Discrepancies between clinical evidence and doctor-patient priorities in acupuncture-assisted in vitro fertilization-embryo transfer: a clinical survey

目的: 本研究旨在对现有的针灸辅助体外受精-胚胎移植（IVF-ET）的临床研究证据进行总结评价并对临床医生与患者进行问卷调查，对比临床证据与问卷结果之间的关注点差异，为未来临床研究指出方向。方法: 计算机检索中国知网、万方数据库、维普、中国生物医学文献数据库、PubMed、Embase和Cochrane Library数据库中针灸辅助IVF-ET的随机对照试验（RCT）。检索时间为建库至2024年12月31日。由2名研究者独立筛选文献，提取资料，采用ROB1.0工具对纳入文献进行方法学质量评价。根据前期研究结果及专家讨论制定调查问卷并向临床医生与患者发放，从人群、干预、对照、结局4个维度比较证据与临床关注问题的差异。结果: 共纳入143篇RCT，存在一定偏倚风险。回收医生问卷103份、患者问卷108份。对比显示，在人群方面，高龄（>35岁）、长期不孕（>5年）及冻胚移植患者受医生关注但证据支持率低。针灸方案中，毫针证据和医患关注度高，灸法、耳针法受患者关注但证据少，经皮穴位电刺激则相反。针灸介入时点及次数方面，医生对取卵日之前、取卵日至胚胎移植日和胚胎移植日之后都较为关注，但部分时段证据支持率低;取卵日前3次以上和胚胎移植日之后1次证据支持率高，但医生关注度中等或偏低。对照措施方面，西药、中药对照受医生和患者关注但证据少，空白对照则相反。结局指标方面，活产率受医生和患者关注但证据支持率低，精神心理状态证据少且医患关注差异大，并发症证据薄弱但医生关注度高，临床妊娠率等证据支持率与医患关注度较一致。结论: 未来研究应提高RCT质量，扩大样本涵盖范围并分层研究，开展高质量试验探究不同干预措施的疗效与安全性，明确针灸最佳介入时点和针刺次数，结合临床合理设置对照，拓展结局指标并重视长期随访，以提升针灸在辅助生殖领域的应用价值。.; OBJECTIVES: To summarize and evaluate the existing evidence on acupuncture-assisted in vitro fertilization-embryo transfer (IVF-ET), to survey clinicians and patients regarding gaps between the evidence and clinical concerns, and to identify directions for future clinical research. METHODS: Randomized controlled trials (RCTs) of acupuncture-assisted IVF-ET were retrieved from CNKI, SinoMed, VIP, WanFang, PubMed, Embase, and Cochrane Library from inception through December 31, 2024. Two researchers independently screened the literature and extracted data. The methodological quality of the included studies was assessed using the Risk of Bias (ROB) 1.0 tool. Questionnaires, developed based on prior research and expert discussions, were distributed to clinicians and patients. Discrepancies between the evidence and clinical priorities were analyzed across the population, intervention, comparison and outcome dimensions. RESULTS: A total of 143 RCTs with potential risks of bias were included. Questionnaires were completed by 103 clinicians and 108 patients. Comparisons reveal that elderly patients (>35 years old), patients with long-standing infertility (>5 years), and patients undergoing frozen embryo transfer are more focused on by clinicians, but the evidence supporting these concerns is limited. In acupuncture modalities, filiform needles have strong evidence and high recognition;moxibustion and ear acupuncture attract patients' attention but have limited evidence, while transcutaneous electrical acupoint stimulation shows the opposite pattern. Regarding acupuncture timing and frequency, doctors focus on the pre-oocyte retrieval, the retrieval-to-transfer, and post-embryo transfer periods, with low evidence in some periods. High-evidence scenarios (≥3 pre-oocyte retrieval, 1 post-embryo transfer) receive moderate-to-low doctors' attention. For control measures, comparisons with Western and Chinese medicine attract doctors' attention but with limited evidence;blank controls show the opposite trend. In terms of outcomes, live birth rate attracts attention but has limited evidence. Mental health outcomes have little evidence and show substantial disparities between doctor and patient priorities. Complications have weak evidence yet high doctors' focus. Clinical pregnancy rate aligns more closely with doctor-patient attention. CONCLUSIONS: Future studies should enhance the quality of RCTs, broaden the range of included samples, and perform stratified analyses. High-quality trials are needed to evaluate the efficacy and safety of different interventions, determine the optimal acupuncture timing and frequency, and design clinically relevant control groups. Outcome measures should be expanded, and long-term follow-up should be emphasized to advance acupuncture's value in assisted reproduction.