坤泰胶囊对脾肾两虚型排卵障碍性不孕症患者内分泌水平及妊娠的影响

目的:探究坤泰胶囊对脾肾两虚型排卵障碍性不孕症患者内分泌水平及妊娠的影响。方法:选取2017年6月-2018年5月收治的脾肾两虚型排卵障碍性不孕症患者120例,采用随机数字表法分为2组,各60例。对照组单纯口服来曲唑治疗,观察组在其基础上加用坤泰胶囊治疗。对比2组治疗情况、治疗前后内分泌水平及妊娠成功率。结果:与对照组相比,观察组成熟卵泡数量较多、卵泡直径较大、子宫内膜厚度均较厚,差异有统计学意义;观察组治疗后FSH、E2、PRL水平高于对照组,LH、P、T水平低于对照组,差异有统计学意义;观察组妊娠成功率高于对照组,差异有统计学意义。结论:坤泰胶囊在治疗脾肾两虚型排卵障碍性不孕症患者中具有较好的临床效果,有助于促进内分泌各指标改善,增加成熟卵泡数量,为卵泡生长提供良好的环境,利于提高妊娠成功率。     

前列腺素E2在排卵过程中作用及机制研究进展

前列腺素E_2主要由颗粒细胞合成,是大多数哺乳类动物排卵卵泡中关键的调节分子。排卵过程中,黄体生成激素激增,通过环氧合酶-2和前列腺素合酶诱导颗粒细胞合成前列腺素E_2。前列腺素E_2释放到胞外后,通过结合卵丘颗粒细胞上前列腺素E_2受体2和受体4,诱导丝裂原活化蛋白激酶磷酸化,增加胞内环磷酸腺苷水平,并激活蛋白激酶B和丝裂原活化蛋白激酶通路,促进排卵发生。前列腺素E_2的调控异常与多种排卵障碍性疾病有关,如多囊卵巢综合征和未破裂卵泡黄素化综合征等。     

中药＋枸橼酸氯米芬治疗排卵障碍性不孕的系统评价

目的评价中药＋枸橼酸氯米芬（CC）治疗排卵障碍性不孕的有效性。方法计算机检索PubMed、荷兰医学文摘数据库、Cochranelibrary、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库,用Googlescholar和Medicalmartix搜索引擎在互联网上查找相关文献,收集中药＋CC治疗排卵障碍性不孕的随机和半随机对照试验。由2名研究者独立依据Cochranereviewer＇shandbook4．2．6推荐的方法评价纳入研究的文献质量,对符合纳入标准的研究采用Cochranecollaboration0RevMan4．2．10进行Meta分析。结果纳入3个随机对照试验和10个半随机对照试验,1555例排卵障碍性不孕患者。与单纯应用CC比较,中药＋CC治疗排卵障碍性不孕妊娠可提高妊娠率,相对危险度（RR）为1．68,95％可信区间（CI）为（1．50,1．89）,P〈0．00001;提高排卯率,RR为1．19,95％CI为（1．12,1．26）,P〈0．00001;提高基础体温,RR为1．27,95％CI为（1．09,1．46）,P〈0．0001;增加子宫内膜厚度,RR为1．71,95％CI为（1．38,2．12）,P〈0．00001。结论中药＋CC治疗排卵障碍性不孕优于单纯CC,但目前的研究质量较低,尚需开展高质量临床试验。     

补肾化痰活血法对多囊卵巢综合征排卵障碍相关调节因子影响的研究进展

对补肾化痰活血法影响多囊卵巢综合征排卵障碍相关调节因子的研究进行综述,指出目前存在的问题,并对未来的研究方向进行展望。     

Randomized controlled trial comparing laparoscopic ovarian diathermy with clomiphene citrate as a first-line method of ovulation induction in women with polycystic ovary syndrome

