RU2770782C1 - Method for ovulation stimulation with a decrease in ovarian reserve - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely gynecology and physiotherapy. The impact is carried out in two stages. The first stage consists of 5 procedures, and the second of two procedures. In the first procedure of the 1st stage, action takes 5 minutes from the left on the TA: R6, R6, AT 23, 32. In the 2nd procedure, the first one is repeated mirror-like. In the 3rd procedure, the left side is affected by TA: P 7, MC 6, RP 4. In the 4th procedure, the third one is repeated mirror-like with the addition of exposure to TA R6. In the 5th procedure, action takes 17 minutes with TA: V 31-33. At the second stage, in the first procedure, the TA is affected from the left: E41, E36, Ig5, Tr6; on the right, the TA: F1, R11, on the left on TA RP6. In the second procedure, the Su Jok points are affected.

EFFECT: method provides an increase in the efficiency of the functioning of the corpus luteum in the second phase of the menstrual cycle.

1 cl, 2 ex

Description

The invention relates to medicine, namely gynecology and physiotherapy, and can be used in the treatment of patients with reduced ovarian reserve to stimulate ovulation.

Known methods of stimulating ovulation with a decrease in ovarian reserve, proposed by A.F. Zharkin, N.A. Zharkin (1988) [1] and G. Luvsan (1990), characterized by the selection of acupuncture points (TA) [2] mainly channels related to Zhang organs.

The disadvantage of the technique proposed by G. Luvsan is the large variability of TA with not quite clear selection criteria and the need to cauterize some of the points, which causes a negative reaction in women. The disadvantage of the methodology proposed by A.F. and N.A. Zharkins, is the need to use a sufficiently large number of TA, in particular, the use of push-button acupuncture needles to influence AT, which increases the pain of the sessions and reduces the quality of life due to the need for constant monitoring of the state of the push-button needles [3].

As a prototype, according to the closest technical essence, we have chosen a method for stimulating ovulation with a decrease in ovarian reserve, developed by T.Yu. Danielyan (1992) [4].

The method consists in the acupuncture effect on the corporal (TA) and auricular (AT) acupuncture points, which starts from the 6th-7th day of the menstrual cycle. Affect acupuncture points: 1. E36, Gi11 - for 10 minutes,

2. R9 -10 minutes

3. RP5, RP3 - 20 minutes.

4. repeat item 2 or item 3

5. R7, R3, V23 -10 minutes

6. repeat p. 5

After that - 5 days break

7. Gi11, Gi4 -10 minutes

8. E45, E42 - 20 minutes

9. V67, V64, V28 - 10 minutes

10. repeat p. 9

11. P7, R6 - 10 minutes.

12. VC2, VC3, VC4, R12 10 minutes.

13. E36, V23 20 minutes.

The disadvantages of the prototype can be attributed to the focus on the treatment of anovulation without taking into account the U-SIN algorithm and the impact on TA wonderful channels and, as a result, insufficient effectiveness in reducing ovarian reserve. When using the prototype examination and treatment of 11 women, statistically significant changes in the level of AMH were not recorded. Pregnancy at the end of treatment occurred only in 2 patients, which is 18.2% [5,6].

In addition, it seems redundant to conduct 7 acupuncture sessions in the 2nd phase of the menstrual cycle, since ovulation in this cycle should have occurred earlier, and we are talking about supporting the functioning of the corpus luteum, the main activity factor of which is the full value of the ovulation that has occurred, for the stimulation of which it was assigned 6 sessions [7].

The objective of the invention is to increase the effectiveness of treatment by increasing the number of patients with pregnancy.

The technical result of the invention is:

prevention of insufficiency of functioning of the corpus luteum in the second phase of the menstrual cycle;

increasing the efficiency of TA selection.

