Ultrasound-guided transvaginal ovarian needle drilling for clomiphene-resistant polycystic ovarian syndrome in subfertile women

Feasibility of acupuncture as an adjunct intervention for ovulatory disorder infertility: A systematic review and meta-analysis

BACKGROUND

Acupuncture (AT) is widely used in treatment of ovulatory disorder infertility (ODI), but the safety and efficacy of AT for ODI still lack an evidence-based basis.

AIM

To evaluate the feasibility and effectiveness of AT as an adjunct intervention for ODI.

METHODS

The Cochrane Library, Embase, PubMed, VIP, China National Knowledge Infrastructure, WanFang Data, and Chinese biomedical literature databases were searched from inception to January 20, 2024. Two reviewers independently selected studies, collected data, and evaluated methodological quality through the Cochrane Risk of Bias tool. Revman 5.4 was used for meta-analysis, and the Grade system was performed to evaluate the level of evidence for the outcomes of the meta-analysis.

RESULTS

A total of 20 randomized controlled trials with 1677 ODI patients were included. Compared with the clomiphene citrate (CC) group, the AT plus CC group exhibited significant improvement of the pregnancy rate [relative risk (RR) = 1.68, 95% confidence interval (CI): 1.45-1.95, P < 0.00001, I² = 23%], ovulation rate (RR = 1.34, 95%CI: 1.22-1.47, P < 0.00001, I² = 32%), serum E₂ level [mean difference (MD) = 31.36, 95%CI: 21.83-40.88, P < 0.00001, I² = 97%], thickness of endometrium (MD = 1.76, 95%CI: 0.71-2.81, P = 0.001, I² = 98%) and decreasing miscarriage rate (RR = 0.25, 95%CI: 0.09-0.65, P = 0.005, I² = 0%), serum follicle-stimulating hormone level (MD = -2.10, 95%CI: -3.27 to -0.94, P = 0.0004, I² = 99%), serum luteinizing hormone level (MD = -6.94, 95%CI: -9.89 to -4.00, P < 0.00001, I² = 100%), and serum progesterone level (MD = -1.66, 95%CI: -2.98 to -0.34, P = 0.01, I² = 96%). The AT group had a more favorable effect than CC group for improving pregnancy rate (RR = 1.52, 95%CI: 1.33-1.73, P < 0.00001, I² = 0%), thickness of endometrium (MD = 2.48, 95%CI: 2.15-2.81, P < 0.00001, I² = 0%) and reducing miscarriage rate (RR = 0.23, 95%CI: 0.13-0.44, P < 0.00001, I² = 0%), serum follicle-stimulating hormone level (MD = -0.55, 95%CI: -0.86 to -0.24, P = 0.0005, I² = 0%), and serum progesterone level (MD = -0.24, 95%CI: -0.28 to -0.20, P < 0.00001). However, the level of evidence was predominantly assessed as very low to moderate.

CONCLUSION

AT can improve the pregnancy outcomes and sex hormone levels for patients with ODI. However, further studies are needed to confirm these findings.

Association of Oxidative Stress with Kidney Injury in a Hyperandrogenemic Female Rat Model

Background

Polycystic ovary syndrome (PCOS) is the most common reproductive dysfunction in premenopausal women. PCOS is associated with oxidative stress (OS), which is the main risk factor for renal diseases. This study aimed to investigate the mechanisms responsible for renal injury in a hyperandrogenemic female rat model.

Methods

This study was conducted from December 2019 to September 2021 at Shiraz Nephro-Urology Research Centre, Shiraz University of Medical Sciences (Shiraz, Iran). Thirty female Sprague-Dawley rats were randomly divided into three groups (n=10), namely control, sham, and dehydroepiandrosterone (DHEA). Plasma total testosterone, plasma creatinine (Cr), and blood urea nitrogen (BUN) levels were measured. In addition, total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), and histopathological changes in the ovaries and kidneys were determined. Data were analyzed using the GraphPad Prism software, and P<0.05 was considered statistically significant.

Results

Plasma total testosterone levels increased by nine-fold in DHEA-treated rats compared to controls (P=0.0001). Administration of DHEA increased Cr and BUN levels and caused severe renal tubular cell injury. In addition, plasma and tissue (kidney and ovary) TAC levels decreased significantly, but TOS levels and OSI values were significantly increased (P=0.019). Significant damage to both glomerular and tubular parts of the kidney and ovarian follicular structure was observed in the DHEA group.

Conclusion

Hyperandrogenemia caused systemic abnormalities through OS-related mechanisms and damaged renal and ovarian tissues. DHEA treatment in rat models is recommended to study the mechanisms that mediate PCOS-associated renal injury.