Acupuncture and clomiphene citrate for anovulatory infertility: a systematic review and meta-analysis

Abstract

Objective: To evaluate the comparative effectiveness of acupuncture or acupuncture combined with clomiphene citrate (CC) versus CC alone on the outcomes of anovulatory infertility. Methods: A literature search in eight databases yielded nine randomised controlled trials (RCTs) that evaluated the comparative effectiveness of acupuncture and CC in anovulatory infertility. Subsequently, data were extracted and the studies were assessed for the quality of their methodological designs and risk of bias. Meta-analyses of the RCT data were conducted. Results: Nine trials including 1441 women were included in the meta-analysis. There were no significant differences in the rates of pregnancy (odds ratio (OR) 1.18, 95% CI 0.83 to 1.69), ovulation (OR 2.57, 95% CI 0.59 to 11.29) or pregnancy loss (OR 0.98, 95% CI 0.59 to 1.63) when acupuncture was used as an adjuvant therapy alongside CC. Although acupuncture alone did not increase the ovulation rate (OR 0.41, 95% CI 0.11 to 1.49), our review demonstrated superior effects in patients who received acupuncture as a separate treatment modality with respect to both the pregnancy rate (OR 2.34, 95% CI 1.76 to 3.10) and the maximum follicular diameter (mean difference 0.50 mm, 95% CI 0.44 to 0.56 mm) when compared with CC alone. Statistical analysis also showed a reduction in the rate of pregnancy loss when acupuncture was used as a separate treatment compared with CC alone (OR 0.19, 95% CI 0.08 to 0.45). Conclusions: Based on the above pooled results of the studies, the use of acupuncture as a monotherapy significantly improved the rate of pregnancy among the study participants compared with the use of CC alone. However, any results drawn from these studies should be interpreted with caution when considering the context of clinical practice.

The Efficacy of Complementary and Alternative Medicine in the Treatment of Female Infertility

“…Compared with CC, acupuncture had better treatment results in pregnancy rate and maximum follicle diameter. At the same time, this meta-analysis also pointed out that CV3, CV4, CV6, ST36, SP6, and EX-CA1 are the most commonly selected for treating anovulatory infertility women, and it suggests that the above acupoints should give priority in future treatment [29].…”

Pregnancy benefit of acupuncture on in vitro fertilization: A systematic review and meta-analysis

“…In addition, LBR should be considered as a primary outcome of the further IVF meta-analysis study. It was undeniable that clinical pregnancy was a major breakthrough in medicine, but for infertile couples, "take-home" babies were the most important long-term and ultimate outcome of interest (25,26). Moreover, the efficacy was significant just for CPR rather than LBR, which may indicate a higher risk of miscarriage.…”

“…In addition, most of meta-analyses considered clinical pregnancy rate (CPR) as a primary outcome and neglected the live birth rate (LBR). LBR was an accepted primary outcome in IVF trials (25,26) and its related results need to be further updated. The conflicted results might be not due to the ineffectiveness of acupuncture but rather to the methodological flaws confound acupuncture IVF RCTs.…”

The Effects of Acupuncture on Pregnancy Outcomes of Recurrent Implantation Failure: A Systematic Review and Meta-Analysis

“…ere was a meta-analysis [9] of 1,441 ovulation-disorders women showing that the use of acupuncture as a monotherapy significantly improved the rate of pregnancy compared with the use of Clomiphene Citrate (CC) alone. Other researchers [10], using meta-analysis to explore the relationship between acupuncture and patients with low ovarian response (POR), found that acupuncture may improve CPR, AMH, AFC, and the number of retrieved oocytes in women with POR undergoing IVF.…”