The technical result of the invention is achieved by the fact that the method of stimulating ovulation with a decrease in ovarian reserve consists in influencing corporal TA and auricular (AT) acupuncture points. The impact is produced in 2 stages. At the first stage, acupuncture is carried out from the 4th day of the menstrual cycle, and at the second stage - from the 18th day. At the first stage, 5 procedures are performed every other day, followed by a 7-day break and then two procedures are performed every other day. At the first procedure of the first stage, the acupuncture points are affected for 5 minutes on the left: R6 (zhao-hai), on the border of the skin of the dorsal and plantar surfaces of the foot under the inner ankle, RP6 (san-ying-jiao) 3 proportional segments above the ankle and on the right on the points: AT 23 (ovary) at the transition point of the lower notch of the ear to the instep, 32 (testicle), on the inner surface in the projection of the apex of the antitragus. In the second procedure, the first procedure is repeated in a mirror manner. In the third procedure, the following points are affected for 5 minutes to the left: P 7 (le-tsue), 1.5 proportional segments proximal to the wrist joint, MS 6 (nei-guan), 2 proportional segments proximal to the wrist joint, RP 4 (gong -sun), at the point of transition of the 1st metatarsal bone to the base on the border of the skin of the dorsal and plantar surfaces of the foot. At the fourth procedure, the third procedure is repeated in a mirror manner with the addition of R6 (zhao-hai) to the acupuncture point. On the fifth procedure, the ba-lyao points are acted on for 17 minutes: V 31 - 33 (shang, tsy and zhong). At the second stage, during the first procedure, TA is acted on the left for 28 minutes: E41 (jie-xi), at the level of the ankle, between the long extensor muscles of the thumb and fingers; E36 (zu-san-li), 3 proportional segments below the lower edge of the patella lateral to the tibial crest; Ig5 (yang-gu), between the styloid process of the ulna and the triquetral bone at the ulnar edge of the tendon of the ulnar extensor of the hand. Influence on the right for 28 minutes on Tr6 (zhi-gou) on 3 proportional segments above the wrist joint and for 7 minutes on TA; F1 (da-dun) angle of the root and lateral edge of the thumb., R11 (heng-gu), above the womb on 1 lateral line of the abdomen, act 7 minutes to the left on the point RP6 (san-ying-jiao), 3 proportional segments above ankle. In the second procedure of this stage, Su Jok points are affected for 12 minutes: hand: between 3 and 4 fingers in the center of the membrane, foot: in the sole in the middle of the crease at the base of the big toes.

The method is carried out as follows:

When performing the method of ovulation stimulation with a decrease in ovarian reserve, the U-SIN algorithm and the effect of miraculous channels on TA are actively used. They affect corporal (TA) and auricular (AT) acupuncture points. Use corporeal needles with a long shaft (sting) from 10 mm (in AT) to 50 mm (in TA).

Procedures are performed in patients in the supine position. Before the procedure and after the end, it is necessary to control blood pressure, heart rate, pulse and dynamic control over the patient's condition during the session.

The impact is produced in 2 stages, at the first stage, acupuncture is carried out from the 4th day of the menstrual cycle, and at the second stage - from the 18th day, at the first stage, 5 procedures are performed every other day, followed by a 7-day break and then two procedures are performed every other day;

When choosing TA for influence in the 1st phase of the menstrual cycle, the command and connecting points of the miraculous Zhen-Mai and Zhong-Mai channels are taken into account.

In the 2nd phase of the cycle, SU CHZHOK is used, which was not used in the prototype and analogues.

First stage.

At the first procedure of the first stage, the acupuncture points are affected for 5 minutes on the left: R6 (zhao-hai), on the border of the skin of the dorsal and plantar surfaces of the foot under the inner ankle, RP6 (san-ying-jiao) 3 proportional segments above the ankle and on the right on the points: AT 23 (ovary) at the transition point of the lower notch of the ear to the instep, 32 (testicle), on the inner surface in the projection of the apex of the antitragus. In the second procedure, the first procedure is repeated in a mirror manner. In the third procedure, the following points are affected for 5 minutes to the left: P 7 (le-tsue), 1.5 proportional segments proximal to the wrist joint, MS 6 (nei-guan), 2 proportional segments proximal to the wrist joint, RP 4 (gong -sun), at the point of transition of the 1st metatarsal bone to the base on the border of the skin of the dorsal and plantar surfaces of the foot. At the fourth procedure, the third procedure is repeated in a mirror manner with the addition of an impact on the acupuncture point R6 (zhao-hai). On the fifth procedure, the ba-lyao points are acted on for 17 minutes: V 31 - 33 (shang, tsy and zhong).

