日本東洋医学雑誌第58巻
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1 日東医誌 Kampo Med Vol.58 No , 原著 体外受精における胚移植時の芍薬甘草湯併用 による妊娠率改善効果についての検討 星本 和倫 大和たまごクリニック 埼玉 ３ ３ ９ ０ ０６ １ さいたま市岩槻区岩槻５ ２０ ２ Combined with Shakuyakukanzoto at the Time of Embryo Transfer in is vitro Fertilization : A Randomized, Retrospective Study Kazunori HOSHIMOTO Daiwa Tamago Clinic, 5202 Iwatsuki, Iwatsuki-ku Saitama, Saitama, Japan Abstract In vitro fertilization-embryo transfer (IVF-ET) therapy for subfertile couples has become widespread. However, it has been reported that high frequency uterine contractions at the time of embryo transfer influence adversely IVF-ET outcome. This article focuses on the methods of administration of shakuyakukanzoto combined with ET for subfertile women. 186 patients who underwent IVF-ET were recruited. 94 women undergoing IVF were randomly assigned to ET with shakuyakukanzoto for 4 days or 92 with no treatment. Background characteristics (age, number of embryo transferred, quality, and luteal function) were similar in the two groups. Pregnancy rate was 33.0 % in the shakuyakukanzoto group as compared with 20.7 % in the nontreated group. The increased pregnancy rate with shakuyakukanzoto compared with no treated was significant. However, the precise mechanism to explain for the results of this investigation remains to be unclear. Therefore, further research might be necessary to evaluate the effect of shakuyakukanzoto, at the time of ET. Key words : shakuyakukanzoto, IVF-ET, uterine contractions 要旨 体外受精 胚移植は難治性不妊に対して広く行われている治療である しかし 胚移植時の子宮収縮が治療効果 に悪影響を与えるという報告がある そこで今回われわれは 平滑筋収縮抑制効果が期待できる芍薬甘草湯を胚移 植時に併用し 体外受精 胚移植の成績が向上するかどうかを検討した 体外受精を行った１ ８ ６症例のうち 体外受精を行った順に１番目 ９ ４番目に対し芍薬甘草湯を胚移植後４日間投与 し ９ ５番目 １ ８ ６番目に対しては何も投与しなかった また二つの群において年齢や移植胚数および胚質 黄体機能 など臨床的背景に有意な差はなかった 芍薬甘草湯を投与した群と非投与群とで胚移植あたりの妊娠率を比較したところ投与群は３ ３ ０ だったのに対し 非投与群は２ ０ ７ となり 両群間に有意な差が認められた しかし 本研究結果を説明する正確なメカニズムは不 明である したがって さらに症例数を増やし 胚移植時の芍薬甘草湯の効果を検討していく必要がある キーワード 芍薬甘草湯 体外受精 胚移植 子宮収縮 緒言 近年 子宮筋の収縮が胚の着床に大きな影響を与 体外受精 胚移植 IVF-ET は現在 多くの施設 えることが報告されている５ また胚移植時の子宮 で行われ 受精率 分割率 着床率 妊娠率ともに 筋の収縮頻度が高い場合には着床率および妊娠率が 一定レベルまで到達したものと思われる しかし 低下し収縮頻度が低い場合には上昇することがわ 依然として良好に分割した胚を子宮内に移植したに かっている６ さらに Fanchin らの報告７ では卵子 もかかわらず充分な妊娠率が得られないことも多い の成熟目的に投与される hcg が子宮収縮を誘発し その原因として各種の生物活性物質の影響が数多く その収縮期間は hcg 投与日から４ ７日程度継続 １ ４ 報告されている 受付 ２００ ６年８月１日 受理 ２ ０ ０ ７年２月１ ４日 することが見出された hcg 刺激は cyclooxygenase
2 Vol.58 No.3, 2007 COX prostaglandin PG F α PGF α hcg ET A PG ET IVF conventional IVF informed concent hmg P IU mm hcgiu ET Veeck Grade Grade ET ET ET g g ET hcg TEST PACK PlusTM : ABBOT Fisher ET P Kruskal-Wallis P Vitros Eci Ortho-Clinical Diagnostics p SD standard deviation G G ET P ng/ml
3 Vol.58 No.3, 2007 p N n.s G ET Png/ml n.s n.s G GGG Kruskal-Wallis p Fisher P PCO LH FSH PCO IVF IVF IVF ET P Kruskal-Wallis ET PG PG COX- gene PG
