Abstract
Diminished ovarian reserve (DOR) is characterized by reduced ovarian follicle quantity and quality, contributing to female infertility. While hormone replacement therapy (HRT) is commonly used, its efficacy is limited and associated with adverse effects. Traditional Chinese medicine (TCM), using multi-target herbal formulations that may support ovarian function through endocrine modulation and microcirculatory improvement, has shown promise in improving ovarian function, though high-quality clinical evidence remains scarce. This study evaluates the efficacy of the Bushen Huoxue Formula in treating DOR and to identify predictors of treatment response. This retrospective cohort study included 122 DOR patients allocated to 3 groups: HRT (n = 32), combined HRT and TCM (n = 32), and TCM alone (n = 58). The primary outcome was the change in anti-Müllerian hormone (ΔAMH) levels after 3 months. Nonparametric tests assessed intergroup differences. Spearman correlation and a generalized linear model were used to evaluate associations between baseline factors and ΔAMH. Subgroup analyses were conducted by age, AMH level, and parity. Compared with the HRT group, both the TCM and combined groups showed significantly greater AMH improvements (generalized linear model: B = 0.300 and 0.270, respectively; both P < .001). Parity was a negative predictor of ΔAMH (B=-0.123, P = .009), while age, baseline AMH, and T4 were not independently associated. Subgroup analyses showed greater treatment effects in patients < 40 years, nulliparous, and with baseline AMH > 0.2 ng/mL (P = .007-<0.001). Bushen Huoxue Formula, either alone or combined with HRT, significantly improves AMH in DOR patients, particularly in younger, nulliparous women with moderate ovarian reserve. These findings support the use of TCM as a potential strategy to enhance ovarian function.