Fertility Research

RESEARCH INTO CHINESE HERBAL MEDICINE AND OVARIAN DYSFUNCTION

(1) The effectiveness of a Chinese formula called “Tian gui fang' in comparison with metformin was tested on patients with polycystic ovarian syndrome [PCOS].  The patients were divided into two groups and either Tian gui fang or metformin was administered for three months.  After treatment, 4 out of the 8 patients on metformin had restoration of menstrual cyclicity, and two of them had a double phase BBT.  The testosterone levels had decreased.  No other measures changed.  In the group that received the Chinese medicine, 6 patients out of 8 had a restored cycle as well as a double phase BBT.  Testosterone and the body mass index (BMI) decreased significantly.  The authors conclude that both therapies can induce ovulation but that Chinese herbal medicine has a higher efficacy in restoring ovulation and normal BBT measures.

Hou J, Yu J, Wei M. “[Study on treatment of hyperandrogenism and hyperinsulinism in polycystic ovary syndrome with chinese herbal formula “tian gui fang]'. Zhongguo Zhong Xi Jie he Za Zhi. 2000; 20 (8):589.

(2) The effectiveness of a Chinese herbal formular was tested on patients with high LH levels due to polycystic ovary syndrome.  Eight weeks of treatment with Chinese herbal medicine significantly reduced plasma LH.

Ushiroyama T, Ikeda A, Sakai M, Hosotani T, Suzuki Y, Tsubokura S, Ueki M. “Effects of unkei-to, an herbal medicine, on endocrine function and ovulation in women with high basal levels of luteinizing hormone secretion.' J Reprod Med. 2001 May; 46(5):451-6.

(3) In Japan, a Chinese herbal formulary was tested on patients with polycystic ovarian disease [PCOD] to find an effective treatment without side effects that could be used instead of clomiphene citrate or gonadotropin therapy.  After a course of treatment, the FSH/ LH ratio had significantly decreased, and the ovulatory rate was 70.6%.  Serum testosterone did not change during treatment.  The authors conclude that the Chinese formula may be useful for the treatment of anovulation in PCOS patients.

Sakai A, Kondo Z, Kamei K, Izumi S, Sumi K. “Induction of ovulation by Sairei-to for polycystic ovary syndrome patients.' Endocr J. 1999 Feb; 46(1):217-20.

(4) A case study from Taiwan discusses the effective treatment of premature ovarian failure using Chinese herbal medicine.  Clomiphene citrate therapy over 8 months had not changed the FSH and LH levels from the postmenopausal range.  A course of 4 months treatment with Chinese herbal medicine based on Zuo gui wan induced an ovulation, and the patient fell pregnant.  The authors conclude that Chinese herbal medicine can restore ovarian function effectively and promptly andoffers another option for treating infertility in patients withpremature ovarian failure.

Chao SL, Huang LW, Yen HR. “Pregnancy in premature ovarianfailure after therapy using Chinese herbal medicine. A case study.'Chang Gung Medical Journal 2003 Jun; 26(6): 449-52.

(5) At Shanghai medical university, the effectiveness of Chinese medical herbs from the category of yin supplementing weretested on 35 patients with polycystic anovulation.  The patients were treated for three months, and a variety of tests were carried out before and after the course of treatment.  Testosterone levels lowered significantly.  In 59.7% of patients and a regular cycle was restablished.  41.2% of women became pregnant.  The authors conclude that Kidney Yin nourishing herbs could provide a good microcircumstance forovarian follicular growth, which results in ovulation and pregnancy.

Zhou LR, Yu J. [Clinical observation on treatment ofhyperinsulinemia and hyperandrogenism anovulatory patient withreplenishing kidney-yin drugs] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1996Sep; 16(9): 515-8.

(6) Hachimijiogan, a Chinese herbal formulary (Liu wei dihuang wan + rou gui, yin yang huo, huang qi), was shown in one study to benefit female infertility due to pituitary dysfunction.  Two infertile women (one with and one without a pituitary adenoma) who were resistant to medical treatment, were given Hachimijiogan which subsequently reduced the serum prolactin level, and resulted in a normal ovulatory cycle and pregnancy, without side effects.

Usuki S; Kubota S; Usuki Y. Treatment with hachimijiogan, anon-ergot Chinese herbal medicine, in two hyperprolactinemic infertilewomen'. Acta Obstet Gynecol Scand 1989, 68 (5) p475-8.