BACKGROUND: Laparoscopic ovarian diathermy (LOD) is currently accepted asa successful second-line treatment for ovulation induction (OI)in clomiphene citrate (CC)-resistant women with polycystic ovarysyndrome (PCOS). The aim of this study was to test the hypothesisthat LOD may be superior to CC as a first-line treatment. METHODS: The study included 72 anovulatory women with PCOS who were randomizedto LOD (n = 36) or CC (n = 36). Women who remained anovulatoryafter LOD were offered CC. Similarly, women receiving CC whofailed to ovulate or conceive were offered LOD. Pregnancy rateswere compared between the two groups using ² and odds ratiowith 95% confidence interval (OR, 95% CI). RESULTS: After randomization, six women conceived before starting treatmentand another patient postponed treatment. The remaining 65 womenreceived the treatment (33 underwent LOD and 32 received CC).After the primary treatment, more pregnancies (44%) occurredin women receiving CC than in those undergoing LOD (27%), althoughthe difference did not reach statistical significance [P = 0.13,OR 2.1 (0.7 – 5.8)]. After adding the second treatment,the pregnancy rate was still higher, but to a less extent, inthe CC group [63% versus 52%, P = 0.2, OR 1.6 (0.6 – 4.2)]. CONCLUSIONS: LOD is not superior to CC as a first-line method of OI in womenwith PCOS. The trial is registered with ClinicalTrials.gov withan identifier number NCT00220545 [ClinicalTrials.gov] .     

Is metformin a primary ovulatory agent in patients with polycystic ovary syndrome?

Insulin resistance is an important pathophysiological feature of the polycystic ovary syndrome (PCOS). Insulin resistance and its compensatory hyperinsulinemia contribute to the anovulation, hyperandrogenism, infertility and early pregnancy loss suffered by women with PCOS. Current evidence supports the role of metformin in the treatment of anovulation in PCOS, both in monotherapy and concomitantly with clomiphene in clomiphene-resistant patients. In addition, novel evidence suggests that insulin sensitizers may also play a role in reducing the risk of early pregnancy loss. The insulin-sensitizing agents available commercially include metformin, rosiglitazone and pioglitazone. Compared with the thiozolidinediones, metformin is the agent that has been most frequently studied in PCOS, and has the most favorable pregnancy safety profile. In conclusion, there is strong evidence supporting the use of metformin as a primary ovulatory agent in women with PCOS.     

Cabergoline influences ovarian stimulation in hyperprolactinaemic patients with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is characterized by abnormal gonadotrophin secretion, in particular an elevated serum concentration of LH, depressed FSH, and an LH/FSH ratio of >or =2. Mild, transient hyperprolactinaemia is frequently associated with PCOS (30% of patients); furthermore, it can be observed during the late follicular and luteal phases of both natural and stimulated cycles. It is suggested that a reduction of the dopamine inhibitory effect might raise both prolactin (PRL) and LH. METHODS AND RESULTS: We compared ovarian stimulation in two groups of hyperprolactinaemic (hyperPRL)-PCOS patients; one group was treated with cabergoline, reducing PRL plasma concentrations to the range normally observed during ovulation induction. In the untreated hyperPRL-PCOS group, we noted a reduced total number of ampoules of recombinant FSH (P < 0.04), fewer days to reach HCG administration (P < 0.04), and significantly higher peak oestrogen plasma concentrations (P < 0.03) compared with the treated group. By ultrasound examination the same group showed significantly higher ovarian volume and an increased total number of follicles of every size. In untreated hyperPRL-PCOS patients, four cycles out of 65 were cancelled due to mild ovarian hyperstimulation syndrome (OHSS) that occurred during ovulation induction. Only one cycle out of 42 in the patients treated with cabergoline was cancelled. No significant differences in pregnancy rate nor in multiple pregnancy were found. CONCLUSION: Our data suggest a dopaminergic control of LH release and support the use of cabergoline in the management of such patients, in order to provide better clinical control of ovarian response and consequently a reduction of the risk of OHSS, with no decrease in pregnancy rate.