Evaluation for effectiveness of oriental medicine-based infertility treatment and spontaneous pregnancy rate of infertile patients using systematic review

Jiseun Lim; Jae-Hyun Kim; Yoo Mi Chae

doi:10.5124/jkma.2019.62.12.645

J Korean Med Assoc > Volume 62(12); 2019 > Article

Lim, Kim, and Chae: Evaluation for effectiveness of oriental medicine-based infertility treatment and spontaneous pregnancy rate of infertile patients using systematic review

Special Contribution

Journal of the Korean Medical Association 2019; 62(12): 645-652.

Published online: December 12, 2019

DOI: http://dx.doi.org/10.5124/jkma.2019.62.12.645

Evaluation for effectiveness of oriental medicine-based infertility treatment and spontaneous pregnancy rate of infertile patients using systematic review

Jiseun Lim, MD^1,^*

, Jae-Hyun Kim, PhD^2,^3,^*

, Yoo Mi Chae, MD⁴

¹Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea.

²Department of Health Administration, College of Health Science, Dankook University, Cheonan, Korea.

³Institute of Health Promotion and Policy, Dankook University, Cheonan, Korea.

⁴Department of Medical Education, College of Medicine, Dankook University, Cheonan, Korea.

Corresponding author: Yoo Mi Chae. 12070108@dankook.ac.kr

Equal contributor:

*These two authors contributed equally to this study.

Received October 08, 2019 Accepted November 11, 2019

Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study is to evaluate the effectiveness of oriental medicine-based infertility treatment and to examine the validity of the oriental medicine-based infertility treatment program through a systematic review. The literature search database included not only PubMed, DBpia, and RISS (Research Information Sharing Service) but also OASIS (Oriental Medicine Advanced Searching Integrated System) and Korean Traditional Knowledge Portal. Among 575 articles that searched, only three papers were randomized controlled trials and could be included for the evaluation of the effects of oriental medicine-based infertility treatment. There was no study showing the effectiveness of oriental medicine-based infertility treatment alone. Among 5,165 articles that searched, only 15 studies could be included for the evaluation of the natural pregnancy rate of infertile patients. These studies reported the natural pregnancy rates from 20.3% to 41.9%. As pregnancy rates ranged from 23.8% to 27.6% after the oriental medicine-based infertility treatment supporting programs, we cannot conclude that pregnancy rates for infertile patients might increase by this project. Therefore, there is a need to reconsider whether the oriental medicine-based infertility treatment program should continue in the future.

Infertility; Pregnancy; Oriental medicine; Acupuncture

Acknowledgement

This research was funded by Korean Medical Association. The assistance of Boyeon Yun in the preparation of this manuscript is gratefully appreciated.

Notes

No potential conflict of interest relevant to this article was reported.

References

1. Organisation for Economic Co-operation and Development. Fertility rates (indicator) [Internet] Paris: Organisation for Economic Co-operation and Development. 2019;cited 2019 Nov 10. Available from: https://data.oecd.org/pop/fertility-rates.htm

2. Nam EY, Yoo SJ, Kim HJ. A study assessing support project of Korean medical treatment in infertility in Jecheon. J Orient Obstet Gynecol 2015;28:120-132.

3. Association of Busan Korean Medicine. Reporting of oriental infertility treatmnet supporting program, 2014. Busan: Association of Busan Korean Medicine; 2014.

4. Association of Busan Korean Medicine. Reporting of oriental infertility treatmnet supporting program, 2015. Busan: Association of Busan Korean Medicine; 2015.

5. Association of Busan Korean Medicine. Reporting of oriental infertility treatmnet supporting program, 2016. Busan: Association of Busan Korean Medicine; 2016.

6. Cho SH. Case reports of 20 female infertility. J Orient Obstet Gynecol 2015;28:109-119.

7. Park JY. Oriental infertility treatment, there is no government support, while the number of local governments increases. Dailymedi 2019;06. 28. cited 2019 Nov 10. Available from: https://www.dailymedi.com/detail.php?number=844680

8. Kim CB, Kim DI, Park MB, Jang BH, Jeong HS, Cho JY. The survey on infertile couples participating oriental infertility treatment programs supported by local governments. Sejong: Ministry of Health and Welfare, Division of Traditional Korean Medicine Policy; 2018.

9. Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-269.

10. Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ 2001;323:334-336.

11. Kim SY, Park JE, Seo HJ, Seo HS, Son HJ, Shin CM, Lee YJ, Jang BH. National Evidence-based Healthcare Collaborating Agency (NECA). Division of New Health Technology Assessment. NECA's guidance for undertaking systematic reviews and meta-analyses for intervention. Seoul: NECA; 2011.

12. Wu XK, Stener-Victorin E, Kuang HY, Ma HL, Gao JS, Xie LZ, Hou LH, Hu ZX, Shao XG, Ge J, Zhang JF, Xue HY, Xu XF, Liang RN, Ma HX, Yang HW, Li WL, Huang DM, Sun Y, Hao CF, Du SM, Yang ZW, Wang X, Yan Y, Chen XH, Fu P, Ding CF, Gao YQ, Zhou ZM, Wang CC, Wu TX, Liu JP, Ng EHY, Legro RS, Zhang H. PCOSAct Study Group. Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial. JAMA 2017;317:2502.

