Impact of combining laparoscopy with traditional Chinese medicine on oxidative stress in endometriosis-related infertility: A systematic review and meta-analysis

Abstract

Background: To evaluate the effect of laparoscopic procedures integrated with traditional Chinese medicine (TCM), specifically aimed at enhancing blood flow and alleviating blood stasis, on oxidative stress levels in individuals with endometriosis-induced infertility.

Methods: We performed a systematic quantitative review to evaluate the effects of laparoscopic surgery combined with TCM on oxidative stress in endometriosis-related infertility by enhancing blood circulation and resolving stasis. A literature search of 9 major databases was performed. Meta-analysis was performed using Review Manager version 5.4 (R Foundation for Statistical Computing, Vienna, Austria) and Stata Release 16.0 (StataCorp LLC, College Station, TX). This systematic review was registered with the International Prospective Register of Systematic Reviews (i.e., "PROSPERO") (registration number: CRD42024526800).

Results: Thirteen trials comprising 1084 participants were included. Laparoscopy combined with TCM for promoting blood circulation and removing blood stasis significantly reduced the levels of 8-isoprostane prostaglandin F2α (mean difference [MD] -29.57 [95% confidence interval (CI) -32.65 to -26.49]; P < .001), regulated on activation, normal T cell expressed and secreted (MD -231.83 [95% CI -341.33 to -122.32]; P < .001), reactive oxygen species (MD -0.92; [95% CI -1.12 to -0.73]; P < .001), monocyte chemoattractant protein-1 (MD -31.23 [95% CI -42.70 to -19.77]; P < .001), and increased glutathione peroxidase (MD 31.45 [95% CI 26.04 to 36.87]; P < .001), vitamin E (MD 4.86 [95% CI 3.77 to 5.94]; P < .001), superoxide dismutase (standardized MD 0.92 [95% CI 0.41 to 1.42]; P < .001).

Conclusion: Compared with laparoscopic surgery alone, the combination of TCM for promoting blood circulation and removing blood stasis demonstrated the potential to ameliorate oxidative stress in patients with endometriosis-induced infertility. However, further large-scale clinical trials are required to confirm these findings.

Keywords: endometriosis-related infertility; oxidative stress; traditional Chinese medicine.

Figure 1.

PRISMA flow diagram of study selection.

Figure 2.

Summary of risk of bias: review of the authors’ judgments on the risk of bias for each of the 13 RCTs included. RCT = randomized controlled trial.

Figure 3.

Forest plot of 8-ios-PGF2α: Forest plot of comparing TCM to promote blood circulation and remove blood stasis combined with laparoscopy versus laparoscopy alone on 8-ios-PGF2α in endometriosis-related infertility patients. 8-ios-PGF2α = 8-isoprostane prostaglandin F2α, TCM = traditional Chinese medicine.

Figure 4.

Forest plot of GSH-Px: Forest plot of comparing TCM to promote blood circulation and remove blood stasis combined with laparoscopy versus laparoscopy alone on GSH-Px in endometriosis-related infertility patients. GSH-Px = glutathione peroxidase, TCM = traditional Chinese medicine.

Figure 5.

Forest plot of RANTES: Forest plot of comparing TCM to promote blood circulation and remove blood stasis combined with laparoscopy versus laparoscopy alone on RANTES in endometriosis-related infertility patients. RANTES = regulated on activation, normal T cell expressed and secreted, TCM = traditional Chinese medicine.

Figure 6.

Forest plot of ROS: Forest plot of comparing TCM to promote blood circulation and remove blood stasis combined with laparoscopy versus laparoscopy alone on ROS in endometriosis-related infertility patients. ROS = reactive oxygen species, TCM = traditional Chinese medicine.

Figure 7.

Forest plot of Vit E: Forest plot of comparing TCM to promote blood circulation and remove blood stasis combined with laparoscopy versus laparoscopy alone on Vit E in endometriosis-related infertility patients. TCM = traditional Chinese medicine, Vit E = vitamin E.

Figure 8.

Forest plot of MCP-1: Forest plot of comparing TCM to promote blood circulation and remove blood stasis combined with laparoscopy versus laparoscopy alone on MCP-1 in endometriosis-related infertility patients. MCP-1 = monocyte chemoattractant protein-1, TCM = traditional Chinese medicine.

Figure 9.

Forest plot of SOD: Forest plot of comparing TCM to promote blood circulation and remove blood stasis combined with laparoscopy versus laparoscopy alone on SOD in endometriosis-related infertility patients. SOD = superoxide dismutase, TCM = traditional Chinese medicine.

Figure 10.

Sensitivity analysis influence plot of 8-ios-PGF2α. 8-ios-PGF2α = 8-isoprostane prostaglandin F2α.

Figure 11.

Funnel plot of publication bias of 8-ios-PGF2α content after treatment. 8-ios-PGF2α = 8-isoprostane prostaglandin F2α.

Figure 12.

Sensitivity analysis influence plot of GSH-Px. GSH-Px = glutathione peroxidase.

Figure 13.

Funnel plot of publication bias of GSH-Px content after treatment. GSH-Px = glutathione peroxidase.

Figure 14.

Sensitivity analysis influence plot of RANTES. RANTES = regulated on activation, normal T cell expressed and secreted.

Figure 15.

Funnel plot of publication bias of RANTES content after treatment. RANTES = regulated on activation, normal T cell expressed and secreted.

Figure 16.

Sensitivity analysis influence plot of ROS. ROS = reactive oxygen species.

Figure 17.

Funnel plot of publication bias of ROS content after treatment. ROS = reactive oxygen species.

Figure 18.

Sensitivity analysis influence plot of Vit E. Vit E = vitamin E.

Figure 19.

Funnel plot of publication bias of Vit E content after treatment. Vit E = vitamin E.

Figure 20.

Sensitivity analysis influence plot of MCP-1. MCP-1 = monocyte chemoattractant protein-1.

Figure 21.

Funnel plot of publication bias of MCP-1 content after treatment. MCP-1 = monocyte chemoattractant protein-1.

Figure 22.

Sensitivity analysis influence plot of SOD. SOD = superoxide dismutase.

Figure 23.

Funnel plot of publication bias of SOD content after treatment. SOD = superoxide dismutase.