Second phase.

At the second stage, during the first procedure, TA is acted on the left for 28 minutes: E41 (jie-xi), at the level of the ankle, between the long extensor muscles of the thumb and fingers; E36 (zu-san-li), 3 proportional segments below the lower edge of the patella lateral to the tibial crest; Ig5 (yang-gu), between the styloid process of the ulna and the triquetral bone at the ulnar edge of the tendon of the ulnar extensor of the hand; on the right Tr6 (zhi-gou) 3 proportional segments above the wrist joint and for 7 minutes act on the right on the TA; F1 (da-dun) angle of the root and lateral edge of the thumb., R11 (hen-gu), above the womb on 1 lateral line of the abdomen, on the left to the point RP6 (san-ying-jiao), 3 proportional segments above the ankle.

In the second procedure of this stage, Su Jok points are affected for 12 minutes: hand: between 3 and 4 fingers in the center of the membrane, foot: in the sole in the middle of the crease at the base of the big toes.

Distinctive essential features of the proposed method and the causal relationship between them and the achieved technical result:

The first stage is carried out from the 4th day of the menstrual cycle in order to directly stimulate ovulation in this menstrual cycle.

Point R6 (zhao-hai) was chosen because it is the point of the kidney channel responsible for the reproductive function, and, in addition, it is the connecting point of the miraculous Zhen-mai channel and the command point of the miraculous Yin-jiao-mai channel.

Point RP6 (san-ying-jiao) is the intersection of the three foot channels of YIN, among the indications for its use are trophic disorders, menstrual disorders, algomenorrhea, infertility, sexual disorders, etc.

The choice of AT 23 (ovary) at the point of transition of the lower notch of the ear into the rise, 32 (testicle) is determined by their effect on the ovaries. Point P 7 (le-tsue) is the point LO channel of the lungs, the command point of the wonderful Zhen-Mai channel, connecting the point of the wonderful channel Yin-jiao-Mai.

Point MS 6 (nei-guan) - point LO of the pericardial canal, connecting the point of the miraculous Zhong-mai channel.

Point RP 4 (gun-sun) is the LO point of the spleen channel, the command point of the miraculous Zhong-mai channel.

Exposure of needles in tissues for 5 minutes provides a rather mild, but pronounced stimulating effect.

The use of the fifth procedure for 17 minutes of exposure to the ba-lyao points V 31 - 33 (shang, tsi and zhong) ensures the harmonization of the functioning of the pelvic organs, creating the most favorable conditions for ovulation.

The second stage of the course should support the functioning of the corpus luteum at a level sufficient for implantation. To do this, we use mild sedation for 28 minutes of the following points:

Point E41 (jie-si). The point of the fire element (according to the U-SIN algorithm) of the stomach canal, has a mild desensitizing effect. Point E36 (tszu-san-li). A point related to the earth element of the gastric canal. It has a wide range of indications, among which there is infertility. The dot is often used as a trial procedure. Point Ig5 (yang-gu). The point of the fire element of the channel of the small intestine, being the "element in the element" the point of fire on the channel related to the element of fire, regulates the distribution of nutrients in the body.

Tr6 (chi-go). Point element fire channel of three heaters. Among the indications of menstrual irregularities.

Gentle stimulation for 7 minutes should provide the following:

F1 (yes-dun). The point of the liver canal tree element is responsible, in particular, for the normalization of the relationship between the ovaries and the uterus.

R11 (hen-gu). The point of the kidney channel and at the same time the wonderful Zhong-mai channel, is responsible, in particular, for the reproductive function. RP6 (san-ying-jiao) as a triple LO channel of the liver, spleen and kidneys is responsible, in particular, for harmonizing the work of the first two points and normalizing metabolism in tissues.

Exposure for 12 minutes to the Su Jok points on the hand (between the 3rd and 4th fingers in the center of the membrane) and on the foot (in the sole in the middle of the crease at the base of the thumbs) should harmonize the work of the hypothalamic-pituitary and ovarian-uterine segments of the reproductive system.

