A systematic review on use of Chinese medicine and acupuncture for treatment of obesity

Sui Y et al, 2012, Obesity Rev, Vol 3, p 409–430
Obesity Reviews

This systematic review (which is not specific to obesity only in PCOS patients) collected data from RCTs that examined the effect of acupuncture and/or Chinese herbal medicine on nearly 5000 overweight patients, compared with a control group of nearly 4000 overweight subjects. The review reports that in terms of weight loss, acupuncture and Chinese herbal medicine are better than placebo and lifestyle interventions and have similar efficacy to anti-obesity drugs (including Metformin), but with fewer side effects. This review also noted that those who used acupuncture or Chinese herbal medicine to lose weight had a lower risk of relapse. More large RCTs are recommended before recommendations for therapeutic interventions can be made.

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Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis

 Zheng CH et al, 2012 Fert Steril, Vol. 97, Issue 3, 599-611
Fertility and Sterility 

Researchers from China analysed results of nearly 6000 women participating in trials examining the effect of acupuncture during IVF. They found that pregnancy rates and birth rates were improved by acupuncture when compared to women having no acupuncture (but not when compared to women having placebo acupuncture with a non penetrating needle).

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The Role of Acupuncture in Assisted Reproductive Technology

 Zheng CH et al, Evid Based Complement Alternat Med. 2012; vol 2012: 543924.
Evidence Based Complementary and Alternat Medicine

This review represents another analysis by the same team who also published their results in Fertility and Sterility 2012 (see above). In this review they emphasise that the effects of administering individualised acupuncture treatments throughout the IVF cycle rather than just at the time of embryo transfer, produces higher pregnancy rates.

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Chinese Herbal Medicine for Infertility with Anovulation: A Systematic Review

Li Tan et al, The Journal of Alternative and Complementary Medicine, 2012, 18(12): 1087-1100

The Journal of Alternative and Complementary Medicine

A meta-analysis of studies done in China involving 1659 women, reports that Chinese medicine significantly increases frequency of ovulation in women with anovulatory infertility compared to treatment with Clomiphene (Clomid). They observe that pregnancy rates are increased and miscarriage rates reduced in women who use Chinese medicine compared with those who use Clomid. However more randomized controlled trials are needed before evidence-based recommendations regarding the effectiveness and safety of Chinese medicine for infertility with anovulation can be provided. Read More

Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: A systematic review.

Ried K, Stuart K Complement Ther Med. 2011 Dec;19(6):319-31
Complementary Therapies in Medicine

This systematic review, from researchers in Adelaide, Australia presents a meta analysis of trials and cohort studies, and compares pregnancy rates achieved with the Chinese medicine compared with assisted reproduction techniques including IVF. The researchers found that Chinese herbal medicine can improve pregnancy rates 2 fold within a 4 month period compared with fertility drug treatment or IVF. The authors comment that the assessment of the quality of the menstrual cycle, integral to TCM diagnosis, appears to be fundamental to successful treatment of female infertility. Read More

Acupuncture and herbal medicine in in vitro fertilisation: a review of the evidence for clinical practice

Cheong Y et al, Hum Fert 2010, Vol. 13, No. 1, Pg 3-12.
Human Fertility 

A further analysis by the authors of a previously published Cochrane review on the role of acupuncture at embryo transfer in an IVF cycle, included more trials. They included a trial which had previously been excluded due to the fact that its methodology introduced too much heterogeneity – this plus the inclusion of another trial which used placebo acupuncture reduced the measurable benefits of acupuncture at the time of embryo transfer to IVF patients  such that there was no difference apparent between acupuncture and control groups. Read More

A Systematic Review and Meta -analysis of the effect of Acupuncture on Outcome of in Vitro Fertilisation Treatment

El-Toukhy T et al BJOG 2008 115 (10); 1203 -13
British Journal of Obstetrics and Gynaecolgy  

This meta analysis indicated that in the trials they chose to include they found no effect of acupuncture on IVF outcomes. This meta analysis included a trial which had been excluded from other meta-analyses because it employed different methodology. Read More

The Role of Acupuncture in the Management of Subfertility

Ng E H et al Fertil Steril. 2008 Jul;90(1):1-13.
Fertility and Sterility  

A systematic review of the literature from a group in Hong Kong concludes that any observed positive effect of acupuncture in the treatment of subfertility may be related to the central sympathetic inhibition by the endorphin system, the change in uterine blood flow and motility, and stress reduction. Read More

Acupuncture and Assisted Conception

Cheong Y et al Cochrane Database of Systematic Reviews 2008 Issue 4
Cochrane Review

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.

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Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis.

 Manheimer E et al. BMJ 2008;336 pg 545-549
British Medical Journal

In early 2008 The British Medical journal published what would be the first of several meta analyses of trials looking at the effect of acupuncture on day of transfer. Their analysis concluded that 10 patients would need to be treated with acupuncture to bring about one additional clinical pregnancy.

When they analysed the trials that measured live births in addition to pregnancy rates, they found that acupuncture increased the odds by 91% and that the number of patients who would need to be treated to bring about an additional pregnancy dropped to 9.

Future meta-analyses have included more studies, with different conclusions.

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Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials

Smith, GCS and J Pell BMJ 2003; 327, 1459 British Medical Journal
A tongue in cheek analysis of meta-analyses, randomised, placebo controlled trials and evidence based medicine. These authors very cleverly make a strong case for the fact that some interventions do NOT lend themselves to randomised blinded trials.But can still have a place in medicine simply because they have been seen to work. While not for a minute purporting to compare an acupuncture treatment to the life saving action of a parachute, we nevertheless would like to point out that there are some aspects of a discipline like acupuncture which will never be able to be squeezed into the confines of a double blind randomised trial, without losing something of its essence. Other aspects of acupuncture, like some of its known physiological effects, can be measured in a trial setting - however the results of these trials should never be taken to be telling the WHOLE story!

 

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