Abstract: With the rapid development of assisted reproductive technology, various reproductive disorders have been effectively addressed. Acupuncture-like therapies, including electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS), become more popular world-wide. Increasing evidence has demonstrated that EA and TEAS are effective in treating gynecological disorders, especially infertility. This present paper describes how to select acupoints for the treatment of infertility from the view of theories of traditional Chinese medicine and how to determine critical parameters of electric pulses of EA/TEAS based on results from animal and clinical studies. It summarizes the principles of clinical application of EA/TEAS in treating various kinds of reproductive disorders, such as polycystic ovary syndrome (PCOS), pain induced by oocyte retrieval, diminished ovarian reserve, embryo transfer, and oligospermia/asthenospermia. The possible underlying mechanisms mediating the therapeutic effects of EA/TEAS in reproductive medicine are also examined.

电针和经皮穴位电刺激技术在生殖医学中的应用：专家共识

[1]Achache, H., Revel, A., 2006. Endometrial receptivity markers, the journey to successful embryo implantation. Hum. Reprod. Update, 12(6):731-746.

[2]Bjelica, A., Nikolic, S., 2015. Development and achievements of assisted reproductive technology. Med. Pregl., 68(9-10):353-357.

[3]Boivin, J., Bunting, L., Collins, J.A., et al., 2007. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum. Reprod., 22(6):1506-1512.

[4]Cheing, G.L., Tsui, A.Y., Lo, S.K., et al., 2003. Optimal stimulation duration of TENS in the management of osteoarthritic knee pain. J. Rehabil. Med., 35(2):62-68.

[5]Chen, X.H., Han, J.S., 1992. Optimal conditions for eliciting maximal electroacupuncture analgesia with DD mode of stimulation. Eur. J. Pharmacol., 211:203-210.

[6]Cui, W., Li, J., Sun, W., et al., 2011. Effect of electroacupuncture on oocyte quality and pregnancy for patients with PCOS undergoing in vitro fertilization and embryo transfervitro fertilization and embryo transfer. Chin. Acupunct. Mox., 31(8):687-690 (in Chinese).

[7]Dieterle, S., Li, C., Robert, G., et al., 2009. A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. Fertil. Steril., 92(4):1340-1343.

[8]Erdem, M., Erdem, A., Biberoglu, K., et al., 2003. Age-related changes in ovarian volume, antral follicle counts and basal follicle stimulating hormone levels: comparison between fertile and infertile women. Gynecol. Endocrinol., 17(3):199-205.

[9]Esteves, S.C., Chan, P., 2015. A systematic review of recent clinical practice guidelines and best practice statements for the evaluation of the infertile male. Int. Urol. Nephrol., 47(9):1441-1456.

[10]Griesinger, G., Verweij, P.J., Gates, D., et al., 2016. Prediction of ovarian hyperstimulation syndrome in patients treated with corifollitropinalfa or rFSH in a GnRH antagonist protocol. PLoS ONE, 11(3):e0149615.

[11]Han, J.S., 2003. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci., 26(1):17-22.

[12]Han, J.S., 2011. Acupuncture analgesia: areas of consensus and controversy. Pain, 152(3 Suppl.):S41-S48.

[13]Han, J.S., Terenius, L., 1982. Neurochemical basis of acupuncture analgesia. Annu. Rev. Pharmacol. Toxicol., 22(1):193-220.

[14]Han, J.S., Ho, Y.S., 2011. Global trends and performances of acupuncture research. Neurosci. Biobehav. Rev., 35(3):680-687.

[15]Han, J.S., Chen, X.H., Sun, S.L., et al., 1991. Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain, 47(3):295-298.

[16]Hançerlioğullarıa, K.Ö., Soyer, T., Tosun, A., et al., 2015. Is B-flow USG superior to Color Doppler USG for evaluating blood flow patterns in ovarian torsion? J. Pediatr. Surg., 50(7):1156-1161.

[17]Jedel, E., Labrie, F., Odén, A., et al., 2011. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. Am. J. Physiol. Endocrinol. Metab., 300(1):E37-E45.

