The use of acupuncture, moxibustion, and herbal medicine has deep roots in women's health in Korea. In this study, we attempted to record the results of such practices pertaining to unexplained female infertility. The use of the standard therapeutic package used in this study is safe and minimally, if at all, risky. The absence of teratogenic or reported neonatal morbidity and mortality solidifies the place of such treatment packages alongside other established medical, natural, and self-administered (drug) infertility interventions. The adherent group of women achieved a successful pregnancy outcome at a rate of 60.9%. Upon assuring appropriate compliance rates (through insurance support, availability of services, positive outcomes reported in the literature, etc.), a promising outcome can be anticipated. Meanwhile, the patients' full comprehension regarding scope of treatment and willingness to comply with it when entering into the course of treatment seems crucial, as the high number of dropouts in the early study stages adversely affected the overall study.
The outcomes that were obtained in the group that completed the study as well as those that dropped out are significant. Although the success for achieving pregnancy is downplayed by the number of dropouts in the study, if more than 22.1% of the initial subject group had followed through until the end, the outcomes might have provided a strong call for the implementation of noninvasive Eastern medical practices to be more than an adjuvant therapy for infertility. Although completion rates for observational studies on infertility may range as high as 90% in studies that involve a stipend,14
it is our understanding that our completion rate of 22.1% in an observational study (which should be markedly less than any designed cohort or case–control study) that asked for a capitation payment from the subjects was acceptable. In contrast to studies where treatments were provided free of charge, in this observational study participants had to pay for their individual treatment. The personal reasons for dropping out could also include unreported illness, emotional or psychologic burden, and loss of interest, which the investigators regret we did not classify in detail. The movement of patients out of the area as well as the desire to seek other treatment options, and administrative issues in contacting participants accounted for the remainder of patients who did not complete the treatment course.
It is important to understand the complex array of effects that play into the seeking out of and adherence to treatment in regard to fertility. In the realm of unexplained in fertility, especially where patients have no pointed abnormality with hormone levels, or physical impediments that have been diagnosed, the emotional and psychologic toll is overarching. To achieve success and completion with the standard package of care in this difficult situation is promising. One interesting point to interpret in future study results will be to look at the demographic composition of women who did complete the treatment. As such a large percentage of dropouts stated that “personal reasons” were the impetus for lack of completion, it brings forth the question, why did personal reasons not get in the way of adherence for those women who completed treatment? Is this group older and therefore more prone to follow through without regard to time constraints or economic detriment? Is this group more inclined to participate in this traditional and noninvasive type of care in other aspects of their lives? Or simply, does this group live closer or have substantial economic means to achieve the final outcome of visiting for a combined six menstrual periods? In addition, are women in this group more desperate for conception than the others?
As we look at previous studies of traditional care for infertility, there is insufficient literature looking at Korean medical practices and their influence on infertility. Much of the current literature on traditional medicine and infertility deals with male infertility, includes the use of medical procedures in conjunction to Eastern medicine,7
or comes from Indian or Chinese researchers who use similar but decisively different methods from those of this study. These alternatives include the use of numerous similar yet different herbs, but exclude the use of acupuncture and herbal pills. Therefore, research in this area is to an extent novel and in its own right a worthwhile endeavor.
The use of traditional Korean medicine has become very appealing to patients as a primary or adjuvant therapeutic tool. The mixed results reported by many researchers in regard to fertility-related outcomes can be explained by the standardization of treatments and therefore lack of personalized care plans.15,16
While further discussion of the individual treatments included in the package is beyond the scope of this study, there may certainly be a benefit to this method of treatment.
This observational study into unexplained infertility treatment would further benefit from work done in the following aspects: (1) investigating the outcomes of consecutive treatment in contrast to a cumulative treatment over a number of months on the success of pregnancy and other symptoms of menstruation; (2) studying detailed categories of reasons for the discontinuation of treatments, including cost and confidence in the treatment; (3) carrying out matched comparative studies on women with unexplained infertility who did not use the standard therapeutic package from Conmaul Hospital versus women who did (introduction of a specific control); (4) investigating outcomes of the standard care package for this unexplained infertility in regard to general health and wellness. What other benefits or detriments can be associated with the package, as most herbal therapeutic packages have extensive effects; (5) looking at distinct groups of women younger than and older than 35, the age commonly designated as when pregnancies become high risk, and the possible difference in treatment outcomes; and (6) performing a similar study with free treatment. Through looking at women who are not self-selected based upon access to hospital care (through economic and motivational means), a better understanding of the population-level effectiveness of CAM fertility package therapy as a whole could be understood.
Upon completion of this study, the limitations of an observational study in the Conmaul Hospital were typified by the relatively low adherence rate of participants. At the same time, the success rate of the standard therapeutic package for treatment of unexplained infertility was strengthened. Overall, whether or not pregnancy was achieved, and whether or not participants finished treatment, or infertility persisted, the multiple psychologic and physiologic problems associated with unexplained infertility were studied and provided a baseline for future research on this meaningful complementary subject field.
In summary, this study is a starting point for future research. Although a large percentage dropped out of the study for myriad nonspecified reasons, the treatment for infertility was beneficial in the small cohort who utilized it as prescribed. Therefore, future research into the mechanisms of action for individual treatment components, the cost effectiveness of the treatment versus conventional infertility methods, and the overall success rate in a double-blind placebo-controlled study, could act to solidify this treatment method as a positive option for women with unexplained infertility.