Evidence-based complementary and alternative medicine conventional surgery combined with traditional Chinese medicinal retention enema for tubal obstructive infertility: A systematic review and meta-analysis.

BACKGROUND: Chinese medicinal retention enemas have gradually attracted the attention of clinicians as an alternative approach for tubal obstructive infertility. The purpose of this study was to investigate the efficacy and safety of conventional surgery combined with traditional Chinese medicinal retention enemas for the treatment of tubal obstructive infertility. MATERIALS AND METHODS: Eight electronic databases were searched from their inception to November 30, 2022. To assess the efficacy and safety of different treatments, following outcomes were measured: clinical pregnancy rate, clinical total effective rate, incidence of ectopic pregnancy, the improvement of Traditional Chinese Medicinal (TCM) symptoms, the improvement of the signs of obstructive tubal infertility and side effects. RESULTS: A total of 23 Randomized Controlled Trials (RCTs) with 1909 patients met the inclusion criteria. The pooled results showed a higher pregnancy rate in the experimental group than in the control group (RR 1.75, 95% CI [1.58, 1.94], Z = 10.55, P<0.00001). The clinical total effective rate in the experimental group was higher than that in the control group (RR 1.28, 95% CI [1.23, 1.34], Z = 11.07, P<0.00001). The incidence of ectopic pregnancy in the experimental group was lower than that in the control group (RR 0.40, 95% CI [0.20, 0.77], Z = -2.73, P = 0.01). CONCLUSION: Based on current evidence, we concluded that conventional surgery combined with traditional Chinese medicinal retention enema for tubal obstructive infertility was superior to conventional surgery alone in improving the clinical pregnancy rate, improving clinical total effective rate, improving TCM symptoms, improving the signs of obstructive tubal infertility and lowering the incidence of ectopic pregnancy. However, further clinical trials with high-quality methodologies need to be conducted.

Phytochemicals: Alternative for Infertility Treatment and Associated Conditions.

Infertility and obstetric complications have become global health issues in the past few years. Infertility is defined as the inability of a couple to conceive even after twelve months or more of regular and unprotected intercourse. According to WHO data published in the year 2020, 186 million people have infertility globally. Factors leading to infertility are variable in both males and females. But some common factors include smoking, alcohol consumption, obesity, and stress. Various synthetic drugs and treatment options are available that are effective in treating infertility, but their prolonged usage produces various unwanted adverse effects like hot flashes, mood swings, headaches, and weight gain. In extreme cases, these may also lead to the development of anxiety and depression. Herbal remedies have gained a lot of popularity over the years, and people's inclination toward them has increased all over the world. The prime reason is that these show significant therapeutic efficacy and have fewer side effects. The therapeutic efficacy of plants can be attributed to the presence of diverse phytochemical classes of constituents like alkaloids, flavonoids, and volatile oils. These secondary metabolites, or phytomolecules, can be used to develop herbal formulations. The review highlights the applications and mechanisms of action of various phytochemicals for treating infertility. Also, it focuses on the various future prospects associated with it.

Drug substitution and adjuvant therapy in patients with genetics related infertility: A review.

With the in-depth study of the human genome and the increasing popularity of gene sequencing, it has been gradually confirmed that genetics can play a crucial role in infertility. To provide references for clinical treatment, we have focused on genes and drug therapy for genetic infertility. This review recommends adjuvant therapy and drug substitution. Examples of these therapies include antioxidants (such as folic acid, vitamin D, vitamin E, inositol, coenzyme Q10 etc.), metformin, anticoagulants, levothyroxine, dehydroepiandrosterone, glucocorticoids, and gonadotropins etc. Based on the pathogenesis, we provide an overview of the current knowledge, including randomized controlled trials and systematic reviews, and predict potential target genes and signaling pathways, proposing possible future strategies for the use of targeted drugs to treat infertility. Non-coding RNAs are anticipated to become a novel target for the treatment of reproductive illnesses since they have a significant role in controlling the occurrence and development of reproductive diseases.

Nonpharmacological Interventions for the Management of Testosterone and Sperm Parameters: A Scoping Review.

