Patterns of Traditional Chinese Medicine Prescription During Assisted Reproduction in Taiwan: A Population-Based Study

Patterns of Traditional Chinese Medicine Prescription During Assisted Reproduction in Taiwan: A Population-Based Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patterns of Traditional Chinese Medicine Prescription During Assisted Reproduction in Taiwan: A Population-Based Study Yi-Chia Shen, Pei-Rung Yang, I-Yun Lee, Wei-Tai Shih, Yao-Hsu Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4932541/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Traditional Chinese medicine (TCM) is widely applied in assisted reproductive technology (ART). However, TCM drug utilization and prescription patterns in assisted reproduction remain unclear. This study was conducted to analyze these patterns. Methods Using data from Taiwan’s Artificial Reproductive Database and National Health Insurance Research Database, we analyzed the frequency of TCM prescriptions and the proportions in which different herbal formulae and individual herbs were prescribed to patients undergoing ART procedures. In addition, common TCM prescription patterns were investigated through association rule learning. Results In total, 59,266 women undergoing 110,329 ART cycles were enrolled in this study. TCM was used in 27,782 ART cycles (25.18%). Jiawei xiaoyao san and tusizi (Semen cuscutae) were the most commonly used herbal formulae and individual herbs used during ART procedures. Conclusions This study demonstrates TCM use patterns in assisted reproduction. Further studies are necessary to evaluate the efficacy and safety of TCMs prescribed during assisted reproduction. Assisted reproductive technology Traditional Chinese medicine Artificial reproductive database National health insurance research database Figures Figure 1 Introduction Assisted reproductive technology (ART) is used to increase fertility. Approximately 2–3% of children are born after assisted reproduction in Europe and the United States.[ 1 , 2 ] Despite a considerable increase in ART use, the rates of successful implantation and delivery have improved only slightly over time.[ 3 ] To increase the likelihood of pregnancy and live birth rates, many individuals use traditional Chinese medicine (TCM) as a complementary treatment to ART. Combining ART with TCM leads to higher pregnancy rates than does the use of ART alone.[ 4 – 7 ] TCM practitioners prescribe various treatments, including TCM decoctions, acupuncture, and manipulative therapy. The use of TCM varies widely across countries, ranging from 9–65%.[ 8 ] Compared with traditional decoctions, compound herbal preparations (CHPs) are advantageous in terms of consistent quality and convenience. CHPs comprising a single herb or herbal formula are fully covered by Taiwan’s National Health Insurance (NHI) and are therefore widely prescribed by TCM practitioners in Taiwan.[ 9 ] Two or more individual herbs can be combined in a herbal formula. TCM practitioners tailor their prescriptions by selecting one or more herbal formulae and several individual herbs on the basis of patient condition and constitution. However, the patterns of TCM drug use and prescription in assisted reproduction remain unclear. The Artificial Reproductive Database (ARD) contains comprehensive records of women undergoing ART procedures in Taiwan. The National Health Insurance Research Database (NHIRD), which contains insurance claim data of > 99% of Taiwan’s population, is a valuable resource for pharmacoepidemiological research; this is because of the NHIRD contains longitudinal data regarding the use of both Western medicines and TCMs. In this study, we analyzed the patterns of TCM drug use and prescription during assisted reproduction in Taiwan. Materials and Methods Data sources Taiwan’s ARD was established in 1998. Artificial reproduction institutions in Taiwan regularly submit corresponding data regarding artificial reproduction procedures. The number of artificial reproduction institutions approved by the competent authority in Taiwan has increased from 48 in 1998 to 85 in 2020. The ARD collects comprehensive medical data, including patient information related to artificial reproduction. To ensure privacy, data in the ARD are deidentified: fields containing direct identifiers such as names and addresses are removed, and information pertaining to identification number, institution code, date of birth, date of medical treatment, and date of admission are masked or blocked as appropriate. The Taiwanese government introduced the NHI program in March 1995, ensuring comprehensive health insurance coverage for almost the entire population of Taiwan. Because NHI is mandatory for all residents, the NHIRD contains comprehensive health-related data and covers almost the entire population of approximately 23.2 million. It contains patients’ medical data such as information on health-care facilities and specialties, medication use, treatment and management approaches, patient demographics (e.g., sex and date of birth), clinical visit or hospitalization dates, hospital transfer identification codes, and diagnoses. As an anonymous database, the NHIRD adheres to the strict guidelines and regulations established by Taiwan’s National Health Research Institutes for protecting patient privacy. The NHIRD data can be used only for research purposes. To ensure patient anonymity in the present study, relevant information was deidentified before analysis. The requirement for informed consent was waived by the Research Ethics Review Board of Chang Gung Memorial Hospital (Chiayi Branch, Taiwan), which approved the use of the NHIRD database in accordance with their ethical standards. Study subjects Our study cohort was selected from the ARD. It comprised individuals who had undergone ART procedures between January 1, 2008, and December 31, 2016, and were registered in the ARD. Individuals without health insurance coverage, using sperms or eggs from other sources, or undergoing consecutive ART procedures within 14 days were excluded from the study. We tracked the study cohort from 90 days before the embryo implantation date of the ART procedure until the day of embryo implantation. Thus, our study encompassed almost all women undergoing ART procedures in Taiwan between January 1, 2008, and December 31, 2016. The use of TCM was defined as receiving at least one TCM prescription during the follow-up period, whereas TCM nonuse referred to not receiving any TCM prescription during this period. Data regarding TCM drug use and prescription patterns in our cohort were extracted from the NHIRD. Study variables We investigated patient demographics to identify key independent variables influencing the use of TCM. The patients were stratified by age (≤ 24, 25–29, 30–34, 35–39, and ≥ 40 years), ART cycle count (1–3, 4–6, 7–12, or > 12), urbanization level (very high to low; on the basis of the location of NHI registration), and monthly insurance fees (NT $ 0, NT $ 1–15,840, NT $ 15,841–25,000, and more than NT $ 25,000). The following ART-related information collected from the ARD served as independent variables: infertility causes (fallopian tube–related factors, ovarian factors, endometriosis, other uterine factors, other female sex–related factors, male sex–related factors, multiple factors, or unknown factors). ART procedure was classified as follows: in vitro fertilization/embryo transfer and other methods. Traditional Chinese medicine The list of CHPs whose fees can be reimbursed under NHI was acquired from the National Health Insurance Administration website. Subsequently, specific drug information pertaining to each mixture or product name was obtained from the website of the National Research Institute of Chinese Medicine, Ministry of Health and Welfare. This information encompassed details such as the proportion of each constituent, date and duration of drug approval, names of drugs, and codes assigned to the drug manufacturers. Statistical analysis The drug registration numbers obtained from the website of the National Research Institute of Chinese Medicine were linked to the outpatient visit records of the ART cohort. The frequencies and proportions of prescriptions involving herbal formulae and individual herbs were analyzed. For each prescription, daily doses and average prescription durations were calculated. TCM practitioners typically treat patients using a single herbal formula or a combination of two or more herbal formulae. Through association rule learning, we identified CHP coprescription patterns for patients undergoing ART treatment. The support factor, which represents the proportion of coprescriptions of two medications (e.g., medications A and B) among all prescriptions, was determined for each CHP. The confidence factor, indicating the proportion of coprescriptions of, for example, medications A and B among all prescriptions containing medication A, was also calculated. Data linkage and the calculation of descriptive statistics regarding the patterns of drug use were performed using SAS (version 9.4; SAS Institute, Cary, NC, USA). Results We excluded 14 women without NHI coverage, 5,048 couples who used sperms or eggs from other sources, and 18 women who underwent consecutive ART procedures (implantation) within 14 days. Finally, 59,266 women (total number of cycles: 110,329) were included in the study (Fig. 1 ). Patient characteristics are summarized