Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis

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Abstract

This was a systematic review and meta-analysis to examine the efficacy, effectiveness and safety of acupuncture as an adjunct to embryo transfer compared with controls to improve reproductive outcomes. The primary outcome was clinical pregnancy. Twenty trials and 5130 women were included in the review. The meta-analysis found increased pregnancies (risk ratio [RR] 1.32, 95% confidence interval [CI] 1.07–1.62, 12 trials, 2230 women), live births (RR 1.30, 95% CI 1.00–1.68, 9 trials, 1980 women) and reduced miscarriage (RR 1.43, 95% CI 1.03–1.98, 10 trials, 2042 women) when acupuncture was compared with no adjunctive control. There was significant heterogeneity, but no significant differences between acupuncture and sham controls. Acupuncture may have a significant effect on clinical pregnancy rates, independent of comparator group, when used in women who have had multiple previous IVF cycles, or where there was a low baseline pregnancy rate. The findings suggest acupuncture may be effective when compared with no adjunctive treatment with increased clinical pregnancies, but is not an efficacious treatment when compared with sham controls, although non-specific effects may be active in both acupuncture and sham controls. Future research examining the effects of acupuncture for women with poorer IVF outcomes is warranted.

Introduction

Assisted reproductive technology (ART), including IVF, has become widespread for treating infertility [European IVF-Monitoring Consortium (EIM) et al., 2016]. Today there are over 6 million children that have been conceived through ART (Dyer et al., 2016). Although a well-established treatment, each step of IVF is complex and invasive, and each step carries with it a possibility of failure. IVF is a resource-intensive and costly treatment option for both women and their families, and for public health care expenditure (Chambers et al., 2009). Therefore, new therapies that improve reproductive outcomes are highly desirable.

Women seek information and treatment about complementary health approaches to increase their chances of achieving a pregnancy and live birth (de Lacey et al., 2017, Rayner et al., 2009, Rayner et al., 2011), and also to improve their health, quality of life and to reduce stress whilst undergoing treatment cycles (de Lacey and Smith, 2013). Acupuncture has become a frequently used adjunctive treatment prior to and during IVF treatment (Domar et al., 2012). In the USA, 30% of a patient cohort engaged in acupuncture prior to IVF treatment and 47% during IVF treatment (Domar et al., 2012).

Acupuncture involves needle insertion and manipulation into specifically chosen acupuncture points located in the subcutaneous tissue. Early trials indicated that a short course of acupuncture administered prior to and immediately following embryo transfer (embryo transfer) may provide benefits in improving reproductive outcomes (Dieterle et al., 2006, Paulus et al., 2002, Smith et al., 2006). Delivery of this short treatment became common in clinical practice (Bovey et al., 2010, Smith et al., 2014). The number of published randomized clinical trials (RCT) has increased over time, and evidence of the effects from acupuncture compared with controls has become less clear. Systematic reviews have found no statistically significant difference in clinical pregnancy or live birth rates when compared with a control (Cheong et al., 2013, Manheimer et al., 2013). This review incorporates new evidence from recently published RCT. The objective of this review was to examine the efficacy, effectiveness and safety of acupuncture as an adjunct to embryo transfer compared with controls or no adjuvant treatment to improve clinical pregnancies live births among women undergoing IVF.

Section snippets

Materials and methods

We included RCT that compared acupuncture with sham acupuncture controls or no adjuvant treatment. We considered only RCT where acupuncture was administered during an IVF cycle and included acupuncture treatment administered within 1 day of embryo transfer and with the objective of improving assisting conception and IVF success rates. Trials administered at other stages of the IVF cycle were excluded due to a different treatment rationale. We excluded non-randomized studies, and crossover

Results

A total of 4681 potential references were identified. After 727 duplicates were removed, the studies were examined by title, abstract and full text for eligibility (Figure 1). Of the 37 studies examined by the full text, 20 trials met the inclusion criteria for this review (Andersen et al., 2010, Arnoldi et al., 2010, Craig et al., 2014, Dieterle et al., 2006, Domar et al., 2009, Feliciani et al., 2011, Gillerman et al., 2016, Madaschi et al., 2010, Morin et al., 2017, Moy et al., 2011, Omodei

Discussion

The search strategy identified 20 trials and 5130 women for inclusion in this review. A benefit from trials of acupuncture when administered within 1 day of embryo transfer increased clinical pregnancy, ongoing pregnancy and live births when compared with no adjunctive treatment. This was a clinically significant 30% increased chance of an improved reproductive outcome, however there was substantial heterogeneity. There was no evidence of an effect when acupuncture was compared with a sham

Acknowledgements

The authors would like to thank Dr Eric Manheimer, the primary author of a previous systematic review, for sharing information on studies requiring follow-up with authors. We also thank Dr Joseph Firth for his assistance with the meta-regression.

Professor Caroline Smith is based at NICM Health Research Institute, Western Sydney University, and leads the Healthy Women research theme and a team of postdoctoral researchers and higher degree candidates. Caroline is a clinical researcher with extensive experience with the conduct of multicentre randomized controlled trials and systematic reviews.

Key message

Acupuncture may be effective when compared to no adjunctive treatment with increasing clinical pregnancies and live

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    Professor Caroline Smith is based at NICM Health Research Institute, Western Sydney University, and leads the Healthy Women research theme and a team of postdoctoral researchers and higher degree candidates. Caroline is a clinical researcher with extensive experience with the conduct of multicentre randomized controlled trials and systematic reviews.

    Key message

    Acupuncture may be effective when compared to no adjunctive treatment with increasing clinical pregnancies and live births, but is not an efficacious treatment when compared with sham controls.

    View full text