A Standardized Protocol for Integrating Yangjing Zhongyu Decoction into IVF/ICSI-ET Cycles in Patients with Diminished Ovarian Reserve

Yangjing Zhongyu Decoction (YZD), a traditional Chinese herbal formula, has been suggested to improve ovarian function and fertility outcomes, but standardized clinical evidence remains limited. This study evaluated the effects of YZD in women with diminished ovarian reserve (DOR) undergoing IVF/ICSI-ET, alongside mechanistic validation in a rat model of premature ovarian failure (POF). In the clinical trial, DOR patients received either the standard GnRH antagonist protocol alone or in combination with YZD. Baseline characteristics between groups were comparable, and the YZD group showed higher numbers of retrieved oocytes and high-quality embryos, as well as improved traditional Chinese medicine syndrome scores. In parallel, POF was induced in rats, and animals treated with YZD exhibited improved estrous cyclicity, restoration of serum estradiol levels, reduction of follicle-stimulating hormone, and healthier ovarian histology. Electron microscopy revealed that YZD reduced excessive autophagosome formation and lipid accumulation in ovarian cells, suggesting regulation of the autophagy–lipid metabolism axis. Together, these findings indicate that YZD enhances ovarian reserve function, improves embryo development, and may increase pregnancy potential in women with DOR. This standardized protocol provides a reproducible framework for integrating YZD into assisted reproductive technology cycles, supporting its translational potential in clinical reproductive medicine.