in Table 1 . The distribution of women by age was as follows: 171 (0.29%) were aged ≤ 24 years, 3,969 (6.70%) were aged 25–29 years, 20,774 (35.05%) were aged 30–34 years, 24,630 (41.56%) were aged 35–39 years, and 9,722 (16.40%) were aged ≥ 40 years. Among the women, 53,537 (90.33%) underwent ART procedures 1–3 times. Table 1 Characteristics of the assisted reproductive technology treatment population in the artificial reproductive database and the national health insurance research database. Characteristics N % Total 59,266 100.00% Embryo age* ≤ 24 171 0.29% 25–29 3,969 6.70% 30–34 20,774 35.05% 35–39 24,630 41.56% ≥ 40 9,722 16.40% ART times 1–3 53,537 90.33% 4–6 4,996 8.43% 7–12 715 1.21% > 12 18 0.03% Urbanization Very high 16,660 28.11% High 31,559 53.25% Moderate 7,661 12.93% Low 3,386 5.71% Income level 0 49 0.08% 1-15840 4,117 6.95% 15841–25000 19,410 32.75% ≥ 25001 35,690 60.22% * Embryo age: Age of the first embryo conceived after 2008 The demographic characteristics of patients who used and did not use TCM during assisted reproduction are presented in Table 2 . Of the total 110,329 ART cycles involving 59,266 women, TCM was used during 27,782 cycles (25.2%) and not used during 82,547 cycles (74.8%). The number and proportion of ART cycles during which TCM was used in each age group were as follows: 38 cycles (16.52%) in women aged ≤ 24 years, 1,228 cycles (20.89%) in women aged 25–29 years, 7,758 cycles (23.11%) in women aged 30–34 years, 12,061 cycles (25.49%) in women aged 35–39 years, and 6,697 cycles (28.70%) in women aged ≥ 40 years. Table 2 Demographic characteristics of traditional Chinese medicine (TCM) used and non-used during assisted reproductive technology (ART) process Total TCM use TCM non-use Characteristics N (%) N (%) N (%) P Total cycles 110,329 100.0% 27,782 25.18% 82,547 74.82% Age < 0.001 ≤ 24 230 0.2% 38 0.1% 192 0.2% 25–29 5,879 5.3% 1,228 4.4% 4,651 5.6% 30–34 33,563 30.4% 7,758 27.9% 25,805 31.3% 35–39 47,320 42.9% 12,061 43.4% 35,259 42.7% ≥ 40 23,337 21.2% 6,697 24.2% 16,640 20.2% TCM used before < 0.001 Yes 93,949 85.2% 26,885 96.8% 67,064 81.2% No 16,380 14.8% 897 3.2% 15,483 18.8% First time of ART < 0.001 First 59,266 53.7% 14,311 51.5% 44,955 54.5% Not first 51,063 46.3% 13,471 48.5% 37,592 45.5% Causes of infertility < 0.001 Fallopian tube factors 14,462 13.1% 3,460 12.5% 11,002 13.3% Ovarian factors 7,885 7.1% 1,936 7.0% 5,949 7.2% Endometriosis 2,308 2.1% 587 2.1% 1,721 2.1% Other uterine factors 1,609 1.5% 411 1.5% 1,198 1.5% Other female factors 32,059 29.1% 8,430 30.3% 23,629 28.6% Male factor 20,181 18.3% 4,817 17.3% 15,364 18.6% Multiple factors 27,101 24.6% 7,007 25.2% 20,094 24.3% Unknown reason 4,724 4.3% 1,134 4.1% 3,590 4.3% Approach 0.010 IVF/ET 108,348 98.2% 27,248 98.1% 81,100 98.2% Others 1,981 1.8% 534 1.9% 1,447 1.8% Pregnant < 0.001 Yes 45,819 41.5% 11,160 40.2% 34,659 42.0% No 64,510 58.5% 16,622 59.8% 47,888 58.0% Among the 93,949 ART cycles involving women with previous TCM use, TCM was used during 26,885 cycles (28.62%) and not used during 67,064 cycles (71.38%). Among the 16,380 ART cycles involving women without previous TCM use, TCM was used during 897 cycles (5.48%) and not used during 15,483 cycles (94.52%). Of the total 59,266 first-time ART cycles, TCM was used during 14,311 cycles (24.15%) and not used during 44,955 cycles (75.85%). Among the 51,063 ART cycles involving women that had previously undergone ART procedures, TCM was used during 13,471 cycles (26.38%) and not used during 37,592 cycles (73.62%). The least and most common infertility causes associated with TCM use were male sex–related factors (23.87%) and other female sex–related factors (26.30%), respectively. Among the 45,819 ART cycles resulting in pregnancy, TCM was used during 11,160 cycles (24.36%). A summary of the herbal formulae and individual herbs most commonly prescribed by TCM practitioners during assisted reproduction is presented in Table 3 . Among the 110,640 TCM records in the ART cohort, the most prescribed herbal formulae were jiawei xiaoyao san (16.0%), danggui shaoyao san (12.8%), wen jing tang (10.5%), zuo gui wan (9.1%), and guizhi fuling wan (8.0%). The most frequently prescribed individual herbs were tusizi (Semen cuscutae; 18.1%), xiang fu (Rhizoma cyperi; 12.5%), yi mu cao (Herba leonuri; 10.3%), nuzhenzi (Fructus ligustri lucidi; 9.5%), and danshen (Radix salvia miltiorrhiza; 8.7%). The average daily dose of individual herbs ranged from 1.0 to 1.3 g, whereas that of herbal formulae ranged from 3.9 to 5.4 g. The average prescription durations for individual herbs and herbal formulae ranged from 5.7 to 8.1 days. Table 3 Top 10 herbal formulae and single herbs prescribed by traditional Chinese medicine Practitioners during assisted reproduction (Total prescriptions = 110,640). Frequency of prescription Average daily dose Average duration for prescription N % g days Single Herb Tusizi (Semen Cuscutae) 19,980 18.1% 1.3 7.5 Xiang fu (Rhizoma Cyperi) 13,823 12.5% 1.0 7.3 Yi mu cao (Herba Leonuri) 11,391 10.3% 1.1 7.1 Nuzhenzi (Fructus Ligustri Lucidi) 10,459 9.5% 1.1 7.1 Danshen (Radix Salvia Miltiorrhizae) 9,610 8.7% 1.2 7.3 Xuduan (Radix Dipsaci) 9,318 8.4% 1.2 7.6 Duzhong (Cortex Eucommiae) 8,661 7.8% 1.1 7.4 Sang ji sheng (Taxillus chinensis) 7,058 6.4% 1.1 7.6 Huangqin (Radix Scutellariae) 6,954 6.3% 1.2 8.1 Han lian cao (Herba Ecliptae) 6,886 6.2% 1.2 7.0 Herbal formulae Jiawei xiaoyao san 17,724 16.0% 4.1 7.4 Danggui shaoyao san 14,130 12.8% 4.3 7.1 Wen jing tang 11,612 10.5% 4.2 7.4 Zuo gui wan 10,064 9.1% 4.2 8.0 Guizhi fuling wan 8,808 8.0% 3.8 7.4 You gui wan 7,300 6.6% 3.9 7.4 Liuwei dihuang wan 5,496 5.0% 4.0 7.4 Guipi tang 5,351 4.8% 4.3 7.7 Shenling baizhu san 5,214 4.7% 5.4 5.7 Shaofu zhuyu tang 4,692 4.2% 3.9 7.0 The association rules for TCM prescriptions during ART procedures are shown in Table 4 . The most commonly prescribed combination of two herbal formulae was jiawei xiaoyao san and danggui shaoyao san , with a support factor of 2.12%. The most frequently prescribed combination of a herbal formula and an individual herb was jiawei xiaoyao san and tusizi , with a support factor of 3.68%. The most commonly prescribed combination of two individual herbs was nuzhenzi and han lian cao (Herba ecliptae), with a support factor of 5.00%. Table 4 Co-prescriptions (one to one association) of single herbs and herbal formulae for the assisted reproductive technology treatment population Herbal associations Support (%) Confidence (%) Transaction count Association rule Single herb to single herb 5.00% 52.86% 5,529 Nuzhenzi (Fructus Ligustri Lucidi) = > Han lian cao (Herba Ecliptae) 3.52% 19.48% 3,893 Tusizi (Semen Cuscutae) = > Nuzhenzi (Fructus Ligustri Lucidi) 3.12% 17.28% 3,452 Tusizi (Semen Cuscutae) = > Xuduan (Radix Dipsaci) 3.11% 17.20% 3,436 Tusizi (Semen Cuscutae) = > Xiang fu (Rhizoma Cyperi) 3.04% 16.83% 3,363 Tusizi (Semen Cuscutae) = > Yin yang huo (Herba Epimedii) Herbal formula to herbal formula 2.12% 13.25% 2,349 Jiawei xiaoyao san = > Danggui shaoyao san 1.81% 14.15% 2,000 Danggui shaoyao san = > Wen jing tang 1.79% 11.18% 1,982 Jiawei xiaoyao san = > Zuo gui wan 1.67% 10.42% 1,847 Jiawei xiaoyao san = > Wen jing tang 1.43% 11.20% 1,583 Danggui shaoyao san = > Guizhi fuling wan Herbal formula to single herb 3.68% 23.00% 4,077 Jiawei xiaoyao san = > Tusizi (Semen Cuscutae) 3.29% 25.74% 3,637 Danggui shaoyao san = > Tusizi (Semen Cuscutae) 3.03% 18.93% 3,356 Jiawei xiaoyao san = > Xiang fu (Rhizoma Cyperi) 2.89% 27.57% 3,202 Wen jing tang = > Tusizi (Semen Cuscutae) 2.22% 17.35% 2,451 Danggui shaoyao san = > Xiang fu (Rhizoma Cyperi) Discussion To the best of our knowledge, this study is the first to utilize a comprehensive national sample to assess TCM prescription patterns for patients undergoing ART procedures. With only a negligible number of individuals deemed ineligible, our study included most women in Taiwan who undergone ART procedures between 2008 and 2016. Although TCM has been widely used during ART procedures in Taiwan, a comprehensive understanding of its prescription and use patterns in this context has been lacking. Leveraging the combined data of the NHIRD and the ARD, we performed a meticulous analysis of TCM use during ART procedures; the findings provide insights into TCM prescription patterns and thus may help develop a framework for effective TCM prescriptions for patients undergoing ART procedures. Earlier studies have revealed that a substantial majority of women experiencing infertility (96.17%) have received TCM prescriptions in conjunction with gynecological interventions.[ 6 ] However, the proportion of women receiving TCM and using ART is relatively low at 25.18%. This significant discrepancy in TCM use may be because of the tendency of gynecologists to advise women undergoing ART procedures to limit their use of alternative therapies during the treatment period to minimize potential interactions and optimize treatment effectiveness. Herein, we offer plausible explanations for the differences in TCM use based on patient characteristics. Certain characteristics appear to contribute to an increased likelihood of TCM utilization during ART procedures; these characteristics include advanced age, TCM use history, ART procedure history, and infertility due to other female sex–related factors. Conversely, young age, no previous TCM use, no previous ART treatment, or infertility stemming from male sex–related factors appeared to be associated with a reduced likelihood of TCM usage. Studies have demonstrated that older age is correlated with lower egg retrieval levels, pregnancy rates, and live birth rates in individuals undergoing ART procedures[ 10 , 11 ]; therefore, older age may enhance individuals’ inclination to seek TCM interventions. In this study, the three most prevalent formulations used during ART were jiawei xiaoyao san , danggui shaoyao san , and wen jing tang . These three formulations have consistently emerged as the most commonly used TCM formulae in relevant studies involving patients with infertility.