Effects of Acupuncture on the Outcomes of Assisted Reproductive Technology: An Overview of Systematic Reviews

Management of Male Infertility with Coexisting Sexual Dysfunction: A Consensus Statement and Clinical Recommendations from the Asia-Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men's Health and Aging (ASMHA)

Male infertility (MI) and male sexual dysfunction (MSD) can often coexist together due to various interplay factors such as psychosexual, sociocultural and relationship dynamics. The presence of each form of MSD can adversely impact male reproduction and treatment strategies will need to be individualized based on patients' factors, local expertise, and geographical socioeconomic status. The Asia Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men's Health and Aging (ASMHA) aim to provide a consensus statement and practical set of clinical recommendations based on current evidence to guide clinicians in the management of MI and MSD within the Asia-Pacific (AP) region. A comprehensive, narrative review of the literature was performed to identify the various forms of MSD and their association with MI. MEDLINE and EMBASE databases were searched for the following English language articles under the following terms: "low libido", "erectile dysfunction", "ejaculatory dysfunction", "premature ejaculation", "retrograde ejaculation", "delayed ejaculation", "anejaculation", and "orgasmic dysfunction" between January 2001 to June 2022 with emphasis on published guidelines endorsed by various organizations. This APSSM consensus committee panel evaluated and provided evidence-based recommendations on MI and clinically relevant MSD areas using a modified Delphi method by the panel and specific emphasis on locoregional socio-economic-cultural issues relevant to the AP region. While variations exist in treatment strategies for managing MI and MSD due to geographical expertise, locoregional resources, and sociocultural factors, the panel agreed that comprehensive fertility evaluation with a multidisciplinary management approach to each MSD domain is recommended. It is important to address individual MI issues with an emphasis on improving spermatogenesis and facilitating reproductive avenues while at the same time, managing various MSD conditions with evidence-based treatments. All therapeutic options should be discussed and implemented based on the patient's individual needs, beliefs and preferences while incorporating locoregional expertise and available resources.

Do acupuncture trials have lower risk of bias over the last five decades? A methodological study of 4 715 randomized controlled trials

Objective

To evaluate the change of the risk of bias (RoB) of acupuncture randomized controlled trials (RCTs) in the past five decades.

Methods

Multiple databases were searched. We included RCTs identified from systematic reviews (SRs) on acupuncture. General characteristics and RoB judgment for each domain were extracted. The proportions of RCTs at high and unclear RoB were calculated and the changes were examined by the Mann-Kendall test.

Results

We included 368 SRs including 4 715 RCTs. The rates of RCTs at unclear RoB were the highest in allocation concealment (63%), and at the lowest in incomplete outcome data (35%); in the last five decades, statistically significant reductions were found for random sequence generation (P < 0.001) and selective reporting (P = 0.01), and increases for blinding of participants and personnel (P < 0.001), blinding of outcome assessment (P < 0.001) and incomplete outcome data (P = 0.04). For the proportions of RCTs at high RoB, blinding of participants and personnel (47%) and blinding of outcome assessment (35%) were the poorest domains; there were no significant differences in changes for all domains.

Conclusions

Although improvements concerning unclear risk were observed for random sequence generation and selective reporting, major issues remain for allocation concealment and blinding. It is imperative to use valid randomization, specify how it is conducted, and try to test for selection bias and the success of masking by using the Berger Exner test.

Acupuncture for the Treatment of Tension-Type Headache: An Overview of Systematic Reviews

Objectives

Because current evidence regarding the effectiveness of acupuncture for a tension-type headache (TTH) is controversial, we evaluated the reliability of the methodological quality and outcome measures of systematic reviews/meta-analyses (SRs/MAs) on acupuncture for TTH.

Methods

We conducted a comprehensive literature search for SRs/MAs in major databases from the database's inception to September 2019. The Methodological Quality of Systematic Reviews 2 (AMSTAR-2) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments were used to assess the methodological quality of the included reviews and the quality of evidence, respectively.

Results

Eight reviews were included in the analysis. The AMSTAR-2 assessment results showed that the methodological quality of all included reviews was critically low. Thirty-six outcome measures were included in these reviews. The GRADE results showed that 25 (25/36, 69.4%) outcomes provided low- or very low-quality evidence, four (4/36, 11.1%) provided moderate-quality evidence, and seven (7/36, 19.4%) provided high-quality evidence. Descriptive analysis results showed that acupuncture treatment for TTH reduced headache frequency and severity.

Conclusions

Acupuncture appears to be an effective treatment modality for TTH, but the credibility of the results is limited owing to the generally low methodological quality and evidence quality in the included SRs/MAs.

Acupuncture and Chinese Herbal Medicine Effects on Assisted Reproductive Technology: Six Cases and Their Clinical Significance

Background: Assisted reproductive technology (ART) is the routine treatment for infertility. The success rate for individual sessions is generally not high, and many patients need to undergo several cycles. To increase their chances of success, many patients turn to acupuncture to complement ART. Many clinical trials of acupuncture helping in vitro fertilization (IVF) have focused only on IVF-embryo transfer (ET). In some difficult cases, when even IVF cannot be offered, acupuncture and Chinese herbs can improve the patients' conditions to reach a level at which ART can be successful. Cases: Six cases showed how acupuncture and Traditional Chinese Medicine (TCM), using Chinese herbs, can make IVF possible in difficult cases and how they can also help prevent miscarriage afterward. The cases included patients with amenorrhea, sperm disorders, polycystic ovary syndrome, diminished ovarian reserve (DOR), tubal blockage, premenopause, and premature ovarian insufficiency. Results: Acupuncture and Chinese herbs worked together to help make ART possible or easier. The ART used for these patients included intrauterine insemination, IVF, IVF with a donor egg, and introcytoplasmic sperm injection. In 3 cases, IVF was not initially successful but was successful after TCM treatment. Conclusions: These 6 cases demonstrated the positive effect of a combined approach, using acupuncture and herbs to reduce DOR and regulate hormonal disorders, creating sustainable environments for conceiving and maintaining pregnancy, thus, translating into clinical success. Clinical observation of these cases sheds new light on designing future clinical trials and practice of TCM for practitioners who provide infertility treatments.