Effect Of Yangluan Prescription Combined With DHEA And CoQ10 On IVF Pregnancy Outcome Of Patients With Decreased Ovarian Reserve Function Due To Kidney Yang Deficiency

Objective:To investigate the effects of Yangluan prescription combined with Dehydroepiandrosterone（DHEA）and Coenzyme Q10（Co Q10）on patients with decreased ovarian reserve function due to kidney yang deficiency,and observe their TCM syndrome score,ovarian reserve related indicators,growth differentiation factor 9（GDF-9）,bone morphogenetic protein 15（BMP-15）,controlled ovarian hyperstimulation related indicators,IVF laboratory result and clinical outcome,and explore the effect of Yangluan prescription combined with DHEA and Co Q10 on ovrian reserve,ovum quality,and pregnancy outcome of patients with decreased ovrian reserve function,and to prelimarily explore the mechanism of action.Methods:The study collected 180 patients with decreased ovarian reserve function due to kidney yang deficiency who met the inclusion criteria.They were divided into three groups using the random number meter method:60 cases in the Yangluan prescription group,60 cases in the DHEA combined with Co Q10group,and 60 cases in the Chinese and Western medicine combined group.The Yangluan prescription group was given Yangluan prescription granule,while the DHEA combined with Co Q10 group was given DHEA and Co Q10,and the Chinese and Western medicine combined group had both treatments performed simultaneously.Three menstrual cycles were pretreated and IVF was performed using an antagonist fixation regimen.Observe the TCM syndrome score,AFC,basic endocrine,AMH,GDF-9 and BMP-15 of follicular fluid,E₂,LH,P levels,and endometrium thickness on h CG-day,the dosage and duration of Gn,IVF laboratory result and clinical outcome,and the mechanism is discussed.Results:（1）TCM syndrome scores:Both the Yangluan prescription group and the Chinese and Western medicine combined group can improve the symptoms of kidney yang deficiency in patients（P<0.05）,but there is little difference before and after treatment in the DHEA combined with Co Q10 group（P>0.05）;the Chinese and Western medicine combined group is improving the curative effect of TCM syndromes is better than that of simple the Yangluan prescription group and DHEA combined with Co Q10 group（P<0.05）;the effect of the Yangluan prescription group is better than that of DHEA combined with Co Q10group（P<0.05）.（2）Basic endocrine and AMH:the Chinese and Western medicine combined group can improve the level of AMH（P=0.010）,the other two programs slightly improve but the difference is not big（P>0.05）;the basic FSH value,basic FSH/LH ratio,E₂value,T value after treatment of the three groups of treatment programs compared with before treatment,there were slight improvements（P>0.05）and there was little difference between the three groups（P>0.05）.（3）Antral follicle count（AFC）:The three groups of treatment programs can significantly increase the AFC（P<0.01）.The Chinese and Western medicine combined group is better than the effect of increasing the AFC in the Yangluan prescription group and the DHEA combined with Co Q10 group（P<0.01）.The Chinese and Western medicine combined group and the DHEA combined with Co Q10 group,there was little difference（P>0.05）.（4）Levels of E₂,LH,P and endometrium thickness on h CG-day:The Chinese and Western medicine combined group is better than DHEA combined with Co Q10 in improving E₂level on h CG-day（P<0.05）,and there is little difference in improving LH,P levels and intima thickness on h CG-day（P>0.05）;There is little difference between the Yangluan prescription group and the DHEA combined coenzyme Q10 group,and the Chinese and Western medicine combined group（P>0.05）.（5）The dosage and duration of Gn:the Chinese and Western medicine combined group is better than DHEA combined with Co Q10 group in improving the dosage of Gn（P<0.05）,and there is little difference in the effect of improving Gn days（P>0.05）;there is a little difference in the effect of the Yangluan prescription group and the Chinese and Western medicine combined group or DHEA combined with Co Q10group（P>0.05）.（6）GDF-9,BMP-15 in follicular fluid:The level of GDF-9 in the Chinese and Western medicine combined group was higher than that in the DHEA combined coenzyme Q10 group（P<0.05）,and the level of GDF-9 in the Yangluan prescription group and the DHEA combined coenzyme Q10 group,and the Chinese and Western medicine combined group were comparable to that of the GDF-9group（P>0.05）.There is little difference in BMP-15 levels between groups（P>0.05）.（7）IVF outcome:The Chinese and Western medicine combined group is better than the Yangluan prescription group or DHEA combined with Co Q10 group in improving the number of retrieved oocytes（P<0.05）,MⅡoocyte rate,2PN fertilization rate,D3 optimal embryo rate,cycle cancellation rate,biochemical pregnancy rate,clinical pregnancy rate,embryo implantation rate and early abortion rate have little difference in curative effect（P>0.05）;the effect of the Yangluan prescription or DHEA combined with Co Q10is equivalent（P>0.05）.Conclusion:1.The combination of Yangluan prescription with DHEA and Co Q10 can improve the TCM syndromes of patients with decreased ovarian reserve function of kidney yang deficiency and provide ideas and basis for TCM diagnosis and treatment.2.The combination of Yangluan prescription with DHEA and Co Q10 can increase the level of AFC,AMH,and the curative effect is better than that of the Yangluan prescription or DHEA and Co Q10 alone,providing effective treatment options for patients.3.By inference mechanism research,the combination of Yangluan prescription with DHEA and Co Q10 may increase the AMH,increase AFC in the early follicular phase,regulate the expression of the secretory factor GDF-9 in oocytes,and affect the quality of oocytes,thereby improving the outcome of patients with assisted pregnancy and providing a theoretical basis for clinical practice.