Acupuncture and assisted reproductive technology: Cochrane systematic review

Abstract

Assessed as up to date: 2013/07/22

Background

Acupuncture is commonly undertaken during an assisted reproductive technology (ART) cycle although its role in improving live birth and pregnancy rates is unclear.

Objectives

To determine the effectiveness and safety of acupuncture as an adjunct to ART cycles for male and female subfertility.

Search methods

All reports which described randomised controlled trials of acupuncture in assisted conception were obtained through searches of the Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL, Ovid MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing & Allied Health Literature), AMED , www.clinicaltrials.gov (all from inception to July 2013), National Research Register, and the Chinese clinical trial database (all to November 2012).

Selection criteria

Randomised controlled trials of acupuncture for couples who were undergoing ART, comparing acupuncture treatment alone or acupuncture with concurrent ART versus no treatment, placebo or sham acupuncture plus ART for the treatment of primary and secondary infertility. Women with medical illness that was deemed to contraindicate ART or acupuncture were excluded.

Data collection and analysis

Twenty randomised controlled trials were included in the review and nine were excluded. Study selection, quality assessment and data extraction were performed independently by two review authors. Meta-analysis was performed using odds ratio (OR) and 95% confidence intervals (CI). The outcome measures were live birth rate, clinical ongoing pregnancy rate, miscarriage rate, and any reported side effects of treatment. The quality of the evidence for the primary outcome (live birth) was rated using GRADE methods.

Main results

This updated meta-analysis showed no evidence of overall benefit of acupuncture for improving live birth rate (LBR) regardless of whether acupuncture was performed around the time of oocyte retrieval (OR 0.87, 95% CI 0.59 to 1.29, 2 studies, n = 464, I2 = 0%, low quality evidence) or around the day of embryo transfer (ET) (OR 1.22, 95% CI 0.87 to 1.70, 8 studies, n = 2505, I2 = 69%, low quality evidence). There was no evidence that acupuncture had any effect on pregnancy or miscarriage rates, or had significant side effects.

Authors' conclusions

There is no evidence that acupuncture improves live birth or pregnancy rates in assisted conception.

Author(s)

Cheong Ying C, Dix Sarah, Hung Yu Ng Ernest, Ledger William L, Farquhar Cindy

Summary

Acupuncture and assisted conception

Review question: does acupuncture improve the outcomes of assisted reproduction?

Background: one in seven couples suffer from subfertility and many will seek help in the form of assisted reproductive technology (ART). Although the use of acupuncture has gained popularity, the use of this traditional Chinese medical treatment in conjunction with ART treatments is still controversial. This review summarised the evidence from well designed studies and evaluated the effectiveness and safety of acupuncture in assisted conception.

Search date: the evidence is current to July 2013.

Study characteristics: there were 20 randomised controlled studies identified. Six studies compared acupuncture at the time of egg collection (912 women) and 14 studies compared acupuncture in assisted conception (3632 women). The studies were further divided into those which used placebo needles in their control groups versus those that had controls who did not undergo any treatment. All the studies identified involved participants undertaking in vitro fertilization (IVF); there were no studies reporting the effect of acupuncture in ovulation induction or intrauterine insemination.

Funding of included studies: no included studies had external funding.

Key results: there is no evidence of benefit for the use of acupuncture in participants undergoing assisted conception treatment around the time of embryo transfer or at egg collection in terms of improving the live birth rate, ongoing or clinical pregnancy rate. There is also no evidence that acupuncture has any effect on miscarriage rate or had significant side effects.

Quality of the evidence: overall, the results are not similar across the studies. This was due to different study designs including the use of different types of control groups that could have introduced bias. More research is needed before recommendations can be made, including studies in which some controls receive placebo needling and others receive no intervention.

Reviewer's Conclusions

Implications for practice

We found no evidence that acupuncture improves live birth rate, ongoing pregnancy rate or clinical pregnancy rate. We also found no evidence that acupuncture increases the rate of miscarriage.

Implications for research

Future research into the value of acupuncture in improving the pregnancy rate of women undergoing IVF treatment should incorporate basic scientific principles and methodologies. Within the realm of RCTs, studies in this area should focus on the use of 'standardised' acupuncture methods so that reasonable comparisons can be made; live birth rate should be used as the primary outcome.The use of 'sham needles' may enhance the quality of the studies performed, though further research into the biological effect of sham acupuncture is needed. Ideally, studies in this area should carefully consider how they determine the necessary treatment points, gather qualitative as well as quantitative data in parallel with a three arm study design, acupuncture, no intervention and placebo needling. They should also provide their centre's pregnancy rates during the time course of the study for comparison. It is with this comprehensive study design that any clinical benefit of acupuncture can be delineated.

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TY - ELEC T1 - Acupuncture and assisted reproductive technology: Cochrane systematic review ID - 433952 BT - Cochrane Abstracts UR - https://evidence.unboundmedicine.com/evidence/view/Cochrane/433952/all/Acupuncture_and_assisted_reproductive_technology:_Cochrane_systematic_review DB - Evidence Central DP - Unbound Medicine ER -