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A Survey on Korean Medicine Doctors’ Recognition and Treatment for Developing Korean Medicine Clinical Practice Guideline of Female Infertility

Article information

J Korean Med. 2022;43(3):122-138
Publication date (electronic) : 2022 September 1
doi : https://doi.org/10.13048/jkm.22035
Hyo-Jeong Jung1orcid_icon, Dong-Il Kim1,orcid_icon, Su-Ji Choi1orcid_icon, Su-In Hwang2orcid_icon, Young-Jin Yoon2orcid_icon, Jang-Kyung Park2orcid_icon
1Dept. of Obstetrics & Gynecology, College of Korean Medicine, Dong-Guk University
2Dept. of Korean Medicine Obstetrics and Gynecology, School of Korean Medicine, Pusan National University
Correspondence to: Dong-Il Kim, Dept. of Korean Medicine Obstetrics & Gynecology, Ilsan Dong-Guk University Korean Medicine Hospital, 27 Dongguk ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea, Tel : +82-31-961-9060, Fax : +82-31-661-9339, E-mail: obgykdi@hanmail.net
Received 2022 July 20; Revised 2022 August 10; Accepted 2022 August 16.

Abstract

Objectives

This study was conducted to develop a Korean Medicine(KM) Clinical Practice Guidelines(CPG) of female infertility. We conducted this questionnaire survey to reflect the experiences of Korean Medicine doctors(KMD) and clinical field in Korea.

Method

We sent a questionnaire survey to KMD belonging to the Association of Korean Medicine by e-mail. We received 665 responds, and analyzed the answers.

Results

51.2% of respondents knew the previously developed CPG of female infertility, and 18.3% actually used. 83.3% agreed about the necessity of CPG of female infertility, and 80.3% had practical use plan. 90.2% of respondents treated less than 5 infertility woman for a month. 22.7% of respondents treated 50% of patients with collaborative treatment of KM and Western medical treatments. The main age group of patients was ‘35~40 years’(54.7%), and the most common cause was unexplained infertility(61.7%). The most common pattern identification of female infertility patients was Kidney deficiency(55.4%). KMD used 'a combination of decoction of herbal medicine, acupuncture and moxibustion treatment' the most(43%), and 'a decoction of herbal medicine treatment alone' was next(35%). 84.2% conducted lifestyle modification education about diet, stress, exercise etc.

Conclusion

We figured out Korean Medicine doctors' recognition about CPG of female infertility, preference of treatments, and also characteristics of patients visiting Korean Medical clinics to make a practical CPG reflecting clinical situation.

Keywords: Female Infertility; Clinical Practice Guideline; Survey; Korean Medicine Doctors’ Recognition
Fig. 1

Proportion of the patients with Western medical treatment of infertility during practice of Korean Medicine treatment

Fig. 2

Proportion of woman receiving treatment alone at Korean medical clinics

Fig. 3

The most common cause of female infertility patients treated with Korean Medical treatment alone or collaborative treatment with Western medical treatment

Fig. 4

A treatment of Korean Medicines that is performed when Korean Medical treatment is used alone or collaborative treatment with Western medical treatment are used

General Characteristics of the Respondents

Recognition and Utilization about Korean Medicine Clinical Practice Guidelines

Current Status of Infertility Treatment of Korean Medicine Doctors

Characteristics of the Patients Visiting Korean Medical Clinics for Infertility

Diagnostic Aspects Applied to Infertility Patients

Pattern Identification of Patients with Infertility

Acupuncture Points for Acupuncture and Moxibustion for Female Infertility Patients

