Abstract: Objective: To investigate the prevention and treatment of ovarian hyperstimulation syndrome (OHSS) and the effect on pregnancy outcome by the “three steps of blood activation” method. METHODS: Seventy patients with polycystic ovary syndrome, young, thin and hypersensitive infertility who had 3-5 follicles of 16 mm or more on each ovary after ovulation promotion were divided into a treatment group and a control group. In the treatment group, the “Three Steps to Invigorate Blood” method was used. In the treatment group, the “Three Steps to Invigorate Blood” method was used, and the control group was treated with Blood Mansions and Blood Stasis Soup. Results: The differences in the number of follicles ruptured, cycle cancellation rate and clinical pregnancy rate between the treatment group and the control group were statistically significant (P<0.05). However, there was no statistically significant difference in the incidence of mild OHSS, miscarriage rate, multiple pregnancy rate, fetal reduction rate, and fetal survival rate at the second week of pregnancy (P>0.05). Conclusion: The “three steps of blood activation” can effectively reduce the occurrence of moderate and severe OHSS, improve the clinical pregnancy rate without increasing the miscarriage rate and multiple pregnancy rate, and is a good choice to avoid cycle cancellation in patients with high response to ovulation promotion. Wei Aiwu, Reproduction Center, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
Keywords: blood activation and three-step method; ovarian hyperstimulation syndrome; pregnancy outcome; clinical study
CICS: R271.1 Document ID: B Article ID: 1000-1719(2Oo9)01-0076-02
Three-Step Method ofPromotion of Blood Circulation in the Prevention of
Ovarian Hyperstimulation Syndrom e and the Im pact on the Rese t of PregnancyWEI Ai-wu
(The First Affiliated Hospital ofHenan College ofTraditional Chinese Medicine, Zhengzhou 450000, Henan, China)
Abstract: D ctive: To syndrome (OHSS) and the impact on the result of pregnancy.Methods:After using the medicine of promoting ovulation to70 cases of sterility patients who were due to polycystic ovarian syndrome (PCOS), yoang, weak, and a high sensitivity, some pa-tients who had 3~5 follicles( ≥16mm) in each ovary, were divided into the treatment group and the control group.The three-step method ofpromotion of blood circulation was used in the treatment group, nevertheless “Decoction In the Chest “was used in the control group.Results: The diferences of the follicle rupture rate, cycle cancellation rate, clinicalpregnancy rate between the treatment, group and the control group all had statistical significance.Compared with the control group, there was an increased trend in the incidence of slight OHSS.However, the diferences of the incidence of slight, moderate and severe OHSS, the abortion rate, the multiple pregnancy rate, the light OHSS. fetal reduction rate, the rate of fetal who survived above 12 weeks between the treatment group and the control group, were no statistical significance (P>0.05).Conclusion: The invigoration of the kindney to promote blood circulation method can effectively reduce the incidence of moderate, and severe OHSS, and Key words: Three-step method of promotion of blood circulation; Ovarian hyperstimulation syndrome; Result of pregnancy. Clinical study OHSS is the most serious complication of superovulation. The pathogenesis of OHSS is still unclear, so there is a lack of targeted and effective prevention and control methods, often using the cancellation of treatment cycles. For this reason, this study used the “three steps of invigoration of the blood” method, i.e., the internal administration of formula I for tonifying the kidneys and invigorating the blood, the internal administration of formula II for tonifying the kidneys and invigorating the blood, and the internal administration of formula II for tonifying the kidneys and invigorating the blood, to prevent and treat moderate and severe OHSS with good efficacy and reduce the cycle cancellation rate. 1 Clinical information The observation cases were obtained from the First Affiliated Hospital of Henan College of Traditional Chinese Medicine from 2005 to 2007, after the application of ovulation promotion, there were three to five follicles of 16mm or more in both ovaries. If herbal treatment is not effective or moderate to severe OHSS still occurs, cycle cance llati on is abandoned or OHSS treatment is performed. The patient’s age was 26-32 years, and the duration of infertility was 3-9 years. A single-blind method was used to randomize the treatment and control groups according to approximately 1:1. In the treatment group, there were 28 cases with polycystic ovary syndrome, 4 cases with thin stature and 3 cases with hypersensitivity; in the control group, there were 25 cases with polycystic ovary syndrome, 8 cases with thin stature and 2 cases with hypersensitivity. diagnostic criteria for OHSS mild, moderate and severe: according to the WHO 1993 grading criteria⋯ . 