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Journal of Integrative Medicine ; (12): 163-172, 2022.
Article in English | WPRIM | ID: wpr-929221


OBJECTIVE@#Moxibustion, a common therapy in traditional Chinese medicine, has potential benefits for treating decreased ovarian reserve (DOR). The present study investigates the protective effect of moxibustion in a rat model of DOR and explores the possible mechanisms.@*METHODS@#Sixty-four female Sprague-Dawley rats were randomly divided into four groups: control, DOR, moxibustion (MOX), and hormone replacement therapy (HRT). The DOR rat model was established by intragastric administration of 50 mg/kg Tripterygium glycoside suspension (TGS), once daily for 14 days. MOX and HRT treatments were given from the day TGS administration was initiated. The ovarian reserve function was evaluated by monitoring the estrus cycle, morphological changes in ovaries, levels of serum estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Mullerian hormone (AMH), pregnancy rate and embryo numbers. Terminal-deoxynucleotidyl transferase-mediated nick-end-labeling staining was used to identify ovarian granulosa cell apoptosis, while the protein and mRNA expressions of Bax, B-cell lymphoma-2 (Bcl-2), phosphatidylinositol 3-kinase (PI3K) and protein kinase B (AKT) in ovarian tissues were examined by immunohistochemistry, Western blot and quantitative reverse transcription-polymerase chain reaction.@*RESULTS@#Compared with the DOR group, MOX improved the disordered estrous cycle, promoted follicular growth, reduced the number of atresia follicles, increased the concentrations of serum E2 and AMH, and decreased serum FSH and LH concentrations. More importantly, the pregnancy rate and embryo numbers in DOR rats were both upregulated in the MOX treatment group, compared to the untreated DOR model. Further, we found that the MOX group had reduced apoptosis of ovarian granulosa cells, increased Bcl-2 expression and reduced expression of Bax. Furthermore, the PI3K/AKT signaling pathway was triggered by the moxibustion treatment.@*CONCLUSION@#Moxibustion improved ovarian function and suppressed apoptosis of ovarian granulosa cells in a rat model of DOR induced by TGS, and the mechanism may involve the PI3K/AKT signaling pathway.

Animals , Female , Follicle Stimulating Hormone , Luteinizing Hormone , Moxibustion , Ovarian Reserve , Phosphatidylinositol 3-Kinase/pharmacology , Phosphatidylinositol 3-Kinases/metabolism , Pregnancy , Proto-Oncogene Proteins c-akt/pharmacology , Rats , Rats, Sprague-Dawley , Signal Transduction , bcl-2-Associated X Protein/genetics
Article in English | WPRIM | ID: wpr-928929


OBJECTIVE@#To explore the therapeutic effect of Bushen Yiqi Huoxue Decoction BYHD) in patients with diminished ovarian reserve (DOR).@*METHODS@#A total of 180 patients with DOR diagnosed from December 2013 to December 2014 were equally assigned into progynova and duphaston (E+D) group, Zuogui Pill group and BYHD group with 60 cases in each by computerized randomization. Patients received E+D, Zuogui Pill or BYHD for 12 months, respectively. Follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-Müllerian hormone (AMH), antral follicle count (AFC), ovarian volume, endometrial thickness, and the resistance indices (RIs) of ovarian arteries and uterine arteries were observed before and after treatment.@*RESULTS@#Nine women (4 from the E+D group, 3 from the Zuogui Pill group, and 2 from the BYHD group) withdrew from the study. After 6 months, Zuogui Pill and BYHD significantly decreased FSH and LH and increased endometrial thickness and AMH (all P<0.01). BYHD also resulted in E2 elevation (P<0.05), ovary enlargement (P<0.05), AFC increase (P<0.01), and RI of ovarian arteries decrease (P<0.05). After 12 months, further improvements were observed in the Zuogui Pill and BYHD groups (all P<0.01), but BYHD showed better outcomes, with lower FSH, larger ovaries and a thicker endometrium compared with the Zuogui Pill group (all P<0.01). However, E+D only significantly increased endometrial thickness (P<0.01) and no significant improvements were observed in the RI of uterine arteries in the three groups.@*CONCLUSIONS@#BYHD had a favorable therapeutic effect in patients with DOR by rebalancing hormone levels, promoting ovulation, and repairing the thin endometrium. The combination of tonifying Shen (Kidney), benefiting qi and activating blood circulation may be a promising therapeutic strategy for DOR.

Anti-Mullerian Hormone/pharmacology , Drugs, Chinese Herbal , Female , Follicle Stimulating Hormone , Humans , Luteinizing Hormone , Ovarian Reserve
Article in Chinese | WPRIM | ID: wpr-927379


To summarize LIU Zhi-shun's clinical experience in treatment of infertility with decreasing ovarian reserve (DOR) with electroacupuncture. LIU Zhi-shun believes that the location of infertility with DOR is the uterus, mainly involving the kidney, thoroughfare and conception vessels. He advocates to select acupoints by combining "disease-symptom-position" with prescription, and selects acupoint prescription of Bushen Tiaochong Zhuyun included Guanyuan (CV 4), Zigong (EX-CA 1), Tianshu (ST 25), Sanyinjiao (SP 6), Ciliao (BL 32) and Zhongliao (BL 33) for electroacupuncture treatment. The key points of operation are accurate positioning and deep acupuncture, focusing on regulating mind and getting qi, adopting electroacupuncture treatment and low frequency stimulation and treating slowly for long-term disease.

