| Objective1.Through retrospective analysis of assisted pregnancy outcomes of patients with poor ovarian response(POR)receiving assisted reproductive therapy in our department under different intervention measures,we intend to investigate the correlation between lowfrequency treatment of midnight-noon ebb-flow acupuncture and assisted fertility outcomes of patients with POR.2.A prospective randomized case-control study was conducted to collect ovarian function indicators,natural cycle ovulation,endometrium related indicators,egg quality related molecular indicators and assisted reproductive outcomes of patients with POR by adding low-frequency treatment of midnight-noon ebb-flow acupuncture before assisted reproductive treatment.Objective to evaluate the efficacy and safety of the treatment for assisted reproductive therapy in infertility patients with POR,and to further explore the possible mechanism to improve the outcome of POR patients.Methods1.Retrospective analysis:Retrospectively collected in January 2015 to December 2016 in guangdong hospital of reproductive medicine clinic parallel assisted reproduction treatment(IVF/ICSI)into the exclusion standard low ovarian response in patients with infertility of electronic medical record data,according to whether to accept a low-frequency treatment of midnight-noon ebb-flow acupuncture into treated groups and did not received into the non-treated group.The electronic medical records of assisted reproduction system and the Excel table data of low-frequency treatment of midnight-noon ebb-flow acupuncture were collected,and the basic information,ovulation promotion information and the outcome of assisted reproduction treatment of patients in the two groups were analyzed by Chi-square test,T test,one-way anova or non-parametric test.2.Randomized controlled prospective study:a total of 80 patients with POR infertility meeting the criteria were included in this part of the randomized controlled prospective study.Patients were divided into observation group(group A)and control group(group B)by randomized,controlled design.Both groups received assisted reproductive therapy as basic treatment.Group A low-frequency treatment of midnight-noon ebb-flow acupuncture received for 2 courses before assisted reproductive technology.3 times a week,20 minutes each time,every other day,1 menstrual cycle for 1 treatment course,non-menstrual period.The protocol of COS was micro-stimulation program,which started gonadotropin for ovarian stimulation on d2-3 days of menstruation.After 8 to 12 days of gonadotropin treatment,all available embryos obtained were frozen after routine egg collection,followed by freeze-thaw embryo thawing and transplantation.Observation before,one period of treatment,two treatment courses of ovarian function index,ovulation and endometrial index and assisted reproduction treatment after laboratory indicators and assisted reproduction treatment outcome indicators,eggs and embryos situation for one menstrual cycle,pregnant outcome after the situation for the intervention measures of three menstrual cycles.Results1.Retrospective study:(1)A total of 108 POR patients were screened and included in this study,with a total of 216 OPU cycles.There were 40 patients who received low-frequency treatment of midnight-noon ebb-flow acupuncture(group 1),including 62 opu cycles,and 68 patients who did not receive low-frequency treatment of midnight-noon ebb-flow acupuncture(group 2),including 154 opu cycles.There was no significant difference in basic information between 2 groups(P>0.05).(2)Patients in both groups took mild stimullation as the dominant scheme.The utilization rate of mid-length scheme in ovulation cycle in group 1 was higher than that in group 2,and the difference in protocol used in cycles between the two groups was statistically significant(P=0.000).(3)There was no significant difference in successful egg pickup rate between the two groups(P>0.05).(4)Comparison of outcomes of assisted reproductive therapy:the number of eggs harvested(P=0.007),the number of mature eggs(MII)(P=0.028)and the number of highquality embryos(P=0.000)in patients who received low-frequency treatment of midnightnoon ebb-flow acupuncture were significantly higher than those who did not received.There was no statistical significance in pregnancy outcome between the two groups(P>0.05)2.Randomized controlled prospective study:(1)Clinical efficacy analysis:①Low-frequency treatment of midnight-noon ebb-flow acupuncture may reduced the level of basal FSH(P=0.004)and E2(P=0.000),significantly increased the level of AFC(P=0.020).②The natural cycle ovulation rate of patients in group A was significantly increased(P=0.015);③In the low-frequency treatment group,the endometrial thickness of natural cycle was significantly increased(P=0.000),and the RI level of endometrial hemodynamics was significantly decreased(P=0.000).④The live birth rate(P=0.015)and cumulative live birth rate(P=0.019)in assisted reproductive therapy group were significantly increased.(2)Laboratory efficacy index analysis:①Egg number(P=0.009)and MⅡ egg number(P=0.017)were significantly increased in the low-frequency treatment of midnight-noon ebb-flow acupuncture group.②The levels of BMP-15,Bcl-2 and MT in follicular fluid of assisted reproductive therapy group were significantly increased(P=0.000),while the level of BAX was significantly decreased(P=0.000).③After assisted reproduction treatment,the number of available embryos in the group A was significantly increased(P=0.023),but there were no significant differences in normal fertilization number,normal fertilization rate,cleavage embryo number,optimal embryo number and cumulative embryo number(P>0.05).(3)Safety and adverse reaction analysis:There were no abnormalities in blood routine,liver and kidney functions and electrocardiogram results before and after low-frequency treatment of midnight-noon ebbflow acupuncture and assisted reproduction treatment,and no adverse reactions occurred in 2 groups(P>0.05).Conclusion1.The intervention of low-frequency treatment of midnight-noon ebb-flow acupuncture before COS for two menstrual cycles can improve the ovarian function of POR,improve the natural cycle ovulation and endometrial receptivity,and increase the number of eggs and available embryos after IVF.The live birth rate and cumulative pregnancy rate of patients with POR were improved.2.Low-frequency treatment of midnight-noon ebb-flow acupuncture is a safe treatment before assisted reproductive technology treatment for POR.3.Low-frequency treatment of midnight-noon ebb-flow acupuncture can improve the level of antioxidant stress,reduce the apoptosis of granulosa cells,promote the growth of granulosa cells,and possibly improve the egg quality and pregnancy outcome by improving the cytoplasmic maturity of oocytes. |
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