Cheong Y et al Cochrane Database of Systematic Reviews 2008 Issue 4
This meta analysis, published as a Cochrane Review (an international and independent organization dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide) found that analysis of ten trials up to 2007 indicated that acupuncture at the time of embryo transfer improved pregnancy rates.
Introduction: Acupuncture has more recently been studied in assisted reproductive treatment, although its role in reproductive medicine is still debated. This is a meta-analysis to determine the effectiveness of acupuncture in the outcomes of assisted reproductive technologies (ART).
Material & Methods: All reports which described randomised controlled trials of acupuncture in assisted conception were obtained through searches via the Menstrual Disorders and Subfertility Group’s specialised Register of controlled trials, the OVID MEDLINE (1996 to August 2007), CINAHL- cumulative Index to Nursing & Allied Health Literature (1982 to August 2007), EMBASE (1980 -August 2007), AMED, National research Register, US equivalent Clinical Trials register (http://www.clinicaltrials.gov) were searched using the OVID software, the Chinese literature databases were searched from the China Academic Journal Electronic full text Database in the China National Knowledge Infrastructure and Index to Chinese Periodical Literature.
All relevant references were also hand searched.
The selection criteria included randomised controlled trials of acupuncture that included couples who were undergoing ART and/or acupuncture and compared these treatments to each other, placebo or no treatment for the treatment of primary and secondary infertility were included.
Women with medical illness deemed contraindications for ART or acupuncture were excluded. Quality assessment and data extraction were performed independently by two reviewers.
Meta-analysis was performed using odds ratio for dichotomous outcomes. Subgroup analysis and sensitivity analysis were performed where necessary. The outcome measures were the live birth rate, the clinical, ongoing pregnancy rate, miscarriage rate and any reported side effects of treatment.
Results: Thirteen randomised controlled trials were identified that involved acupuncture and assisted conception. Ten trials were included and three were excluded.
Acupuncture on the day of ET improves the ongoing pregnancy rate (Odds Ratio = 1.85; 95% confidence interval 1.18-2.91) and the clinical pregnancy rate (Odds ratio = 1.65; 95% confidence interval 1.22-2.24), but there was no evidence of a difference in the miscarriage rate compared to controls. Acupuncture on the day of ET + 2 to 3 days after ET (repeated acupuncture) improves the clinical pregnancy rate (Odds Ratio = 2.23, 95% CI 1.41 – 3.51) but not the ongoing pregnancy rate (Odds Ratio = 1.93, 95% CI 0.86-4.36). Repeated acupuncture did not affect the miscarriage rate.
Acupuncture around the time of oocyte retrieval has no evidence of benefit over the live birth rate (Odds Ratio 0.84, 95% CI 0.50 – 1.42), ongoing pregnancy (Odds Ratio 0.84, 95% CI 0.5 -1.42), clinical pregnancy (Odds ratio 1.07, 95% CI 0.71-1.61), and miscarriage rate (Odds Ratio 0.59, 95% CI 0.14-2.56).
Conclusions: The data from this meta-analysis suggests that acupuncture performed on the day of ET does increase the clinical pregnancy rate of IVF treatment; however, this could be attributed to placebo effect and the small number of patients included. Further larger RCTs are necessary to confirm the results.