Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization: a randomized clinical trial

Caroline Smith et al, JAMA, 2018 DOI: 10.1001/jama.2018.5336

Journal of the American Medical Association.

 

848 women at 16 different IVF centres in Australia and New Zealand were given acupuncture (with real or sham needles)  by 80 different acupuncturists. A standardised protocol was delivered on Day 6 of the stimulation phase and another at some point before and after the embryo transfer. The data indicated that at this dose of acupuncture, and using these protocol points, there was no significant difference in live births between those who received the real or the sham needles.

The authors admit that ” the lack of frequent treatments was a limitation of our trial” since in real clinical practice acupuncture treatment is individualised with variation in dosing, including more frequent treatment prior to and during the IVF cycle.

They also noted that while a very short course of acupuncture may statistically be no better than sham at improving live birth and pregnancy outcomes, a psycho-social benefit from acupuncture was reported by women undergoing IVF.

Abstract

Importance  Acupuncture is widely used by women undergoing in vitro fertilization (IVF), although the evidence for efficacy is conflicting.

Objective  To determine the efficacy of acupuncture compared with a sham acupuncture control performed during IVF on live births.

Design, Setting, and Participants  A single-blind, parallel-group randomized clinical trial including 848 women undergoing a fresh IVF cycle was conducted at 16 IVF centers in Australia and New Zealand between June 29, 2011, and October 23, 2015, with 10 months of pregnancy follow-up until August 2016.

Interventions  Women received either acupuncture (n = 424) or a sham acupuncture control (n = 424). The first treatment was administered between days 6 to 8 of follicle stimulation, and 2 treatments were administered prior to and following embryo transfer. The sham control used a noninvasive needle placed away from the true acupuncture points.

Main Outcomes and Measures  The primary outcome was live birth, defined as the delivery of 1 or more living infants at greater than 20 weeks’ gestation or birth weight of at least 400 g.

Results  Among 848 randomized women, 24 withdrew consent, 824 were included in the study (mean [SD] age, 35.4 [4.3] years); 371 [45.0%] had undergone more than 2 previous IVF cycles), 607 proceeded to an embryo transfer, and 809 (98.2%) had data available on live birth outcomes. Live births occurred among 74 of 405 women (18.3%) receiving acupuncture compared with 72 of 404 women (17.8%) receiving sham control (risk difference, 0.5% [95% CI, −4.9% to 5.8%]; relative risk, 1.02 [95% CI, 0.76 to 1.38]).

Conclusions and Relevance  Among women undergoing IVF, administration of acupuncture vs sham acupuncture at the time of ovarian stimulation and embryo transfer resulted in no significant difference in live birth rates. These findings do not support the use of acupuncture to improve the rate of live births among women undergoing IVF.