OBJECTIVETo evaluate the effect of superovulation with recombinant follicle stimulating hormone (r-FSH) therapy and intrauterine insemination in the treatment of idiopathic infertility.

METHODSSuperovulation with r-FSH therapy and intrauterine insemination were used in 202 cycles of 88 couples in the Department of Obstetrics and Gynecology of Monash Medical Centre.

RESULTSThe per cycle ovulation rate and in-ovulation rate were 95.7% and 4.3% respectively, and the per cycle pregnancy rate was 11.6% with no cases of hyperstimulation. The cancelling rate was 7.4% because of the development of multiple follicles. The overall cumulative conception rate was 22.7% per patient, with 15% of twin pregnancies. There were no differences between pregnancy group and non-pregnancy group in age, BMI, treatment days, number of mature follicles, endometrial thickness and number of treatment cycles. The only significant parameter observed between the two groups was infertility time (P < 0.05), which was longer in non-pregnancy group [(30.52 +/- 13.08) months] than in pregnancy group [(24.25 +/- 6.45) months].

CONCLUSIONSSuperovulation and intrauterine insemination is a safe and more cost-effective method in treatment of idiopathic infertility.

Adult ; Female ; Follicle Stimulating Hormone, Human ; biosynthesis ; genetics ; therapeutic use ; Humans ; Infertility, Female ; therapy ; Insemination, Artificial, Homologous ; methods ; Recombinant Proteins ; biosynthesis ; genetics ; therapeutic use ; Superovulation ; drug effects

OBJECTIVEExplore the optimal treatment of infertility patients infected with different types of human papillomavirus (HPV).

METHODSAccording to cervical pathology, cervical status and the procreate desire of the infertility patients, the 144 clinic cases of high-risk human papillomavirus infected infertile patients were divided into two gruoups: group with treatment and without treatment. Real-time quantitative fluorescent PCR (RT-PCR) has been employed, follow-up time is 6 months, to detect the HPV-DNA in the crevical exfoliated cells, to observe the negative conversion rate and pregnancy rate, and compare analyzed.

RESULTS(1) In high-risk HPV infectors, the negative conversion rate of treatment group (56.67%) is higher than those in non-treatment group (50.00%); (2) The pregnancy rate of secondary high-risk HPV non-treatment group (50.00%) is higher than the treatment group. The pregnancy rate of primary high-risk HPV treatment group (31.67%) is higher than the non-treatment group (4.00%). (3) Negative conversion rate increases accordingly, on primary high-risk HPV infected groups with Leep, with single drug and with Leep combined with drug therapy. (4) The negative conversion rate and the pregnancy rate of primary high-risk HPV infected groups with surgical therapy is higher than the groups with drug therapy. Surgical + Drugs is better in the two surgical therapies.

CONCLUSIONInfertile patients should be routinely screened for cervical HPV. The primary high-risk cervical HPV infection is the etiology of infertility. Preferably, patients with primary high-risk HPV infection in cervical lesions is treated with Leep combined drugs.

Adult ; DNA, Viral ; analysis ; drug effects ; Drug Therapy ; Female ; Humans ; Infertility ; virology ; Papillomaviridae ; drug effects ; genetics ; Papillomavirus Infections ; drug therapy ; epidemiology ; therapy ; Pharmaceutical Preparations ; Polymerase Chain Reaction ; Pregnancy ; Pregnancy Rate ; Risk Factors ; Therapeutic Human Experimentation

OBJECTIVETo investigate the clinical effects of the combined therapy of the Chinese medicine Compound Xuanju Capsule and vitamin E on sperm chromatin damage in idiopathic oligoasthenospermia.

METHODSWe assigned 50 infertile men with seminal abnormality to a control group (n = 26) and a trial group (n = 24) to receive vitamin E and the combined therapy of Compound Xuanju Capsule plus vitamin E, respectively, both treated for 3 months. Before and after the treatment, we detected semen routine parameters and sperm DNA fragmentation indexes (DFI) by computer aided semen analysis (CASA) and sperm chromatin structure assay (SCSA), and compared them between the two groups.

RESULTSThere was no obvious difference between the percentage of progressively motile sperm in the trial group and that in the control group (21.55 +/- 8.68 vs 21.47 +/- 11.53, P > 0.05). The trial group showed a significantly decreased sperm DFI after medication as compared with pre-medication (29.57 +/- 12.19 vs 34.09 +/- 10.32, P < 0.05).