[ 6 , 12 ] A study indicated that the most frequently utilized formulations, namely, jiawei xiaoyao san , wen jing tang , danggui shaoyao san , and guizhi fuling wan , are the most effective TCM formulae in enhancing female fertility.[ 12 ] These formulations are also commonly used to treat conditions such as endometriosis and uterine fibroids.[ 13 , 14 ] Jiawei xiaoyao san is effective in the treatment of premenstrual syndrome and possesses antianxiety properties.[ 15 , 16 ] Although the precise mechanism of jiawei xiaoyao san in ART-based treatment remains unclear, this herbal formula is widely prescribed for various gynecological conditions, including primary dysmenorrhea, premenstrual syndrome, polycystic ovary syndrome, and dysfunctional uterine bleeding.[ 17 – 20 ] It is considered to be the most commonly utilized Chinese herbal formula for these gynecological ailments. Danggui shaoyao san is frequently used to treat various gynecological conditions.[ 17 – 20 ] In patients with dysmenorrhea, it suppresses prostaglandin F2α and acetylcholine-induced uterine contractions.[ 21 ] Danggui shaoyao san has also exhibited efficacy in alleviating premenstrual syndrome symptoms,[ 22 ] improving luteal insufficiency in women[ 23 ], and exerting antidepressant effects in mouse and rat models of depression.[ 24 ] Clinical studies have highlighted the efficacy of danggui shaoyao san in addressing mild to moderate anemia symptoms associated with uterine fibroids.[ 25 ] Wen jing tang is effective against various menstrual disorders, abnormal uterine bleeding, and infertility.[ 26 ] It is effective in treating ovulation disorders and improving endocrine status in patients with polycystic ovary syndrome.[ 27 ] Furthermore, wen jing tang is clinically beneficial for women with anovulation or infertility.[ 28 ] Guizhi fuling wan is a frequently prescribed remedy for uterine fibroids and endometriosis in Taiwan.[ 13 , 14 ] It is recognized for its efficacy in managing menorrhagia and dysmenorrhea and treating uterine fibroids.[ 29 , 30 ] Guizhi fuling wan can stimulate the corpus luteum to secrete progesterone[ 31 ] and thus can be used to treat various gynecological conditions. Tusizi is widely recognized for its frequent use in the treatment of male and female infertility.[ 6 , 32 ] Studies have highlighted tusizi ’s antioxidant properties as well as its ability to scavenge free radicals and modulate immune responses.[ 33 ] It is also effective in treating ovarian endocrine dysfunction in rats subjected to psychological stress.[ 34 ] Xiang fu is a potent antioxidant.[ 35 ] Extracts of xiang fu have exhibited prominent antioxidant and antimutagenic activities.[ 36 ] It has also been demonstrated to exert estrogen-like and neuroprotective effects on estrogen-deficient mice.[ 37 ] Yi mu cao exhibits various functions, including the alleviation of uterine spasms, suppression of inflammation, and increase of serum progesterone levels; these functions make y i mu cao a valuable herb for dysmenorrhea treatment.[ 38 – 40 ] It is frequently prescribed individually for polycystic ovary syndrome.[ 19 ] Both xiang fu and yi mu cao are commonly used to treat patients with uterine fibroids.[ 13 ] Yi mu cao extract has exhibited antidepressant effects in mice and improved hippocampal neuronal damage in mice experiencing chronic mild stress.[ 41 ] Danshen is renowned for its antioxidant, anti-inflammatory, and dysmenorrhea-relieving properties.[ 42 – 44 ] It enhances estrogenic effects in ovariectomized rats.[ 45 ] Danshen is key in the treatment of various gynecological diseases, including menstrual disorders, female genital pain, and menopausal disorders.[ 46 ] On the basis of symptom differences and treatment principles, TCM practitioners prescribe CHPs to patients undergoing ART procedures. However, CHP prescriptions vary because of the differences among TCM practitioners in experience and knowledge. In this study, we found that the patterns of combined CHP prescriptions by TCM practitioners were different from those of decoctions. TCM practitioners typically use fully documented prescriptions based on TCM theory as a core prescription. They may make modifications by adding herbs to a decoction to address a specific patient condition. However, when using CHPs, TCM practitioners can only add individual herbs to the core formula. They are unable to remove herbs in a CHP or alter their proportions. To provide personalized treatment, TCM practitioners may combine other formulae or herbs in a prescription on the basis of patient needs. The reimbursement policy of the NHI in Taiwan only covers CHPs and not decoctions. This policy may lead to the frequent coprescription of CHPs with high support factors by TCM practitioners in Taiwan.[ 47 ] This could explain why four of the six individual herbs in danggui shaoyao san are also present in jiawei xiaoyao san and why the combination of these two formulae is the most frequently prescribed CHP combination for patients using ART. In our study, the most common combination of herbal formulae prescribed was jiawei xiaoyao san with danggui shaoyao san . The most common combination of a herbal formula and an individual herb was that of jiawei xiaoyao san with tusizi , one of the two most frequently prescribed herbal formulae and the most frequently prescribed individual herb (Table 3 ). However, the most commonly prescribed combination of individual herbs was that of nuzhenzi and han lian cao , rather than the two most commonly individually prescribed herbs. This combination involved the first and tenth most commonly prescribed individual herbs (Table 3 ). The blending of nuzhenzi and han lian cao produces er zhi wan , which can enhance hematopoietic stem cell functionality, suppress oxidation, and stimulate the immune system.[ 48 – 50 ] Our study has three limitations. First, because of the varied diagnostic approaches adopted by TCM practitioners, symptoms rather than specific disease names are often used for diagnosis. Consequently, in certain cases in our study, ascertaining whether a patient’s treatment goals were directly associated with ART was impossible. Nonetheless, the objective of this study was to investigate the use of TCM during ART-based treatment. Thus, the purpose for which TCM was employed is not directly related to the findings of this study. Second, the NHI program only covers the cost of CHPs dispensed by TCM practitioners. Data on CHPs or decoctions obtained by women directly from pharmacies are not captured in the NHIRD; therefore, these treatments were not accounted for in this study. Consequently, the use of TCM by patients undergoing ART procedures may have been underestimated.[ 51 ] Finally, the prescription duration recorded in the database represented the duration of treatment prescribed by TCM practitioners and did not necessarily reflect the actual duration of medication use by the patients. Conclusions To the best of our knowledge, this is the first large-scale population-based study on TCM use by patients undergoing ART procedures. The prescription patterns identified in this study hold promising implications for future clinical and pharmacological investigations. Future studies are warranted to ascertain whether women’s exposure to TCM during ART procedures influences ART outcomes. Future studies should also provide additional evidence concerning the safety and efficacy of the aforementioned CHPs, thereby advancing our understanding of their therapeutic potential. Clinical trial number: not applicable. Abbreviations TCM traditional Chinese medicine ART assisted reproductive technology CHPs compound herbal preparations NHI National Health Insurance ARD Artificial Reproductive Database NHIRD National Health Insurance Research Database. Declarations Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Consent for publication All authors agree to publish this article. Author details 1 Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan. 2 School of Traditional Chinese medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. 3 Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan. Funding This study received support through a grant from Chang Gung Memorial Hospital, Chia-yi Branch (CFRPG6K0081). Author Contribution Yi-Chia Shen: study conception and design, drafting of manuscript. Pei-Rung Yang: analysis and interpretation of data. I-Yun Lee: analysis and interpretation of data. Wei-Tai Shih: study conception and design, critical revision. Yao-Hsu Yang: study conception and design, acquisition of data, critical revision. Acknowledgement The authors express their gratitude to the Health Information and Epidemiology Laboratory at the Chiayi Branch of Chang Gung Memorial Hospital for their valuable assistance in data analysis. Data availability Data will be made available on request. References Sunderam S, Kissin DM, Zhang Y, Folger SG, Boulet SL, Warner L, Callaghan WM, Barfield WDJMSS. Assisted reproductive technology surveillance—United States, 2016. 