■不明原因的复发性植入失败和不孕患者辅助生殖技术的高成本越来越多地导致针灸的使用。然而,针灸治疗自然受孕不孕症的发展趋势和研究现状还没有系统的总结。本范围综述和知识图分析旨在总结现有的针灸治疗导致自然受孕的不孕症的临床研究。
■七个数据库,即,PubMed,Embase,Cochrane图书馆,CNKI,VIP,万方数据,和SinoMed,直到2023年8月(4月1日更新)。两位作者独立确定了相关的临床研究和系统评价,并从针灸治疗不孕症的研究中提取数据;任何差异都可以通过讨论解决或由第三作者判断。基于随机对照试验(RCTs)进行了荟萃分析,数据使用风险比和95%置信区间合成.
■在符合入选标准的310篇文章中,274项是初级研究,7是系统评价,29例病例报告。报告的不良事件包括轻度卵巢刺激和早期流产迹象。在274项主要研究中,男性不育40例(14.60%),女性不育234例(85.40%)。目前针灸治疗不孕症的研究热点集中在多囊卵巢综合征引起的女性不孕症,排卵障碍,和未破裂卵泡黄素化综合征(LUFS),而针灸治疗男性不育是早期研究的热点。荟萃分析还表明,针灸比人绒毛膜促性腺激素(HCG)更有效[RR=1.89,95%CI(1.47,2.42),11项随机对照试验,662人]。针刺联合HCG与HCG相当[RR=2.33,95%CI(1.53,3.55),四个RCT,259人]。与不治疗相比,针刺导致更高的妊娠率[RR=22.12,95%CI(1.39,353.09),一个RCT,47名与会者]。针刺联合HCG+来曲唑与HCG+来曲唑无统计学差异[RR=1.56,95%CI(0.84,2.89),一个RCT,84名与会者]。
■目前针灸治疗不孕导致自然受孕的研究热点集中在多囊卵巢综合征引起的女性不孕上,排卵障碍,和LUFS,而研究男性不育症和输卵管阻塞引起的女性不育症,薄薄的子宫内膜,其他因素不足。由于大多数研究的研究假设尚不清楚,因此仍需要精心设计的验证性临床研究。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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].
UNASSIGNED: 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.