CONCLUSIONThe combined therapy of Compound Xuanju Capsule and vitamin E can effectively improve seminal quality and reduce sperm chromatin damage in infertile men with idiopathic oligoasthenospermia.

Adult ; Capsules ; Chromatin ; drug effects ; DNA Damage ; drug effects ; DNA Fragmentation ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Humans ; Infertility, Male ; drug therapy ; genetics ; Male ; Spermatozoa ; drug effects ; Vitamin E ; pharmacology ; therapeutic use ; Young Adult

To explore the influence for combination of nourishing yin and tonifying yang sequential therapy (NYTYST) with Western medicine in treating anovulatory infertility rats with diminished ovarian reserve (DOR) based on TGF-β1/Smads signaling pathway. 
 Methods: A total of 40 female rats were randomly divided into 5 groups, a normal control group, a model group, a Western medicine group, a NYTYST group and a combination group (n=8 in each group). The DOR model was established through orally taking tripterygium pill for continuous 2 weeks. The normal control group and the model group were treated with saline for 10 days. The Western medicine group was treated with hormone replacement therapy (HRT) and ovarian stimulation. The NYTYST group was treated with nourishing yin herbs in proestrus and tonifying yang herbs in late estrus and the combination group was treated with Chinese herb and Western drugs for 10 days. HE staining was used to observe histopathologic changes in ovary. Expression levels of transforming growth factor β1 receptor (TGF-β1R) in rats ovarian were detected by immunohistochemistry. Expression levels of Smad2, Smad3 and Smad7 protein in rat ovarian were detected by Western blot.
 Results: Compared with the control group, the numbers of developing follicles, mature follicles and corpus luteum were decreased , while atrefic follicles were increased significantly in the model group (P<0.01); the levels of TGF-β1R, Smad2 and Smad3 were decreased significantly, while Smad7 was increased significantly (P<0.01). Compared with the model group, the numbers of developing follicles, mature follicles and corpus luteum, Smad2 and Smad3 expression were increased, while atrefic follicles and Smad7 were decreased significantly in the treatment group (P<0.05 or P<0.01). The numbers of developing follicles and corpus luteum in the combination group was superior to the Western medicine group (P<0.05). Compared with the Western medicine group, the levels of TGF-β1R, Smad2 and Smad3 were increased significantly, while Smad7 was decreased significantly in the combination group (P<0.05 or P<0.01). 
 Conclusion: NYTYST combined with Western medicine can improve the function of ovaries reserve by up-regulation of TGF-β1R, Smad2 and Smad3 while down-regulation of Smad7 in DOR rats.
Animals ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gene Expression Regulation ; drug effects ; Infertility ; therapy ; Medicine, Chinese Traditional ; Ovarian Reserve ; drug effects ; Rats ; Signal Transduction ; drug effects ; Smad2 Protein ; genetics ; metabolism ; Smad3 Protein ; genetics ; metabolism ; Transforming Growth Factor beta1 ; genetics ; metabolism

Estrogen is implicated as playing an important role in aging and tumorigenesis of estrogen responsive tissues; however the mechanisms underlying the mitogenic actions of estrogen are not fully understood. Here we report that estrogen deficiency in mice caused by targeted disruption of the aromatase gene results in a significant inhibition of telomerase maintenance of telomeres in mouse ovaries in a tissue-specific manner. The inhibition entails a significant shortening of telomeres and compromised proliferation in the follicular granulosa cell compartment of ovary. Gene expression analysis showed decreased levels of proto-oncogene c-Myc and the telomerase catalytic subunit, telomerase reverse transcriptase (TERT), in response to estrogen deficiency. Estrogen replacement therapy led to increases in TERT gene expression, telomerase activity, telomere length and ovarian tissue growth, thereby reinstating ovary development to normal in four weeks. Our data demonstrate for the first time that telomere maintenance is the primary mechanism mediating the mitogenic effect of estrogen on ovarian granulosa cell proliferation by upregulating the genes of c-Myc and TERT in vivo. Estrogen deficiency or over-activity may cause ovarian tissue aging or tumorigenesis, respectively, through estrogen regulation of telomere remodeling.
46, XX Disorders of Sex Development ; drug therapy ; genetics ; metabolism ; Aging ; genetics ; metabolism ; Animals ; Aromatase ; deficiency ; genetics ; metabolism ; Cell Proliferation ; drug effects ; Estrogen Replacement Therapy ; Estrogens ; deficiency ; pharmacology ; Female ; Gene Expression ; Genes, myc ; genetics ; Granulosa Cells ; drug effects ; metabolism ; pathology ; Gynecomastia ; drug therapy ; genetics ; metabolism ; Humans ; Infertility, Male ; drug therapy ; genetics ; metabolism ; Metabolism, Inborn Errors ; drug therapy ; genetics ; metabolism ; Mice ; Mice, Knockout ; Telomerase ; genetics ; metabolism ; Telomere ; chemistry ; metabolism ; pathology