Acupuncture Points , Acupuncture Therapy , Electroacupuncture , Female , Humans , Infertility , Ovarian Reserve
Rev. Assoc. Med. Bras. (1992) ; 67(10): 1415-1420, Oct. 2021. graf
Article in English | LILACS | ID: biblio-1351432


SUMMARY OBJECTIVE: This study evaluates the effects of a ketogenic diet on morphology and follicle reserve. METHOD: Sixteen Sprague-Dawley rats were randomized into two groups: standard diet group (n=8) and ketogenic diet group (n=8). Rats were time mated. Dams were permitted to deliver spontaneously. The animals were monitored for the onset of puberty. All the rats were weighed and anesthetized, serum anti-Müllerian hormone level was measured, and the oviducts were removed. The morphological characteristics of follicles were determined and total ovarian volumes were calculated. RESULTS: The mean ovarian volume was statistically significantly lower in the ketogenic diet group compared to the standard diet group (14.41±0.99 mm3 versus 18.89±1.28 mm3) (p=0.000). The mean number of antral follicles was 13.63±1.80 in the standard diet group and 4.462±0.760 in the ketogenic diet group. The mean ovarian weight of the ketogenic diet group was significantly lower than that of the standard diet group (0.42±0.06 g versus 0.815±107 g). The mean anti-Müllerian hormone levels were significantly higher in the standard diet group compared to the ketogenic diet group (1.023±4.75 ng/mL versus 0.69±0.07 ng/mL) (p=0.000). The mean percentage of staining of Ki-67 was 35.28±4.75 in the standard diet group and 16.98±3.33 in the ketogenic diet group (p=0.000). CONCLUSION: Maternal ketogenic diet reduces ovarian follicular reserve in female offspring and has important implications for maintaining reproductive potential at a population level.

Humans , Animals , Female , Rats , Diet, Ketogenic/adverse effects , Ovarian Reserve , Ovary , Rats, Sprague-Dawley , Anti-Mullerian Hormone
Article in Chinese | WPRIM | ID: wpr-877549


OBJECTIVE@#To observe the effect of moxibustion on Nrf2/HO-1 signaling pathway in rats with diminished ovarian reserve (DOR), and to explore the protective mechanism of moxibustion on ovarian reserve function.@*METHODS@#Forty SD rats were randomly divided into a blank group, a model group, a moxibustion group and a hormone group, 10 rats in each group. The rats in the model group, moxibustion group and hormone group were treated with intragastric administration of tripterysium glycosides turbid liquid to prepare DOR model. The rats in the blank group were treated with intragastric administration of sodium chloride solution with the same volume, once a day for 14 days. The rats in the hormone group were treated with hormone sequential therapy for 14 days from the day of modeling; the rats in the moxibustion group were treated with moxibustion at bilateral "Shenshu" (BL 23) or "Guanyuan" (CV 4) and "Zhongwan" (CV 12) from the day of modeling, and the two groups acupoints were alternated every other day, 10 min each time, for 14 consecutive days. The estrus cycle was observed every day by vaginal exfoliated cell smear, and the estrus cycle disorder rate in each group was calculated. After the intervention, the HE staining was used to observe the histological morphology of ovaries; ELISA was used to detect the contents of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E@*RESULTS@#Compared with the blank group, the rate of estrus cycle disorder in the model group was increased (@*CONCLUSION@#Moxibustion could reduce the rate of estrus cycle disorder, improve the level of serum sex hormones and antioxidant stress in DOR rats, and the mechanism may be related to the regulation of Nrf2/HO-1 signaling pathway.

Animals , Female , Humans , Moxibustion , NF-E2-Related Factor 2/metabolism , Ovarian Reserve , Rats , Rats, Sprague-Dawley , Signal Transduction
Article in Chinese | WPRIM | ID: wpr-921809


