Effect Of Acupuncture On IVF Remains Unclear

Main Category: Fertility
Also Included In: Clinical Trials / Drug Trials
Article Date: 15 Oct 2008 - 1:00 PDT

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The use of acupuncture to increase fertility is far from new dating back to Taoist tradition over 8,000 years ago but its use in societies in which Western medicine dominates is less than a century old, and no one knows for sure whether acupuncture can increase the chances of becoming pregnant. A new review of studies attempts to come closer to an answer.

The review found no strong evidence that acupuncture improves the chances of becoming pregnant, but did find a small difference in the live birth rate; however, this was only when patients underwent acupuncture on the day of the embryo transfer. There was no benefit noted when the patients had acupuncture during egg retrieval or in the days following embryo transfer.

The review included 13 studies that each examined whether acupuncture improved the pregnancy rate in women undergoing in vitro fertilization treatment, but for reasons that are unclear, the studies used different acupuncture points to achieve the same objectives.

Lead review author Ying Cheong said he doesn't think that at this time point we have enough evidence to say acupuncture does have influence. "There are one or two studies but they are not randomized, which is a method we use to ensure that the study is done fairly."

"There are several theories as to how acupuncture may work," said Cheong, a senior lecturer and consultant in obstetrics and gynecology at the University of Southampton in England. "Acupuncture has been shown to alter endorphin levels, which in turn can affect [sex hormone] secretion."

He also said that animal studies have shown that acupuncture can lead to the release of stress hormones that benefit reproductive function and pregnancy, as well as reduce uterine artery resistance, which might help with implantation.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Referring to the different acupuncture points and techniques in the included studies, Cheong said, "As this meta-analysis is examining the effectiveness of a traditional Chinese medicine technique in Western technology (IVF), there are some areas which prove challenging to integrate in terms of the results…but this is the best information we have so far."

The review authors considered the timing of acupuncture, the selection of acupuncture points and the characteristics of acupuncturists. Seven of the studies occurred around the time of the embryo transfer and, in five of the studies, patients had acupuncture treatment during egg retrieval. In two studies, patients also had acupuncture treatment two to three days following the embryo transfer.

The authors found a beneficial effect on the live birth rate when the women had acupuncture treatments on the day of the embryo transfer, "however, with the present evidence this could be attributed to placebo effect and the small number of women included in the trials," the authors wrote.

"The impact of acupuncture on reproductive outcomes has been verified worldwide in both traditional Chinese literature and in randomized controlled trials that have met the rigors of Western medicine," said Paul Magarelli, M.D., the medical director of Reproductive Medicine & Fertility Centers in Colorado Springs, Colo., and Albuquerque, N.M.

Magarelli said the new review has far too many errors to reflect those outcomes accurately. He questioned the reviewers' choice of included studies and methods of statistical analysis, among other criticisms.

Wallace Sampson, M.D., a clinical professor of medicine at Stanford University and editor of the Scientific Review of Alternative Medicine, said that "the review attempts to seek relationships or indications of efficacy for a method that has no historical reason for performance of clinical trials, since historically, the technology for embryo transfer did not exist until several decades ago never in TCM [traditional Chinese medicine] times." He added that the practice "has no physiological or biological rationale."

"The proposed mechanisms are entirely speculative; making connections not proved to exist," Wallace said, adding, "if they were to exist, one has no indication of whether an effect would be measurable."

So, we don't know if it works, but is it safe?

When the review authors looked at adverse reactions, "The most frequently reported outcome in that trial was relaxation, and women in the control group were more likely to report relaxation with acupuncture."

Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted conception. Cochrane Database of Systematic Reviews 2008, Issue 4.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

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