Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2024; 12(22): 5108-5123
Published online Aug 6, 2024. doi: 10.12998/wjcc.v12.i22.5108
Feasibility of acupuncture as an adjunct intervention for ovulatory disorder infertility: A systematic review and meta-analysis
Yu-Qi Chen, Tao Shen, Ying Lv, Mei-Hong Shen
Yu-Qi Chen, Ying Lv, Department of Acupuncture and Tuina Rehabilitation, Kunshan Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Kunshan 210023, Jiangsu Province, China
Yu-Qi Chen, Mei-Hong Shen, School of Acupuncture-Moxibustion and Tuina, Nanjing University of Traditional Chinese Medicine, Nanjing 210023, Jiangsu Province, China
Tao Shen, Department of Traditional, Chinese Medicine Kunshan Rehabilitation Hospital, Kunshan 215300, Jiangsu Province, China
Co-first authors: Yu-Qi Chen and Tao Shen.
Author contributions: Chen YQ and Shen T conducted the systematic review and data collection and proposed an explanation that played an important role in the writing of the paper; Chen YQ and Lv Y carefully evaluated and verified the manuscript and confirmed the funding; Chen YQ analyzed and reviewed the data; Shen MH reviewed the papers, supervised and critically evaluated the work, and confirmed the manuscript; All authors wrote and approved the manuscript.
Supported by Kunshan Chinese Medicine Science and Technology Development Fund, No. KZYY2212.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mei-Hong Shen, Doctor, School of Acupuncture-Moxibustion and Tuina, Nanjing University of Traditional Chinese Medicine, No. 388 Zuchongzhi South Road, Kunshan, Jiangsu Province, China. gochenyq@163.com
Received: April 21, 2024
Revised: May 27, 2024
Accepted: June 14, 2024
Published online: August 6, 2024
Processing time: 71 Days and 21.3 Hours
Abstract
BACKGROUND

Acupuncture (AT) is widely used in treatment of ovulatory disorder infertility (ODI), but the safety and efficacy of AT for ODI still lack an evidence-based basis.

AIM

To evaluate the feasibility and effectiveness of AT as an adjunct intervention for ODI.

METHODS

The Cochrane Library, Embase, PubMed, VIP, China National Knowledge Infrastructure, WanFang Data, and Chinese biomedical literature databases were searched from inception to January 20, 2024. Two reviewers independently selected studies, collected data, and evaluated methodological quality through the Cochrane Risk of Bias tool. Revman 5.4 was used for meta-analysis, and the Grade system was performed to evaluate the level of evidence for the outcomes of the meta-analysis.

RESULTS

A total of 20 randomized controlled trials with 1677 ODI patients were included. Compared with the clomiphene citrate (CC) group, the AT plus CC group exhibited significant improvement of the pregnancy rate [relative risk (RR) = 1.68, 95% confidence interval (CI): 1.45-1.95, P < 0.00001, I2 = 23%], ovulation rate (RR = 1.34, 95%CI: 1.22-1.47, P < 0.00001, I2 = 32%), serum E2 level [mean difference (MD) = 31.36, 95%CI: 21.83-40.88, P < 0.00001, I2 = 97%], thickness of endometrium (MD = 1.76, 95%CI: 0.71-2.81, P = 0.001, I2 = 98%) and decreasing miscarriage rate (RR = 0.25, 95%CI: 0.09-0.65, P = 0.005, I2 = 0%), serum follicle-stimulating hormone level (MD = -2.10, 95%CI: -3.27 to -0.94, P = 0.0004, I2 = 99%), serum luteinizing hormone level (MD = -6.94, 95%CI: -9.89 to -4.00, P < 0.00001, I2 = 100%), and serum progesterone level (MD = -1.66, 95%CI: -2.98 to -0.34, P = 0.01, I2 = 96%). The AT group had a more favorable effect than CC group for improving pregnancy rate (RR = 1.52, 95%CI: 1.33-1.73, P < 0.00001, I2 = 0%), thickness of endometrium (MD = 2.48, 95%CI: 2.15-2.81, P < 0.00001, I2 = 0%) and reducing miscarriage rate (RR = 0.23, 95%CI: 0.13-0.44, P < 0.00001, I2 = 0%), serum follicle-stimulating hormone level (MD = -0.55, 95%CI: -0.86 to -0.24, P = 0.0005, I2 = 0%), and serum progesterone level (MD = -0.24, 95%CI: -0.28 to -0.20, P < 0.00001). However, the level of evidence was predominantly assessed as very low to moderate.

CONCLUSION

AT can improve the pregnancy outcomes and sex hormone levels for patients with ODI. However, further studies are needed to confirm these findings.

Keywords: Acupuncture; Ovulatory disorder; Infertility; Pregnancy; Meta-analysis; Systematic review

Core Tip: Ovulation dysfunction is the most common cause of infertility. This meta-analysis aimed to evaluate the feasibility and effectiveness of acupuncture as an adjunctive intervention to ovulatory disorder infertility (ODI). The results showed that acupuncture effectively improved pregnancy outcomes and sex hormone levels in patients with ODI, indicating its potential as a treatment strategy for ODI. However, further studies are needed to confirm these findings.