加味归芍地黄汤对不孕妇女增殖期子宫内膜影响的研究
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摘要
研究目的
不孕症是妇科常见病,它不是一种独立的疾病,而是由许多疾病或多种因素造成的生殖障碍。近年来不孕症发病率有逐年上升的趋势,与高龄、多次流产、心理压力过大和环境污染等因素有关。不孕症已成为影响人类发展与健康的一个全球性医学和社会问题。本研究是临床研究,主要是探讨不孕的子宫因素,观察药物干预后对不孕妇女增殖期子宫内膜的影响。
方法
60位受试者就诊于台北市联合医院中医科。分为2组：对照组30人,用纯中药加味归芍地黄汤进行干预；实验组30人,用加味归芍地黄汤加西医促排卵药克罗米芬干预。两组皆观察受试者服药前后的变化、做自我比较,然后再观察两组之异同。评估的时间是在排卵前1～2天,方法是利用经阴道多普勒超声,测量子宫内膜厚度及内膜三线征(Triple line),测量子宫动脉、螺旋动脉之多普勒Pulse Index(PI), Resistance Index(RI)和S/D ratio,还测量其卵泡的大小与数量。同时观察子宫颈黏液之多寡。计算治疗后的妊娠率。
结果
受试者平均年龄为35.7±3.5,大部份为高龄患者。体重平均为55.0±5.4,BMI(kg/m2)为21.4±2.0。两组受试者来就诊时皆有不孕多年、高龄、经血量少、怀孕压力大、眠不安宁、倦怠乏力、无性欲等症状。
研究发现,纯中药组(加味归芍地黄汤)受试者,治疗后优势卵泡达1.92±0.3cm,子宫内膜增厚,达0.92±0.21cm,80%的患者子宫内膜出现“三线”(Triple line)征。怀孕率占67%。加味归芍地黄汤加克罗米芬组治疗后,排卵数目1～3颗,卵泡达1.80±0.39cm。子宫内膜增厚,达0.89±0.23cm,76.7%有出现“三线”(Triple line)征。妊娠率33%。
关于多普勒效应,中药组服药前后有非常显著的改变,服药后子宫动脉和螺旋动脉多普勒RI、PI、S/D皆有下降的现象(P<0.001)。实验组服药后子宫动脉和螺旋动脉多普勒RI、PI、S/D亦有下降的现象(P<0.01),但是对照组下降数值较高、效果较好。可见,加味归芍地黄汤对子宫内膜的血液微循环阻力有下降之作用,能促进子宫血液正常灌注,使子宫内膜对胚胎的接受度而提高怀孕率。
结论
1.加味归芍地黄汤能促进子宫内膜发育至正常的厚度,出现三线征,并降低子宫动脉和螺旋动脉的血流阻力(RI)；改善子宫内膜的血液灌注。为胚胎着床提供条件。
2.加味归芍地黄汤有助于卵泡正常发育,也增加宫颈分泌清稀透明的黏液以利精子的活动,从而提高妊娠的机会。
3.对于排卵障碍的患者,使用西药克罗米芬虽然可以促排卵,但可能引起子宫内膜发育不良,宫颈黏液变稠,反而不利于怀孕。本研究发现,应用加味归芍地黄汤可以克服克罗米芬的副作用,从而提高妊娠率。
Purpose
Infertility is a common gynaecological problem of reproductive disturbance that involved by many diseases and multiple factors. It relates to high aging, multiple abortions, psychological stress and environmental air pollutants. Rising infertility rates around the world have had a profound impact on human development and female reproductive health, nowadays it is considered as a worldwide public problem. This is a prospective clinical observation research, our aim is to study the effects of endometrium during proliferative phase after medication in women with infertility.
Methods
60 participants from the Taipei United Hospital, department of Chinese medicine were recruited, they were divided into two groups:30 of them were in controlled group, they received Chinese herbal medicine Jia Wey Guei Shuoh Dih Hwang Tang alone, and the other 30 participants in experimental group, they received Jia Wey Guei Shuoh Dih Hwang Tang with Clomiphene Citrate together, we observed the changes of endometrium before and after medication, making self compared firstly, and then compared the difference between these two groups. Our investigation time was one or two days before ovulation. Transvaginal ultrasound-color flow Doppler was the investigative tool. We measured the thickness of endometrium, observing endometrial triple line, and measured the Doppler flow indices (resistance index (RI),pulsatility index (PI) and systolic/diastolic (S/D) ratio) of uterine and spiral arteries. The number and size of follicles were measued and we also observed the amount of cervical mucus. The fertility rate was counted after medication.
Results
The average age of participants was 35.7±3.5, most of them are high age. The average weight was 55.0±5.4, BMI (kg/m2) was 21.4±2.0. They came for treatment due to unable to conceive for many years, high age, hypomenorrhea, high stress of infertility, no sexual desire etc.
The findings of the controlled group, that received only the Chinese herbal medicine Jia Wey Guei Shuoh Dih Hwang Tang, only one mature follicle was found before and after medication, but the size of follicle is bigger after medication. The average size was 1.92±0.3cm. The endometrium became thicker, the average thickness was 0.92±0.21cm. Triple line was found in 80% of endometrium. The fertility rate of this group is 67%. In the experimental group, they received Jia Wey Guei Shuoh Dih Hwang Tang and Clomiphene Citrate together.1-3 mature follicles were found, The average size was 1.80±0.39cm. The endometrium also became thicker, the average thickness was 0.89±0.23cm. Triple line was found in76.7% of endometrium. The fertility rate of this group is 33%.
Concerning the Doppler effect, the controlled group had a significance change before and after medication, the RI, PI, S/D ratio of uterine and spiral arteries were lower (P＜0.001). The RI, PI, S/D of uterine and spiral arteries in the experimental group were also became lower (P＜0.01).Both of these two groups have good effects in the endometrium, but the controlled group is better. Jia Wey Guei Shuoh Dih Hwang Tang can decrease the Doppler flow indices, improve blood perfusion of uterus, regulate uterine receptivity and implantation and increase the outcome of pregnancy.
Conclusions
1. Jia Wey Guei Shuoh Dih Hwang Tang can improve the growth of endometrial thickness and triple line, it can decrease the RI of uterine and spiral arteries, improve blood perfusion of uterus,regulate uterine receptivity and implantation of embryo.
2. Jia Wey Guei Shuoh Dih Hwang Tang can improve the growth of follicle, increase ovulatary cervical mucus that benefits the motility of sperms, this condition will increase the chance of pregnancy.
