| Objective To observe the impact on pregnancy outcomes,endometrial receptivity-related indicators,traditional Chinese medicine(TCM)syndromes,psychological scales,and neuroendocrine levels in unexplained infertility(UI)patients with Liver stasis and Kidney deficieney when treated by Jia Jian Kai Yu Zhong Yu decoction combined with group psychological intervention,and to study the clinical efficacy of TCM combined with psychotherapy in improving pregnancy outcome of UI patients and its possible mechanism,in order to provide data support of this combined therapy,as well as scientifical accordances for "jealousy infertility" theory.Methods A total of 90 patients with UI who met the criterion from the Reproductive Center of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from November 2018 to November 2019 were randomly assigned at a ratio of 1: 1: 1 to the TCM combined with group psychological intervention(combination group),TCM group and control group.The combination group used Jia Jian Kai Yu Zhong Yu decoction combined with group psychotherapy,the TCM group used Jia Jian Kai Yu Zhong Yu decoction,and the control group used expectant therapy,with a course of 1 month and for 3 courses.Study 1 observed the pregnancy outcomes,endometrial receptivity indexes,TCM effects and FPI(fertility problem inventory),SRQ(stress restion queationnaire)in each group before and after trail to confirm its clinical efficacy.Study 2 observes the neuroendocrine indicators of each group before and after treatment,including ACTH(adreno-cortico-tropic-hormone),NE(norepinephrine),DA(dopamine)and 5-HT(5-hydroxytryptamine),so as to explore the possible neuroendocrine mechanism of how TCM combined with psychotherapy improving pregnancy outcomes.All datas were analyzed by SPSS 23.0 software.Results 1 Comparison of basic datas among three groups The age,infertility years,body mass index(BMI),educational background,and occupations of the three groups were compared,and the difference was not statistically significant(P> 0.05);single symptom score,TCM syndrome score,psychological scale and neuroendocrine related indicators were compared,the differences were not statistically significant(P> 0.05),indicating that the three groups of patients were comparable.2 Comparison of pregnancy outcomes among three groupsThe clinical pregnancy rates of the combined group,the TCM group and the control group were 27.6%,20.0% and 7.4%,the combined group’s rate was higher than the control’s,the difference was statistically significant(P <0.05);The TCM group’s rate was higher than the control’s,but the difference was not statistically significant(P> 0.05).The continuous pregnancy rates of the combination group,the TCM group and the control group were 27.6%,16.7%,and 7.4%,the combination group’s rate was higher than the control’s,and the difference was statistically significant(P <0.05);the TCM group’s rate was higher than the control group’s,but the differences were not statistically significant(P> 0.05).3 Comparison of endometrial receptivity indexes among three groups of patientsComparing the endometrial thickness of HCG day before and after treatment,the endometrial thickness of HCG day in the combination group and the TCM group were all increased when comparing with before,the difference was statistically significant(P <0.05),and the difference in the control group before and after treatment was not statistically significant(P> 0.05);comparing the difference in endometrial thickness between HCG day before and after treatment between groups,the increase in endometrial thickness of the combined group as well as the TCM group were statistically significant compared with the control group,and the combined group was greater than the TCM group,and the difference was statistically significant(P <0.05).Comparing endometrial classification and blood flow grade before and after treatment,the endometrial types of the combined group changed toward type A,and endometrial blood flow classification changed toward grade 3,all of which were statistically significant(P <0.05),The endometrial type and blood flow grade of the TCM group and the control group were not significantly changed(P> 0.05);after treatment,endometrial classification and blood flow grade were compared between groups,and the difference between the combined group and the control group was statistically significant(P < 0.05),while the difference was not statistically significant(P > 0.05)between the TCM group and the other two groups.Comparing the blood flow parameters of uterine arteries before and after treatment,the levels of hemodynamic index(PI),resistance index(RI),uterine artery systolic peak flow rate/end-diastolic flow rate ratio(S/D)in both uterine arteries of the combination group and the TCM group were lower than before,and the differences were statistically significant(P <0.05),and the difference in the control group was not statistically significant(P> 