Acupuncture for oligospermia and asthenozoospermia

Abstract

Background: Acupuncture is widely used for oligospermia and asthenozoospermia in China, but its effect is unclear. We aimed to determine the effectiveness and safety of acupuncture in treating oligospermia and asthenozoospermia. Methods: An electronic search for randomized controlled trials evaluating acupuncture treatment in patients with oligospermia and asthenozoospermia published from database inception to October 2018 was conducted in PubMed, EMBASE, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database (VIP Database), the Wan-Fang Database, the China National Knowledge Infrastructure and the Cochrane Library. We established search terms related to 3 areas (oligospermia, asthenozoospermia, and acupuncture). Two authors independently screened all identified citations and extracted the data. The methodological quality of the included trials was assessed using the Cochrane criteria. Results: Seven studies with a total of 527 subjects were screened according to inclusion and exclusion standards, and most of the studies had significant methodological weaknesses. Seven randomized controlled trials tested the effects of acupuncture compared with placebo acupuncture and conventional medications in patients with oligospermia and asthenozoospermia. The results of this study suggest that acupuncture alone has no clear superiority in improving sperm motility (standard mean difference [SMD] = 1.13, 95% confidence interval [CI]: −0.64 to 2.89), the sperm concentration (SMD = 0.32, 95% CI: 0.27–0.92) or semen volume compared with placebo acupuncture. No significant difference was found between acupuncture alone and conventional medications in improving sperm motility (SMD = −0.53, 95% CI: −2.54 to 1.48), the sperm concentration (SMD = −1.10, 95% CI: −1.48 to −0.72) or semen volume. However, adjuvant acupuncture may enhance the effect of medications on improving sperm motility (SMD = 4.10, 95% CI: 1.09–7.12) and the sperm concentration (SMD = 1.07, 95% CI: 0.739–1.40), but the study heterogeneity was too high to establish robust conclusions. Conclusion: These results suggest that the current evidence does not support acupuncture as an effective treatment for oligospermia and asthenozoospermia; therefore, acupuncture is not currently recommended as a treatment for these conditions. However, owing to the high risk of bias among the included studies, the evidence is limited, and more large-scale, high-quality clinical trials are needed in the future. Trial registration number: PROSPERO CRD42018083885

Efficacy and safety of nonpharmacological strategies for the treatment of oligoasthenospermia: a systematic review and Bayesian network meta-analysis

“…In the evaluation of the risk of bias regarding the randomization process, only 3 studies [ 27 , 44 , 60 ] were evaluated as “high risk”, 10 articles [ 25 , 28 , 29 , 36 , 39 , 40 , 49 , 53 , 58 , 62 ] were evaluated as having “some concerns”, and 25 articles were evaluated as “low risk”. In the evaluation of the risk of bias regarding deviations from intended interventions, 7 studies [ 27 , 29 , 32 , 39 , 40 , 46 , 59 ] were rated as having “some concerns”, and the remaining 31 articles were rated as “low risk”. In the evaluation of the risk of bias regarding missing outcome data, all 38 studies were rated “low risk”.…”

“…Twenty-eight studies [ 26 – 32 , 34 , 37 – 39 , 42 – 44 , 46 – 48 , 50 – 60 ] reported on sperm concentration, involving 11 interventions. Thus, 55 two-by-two comparisons were formed, and the evidence network was generally centred on CM, thereby forming eight closed loops (see Fig.…”

“…Twenty-six studies [ 26 , 28 , 30 – 39 , 43 , 46 – 49 , 52 – 60 ] reported sperm motility a + b%, involving 11 interventions. Thus, 55 two-by-two comparisons were formed, with an overall network of evidence centred on no treatment, thereby forming nine closed loops (see Fig.…”

“…Second, the three papers [ 27 , 44 , 60 ] that were evaluated as high risk in terms of literature quality were excluded, and then sensitivity analyses were performed before and after exclusion. Third, considering that the RCTS with a small sample size may affect the accuracy of the results, 10 literatures [ 34 , 42 , 46 , 49 – 51 , 55 , 57 , 61 , 62 ] with a sample size less than 60 were excluded for sensitivity analysis. Finally, the treatment duration of 5 articles [ 35 , 36 , 49 , 59 , 60 ] is less than or equal to 1 month, which may cause potential bias.…”

The efficacy and mechanism of acupuncture in the treatment of male infertility: A literature review

“…There are also studies showing that acupuncture versus placebo acupuncture has no statistically significant effect on in vitro fertilization outcomes (115). In addition, a meta-analysis conducted by Wen Jia et al (116) suggested that compared with medications or sham acupuncture, acupuncture alone has no clear superiority in improving sperm quality. Although acupuncture may have the similar effect to medications, the considerable clinical heterogeneity and the poor methodological quality among the included studies made the present evidence inadequate to draw a definite conclusion.…”