Herbal Medicines for Female Infertility Patients

Lifestyle Modifications for Female Infertility Patients

References

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5. The Society of Korean Medicine Obstetrics and Gynecology. 2021. Korean medicine obstetrics & gynecology Seoul: Euiseongdang. p. 169.
6. Gurunath S., Pandian Z., Anderson R.A., Bhattacharya S.. 2011;Defining infertility- a systematic review of prevalence studies. Human Reproduction Update 17(5):575–88. https://doi.org/10.1093/humupd/dmr015 .
7. Choi S.J., Kim D.I., Park J.K., Lee M.Y.. 2019;A study assessing 2018 Gyenggi-do korean medicine support project for subfertility. J Korean Med 40(3):76–86. http://dx.doi.org/10.13048/jkm.19028 .
8. Yun Y.S., Jeong S.M., Yang S.J., Cho S.H.. 2022;A study reporting the korean medicine treatment infertility support program in Gwang-ju metropolitan city in 2021. J Korean Obstet Gynecol 35(2):1–15. https://doi.org/10.15204/jkobgy.2022.35.2.001 .
9. Kim D.I.. 2022;A Literature Study on Korean Medicine Treatment of Infertility due to Diminished Ovarian Reserve. J Korean Obstet Gynecol 35(1):12–33. https://doi.org/10.15204/jkobgy.2022.35.1.012 .
10. Special Countermeasures Committee for Low Fertility and Population Aging of The Association of Korean Medicine. 2010. Korean Medicine Clinical Practice Guideline for Infertility The Association of Korean Medicine. p. 1–144.
11. The Society of Korean Medicine Obstetrics and Gynecology. 2017;Korean Medicine Standard Recommendation for Female Infertility. J Korean Obstet Gynecol :1–26.
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13. The Society of Korean Medicine Obstetrics and Gynecology. 2021. Korean medicine obstetrics & gynecology Seoul: Euiseongdang. p. 169–187.

Article information Continued

Fig. 1

Fig. 1

Proportion of the patients with Western medical treatment of infertility during practice of Korean Medicine treatment

Fig. 2

Fig. 2

Proportion of woman receiving treatment alone at Korean medical clinics

Fig. 3

Fig. 3

The most common cause of female infertility patients treated with Korean Medical treatment alone or collaborative treatment with Western medical treatment

Fig. 4

Fig. 4

A treatment of Korean Medicines that is performed when Korean Medical treatment is used alone or collaborative treatment with Western medical treatment are used

Table 1

General Characteristics of the Respondents

Variables N %
Gender (N=664) Male 476 71.7
Female 188 28.3
Age (N=664) 20s 49 7.4
30s 229 34.5
40s 246 37.0
50s 113 17.0
≥60s 27 4.1
Clinical career (N=664) < 5 years 84 12.7
5–10 years 186 28.0
10–15 years 127 19.1
15–20 years 106 16.0
20–25 years 81 12.2
25–30 years 41 6.2
≥ 30 years 39 5.9
Type of institution (N=664) Korean Medicine clinic 483 72.7
Korean Medicine hospital (other) 71 10.7
Korean Medicine hospital (university-affiliated) 44 6.6
Gynecology specialized Korean Medicine clinic 23 3.5
Nursing hospital 19 2.9
Public health center 16 2.4
Hospital 5 0.8
Government agencies, Research institution 1 0.2
Other 2 0.3
Specialty (N=664) Yes 181 27.3
No 483 72.7
Specialized Practitioner (N=181) Internal Medicine 54 29.8
Acupuncture & Moxibustion 40 22.1
Gynecology 40 22.1
Ophthalmology, Otorhinolaryngology & Dermatology 13 7.2
Rehabilitation Medicine 12 6.6
Sasang Constitutional 11 6.1
Neuropsychiatry 6 3.3
Paediatrics 5 2.8

Table 2

Recognition and Utilization about Korean Medicine Clinical Practice Guidelines

Variables N %
Recognition and utilization about previously developed female infertility CPG* (N=664) Didn’t know 324 48.8
Know 340 51.2
Very actively used 29 4.4
Actively used 92 13.9
Moderately used 157 23.6
Rarely used 37 5.6
Never used 25 3.8
Recognition and utilization about Previously Developed other CPGs (N=664) Didn’t know 224 33.7
Know 440 66.3
Very actively used 30 4.5
Actively used 108 16.3
Moderately used 197 29.7
Rarely used 60 9.0
Never used 45 6.8
Necessity of developing female infertility CPG (N=664) Certainly necessary 294 44.3
Necessary 259 39.0
Moderately necessary 107 16.1
Unnecessary 3 0.5
Certainly unnecessary 1 0.2
Practical use plan of female infertility CPG (N=664) Very actively use 267 40.2
Actively use 266 40.1
Moderately use 122 18.4
Rarely use 7 1.1
Never use 2 0.3

CPG : Clinical Practice Guideline

Table 3

Current Status of Infertility Treatment of Korean Medicine Doctors

Variables N %
Clinical career for Infertility (N=664) < 5 years 195 29.4
5–10 years 150 22.6
10–15 years 109 16.4
15–20 years 71 10.7
20–25 years 89 13.4
25–30 years 21 3.2
≥ 30 years 29 4.4
Average number of patients with infertility per month (N=664) 0 77 11.6
1 355 53.5
2 116 17.5
3 45 6.8
4 5 0.8
5–10 34 5.1
10–15 18 2.7
≥15 14 2.1
Average duration for treatment of patients with infertility (N=587) 1 month 23 3.9
2 months 44 7.5
3 months 277 47.2
4 months 24 4.1
5 months 7 1.2
6 months 169 28.8
≥7 months 43 7.3
Average visiting days of a patient with infertility per month (N=587) ≦ 1 111 18.9
2 133 22.7
3 49 8.3
4 132 22.5
≥5 162 27.6

