Prospective Study On The Clinical Efficacy Of The Treatment For Infertility Due To Fallopion Tube Obstruction On Relieving The Primary And The Secondary Aspects

ObjectiveTo assess the short-term clinical efficacy of the protocol of treating both the primary and the secondary aspects for infertility induced by oviduct blockage, prospectively and randomly. Evaluate its safety and effectiveness according to patency testing and manifestation of the symptoms and syndromes.Methods151consectuive patients with infertility induced by oviduct blockage defined according to the inclusion and exclusion criteria were divided into two groups-experimental group and controls by4:1ratio from Apr.2009to Nov.2010, randomly. All of patients received HSG in the first affiliated Hospital of Guangzhou University of TCM.Experimental group data:122patients with mean age of28.66+3.983years(range21to40), course of3.17±2.144years(range1to12) and fllowed for a median of6.82±3.165months(range1to18). There were divided into three syndromes including qi stagnation and blood stasis, stagnation of damp and heat and stagnation of cold and damp(39,18,5respentively) according to the syndrome differentiation of TCM. There were17patients of primary infertility and45of secondary infertility,40bilateral obstructed oviducts and22unilateral ones. Anatomically, the position of oviduct blockage include uterine part, isthmus and junction between isthmus and ampulla, which the sum of affected position is74,24and4, respectively.Controls data:29patients with mean age of30.14±3.907years (range22to38), course of3.66±2.581years (range1to12) and fllowed for a median of7.14±2.601months (range3to14). There were divided into three syndromes including qi stagnation and blood stasis, stagnation of damp and heat and stagnation of cold and damp(18,7,4respentively) according to the syndrome differentiation of TCM. There were7patients of primary infertility and22of secondary infertility,23bilateral obstructed oviducts and6unilateral ones. Anatomically, the position of oviduct blockage include uterine part, isthmus and junction between isthmus and ampulla, which the sum of affected position is38,11and3, respectively.All of the patients were received fallopian tube recanalization. The patients of experimental group were received the treatment of Chinese herbs by oral, enema and external application according to syndrome differentiation of TCM about one week per month in3months after fallopian tuberecanalization. Perfuse the drugs which are different in two groups into uterine cavity about two times per month in2months after operation. The drugs include Radix Salvia Miltiorrhiza and gentamycin,dexamethasone,α-chymotrypsin in experimental and control groups, respectively. Observe the clinical symptoms and sign of chronic pelvic inflammation and record findings in two groups. The patients were regularly followed up for2years. The patient which is not perceived during follow-up will be tested on HSG. The findings before operation were compared between two groups by independent-samples t test and x2test. The statistic method was respectively adopted the matched t-test,and of measurement data and the Wilcoxon test to analyse by SPSS13.0statistic software.ResultsThere were successful rate of88.249,92.31%, patent rate of82.02%,64.29%, oviduct obstructed rate of17.98%,35.71%, re-adhesion rate of12.66%,31.58%, intrauterine pregnant rate of27.78%,16.67%, ectopic pregnant rate of1.85%,12.5%, response rate of76.40%,42.86%in experimental and control groups,respectively.The patent rate of oviduct in experimental group was higher than that of the control group, the obvious significant between two groups in statistic(P<0.01). The patent rate of oviduct in experimental group was higher than that of the control group in the syndrome of qi stagnation and blood stasis and stagnation of cold and damp, the obvious significant between two groups in statistic(P<0.001). The patent rate of oviduct in two groups was not different significantly in the syndrome of stagnation of damp and heat. The improvement of symptoms and signs on chronic pelvic inflammation (such as lower quadrant abdominal pain,menstruating abdominal pain and CTB) in experimental group was obviously than that of the control group, the obvious significant between two groups in statistic(P<0.01).ConelusionChinese Herbs, topical combined interventional recanalization treatment of tubal proximal obstruction infertility can significantly improve the intrauterine pregnancy rate, lower ectopic pregnancy rate and keep the tubal patency rate after operation in the6months, and have good clinical efficacy. The treatment focusing on relieving the primary and the secondary aspects is quite effective for infertility due to tubal obstruction. It can improve the tubal patency and decrease the recurrence of fallopian tube adhesion and be treated as one of the routine therapy for infertility due to proximal tubal obstruction.