DOI QR코드

DOI QR Code

East Asian Herbal Medicine (EAHM) Alone for the Treatment of Women with Diminished Ovarian Reserve (DOR): A Systematic Review and Meta-analysis

난소예비력 저하 여성에 대한 한약 단독 치료의 임신 관련 지표 개선 효과에 관한 체계적 문헌 고찰 및 메타분석

  • Lee, Ju Hyun (Dept. of Pediatrics, College of Korean Medicine, Dong-Guk University) ;
  • Choi, Su-Ji (Dept. of Obstetrics & Gynecology, College of Korean Medicine, Dong-Guk University) ;
  • Noh, Eun-Ji (Dept. of Obstetrics & Gynecology, College of Korean Medicine, Dong-Guk University) ;
  • Min, Sang-Yeon (Dept. of Pediatrics, College of Korean Medicine, Dong-Guk University) ;
  • Kim, Dong-Il (Dept. of Obstetrics & Gynecology, College of Korean Medicine, Dong-Guk University)
  • 이주현 (동국대학교 한의과대학 소아과교실) ;
  • 최수지 (동국대학교 한의과대학 부인과교실) ;
  • 노은지 (동국대학교 한의과대학 부인과교실) ;
  • 민상연 (동국대학교 한의과대학 소아과교실) ;
  • 김동일 (동국대학교 한의과대학 부인과교실)
  • Received : 2022.01.07
  • Accepted : 2022.02.22
  • Published : 2022.03.01

Abstract

Objectives: The aim of this study was to find out whether east asian herbal medicine (EAHM) treatment alone is effective in improving pregnancy-related indicators compared to conventional medicine in women with Diminished Ovarian Reserve (DOR). Methods: We searched eligible studies from PubMed, Cochrane Library, EMBASE, Chinese National Knowledge Infrastructure Database, CiNii, Korean Medical Database, Korean Studies Information Service System, Oriental Medicine Advanced Searching Integrated System, ScienceOn. GRADE pro was used to evaluate the current evidence of the study. Result: A total of 5 studies, 325 women with DOR were included. EAHM showed a significant effect on improvement of pregnancy rate (n=270, RR 2.13 [95% CI 1.44 to 3.15], Z=3.78, p=0.0002, I2=0%) and Anti-Mullerian Hormone (AMH) level (n=211, SMD 0.82 [95% CI 0.40 to 1.25], Z=3.80, p=0.0001) compared to conventional medicine. In ovulation rate (n=156, RR 0.86 [95% CI 0.70 to 1.06], Z=1.43, p=0.15, I2=0%), Antral Follicle Count (n=245, SMD 0.27 [95% CI -0.25 to 0.79], Z=1.01, p=0.31), and follicle stimulating hormone (n=245, SMD 0.29 [95% CI -0.13 to 0.70], Z=1.36, p=0.17) level, EAHM showed similar effects to conventional medicine. In this study, the most frequently used herbal medicines were Cuscutae Semen, Dipsaci Radix, and Angelicae Gigantis Radix. Conclusion: This meta-analysis showed that EAHM could improve pregnancy rates and AMH levels in women with DOR. However, more well-designed RCTs will have to be performed further in the future.

Keywords

Acknowledgement

이 연구는 보건복지부의 재원으로 한국보건산업진흥원의 한의약혁신기술개발사업 지원에 의하여 이루어진 것임 (HF21C0028).