(7) In another study looking at pituitary dysfunction causinginfertility, 27 women were given the same formulae as discussed above.  6 of the women had amenorrhea.  In 15 patients, the prolactin levels dropped to a healthy range, and remained low 6 months after the course of treatment.  Four patients with amenorrhea ovulated.  Eleven patients conceived and delivered a healthy baby.  In three women, the prolactinlevel did not lower.  The authors conclude that a modification of Liuwei di huang wan can be a safe and effective treatment for hyperprolactinemic women.

Usuki S, Usuki Y. “Hachimijiogan treatment is effective in themanagement of infertile women with hyperprolactaemia orbromocriptine-resistant hyperprolactaemia.' American Journal of ChineseMedicine 1989; 17 (3-4):225-41.

(8) In one study of female infertility, 53 patients with luteal phase defect (LPD) were treated with different Chinese medicinal herbs at different phases of their menstrual cycle.  The patients were treated for three menstrual cycles and there was significant improvement in the luteal phase of endometrium, and a tendency for normalisation of the wave forms and its amplitude after the treatment.  The findings suggested that Chinese herbal medicines are capable of replenishing the Kidney and regulate the hypothalamus-pituitary-ovarian axis and thus improve the luteal function.  Among the 53 cases, 22 (41.5%) conceived but 68.18% of them required other measures to preserve the pregnancy.

Zhang HY; Yu XZ; Wang GL Preliminary report of the treatment ofluteal phase defect by replenishing kidney. An analysis of 53 cases.Zhongguo Zhong Xi Yi Jie He Za zhi Aug 1992, 12 (8) p473-4, 452-3.

(9) Women with normal menstrual cycles but low basal body temperature and progesterone levels (luteal insufficiency) were effectively treated with a Chinese herbal formulary called Dang guishao yao tang, with no observed side effects.

Usuki S, Higa TN, Soreya K. “The improvement of lutealinsufficiency in fecund women by tokishakuyakusan treatment'. Am J ChinMed. 2002; 30(2-3):327-38.

RESEARCH INTO ACUPUNCTURE AND OVULATORY DYSFUNCTION

(1) A study involving 45 infertile women suffering from oligo-amenorrhea (27 cases) or luteal insufficiency (18 cases) was carried out.  Following a complete gynaecologic-endocrinologic examination, the women were treated with auricular acupuncture.  Results were compared to those of 45 women who received hormone treatment.  Both groups were matched for age, duration of infertility, body mass index, previous pregnancies, menstrual cycle and tubal patency.  Women treated with acupuncture had 22 pregnancies whereas women treated with hormones had 20 pregnancies.  It was also noted that side-effects were observed only during hormone treatment, and various disorders of the autonomic nervous system normalized during acupuncture. The study concluded that "auricular acupuncture seems to offer a valuable alternative therapy for female infertility due to hormone disorder"; being more effective than hormone therapy and with no side effects.  Auricular acupuncture in the treatment of female infertility.

Gerhard I; Postneek F Department for Gynecological Endocrinology and Reproduction, Women's Hospital, University of Heidelberg, Germany. Gynaecol Endocrinol (ENGLAND) Sep 1992,6 (3) p171.

(2) Acupuncture was used in 15 women with oligo-amenorrhea and 12 women with luteal body insufficiency who had come for hormone consultation because of infertility.  In both groups the subsequent incidence of pregnancy was comparable to that achieved by drug therapy.  The authors conclude that acupuncture deserves to be more widely used, considering the lack of side effects, the low miscarriage rate and its positive influence on the patient's general condition compared to drug therapy.

Gerhard I, Postneek F. [Possibilities of therapy by ear acupuncture in female sterility] Geburtshilfe Frauenheilkd. 1988 Mar; 48(3):165-71.

(3) Acupuncture can effectively normalise the hypothalamic-pituitary-ovarian axis and thus regulate ovulation.  Studies show that acupuncture may adjust FSH and LH and normalize oestrogen and progesterone levels, thus affecting ovulation.  Its efficacy to treat female infertility should be further investigated.

Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril. 2002 Dec; 78(6):1149-53.

Chen BY. Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis. Acupunct Electrother Res. 1997; 22(2):97-108.

Mo X, Li D, Pu Y, Xi G, Le X, Fu Z. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med. 1993 Jun; 13(2):115-9.)

Yu J, Zheng HM, Ping SM. [Changes in serum FSH, LH and ovarian follicular growth during electro-acupuncture for induction of ovulation] Zhong Xi Yi Jie He Za Zhi. 1989 Apr; 9(4):199-202, 195.

(4) Professor Adrian White, of Exeter University reviewed trials on acupuncture for women's reproductive health care and concluded that acupuncture for infertility appears promising and further studies are justified.