13. Dieterle S, Ying G, Hatzmann W, Neuer A. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril 2006;85:1347-1351.

14. Rashidi BH, Tehrani ES, Hamedani NA, Pirzadeh L. Effects of acupuncture on the outcome of in vitro fertilisation and intracytoplasmic sperm injection in women with polycystic ovarian syndrome. Acupunct Med 2013;31:151-156.

15. Shokeir T, Ebrahim M, El-Mogy H. Hysteroscopic-guided local endometrial injury does not improve natural cycle pregnancy rate in women with unexplained infertility: Randomized controlled trial. J Obstet Gynaecol Res 2016;42:1553-1557.

16. Aboulghar MA, Mansour RT, Serour GI, Rizk P, Riad R. Improvement of spontaneous pregnancy rate after stopping gonadotropin therapy for anovulatory infertility. Fertil Steril 1991;55:722-725.

17. Steures P, van der Steeg JW, Hompes PG, Habbema JD, Eijkemans MJ, Broekmans FJ, Verhoeve HR, Bossuyt PM, van der Veen F, Mol BW. Collaborative Effort on the Clinical Evaluation in Reproductive Medicine. Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial. Lancet 2006;368:216-221.

18. Frank-Herrmann P, Jacobs C, Jenetzky E, Gnoth C, Pyper C, Baur S, Freundl G, Goeckenjan M, Strowitzki T. Natural conception rates in subfertile couples following fertility awareness training. Arch Gynecol Obstet 2017;295:1015-1024.

19. van Eekelen R, Scholten I, Tjon-Kon-Fat RI, van der Steeg JW, Steures P, Hompes P, van Wely M, van der Veen F, Mol BW, Eijkemans MJ, Te Velde ER, van Geloven N. Natural conception: repeated predictions over time. Hum Reprod 2017;32:346-353.

20. Bensdorp AJ, van der Steeg JW, Steures P, Habbema JDF, Hompes PGA, Bossuyt PMM, van der Veen F, Mol BWJ, Eijkemans MJC. CECERM study group. A revised prediction model for natural conception. Reprod Biomed Online 2017;34:619-626.

21. Lee HJ, Lee JE, Ku SY, Kim SH, Kim JG, Moon SY, Choi YM. Natural conception rate following laparoscopic surgery in infertile women with endometriosis. Clin Exp Reprod Med 2013;40:29-32.

22. Snick HK, Snick TS, Evers JL, Collins JA. The spontaneous pregnancy prognosis in untreated subfertile couples: the Walcheren primary care study. Hum Reprod 1997;12:1582-1588.

23. Akande VA, Hunt LP, Cahill DJ, Jenkins JM. Differences in time to natural conception between women with unexplained infertility and infertile women with minor endometriosis. Hum Reprod 2004;19:96-103.

24. Osmanagaoglu K, Collins J, Kolibianakis E, Tournaye H, Camus M, Van Steirteghem A, Devroey P. Spontaneous pregnancies in couples who discontinued intracytoplasmic sperm injection treatment: a 5-year follow-up study. Fertil Steril 2002;78:550-556.

25. Donckers J, Evers JL, Land JA. The long-term outcome of 946 consecutive couples visiting a fertility clinic in 2001-2003. Fertil Steril 2011;96:160-164.

26. Troude P, Bailly E, Guibert J, Bouyer J, de la Rochebrochard E. DAIFI Group. Spontaneous pregnancies among couples previously treated by in vitro fertilization. Fertil Steril 2012;98:63-68.

Appendices

Appendix 1

Searching equation for evaluating the effectiveness and safety of Oriental infertility treatments and the spontaneous pregnancy rate of infertile patients

RISS, Research Information Sharing Service; OASIS, Oriental Medicine Advanced Searching Integrated System.

Figure 1

Flowchart of literature selection process of studies examining the effectiveness of the oriental medicine-based infertility treatment on infertile patients.

Figure 2

Flowchart of literature selection process of studies examining the spontaneous pregnancy rate of infertile patients.

Table 1

Scottish Intercollegiate Guideline Network criteria for assignment of levels of evidence

RCT, randomized controlled trial.

Table 2

Scottish Intercollegiate Guideline Network criteria for assignment of levels of grades of recommendation

Table 3

Characteristics of included studies examining the effectiveness and safety of acupuncture

RCT, randomized controlled trial; IVF, in vitro fertilization; ICSI, intracytoplasmic sperm injection.

Table 4

Summary of results in studies examining the effectiveness and safety of acupuncture on infertile patients

IVF, in vitro fertilization; ICSI, intracytoplasmic sperm injection.

Table 5

Characteristics of included studies examining the spontaneous pregnancy rate of infertile patients

ICSI, intracytoplasmic sperm injection; IVF, in vitro fertilization.

^a)Means of age and duration of infertility among a total of 126 women including 25 women who received intrauterine insemination. ^b)Means of age and duration of infertility among a total of 726 women, some who received treatment (n=384) and others did not receive treatment (n=342). ^c)Means of age and duration of infertility among 946 women enrolled in the study including women who received treatment or dropped out.

Table 6

Summary of results in studies examining the spontaneous pregnancy rate of infertile patients

Values are presented as % (number).

ICSI, intracytoplasmic sperm injection; IVF, in vitro fertilization.