A systematic review and meta-analysis of acupuncture in in vitro fertilisation

Assisted Conception Unit, Guy's and St Thomas' Hospital, London, UK.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.86). 09/2008; 115(10):1203-13. DOI: 10.1111/j.1471-0528.2008.01838.x
Source: PubMed

ABSTRACT Numerous randomised studies have reported pregnancy outcome in women who received acupuncture during their in vitro fertilisation (IVF) treatment cycle.
The objective of this study was to conduct a systematic review with meta-analysis of the trials of acupuncture during IVF treatment on the outcomes of clinical pregnancy and live birth rates.
Searches were conducted in MEDLINE, EMBASE, Cochrane Library, ISI Proceedings and SCISEARCH.
All randomised controlled trials that evaluated the effects of acupuncture compared with no treatment or sham acupuncture in women undergoing IVF-intracytoplasmic sperm injection treatment were included.
Study selection, quality appraisal and data extraction were performed independently and in duplicate. A sensitivity analysis was conducted where the meta-analysis was restricted to trials in which sham acupuncture was used in the control group. Meta-regression analysis was used to explore the association between study characteristics and pregnancy rates.
Thirteen relevant trials, including a total of 2500 women randomised to either acupuncture or control group, were identified. No evidence of publication bias was found (Begg's test, P = 0.50). Five trials (n = 877) evaluated IVF outcome when acupuncture was performed around the time of transvaginal oocyte retrieval, while eight trials (n = 1623) reported IVF outcome when acupuncture was performed around the time of embryo transfer (ET). Meta-analysis of the five studies of acupuncture around the time of egg collection did not show a significant difference in clinical pregnancy (relative risks [RR] = 1.06, 95% CI 0.82-1.37, P = 0.65). Meta-analysis of the eight studies of acupuncture around the time of ET showed no difference in the clinical pregnancy rate (RR = 1.23, 95% CI 0.96-1.58, P = 0.1). Live birth data were available from five of the eight studies of acupuncture around the time of ET. Meta-analysis of these studies did not show a significant increase in live birth rate with acupuncture (RR = 1.34, 95% CI 0.85-2.11). Using meta-regression, no significant association between any of the studied covariates and clinical pregnancy rate was found (P > 0.05 for all covariates).
Currently available literature does not provide sufficient evidence that adjuvant acupuncture improves IVF clinical pregnancy rate.

