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?

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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Effect of acustimulation on nausea and vomiting and on hyperemesis in pregnancy: a systematic review of Western and Chinese literature.

Van den Heuvel E et al, 2016 Jan 13;16:13

This review of twenty-nine randomised controlled trials (including 3519 patients) found that there was a significant reduction in nausea and vomiting in pregnancy with the application of various acupuncture techniques, when trials reporting dichotomous data (ie symptoms improved or not) were analysed. 73 % fewer patients had symptoms after treatment compared to those who did not have treatment. However when trials reporting continuous data were analysed this difference between treatment and control groups was not found.

The included studies examined acupressure, acupuncture, auricular acupressure and moxibustion. Treatment duration varied from four to ten days in 25 studies. Four studies continued treatment for two to four weeks. Treatment frequency varied from once a day to once every week.

The authors advised that these findings need to be evaluated in future clinical trials with rigorous design and large sample sizes.

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Effects of acupuncture during in vitro fertilisation or intracytoplasmic sperm injection: An updated systematic review and meta-analysis.

Xian Zhang et al, 2018, Eur Jnl Int Med,  https://doi.org/10.1016/j.eujim.2018.09.001

European Journal of Integrative Medicine.

The most recent meta analysis of outcomes for IVF patients concluded that those who had acupuncture during their cycle compared to those who had routine care, had a higher chance of having a live birth. However the authors believe that more trials are warranted to further validate its effects.



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Effectiveness of acupuncture in women with polycystic ovarian syndrome undergoing in vitro fertilisation or intracytoplasmic sperm injection: a systematic review and meta-analysis

Junyoung Jo and  Yoon Jae Lee, 2017 Acup in Med, Vol: 35 issue: 3, 162-170

British Medical Journal; Acupuncture in Medicine

This systematic review of randomised controlled trials examined the effect of acupuncture on 430 PCOS patients undergoing IVF, The findings indicate that acupuncture (both electro acupuncture and manual acupuncture) improves pregnancy rates and reduces the risk of OHSS. Acupuncture was delivered only during the IVF cycle and did not improve live birth outcomes in this review. Further studies are recommended to examine the efficacy and safety of acupuncture in PCOS patients doing IVF.

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Therapeutic effect of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis

Qian Y et al, 2016  Arch Gynecol Obstet Dec p 1-16

Archives of Gynecology and Obstetrics

Data from nearly six and a half thousand women undergoing IVF reveals that acupuncture improves pregnancy rates especially when it is carried out in the stimulation phase of the IVF cycle when the follicles are developing (compared to acupuncture applied only on day of embryo transfer). In general studies carried out in Asia using electro acupuncture showed a stronger trend to improved IVF outcomes than did non Asian studies that did not use electro-acupuncture.

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The Role of Acupuncture in in vitro Fertilization: A Systematic Review and Meta-Analysis

Shen C et al, 2015 Gynecol Obstet Invest 79:1-12

Gynecological and Obstetric Investigations


A review of 21 Randomized Controlled trials (that included nearly 5,500 patients) concluded that while acupuncture administered to IVF patients only at the time of embryo transfer did not confer any significant advantage, acupuncture administered during the IVF cycle stimulation phase and/or during implantation phase in addition to treatment at the time of transfer showed  significant improvement in pregnancy rates.


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Can Chinese Herbal Medicine Improve Outcomes of In Vitro Fertilization? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Acupuncture-Pregnancy-478Huijuan Cao et al, PLOS one, 2013, Vol 8, 12, e81650


This collaboration between China and the UK analysed 20 eligible randomised trials that looked at the effect of Chinese herbal medicine taken during IVF cycles. Most IVF clinics in the west discourage the use of herbs during IVF, so the 20 trials used in this meta-analysis came from IVF clinics in China, and were reported in Chinese medical journals.The combination of Chinese herbal medicine with IVF significantly increased the pregnancy rate, though the authors express concern about a risk of bias since reporting and analysis requirements are different in Chinese journals. Hence further large RCTs are warranted.

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Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes

cov150h-1Hullender Rubin L et al, Reprod Biomed Online, Vol 30, 602-612, 2015

Reproductive BioMedicine Online

Lee Hullender Rubin and her colleagues retrospectively analyzed the outcomes of more than a thousand IVF cycles, and found that women who used Chinese Medicine (acupuncture with or without herbs, dietary advice etc), had a higher live birth rate than those doing IVF alone. The proportion of live births was significantly higher in the Chinese Medicine group (61.3%) compared with either the usual IVF care (48.2%) or acupuncture only on day of embryo transfer (50.8%). Women in the Chinese Medicine group had on average 12 acupuncture treatments before and during the IVF cycle. While this audit is a useful perspective of Chinese medicine as it is practiced in real life situations, more trials that examine the action of Chinese medicine as an individualised therapy will be needed before conclusive recommendations can be made.


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