3. For the patients who are disturbed by anovulation, inducing ovulation by using clomiphene citrate is effective but it may adversely affect the endometrium and impair formation of cervical mucus and so reduce the chance of conception. In this study, we found out that using Jia Wey Guei Shuoh Dih Hwang Tang and clomiphene citrate together could decrease the side effects of clomiphene citrate and raise the outcome of pregnancy.
不孕症是妇科常见病,它不是一种独立的疾病,而是由许多疾病或多种因素造成的生殖障碍。近年来不孕症发病率有逐年上升的趋势,与高龄、多次流产、心理压力过大和环境污染等因素有关。不孕症已成为影响人类发展与健康的一个全球性医学和社会问题。本研究是临床研究,主要是探讨不孕的子宫因素,观察药物干预后对不孕妇女增殖期子宫内膜的影响。
方法
60位受试者就诊于台北市联合医院中医科。分为2组：对照组30人,用纯中药加味归芍地黄汤进行干预；实验组30人,用加味归芍地黄汤加西医促排卵药克罗米芬干预。两组皆观察受试者服药前后的变化、做自我比较,然后再观察两组之异同。评估的时间是在排卵前1～2天,方法是利用经阴道多普勒超声,测量子宫内膜厚度及内膜三线征(Triple line),测量子宫动脉、螺旋动脉之多普勒Pulse Index(PI), Resistance Index(RI)和S/D ratio,还测量其卵泡的大小与数量。同时观察子宫颈黏液之多寡。计算治疗后的妊娠率。
结果
受试者平均年龄为35.7±3.5,大部份为高龄患者。体重平均为55.0±5.4,BMI(kg/m2)为21.4±2.0。两组受试者来就诊时皆有不孕多年、高龄、经血量少、怀孕压力大、眠不安宁、倦怠乏力、无性欲等症状。
研究发现,纯中药组(加味归芍地黄汤)受试者,治疗后优势卵泡达1.92±0.3cm,子宫内膜增厚,达0.92±0.21cm,80%的患者子宫内膜出现“三线”(Triple line)征。怀孕率占67%。加味归芍地黄汤加克罗米芬组治疗后,排卵数目1～3颗,卵泡达1.80±0.39cm。子宫内膜增厚,达0.89±0.23cm,76.7%有出现“三线”(Triple line)征。妊娠率33%。
关于多普勒效应,中药组服药前后有非常显著的改变,服药后子宫动脉和螺旋动脉多普勒RI、PI、S/D皆有下降的现象(P<0.001)。实验组服药后子宫动脉和螺旋动脉多普勒RI、PI、S/D亦有下降的现象(P<0.01),但是对照组下降数值较高、效果较好。可见,加味归芍地黄汤对子宫内膜的血液微循环阻力有下降之作用,能促进子宫血液正常灌注,使子宫内膜对胚胎的接受度而提高怀孕率。
结论
1.加味归芍地黄汤能促进子宫内膜发育至正常的厚度,出现三线征,并降低子宫动脉和螺旋动脉的血流阻力(RI)；改善子宫内膜的血液灌注。为胚胎着床提供条件。
2.加味归芍地黄汤有助于卵泡正常发育,也增加宫颈分泌清稀透明的黏液以利精子的活动,从而提高妊娠的机会。
3.对于排卵障碍的患者,使用西药克罗米芬虽然可以促排卵,但可能引起子宫内膜发育不良,宫颈黏液变稠,反而不利于怀孕。本研究发现,应用加味归芍地黄汤可以克服克罗米芬的副作用,从而提高妊娠率。
Purpose
Infertility is a common gynaecological problem of reproductive disturbance that involved by many diseases and multiple factors. It relates to high aging, multiple abortions, psychological stress and environmental air pollutants. Rising infertility rates around the world have had a profound impact on human development and female reproductive health, nowadays it is considered as a worldwide public problem. This is a prospective clinical observation research, our aim is to study the effects of endometrium during proliferative phase after medication in women with infertility.
Methods
60 participants from the Taipei United Hospital, department of Chinese medicine were recruited, they were divided into two groups:30 of them were in controlled group, they received Chinese herbal medicine Jia Wey Guei Shuoh Dih Hwang Tang alone, and the other 30 participants in experimental group, they received Jia Wey Guei Shuoh Dih Hwang Tang with Clomiphene Citrate together, we observed the changes of endometrium before and after medication, making self compared firstly, and then compared the difference between these two groups. Our investigation time was one or two days before ovulation. Transvaginal ultrasound-color flow Doppler was the investigative tool. We measured the thickness of endometrium, observing endometrial triple line, and measured the Doppler flow indices (resistance index (RI),pulsatility index (PI) and systolic/diastolic (S/D) ratio) of uterine and spiral arteries. The number and size of follicles were measued and we also observed the amount of cervical mucus. The fertility rate was counted after medication.
Results
The average age of participants was 35.7±3.5, most of them are high age. The average weight was 55.0±5.4, BMI (kg/m2) was 21.4±2.0. They came for treatment due to unable to conceive for many years, high age, hypomenorrhea, high stress of infertility, no sexual desire etc.
The findings of the controlled group, that received only the Chinese herbal medicine Jia Wey Guei Shuoh Dih Hwang Tang, only one mature follicle was found before and after medication, but the size of follicle is bigger after medication. The average size was 1.92±0.3cm. The endometrium became thicker, the average thickness was 0.92±0.21cm. Triple line was found in 80% of endometrium. The fertility rate of this group is 67%. In the experimental group, they received Jia Wey Guei Shuoh Dih Hwang Tang and Clomiphene Citrate together.1-3 mature follicles were found, The average size was 1.80±0.39cm. The endometrium also became thicker, the average thickness was 0.89±0.23cm. Triple line was found in76.7% of endometrium. The fertility rate of this group is 33%.
Concerning the Doppler effect, the controlled group had a significance change before and after medication, the RI, PI, S/D ratio of uterine and spiral arteries were lower (P＜0.001). The RI, PI, S/D of uterine and spiral arteries in the experimental group were also became lower (P＜0.01).Both of these two groups have good effects in the endometrium, but the controlled group is better. Jia Wey Guei Shuoh Dih Hwang Tang can decrease the Doppler flow indices, improve blood perfusion of uterus, regulate uterine receptivity and implantation and increase the outcome of pregnancy.
Conclusions
1. Jia Wey Guei Shuoh Dih Hwang Tang can improve the growth of endometrial thickness and triple line, it can decrease the RI of uterine and spiral arteries, improve blood perfusion of uterus,regulate uterine receptivity and implantation of embryo.
2. Jia Wey Guei Shuoh Dih Hwang Tang can improve the growth of follicle, increase ovulatary cervical mucus that benefits the motility of sperms, this condition will increase the chance of pregnancy.
