Effect of acupuncture and moxibustion as the adjuvant therapy on frozen-thawed embryo transfer: A network meta-analysis

To evaluate the clinical effect of acupuncture- moxibustion as the adjuvant therapy on frozen-thawed embryo transfer (FET) using network meta-analysis. In PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Wanfang database (WanFang), VIP database and Chinese Biomedical Literature Database (SinoMed), the randomized controlled trials (RCTs) of the adjuvant therapy of acupuncture-moxibustion for FET were retrieved, from database inception to April 1, 2021. Cochrane risk of bias assessment tool was used to screen and evaluate the quality of the included studies, and RevMan 5.3, GeMTC0.14.3 and Stata16.0 software were adopted to complete the network meta-analysis. Twenty-nine RCTs comprising 2880 patients were finally included, involving 17 interventions and 4 outcome measures. The results of network meta-analysis showed that the top three therapies under each outcome based on the magnitude of SUCRA values were: ① Clinical pregnancy rate (CPR, %): "transcutaneous electrical acupoint stimulation + herbal medicine" (76.4), "moxibustion + herbal medicine" (74.7), "acupuncture + moxibustion" (73.3); ②Biochemical pregnancy rate (BPR): "moxibustion + herbal medicine" (89.3), "acupuncture + moxibustion" (82.1), "acupuncture + herbal medicine" (78.7); ③Endometrial thickness: "acupoint injection + Western medicine" (87.2), auricular therapy (76.8), "acupuncture + herbal medicine" (73.5); ④Type A endometrial morphology rate: "acupoint injection + Western medicine "(78.3), "moxibustion + herbal medicine" (58.0) and "acupuncture + moxibustion" (52.6). The combined treatment of acupuncture-moxibustion was superior to single therapy for FET patients. The combined therapy of transcutaneous electrical acupoint stimulation and herbal medicine had the best effect for improving CPR, "moxibustion + herbal medicine" obtained the best average comprehensive effect, and "acupoint injection + Western medicine" was conductive to ameliorate the endometrial thickness and morphology. Due to the limitations of existing studies, more high-quality RCTs are needed in the future to further verify these conclusions.