The present study investigated the effect of Modified Dihuang Decoction in improving ovarian reserve in mice through the Bcl-2-related mitochondrial apoptosis pathway. Forty-eight adult female BALB/c mice were randomly divided into the following six groups with eight mice in each group: a blank group, a model group, a femoston group(three cycles of treatment with 0.13 mg·kg~(-1) estradiol tablets for 2 days and 1.43 mg·kg~(-1) estradiol and dydrogesterone tablets for 3 days), and high(64.74 g·kg~(-1))-, medium(43.16 g·kg~(-1))-, and low-dose(21.58 g·kg~(-1)) Modified Dihuang Decoction groups. Mice in other groups except the blank group received a single intraperitoneal injection of 12 mg·kg~(-1) cyclophosphamide and 1.2 mg·kg~(-1) busulfan to induce a model of diminished ovarian reserve(DOR), while those in the blank group received an equal volume of normal saline. Mice were treated with corresponding drugs for 15 d from the 36 th day, once per day, and the mice in the blank group and the model group were treated with an equal volume of normal saline. The general condition and oestrous cycle were observed. The serum hormone levels were detected with the enzyme-linked immunosorbent assay(ELISA). The morphological changes of ovaries were observed by HE staining. Western blot was used to detect the protein expression of cysteinyl aspartate specific proteinase-9(caspase-9), cleaved caspase-3, Bcl-2 associated X protein(Bax), Bcl-2, superoxide dismutase-2(SOD-2), and glutathione peroxidase-1(GPx-1). The mRNA expression of Bax and Bcl-2 was detected by real-time fluorescence-based quantitative polymerase chain reaction(real-time PCR). The results showed that compared with the blank group, the model group showed body weight loss, disordered oestrous cycle, elevated serum levels of follicle-stimulating hormone(FSH) and luteinizing hormone(LH), reduced serum levels of estradiol(E_2), anti-mullerian hormone(AMH), and inhibin B(INHB), the declining number of ovarian follicles and granulosa layers, increased number of atretic follicles, up-regulated protein expression of caspase-9, cleaved caspase-3, and Bax and Bax mRNA expression in ovaries, and down-regulated protein expression of Bcl-2, SOD-2 and GPx-1, and Bcl-2 mRNA expression. Compared with the model group, the Modified Dihuang Decoction groups displayed restored body weight and oestrous cycle, decreased serum levels of FSH and LH, elevated serum levels of E_2, AMH, and INHB, increased number of ovarian follicles, thickened granulosa layers, and declining number of atretic follicles. Additionally, the protein expression of caspase-9, cleaved caspase-3, and Bax, and Bax mRNA expression was down-regulated, and the protein expression of Bcl-2, SOD-2, and GPx-1, and Bcl-2 mRNA expression was up-regulated. The results suggest that Modified Dihuang Decoction can regulate endocrine hormone, promote follicle growth and improve ovarian reserve by enhancing ovarian anti-oxidant capacity, inhibiting the Bcl-2-related mitochondrial apoptosis pathway, and further inhibiting cell apoptosis.

Animals , Apoptosis , Female , Mice , Mice, Inbred BALB C , Ovarian Follicle , Ovarian Reserve , Ovary
Article in Chinese | WPRIM | ID: wpr-887934


To study the clinical efficacy and safety of Bushen Huoxue Culuan Formula in treating infertility caused by diminished ovarian reserve(DOR) with kidney deficiency and blood stasis. A total of 100 DOR patients treated at Xiyuan Hospital, Acupuncture Hospital and Clinic of China Academy of Chinese Medical Sciences from 2017 to 2020 in line with the inclusion criteria were selected and randomly divided into experimental group and control group at the ratio of 1∶1. The experimental group was treated with Bushen Huoxue Culuan Formular, while the control group was treated with Climen and Clomiphene for 3 menstrual cycles. The ovulation rate, pregnancy rate, pregnancy success rate, serum hormone levels, and traditional Chinese medicine(TCM) symptom scores were observed in the 2 groups. The total effective rate was 92.00% in the experimental group and 72.00% in the control group, with a statistical difference between the two groups(P<0.01); the experimental group was superior to the control group in reducing FSH level, increasing AMH level, improving TCM symptoms, increasing pregnancy rate and pregnancy success rate, with a significant difference(P<0.05). There was no abnormal safety indicator and adverse reaction. Bushen Huoxue Culuan Formular is effective in treating infertility caused by DOR due to kidney deficiency and blood stasis, with a safety and reliability.

China , Drugs, Chinese Herbal , Female , Humans , Infertility, Female/drug therapy , Kidney , Ovarian Reserve , Pregnancy , Reproducibility of Results , Treatment Outcome
Article in English | WPRIM | ID: wpr-880339


BACKGROUND@#Mounting evidence implicates an association between ambient air pollution and impaired reproductive potential of human. Our study aimed to assess the association between air pollution and ovarian reserve in young, infertile women.@*METHODS@#Our study included 2276 Korean women who attended a single fertility center in 2016-2018. Women's exposure to air pollution was assessed using concentrations of particulate matter (PM@*RESULTS@#The mean age was 36.6 ± 4.2 years and AMH level was 3.3 ± 3.1 ng/mL in the study population. Average AMH ratio was 0.8 ± 0.7 and low AMH was observed in 10.3% of women (n=235). The average concentration of six air pollutants was not different between the normal ovarian reserve and low AMH groups for all averaging periods. In multivariable models, an interquartile range (IQR)-increase in 1 month-average PM@*CONCLUSIONS@#In a cohort of infertile Korean women, there was a suggestive evidence of the negative association between ambient PM concentration and ovarian reserve, highlighting the potential adverse impact of air pollution on women's fertility.

