Zhong Xi Yi Jie He Xue Bao

4. INFERTILITY AND ASSISTED REPRODUCTION 4.1. Anti-sperm antibodies [Chinese traditional medicine yi kang ling to treat immunity infertility caused by anti-sperm antibody: the experimental research II] Zhonghua Nan Ke Xue. 2003 Dec;9(9):713-5 [Article in Chinese] Dai XL, Cui YX, Wang YM, Hu YA, Xu JP, Yao B, Li BT. Department of Pharmacology, Nanjing General Hospital, Nanjing Command, PLA, Nanjing, Jiangsu 210002, China. OBJECTIVE: To observe the effects of Chinese traditional medicine Yi Kang Ling (YKL) on immunity infertility caused by anti-sperm antibodies (AsAb). METHODS: With the AsAb infertile rabbit as the experimental model, seventy-five pairs of New zealand rabbits were divided into three group including YKL treatment group (subdivided into mini-, midi- and maxi-dosage groups), prednisone treatment group and non-treatment group. Rabbits of the YKL treatment sub-groups were further divided into M+F- (male positive, female negative), M-F+, (male negative, female positive) and M+F+ (male positive, female positive) pairs according to their initial AsAb detection results. The control group consisted of five pairs of normal rabbits. When the expected AsAb reversing ratio was achieved, the rabbits were matted and observed for the number of the pregnant and the weight of the newborn. RESULTS: Statistics showed that in M+F- pairs both the midi-dosage of YKL and prednisone treatment groups had fertility, in the mini- and maxi-dosage of YKL treatment groups, 20% of the female rabbits failed to be pregnant, while in the non-treatment group, 60% female rabbits remained sterile. The sterile ratios of the M-F+ pairs in the mini-, midi- and maxi-dosage of YKL and prednisone treatment groups were 0, 20%, 25% and 25%, respectively, while the sterile ratio in the non-treatment M-F+ group was 40%. In M+F+ groups, the sterile ratios of the three YKL sub-groups, prednisone treatment and non-treatment groups were 20%, 20% and 60% respectively. In the control group the sterile ratio was 20%. The weight of the newborn rabbits were around 50 grams with no visible malformation. CONCLUSIONS: YKL can effectively reverse the AsAb positive results, and restore the fertility of female rabbits. Mini-dosage of YKL for 45 days produced the best results and maxi-dosage of YKL had no negative effects on the weight of the newborn rabbit. An experimental study on inhibitory effect of Chinese medicine tai-bao on antisperm antibody] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1997 Jun;17(6):360-2 [Article in Chinese] Lai AN, Song JF, Liu XJ. Xiyuan Hospital, China Academy of TCM, Beijing. OBJECTIVE: To investigate whether Chinese medicine Tai-bao could inhibit antisperm antibody in experimental mice. METHODS: The experimental immunoinfertility mice were due to antisperm antibody induced by injection of human sperm membrane antigens. The experimental immuno-infertile mice used in the present study were divided into four groups including Tai-bao high dose group (46.8 g.kg-1.d-1), Taibao low dose group (31.2 g.kg-1.d-1), prednisone group and normal saline group. The enzyme linked immune sorbent assay (ELISA) and microcytotoxic assay were used for detection of antisperm antibody. The change of levels of antisperm antibody before and after treatment, pregnant rate, and the number of implantation were investigated in tested mice. RESULTS: The pregnant rates in normal saline group, prednisone group, Tai-bao high dose group and low dose were 38.89%, 47.06%, 70.00% and 75.00% respectively. The rate of pregnancy in Tai-bao low dose group was significantly higher as compared with normal saline group (P < 0.05). The rate of implantation in Tai-bao low dose group was significantly higher than that in prednisone group (P < 0.05). The results of detection of the cytotoxic antibody to sperm showed that cytotoxic percentages in Tai-bao high dose group (63.0 +/10.3%) and prednisone group (56.3 +/- 13.7%) were significantly lower (P < 0.05 and P < 0.01) than that in normal saline group (72.84 +/- 5.05%). CONCLUSION: Chinese medicine Tai-bao possesses regulatory effect on reproductive immune function, inhibitory effect on antisperm cytotoxic antibody, and promoting effect on pregnancy. [Exploration on the relationship between positive antisperm antibody and nitric oxide level of infertile patients and on integrative Chinese and Western medicine treatment] Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004 Apr;24(4):306-8 [Article in Chinese] Liao DL, Yu LQ, Xin H. Second Affiliated Hospital of Jiangxi Medical College, Nanchang 330006. OBJECTIVE: To study the relationship between the positive antisperm antibody (AsAb) and nitric oxide (NO) content in blood of infertile patients and the therapeutic effect of integrative Chinese and western medicine (ICWM) treatment on the disease. METHODS: Infertile patients, 75 of AsAb positive and 68 of AsAb negative were selected to observe the mature partuient rate and abortion rate. Serum NO level were measured before treatment to observe the relationship between NO and positive AsAb. Patients were treated with ICWM and followed-up for five years. RESULTS: Mean value of serum NO in patients with positive AsAb was significantly higher than that in fertile women, and there was no significant difference between patients with negative AsAb and fertile women (P < 0.01). In the 5 years after treatment, the mature partuient rate between the two groups showed insignificant difference (P > 0.05). CONCLUSION: AsAb positive and NO level abnormal may interfere mutually, to intervent the reproductive process. ICWM therapy could effectively regulate auto-immunity and endocrine function, and make the infertile patients obtain satisfactory efficacy. 4.2. Luteal phase defect TCM treatment of luteal phase defect--an analysis of 60 cases. J Tradit Chin Med. 1991 Jun;11(2):115-20. Lian F. Nanjing College of Traditional Chinese Medicine. Sixty cases of infertility due to luteal phase defect were treated with herbs to tonify the kidney and regulate the menstrual cycle. After the treatment, the hyperthermal phase score of basal body temperature (BBT) was markedly increased (P less than 0.05), the hyperthermal phase 7-8 days after ovulation improved (P less than 0.001), the transitional period of BBT remarkably shortened, and the pregnancy rate in 32 uncomplicated cases of luteal phase defect was 56%. The close relationship between luteal phase defect and the kidney deficiency syndrome in TCM was discussed. The key points of the treatment included coordination of yin and yang, regulation of qi and blood, and combination of tonification with reduction. The improvement of luteal insufficiency in fecund women by tokishakuyakusan treatment. Am J Chin Med. 2002;30(2-3):327-38 Usuki S, Higa TN, Soreya K. Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan. The effect of tokishakuyakusan, a Chinese herbal medicine, was examined, in vivo, in women with luteal insufficiency and in women with normal menstrual cycles. Luteal insufficiency was determined by daily measurement of basal body temperature and plasma progesterone levels. Tokishakuyakusan improved luteal insufficiency. Furthermore, the effects of tokishakuyakusan on prolactin, gonadotropins, steroids, angiotensin II, ANP and renin levels in the blood of women with normal menstrual cycles were studied, as were the medicine's effects on estrogens, pregnenediol and LH in the urine of the same women. Tokishakuyakusan had no adverse effect on hormonal levels in either blood or urine. Furthermore, no clinical side effects were detected. These results suggest that tokishakuyakusan improves luteal insufficiency in women but does not affect the hormonal levels of women with normal menstrual cycles. [Preliminary report of the treatment of luteal phase defect by replenishing kidney. An analysis of 53 cases] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1992 Aug;12(8):473-4, 452-3 [Article in Chinese] Zhang HY, Yu XZ, Wang GL. Xijing Hospital, Fourth Military Medical University, Shaanxi. 53 patients with Luteal phase defect (LPD) were treated with different Chinese medicinal herbs at different phases of menstrual cycle. On the 5th day of the menstrual cycle, the treatment was implemented with the rationale of "nourishing the Kidney Yin, invigorating the Spleen and replenishing the Qi, promoting the blood circulation and enriching the Blood" which might promote follicular development. The principle for the postovulatory treatment was that "invigorating the Kidney and strengthening the Yang" might enhance the development of corpus luteum and maintain its function. The patients were treated for three menstrual cycles. There were significant improvement in the luteal phase of endometrium, and prolonged basal body temperature elevation in progestational stage with a tendency for normalization of the wave forms and its amplitude after the treatment. In the midprogestational stage, the level of serum LH and PRL were reduced (P < 0.05) and that of serum progestin (P) rose significantly (P < 0.01), as compared with those before the treatment. The findings suggested that Chinese herbal medicines capable of replenishing the Kidney could regulate the hypothalamus-pituitary-ovarian axis and thus improve the luteal function. Among the 53 cases, 22 (41.5%) conceived but 68.18% of them required other measures to preserve the pregnancy. 4.3. Ovulatory dysfunction Pregnancy in premature ovarian failure after therapy using Chinese herbal medicine. Chang Gung Med J. 2003 Jun;26(6):449-52. Chao SL, Huang LW, Yen HR. Department of Gynecology and Pediatrics, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan. We present ovulation that occurred after the administration of traditional Chinese herbal medicine for 3 months in a woman with premature ovarian failure (POF) and secondary amenorrhea for 8 years. Traditional Chinese medicine concentrated herbal extracts of cooked rehmannia, Chinese yam, wolfberry fruit, dogwood fruit, cyathula root, dodder seed, antler glue, tortoise-plastron glue, epimedium and morinda root were prescribed, which were a modification of the herbal formula Zuo-gui-wan. When the patient discontinued the Chinese herbal medicine treatment and tried therapy with clomiphene citrate, neither ovulation nor conception occurred. Eight months after beginning clomiphene citrate therapy, the concentrations of follicle stimulating hormone and luteinizing hormone were still in the postmenopausal range. The modified formula of Zuo-gui-wan was prescribed again and the patient conceived 1 month after taking Zuo-gui-wan. Thus, we suggested that Chinese herbal medicine restored ovarian function effectively and promptly, and offers another option for treating infertility in patients with POF. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med. 1993 Jun;13(2):115-9 Mo X, Li D, Pu Y, Xi G, Le X, Fu Z. Zhejiang College of Traditional Chinese Medicine, Hangzhou. Ovulatory dysfunction is commonly seen in gynecology clinic. It may cause infertility, amenia, functional uterine bleeding and a variety of complications. This research according to TCM theory records treating with acupuncture 34 patients suffering from ovulatory dysfunction. Changes in clinical symptoms and some relative targets are reported, plus findings in animal experiments. The effect of acupuncture in improving ovulation and the rationale are discussed. According to TCM theory concerning the generative and physiologic axis of women, this research involved the following points: Ganshu (UB 18), Shenshu (UB 23), Guanyuan (Ren 4), Zhongji (Ren 3), and Sanyinjiao (Sp 6). The reinforcement and reduction of acupuncture enables it to strengthen liver and kidney. Through the Chong and Ren channels it nourishes uterus to adjust the patient's axis function and recover ovulation. Treated on an average of 30 times, the patients' symptoms improved to varying degrees. The marked effective rate was 35.29%, the total effective rate being 82.35%. BBT, VS, CMS, and B ultrasonic picture all improved to some degree. The results also showed that acupuncture may adjust FSH, LH, and E2 in two directions and raise the progesterone level, bringing them to normal. The animal experiments confirmed this result. Results showed that acupuncture may adjust endocrine function of the generative and physiologic axis of women, thus stimulating ovulation. The results of this research will provide some scientific basis for treating and further studying this disorder. Effects of unkei-to, an herbal medicine, on endocrine function and Effects of unkei-to, an herbal medicine, on endocrine function and ovulation in women with high basal levels of luteinizing hormone secretion. J Reprod Med. 2001 May;46(5):451-6 Ushiroyama T, Ikeda A, Sakai M, Hosotani T, Suzuki Y, Tsubokura S, Ueki M. Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan. gyn003@poh.osaka-med.ac.jp OBJECTIVE: To treat anovulatory women with high plasma LH levels with unkei-to. STUDY DESIGN: A total of 100 patients with polycystic ovary syndrome (n = 38) or non-polycystic ovary syndrome (n = 62) were allocated randomly into two groups. Endocrine levels (FSH, LH and estradiol), follicle growth and response to unkei-to were compared for 52 subjects in the unkei-to group and 48 subjects in the control group. RESULTS: Unkei-to induced significant decreases in plasma LH in polycystic ovary syndrome and non-polycystic ovary syndrome with high LH levels. Plasma estradiol levels increased significantly (43.5%) in eight weeks of treatment with unkei-to. Significant development of the dominant follicle was also observed in patients treated with unkei-to. When women suffering from ovulatory failure or irregular menstruation and having high plasma LH concentration were treated with unkei-to for eight weeks, a reduction in the serum LH level of at least 1 SD from baseline was noted in 45.5% of polycystic ovary syndrome patients and in 80.0% of non-polycystic ovary syndrome patients. The mean rate of reduction of serum LH was 22.2 +/- 35.7% in polycystic ovary syndrome patients and 49.7 +/- 15.3% in non-polycystic ovary syndrome patients. This reduction was significant in the nonpolycystic ovary syndrome patients (P = .030). The rate of menstrual cycle improvement, including successful ovulation, was 50.0% in the polycystic ovary syndrome group and 60.0% in the non-polycystic ovary syndrome group, with no significant difference between the two groups. [Therapeutic effect of Chinese herbal medicines for nourishing blood and reinforcing shen in treating patients with anovulatory sterility of shendeficiency type and its influence on the hemodynamics in ovarian and uterine arteries] Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004 Apr;24(4):299-302. [Article in Chinese] Xia YW, Cai LX, Zhang SC. Xiyuan Hospital, China Academy of TCM, Beijing 100091. OBJECTIVE: To observe the clinical therapeutic effect of Nuzhen Yunyu Decoction (NYD, a Chinese recipe for nourishing blood and reinforcing Shen) and its influence on the hemodynamic parameters in ovarian and uterine arteries. METHODS: Sixtyeight patients were randomly divided into two groups at the ratio of 2:1, 45 in the TCM group treated with Chinese medicine and 23 in the control group treated with clomiphene citrate. Menstrual cycle were taken as the indexes for clinical observation; basal body temperature, cervical mucus, vaginal exfoliative cells, serum hormones and B ultrasonic examination were taken as the indexes for ovulation and pregnancy assessment. The hemodynamic parameters of uterus and ovary were determined by using color Doppler ultrasonography, and the growth of follicles and ovulation, thickness of uterine endometrium were also monitored continuously. RESULTS: Results of 3 cycles treatment and 1 year follow-up study showed that the ovulation promoting rate, pregnancy rate and abortion rate in the two groups were similar, but the treated group showed better effects than that of control group, in such aspects as regulating menstruation, promoting growth and development of follicle, strengthening endometrium, improving blood supply and circulation of uterine and ovary (P < 0.05, P < 0.01). CONCLUSION: NYD has the effects of ovulation promotion and holistic regulation of reproductive system. [Clinical observation on treatment of hyperinsulinemia and hyperandrogenism anovulatory patient with replenishing kidney-yin drugs] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1996 Sep;16(9):515-8 [Article in Chinese] Zhou LR, Yu J. The Obstetrics and Gynecology Hospital, Shanghai Medical University. In order to investigate the effect of Chinese herbal medicine for replenishing KidneyYin in treating hyperinsulinemia and hyperandrogenism anovulatory syndrome, 35 patients were treated with replenishing Kidney-Yin drugs for 3 months, basic body temperature, ultrasonic examination and blood levels of sex hormones were taken for monitoring the ovulation, and changes of serum insulin, blood sugar as well as oral glucose tolerence test were observed before and after treatment. Thirty-five patients showed high serum insulin and testosterone levels but normal dehydroepiandrosterone (DHEA) level. Twenty-nine percent of their luteinizing hormone/folliclestimulating hormone (LH/FSH) ratio were in normal range. Twenty four cases completed the regular treatment and 20 of them showed ovulation in the 43 menstrual cycles (59.7%). Seven of 17 (41.2%) infertile cases become pregnant within 6 months. After 3 months of treatment, blood sugar and insulin level significantly decreased but the latter was still slightly higher than normal level. Serum testosterone level decreased significantly and reached normal. Results suggested that replenishing Kidney-Yin Drugs could provide a good microcircumstance for ovarian follicular growth, and resulted in ovulation and pregnancy. The mechanism is remained to be further explored. 4.4. Polycystic ovary syndrome Electro-acupuncture reverses nerve growth factor abundance in experimental polycystic ovaries in the rat. Gynecol Obstet Invest. 2004;57(2):80-5. Epub 2003 Dec 9 Bai YH, Lim SC, Song CH, Bae CS, Jin CS, Choi BC, Jang CH, Lee SH, Pak SC. Research Division of Biological Science, Chosun University Medical School, Gwangju, Korea. Polycystic ovary syndrome (PCOS) remains one of the most common causes of anovulation in women of reproductive age. There is some evidence that nerve growth factor (NGF) is involved in the pathogenesis of PCOS. Therefore, seeking the pathogenesis of PCOS is important for controlling fertility. In traditional Oriental Medicine, acupuncture has been used for the function of ovaries. The present study was designed to determine whether electro-acupuncture (EA) could affect experimentally induced polycystic ovary (PCO) in the rat. The two acupoints Sp-6 and E-128 were stimulated to test for efficacy in the protein expression of NGF. Polycystic ovaries were induced by a single injection of estradiol valerate (4 mg i.m.). During the experimental period of 8 weeks, some