Abstract
Objective To identify the biological function and metabolic pathway of differential metabolites in follicular fluid of senile patients with kidney qi deficiency undergoing in vitro fertilization-embryo transfer (IVF-ET) and observe the effect of kidney-invigorating herbs on IVF outcomes in senile patients. Methods A total of 95 women undergoing IVF treatment were recruited and divided into three groups, including 34 cases in the treatment group (the senile patients with kidney qi deficiency after the intervention of Chinese medicine), 31 cases in the experiment group (the senile patients with kidney qi deficiency of no intervention of Chinese medicine), and 30 cases in the control group (young women with infertility due to male factor). The three groups of women were treated with long protocol ovarian hyperstimulation; the treatment group was given Qi-Zi-Yu-Si decoction on the day of HCG downregulation. Their IVF clinical outcomes were observed. The metabolites changes of kidney qi deficiency syndrome were analyzed in follicular fluid metabolomics using liquid chromatography-mass spectrometry (UPLC-MS/MS). Results The syndrome score of kidney qi deficiency syndrome in the treatment group was significantly improved after treatment (P < 0.01). Compared with the experiment group, the available embryo rate and implantation rate were increased, and the difference was statistically significant (P < 0.05). Progesterone, indoleacrylic acid, 2-propenyl 1-(1-propenylsulfinyl) propyl disulfide, N-acetyltryptophan, decanoylcarnitine, 20a-dihydroprogesterone, testosterone acetate, eicosatrienoic acid, 1H-indole-3-carboxaldehyde, choline, phosphorylcholine, and tryptophan were downregulated in the treatment group. Through pathway analysis, glycerophospholipid metabolism and steroid hormone biosynthesis were regulated in senile patients with kidney qi deficiency after Qi-Zi-Yu-Si decoction intervention. Conclusion Qi-Zi-Yu-Si decoction can effectively improve the IVF outcome and clinical symptoms of senile patients. Follicular fluid metabolites were significantly changed in senile infertile women with kidney qi deficiency, and the mechanism by which kidney-invigorating herbs improve IVF treatment outcomes may be related to glycerophospholipid metabolism and steroid hormone biosynthesis. This study was registered in the Chinese Clinical Trials Registry Platform (ChiCTR1800014422).
Highlights
It is reported that 8% to 12% of couples of childbearing ages worldwide will be affected by infertility [1]
Clinical Background. ere was no significant difference in age, body mass index (BMI), duration of infertility, basal follicle-stimulating hormone, basal luteinizing hormone, basal estradiol, gravidity, parity, and abortion rate between the treatment and control groups (P > 0.05) (Table 1)
As shown in the Partial least-squares discriminant analysis (PLS-DA) score plots, follicular fluid samples from the control group, the experiment group, and the treatment group were well separated into three categories (Figure 2), suggesting that metabolic perturbation significantly occurred in elder patients
Summary
It is reported that 8% to 12% of couples of childbearing ages worldwide will be affected by infertility [1]. At present, assisted reproductive technologies have developed rapidly, but the pregnancy rate in in vitro fertilizationembryo transfer (IVF-ET) cycles is still hovering between 30% and 40% [3]. E quality of oocytes has an important impact on fertilization and early embryonic development and is one of the key factors affecting the therapeutic outcome of human assisted reproductive technologies. The decline in the number and quality of oocytes due to increasing age is the main reason for the low IVF success rate. Erefore, how to improve pregnancy outcomes in senile infertile women is currently one of the challenges facing the reproductive community. In the process of assisted reproductive technology treatment, the use of kidney-invigorating herbs to improve female reproductive function has achieved significant outcomes, but the mechanism of their action needs to be further studied
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