Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis
1. Eric Manheimer, research associate
2. Grant Zhang, assistant professor
3. Laurence Udoff, assistant professor
4. Aviad Haramati, professor
5. Patricia Langenberg, professor and vice-chair
6. Brian M Berman, professor,
7. Lex M Bouter, professor and vice chancellor (rector magnificus)
Objective To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation.
Systematic review and meta-analysis.
Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.
Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.
Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth. The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).
Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.
BMJ 336 : 545 doi: 10.1136/bmj.39471.430451.BE (Published 7 February 2008)
This comment to the BMJ paper was added by Laurie Barclay, MD:
Acupuncture has been associated with statistically and clinically significant improvements in pregnancy rates resulting from the embryo transfer process, according to the results of a systematic review and meta-analysis published online February 7 in the British Medical Journal. In China, acupuncture has been used for centuries to help control the female reproductive system.
"Firstly, acupuncture may mediate the release of neurotransmitters, which may in turn stimulate secretion of gonadotrophin releasing hormone, thereby influencing the menstrual cycle, ovulation, and fertility," write Eric Manheimer, from the University of Maryland School of Medicine in Baltimore, and colleagues. "Secondly, acupuncture may stimulate blood flow to the uterus by inhibiting uterine central sympathetic nerve activity. Thirdly, acupuncture may stimulate the production of endogenous opioids, which may inhibit the central nervous system outflow and the biological stress response."
The goal of this systematic review and meta-analysis of randomized controlled trials was to assess the effect of acupuncture given with embryo transfer on the rates of pregnancy and live birth among women undergoing in vitro fertilization.
This comment is from Orly Barziv:
This article investigates whether acupuncture improves the rate of pregnancy when administered before and after embryo transfer in women undergoing IVF (in vitro fertilization).
The authors have included in their analysis 8 previously published research controlled trials (1366 women with a wide range of ages and causes of infertility) that compared the number of clinical pregnancies in two groups, one of which received acupuncture within one day of embryo transfer (typically one session 25 minutes before transfer and one immediately after).
Their analysis found that embryo transfer with acupuncture is associated with higher rates of clinical pregnancy and this result was not affected from sensitivity analyses performed for all but one sets of studies. This provides preliminary yet significant evidence that IVF, when performed alongside acupuncture, has increased chances of a successful outcome.