Chinese herbal medicine for female infertility: An updated meta-analysis (2024)

Polycystic ovary syndrome (PCOS) is one of the most common endocrine-metabolic disorders in women of reproductive age worldwide. Previous studies using randomized controlled trials (RCTs) have revealed that Xiao Yao San (XYS), a classic Chinese patent medicine formula, can effectively treat PCOS. However, the entire evidence has yet to be systematically summarized.

The aim of this systematic review and meta-analysis of clinical trials was to assess the effect of XYS for the treatment of PCOS.

7 databases were thoroughly reviewed for RCTs published from inception to July 2022, assessing the effect of XYS in treating PCOS, including Cochrane Library, PubMed, Embase, Wan Fang Database, Chinese Biomedical Database, China National Knowledge Infrastructure, and China Science and Technology Journal Database. Outcome measures included ovulation rate, pregnancy rate, hormonal levels, and glycemic parameters. Either a random-effects model or a fixed-effect models was used to pool data. Pooled effect sizes were reported as odds ratios (ORs) or standardized mean differences (SMDs) with their 95% confidence intervals (CIs).

A total of 9 trials including 736 PCOS patients met the selection criteria. Our results indicate that XYS plus conventional medicines for PCOS significantly improved ovulation rate (OR=2.45, 95% CI=1.94 to 3.08, P<0.001) and pregnancy rate (OR=2.65, 95% CI=1.87 to 3.75, P<0.001), meanwhile decreased levels of fasting insulin (FINS) (SMD=- 0.46, 95% CI: 0.65 to - 0.27, P<0.001) and homeostatic model assessment for insulin resistance (HOMA-IR) (SMD=- 0.65, 95% CI=- 0.93 to - 0.37, P<0.001). XYS plus conventional medicines for PCOS did not have a significant impact on levels of total testosterone (T), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and fasting plasma glucose (FPG). No serious adverse reactions were observed.

XYS combined with conventional medicines can improve ovulation and pregnancy rates, decrease FINS and HOMA-IR in PCOS patients, indicating that XYS treatment may be used as a promising adjuvant therapy to the conventional medicines of PCOS. However, due to significant heterogeneity and methodological shortcomings, these results should be interpreted with great caution. Larger, higher quality RCTs are needed to rigorously assess the effect of XYS as a complementary therapy in managing PCOS.

Whole-systems traditional Chinese medicine (WS-TCM) therapy has been widely used as a multi-dimensional intervention for in vitro fertilization and embryo transfer (IVF-ET) during clinical practice in China. This study aimed to assess the impact of WS-TCM on IVF-ET outcomes.

This retrospective cohort study was conducted on 2733 patients at a tertiary-referral academic university hospital from January 2018 to June 2021. We compared the outcomes of WS-TCM therapies, including acupuncture, moxibustion, Chinese herbs, as well as dietary and lifestyle recommendations (WS-TCM group) with conventional IVF-ET care alone (Non-WS-TCM group) during fresh IVF (n=1048) and frozen-thawed embryo transfer (FET) cycles (n=1685). The live birth rate (LBR) per ET was the primary endpoint. Propensity score (PS) matching and multivariable logistic regression analyses were performed to adjust for potential confounders.

The LBR per ET was comparable between the WS-TCM and Non-WS-TCM groups (39.9% versus 38.0%, P=0.604) in fresh IVF cycles after PS matching, while significant differences in cumulative LBR (60.5% versus 52.7%, P=0.045) were detected. Meanwhile, for patients that underwent FET cycles, significant differences in LBR were detected between the WS-TCM and Non-WS-TCM groups (42.7% versus 35.3%, p=0.019, after PS matching). These findings were validated by multivariate logistic regression analysis (adjusted odds ratio [aOR] 1.28, 95% confidence interval [CI] 1.01–1.63, p=0.044).

Our findings suggest that WS-TCM therapy may improve the LBRs and cumulative LBRs of subfertile women undergoing IVF-ET. Nonetheless, more comprehensive, rigorous, large-scale prospective comparative studies are needed to verify these findings.

Citation Excerpt :

Fourteen SRs analyzed the effects of acupuncture on infertile women undergoing in vitro fertilization (IVF).11,16-19,21,23,25-27,30,32-34 Two SRs analyzed the effects of herbal medicine on infertility.12,20 One SR analyzed the effects of acupuncture on infertile women with PCOS undergoing IVF.31

Acupuncture and herbal medicine have been used as additional treatments for infertility or as an adjuvant treatment of assisted reproductive technology (ART) in infertility. Many systematic reviews (SRs) and meta-analyses (MA) have been published. This paper reviews the SRs and MA of acupuncture and herbal medicine on infertility to provide evidence for clinical decision making.

A comprehensive literature search of SRs and MA for the effects of acupuncture and herbal medicine on infertility was conducted using nine databases. Two independent reviewers extracted the data of the selected SR and MA and evaluated their methodological quality using the ‘Assessment of multiple systematic reviews 2 (AMSTAR2)’.