2 Treatment method 2.1 The treatment group adopted the three-step method of invigorating Blood: the first step: the same day oral self-preparation tonic. Kidney invigorating blood I formula (composed of 30g of deer horn cream, 20g of Epimedium, 30g of Trigonella, 30g of Curcuma, 30g of Danshen, lOg of Radix et Rhizoma, 30g of Saponaria, 15g of Hypericum) 150mL, 2 times/day for 3 days; Step 2: 20mL of each of compound Danshen injection on the next day, in the abdominal midline three fingers above the pubic symphysis on the bilateral side of the two fingers (below is near where the double ovaries are located) pelvic cavity Sealing once; Step 3: After follicle rupture, self-treatment was given. Kidney activating blood Ⅱ formula (composed of Cuscuta sinensis 30g, Chuanjian lOg, Sambucus nigra 15g, Salvia miltiorrhiza 30g, Paeonia lactiflora 20g, Radix et Rhizoma lOg), 150ruL, 2 times/day, taken orally for 7 days. 2.2 In the control group, Blood Mansions and Blood Stasis Soup (composed of Angelica sinensis, Chuanxiong rhizome, Red peony, Red flower, Peach kernel, Chai Hu, Citrus aurantium, Radix et Rhizoma oryzaeum, Radix et Rhizoma ginseng, Licorice), 150 mL, 2 times/day, was administered orally for 10 days. The preparations were provided by the Department of Pharmacy of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine. 2.3 Statistical methods Statistical analysis was performed using SPSS13.0 software, and the X test was used for the count data. 3 Results 3.1 Comparison of cycle cancellation rate OHSS incidence clinical pregnancy rate fetal survival rate at 12 weeks of gestation between the two groups is shown in Table 1. the number of follicles ruptured in the treatment group ranged from 1 to 4. There were 19 cases of rupture of one, 11 cases of rupture of two, 3 cases of rupture of three, and 2 cases of rupture of four. In the control group, the number of follicles ruptured was 1 to 2. There were 11 cases with one rupture and 3 cases with two ruptures. The difference in cycle cancellation rate, follicle rupture number and clinical pregnancy rate between the two groups was statistically significant by x-test (P<0.05). The difference in OHSS incidence rate was not statistically significant by)(2 test (P>0.05). Table 1 Comparison of cycle cancellation rate OHSS incidence clinical pregnancy rate between the two groups [cases (%) Note: Compared with the control group, P0.05. 3.2 Comparison of the incidence of mild, moderate and severe OHSS in the two groups See Table 2. Table 2 Comparison of the incidence of mild to moderate severe OHSS in the two groups [cases (%) Note: P>0.05 compared with the control group. 3.3 Comparison of multiple pregnancy rate and fetal reduction rate between the two groups See Table 3. The difference in multiple pregnancy rate and fetal reduction rate between the two groups was not statistically significant by x-test (P>0.05). Table 3 Comparison of multiple pregnancy rate and reduction rate between the two groups [cases (%) Note: P>0.05 compared with the control group. The number of miscarriages (rate) and fetal survival at 12 weeks of gestation (rate) in the two groups are shown in Table 4. The difference in the number of miscarriages (including embryonic abortion and reduction) between the two groups was not statistically significant by x-test (P>0.05). Fetal survival rate at 12 weeks of gestation, by)(2 test, the difference in comparison was not statistically significant (P>0.05). Table 4 Comparison of multiple pregnancy rate and fetal reduction rate between two groups [cases (%) Note: Compared with the control group, P>0.05. 4 Discussion The most common complication of OHSS, which is closely related to coagulation, occurs in patients with anovulation, but the main pathological changes in moderate to severe OHSS are multiple ovarian follicles and corpus luteum cysts, increased capillary permeability, massive extravasation of body fluid, hemoconcentration, hepatic and renal impairment, and thrombosis. The pathogenesis of OHSS has not been elucidated, but it is known that it must occur after hCG injection when there is a large number of follicles growing in the ovulation promotion, so it can be The hypothesis is that hCG triggers a series of manifestations of OHSS through the mediation of certain substances Therefore, during superovulation promotion, interventions should be actively taken if there is a large number of follicles growing, especially a large number of small and medium-sized follicles and high levels of estrogen. Due to the lack of targeted and effective prevention and treatment methods, hCG injections are often stopped and treatment cycles are cancelled to avoid moderate to severe OHSS. It can be seen that eliminating the use of hCG and reducing intravascular fluid extravasation to prevent and improve the hypercoagulable state of blood is the key to prevent and treat OHSS. However, the increase in cycle cancellation rate increases the subsequent treatment cycle and patient anxiety, for which the author hopes to find effective prevention and treatment methods from Chinese medicine. According to Chinese medicine, the menstrual cycle consists of 4 phases: menstrual phase, late menstrual phase, true organic phase (ovulation), and premenstrual phase. The physiological characteristics of each