PURPOSE: Testosterone replacement and associated pharmacologic agents are effective strategies to treat male hypogonadism; however, nutraceutical agents and lifestyle modification approaches have gained medical interest. The purpose of this scoping review is to highlight the evidence (or lack thereof) of nutraceuticals and lifestyle modification approaches in the management of testosterone levels and sperm parameters. METHODS: A scoping review of nonpharmacologic interventions (supplements, herbal medicines, diets, sleep, and exercise) with the potential to improve male health was undertaken to elucidate changes in testosterone levels and sperm parameters in men with hypogonadism or infertility compared with healthy patients. FINDINGS: A multitude of nutraceuticals and functional nutrients are purported to stimulate testosterone production; however, only a select few have had promising results, such as zinc, vitamin D (in case of hypovitaminosis D), l-arginine, mucuna, and ashwagandha, based on well-controlled randomized clinical trials of men with low testosterone levels and related problems. Except for l-arginine, these natural agents, as well as tribulus and ω3 fatty acids, can improve some degree of sperm parameters in infertile men. Before implementing these nutraceutical agents, adequate sleep, exercise, and weight loss in patients with obesity are imperative. The effects of nonpharmacologic interventions on testosterone levels are modest and hence do not directly translate into clinical benefits. Correspondingly, androgen receptor content, but not endogenous androgens, has been regarded as the principal factor in muscle hypertrophy. IMPLICATIONS: A limited number of supplements and herbal medicines can be considered as adjunctive approaches in the management of testosterone levels and sperm parameters, primarily in men with low testosterone levels and infertility, whereas most nonpharmacologic supplements appear to lack evidence. Although proper physical exercise, sleep, and diet are indisputable approaches because of the general benefits to health, the use of nutraceuticals, if considered, must be personalized by physicians and/or registered dietitians.

Persea americana seed extract restores defective sperm quality and biochemical parameters relevant to reproduction in male wistar rats treated with cyclosporine A.

Studies have shown that some drugs impair spermatogenesis, thereby causing infertility. Thus, this study aims at investigating the effect of Persea americana seed extract on the male reproductive system in cyclosporine-induced rats. Thirty male albino rats were randomly divided into five groups; all groups were induced with cyclosporine except the control group. Group 3 was treated with 10 mg/kg of lisinopril, groups 4 and 5 received 50 and 100 mg/kg of PAE, respectively. The experiment lasted for 7 days. The antioxidant enzymes [superoxide dismutase (SOD) and catalase (CAT)], and arginase activities were evaluated, nitric oxide (NO) and malondialdehyde (MDA) level of the penile tissue homogenate were determined with serum hormonal (follicle stimulating hormone, luteinizing hormone and testosterone) concentration and sperm quality. This study showed that cyclosporine induction caused a significant (p < .05) decrease in the SOD, CAT, sperm quality, NO, and hormonal level as compared to the control group, with a simultaneous increase in arginase activity and MDA level. However, treatment with PAE and lisinopril significantly (p < .05) increase antioxidant enzyme activities, sperm quality, NO, and serum hormonal level, with a decrease MDA level and arginase activity when compared with cyclosporine-induced group. This study showed that P. americana seed extract could be useful in the management of hormonal disruption resulting from oxidative stress in male folks. PRACTICAL APPLICATIONS: Some pharmaco-agents have been reported to alter spermatogenesis, thereby causing infertility. Plants represent natural resources use in the management of several human diseases from time immemorial. Persea americana seed is a part of the fruit that most people do throw away after consuming the edible portion of the fruit. However, the therapeutic and pharmacological activities of P. americana seed have been reported. Therefore, this study sought to investigate the effects of P. americana seed extract on cyclosporine-induced reprotoxicity.

Selenium.