0.05);comparing the difference of uterine artery blood flow parameters before and after treatment between the groups,the diferrences of PI,RI,S/D were statistically significant(P <0.05)when comparing control group to the other two groups,the reduction of S / D in the combined group was greater than the TCM group,the difference was statistically significant(P <0.05).4 Comparison of therapeutic effect of TCM among three groupsComparing single symptom score of the three groups,the combined group had lower scores on lumbosacral pain,decreased libido,premenstrual breast swelling,dizziness and tinnitus,emotional depression,flank pain,and lower abdominal pain after treatment,the differences of which were all statistically significant(P < 0.05).The TCM group had lower scores on lumbosacral pain,decreased libido,premenstrual breast swelling,dizziness,tinnitus,emotional depression,and flank pain after treatment,and the differences were all statistically significant(P <0.05).There was no significant difference before and after treatment in the control group(P> 0.05);after treatment,the scores of lumbosacral pain,decreased libido,premenstrual breast swelling,dizziness and tinnitus,emotional depression,flank pain and lower abdominal pain in the combined group were lower than the control group’s,and the differences were statistically significant(P < 0.05);the scores of lumbosacral pain,decreased libido,premenstrual breast swelling and emotional depression in the TCM group were lower than the control group,and the differences were statistically significant(P < 0.05);there was no significant difference in symptom scores between the combined group and the TCM group(P >,0.05).Comparing the scores of TCM syndromes during the three groups,the total effective rates of the combined group,the TCM group and the control group were 86.1%,83.4% and 18.5%.The total effective rate of the combined group and the TCM group were all higher than that of the control group,the differences were statistically significant Significance(P <0.05),the difference between the combination group and the TCM group was not statistically significant(P> 0.05).5 Comparison of psychological indicators of three groups of patientsComparing the psychological stress-related indicators of the three groups,the FPI and SRQ scores of the combined group were lower than that before treatment,and the differences were statistically significant(P <0.05).The FPI scores of the TCM group were lower than before,and the differences were statistically significant(P <0.05).The difference of the control group was not statistically significant before and after treatment(P> 0.05);Comparing diferrence of FPI and SRQ before and after treatment between groups,the diferrence of FPI is not statistically significant between combined group and the other two groups(P> 0.05),while the diferrence of SRQ was statistically significant(P < 0.05),no statistically significant difference were observed in the differences between the TCM group and the control group(P > 0.05).6 Comparison of neuroendocrine indexes of three groups of patientsComparing the neuroendocrine indexes tested by ELISA of the three groups,the levels of ACTH and NE from serum in the combination group and the TCM group were lower than before,and the levels of DA and 5-HT were higher than before,and the differences were all statistically significant(P <0.05).The differences of ACTH,NE,DA,5-HT before and after treatment in the control group were not statistically significant(P> 0.05);comparing the differences of neuroendocrine indicators before and after treatment were compared between groups,the changes of ACTH,NE,DA,and 5-HT in combined group were more obvious than those of the conrtol group,and the differences were statistically significant(P <0.05),the changes of ACTH,NE,and DA in the TCM group were larger than the control group’s,and the differences were statistically significant(P <0.05),the changes of ACTH,DA,and 5-HT in combined group were more obvious than the TCM group’s,and the differences were statistically significant(P <0.05).ConclusionJia Jian Kai Yu Zhong Yu decoction had a significant effect on UI patients with liver stagnation and kidney deficiency,and can reduce the fertility pressure of the patient.The endometrial receptivity indexes and neuroendocrine levels were improved compaired to control group.Then the clinical pregnancy rate and continuous pregnancy rate tend to increase compared with the control group.Jia Jian Kai Yu Zhong Yu decoction combined with group psychological intervention therapy can reduce stress response,and further improve the endometrial receptivity,regulated neuroendocrine levels.Eventually the pregnancy outcomes were significantly improved compared with control group,suggesting that the two therapies can treat both physical and mental,and the effect is reliable,so it is worthy of promotion in the clinic. |
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