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.

Clinical effect of Jiutengzhuyu tablets on promoting blood circulation in women with oviducal obstruction.

OBJECTIVE: To test the clinical curative effect of Jiutengzhuyu tablets, a patented Chinese vine-derived drug used for promoting blood circulation, on women with oviducal obstruction. METHODS: Patients with tubal infertility were divided randomly into two groups: 58 patients in the treatment group and 57 in a control group. The treated patients took Jiutengzhuyu tablets orally for 25 days. The control group received an intrauterine infusion of 5 mg dexamethasone sodium phosphate, 4000 units of chymotrypsin, 80 000 units of gentamicin sulfate dissolved in 20 mL of normal saline at 1 mL/min. After 3 months of treatment, the curative effect on tubal patency was assessed and a 1-year follow-up visit was used to document any pregnancies. RESULTS: The total effective rate was 78% in the treatment group and 32% in the control group with a statistically significant difference (chi2 = 24.57, P < 0.01). CONCLUSION: Jiutengzhuyu was effective in treating infertility caused by tubal infertility with a Traditional Chinese Medicine diagnosis of blood stasis.

After the FLUSH trial: a prospective observational study of lipiodol flushing as an innovative treatment for unexplained and endometriosis-related infertility.

OBJECTIVES: To assess the demographics, efficacy and safety of lipiodol flushing fertility treatment. DESIGN: Prospective observational study. SETTING: Secondary level care infertility clinic and radiology centre based in Auckland, New Zealand. POPULATION: The first cohort of 100 New Zealand women with infertility to undergo lipiodol flushing as an innovative fertility treatment. METHODS: Women received lipiodol flushing performed by a hysterosalpingogram technique and were followed up at 6 months. MAIN OUTCOME MEASURES: Clinical pregnancy at 6 months post-treatment; and live birth or ongoing pregnancy. RESULTS: The overall pregnancy rate was 30% and the live birth or ongoing pregnancy rate 27%. For women under 40 years old, a 32% pregnancy rate and a 25% live birth or ongoing pregnancy rate were seen in women with unexplained infertility, and a 50% pregnancy rate and a 47% live birth or ongoing pregnancy rate were seen in women with endometriosis. Of women aged 40 years and older, the pregnancy rate was 13% and the live birth or ongoing pregnancy rate was 13%. The pregnancy rates included those occurring after additional interventions, such as intrauterine insemination and in vitro fertilisation, accounting for 12 of the 30 pregnancies. There were no treatment complications. CONCLUSION: This study provides further evidence of the efficacy and safety of lipiodol flushing fertility treatment.

Survey of Australasian clinicians' prior beliefs concerning lipiodol flushing as a treatment for infertility: a Bayesian study.

OBJECTIVE: To evaluate clinicians' beliefs concerning the effectiveness of lipiodol flushing as a treatment for unexplained infertility, and to integrate these prior beliefs with evidence from randomised trials. DESIGN: Survey. SETTING: Specialists in Australasian in vitro fertilisation (IVF) clinics in 2001. METHODS: One of two types of structured survey was used to gather information from fertility specialists in Australasian IVF clinics. Prior beliefs were captured graphically and textually from responses. RESULTS: Nineteen specialists returned questionnaires. Eighteen of the 19 specialists believed that lipiodol flushing was more likely to be beneficial than harmful. The most widely held prior belief, reflected in both textual and numerical responses, was that lipiodol was likely to produce a small beneficial response. The credible limits of this belief were compatible with a reasonable fertility benefit, as more than 50% believed that a 1.5-fold increase in pregnancy rate was plausible. The two surveys found that a 1.2-fold or 1.4-fold increase in pregnancy rate was the median expected level of benefit at which clinicians would have been inclined to recommend lipiodol flushing to their patients (combined range 1.1- to 2.3-fold) - new evidence suggests that for women with endometriosis but otherwise unexplained infertility, these levels of benefit are exceeded. CONCLUSIONS: Among Australasian fertility specialists there is variation in prior beliefs concerning the effectiveness of lipiodol flushing as a treatment for unexplained infertility and in the expected level of benefit at which clinicians are inclined to recommend this treatment. Generalisability of these beliefs remains uncertain owing to a low study response rate.

Application of traditional Chinese medicine in the treatment of infertility.

The philosophy and practice of traditional Chinese medicine (TCM) have been evolving for thousands of years in China, Japan and other Asian countries. TCM is now generating popular interest worldwide for reproductive health care and disease prevention, including applications for treating infertility and improving sexual function. This review focuses on the application of TCM for infertility patients, and provides a critical reflection on the efficacy and safety of selected Chinese herbal formulas. It has been claimed that some formulas produce high clinical pregnancy rates with few or no side effects, as well as improving the general well-being of patients. The need for randomized control trials and research into possible mechanisms of action, effective doses, contra-indications and toxicity is self-evident. However, the task is enormous in view of the number of herbal products currently available on the market; yet among these products are undoubtedly some that will prove to be safe and beneficial.

[Experimental and clinical study of tong jing bao and Angelicae complex injection in treating fallopian tube obstruction].

Twenty-two female rabbits with fallopian tube obstruction as the model, were made by 25% Phenol-Tragacanth Mucilage in the laboratory study. Eight rabbits were treated by taking Tong Jing Bao and giving transcervical intrauterine injecting of Angelicae complex injection. Seven were treated with the latter and other seven with 0.9% saline only as the control group. The study showed that in the opening fallopian tube, anti-inflammation, limiting the hyperplasia of fibro-connective tissue and improving the regeneration of epithelial tissue, the first group was more effective than the other two groups (P less than 0.05). Forty-eight infertile women, in whom the fallopian tube obstruction were proved by hysterosalpingography, were divided into two groups for the clinical study. Thirty patients were treated as same as the first group of rabbits. As the control group, other eighteen women were treated with transcervical intrauterine injecting of gentamycin and 0.9% saline in 3 to 6 months. The effective rates were 94.6% and 56.6% (P less than 0.01) and the subsequent pregnancy rates were 46.7% and 27.8% respectively in the different two groups.