3. For the patients who are disturbed by anovulation, inducing ovulation by using clomiphene citrate is effective but it may adversely affect the endometrium and impair formation of cervical mucus and so reduce the chance of conception. In this study, we found out that using Jia Wey Guei Shuoh Dih Hwang Tang and clomiphene citrate together could decrease the side effects of clomiphene citrate and raise the outcome of pregnancy.
引文
1. L. Oakley, P. Doyle and N. Maconochie. Lifetime prevalence of infertility and infertility treatment in the UK:results from a population-based survey of reproduction.Human Reproduction 2008 23(2):447-450
2. Veras MM, Caldini EG, Dolhnikoff M, Saldiva PH. Air pollution and effects on reproductive-system functions globally with particular emphasis on the Brazilian population. J Toxicol Environ Health B Crit Rev.2010 Jan; 13(1):1-15.
3. Speroff L. The effect of aging on fertility. Curr Opin Obstet Gynecol.1994 Apr; 6 (2):115-20.
4. Abha Maheshwari, Mark Hamilton and Siladitya Bhattacharya. Effect of female age on the diagnostic categories of infertility. Human Reproduction 2008 23(3):538-542
5. Menken J, Trussell J, Larsen U, Age and infertility, Science 233:1389, 1986
6.吴瑞瑾,周馥贞.原因不明不孕患者子宫内膜胰岛素样生长因子-Ⅱ及其受体mRNA的表达及其与性激素水平的相关性.中华妇产科杂志,2004,39(4)：242-245
7. Lessey BA, et al. Integrin adhesion molecules in the human endometrium. Correlation with the normal and abnormal menstrual cycle. J-Clin-Invest, 1992 July,90(1):188-195
8. Lessey BA.The use of integrines for assessment of uterine receptivity. Fertil Steril,1994,61:812-813
9.王华云,邢福祺,陈士岭.Trophinin粘附分子在子宫内膜的表达及其与不孕的关系.第一军医大学学报,2002,22(6)：539-541
10. Israel D, Chua S Jr. Leptin receptor modulation of adiposity and fertility. Trends Endocrinol Metab.2010 Jan;21(1):10-6.
11. Keisler DH, Daniel JA, Morrison CD. The role of leptin in nutritional status and reproductive function. Reprod Fertil Suppl.1999;54:425-35.
12.张玉珍,罗颂平.罗元恺教授论治不孕不育学术经验介绍.新中医,2002,34(4)：7-9
13.班秀文.班秀文妇科医论医案选.北京：人民卫生出版社,1987.198-210
14.哈荔田.哈荔田妇科医案医话选.天津：天津科学技术出版社,1982.187-196
15.北京中医医院,等.刘奉五妇科经验.北京：人民卫生出版社,1977.185-195
16.韩延华.百灵妇科传真.中国中医药出版社,2007：159-161
17.夏桂成.328例肾虚不孕症辨治分析.中国医药学报,1989.(5)：333-334
18.庞保珍,等.补肾疏肝与补肾治疗无排卵性不孕149例.浙江中医杂志,1992,27(12)：539
19.庞保珍,等.祛痰补肾法治疗无排卵型不孕67例疗效观察.浙江中医杂志,1966.(11)：496
20.谭德梅.以中药宫内给药为主治疗输卵管不通16例.浙江中医杂志,1993.(7)：303
21.刘茂林,等.34例输卵管阻塞的治疗体会.陕西中医学院学报,1992.(1)：23
22.万红,刘林清.浅议子宫内膜异位与不孕.河南中医药学刊,1994,9(4)：44-45
23.司徒仪,等.子宫内膜异位症本质及活血化瘀机理探讨.北京中医,1998,(3)：11
24.赵志梅.子宫内膜异位症合并不孕之肾虚血瘀病机分析.天津中医,2002,19(3)?35-36
25.莫惠,郭惠红.免疫性不孕(AsAb)中医病机探讨.江苏中医,1998,19(12)：8
26.姚石安.女性免疫性不孕证治有何特点.中医杂志,1993.(7)：30
27.罗颂平,梁国珍,张玉珍,等.助孕Ⅰ号、Ⅱ号丸治疗血清抗精子抗体阳性患者的临床研究.新中医,1996(8)：46-48
28.郭家英.人工流产术9948例临床分析.中国医师杂志,2004,(8)79-80
29.邹淑华,等.生育前人工流产与继发性不孕症关系的分析.现代妇产科发展,1998.(1)：93-94
30.杨石强,等.人工流产后不孕患者抗精子抗体监测.河南医科大学学报,1997.(6)：55-56
31.何少山,等.流产继发不孕症的论治.中国医药学报,1998.(2)：46-47
32. Volgsten H, Skoog Svanberg A, Ekselius L, Lundkvist 0, Sundstrom Poromaa I. Risk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Fertil Steril. 2010:93(4):1088-96.
33.李广文.情志与孕育.山东中医杂志,1986.(4)：33-34
34. MerceLT, Barco MJ, Troyano J, Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro/embryo transfer outcome. Fertil Steri.2008 Jan; 89 (1):111-7
35.金素坤,李晶,王晓光,孙玉芬.彩色多普勒阴道超声在妇产科的应用[J].中国医学影像技术,1995,(2)147-148
36. Ginekol Pol. Cost-effectiveness of IVF infertility treatment in different legislative settings. Curr Womens Health Rep.2010 Feb;81(2):125-30.
37. Gosling RG, King DH. Arterial assessment by Doppler-shift ultrasound. Proc Roy Soc Med 67:1974,447-449
38.高琳,谢鸣.关于“中草药肾病”及中药毒性认识.中国医药学报,2002,17(11)：668
39. J. Drife, B. Magowan. Clinical Obstetrics and Gynaecology. Saunders,2004：57
40.王群,张振宇.116例女性不孕症病因分析.中国优生与遗传学杂志,2006,14(11)：111
41. Kondoh E, Okamoto T, Higuchi T, Tatsumi K, Baba T, Murphy SK, Takakura K, Konishi I, Fujii S.Stress affects uterine receptivity through an ovarian-independent pathway. Hum Reprod.2009 Apr;24(4):945-53.
42. Smith S, Pfeifer SM, Collins JA. Diagnosis and management of female infertility. JAMA.2003 Oct 1;290(13):1767-70.
43. Brown J, Farquhar C, Beck J, Boothroyd C, Hughes E. Clomiphene and anti-oestrogens for ovulation induction in PCOS. Cochrane Database Syst Rev.2009 Oct 7;(4):CD002249.
