| objectiveTo understand the metrological characteristics and the overall qualit y of Chinese literature about the treatment of acupuncture for infertilit y.And to know efficacy and safety about the treatment of acupuncture for infertility.MethodsRetrieving the target literature from Chinese Biomedical Literature Database (CBM), WanFang Data Medical Information System (WanFangDate),China Journal Net (CNKI),and VIP Information Resource System (VIP).NoteExpress was then used to analyze and summarize the general characteristics of the chosen literature and the reported treatment methods.The quality of the literature was evaluated by Reviewmanager5.2. Finally, using cure rate, efficiency, sperm concentration, sperm motility A level, sperm motility A+B level as criteria, we evaluated the efficacy and safety of acupuncture treatment for male infertility.ResultsA total of 153 articles have been retrieved. Their years of publicatio n spanned across 55 years, with an average publication rate of 2.8per year and the highest seen in 2004. The literature originated from 23 provinces, the ones with the top five publication rates being respectively Guandong, Jiangsu, Fujian, Shanghai, and Sichuan. The literature was collected from 63 journals and mostly from Chinese Acupuncture and Moxibustion, Shanghai Jou rnal of Acupuncture, New journal of Traditional Chinese Medicine, Journal o f Clinical Acupuncture and Moxibustion, and Henan Journal of Traditional C hinese Medicine. It was found that clinical reports with no control groups studied constitute most of the literature investigated. A total of 265 are involved in the literature with 381 signatures, among whom Dong Chen and X in Lun are the two most productive authors. Out of the 153 articles,51 fai 1 to provide any keywords. Overall,214 keywords totaling 380 occurrences w ere found in the literature with an average of 2.48 keywords used per art icle. The ten most frequently used keywords are "acupuncture therapy", "ma le infertility", "male infertility", "dysspermia", "acupuncture", "acu puncture therapy", "acupuncture medication combined", "infertility", "s terile, male", and "electro-acupuncture";Nighty three institutions are i nvolved including 27 universities,61 hospitals,4 research institutes and one private clinic, among which Guangzhou University of Traditional Chines e Medicine, Jinan University School of Medicine, Shanghai University of Tra ditional Chinese Medicine and Guangdong Provincial TCM Hospital have publ ished more than four articles;Guangzhou University of Traditional Chinese Medicine,Jinan University School of Medicine, Nanjing university of Tradit ional Chinese Medicine, Chengdu university of Traditional Chinese Medicine, Gansu College of Traditional Chinese Medicine, Fujian Chinese MedicineUniv ersity are among the top five with the largest number of publications. Thi rty publications were from funded research projects involving 14 foundati ons, of which three are national-level, three provincial, six municipal, and the other two being universities. Ten acupuncture methods are introduced:s imple acupuncture, electro-acupuncture, moxibustion, needle knife, slip stitc h, point embedding therapy, point injection, auricular-plaster, wrist-ankle a cupuncture, and massage. Thirty four treatment methods are mentioned, meanin g that the same treatment method was used by every 3.65 articles;amongthe se methods, "acupuncture+moxibustion", acupuncture, "acupuncture+Tradit ional Chinese Medicine", needle pricking, electroacupuncture, "acupuncture+ moxibustion+Traditional Chinese Medicine" are used more than five times. A total of 115 prescriptions are ultimately entered, each involving 2-15 acu points with a total number of 66 acupoints mentioned. There is only one ex tra-median point, precisionuterine. Acupoints are used with a frequency of 752, with 6.54 acupoints formed into each prescription and each acupoint u sed for 11.39 times on average.Ten of the most frequently used acupoints aggregate 511 occurrences accounting for 67.95% and they are:Guanyuan, San yinjiao, Shenshu, Zusanli, Zhongji, Taixi, Qihai, Ciliao, Taichong;12 meridians are involved, the five most popular being bladder meridian of foot taiyang, conception vessel, spleen meridian of foot taiyin, stomach meridian of foot yangming, and governor vessel. Twenty two articles incorporated randomized controlled trials and recruited 3485 patients. The interventions quality i s mediocre. According to the Meta analysis structure of the cure rate in d ifferent treatments, there is no significant difference between theacupunc ture and Traditional Chinese Medicine[RR=1.11,95%CI(0.92,1.34), P>0.05]; there is a significant difference between the Acupuncture and Western Med icine[RR=1.84,95%CI (1.36,2.50), P<0.01]; "Acupuncture+Traditional Ch inese Medicine" differs remarkably from Western Medicine[RR=1.88,95%CI(1. 