2019, 68(4):1. Wyns C, Bergh C, Calhaz-Jorge C, De Geyter C, Kupka M, Motrenko T, Rugescu I, Smeenk J. Tandler-Schneider AJHro: ART in Europe, 2016: results generated from European registries by ESHRE. 2020, 2020(3):hoaa032. 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Effects of switching to wen-jing-tang (unkei-to) from preceding herbal preparations selected by eight-principle pattern identification on endocrinological status and ovulatory induction in women with polycystic ovary syndrome. 2006, 34(02):177–87. Ushiroyama, TJRm. biology: Endocrinological actions of Unkei-to, a herbal medicine, and its clinical usefulness in anovulatory and/or infertile women. 2003, 2(2):45–61. Sun L, Liu L, Zong S, Wang Z, Zhou J, Xu Z, Ding G, Xiao W. Kou JJJoe: Traditional Chinese medicine Guizhi Fuling capsule used for therapy of dysmenorrhea via attenuating uterus contraction. 2016, 191:273–9. Sakamoto S, Yoshino H, Shirahata Y, Shimodairo K, Okamoto, RJTAjoCm. Pharmacotherapeutic effects of kuei-chih-fu-ling-wan (keishi-bukuryo-gan) on human uterine myomas. 1992, 20(03n04):313–7. Usuki SJTAJCM. Effects of hachimijiogan, tokishakuyakusan and keishibukuryogan on progesterone secretions by corpus luteum. 1987, 15(03n04):109–15. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4932541","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":358331028,"identity":"e067b427-56fe-49a7-91ed-fef159c35642","order_by":0,"name":"Yi-Chia Shen","email":"","orcid":"","institution":"Chiayi Chang Gung Memorial Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yi-Chia","middleName":"","lastName":"Shen","suffix":""},{"id":358331029,"identity":"9aa914fc-ee77-4f5f-adf9-40573e459310","order_by":1,"name":"Pei-Rung Yang","email":"","orcid":"","institution":"Chiayi Chang Gung Memorial Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Pei-Rung","middleName":"","lastName":"Yang","suffix":""},{"id":358331030,"identity":"7889c0f4-d0ab-40eb-bc8e-36bc5859a8b2","order_by":2,"name":"I-Yun Lee","email":"","orcid":"","institution":"Chiayi Chang Gung Memorial Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"I-Yun","middleName":"","lastName":"Lee","suffix":""},{"id":358331031,"identity":"4946cd6a-a496-4e35-9a8a-7a3a5169c16c","order_by":3,"name":"Wei-Tai Shih","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYFACxsYHH//8kwOy2IjUwcbYbDiz4YAxQgtBnWwMbNK8DQcSG4jWwj+/udmYd8ed9P7+1WkPGCru2TXI9xjg1SJxjLHx4dwzz3Jn3Hi73YDhTHFyAxsPfi0MxxibDd6wMedukDi7TYKxLSGZgY13A14d8scY2yR42JjTDYjWYgDUIsnbdjjBgL8XrMWOoBbDY4nNhjPOpBnOuMG7TSLhTEICG1v+B7xa5A4ff/jgQ4WNPH8/0GEfKhLs+ZmPJeDVggASQIVAlNhGpHog4D8ApuyJ1zEKRsEoGAUjBQAAgiNJXA0RiM8AAAAASUVORK5CYII=","orcid":"","institution":"Chiayi Chang Gung Memorial Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Wei-Tai","middleName":"","lastName":"Shih","suffix":""},{"id":358331032,"identity":"7378b192-3abd-4301-894c-0eeeca503d0f","order_by":4,"name":"Yao-Hsu Yang","email":"","orcid":"","institution":"Chiayi Chang Gung Memorial Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yao-Hsu","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2024-08-18 08:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4932541/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4932541/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66949220,"identity":"b0aa83d8-23bd-4719-be2d-1772ab0ba87b","added_by":"auto","created_at":"2024-10-18 10:02:04","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":423858,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4932541/v1/ac7b88a32d34e16c88879936.jpeg"},{"id":75536002,"identity":"b3f6d8d5-3824-483d-a006-55156781f5f7","added_by":"auto","created_at":"2025-02-05 14:54:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1429058,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4932541/v1/17fcdbce-a8c9-4345-bc72-e065aa8cb5cb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patterns of Traditional Chinese Medicine Prescription During Assisted Reproduction in Taiwan: A Population-Based Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAssisted reproductive technology (ART) is used to increase fertility. Approximately 2\u0026ndash;3% of children are born after assisted reproduction in Europe and the United States.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Despite a considerable increase in ART use, the rates of successful implantation and delivery have improved only slightly over time.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] To increase the likelihood of pregnancy and live birth rates, many individuals use traditional Chinese medicine (TCM) as a complementary treatment to ART. Combining ART with TCM leads to higher pregnancy rates than does the use of ART alone.[\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTCM practitioners prescribe various treatments, including TCM decoctions, acupuncture, and manipulative therapy. The use of TCM varies widely across countries, ranging from 9\u0026ndash;65%.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Compared with traditional decoctions, compound herbal preparations (CHPs) are advantageous in terms of consistent quality and convenience. CHPs comprising a single herb or herbal formula are fully covered by Taiwan\u0026rsquo;s National Health Insurance (NHI) and are therefore widely prescribed by TCM practitioners in Taiwan.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Two or more individual herbs can be combined in a herbal formula. TCM practitioners tailor their prescriptions by selecting one or more herbal formulae and several individual herbs on the basis of patient condition and constitution. However, the patterns of TCM drug use and prescription in assisted reproduction remain unclear.\u003c/p\u003e \u003cp\u003eThe Artificial Reproductive Database (ARD) contains comprehensive records of women undergoing ART procedures in Taiwan. The National Health Insurance Research Database (NHIRD), which contains insurance claim data of \u0026gt;\u0026thinsp;99% of Taiwan\u0026rsquo;s population, is a valuable resource for pharmacoepidemiological research; this is because of the NHIRD contains longitudinal data regarding the use of both Western medicines and TCMs. In this study, we analyzed the patterns of TCM drug use and prescription during assisted reproduction in Taiwan.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData sources\u003c/h2\u003e \u003cp\u003eTaiwan\u0026rsquo;s ARD was established in 1998. Artificial reproduction institutions in Taiwan regularly submit corresponding data regarding artificial reproduction procedures. The number of artificial reproduction institutions approved by the competent authority in Taiwan has increased from 48 in 1998 to 85 in 2020. The ARD collects comprehensive medical data, including patient information related to artificial reproduction. To ensure privacy, data in the ARD are deidentified: fields containing direct identifiers such as names and addresses are removed, and information pertaining to identification number, institution code, date of birth, date of medical treatment, and date of admission are masked or blocked as appropriate.\u003c/p\u003e \u003cp\u003eThe Taiwanese government introduced the NHI program in March 1995, ensuring comprehensive health insurance coverage for almost the entire population of Taiwan. Because NHI is mandatory for all residents, the NHIRD contains comprehensive health-related data and covers almost the entire population of approximately 23.2\u0026nbsp;million. It contains patients\u0026rsquo; medical data such as information on health-care facilities and specialties, medication use, treatment and management approaches, patient demographics (e.g., sex and date of birth), clinical visit or hospitalization dates, hospital transfer identification codes, and diagnoses.\u003c/p\u003e \u003cp\u003e As an anonymous database, the NHIRD adheres to the strict guidelines and regulations established by Taiwan\u0026rsquo;s National Health Research Institutes for protecting patient privacy. The NHIRD data can be used only for research purposes. To ensure patient anonymity in the present study, relevant information was deidentified before analysis. The requirement for informed consent was waived by the Research Ethics Review Board of Chang Gung Memorial Hospital (Chiayi Branch, Taiwan), which approved the use of the NHIRD database in accordance with their ethical standards.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy subjects\u003c/h2\u003e \u003cp\u003eOur study cohort was selected from the ARD. It comprised individuals who had undergone ART procedures between January 1, 2008, and December 31, 2016, and were registered in the ARD. Individuals without health insurance coverage, using sperms or eggs from other sources, or undergoing consecutive ART procedures within 14 days were excluded from the study. We tracked the study cohort from 90 days before the embryo implantation date of the ART procedure until the day of embryo implantation. Thus, our study encompassed almost all women undergoing ART procedures in Taiwan between January 1, 2008, and December 31, 2016. The use of TCM was defined as receiving at least one TCM prescription during the follow-up period, whereas TCM nonuse referred to not receiving any TCM prescription during this period. Data regarding TCM drug use and prescription patterns in our cohort were extracted from the NHIRD.