Adult , Air Pollutants/adverse effects , Air Pollution/adverse effects , Environmental Exposure/adverse effects , Female , Humans , Infertility, Female/etiology , Ovarian Reserve/physiology , Republic of Korea
Article in Chinese | WPRIM | ID: wpr-879582


OBJECTIVE@#To explore the correlation between Fragile X mental retardation gene-1 (FMR1) gene CGG repeats with diminished ovarian reserve (DOR).@*METHODS@#For 214 females diagnosed with DOR, DNA was extracted from peripheral blood samples. FMR1 gene CGG repeats were determined by PCR and capillary electrophoresis.@*RESULTS@#Three DOR patients were found to carry FMR1 premutations, and one patient was found to carry gray zone FMR1 repeats. After genetic counseling, one patient and the sister of another patient, both carrying FMR1 permutations, conceived naturally. Prenatal diagnosis showed that both fetuses have carried FMR1 permutations.@*CONCLUSION@#FMR1 gene permutation may be associated with DOR. Determination of FMR1 gene CGG repeats in DOR patients can provide a basis for genetic counseling and guidance for reproduction.

Female , Fragile X Mental Retardation Protein/metabolism , Fragile X Syndrome/genetics , Humans , Ovarian Diseases , Ovarian Reserve/genetics , Primary Ovarian Insufficiency/genetics , Trinucleotide Repeats/genetics
Rev. MED ; 28(1): 77-88, ene.-jun. 2020.
Article in Spanish | LILACS | ID: biblio-1143834


Resumen: La necesidad de investigar la reserva ovárica para apoyar la consejería acerca del éxito o fracaso de los tratamientos de reproducción asistida, principalmente en pacientes con riesgo de falla reproductiva, ha generado la descripción y el uso de pruebas histológicas, basales, dinámicas y ultrasonográficas. La presente revisión tiene como objetivo describir y analizar las diferentes pruebas de evaluación de la reserva ovárica, sus limitaciones y ventajas, y ampliar la información referente a las que, por sus características y resultados, son más utilizadas en la actualidad. Para cumplirlo se realizó búsqueda en bases de datos, incluyendo investigaciones originales, revisiones sistemáticas, metaanálisis, reportes de casos y consensos de expertos, en inglés y español, desde 1980. En cuanto a los resultados, puede decirse que pruebas como la biopsia ovárica, medición de Inhibina B, test de estímulo con FSH o con GnRH, y con citrato de clomifeno, han caído en desuso; la medición de la FSH, si bien todavía utilizada, claramente tiene menor capacidad predictiva que el Conteo de Folículos Antrales (CFA) y la Hormona Antimülleriana (HAM). Se concluye que el CFA y la medición de ham son las pruebas más recomendadas, con mejor capacidad predictiva y que, no obstante algunas limitaciones, permiten un acercamiento a la estimación de la respuesta al estímulo ovulatorio. Se plantean opciones para el futuro que permitirán, a mediano plazo, resolver los interrogantes sobre la "verdadera" reserva ovárica.

Abstract: The need to investigate the ovarian reserve to support counseling about the success or failure of assisted reproduction systems has generated the description and use of histological, basal, dynamic, and ultrasound text. The purpose of this review is to describe and analyze the different tests for evaluating ovarian reserve, their limitations and advantages, and to expand the information regarding those that, due to their characteristics and results, are most widely used today. To achieve this, databases searches were carried out, including for original research, systematic reviews, meta-nalyses, case reports and expert consensus, in English and Spanish, since 1980. Regarding the results, it can be said that tests such as ovarian biopsy, measurement of Inhibin B, FSH or GnRH stimulation test, and with clomiphene citrate, have fallen into disuse. FSH measurement, although still used, clearly has a lower predictive capacity than the Antral Follicle Count (AFC) and the Antimullerian Hormone (AMH). It is concluded that the AFC and the AMH measurement are the most recommended tests, with better predictive capacity and that, despite some limitations, they allow closer estimation of the response to ovulatory stimulus. Options for the future that will allow solving the questions in the medium term about the "true" ovarian reserve are proposed.

