The Preliminary Research Of Bionic Electrical Stimulation Treatment In Decreasing Ovarian Reserve

Premature ovarian failure(POF) is also known as premature menopause that is common among women under the age of40characterized by reduced serum gonadal hormone and low estrogen levels.Clinical manifestations a series of symptoms of primary or secondary amenorrhea, infertility, hypaphrodisia, menopausal syndrome and so on, have most severe effect on women’s fertility and quality of life. But the pathogenesis and treatment research has not yet been a breakthrough at present, and its incidence is rising year by year in recent years and younger trend, has become a thorny problem of obstetrics and gynecology. Decreasing ovarian reserve by actually early ovarian function failure status, the existing research shows that part of patients can be restored even a successful pregnancy after treatment.It is of an important clinical significance that early detection and intervention, and treatment of decreasing ovarian reserve.There are many indicators for evaluation of ovarian reserve capacity, such as age, serum basal follicle-stimulating hormone (FSH), luteiniizing hormone (LH) ratio, clomiphene stimulation test, gonadotropin releasing hormone (GnRH)-a stimulation test, based ovarian volume and ovarian the sinus follicle number and so on, but for the ability to predict these indicators are now more controversy. In recent years, systematic research of premature ovarian failure with transvaginal color ultrasound by some scholars, Research results show that the change of ovarian blood flow should be the important factors that affect ovarian function.But the object of study only for premature ovary failure patients and healthy people, not in the transitional period between the two-decreasing ovarian reserve in patients with research.The first part of this article aims to through the comparison research on the childbearing age women of premature ovary failure, decreasing ovarian reserve and normal ovarian reserve function,exploration serum hormone FSH, E2, LH, uterine size, endometrial thickness, sinus follicle counting, ovarian volume and ovarian arterial blood flow mechanics parameters value for ovarian reserve function. The relationship between situation of ovarian blood supply and ovarian reserve is on a priority watch listModern medical treatment for decreasing ovarian reserve and premature ovary failure is mainly induced by hormone replacement therapy, ovulation induction, donor eggs and immunosuppressive application, curative effect is better, But there is big limitation in the choice of therapies, relapse after drug withdrawal, increased endometrial adenocarcinoma and incidence of breast cancer such as side effects,long-term use of estrogen may cause liver and kidney dysfunction at the same time and increase the incidence of cardiovascular events.The pelvic floor rehabilitation therapy (including biofeedback and pelvic floor electrical stimulation, pelvic floor muscle exercise, etc.)is introduced into China become the another subject of obstetrics and gynecological after tumor and endoscopic disciplines in recent years. Pelvic floor imitation bioelectricity stimulus refers to the electrodes placed on the perineum through different frequency of the current stimulus, strengthen the pelvic floor muscles, stimulate your pelvic floor muscles at the mercy of the nerve, the nerve reflex to strengthen pelvic floor muscle contraction. Also can through the prevention of muscle atrophy, neural function recovery. Imitation bioelectricity stimulation, on the other hand, can make the cell biological membrane and the surrounding molecules in resonance, increased energy, and promote cell metabolism, accelerate the velocity of blood, flow rate increases. Mechanism based on the above, we think the copy around electrical stimulation treatment can improve the ovarian and ovarian transfusion institution, to achieve the purpose of improve ovarian function.The second part of this paper on the basis study of the first part, aims to explore short-term therapeutic effects of bioelectricity stimulation technology of pelvic floor rehabilitation technology for patients of decreasing ovarian reserve or premature ovarian failure.Chapter1Research of transvaginal color doppler characteristics and ovarian reserve on reproductive age womenContents and MethodsRetrospective analysis the transvaginal color Doppler characteristics, serum FSH levels and ovarian reserve