Selenium (Se) is an element commonly found in the environment at different levels. Its compounds are found in soil, water, and air. This element is also present in raw materials of plant and animal origin, so it can be introduced into human organisms through food. Selenium is a cofactor of enzymes responsible for the antioxidant protection of the body and plays an important role in regulating inflammatory processes in the body. A deficiency in selenium is associated with a number of viral diseases, including COVID-19. This element, taken in excess, may have a toxic effect in the form of joint diseases and diseases of the blood system. Persistent selenium deficiency in the body may also impact infertility, and in such cases supplementation is needed.

Sterility of Ethyl Chloride Spray After Use in the Clinic.

Background: Ethyl chloride spray is used frequently in the outpatient setting as a local anesthetic for injections and aspirations with varying consensus about the sterility of the spray. We hypothesize that ethyl chloride spray remains sterile and would show no bacterial growth during routine clinical use. Methods: Thirteen ethyl chloride bottles were collected for testing. Two unopened bottles were used as controls. Eleven unopened bottles were placed in orthopedic clinics and recollected after varying duration of use. The final volume and duration of use were recorded. Each bottle was sprayed in a separate test tube and allowed to evaporate. Trypticase soy broth was added to each tube and incubated for 48 hours. Control test tubes with broth alone were prepared and incubated under the same conditions. Cultures were evaluated at 24 and 48 hours. Results: The mean duration of ethyl chloride bottle use prior to culturing was 26 days. The average volume used per day was 1.9 mL. Each ethyl chloride bottle had an initial volume of 103.5 mL. Using the average daily volume usage, an extrapolated lifespan of each bottle was estimated at 7.7 weeks. None of the samples showed bacterial or fungal growth at 24 or 48 hours. Conclusion: Ethyl chloride bottles used in the clinical settings showed no bacterial or fungal contamination through their shelf life and routine use. The duration and amount of use did not affect sterility. Although the antimicrobial activity of ethyl chloride spray on skin is debated, ethyl chloride itself remains sterile through clinical use.

Reproductive outcomes in women and men using complementary and alternative medicine treatment and not receiving artificial reproductive technology: a systematic review.

PURPOSE: Infertility is a global problem, but only a minority of couples access assisted reproductive technologies due to financial and sociocultural barriers. Complementary and alternative medicine are seen as another option. We aimed to determine the impact of complementary and alternative medicine on conception, miscarriage and live birth rates in couples not receiving assisted reproductive technology treatments. METHODS: The electronic databases EMBASE, PubMed, Web of Science and the Allied and Complementary Medicine Database were systematically searched before March 24th 2020. Reference lists of eligible studies were searched for relevant studies. Eligible studies included trials and observational studies that assessed a complementary or alternative medicine and conception, miscarriage or live births in men or women not undergoing fertility treatment. Data were extracted by two independent reviewers using a pre-designed data collection form. The study protocol was published in the PROSPERO database (CRD42018086980). RESULTS: Twenty randomized controlled trials were identified, including 2748 individuals. Most studies did not demonstrate any effect of a complementary or alternative medicine on pregnancy, live birth or miscarriage rates. Limited evidence was found for a positive effect of herbal therapies taken by women on conception rates. There was substantial diversity in quality across the studies. CONCLUSION: There is limited evidence of the effectiveness of complementary and alternative medicine on improving the chances of conception and live births, or increasing miscarriage risk. Owing to the generally sub-optimal quality and heterogeneous nature of the evidence, rigorous studies are needed to determine the impact of complementary and alternative medicine on fertility.

New infertility therapy effects of polysaccharides from Althaea officinalis leaf with emphasis on characterization, antioxidant and anti-pathogenic activity.

Characterization, antioxidant, anti-pathogenic and infertility therapy effects of polysaccharides from Althaea officinalis (marshmallow) leaf (AOLPS) were investigated. AOLPS was fractionated using ion-exchange chromatography, affording fractions of AOLPS-1, AOLPS-2, AOLPS-3 and AOLPS-4. The fractions were mainly composed of d-galactopyranose (α-(1 â†’ 4)-glycosidic bond) with the average molecular weight of 1220, 2240, 998 and 2670 Da, respectively which means it was a pectin-like polysaccharide. Differential scanning calorimetry (DSC) and Fourier-transform infrared spectroscopy (FT-IR) techniques were employed to characterize the structure of purified polysaccharides. Compared with AOLPS-1, AOLPS-2 and AOLPS-4, AOLPS-3 had higher potential as a natural antioxidant and antimicrobial. At the same time, the infertility therapy effects of four fractions of AOLPS were in the order AOLPS-3 > AOLPS-4 > AOLPS-1 > AOLPS-2. The experimental study provides strong evidence to exploit A. officinalis leaf in food and pharma manufacturing processes and presents new benefit of this plant in infertility therapy.