Resumo: A necessidade de pesquisar sobre a reserva ovariana para apoiar o aconselhamento acerca do sucesso ou do fracasso dos tratamentos de reprodução assistida, principalmente em pacientes com risco de falha reprodutiva, vem gerando a descrição e o uso de exames histológicos, basais, dinâmicos e ultrassonográficos. Esta revisão tem o objetivo de descrever e analisar os diferentes exames de avaliação da reserva ovariana, suas limitações e vantagens, e ampliar a informação referente aos que, por suas características e resultados, são mais utilizados na atualidade. Para isso, foi realizada busca em base de dados, que incluiu pesquisas originais, revisões sistemáticas, meta-aná-lise, relatos de caso e consenso de especialistas, em inglês e em espanhol, desde 1980. Quanto aos resultados, pode-se dizer que os exames como biópsia ovariana, a medição de Inibina B, exame de estímulo com FSH ou com GnRH, e com citrato de clomifeno estão em desuso; a medição da FSH, embora ainda utilizada, claramente tem menor capacidade preditiva que a contagem de folículos antrais (CFA) e o hormônio antimulleriano (HAM). Conclui-se que o CFA e a medição do HAM são os exames mais recomendados, com melhor capacidade preditiva e que, apesar de algumas limitações, permitem uma aproximação da estimativa da resposta ao estímulo da ovulação. São apresentadas opções para o futuro que possibilitarão, em médio prazo, resolver as questões sobre a "verdadeira" reserva ovariana.

Humans , Female , Adolescent , Adult , Ovarian Reserve , Counseling , Basic Reproduction Number , Anti-Mullerian Hormone
Rev. colomb. obstet. ginecol ; 71(1): 56-62, Jan.-Mar. 2020.
Article in Spanish | LILACS | ID: biblio-1115620


RESUMEN Objetivos: reportar el caso de una paciente con síndrome de Turner en mosaico, a quien se le realizó un tratamiento de reproducción asistida con análisis genético preimplantatorio para aneuploidias, logrando el nacimiento de una niña sana con cariotipo normal, y realizar una revisión de la literatura sobre la utilidad del diagnóstico genético preimplantatorio en las mujeres con síndrome de Turner. Materiales y métodos: se presenta el caso de una mujer de 27 años, con diagnóstico de síndrome de Turner en mosaico y con alteración secundaria en la reserva ovárica, atendida en centro de referencia para el manejo de infertilidad en Medellín, Colombia, a quien se le realizó un tratamiento de fertilización in vitro con análisis genético preimplan-tatorio para prevenir la transmisión del síndrome de Turner a su descendencia. Se realizó una búsqueda de la literatura en las bases de datos Medline vía PubMed, Clinical Key, OVID, Embase, Lilacs, SciE- LO y Oxford Journals, con los siguientes términos: "Turner Syndrome", "Mosaic Turner", "Preim- plantation Genetic Screening", "Preimplantation Genetic Testing", "Preimplantation Genetic Diagnosis", "Pregnancy", "Successful pregnancy". Como criterios de inclusión se consideraron artículos tipo series y reportes de casos, cohortes y artículos de revisión desde enero de 1980 hasta junio de 2017, que incluyeran mujeres con síndrome de Turner embarazadas por medio de técnicas de fertilización in vitro, con sus propios óvulos, y que hubiesen sido sometidas a biopsia embrionaria para diagnóstico genético preimplantatorio. La búsqueda se limitó a los idiomas español e inglés. Resultados: un estudio cumplió con los criterios de inclusión. Tanto en este reporte como en nuestro caso, las pacientes con síndrome de Turner en mosaico se sometieron a varios ciclos de inyección intracitoplasmática de espermatozoides (ICSI) con sus propios óvulos, luego se realizó biopsia em- brionaria para análisis genético preimplantatorio utilizando diferentes técnicas. En ambos casos se logró la transferencia al útero de embriones euploides con el posterior nacimiento de niñas sanas con cariotipo normal. Conclusión: Las pacientes con ST mosaico podrían beneficiarse de la biopsia embrionaria y análisis genético preimplantatorio para prevenir la transmisión del defecto genético a su descendencia.

ABSTRACT Objectives: To report the case of a patient with mosaic Turner syndrome who underwent assisted reproduction treatment with preimplantation genetic testing for aneuploidy and gave birth to a healthy baby girl with normal karyotype; and to conduct a review of the literature on the usefulness of preimplantation genetic diagnosis in women with Turner syndrome. Materials and methods: A case of a 27 year-old woman diagnosed with mosaic Turner syndrome and secondary altered ovarian reserve, seen in a referral center for infertility management in Medellín, Colombia. The patient underwent in vitro fertilization followed by pre-implantation genetic testing to prevent transmission of Turner syndrome to her progeny. A literature search was conducted in the Medline via PubMed, Clinical Key, OVID, Embase, Lilacs, SciELO and Oxford Journals data- bases using the following terms: "Turner Syndrome," "Mosaic Turner," "Preimplantation Genetic Screening," "Preimplantation Genetic Testing," "Preimplantation Genetic Diagnosis," "Pregnancy," "Successful pregnancy." Inclusion criteria were case series and case reports, cohort studies and review articles published between January 1980 and June 2017 that included women with Turner syndrome achieving pregnancy by means of in vitro fertilization techniques with their own oocytes and who had undergone embryo biopsy for preimplantation genetic diagnosis. The search was limited to articles in Spanish and English. Results: one study met the inclusion criteria. Both in this report and in our case, patients with mosaic Turner syndrome underwent several cycles of intracytoplasmic sperm injection (ICSI) with their own eggs, then performed embryonic biopsy for preimplantation genetic analysis using different techniques. In both cases, euploid embryos were transferred to the uterus with the subsequent birth of healthy girls with normal karyotype. Conclusion: Patients with mosaic Turner syndrome could benefit from preimplantation biopsy and genetic analysis to prevent transmission of the genetic defect to their progeny.

