Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.
Front Endocrinol (Lausanne). 2024 Jun 4;15:1351281. doi: 10.3389/fendo.2024.1351281. eCollection 2024.
Unexplained recurrent implantation failure and the high cost of assisted reproductive techniques for those experiencing infertility have increasingly resulted in the use of acupuncture. However, the trends and research status of acupuncture on infertility resulting in natural conception have not been systematically summarized. This scoping review and knowledge graph analysis aimed to summarize existing clinical studies on acupuncture for infertility that resulted in natural conception.
Seven databases, namely, PubMed, Embase, the Cochrane Library, CNKI, VIP, Wanfang Data, and SinoMed, were searched up to August 2023 (updated on 1 April). Two authors independently identified related clinical studies and systematic reviews, and extracted data from included studies on acupuncture for infertility; any discrepancies were resolved by discussion or judged by a third author. A meta-analysis was conducted based on randomized controlled trials (RCTs), and data were synthesized using risk ratios with 95% confidence intervals.
Of the 310 articles meeting the inclusion criteria, 274 were primary studies, 7 were systematic reviews, and 29 were case reports. Reported adverse events included mild ovarian irritation and early signs of miscarriage. Out of the 274 primary studies, there were 40 (14.60%) cases of male infertility and 234 (85.40%) cases of female infertility. Current research highlights on acupuncture for infertility focused on female infertility caused by polycystic ovary syndrome, ovulation disorder, and luteinized unruptured follicle syndrome (LUFS), while acupuncture for male infertility was a hotspot in the early research stage. The meta-analysis also suggested that acupuncture was more effective than human chorionic gonadotropin (HCG) [RR = 1.89, 95% CI (1.47, 2.42), 11 RCTs, 662 participants]. Acupuncture combined with HCG was comparable to HCG [RR = 2.33, 95% CI (1.53, 3.55), four RCTs, 259 participants]. Compared with no treatment, acupuncture resulted in a higher pregnancy rate [RR = 22.12, 95% CI (1.39, 353.09), one RCT, 47 participants]. There was no statistical difference between acupuncture combined with HCG plus letrozole and HCG plus letrozole [RR = 1.56, 95% CI (0.84, 2.89), one RCT, 84 participants].
Current research highlights on acupuncture for infertility resulting in natural conception focused on female infertility caused by polycystic ovary syndrome, ovulation disorder, and LUFS, while studies on male infertility and female infertility caused by blockage in the fallopian tube, thin endometrium, and other factors were insufficient. Well-designed confirmatory clinical studies are still needed as the research hypotheses of most studies were unclear.
不明原因的反复着床失败和辅助生殖技术治疗不孕的高昂费用，使得越来越多的人开始使用针灸。然而，针灸治疗不孕自然受孕的趋势和研究现状尚未得到系统总结。本 scoping 综述和知识图谱分析旨在总结现有的针灸治疗不孕自然受孕的临床研究。
截至 2023 年 8 月（2023 年 4 月 1 日更新），我们在 7 个数据库（PubMed、Embase、Cochrane 图书馆、CNKI、VIP、万方数据和 SinoMed）中搜索了相关临床研究和系统评价。两位作者独立识别与针灸治疗不孕自然受孕相关的临床研究和系统评价，并从纳入研究中提取关于针灸治疗不孕的资料；任何分歧均通过讨论解决，或由第三位作者判断。对随机对照试验（RCT）进行了荟萃分析，并使用风险比（RR）及其 95%置信区间（CI）进行综合。
符合纳入标准的 310 篇文章中，274 篇为原始研究，7 篇为系统评价，29 篇为病例报告。报告的不良事件包括轻度卵巢刺激和早期流产迹象。在 274 篇原始研究中，有 40 例（14.60%）为男性不育，234 例（85.40%）为女性不育。目前针灸治疗不孕的研究热点集中在多囊卵巢综合征、排卵障碍和黄体化未破裂卵泡综合征（LUFS）引起的女性不孕，而针灸治疗男性不育则是早期研究阶段的热点。荟萃分析还表明，与人绒毛膜促性腺激素（HCG）相比，针灸更有效[RR=1.89，95%CI（1.47，2.42），11 项 RCT，662 名参与者]。与 HCG 相比，针灸联合 HCG 效果相当[RR=2.33，95%CI（1.53，3.55），4 项 RCT，259 名参与者]。与不治疗相比，针灸可提高妊娠率[RR=22.12，95%CI（1.39，353.09），1 项 RCT，47 名参与者]。与 HCG 联合来曲唑加 HCG 联合来曲唑相比，针灸联合 HCG 联合来曲唑无统计学差异[RR=1.56，95%CI（0.84，2.89），1 项 RCT，84 名参与者]。
目前针灸治疗不孕自然受孕的研究热点集中在多囊卵巢综合征、排卵障碍和 LUFS 引起的女性不孕，而对男性不育和由输卵管阻塞、薄型子宫内膜等因素引起的女性不孕的研究不足。仍需要设计良好的确证性临床研究，因为大多数研究的研究假设并不明确。