White A.R. A review of controlled trials of acupuncture for women's reproductive health care. J Fam Plann Reprod Health Care. 2003 Oct;29(4):233-6.

FALLOPIAN TUBE DYSFUNCTION AND CHINESE HERBAL MEDICINE

A study was carried out in Guangzhou, China, to find an effective treatment for tubal obstruction.  The results of 120 women divided into three treatment groups were compared.  One group received a combination of Western medical treatment and Chinese herbal medicine, one group received Chinese herbal medicine only and another group received Western medical treatment only.  After treatment, the fallopian tube patency rate 86.7% and the pregnancy rate 85.0% in the TCM/ WM group, 66.7% and 63.3% in the TCM group and 53.3% and 50% in the WM group respectively.  The effectiveness in the combination group was significant.  The authors conclude that the combination of western and Chinese medicine is the most effective method in treating tubal obstruction.

Kang JL, XIa W, He QY.'[Clinical study on treatment of oviduct obstruction by integrative traditional Chinese and Western medicine]. Zhongguo Zhong Xi Yi Jie He ZaZhi. 2001, 21 (6): 416-8.

RESEARCH INTO ENDOMETRIOSIS AND CHINESE HERBAL MEDICINE

(1) A study from Beijing compared three treatment methods to find the most effective treatment for endometrial ovarian cysts.  152 patients with endometrial ovarian cysts were divided into three groups: an integrated laparoscopy and Chinese herbal medicine (combination group), a Chinese herbal medicine group, and a Danazol group.  The clinical efficacy, side-effects and reproductive hormones were compared.  The shrinking rate and disappearance rate of the cysts were highest in the combination group as was the pregnancy rate.  Few side effects were noticed in the combination and Chinese herbal medicine group.  The authors conclude that combining laparoscopy with Chinese herbal medicine is an effective treatment for endometrial ovarian cysts with minimal side effects and a maximal preservation of the reproductive function.

Wu Y, Hua L, Jin Y [Clinical study on endometrial ovarian cyst treated by integrated laparoscopy and Chinese herbal medicine] Zhongguo Zhong Xi Yi Jie He Za Zhi. 2000 Mar; 20 (3):183-6.

(2) A study was carried out in Shanghai to explore the mechanism of treating endometriosis by tonifying Kidney and removing blood stasis with Neiyixiao Recipe (NYXR).  METHODS: One hundred and three patients with endometriosis were divided randomly into the NYXR group (58 cases, treated with NYXR) and the control group (45 cases, treated with danazol) and were reviewed for the improvement of clinical symptoms, serum level of FSH, LH, PRL, E2, P and T, humoral and cellular immunity (C3, C4, CD3, CD4, CD8), and plasma prostaglandin after treatment.  RESULTS: There was no significant difference in effect between the NYXR group and the control group in relief of dysmenorrhea and degradation of elevated plasma prostaglandin (chi 2 = 0.71, P > 0.05).  But there was significant difference between the two groups in curing infertility (chi 2 = 14.77, P < 0.01), and the effect of NYXR in regulating endocrine and immunity was significantly better than that of danazol.  The authors conclude that by tonifying Kidney and removing blood stasis, Chinese herbal medicine is an effective method for the treatment of endometriosis, simultaneously maintaining and improving fertility.

Liu J, Li X, Hu X. [Clinical observations on treatment of endometriosis by tonifying kidney and removing blood stasis] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1998 Mar;18 (3):145-7.

(3) A study in Shanghai tested the therapeutic mechanism of endometriosis by the treatment of Yiqi Huoxue Huayu Tongfu Principle (YQHXHYTFP, tonifying Qi and promoting blood circulation to remove stasis and purgation therapy) with Neiyi 1+ pill.  METHODS: Forty-five cases with endometriosis were divided randomly into TCM group (30 cases, treated with Neiyi 1+ pill) and the control group (15 cases, treated with tamoxifen).  The activity of natural killer cell of peripheral blood, T lymphocyte subsets, secreting interleukin-II and the EmAb were determined.  RESULTS: Endometriosis is associated with immunologic disturbance.  After treatment, the activity of NK cells and the count of T-suppressor cells were significantly increased (P < 0.01), the count of T-helper cells, the secretion of interleukin-II and TH/TS ratio were significantly reduced (P < 0.01).  Over 50% of the cases whose EmAb was positive eventually turned to negative.  The effective rate of this therapy was 90%.  There was no significant difference between TCM group and the control group.  CONCLUSION: Chinese herbal medicine could modulate the immunologic disturbance in women with endometriosis, and could clearly improve clinical symptoms and signs.

