Meta Analyses and Systematic Reviews
The final section of our archives, has gathered 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.
Because the number of Systematic Reviews has grown so rapidly (reflecting the large number of trials in the area of Chinese medicine and fertility) there is now a Systematic Review of Systematic Reviews!
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 clinicians and their patients and encouraged more research to follow.
While all the meta-analyses listed here include only eligible RCTs chosen with strict inclusion criteria, the heterogeneity and risk of bias in some trials has lead many authors to suggest that more RCTs are required before any specific recommendations are made to patients regarding treatment.
Another important proviso we must add here, is that many trials did not administer what most TCM doctors would consider the optimal number of acupuncture treatments and few used acupuncture as it used traditionally (ie highly individualised treatments). Despite this, the findings in these meta-analyses and systematic reviews are highly encouraging in terms of further research and application in the clinic.
To comply with AHPRA advertising guidelines we have removed the plain English summaries of the findings of these Meta-analyses along with all abstracts and PDFs. Please feel free to contact us if you would like any information about any of these publications.
Please click Read More to find a clear summary of some of the relevant meta analyses published over the last 13 years…….
1
ET ACUPUNCTURE
Over the last 12 years there have been more than 10 meta-analyses of ET acupuncture trials (wherein acupuncture is administered to an IVF patient primarily at or around the time of embryo transfer, 2-3 treatments in total). Early meta-analyses were mixed in their conclusions, some finding a benefit to IVF patients receiving acupuncture, others finding no benefit.
Most of the later meta analyses reported provisional benefits of ET acupuncture to certain groups of IVF patients, specifically the group of women with a low baseline pregnancy rate expectation (ie previous failed IVF cycles, or older age group). In some Meta analyses acupuncture only appeared to confer a benefit in trials when compared to controls that did not use sham acupuncture.
- 2008 British Medical Journal Manheimer E et al – Pregnancy rate improved by acupuncture
- 2008 Cochrane Review Cheong Y et al – Live birth rate improved by acupuncture
- 2008 British Journal of Obstetrics and Gynaecology El-Toukhy T et al – Pregnancy rate not improved by Acupuncture
- 2009 Cochrane Review Cheong Y et al – Live birth rate improved by Acupuncture
- 2010 Human Fertility Cheong Y et al – Pregnancy rate not improved by Acupuncture
- 2012 Fertility and Sterility Zheng CH et al – Pregnancy rate improved by Acupuncture compared to routine care but not compared to sham needle control
- 2013 Human Reproduction Update Manheimer E et al, – Pregnancy rate improved by Acupuncture in low baseline pregnancy rate group
- 2013 Cochrane Review Cheong Y et al – Live birth rate improved by Acupuncture when compared to routine care but not compared to sham needle control.
- 2018 European Journal of Integrative Medicine Xian Zhang et al – Live birth rate improved by Acupuncture when compared with routine care.
- 2019 Reproductive Biomedicine Online Smith C et al – Pregnancy rate improved by Acupuncture in low baseline pregnancy rate group.
- 2019 BMC Complementary and Alternative Medicine Xie ZY et al – Pregnancy rate improved by Acupuncture in low baseline pregnancy rate group.
2
IVF ACUPUNCTURE
IVF acupuncture is the term we are using to describe a treatment programme wherein a number of acupuncture treatments (often around 10-12) are delivered before and during an IVF cycle according to Chinese medicine principles, as well as the ET acupuncture treatments used in the above category. Three meta analyses in this category found that acupuncture conferred a benefit to IVF patients. This may indicate that acupuncture given in a greater dose makes a significant difference, information we are using in our clinic IVF support programs.
- 2012 Evidence Based Complementary and Alternative Medicine Zheng CH et al – Pregnancy rate improved by Acupuncture
- 2015 Gynecological and Obstetric Investigations Shen C et al – Pregnancy rate improved by Acupuncture
- 2016 Archives of Gynecology and Obstetrics Qian Y et al – Pregnancy rate improved by Acupuncture
3
CHINESE HERBAL MEDICINE DURING IVF
It is not common in the west for IVF patients to be treated with herbs during IVF cycles, although in China and other countries in Asia herbal medicine is a popular adjunct. A 2020 meta-analysis in the English language compiled by a group of clinicians in different hospitals in Korea has gathered the outcomes of trials looking at the effect of herbal medicine taken before and during IVF.
- 2020 Integrative Medicine Research Jang Won Lee et al – Pregnancy rate improved by Chinese herbal medicine
- 2020 Complementary Therapies in Medicine Kwon CY et al – Pregnancy rate improved by Chinese herbal medicine
4
ACUPUNCTURE OR CHINESE HERBAL MEDICINE USED FOR NATURAL FERTILITY
It is also not common to find trials that measure the effect of Chinese herbs in women who are not doing IVF, due to the difficulties in recruitment. Three reviews include RCT’s, cohort studies and case studies .
5
PCOS
Polycystic Ovarian Syndrome may underlie many metabolic and endocrine problems, including ovarian dysfunction. Research into this syndrome is active in many countries, and there are several meta-analyses that summarise trials measuring the effect of acupuncture on ovulation frequency in PCOS patients, and IVF outcomes and hormone levels in PCOS patients. Emerging trends from these trials inform some of the treatment programs we offer in clinic.
6
ANOVULATORY INFERTILITY
Two meta-analyses have been performed on trials examining anovulatory infertility, one assessing the effect of Chinese herbs and the other acupuncture on ovulation rates compared to Clomiphene. The results will encourage further research in this area.
7
PREGNANCY NAUSEA
One meta-analysis has examined trials of acupuncture for pregnancy nausea with different results for continuous and dichotomous (ie improvement or no improvement) variables.
8
ENDOMETRIOSIS
Four meta-analyses have examined trials using Chinese medicine to treat endometriosis in terms of pregnancy outcomes and ovarian function and also one examining pain related to endometriosis.
9
MALE INFERTILITY
Two meta-analyses have examined trials using acupuncture and Chinese herbal medicine to treat male infertility.