Humans , Female , Infant, Newborn , Turner Syndrome , Preimplantation Diagnosis , Ovarian Reserve , Aneuploidy
Article in Chinese | WPRIM | ID: wpr-826683


OBJECTIVE@#To evaluate the clinical effect of acupuncture at "thirteen acupoints for regulating menstruation and promoting pregnancy" on diminished ovarian reserve (DOR) and its influence on ovarian reserve function.@*METHODS@#A total of 32 patients with DOR were treated by acupuncture at "thirteen acupoints for regulating menstruation and promoting pregnancy". Acupoints group 1: Baihui (GV 20), Shenting (GV 24), Benshen (GB 13), Zhongwan (CV 12), Tianshu (ST 25), Guanyuan (CV 4), Zigong (EX-CA 1), Dahe (KI 12), Zusanli (ST 36), Sanyinjiao (SP 6), Taichong (LR 3); acupoints group 2: Baihui (GV 20), Shenshu (BL 23), Ciliao (BL 32). Acupoints group 1 and group 2 were alternately used, and acupoints group 1 was used for the first time. The needles were stayed for 30 min each time, once every 1 or 2 days, 3 times a week, 36 times (3 months) as a course of treatment. The treatment could be continued until the patient was pregnant or the patient given up acupuncture, and the acupuncture was uninterrupted during menstruation. The changes of modified Kupperman scale score, serum sex hormones, anti-müllerian hormones (AMH), ovarian peak systolic velocity (PSV), resistive index (RI) and antral follicle count (AFC) were compared before and after treatment, and the clinical effect and pregnancy rate were observed.@*RESULTS@#The total score of modified Kupperman scale after treatment was lower than that before treatment (<0.05); The total effective rate was 90.6% (29/32) and the pregnancy rate was 15.6% (5/32). After treatment, the levels of follicle stimulating hormone (FSH), FSH/ luteinizing hormone (LH) were lower than before treatment, ovarian PSV was higher than before treatment, RI was lower than before treatment, and AFC was more than before treatment (<0.05).@*CONCLUSION@#Acupuncture at "thirteen acupoints for regulating menstruation and promoting pregnancy" can effectively improve the ovarian reserve function of DOR patients.

Acupuncture Points , Acupuncture Therapy , Female , Humans , Infertility, Female , Therapeutics , Menstruation , Ovarian Reserve , Pregnancy , Prospective Studies
Rev. bras. ginecol. obstet ; 41(6): 400-408, June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013629


Abstract Objective The objective of this review was to analyze the impact on ovarian reserve of the different hemostatic methods used during laparoscopic cystectomy. Data Sources The studies were identified by searching electronic databases (MEDLINE, Embase, Cochrane, LILACS) and scanning reference lists of articles. Methods of Study Selection We selected clinical trials that assessed the influence of hemostatic techniques on ovarian reserve in patients with ovarian cysts with benign sonographic appearance submitted to laparoscopic cystectomy by stripping technique. The included trials compared different laparoscopic hemostatic techniques: suture, bipolar electrocoagulation, ultrasonic energy and hemostatic sealants. The outcomes evaluated were level of serum anti-Mullerian hormone (AMH) and antral follicle count (AFC). The possibility of publication bias was evaluated by funnel plots. Tabulation, Integration and Results Twelve trials involving 1,047 patients were evaluated. Laparoscopic suturewas superior to bipolar coagulationwhen evaluating serum AMHand AFC, in the 1st, 3rd, 6th and 12thmonth after surgery. In the comparison between bipolar and hemostatic sealants, the results favored the use of hemostatic agents. The use of ultrasonic energy was not superior to the use of bipolar energy. Conclusion We recommend suture for hemostasis during laparoscopic cystectomy.

Resumo Objetivo O objetivo desta revisão foi comparar o impacto dos diferentes métodos hemostáticos na reserva ovariana durante a ooforoplastia laparoscópica. Fontes de Dados Os estudos foram identificados através da pesquisa de bases de dados eletrônicas (MEDLINE, Embase, Cochrane, LILACS) e listas de referência de artigos. Seleção dos estudos Selecionamos ensaios clínicos que avaliaram a influência das técnicas hemostáticas na reserva ovariana em pacientes com cistos ovarianos com aspecto ultrassonográfico benigno submetidos à ooforoplastia laparoscópica pela técnica de tração e contra-tração. Os estudos incluídos compararam as técnicas hemostáticas: sutura, energia bipolar, energia ultrassônica e selantes hemostáticos. Coleta de dados Os desfechos avaliados foram o hormônio antimülleriano e a contagem de folículos antrais. A possibilidade de viés de publicação foi avaliada por gráficos de funil. Síntese dos dados Doze estudos envolvendo 1.047 pacientes foram avaliados. A sutura foi superior à coagulação bipolar, e, na comparação entre selantes e energia bipolar, os resultados favoreceram o uso do primeiro grupo. O uso de energia ultrassônica não foi superior ao uso da energia bipolar. Conclusão Em conclusão, recomendamos a sutura para hemostasia durante a ooforoplastia laparoscópica.