of the rats were treated with EA twice weekly; this group was compared with a vehicle-treated control group and an estradiol-injected group not subjected to EA. At day 60, the protein expression of NGF was examined by immunohistochemistry in the ovaries, the adrenal glands and some parts of the brain. The estradiol treatment induced a clear PCO appearance, and was associated with a robust increase in NGF expression in the ovaries, the adrenal glands and the brain. EA treatment partly reversed the NGF abundance, particularly in the ovaries, but not in the brain. Our data show that EA affects the NGF involvement in ovarian dysfunction. [Study on treatment of hyperandrogenism and hyperinsulinism in polycystic ovary syndrome with Chinese herbal formula "tiangui fang"] Zhongguo Zhong Xi Yi Jie He Za Zhi. 2000 Aug;20(8):589-92 [Article in Chinese] Hou J, Yu J, Wei M. Gynecology and Obstetrics Hospital, Shanghai Medical University, Shanghai (200011). OBJECTIVE: To observe the efficacy of Chinese herbal formula "Tiangui Fang" (TGF) in hyperandrogenism and hyperinsulinism patients of polycystic ovarian syndrome (PCOS), and compare with western medicine metformin. METHODS: Twenty-two anti-clomiphen citrite patients were divided into two treatment groups: "Tiangui Fang" (n = 10) and metformin (n = 12) for three months. Insulin response during oral glucose tolerance test and serum level of LH, FSH, testosterone (T), estradiol (E2) and waist to hip ratio (WHR), body mass index (BMI) were measured before and after treatment. RESULTS: After treatment for three months with metformin or TGF, fasting and the integrated insulin response to the glucose load decreased. Treated by metformin 4 out of 8 patients had restoration of menstrual cyclicity and 2 of them had double phase bases body temperature (BBT). This was accompanied by lowering in serum logT/E2 but had no significant difference, the BMI, WHR and serum E2, LH:FSH ratio were not changed. Treated by TGF for three months, 6 out of 8 patients had restoration of menstrual cyclicity and double phase BBT. This was accompanied by significant lowering in serum T, logT/E2 and BMI (P < 0.05), serum LH:FSH ratio were not changed. CONCLUSION: Both metformin and TGF can reduce the high concentration of insulin in PCOS patients and induce ovulation, the herbal formula has a better efficacy. [Clinical study of yishen jianpi yangxue tongli therapy in treating polycystic ovary syndrome] Zhongguo Zhong Xi Yi Jie He Za Zhi. 2003 Nov;23(11):819-22. [Article in Chinese] Hua L, Wu YN, Zhang JM. Department of Gynecology, Beijing Hospital of TCM, Beijing 100010. qiqihualing@yahoo.com.cn OBJECTIVE: To observe the effect of Yishen Jianpi Yangxue Tongli Therapy (YJYTT) in treating polycystic ovary syndrome (PCOS) and to explore the therapeutic mechanism of YJYTT. METHODS: One hundred and seven PCOS patients with syndrome differentiation of TCM as Pi-Shen Yang deficiency were randomly divided into two groups, the treated group (n = 76) was treated with Chinese herbal medicine, while the control group (n = 31) was treated by clomiphen. The therapeutic effect in both groups and the change of body mass index (BMI), Ferriman-Gallway (F-G) score, serum sex hormones and serum oral glucose tolerance test (OGTT) before and after treatment were observed. RESULTS: The comparison of total effective rate between two groups was insignificantly different, but the pregnancy rate of the treated group (65.7%) was markedly higher than that of control group (25.0%, P < 0.01). Also, significant difference was shown in the aspect of BMI, F-G score, serum testosterone (T), luteinizing hormone (LH) and OGTT, etc. between the two groups (P < 0.05). CONCLUSION: The YJYTT could markedly improve the clinical symptoms and pregnancy rate of PCOS patients, particularly showing good effect to the clomiphen resistant patients. The mechanism possibly was due to its regulation on hypothalamus-pituitary-ovarium axis and reducing the insulin resistance. The effect of herbal medicine on nerve growth factor in estradiol valerateinduced polycystic ovaries in rats. Am J Chin Med. 2003;31(6):885-95 Lee JC, Pak SC, Lee SH, Lim SC, Bai YH, Jin CS, Kim JS, Na CS, Bae CS, Oh KS, Choi BC. Environmental Department, Naju College, Naju, Korea. A type of polycystic ovary resembling some aspects of human polycystic ovarian syndrome (PCOS) can be induced in the rat with a single injection of long-acting estradiol valerate. Among several theories behind the development of polycystic ovaries (PCO), the involvement of the sympathetic nervous system draws much attention, and herbal medicine is known to relieve the abnormal symptoms of PCO. Two herbal formulas, Changbudodam-Tang (cang fu dao tan tang) and Yongdamsagan-Tang (long dan xie gan tang), were used in the present study. The administration of herbal medicine was done every other day for 60 days. The morphological changes of ovaries from herbal medicine treatment were compared to those from an oil-treated control group and an estradiol valerate-injected group. This study also examined the possible hypothesis of neurogenic participation in terms of nerve growth factor (NGF) in the pathology of ovarian dysfunction. The nerve growth factor was analyzed in the central nervous system and ovaries by immunohistochemistry. The main findings of the present study were: (1) PCO were fully developed in rats with a single intramuscular injection of estradiol valerate, (2) PCO resulted in the expression of NGF in the ovaries and the brain tissues, and (3) herbal medicine administration significantly decreased the elevated NGF staining in the ovaries without affecting the brain tissues significantly. Induction of ovulation by Sairei-to for polycystic ovary syndrome patients. Endocr J. 1999 Feb;46(1):217-20 Sakai A, Kondo Z, Kamei K, Izumi S, Sumi K. Department of Obstetrics and Gynecology, Nippon Kokan Hospital, Kanagawa, Japan. In anovulatory patients ovulation is usually induced by clomiphene citrate (CC) or gonadotropin therapy, but in the case of polycystic ovary syndrome (PCOS), diagnosed by the presence of several micropolycysts in the ovaries and a high LH/FSH ratio in the serum, CC is only minimally effective, and side effects are often a problem with gonadotropin therapy. In the present study we administered a Chinese herbal medicine Sairei-to which appears to have a steroidal effect in anovulatory PCOS patients. As a result of the treatment, serum LH and the LH/FSH ratio significantly decreased (P<0.01) and the ovulatory rate was 70.6%. Serum testosterone levels were within normal limits before the treatment, and did not significantly change during the treatment. Sairei-to may therefore be useful for the treatment of anovulation in PCOS patients. Immunity and beta-endorphin concentrations in hypothalamus and plasma in rats with steroid-induced polycystic ovaries: effect of low-frequency electroacupuncture. Biol Reprod. 