Acupuncture for infertility: is it an effective therapy? / 中国结合医学杂志

Acupuncture has been used to treat infertility extensively, including ovulatory dysfunction, in vitro fertilization and embryo transfer (IVF-ET), and male infertility. This review summarizes the recent studies which investigated the role of acupuncture in infertility. In conclusion, most of the existing studies suggest a positive effect of acupuncture in infertility treatment. Firstly, acupuncture may improve ovulation by modulating the central and peripheral nervous systems, the neuroendocrine and endocrine systems, the ovarian blood flow, and metabolism. Secondly, acupuncture can improve the outcome of IVF-ET, and the mechanisms may be related to the increased uterine blood flow, inhibited uterine motility, and the anesis of depression, anxiety and stress. Its effect on modulating immune function also suggests helpfulness in improving the outcome of IVF-ET. Finally, the studies suggest that acupuncture plays a positive role in male infertility, the mechanism of which is not yet clear. Even though a positive effect of acupuncture in infertility has been found, well-designed multi-center, prospective randomized controlled studies are still needed to provide more reliable and valid scientific evidence. Furthermore, it is urgent and necessary to clarify the mechanism of acupuncture for infertility.

Genetic polymorphism in an inflammasome component, cervical mycoplasma detection and female infertility in women undergoing in vitro fertilization.

The inflammasome is an inducible cytoplasmic structure that is responsible for production and release of biologically active interleukin-1 (IL-1). A polymorphism in the inflammasome component NALP3 has been associated with decreased IL-1 levels and increased occurrence of vaginal Candida infection. We hypothesized that this polymorphism-induced variation would influence susceptibility to infertility. DNA was obtained from 243 women who were undergoing in vitro fertilization (IVF) and tested for a length polymorphism in intron 2 of the gene coding for NALP3 (gene symbol CIAS1). At the conclusion of testing the findings were analyzed in relation to clinical parameters and IVF outcome. The frequency of the 12unit repeat allele, associated with maximal inflammasome activity, was 62.3% in cases of female infertility vs. 75.6% in cases where only the male partner had a detectable fertility problem (p=0.0095). Conversely, the frequency of the 7unit repeat allele was 28.9% in those with a female fertility problem, 17.0% in women with infertile males and 18.4% in idiopathic infertility (p=0.0124). Among the women who were cervical culture-positive for mycoplasma the frequency of the 7unit repeat was 53.7% as opposed to 19.5% in those negative for this infection (p<0.0001). We conclude that the CIAS1 7unit repeat polymorphism increases the likelihood of mycoplasma infection-associated female infertility.

Hyaluronan in follicular fluid and embryo implantation following in vitro fertilization and embryo transfer.

PURPOSE: To determine whether the concentration of hyaluronan (HA) in follicular fluid predicts implantation success following embryo transfer. METHODS: Follicular fluids from 170 IVF patients were tested by ELISA for HA concentration. RESULTS: The mean (standard error) HA concentration in follicular fluids was 158.0 (21.9) ng/ml from women whose embryos did not implant, 220.0 (21.3) ng/ml from women in which one embryo implanted and 239.3 (40.1) ng/ml from women with 2-3 implantations (implantation vs. no implantation p = .019). The HA level was unrelated to maternal age, number of oocytes harvested or fertilized or number of embryos transferred. Follicular fluids from women with an endocrine problem had a lower mean HA level (142.0 ng/ml) as compared to women undergoing IVF due to male factor infertility (257.3 ng/ml) (P = .05). CONCLUSIONS: HA in follicular fluid is decreased in women with unsuccessful implantation or with an endocrine disorder. A woman's level of HA production may influence the potential for implantation of her embryos.

Antibody to the Chlamydia trachomatis 60 kDa heat shock protein in follicular fluid and in vitro fertilization outcome.

PROBLEM: The association between 60 kDa Chlamydia trachomatis heat shock protein (CHSP60) antibodies and the etiology and outcomes of in vitro fertilization (IVF) outcomes is not well known. METHOD OF STUDY: A retrospective study with a double-blind analysis of follicular fluid from 253 IVF patients for IgG antibodies to CHSP60. RESULTS: The CHSP60 antibodies were detected in 74.1% of women without embryo implantation and in 47.9% of women with 1-3 implantations per IVF cycle (P = 0.0004). CHSP60 antibodies were detected in 69.5% of women with tubal occlusion and 49.7% of women with other causes of infertility (P = 0.01). CHSP60 antibody detection was unrelated to maternal age, number of oocytes collected, or percentage of oocytes fertilized. CONCLUSION: Detection of IgG antibody to CHSP60 may indicate persistence of C. trachomatis in the upper genital tract with low implantation rates resulting from a chronic inflammatory reaction. Alternatively, as human hsp60 is expressed in early stage embryogenesis, a cross-reacting antibody may induce destruction of the embryo.

Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study.

OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI). DESIGN: Randomized, prospective, controlled clinical study. SETTING: University IVF center. PATIENT(S): Two hundred twenty-five infertile patients undergoing IVF/ICSI. INTERVENTION(S): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture. MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancy rates. RESULT(S): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%). CONCLUSION(S): Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

Seminal antibodies to human 60kd heat shock protein (HSP 60) in male partners of subfertile couples.

BACKGROUND: Heat shock proteins (HSP) are essential mammalian and bacterial stress proteins. At the cellular level, they act as chaperones, have important regulatory functions, and are considered to be an essential factor for reproduction. Scarce information exists on the role of sensitization to HSP and the potential role in the aetiology of male infertility. METHODS: The potential association of immunoglobulin (Ig)A antibodies (Ab) to the human 60 kDa heat shock protein (HSP 60) with several parameters of subclinical male genital tract infection/inflammation and with semen quality and sperm fertilizing capacity was analysed in a prospective study. IgA Ab to human HSP 60 were determined in seminal plasma of 202 randomly chosen male partners of subfertile couples with a median duration of infertility of 4 years (range 1-15 years), who were asymptomatic for genital tract infection. After medical history and clinical examination, a comprehensive evaluation of semen quality, in aliquots of the same ejaculates used for HSP Ab determination, included: sperm analysis; local antisperm antibody (ASA) screening; standardized sperm-cervical mucus (CM) penetration testing; immunocytochemical round cell differentiation to determine seminal leukocyte counts; evaluation of complement fraction C(3) and of some pro-inflammatory cytokines; and microbial screening. Subsequent fertility was recorded after 6 months. RESULTS: The presence of HSP 60 IgA Ab in seminal fluid (total positive 6.9%) was significantly associated with leukocytospermia, the presence of C(3), and also with high interleukin (IL) levels in seminal plasma. HSP 60 Ab were not related to the bacterial colonization of ejaculates. There was no association of seminal IgA Ab to human HSP 60 with semen quality, determined with microscopical semen analysis, nor with local IgG- or IgA-class ASA. There was no relationship with sperm intrinsic motility and duration of motility in the sperm CM-penetration test, nor with sperm fertilizing capacity. CONCLUSIONS: The combined presence of IgA Ab to human 60 kDa HSP, leukocytes and other established infection/inflammation markers in semen might suggest a potential role of the immune response to heat shock proteins (HSP) in cases of silent male genital tract infection, but the results do not indicate a marked relationship of HSP 60 Ab in seminal fluid with standard parameters of semen quality.

Immunity to the 60kD heat shock proteins

A brief review on the role of the heat shock proteins (hsp), their common properties and possible consequences for early pregnancy development is described. The 60kD hsp plays an important role as immunogenic antigen of many microbial pathogens and possibly in postinfectious autoimmunity. The immune responce to hsp may cause pregnancy failure. The consequences of previous sensitization to microbial hsp and the effects of human autoantibodies to hsp, are demonstrated in a mouse embryo culture model.

O papel das Heat Shock Proteins no entendimento das infeccoes ginecologicas / The hole of heat shock proteins regards to gynecological infections

Os autores enfocam a importância da biologia molecular no avanço do entendimento dos processos fisiopatogênicos das doenças infecciosas. A Heat Shock Proteínas, tidas como importante mecanismo de defesa celular quando estas estäo submetidas ao estresse, säo descritas em detalhes, classificando-as e dando suas principais funçöes. Os efeitos destas proteínas no organismo humano foram considerados, mostrando-se como hipoteticamente o aumento de sua produçäo, poderia ajudar o indivíduo em determinadas circunstâncias, favorecendo o combate de algumas infecçöes e eventualmente, potencializando a recuperaçäo celular. As situaçöes desfavoráveis também foram destacadas, uma vez que mais esporadicamente, em alguns casos, pode haver possíveis reaçöes imunogênicas cruzadas, levando ao aparecimento de doenças crônicas