In our article on acupuncture and IVF, we gave a brief description of the research contained in the seminal Paulus paper, which showed that 34 out of 80 (42.5%) patients in the acupuncture group became pregnant, as opposed to 21 out of 80 (26.3%) in the control group. This paper was instrumental in popularising the use of acupuncture alongside IVF treatment.
Since the original Paulus paper was published, a number of basic research and meta-studies have been done to examine and try and replicate their findings. As is often the case in acupuncture research, conflicting results have emerged. Read on to find out about some of the most interesting studies published in some of the more prestigious Obstetrics and Gynaecological journals. For each journal, we indicate its impact factor as of 2013, which gives a measure of how respected the journal is within its community. The higher the impact factor, the more weight you should give the research.
Fertility and Sterility has an impact factor of 4.174, placing it at number 4 in the Obs and Gynae journals. In May 2006, a study was published in Fertility and Sterility (Vol 85, Issue 5, May 2006, Pages 1341–1346) that also produced results to suggest that acupuncture on the day of embryo transfer (ET) could improve pregnancy rates in IVF. Lars Westergaard and his co-researchers designed a prospective, randomized trial comparing a group of 95 women who had acupuncture on the day of embryo transfer with a second group of 91 women who had acupuncture on that day and also 2 days later, and a third group of 87 women who had no acupuncture at all. They found that pregnancy rates at 18 weeks were significantly higher for the group that had acupuncture on the day of embryo transfer compared with the control group (36% vs 22%), and also found that in their study additional acupuncture two days after embryo transfer had no extra beneficial effect.
In the same volume, another positive result was obtained by Dieterle et. al. (Vol 85, Issue 5, May 2006, Pages 1347–1351). They ran a randomized, prospective, controlled clinical study comparing a group of 116 women who received acupuncture during the luteal phase of their IVF or ICSI cycle with a group of 109 women who were given placebo acupuncture. Again, they found that the pregnancy rate at 18 weeks was increased in the acupuncture group (28.4%) compared to the placebo group (13.8%), suggesting that acupuncture given in the luteal phase could have a positive effect.
In a third separate study in the same volume, Smith et. al. (Vol 85, Issue 5, May 2006, Pages 1352–1358) used a single-blind, randomized controlled trial to look at the effects of acupuncture on pregnancy rates for women having IVF or ICSI. They looked at a group of 228 women split into two groups (acupuncture vs noninvasive sham acupuncture) and found that although the pregnancy rate at 18 weeks was higher in the acupuncture group (28% compared to 18%), it was not statistically significant. They concluded that acupuncture could be considered safe for women undergoing embryo transfer.
In March 2009, Domar et. al. (Vol 91, Issue 3, March 2009, Pages 723–726) aimed to replicate the earlier research on increased pregnancy rates to try and determine whether the increase was due to a placebo effect. They conducted a prospective, randomized, controlled single blind trial of 150 women split between an acupuncture group and a control group. The women were also asked about their levels of anxiety and optimism. The study did not find any significant difference in pregnancy rates between the two groups, but women in the acupuncture group experienced significantly less anxiety after the embryo transfer.
In 2011, Moy et. al. (Vol 95, Issue 2, Feb 2011, Pages 583–587) published the results of another randomized controlled trial. It was a double blind trial with 160 women going through IVF or ICSI. the overall pregnancy rate in the study was fairly high, with no significant difference between the real and sham acupuncture, and no adverse effects observed. The authors concluded that acupuncture was safe for women having IVF or ICSI.
BJOG has an impact factor of 3.760. In September 2008, a systematic review and meta-analysis of acupuncture and IVF was published in BJOG (Vol 115, Issue 10, Sep 2008, pages 1203–1213). El-Toukhy et. al. looked at 13 randomized controlled trials for IVF acupuncture where acupuncture was compared with either no treatment or placebo treatment. 5 of the trials involved acupuncture around the time of egg collection, and 8 of the trials involved acupuncture around the time of embryo transfer. When they averaged the results of all the trials they found no significant increase in pregnancy rates for women who had acupuncture.
Human Reproduction has an impact factor of 2.675. In September 2010, Andersena et. al. (Vol 21, Issue 3, Sep 2010, Pages 366-372) presented the results of a prospective, randomized, controlled, double blinded trial. 314 women having IVF or ICSI received acupuncture according to the principles of Traditional Chinese Medicine, and 321 women were given placebo acupuncture. There were no statistically significant differences in pregnancy rates between the two groups.
Human Reproduction has an impact factor of 4.670. In February 2009, So et. al. (Vol 24, Issue 2, Feb 2009, pages 341-348) published the results of their randomized double blind comparison of real and placebo acupuncture for IVF. 370 women were assigned to either the real or placebo acupuncture groups, with all treatment sessions given just before and after the embryo transfer. In this study, they noticed a reduction in cortisol and anxiety levels for both groups, and interestingly found that the placebo acupuncture led to a higher pregnancy rate than ‘real’ acupuncture (55.1% compared to 43.8%).
Human Reproduction Update has an impact factor of 8.847. In November 2013, Manheimer et. al. (Vol 19, Issue 6, Nov/Dec 2013, pages 696-713) published a systematic review and meta-analysis of the effects of acupuncture on clinical pregnancy rates for women going through IVF. They included 16 randomized controlled trials comparing acupuncture with sham or no acupuncture, and found no statistically significant difference when they combined all the trials together. However, they did find that in trials where the control group pregnancy rates were lower showed larger effects from the acupuncture intervention when compared to trials with relatively high pregnancy rates in the control group. Their conclusion suggested focusing further research on this particular effect.
Finally, in July 2013 a Cochrane Review titled ‘Acupuncture and Assisted Conception’, was published. Cheong et. al. aimed to review the evidence as to whether acupuncture improves pregnancy rates for IVF and ICSI. They included 20 randomized controlled studies in their review, with 6 studies looking at acupuncture around the time of egg collection, and 14 studies of acupuncture at embryo transfer. Overall their opinion was that there is no clear evidence for a beneficial effect of acupuncture for women having assisted conception.
Saturday, March 29th, 2014
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