Live births in women who integrate whole systems traditional Chinese medicine with IVF: does age matter?

Hullender Ruben L et al, Fertil Steril 2017, Vol 108, Issue 3, Supplement, Page e352

Fertility and Sterility

LH Ruben and colleagues have further analysed data from a review published in 2015. This analysis of the data showed that the advantage that Traditional Chinese Medicine offered to women undergoing IVF was most pronounced in the older age groups, particularly women between 38 and 42.

 

 

 

Objective

To evaluate In Vitro Fertilization (IVF) outcomes stratified by age in women who integrated Whole Systems Traditional Chinese Medicine (WSTCM).

Design

Secondary analysis of a retrospective patient cohort from 2005 to 2010.

Materials and Methods

A multi-modal intervention, WSTCM is individualized acupuncture combined with diet, lifestyle, nutritional supplements, and Chinese herbs, if appropriate. We reviewed 1,069 IVF patient charts to assess the effect of adjuvant WSTCM (N=119) on IVF live births compared with IVF alone (N=580) or day of ET acupuncture (N=370) and stratified by age group (<35, 35-37, 38-40, 41-42, >43 years old). Donor egg (n=225), frozen (N=251), cycles with no transfer (n=312) were excluded. The primary outcome was live birth. Groups were compared using Fisher exact and Chi-square, p<0.05 was significant. Treatment effect was assessed using multivariate logistic regression, adjusted by covariates associated with outcome. Nonsignificant covariates were removed from the model using a stepwise method.

Results

Demographics and characteristics were comparable on all variables except: total antral follicles (p=0.0497), diminished ovarian reserve diagnosis (p=0.01), other diagnosis (p=0.03), prior IVF (p=0.004), number of mature eggs (p=0.02), and number of embryos transferred (p=0.003).

IVF augmented with WSTCM was associated with an increase in live births in 38- to 40-year-old women compared with IVF alone (p=0.04), and in 41- to 42-year-old women compared to all cycles (p=0.01). There were trends toward a significant difference in live births in the 38-40 age group compared with all cycles (p=0.05), and clinically relevant differences in the <35 and 35-37 age groups with WSTCM compared with the other groups, though not significant. Confidence intervals were broad, therefore larger populations are needed to confirm these observations.

Conclusions

Age may be a consideration when integrating acupuncture or WSTCM with IVF and may benefit women aged 38 and older. In this retrospective study, adjuvant WSTCM and IVF was associated with increased odds of live birth in women aged 38 to 42 years old. Small group numbers limit the strength of these observations.

Live births stratified by age group. Data are % (group N), adjusted odds ration (95% CI)
Age group (N) WSTCM + IVF IVF alone ET Acupuncture + IVF
Under 35 (530) 67.9 (53) 1.30 (0.71 – 2.39) 60.0 (305) 1.40 (0.75 – 2.61) 65.7 (172) 1.08 (0.56 – 2.10)
35-37 (239) 61.8 (34) 1.72 (0.78 – 3.80) 43.3 (127) 2.10 (0.90-4.96) 47.4 (78) 1.79 (0.79 – 4.05)
38-40 (222) 54.2 (24) 2.32 (0.99-5.74) 31.5 (108) 2.67 (1.06 – 6.73) 36.7 (21) 1.79 (0.70- 4.58)
41-42 (52) 60.0 (5) 17.35 (1.88 – 160.04) 19.2 (26) 6.00 (0.78 – 46.14) 19.0 (21) 6.38 (0.78 – 51.8)
43 and over (26) 0 (3) — 21.4 (14) — 11.1 (9) —

 

© 2017 Published by Elsevier Inc.