3. Discussion
The decline of fertility in advanced-age women can be attributed to 2 aspects: 1 is the ovarian reserve diminishes with aging. The second is the decline in the quality of oocytes, which subsequently results in poor-quality embryos.An important part of TCM theory is the “holistic concept,” which means the TCM treatment usually involves multi-system, multi-pathway, and multi-target. Therefore, the current studies on the mechanism of EZTG efficacy also include several hypotheses. Two studies reported that EZTG can reduce the apoptosis of granulosa cells by inhibiting the PT3K/Akt1 and Fas/FasL signaling pathways.This effect of EZTG can also be achieved by promoting the expression of the mitochondrial membrane protein Mitofusin 2 to regulate the energy metabolism of granulosa cells.In addition, Glial cell line-derived neurotrophic factor and its receptors have been found to express in the human ovary and have crosstalk with the reproductive endocrine signaling system, which indicates its involvement in the regulation of primordial follicular activation.We previously conducted a pilot study, in which 100 women of advanced age undergoing IVF were included and allocated to EZTG or placebo groups in a 1:1 ratio.In conclusion, the results of this study are expected to provide high-quality evidence for the effectiveness and safety of EZTG formula as an adjuvant treatment in IVF-ET for advanced-age women with POR.