RESUMO
Objective To explore the effect of laparoscopic salpingectomy on ovarian reserve function and serum neuropeptide Y(NPY)and cortisol(Cor)in patients with ectopic pregnancy.Methods 82 patients with ectopic pregnancy who had visited Chaohu Hospital Affiliated to Anhui Medical University from June 2018 to June 2021 were randomly divided into two groups,with 41 in each group.The control group underwent laparoscopic salpingostomy and suturing for embryo retrieval,while the study group underwent laparoscopic salpingectomy.Surgical duration,intraoperative blood loss,time to postsurgical mobilization,length of hospital stay,serum NPY and Cor levels,antral follicle count(AFC),indexes for peak flow velocity and resistance of ovarian artery were compared between the two groups.Follow-up was conducted for two years after surgery,and the success rate of pregnancy and the ectopic pregnancy rate were recorded.Results The surgical duration in the study group was shorter than that in the control group(P<0.05).The differences in serum NPY and Cor values between the two groups immediately after surgery and at postoperative week one were not statistically significant(P>0.05).At postoperative months1 and 6,the peak flow velocity of the affected ovary was lower in the study group than in the control group,whereas the resistance index was higher(P<0.05).At postoperative month 6,both groups showed an increase in peak flow velocity and a decrease in resistance index(P<0.05).There were no statistically signifi-cant differences in AFC and the success rate of pregnancy between the two groups postoperatively(P>0.05).The ectopic pregnancy rate in the study group was lower than that in the control group(P<0.05).Conclusion As compared with laparoscopic salpingostomy,laparoscopic salpingectomy for ectopic pregnancy can also preserve postoperative ovarian antral follicle count(AFC),and it has greater advantage in reducing the risk of recurrent ectopic pregnancy after surgery.
RESUMO
OBJECTIVE To observe the efficacy and safety of goserelin combined with estradiol valerate in the treatment of endometriosis （EMs） in patients of childbearing age after laparoscopic surgery. METHODS The clinical data of 144 patients with EMs of childbearing age who underwent laparoscopic surgery in our hospital from January 2020 to December 2022 were collected retrospectively， and those patients were divided into control group （70 cases） and combination group （74 cases） based on different postoperative medication regimens. Control group was given Acetate goserelin sustained-release implant on the 1st to 5th day of their first menstrual cycle after laparoscopic surgery， while combination group was additionally given Estradiol valerate tablets on the basis of control group. The short-term and long-term efficacy of 2 groups were observed； preoperative and postoperative pain scores， ovarian reserve function， and the incidence of adverse reactions were all recorded in 2 groups. RESULTS There was no statistically significant difference in short-term total effective rate， 1-year postoperative recurrence rate and the incidence of decreased libido， vaginal dryness， gastrointestinal reactions， rash， or arrhythmia between two groups （P＞0.05）. The natural pregnancy rate of combination group was significantly higher than control group at 1 year after surgery， while the incidence E-mail：wanghuiling0518@126.com of early miscarriage， hot flashes and sweating， emotional fluctuations， insomnia and fatigue， joint muscle pain， dizziness and headache were significantly lower than control group （P＜0.05）. However， at 6 months after surgery， pain scores and the levels of anti-Müllerian hormone， follicle stimulating hormone， luteinizing hormone， estradiol of both groups were significantly lower than before surgery in the same group， while the number of antral follicle count was significantly higher than before surgery in the same group； the levels of anti-Müllerian hormone， luteinizing hormone， estradiol， and the number of antral follicles in the combination group were significantly higher than control group， while pain score and follicle stimulating hormone level were significantly lower than control group （P＜0.05）. CONCLUSIONS The combination of goserelin and estradiol valerate after laparoscopic surgery has a significant therapeutic effect and good safety in the treatment of EMs of childbearing age.
