85.0%. The ovulation rate of the two groups was enhanced,but the difference between the two groups was insignificant(P > 0.05).(3)Pregnancy rate of the treatment group was 51.2%,and that of the control group was 30.0%, the differen ce being significant between the two groups(P < 0.05).(4)Alive fetus rate of the treatment group was 45.2%,and that of the control group was 22.5%,the difference being significant between the two groups(P < 0.05).(5)No adverse reaction was found in the two groups during the treatment. Conclusion The disease-syndrome combination therapy for WHO type Ⅱanovulatory infertility shows the advantages of higher pregnancy rate and alive fetus rate, which makes up for the disadvantages of low pregnancy rate and high abortion rate of Clomiphene.

Effect of Rosiglitazone on Spontaneous and Clomiphene Citrate-induced Ovulation in Polycystic Ovary Syndrome.

Objective: The aim of this study was to evaluate the effect of rosiglitazone on spontaneous and clomiphene-induced cycle in polycystic ovary syndrome (PCOS) women. Methods: A randomized controlled trial was carried out on 30 women of PCOS divided into two groups of 15 each. Group I women received rosiglitazone and Group II women received both rosiglitazone and clomiphene citrate for three months. Main outcome measures: Primary outcome measures were improvement in body mass index (BMI), Hirsutism scoring and ovulation rate. Secondary outcome measures included conception rate and changes in hormonal profile. Results: Overall 20 of 30 (66.67%) women ovulated successfully. Ovulation occurred in nine of 15 women (60.00%) in Group I as compared to 11 of 15 (73.33%) in Group II (p value 0.6). Out of 30, total 53.33% became pregnant, 40% from Group I and 66.67% from Group II (p value 0.14). No significant improvement in follicle-stimulating hormone (FSH) and Hirsutism score was observed. Mean BMI of patient improved significantly and fasting insulin declined but not statistically significant. The hormonal profile showed improvement in both the groups, with decline in luteinizing hormone (LH), LH/FSH ratio and testosterone. Conclusion: Thus rosiglitazone, a wonderful insulin sensitizer, plays a significant role alone as well as in adjunct with clomiphene citrate in PCOS women.

Clinical observation on the effects of TKRPM combined with clomiphene for infertility / 国际中医中药杂志

Objective To summary Jiangsu Province Hospital of TCM Professor Xia GuiCheng's experience on treatment of infertility by the method of Tonifying the Kidney and Regulating the Period of Menses(TKRPM), meanwhile to observe the clinic curative effect of TKRPM combined with clomiphene for infertility.Methods The patients were randomly recruited into a TCM group and a TCM combined western medicine group by digital randomized methed,30 cases in each group.The TCM treated group was treated by the method of TKRPM, while the other group was treated by TCM combined with clomiphene. Both groups were treated for three months.Syndromes, basal body temperature, results of B ultrasonic, and hormone in serum were observed. Results In TCM treated group , the clinic effective rate was 93.3%, the pregnant ratio was 33.3%, mean-cure-time for pregnant was(8.20±2.35)months; while in TCM combined western medicine group, the clinic effective rate was 100%, the pregnant ratio was 20%, and mean-cure-time for pregnant was (5.17±1.72) months.The clinic effective rates (U=0.358) and the pregnant ratios (x2=1.346) of two groups were not markedly difference (P＞0.05), but the mean-cure-time for pregnant of the two groups was markedly difference(P＜0.05). Conclusion TKRPM combined with induction drugs can cure infertility in a shorter time than using TCM only. Western medicine improves endocrine environment,while traditional Chinese medicine regulates the relationship among kidney, TianGui and the uterus fundamentally. The method will be more acceptable to patients.