Study Of Mechanism And Clinical Evaluation Of Tcm Herbs Therapy For Improving Ovarian Reserve

1. Objective of the researchDecreasing ovarian Reserve (DOR)is conditions where women between age of16to40have impaired ovarian function, the ovarian reserve are decreasing or the quality of oocyte is declining. If not treated seriously, in1to6years range, DOR could develop into Premature Ovarian Failure (POF). POF is conditions where female with normal age of menarche or delayed puberty with fully developed secondary sexual characteristics reach persistent amenorrhea and genital atrophy before the age of40, along with elevated level of follicle stimulating hormone (FSH) and hypoestrogenism. DOR and POF are major difficulties in gynecological endocrinology. In western medicine, definitive effective treatments for the disease are yet to be found. TCM from holistic regulation had proven to improve ovarian function, with no side effect.Therefore this study is made to evaluate the clinical efficacy of supplementing essence and tonifying kidney, shooting liver and tonifying blood method in Premature Ovarian Failure (POF) and Decreased Ovarian Reserve (DOR) treatment, and to make preliminary assumption on the mechanism of the method in this disease. Also to evaluate the clinical value of Inhibin B and Anti-Mullerian hormone in predicting ovarian reserve.2. Literature reviewBy referring to10classic literatures and100Chinese and foreign journals in the last10years period, summarizing the cause, mechanism and treatment methods of DOR and POF based on TCM POFnt of view, followed by the review on the western medicine on etiology, pathology, current treatment methods and, evaluation on methods used in determining ovarian reserve.3Clinical observationMethod:Clinical summary on90cases of DOR or POF with Kidney-Liver deficiency syndrome were divided into two groups:60cases in TCM group,30cases in Integrative group. All were treated with supplementing essence and tonifying kidney, shooting liver and tonifying blood method (using Processed Tortoise Carapace and Plastron, Dodder Seed, Glossy Privet Fruit, Human Placenta, Chinese Angelica, Salvia Root, Silktree Albizia Bark, etc). The herbs were taken orally,1formula for each day, stopped on menstrual period.TCM group were treated with oral decoction and external application therapy using Suberect Spatholobus Stem, Chinese Angelica, Cassia Twig, Safflower, Garden Balsam Stem, Argy Wormwood Leaf. Whereas integrated group were treated with oral decoction combined with Climen (Complex Packing Estradiol Valerate Tablets). Duration of treatment were three months. Menstrual cycle, symptom, serum hormones, B ultrasonic before and after taking treatments were being compared.80cases of blood sample were taken from55patients with POF or DOR and25healthy women. ELISA method was used to determine basic level of Inhibin B and Anti-Mullerian hormone.Statistical analysis was using SPSS13.0software. Data before and after treatment were compared using paired-samples t test or rank sum test, independent-sample t test were used to compare between two groups.Result:In TCM group and integrative group, the total effective rate was subsequently95%and100%. There was no significant difference between two groups (P>0.05).Both groups had significant improvement in menstrual disorder and TCM syndrome score (P<0.05). Basal FSH and LH were significantly decreased, E2level were also significantly increased (P<0.05). For above results, there were no significance difference between two groups (P>0.05) For both groups, there were no significance difference on the volume of the uterine and ovaries (P>0.05)There was significant difference between blood sample of normal group and patients group in basic Inhibin B(P<0.05), but no significant difference in Anti-Mullerian hormone (P>0.05)There was no side effect found in TCM group, whereas there were2cases of nausea during time of medication in Integrative group. No liver or kidney damage case on both groups. Conclusion:Supplementing essence and tonifying kidney, shooting liver and tomifying blood herbs are effective for managing ovarian dysfunction symptoms such as hot flashes, vaginal dryness, vexing heat in chest、palms and soles, aching back and legs, dizziness, tinnitus and dry mouth. These methods had proven to improve ovarian function by decreasing high level of FSH and LH, whereas enhancing the estrogen level, therefore promote menstruation cycle.This study had proven that basic level Inhibin B could be used to predict ovarian reserve.