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cp\u003e We investigated patient demographics to identify key independent variables influencing the use of TCM. The patients were stratified by age (\u0026le;\u0026thinsp;24, 25\u0026ndash;29, 30\u0026ndash;34, 35\u0026ndash;39, and \u0026ge;\u0026thinsp;40 years), ART cycle count (1\u0026ndash;3, 4\u0026ndash;6, 7\u0026ndash;12, or \u0026gt;\u0026thinsp;12), urbanization level (very high to low; on the basis of the location of NHI registration), and monthly insurance fees (NT\u003cspan\u003e$\u003c/span\u003e0, NT\u003cspan\u003e$\u003c/span\u003e1\u0026ndash;15,840, NT\u003cspan\u003e$\u003c/span\u003e15,841\u0026ndash;25,000, and more than NT\u003cspan\u003e$\u003c/span\u003e25,000).\u003c/p\u003e \u003cp\u003eThe following ART-related information collected from the ARD served as independent variables: infertility causes (fallopian tube\u0026ndash;related factors, ovarian factors, endometriosis, other uterine factors, other female sex\u0026ndash;related factors, male sex\u0026ndash;related factors, multiple factors, or unknown factors). ART procedure was classified as follows: in vitro fertilization/embryo transfer and other methods.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eTraditional Chinese medicine\u003c/h2\u003e \u003cp\u003eThe list of CHPs whose fees can be reimbursed under NHI was acquired from the National Health Insurance Administration website. Subsequently, specific drug information pertaining to each mixture or product name was obtained from the website of the National Research Institute of Chinese Medicine, Ministry of Health and Welfare. This information encompassed details such as the proportion of each constituent, date and duration of drug approval, names of drugs, and codes assigned to the drug manufacturers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe drug registration numbers obtained from the website of the National Research Institute of Chinese Medicine were linked to the outpatient visit records of the ART cohort. The frequencies and proportions of prescriptions involving herbal formulae and individual herbs were analyzed. For each prescription, daily doses and average prescription durations were calculated.\u003c/p\u003e \u003cp\u003eTCM practitioners typically treat patients using a single herbal formula or a combination of two or more herbal formulae. Through association rule learning, we identified CHP coprescription patterns for patients undergoing ART treatment. The support factor, which represents the proportion of coprescriptions of two medications (e.g., medications A and B) among all prescriptions, was determined for each CHP. The confidence factor, indicating the proportion of coprescriptions of, for example, medications A and B among all prescriptions containing medication A, was also calculated. Data linkage and the calculation of descriptive statistics regarding the patterns of drug use were performed using SAS (version 9.4; SAS Institute, Cary, NC, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWe excluded 14 women without NHI coverage, 5,048 couples who used sperms or eggs from other sources, and 18 women who underwent consecutive ART procedures (implantation) within 14 days. Finally, 59,266 women (total number of cycles: 110,329) were included in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatient characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The distribution of women by age was as follows: 171 (0.29%) were aged\u0026thinsp;\u0026le;\u0026thinsp;24 years, 3,969 (6.70%) were aged 25\u0026ndash;29 years, 20,774 (35.05%) were aged 30\u0026ndash;34 years, 24,630 (41.56%) were aged 35\u0026ndash;39 years, and 9,722 (16.40%) were aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years. Among the women, 53,537 (90.33%) underwent ART procedures 1\u0026ndash;3 times.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the assisted reproductive technology treatment population in the artificial reproductive database and the national health insurance research database.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59,266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmbryo age*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.29%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20,774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.05%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24,630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.56%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9,722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eART times\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53,537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.43%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUrbanization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16,660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31,559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7,661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.93%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.71%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncome level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.08%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-15840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15841\u0026ndash;25000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19,410\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.75%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35,690\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e* Embryo age: Age of the first embryo conceived after 2008\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe demographic characteristics of patients who used and did not use TCM during assisted reproduction are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Of the total 110,329 ART cycles involving 59,266 women, TCM was used during 27,782 cycles (25.2%) and not used during 82,547 cycles (74.8%). The number and proportion of ART cycles during which TCM was used in each age group were as follows: 38 cycles (16.52%) in women aged\u0026thinsp;\u0026le;\u0026thinsp;24 years, 1,228 cycles (20.89%) in women aged 25\u0026ndash;29 years, 7,758 cycles (23.11%) in women aged 30\u0026ndash;34 years, 12,061 cycles (25.49%) in women aged 35\u0026ndash;39 years, and 6,697 cycles (28.70%) in women aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of traditional Chinese medicine (TCM) used and non-used during assisted reproductive technology (ART) process\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTCM use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eTCM non-use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharacteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal cycles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110,329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27,782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82,547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e74.82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4,651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33,563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25,805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47,320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12,061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35,259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23,337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16,640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTCM used before\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93,949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26,885\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67,064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e81.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16,380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e897\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15,483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFirst time of ART\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59,266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14,311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44,955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot first\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51,063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13,471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37,592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCauses of infertility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFallopian tube factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14,462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11,002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOvarian factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,885\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,936\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometriosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther uterine factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther female factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32,059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8,430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23,629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20,181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15,364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27,101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20,094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown reason\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3,590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eApproach\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVF/ET\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108,348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27,248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e81,100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e98.