4 Vol.58 No.3, 2007 ET Carlberg M, Nejaty J, Froysa B, Guan Y, Soder O, Bergqvist A. : Elevated expression of tumour necrosis factor alpha in cultured with granulosa cells from women with endometriosis. Hum Reprod. 15 Barron Vallejo J,Corona de Lau C,Mendez Espinosa G, Diez Castillo I,Karhmer Krivitzkys, Kably Ambe A. : Effect of intrafollicular interleukin-6 levels on the secretion of estradiol and progesterone in patients treated with in vitro fertilization and embryo transfer. Ginecol Obstet Mex Ijland, M.M,Evers JL,Dunselman, G.A.J,Hoogland, H. J. : Endometrlal wave direction switch and the outcome of in vitro fertilization. Fertil Steril. 71 Fanchin R.,Righini C.,Olivennes F.Taylor S,de Ziegler D,Fryman R. : Uterine contractions at the time of embryo transfer alter pregnancy rates after in vitro fertilization. Hum Reprod. 13 Fanchin R.Ayoubi JM,Righini C,Olivennes F, Schonauer LM,Frydman R. : Uterlne contractlllty decreases at the time of blastocyst transfers. Hum Reprod. 16 Hizaki H, Segi E, Sugimoto Y, Hirose M. Saji T, Ushikubi F, Matsuoka T, Noda Y, Tanaka T, Yoshida N, Narumiya S, Ichikawa A. : Abortive expansion of the cumulus and impaired fertility in mice lacking the prostaglandin Ereceptor subtype EP(2). Proc Natl Acad Sci USA. 96 Lim H,Gupta RA,Ma WG,Paria BC,Moller DE,Morrow JD,Dubois RN,Trzaskos JM,Dey SK. : Cyclooxygenase-2-derived prostacyclin mediates embryo implantation in the mouse via PPARdelta.Genes Dev. 13 Sugimoto Y,Hasumoto K,Namba T,Irie A,Katsuyama M,Negishi M,Kakizuka A,Narumiya S,Ichikawa A. : Cloning and expression of a cdna for mouse prostaglandin F receotor.j Biol Chem Bando M,Shibahara N,Shimada Y. : Pharmacokinetic study of paeoniflorin, paeonimetabolin-i and giycyrrhetic acid in humans after oral administration of peaony root, glycyrrhiza and Shakuyaku-kanzo-to.J Trad Med. 17 Tanaka T,Umesaki N,Ogita S. : Thawlng of frozen shoulder in menopausal women treated with a Japanese herbal medicines, Kanzo-to extract : report of two cases. Clin Exp Obst Gyn Imai A,Horibe S,Fuseya S,Iida K,Takagi H,Tamaya T. : Possible evidence that herbal medicine Shakuyaku -kanzo-to decreases prostaglandin levels through suppresslng arachidonate turnover in endometrium. J Med.
5 Vol.58 No.3, Prostglandin visual analgue scale VAS TJ Takahashi K,Kitao M : Effect of TJ-68 (Shakuyakukanzo-to) on polycystic ovarian disease. Int J Feril. 39! androgen Dunn CL,Kelly RW,Critchley HO. : Decidualization of the human endometrial stromal cell : an enigmatic transformation. Reprod Biomed Online. 7 Poyser NL. : The control of prostaglandin production by the endometrium in relation to luteolysis and menstruation. Prostagl Leukot Essent Fatty Acids. 53 Kennedy TG,Lukash LA. : Induction of decidualization in rats by the intrauterine infusion of prostaglandins. Biol Reprod. 27 Rankin JC,Ledford BE,Jonsson HT Jr,Baggett B. : Prostaglandins, indomethacin and the decidual cell reaction in the mouse uterus. Biol Reprod. 20 Lim H,Paria BC,Das SK,Dinchak JE,Langenbash R, Trzaskos JK,Dey SK. : Multiple female reproductive failures in cyclooxygenes 2-deficient mice. Cell. 91! testosterone 1
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