Chen Yu-Qi, Shen Tao, Lv Ying, Shen Mei-Hong
Department of Acupuncture and Tuina Rehabilitation, Kunshan Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Kunshan 210023, Jiangsu Province, China.
School of Acupuncture-Moxibustion and Tuina, Nanjing University of Traditional Chinese Medicine, Nanjing 210023, Jiangsu Province, China.
World J Clin Cases. 2024 Aug 6;12(22):5108-5123. doi: 10.12998/wjcc.v12.i22.5108.
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.
To evaluate the feasibility and effectiveness of AT as an adjunct intervention for ODI.
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.
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, < 0.00001, = 23%], ovulation rate (RR = 1.34, 95%CI: 1.22-1.47, < 0.00001, = 32%), serum E level [mean difference (MD) = 31.36, 95%CI: 21.83-40.88, < 0.00001, = 97%], thickness of endometrium (MD = 1.76, 95%CI: 0.71-2.81, = 0.001, = 98%) and decreasing miscarriage rate (RR = 0.25, 95%CI: 0.09-0.65, = 0.005, = 0%), serum follicle-stimulating hormone level (MD = -2.10, 95%CI: -3.27 to -0.94, = 0.0004, = 99%), serum luteinizing hormone level (MD = -6.94, 95%CI: -9.89 to -4.00, < 0.00001, = 100%), and serum progesterone level (MD = -1.66, 95%CI: -2.98 to -0.34, = 0.01, = 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, < 0.00001, = 0%), thickness of endometrium (MD = 2.48, 95%CI: 2.15-2.81, < 0.00001, = 0%) and reducing miscarriage rate (RR = 0.23, 95%CI: 0.13-0.44, < 0.00001, = 0%), serum follicle-stimulating hormone level (MD = -0.55, 95%CI: -0.86 to -0.24, = 0.0005, = 0%), and serum progesterone level (MD = -0.24, 95%CI: -0.28 to -0.20, < 0.00001). However, the level of evidence was predominantly assessed as very low to moderate.
AT can improve the pregnancy outcomes and sex hormone levels for patients with ODI. However, further studies are needed to confirm these findings.
针灸广泛应用于排卵障碍性不孕症（ODI）的治疗，但针灸治疗ODI的安全性和有效性仍缺乏循证依据。
评估针灸作为ODI辅助干预措施的可行性和有效性。
检索Cochrane图书馆、Embase、PubMed、维普、中国知网、万方数据和中国生物医学文献数据库，检索时间从建库至2024年1月20日。两名研究者独立筛选研究、收集数据，并通过Cochrane偏倚风险工具评估方法学质量。使用Revman 5.4进行荟萃分析，并采用GRADE系统评估荟萃分析结果的证据水平。
共纳入20项随机对照试验，涉及1677例ODI患者。与枸橼酸氯米芬（CC）组相比，针灸联合CC组的妊娠率[相对危险度（RR）=1.68，95%置信区间（CI）：1.45-1.95，P<0.00001，I²=23%]、排卵率（RR = 1.34，95%CI：1.22-1.47，P<0.00001，I²=32%）、血清E水平[平均差（MD）= 31.36，95%CI：21.83-40.88，P<0.00001，I²=97%]、子宫内膜厚度（MD = 1.76，95%CI：0.71-2.81，P = 0.001，I²=98%）及流产率降低（RR = 0.25，95%CI：0.09-0.65，P = 0.005，I²=0%）、血清促卵泡生成素水平（MD = -2.10，95%CI：-3.27至-0.94，P = 0.0004，I²=99%）、血清促黄体生成素水平（MD = -6.94，95%CI：-9.89至-4.00，P<0.00001，I²=100%）及血清孕酮水平（MD = -1.66，95%CI：-2.98至-0.34，P = 0.01，I²=96%）均有显著改善。针灸组在提高妊娠率（RR = 1.52，95%CI：1.33-1.73，P<0.00001，I²=0%）、子宫内膜厚度（MD = 2.48，95%CI：2.15-2.81，P<0.00001，I²=0%）及降低流产率（RR = 0.23，95%CI：0.13-0.44，P<0.00001，I²=0%）、血清促卵泡生成素水平（MD = -0.55，95%CI：-0.86至-0.24，P = 0.0005，I²=0%）和血清孕酮水平（MD = -0.24，95%CI：-0.28至-0.20，P<0.00001）方面比CC组效果更优。然而，证据水平主要评估为极低至中等。
针灸可改善ODI患者的妊娠结局和性激素水平。然而，需要进一步研究来证实这些发现。
