By using human menopausal
gonadotropin (HMG) and human chorionic gonadotropin (HCG), fairly good clinical
therapeutic efficacy has been obtained in the treatment of infertility. However,
difficulties are brought about due to the ovarian hyperstimulation syndrome
(OHSS) easily induced by these two drugs. Therefore, we attempted to use
acupuncture instead of HCG in the induction of ovulation from 1989 to 1992, and
satisfactory therapeutic effect was achieved as reported in the
following.
General DataTen patients were hospitalized with
confirmed diagnosis of infertility and totally observed for 11 menstrual cycles
(one patient had recurrence of OHSS for 2 times). Their ages ranged from 27 to
30 years with an average of 29 years. After treatment by HMG, all patients
manifested OHSS in varying degrees. In accordance with the criteria for grading
of OHSS issued by WHO, among these 11 menstrual cycles 4 cycles were mild
(ovarian slight enlargement less than 5 cm with symptoms of slight malaise of
lower abdomen); 7 were moderate (marked enlargement of ovary with nausea,
vomiting and abdominal distension); no severe case occurred (extreme enlargement
of ovary with hydrothorax, ascites, pycnemia and electrolyte disturbance). In
order to prevent the exacerbation of OHSS caused by combined use of HMG and HCG,
acupuncture was used after HMG treatment to replace HCG for the ovulation
induction in 11 menstrual cycles of these patients.
Therapeutic Method1.5-3
cun long
filiform needles (no. 28-30) were used. The acupoints used for needling were
Zigong (Extra 16), Shenshu (UB 23), Ciliao (UB 32), (the above acupoints were
used bilaterally) and Guanyuan (Ren 4). Baohuang (UB 53) and Zhongji (Ren 3)
were selected according to the signs and symptoms as adjuvant points. The
manipulation techniques included twirling, rotating, lifting and thrusting.
Reinforcing method was used in Shenshu point and the remaining points were
punctured by reducing manipulation. The needling sensation should be transmitted
toward both sides of lower abdomen. When arrival of Qi, retained the needles for
15 min. and manipulated the needles intermittently during the retaining period
to enhance the stimulation. Moxibustion with moxa stick was used for some of
these acupoints.
Observation of Therapeutic EffectCriteria for assessment of
therapeutic effect: Therapeutic effect was appraised mainly by comparison of
ultrasonic B examination after needling with that before treatment and referred
to the score of cervix uteri and basal body temperature to sit judgment on
ovulation. Ovulation occurred within 24 h after 1st needling was considered as
marked effect; ovulation within 72 h after 2-3 times of needling was effective;
no ovulation occurred after 72 h after more than 3 times of needling was scored
as ineffective.
Results of TreatmentOf the 11 menstrual cycles, marked
effect was shown in 5 cycles, effective in 5 cycles and failed in 1 cycle. Among
the 10 markedly effective and effective cycles, ovulation was induced in 2 cases
after needling and diagnosed pregnancy by blood HCG assay and ultrasonography.
In 9 of the 10 cycles treated with acupuncture for ovulation induction without
using HCG and other drugs, the symptoms of OHSS were significantly remitted or
even disappeared. Only in one cycle, HCG (with dosage less than for ovulation)
was used after needling to maintain the function of corpus luteum and resulted
in exacerbation of OHSS and finally remitted by drug treatment.
Typical CaseFang, 27-year-old,
suffered from polycystic ovary syndrome. She was unpregnant after married 2
years and the menstruation was only 1-2 times a year. The basal body temperature
was monophase. No effect was observed using clomiphene and then treated with
HMG. From the day 5, for bleeding due to withdrawal of progesterone,
intramuscular injection of HMG was given at a dose of 150 U once a day for 8
days. The score of cervix uteri was 12 mark. The ultrasonogram showed that the
size of right ovary was 9.6 cm x 7.8 cm x 4.6 cm and the left side was 9.2 cm x
7.2 cm x 4.7 cm. Both sides of ovary had 10-20 follicles with maximum size 1.8
cm. In order to avoid severe OHSS, acupuncture was used instead of HCG for
ovulation induction after stopping HMG treatment. On the next day after the
first needling, the basal body temperature elevated from 36.3°C to 36.8°C and
the score of cervix uteri fell from 12 mark to 9 mark, and ultrasonic B
examination suggested that part of the follicles were ovulated. After the l9th
day of ovulation, the blood concentration of HCG started rising and after 40
days the blood level of HCG reached to 35.6 ng/ml. The ultrasonogram showed that
the diameter of embryonic sac was 1.5 cm and early pregnancy was
diagnosed.
DiscussionIt was reported in literature that using HMG-HCG in the induction
of ovulation, the ovulatory rate was about 70%-90%, but the incidence of OHSS
might be 10%-15.4% and even life-threatening in the severe case. At present,
there were no satisfactory measures for the prevention and remission of OHSS. In
most reports, it is considered that when OHSS inclines to occur, stopping
injection of HCG is the effective way to avoid severe OHSS. However, stopping
HCG would not only discontinue the ovulation of HCH, but also gave up the
already developed follicles. Our clinical practice demonstrated that acupuncture
is effective in ovulation induction and also the remission of OHSS induced by
HMG. Furthermore, we also noted that in most OHSS patients enlarged ovaries and
numerous developed follicles were revealed. As a result of excessive follicles
developed, dysplasia of ova and insufficiency of corpus luteum often occurred,
thus leading to uneasy pregnancy after ovulation. So it is reasonable to infer
that using some Chinese drugs benefiting the function of corpus luteum or using
certain amount of progesterone as supplementary treatment after acupuncture, the
pregnancy rate could be raised.
A Brief Introduction
to the Training Center
of China Academy of Traditional Chinese
Medicine
The Training Center of China Academy of Traditional Chinese Medicine is
an educational institution of traditional Chinese medicine, and has excellent
teachers and good bases for clinical practice and provides proper board and
lodging.
The
Center regularly conducts three-month advanced and general courses of
traditional Chinese medicine, acupuncture, Tuina (massage), Qigong (breathing
exercises) and Taiji (shadow boxing). It also runs short-term training courses
on some special topics, and preparatory guidance courses for licensure
examination of tradi tional Chinese medicine, acupuncture and moxibustion. In
addition, various courses based on the participant's requirements may be
arranged in the center. All those who complete the required courses will receive
relevant certificates.
The Training Center is always ready to establish friendly relations
of exchange and cooperation with medical institutions of various countries. It
warmly welcomes medical professionals from home and abroad to take training
courses.
Address:
Training Center of China Academy of Traditional Chinese Medicine
No 18
Beixincang Dongzhimennei, Beijing 100700 China
Dr. Pan Ping Dr. Zhao
Jihui
Tel: 86-10-64075193 64062096
Fax: 86-10-64061635 64062096