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Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis

  • Cui Hong Zheng
    Correspondence
    Reprint requests: Cui Hong Zheng, M.D., Ph.D., Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei 430030, People’s Republic of China.
    Affiliations
    Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
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  • Guang Ying Huang
    Correspondence
    Guang Ying Huang, M.D., Ph.D.
    Affiliations
    Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
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  • Ming Min Zhang
    Affiliations
    Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
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  • Wei Wang
    Affiliations
    Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
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      Objective

      To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.

      Design

      Systematic review and meta-analysis.

      Patient(s)

      Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects of acupuncture on IVF outcomes.

      Setting

      Not applicable.

      Intervention(s)

      The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture.

      Main Outcome Measure(s)

      The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.

      Result(s)

      Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation.

      Conclusion(s)

      Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects from using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

      Key Words

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      References

        • Rosenthal L.
        • Anderson B.
        Acupuncture and in vitro fertilisation: recent research and clinical guidelines.
        J Chin Med. 2007; : 28-35
        • Engmann L.
        • DiLuigi A.
        • Schmidt D.
        • Nulsen J.
        • Maier D.
        • Benadiva C.
        The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study.
        Fertil Steril. 2008; 89: 84-91
        • Wang W.
        • Check J.H.
        • Liss J.R.
        • Choe J.K.
        A matched controlled study to evaluate the efficacy of acupuncture for improving pregnancy rates following in vitro fertilization–embryo transfer.
        Clin Exp Obstet Gynecol. 2007; 34: 137-138
        • Fisher P.
        • Ward A.
        Complementary medicine in Europe.
        BMJ. 1994; 309: 107-111
        • Thomas K.J.
        • Nicholl J.P.
        • Coleman P.
        Use and expenditure on complementary medicine in England: a population based survey.
        Complement Ther Med. 2001; 9: 2-11
        • Cheong Y.C.
        • Hung Yu Ng E.
        • Ledger W.L.
        Acupuncture and assisted conception.
        Cochrane Database Syst Rev. 2009; : CD006920
        • Stener-Victorin E.
        • Waldenstrom U.
        • Nilsson L.
        • Wikland M.
        • Janson P.O.
        A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization.
        Hum Reprod. 1999; 14: 2480-2484
        • Manheimer E.
        • Zhang G.
        • Udoff L.
        • Haramati A.
        • Langenberg P.
        • Berman B.M.
        • et al.
        RCT: Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis.
        BMJ. 2008; 336: 545-549
        • Ng E.H.
        • So W.S.
        • Gao J.
        • Wong Y.Y.
        • Ho P.C.
        The role of acupuncture in the management of subfertility.
        Fertil Steril. 2008; 90: 1-13
        • El-Toukhy T.
        • Sunkara S.K.
        • Khairy M.
        • Dyer R.
        • Khalaf Y.
        • Coomarasamy A.
        A systematic review and meta-analysis of acupuncture in in vitro fertilisation.
        BJOG. 2008; 115: 1203-1213
        • Cheong Y.
        • Nardo L.G.
        • Rutherford T.
        • Ledger W.
        Acupuncture and herbal medicine in in vitro fertilisation: a review of the evidence for clinical practice.
        Hum Fertil (Camb). 2010; 13: 3-12
        • El-Toukhy T.
        • Khalaf Y.
        The impact of acupuncture on assisted reproductive technology outcome.
        Curr Opin Obstet Gynecol. 2009; 21: 240-246
        • Sunkara S.K.
        • Coomarasamy A.
        • Khalaf Y.
        • El-Toukhy T.
        Acupuncture and in vitro fertilization: updated meta-analysis.
        Hum Reprod. 2009; 24: 2047-2048
        • Stener-Victorin E.
        Acupuncture in in vitro fertilisation: why do reviews produce contradictory results?.
        Focus Altern Complement Ther. 2009; 14: 8-11
        • Quintero R.
        A randomized, controlled, double-blind cross-over study evaluating acupuncture as an adjunct to IVF.
        Fertil Steril. 2004; 81: S11-S12
        • Udoff L.
        • Zhang G.
        • Patwardhan S.
        • Wei Z.
        • McClamrock H.
        The effect of acupuncture on outcomes in in-vitro fertilization (IVF).
        Fertil Steril. 2006; 86: S145
        • Humaidan P.
        • Brock K.
        • Bungum L.
        • Stener-Victorin E.
        Pain relief during oocyte retrieval—exploring the role of different frequencies of electro-acupuncture.
        Reprod Biomed Online. 2006; 13: 120-125
        • Moy I.