2004 Feb;70(2):329-33. Epub 2003 Oct 15 Stener-Victorin E, Lindholm C. Department of Physiology, Gotenborg University, Gotenborg, Germany. elsv@fhs.gu.se The human endocrinological disorder polycystic ovary syndrome (PCOS) is a common cause of reproductive failure. Even though the cause of PCOS is unknown, hormone and immune disturbances as well as hyperactivity in the sympathetic nervous system are likely to be involved in the pathogenesis of the disease. The present study was undertaken to elucidate if rats with estradiol valerate (EV)-induced polycystic ovaries (PCO) have altered beta-endorphin concentrations in the hypothalamus and in plasma and if they have alterations in circulating immune cell populations and the activity. Repeated low-frequency (2 Hz) electroacupuncture (EA) treatments are known to modulate the release of beta-endorphin, immune responses, and the activity in the autonomic nervous system. We therefore also investigated the effect of EA treatments on the beta-endorphin and the immune systems. Low-frequency EA was given 12 times, 25 min each, over 30 days starting 2-3 days after i.m. injection of EV. The beta-endorphin concentrations in the hypothalamus and in plasma as well as the frequencies of CD4+ T cells and CD8+ T cells were significantly lower in EVinjected control rats as compared to oil-injected control rats. Repeated EA treatments in EV-injected rats significantly increased beta-endorphin concentrations in the hypothalamus. In conclusion, these findings show that both the betaendorphinergic and the immune system are significantly impaired in rats with steroid-induced PCO and that repeated EA treatments can restore some of these disturbances. Effect of TJ-68 (shakuyaku-kanzo-to) on polycystic ovarian disease. Int J Fertil Menopausal Stud. 1994 Mar-Apr;39(2):69-76 Takahashi K, Kitao M. Department of Obstetrics and Gynecology, Shimane Medical University, Izumo, Japan. OBJECTIVE--To investigate the effect of an herbal medicine, Shakuyaku-Kanzo-To (TJ-68), on endocrine variables in patients with polycystic ovarian disease (PCOD). SETTING--Medical university hospital. PATIENTS AND INTERVENTIONS--Thirty-four Japanese women with PCOD were treated daily with 7.5 g of TJ-68 for 24 weeks. Testosterone (T), free-testosterone (free-T), sex hormone binding globulin (SHBG), LH, FSH, estrone, 17 beta-estradiol, 3,4-dihydroxyphenylglycol (DOPEG), and 3, 4- dihydroxyphenylacetic acid (DOPAC) were examined. RESULTS--No side effects were observed in any cases. At 4 weeks after initiation of treatment, serum T and free-T levels significantly decreased, while SHBG was not significantly elevated. Meanwhile, after 12 weeks of treatment, the mean serum T level of the patients who became pregnant decreased to 35% of that before the treatment, but levels did not change in the patients who failed to conceive. There was no significant difference in estrone/estradiol ratio before and after treatment, but the estradiol/testosterone ratio increased significantly after 4 weeks of treatment. The LH/FSH ratio after 24 weeks of treatment was significantly lower than that before treatment. DOPEG and the DOPEG/DOPAC ratio significantly decreased after 4 weeks of treatment. CONCLUSIONS--It is suggested that TJ-68 acts directly on the ovary first, increasing the activity of aromatase, which promotes the synthesis of estradiol from testosterone, thus lowering serum T levels. Furthermore, the effect on catecholamines results in gradually improving the dissociate phenomenon of LH/FSH ratio. Therefore, TJ-68 is an effective herbal medicine for decreasing serum free-T levels and achieving pregnancy in patients with PCOD. Effects of unkei-to, an herbal medicine, on endocrine function and Effects of unkei-to, an herbal medicine, on endocrine function and ovulation in women with high basal levels of luteinizing hormone secretion. J Reprod Med. 2001 May;46(5):451-6 Ushiroyama T, Ikeda A, Sakai M, Hosotani T, Suzuki Y, Tsubokura S, Ueki M. Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan. gyn003@poh.osaka-med.ac.jp OBJECTIVE: To treat anovulatory women with high plasma LH levels with unkei-to. STUDY DESIGN: A total of 100 patients with polycystic ovary syndrome (n = 38) or non-polycystic ovary syndrome (n = 62) were allocated randomly into two groups. Endocrine levels (FSH, LH and estradiol), follicle growth and response to unkei-to were compared for 52 subjects in the unkei-to group and 48 subjects in the control group. RESULTS: Unkei-to induced significant decreases in plasma LH in polycystic ovary syndrome and non-polycystic ovary syndrome with high LH levels. Plasma estradiol levels increased significantly (43.5%) in eight weeks of treatment with unkei-to. Significant development of the dominant follicle was also observed in patients treated with unkei-to. When women suffering from ovulatory failure or irregular menstruation and having high plasma LH concentration were treated with unkei-to for eight weeks, a reduction in the serum LH level of at least 1 SD from baseline was noted in 45.5% of polycystic ovary syndrome patients and in 80.0% of non-polycystic ovary syndrome patients. The mean rate of reduction of serum LH was 22.2 +/- 35.7% in polycystic ovary syndrome patients and 49.7 +/- 15.3% in non-polycystic ovary syndrome patients. This reduction was significant in the nonpolycystic ovary syndrome patients (P = .030). The rate of menstrual cycle improvement, including successful ovulation, was 50.0% in the polycystic ovary syndrome group and 60.0% in the non-polycystic ovary syndrome group, with no significant difference between the two groups. Zhong Xi Yi Jie He Xue Bao. 2004 Mar;2(2):83-5 [Integrated traditional Chinese and western medicine should make new contribution to the reproductive health