Substitution of Acupuncture for HCG in Ovulation Induction.
Cai Xuefen, Obstetrical & Gynecological Hospital, Zhejiang Medical
University, Zhejiang Province 310006
Source: Journal of Traditional
Chinese Medicine 17 (2):119-121,1997
By using human menopausal gonadotropin (HMG)
and human chorionic gonadotropin (HCG), fairly good clinical
therapeutic efficacy has been obtained in the treatment of infertility.
However, difficulties are brought about due to the ovarian hyperstimulation
syndrome (OHSS) easily induced by these two drugs. Therefore,
we attempted to use acupuncture instead of HCG in the induction
of ovulation from 1989 to 1992, and satisfactory therapeutic
effect was achieved as reported in the following.
GENERAL DATA
Ten patients were hospitalized
with confirmed diagnosis of infertility and totally observed for
11 menstrual cycles (one patient had recurrence of OHSS for 2 times).
Their ages ranged from 27 to 30 years with an average of 29 years.
After treatment by HMG, all patients manifested OHSS in varying
degrees. In accordance with the criteria for grading of OHSS issued
by WHO, among these 11 menstrual cycles 4 cycles were mild (ovarian
slight enlargement less than 5 cm with symptoms of slight malaise
of lower abdomen); 7 were moderate (marked enlargement of ovary
with nausea, vomiting and abdominal distension); no severe case
occurred (extreme enlargement of ovary with hydrothorax, ascites,
pycnemia and electrolyte disturbance). In order to prevent the
exacerbation of OHSS caused by combined use of HMG and HCG, acupuncture
was used after HMG treatment to replace HCG for the ovulation induction
in 11 menstrual cycles of these patients.
THERAPEUTIC METHOD
1.5-3 cun long
filiform needles (no. 28-30) were used. The acupoints used for
needling were Zigong (Extra 16), Shenshu (UB 23), Ciliao (UB 32),
(the above acupoints were used bilaterally) and Guanyuan (Ren 4).
Baohuang (UB 53) and Zhongji (Ren 3) were selected according to
the signs and symptoms as adjuvant points. The manipulation techniques
included twirling, rotating, lifting and thrusting. Reinforcing
method was used in Shenshu point and the remaining points were
punctured by reducing manipulation. The needling sensation should
be transmitted toward both sides of lower abdomen. When arrival
of Qi, retained the needles for 15 min. and manipulated the needles
intermittently during the retaining period to enhance the stimulation.
Moxibustion with moxa stick was used for some of these acupoints.
Observation of Therapeutic Effect:
Criteria for assessment of therapeutic effect: Therapeutic effect
was appraised mainly by comparison of ultrasonic B examination
after needling with that before treatment and referred to the score
of cervix uteri and basal body temperature to sit judgment on ovulation.
Ovulation occurred within 24 h after 1st needling was considered
as marked effect; ovulation within 72 h after 2-3 times of needling
was effective; no ovulation occurred after 72 h after more than
3 times of needling was scored as ineffective.
RESULTS OF TREATMENT
Of the 11 menstrual
cycles, marked effect was shown in 5 cycles, effective in 5 cycles
and failed in 1 cycle. Among the 10 markedly effective and effective
cycles, ovulation was induced in 2 cases after needling and diagnosed
pregnancy by blood HCG assay and ultrasonography. In 9 of the 10
cycles treated with acupuncture for ovulation induction without
using HCG and other drugs, the symptoms of OHSS were significantly
remitted or even disappeared. Only in one cycle, HCG (with dosage
less than for ovulation) was used after needling to maintain the
function of corpus luteum and resulted in exacerbation of OHSS
and finally remitted by drug treatment.
Typical Case: Fang, 27-year-old,
suffered from polycystic ovary syndrome. She was unpregnant after
married 2 years and the menstruation was only 1-2 times a year.
The basal body temperature was monophase. No effect was observed
using clomiphene and then treated with HMG. From the day 5, for
bleeding due to withdrawal of progesterone, intramuscular injection
of HMG was given at a dose of 150 U once a day for 8 days. The
score of cervix uteri was 12 mark. The ultrasonogram showed that
the size of right ovary was 9.6 cm x 7.8 cm x 4.6 cm and the left
side was 9.2 cm x 7.2 cm x 4.7 cm. Both sides of ovary had 10-20
follicles with maximum size 1.8 cm. In order to avoid severe OHSS,
acupuncture was used instead of HCG for ovulation induction after
stopping HMG treatment. On the next day after the first needling,
the basal body temperature elevated from 36.3°C
to 36.8°C and the score of cervix uteri fell from 12 mark to
9 mark, and ultrasonic B examination suggested that part of the
follicles were ovulated. After the l9th day of ovulation, the blood
concentration of HCG started rising and after 40 days the blood
level of HCG reached to 35.6 ng/ml. The ultrasonogram showed that
the diameter of embryonic sac was 1.5 cm and early pregnancy was
diagnosed.
DISCUSSION
It
was reported in literature that using HMG-HCG in the induction
of ovulation, the ovulatory rate was about 70%-90%, but the incidence
of OHSS might be 10%-15.4% and even life-threatening in the severe
case. At present, there were no satisfactory measures for the prevention
and remission of OHSS. In most reports, it is considered that when
OHSS inclines to occur, stopping injection of HCG is the effective
way to avoid severe OHSS. However, stopping HCG would not only
discontinue the ovulation of HCH, but also gave up the already
developed follicles. Our clinical practice demonstrated that acupuncture
is effective in ovulation induction and also the remission of OHSS
induced by HMG. Furthermore, we also noted that in most OHSS patients
enlarged ovaries and numerous developed follicles were revealed.
As a result of excessive follicles developed, dysplasia of ova
and insufficiency of corpus luteum often occurred, thus leading
to uneasy pregnancy after ovulation. So it is reasonable to infer
that using some Chinese drugs benefiting the function of corpus
luteum or using certain amount of progesterone as supplementary
treatment after acupuncture, the pregnancy rate could be raised.
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