Electrical and manual acupuncture stimulation affects estrous cyclicity and neuroendocrine function in a DHT-induced rat polycystic ovary syndrome model

Yi Feng, Julia Johansson, Ruijin Shao, Louise Mannerås Holm, Håkan Billig, Elisabet Stener-Victorin

Abstract

Both low-frequency electro-acupuncture (EA) and manual acupuncture improve menstrual frequency and decrease circulating androgens in women with polycystic ovary syndrome (PCOS). We sought to determine whether low-frequency EA is more effective than manual stimulation in regulating disturbed estrous cyclicity in rats with PCOS induced by 5?-dihydrotestosterone (DHT). To identify the central mechanisms of the effects of stimulation, we assessed hypothalamic mRNA expression of molecules that regulate reproductive and neuroendocrine function.

From age 70 days, rats received 2-Hz EA or manual stimulation of the needles five times/week for 4–5 weeks; untreated rats served as controls. Specific hypothalamic nuclei were obtained by laser microdissection, and mRNA expression was measured with TaqMan low-density arrays. Untreated rats were acyclic. During the last 2 weeks of treatment, seven of eight (88%) rats in the EA group had epithelial keratinocytes, demonstrating estrous cycle change (p= 0.034 vs. controls). In the manual group, five of eight (62%) rats had estrous cycle changes (ns vs. controls). mRNA expression of the opioid receptors Oprk1 and Oprm1 in the hypothalamic arcuate nucleus was lower in the EA group than in untreated controls. mRNA expression of the steroid hormone receptors Esr2, Pgr, and Kiss1r was lower in the manual group than in the controls.

In rats with DHT-induced PCOS, low-frequency EA restored disturbed estrous cyclicity but did not differ from manual stimulation group, although electrical stimulation lowered serum testosterone in responders, those with restored estrus cyclicity, and differed from both controls and the manual stimulation group. Thus, EA cannot in all aspects be considered superior to manual stimulation.

The effects of low-frequency EA may be mediated by central opioid receptors, while manual stimulation may involve regulation of steroid hormone/peptide receptors.

Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis.

Zheng CH, Huang GY, Zhang MM, Wang W.

Abstract

You can read the full paper here.

OBJECTIVE:
To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.

DESIGN:
Systematic review and meta-analysis.

PATIENT(S):
Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects of acupuncture on IVF outcomes.

INTERVENTION(S):
The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture.

MAIN OUTCOME MEASURE(S):
The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.

RESULT(S):
Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation.

CONCLUSION(S):
Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects of using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

fertility and sterility acupuncture Acupuncture improves clinical pregnancy, implantation rate and live birth rate of IVF embryo transfer. The researchers used Transcutaneous electro acupuncture in this study. Transcutaneous electrostimulation is another way to stimulate acupuncture points. And needles are not necessary!

As you can see from the abstract below, clinical pregnancy rate, implantation rate, and live birth rate all improved in the acupuncture group. With pregnancy rate improving from 29.3% to 50%, implantation rate increasing from 15.0% to 25.9% and live birth dramatically increasing from 21.2% to 42.0%.

The study was published in Fertility and Sterility in 2011.

Fertil Steril. 2011 Oct;96(4):912-6. doi: 10.1016/j.fertnstert.2011.07.1093. Epub 2011 Sep 8.
Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupuncture point stimulation: a prospective randomized placebo-controlled study.

Author information
Zhang R1, Feng XJ, Guan Q, Cui W, Zheng Y, Sun W, Han JS.

Abstract

OBJECTIVE:
To evaluate the effect of transcutaneous electrical acupuncture point stimulation (TEAS) on pregnancy rates (PR) in women undergoing ET.

DESIGN:
Prospective, randomized, single-blinded placebo-controlled clinical trial.

SETTING:
Research and laboratory facilities.

PATIENT(S):
A total of 309 patients, less than 45 years old, undergoing cryopreservation embryos transplant or fresh cycle IVF with or without intracytoplasmic sperm injection (ICSI).

INTERVENTION(S):
The subjects were randomly allocated to three groups: mock TEAS treatment: 30 minutes after ET (group I, n = 99); single TEAS treatment: 30 minutes after ET (group II, n = 110); and double TEAS treatments: 24 hours before ET and 30 minutes after ET (group III, n = 100).