The set of essential distinguishing features is new and ensures the achievement of the technical result and the achievement of the objective of the invention.

Here are clinical examples:

Example 1. Patient N., 42 years old. Mother of two children. In connection with the absence of pregnancy, she began an examination by a reproductive specialist. FSH 11.42 mIU/ml; AMH 0.56 ng/ml; anovulation was diagnosed by ultrasound. In connection with the depletion of the ovarian reserve, surrogacy was proposed, which the patient refused. 4 days of the menstrual cycle, 5 procedures were performed every other day:

one). Within 5 minutes, on the left, the placement of needles at acupuncture points: R6, RP6, on the right AT 23 and AT 32.

2). Mirror repetition of the first procedure.

3). Within 5 minutes on the left setting of needles in points: P 7, MS 6, RP

4). Mirror repetition of the third procedure with the addition of exposure to R6.

5). Within 17 minutes, the impact on the ba-lyao points: V 31 - 33

7 - day break and after that two procedures every other day: 6). Within 28 minutes, the presence of needles at points E41, E36, Ig5 on the left and Tr6 on the right. Within 7 minutes, the impact on the right on the TA; F1, R11.

7). Impact for 12 minutes on the Su Jok points: hand: between 3rd and 4th fingers in the center of the membrane, foot: in the sole in the middle of the crease at the base of the big toes.

At the end of the course of acupuncture, control: according to ultrasound, a dominant follicle was formed, FSH 10.96 mIU/ml; AMH 1.02 ng/ml. In the next menstrual cycle, the patient became pregnant. The pregnancy ended with the birth of a full-term girl 3600 g, 53 cm. At present, her daughter is 2.5 years old. With the control of AMH 1.1 ng/ml, by ultrasound, the dominant follicle is formed. She is planning a fourth pregnancy.

Example 2. Patient I., aged 43. The son is 14 years old. She remarried, due to the lack of pregnancy with regular sexual life without contraception, she began to be examined. FSH 10.53 mIU/ml; AMH 0.72 ng/ml; according to ultrasound anovulation. She refused the proposed IVF procedure.

From the 4th day of the menstrual cycle, 5 procedures were performed every other day: 1). Placement of needles at acupuncture points: R6, RP6 on the left, AT 23 and AT 32 on the right. Exposure of needles in tissues for 5 minutes.

2). Mirror repetition of the first procedure.

3). Setting needles in points: P 7, MS 6, RP. Exposure of needles in tissues for 5 minutes.

4). Mirror repetition of the third procedure with the addition of exposure to R6.

5). Within 17 minutes, the presence of needles at the points of ba-lyao: V 31 - 33 Break for 7 days and two procedures every other day:

6). Impact on points E41, E36, Ig5 on the left and Tr6 on the right. Exposure of needles in tissues for 28 minutes. For 7 minutes, exposure to the right on TA: F1, R11.

7). Acupuncture exposure for 12 minutes on Su Jok points: hand: between 3 and 4 fingers in the center of the membrane, foot: in the sole in the middle of the crease at the base of the big toes.

At the end of the course, pregnancy occurred. The patient is currently in a progressing pregnancy of 27 weeks.

We examined 17 women with reduced AMH, a desire to have a pregnancy, and not participating in assisted reproductive technologies (ART) programs, in whom the proposed method of ovulation stimulation was tested with a decrease in ovarian reserve. As a result of treatment, the level of AMH increased statistically significantly in 7 patients, that is, 35.3% of patients became pregnant after the end of treatment.

When using the prototype in 11 women, according to the literature data, statistically significant changes in the level of AMH were not recorded. Pregnancy at the end of treatment occurred only in 2 patients, which is 18.2%.

Thus, the claimed method of ovulation stimulation with a decrease in ovarian reserve provides:

профилактику недостаточности функционирования желтого тела во вторую фазу менструального цикла;

prevention of insufficient functioning of the corpus luteum in the second phase of the menstrual cycle;

повышение эффективности выбора ТА, что, в свою очередь, позволяет повысить эффективность лечения на 17,1% за счет увеличения количества пациенток с наступившей беременностью.

increasing the efficiency of TA choice, which, in turn, makes it possible to increase the effectiveness of treatment by 17.1% due to an increase in the number of patients with pregnancy.