44.张帝开,罗虹,邝健全.支原体感染引起输卵管性不孕的免疫机制.中国实用妇科与产科杂志,2003,24(4)394-396
45.刘利,常红军,等.细菌性阴道炎与女性免疫性不孕的相关性研究.中国全科医学,4(6)：499-450
46.陈利生,倪雅莲,等.男女不育症中西医现代诊断与治疗.上海世界图患书出版公可,2006：341
47.王馨世.女性生殖与内分泌学.台湾：合记出版社,1999.70-72
48. Kent M. Van De Graaaff, Human Anatomy, Wm. C. Brown Publishers.1995,21: 698-700
49.程秋蓉,田晓萍.妇科激素测定在生殖内分泌性不孕原因诊断中的价值(附75例分析)[J].中国医师杂志,2002,(08),888-889
50.杨自更,张阳.226例不孕患者性激素水平变化及分析[J].放射免疫学杂志,2009(01),39-40
51. J. Drife, B. Magowan. Clinical Obstetrics and Gynaecology. Saunders, 2004:122
52. H. I addressed, Endometrial thickness:a predictor of implantation in ovum recipients? Human Reproduction,1994; 9 (2):363-365
53. Zaidi J, Campbell S, Tan SL. Endometrial thickness, morphology, vascular penetration and velocimetry in predicting implantation in an in vitro fertilization program. Human Reproduction 2006 21 (6):1612-17
54..Curtis Hewitt S, Goulding EH, Eddy EM, Korach KS. Studies using the estrogen receptor alpha knockout uterus demonstrate that implantation but not decidualization-associated signaling is estrogen dependent. Biol Reprod.2002 Oct;67(4):1268-77.
55. Toloubeydokhti T, Bukulmez 0, Chegini N. Potential regulatory functions of microRNAs in the ovary. Semin Reprod Med.2008 Nov;26(6):469-78.
56.石红.卵巢旁分泌与自分泌.中国实用妇科与产科杂志,2001,17(14)：241-243
57. Najwa AR, Sengupta J, Ghosh D.A systems biology approach towards understanding the process of blastocyst implantation. Indian J Physiol Pharmacol.2009 Jul-Sep;53(3):197-208.
58.李真,王智标,顾美礼,等.整合素在胚胎着床、生长发育及某些妇科疾病中的应用.中华妇产科杂志,1999,(4)254-256
59. Bluher S, Mantzoros CS. Leptin in reproduction. Curr Opin Endocrinol Diabetes Obes.2007 Dec;14(6):458-64.
60. Ohno Y, Fujimoto Y. Endometrial oestrogen and progesterone receptors and their relationship to sonographic appearance of the endometrium. Hum Reprod Update.1998 Sep-Oct;4(5):560-4.
61. Kupesic S, Kurjak A. Uterine and ovarian perfusion during the periovulatory period assessed by transvaginal color Doppler. Fertil Steril.1993 Sep; 60 (3):439-43.
62.李淑玲.肾虚不孕的治疗与机理研究.山东中医杂志,1995.(7)：298-299
63.蒋惠芳.疏肝益肾治疗功能性不孕102例.辽宁中医杂志,1994.(10)456-466
64.李超荆,俞谨,郭焕如,等.肾主生殖与排卵机理的初步探讨.中医杂志,1982,(6)：69-71
65.张婷婷.温经汤治疗不孕症在日本的研究及应用.实用中医药杂志,1998,14(2)28-29
66.马申.不孕症妇女心理状态分析[J].上海预防医学杂志,2006,(05)100-101
67.陆亚文,杨玲玲,卢光,等.不育妇女精神状况与个性的探讨.中华妇产科杂志,1995,30(1)：34-37
68.张嵘,李潭,宋平.家庭亲密度、适应性与不孕症患者就诊行为研究[J].中国性科学,2009,(02)：80-81
69. Pandey S, Bhattacharya S. Impact of obesity on gynecology. Womens Health (Lond Engl).2010 Jan;6(1):107-17.
70. Pasquali R, Patton L, Gambineri A. Obesity and infertility. Curr Opin Endocrinol Diabetes Obes.2007 Dec;14 (6):482-7.
71.罗序清,胡莉萨.影响子宫内膜发育的研究进展[J].江西中医学院学报,2009,(01)98-100
72.张燕萍.人工流产引起继发不孕的原因及治疗[J].中国生育健康杂志,2005,(05)304-305
73. Kent M. Van De Graaaff, Human Anatomy, Wm. C. Brown Publishers.1995,21: 700
74.夏桂成.中医妇科理论与实践.北京：人民卫生出版社,2003.96-98
75. Ng EH, Chan CC, Tang OS, Yeung WS, Ho PC. The role of endometrial and subendometrial blood flows measured by three-dimensional power Doppler ultrasound in the prediction of pregnancy during IVF treatment. Hum Reprod. 2006 Jan;21(1):164-70.
76.吴洪波：李柳铭；袁华；李慕军；HCG注射日应用彩色多普勒超声检测子宫内膜和内膜下血流评价IVF-ET结局中国现代医学杂志,2009,(15)：132-136
77.袁华,李慕军,江莉,马燕,吴惠梅.阴道超声评估不孕妇女子宫内膜容受性的价值研究[J].现代妇产科进展,2009,(02)：125-128
78.颜华华.中药学.台北知音出版社,1994：750-754,793,815-823
79.沈映君.中药药理学.人民卫生出披社,2002：861-929
80.卓大宏.中药临床应用.广东人民出版社,2002：352-353,397-407
81.杨恒茂.实用中医妇科方药学.陕西科学技术出版社,1988：116-122,169,216
82. Hughes E, Collins J, Vandekerckhove P. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. Cochrane Database Syst Rev. 1996 Apr 22;(1):CD000056.
83. Hughes E, Brown J, Collins JJ, Vanderkerchove P. Clomiphene citrate for unexplained subfertility in women. Cochrane Database Syst Rev.2010 Jan 20;(1):CD000057.
84. Shahin AY. Endometrial sonographic characters predicting pregnancy following recurrent clomiphene induction in unexplained infertility. Reprod Biomed Online.2008 Dec;17(6):795-802.
85.郑丞杰.妇产科超音波学.台湾：艺轩出版社,2007：33-59、277-280
86. TaylorKJ, BurnsPN, WellsPN, et al. Ultrasound Doppler flow studies of the ovarian and uterine arteries[J]. BrJ Obstet Gynaecol,2006,92:240-242.
87. Long MG, Boultbee JE, Hanson ME, et al. Dopplertimevelocity wave form studies of the uterine artery and uterus [J]. BrJObstet Gynaecol,2007,96:588-593.
88. American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of pelvic ultrasound examinations. J Ultrasound Med.2010 Jan; 29(1):166-72.
