Ding Kundan's Intervention Mechanism On Infertility Caused By Ovulation Dysfunction In Polycystic Ovary Syndrome

Objective:1.Clinical part:By observing the effects of Ding Kundan on cycle ovulation rate,cycle pregnancy rate,cycle cancellation rate,cumulative pregnancy rate,total amount of Gn,duration of Gn,endometrial thickness,the occurring rate of ovarian hyperstimulation syndrome and luteinized unruptured follicle syndrome on PCOS patients with dysfunctional ovulatory infertility,to evaluate the clinical effect and safety of Ding Kundan's promoting ovulation effect on PCOS infertility patients,and to provide ideas and methods for traditional Chinese medicine assisted reproductive treatment.2.Experiment part:By observing the effects of Ding Kundan on ovarian morphology,sex hormone level,the expression of TGF-?1,CTGF and AR in PCOS model rats,the mechanism of Ding Kundan in the treatment of PCOS ovulatory dysfunction is discussed.Methods:1.Clinical part:This study selected 120 PCOS infertility patients treated with ovulation induction in reproductive medicine clinic,affiliated hospital of Nanjing University of TCM and Changzhou Hospital TCM and Changzhou Hospital TCM during 2015.10.01~2018.01.18.They were randomly divided into two groups:Group A(CC+Gn+HCG)and Group B(CC+Gn+Ding Kundan).These results in each group were observed and compared including cycle ovulation rate,cycle pregnancy rate,cycle cancellation rate,cumulative pregnancy rate,total amount of Gn,duration of Gn,endometrial thickness,the occurring rate of LUFS and OHSS.2.Experiment part:The PCOS model rats induced by DHEA were intervened with high,medium and low dose of Ding Kundan(4.5,2.25,1.125g/kg);ELISA,HE staining,immunohistochemistry,RT-PCR and Western blot were used to detect serum hormone levels,ovarian morphology,mRNA and protein expression of TGF-?1,CTGF and AR in each group of rats.Results:1.Clinical part:Group A had lower cumulative pregnancy rate,cycle pregnancy rate,cycle ovulation rate and endometrial thickness,compared with Group B,the difference was statistically significant(P<0.05).However,Group A had higher total amount of Gn and duration of Gn,cycle cancellation rate,compared with Group B,the difference was statistically significant(P<0.05).In this study,no case of LUFS or OHSS was found in all patients.2.Experiment part:Compared with model group Ding Kundan high,medium and low dose group of E2,LH and T were decreased,while FSH was increased.And the differences were statistically significant.Moreover,ovarian follicles were distributed at all levels,and more corpora luteum could be seen.Protein expression and mRNA of TGF-?1,CTGF and AR were decreased,and the differences were statistically significant.Conclusion:1.Ding Kundan can improve cycle ovulation rate of PCOS infertility patients,increase endometrial thickness,thus increase cycle pregnancy rate and cumulative pregnancy rate,reduce the abortion rate,improve the pregnancy outcome.2.Ding Kundan can reduce cycle cancellation rate of PCOS infertility patients,reduce total amount of Gn and duration of Gn,and avoid LUFS or OHSS,so it has high clinical safety.3.Ding Kundan has the effect of promoting ovulation on PCOS infertility patients,and CC+Gn+Ding Kundan can elevate the pregnancy rate.4.DHEA induced PCOS rat model is an ideal animal model to study PCOS ovulation disorder.5.Ding Kundan shows significantly therapeutic efficacy on PCOS rats,and its possible mechanism is related to regulating expression levels of TGF-?1,CTGF and AR in ovarian tissue.