Acupuncture in improving endometrial receptivity: a systematic review and meta-analysis

Yajing Zhong et al, BMC Comp Alt Med (2019) 19:61

BMC Complementary and Alternative Medicine

The authors examined data from Korean, Chinese and Japanese data bases and found nearly 400 articles relating to endometrial receptivity and fertility. After applying strict exclusion criteria only 13 RCTs were included in the analysis. Statistically significant evidence was found to show that acupuncture increased the quality and thickness of the endometrium leading to increased pregnancy rates. However the meta-analysis conclusions are limited by heterogeneity, low level evidence and risk of bias .



Background: This systematic review aimed at summarizing and evaluating the evidence of randomized controlled trials (RCTs) using acupuncture to improve endometrial receptivity (ER).
Methods: We searched 12 databases electronically through August 2018 without language restrictions. We
included RCTs of women of infertility due to low ER, and excluded infertility caused by other reasons or non-RCTs.
Two independent reviewers extracted the characteristics of studies and resolved the differences through consensus.
Data were pooled and expressed as standard mean difference (SMD) or mean difference (MD) for continuous
outcomes and risk ratio (RR) for dichotomous outcomes, with 95% confidence interval (CI).
Results: We found very low to moderate level of evidence that acupuncture may improve pregnancy rate
(RR = 1.23 95%CI[1.13, 1.34] P < 0.00001) and embryo transfer rate (RR = 2.04 95%CI[1.13, 3.70] P = 0.02), increase trilinear endometrium (RR = 1.47 95%CI [1.27, 1.70] P < 0.00001), thicken endometrium (SMD = 0.41 95% CI [0.11, 0.72] P = 0.008), reduce resistive index (RI) (MD = -0.08 95% CI [− 0.15, − 0.02] P = 0.01), pulse index (PI) (SMD = -2.39 95% CI [− 3.85, − 0.93] P = 0.001) and peak systolic velocity/ end-diastolic blood velocity (S/D) (SMD = -0.60 95%
CI [− 0.89, − 0.30] P < 0.0001), compared with medication, sham acupuncture or physiotherapy. Acupuncture was statistically significant as a treatment approach.
Conclusion: The efficacy and safety of acupuncture on key outcomes in women with low ER is statistically significant, but the level of most evidence was very low or low. More large-scale, long-term RCTs with rigorous methodologies are needed.
Keywords: Acupuncture, Endometrial receptivity, Systematic review, Meta-analysis, Randomized controlled trial