89. Kupesic S. The first three weeks assessed by transvaginal color Doppler. J Perinat Med.1996;24(4):301-17.
90. Baruah J, Roy KK, Rahman SM, Kumar S, Sharma JB, Karmakar D. Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery 220.Doppler. Arch Gynecol Obstet.2009 Mar; 279 (3):311-4.
91. Wakeman S, Benny P. Is it possible to predict a fertile cycle? Uteroovarian blood flow parameters in conception versus nonconception cycles. Fertil Steril.2009 Jun;91(6):2726-31.
92. Ab dalla, A. A. Brooks, A. Kirkland, Assessment of Uterine Receptivity by Endometrial and Subendometrial Blood Flows Measured by vaginal color DopplerUltrasound in women undergoing IVF treatment. Fertil Steri,2007; 3
93.候娟.中西药联合应用不良反应浅析.现代中西医结合杂志,2003,12(9)：999
94.李丽芸,徐珉.辨病结合辨证治疗不孕症经验与体会.新中医,2001,33(6)：103-104
95. Miller JH, Weinberg RK, Canino NL, Klein NA, Soules MR. The pattern of infertility diagnoses in women of advanced reproductive age. Am J Obstet Gynecol.1999 Oct;181(4):952-7.
96.周坤福,等.六味地黄丸延缓衰老作用机理的实验研究.江苏中医,1999,20(1)：44
97.傅佳云.六味地黄丸药理研究.中成药研究,1986,(4)：26
98. Loret de Mola JR. Obesity and its relationship to infertility in men and women. Obstet Gynecol Clin North Am.2009 Jun;36(2):333-46
99. Ryan D. Obesity in women:a life cycle of medical risk. Int J Obes (Lond). 2007 Nov;31 Suppl 2:S3-7;
100. Papanek PE. The female athlete triad:an emerging role for physical therapy. J Orthop Sports Phys Ther.2003 Oct;33(10):594-614.
101.Hurvitz M, Weiss R. The young female athlete. Pediatr Endocrinol Rev.2009 Dec; 7 (2):123-9.
102. Zain MM, Norman RJ. Impact of obesity on female fertility and fertility treatment.Womens Health (Lond Engl).2008 Mar;4(2):183-94.
103. Al-Azemi M, Omu FE, Omu AE. The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome. Arch Gynecol Obstet.2004 Dec;270(4):205-10.
104.张梅.宫颈粘液监测排卵在治疗不孕症中的应用[J].医学理论与实践,2001,(12)：24-25
105. El Hakim EA, Epee M, Draycott T, Gordon UD, Akande VA. Significance of positive Chlamydia serology in women with normal-looking Fallopian tubes. Reprod Biomed Online.2009 Dec;19(6):847-51.
106.王立新.中西医结合治疗无排卵性不孕疗效观察[J].辽宁中医杂志,2006,(04)：144-145
107.杨玉红.克罗米酚合中药促排卵汤治疗排卵障碍性不孕症疗效观察[J].现代中西医结合杂志,2003,(16)：1734-1735
108. Lai SK, Wang YY, Cone R, Wirtz D, Hanes J. Altering mucus rheology to "solidify" human mucus at the nanoscale. PLoS One.2009;4(1):e4294.
109.沈洪沁,洪波.补肾活血综合治疗子宫内膜异位症不孕的临床观察.中华实用中西医杂志,2004,4(17)：1939-1940
110.俞瑾,孙月丽,邵公权,等.补肾化痰治疗多囊性卵巢综合征中对下丘脑-垂体-卵巢功能的调节.中西医结合杂志,1986,6(4)：218-219
111.吴斌,高峰,严石林,李炜弘,王米渠.肾阳虚证的辨证因子规律初探[J].现代中西医结合杂志,2004,(14)：1819-1820
112.陈瑞秀.现代不孕症的诊断治疗研究新进展[J].哈尔滨医药2009,(01)：52-53
113. Kafy S, Tulandi T.New advances in ovulation induction. Curr Opin Obstet Gynecol.2007 Jun;19(3):248-52.
114. Kousta E, White DM, Franks S. Modern use of clomiphene citrate in induction of ovulation. Hum Reprod Update.1997 Jul-Aug;3(4):359-65.
115.邵瑞云,朗丰君.补肾活血中药加克罗米芬治疗多囊性卵巢综合征所致不孕的临床观察.中国中西医结合杂志,2004,24(1)：41-43
116. Chen SL, Wu FR, Luo C, Chen X, Shi XY, Zheng HY, Ni YP. Combined analysis of endometrial thickness and pattern in predicting outcome of in vitro fertilization and embryo transfer:a retrospective cohort study. Reprod Biol Endocrinol.2010 Mar 24;8:30.
117. Tsai YC, Tai MC, Chang JC. Predictive value of endometrial sonography in ovulation induction for intrauterine insemination. J Formos Med Assoc. 1995 Oct;94(10):626-9.
118. Tublin M. E, Platt JF. The resistance index in renal Doppler sonography: where do we stand? AJR Am J Roentgenol 2003,180:885-892
119. Platt JF et al. Duplex Doppler ultrasound of the kidney:differentiation of obstructive from non-obstructive dilatation.1989, Radiology 171: 515-517
120. Ardalan MR, Shoja MM. A correlation between direct and indirect Doppler ultrasono graphic measures in transplant renal artery stenosis. Transplant Proc 39,2007:1426-1438
121. Nakai A, Yokota A, Koshino T, Araki T. Assessment of endometrial perfusion with Doppler ultrasound in spontaneous and stimulated menstrual cycles. J Nippon Med Sch.2002 Aug;69(4):328-32.
122. Ramathal CY, Bagchi IC, Taylor RN, Bagchi MK. Endometrial decidualization: of mice and men. Semin Reprod Med.2010 Jan;28(1):17-26.
123. Kurjak A, Kupesic-Urek S, Schulman H, Zalud I. Transvaginal color flow Doppler in the assessment of ovarian and uterine blood flow in infertile women. Fertil Steril.1991 Nov;56(5):870-3.
124. Jahromi AS, Cina CS, Liu Y, Clase CM. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis:a systematic review and meta-analysis. Vasc Surg.2005 Jun; 41 (6):962-72.
125.张力,杨晓晖.中药不良反应发生的原因及其相关对策.中国医药学报,2004,19(8)：496
126. Van den Broeck U, Holvoet L, Enzlin P, Bakelants E, Demyttenaere K, D'Hooghe T. Reasons for dropout in infertility treatment. Gynecol Obstet Invest.2009; 68(1):58-64.