of women] Yu J, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China. The Obstectrics and Gynecology Hospital attached to Fudan University has made great achievements in the clinical and experimental study of integrated traditional Chinese and western medicine in the past 45 years. Study on induction of ovulation with acupuncture revealed the relationship between circulating estrogen and central beta-endorphin, and suggested that the depletion of central beta-endorphin resulted in the release of GnRH and ovulation, and the main indication for acupuncture treatment was pubertal dysfunctional uterine bleeding. Acupuncture was also successfully used to treat anorexia nervosa. The successful treatment of polycystic ovary syndrome (PCOS) with Yu's Tonifying Recipe for tonifying the kidney and resolving phlegm was found to be related to the elevation of serum FSH which resulted in ovulation. Good result was obtained in hyperinsulinemia pattern of PCOS treated with Tiangui Recipe for replenishing the kidney and activating blood. In studies on patients and animal model, Tiangui Recipe was found to decrease peripheral androgen and insulin levels and lead to central regulation of proopiomelanocortin, neuropeptide Y and leptin receptor, as well as regulation of neuro-endocrine-metabolic network. Thus it can promote ovulation and reduce body weight. In the studies, a new way to classify PCOS was suggested. Gengnianchun Recipe for women with postmenopausal syndrome was found to be effective in increasing estrogen receptors (ERs) and ER mRNA in hypothalamus and peripheral organs and regulating neuro-endocrine-immune-metabolic network in patients and aging rats. Gongtai was effective for controlling menorrhagia under the mechanism of regulating endometrial prostaglandins. The researches mentioned above indicate that illness is the disorder of some key-links in the life network of the patient which may be affected by factors from the environment. And this idea is different from the ideas in traditional Chinese medicine and biomedicine. It indicates that woman in subclinical health state has already got something incontrollable in her life network, and it also gives a new impact on the treatment and prevention of women's diseases as well as the prevention and treatment of women's reproductive health. 4.5. Infertility – Miscellaneous Acupuncture and acupressure. Applications to women's reproductive health care. J Nurse Midwifery. 1999 May-Jun;44(3):217-30 Beal MW. Yale University School of Nursing, New Haven, CT 06536-0747, USA. An introduction to the therapeutic applications, history, and theory of acupuncture and acupressure is presented. The traditional concepts that underlie treatment of imbalances of ch'i, or vital energy, are presented, along with the theories of yin and yang, meridians, vital substances, pathogenic factors, five phases, and the eight principle patterns. Contemporary Western research findings on the biochemical mediaries and effects of acupuncture are reviewed. Clinical applications to women's reproductive care that are presented include treatment for dysmenorrhea, infertility, and childbearing. Data on clinical trials are reviewed, and licensure and educational preparation for practice of these modalities are discussed. Gauging a woman's health by her fertility signals: integrating western with traditional Chinese medical observations. Altern Ther Health Med. 1999 Nov;5(6):70-83 Ehling D, Singer K. Women's Health Services, Santa Fe, NM, USA. This article presents observations of traditional Chinese medical and Western concepts of a woman's fertility signals. A woman of child-bearing age cycles through processes of heating and cooling and moistening and drying to make her fertile. Her fertility signals--basal body temperature, cervical fluid, and cervix changes--can be observed and charted to gauge the woman's gynecological health as well as to avoid or enhance her chances of achieving pregnancy. Introductory information about charting fertility signals, an introduction to traditional Chinese medicine theories, and various basal body temperature charts with analysis from traditional Chinese medicine and Western medical perspectives are included. [Treatment of secondary amenorrhea and oligohypomenorrhea with combined traditional Chinese and Western medicine] Zhong Xi Yi Jie He Za Zhi. 1991 Nov;11(11):661-3, 645 [Article in Chinese] Ge XL. Dept. of Gynecology, Second Affiliated Hospital, Hebei Medical College, Shijiazhuang. This article reported the treatment of 149 cases (1087 cycles) with secondary amenorrhea and oligohypomenorrhea, including 42 cases who were treated by cycle treatment with traditional Chinese medicine (TCM) and clomiphene in comparison with clomiphene in 67 cases and/or TCM in 40 cases at the same time. The results showed that ovulatory rate of secondary amenorrhea, calculated according to menstrual cycles, was significantly higher in the group of TCM and clomiphene than that of clomiphene or TCM (P less than 0.01). The efficacy of clomiphene was better than that of TCM (P less than 0.01). The ovulatory rate of oligohypomenorrhea was significantly increased by using TCM and clomiphene in contrast to only western medicine (P less than 0.05). The phenomena mentioned above indicate that the TCM-WM treatment has obvious advantages. [Clinical study of the treatment of fallopian tube obstruction with catheter recanalization and blood stasis removing drugs] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1994 Feb;14(2):80-2, 68 [Article in Chinese] Lian F, Zhao B, Hu AC. Dept. of Gynecology, Affiliated Hospital of Shandong College of TCM, Jinan. 