The Role of Acupuncture in in vitro Fertilization: A Systematic Review and Meta-Analysis

Abstract

Background/Aims: In recent years, acupuncture has become more and more popular in the management of subfertility. The aim of this study was to evaluate the impact of acupuncture during in vitro fertilization (IVF) treatment on the outcomes of clinical pregnancy in published randomized studies. Methods: This is a systematic review and meta-analysis. Data sources used were MEDLINE, Embase, Web of Knowledge and the Chinese Biomedical Database. Results: There was no statistically significant difference between the acupuncture group and no acupuncture (intervention) controls around the time of embryo transfer (ET; risk ratio, RR, 1.24, 95% confidence interval, CI, 1.02-1.50) or in unblinded trials, trials blinded to physicians and double-blind trials (95% CI 1.26-1.88, 0.82-1.33 and 0.89-1.25, respectively). This was also the case when comparing acupuncture with sham acupuncture controls around the time of ET (RR, 1.03, 95% CI 0.87-1.22) or when restricting to unblinded trials, trials blinded to physicians and double-blind trials (95% CI 0.80-2.02, 0.82-1.18 and 0.77-1.17, respectively). There was a statistically significant difference when performed at 30 min after ET and implantation phase (RR 1.76, 95% CI 1.22-2.55). There was also a statistically significant difference when performed at follicle phase and 25 min before and after ET (RR 1.56, 95% CI 1.04-2.33). Conclusion: Our study showed that acupuncture did not significantly improve the IVF clinical pregnancy rate when performed only at the time of ET, while we found pooled benefit of acupuncture for IVF when performed at follicle phase and 25 min before and after ET, as well as 30 min after ET and implantation phase.

Somatosensory Stimulation and Assisted Reproduction

“…The relevance of shamcontrolled trials in IVF research has been debated at length (see Manheimer 57 for a comprehensive overview), particularly in view of the fact that pregnancy is an objective outcome measure for which blinding is less critical. [58][59][60][61] When sham-controlled trials are included, the three latest systematic reviews demonstrate no pooled benefit of acupuncture [10][11][12] although Shen et al 12 did find evidence of benefit with follicular phase treatment plus treatment around ET. Manheimer et al 11 reported that acupuncture treatment appears to be more successful in studies with lower baseline pregnancy rates.…”

Management of Acupuncture as Adjuvant Therapy for In Vitro Fertilization

“…In addition to increasing blood flow to the uterus and ovaries, acupuncture increases endometrial and follicular receptivity, which, in turn, improves the quality of oocytes produced by the follicles, and also helps repair the endometrial lining, which is needed for implantation. 3,6,7 Increasing blood flow is influenced by vascular endothelial growth factor (VEGF), which promotes angiogenesis. 9 It has been reported that acupuncture can reduce uterine contractility to prevent embryo expulsion after ET.…”

“…9 It has been reported that acupuncture can reduce uterine contractility to prevent embryo expulsion after ET. 3,6,7 Increasing the quality of oocytes might be related to tumor-necrosis factor-a (TNF-a) levels, wherein acupuncture could reduce TNF-a levels in follicular fluid, reduce apoptosis of granulosa cells, and improve oocyte quality, thereby, increasing pregnancy rates in patients undergoing IVF. 16 The effect of acupuncture on increasing IVF success is influenced by immune-system modulation.…”

“…A systematic review and meta-analysis in 2015 by Shen et al produced controversial results. 6 These authors evaluated the effect of acupuncture on IVF success RCTs. 6 The analysis included 21 RCTs were included with a total of 5428 participants.…”

“…4 Many studies have examined the effects of acupuncture as an adjuvant therapy in IVF, but systematic reviews and meta-analyses still yield controversial results. 3,[5][6][7] The purpose of this review is to describe acupuncture as an adjuvant therapy for IVF based on relatively recent studies.…”