in different ovarian reserve status reproductive age women to find an economical, convenient and sensitive indicator in the early detection of decreasing ovarian reserve patients. A retrospective analysis of91menstrual disorders patients from January2011to December2012in our hospital.According to the ovarian reserve status,91observed objects were divided into premature ovarian failure(POF) group(33cases), decreasing ovarian reserve(DOR) group(32cases),and normal ovarian reserve(NOR) group(26cases),corresponding to A、B、C three groups. The uterus size, endometrial thickness, both ovarian average volumes (OVFs), antral follicle counts (AFCs), ovarian stromal artery peak systolic velocity(PSV), peak systolic blood flow velocity (psBFV) and end-diastolic blood flow velocity (edBFV) ratio (S/D) of ovarian stromal artery, ovarian artery pulsatility index(PI), resistance index(RI) were measured with transvaginal color Doppler. Meanwhile,serum estradiol hormone(E2), follicle-stimulating hormone(FSH) and luteinizing hormone(LH) levels were also detected in these patients.Results1) Compared with DOR ang NOR groups,the uterine volume,ovarian average volume were significantly smaller (P<0.01),endometrium was significantly thinner(P<0.01); the AFCs,PI,RI and PSV with a significant difference(P<0.05) in POF group.2) Size of uterine volume, endometrial thickness, OVFs,AFCs,ovarian PI, ovarian stromal artery PSV were negatively correlated to FSH level (r=-0.415, p=0.000; r=-0.552, p=0.000; r=-0.556, p=0.000; r=-0.585, p=0.000; r=-0.402, p=0.006; r=-0.527, p=0.000)3) The ovarian artery RI was positively correlated with FSH in three group patients (r=0.267, p=0.011)4) The psBFV and edBFV ratio S/D was not statistically significant difference (P>0.05) in three group patients.5) The uterine volume and endometrial were not statistically significant difference between DOR group,and NOR group (p=1.00, p=1.00), but the mean uterine volume of DOS group (100.37+/-56.86(centimeter-squared)) is less than the NOR group (105.18+49.39(centimeter-squared)), and endometrium of DOR group (5.52+1.75(cm)) is thinner than the NOR group (6.35+/-1.74(cm)).6) Compared with DOR and NOR group the ovarian average volume and the AFCs were significantly smaller (p=0.011,p=0.000), the ovarian average volume of DOR group (5.41+/-2.34(cm2) is less than the NOR group (7.59+3.44(cm2)), at the same time, the AFCs of DOR group (3.68+±3.16) is less than the NOR group (7.04±3.90).SummaryTransvaginal color Doppler ultrasound has the advantages of accurate, convenient, non-invasive and repeatable,witch is one of the common means of inspection of Department of Obstetrics and Gynecology, and can be used as a clinical evaluation of the ovarian reserve function by means of uterine size, endometrial thickness, ovarian volume, antral follicle count and ovarian stromal blood flow. But the ovarian artery PI, RI, PSV did not change significantly between DOR group and NOR group. Therefore, the images of ovarian artery in decreasing ovarian reserve phase can be used as a reference, but the parameters change is not obvious, can not be used as a clinical diagnosis basis. Ovarian average volumes (OVFs) and antral follicle counts (AFCs) were the sensitive index to monitor ovarian reserve function by color doppler ultrasound., for early detection of ovarian reserve function change and timely treatment in patients with decreasing ovarian reserve has important significance and in ovarian reserve decline phase,it has been obvious difference with normal ovarian reserve function phase. It provides a simple objective evaluation for patients with DOR or POF pretherapy and post-treatment.Chapter2The preliminary research of bionic electrical stimulation treatment in decreasing ovarian reserve patients Contents and MethodsTo observed the short-term treatment effect with bionic electrical stimulation in decreasing ovarian reserve patients. Retrospective analysis of65patients’ clinical medical records,from January2007to October2012,with decreasing ovarian reserve,or premature ovarian failure in our hospital. According to the treatment plans, these patients were divided into A, B, C,three groups. A Group (23cases):estrogen and progesterone sequential treatment group; B group (22cases):bionic electrical stimulation treatment group; C group (20cases):bionic electrical stimulation+sequential estrogen and progesterone treatment group. The treatment results in three groups were compared with the following