MAIN OUTCOME MEASURE(S):
Clinical PR, embryos implantation rate, live birth rate.

RESULT(S):
The clinical PR, embryos implantation rate, and live birth rate of group I (29.3%, 15.0%, and 21.2%, respectively) were significantly lower than those in group II (42.7%, 25.7%, and 37.3%, respectively) and group III (50.0%, 25.9%, and 42.0%, respectively).

CONCLUSION(S):
Transcutaneous electrical acupoint stimulation, especially double TEAS, significantly improved the clinical outcome of ET.

http://www.ncbi.nlm.nih.gov/pubmed/21862001

The Effect of Acupuncture on Psychosocial Outcomes for Women Experiencing Infertility: A Pilot Randomized Controlled Trial

Caroline A. Smith, PhD, Jane M. Ussher, PhD, Janette Perz, PhD, Bridget Carmady, and Sheryl de Lacey, PhD

Abstract

Objectives:

The study objectives were to examine the effectiveness of acupuncture for reducing infertility-related stress.

Design:

The study design was a randomized controlled trial of acupuncture compared with a wait-list control.

Setting:

The study was conducted at The University of Western Sydney.

Subjects:

Thirty-two (32) women aged 20–45 years, with a diagnosis of infertility, or a history of unsuccessfully trying to conceive for 12 months or more, were the subjects of the study.

Interventions:

Women received six sessions of acupuncture for over 8 weeks.

Outcome measures:

The primary outcomes were infertility self-efficacy, anxiety, and infertility-related stress. The women’s experience of infertility and acupuncture is also reported.

Results:

At the end of the 8-week intervention, women in the acupuncture group reported significant changes on two domains on the Fertility Problem Inventory with less social concern (mean difference [MD] ?3.75, 95% confidence interval [CI] ?7.58 to 0.84, p=0.05), and less relationship concern (MD ?3.66, 95% CI ?6.80 to ?0.052, p=0.02). There were also trends toward a reduction of infertility stress on other domains, and a trend toward improved self-efficacy (MD 11.9, 95% CI ? 2.20 to 26.0, p=0.09) and less anxiety (MD ? 2.54, 95% CI ? 5.95 to 0.86, p=0.08) in the acupuncture group compared with the wait-list control. Women described the experience and impact of acupuncture as positive relating to a sense of relaxation and time out, the engagement with the practitioner, and intervention that had very few negative side-effects. Changes were also perceived after treatment with women describing a physical and psychologic sense of relaxation and calmness, and a changed perspective in relation to coping.

Conclusions:

Acupuncture may be a useful intervention to assist with the reduction of infertility-related stress. Further research is justified.

Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study

Objective

To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on pregnancy rates (PR) in women undergoing ET.
Design

Prospective, randomized, single-blinded placebo-controlled clinical trial.
Setting

Research and laboratory facilities.
Patient(s)

A total of 309 patients, less than 45 years old, undergoing cryopreservation embryos transplant or fresh cycle IVF with or without intracytoplasmic sperm injection (ICSI).
Intervention(s)

The subjects were randomly allocated to three groups: mock TEAS treatment: 30 minutes after ET (group I, n = 99); single TEAS treatment: 30 minutes after ET (group II, n = 110); and double TEAS treatments: 24 hours before ET and 30 minutes after ET (group III, n = 100).
Main Outcome Measure(s)

Clinical PR, embryos implantation rate, live birth rate.
Result(s)

The clinical PR, embryos implantation rate, and live birth rate of group I (29.3%, 15.0%, and 21.2%, respectively) were significantly lower than those in group II (42.7%, 25.7%, and 37.3%, respectively) and group III (50.0%, 25.9%, and 42.0%, respectively).
Conclusion(s)

Transcutaneous electrical acupoint stimulation, especially double TEAS, significantly improved the clinical outcome of ET.

