Acupuncture versus placebo acupuncture for in vitro fertilisation: a systematic review and meta-analysis

Abstract

Objective: To evaluate the efficacy of acupuncture compared to placebo acupuncture for women undergoing in vitro fertilisation (IVF) in a systematic review and meta-analysis. Methods: A search was conducted in seven English-language biomedical databases from their inception to 3 April 2019 to identify studies evaluating acupuncture as an adjunct to IVF treatment. Randomised controlled trials (RCTs) that compared acupuncture with placebo acupuncture using a non-invasive placebo acupuncture device in women undergoing a fresh or frozen IVF cycle were eligible, as were studies that tested placebo acupuncture as the intervention. Outcomes were clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, live birth rate and adverse events. Results: Eight RCTs involving 3607 women were included. Studies were judged to be low risk for most of the risk of bias domains. Acupuncture around the time of embryo transfer was not significantly different to placebo acupuncture in terms of the clinical pregnancy rate (6 RCTs, 2473 women, risk ratio (RR) = 0.99 (95% confidence interval (CI) = 0.88, 1.11), I2 = 51%, moderate certainty evidence), ongoing pregnancy rate (4 RCTs, 1459 women, RR = 0.88 (95% CI = 0.75, 1.02), I2 = 50%, moderate certainty evidence), miscarriage rate (4 RCTs, 502 women, RR = 1.23 (95% CI = 0.89, 1.71), I2 = 30%, high certainty evidence) or live birth rate (4 RCTs, 1835 women, RR = 0.87 (95% CI = 0.75, 1.01), I2 = 0%, high certainty evidence). Outcomes with placebo acupuncture were not significantly different to usual care. Adverse events relating to acupuncture, such as discomfort and bruising, were mild to moderate. Conclusion: Acupuncture administered around the time of embryo transfer did not have a statistically significant effect on IVF outcomes compared with placebo acupuncture.

Transcutaneous electrical acupoint stimulation improves endometrial receptivity resulting in improved IVF-ET pregnancy outcomes in older women: a multicenter, randomized, controlled clinical trial

“…In this study, TEAS appeared to be safe, and no adverse safety profile was reported on reproductive functions. These results are consistent with previous studies of TEAS and acupuncture in general [ 10 – 15 , 19 – 21 ]. It is not clear why there was a trend for a higher abortion rate in the treatment group, especially in women over 35.…”

“…Acupuncture has been suggested to increase female infertility and improve IVF-ET outcomes [10][11][12][13], but the results are sometimes controversial [14,15]. There is a need for more high-quality randomized controlled trials to prove or disprove the efficacy of acupuncture in infertile women [10,11].…”

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

“…The non-specific effects between treatment and sham acupuncture may be reduced to the greatest extent through blind and random methods. Therefore, in order to improve the reliability, an appropriate control group should be selected by the specific study objective like examining the pragmatic or comparative effectiveness (22).…”

“…However, the conclusions in inconclusive. Even if many systematic reviews and meta-analyses still revealed both positive effects (8)(9)(10)(11)(12)(13)(14)(15) and negative benefits of acupuncture assisting IVF success (16)(17)(18)(19)(20)(21)(22)(23)(24). Different searching databases and literature selection criteria may partly contribute to the unconfirmed results.…”

“…For example, some analyses (11,14,16,17) just included English language literature. Several analyses did not cover all the acupuncture types or control (12,14,22). In addition, most of meta-analyses considered clinical pregnancy rate (CPR) as a primary outcome and neglected the live birth rate (LBR).…”