127.任光友,等.六味地黄丸对阴虚动物药理作用研究.中成药,1999,21(11)：586
128.李炳如.补肾药对下丘脑-垂体-卵巢性腺轴功能的影响.中西医结合杂志,1984,14(6)：21
129.曹治权,等.微量元素与中医学.北京：中国中医药出版社,1993.15
130.潘颖宜,周志锦,等.四物汤中微量元素Cu、Zn、Fe在家兔体内的吸收.中成药,1997,19(2)：33-35
2. Veras MM, Caldini EG, Dolhnikoff M, Saldiva PH. Air pollution and effects on reproductive-system functions globally with particular emphasis on the Brazilian population. J Toxicol Environ Health B Crit Rev.2010 Jan; 13(1):1-15.
3. Speroff L. The effect of aging on fertility. Curr Opin Obstet Gynecol.1994 Apr; 6 (2):115-20.
4. Abha Maheshwari, Mark Hamilton and Siladitya Bhattacharya. Effect of female age on the diagnostic categories of infertility. Human Reproduction 2008 23(3):538-542
5. Menken J, Trussell J, Larsen U, Age and infertility, Science 233:1389, 1986
6.吴瑞瑾,周馥贞.原因不明不孕患者子宫内膜胰岛素样生长因子-Ⅱ及其受体mRNA的表达及其与性激素水平的相关性.中华妇产科杂志,2004,39(4)：242-245
7. Lessey BA, et al. Integrin adhesion molecules in the human endometrium. Correlation with the normal and abnormal menstrual cycle. J-Clin-Invest, 1992 July,90(1):188-195
8. Lessey BA.The use of integrines for assessment of uterine receptivity. Fertil Steril,1994,61:812-813
9.王华云,邢福祺,陈士岭.Trophinin粘附分子在子宫内膜的表达及其与不孕的关系.第一军医大学学报,2002,22(6)：539-541
10. Israel D, Chua S Jr. Leptin receptor modulation of adiposity and fertility. Trends Endocrinol Metab.2010 Jan;21(1):10-6.
11. Keisler DH, Daniel JA, Morrison CD. The role of leptin in nutritional status and reproductive function. Reprod Fertil Suppl.1999;54:425-35.
12.张玉珍,罗颂平.罗元恺教授论治不孕不育学术经验介绍.新中医,2002,34(4)：7-9
13.班秀文.班秀文妇科医论医案选.北京：人民卫生出版社,1987.198-210
14.哈荔田.哈荔田妇科医案医话选.天津：天津科学技术出版社,1982.187-196
15.北京中医医院,等.刘奉五妇科经验.北京：人民卫生出版社,1977.185-195
16.韩延华.百灵妇科传真.中国中医药出版社,2007：159-161
17.夏桂成.328例肾虚不孕症辨治分析.中国医药学报,1989.(5)：333-334
18.庞保珍,等.补肾疏肝与补肾治疗无排卵性不孕149例.浙江中医杂志,1992,27(12)：539
19.庞保珍,等.祛痰补肾法治疗无排卵型不孕67例疗效观察.浙江中医杂志,1966.(11)：496
20.谭德梅.以中药宫内给药为主治疗输卵管不通16例.浙江中医杂志,1993.(7)：303
21.刘茂林,等.34例输卵管阻塞的治疗体会.陕西中医学院学报,1992.(1)：23
22.万红,刘林清.浅议子宫内膜异位与不孕.河南中医药学刊,1994,9(4)：44-45
23.司徒仪,等.子宫内膜异位症本质及活血化瘀机理探讨.北京中医,1998,(3)：11
24.赵志梅.子宫内膜异位症合并不孕之肾虚血瘀病机分析.天津中医,2002,19(3)?35-36
25.莫惠,郭惠红.免疫性不孕(AsAb)中医病机探讨.江苏中医,1998,19(12)：8
26.姚石安.女性免疫性不孕证治有何特点.中医杂志,1993.(7)：30
27.罗颂平,梁国珍,张玉珍,等.助孕Ⅰ号、Ⅱ号丸治疗血清抗精子抗体阳性患者的临床研究.新中医,1996(8)：46-48
28.郭家英.人工流产术9948例临床分析.中国医师杂志,2004,(8)79-80
29.邹淑华,等.生育前人工流产与继发性不孕症关系的分析.现代妇产科发展,1998.(1)：93-94
30.杨石强,等.人工流产后不孕患者抗精子抗体监测.河南医科大学学报,1997.(6)：55-56
31.何少山,等.流产继发不孕症的论治.中国医药学报,1998.(2)：46-47
32. Volgsten H, Skoog Svanberg A, Ekselius L, Lundkvist 0, Sundstrom Poromaa I. Risk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Fertil Steril. 2010:93(4):1088-96.
33.李广文.情志与孕育.山东中医杂志,1986.(4)：33-34
34. MerceLT, Barco MJ, Troyano J, Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro/embryo transfer outcome. Fertil Steri.2008 Jan; 89 (1):111-7
35.金素坤,李晶,王晓光,孙玉芬.彩色多普勒阴道超声在妇产科的应用[J].中国医学影像技术,1995,(2)147-148
36. Ginekol Pol. Cost-effectiveness of IVF infertility treatment in different legislative settings. Curr Womens Health Rep.2010 Feb;81(2):125-30.
37. Gosling RG, King DH. Arterial assessment by Doppler-shift ultrasound. Proc Roy Soc Med 67:1974,447-449
38.高琳,谢鸣.关于“中草药肾病”及中药毒性认识.中国医药学报,2002,17(11)：668
39. J. Drife, B. Magowan. Clinical Obstetrics and Gynaecology. Saunders,2004：57
40.王群,张振宇.116例女性不孕症病因分析.中国优生与遗传学杂志,2006,14(11)：111
41. Kondoh E, Okamoto T, Higuchi T, Tatsumi K, Baba T, Murphy SK, Takakura K, Konishi I, Fujii S.Stress affects uterine receptivity through an ovarian-independent pathway. Hum Reprod.2009 Apr;24(4):945-53.
42. Smith S, Pfeifer SM, Collins JA. Diagnosis and management of female infertility. JAMA.2003 Oct 1;290(13):1767-70.
43. Brown J, Farquhar C, Beck J, Boothroyd C, Hughes E. Clomiphene and anti-oestrogens for ovulation induction in PCOS. Cochrane Database Syst Rev.2009 Oct 7;(4):CD002249.