Li J, Zheng J, Wang D. [Clinical observation on treatment of endometriosis by tonifying qi and promoting blood circulation to remove stasis and purgation principle] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1999 Sep; 19 (9):533-5.

(4) A study in Kunmin aimed to find a medicine that treats endometriosis effectively with less side-effects. METHODS: A Chinese herbal prescription [Dan'e mixture] (DEM, consists of Radix Salviae Miltiorrhizae and Rhizoma Zedoariae) was used to treat 189 cases of endometriosis and the change of symptom and sign, the B ultrasonograph, the anti-endometrium antibody and endometriosis quantitative diagnostic index were observed.  Another 160 cases were treated with Danazol as control.  RESULTS: One hundred and eighty-nine cases were treated for 9 months.  According to National Standards, 39 cases (20.6%) were cured, 67 cases (35.4%) were markedly effective, 67 cases (35.4%) were effective, and 16 cases (8.4%) were ineffective.  Compared with 160 cases treated with Danazol for 9 months, the total effective rates were 95% and 91.5% respectively, the difference between them was insignificant.  Animal experiments showed similar results to the clinical ones.  CONCLUSION: The authors conclude that the Chinese herbal prescription is as effective as Danazol for the treatment of endometriosis, without observed side effects.  It is particularly helpful for diagnosis, treatment and prevention of endometriosis in the early stage.

Cai L, Shu Y, Xie H. [Clinical and experimental study on the treatment of endometriosis with dan'e mixture] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1999 Mar;19 (3):159-61.

(5) Another study from Shanghai observed the clinical effectiveness of Chinese herbal medicine on endometriosis and the uterine arterial blood flow.  The study group consisted of 53 women with endometriosis who manifested with dysmenorrhea, menoxenia, ovarian chocolate cysts and enlarged uterus.  The control group consisted of ten women with normal regular menstrual cycle.  This article deals with the method of using the hemodynamic index of uterus arterial blood flow.  After treatment the blood flow amount of uterus arteries of 53 cases (study group) obviously decreased and their uterus arterial blood flow speed reduced markedly as compared with pre-treatment status, (P < 0.001 and P < 0.01 respectively), while pre-treatment group was significantly higher than that of control group (P < 0.001).  After medical treatment for 3.5 months, symptoms such as dysmenorrheao (period pain) and menstrual disorder basically disappeared.  22 ovarian chocolate cysts became smaller and 16 disappeared.  The pregnancy rate was 45%.  The data of this study suggest that the mechanism of treatment of promoting blood circulation to remove stasis might be closely related to the regulation of physico-chemical characteristics of blood and the adjustment of hemodynamics.

Zhu WX, Cheng XA. [Clinical study of the treatment of endometriosis with promoting blood circulation and stasis removing method] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1993 Jan;13 (1):16-8, 4.

RESEARCH INTO ACUPUNCTURE AND ABNORMALITY OF SPERM

(1) Idiopathic infertility A study carried out in Brazil observed the effect of acupuncture and moxibustion on sperm abnormalities.  19 patients with idiopathic infertility were divided into a study and into a control group.  The study group was treated twice a week for 10 weeks (25 min acupuncture, 20 min moxa).  Sperm analysis was carried out before and after the treatment course.  The patients in the study group showed a significant increase in the percentage of normal-form sperm.  The authors conclude that acupuncture and moxa treatments seem to favourably modify normal-form sperm counting.'

Gurfinkel E, Cedenho AP, Yamamura Y, Srougi M.Effects of acupuncture and moxa treatment in patients with semen abnormalities. Asian J Androl. 2003 Dec; 5(4):345-8.

(2) Low sperm count (Oligospermia) A study carried out in Tel Aviv observed the effect of acupuncture on males with very low sperm count.  15 of the males were azoospermic patients, two were pseudoazoospermic and three had severe oligoteratoasthenozoospermia (OTA).  After a course of acupuncture, the OTA had only a slight increase in sperm count.  67% of azoospermic patients showed a definite increase in sperm count, seven of them significantly.  Males with genital tract inflammation exhibited the most remarkable improvement in sperm density.  Two pregnancies were achieved in conjunction with IVF-ICSI.  The authors conclude that acupuncture might be a useful treatment for males with very poor sperm count, especially those with a history of genital tract inflammation.

Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia. 2000 Jan; 32(1):31-9.