Calcium Supplementation Alleviates High-Fat Diet-Induced Estrous Cycle Irregularity and Subfertility Associated with Concomitantly Enhanced Thermogenesis of Brown Adipose Tissue and Browning of White Adipose Tissue.

Obesity has been demonstrated as a disruptor of female fertility. Our previous study showed the antiobesity effects of calcium on HFD-fed male mice. However, the role of calcium in alleviating reproductive dysfunction of HFD-fed female mice remains unclear. Here, we found that HFD led to estrus cycle irregularity (longer cycle duration and shorter estrus period) and subfertility (longer conception time, lower fertility index, and less implantations) in mice. However, the HFD-induced reproductive abnormality was alleviated by calcium supplementation. Additionally, calcium supplementation enhanced activation/thermogenesis of BAT and browning of WAT in HFD-fed mice. Consequently, the abnormality of energy metabolism and glucose homeostasis induced by HFD were improved by calcium supplementation, with elevated metabolic rates and core temperature. In conclusion, these data showed that calcium supplementation alleviated HFD-induced estrous cycle irregularity and subfertility associated with concomitantly enhanced BAT thermogenesis and WAT browning, suggesting the potential application of calcium in improving obesity-related reproductive disorders.

Preventive effects of Aframomum melegueta extracts on the reproductive complications of propylthiouracil-induced hypothyroidism in male rat.

Recent studies have demonstrated that hypothyroidism is associated with infertility. This work was undertaken to evaluate the protective effects of Aframomum melegueta on testicular functions and fertility of hypothyroid male rats. Male rats were orally treated with propylthiouracil (PTU: 10 mg/kg) in combination with plant aqueous or methanol seed extract (20 and 100 mg/kg) for 56 days. Vitamin E and clomiphene citrate served as positive controls. On day 47 of treatment, each male was mated with two adult females for fertilization potential evaluation. At the end of the treatment, genital sex organ weights, sperm characteristics, testicular histology, oxidative status, plasmatic hormones and fertility potential were evaluated. Results indicated that PTU created hypothyroidism characterised by a significant increase in TSH with reduction of T3 and T4. PTU also lowered genital sex organ weights, sperm count, viability and motility, plasmatic levels of luteinising hormone, follicle-stimulating hormone and testosterone, and increased prolactin, cholesterol and testicular oxidative stress. Alteration in sperm morphology, testis and epididymis histology, and fertilization potential was also noticed. Co-administration with A. melegueta extracts successfully reversed PTU-induced infertility without any effect on thyroid hormones. These results provide evidence that A. melegueta has a protective effect on fertility in hypothyroid condition.

[Research rules of famous veteran traditional Chinese medicine practitioners in treating infertility].