[18]Jiang, Y.L., Yin, X.H., Shen, Y.F., et al., 2013. Low frequency electroacupuncture alleviated spinal nerve ligation induced mechanical allodynia by inhibiting TRPV1 upregulation in ipsilateral undamaged dorsal root ganglia in rats. Evid.-Based Complement. Alternat. Med., 2013:170910.

[19]Jin, Z.R., Liu, B.H., Tang, W.H., 2016a. Clinical trial of transcutanclus electrical acupoint stimulation for the treatment of patients with asthenozoospermia. Chin. J. Male Sci., in press (in Chinese).

[20]Jin, Z.R., Liu, B.H., Cai, J., 2016b. Experimental study for the treatment of asthenozoospermia by electroacupuncture in rats. Acupunct. Res., in press (in Chinese).

[21]Johansson, J., Redman, L., Veldhuis, P.P., et al., 2013. Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial. Am. J. Physiol. Endocrinol. Metab., 304(9):E934-E943.

[22]Kagitani, F., Uchida, S., Hotta, H., et al., 2005. Manual acupuncture needle stimulation of the rat hindlimb activates groups I, II, III and IV single afferent nerve fibers in the dorsal spinal roots. Jpn. J. Physiol., 55(3):149-155.

[23]Lee, S., Lee, M.S., Choi, D.H., et al., 2013. Electroacupuncture on PC6 prevents opioid-induced nausea and vomiting after laparoscopic surgery. Chin. J. Integr. Med., 19(4):277-281.

[24]Lei, H., Feng, L.C., 2014. Study on effects of acupuncture on menstruation and endocrine in patients of normal body weight with polycystic ovary syndrome. World J. Acupunct. Mox., 24(2):10-14.

[25]Li, R., Sun, W., Lin, Y., et al., 2016. Application of transcutaneous electrical acupoint stimulation in reproductive medicine: a group consensus. Reprod. Contraception, 7(36):211-219 (in Chinese).

[26]Liang, J., Ping, X.J., Li, Y.J., et al., 2010. Morphine-induced conditioned place preference in rats is inhibited by electroacupuncture at 2 Hz: role of enkephalin in the nucleus accumbens. Neuropharmacology, 58(1):233-240.

[27]Liu, H.X., Tian, J.B., Luo, F., et al., 2007. Repeated 100 Hz TENS for the treatment of chronic inflammatory hyperalgesia and suppression of spinal release of substance P in monoarthriticrats. Evid.-Based Complement. Alternat. Med., 4(1):65-75.

[28]Mi, H., Gong, A.L., Sun, W., et al., 2013. Effect of transcutaneous electrical acupoint stimulation on 30 patients with poor ovarian function. J. Shandong Univ. TCM, 37(6):495-496 (in Chinese).

[29]Michikami, D., Kamiya, A., Kawada, T., et al., 2006. Short-term electroacupuncture at Zusanli resets the arterial baroreflex neural arc toward lower sympathetic nerve activity. Am. J. Physiol. Heart. Circ. Physiol., 291(1):H318-H326.

[30]Mutlu, M.F., Erdem, A., 2012. Evaluation of ovarian reserve in infertile patients. J. Turk. Ger. Gynecol. Assoc., 13(3):196-203.

[31]Neyens, S., de Neubourg, D., Peeraer, K., et al., 2016. Is there a correlation between the number of follicular flushings, oocyte/embryo quality and pregnancy rate in assisted reproductive technology cycles? Results from a prospective study. Gynecol. Obstet. Invest., 81(1):34-40.

[32]Polisca, A., Zelli, R., Troisi, A., et al., 2013. Power and pulsed Doppler evaluation of ovarian hemodynamic changes during diestrus in pregnant and nonpregnant bitches. Theriogenology, 79(2):219-224.

[33]Qiu, W.X., Zhang, X.Y., Lin, X.X., et al., 2012. The clinical trial on the effects of using TEAS on the quality of embryo and the outcomes in low ovarian reaction patients. Chin. J. Hum. Sex., 21(7):22-24.

[34]Rashidi, B.H., Tehrani, E.S., Hamedani, N.A., et al., 2013. Effects of acupuncture on the outcome of in vitro fertilisation and intracytoplasmic sperm injection in women with polycystic ovarian syndrome. Acupunct. Med., 31(2):151-156.