indicators:clinical symptoms and signs score before and after the treatment, transvaginal color Doppler parameters, serum estradiol(E2), follicle-stimulating hormone(FSH) and luteinizing hormone(LH) levels of the patients’.Results1) Transvaginal color Doppler parameters and serum sex hormone levels after treatment in each group showed no significant difference(p>0.05).2) In A group, transvaginal color Doppler parameters of endometrial thickness, ovarian average volume(OAV) and ovarian artery pulsatility index(PI) showed significant differences before and after treatment (p=0.002, p=0.044, p=0.015)3) In B group, transvaginal color Doppler parameters of endometrial thickness,OAV,ovarian artery resistive index(RI) and stroma arterial peak systolic velocity(PSV) were significant differences before and after treatment (p=0.000, p=0.006, p=0.017, p=0.003);4) In group C, transvaginal color Doppler parameters of endometrial thickness,OAV,antral follicle counts(AFCs), ovarian stromal artery peak systolic blood flow velocity (psBFV) and end-diastolic blood flow velocity (edBFV) ratio (S/D),PI, RI, PSV were found in significant differences (p=0.001, p=0.004, p=0.00, p=0.031, p=0.027, p=0.036, p=0.00);5) In A group, serum FSH,E2levels also showed significant differences (p=0.04, p=0.018).6) There were significant differences in serum FSH level and clinical symptoms and signs score (p=0.00, p=0.00)In group B.7) In group C, Significant differences were found in serum FSH, E2llevel and clinical symptoms and signs score (p=0.00, p=0.31, p=0.00).SummaryTo reduce the value of FSH, short-term efficacy of bionic electrical stimulation treatment versus the estrogen progestogen sequential therapy were much similar, It can improve the clinical symptoms and signs and rise value of E2, while combined with the sequential estrogen and progesterone therapy effect is better, worthy of clinical promotion. Bionic electrical stimulation treatment provides us with a convenient, safe, noninvasive,non-toxic side effects, compliance treatment of new ideas, new directions. For patients with fertility requirements can be recommended the use of biomimetic electrical stimulation treatment for guidance of reproduction treatment at the same time, and for patients without fertility requirements recommended the use of sequential estrogen and progesterone combined biomimetic electrical stimulation therapy, to achieve the optimal effect of treatment. The long-term efficacy of bionic electrical stimulation still need follow-up observation due to the short time of this study, and the best treatment cycles, the optimal range of the intensity, the best time of the treatment still need further discussion.Conclusion1、Ovarian artery image can be used as the reference for the period of decreasing ovarian reserve, but the parameter change is not obvious, and can not be used as a clinical diagnosis basis.2、Ovarian average volumes (OVFs) and antral follicle counts (AFCs) were the sensitive index to monitor ovarian reserve function by color doppler ultrasound., in ovarian reserve decline phase,it has been obvious difference with normal ovarian reserve function phase.3、Change of color Doppler ultrasound imaging has important significance for early detection of ovarian reserve function change and timely treatment in patients with decreasing ovarian reserve. It provides a simple objective evaluation for patients with DOR or POF pretherapy and post-treatment.4、In terms of lower levels of FSH, short-term efficacy of bionic electrical stimulation treatment versus the estrogen progestogen sequential therapy were much similar, while combined with the sequential estrogen and progesterone the therapy effect is better, in terms of enhance the level of E2, improve ovarian blood supply and improve the patients’ clinical symptoms and signs, worthy of clinical promotion.5、For patients with fertility requirements can be recommended the use of biomimetic electrical stimulation treatment for guidance of reproduction treatment at the same time, and for patients without fertility requirements recommended the use of sequential estrogen and progesterone combined biomimetic electrical stimulation therapy, to achieve the optimal effect of treatment.6、The long-term efficacy of bionic electrical stimulation still need follow-up observation due to the short time of this study, and the best treatment cycles, the optimal range of the intensity, the best time of the treatment still need further discussion.