Effects of Gegen-Heisu Decoction on Endometrial Receptivity in Patients with Thin Endometrium-Related Infertility: A Prospective Randomized Controlled Trial

Objective: This study aimed to evaluate the synergistic effects of Gegen-Heisu decoction (GHD) combined with estrogen-progestin therapy on thin endometrium (TE)-related infertility. Methods: A single-center, prospective randomized controlled study was conducted from June 2023 to June 2024, enrolling 250 women with TE. Participants were randomly assigned to either the control group (estradiol and dydrogesterone) or the GHD group (GHD plus estradiol and dydrogesterone). The primary outcomes were endometrial thickness (EMT) and endometrial type on the ovulation day. Secondary outcomes included blood flow parameters, traditional Chinese medicine (TCM) syndrome scores, serum leukemia inhibitory factor (LIF), and vascular endothelial growth factor levels. Results: The GHD group demonstrated significant improvements in EMT (p < 0.001) and endometrial type (p = 0.005) compared with the control group. In addition, the GHD group exhibited a lower pulsation index and resistance index, as well as a higher peak systolic velocity of the uterine spiral arteries (p < 0.05). Patients in the GHD group also had lower TCM syndrome scores than those in the control group (p < 0.001) and higher serum LIF levels (p = 0.003). No hepatic or renal adverse effects were observed in either group. One participant in the GHD group experienced mild skin pruritus, and one participant in the control group reported gastrointestinal discomfort. Conclusion: The combination of GHD and estrogen-progestin therapy effectively enhances endometrial receptivity in women with TE. GHD modulates key cytokines, offering a promising adjunct therapy for TE-related infertility.