        • Milad M.
        • Kazer R.
        • Confino E.
        • Barnes R.
        • Zhang J.
        RCT: effects of acupuncture on pregnancy rates in women undergoing assisted reproductive technologies.
        Fertil Steril. 2008; 90: S106
        • Kong S.
        • Hughes A.
        Acupuncture as an adjunct to in vitro fertilization: a randomized trial.
        Med Acupunct. 2009; 21: 179-182
        • Li J.
        • Cui W.
        • Sun W.
        Effects of electroacupuncture on in vitro fertilization–embryo transfer (IVF-ET) of patients with polycystic ovary syndrome.
        Chin J Hum Sex. 2009; 18: 28-30
        • Omodei U.
        • Piccioni G.
        • Tombesi S.
        • Dordoni D.
        • Fallo L.
        • Ghilardi F.
        Effect of acupuncture on rates of pregnancy among women undergoing in vitro fertilization.
        Fertil Steril. 2010; 94: S170
        • Paulus W.E.
        • Zhang M.
        • Strehler E.
        • El-Danasouri I.
        • Sterzik K.
        Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy.
        Fertil Steril. 2002; 77: 721-724
        • Paulus W.E.
        • Zhang M.
        • Strehler E.
        • Seybold B.
        • Sterzik K.
        Placebo-controlled trial acupuncture effects in assisted reproductive therapy.
        Hum Reprod. 2003; 18: S18
        • Smith C.
        • Coyle M.
        • Norman R.J.
        Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer.
        Fertil Steril. 2006; 85: 1352-1358
        • Westergaard L.G.
        • Mao Q.
        • Krogslund M.
        • Sandrini S.
        • Lenz S.
        • Grinsted J.
        Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial.
        Fertil Steril. 2006; 85: 1341-1346
        • Dieterle S.
        • Ying G.
        • Hatzmann W.
        • Neuer A.
        Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study.
        Fertil Steril. 2006; 85: 1347-1351
        • Benson M.
        • Elkind-Hirsch K.E.
        • Theall A.
        • Fong K.
        • Hogan R.B.
        • Scott R.T.
        Impact of acupuncture before and after embryo transfer on the outcome of in vitro fertilization cycles: a prospective single blind randomized study.
        Fertil Steril. 2006; 86: S135
        • Craig L.B.
        • Criniti A.R.
        • Hansen K.R.
        • Marshall L.A.
        • Soules M.R.
        Acupuncture lowers pregnancy rates when performed before and after embryo transfer.
        Fertil Steril. 2007; 88: S40
        • Cui W.
        • Sun W.
        • Liu L.
        • Wen J.
        Study of the effect of electro-acupuncture treatment on the patients undergomg in vitro-fertilization and embryo transfer.
        Chin Matern Child Health. 2007; 22: 3403-3405
        • Fratterelli J.L.
        • Leondires M.R.
        • Fong K.
        • Theall A.
        • Locatelli S.
        • Scott R.T.
        Laser acupuncture before and after embryo transfer improves art delivery rates: results of a prospective randomized double-blinded placebo controlled five-armed trial involving 1000 patients.
        Fertil Steril. 2008; 90: S105
        • Chen J.
        • Liu L.L.
        • Cui W.
        • Sun W.
        Zhongguo Zhen Jiu. 2009; 29 (Chinese): 775-779
        • Domar A.D.
        • Meshay I.
        • Kelliher J.
        • Alper M.
        • Powers R.D.
        The impact of acupuncture on in vitro fertilization outcome.
        Fertil Steril. 2009; 91: 723-726
        • Ho M.
        • Huang L.C.
        • Chang Y.Y.
        • Chen H.Y.
        • Chang W.C.
        • Yang T.C.
        • et al.
        Electroacupuncture reduces uterine artery blood flow impedance in infertile women.
        Taiwan J Obstet Gynecol. 2009; 48: 148-151
        • Magarelli P.C.
        • Cridennda D.K.
        • Cohen M.
        Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment.
        Fertil Steril. 2009; 92: 1870-1879
        • So E.W.
        • Ng E.H.
        • Wong Y.Y.
        • Lau E.Y.
        • Yeung W.S.
        • Ho P.C.
        A randomized double blind comparison of real and placebo acupuncture in IVF treatment.
        Hum Reprod. 2009; 24: 341-348
        • So E.W.
        • Ng E.H.
        • Wong Y.Y.
        • Yeung W.S.
        • Ho P.C.
        Acupuncture for frozen-thawed embryo transfer cycles: a double-blind randomized controlled trial.
        Reprod Biomed Online. 2010; 20: 814-821
        • Andersen D.
        • Lossl K.
        • Nyboe Andersen A.
        • Furbringer J.
        • Bach H.
        • Simonsen J.
        • et al.
        Acupuncture on the day of embryo transfer: a randomized controlled trial of 635 patients.
        Reprod Biomed Online. 2010; 21: 366-372
        • Madaschi C.
        • Braga D.P.
        • Figueira Rde C.
        • Iaconelli Jr., A.
        • Borges Jr., E.
        Effect of acupuncture on assisted reproduction treatment outcomes.
        Acupunct Med. 2010; 28: 180-184
      1. Arnoldi M, Diaferial D, Corbucci MG, Lauretisl L De. The role of acupuncture in patients at unfavourable reproductive prognosis in IVF: a prospective randomised study. Abstracts of the 26th Annual Meeting of the European Society for Human Reproduction and Embryology, Rome, Italy, 2010:i257.