[35]Research Group of Acupuncture Anesthesia, Peking Medical College, 1973. Effect of acupuncture on the pain threshold of human skin. Chin. Med. J., 3:151-157 (in Chinese).

[36]Research Group of Acupuncture Anesthesia, Peking Medical College, 1974. The role of some neurotransmitters of brain in finger-acupuncture analgesia. Sci. Sin., 17(1):112-130.

[37]Schild, R.L., Holthaus, S., D'Alquen, J., et al., 2000. Quantitative assessment of subendometrial blood flow by three-dimensional-ultrasound is an important predictive factor of implantation in an in-vitro fertilization programme. Hum. Reprod., 15(1):89-94.

[38]Stener-Victorin, E., Lindholm, C., 2004. Immunity and β-endorphin concentrations in hypothalamus and plasma in rats with steroid-induced polycystic ovaries: effect of low-frequency electroacupuncture. Biol. Reprod., 70(2):329-333.

[39]Stener-Victorin, E., Waldenstro, U., Wikland, M., et al., 2003. Electro-acupuncture as a peroperative analgesic method and its effects on implantation rate and neuropeptide Y concentrations in follicular fluid. Hum. Reprod., 18(7):1454-1460.

[40]Sun, R.Q., Wang, H.C., Jing, Z., et al., 2003. Electroacupuncture at 2 Hz relieved mechanical allodynia and cold-induced ongoing pain in rat model of neuropathic pain. Chin. J. Pain Med., 4(9):220-224 (in Chinese).

[41]Wang, Q., Mao, L., Han, J.S., 1992. Comparison of the antinociceptive effects induced by electroacupuncture and transcutaneous electrical nerve stimulation in the rat. Inrern. J. Neuromence, 65:117-129.

[42]Wang, S.M., Kain, Z.N., White, P., 2008. Acupuncture analgesia: I. The scientific basis. Anesth. Analg., 106(2):602-610.

[43]Wildt, L., Sir-Petermann, T., Leyendecker, G., et al., 1993. Opiate antagonist treatment of ovarian failure. Hum. Reprod., 8(Suppl. 2):168-174.

[44]Wu, Y., Robinson, N., Hardiman, P.J., et al., 2016. Acupuncture for treating polycystic ovary syndrome: guidance for future randomized controlled trials. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 17(3):169-180.

[45]Xu, G.Y., Li, G., Liu, N., et al., 2011. Mechanisms underlying purinergic P2X3 receptor-mediated mechanical allodynia induced in diabetic rats. Mol. Pain, 7:60.

[46]Zhan, M.J., Wang, H.M., 2008. Observation on therapeutic effects of electroacupuncture for obesity polycystic ovary syndrome. J. Acupunct. Tuina. Sci., 6(2):90-93.

[47]Zhang, J., Wang, X., Lü, R., 2013. Analgesic effect of acupuncture at Hegu (LI 4) on transvaginal oocyte retrieval with ultrasonography. J. Tradit. Chin. Med., 33(3):294-297.

[48]Zhang, R., Feng, X.J., Guan, Q., et al., 2011. Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study. Fertil. Steril., 96(4):912-916.

[49]Zhang, T., He, Y., Wang, Y., et al., 2016. The role of three-dimensional power Doppler ultrasound parameters measured on hCG day in the prediction of pregnancy during in vitro fertilization treatment. Eur. J. Obstet. Gynecol. Reprod. Biol., 203:66-71.

[50]Zhang, Y., Zhang, R.X., Zhang, M., et al., 2012. Electroacupuncture inhibition of hyperalgesia in an inflammatory pain rat model: involvement of distinct spinal serotonin and norepinephrine receptor subtypes. Br. J. Anaesth., 109(2):245-252.

[51]Zhao, H., Tian, Z.Z., Chen, B.Y., 2005. Electroacupuncture stimulates hypothalamic aromatization. Brain Res., 1037(1-2):164-170.

[52]Zhao, Z.Q., 2008. Neural mechanism underlying acupuncture analgesia. Prog. Neurobiol., 85(4):355-375.

[53]Zhou, J., Qu, F., 2009. Treating gynaecological disorders with traditional Chinese medicine: a review. Afr. J. Tradit. Complement. Altern. Med., 6(4):494-517.