New advances in the treatment of thin endometrium.

Thin endometrium (TE) is defined as a mid-luteal endometrial thickness ≤7mm. TE can affect endometrial tolerance, leading to lower embryo implantation rates and clinical pregnancy rates, and is also associated with impaired outcomes from assisted reproductive treatment. Herein, we systematically review TE causes, mechanisms, and treatments. TE pathogenesis has multiple causes, with the endometrium becoming thinner with age under hormonal influence. In addition, uterine cavity factors are important, as the inflammatory environment may affect expressions of certain genes thereby inhibiting endometrial stromal cell proliferation and promoting apoptosis. Long-term oral contraceptive use or the use of ovulation-promoting drugs are also definite factors contributing to endometrial thinning. Other patients have primary factors, for which the clinical etiology remains unknown. The main therapeutic strategies available for TE are pharmacological (including hormonal and vasoactive drugs), regenerative medicine, intrauterine infusion of growth factor-granulocyte colony-stimulating factor, autologous platelet-rich plasma, and complementary alternative therapies (including traditional Chinese herbal medicine and acupuncture). However, the associated mechanisms of action are currently unclear. Clinical scholars have proposed various approaches to improve treatment outcomes in patients with TE, and are exploring the principles of efficacy, offering potentials for novel treatments. It is hoped that this will improve TE tolerance, increase embryo implantation rates, and help more couples with infertility with effective treatments.

Research Progress on the Effect of Traditional Chinese Medicine on Signal Pathway Related to Premature Ovarian Insufficiency.

The occurrence and development of premature ovarian insufficiency involves the abnormality of multiple signal pathways. It is a complex disease. Traditional Chinese medicine affects the relevant factors of the occurrence and development of premature ovarian insufficiency (granulosa cell apoptosis, ovarian blood supply, ovarian reserve, ovarian oxidative damage, gap junction, ovarian fibrosis, follicular development, follicular atresia, and other biological processes) by regulating a variety of signal pathways, thus playing the role in antioxidant stress, prevention and treatment of chemotherapy side effects, protection of ovarian function, control of aging, and improvement of ovarian reserve function. The research shows that the research on the related pathways of traditional Chinese medicine in the treatment of premature ovarian insufficiency has been quite extensive. Based on the search of the domestic and foreign literature, it is found that Yulinzhu and Xianziyizhen capsule and ginsenoside Rg1 can promote the proliferation and differentiation of granulosa cells, inhibit apoptosis, and reduce follicular atresia by affecting the PI3K/Akt/mTOR signal pathway; Guiluo's Anzang decoction, Kuntai capsule, and Yangyin Shugan granule can maintain the balance between pro-apoptotic protein and anti-apoptotic protein through the Bax/cytc/caspase-3 pathway to improve ovarian reserve function; Bushen Jianpi recipe can control cell apoptosis and promote the proliferation and development of ovarian granulosa cells by regulating the MAPK signal pathway; Siwu mixture and Zuo Gui pill can regulate the TGF-ß/Smads signaling pathway to promote the recruitment of primordial follicles, promotes follicular development, inhibits follicular atresia, and regulates ovarian function; Erxian decoction, Yiqi Yangrong Fujing formula, and Cistanche deserticola can antagonize the inflammatory symptoms of premature ovarian failure, promote the secretion of relevant vascular growth factors, and enhance the ovarian reserve function through the NF-KB signal pathway; Bushen Culuan decoction can promote damage repair and protect normal ovarian cells through antioxidant stress. The above summary aims at providing reference for the in-depth study of traditional Chinese medicine in the treatment of premature ovarian insufficiency and inspiring new diagnosis and treatment ideas.

The effect of Bushen Culuan Decoction on anovulatory infertile women among 6 different diseases: a study protocol for a randomized, double-blinded, positively controlled, adaptive multicenter clinical trial.

BACKGROUND: Anovulation is one of the main causes of female infertility. This study will evaluate the effectiveness and safety of Bushen Culuan Decoction for anovulatory infertility caused by six diseases, including anovulatory abnormal uterine bleeding, polycystic ovarian syndrome, hyperprolactinemia, luteinized unruptured follicle syndrome, corpus luteum insufficiency, and premature ovarian insufficiency. METHODS: This is a randomized, double-blinded, double-dummy, parallel, positively controlled, adaptive, multicenter clinical trial. All participants will be randomly allocated by a central randomization system to the treatment group or the control group in a 1:1 ratio. The treatment group will undergo a 14-day treatment with Bushen Culuan Decoction 13 g three times a day and a 5-day treatment with clomiphene citrate placebo tablets 50 mg once a day starting on day 5 of every menstrual period. The control group will undergo a 14-day treatment with Bushen Culuan Decoction placebo 13 g three times a day and a 5-day treatment with clomiphene citrate tablets 50 mg once a day from day 5 in every menstrual period. The whole treatment will last through 3 menstrual periods or 6 menstrual periods, depending on whether ovulation is regained in the first 3 menstrual periods. All statistical analyses will be performed in SPSS 21.0 (SPSS, Chicago, Illinois, USA), and a p value < 0.05 will be considered statistically significant. DISCUSSION: The objective of this RCT is to evaluate whether Bushen Culuan Decoction enables a higher pregnancy rate than clomiphene citrate in women with anovulatory infertility and to identify the anovulatory diseases for which Bushen Culuan Decoction has higher effectiveness .This study has been approved by the Medical Ethics Committee of Xiyuan Hospital China Academy of Chinese Medical Sciences (No. 2017XLA037-2). The results of this study will be offered for publication in peer-reviewed journals. TRIAL REGISTRATION: ClinicalTrials.gov NCT03709849 . Registered on 19 November 2018.