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePregnant\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45,819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11,160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34,659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64,510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16,622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47,888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e58.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the 93,949 ART cycles involving women with previous TCM use, TCM was used during 26,885 cycles (28.62%) and not used during 67,064 cycles (71.38%). Among the 16,380 ART cycles involving women without previous TCM use, TCM was used during 897 cycles (5.48%) and not used during 15,483 cycles (94.52%).\u003c/p\u003e \u003cp\u003eOf the total 59,266 first-time ART cycles, TCM was used during 14,311 cycles (24.15%) and not used during 44,955 cycles (75.85%). Among the 51,063 ART cycles involving women that had previously undergone ART procedures, TCM was used during 13,471 cycles (26.38%) and not used during 37,592 cycles (73.62%).\u003c/p\u003e \u003cp\u003eThe least and most common infertility causes associated with TCM use were male sex\u0026ndash;related factors (23.87%) and other female sex\u0026ndash;related factors (26.30%), respectively. Among the 45,819 ART cycles resulting in pregnancy, TCM was used during 11,160 cycles (24.36%).\u003c/p\u003e \u003cp\u003eA summary of the herbal formulae and individual herbs most commonly prescribed by TCM practitioners during assisted reproduction is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Among the 110,640 TCM records in the ART cohort, the most prescribed herbal formulae were \u003cem\u003ejiawei xiaoyao san\u003c/em\u003e (16.0%), \u003cem\u003edanggui shaoyao san\u003c/em\u003e (12.8%), \u003cem\u003ewen jing tang\u003c/em\u003e (10.5%), \u003cem\u003ezuo gui wan\u003c/em\u003e (9.1%), and \u003cem\u003eguizhi fuling wan\u003c/em\u003e (8.0%). The most frequently prescribed individual herbs were \u003cem\u003etusizi\u003c/em\u003e (Semen cuscutae; 18.1%), \u003cem\u003exiang fu\u003c/em\u003e (Rhizoma cyperi; 12.5%), \u003cem\u003eyi mu cao\u003c/em\u003e (Herba leonuri; 10.3%), \u003cem\u003enuzhenzi\u003c/em\u003e (Fructus ligustri lucidi; 9.5%), and \u003cem\u003edanshen\u003c/em\u003e (Radix salvia miltiorrhiza; 8.7%). The average daily dose of individual herbs ranged from 1.0 to 1.3 g, whereas that of herbal formulae ranged from 3.9 to 5.4 g. The average prescription durations for individual herbs and herbal formulae ranged from 5.7 to 8.1 days.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTop 10 herbal formulae and single herbs prescribed by traditional Chinese medicine Practitioners during assisted reproduction (Total prescriptions\u0026thinsp;=\u0026thinsp;110,640).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrequency of prescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAverage daily dose\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAverage duration for prescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edays\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSingle Herb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTusizi\u003c/em\u003e (Semen Cuscutae)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19,980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eXiang fu\u003c/em\u003e (Rhizoma Cyperi)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13,823\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eYi mu cao\u003c/em\u003e (Herba Leonuri)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNuzhenzi\u003c/em\u003e (Fructus Ligustri Lucidi)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDanshen\u003c/em\u003e (Radix Salvia Miltiorrhizae)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eXuduan\u003c/em\u003e (Radix Dipsaci)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDuzhong\u003c/em\u003e (Cortex Eucommiae)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8,661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSang ji sheng\u003c/em\u003e (Taxillus chinensis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHuangqin\u003c/em\u003e (Radix Scutellariae)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHan lian cao\u003c/em\u003e (Herba Ecliptae)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHerbal formulae\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eJiawei xiaoyao san\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17,724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDanggui shaoyao san\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14,130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eWen jing tang\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eZuo gui wan\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGuizhi fuling wan\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8,808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eYou gui wan\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLiuwei dihuang wan\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,496\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGuipi tang\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eShenling baizhu san\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShaofu zhuyu tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe association rules for TCM prescriptions during ART procedures are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The most commonly prescribed combination of two herbal formulae was \u003cem\u003ejiawei xiaoyao san\u003c/em\u003e and \u003cem\u003edanggui shaoyao san\u003c/em\u003e, with a support factor of 2.12%. The most frequently prescribed combination of a herbal formula and an individual herb was \u003cem\u003ejiawei xiaoyao san\u003c/em\u003e and \u003cem\u003etusizi\u003c/em\u003e, with a support factor of 3.68%. The most commonly prescribed combination of two individual herbs was \u003cem\u003enuzhenzi\u003c/em\u003e and \u003cem\u003ehan lian cao\u003c/em\u003e (Herba ecliptae), with a support factor of 5.00%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCo-prescriptions (one to one association) of single herbs and herbal formulae for the assisted reproductive technology treatment population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHerbal associations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupport (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConfidence (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTransaction count\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssociation rule\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle herb \u003c/p\u003e \u003cp\u003eto single herb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.86%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eNuzhenzi\u003c/em\u003e (Fructus Ligustri Lucidi)\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eHan lian cao\u003c/em\u003e (Herba Ecliptae)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.52%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eTusizi\u003c/em\u003e (Semen Cuscutae)\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eNuzhenzi\u003c/em\u003e (Fructus Ligustri Lucidi)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eTusizi\u003c/em\u003e (Semen Cuscutae)\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eXuduan\u003c/em\u003e (Radix Dipsaci)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eTusizi\u003c/em\u003e (Semen Cuscutae)\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eXiang fu\u003c/em\u003e (Rhizoma Cyperi)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.04%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.83%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eTusizi\u003c/em\u003e (Semen Cuscutae)\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eYin yang huo\u003c/em\u003e (Herba Epimedii)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHerbal formula \u003c/p\u003e \u003cp\u003eto herbal formula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eJiawei xiaoyao san\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eDanggui shaoyao san\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.81%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.15%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eDanggui shaoyao san\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eWen jing tang\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eJiawei xiaoyao san\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eZuo gui wan\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.42%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eJiawei xiaoyao san\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eWen jing tang\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.43%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eDanggui