The Clinical Observation Of Acupuncture Combined With Letrozole+Gonadotropin On Infertile Women With Polycystic Ovary Syndrome Unsensitive To Clomiphene

ObjectiveTo observe clinical curative effext of Acupuncture combined with Letrozole(LE)+ Gonadotropin(Gn)on Infertile Women with Polycystic Ovary Syndrome(PCOS)unsensitive to Clomiphene,in order to develop new ideas and methods of treatment for PCOS anovulatory infertility,and fully carry theadvantages of acupuncture treatment in female infertility.Methods In this study,175 patients with PCOS androgenosis who were treated in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from December 1,2016 to December 1,2017 were recruited.After three cycles of Ying-35 Kasugao treatment,the serum total was reviewed.A total of 68 patients with normal testosterone levels and unsuccessful treatment of ovulation with CC eventually entered the study.Randomized controlled trials were randomly divided into experimental group(letrozole(LE)+ gonadotropin(Gn)+ acupuncture)in 35 cases and control group(letrozole + gonadotropin)in 33 cases;The group was removed in 5 cases and the control group in 3 cases;the actual two groups were completed in 30 cases.In the experimental group,LE 5 mg qd was administered for 5 days starting on the 5th day of menstrual period.The follicles were monitored by B-ultrasound before the 10 th day of menstruation.Gn(HMG and/or Gonafin)was selected according to the development of follicles,when B-monitoring had 1~ When the diameter of the two dominant follicles is 18 to 25 mm,according to the size of the ovary,intramuscular injection of chorionic gonadotropin(HCG)5 000/10 000 U and guidance of the same room.After 48 h of injection of HCG,B-ultrasound was used to observe endometrial thickness and follicle excretion.If the follicles are excreted,support with the corpus luteum.If pregnancy is not successful,the same menstrual cycle will be used for the next menstrual cycle.At the same time after the end of menstruation with acupuncture treatment(abdominal group and back group alternating),once every 2-3 days,until the next menstrual cramps to stop acupuncture.Control group: The Western medicine ovulationpromoting scheme is the same as the experimental group,but it does not cooperate with acupuncture after the menstrual period.The treatment of both groups was 6 menstrual cycles,and if successful,the treatment was stopped immediately.Observe and compare the serum hormones,sex hormone binding globulin(SHBG)and other indicators before and after treatment in the two groups,and calculate the free testosterone index(FAI=TT*100/SHBG)based on total testosterone(TT)and SHBG,and count the ovulation rate per cycle.Endometrial thickness,Gn dose,and final pregnancy rate.Results1.Two groups of age,pregnancy time,course of disease and other baseline comparison,as well as pre-treatment serological indicators,ultrasound examination and other indicators,the difference was not statistically significant(P> 0.05),indicating that the two groups are comparable.2.The comparison of FSH,LH and LH / FSH between the two groups showed no significant difference(P> 0.05)between the experimental group and the control group before and after treatment.3.The comparison of TT,SHBG and FAI between the two groups showed no significant difference(P> 0.05)between the experimental group and the control group before and after treatment.There were no significant differences in SHBG and FAI between the experimental group and the control group before treatment(P> 0.05).SHBG in both groups was significantly higher than that before treatment,and the experimental group was higher than the control group(P <0.05)P <0.01).FAI in both groups decreased after treatment,and the experimental group was lower than the control group,the difference was statistically significant(P <0.05).4.The ovulation rate,follicular size and intima thickness in the two groups were significantly higher than those in the control group(P <0.01).There was no significant difference in the follicle size between the experimental group and the control group before and after treatment(P> 0.05).However,the differences in the size of follicles between the two groups were further compared(P <0.01).After treatment,the size of follicles in both groups were significantly increased compared with those before treatment(all P <0.01).There was no significant difference between the experimental group and the control group in the thickness of endometrium before treatment(P> 0.05).The intima of the two groups were thicker than those before treatment,the difference was statistically significant(P <0.01),the experimental group was better than the control group(P <0.01).5.Comparison of two groups of Gn dosage: Compared with the control group,the experimental group Gn dose per cycle is less than the control group,the difference was statistically significant(P <0.05).6.Comparison of pregnancy rates between the two groups: pregnancy rate in the experimental group than in the control group,the difference was statistically significant(P <0.05).7.Comparison of the efficacy of the two groups: The efficacy of the experimental group was better than that of the control group,and there was a significant difference in the distribution of the efficacy between the two groups(P<0.01).Conclusion1.SHBG elevation and FAI decrease after treatment in both groups,and the experimental group achieved higher SHBG and lower FAI levels after acupuncture treatment,suggesting that the free testosterone levels decreased after treatment in the two groups,and the experimental group cooperated with the needle The effect of reducing free testosterone after thorn treatment is better.2.There was no significant difference in TT levels before and after treatment.The development of follicles may be more related to FAI,suggesting that it is more reliable to calculate FAI to evaluate the excess of androgen than to simply measure TT concentration by measuring TT and SHBG.3.Both groups can increase the ovulation rate and clinical pregnancy rate of the patients and promote the growth of the endometrium,but the effect of acupuncture combined with LE+Gn group is more significant.Both groups can promote follicular growth,and the efficacy of the experimental group is more significant.4.After the acupuncture treatment,the experimental group increased the reactivity of the ovaries to Gn,so the use of Gn was less than that of using Western medicine alone to reduce ovulation,which can reduce the occurrence of adverse reactions to ovulation induction.