Bibliography:

1. Zharkin A.F., Zharkin N.A. Reflexology in obstetrics and gynecology. - P.: Medicine, 1988.- 160 p.

2. Luvsan G. Traditional and modern aspects of oriental reflexology. - M.: Nauka, 1990. - 576 p.

3. Linde V.A. Zhen-jiu therapy in obstetrics and gynecology. - St. Petersburg: Hippocrates.-2004 - 176 p.

4. Danielyan T.Yu. Reflexotherapy of ovulatory disorders and a comprehensive assessment of its effectiveness: Abstract of the thesis. dis. … cand. honey. Sciences. - Perm, 1992.-28 p.

5. Danielyan T.Yu. Reproductive function in women with endocrine infertility of the central genesis / Topical issues of obstetrics and gynecology Abstract: dokl. Second United Congress of Obstetricians-Gynecologists and Pediatricians of the Chuvash ASSR. -Cheboksary, 1987. -p. 74-77.

6. Drobyshevskaya V.A., Latysheva V.Ya. Reflexotherapy of impaired lipid metabolism in obesity // Physiotherapy, balneology and rehabilitation. - 2013. - No. 3. - S. 23-26.

7. Zharkin A.F. The mechanism of influence of reflexotherapy in endocrine infertility in women / A.F. Zharkin, L.V. Tkachenko // Actual problems of reflexology and traditional medicine. - M., 1990. - Part 2. - S. 188-189.

Claims (3)

A method for stimulating ovulation with a decrease in ovarian reserve, which consists in influencing corporal (TA) and auricular (AT) acupuncture points, characterized in that the effect is performed in 2 stages, at the first stage, acupuncture is carried out from the 4th day of the menstrual cycle and 5 procedures are performed every other day followed by a 7-day break and the implementation after this second stage, consisting of two procedures carried out every other day; in the first procedure of the first stage, the acupuncture points are affected for 5 minutes to the left: R6 zhao-hai on the border of the skin of the back and plantar surface of the foot under the inner ankle, RP6 san-ying-jiao 3 proportional segments above the ankle and to the right on the points: AT23 ovary at the point of transition of the lower notch of the ear into the instep, AT32 testicles, on the inner surface in the projection of the apex of the antitragus; in the second procedure, the first procedure is repeated in a mirror manner; in the third procedure, the following points are acted for 5 minutes on the left: P7 let-tsue, 1.5 proportional segments proximal to the wrist joint, MC6 nei-guan, 2 proportional segments proximal to the radiocarpal joint, RP 4 gun-sun, at the junction of the first metatarsal bone at the base on the border of the skin of the dorsal and plantar surfaces of the foot; on the fourth procedure, the third procedure is repeated in a mirror manner with the addition of P6 zhao-hai to the acupuncture point; on the fifth procedure, for 17 minutes, they act on the points of ba-lyao: V31-33 shang, tsy and zhong; at the second stage, during the first procedure, the TA is acted on the left for 28 minutes: E41 jie-si, at the level of the ankle between the long extensor muscles of the thumb and fingers; E36 zu-san-li, 3 proportional segments under the lower edge of the patella lateral to the tibial crest; Ig5 yang-gu, between the styloid process of the ulna and the triquetral bone at the ulnar edge of the tendon of the ulnar extensor of the hand; on the right Tr6 zhi-gou 3 proportional segments above the wrist joint and for 7 minutes act on the right on TA F1 da-dun angle of the root and lateral edge of the thumb, R11 heng-gu, above the womb on the first lateral line of the abdomen, on the left on the point RP6 san-ying-jiao, 3 proportional segments above the ankle, in the second procedure of this stage, the Su Jok points are affected for 12 minutes: hand, between 3 and 4 fingers in the center of the membrane and Su Jok: foot, in the sole in the middle of the crease at bases of thumbs.