The effect of growth hormone adjuvant therapy on assisted reproductive technologies outcomes in patients with diminished ovarian reserve or poor ovarian response

Bushen Tianjing Recipe inhibits human ovarian granulosa cell line KGN apoptosis induced by miR-23a through the regulation of the sirtuin family

ETHNOPHARMACOLOGICAL RELEVANCE

Bushen Tianjing Recipe (BTR) is a tonic-kidney formula of Traditional Chinese Medicine (TCM) with good therapeutic effects in clinical settings. It was mainly applied to inhibit the decrease of ovarian reserve function in patients. However, the anti-apoptosis mechanism of BTR remains unknown.

AIM OF THE STUDY

The formula of BTR is composed of prepared rehmannia root, debark peony root, carapax testudinis and asiatic cornelian cherry fruit. All four components contain the essences of nourishing yin and tonic-kidney. In the theory of TCM, the kidneys store the essence and are primarily responsible for reproduction and development. Hence, we speculated that BTR had some effect on women's reproductive system. In our research, rat serum contains BTR resolved into culture medium for incubation with miR-23a-induced KGN cells to test and determine our hypothesis.

MATERIALS AND METHODS

BTR was prepared by the traditional decoction method to collect concentrated liquids for oral administration to rats (15.00 g/kg) for 14 days. The group with miR-23a-induced KGN cells was selected as the positive control, while the mimic one was the control. Pro-apoptosis and anti-apoptosis biomarkers were detected and analyzed by western blot together with upstream transcription factors and intracellular apoptotic signal pathways.

RESULTS

The medium- and high-concentration of BRT greatly reduced the apoptosis of miR-23a-induced KGN cells both in mitochondria and cytoplasm. It showed the up-regulation of SIRT1 and SIRT3, the down-regulation of pro-apoptosis factor Bax and apoptotic-related proteins Caspase 3, 8, 9, and the reduction of phosphorylation of ERK1/2 and NF-κB. however, there was no consistency in the group with a low concentration of BTR, compared with those of other groups.

CONCLUSION

Our research verified that BTR had a positive effect on women's reproductive system under medium or high concentration, illuminated the intrinsic mechanism at molecular levels, and convinced its potential application values in clinical settings.

Acupuncture and moxibustion for diminished ovarian reserve: A scoping review

OBJECTIVE

Diminished ovarian reserve (DOR) refers to the decreased number and quality of oocytes in the ovary. Acupuncture and moxibustion has a certain effect on DOR; however, the number of studies and reports of research evidence are limited. This study aimed to conduct a scoping review of the clinical research status of acupuncture and moxibustion for treating patients with DOR.

METHOD

PubMed, Cochrane Library, Excerpta Medica database, Allied and Complementary Medicine Database, Chinese Biological Medicine, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang database were searched from January 2010 to May 2022 using keywords and medical subject heading terms. After applying the inclusion and exclusion criteria, relevant studies were selected. Structured tables and descriptive charts were made to visually express research features by using Excel, Original, IBM SPSS Model 18.0, Adobe Illustrator and other software packages. Report quality was evaluated for Cochrane bias using Review Manager 5.3.

RESULTS

Overall, 851 studies were identified; of these, 90 met the inclusion criteria. The results extracted from these studies were classified into four categories: research characteristics, study type, acupuncture and moxibustion prescriptions, and efficacy observation.

CONCLUSIONS

The quality assessment of acupuncture and moxibustion for DOR is not ideal. Therefore, standardisation and normalisation should be strengthened, and high-quality evidence is needed to further demonstrate the effectiveness of this approach. Due to heterogeneity in DOR diagnosis, the observation index should be updated with reference to the latest research to improve efficacy evaluation.

The effect of growth hormone on the metabolome of follicular fluid in patients with diminished ovarian reserve

BACKGROUND

Increasing evidence supports that the co-treatment with growth hormone (GH) enhances ovarian response and oocyte quality during controlled ovarian stimulation (COS) in patients with diminished ovarian reserve (DOR). The composition of follicular fluid (FF) plays an essential role in oocyte development and mirrors the communication occurring between the oocyte and follicular microenvironment. However, the effect of GH on the FF metabolome remains unclear.

METHODS

This prospective observational study recruited DOR patients undergoing in vitro fertilization (IVF) cycles with minimal stimulation protocol for COS. Each patient receiving GH co-treatment was matched to a patient without GH co-treatment by propensity score matching. The FF was collected after isolating oocytes and assayed by gas chromatograph-mass spectrometry (GC-MS) metabolomics. The Pearson correlation was performed to evaluate the relationship between the number of oocytes retrieved and the levels of differential metabolites. The KEGG database was used to map differential metabolites onto various metabolic pathways.

RESULTS

One hundred thirty-four FF metabolites were identified by GC-MS metabolomics. Twenty-four metabolites, including glutathione, itaconic acid and S-adenosylmethionin (SAM) showed significant differences between the GH and control groups (p-value < 0.05 and q-value < 0.1). In addition, the number of oocytes retrieved was significantly higher in the GH group compared to the control group (3 vs 2, p = 0.04) and correlated with the levels of five differential metabolites. Among them, the levels of antioxidant metabolite itaconic acid were upregulated by GH administration, while SAM levels were downregulated.

CONCLUSIONS

The co-treatment with GH during COS may improve oocyte development by altering FF metabolite profiles in DOR patients. However, given the downregulation of SAM, a regulator of genomic imprinting, the potential risk of imprinting disturbances should not be neglected.

The Clinical Application of Growth Hormone and Its Biological and Molecular Mechanisms in Assisted Reproduction

Growth hormone (GH) has been used as a co-gonadotrophin in assisted reproduction, particularly in poor ovarian responders. The application of GH has been alleged to activate primordial follicles and improve oocyte quality, embryo quality, and steroidogenesis. However, the effects of GH on the live birth rate among women is controversial. Additionally, although the basic biological mechanisms that lead to the above clinical differences have been investigated, they are not yet well understood. The actions of GH are mediated by GH receptors (GHRs) or insulin-like growth factors (IGFs). GH regulates the vital signal transduction pathways that are involved in primordial follicular activation, steroidogenesis, and oocyte maturation. However, the therapeutic windows and duration of GH administration during assisted reproductive technology require further investigation. The review aimed to clarify the role of GH in human fertility from a molecular and biological point of view to provide evidence for proper GH administration.

Treatment Progress in Diminished Ovarian Reserve: Western and Chinese Medicine

Diminished ovarian reserve (DOR), generally defined as a decreased number or quality of oocytes, has a significant impact on quality of life and fertility in women. In recent years, the incidence of DOR has been increasing and the ages of patients are younger. The search for an effective DOR treatment has emerged as one of the preeminent research topics in reproductive health. An effective DOR therapy would improve ovarian function, fertility, and quality of life in patients. In this review we evaluated DOR treatment progress both in Western medicine and Chinese medicine, and elucidated the characteristics of each treatment.