Objective: To observe the clinical effect of acupuncture plus medication in the treatment of poor ovarian response (POR) patients and to explore its mechanisms in assisting pregnancy.
Methods: A total of 100 volunteer POR women undergoing in vitro fertilization-embryo transplantation (IVF-ET) were recruited in the present study. On the 1st cycle of IVF-ET, these POR women received microstimulation of ovulation program (oral administration of Clomiphene, muscular injection of Menotrophin, Chorionic Gonadotrophin triggering, etc.). Before receiving the 2nd period of IVF-ET, these patients were equally and randomly divided into control, medication (Climen, composed of estradiol valerate and cyproterone acetate), acupuncture and acupuncture+medication (combined treatment) groups according to the random number table. Patients of the medication group were asked to orally take Climen (1 tablet/d for 21 days) beginning from the 3rd day of the menstruation, which was repeated for 3 menstrual cycles. Patients of the acupuncture group received manual acupuncture stimulation of Guanyuan (CV4), and bilateral Taixi (KI3), Sanyinjiao (SP6) of and Tai-chong (LR3) from day 8 to 15 of menstruation (follicular phase), once daily for 3 menstrual cycles. On the 2nd day of menstruation of the 1st and 2nd IVF-ET cycle, the ovarian reserve function was detected, including measurement of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) contents by using radioimmunoassay, and serum anti-mullerian hormone (AMH) level by using ELISA, and the antral follicles count (AFC) of the ovaries by using a color Doppler ultrasonic diagnosis apparatus. At the end of ovulation induction, the assisted pregnancy indexes and outcomes were detected, including administration of dosage and days of gonadotropin (Gn), the diameter of dominant oocyte, level of E2 on the trigger day, the numbers of ultrasound-guided-retrieved oocyte and the cultivated high-quality embryo (grade 1 and 2).
Results: After the treatment, the contents of serum FSH, LH and E2 in the medication, acupuncture and combined treatment groups were significantly reduced (P<0.05), and the content of serum AMH and ovary AFC in the medication, acupuncture and combined treatment groups were obviously increased (P<0.05) in comparison with their own pre-treatment (P<0.05). Compared with the control group, the levels of FSH, LH and E2 contents were notably decreased, and the AMH content and AFC significantly increased in the medication, acupuncture and combined treatment groups (P<0.05). Comparison among the three treatment groups showed that the levels of FSH, LH and E2 were notably lower in the combined treatment group than in the acupuncture group (P<0.05), and the AFC was markedly more in the combined treatment group than in the acupuncture group (P<0.05), and LH content was also significantly lower in the combined treatment group than in the medication group (P<0.05). Regarding the pregnancy-assistant indexes and outcomes, the dosage of Gn in the combined treatment group and the number of Gn administration days in the acupuncture and combined treatment groups were significantly fewer (P<0.05), serum E2 levels on the trigger day in the medication, acupuncture and combined treatment groups, and the high-quality embryo number in the combined treatment group were considerably higher in comparison with their own levels of the 1st IVF-ET cycle in each group (P<0.05). Comparison among the three groups showed that the dosage and number of administration days of Gn in the combined treatment group were fewer than those in the medication group(P<0.05), and the dosage of Gn in the combined treatment group were significantly lower than that in the acupuncture group (P<0.05), E2 content of the combined treatment group was markedly higher than that of the medication and acupuncture groups (P<0.05). The high-quality embryo number in the combined treatment group was obviously larger than that of the medication group (P<0.05). No significant differences were found between the 2nd and 1st IVF-ET cycles in the number of the obtained oocyte, between the acupuncture and medication groups in the E2 content at the trigger day, and the numbers of Gn administration days and the high-quality embryo (P>0.05).
Conclusion: Acupuncture combined with medication improves the level of endocrinal hormones and ovarian reservation function in POR women undergoing IVF-ET, benefiting the ovary environment of pregnancy.
Keywords: Acupuncture; Acupuncture combined with medication; Climen; Endocrinal hormones; In vitro fertilization-embryo transplantation; Ovarian reservation function; Poor ovarian response.