(3) Spem motility In a study from Israel, 16 patients with subfertility related to sperm impairment were treated with acupuncture twice a week for 5 weeks and compared to a control group. The sperm motility and intactness of the axonema were greatly increased in the study group.

Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B.Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl. 1997 Sep-Oct; 39(2):155-61.

(4) Sperm morphology A study in treating subfertility by acupuncture was carried out in Germany on 28 men.  Each patient received a total of 10 treatments for a period of three weeks.  The spermiograms and hormone levels were checked before and after acupuncture.  Total count, concentration and motility were evaluated and in all cases the researchers observed a statistically significant improvement of sperm quality.  The authors conclude that acupuncture therapy at the time of ovulation might increase the chances of a pregnancy.

Fischl F, Riegler R, Bieglmayer C, Nasr F, Neumark J. [Modification of semen quality by acupuncture in subfertile males] Geburtshilfe Frauenheilkd. 1984 Aug;44 (8):510-2.

(5) A Chinese study was carried out on 54 males with impaired fertility.  1-3 months of acupuncture therapy was given, and sperm analysis carried out before and after treatment.  55.5% of patients impregnated their partners in that period of time, and 24% showed a significant improvement in sperm parameters.  20% of patients, previously diagnosed with azoospermia and immune disturbance, did not improve.  The best improvement was seen in patients with abnormal sperm.

Qian, Z [Clinical observation of 54 cases of male infertility treated by acupuncture and moxibustion] Journal of Chinese Medicine, 1996 Sep; 52.

(6) A Chinese study was carried out on 248 males who suffered from sperm abnormities, absence of ejaculation and impotence.  Treatment of acupuncture was given every other day.  20 treatments comprised one course.  2 courses were given (approx 2 months).  About half of the patients with abnormal sperm achieved good sperm count and motility.  (20-60mill/ml with 20-60% motility and less than 20% deformity).  52% of patients with abnormal sperm failed to respond, a large percentage of those (40%) who were diagnosed with azoospermia, failed to respond at all.

Zhang J [The Acupuncture treatment of 248 cases of male infertility], Chinese Acupuncture and Moxibustion, Vol 7, 1987.

RESEARCH INTO RECURRENT MISCARRIAGE & CHINESE HERBAL MEDICINE

(1) The effect of Chinese herbal medicine in threatened miscarriage was observed in a study at Shanghai Gynaecology & Obstetrics Department of Shanghai Medical University.  In 40 women with threatened abortion and a history of miscarriage, blood test showed threatened abortion (TA), compared to the blood test of normal pregnant women (the plasma beta-EP level in TA was significantly higher than that in normal pregnant women, P < 0.01.  On the contrary, plasma GnRH, HCG and P4 were obviously lower in TA as compared with those of the normal cases, P < 0.01.)  After treatment with Chinese herbal medicine that supported reproduction and blood circulation and protected the foetus, 36 of the 40 patients continued their pregnancy without symptoms of TA, and the above-mentioned four criteria measured at 10-12th week of gestation were similar to those of normal cases, P > 0.05.  The authors concluded that Chinese herbal Medicine can regulate plasma beta-EP and placental endocrine function in threatened abortion in women with a history of recurrent miscarriage.

Sun F, Yu J. [Effect of TCM on plasma beta-endorphin and placental endocrine in threatened abortion] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1999 Feb; 19 (2):87-9.

(2) A study in Japan showed that recurrent miscarriages with an immunological component (rejection of the foetus as foreign) benefit positively to the treatment with Chinese herbal medicine.  Twelve patients with recurrent abortion who had shown positive anti-phospholipid antibodies were treated through the administration of a Japanese modified traditional Chinese herbal medicine Sairei-To (Cai ling Tang).  The patients had experienced a total of 27 spontaneous abortions in their previous pregnancies and had no other pregnancy history except for one patient.  The patients were treated with 9.0 g of Sairei-To per day before their next pregnancy.  The positive value of antiphospholipid antibodies returned to negative in 9 patients out of 12 patients through the treatment.  Out of 12 patients, 10 patients continued their new pregnancy uneventfully, and they delivered an offspring (success rate: 83.3%).  Thus, the current treatment was considered to be an effective therapy for patients with recurrent abortion whose miscarriage is immune related (positive anti-phospholipid antibodies).

Takakuwa K, Yasuda M, Hataya I, Sekizuka N, Tamura M, Arakawa M, Higashino M, Hasegawa I, Tanaka K. Treatment for patients with recurrent abortion with positive antiphospholipid antibodies using a traditional Chinese herbal medicine. J Med. 1996; 24(5):489-94.