17,3.02), P=0.01]; "Acupuncture +Traditional Chinese Medicine + Western M edicine" and "Traditional Medicine+Western Medicine" are significantly di fferent [RR=3.45,95%CI (2.90,4.11), P<0.01], "Acupuncture + Traditional Chinese Medicine+Western Medicine" is significantly different from "West ern Medicine" [RR=3.00,95%CI (1.44,6.25), P<0.01];Embedding greatly var ies from Traditional Chinese Medicine[RR=1.64,95%CI (1.28,2.10), P<0.01] and from Western Medicine [RR=2.73,95%CI (1.61,4.64), P<0.01] In terms of cure efficiency, significant differences are found between Acupuncture and Traditional Chinese Medicine [RR=1.03,95%CI (0.95,1.12), P>0.05] bu t no significant difference was found between Acupuncture and Western Med icine [RR=2.04,95%CI (1.36,3.06), P<0.01]; "Acupuncture+Traditional C hinese Medicine" is greatly different from Traditional Medicine[RR=1.12,9 5%CI (1.03,1.23), P=0.01],and "Acupuncture + Traditional Chinese Medicin e" is greatly different from Western Medicine[RR=1.36,95%CI (1.22,1.52), P<0.01]; "Acupuncture+Western Medicine" is significantly different from Western Medicine[RR=1.25,95%CI (1.05,1.49), P=0.01], "Acupuncture+Trad itional Chinese Medicine + Western Medicine" is significantlydifferent fr om Western Medicine[RR=1.48,95%CI (1.15,1.91), P<0.01];Embedding is sig nificantly different from Western Medicine [RR=1.30,95%CI (1.13,1.50), P <0.01]; In terms of improvement on sperm density, there is no significant difference between the Acupuncture and Traditional Chinese Medicine [RR=O. 88,95%CI (0.01,1.76), P=0.05];there is a significant difference between Acupuncture and Western Medicine [RR=27.00,95%CI (24.27,29.73), P<0.01], "Acupuncture+Traditional Chinese Medicine" is significantly different fr om Traditional Medicine [RR=14.65,95%CI (7.58,21.72), P<0.01]; "Acupunc ture+Traditional Chinese Medicine" is significantly different from Weste rn Medicine [RR=11.89,95%CI (6.59,17.19), P<0.01], "Acupuncture + Tradi tional Chinese Medicine + Western Medicine" is significantly different fro m Western Medicine [RR=10.99,95%CI (7.64,14.34), P<0.01]; Embedding is s ignificantly different from Western Medicine[RR=25.40,95%CI(22.84,27.96), P<0.01]; In terms of improvement of sperm motility A level, acupuncture is significantly different from Traditional Chinese Medicine [RR=5.23,95%CI (-3.69,14.14), P>0.05]; Acupuncture + Traditional ChineseMedicine is sign ificantly different from Traditional Chinese Medicine [RR=7.87,95%CI (3.5 1,12.23), P<0.01], "Acupuncture + Traditional Chinese Medicine" is signi ficantly different from Western Medicine [RR=6.08,95%CI (-3.69,15.85), P >0.05]. In terms of sperm motility A+B level, "Acupuncture+Traditional C hinese Medicine"is significantly different from Traditional Medicine [RR= 11.00,95%CI (3.17,18.82), P<0.01], "Acupuncture + Traditional Chinese M edicine" is significantly different from Western Medicine[RR=13.49,95%CI (9.95,17.02), P<0.01].ConclusionThe literature on acupuncture in treatment of infertility has been ma inly contributed by authorship from Southern China, mainly publishedin Chi nese Acupuncture, Shanghai Journal of Acupuncture, New Chinese, Journal of C linical Acupuncture, and Henan Traditional Chinese Medicine, ed by research ers such as Dong Chen and Xin Lun, and formed a group of core research ins titutions represented by Guangzhou University of Traditional Chinese Medi cine, Jinan University School of Medicine. But the use of keywords in the literature is not standardized, the presented treatmentinterventions are u ncontrolled, and the financial support for the relevant research is severe ly insufficient. Acupoints examined in the literature are dominated by bla dder meridian of foot taiyang, conception vessel,and spleen meridian of fo ot taiyin;reinforcing kidney and Lean pulp underlies most of the treatmen t methods.Research on acupuncture treatment for infertility has currently encountered a bottleneck, calling for an urgent breakthrough. A severe shor tage of research funding compounded with a lack of research collaboration may have attributed to the formation of this bottleneck. The overall effic acy of acupuncture in treating infertility is comparable to Traditional C hinese Medicine, better than Western Medicine, and can be enhanced if used togetherwith Traditional Chinese Medicine and Western Medicine. Acupunctur e shows an advantage in improving sperm quality compared with the other m entioned methods.Embedding excels Traditional Medicine and Western Medici ne in both treatment efficacy and sperm quality improvement. However, the g eneral poor quality of the literature investigated has negatively influen ced the authenticity of the Meta-analysis results. Furtherresearch should aim to collect and measure a larger sample of higher-quality literature a gainst key criteria. |
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