RESUMO
Objective:To investigate the predictive value of serum anti-Mullerian hormone (AMH) combined with transvaginal color Doppler ultrasonography (vaginal color ultrasound) for ovarian reserve function in infertility patients.Methods:A total of 105 infertility patients diagnosed and treated in Dezhou People′s Hospital from January 2018 to October 2020 were selected as study subjects. Among them, 32 patients with less than 5 eggs obtained after the first treatment (low ovarian response) were included in group A, and 73 patients with 5 to 15 eggs obtained (normal ovarian response) were included in group B. Serum AMH levels were measured, antral follicle count (AFC), ovarian volume (OV), and ovarian stromal peak diastolic systolic velocity (PSV) were recorded by vaginal ultrasound. The levels of above index in A, B groups, patients aged > 35 years old, and those aged ≤35 years old were compared. Moreover, the correlation among serum AMH level and aged, ultrasonic parameters were analyzed. The efficacy of serum AMH level and AFC, OV and PSV in predicting low ovarian response was analyzed by receiver operating characteristic (ROC) curve.Results:The levels of serum AMH, AFC, OV and PSV in group A were lower than those in group B: (0.69 ± 0.28) μg/L vs. (1.43 ± 0.44) μg/L, (8.52 ± 2.29) eggs vs. (11.15 ± 2.56) eggs, (3.12 ± 0.70) cm 3 vs. (4.50 ± 1.31) cm 3, (8.80 ± 2.14) cm/s vs. (15.80 ± 4.43) cm/s, the differences were statistically significant ( P<0.05). The levels of serum AMH, AFC, OV and PSV in aged > 35 years old group were lower than those in aged ≤35 years old group: (0.64 ± 0.20) g/L vs. (1.71 ± 0.46) μg/L, (8.35 ± 2.68) eggs vs. (12.17 ± 2.79) eggs, (3.05 ± 0.78) cm 3 vs. (5.02 ± 1.26) cm 3, (9.01 ± 3.04) cm/s vs. (17.90 ± 4.19) cm/s, the differences were statistically significant ( P<0.05). Serum AMH level was negatively correlated with age ( r = -0.317, P<0.05), and positively correlated with AFC, OV and PSV ( r = 0.288, 0.326, 0.370, P<0.05). The sensitivity and specificity for the evaluation of low ovarian response by AMH+AFC+OV+PSV were 96.90% and 100.00% respectively. Conclusions:The sensitivity and specificity of serum AMH combined with vaginal color ultrasound for the evaluation of ovarian reserve function in infertility patients are both high.
RESUMO
OBJECTIVE@#To observe the effect of electroacupuncture (EA) combined with pill on clinical symptoms, levels of serum sex hormone and Th2 cytokines in patients of decreased ovarian reserve function (DOR) with liver-kidney deficiency, and to compare the efficacy between EA combined with pill and pill alone.@*METHODS@#Sixty patients with DOR were randomly divided into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 1 case dropped off). The patients in the control group were treated with pill, 1 pill each time, 3 times a day. Based on the treatment of the control group, the patients in the observation group were additionally treated with acupuncture at Guanyuan (CV 4), Zhongji (CV 3), Guilai (ST 29), Zigong (EX-CA 1), Zusanli (ST 36), Sanyinjiao (SP 6), Taixi (KI 3) and Taichong (LR 3); EA was applied at bilateral Zusanli (ST 36) and Sanyinjiao (SP 6), with continuous wave, in frequency of 20 Hz and current intensity of 1 to 4 mA, for 20 min. The treatment was given 3 times a week. All the patients terminated treatment during menstrual period, and the treatment was given for 3 continuous menstrual cycles. The menstrual condition score and systemic symptom score were compared between the two groups before and after treatment. The levels of serum sex hormones on 2nd to 3rd day of menstruation, including follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), and the serums levels of interleukin (IL) -4 and IL-10 secreted by Th2 cytokines were compared between the two groups before and after treatment.@*RESULTS@#After the treatment, the menstruation condition scores and systemic symptom scores in the two groups were reduced (<0.05), and the scores in the observation group were lower than those in the control group (<0.05). After the treatment, the levels of serum FSH, LH and FSH/LH were reduced (<0.05), and the E2 levels were increased in the two groups (<0.05), and the levels of FSH, LH in the observation group were lower than those in the control group (<0.05), and the E2 level was higher than that in the control group (<0.05). After the treatment, the levels of serum IL-4 and IL-10 in the two groups were increased (<0.05), and the levels of IL-4 and IL-10 in the observation group were higher than those in the control group (<0.05).@*CONCLUSION@#EA combined with pill could significantly improve menstruation, systemic symptoms and serum sex hormone levels in patients of decreased ovarian reserve function with liver-kidney deficiency, which may restore ovarian function by up-regulating the expression of Th2 cytokines.
