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: 3.45). 09/2008; 115(10):1203-13. DOI: 10.1111/j.1471-0528.2008.01838.x
Source: PubMed


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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    • "None of the reviews call for a rejection of this intervention and all, in fact, call for more exploration of its value to enhance IVF cycles. Although the intervention is assessed as being relatively painless and causing few side effects, another review78 implies that the cost, invasiveness, and potential for the harm of acupuncture means that it should not be recommended for women receiving IVF treatment. Given that the studies reported very few adverse events and that the cost of acupuncture compared to additional IVF cycles is substantially less, it can only be surmised that these SR authors were in some way biased against the intervention to make such a conclusion. "
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    ABSTRACT: Acupuncture and other modalities of Chinese/East Asian medicine have been used to treat women's health for many centuries. Gynecology specialties focus particularly on menstrual and reproductive disorders. Both the adoption of the use of acupuncture outside Asia, and the incorporation of scientific analysis in Asia have challenged biomedical conceptions of what can be achieved with this treatment method. The scale of research activity in relation to acupuncture and women's health has increased over the last 20 years. This review aims to explore the research evidence in relation to acupuncture use for women's reproductive disorders, focusing on both clinical findings and experimental research on acupuncture's mechanisms of action in relation to women's health. A narrative literature search was undertaken using searches of electronic databases and manual searches of journals and textbooks. The search included all literature published prior to June 2013. The literature was assessed as to the nature of the study it was reporting and findings synthesized into a commentary. For acupuncture's mechanism of action the search resulted in 114 relevant documents; in relation to clinical reports on the use of acupuncture for women's health 204 documents were found and assessed. There is preliminary data indicating acupuncture may improve menstrual health and coping for women experiencing delays falling pregnant. There is experimental data showing that acupuncture can influence female reproductive functioning, although the actual mechanisms involved are not yet clarified. Further well-conducted clinical research would benefit our understanding of the usefulness of acupuncture to women's health.
    Full-text · Article · Mar 2014 · International Journal of Women's Health
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    • "Group A willing to conceive appears to decrease gradually during marriage (as clearly shown in the last 6 month period of their marriage time), whereas, group B curiousness increases. This observation is illustrated in Figure 2. To date, studies on CAM as a treatment option for infertility have demonstrated benefit [24] , ineffectiveness [25] and harm [26]. Although there is little evidence supporting their effectiveness to treat infertility, the demonstrated role of CAM in infertility treatment could be attributed to its psychological effect. "
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    ABSTRACT: Background Although there is little information available to quantify the use of complementary and alternative medicine (CAM), growing evidence suggests that CAM prevalence among patients seeking infertility treatment is increasing worldwide. There are many products available on the market and many infertile patients demand information about CAM from their health care providers. This paper investigates the prevalence of CAM use among infertile couples in Jordan. Additionally, trends and factors contributing to CAM use for infertility treatment among these couples have been evaluated. Methods A face-to-face questionnaire inquiring demographic information, use of CAM for medical conditions, in general, and types of CAM used for infertility treatment, in specific, was completed by one thousand twenty one infertile patients attending at two types of facilities; in vitro Fertilization (IVF) centers at both public and private hospitals and infertility private clinics. Both types of facilities were distributed in different areas of Amman, the capital city of Jordan. The study was conducted between May and August 2012. Results Our results show that CAM therapies for infertility treatment were encountered in 44.7% of the study sample. The vast majority of CAM users were females. The most commonly used CAM therapies were herbs and spiritual healing. A clear correlation between the use of CAM for infertility versus the use of CAM for other chronic medical conditions has been found. Conclusions The prevalence of CAM use for infertility treatment in Jordan is relatively high, particularly among young females, well educated and with a low income, in consistence with the studies reported elsewhere. Herbs and spiritual healing are widely used among patients in adjunct to conventional medical interventions. As CAM use is prevalent among patients, there is a clear need for health providers to become more aware of this phenomenon and for further research in this field.
    Full-text · Article · Feb 2013 · BMC Complementary and Alternative Medicine
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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.
    Full-text · Article · Sep 2012 · European Journal of Integrative Medicine
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