Feasibility of acupuncture as an adjunct intervention for ovulatory disorder infertility: A systematic review and meta-analysis

Table 3 Grade of evidence of outcomes of the included trials

Outcomes	Certainty assessment						Effect sizes	Certainty	Importance
	Number of trials (patients)	Risk of bias1	Inconsistency2	Indirectness3	Imprecision4	Publication bias5	RR or MD (95%CI)
AT plus CC vs CC
Pregnancy	10 (790)	Serious	No serious	No serious	No serious	Likelihood	RR 1.68 (1.45-1.95)	Moderate6	Critical
Ovulation	6 (1042)	Serious	No serious	No serious	No serious	Undetected	RR 1.34 (1.22-1.47)	Moderate6	Critical
Miscarriage rate	4 (102)	Serious	No serious	No serious	Serious	Undetected	RR 0.25 (0.09-0.65)	Low7	Critical
FSH	6 (572)	Serious	Serious	No serious	No serious	Undetected	MD -2.10 (-3.27 to -0.94)	Low7	Important
LH	6 (572)	Serious	Serious	No serious	No serious	Undetected	MD -6.94 (-9.89 to -4.00)	Low7	Important
E2	5 (515)	Serious	Serious	No serious	No serious	Undetected	MD 31.36 (21.83-40.88)	Low7	Important
P	3 (211)	Serious	Serious	No serious	Serious	Undetected	MD -1.66 (-2.98 to -0.34)	Very low8	Important
Thickness of endometrium	6 (538)	Serious	Serious	No serious	No serious	Undetected	MD 1.76 (0.71-2.81)	Low7	Important
AT vs CC
Pregnancy	8 (706)	Serious	No serious	No serious	No serious	Undetected	RR 1.52 (1.33-1.73)	Moderate	Important
Ovulation	6 (1151)	Serious	Serious	No serious	No serious	Undetected	RR 0.95 (0.87-1.04)	Low7	Important
Miscarriage rate	7 (376)	Serious	No serious	No serious	Serious	Undetected	RR 0.23 (0.13-1.04)	Low7	Important
FSH	2 (134)	Serious	Serious	No serious	Serious	Undetected	MD -0.55 (-0.86 to -0.24)	Very low8	Important
LH	2 (134)	Serious	Serious	No serious	Serious	Undetected	MD 3.27 (1.55-4.99)	Very low8	Important
E2	2 (134)	Serious	Serious	No serious	Serious	Undetected	MD 2.19 (1.10-3.28)	Very low8	Important
P	1 (72)	Serious	Undetected	No serious	Serious	Undetected	MD 3.02 (1.33-4.71)	Low7	Important
Thickness of endometrium	3 (194)	Serious	Serious	No serious	Serious	Undetected	MD 2.06 (1.23-2.89)	Very low8	Important

¹Risk of bias: Serious, study with unclear risk of bias.

²Inconsistency: Serious, I² > 50%.

³Indirectness: No indirectness of evidence was found in any study.

⁴Imprecision (based on sample size): Serious, n < 500 participants.

⁵Publication bias: Undetected due to the number of trials less than the recommended arbitrary minimum number of 10.

⁶Moderate: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

⁷Low: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

⁸Very low: We are very uncertain about the estimate. AT: Acupuncture; CC: Clomiphene citrate; CI: Confidence interval; E₂: Estradiol; FSH: Follicle-stimulating hormone; LH: Luteinizing hormone; MD: Mean difference; P: Progesterone; RR: Risk ratio.