Key Words: Acupuncture, transcutaneous electrical acupoint stimulation (TEAS), pregnancy rate (PR), in vitro fertilization (IVF), embryo transfer (ET), intracytoplasmic sperm injection (ICSI)

Effect of acupuncture-moxibustion therapy on sperm quality in infertility patients with sperm abnormality

Objective
Working on seminal plasma acid phosphatase, to explore the mechanism by which acupuncture improves sperm quality (concentration, viability and motility) in infertility patients.
Methods
A total of 118 patients received acupuncture-moxibustion treatment. Before and 3, and 6 months after the treatment were detected their seminal plasma acid phosphatase, sperm concentration, sperm viability and sperm motility were measured.
Results
The differences between before and after treatments in sperm motility and seminal plasma acid phosphatase levels were statistically significant (P<0.01). Conclusion Acupuncture-moxibustion can improve seminal plasma acid phosphatase levels in infertility patients. Authors: An Chen, Aiming Shen, Renhua Li and Zhiping Xia Key Words Acupuncture Therapy – Infertility, Male – Acid Phosphatase – Spermatozoa


Abstract
Objective
To observe the clinical efficacy of acupuncture-moxibustion therapy for infertility due to sperm abnormality (SAI).
Methods
We treated a series of 35 cases of SAI with electroacupuncture combined with herb cake-partitioned moxibustion, observing the variation before and after treatment in symptom integral, sperm status, sex hormone and prostate function.
Results
After treatment, the patients were remarkably improved in symptom integral, sperm status, sex hormone and prostate function as compared with those prior to treatment.
Conclusion
Acupuncture is an effective therapy for SAI.

Key Words Acupuncture-moxibustion Therapy – Infertility, Male – Spermatozoa – Azoospermia – Oligospermia

Author: He Jinsen, doctor of medicine, professor

human-reproduction-infertility-acupuncture

Title: Effect of electro-acupuncture on ovarian expression of ? (1)- and ? (2)-adrenoceptors, and p75 neurotrophin receptors in rats with steroid-induced polycystic ovaries
Author: Manni Luigi ; Lundeberg Thomas ; Holmäng Agneta ; Aloe Luigi ; Stener-Victorin Elisabet
Abstract:

Abstract

Background

Estradiol valerate (EV)-induced polycystic ovaries (PCO) in rats is associated with an increase in ovarian sympathetic outflow. Low-frequency (2 Hz) electro-acupuncture (EA) has been shown to modulate sympathetic markers as well as ovarian blood flow as a reflex response via the ovarian sympathetic nerves, in rats with EV-induced PCO.

Methods

In the present study, we further tested the hypothesis that repeated 2 Hz EA treatments modulate ovarian sympathetic outflow in rats with PCO, induced by a single i.m. injection of EV, by investigating the mRNA expression, the amount and distribution of proteins of ?1a-, ?1b-, ?1d-, and ?2-adrenoceptors (ARs), as well as the low-affinity neurotrophin receptor (p75NTR).

Results

It was found that EV injection results in significantly higher mRNA expression of ovarian ?1b- and ?1d-AR in PCO rats compared to control rats. The p75NTR and ?2-ARs mRNA expression were unchanged in the PCO ovary. Low-frequency EA resulted in a significantly lower expression of ?2-ARs mRNA expression in PCO rats. The p75NTR mRNA was unaffected in both PCO and control rats. PCO ovaries displayed significantly higher amount of protein of ?1a-, ?1b- and ?1d-ARs, and of p75NTR, compared to control rats, that were all counteracted by repeated low-frequency EA treatments, except for ?1b-AR.

Conclusion

The present study shows that EA normalizes most of the EV-induced changes in ovarian ARs. Furthermore, EA was able to prevent the EV-induced up regulation of p75NTR, probably by normalizing the sympathetic ovarian response to NGF action. Our data indicate a possible role of EA in the regulation of ovarian responsiveness to sympathetic inputs and depict a possible complementary therapeutic approach to overcoming sympathetic-related anovulation in women with PCOS.
Journal: Reproductive Biology and Endocrinology
Issn: 14777827

Selecting a control for in vitro fertilization and acupuncture randomized controlled trials (RCTs): how sham controls may unnecessarily complicate the RCT evidence base

Eric Manheimer M.S.Corresponding Author Contact Information, a, E-mail The Corresponding Author

a Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, Maryland
Available online 13 May 2011.

Objective

To examine the theoretical and methodologic rationales for the use of sham acupuncture controls in trials of adjuvant acupuncture for in vitro fertilization (IVF), and to identify the drawbacks of using a sham acupuncture control that may have its own effects on the pregnancy outcome. Read more

Title: Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries
Author: Stener-Victorin Elisabet ; Kobayashi Rie ; Watanabe Orie ; Lundeberg Thomas ; Kurosawa Mieko
Abstract:

Abstract

Background

Maintenance of ovarian blood flow (OBF) is suggested to be important for regular ovulation in women with polycystic ovaries (PCO). Read more

Gynecological Endocrinology: Acupuncture PCOS
Current evidence of acupuncture on polycystic ovarian syndrome.