50 patients with fallopian tube obstruction were initially treated by catheter recanalization, and then randomly divided into two groups. Chinese medicine group (CMG) treated with Tongjingbao and Angelicae Complex Injection and Western medicine (Gentamycin, Dexamethasone, Chymotrypsin) group (WMG) as a control. The course of treatment was three months. Before and after treatment, the hemorheology change was analysed. After treatment, all patients except subsequent pregnancy were repeatedly performing hysterosalpingography. The results showed effective rate of recanalization was 94%; corrected pregnancy rate was 100% in CMG and 50% in WMG; the reocclusion rate of fallopian tube was 9% in CMG and 25% in WMG (P < 0.05). The difference of hemorheology change between two groups was significant (P < 0.01) and it was also different before and after treatment in CMG (P < 0.01). This study showed that catheter recanalization was effective in recanalizing the mechanical occluded fallopian tube. The Chinese medicine would inhibit the reocclusion and re-adhesion of tube. Clinical observation on the effects of combined traditional Chinese and Western medicine therapy for excessive suppressive syndrome. J Tradit Chin Med. 1994 Dec;14(4):247-53 Wang Z. Gulou Hospital, Xuzhou, Jiangsu Province. Sixty-eight cases of sterility due to excessive suppressive syndrome were treated by differential administration of Chinese drugs combined with clomiphene citrate and progesterone. This combined therapy was found to be significantly superior in therapeutic effect to administration of Western drugs alone or administration of Chinese drugs supplemented by progesterone. Resultant pregnancy rate was 57.4%. A nutritional supplement for improving fertility in women: a pilot study. J Reprod Med. 2004 Apr;49(4):289-93 Westphal LM, Polan ML, Trant AS, Mooney SB. Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California 94305, USA. lynnw@stanford.edu OBJECTIVE: To determine the impact of nutritional supplementation on optimization of reproductive health in women. STUDY DESIGN: A double-blind, placebo-controlled pilot study was initiated to determine the effects of FertilityBlend (Daily Wellness Co., Sunnyvale, California), a proprietary nutritional supplement containing chasteberry and green tea extracts, L-arginine, vitamins (including folate) and minerals. Changes in progesterone level, basal body temperature, menstrual cycle, pregnancy rate and side effects were monitored. RESULTS: Thirty women aged 24-46 years who had tried unsuccessfully to conceive for 6-36 months completed the study. After 3 months, the supplement group (n = 15) demonstrated a trend toward an increase in mean midluteal phase progesterone level (from 8.2 to 12.8 ng/mL, P = .08) and a significant increase in the average number of days in the cycle with basal temperatures >37 degrees C during the luteal phase (6.8-9.7 days, P = .04). The placebo group (n = 15) did not show any notable changes after treatment in any of the parameters studied. After 5 months, 5 of the 15 women in the supplement group were pregnant (33%), and none of the 15 women in the placebo group were (P <.01). No significant side effects were noted. CONCLUSION: Nutritional supplementation may provide an attractive alternative or complement to conventional fertility therapy. A review of controlled trials of acupuncture for women's reproductive health care. J Fam Plann Reprod Health Care. 2003 Oct;29(4):233-6. White AR. Institute of Health and Social Care Research, Peninsula Medical School, 25 Victoria Park Road, Exeter EX2 4NT, UK. Adrian.White@pms.ac.uk BACKGROUND: Acupuncture as a therapy, and acupressure as self-treatment, are increasingly widely used for gynaecological conditions, and this study aims to review the scientific literature on their effectiveness. METHOD: A systematic review of controlled trials of acupuncture or acupressure for gynaecological conditions, published in a European language. Synthesis: No studies in mastalgia, menorrhagia, pelvic pain, premenstrual syndrome or vulvodynia met the inclusion criteria. Four studies, two of which were patient-blinded, of acupuncture or acupressure for dysmenorrhoea suggest that it may have an effect. Three studies of acupuncture given at various stages of infertility treatment are promising, but none was patientblind. Two studies of acupuncture for menopausal symptoms showed no effect during the treatment period when compared with sham acupuncture, and a third study showed no effect on hypertension in postmenopausal women, though some improvement in symptoms was noted. CONCLUSION: In view of the small number of studies and their variable quality, doubt remains about the effectiveness of acupuncture for gynaecological conditions. Acupuncture and acupressure appear promising for dysmenorrhoea, and acupuncture for infertility, and further studies are justified. Application of traditional Chinese medicine in the treatment of infertility. Hum Fertil (Camb). 2003 Nov;6(4):161-8 Xu X, Yin H, Tang D, Zhang L, Gosden RG. The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynaecology, Norfolk, Virginia 23507, USA. The philosophy and practice of traditional Chinese medicine (TCM) have been evolving for thousands of years in China, Japan and other Asian countries. TCM is now generating popular interest worldwide for reproductive health care and disease prevention, including applications for treating infertility and improving sexual function. This review focuses on the application of TCM for infertility patients, and provides a critical reflection on the efficacy and safety of selected Chinese herbal formulas. It has been claimed that some formulas produce high clinical pregnancy rates with few or no side effects, as well as improving the general well-being of patients. The need for randomized control trials and research into possible mechanisms of action, effective doses, contra-indications and toxicity is self-evident. However, the task is enormous in view of the number of herbal products currently available on the market; yet among these products are undoubtedly some that will prove to be safe and beneficial. 4.6. Assisted reproduction therapy Upregulation of steroidogenic enzymes and ovarian 17beta-estradiol in human granulosa-lutein cells by Cordyceps sinensis mycelium. Biol Reprod. 