Enhancing Embryo Quality in Advanced Maternal Age: The Role of Erzhi Tiangui Formula

Use of the Erzhi Tiangui formula in patients undergoing IVF produced a statistically significant increase in the number of high-quality blastocysts and improved fertilization rates in patients of advanced maternal age in a randomized controlled study.

The trial enrolled 240 patients aged 35–42 years and randomized them to Erzhi Tiangui versus placebo. The intervention was administered orally starting in the menstrual cycle before ovarian stimulation and continued through oocyte retrieval. Primary endpoints were the number of high-quality blastocysts and fertilization rate; granulosa cell biomarker analyses were also performed.

Both primary endpoints reached statistical significance; counts of high-quality blastocysts and fertilization rates were higher in the Erzhi Tiangui arm versus control (P<0.05).

At the cellular level, treatment upregulated the Nrf2/HO-1 signaling pathway, increased antioxidant enzyme activity, and raised intracellular GSH and ATP in granulosa cells. Protein and mRNA analyses showed increased Nrf2, HO-1, SOD, CAT, GPX and Bcl-2 with decreased Keap1, Bax and Caspase‑3—changes consistent with reduced apoptosis and offering a plausible mechanism for improved blastocyst quality.

Tolerability was acceptable; no significant adverse events were reported among trial participants. However, the trial’s inclusion and exclusion criteria—restricted to patients aged 35–42 and excluding extreme diminished ovarian reserve—limit extrapolation to much younger patients or those with very low reserve.