To explore the medication rules of famous veteran traditional Chinese medicine practitioners in treating infertility based on medical cases of infertility collected from book series of Hundred Traditional Chinese Medicine Clinicians of Hundred Years in China and Prescription Proven by Traditional Chinese Medicine Masters. Researchers extracted the information of prescriptions from these cases according to the inclusion and exclusion criteria. Then, Excel 2010, SPSS Clementine(ver.12.0) and SPSS(ver. 22.0) were adopted respectively for frequency analysis, association rules analysis, cluster analysis and factor analysis. Cluster analysis was carried out by Ochiai algorithm of binary variable data, which was a systematic clustering method. And principal component analysis was used for factor analysis. Besides, KMO test and Bartlett spherical test were used for factor adaptation test. Finally, 151 medical cases and 396 prescriptions were included in total. A total of 60 kinds of frequently used herbs were identified according to the results of frequency analysis for medication, they were mainly used for activating blood and resolving stasis, tonifying and clearing heat respectively. The association rules analysis found out 25 drug pair association rules and 14 3-drug combination association rules. A total of 15 medicine groups were extracted by cluster analysis. KMO test and Bartlett spherical test indicated that the method was suitable for factor analysis, and 21 common factors were respectively extracted by factor analysis. Association rules indicated the characteristics of the therapeutic methods, like tonifying Qi and replenishing blood. The famous veteran traditional Chinese medicine practitioners utilized modified Siwu Decoction for tonifying blood and preferred Atractylodis Macrocephalae Rhizoma(Baizhu) for tonifying Qi. The results of both cluster analysis and factor analysis demonstrated the characteristics of the therapies for tonifying kidney, activating blood, tonifying spleen and dispelling dampness. In addition, factor analysis could reflect the therapies for nourishing Yin, tonifying kidney, warming the meridian, dissipating cold, nourishing blood and dispelling blood stasis. These results of analysis comprehensively showed out the medication characteristics of famous veteran traditional Chinese medicine practitioners of strictly following the pathogenesis, making good use of classical formulas and providing proper compatibility. In conclusion, data mining techniques(including frequency analysis, association rules analysis, cluster analysis and factor analysis) were used to comprehensively analyze the medication rules of famous veteran traditional Chinese medicine practitioners in treating infertility, which is helpful for guiding the clinical practice of treating infertility with traditional Chinese medicine.

Combined chitosan and Dan-shen injection for long-term tubal patency in fallopian tube recanalization for infertility.

To prospectively study the efficacy of different anti-adhesion agents for the prevention of tubal obstruction after recanalization, this trial was approved by our hospital ethics committee. Four hundred patients with fallopian tube obstruction were randomly assigned to four groups. The control group underwent recanalization alone, whereas the other groups were injected with chitosan, Dan-shen, or combined chitosan and Dan-shen after recanalization. The tubal patency rate in all four groups was recorded after 12 day, 3 months, and 12 months. The pregnancy rates were noted after 12 months. The recanalization rates after 1 day in the control, chitosan, Dan-shen, and combined chitosan and Dan-shen groups were 94.1, 97.1, 96.5, and 98.2%, respectively (p = 0.18, p > 0.05). The rates of tubal patency after 3 months were significantly higher in the combined chitosan and Dan-shen (96.5%), chitosan (88%), and Dan-shen (85.2%) groups compared with the control group (73.9%) (p = 0.0001, p < 0.05). The recanalization rate and intrauterine pregnancy rate after 12 months was significantly higher in the combined chitosan and Dan-shen group (93.8 and 63.9%, respectively) compared with the other groups (control 39 and 30.6%, chitosan 78.4 and 46.9%, and Dan-shen 77.3 and 43.3%) (p = 0.0029 and p = 0.0001, p < 0.05). Chitosan, Dan-shen, or a combination of the two compounds could be effective for preventing tubal obstruction after interventional recanalization, possibly increasing the rate of pregnancy in affected women. The combined chitosan and Dan-shen injection has unique advantages in the interventional recanalization of obstructed fallopian tubes.

Feeding rosemary leaves powder ameliorates rooster age-related subfertility.