2004 May;70(5):1358-64. Epub 2004 Jan 7 Huang BM, Hsiao KY, Chuang PC, Wu MH, Pan HA, Tsai SJ. Department of Cell Biology and Anatomy, The Institute of Clinical Medicine, National Cheng Kung University Medical College, Tainan, Taiwan, Republic of China. There is increasing evidence that 17beta-estradiol (E2) directly influences the quality of maturing oocytes and thus the outcome of assisted reproduction treatment. Although Cordyceps sinensis (CS) mycelium, a Chinese herbal medicine, is believed to enhance libido and fertility in both sexes, the mechanism of its effect in women has not been determined. The aim of the present study was to evaluate the effects of CS on steroidogenic enzyme expression and E2 biosynthesis in human granulosalutein cells (GLC). We found that CS induced E2 production by GLC in a dose- and time-dependent manner and that a 3-h treatment with CS induced increased levels of mRNAs coding for the P450 side chain cleavage enzyme (P450scc), 3betahydroxysteroid dehydrogenase (3beta-HSD), and aromatase. Western blot analysis demonstrated that, after treatment with CS for 3 h, protein levels of steroidogenic acute regulatory protein (StAR) and aromatase were upregulated while P450scc and 3beta-HSD levels showed no substantial change. New protein synthesis was required for CS-induced E2 production because it was abrogated by cycloheximide pretreatment. Addition of 22(R)-hydroxycholesterol, thus bypassing the need for StAR protein, did not induce as much E2 production as CS treatment, indicating that upregulation of StAR protein was not the only factor contributing to CS-induced steroidogenesis. Cotreatment of GLCs with CS and aminoglutethimide, an aromatase inhibitor, completely abolished CS-induced E2 production. In conclusion, treatment of GLCs with CS results in increased E2 production due, at least in part, to increased StAR and aromatase expression. These data may help in the development of treatment regimens to improve the success rate of in vitro fertilization. [Experimental study on effect of erzhi tiangui recipe on quality of oocyte in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004 Jul;24(7):625-7 [Article in Chinese] Lian F, Sun ZG, Zhang JW, Zhang N, Liu Y, Mu L, Zhang P. The Reproductive and Hereditary Center of the Affiliated Hospital of Shandong University of TCM, Jinan 250011. flian@chinaivf.com OBJECTIVE: To observe the effect of Erzhi Tiangui recipe (ETR) on quality of oocyte in the process of external fertilization and embryo-transplantation. METHODS: Eighty mice were randomly divided into 4 groups, Group A treated with ETR plus human menopausal gonadotropin (HMG), Group B with ETR, Group C with HMG and Group D with normal saline. Ovulation test and cleavage test were conducted to observe the effect of treatment on quality of oocytes. RESULTS: The difference on ovulation number between Group A and C was insignificant, but the difference in comparison between the two groups was significant in aspects of oocyte morphological scoring, fertilization rate and cleavage rate (P<0.05). CONCLUSION: ETR could play its effect synergistically with Western medicine, and raise the quality of oocytes. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril. 2002 Apr;77(4):721-4. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Department of Reproductive Medicine, Christian-Lauritzen-Institut, Ulm, Germany. paulus@reprotox.de OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture. DESIGN: Prospective randomized study. SETTING: Fertility center. PATIENT(S): After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80). INTERVENTION(S): Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy. MAIN OUTCOME MEASURE(S): Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer. RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group. CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after ART. A nutritional supplement for improving fertility in women: a pilot study. J Reprod Med. 2004 Apr;49(4):289-93 Westphal LM, Polan ML, Trant AS, Mooney SB. Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California 94305, USA. lynnw@stanford.edu OBJECTIVE: To determine the impact of nutritional supplementation on optimization of reproductive health in women. STUDY DESIGN: A double-blind, placebo-controlled pilot study was initiated to determine the effects of FertilityBlend (Daily Wellness Co., Sunnyvale, California), a proprietary nutritional supplement containing chasteberry and green tea extracts, L-arginine, vitamins (including folate) and minerals. Changes in progesterone level, basal body temperature, menstrual cycle, pregnancy rate and side effects were monitored. RESULTS: Thirty women aged 24-46 years who had tried unsuccessfully to conceive for 6-36 months completed the study. After 3 months, the supplement group (n = 15) demonstrated a trend toward an increase in mean midluteal phase progesterone level (from 8.2 to 12.8 ng/mL, P = .08) and a significant increase in the average number of days in the cycle with basal temperatures >37 degrees C during the luteal phase (6.8-9.7 days, P = .04). The placebo group (n = 15) did not show any notable changes after treatment in any of the parameters studied. After 5 months, 5 of the 15 women in the supplement group were pregnant (33%), and none of the 15 women in the placebo group were (P <.01). No significant side effects were noted. CONCLUSION: Nutritional supplementation may provide conventional fertility therapy. an attractive alternative or complement to A review of controlled trials of acupuncture for women's reproductive health care. J Fam Plann Reprod Health Care. 2003 Oct;29(4):233-6. White AR. Institute of Health and Social Care Research, Peninsula Medical School, 25 Victoria Park Road, Exeter EX2 4NT, UK. Adrian.White@pms.ac.uk BACKGROUND: Acupuncture as a therapy, and acupressure as self-treatment, are increasingly widely used for gynaecological conditions, and this study aims to review the scientific literature on their effectiveness. METHOD: A systematic review of controlled trials of acupuncture or acupressure for gynaecological conditions, published in a European language. Synthesis: No studies in mastalgia, menorrhagia, pelvic pain, premenstrual syndrome or vulvodynia met the inclusion criteria. Four studies, two of which were patient-blinded, of acupuncture or acupressure for dysmenorrhoea suggest that it may have an effect. Three studies of acupuncture given at various stages of infertility treatment are promising, but none was patientblind. Two studies of acupuncture for menopausal symptoms showed no effect during the treatment period when compared with sham acupuncture, and a third study showed no effect on hypertension in postmenopausal women, though some improvement in symptoms was noted. CONCLUSION: In view of the small number of studies and their variable quality, doubt remains about the effectiveness of acupuncture for gynaecological conditions. Acupuncture and acupressure appear promising for dysmenorrhoea, and acupuncture for infertility, and further studies are justified.