Clinical Study Of Bushen Zhuyun Decoction In The Treatment Of Infertility With Luteal Dysfunction Induced By Continuous Stress

Objective:To further study the clinical effect of Bushen Zhuyun recipe in the treatment of luteal dysfunction infertility induced by continuous stress,this study used the method of cohort study,divided into Chinese medicine group(Bushen Zhuyun recipe group)and Western medicine group(letrozole group),combined with life event scale to screen cases,through the observation of life event scale score,clinical pregnancy rate,sex hormone level in basic state,sex hormone level in luteal metaphase,kisspeptin,adrenocorticotropic hormone,cortisol level and the improvement of endometrial receptivity after treatment,to explore the clinical effect of Bushen Zhuyun recipe in the treatment of luteal dysfunction infertility induced by continuous stress,to explore the clinical mechanism of Bushen Zhuyun Decoction in the treatment of luteal dysfunction infertility induced by continuous stress,and to provide scientific basis for its extensive clinical application.Methods:From January 2019 to January 2020,LPD infertility patients were treated in the outpatient department of gynecology and reproduction Department of Jiangsu Hospital of traditional Chinese medicine,with complete clinical data and auxiliary examination indicators.According to the diagnosis standard of infertility and LPD,60 cases were selected according to the life events scale(LES).Using the method of cohort study,60 patients were divided into two groups,western medicine group and traditional Chinese medicine group,30 cases in each group.The traditional Chinese medicine group was treated by Bushen Zhuyun recipe to warm the kidney and promote Yang,regulate the menstruation and promote pregnancy in the luteal phase,after the elimination of the dominant follicles by the combination of B-ultrasonic examination and basic body temperature monitoring.In the western medicine group,from the 5th day of menstrual cycle or retreating bleeding,letrozole was given to promote the excretion,2.5mg/d,for a total of 5 days.Through the B-ultrasound examination of vagina,the follicular development was observed dynamically,and the changes of endometrial thickness and volume were understood,so as to determine the use plan of HMG.When the B-ultrasound examination of vagina found that the follicle diameter ? 18mm,the dominant follicle was mature,and hCG 5000U or 10000U was given on the same day After intramuscular injection,the patients were instructed to go to the same room twice 24 hours and 48 hours after intramuscular injection of hCG.48 hours after intramuscular injection of hCG,vaginal B-ultrasonic examination and monitoring of basal body temperature were used to determine the follicle excretion.Then,didroprogesterone tablets were orally taken,10mg/time,once every 12 hours,for 10 days.All patients were treated for 3 menstrual cycles as a course of treatment,and the therapeutic effect was evaluated after 2 courses of continuous medication.The LES scale score,follicular development,ovulation rate,clinical pregnancy rate,hormone level of luteal metaphase,kisspeptin,ACTH,cortisol and endometrial receptive change were observed before and after treatment.Results:(1)The level of LH in the basic state and the levels of E2,P in the mid-luteal phase improved:the average level of LH in the basic state and the levels of E2,P in the mid-luteal phase improved after treatment in the two groups,P<0.05,with statistical significance.Compared with the western medicine group,there was significant difference between the Chinese medicine group and the western medicine group,and the level of LH in the basic state and the levels of E2,P in the mid-luteal phase in the traditional Chinese medicine group was significantly higher than that in the western medicine group,indicating that both groups could improve the luteal function,but compared with the western medicine group Compared with western medicine,Bushen Zhuyun formula is more effective.(2)The improvement of kisspeptin,ACTH and cortisol in plasma:the level of kisspeptin in the Chinese medicine group increased before and after treatment,while the level of ACTH and cortisol decreased with statistical significance(P<0.05);the level of kisspeptin,ACTH and cortisol in the western medicine group had no significant change before and after treatment,P>0.05,without statistical significance;the curative effect of the Chinese medicine group was significantly better than that of the western medicine group(P<0.05)It is statistically significant that Bushen Zhuyun formula can better improve the state of sustained stress,and thus regulate the luteal function.(3)The endometrial condition under the three-dimensional B-ultrasound of the uterine cavity in the middle luteal phase:the thickness and volume of the endometrium in the middle luteal phase were improved in the Chinese medicine group and the western medicine group after treatment,with a significant difference(P It can increase the thickness and volume of endometrium and improve the receptivity of endometrium.(4)Les scale score:after treatment,Les scale score in the Chinese medicine group was significantly lower than that before treatment(P<0.05),with significant difference;before and after treatment,Les scale score in the western medicine group had no significant change,P>0.05,with no statistical significance;it indicated that Bushen Zhuyun recipe could effectively improve the state of sustained stress.(5)Pregnancy:after treatment,the pregnancy rate of traditional Chinese medicine group was 60%and Western medicine group was 30%with significant difference(P<0.05).(6)Syndrome points of traditional Chinese medicine:after treatment,both groups can reduce syndrome points of traditional Chinese medicine,with significant difference(p<0.05).After treatment,compared with western medicine group,traditional Chinese medicine group is significantly better than western medicine group(p<0.05),which indicates that tonifying kidney and helping pregnancy can better relieve clinical symptoms of patients and improve the quality of life of patients.(7)Comprehensive effect comparison:after treatment,the total effective rate of traditional Chinese medicine group was 96.67%,the total effective rate of Western medicine group was 53.33%,there was significant difference by chi square test(P<0.05),indicating that Bushen Zhuyun formula had significant effect on the treatment of luteal dysfunction infertility induced by continuous stress.(8)There were no adverse reactions or side effects in both groups.Conclusion:Bushen Zhuyun decoction has a better therapeutic effect on the infertility of luteal dysfunction induced by continuous stress,which can effectively improve the accompanying symptoms and improve the quality of life of patients.It can significantly improve the LH level in the basic state and the E2 and P levels in the mid luteal phase,reduce the LES score of the patients,significantly improve the level of kisspeptin in the plasma,reduce the level of ACTH and cortisol in the plasma,improve the endometrial receptivity,improve the induced state of sustained stress,so as to regulate the luteal function,provide a good environment for embryo implantation,and improve the clinical pregnancy rate.Therefore,Bushen Zhuyun formula is an effective method for the treatment of infertility induced by continuous stress,which can be widely used in clinical practice.