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Available from: Yacoub Khalaf, Aug 03, 2015
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    • "As our systematic review with meta-analysis was completed in October 2010, the new research published after that date had not been included [15], however, this comprehensive review includes all of these new papers. By investigating the individual studies identified and the differences in these studies, the authors highlight the factors which may have contributed to the variability of the results as seen in previous meta-analyses [2] [3] [4] [5] [6] [7] [8], and which should be considered in the design of future studies. The key factors identified which may e236 F. Qu et al. / European Journal of Integrative Medicine 4 (2012) e234–e244 Table 1 Summary of the studies. "
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    ABSTRACT: Introduction The comprehensive review was to appraise the current evidence from both randomized and non-randomized trials by using both Chinese and western databases and to highlight the issues which could guide future trial design. Many infertile couples have chosen acupuncture as an adjunct when they undergo in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment. More than forty trials have emerged since the first clinical research published in 1999 explored the effects of acupuncture on the outcomes of IVF. However, the current evidence makes it difficult for clinical practitioners and patients to make a decision on whether to choose acupuncture as an adjunct when undergoing IVF or ICSI treatment. Methodology A total of thirty-three randomized and 5 non-randomized controlled trials were included in the review. Results Based on this comprehensive review and analysis of all the relevant trials, the authors identify the factors which have contributed to these inconsistencies, and which should be considered in the design of future studies. Discussion/conclusions These items included in the review could provide useful recommendations and guidelines, which will in turn promote better trial design and improve the evidence base for the use of acupuncture for IVF.
    European Journal of Integrative Medicine 09/2012; 4(3). DOI:10.1016/j.eujim.2012 · 0.65 Impact Factor
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    • "The third analysis, published by Cheong et al. [6] in the Cochrane Collaboration in 2008 (13 trials, 2,300 participants ), concluded that acupuncture performed on the day of the embryo transfer increases live birth rates but does not increase clinical pregnancy rates, and there are no beneficial effects on pregnancy outcomes when acupuncture was performed around the time of oocyte retrieval. The other four meta-analyses, published by El-Toukhy et al. (13 trials, 2,500 participants) [7], Cheong et al. (14 trials, 2,670 subjects) [8], El-Toukhy and Khalaf [9], and Sunkara et al. [10] (14 trials, 2,870 subjects), could not confirm a beneficial effect from using acupuncture during IVF. Why did these meta-analyses addressing the same question producing such different answers? "
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    ABSTRACT: The aim of this paper was to provide reliable evidence by performing a systematic review and meta-analysis for evaluating the role of acupuncture in assisted reproductive technology. All randomized controlled trials that evaluated the effects of acupuncture, including manual, electrical, and laser acupuncture (LA) techniques, on the clinical pregnancy rate (CPR) and live birth rate (LBR) of in vitro fertilization (IVF) or artificial insemination were included. The controlled groups consisted of no acupuncture and sham acupuncture groups. The sham acupuncture included sham acupuncture at acupoints, sham acupuncture at non- or inappropriate points, sham LA, and adhesive tapes. Twenty-three trials (a total of 5598 participants) were included in this paper. The pooled CPR from all acupuncture groups was significantly higher than that from all controlled groups, whereas the LBR was not significantly different between the two groups. However, the results were quite distinct when the type of control and/or different acupuncture times were examined in a sensitivity analysis. The results mainly indicate that acupuncture, especially around the time of the controlled ovarian hyperstimulation, improves pregnancy outcomes in women undergoing IVF. More positive effects from acupuncture in IVF can be expected if a more individualized acupuncture programs are used.
    Evidence-based Complementary and Alternative Medicine 07/2012; 2012:543924. DOI:10.1155/2012/543924 · 1.88 Impact Factor
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    • "12 Acupuncture has been used on the day of ET with an aim to improve the pregnancy rate of 13 IVF treatment (Paulus et al., 2002 and 2003; Dieterle et al., 2006; Smith et al., 2006; 14 Westergaard et al., 2006; Craig et al., 2007; Domar et al., 2008; Fratterelli et al., 2008; Moy 15 et al., 2008; So et al., 2009). Four meta-analyses (Cheong et al., 2008; Manheimer et al., 2008; 16 Ng et al., 2008; El-Toukhy et al., 2008) have been published on the role of acupuncture in 17 IVF. Three (Cheong et al., 2008; Manheimer et al., 2008; Ng et al., 2008) of these showed an 18 improvement of pregnancy rate and live birth rate following acupuncture while El-Toukhy et 19 al. (2008) could not find any differences in pregnancy rate and live birth rate between the 20 acupuncture group and the control group. "
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    ABSTRACT: The role of acupuncture on the pregnancy rate has not been evaluated in frozen-thawed embryo transfer (FET) cycles. This randomized double-blind study aimed to determine whether acupuncture performed on the day of FET improves clinical outcomes. On the day of FET, 226 patients were randomly allocated to either real or placebo acupuncture according to a computer-generated randomization list in sealed opaque envelopes. They received a session of real or placebo acupuncture for 25 min on site immediately after FET. The anxiety level and serum cortisol concentration were evaluated before and after real and placebo acupuncture. There were no significant differences in rates of overall pregnancy, clinical pregnancy, ongoing pregnancy, live birth and implantation in the placebo acupuncture group, when compared with the real acupuncture group. The anxiety level and serum cortisol concentration were similar for both groups. Only the placebo acupuncture group had significantly higher ongoing pregnancy (P=0.022) and implantation rates (P=0.038) than those who declined to join the study and received no acupuncture. In conclusion, comparable pregnancy and live birth rates of FET treatment were found in patients who had one session of real or placebo acupuncture after FET.
    Reproductive biomedicine online 03/2010; 20(6):814-21. DOI:10.1016/j.rbmo.2010.02.024 · 2.98 Impact Factor
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