phase are yin and yang qi and blood and their transformation and waxing and waning: menstrual phase is heavy on yang to yin, late menstrual phase is long on yin and yang, true organic phase is heavy on yin to yang, and premenstrual phase is long on yang and yin. Different treatments are given at different stages of the cycle to promote an orderly yin-yang transformation. The author believes that the true phase (ovulation) is the time of transformation of yin and yang, which must be supplemented with yin on the basis of kidney yang, while blood activating drugs can promote the operation of qi and blood to promote the transformation of yin and yang, so as to achieve the purpose of ovulation, especially in the case of ovulation disorders, it is more important to use blood activating drugs to dissolve the interstitium and hydrolyze collagen fibers to help follicle rupture. However, clinical observation of ovulation disorders is mostly manifested by patients. If the kidney is deficient in blood stasis J, if the kidney is deficient in yang, it is unable to drum, the egg escapes, and blood stasis blocks the cellular channels and veins, which increases the difficulty of egg elimination. the rate of ovulation promotion in such patients with blood activating drugs alone is low and the cycle cancellation rate is high. Therefore, in this study, in patients who had 3-5 follicles in both ovaries after applying ovulation promotion due to polycystic ovary syndrome, young, thin and with hypersensitivity to infertility For more than 16ram follicle growth, the first step of blood activation was firstly used, that is, the same day oral self-preparation tonic. Kidney activating Blood I formula warms Yang and invigorates Blood to promote the development and maturation of the cytosol, nucleus and cytoplasm, and drums the eggs to escape; the next day, the second step of activating Blood is used to increase the power of activating Blood and resolving blood stasis, with the addition of compound Danshen injection pelvic acupuncture point closure to promote local blood circulation in the ovary and accelerate ovulation, avoiding the use of hCG, while improving capillary permeability, preventing J]tt fluid concentration and preventing the occurrence of OHSS; follicular part After rupture, there are still multiple follicles and luteal cysts present, and Yang grows and Yin subsides during this period, using the third step of invigorating Blood and taking oral tonics. Kidney invigorating Blood II formula warms Yang and invigorates Blood. On one hand, it warms the uterus and regulates the balance of Qi and Blood in the internal organs to create favorable conditions for sperm-egg union and implantation, while invigorating Blood and resolving blood stasis to promote the disappearance of multiple follicles and luteal cysts, and further improves capillary permeability to prevent blood concentration. The results showed that the number of follicular rupture and cycle cancellation rate increased significantly in the treated group, and the clinical pregnancy rate also increased significantly compared with the control group; there was a tendency for the incidence of mild 0HSS to increase, but there was no significant difference in the incidence of mild, moderate and severe OHSS. There was an increasing trend in the rate of multiple pregnancy, but there was no significant difference in the rate of miscarriage and fetal survival rate at l2 weeks of gestation. It is suggested that the “Three Steps to Invigorate Blood” can effectively prevent the occurrence of moderate to severe OHSS and improve the clinical pregnancy rate without increasing the miscarriage and multiple birth rates. The mechanism of action may be that by improving the local endocrine a immune function of ovaries, a series of ovulation mechanisms are induced, while by improving the systemic blood circulation, the extravasation of body fluids is effectively reduced, the hemoconcentration state is improved, and the occurrence of moderate to severe OHSS is prevented. The exact mechanism of action remains to be further elucidated. References [1] Zhou Zhiting, Jin Jianyun. The treatment experience of 1O cases of ovarian hyperstimulation syndrome [J]. Chinese Journal of Eugenics and Genetics, 2004, 12(2): 65-66. [2] Xu JQ, Wang JZ. Formulary. The results showed that the number of follicular rupture and cycle cancellation rate increased in the treated group, and the clinical pregnancy rate also increased significantly compared with the control group. Shanghai: Shanghai Science and Technology Publishing House, 1993: 148.5 [3] Cai Xia. The rate of multiple pregnancies tended to increase. Chinese Journal of Practical Gynecology and Obstetrics, 2006, 23(3): 177-178. [4] Li Rong, Qiao J. The use of anticoagulants in the field of reproduction [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2007, 22(3): 169-170. [5] Huang, Ho-Fung. Modern assisted reproductive techniques [M]. Beijing: People’s Military Medical Publishing House, 2003: 277. [6] Dong Zhaogao, Tan Hua. The exact mechanism of action remains to be determined. Shandong Journal of Traditional Chinese Medicine, 2002, 12: 719-720__