Fan Huaying, Zhou Jie, Tang Chenjian, Liu Huan
Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
The First Affiliated Hospital of Traditional Chinese Medicine of Chengdu Medical College, Chengdu, China.
Front Med (Lausanne). 2025 Aug 28;12:1609519. doi: 10.3389/fmed.2025.1609519. eCollection 2025.
Endometrial receptivity (ER) enhancement is crucial in managing infertility. Although systematic reviews (SRs) have investigated acupuncture's potential to improve ER in infertile women, the evidence remains fragmented due to insufficient quality assessment. This overview aimed to rigorously evaluate the reporting quality, methodological rigor, risk of bias, and evidence confidence of existing SRs, while synthesizing clinical evidence on acupuncture's efficacy and safety for ER enhancement in infertility.
Seven databases (PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, Wanfang) were systematically searched from inception to March 1, 2025, using combined subject headings and free-text terms ("acupuncture therapy," "endometrial receptivity," "infertility," "systematic review").
SRs investigating acupuncture's therapeutic effects on ER in infertile women were eligible.
Two independent reviewers performed study selection and data extraction. Methodological quality, reporting completeness, bias risk, and evidence certainty were evaluated using validated tools: AMSTAR 2, ROBIS, PRISMA-A, and GRADE.
From 524 screened records, 10 SRs (published 2019-2023, encompassing 7-25 RCTs each) were included. Methodological quality assessed by AMSTAR 2 showed that all 10 SRs exhibited critically low quality. Reporting quality assessed by PRISMA-A showed that overall completeness >70%, but deficiencies in protocol registration (50%) and funding disclosure (10%). Risk of bias assessed by ROBIS showed that only one SR had low risk of bias. As to the evidence confidence, among the 55 evaluated outcomes, 92.72% (51/55) were low/very low quality (2 high, 2 moderate, 24 low, 27 very low). Descriptive analyses suggested that combining acupuncture with other treatments (medications, Chinese herbal medicine, and IVF-ET) may improve pregnancy and ovulation rates, with a high to moderate quality of evidence.
Current evidence supporting acupuncture for ER enhancement is predominantly low quality, limited by critical methodological weaknesses and heterogeneity. While combination therapies show preliminary promise, definitive conclusions require high-quality RCTs with standardized outcome measures.
This study was registered in PROSPERO (CRD42024497881).
增强子宫内膜容受性（ER）对治疗不孕症至关重要。尽管系统评价（SRs）已探究针刺改善不孕女性ER的潜力，但由于质量评估不足，证据仍然零散。本综述旨在严格评估现有SRs的报告质量、方法严谨性、偏倚风险和证据可信度，同时综合针刺增强不孕症患者ER的疗效和安全性的临床证据。
从数据库建库至2025年3月1日，系统检索了七个数据库（PubMed、Embase、Web of Science、Cochrane Library、中国知网、维普、万方），使用联合主题词和自由文本词（“针刺疗法”、“子宫内膜容受性”、“不孕症”、“系统评价”）。
调查针刺对不孕女性ER治疗效果的SRs符合纳入标准。
两名独立评审员进行研究筛选和数据提取。使用经过验证的工具（AMSTAR 2、ROBIS、PRISMA - A和GRADE）评估方法学质量、报告完整性、偏倚风险和证据确定性。
从524条筛选记录中，纳入了10篇SRs（发表于2019 - 2023年，每篇包含7 - 25项随机对照试验）。AMSTAR 2评估的方法学质量显示，所有10篇SRs质量极低。PRISMA - A评估的报告质量显示，总体完整性>70%，但方案注册（50%）和资金披露（10%）存在不足。ROBIS评估的偏倚风险显示，只有一篇SRs偏倚风险低。关于证据可信度，在55项评估结果中，92.72%（51/55）为低/极低质量（2项高质量，2项中等质量，24项低质量，27项极低质量）。描述性分析表明，针刺与其他治疗方法（药物、中药和体外受精 - 胚胎移植）联合使用可能提高妊娠率和排卵率，证据质量高至中等。
目前支持针刺增强ER的证据主要质量较低，受到关键方法学缺陷和异质性的限制。虽然联合疗法显示出初步前景，但明确的结论需要采用标准化结局指标的高质量随机对照试验。
本研究已在PROSPERO（CRD42024497881）注册。