Having a high proportion of polyunsaturated fatty acids avian spermatozoa predispose to lipoperoxidation which results in fertility reduction. In the current study, rosemary leaves powder (RLP) was fed to senescent breeder roosters to improve their reproductive performance. Twenty four 70-week-old roosters were randomly divided into four groups and received following treatments including 0 (RLP-0), 2.5 (RLP-2.5), 5 (RLP-5) or 7.5 (RLP-7.5) g of RLP/kg of diet for eight consecutive weeks. Semen characteristics were evaluated weekly. Sperm penetration rate was assessed once, however, fertility, hatchability, embryonic mortality and hatchling quality evaluated twice (using eggs collected during 1st and 2nd weeks following AI) at the end of experiment. Excluding body weight and sperm abnormality percentage, other traits including semen concentration (RLP-2.5 = 3.57, RLP-5 = 4.21 and RLP-7.5 = 3.79; SEM = 0.12; p < 0.01), total sperm production (RLP-2.5 = 1.33, RLP-5 = 1.8 and RLP-7.5 = 1.47; SEM = 0.07; p < 0.01), forward motility (RLP-2.5 = 72.96, RLP-5 = 83.65 and RLP-7.5 = 78.84; SEM = 0.47; p < 0.01) and viability (RLP-2.5 = 82.93, RLP-5 = 88.69 and RLP-7.5 = 86.85; SEM = 0.45; p < 0.01) were improved in RLP treated groups compared to control group (3.08 ± 0.12, 1.05 ± 0.07, 68.39 ± 0.47 and 76 ± 0.45 for semen concentration, total sperm production, sperm forward motility and viability, respectively). In addition, semen volume and sperm plasma membrane functionality were higher in both RLP-5 (0.43 ± 0.01 and 66.66 ± 0.55) and RLP-7.5 (0.39 ± 0.01 and 65.52 ± 0.55) than control group (0.34 ± 0.01; p < 0.05 and 62.89 ± 0.55; p < 0.05). Supplementation of RLP significantly decreased semen Malondialdehyde (MDA) concentration. Moderate level of RLP (RLP-5) had significantly higher numbers of sperm penetration holes compared to other groups. Fertility rate of collected eggs from both RLP-5 (first week: 91.09 ± 1.27 (P < 0.01); second week: 88.73 ± 1.27 (p < 0.05)) and RLP-7.5 (first week: 93.11 ± 1.27 (P < 0.01); second week: 90.87 ± 1.27 (p < 0.05)) groups was higher than other groups at 1st and 2nd weeks of egg collection. Hatchability of eggs set at 2nd week (83.64 ± 3.54; p < 0.05) was higher and embryonic mortality at 1st week (1-6 day mortality: 5.03 ± 1.25 (p < 0.05); 18-21 day and pipped mortality: 8.55 ± 1.31 (p < 0.05)) was in RLP-0.5 group than other groups, respectively. To conclude, RLP supplementation could successfully attenuate age-related sub-fertility in senescent roosters. Further studies are needed to divulge the causal mechanisms involved.

Prospective Analysis on the Effect of Botanical Medicine (Tribulus terrestris) on Serum Testosterone Level and Semen Parameters in Males with Unexplained Infertility.

We evaluated the role of Tribulus terrestris in males with unexplained infertility and its effect on serum testosterone and semen parameters. Thirty randomized male patients presenting to Andrology outpatient clinic complaining of idiopathic infertility were selected. They were given Tribulus terrestris (750 mg) in three divided doses for three months. The effect of Tribulus terrestris on serum testosterone (total and free) and luteinizing hormone (LH), as well as its impact on semen parameters in those patients, was studied. No statistically significant difference was observed in the levels of testosterone (total and free) and LH and semen parameters (sperm concentration or motility, or abnormal forms) before and after the treatment. In addition, no statistically significant correlations were observed between testosterone (free and total) and LH and semen parameters before and after the treatment. Tribulus terrestris was ineffective in the treatment of idiopathic infertility.

