Electroacupuncture Enhances Number of Mature Oocytes and Fertility Rates for In Vitro Fertilization
ABSTRACT
Objective: The increasing prevalence of infertility every year is in line with the increasing need for in vitro fertilization (IVF) programs. Failure of oocyte maturation is an obstacle that often causes low success in IVF. According to several studies, controlled ovarian stimulation (COS) has been reported to increase the risk of granulosa-cell apoptosis associated with inhibition of oocyte maturation. This study was conducted to deter- mine the effect of electroacupuncture (EA) on oocyte maturation; rate of fertilization; granulosa-cell apoptosis; and levels of growth-differentiation factor 9 (GDF9) and bone-morphogenetic protein 15 (BMP15) an IVF program.
Materials and Methods: A randomized controlled trial was conducted with 24 subjects who were in the IVF program. Subjects were randomly allocated into verum-EA (n = 12) and sham-EA groups (n = 12). Microscopic assessment of oocyte maturation and rate of fertilization was performed by embryologists, and examinations of granulosa-cell apoptosis index (Bax/Bcl-2 ratio), GDF9, and BMP15 were performed, using real-time quan- titative polymerase chain reaction and messenger-RNA techniques.
Results: There were significant differences in oocyte maturation (P = 0.02) and fertilization rates (P = 0.03) between the verum-EA and sham-EA groups. There were differences in granulosa-cell apoptosis index between the verum- EA and sham-EA groups (P < 0.001). There were significant differences in Bax-protein expression (P = 0.04) and Bcl-2 (P = 0.03) granulosa cells between the verum-EA and sham-EA groups. There was no significant difference in GDF9 levels (P = 0.34) and BMP15 (p = 0.47) between the verum-EA and sham-EA groups.
Conclusions: EA can enhance oocyte maturation and fertilization rate, and reduce the granulosa-cell apoptosis index in an IVF program.
Keywords: Bax, Bcl-2, BMP15, GDF9, granulosa-cell apoptosis, oocyte maturation
Elektroakupunktur Meningkatkan Jumlah Oosit Matur dan Tingkat Fertilitas untuk Fertilisasi In Vitro
Tujuan: Meningkatnya prevalensi infertilitas setiap tahunnya sejalan dengan peningkatan kebutuhan untuk program fertilisasi in vitro (IVF). Kegagalan maturasi oosit adalah sebuah hambatan yang sering menyebabkan tingkat keberhasilan yang rendah dalam IVF. Menurut beberapa penelitian, stimulasi ovarium terkontrol (controlled ovarian stimulation, COS) dilaporkan dapat meningkatkan risiko apoptosis sel granulosa yang berhubungan dengan inhibisi maturasi oosit. Penelitian ini dilakukan untuk menentukan efek elektroakupunktur (EA) pada maturasi oosit; tingkat fertilisasi; apoptosis sel granulosa; dan kadar growth-differentiation factor 9 (GDF9) dan bone-morphogenetic protein 15 (BMP15) dalam program IVF.
Bahan dan Metode: Sebuah uji acak terkontrol dilakukan dengan 24 subjek yang menjalani program IVF. Subjek dialokasikan secara acak kedalam kelompk verum-EA (n=12) dan sham-EA (n=12). Pemeriksaan mikroskopis untuk menilai maturasi oosit dan tingkat fertilisasi dilakukan oleh embriologis, dan pemeriksaan untuk indeks apoptosis sel granulosa (rasio Bax/Bcl-2), GDF9, dan BMP15 dilakukan, menggunakan real-time quantitative polymerase chain reaction dan teknik RNA messenger.
Hasil: Terdapat perbedaan signifikan pada maturasi oosit (P=0,02) dan tingkat fertilisasi (P=0,03) diantara kelompok verum-EA dan sham-EA. Terdapat perbedaan indeks apopsosis sel granulosa diantara kelompok verum-EA dan sham-EA (P<0,001). Terdapat perbedaan signifikan pada ekspresi protein Bax (P=0,04) dan Bcl-2 (P=0,03) sel granulosa diantara kelompok verum-EA dan sham-EA. Tidak ada perbedaan signifikan pada kadar GDF9 (P=0,34) dan BMP15 (P=0,47) diantara kelompok verum-EA dan sham-EA.
Kesimpulan: EA dapat meningkatkan maturasi oosit dan tingkat fertilitas, dan mengurangi indeks apoptosis sel granulosa pada program IVF. Kata kunci: Bax, Bcl-2, BMP15, GDF9, apoptosis sel granulosa, maturasi oosit
