| Objective: To explore the clinical effect and mechanism of Erzhi Tiangui Granules improving the ovarian response of senile infertile women undergoing IVF-ET.Methods: In clinical study, Sixty senile infertile patients with tubal factors undergoing IVF-ET were divided into two groups at random, 30 cases in the study group treated with Erzhi Tiangui Granules and western medicine, and 30 cases in the control group were treated with gonadotropin-releasing hormone agonist (GnRH-a) and gonadotropin (Gn) alone. The short term protocol was adopted. The expression of INHB and FSH in follicular fluid on the day of retrieving oocytes were detected by ELISA and ECLIA, and symptom scores, number of retrieved oocytes, fertilization rate, high quality embryo rate and pregnancy rate were evaluated. In experimental study, 12-months old Kunming female mice whose oestrus elongation were set as primary senile female mouse model and randomized into model control group, Erzhi Tiangui Granules in high dosage, middle dosage and low dosage group. 4-months old female mice was selected as young control group additionally. The serum with decoction from primary senile mice was added to cultured granulosa cells and was incubated for 48 h.Then the concentration of estradiol progesterone and inhibin B in culture medium were measured by chemiluminescence immunoassay (CLIA) and sandwich ELISA respectively. The ovaries were treated by HE staining and In situ hybridization method to observe growing follicles, corpus luteum, expression of inhibinαmRNA,FSHRmRNA.Results: By treating the disease with combination of TCM and western medicine, not only can obtain better effects than that of western medicine alone, but also avoid the side effects which result from prolonged use of western medicine. The methods are simple and convenient. The cost is cheap and is easily accepted by the patients. It is showed that Erzhi Tiangui Granules can promote oocyte quality of senile infertile women and improve endometrial receptivity. The possible mechanism of combined therapy is that: promoting oocyte maturation by regulating the level of INHBexpression in follicular fluid; balancing the reproductive endocrine environment in controlled ovarian hyperstimulation cycle; benefiting follicular theca and endometrium perfusion in short term protocol. There are correlations between deficiency of kidney and serum FSH,INHB and AMH in the day of commencement of IVF treat. The experimental research showed that the serum contained Erzhi Tiangui Granule could increase secretion of E2,P and INHB with certain dose compliance. Erzhi Tiangui Granules can improve the function of granule cells by ameliorating morphological index in mice ovarian tissue and increasing the expression of i n h i b i nαm R N A,F S H R m R N A t o i m p r o v e t h e o v a r i a n r e s p o n s e .Conclusion: Erzhi Tiangui Granule combined with western medicine can decrease amount of FSH obviously and improve the ovarian response,the quality of oocyte,ratio of pregnancy.It indicate that functional mechanism of Erzhi Tiangui Granule is related to increasing secretion of E2,P and INHB and regulating the expression of inhibinαmRNA,FSHRmRNA.Basal concentration of serum FSH,INHB and AMH could be objective indexes of deficiency of kidney which demonstrate the theory of kidney dominating reproduction.
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