shaoyao san\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eGuizhi fuling wan\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHerbal formula to single herb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eJiawei xiaoyao san\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eTusizi\u003c/em\u003e (Semen Cuscutae)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eDanggui shaoyao san\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eTusizi\u003c/em\u003e (Semen Cuscutae)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.03%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.93%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eJiawei xiaoyao san\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eXiang fu\u003c/em\u003e (Rhizoma Cyperi)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eWen jing tang\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eTusizi\u003c/em\u003e (Semen Cuscutae)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eDanggui shaoyao san\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003eXiang fu\u003c/em\u003e (Rhizoma Cyperi)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this study is the first to utilize a comprehensive national sample to assess TCM prescription patterns for patients undergoing ART procedures. With only a negligible number of individuals deemed ineligible, our study included most women in Taiwan who undergone ART procedures between 2008 and 2016. Although TCM has been widely used during ART procedures in Taiwan, a comprehensive understanding of its prescription and use patterns in this context has been lacking. Leveraging the combined data of the NHIRD and the ARD, we performed a meticulous analysis of TCM use during ART procedures; the findings provide insights into TCM prescription patterns and thus may help develop a framework for effective TCM prescriptions for patients undergoing ART procedures.\u003c/p\u003e \u003cp\u003eEarlier studies have revealed that a substantial majority of women experiencing infertility (96.17%) have received TCM prescriptions in conjunction with gynecological interventions.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] However, the proportion of women receiving TCM and using ART is relatively low at 25.18%. This significant discrepancy in TCM use may be because of the tendency of gynecologists to advise women undergoing ART procedures to limit their use of alternative therapies during the treatment period to minimize potential interactions and optimize treatment effectiveness.\u003c/p\u003e \u003cp\u003eHerein, we offer plausible explanations for the differences in TCM use based on patient characteristics. Certain characteristics appear to contribute to an increased likelihood of TCM utilization during ART procedures; these characteristics include advanced age, TCM use history, ART procedure history, and infertility due to other female sex\u0026ndash;related factors. Conversely, young age, no previous TCM use, no previous ART treatment, or infertility stemming from male sex\u0026ndash;related factors appeared to be associated with a reduced likelihood of TCM usage. Studies have demonstrated that older age is correlated with lower egg retrieval levels, pregnancy rates, and live birth rates in individuals undergoing ART procedures[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]; therefore, older age may enhance individuals\u0026rsquo; inclination to seek TCM interventions.\u003c/p\u003e \u003cp\u003eIn this study, the three most prevalent formulations used during ART were \u003cem\u003ejiawei xiaoyao san\u003c/em\u003e, \u003cem\u003edanggui shaoyao san\u003c/em\u003e, and \u003cem\u003ewen jing tang\u003c/em\u003e. These three formulations have consistently emerged as the most commonly used TCM formulae in relevant studies involving patients with infertility.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] A study indicated that the most frequently utilized formulations, namely, \u003cem\u003ejiawei xiaoyao san\u003c/em\u003e, \u003cem\u003ewen jing tang\u003c/em\u003e, \u003cem\u003edanggui shaoyao san\u003c/em\u003e, and \u003cem\u003eguizhi fuling wan\u003c/em\u003e, are the most effective TCM formulae in enhancing female fertility.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] These formulations are also commonly used to treat conditions such as endometriosis and uterine fibroids.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cem\u003eJiawei xiaoyao san\u003c/em\u003e is effective in the treatment of premenstrual syndrome and possesses antianxiety properties.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Although the precise mechanism of \u003cem\u003ejiawei xiaoyao san\u003c/em\u003e in ART-based treatment remains unclear, this herbal formula is widely prescribed for various gynecological conditions, including primary dysmenorrhea, premenstrual syndrome, polycystic ovary syndrome, and dysfunctional uterine bleeding.[\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] It is considered to be the most commonly utilized Chinese herbal formula for these gynecological ailments.\u003c/p\u003e \u003cp\u003e \u003cem\u003eDanggui shaoyao san\u003c/em\u003e is frequently used to treat various gynecological conditions.[\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] In patients with dysmenorrhea, it suppresses prostaglandin F2α and acetylcholine-induced uterine contractions.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] \u003cem\u003eDanggui shaoyao san\u003c/em\u003e has also exhibited efficacy in alleviating premenstrual syndrome symptoms,[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] improving luteal insufficiency in women[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and exerting antidepressant effects in mouse and rat models of depression.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Clinical studies have highlighted the efficacy of \u003cem\u003edanggui shaoyao san\u003c/em\u003e in addressing mild to moderate anemia symptoms associated with uterine fibroids.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cem\u003eWen jing tang\u003c/em\u003e is effective against various menstrual disorders, abnormal uterine bleeding, and infertility.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] It is effective in treating ovulation disorders and improving endocrine status in patients with polycystic ovary syndrome.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] Furthermore, \u003cem\u003ewen jing tang\u003c/em\u003e is clinically beneficial for women with anovulation or infertility.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cem\u003eGuizhi fuling wan\u003c/em\u003e is a frequently prescribed remedy for uterine fibroids and endometriosis in Taiwan.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] It is recognized for its efficacy in managing menorrhagia and dysmenorrhea and treating uterine fibroids.[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] \u003cem\u003eGuizhi fuling wan\u003c/em\u003e can stimulate the corpus luteum to secrete progesterone[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and thus can be used to treat various gynecological conditions.\u003c/p\u003e \u003cp\u003e \u003cem\u003eTusizi\u003c/em\u003e is widely recognized for its frequent use in the treatment of male and female infertility.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] Studies have highlighted \u003cem\u003etusizi\u003c/em\u003e\u0026rsquo;s antioxidant properties as well as its ability to scavenge free radicals and modulate immune responses.[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] It is also effective in treating ovarian endocrine dysfunction in rats subjected to psychological stress.[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cem\u003eXiang fu\u003c/em\u003e is a potent antioxidant.[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] Extracts of \u003cem\u003exiang fu\u003c/em\u003e have exhibited prominent antioxidant and antimutagenic activities.[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] It has also been demonstrated to exert estrogen-like and neuroprotective effects on estrogen-deficient mice.[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cem\u003eYi mu cao\u003c/em\u003e exhibits various functions, including the alleviation of uterine spasms, suppression of inflammation, and increase of serum progesterone levels; these functions make y\u003cem\u003ei mu cao\u003c/em\u003e a valuable herb for dysmenorrhea treatment.[\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] It is frequently prescribed individually for polycystic ovary syndrome.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] Both \u003cem\u003exiang fu\u003c/em\u003e and \u003cem\u003eyi mu cao\u003c/em\u003e are commonly used to treat patients with uterine fibroids.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] \u003cem\u003eYi mu cao\u003c/em\u003e extract has exhibited antidepressant effects in mice and improved hippocampal neuronal damage in mice experiencing chronic mild stress.[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cem\u003eDanshen\u003c/em\u003e is renowned for its antioxidant, anti-inflammatory, and dysmenorrhea-relieving properties.[\u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] It enhances estrogenic effects in ovariectomized rats.