| Chapter 1 Acupuncture treatment improves pregnancy outcome of in vitro fertilization and embryo transfer:a meta analysis studyObjective:To explore the effectiveness of acupuncture as an auxiliary means of IVF-ET to improve pregnancy outcome and the reasons for different research conclusions.Methods:A systematic review and meta-analysis was conducted on the clinical randomized controlled trials(RCT s)published before February 2020,in which acupuncture therapy was used as an auxiliary means of in vitro fertilization and embryo transfer to improve pregnancy outcome.The outcome indicators are clinical pregnancy rate(CPR)and live birth rate(LBR).The literature form includes Chinese literature and English literature.English literature is searched by English databases such as pubmed,web of science,Cochrane.Chinese literature is searched by Chinese database such as China knowledge Network,Wanfang and VIP.The quality of included literature is evaluated by Cochrane manual.The data of included literature is merged and analyzed by Revman software.The results of meta analysis are displayed in the form of forest map.The reasons for heterogeneity of evaluation results are analyzed by subgroup.Funnel chart and eggertest were used to evaluate the publication bias of the literature.Results:A total of 34 studies were selected,including 5817 women in this meta analysis.There was a significant statistical difference in CPR between the acupuncture group and the control group(N/n=34/5817,RR=1.21,95%CI[1.09,1.35],Z=3.48,P=0.0005),while there was no significant statistical difference in the live birth rate of the acupuncture treatment group and the control group(N/n=13/3211,RR=1.18,95%CI[0.96,1.46],Z=0.38,P=0.12).However,there is a large heterogeneity in both the clinical pregnancy rate(I2=55%)and the live birth rate(I2=59%).The subgroup analysis of clinical pregnancy rate showed that the causes of heterogeneity were related to acupoint selection,acupuncture times,acupuncture duration,acupuncture timing,acupuncture form,the CPR of control group,number of cycles and so on.The subgroup analysis of the live birth rate showed that the cause of heterogeneity was related to acupuncture times and the timing of acupuncture.Conclusion:Acupuncture treatment can significantly increase the clinical pregnancy rate of patients receiving IVF-ET,but can not significantly increase the live birth rate of patients,but there is great heterogeneity in both results.Among them,intervention factors,including acupoint selecti-on and acupuncture timing,have a significant impact on the heterogeneity of results.Therefore,it is necessary to further formulate more reasonable,standardized and effect-ive intervention measures in the future.And conducting more RCTs and evidence-based medicine research to reveal the truth of this problem.Chapter 2 Effect of "Biao-Ben acupoint combination"acupuncture on pregnancy outcome of patients with repeated transplantation failureObjective:To explore the clinical efficacy,safety and possible mechanism of "Biao-Ben acupoint combination"acupuncture in the treatment of patients with repeated implantation failure in IVF-ET.Methods:From December 2018 to December 2019,100 patients with repeated transplant failure in Edwards Gynecology Clinic in Wuhan were randomly divided into control group and experimental group.The control group was treated with routine hormone replacement therapy,and the experimental group was treated with acupuncture with "Biao-Ben acupoint combination" acupuncture.The clinical pregnancy rate(CPR)and live birth rate(LBR)were used to evaluate the clinical efficacy of acupuncture with "Biao-Ben acupoint combination" acupuncture to improve the clinical efficacy of RIF patients.The safety of acupuncture treatment with"Biao-Ben acupoint combination" acupuncture was evaluated by the incidence of adverse reactions.The contents of cytokines such as serum interleukin-10(IL-10)and tumor necrosis factor-?(TNF-?)were used,and the thickness and morphology of endometrium were measured,and emotional state indexes such as anxiety and depression self-rating scale were measured to explore the possible mechanism of "Biao-Ben acupoint combination" acupuncture in the in the treatment of patients with repeated implantation failure in IVF-ET.Results:After treatment,the clinical pregnancy rate and live birth rate in the test group were significantly higher than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups during treatment(P>0.05).There was no difference in the content of serum cytokines such as IL-10 and TNF-?,the thickness and shape of endometrium and the scores of self-rating anxiety scale and depression scale between the two groups before treatment,but there was comparability between the two groups.After treatment,the above-mentioned indexes in the two groups were significantly improved as compared with those before treatment(P<0.05),and the above-mentioned indexes in the experimental group were more significantly improved than those in the control group after treatment,and there was significant difference between the two groups(P<0.05).Conclusion:“Biao-Ben acupoint combination”acupuncture can significantly improve the clinical pregnancy rate,live birth rate and other pregnancy outcome indexes of patients with RIF,and there is no obvious adverse reaction.Its mechanism may be related to the regulation of serum cytokines such as IL-10 and TNF-?,the improvement of endometrial thickness and shape,and the improvement of anxiety and depression in patients with repeated implantation failure.Chapter 3 Effect of "Biao-Ben acupoint combination" acupun-cture on the expression of cytokines in rats of implantation failureObjective:To explore the effect of "Biao-Ben acupoint comb ination" acupuncture on the expression of IL-10,TNF-?,IL-4 and IFN-? in rats with embryo implantation failure.Methods:40 early pregnant rats were randomly divided into Control group(C),Model group(M),Progesterone group(P)and acupuncture group with "Biao-Ben acupoint combination"Acupuncture(A),with 10 rats in each group.The model was made by subcutaneous injection of mifepristone sesame oil solution in group M,group P and group P was treated with subcutaneous injection of proggroup A.From the day of modeling,group A was given acupuncture treatment with"Biao-Ben acupoint combination" and esterone sesame oil solution.The rats in each group were killed on the 8th day after cervical vertebra dislocation.The number of embryo implantation in each group was observed and the contents of IL-10,IL-4,IFN-? and TNF-? in serum were detected by enzyme linked immunosorbent assay(ELISA).The protein expressions of IL-10,IL-4,IFN-? and TNF-? in endometrium of rats in each group were detected by Western blot.Real-time fluorescence quantitative polymerase chain reaction(Rt-PCR)was used to detect the mRNA expression of IL-10,IL-4,IFN-?and TNF-? in endometrium of rats in each group.Results:There were significant differences in the above indexes among all groups(P<0.05).The results showed that compared with group C,the number of embryo implantation in group M,group A and group P decreased significantly(P<0.05),the contents of IL-4 and IL-10 in serum decreased significantly(P<0.05),and the protein and mRNA expression of IL-4,IL-10 and mRNA in endometrium decreased significantly(P<0.05).However,the contents of IFN-? and TNF-? in serum,the protein and mRNA of IFN-? and TNF-?in endometrium were significantly increased(P<0.05).Compared with group M,the number of embryo implantation in group A and group P increased significantly(P<0.05),the contents of IL-4 and IL-10 in serum increased significantly(P<0.05),the expression of IL-4,IL-10 and mRNA in endometrium increased significantly(P<0.05),while the contents of IFN-Y and TNF-? in serum decreased significantly(P<0.05),and the protein and mRNA of IFN-?and TNF-? in endometrium decreased significantly(P<0.05).Compared with group P,there was no significant difference in the number of embryo implantation,the content of serum IL-10,IL-4,IFN-?,TNF-? and the expression of IL-10,IL-4,IFN-?,TNF-? protein and mRNA in endometrium in group A(P>0.05).Conclusion:“Biao-Ben acupoint combination”acupuncture can significantly increase the number of embryo implantation in rats with embryo implantation failure,and its mechanism may be related to the up-regulation of IL-4,IL-10 and down-regulation of the expression of IFN-? and TNF-? in serum and endometrium,and the restoration of the balance between the expression of Thl and Th2 cytokines. |
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