RESUMO
Objective@#To investigate the protective effect of laparoscopic water separation and removal combined with suture hemostasis on ovarian reserve function after bilateral ovarian endometriotic cyst (OEC) stripping.@*Methods@#From January 2016 to January 2018, 60 patients with bilateral ovarian endometriosis cystectomy underwent laparoscopic surgery in the Department of Obstetrics and Gynecology, Jiading Hospital of traditional Chinese medicine.According to the random number table method, they were divided into study group (water separation and stripping combined suture hemostasis group) and the control group (direct stripping combined with electrocoagulation hemostasis group), 30 cases in each group.The changes of operation time, hemoglobin level before and after operation and the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and anti Mullerian hormone (AMH) were compared between the two groups.@*Results@#There was no significant difference in operation time (47.52 ±10.11) min, hemoglobin decrease (0.55 ±0.26) g/L, hospital stay (6.1 ±0.3) d, control group (48.01 ±10.24) min, hemoglobin decrease (0.56 ±0.25) g/L and hospitalization time (6.2 ±0.4) d before and after operation (t=0.056, 0.964, 0.863, all P>0.05). The levels of FSH, E2, LH and AMH in the study group before operation were (6.15 ±2.31) U/L, (152.41 ±41.40) nmol/L, (5.44 ±1.52) U/L and (2.21 ±0.13) μg/L, respectively.One month after operation, they were(6.21±2.24) U/L, (150.63±40.33) nmol/L, (5.13±1.58) U/L, (2.18±0.16) μg/L, respectively.Three months after operation, they were (6.52±2.41) U/L, (149.57±42.37) nmol/L, (5.30±1.45) U/L, (2.17± 0.15) μg/L, respectively.Six months after operation, they were (6.53±2.44) U/L, (151.36±41.54) nmol/L, (4.98±1.61) U/L, (2.20±0.08) μg/L, respectively.The levels of FSH, E2, LH and AMH in the control group before operation were (6.14±2.21) U/L, (153.31±40.39) nmol/L, (5.51±1.46) U/L, (2.23±0.13) μg/L, respectively.One month after operation, they were (8.11±2.44) U/L, (131.43±41.23) nmol/L, (5.92±1.64) U/L, (1.58±0.14) μg/L, respectively.Three months after operation, they were (8.42±2.35) U/L, (135.67±40.38) nmol/L, (6.12±1.51) U/L, (1.54±0.16) μg/L, respectively.Six months after operation, they were (9.17±2.64) U/L, (133.66±40.44) nmol/L, (6.28±1.74) U/L, (1.51±0.13) μg/L, respectively.There was no significant difference in the levels of FSH, E2, LH and AMH between the two groups (all P>0.05). There was significant difference between the preoperative FSH level and the postoperative 1, 3, 6 months in the control group (all P<0.05); there was significant difference between the preoperative E2 level and the postoperative 1 month in the control group (P<0.05); there was statistical significance between the preoperative AMH level and the postoperative 1, 3 months in the control group (all P<0.05). The levels of FSH, LH, E2 and AMH in the study group were significantly higher than those in the control group (all P<0.05).@*Conclusion@#Laparoscopic hydrodissection combined with suture hemostasis does not increase the operation time and the amount of bleeding, and does not affect the ovarian reserve function after operation.
