Meta Analyses and Systematic Reviews

This final section of our archives, gathers around 30 Meta-analyses and Systematic Reviews relating to Acupuncture and Chinese herbal medicine used with fertility patients (mostly IVF) and for conditions related to reproductive health. A systematic review collects and summarises evidence and a meta-analysis applies statistical methods to summarise the results of these studies. Systematic reviews and meta-analysis are considered to be the highest quality evidence because their strict inclusion criteria can reduce bias and produce more reliable findings. Each Meta analysis typically analyses pooled data collected from thousands of women.

Most of the early research that was published in English language medical journals concerned the treatment of IVF patients with acupuncture administered on the day of Embryo transfer. The randomised controlled trials (RCTs) collected for analysis started back as far as 2002 and by 2008 a Meta-analysis of 7 eligible RCTs  was published in the prestigious British Medical Journal. This first meta-analysis generated a lot of excitement among IVF patients and encouraged more research to follow.

Important provisos; while all the meta analyses listed here include only eligible RCTs chosen with strict inclusion criteria, the heterogeneity and risk of bias in these trials has lead most authors to suggest that more RCTs are required before any specific recommendations are made to patients. Another proviso we must add here, is that many trials did not administer the optimal number of acupuncture treatments and few used acupuncture as it used traditionally (ie highly individualised treatments).

Please click Read More for a summary of what has been published over the last 12 years…… with mention of pertinent conclusions.

1

ET ACUPUNCTURE

Over the last 12 years there have been 10 meta-analyses of ET acupuncture trials (wherein acupuncture is administered to an IVF patient primarily at or around the time of embryo transfer, 2-3 treatments in total). Early meta-analyses were mixed in their conclusions, some finding a benefit to IVF patients receiving acupuncture, others finding no benefit.

Most of the later meta analyses reported only provisional benefits of ET acupuncture to certain groups of IVF patients, specifically the group of women with a low baseline pregnancy rate expectation (ie previous failed IVF cycles, or older age group). In some Meta analyses acupuncture only appeared to confer a benefit in trials when compared to controls that did not use sham acupuncture.

 

  • 2008 British Medical Journal Manheimer E et al – Conclusion, pregnancy rate improved by acupuncture 
  • 2008 Cochrane Review Cheong Y et al – Conclusion, live birth rate improved by acupuncture 
  • 2008 British Journal of Obstetrics and Gynaecology El-Toukhy T et al – Conclusion, Pregnancy rate not improved by Acupuncture
  • 2009 Cochrane Review Cheong Y et al – Conclusion, live birth rate improved by acupuncture
  • 2010 Human Fertility Cheong Y et al – Conclusion, Pregnancy rate not improved by Acupuncture
  • 2012 Fertility and Sterility Zheng CH et al  – Conclusion, pregnancy rate improved by Acupuncture compared to routine care but not compared to sham needle control
  • 2013 Human Reproduction Update Manheimer E et al, – Conclusion, pregnancy rate improved by Acupuncture only in low baseline pregnancy rate group
  • 2013 Cochrane Review Cheong Y et al  – Conclusion, live birth rate improved by Acupuncture when compared to routine care but not compared to sham needle control.
  • 2018 European Journal of Integrative Medicine Xian Zhang et al – Conclusion, live birth rate improved by Acupuncture when compared with routine care.
  • 2019 Reproductive Biomedicine Online Smith C et alConclusion, pregnancy rate improved by Acupuncture only in low baseline pregnancy rate group.

 

2

IVF ACUPUNCTURE

IVF acupuncture is the term we are using to describe a treatment programme wherein a number of acupuncture treatments (often around 10-12) are delivered before and during an IVF cycle according to Chinese medicine principles, as well as the ET acupuncture treatments used in the above category. Three meta analyses in this category found that acupuncture conferred a benefit to IVF patients. This may indicate that acupuncture given in a greater dose makes a significant difference.

  • 2012 Evidence Based Complementary and Alternative Medicine Zheng CH et al – Conclusion, pregnancy rate improved by acupuncture
  • 2015 Gynecological and Obstetric Investigations Shen C et alConclusion, pregnancy rate improved by acupuncture
  • 2016 Archives of Gynecology and Obstetrics Qian Y et alConclusion, pregnancy rate improved by acupuncture

 

3

CHINESE HERBAL MEDICINE DURING IVF

It is not common in the west for IVF patients to be treated with herbs during IVF cycles, and only one meta analysis of this sort of treatment was found in English language medical journals.

  • 2013 PLOS one Huijuan Cao et al  Conclusion, pregnancy rate improved by Chinese herbal medicine.

 

4

ACUPUNCTURE OR CHINESE HERBAL MEDICINE USED FOR NATURAL FERTILITY

It is also not common to find trials that measure the effect of Chinese herbs in women who are not doing IVF, due to the difficulties in recruitment. These reviews include RCT’s, cohort studies and case studies.

  • 2011 Complementary Therapies in Medicine Ried KConclusion, pregnancy rate higher with Chinese herbal medicine compared to IVF and fertility drugs.
  • 2015 Complementary Therapies in Medicine Reid K Conclusion, pregnancy rate improved by Chinese herbal medicine compared to western pharmaceutical treatment.
  • 2019 Medicine (Balt). Liu Yun et alConclusion, Pregnancy rate improved by Acupuncture and Chinese herbal medicine compared to western pharmaceutical treatment or no treatment.

5

PCOS

Polycystic Ovarian Syndrome may underlie many metabolic and endocrine problems, including  ovarian dysfunction. Research into this syndrome is still in its early days, however there are a few meta-analyses that summarise the effect of acupuncture on ovulation frequency in PCOS patients.

  • 2017 British Medical Journal; Acupuncture in Medicine, Junyoung Jo and  Yoon Jae Lee – Conclusion, Acupuncture improved pregnancy rates in IVF patients with PCOS compared to routine care.
  • 2019 Human Reproduction Update, Jyotsna Pundir et al – Conclusion, Acupuncture and Chinese Medicine can improve ovulation frequency in PCOS patients.
  • 2019 Cochrane Review Lim CED et al – Conclusion, Acupuncture may improve number of inter-menstrual days in PCOS patients.

6

ANOVULATORY INFERTILITY

Only one meta-analysis has been performed on trials examining the effect of Chinese herbal medicine on ovulation frequency.

  • 2012 The Journal of Alternative and Complementary Medicine Li Tan et alConclusion Chinese herbal medicine can improve ovulation frequency compared to clomiphene.

7

PREGNANCY NAUSEA

One meta-analysis has examined trials of acupuncture and pregnancy nausea with mixed results.

  • 2016 BMC Complementary and Alternative Medicine, Van Den Heuvel et al, Conclusion Acupuncture or acupressure improved pregnancy nausea and vomiting (for dichotomous but not continuous data)