Meta Analyses and Systematic Reviews

This final section of our archives, gathers 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 Read More for a summary of what has been published over the last 12 years…… with mention of pertinent conclusions.

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ACUPUNCTURE, HERBS AND ENDOMETRIOSIS:

To date there is not a lot of research published on the treatment of endometriosis with Chinese medicine that meets the standard required for us to draw firm conclusions on efficacy. One review has analysed findings from 10 small trials that used acupuncture to treat endometriosis pain, and randomised controlled trials have examined the use of chinese medicine to prevent recurrence and to improve pregnancy rates after surgery. A large review has analysed the effect of acupuncture on dysmenorrhoea and is included here since pelvic pain from any source is considered to represent a blockage and must be addressed in a fertility  consultation.

Chinese Medicine Sequential Therapy Improves Pregnancy Outcomes after Surgery for Endometriosis-Associated Infertility: A Multicenter Randomized Double-blind Placebo Parallel Controlled Clinical Trial

Rui-hua Zhao et al, 2020, Chin J Int Med volume 26, pages92–99

Chinese Journal of Integrative Medicine

In this trial 100 women who underwent laparoscopic surgery for endometriosis were treated with chinese herbal medicine to promote fertility for the subsequent 6 cycles. Another group of women were followed but received no treatment after their laparoscopy. The women taking the Chinese herbs had a higher pregnancy and live birth rate than the control group.

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The efficacy and safety of acupuncture in women with primary dysmenorrhea

Woo, Hye Lin KMD et al, Med: 2018 Volume 97 Issue 23 – p e11007

Medicine

This review finds that acupuncture treatment of dysmenorrhoea confers benefit compared with NSAIDs or no treatment.

Patients (over 3000) with primary dysmenorrhoea (not pain from endometriosis) were included in this systematic review. In Chinese medicine terms pain indicates stagnation or blockage, and is one of the first things addressed in a fertility consultation whether diagnosed as endometriosis or dysmenorrhoea. .

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ACUPUNCTURE and SPERM

There have been a number of randomised controlled trials and pilot studies that have looked at the effect of acupuncture or electro stimulation of acupuncture points, on sperm quality in men with low counts, poor motility and morphology or a varicocele, most with favourable results. Because these trials all had different methodology and measured different outcomes, it is difficult to pool results in a meta-analysis and therefore it is also difficult to make recommendations for clinical practice at this stage.

Acupuncture and Clomiphene Citrate for Anovulatory Infertility: A Systematic Review and Meta-Analysis

Ranran Gao et al, 2020 Acupunct Med 38 (1) 25-36

Acupuncture Medicine

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Clinical Effect of Acupuncture Combined With Traditional Chinese Medicine in Treatment of Oligozoospermia/Asthenozoospermia: A Meta-Analysis

Bin Yang et al, 2020, Zhen Ci Yan Jiu 45(3):243-50

This meta analysis found that the combination of acupuncture and Chinese herbal medicine improved sperm count, morphology and motility and produced a better pregnancy rate than using herbal medicine alone.

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Overview of systematic reviews of non-pharmacological interventions in women with polycystic ovary syndrome

Jyotsna Pundir et al, Hum Reprod Update, Volume 25, Issue 2, 2019, Pages 243–256

Human Reproduction Update

The authors reviewed 12 systematic reviews of randomized trials (high quality score AMSTAR) that have evaluated the effects of non-pharmacological interventions, such as lifestyle interventions, nutritional supplements or acupuncture and Chinese medicine in women with PCOS on fertility, endocrine, glycaemic and weight-related outcomes. Acupuncture and Chinese medicine, N-acetylcysteine and inositol were all seen to improve ovulation and show preliminary potential to improve fertility (odds ratios (OR) for clinical pregnancy rate range from 1.99 to 4.83)

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Point of Influence: What is the Role of Acupuncture in In Vitro Fertilization Outcomes?

LH Rubin MEDICAL ACUPUNCTURE
Volume 31, Number 6, 2019

Lee Hollander Rubin from the University of California summarises the latest analyses of the effectiveness of acupuncture intervention for IVF patients. The incidence of live births in IVF patients who had acupuncture was seen to be significantly increased in recent meta-analyses, especially in women who had had previous failed cycles.

 

 

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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 .

 

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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 application of 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.

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