Table 4

Characteristics of the Patients Visiting Korean Medical Clinics for Infertility

Variables N %
Main age group of patients with infertility <30 16 2.7
30–35 196 33.4
35–40 321 54.7
≥40 54 9.2
Period of infertility 1–2 years 92 15.7
2–3 years 228 38.8
3–4 years 130 22.1
≥4 years 137 23.3
Cause of infertility Ovulation disorders 107 18.2
Fallopian tube abnormalities 24 4.1
Uterine abnormalities 87 14.8
Unexplained 362 61.7
Others 7 1.2
Proportion of patients who have undergone gynecological examinations before visiting KM clinics 0–20 % 26 4.4
20–40 % 37 6.3
40–60 % 73 12.4
60–80 % 69 11.7
80–99% 232 39.6
100 % 150 25.6

KM : Korean Medical

Table 5

Diagnostic Aspects Applied to Infertility Patients

Variables N %
Experience and cause of request for cooperation with Obstetrics and Gynecology or infertility clinics Didn't experience 440 75
Experienced 147 25
Cause (N=147) infertility examination 109 74.1
medical treatment 25 17
patient's wants 13 8.8
Utilization of Korean medical tests Not used 369 62.9
Used 218 37.1
Type of Korean medical test (N=218) Heart Rate Variability 140 64.2
Bioelectrical Impedance Analyzer 116 53.2
Thermography 81 37.2
Yangdorak (Ryodoraku) 35 8.4
Pulse Analyzer 29 7.0
Other 14 6.4

Table 6

Pattern Identification of Patients with Infertility

Pattern Identification N %
Kidney deficiency 325 55.4
Stagnation of liver qi 297 50.6
Blood deficiency 288 49.1
Dampness-Phlegm 278 47.4
Blood stagnation 260 44.3
Damp-Heat 84 14.3
Other 18 3.1

Table 7

Acupuncture Points for Acupuncture and Moxibustion for Female Infertility Patients

Acupuncture point KM treatment alone N(%) KM & WM collaborative treatment N(%)
(N=426) (N=412)
Acupuncture SP6 305(71.6%) 299(72.6%)
CV4 222(52.1%) 221(53.6%)
ST36 155(36.4%) 149(36.2%)
SP9 136(31.9%) 143(34.7%)
LR3 130(30.5%) 115(27.9%)
CV6 125(29.3%) 128(31.1%)
SP10 100(23.5%) 91(22.1%)
CV12 95(22.3%) 88(21.4%)
EX-CA1 78(18.3%) 72(17.5%)
KI3 60(14.1%) 68(16.5%)
(N=359) (N=341)
Moxibustion CV4 320(89.1%) 300(88%)
SP6 86(24%) 86(25.2%)
BL23 75(20.9%) 73(21.4%)
胞門 30(8.4%) 28(8.2%)
SP11 25(7%) 26(7.6%)

KM : Korean medical, WM : Western medical

Table 8

Herbal Medicines for Female Infertility Patients

herbal medicine KM treatment alone N(%) KM & WM collaborative treatment N(%)
N=559 N=522
Decoction of herbal medicine Jokyeongjongok-tang 387(69.2%) 343(65.7%)
Onkyungtang 274(49%) 253(48.5%)
Kwibi-tang 161(28.8%) 150(28.7%)
Gaeuljongok-tang 128(22.9%) 116(22.2%)
Yuglinju 82(14.7%) 73(14%)
Changbudodam-tang 72(12.9%) 61(11.7%)
(N=173) (N=169)
Granulation or pill types of herbal medicine Geijibokryunghwan 77(44.5%) 70(41.4%)
Onkyungtang 71(41%) 78(46.2%)
Gamisoyo-san 63(36.4%) 65(38.5%)
GamiKwibi-tang 60(34.7%) 68(40.2%)
Dangui-jakyak-san 47(27.2%) -
Samul-tang 36(20.8%) 36(21.3%)

KM : Korean medical, WM : Western medical

Table 9

Lifestyle Modifications for Female Infertility Patients

N (N=494) %
Diet 393 79.6
Stress 384 77.7
Exercise 352 71.3
Alcohol 338 68.4
Intercourse 311 63.0
Smoking 300 60.7
Caffeine 255 51.6
Other 11 2.2