Metabolomics Mechanism Of Chinese Medicine Intervention On IVF Outcome In Patients With Spleen Deficiency And Dampness Type PCOS

Objective: To use the SCIEX API 4000 QTRAP method to detect follicles before and after administration of spleen-deficiency and damp-type polycystic ovary syndrome patients undergoing in vitro fertilization-embryo transfer(IVF-ET)by SIMCA-P omics analysis software.The liquid was subjected to quasi-targeted metabolomics analysis to identify potential biomarkers.From the metabolomics level,the possible mechanism of the treatment of spleen deficiency and dampness polycystic ovary syndrome was studied.Methods: A prospective randomized controlled trial was performed to select 95 patients with IVF-ET assisted pregnancy.65 patients with polycystic ovary syndrome were randomly divided into two groups: group A: 33 patients with Cangfu Guiqi Decoction;B Group: 32 patients with polycystic ovary syndrome alone;group C: 30 patients with normal IVF group(referred to as normal control group).Three groups of patients were treated with a long-term regimen to promote ovulation,and group A was given Cangfu Guishen Decoction on the day of the down-regulation to HCG.IVF treatment outcomes between observation groups(number of eggs obtained,MII egg rate,IVF 2PN fertilization rate,ICSI 2PN fertilization rate,2PN cleavage rate,available embryo rate,excellent embryo rate,implantation rate,clinical pregnancy rate)and spleen deficiency and dampness Changes in TCM syndrome points.The SIMCA-P omics analysis software was used to perform quasi-targeted metabolomics analysis of the follicular fluids collected from the three groups of patients,and to find the changes of differential metabolite content and related metabolic pathways among the three groups.Result:(1)The TCM syndrome score of HCG day in patients with Cangfu Guiyu Decoction group was significantly lower than that on the day of downregulation,the difference was statistically significant(P<0.05),and there was significant correlation between the two..Symptoms of "small menstruation,limb edema,chest tightness,dysfunction,poor appetite,etc." showed significant improvement compared with before treatment(P<0.05),"the amount of the spleen deficiency and dampness syndrome" Although there was no statistical difference in the improvement of symptoms(P>0.05),it showed a trend of improvement.(2)There were significant differences in the total number of eggs,MII eggs,2PN cleavage,number of transplantable embryos,number of high quality embryos,fertilization rate,cleavage rate and excellent embryo rate among the three groups.(P<0.05)Cleavage rate(88.3% vs 76.1%,P<0.001)and excellent embryo rate(80.6% vs 46.2%,P<0.001)in the group of Cangfu Guiling Decoction and the simple polycystic ovary syndrome group,The difference was statistically significant.There was a statistically significant difference in the amount of Gn,the number of eggs obtained,and the number of eggs in MII between Cangfu Guishen Decoction group and normal control group.(P<0.05)There was a statistically significant difference in the number of transplantable embryos and the number of high quality embryos between the simple polycystic ovary syndrome group and the normal control group.(P<0.05)The number of transplantable embryos and the number of high quality embryos in the polycystic ovary syndrome group were significantly lower than those in the normal control group.(3)Analysis of experimental results: After the intervention of traditional Chinese medicine in patients with PCOS,the content of Leucine,N-acetyltryptophan,3-sulfopyruvic acid,uricacid,Acrylamide,creatine,lactate in the follicular fluid was up-regulated,while Progesterone,phytosphingosine,decanoylcarnitine,dihomolinoleic The contents of acid,choline,phosphorylcholine,betaine,parahydroxybenzoate and other ingredients have been lowered.Through the pathway analysis pathway analysis,after the intervention of traditional Chinese medicine,the steroid hormone biosynthesis pathway,glycine,serine and threonine metabolic pathways,biosynthetic pathways of valine,leucine and isoleucine,purine metabolic pathway,The pyruvate metabolic pathway and the like are regulated.Conclusion: 1.Cangfu Guitang Decoction can improve the syndrome of spleen deficiency and dampness in traditional Chinese medicine.2.Cangfu Guitang Decoction can increase the number of eggs,the number of transplantable embryos,the number of high quality embryos in PCOS patients,improve the patient’s egg retrieval rate,fertilization rate and clinical pregnancy rate,thus improving the IVF outcome of PCOS patients.3.Cangfu Guitang Decoction can change follicular fluid metabolites in patients with spleen deficiency and dampness type PCOS,involving lipids(sphingosine)and organic acids(lactic acid).These substances may be potential for patients with spleendeficiency and dampness type PCOS.Biological markers.4.Cangfu Guitang Decoction may improve pregnancy outcome by improving amino acid metabolism,lipid metabolism pathway and pyruvate metabolism in follicular fluid of PCOS patients.Up-regulation of lactate content suggests that Cangfu Guitang Decoction can improve pyruvate metabolism,and down-regulation of phytosphingosine suggests that correcting lipid metabolism disorder may be a possible mechanism for Cangfu Guishen Decoction to improve ART outcome in patients with PCOS.