Acupuncture for infertile women not undergoing assisted reproductive techniques (ART) A systematic review and meta-analysis

Liu Yun et al, Med (Balt). 2019 Jul; 98(29): e16463.

Medicine (Baltimore)

Research into treatment of general infertility with acupuncture and Chinese medicine is rare in countries outside of China – one, it is difficult to recruit patients (much easier to collect data on IVF patients) and two there is no financial incentive for such research since acupuncture cannot be patented. However a group based in Guangzhou, China have made an attempt to gather as much relevant data as possible concerning Chinese medicine treatment of infertility by reviewing publications in 6 different data bases. They found nearly 5000 publications, but only 22 trials with a total of 2591 participants were included in this systematic review after the authors applyied strict selection criteria. Even with such criteria, it is not common to find high quality large randomised controlled trials involving acupuncture and fertility, for the above mentioned reasons. Meta-analysis showed significant increases in pregnancy rate in groups who received acupuncture or Chinese medicine compared to those who received western medicine treatment.

Abstract

Background:

Acupuncture is widely used for infertile women without undergoing assisted reproductive techniques (ART) in China but its effect is unclear. We aim to assess whether acupuncture and its combined therapy exert a positive influence on the outcome of female fertility.

Methods:

We searched 6 databases, including Medline, EMBASE, the Cochrane Central Register of Controlled Trials, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Journal Database (VIP), and Wan-Fang Data, from inception to June 2018. Studies of randomized controlled trials (RCTs) on women with infertility treated by acupuncture or its combined therapy were included. A meta-analysis was performed using Revman 5.3. The methodological quality of the studies was assessed through the risk of bias assessment tool by the Cochrane Collaboration.

Results:

The pregnancy rate was significantly improved with treatment (RR = 1.84, 95% CI 1.62 to 2.10, P < .00001), compared to that in the control group. Subgroup analysis showed that comparing with pure western medicine intervention, no matter intervention with acupuncture alone, with acupuncture plus western medicine, with acupuncture plus Chinese medicine, or acupuncture plus Chinese medicine and western medicine, all of these subgroups exhibited significant improvement. The subgroup according to different types of infertility showed a significant improvement in infertility caused by polycystic ovary syndrome, tubal infertility, ovulatory disorder, and other factors. In addition, the ovulation rate and endometrial thickness were significantly increased. The level of LH was obviously decreased. Moreover, with acupuncture, less adverse effects occurred. The funnel plot revealed that publication bias might exist. All trials included had unclear risks in the aspects of allocation concealment, blinding of participants and personnel, blinding of outcome assessment, selective reporting, and other bias. Only 1 study was assessed as unclear risk in random sequence generation. In the incomplete outcome data, all studies were low risk, except 1.

Conclusions:

Acupuncture and its combined therapy may be effective for treating female infertility. However, the included studies are not robust enough to draw a firm conclusion due to the not robustly sampled quality of the included studies. Future high-quality RCTs are needed to confirm our findings.

Keywords: acupuncture, female infertility, meta-analysis, systematic review