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

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.

Keywords: Alternative medicine; Complementary medicine; Conception; Live births; Miscarriage; Pregnancy.

Fig. 1

Flow diagram of identification and selection of studies included in the systematic review

Fig. 2

Summary of the included studies results

Fig. 3

Quality of studies in the review as assessed by the Cochrane Collaboration’s tool

Fig. 4

Clinical implications of findings on complementary and alternative medicines and reproductive outcomes. Quality of evidence assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE): C: low quality of evidence (our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect). D: very low quality of evidence (out confidence in the effect estimates is severely limited. The true effect is probably markedly different from the estimated effect)