Twenty-one studies were included in this analysis. Eight studies were published in China, and three studies each were published in the USA, UK, and Australia. Conflicting evidence on the efficacy of acupuncture for infertile women has been reported. Herbal medicine for infertile women undergoing ART, women with anovulation, and women with polycystic ovary syndrome helped improve the clinical pregnancy rate. The methodological quality of SRs and MAs evaluated by AMSTAR 2 was low or very low because the protocol or list of excluded studies were omitted.

Herbal medicine tended to be effective in infertility, but acupuncture had low evidence of an effect on infertility. The methodological quality of the published SRs and MAs was underestimated because AMSTAR2 is a more rigorous assessment tool than the previous version.

Patients with endometriosis may seek traditional Chinese medicine (TCM) to help them conceive. The present study aims to evaluate the effects of TCM on reproductive and pregnancy outcomes in patients with endometriosis.

The patients with endometriosis taken from the National Health Insurance (NHI) research database between 2000 and 2012 were divided into two cohorts based on the use of TCM treatment. The two cohorts were matched by age and comorbidities and followed up until a new diagnosis of infertility, ectopic pregnancy, or miscarriage. Multivariable Cox proportional hazards models were used to evaluate the hazard ratio (HR) of reproductive and pregnancy outcomes.

A total of 5244 patients with endometriosis were analyzed, including 1748 TCM users and 3496 matched control subjects. The proportion of infertility was higher in TCM users than in non-TCM users (adjusted hazard ratio [HR]: 1.34, 95% confidence interval [CI]: 1.13–1.60). However, there was no significant difference in the proportion of ectopic pregnancies between TCM users and non-TCM users (adjusted HR: 0.82, 95% CI: 0.60–1.13). There was no significant difference in the proportion of miscarriages between TCM users and non-TCM users (adjusted HR: 1.23, 95% CI: 0.95–1.61).

TCM treatment showed insignificant efficacy in decreasing the risk of ectopic pregnancy and miscarriage in patients with endometriosis.

The use of complementary and alternative medicine (CAM) by patients and physicians has increased markedly in recent years. Many case reports, case series, and uncontrolled trials of varying quality have been completed; however, there is now a slowly increasing number of randomized controlled trials (RCTs) examining the use of CAM.

To identify, survey, and review RCTs investigating the use of CAM for infertility treatment.

The MEDLINE and Cochrane databases were electronically searched.

RCTs examining modalities for treatment or improvement of health status were reviewed.

RCTs were included based on use of objective measures, articles written in English, availability through the University of Michigan database, and clear published clinical outcomes.

Thirty-seven articles assessing a variety of CAM modalities met inclusion criteria. Acupuncture, selenium supplementation, weight loss, and psychotherapeutic intervention had 3 or more studies demonstrating beneficial effect. Other interventions had been studied less and evidence for them was limited.

Although there is preliminary evidence of the effectiveness of some CAM interventions among infertile patients, many of these interventions require further investigation before they can be considered for routine clinical use.

Dahuang zhechong formula has been used for the treatment of chronic hepatitis B, but its efficacy on the liver fibrosis is conflicting. We performed a meta-analysis to quantitatively investigate the efficacy of Dahuang zhechong formula as an adjunctive therapy treatment for liver fibrosis in patients with hepatitis B.

We searched the PubMed, EMBASE, VIP database, China National Knowledge Infrastructure, and Wanfang database through January 2014. Only randomized controlled trials investigating Dahuang zhechong formula as an adjunctive therapy treatment for liver fibrosis in patients with chronic hepatitis B were selected.

Seventeen trials involving 1212 patients were included. Dahuang zhechong formula reduced serum hyaluronic acid level (standardized mean difference [SMD]=−1.27; 95% confidence interval [CI]: −1.72 to −0.83), type-III procollagen level (SMD=−1.71; 95%CI: −2.34 to −1.09), type-IV collagen level (SMD=−1.06; 95%CI: −1.41 to −0.70), and laminin level (SMD=−0.75; 95%CI: −0.89 to −0.62). In particular, subgroup analyses showed that patients who did not receive anti-viral agents have achieved a greater reduction in serum fibrosis markers.

Dahuang zhechong formula appears to reduce serum biomarkers of liver fibrosis in patients with chronic hepatitis B. However, robust conclusions cannot be reached due to the methodological flaws of the included trials.

The purpose of this RCT was to investigate whether a 24-week program of high-intensity exercise was beneficial for improving reproductive function in infertile male patients.

Infertile men (n= 433) were randomly assigned to exercise (n= 218) and non-exercise (n= 215) groups. The seminal markers of inflammation and oxidative stress, sem*n quality parameters, sperm DNA fragmentation, and pregnancy rate were measured at baseline, at the end of week 12, at the end of week 24, and at 7 and 30 days during recovery. Exercise programs included a treadmill running protocol, three times a week, at an intensity >70% to 85% of maximal oxygen consumption.