References

  1. Gnoth, C., Godehardt, E., Frank-Herrmann, P., Friol, K., Tigges, J., & Freundl, G. (2005). Definition and prevalence of subfertility and infertility. Human reproduction (Oxford, England), 20(5), 1144-1147. https://doi.org/10.1093/humrep/deh870
  2. Statistics Korea. Regional indicators: Total fertility rate [Internet]. Daejeon: Statistics Korea; c2020 [cited 2021 Nov 26]. Available from: https://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1B81A21&vw_cd=&list_id=&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=E1&docId=0028401391&markType=S&itmNm=%EC%A0%84%EA%B5%AD
  3. Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, & Practice Committee of the American Society for Reproductive Medicine (2020). Testing and interpreting measures of ovarian reserve: a committee opinion. Fertility and sterility, 114(6), 1151-1157. https://doi.org/10.1016/j.fertnstert.2020.09.134
  4. Mutlu, M. F., & Erdem, A. (2012). Evaluation of ovarian reserve in infertile patients. Journal of the Turkish German Gynecological Association, 13(3), 196-203. https://doi.org/10.5152/jtgga.2012.28
  5. Yilmaz, N., Uygur, D., Inal, H., Gorkem, U., Cicek, N., & Mollamahmutoglu, L. (2013). Dehydroepiandrosterone supplementation improves predictive markers for diminished ovarian reserve: serum AMH, inhibin B and antral follicle count. European journal of obstetrics, gynecology, and reproductive biology, 169(2), 257-260. https://doi.org/10.1016/j.ejogrb.2013.04.0039.
  6. Wang, Y., Wu, J. Z., Li, Y., & Qi, X. (2019). Polysaccharides of Fructus corni Improve Ovarian Function in Mice with Aging-Associated Perimenopause Symptoms. Evidence-based complementary and alternative medicine : eCAM, 2019, 2089586. https://doi.org/10.1155/2019/2089586
  7. Yin, J., Chang, H. M., Li, R., & Leung, P. C. (2021). Recent progress in the treatment of women with diminished ovarian reserve. Gynecology and Obstetrics Clinical Medicine, 1(4), 186-189. https://doi.org/10.1016/j.gocm.2021.10.004
  8. Liu, L., Liu, Y., Yang, M., Xu, G., Li, R., Xu, X., Pan, X., & Liang, J. (2020). Effectiveness of tonifying-kidney and regulating-liver therapy on diminished ovarian reserve: a systematic review and Meta-analysis of randomized controlled trials. Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan, 40(3), 343-354. https://doi.org/10.19852/j.cnki.jtcm.2020.03.001
  9. Higgins, J. P., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2019). Cochrane handbook for systematic reviews of interventions. John Wiley & Sons.
  10. Guyatt, G., Oxman, A. D., Akl, E. A., Kunz, R., Vist, G., Brozek, J., Norris, S., Falck-Ytter, Y., Glasziou, P., DeBeer, H., Jaeschke, R., Rind, D., Meerpohl, J., Dahm, P., & Schunemann, H. J. (2011). GRADE guidelines: 1. Introduction -GRADE evidence profiles and summary of findings tables. Journal of clinical epidemiology, 64(4), 383-394. https://doi.org/10.1016/j.jclinepi.2010.04.026
  11. Wang Zhuran.(2012).Clinical Research on Effect of Kidney-tonilying Traditional Chinese Herbs to Improve the Female Reproductive Potential in Late-reproductive Age(Master's thesis, Guangzhou University of Traditional Chinese Medicine).
  12. Guan Yu.(2016). Clinical Observation on Treatment of Decreased Ovarian Reserve Function by Tonifying Kidney, Soothing Liver and Nourishing Blood(Master's thesis, Beijing University of Chinese Medicine).
  13. Wang Kaili.(2020). Clinical Study of Bushen Culuan Formula Treatment for Infertility Caused by Premature Ovarian Insufficiency (Master's thesis, China Academy of Chinese Medical Sciences).
  14. Duan Wenxu & Cheng Yueyi.(2021). Sequential therapy for kidney-tonifying via traditional Chinese medicine effectively improves the reproductive potential and quality of life of women with decreased ovarian reserve: a randomized controlled study.. American journal of translational research(4)
  15. Ma Kun, Wu Jingxian, Zhang Huixian, Wang Kaili & Peng Bihui.(2021).Clinical Study on Treatment of Infertility Caused by Low Ovarian Reserve Function of Kidney Deficiency and Blood Stasis Syndrome with Bushen Huoxue Huo Decoction. Chinese Journal of Traditional Chinese Medicine(11),2644-2649. doi:10.19540/j.cnki.cjcmm.20210317.502.
  16. Ramalho de Carvalho, B., Gomes Sobrinho, D. B., Vieira, A. D., Resende, M. P., Barbosa, A. C., Silva, A. A., & Nakagava, H. M. (2012). Ovarian reserve assessment for infertility investigation. ISRN obstetrics and gynecology, 2012, 576385. https://doi.org/10.5402/2012/576385
  17. Qin, J. C., Fan, L., & Qin, A. P. (2017). The effect of dehydroepiandrosterone (DHEA) supplementation on women with diminished ovarian reserve (DOR) in IVF cycle: Evidence from a meta-analysis. Journal of gynecology obstetrics and human reproduction, 46(1), 1-7. https://doi.org/10.1016/j.jgyn.2016.01.002