44.张帝开,罗虹,邝健全.支原体感染引起输卵管性不孕的免疫机制.中国实用妇科与产科杂志,2003,24(4)394-396
45.刘利,常红军,等.细菌性阴道炎与女性免疫性不孕的相关性研究.中国全科医学,4(6)：499-450
46.陈利生,倪雅莲,等.男女不育症中西医现代诊断与治疗.上海世界图患书出版公可,2006：341
47.王馨世.女性生殖与内分泌学.台湾：合记出版社,1999.70-72
48. Kent M. Van De Graaaff, Human Anatomy, Wm. C. Brown Publishers.1995,21: 698-700
49.程秋蓉,田晓萍.妇科激素测定在生殖内分泌性不孕原因诊断中的价值(附75例分析)[J].中国医师杂志,2002,(08),888-889
50.杨自更,张阳.226例不孕患者性激素水平变化及分析[J].放射免疫学杂志,2009(01),39-40
51. J. Drife, B. Magowan. Clinical Obstetrics and Gynaecology. Saunders, 2004:122
52. H. I addressed, Endometrial thickness:a predictor of implantation in ovum recipients? Human Reproduction,1994; 9 (2):363-365
53. Zaidi J, Campbell S, Tan SL. Endometrial thickness, morphology, vascular penetration and velocimetry in predicting implantation in an in vitro fertilization program. Human Reproduction 2006 21 (6):1612-17
54..Curtis Hewitt S, Goulding EH, Eddy EM, Korach KS. Studies using the estrogen receptor alpha knockout uterus demonstrate that implantation but not decidualization-associated signaling is estrogen dependent. Biol Reprod.2002 Oct;67(4):1268-77.
55. Toloubeydokhti T, Bukulmez 0, Chegini N. Potential regulatory functions of microRNAs in the ovary. Semin Reprod Med.2008 Nov;26(6):469-78.
56.石红.卵巢旁分泌与自分泌.中国实用妇科与产科杂志,2001,17(14)：241-243
57. Najwa AR, Sengupta J, Ghosh D.A systems biology approach towards understanding the process of blastocyst implantation. Indian J Physiol Pharmacol.2009 Jul-Sep;53(3):197-208.
58.李真,王智标,顾美礼,等.整合素在胚胎着床、生长发育及某些妇科疾病中的应用.中华妇产科杂志,1999,(4)254-256
59. Bluher S, Mantzoros CS. Leptin in reproduction. Curr Opin Endocrinol Diabetes Obes.2007 Dec;14(6):458-64.
60. Ohno Y, Fujimoto Y. Endometrial oestrogen and progesterone receptors and their relationship to sonographic appearance of the endometrium. Hum Reprod Update.1998 Sep-Oct;4(5):560-4.
61. Kupesic S, Kurjak A. Uterine and ovarian perfusion during the periovulatory period assessed by transvaginal color Doppler. Fertil Steril.1993 Sep; 60 (3):439-43.
62.李淑玲.肾虚不孕的治疗与机理研究.山东中医杂志,1995.(7)：298-299
63.蒋惠芳.疏肝益肾治疗功能性不孕102例.辽宁中医杂志,1994.(10)456-466
64.李超荆,俞谨,郭焕如,等.肾主生殖与排卵机理的初步探讨.中医杂志,1982,(6)：69-71
65.张婷婷.温经汤治疗不孕症在日本的研究及应用.实用中医药杂志,1998,14(2)28-29
66.马申.不孕症妇女心理状态分析[J].上海预防医学杂志,2006,(05)100-101
67.陆亚文,杨玲玲,卢光,等.不育妇女精神状况与个性的探讨.中华妇产科杂志,1995,30(1)：34-37
68.张嵘,李潭,宋平.家庭亲密度、适应性与不孕症患者就诊行为研究[J].中国性科学,2009,(02)：80-81
69. Pandey S, Bhattacharya S. Impact of obesity on gynecology. Womens Health (Lond Engl).2010 Jan;6(1):107-17.
70. Pasquali R, Patton L, Gambineri A. Obesity and infertility. Curr Opin Endocrinol Diabetes Obes.2007 Dec;14 (6):482-7.
71.罗序清,胡莉萨.影响子宫内膜发育的研究进展[J].江西中医学院学报,2009,(01)98-100
72.张燕萍.人工流产引起继发不孕的原因及治疗[J].中国生育健康杂志,2005,(05)304-305
73. Kent M. Van De Graaaff, Human Anatomy, Wm. C. Brown Publishers.1995,21: 700
74.夏桂成.中医妇科理论与实践.北京：人民卫生出版社,2003.96-98
75. Ng EH, Chan CC, Tang OS, Yeung WS, Ho PC. The role of endometrial and subendometrial blood flows measured by three-dimensional power Doppler ultrasound in the prediction of pregnancy during IVF treatment. Hum Reprod. 2006 Jan;21(1):164-70.
76.吴洪波：李柳铭；袁华；李慕军；HCG注射日应用彩色多普勒超声检测子宫内膜和内膜下血流评价IVF-ET结局中国现代医学杂志,2009,(15)：132-136
77.袁华,李慕军,江莉,马燕,吴惠梅.阴道超声评估不孕妇女子宫内膜容受性的价值研究[J].现代妇产科进展,2009,(02)：125-128
78.颜华华.中药学.台北知音出版社,1994：750-754,793,815-823
79.沈映君.中药药理学.人民卫生出披社,2002：861-929
80.卓大宏.中药临床应用.广东人民出版社,2002：352-353,397-407
81.杨恒茂.实用中医妇科方药学.陕西科学技术出版社,1988：116-122,169,216
82. Hughes E, Collins J, Vandekerckhove P. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. Cochrane Database Syst Rev. 1996 Apr 22;(1):CD000056.
83. Hughes E, Brown J, Collins JJ, Vanderkerchove P. Clomiphene citrate for unexplained subfertility in women. Cochrane Database Syst Rev.2010 Jan 20;(1):CD000057.
84. Shahin AY. Endometrial sonographic characters predicting pregnancy following recurrent clomiphene induction in unexplained infertility. Reprod Biomed Online.2008 Dec;17(6):795-802.
85.郑丞杰.妇产科超音波学.台湾：艺轩出版社,2007：33-59、277-280
86. TaylorKJ, BurnsPN, WellsPN, et al. Ultrasound Doppler flow studies of the ovarian and uterine arteries[J]. BrJ Obstet Gynaecol,2006,92:240-242.
87. Long MG, Boultbee JE, Hanson ME, et al. Dopplertimevelocity wave form studies of the uterine artery and uterus [J]. BrJObstet Gynaecol,2007,96:588-593.
88. American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of pelvic ultrasound examinations. J Ultrasound Med.2010 Jan; 29(1):166-72.
89. Kupesic S. The first three weeks assessed by transvaginal color Doppler. J Perinat Med.1996;24(4):301-17.
90. Baruah J, Roy KK, Rahman SM, Kumar S, Sharma JB, Karmakar D. Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery 220.Doppler. Arch Gynecol Obstet.2009 Mar; 279 (3):311-4.
