Editorial group: Cochrane Menstrual Disorders and Subfertility Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 4, 2009.

IMPORTANCE Acupuncture is widely used by women undergoing in vitro fertilization (IVF), although the evidence for efficacy is conflicting. OBJECTIVE To determine the efficacy of acupuncture compared with a sham acupuncture control performed during IVF on live births. DESIGN, SETTING, AND PARTICIPANTS A single-blind, parallel-group randomized clinical trial including 848 women undergoing a fresh IVF cycle was conducted at 16 IVF centers in Australia and New Zealand between June 29, 2011, and October 23, 2015, with 10 months of pregnancy follow-up until August 2016. INTERVENTIONS Women received either acupuncture (n = 424) or a sham acupuncture control (n = 424). The first treatment was administered between days 6 to 8 of follicle stimulation, and 2 treatments were administered prior to and following embryo transfer. The sham control used a noninvasive needle placed away from the true acupuncture points. MAIN OUTCOMES AND MEASURES The primary outcome was live birth, defined as the delivery of 1 or more living infants at greater than 20 weeks' gestation or birth weight of at least 400 g. RESULTS Among 848 randomized women, 24 withdrew consent, 824 were included in the study (mean [SD] age, 35.4 [4.3] years); 371 [45.0%] had undergone more than 2 previous IVF cycles), 607 proceeded to an embryo transfer, and 809 (98.2%) had data available on live birth outcomes. Live births occurred among 74 of 405 women (18.3%) receiving acupuncture compared with 72 of 404 women (17.8%) receiving sham control (risk difference, 0.5% [95% CI, −4.9% to 5.8%]; relative risk, 1.02 [95% CI, 0.76 to 1.38]). CONCLUSIONS AND RELEVANCE Among women undergoing IVF, administration of acupuncture vs sham acupuncture at the time of ovarian stimulation and embryo transfer resulted in no significant difference in live birth rates. These findings do not support the use of acupuncture to improve the rate of live births among women undergoing IVF.

Objectives: To estimate cumulative live birth rates (CLBRs) following repeated assisted reproductive technology (ART) ovarian stimulation cycles, including all fresh and frozen/thaw embryo transfers (complete cycles). Design, setting and participants: Prospective follow‐up of 56 652 women commencing ART in Australian and New Zealand during 2009–2012, and followed until 2014 or the first treatment‐dependent live birth. Main outcome measures: CLBRs and cycle‐specific live birth rates were calculated for up to eight cycles, stratified by the age of the women (< 30, 30–34, 35–39, 40–44, > 44 years). Conservative CLBRs assumed that women discontinuing treatment had no chance of achieving a live birth if had they continued treatment; optimal CLBRs assumed that they would have had the same chance as women who continued treatment. Results: The overall CLBR was 32.7% (95% CI, 32.2–33.1%) in the first cycle, rising by the eighth cycle to 54.3% (95% CI, 53.9–54.7%) (conservative) and 77.2% (95% CI, 76.5–77.9%) (optimal). The CLBR decreased with age and number of complete cycles. For women who commenced ART treatment before 30 years of age, the CLBR for the first complete cycle was 43.7% (95% CI, 42.6–44.7%), rising to 69.2% (95% CI, 68.2–70.1%) (conservative) and 92.8% (95% CI, 91.6–94.0) (optimal) for the seventh cycle. For women aged 40–44 years, the CLBR was 10.7% (95% CI, 10.1–11.3%) for the first complete cycle, rising to 21.0% (95% CI, 20.2–21.8%) (conservative) and 37.9% (95% CI, 35.9–39.9%) (optimal) for the eighth cycle. Conclusion: CLBRs based on complete cycles are meaningful estimates of ART success, reflecting contemporary clinical practice and encouraging safe practice. These estimates can be used when counselling patients and to inform public policy on ART treatment.

OHSS is a serious condition for which there are a number of proven preventative strategies. OHSS is an area requiring ongoing research and development of a universally agreed definition will allow development of optimal prevention strategies and facilitate improved early detection of women at risk.

(Abstracted from JAMA 2018;319:1990–1998) Acupuncture during in vitro fertilization (IVF) is a frequently used adjunctive treatment. Evidence for its efficacy is conflicting.