The exercise group reported significantly attenuated inflammatory biomarkers (interleukin-6 and tumour necrosis factor-α), oxidative stress (reactive oxygen species and malondialdehyde), and antioxidants (superoxide dismutase, catalase, and total antioxidant capacity) (P < 0.05), and these changes coincided with favorable improvements in sem*n parameters, sperm DNA integrity, and pregnancy rate (P < 0.05). These findings indicate that our exercise training program was adequate to elicit improvements in markers of male reproductive function in infertile patients.

We concluded that a high-intensity exercise program could be recommended as an adjunct lifestyle approach to male factor infertility treatment or used in combination with other therapies.

Cet ECR visait à déterminer si un programme d’exercice à haute intensité de 24 semaines pouvait améliorer la fonction reproductrice des hommes infertiles.

Des hommes souffrant d’infertilité (n= 433) ont été aléatoirement répartis en deux groupes : un groupe suivant le programme d’exercice (n= 218) et un groupe témoin (n= 215). La présence de marqueurs d’inflammation et de stress oxydatif dans le sperme, les indices de la qualité séminale, la fragmentation de l’ADN spermatique et le taux de grossesse ont été évalués au début de l’essai, à la fin de la 12^e et de la 24^e semaine, puis après 7 et 30 jours de récupération. Le programme prévoyait un protocole de course sur tapis roulant à une intensité de 70 à 85 % de l’absorption maximale d’oxygène, à réaliser trois fois par semaine.

Dans le groupe suivant le programme d’exercice, une amélioration statistiquement significative (P < 0,05) a été observée quant aux biomarqueurs d’inflammation (interleukine 6 et facteur de nécrose tumorale alpha) et de stress oxydatif (dérivés réactifs de l’oxygène et malonaldéhyde) et à la quantité d’antioxydants (superoxyde dismutase, catalase et capacité antioxydante totale), tandis que la qualité du sperme, l’intégrité de l’ADN spermatique et le taux de grossesse ont augmenté (P < 0,05). Ces résultats indiquent que notre programme d’exercice est parvenu à améliorer les indicateurs de la fonction reproductrice masculine chez les patients infertiles.

Il conviendrait de recommander un programme d’exercice à haute intensité comme complément au traitement de l’infertilité masculine.

To observe the clinical efficacy of prescription of Chinese medical retention enema, Chinese herbal decoction and acupncture at acupoints of thoroughfare vessel and conception vessel in treating tubal obstructive infertility.

One hundred and five patients with tubal obstructive infertility were randomly divided into 3 groups according to random number table (A, B and C) with 35 cases in each group). The patients in group A were treated by retention enema with concentrated decoction of Táorén (

The total effective rate of group A was 45.71%; the total effective rate of group B was 77.14%; the total effective rate of group B was 85.71%. The difference in statistics of group A and group B, Group A and group C had obvious statistical significance (both P<0.05) but statistics of group B and group C had no statistical significance (P>0.05).

Different kinds of traditional Chinese medicine treatments all have an effect in treating tubal obstructive infertility, Chinese herbal decoction and acupncture in thoroughfare vessel and conception vessel have better effects than retention enema.

Systematic reviews need constantly updating as new evidence emerges. The aim of this comprehensive systematic review/meta-analysis focused on trials that provided acupuncture during in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) which were compared with routine care for a range of outcomes - implantation rate, biochemical pregnancies (presence of a positive urinary pregnancy test or a positive serum human chorionic gonadotrophin test), clinical pregnancies, ongoing pregnancies, and rates of miscarriage and live birth.

A systematic search of MEDLINE and EMBASE databases for randomized controlled trials (RCTs) on acupuncture treatment during IVF or ICSI was carried out from database inception until July 31, 2017. Study selection, data extraction, quality assessment and bias assessment were carried out by 2 researchers independently, with adjudication by the third researcher when necessary. A meta-analysis was performed to compare outcomes between women receiving acupuncture and those receiving routine care, and pooled relative risks (RR) were calculated.

Statistically significant differences were observed in rates of clinical pregnancy (RR = 1.19, 95% confidence intervals (CI): 1.06–1.34 p = 0.002), live birth (RR = 1.36, 95% CI: 1.09–1.69 p = 0.006), and implantation rate (RR = 1.31, 95% CI: 1.08–1.59 p = 0.006) between the acupuncture and the control groups. No significant differences were found for biochemical pregnancies (RR = 1.12, 95% CI: 0.92–1.35 p = 0.268), ongoing pregnancies (RR = 1.21, 95% CI: 0.95–1.55 p = 0.130), or miscarriage (RR = 0.89, 95% CI: 0.67–1.20 p = 0.447) between the two groups. Adverse events were described in 4 studies.

Acupuncture may have an impact on the outcome rates of implantation, clinical pregnancy, and live birth; however, well-designed RCTs are warranted to further validate its effects.