91. Wakeman S, Benny P. Is it possible to predict a fertile cycle? Uteroovarian blood flow parameters in conception versus nonconception cycles. Fertil Steril.2009 Jun;91(6):2726-31.
92. Ab dalla, A. A. Brooks, A. Kirkland, Assessment of Uterine Receptivity by Endometrial and Subendometrial Blood Flows Measured by vaginal color DopplerUltrasound in women undergoing IVF treatment. Fertil Steri,2007; 3
93.候娟.中西药联合应用不良反应浅析.现代中西医结合杂志,2003,12(9)：999
94.李丽芸,徐珉.辨病结合辨证治疗不孕症经验与体会.新中医,2001,33(6)：103-104
95. Miller JH, Weinberg RK, Canino NL, Klein NA, Soules MR. The pattern of infertility diagnoses in women of advanced reproductive age. Am J Obstet Gynecol.1999 Oct;181(4):952-7.
96.周坤福,等.六味地黄丸延缓衰老作用机理的实验研究.江苏中医,1999,20(1)：44
97.傅佳云.六味地黄丸药理研究.中成药研究,1986,(4)：26
98. Loret de Mola JR. Obesity and its relationship to infertility in men and women. Obstet Gynecol Clin North Am.2009 Jun;36(2):333-46
99. Ryan D. Obesity in women:a life cycle of medical risk. Int J Obes (Lond). 2007 Nov;31 Suppl 2:S3-7;
100. Papanek PE. The female athlete triad:an emerging role for physical therapy. J Orthop Sports Phys Ther.2003 Oct;33(10):594-614.
101.Hurvitz M, Weiss R. The young female athlete. Pediatr Endocrinol Rev.2009 Dec; 7 (2):123-9.
102. Zain MM, Norman RJ. Impact of obesity on female fertility and fertility treatment.Womens Health (Lond Engl).2008 Mar;4(2):183-94.
103. Al-Azemi M, Omu FE, Omu AE. The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome. Arch Gynecol Obstet.2004 Dec;270(4):205-10.
104.张梅.宫颈粘液监测排卵在治疗不孕症中的应用[J].医学理论与实践,2001,(12)：24-25
105. El Hakim EA, Epee M, Draycott T, Gordon UD, Akande VA. Significance of positive Chlamydia serology in women with normal-looking Fallopian tubes. Reprod Biomed Online.2009 Dec;19(6):847-51.
106.王立新.中西医结合治疗无排卵性不孕疗效观察[J].辽宁中医杂志,2006,(04)：144-145
107.杨玉红.克罗米酚合中药促排卵汤治疗排卵障碍性不孕症疗效观察[J].现代中西医结合杂志,2003,(16)：1734-1735
108. Lai SK, Wang YY, Cone R, Wirtz D, Hanes J. Altering mucus rheology to "solidify" human mucus at the nanoscale. PLoS One.2009;4(1):e4294.
109.沈洪沁,洪波.补肾活血综合治疗子宫内膜异位症不孕的临床观察.中华实用中西医杂志,2004,4(17)：1939-1940
110.俞瑾,孙月丽,邵公权,等.补肾化痰治疗多囊性卵巢综合征中对下丘脑-垂体-卵巢功能的调节.中西医结合杂志,1986,6(4)：218-219
111.吴斌,高峰,严石林,李炜弘,王米渠.肾阳虚证的辨证因子规律初探[J].现代中西医结合杂志,2004,(14)：1819-1820
112.陈瑞秀.现代不孕症的诊断治疗研究新进展[J].哈尔滨医药2009,(01)：52-53
113. Kafy S, Tulandi T.New advances in ovulation induction. Curr Opin Obstet Gynecol.2007 Jun;19(3):248-52.
114. Kousta E, White DM, Franks S. Modern use of clomiphene citrate in induction of ovulation. Hum Reprod Update.1997 Jul-Aug;3(4):359-65.
115.邵瑞云,朗丰君.补肾活血中药加克罗米芬治疗多囊性卵巢综合征所致不孕的临床观察.中国中西医结合杂志,2004,24(1)：41-43
116. Chen SL, Wu FR, Luo C, Chen X, Shi XY, Zheng HY, Ni YP. Combined analysis of endometrial thickness and pattern in predicting outcome of in vitro fertilization and embryo transfer:a retrospective cohort study. Reprod Biol Endocrinol.2010 Mar 24;8:30.
117. Tsai YC, Tai MC, Chang JC. Predictive value of endometrial sonography in ovulation induction for intrauterine insemination. J Formos Med Assoc. 1995 Oct;94(10):626-9.
118. Tublin M. E, Platt JF. The resistance index in renal Doppler sonography: where do we stand? AJR Am J Roentgenol 2003,180:885-892
119. Platt JF et al. Duplex Doppler ultrasound of the kidney:differentiation of obstructive from non-obstructive dilatation.1989, Radiology 171: 515-517
120. Ardalan MR, Shoja MM. A correlation between direct and indirect Doppler ultrasono graphic measures in transplant renal artery stenosis. Transplant Proc 39,2007:1426-1438
121. Nakai A, Yokota A, Koshino T, Araki T. Assessment of endometrial perfusion with Doppler ultrasound in spontaneous and stimulated menstrual cycles. J Nippon Med Sch.2002 Aug;69(4):328-32.
122. Ramathal CY, Bagchi IC, Taylor RN, Bagchi MK. Endometrial decidualization: of mice and men. Semin Reprod Med.2010 Jan;28(1):17-26.
123. Kurjak A, Kupesic-Urek S, Schulman H, Zalud I. Transvaginal color flow Doppler in the assessment of ovarian and uterine blood flow in infertile women. Fertil Steril.1991 Nov;56(5):870-3.
124. Jahromi AS, Cina CS, Liu Y, Clase CM. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis:a systematic review and meta-analysis. Vasc Surg.2005 Jun; 41 (6):962-72.
125.张力,杨晓晖.中药不良反应发生的原因及其相关对策.中国医药学报,2004,19(8)：496
126. Van den Broeck U, Holvoet L, Enzlin P, Bakelants E, Demyttenaere K, D'Hooghe T. Reasons for dropout in infertility treatment. Gynecol Obstet Invest.2009; 68(1):58-64.
127.任光友,等.六味地黄丸对阴虚动物药理作用研究.中成药,1999,21(11)：586
128.李炳如.补肾药对下丘脑-垂体-卵巢性腺轴功能的影响.中西医结合杂志,1984,14(6)：21
129.曹治权,等.微量元素与中医学.北京：中国中医药出版社,1993.15
130.潘颖宜,周志锦,等.四物汤中微量元素Cu、Zn、Fe在家兔体内的吸收.中成药,1997,19(2)：33-35