[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] \u003cem\u003eDanshen\u003c/em\u003e is key in the treatment of various gynecological diseases, including menstrual disorders, female genital pain, and menopausal disorders.[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOn the basis of symptom differences and treatment principles, TCM practitioners prescribe CHPs to patients undergoing ART procedures. However, CHP prescriptions vary because of the differences among TCM practitioners in experience and knowledge. In this study, we found that the patterns of combined CHP prescriptions by TCM practitioners were different from those of decoctions.\u003c/p\u003e \u003cp\u003eTCM practitioners typically use fully documented prescriptions based on TCM theory as a core prescription. They may make modifications by adding herbs to a decoction to address a specific patient condition. However, when using CHPs, TCM practitioners can only add individual herbs to the core formula. They are unable to remove herbs in a CHP or alter their proportions. To provide personalized treatment, TCM practitioners may combine other formulae or herbs in a prescription on the basis of patient needs.\u003c/p\u003e \u003cp\u003eThe reimbursement policy of the NHI in Taiwan only covers CHPs and not decoctions. This policy may lead to the frequent coprescription of CHPs with high support factors by TCM practitioners in Taiwan.[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] This could explain why four of the six individual herbs in \u003cem\u003edanggui shaoyao san\u003c/em\u003e are also present in \u003cem\u003ejiawei xiaoyao san\u003c/em\u003e and why the combination of these two formulae is the most frequently prescribed CHP combination for patients using ART.\u003c/p\u003e \u003cp\u003eIn our study, the most common combination of herbal formulae prescribed was \u003cem\u003ejiawei xiaoyao san\u003c/em\u003e with \u003cem\u003edanggui shaoyao san\u003c/em\u003e. The most common combination of a herbal formula and an individual herb was that of \u003cem\u003ejiawei xiaoyao san\u003c/em\u003e with \u003cem\u003etusizi\u003c/em\u003e, one of the two most frequently prescribed herbal formulae and the most frequently prescribed individual herb (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, the most commonly prescribed combination of individual herbs was that of \u003cem\u003enuzhenzi\u003c/em\u003e and \u003cem\u003ehan lian cao\u003c/em\u003e, rather than the two most commonly individually prescribed herbs. This combination involved the first and tenth most commonly prescribed individual herbs (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The blending of \u003cem\u003enuzhenzi\u003c/em\u003e and \u003cem\u003ehan lian cao\u003c/em\u003e produces \u003cem\u003eer zhi wan\u003c/em\u003e, which can enhance hematopoietic stem cell functionality, suppress oxidation, and stimulate the immune system.[\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur study has three limitations. First, because of the varied diagnostic approaches adopted by TCM practitioners, symptoms rather than specific disease names are often used for diagnosis. Consequently, in certain cases in our study, ascertaining whether a patient\u0026rsquo;s treatment goals were directly associated with ART was impossible. Nonetheless, the objective of this study was to investigate the use of TCM during ART-based treatment. Thus, the purpose for which TCM was employed is not directly related to the findings of this study. Second, the NHI program only covers the cost of CHPs dispensed by TCM practitioners. Data on CHPs or decoctions obtained by women directly from pharmacies are not captured in the NHIRD; therefore, these treatments were not accounted for in this study. Consequently, the use of TCM by patients undergoing ART procedures may have been underestimated.[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] Finally, the prescription duration recorded in the database represented the duration of treatment prescribed by TCM practitioners and did not necessarily reflect the actual duration of medication use by the patients.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTo the best of our knowledge, this is the first large-scale population-based study on TCM use by patients undergoing ART procedures. The prescription patterns identified in this study hold promising implications for future clinical and pharmacological investigations. Future studies are warranted to ascertain whether women\u0026rsquo;s exposure to TCM during ART procedures influences ART outcomes. Future studies should also provide additional evidence concerning the safety and efficacy of the aforementioned CHPs, thereby advancing our understanding of their therapeutic potential.\u003c/p\u003e \u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTCM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etraditional Chinese medicine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eART\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eassisted reproductive technology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHPs compound herbal preparations\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health Insurance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eARD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArtificial Reproductive Database\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHIRD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health Insurance Research Database.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003e All authors agree to publish this article.\u003c/p\u003e \u003ch2\u003eAuthor details\u003c/h2\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003e Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan. \u003csup\u003e2\u003c/sup\u003e School of Traditional Chinese medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. \u003csup\u003e3\u003c/sup\u003e Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study received support through a grant from Chang Gung Memorial Hospital, Chia-yi Branch (CFRPG6K0081).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYi-Chia Shen: study conception and design, drafting of manuscript. Pei-Rung Yang: analysis and interpretation of data. I-Yun Lee: analysis and interpretation of data. Wei-Tai Shih: study conception and design, critical revision. Yao-Hsu Yang: study conception and design, acquisition of data, critical revision.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors express their gratitude to the Health Information and Epidemiology Laboratory at the Chiayi Branch of Chang Gung Memorial Hospital for their valuable assistance in data analysis.\u003c/p\u003e\u003ch2\u003eData availability\u003c/h2\u003e \u003cp\u003eData will be made available on request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSunderam S, Kissin DM, Zhang Y, Folger SG, Boulet SL, Warner L, Callaghan WM, Barfield WDJMSS. 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Prescription pattern of traditional Chinese medicine for climacteric women in Taiwan. 2009, 12(6):541\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Assisted reproductive technology, Traditional Chinese medicine, Artificial reproductive database, National health insurance research database","lastPublishedDoi":"10.21203/rs.3.rs-4932541/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4932541/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTraditional Chinese medicine (TCM) is widely applied in assisted reproductive technology (ART). However, TCM drug utilization and prescription patterns in assisted reproduction remain unclear. This study was conducted to analyze these patterns.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing data from Taiwan\u0026rsquo;s Artificial Reproductive Database and National Health Insurance Research Database, we analyzed the frequency of TCM prescriptions and the proportions in which different herbal formulae and individual herbs were prescribed to patients undergoing ART procedures. In addition, common TCM prescription patterns were investigated through association rule learning.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn total, 59,266 women undergoing 110,329 ART cycles were enrolled in this study. TCM was used in 27,782 ART cycles (25.18%). \u003cem\u003eJiawei xiaoyao san\u003c/em\u003e and \u003cem\u003etusizi\u003c/em\u003e (Semen cuscutae) were the most commonly used herbal formulae and individual herbs used during ART procedures.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study demonstrates TCM use patterns in assisted reproduction. Further studies are necessary to evaluate the efficacy and safety of TCMs prescribed during assisted reproduction.\u003c/p\u003e","manuscriptTitle":"Patterns of Traditional Chinese Medicine Prescription During Assisted Reproduction in Taiwan: A Population-Based Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-18 10:02:00","doi":"10.21203/rs.3.rs-4932541/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"931deaf1-4ebe-4445-9955-97c18a71a101","owner":[],"postedDate":"October 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-05T14:53:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-18 10:02:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4932541","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4932541","identity":"rs-4932541","version":["v1"]},"buildId":"cTy_lsJlmDsVRNrSptgXS","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}