  18. Narkwichean, A., Maalouf, W., Campbell, B. K., & Jayaprakasan, K. (2013). Efficacy of dehydroepiandrosterone to improve ovarian response in women with diminished ovarian reserve: a meta-analysis. Reproductive biology and endocrinology : RB&E, 11, 44. https://doi.org/10.1186/1477-7827-11-44
  19. Klinge, C. M., Clark, B. J., & Prough, R. A. (2018). Dehydroepiandrosterone Research: Past, Current, and Future. Vitamins and hormones, 108, 1-28. https://doi.org/10.1016/bs.vh.2018.02.002
  20. Mitwally, M. F., & Casper, R. F. (2003). Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Human reproduction (Oxford, England), 18(8), 1588-1597. https://doi.org/10.1093/humrep/deg311
  21. Song, D., Shi, Y., Zhong, Y., Meng, Q., Hou, S., & Li, H. (2016). Efficiency of mild ovarian stimulation with clomiphene on poor ovarian responders during IVF\ICSI procedures: a meta-analysis. European journal of obstetrics, gynecology, and reproductive biology, 204, 36-43. https://doi.org/10.1016/j.ejogrb.2016.07.498
  22. Bishop, L. A., Richter, K. S., Patounakis, G., Andriani, L., Moon, K., & Devine, K. (2017). Diminished ovarian reserve as measured by means of baseline follicle-stimulating hormone and antral follicle count is not associated with pregnancy loss in younger in vitro fertilization patients. Fertility and sterility, 108(6), 980-987. https://doi.org/10.1016/j.fertnstert.2017.09.011
  23. Chang, Y., Li, J., Li, X., Liu, H., & Liang, X. (2018). Egg Quality and Pregnancy Outcome in Young Infertile Women with Diminished Ovarian Reserve. Medical science monitor : international medical journal of experimental and clinical research, 24, 7279-7284. https://doi.org/10.12659/MSM.910410
  24. Cao, H., Han, M., Ng, E. H., Wu, X., Flower, A., Lewith, G., & Liu, J. P. (2013). Can Chinese herbal medicine improve outcomes of in vitro fertilization? A systematic review and meta-analysis of randomized controlled trials. PloS one, 8(12), e81650. https://doi.org/10.1371/journal.pone.0081650
  25. Ried, K., & Stuart, K. (2011). Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic review. Complementary therapies in medicine, 19(6), 319-331. https://doi.org/10.1016/j.ctim.2011.09.003
  26. Xia, T., Ma, R. H., Mu, W., Ma, S. H., Mao, S. W., & Fu, Y. (2014). Traditional Chinese medicine for diminished ovarian reserve: a systematic review and meta-analysis. Chinese Herbal Medicines, 6(2), 93-102. https://doi.org/10.1016/S1674-6384(14)60014-9
  27. Jang, S., Kim, K. H., Jun, J. H., & You, S. (2020). Acupuncture for in vitro fertilization in women with poor ovarian response: a systematic review. Integrative medicine research, 9(2), 100395. https://doi.org/10.1016/j.imr.2020.02.003
  28. Zheng, Y., Feng, X., Mi, H., Yao, Y., Zhao, Y., Li, J., Jiao, J., Gong, A., Sun, W., & Deng, X. (2015). Effects of transcutaneous electrical acupoint stimulation on ovarian reserve of patients with diminished ovarian reserve in in vitro fertilization and embryo transfer cycles. The journal of obstetrics and gynaecology research, 41(12), 1905-1911. https://doi.org/10.1111/jog.12810
  29. Romanski, P. A., Bortoletto, P., Rosenwaks, Z., & Schattman, G. L. (2020). Delay in IVF treatment up to 180 days does not affect pregnancy outcomes in women with diminished ovarian reserve. Human reproduction (Oxford, England), 35(7), 1630-1636. https://doi.org/10.1093/humrep/deaa137
  30. Huang, C., Song, K., Ma, W., Ding, J., Chen, Z., & Zhang, M. (2017). Immunomodulatory mechanism of Bushen Huoxue Recipe alleviates cyclophosphamide-induced diminished ovarian reserve in mouse model. Journal of ethnopharmacology, 208, 44-56. https://doi.org/10.1016/j.jep.2017.06.022
  31. Sun, Y., Chen, S., & Tan, Y. (2018). Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences, 43(10), 1068-1074. https://doi.org/10.11817/j.issn.1672-7347.2018.10.005
  32. Hung, Y. C., Kao, C. W., Lin, C. C., Liao, Y. N., Wu, B. Y., Hung, I. L., & Hu, W. L. (2016). Chinese herbal products for female infertility in Taiwan: a population-based cohort study. Medicine, 95(11).
  33. Kim, D. I., Choi, M. S., Pak, S. C., Lee, S. B., & Jeon, S. (2012). The effects of Sutaehwan-Gami on menopausal symptoms induced by ovariectomy in rats. BMC complementary and alternative medicine, 12, 227. https://doi.org/10.1186/1472-6882-12-227
  34. Ke, J., & Duan, R. (2013). Effects of flavonoids from semen cuscutae on the hippocampal-hypothalamic-pituitary-ovarian sex hormone receptors in female rats exposed to psychological stress. Clinical and experimental obstetrics & gynecology, 40(2), 271-274.
  35. Liu, C., Liu, L. H., Li, N., Xiu, A., Zhang, Z., & Ai, H. (2021). Efficacy of an Yinyanghuo (Herba Epimedii Brevicornus)-Xianmao (Rhizoma Curculiginis) drug pair in a rat model of polycystic ovary syndrome. Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan, 41(4), 588-599. https://doi.org/10.19852/j.cnki.jtcm.2021.03.011