RESUMO
Objective:To observe the effect of addition and subtraction therapy of Guyinjian on oocyte quality, pregnancy outcome and ovarian reserve function in patients with poor ovarian response (POR) with kidney Yin deficiency syndrome. Method:Ninety patients were randomly divided into control group (45 cases) and observation group (45 cases) by random number table. The patients in both groups got antagonist. Based on such treatment, the patients in observation received additional addition and subtraction therapy of Guyinjian. The using time and amount of gonadotropin (Gn), ovum taking cycle, cycle canceling rate, fertilization rate, available embryo rate, quality embryo rate, ovulation cycle clinical pregnancy rate were recorded. Levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), serum estradiol (E2) and endometrial thickness, anti mullerian hormone (AMH), resistance index (RI), pulsation index (PI), end diastolic velocity (EDV) and peak systolic velocity (PSV) were detected. Ratio of PSV/EDV (S/D) was calculated, and scores of kidney yin deficiency syndrome were graded before and after treatment. Result:Total amount of Gn in observation group was less than that in control group (PP2 were higher than those in control group (PPPχ2=5.124, Pχ2=5.767, PPPPPConclusion:Addition and subtraction therapy of Guyinjian can increase ovarian blood supply, improve high ovarian reserve function, reduce Gn consumption, increase number of acquired eggs, alleviate symptoms of kidney yin deficiency, and can ameliorate ovarian responsiveness and pregnancy outcome.
RESUMO
OBJECTIVE: To investigate the effect of laparoscopic treatment for bilateral hydrosalpinx on ovarian reserve function and IVF-ET(in vitro fertilization and embryo transfer,IVF-ET)outcomes.METHODS: A retrospective analysis was performed in 84 patients with bilateral hydrosalpinx admitted to Shengjing Hospital Affiliated to China Medical University from January 2015 to January 2017.Group A underwent bilateral salpingectomy(21 cases)and group B underwent laparoscopic bilateral tubal proximal ligation distal ostomy(63 cases);group B1 included cases of tubal interstitial tubal ligation and distal ostomy(28 cases)and group B2 included cases of fallopian tube tubal ligation and distal ostomy(35 tubal ligation cases).RESULTS: There was no significant difference in anti-Mullerian hormone(AMH),follicle stimulating hormone(FSH),estradiol(E2),or FSH/luteinizing hormone(LH)levels between groups A and B(P>0.05),but the LH level of group A was higher than that of group B[(5.44±2.93)U/L vs.(3.20±1.40)U/L];this difference was statistically significant(P0.05).There was no significant difference in reproductive outcomes between groups B1 and B2(P>0.05).CONCLUSION: Compared with tubal ligation,salpingectomy can reduce ovarian reserve function to a certain extent;there is no significant difference in IVF-ET outcomes after tubal ligation at different locations.
RESUMO
Objective To investigate the effects of Kidney nourishing decoction in the treatment of reproduce patients in serum hormone .Methods 120 cases with reproduce patients from June 2014 to June 2016 in hangzhou traditional chinese medical hospital were selected,and divided into control group and experiment group, 60 cases in each group.The control group was given artificial cycle treatment, the experiment group was treated with Kidney nourishing decoction, two groups were treated for three months.Serum sex hormone and AMH content, clinical effect and pregnancy rate were compared before and after treatment.Results Compared with before treatment, levels of FSH, LH, E2 and FSH/LH in two groups decreased, AMH content increased after treatment,the thickness of endometrium and ovarian antral follicle number increased,symptom scores decreased after treatment (P <0.05);Compared with the control group, levels of FSH, LH, E2 and FSH/LH in the experiment group were lower, AMH content were higher, the thickness of endometrium and ovarian antral follicle number in the experiment group were higher,and the symptom scores were lower (P<0.05).The total effective rate of the study group was 90.00% higher than the total effective rate of the control group 73.33% (P<0.05).There was no significant difference in adverse reaction rate between the two groups, the pregnancy rate in the experiment group 30.00% was higher than the control group 11.67% ( P <0.05 ) .Conclusion Kidney nourishing decoction can reduce the sex hormone and increase the content of AMH , and increase the pregnancy rate in the treatment of reproduce patients.