Humans , Female , Adult , Ovarian Cysts/surgery , Cystectomy/methods , Laparoscopy/methods , Ovarian Reserve/physiology , Hemostasis/physiology , Randomized Controlled Trials as Topic , Practice Guidelines as Topic
Rev. argent. endocrinol. metab ; 56(1): 20-29, mar. 2019.
Article in Spanish | LILACS | ID: biblio-1041756


RESUMEN La insuficiencia ovárica prematura es la pérdida de la función ovárica antes de los 40 años de edad. Se caracteriza por hipogonadismo hipergonadotrófico y amenorrea u oligomenorrea. Su etiología es multifactorial, pudiendo deberse a causas iatrogénicas, genéticas, metabólicas, autoinmunes y ambientales; siendo de origen idiopático en el 90 % de los casos. Su incidencia es de 1 cada 100 mujeres menores de 40 años y 1 cada 1000 mujeres menores de 30 años. En la actualidad no existe un único marcador que se pueda utilizar para calcular la reserva ovárica; sin embargo, en los últimos años la hormona antimülleriana ha demostrado presentar algunas ventajas respecto a los biomarcadores clásicamente utilizados. Además, diversos estudios indican que existe una correlación positiva entre los niveles de esta hormona y el recuento de folículos antrales, que es, por el momento, el método más confiable para evaluar reserva ovárica debido a las actuales dificultades técnicas para la determinación de hormona antimülleriana.

ABSTRACT Premature ovarian insufficiency, the loss of ovarian function before the age of 40 years, is characterized by hipergonadotrofic hipogonadism and amenorrhea or oligomenorrhea. The etiology is multifactorial, and can be due to genetic, metabolic, autoimmune, environmental or iatrogenic causes, being idiopathic 90% of cases. Currently there is not a single marker that can be used for estimate ovarian reserve in this patients; however, in recent years antimüllerian hormone has proved to have some advantages over other classical biomarkers. Moreover, several studies indicate a positive correlation between antimüllerian hormone concentration and antral follicle count, considered nowadays the most reliable method for ovarian reserve estimation.

Humans , Female , Primary Ovarian Insufficiency/diagnosis , Primary Ovarian Insufficiency/etiology , Biomarkers , Anti-Mullerian Hormone/physiology , Ovarian Reserve
Article in English | WPRIM | ID: wpr-763357


Anti-Müllerian hormone (AMH), a peptide growth factor of the transforming growth factor-β family, is a reliable marker of ovarian reserve. Regarding assisted reproductive technology, AMH has been efficiently used as a marker to predict ovarian response to stimulation. The clinical use of AMH has recently been extended and emphasized. The uses of AMH as a predictive marker of menopause onset, diagnostic tool for polycystic ovary syndrome, and assessment of ovarian function before and after gynecologic surgeries or gonadotoxic agents such as chemotherapy have been investigated. Serum AMH levels can also be affected by environmental and genetic factors; thus, the effects of factors that may alter AMH test results should be considered. This review summarizes the findings of recent studies focusing on the clinical application of AMH and factors that influence the AMH level and opinions on the use of the AMH level to assess the probability of conception before reproductive life planning as a “fertility test.”

Drug Therapy , Female , Fertility , Fertilization , Gynecologic Surgical Procedures , Humans , Menopause , Ovarian Reserve , Polycystic Ovary Syndrome , Reproductive Techniques, Assisted
Article in English | WPRIM | ID: wpr-763347


OBJECTIVE: Bilateral uterine artery ligation (UAL) is a fertility-preserving procedure used in women experiencing postpartum hemorrhage (PPH). However, the long-term effects of this procedure on ovarian function remain unclear. The aim of this study was to investigate whether bilateral UAL compromised ovarian reserve and ovarian blood supply. METHODS: This prospective study included 49 women aged between 21 and 36 years who had undergone a cesarean section for obstetric indications. Of these, 25 underwent uterine bilateral UAL to control intractable atonic PPH. The control group consisted of 24 women who had not undergone bilateral UAL. Standard clinical parameters, the results of color Doppler screening, and ovarian reserve markers were assessed in all participants at 6 months after surgery. The clinical parameters included age, parity, cycle history, body mass index, and previous medication and/or surgery. Color Doppler screening findings included the pulsatility index (PI) and resistance index (RI) for both the uterine and ovarian arteries. The ovarian reserve markers included day 3 follicle-stimulating hormone (FSH) levels, antral follicle count, and anti-Müllerian hormone (AMH) levels. RESULTS: There were no significant differences in the ovarian reserve markers of day 3 FSH levels, antral follicle count, and AMH levels between the study and control groups (p>0.05 for all). In addition, no significant differences were observed in the PI and RI indices of the uterine and ovarian arteries (p>0.05 for all). CONCLUSION: In this study, we showed that bilateral UAL had no negative effects on ovarian reserve or ovarian blood supply, so this treatment should be used as a fertility preservation technique to avoid hysterectomy in patients experiencing PPH.