Lim CE, Wong WS.

Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia. celim@unswalumni.com Gynecol Endocrinol. 2010 Jun;26(6):473-8.
Abstract

OBJECTIVE: This paper aims to provide a literature review on evaluating the efficacy of acupuncture therapy in the treatment of polycystic ovarian syndrome (PCOS) by reviewing clinical trials; randomised and non-randomised and observational studies on PCOS. The paper will also determine the possible mechanism of acupuncture treatment in PCOS, limitations of recruited studies and suggest further improvements in future studies.
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Acupuncture PCOS Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial
Elizabeth Jedel1, Fernand Labrie2, Anders Odén3, Göran Holm4, Lars Nilsson5, Per Olof Janson5, Anna-Karin Lind5, Claes Ohlsson6, and Elisabet Stener-Victorin7,8
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Role of acupuncture in the treatment of female infertility

Fertility and Sterility, Volume 78, Issue 6, Pages 1149-1153 (December 2002)
Raymond Chang M.D.a,b, Pak H. Chung M.D. b* and Zev Rosenwaks M.D.c
Received 24 June 2002; revised 19 July 2002; accepted 19 July 2002.

Abstract

Objective: To review existing scientific rationale and clinical data in the utilization of acupuncture in the treatment of female infertility.
Read more

J Altern Complement Med. 2010 Feb;16(2):193-8.
Unexplained infertility treated with acupuncture and herbal medicine

Park JJ, Kang M, Shin S, Choi E, Kwon S, Wee H, Nam B, Kaptchuk TJ.

Asian Medicine & Acupuncture Research, Department of Physical Medicine & Rehabilitation, University of North Carolina at Chapel Hill, NC, USA.

Erratum in:
J Altern Complement Med. 2010 Jul;16(7):817.

Abstract

AIM: We aim to determine the safety and effectiveness of a standard therapeutic package of Korean medicine for the treatment of unexplained infertility in a cross-section of women who sought treatment at an integrative hospital in Seoul, Korea.
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Effects of electro-acupuncture on in vitro fertilization-embryo transfer (IVF-ET) of patients with poor ovarian response

[Article in Chinese]

Zhongguo Zhen Jiu. 2009 Oct;29(10):775-9.

Chen J, Liu LL, Cui W, Sun W.

Department of Reproduction, The Second Affiliated Hospital of Shandong University of TCM, Jinan 250001, China. fusantai@126.com
Abstract

OBJECTIVE: To observe the effect of electro-acupuncture therapy on oocyte quality and pregnancy outcome of patients with the poor ovarian response or decreased reserve in the course of in vitro fertilization (IVF).

METHODS: Sixty cases accepting IVF-ET were randomly divided into an observation group and a control group, 30 cases in each group. The two groups were both treated with antagonist scheme for ovulation induction, and the electro-acupuncture intervention was also added in the observation group, Guanyuan (CV 4), Taixi (KI 3), Sanyinjiao (SP 6) etc. were selected. The therapeutic effects in the two groups were compared after treatment.

RESULTS: There was no significant difference between the two groups before treatment. The symptoms of kidney deficiency in the observation group were significantly improved after treatment, and the levels of serum estradiol (E2), fertilization rate, oocyte maturation rate, good quality embryos rate, and implantation rate in the observation group were superior to those in the control group on human Chorionic Gonadotropin (hCG) injection day (all P<0.05); the levels of stem cell factor (SCF) in follicular fluid and serum in the observation group were significantly higher than those in the control group (both P<0.05). The pregnancy rate in the observation group was higher than that in the control group, and the abortion rate in the observation group was lower than that in the control group, but there was no significant difference between the two groups (both P>0.05).

CONCLUSION: Electro-acupuncture therapy has a good clinical effect for IVF patients with poor ovarian reserve, and can improve oocyte (egg) quality and pregnancy outcome.

PMID: 19873910 [PubMed – indexed for MEDLINE]

fertility and sterility acupuncture Fertil Steril. 2008 Nov;90(5):1732-8. Epub 2008 Feb 20.
Point- and frequency-specific response of the testicular artery to abdominal electroacupuncture in humans.

