Reproductive outcomes in women and men using complementary and alternative medicine treatment and not receiving artificial reproductive technology: a systematic review

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Abstract

Purpose

Infertility is a global problem, but only a minority of couples access assisted reproductive technologies due to financial and sociocultural barriers. Complementary and alternative medicine are seen as another option. We aimed to determine the impact of complementary and alternative medicine on conception, miscarriage and live birth rates in couples not receiving assisted reproductive technology treatments.

Methods

The electronic databases EMBASE, PubMed, Web of Science and the Allied and Complementary Medicine Database were systematically searched before March 24th 2020. Reference lists of eligible studies were searched for relevant studies. Eligible studies included trials and observational studies that assessed a complementary or alternative medicine and conception, miscarriage or live births in men or women not undergoing fertility treatment. Data were extracted by two independent reviewers using a pre-designed data collection form. The study protocol was published in the PROSPERO database (CRD42018086980).

Results

Twenty randomized controlled trials were identified, including 2748 individuals. Most studies did not demonstrate any effect of a complementary or alternative medicine on pregnancy, live birth or miscarriage rates. Limited evidence was found for a positive effect of herbal therapies taken by women on conception rates. There was substantial diversity in quality across the studies.

Conclusion

There is limited evidence of the effectiveness of complementary and alternative medicine on improving the chances of conception and live births, or increasing miscarriage risk. Owing to the generally sub-optimal quality and heterogeneous nature of the evidence, rigorous studies are needed to determine the impact of complementary and alternative medicine on fertility.

Electronic supplementary material

The online version of this article (10.1007/s00404-020-05836-4) contains supplementary material, which is available to authorized users.

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Most cited references 42

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The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

Julian P. T. Higgins, Douglas G. Altman, Peter C. Gøtzsche … (2014)

Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate

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Why do patients turn to complementary medicine? An empirical study.

A Furnham, C Vincent-Delorme (1996)

Over 250 patients from three complementary medicine practices-acupuncture, osteopathy and homoeopathy-completed a questionnaire rating 20 potential reasons for seeking complementary treatment. The reasons that were most strongly endorsed were "because I value the emphasis on treating the whole person'; "because I believe complementary therapy will be more effective for my problem than orthodox medicine'; "because I believe that complementary medicine will enable me to take a more active part in maintaining my health'; and "because orthodox treatment was not effective for my particular problem'. Five factors were identified, in order of importance: a positive valuation of complementary treatment, the ineffectiveness of orthodox treatment for their complaint, concern about the adverse effects of orthodox medicine, concerns about communication with doctors and, of less importance, the availability of complementary medicine. Groups were compared, using analysis of covariance to control for demographic differences between the three patient groups. Osteopathy patients' reasons indicated they were least concerned about the side effects of orthodox medicine and most influenced by the availability of osteopathy for their complaints. Homoeopathy patients were most strongly influenced by the ineffectiveness of orthodox medicine for their complaints, a fact which was largely accounted for by the chronicity of their complaints. Results are discussed in terms of the limited research in this area. Future studies should separate the reasons for beginning complementary treatment from the reasons for continuing it. It is possible, for instance, that the failure of orthodox medicine is the strongest motive for seeking complementary treatment but that, once treatment has been experienced, other more positive factors become more important.

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A placebo-controlled double-blind randomized trial of the use of combined l-carnitine and l-acetyl-carnitine treatment in men with asthenozoospermia.

Andrea Lenzi, Paolo Sgrò, Pietro Salacone … (2004)

To determine the efficacy of combined l-carnitine and l-acetyl-carnitine therapy in infertile males with oligo-astheno-teratozoospermia. Placebo-controlled double-blind randomized trial. University tertiary referral center. Sixty infertile patients (aged 20-40 years) with the following baseline sperm selection criteria: concentration, 10 to 40 x 10(6)/mL; forward motility, <15%; total motility, 10% to 40%; and atypical forms, <80%. Fifty-six patients completed the study. Patients were submitted to a combined treatment of l-carnitine (2 g/d) and l-acetyl-carnitine (1 g/d) or of placebo; the study design was 2 months' wash-out, 6 months of therapy or of placebo, and 2 months' follow-up. Variation in the semen parameters that were used for patient selection. Even though increases were seen in all sperm parameters after combined carnitine treatment, the most significant improvement in sperm motility (both forward and total) was present in patients who had lower initial absolute values of motile sperm (<4 x 10(6) forward or <5 x 10(6) total motile spermatozoa per ejaculate). Combined treatment with l-carnitine and l-acetyl-carnitine in a controlled study of efficacy was effective in increasing sperm motility, especially in groups with lower baseline levels.

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Author and article information

Contributors

Clare Oliver-Williams:

ORCID: http://orcid.org/0000-0002-3573-2426

cto21@cam.ac.uk

Journal

Journal ID (nlm-ta): Arch Gynecol Obstet

Journal ID (iso-abbrev): Arch Gynecol Obstet

Title: Archives of Gynecology and Obstetrics

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0932-0067

ISSN (Electronic): 1432-0711

Publication date (Electronic): 20 October 2020

Publication date PMC-release: 20 October 2020

Publication date (Print): 2021

Volume: 303

Issue: 3

Pages: 821-835

Affiliations

[1 ]GRID grid.5335.0, ISNI 0000000121885934, School of Clinical Medicine, , University of Cambridge, ; Cambridge, UK

[2 ]GRID grid.7372.1, ISNI 0000 0000 8809 1613, Warwick Medical School, , University of Warwick, ; Coventry, UK

[3 ]GRID grid.412570.5, ISNI 0000 0004 0400 5079, University Hospitals Coventry and Warwickshire, ; Coventry, UK

[4 ]GRID grid.83440.3b, ISNI 0000000121901201, University College London, ; London, UK

[5 ]GRID grid.5335.0, ISNI 0000000121885934, Homerton College, University of Cambridge, ; Hills Road, Cambridge, UK

[6 ]GRID grid.5335.0, ISNI 0000000121885934, Department of Public Health and Primary Care, , University of Cambridge, ; 2 Worts’ Causeway, Cambridge, CB1 8RN UK

Author information

Siobhan Quenby http://orcid.org/0000-0003-3221-5471

Clare Oliver-Williams http://orcid.org/0000-0002-3573-2426

Article

Publisher ID: 5836

DOI: 10.1007/s00404-020-05836-4

PMC ID: 7960609

PubMed ID: 33083872

SO-VID: c8b02a12-6129-4a2b-8dbc-835be6e3d111

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 4 June 2020

Date accepted : 7 October 2020

Funding

Funded by: Medical Research Council (GB)

Funded by: FundRef http://dx.doi.org/10.13039/501100000274, British Heart Foundation;

Funded by: FundRef http://dx.doi.org/10.13039/501100008420, Homerton College, University of Cambridge;

Funded by: University of Cambridge

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: pregnancy,conception,live births,miscarriage,complementary medicine,alternative medicine

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: pregnancy, conception, live births, miscarriage, complementary medicine, alternative medicine

Reproductive outcomes in women and men using complementary and alternative medicine treatment and not receiving artificial reproductive technology: a systematic review

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 42

The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

Why do patients turn to complementary medicine? An empirical study.

A placebo-controlled double-blind randomized trial of the use of combined l-carnitine and l-acetyl-carnitine treatment in men with asthenozoospermia.

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