Chinese herbal medicine for subfertile women with polycystic ovarian syndrome.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is one of the most common reproductive endocrinology abnormalities, and affects 5% to 10% of women of reproductive age. Western medicines, such as oral contraceptives, insulin sensitizers and laparoscopic ovarian drilling (LOD), have been used to treat PCOS. Recently, many studies have been published that consider Chinese herbal medicine (CHM) as an alternative treatment for women with PCOS. OBJECTIVES: To assess the efficacy and safety of CHM for subfertile women with PCOS. SEARCH METHODS: We searched sources, including the following databases, from inception to 9 June 2016: the Cochrane Gynaecology and Fertility Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Allied and Complementary Medicine (AMED), PsycINFO, Chinese National Knowledge Infrastructure (CNKI), VIP, Wanfang and trial registries. In addition, we searched the reference lists of included trials and contacted experts in the field to locate trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) that considered the use of CHM for the treatment of subfertile women with PCOS. DATA COLLECTION AND ANALYSIS: Two review authors independently screened appropriate trials for inclusion, assessed the risk of bias in included studies and extracted data. We contacted primary study authors for additional information. We conducted meta-analyses. We used the odds ratios (ORs) to report dichotomous data, with 95% confidence intervals (CI). We assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS: We included five RCTs with 414 participants. The comparisons in the included trials were as follows: CHM versus clomiphene, CHM plus clomiphene versus clomiphene (with or without ethinyloestradiol cyproterone acetate (CEA)), CHM plus follicle aspiration plus ovulation induction versus follicle aspiration plus ovulation induction alone, and CHM plus laparoscopic ovarian drilling (LOD) versus LOD alone. The overall quality of the evidence for most comparisons was very low.None of the included studies reported live birth rate, and only one study reported data on adverse events.When CHM was compared with clomiphene (with or without LOD in both arms), there was no evidence of a difference between the groups in pregnancy rates (odds ratio (OR) 1.98, 95% confidence interval (CI) 0.78 to 5.06; two studies, 90 participants, I² statistic = 0%, very low quality evidence). No study reported data on adverse events. When CHM plus clomiphene was compared with clomiphene (with or without CEA), there was low quality evidence of a higher pregnancy rate in the CHM plus clomiphene group (OR 2.62, 95% CI 1.65 to 4.14; three RCTs, 300 women, I² statistic = 0%,low quality evidence). No data were reported on adverse events.When CHM with follicle aspiration and ovulation induction was compared with follicle aspiration and ovulation induction alone, there was no evidence of a difference between the groups in pregnancy rates (OR 1.60, 95% CI 0.46 to 5.52; one study, 44 women, very low quality evidence), severe luteinized unruptured follicle syndrome (LUFS) (OR 0.60, 95% CI 0.06 to 6.14; one study, 44 women, very low quality evidence), ovarian hyperstimulation syndrome (OHSS) (OR 0.16, 95% CI 0.00 to 8.19; one study, 44 women, very low quality evidence) or multiple pregnancy (OR 0.60, 95% CI 0.06 to 6.14; one study, 44 women, very low quality evidence).When CHM with LOD was compared with LOD alone, there was no evidence of a difference between the groups in rates of pregnancy (OR 3.50, 95% CI 0.72 to 17.09; one study, 30 women, very low quality evidence), No data were reported on adverse events.There was no evidence of a difference between any of the comparison groups for any other outcomes. The quality of the evidence for all other comparisons and outcomes was very low. The main limitations in the evidence were failure to report live birth or adverse events, failure to describe study methods in adequate detail and imprecision due to very low event rates and wide CIs. AUTHORS' CONCLUSIONS: There is insufficient evidence to support the use of CHM for women with PCOS and subfertility. No data are available on live birth, and there is no consistent evidence to indicate that CHM influences fertility outcomes. However there is very limited low quality evidence to suggest that the addition of CHM to clomiphene may improve pregnancy rates. There is insufficient evidence on adverse effects to indicate whether CHM is safe.

The role of steroid hormone supplementation in non-assisted reproductive technology treatments for unexplained infertility.

Fertility treatment strategies are evolving, with a more rapid transition to assisted reproductive technology (ART) treatments after unsuccessful non-ART treatments. This trend increases the potential importance of adjuvant treatments in non-ART cycles, such as steroid hormone supplementation. It has been established that success rates of ART treatments are increased with the use of luteal support with progesterone. In the setting of non-ART cycles, however, the evidence is less clear, and clinical practices vary widely between providers and clinics. In this review, we aimed to provide an overview of the current evidence for the use of steroid hormone supplementation, including progesterone for luteal support, estrogens, androgens, and mineralocorticoids, in the setting of non-ART treatments for ovulatory women.

Medicinal plants used in Lesotho for treatment of reproductive and post reproductive problems.