Cakmak YO, Akpinar IN, Ekinci G, Bekiroglu N.

Department of Anatomy, School of Medicine, University of Marmara, Istanbul, Turkey. ycakmak@marmara.edu.tr
Abstract

OBJECTIVE: To clarify the role of the abdominal acupuncture points and the frequency of short-term electroacupuncture (EA) stimulation on testicular blood flow (TBF) in humans.

DESIGN: A prospective, randomized study.

SETTING: University hospital, Department of Radiology, ultrasound unit.

PATIENT(S): Eighty healthy male volunteers were randomly allocated to three groups in stage one and to a single group in stage two. In the first stage of the study, the abdominal acupuncture points ST-29 (guilai) were stimulated using simple needle insertion, 2 Hz burst EA or 10 Hz EA, in three different groups. In the second stage of the study, abdominal acupuncture points ST-25 (tianshu) were stimulated with the frequency found to be more effective in stage one. Stimulation was for 5 minutes in each group.

INTERVENTION(S): Electroacupuncture and Doppler flowmeter.

MAIN OUTCOME MEASURE(S): Four groups were compared for volume flow and other related parameters of TBF.

RESULT(S): The 10-Hz EAcupuncture stimulation of ST-29 (guilai) increased TBF, but simple needle insertion and 2-Hz burst stimulation did not. The 10-Hz EA stimulation of ST-25 (tianshu) did not result in significant changes in TBF.

CONCLUSION(S): For the first time point- and frequency-specific effects of abdominal E Acupuncture on testiclar blood flow are shown in humans. Further investigation is required to ascertain whether these findings may be helpful in the clinical treatment of infertile men.

PMID: 18076881 [PubMed – indexed for MEDLINE]

Complement Ther Clin Pract. 2010 Aug;16(3):154-7. Epub 2009 Dec 24.
The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: a pilot study.

Balk J, Catov J, Horn B, Gecsi K, Wakim A.

University of Pittsburgh, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA. jbalk@magee.edu
Abstract

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

PATIENT(S): 57 infertile patients undergoing IVF or IVF/ICSI. INTERVENTIONS(S): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.

MAIN OUTCOME MEASURE(S): Perceive Stress Scale scores, pregnancy rates.

RESULT(S): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased their perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status. CONCLUSIONS(S): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

PMID: 20621276 [PubMed – in process]PMCID: PMC2904299 [Available on 2011/8/1]

IVF is stressful. And Acupuncture offsets the effects of stress on some reproductive hormones during the in vitro fertilisation.

In this study acupuncture effectively helped patients suffering from both reduced sperm motility and low sperm count. This kind of condition is called oligoasthenozoospermia. The study showed that acupuncture significantly improved percentage of motile sperm.

sperm-motility

Fertil Steril. 2009 Oct;92(4):1340-3. doi: 10.1016/ j.fertnstert. 2009.02.041. Epub 2009 Apr 25.
A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia.
Dieterle S, Li C, Greb R, Bartzsch F, Hatzmann W, Huang D.
Source
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Witten/Herdecke, Dortmund, Germany. dieterle@ivf-dortmund.de
Abstract
In this first prospective, randomized, single-blind, placebo-controlled study, 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A-C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.

Cochrane: Endometriosis and Chinese medicine Chinese herbal medicine for endometriosis a publication in one of the most prestigious evidence journals. Evidence doesn’t get stronger than this.

Chinse herbal medicine outperformed conventional drugs in endometriosis management.  Authors concluded that Chinese medicine has fewer side effects, but similar benefits to gestrinone. Oral Chinese medicine tinctures may have a better effect than danazol in relieving dysmenorrhea, even shrinking adnexal masses when used in combination with a Chinese medicine enema.

Chinese herbs for endometriosis

Flower A, Liu JP, Chen S, Lewith G, Little P

Endometriosis is a common gynaecological condition causing menstrual and pelvic pain. Treatment involves surgery and hormonal drugs, with potentially unpleasant side effects and high rates of reoccurrence of endometriosis. This review suggests that Chinese herbal medicine (CHM) may be useful in relieving endometriosis-related pain with fewer side effects than experienced with conventional treatment. However, the two trials included in this review are of poor methodological quality so these findings must be interpreted cautiously. Better quality randomised controlled trials are needed to investigate a possible role for CHM in the treatment of endometriosis.

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