Clinical Research On The Effect Of Prescription Pill Yishenhuoxue On Ovarian Function And Endometrial Receptivity Of The Patients With PCOS

Objectives:1. To evaluate the effect of Yishenhuoxue pill on ovarian function and endometrial receptivity of the patients with PCOS, from multiple aspects including clinical effects, gonadal hormone concentrations, hemorheology, uterine and ovarian hemodynamics so on.2. From the vascular endothelial growth factor to discussed the mechanism of Yishenhuoxue pill on the receptivity of endometrium of the induced ovulation patients with PCOS.Methods:100 case of patients match the criterion of kidney deficiency and blood stasis, polycystic ovary syndrome and infertility were randomly divided into TCM treatment group and western medicine control group,50 cases in each group.TCM treatment group to take Yishenhuoxue pill and clomiphene, while western medicine control group to take Aspirin, Progynova and clomiphene, both of them received treatment for 3 menstrual cycles. Clinical symptoms, comprehensive therapeutic effect, promoting ovulation effect, sex hormone levels, ovarian volume, the number of follicles, the largest follicle diameter, follicular period, endometrial thickness, endometrial type, ovulation rate and pregnancy rate, basal body temperature were compared. Compared the hemorheology index, estrogen, progesterone, endometrial blood flow index, ovarian stromal artery blood flow index in mplantation window period of the third menstrual cycle. Scraped the endometrial lining in mplantation window period of the third menstrual cycle to detect VEGF of lining useing immunohistochemistry and RT-PCR methods, compared the difference of them between two groups. Selected partial cases randomly in two groups to compare related indexes before and after treatment.Results:1. Comparison of the two groups after treatment:Compared with control group, the TCM syndrome score of treatment group lower than the control group, the difference is statistically significant (P<0.01); Compared basic sex hormones between the two groups, the difference on FSH, E2, T, PRL is not significant (P>0.05), but LH, LH/FSH of treatment group is lower than the control group (P<0.01); There is no significant difference of ovarian volume between the two groups(P>0.05); The number of optimal eggs, the maximal follicle diameter, follicular phase of treatment group is similar to that of control group(P>0.05); The Ovulation rate、curative effect on promoting ovulation and pregnancy rate of treatment group are higher than control group, but there was no significant difference (P>0.05);The comprehensive curative effect, BBT classification of treatment group is better than that of control group, the differences is significant (P<0.05); The incidence rate of CC no reaction, and LUFS between the two groups is similar (P>0.05); The whole blood high shear rate, whole blood low shear rate of treatment group are lower than that of control group, the difference is significant (P<0.05);There was no significant difference on plasma viscosity and hematokrit between the two groups (P>0.05); Compared E2 of two groups, there was no significant difference (P>0.05), but P of Treatment group is higher than control group, the difference is significant (P<0.05);The endometrial thickness on the ovulation days of treatment group is similar to control group(P>0.05),while the optimal endometrial type of treatment group is better control group (P<0.05); There is no significant difference on endometrial thickness of implantation window period between two groups (P>0.05); Comparison of ovarian stromal artery blood flow (PI) between the two groups, there was no significant difference(P>0.05); But comparison of ovarian stromal artery blood flow resistance index (RI) between two groups, the difference is significant (P<0.05); There was no significant difference on endometrial blood flow pulsation index (PI) between two groups (P>0.05).The endometrial blood flow resistance index(RI) of treatment group is significantly lower than control group(P<0.01); There is a significant difference on the VEGF protein expression between two groups (P<0.01), the VEGF protein expression of endometrial glandular epithelium and leydig cell in treatment group is higher than the control group. There is a significant difference on expression of VEGF mRNA between two groups (P<0.01).2. Comparison of before and after treatment:Compared with before treatment, the TCM syndrome score of two groups after treatment is decreased, the difference is significant (P<0.01); There is a significant difference on LH, LH/FSH of treatment group between before and after treatment (P<0.05), but, the comparison of LH, LH/FSH of control group between before and after treatment is no significant difference (P>0.05); There is no significant difference on other sex hormone indicators between before and after treatment (P>0.05); The whole blood high shear rate, whole blood low shear rate and plasma viscosity in both groups between before and after treating have significant difference(P<0.05);But the hematokrit between before and after treating, there was no significant difference in both groups (P>0.05); There is no significant difference on Estrogen levels between before and after treatment in both groups (P>0.05). Compared with before treatment, P value of treatment group after treatment is significantly increased, the difference is significant (P<0.05), P value of control group between before and after treating, there is no significant difference (P>0.05); The endometrial thickness in implantation window period of treatment group after treatment is increased significantly(P<0.01);While the endometrial thickness of control group between before and after treatment, there was no significant difference(P>0.05);The Endometrial blood flow resistance index (RI) in both groups after treatment is decreased, the difference is statistically significant (P<0.05);The comparison of endometrial blood flow pulsation index (PI) between before and after treatment in both groups, there were no significant difference(P>0.05); Ovarian stromal artery blood flow resistance index(RI) of treatment group is lower after treatment, there is significant difference (P<0.05); For control group, the ovarian stromal artery blood flow resistance index (RI) between before and after treatment, there was no statistically significant difference(P>0.05); The ovarian stromal artery blood flow pulsation index (PI) between before and after treatment in both groups, there is no statistically significant difference(P>0.05); The VEGF protein expression of treatment group after treatment is significantly higher than before the treatment, the difference is significant (P<0.05). The VEGF protein expression of control group between before and after treatment, there was no significant difference (P>0.05). There is significant difference on the expression of VEGF mRNA in treatment group after treatment compared with before treatment (P<0.01); For control group, the endometrial VEGF mRNA expression between before and after treatment, there was no significant difference (P>0.05).3. Correlation results: It is a significant inverse correlation between the endometrial blood flow RI with the VEGF expression of endometrium. The correlation coefficient r=-0.816, (P<0.01); there is no correlation between E2 with VEGF expression,but P and VEGF expressed by the positive correlation, the correlation coefficient r=0.357, (P<0.05). There is a significant and negative correlation between whole blood high shear rate, whole Blood low shear rate, plasma viscosity and VEGF expression. The correlation coefficient r=-0.583、-0.542.-0.656 respectively, P<0.01.Conelusion:1. Pill Yishen huo xue could adjust the disorder endocrine with PCOS patients, improve the hemodynamic indexes, increase the blood flow perfusion of uterine and ovary, the overall effect is better than the control group.2. Hemodynamic indexes could be used as an indicator of evaluation of blood stasis, the elevated indicators may affect VEGF expression of the endometrium.3. The endometrial spiral artery blood flow resistance index (RI)and progesterone levels (P)may be the important factors that affect the endometrial receptivity. Pill Yishen huoxue can effectively reduce endometrial spiral artery blood flow resistance index (RI) and increase the level of P to improve the endometrial receptivity.4. Vascular endothelial growth factor is probably one of the key factors that affect the endometrial receptivity, and its high expression can help establish the endometrial receptivity. Pill Yishen huoxue can increase the expression of vascular endothelial growth factor in the endometrium to improve the endometrial receptivity.