ETHNOPHARMACOLOGICAL RELEVANCE: Reproductive healthcare has been highlighted as a major challenge in Lesotho mainly due to the high prevalence of HIV/AIDS and sexually transmitted infections. As a result other reproductive ailments have not received much attention, particularly because healthcare facilities are already limited and many of them are inaccessible. For these reasons, medicinal plants play a major role in primary healthcare system in the country, in addition the plants are easily accessible, more affordable, and their use forms part of the cultural heritage. However, documentation of medicinal plants used for reproductive ailments is scattered, more importantly the biological and pharmacological properties, as well as toxicity of many of these plants are not yet known. AIM OF THE STUDY: To document the plants used by both male and female Basotho (residing in Lesotho) for the treatment of reproductive ailments, to explore their recorded biological and pharmacological effects as well as their toxicity, and to establish if these plants are used for similar purposes in other southern African cultures. MATERIALS AND METHODS: The results stem from published findings of recent interviews of traditional medicinal practitioners in the Maseru District of Lesotho, first author's own experiences and observations from the Qacha's Nek District as well as comprehensive literature survey including numerous books and unpublished data. Electronic databases such as Google, Google Scholar, PubMed, and ScienceDirect were also used to search for the chemical compounds, pharmacological activity, and toxicity of the plants. RESULTS: A total of 87 plant species are reported to be used for the treatment of several reproductive problems such as infertility, complications associated with pregnancy (twelve plants are used to treat conditions such as colic, heartburn, nausea, and constipation), cleansing and/ or toning of the uterus (with a purpose either to induce pregnancy or to get rid of the placenta, for example Withania somnifera and Zantedeschia albomaculata), difficult childbirth, as well treatment of breast and cervical cancer, cysts, fibroids, and testicular tumours (e.g. Hypoxis hemerocallidea). For the toning of the uterus, it is common to use a combination of plants, e.g. Gunnera perpensa, Scabiosa columbaria, and Eriospermum ornithogaloides. CONCLUSIONS: Of the 87 plants used for reproductive healthcare, the highest number (31) is used for the treatment of infertility (in both men and women). The pharmacological effects, active compounds, and toxicology of many of these plants are not yet known.

[Efficacy of Chinese Herbs in Multiple Paths for Tubal Factor Infertility Patients and Their Effects on Serum Inflammatory Factors].

Objective To evaluate the clinical efficacy of Chinese herbs in multiple paths for tub- al factor infertility (TFI) patients, and to observe their effects on serum inflammatory factor. Methods Totally 100 TFl patients were assigned to the observation group and the control group according to grouping sequence, 50 in each group. All patients received laparoscopy. Patients in the observation group were additionally combined with traditional Chinese herbal treatment program in multiple paths (oral administration of Chinese herbs + retention enema of Chinese herbs + iontophoresis). All treatment lasted for 3 successive months. Scores of Chinese medicine (CM) symptoms, clinical efficacy, pregnancy rate, and levels of interleukin-6 ( IL-6) and tumor necrosis factor-α ( TNF-α) were compared between the two groups after 6 months of treatment. Results Scores of CM symptoms were significantly lower in the two groups after treatment ( P <0. 05). They were lower in the observation group than in the control group (P <0. 05). Serum levels of TNF-a and IL-6 were significantly lower in the observation group than in the control group, with statistical difference (P <0. 05). The effective rate was 96. 0% (48/50) in the observation group and 82. 0% (41/50) in the control group, with statistical difference (x² =5. 005, P <0. 05). After one year of postoperative follow-up, the intrauterine pregnancy rate was 58. 0% (29/50) in the observation group and 34. 0% (17/50) in the control group, with statistical difference (x² =5.797, P <0. 05). The ectopic gestation occurred in one patient of the control group, and none in the observation group, with no statistical difference in the ectopic gestation rate between the two groups (x² =1. 010, P >0. 05). Conclusion Chinese herbs in multiple paths for treating TFI could significantly improve clinical symptoms, reduce expressions of serum inflammatory factors, and elevate efficacy and pregnancy rate, which showed superiority when compared with laparoscopy alone.