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

Human Reproduction Update

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

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 summaries 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. Significant evidence was found to show that acupuncture increased the quality and thickness of the endometrium leading to increased pregnancy rates. We look forward to more large RCTs to verify this finding.

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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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ACUPUNCTURE, HERBS, IVF and PREGNANCY RATE

The collection of papers in this section includes some that examined the role of acupuncture at the time of embryo transfer in an IVF cycle.

  • Acupuncture and IVF; The largest randomised controlled trials in this area found that there was no benefit from  acupuncture on the day of transfer, (and in some cases with an additional treatment before the day of transfer) compared with sham acupuncture.  Two smaller but well designed RCTs examined the effect of administering acupuncture throughout the stimulation phase as well as at, or near embryo transfer on IVF patients with a past history of failed cycles or a poor prognosis. Both of these found that the acupuncture groups pregnancy rate was significantly higher than the control groups. See also Meta-analyses.

Other publications in this section include studies on the impact of acupuncture or chinese herbs on low ovarian reserve, intrauterine insemination, natural fertility, endometrial receptivity and frozen embryo transfer.

  • Low ovarian reserve; Two studies examining electro-acupuncture or TEAS’s impact on responsiveness of ovaries with low reserve reported encouraging findings, as did one where herbal medicine’s effect on ovarian reserve was examined but we await larger randomised controlled trials before firm conclusions can be drawn as to therapeutic efficacy.
  • Endometrial receptivity/FET; Pregnancy rates and endometrium quality were examined in 2 randomised controlled trials that used well known Chinese herbal formulas. In another couple of randomised controlled trials the effect of TEAS acupuncture point stimulation on endometrial receptivity and pregnancy rates was examined in women preparing for frozen or fresh embryo transfers. Promising results are reported in all these trials, and we look forward to further RCTs.
  • Intrauterine insemination; Only one study has been published as far as we know on the effect of Chinese Medicine treatment on the outcomes of Intrauterine insemination. A small controlled but non randomised trial found that the group of women who used Chinese medicine had a markedly higher pregnancy and live birth rate. As with the above, larger RCTs are required before definitive conclusions can be reached.
  • Natural fertility; The logistics of recruitment and funding mean that very few studies of the effect of Chinese medicine on fertility have been published. One small randomised controlled trial found that Chinese medicine treatment halved the time to conception compared to a control group. If this sort of trial can be mounted with larger numbers we may be able to make some claims about the effect of Chinese medicine on fertility.

Acupuncture for Depression: A Systematic Review and Meta-Analysis

Armour M et al J. Clin. Med. 2019, 8(8), 1140

Journal of Clinical Medicine

The authors of this meta-analysis scrutinised more than 1000 reports on the effect of acupuncture on depression in medical journals, and by applying strict clinical trial standards reduced the number of reports down to 29 for analysis. These reports included more than 2000 patients. Their analysis indicates that acupuncture can make a useful contribution to the management of depression, either on its own or alongside medication.  This report did not focus particularly on women, or on women who were pregnant, post partum or infertile. However its findings could find application in these areas where depression has been diagnosed. Read More

Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms − a randomised controlled study

Bergdahl L et al, Eur Jn Int Med, Vol 16, 2017,  15-21
European Journal of Integrative Medicine

Ear Acupuncture was seen to reduce anxiety and depression in this study on 57 participants with insomnia disorder and long term use of hypnotic drugs. 74% of them managed to discontinue their hypnotic drug consumption post-treatment. Future studies could examine whether ear acupuncture could be useful for women suffering anxiety, depression or insomnia related to infertility.

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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 to make therapeutic recommendations at this stage.

Effects and mechanism of action of transcutaneous electrical acupuncture point stimulation in patients with abnormal semen parameters

Yan Yu et al, Acup Med BMJ, 2019

 

Acupuncture in Medicine, British Medical Journal

A randomised controlled trial examined the effect of electrical stimulation of acupuncture points (using TEAS), on sperm parameters. They found that low frequency stimulation significantly improved sperm count and motility in men with abnormal semen analysis.

 

 

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ACUPUNCTURE AND EMBRYO TRANSFER – published in Fertility and Sterility

The large majority of small randomised controlled trials that examined the effect of acupuncture on IVF outcomes when administered on the day of embryo transfer, found a positive effect. However some more recent large randomised controlled trials (published in other journals) have not replicated this result, concluding that acupuncture on the day of transfer does not increase live birth rates for IVF patients. The more recent reviews of trials examining more extensive use of acupuncture before and during an IVF cycle indicate a benefit, compared to those where only 2-3 treatments were administered.

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 one randomised controlled trial has examined the use of chinese medicine to prevent recurrence after surgery.