OBJECTIVETo investigate the effect of Yangjing Zhongyu Decoction (YJZYD) on expression of insulin-like growth factor II (IGF-II) and its receptor II (IGF-II R) in endometrium of women with unexplained infertility, and the relationship of which with the receptibility of endometrium to ovum implantation.

METHODSReverse transcription-polymerase chain reaction (RT-PCR) assay was used to detect quantitatively the expression of IGF-II and IGF-II R in 22 women with unexplained infertility before and after YJZYD treatment during mid-luteal phase.

RESULTSThe levels of IGF-II and IGF-II R before treatment were 0.794 +/- 0.453 and 0.725 +/- 0.354 (in grey level, the same below) respectively, which were significantly increased in the same phase after treatment, reaching 1.202 +/- 0.551 and 1.045 +/- 0.581 respectively (P < 0.01 and P < 0.05). Correlation analysis showed the level of IGF-II mRNA was positively correlated with the level of IGF-II mRNA either before or after treatment.

CONCLUSIONYJZYD could enhance the expression of IGF-II and IGF-II R in the endometrium during mid-luteal phase, promote the differentiation of endometrium and increase its reception to ovum implantation.

Adult ; Embryo Implantation ; drug effects ; Endometrium ; metabolism ; Female ; Humans ; Infertility, Female ; drug therapy ; metabolism ; Insulin-Like Growth Factor II ; biosynthesis ; genetics ; Luteal Phase ; RNA, Messenger ; biosynthesis ; genetics ; Receptor, IGF Type 2 ; biosynthesis ; genetics

OBJECTIVETo investigate the effect of Yangjing Zhongyu decoction (YZD) on metalloproteinase-9 (MMP-9) and its inhibitor-1 (TIMP-1) expression and sex hormone regulation in mid-luteal phase endometrium of women with cryptogenic infertility.

METHODSIn situ hybridization and reverse transcription-polymerase chain reaction method was used to detect MMP-9 and TIMP-1 mRNA, and radioimmunoassay was used to determine levels of serum estradiol (E2) and progesterone (P) synchronously, of 22 infertile women during mid-luteal phase.

RESULTSAfter treatment, the mid-luteal serum E2 and P level was 451.501 +/- 226.342 pmol/L and 46.502 +/- 19.948 nmol/L respectively, significantly higher than that before treatment (304.656 +/- 135.853 pmol/L and 33.782 +/- 15.459 nmol/L respectively), the difference was significant (P < 0.01). Staining of MMP-9 mRNA positive granules in cytoplasm and nuclei of adeno-epithelial cell mid-luteal phase endometrium deepened significantly, but the change in mesenchym was insignificant. The MMP-9 mRNA expression after treatment was 0.617 +/- 0.186 (grey level), significantly higher than the level before treatment (0.490 +/- 0.370), comparison between them showed significant difference (P < 0.05). Change of TIMP-1 mRNA expression in adeno-epithelial and mesenchym before and after treatment was insignificant (0.588 +/- 0.191 vs 0.621 +/- 0.146, P < 0.05). Correlation analysis showed that the quantitative difference of P value before and after treatment was positively correlated with the difference of MMP-9 mRNA before and after treatment (r = 0.682, P < 0.01).