Arteries , Body Mass Index , Cesarean Section , Female , Fertility Preservation , Follicle Stimulating Hormone , Humans , Hysterectomy , Ligation , Mass Screening , Ovarian Reserve , Parity , Postpartum Hemorrhage , Postpartum Period , Pregnancy , Prospective Studies , Uterine Artery
Article in English | WPRIM | ID: wpr-785641


OBJECTIVE: To determine the clinical pregnancy (CP) and live birth (LB) rates arising from frozen embryo transfers (FETs) that had been generated under the influence of in vitro fertilization (IVF) adjuvants given to women categorized as poor-prognosis.METHODS: A registered, single-center, retrospective study. A total of 1,119 patients with first FETs cycle include 310 patients with poor prognosis (109 treated with growth hormone [GH], (+)GH group vs. 201 treated with dehydroepiandrosterone, (–)GH group) and 809 patients with good prognosis (as control, (–)Adj (Good) group).RESULTS: The poor-prognosis women were significantly older, with a lower ovarian reserve than the (–)Adj (Good) group, and demonstrated lower chances of CP (p<0.005) and LB (p<0.005). After adjusting for confounders, the chances of both CP and LB in the (+)GH group were not significantly different from those in the (–)Adj (Good) group, indicating that the poor-prognosis patients given GH had similar outcomes to those with a good prognosis. Furthermore, the likelihood of LB was significantly higher for poor-prognosis women given GH than for those who did not receive GH (p<0.028). This was further confirmed in age-matched analyses.CONCLUSION: The embryos cryopreserved from fresh IVF cycles in which adjuvant GH had been administered to women classified as poor-prognosis showed a significant 2.7-fold higher LB rate in subsequent FET cycles than a matched poor-prognosis group. The women with a poor prognosis who were treated with GH had LB outcomes equivalent to those with a good prognosis. We therefore postulate that GH improves some aspect of oocyte quality that confers improved competency for implantation.

Dehydroepiandrosterone , Embryo Transfer , Embryonic Structures , Female , Fertilization in Vitro , Growth Hormone , Humans , Live Birth , Melatonin , Oocytes , Ovarian Reserve , Pregnancy , Prognosis , Retrospective Studies , Single Embryo Transfer
Yonsei Medical Journal ; : 285-290, 2019.
Article in English | WPRIM | ID: wpr-742533


PURPOSE: To elucidate the correlation between ovarian reserve and the incidence of ectopic pregnancy (EP) following in vitro fertilization and embryo transfer (IVF/ET) cycles. MATERIALS AND METHODS: In this observational study, 430 fresh IVF/ET cycles were examined from patient data of two university hospital infertility clinics. All included patients were positive for β-human chorionic gonadotropin (hCG) at 2 weeks after oocyte retrieval via controlled ovarian stimulation. For each cycle, information on age, duration of infertility, basal follicle stimulating hormone (FSH), anti-Müllerian hormone (AMH), days of ovarian stimulation, numbers of retrieved oocytes and transferred embryos, and pregnancy outcomes was collected. Patients with AMH lower than 1.0 ng/dL or basal FSH higher than 10 mIU/mL were classified into the decreased ovarian reserve (DOR) group, and the remaining patients were classified into the normal ovarian reserve (NOR) group. RESULTS: In total, 355 cycles showed NOR, and 75 cycles DOR. There were no significant differences between the DOR and NOR groups regarding intrauterine (74.7% vs. 83.4%, respectively) or chemical (14.7% vs. 14.1%, respectively) pregnancies. The DOR group had a higher EP than that of NOR group [10.7% (8/75) vs. 2.5% (9/355), p=0.004]. In both univariate [odds ratio (OR) 5.6, 95% confidence interval (CI) 1.4–9.6, p=0.011] and multivariate (adjusted OR 5.1, 95 % CI 1.1–18.7, p=0.012) analysis, DOR was associated with a higher risk of EP. CONCLUSION: DOR may be associated with a higher risk of EP in IVF/ET cycles with controlled ovarian stimulation. More careful monitoring may be necessary for pregnant women with DOR.

Chorionic Gonadotropin , Embryo Transfer , Embryonic Structures , Female , Fertilization in Vitro , Follicle Stimulating Hormone , Humans , In Vitro Techniques , Incidence , Infertility , Observational Study , Oocyte Retrieval , Oocytes , Ovarian Reserve , Ovulation Induction , Pregnancy , Pregnancy Outcome , Pregnancy, Ectopic , Pregnant Women