Tiaogeng Yijing decoction improves the pregnancy outcomes of patients with poor ovarian response undergoing in vitro fertilization-embryo transfer

Abstract

The present study aimed to explore the therapeutic effects of the Tiaogeng Yijing decoction on patients with poor ovarian response (POR) undergoing in vitro fertilization-embryo transfer (IVF-ET), in addition to the underlying molecular mechanisms of these effects. A total of 40 patients were randomly and equally assigned to the treatment or control group. Patients in the treatment group received the Tiaogeng Yijing decoction continuously for three menstrual cycles in addition to microstimulation, while patients in the control group underwent microstimulation only. The following molecules were measured following treatment: Serum levels of sex hormones, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and anti-mullerian hormone (AMH); follicular fluid levels of cytokines, including growth differentiation factor (GDF)-9, transforming growth factor (TGF)-β1, leukemia inhibitory factor (LIF), granulocyte-colony stimulating factor (G-CSF) and vascular endothelial growth factor (VEGF); and endometrial levels of cytokines, including integrin αVβ3, TGF-β1, LIF, G-CSF and VEGF. In addition, the antral follicle count (AFC), mean ovarian diameter (MOD) and pregnancy outcomes were measured. The results revealed that the Tiaogeng Yijing decoction significantly decreased serum levels of FSH and E2, and significantly increased serum AMH levels, the AFC, follicular fluid levels of GDF-9, TGF-β1 and VEGF, and endometrial levels of integrin αVβ3, TGF-β1 and VEGF, in addition to pregnancy outcomes (all P<0.05 vs. the control group). However, no significant differences were found in the MOD or levels of LH, LIF and G-CSF. In conclusion, the present study demonstrated that the Tiaogeng Yijing decoction promotes pregnancy outcomes in patients with POR undergoing IVF-ET, and that this effect may be associated with the upregulation of TGF-β1 and VEGF in the follicular fluid and endometrium.

Keywords: Tiaogeng Yijing decoction; in vitro fertilization-embryo transfer; poor ovarian response; pregnancy outcomes; transforming growth factor β1; vascular endothelial growth factor.

Figure 1.

Tiaogeng Yijing increases endometrial levels of integrin αVβ3, TGF-β1 and VEGF in patients with poor ovarian response. Endometrial protein expression levels of integrin αVβ3, TGF-β1, LIF, G-CSF and VEGF were measured via western blot analysis in the control and treatment groups. (A) Western blot and (B) western blot quantification revealed that the Tiaogeng Yijing decoction significantly increased the levels of integrin αVβ3, TGF-β1 and VEGF, but not LIF and G-CSF, compared with the control group. Data are expressed as the mean ± standard deviation and were compared by paired t-test. *P<0.05, **P<0.01 vs. the control group. TGF, transforming growth factor; LIF, leukemia inhibitory factor; G-CSF, granulocyte-colony stimulating factor; VEGF, vascular endothelial growth factor.