RESUMO
<p><b>OBJECTIVE</b>To compare the efficacy differences between ginger-separated moxibustion atpoints combined withformula andformula alone on patients with decreased ovarian reserve function.</p><p><b>METHODS</b>Fifty patients of decreased ovarian reserve function were randomly divided into an observation group and a control group, 25 cases in each one. The patients in the observation group were treated with ginger-separated moxibustion atpoints combined withformula; the moxibustion was given for 1.5 h, once every seven days, and no treatment was given during menstrual period. The patients in the control group were treated withformula. One-month treatment was taken as one treatment course, and totally three courses were given. The change of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E), anti-mullerian hormone (AMH), antral follicle count (AFC), peak systolic velocity (PSV), resistance index (RI) were observed before and after treatment in the two groups.</p><p><b>RESULTS</b>After treatment, the FSH, FSH/LH and RI were significantly lowered, but the E, AFC, PSV were significantly increased in the two groups (all<0.05); the FSH, FSH/LH and Ein the observation group were lower and AFC was higher than those in the control group (all<0.05).</p><p><b>CONCLUSION</b>The ginger-separated moxibustion atpoints combined withformula are superior toformula alone in improving ovarian reserve function.</p>
RESUMO
Objective To investigate the influence of different treatments for tubal pregnancy on ovarian reserve function by transvaginal color Doppler ultrasonography.Methods One hundred and twentyfour cases of tubal pregnancy were divided into three groups according to the treatment,group A with 45 cases under the salpingectomy,group B with 36 cases under the laparoscopic conservative surgery for retaining oviduct,group C with 43 cases taken by Methotrexate.On the day of a spontaneous cycle,all the cases' antral follicles,the ovarian volume,peak systolic velocity (PSV),resistance index (RI),pulsatility index(PI) were measured by transvaginal color Doppler ultrasound.Results The antral follicles,varian volume and PSV of diseased side in group A were lower than those of the other side(P ＜0.05).The antral follicles,varian volume and PSV of diseased side in group A were lower than those of other groups (P ＜0.001).The PI and RI of diseased side in group A were higher than those of the unaffected side.The PI and RI of two sides in group B and C were not significantly different(P ＞0.05).Conclusions Salpingectomy affects the ovarian reserve function.Methotrexate and conservative surgery could not reduce the ovarion reserve.
RESUMO
Objective To investigate the influence of wound treatment methods on residual ovarian reserve function after laparoscopic ovarian cystectomy.Methods A total of 120 patients with ovarian cyst who underwent laparoscopic ovarian cystec‐tomy in the hospital were randomly divided into three groups in terms of different wound treatment methods:electric coagulation group ,ultrasound group and suture group ,with 40 cases in each group.The levels of follicle stimulating hormone(FSH) ,luteini‐zing hormone(LH) ,and estradiol(E2 ) were detected in the blood before and immediately after the operation ,2 days after men‐struation at postoperative 3 and 6 months ,and the number of ovarian reserve follicles determined by transvaginal ultra‐sound.The changes of menstruation and clinical manifestations of the patients were recorded at the same time.Results The lev‐els of LH ,E2 and FSH were dramatically changed in electric coagulation group ,which was followed by the ultrasonic group.Patients in the suture group had the smallest changes of these indices and recovered quickly(P<0.05).In the electric co‐agulation group relative to the other two groups ,the number of ovarian reserve follicles was significantly decreased and the inci‐dence of adverse reactions was profoundly increased.Conclusion Electric coagulation greatly adversely affects the residual ovar‐ian reserve function after laparoscopic ovarian cystectomy ,and ultrasonic and suture hemostasis techniques can help to protect o‐varian function.