CONCLUSIONYZD could soothen Gan and nourish Shen, raise the level of mid-luteal phase serum P, and further promote MMP-9 gene expression in endometrium to benefit the degradation of extracellular matrix of endometrium, and facilitate for blastocyst implantation.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Endometrium ; metabolism ; Estradiol ; blood ; Female ; Humans ; Infertility, Female ; drug therapy ; metabolism ; Matrix Metalloproteinase 9 ; biosynthesis ; genetics ; Phytotherapy ; Progesterone ; blood ; RNA, Messenger ; biosynthesis ; genetics ; Tissue Inhibitor of Metalloproteinase-1 ; biosynthesis ; genetics

OBJECTIVETo explore the correlation between anti-sperm antibody-positive immune infertility patients and human leucocyte antigen (HLA) DQA1 gene, and to study the correlation between the treatment of Chinese medicine and pharmacy and HLA-DQA1 genotype.

METHODSThe polymerase chain reaction-sequence specific primers (PCR-SSP) technique was used in studying HLA-DQA1 genotypes of 51 anti-sperm antibody-positive immune infertility patients and 60 healthy subjects. Mianbu III (consisting of rehmannia root, white peony root, Fructus Comi, yam, barbary wolfberry fruit, moutan bark, and dwarf lilyturf root) was used in patients for three months.

RESULTSThe HLA-DQA1 *0401 allele in the immune infertility group was obviously higher than that in the healthy control group (chi2 = 29.869, P < 0.01). As for the therapeutic efficacy 22 cases of the 27 positive HLA-DQA1 * 0401 turned to negative with statistical difference (chi2 = 5.24, P = 0.022).

CONCLUSIONHLA-DQA1 *0401 allele might be predisposing gene of the anti-sperm antibody-positive immune infertility. The Chinese medicinal treatment was effective for the HLA-DQA1 *0401 allele patients.

Adult ; Alleles ; Asian Continental Ancestry Group ; genetics ; Case-Control Studies ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; HLA-DQ alpha-Chains ; genetics ; Humans ; Infertility ; drug therapy ; genetics ; Male ; Phytotherapy

AIMTo test the hypothesis that levels of sperm disomy fell significantly in six men treated by traditional Chinese medicine (TCM).

METHODSFluorescence in situ hybridization (FISH) was done on the sperm heads of six men before and during treatment by TCM.

RESULTSThere was a significant reduction in sperm disomy in all six men. This coincided with TCM treatment.

CONCLUSIONThis is the first study reporting a significant reduction in sperm disomy in men over a given time course. The fact that this coincided with TCM treatment is intriguing but no conclusions can be drawn from this until placebo-controlled clinical trials are implemented.

Adult ; Aneuploidy ; Chromosomes, Human, X ; genetics ; Chromosomes, Human, Y ; genetics ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; In Situ Hybridization, Fluorescence ; Infertility, Male ; drug therapy ; genetics ; pathology ; Male ; Medicine, Chinese Traditional ; Spermatozoa ; pathology ; physiology ; Treatment Outcome

CYP2D6 is primarily responsible for the metabolism of clomiphene citrate (CC). The purpose of the present study was to investigate the relationship between CYP2D6 genotypes, concentrations of CC and its major metabolites and drug response in infertility patients. We studied 42 patients with ovulatory dysfunction treated with only CC. Patients received a dose of 100 mg/day CC on days 3-7 of the menstrual cycle. CYP2D6 genotyping and measurement of CC and the major metabolite concentrations were performed. Patients were categorized into CC responders or non-responders according to one cycle response for the ovulation. Thirty-two patients were CC responders and 10 patients were non-responders with 1 cycle treatment. The CC concentrations were highly variable within the same group, but non-responders revealed significantly lower (E)-clomiphene concentration and a trend of decreased concentrations of active metabolites compared to the responders. Nine patients with intermediate metabolizer phenotype were all responders. We confirmed that the CC and the metabolite concentrations were different according to the ovulation status. However, our results do not provide evidence for the contribution of CYP2D6 polymorphism to either drug response or CC concentrations.
Adult ; Chromatography, High Pressure Liquid ; Clomiphene/blood/metabolism/*therapeutic use ; Cytochrome P-450 CYP2D6/*genetics ; Estrogen Antagonists/analysis/metabolism/therapeutic use ; Female ; Genotype ; Humans ; Infertility/*drug therapy/genetics ; Ovulation Induction ; Phenotype ; *Polymorphism, Genetic ; Republic of Korea ; Tandem Mass Spectrometry