        • Moy I.
        • Milad M.P.
        • Barnes R.
        • Confino E.
        • Kazer R.R.
        • Zhang X.
        Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization.
        Fertil Steril. 2011; 95: 583-587
        • Stener-Victorin E.
        • Waldenstrom U.
        • Wikland M.
        • Nilsson L.
        • Hagglund L.
        • Lundeberg T.
        Electro-acupuncture as a peroperative analgesic method and its effects on implantation rate and neuropeptide Y concentrations in follicular fluid.
        Hum Reprod. 2003; 18: 1454-1460
        • Humaidan P.
        • Stener-Victorin E.
        Pain relief during oocyte retrieval with a new short duration electro-acupuncture technique—an alternative to conventional analgesic methods.
        Hum Reprod. 2004; 19: 1367-1372
        • Gejervall A.L.
        • Stener-Victorin E.
        • Moller A.
        • Janson P.O.
        • Werner C.
        • Bergh C.
        Electro-acupuncture versus conventional analgesia: a comparison of pain levels during oocyte aspiration and patients’ experiences of well-being after surgery.
        Hum Reprod. 2005; 20: 728-735
        • Sator-Katzenschlager S.M.
        • Wolfler M.M.
        • Kozek-Langenecker S.A.
        • Sator K.
        • Sator P.G.
        • Li B.
        • et al.
        Auricular electro-acupuncture as an additional perioperative analgesic method during oocyte aspiration in IVF treatment.
        Hum Reprod. 2006; 21: 2114-2120
      2. Huang DM, Huang GY, Lu FE, Stefan D, Andreas N, Robert G. Acupuncture for infertility: is it an effective therapy? Chin J Integr Med; 17:386–95.

        • Anderson B.J.
        • Rosenthal L.
        Acupuncture and IVF Controversies.
        Fertil Steril. 2007; 87: 1000
        • Manheimer E.
        Selecting a control for in vitro fertilization and acupuncture randomized controlled trials (RCTs): how sham controls may unnecessarily complicate the RCT evidence base.
        Fertil Steril. 2011; 95: 2456-2461

      Linked Article

      • Erratum
        Fertility and SterilityVol. 97Issue 4
        • Preview
          In the article, “Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis” (Fertil Steril 2012;97:599–611), the labels “favours treatment” and “favours control” were reversed in the forest plots in Figures 1 and 2. In addition, the acupuncture junction for “23. Gejervall 2005” in Table 1 should be B. The authors regret the errors.
        • Full-Text
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      • Acupuncture for IVF: do not let needles stand in the way of empathy
        Fertility and SterilityVol. 97Issue 5
        • Preview
          Zheng et al. (1) claim in their meta-analysis that there is no significant difference between acupuncture and placebo when it comes to live birth rates among women undergoing in vitro fertilization because the Streitberger procedure, in which needles do not enter the skin and which was used as placebo acupuncture, appears to be more effective than acupuncture itself. This might be interpreted as a recommendation to choose the Streitberger procedure over acupuncture as the active treatment. The authors seem to agree, saying “the harmful reaction produced by real acupuncture can be avoided by this noninvasive stimulation.”
        • Full-Text
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