Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis

This systematic review and meta-analysis represents an important landmark in reproductive medicine, providing robust evidence on the benefits of acupuncture as an adjunctive treatment to in vitro fertilization (IVF). The researchers conducted a comprehensive analysis of seven randomized clinical trials, including 1,366 women, to determine whether acupuncture can improve reproductive success rates.

The methodology of the study was rigorous, involving systematic searches in multiple medical databases, including MEDLINE, Embase, Cochrane Central, and Chinese databases. Inclusion criteria were specific: randomized studies that compared acupuncture with real needles versus sham acupuncture or no adjunctive treatment, administered within one day of embryo transfer. The outcomes analyzed included clinical pregnancy, ongoing pregnancy, and live birth.

The results demonstrated clinically significant benefits of acupuncture. The odds ratio for clinical pregnancy was 1.65, indicating that acupuncture increased the chances of pregnancy by 65% compared with control groups. For ongoing pregnancy, the odds ratio was 1.87, and for live birth, 1.91. The number needed to treat was 10, meaning that for every 10 women treated with acupuncture, one additional pregnancy would be achieved.

All included studies used similar acupuncture protocols, with sessions performed immediately before or after embryo transfer, lasting 25 to 30 minutes. Acupuncture points were specifically selected to improve fertility, based on traditional Chinese medicine principles. Most studies also included auricular therapy as a complement.

The methodological quality of the studies was considered high, with adequate randomization procedures, allocation concealment, and participant follow-up. Three studies used sham acupuncture controls, while four used groups with no adjunctive treatment. It is important to note that the measured outcomes (pregnancy and birth) are objective, reducing the risk of bias related to knowledge of the treatment.

An interesting finding was that the benefit of acupuncture appeared to depend on the baseline pregnancy rates of the centers. In clinics with already high success rates, the additional benefit of acupuncture was smaller and not significant. This suggests that acupuncture may be more beneficial in contexts where IVF success rates are moderate.

Proposed mechanisms for the effects of acupuncture include modulation of neurotransmitters that affect reproductive hormone release, improvement of uterine blood flow through inhibition of sympathetic activity, and stimulation of endogenous opioid production that may reduce biological stress.

From a safety standpoint, two studies reported no significant adverse events. Considering that each IVF cycle costs on average $12,400 in the United States, even a small increase in success rates could be economically advantageous, given the relatively low cost of acupuncture.

Limitations include heterogeneity in baseline rates across studies, possible publication bias, and the fact that three studies were published only as abstracts. In addition, some studies did not use adequate patient or physician blinding.

The clinical implications are substantial. The evidence suggests that acupuncture can be offered as a safe and potentially effective adjunctive treatment for women undergoing IVF. However, the authors emphasize that more research is needed to confirm these findings and to further investigate the relationship between baseline success rates and acupuncture efficacy. Future studies should adhere to CONSORT guidelines and focus on standardized acupuncture protocols.