Therapeutic effect of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis

Abstract

Purpose

Controversial results have been reported concerning the effect of acupuncture on in vitro fertilization (IVF) outcomes. The current review was conducted to systematically review published studies of the effects of acupuncture on IVF outcomes.

Methods

Women undergoing IVF in randomized controlled trials (RCTs) were evaluated for the effects of acupuncture on IVF outcomes. The treatment groups involved traditional, electrical, laser, auricular, and other acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture. The PubMed, Embase, and Web of Science databases were searched. The pregnancy outcomes data are expressed as odds ratios (ORs) with 95% confidence intervals (CIs) based on a fixed model or random model depending on the heterogeneity determined by the Q test and I2 statistic. The major outcomes were biochemical pregnancy rate (BPR), clinical pregnancy rate (CPR), live birth rate (LBR), and ongoing pregnancy rate (OPR). Heterogeneity of the therapeutic effect was evaluated by a forest plot analysis, and publication bias was assessed by a funnel plot analysis.

Results

Thirty trials (a total of 6344 participants) were included in this review. CPR data showed a significant difference between the acupuncture and control groups (OR 1.26, 95% CI 1.06–1.50, p = 0.01), but there was significant statistical heterogeneity among the studies (p = 0.0002). When the studies were restricted to Asian or non-Asian area trials with a sensitivity analysis, the results significantly benefited the CPR in Asian group (OR 1.51, 95% CI 1.04–2.20, p = 0.03). Based on the area subgroup analysis, we found that in the Asian group, the IVF outcomes from the EA groups were all significantly higher than those from the control groups (CPR: OR 1.81, 95% CI 1.20–2.72, p = 0.005; BPR: OR 1.84, 95% CI 1.12–3.02, p = 0.02; LBR: OR 2.36, 95% CI 1.44–3.88, p = 0.0007; OPR: OR 1.94, 95% CI 1.03–3.64, p = 0.04). Meanwhile, compared with other acupuncture time, the IVF outcome results were significantly superior in the acupuncture group when acupuncture was conducted during controlled ovarian hyperstimulation (COH) (CPR: OR 1.71, 95% CI 1.27–2.29, p = 0.0004; LBR: OR 2.41, 95% CI 1.54–3.78, p = 0.0001; BPR: OR 1.50, 95% CI 1.02–2.20, p = 0.04; OPR: OR 1.88, 95% CI 1.06–3.34, p = 0.03). However, when acupuncture was conducted at the time of embryo transfer, the BPR and OPR from the acupuncture groups were significantly lower than those of the controls in the Asian group (BPR: OR 0.67, 95% CI 0.48–0.92, p = 0.01; OPR: OR 0.68, 95% CI 0.49–0.96, p = 0.03).

Conclusions

Based on an analysis of the studies, acupuncture improves the CPR among women undergoing IVF. When the studies were restricted to Asian or non-Asian area patients, compared with traditional acupuncture and other methods, electrical acupuncture yielded better IVF outcomes. Optimal positive effects could be expected using acupuncture in IVF during COH, especially in Asian area. However, as a limitation of this review, most of the included studies did not mention the number of embryos transferred.

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References

  1. 1.

    Andersen D, Lossl K, Andersen AN, Furbringer J, Bach H, Simonsen J, Larsen EC (2010) Acupuncture on the day of embryo transfer: a randomized controlled trial of 635 patients. Reprod Biomed Online 21:366–372. doi:10.1016/j.rbmo.2010.03.029

    Article  PubMed  Google Scholar 

  2. 2.

    Arnoldi M, Diaferia D, Corbucci MG, De Lauretis L (2010) The role of acupuncture in patients at unfavourable reproductive prognosis in IVF: a prospective randomised study. Hum Reprod 25:I257–I257

    Google Scholar 

  3. 3.

    Benson MR, Elkind-Hirsch KE, Theall A, Fong K, Hogan RB, Scott RT (2006) Impact of acupuncture before and after embryo transfer on the outcome of in vitro fertilization cycles: a prospective single blind randomized study. Fertil Steril 86:S135–S135. doi:10.1016/j.fertnstert.2006.07.362

    Article  Google Scholar 

  4. 4.

    Chen J, Liu LL, Cui W, Sun W (2009) Effects of electroacupuncture on in vitro fertilization-embryo transfer (IVF-ET) of patients with poor ovarian response. Zhongguo Zhen Jiu 29:775–779

    CAS  PubMed  Google Scholar 

  5. 5.

    Cheong YC, Dix S, E Hung Yu Ng, Ledger WL, Farquhar C (2013) Acupuncture and assisted reproductive technology. Cochrane Database Syst Rev 7:CD006920. doi:10.1002/14651858.CD006920.pub3

    Google Scholar 

  6. 6.

    Christensen PA, Noreng M, Andersen PE, Nielsen JW (1989) Electroacupuncture and postoperative pain. Br J Anaesth 62:258–262

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Craig LB, Criniti AR, Hansen KR, Marshall LA, Soules MR (2007) Acupuncture lowers pregnancy rates when performed before and after embryo transfer. Fertil Steril 88:S40–S40. doi:10.1016/j.fertnstert.2007.07.143

    Article  Google Scholar 

  8. 8.

    Craig LB, Rubin LEH, Peck JD, Anderson M, Marshall LA, Soules MR (2014) Acupuncture performed before and after embryo transfer a randomized controlled trial. J Reprod Med 59:313–320

    PubMed  Google Scholar 

  9. 9.

    Cui W, Li J, Sun W, Wen J (2011) Effect of electroacupuncture on oocyte quality and pregnancy for patients with PCOS undergoing in vitro fertilization and embryo transfervitro fertilization and embryo transfer. Zhongguo Zhen Jiu 31:687–691

    CAS  PubMed  Google Scholar 

  10. 10.

    Daya S (2003) Pitfalls in the design and analysis of efficacy trials in subfertility. Hum Reprod 18:1005–1009

    Article  PubMed  Google Scholar 

  11. 11.

    Deurenberg P, Deurenberg-Yap M, Schouten FJ (2002) Validity of total and segmental impedance measurements for prediction of body composition across ethnic population groups. Eur J Clin Nutr 56:214–220. doi:10.1038/sj.ejcn.1601303

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    di Villahermosa DI, dos Santos LG, Nogueira MB, Vilarino FL, Barbosa CP (2013) Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial. Acupunct Med 31:157–161. doi:10.1136/acupmed-2012-010269

    Article  PubMed  Google Scholar 

  13. 13.

    Dieterle S, Ying G, Hatzmann W, Neuer A (2006) Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril 85:1347–1351. doi:10.1016/j.fertnstert.2005.09.062

    Article  PubMed  Google Scholar 

  14. 14.

    Domar AD, Meshay I, Kelliher J, Alper M, Powers RD (2009) The impact of acupuncture on in vitro fertilization outcome. Fertil Steril 91:723–726. doi:10.1016/j.fertnstert.2008.01.018

    Article  PubMed  Google Scholar 

  15. 15.

    Dong C, Hu L, Liang F, Zhang S (2015) Effects of electro-acupuncture on labor pain management. Arch Gynecol Obstet 291:531–536. doi:10.1007/s00404-014-3427-x

    Article  PubMed  Google Scholar 

  16. 16.

    Du XF, Yang XH, Li J, Hao M, Guo YH (2016) Growth hormone co-treatment within a GnRH agonist long protocol improves implantation and pregnancy rates in patients undergoing IVF-ET. Arch Gynecol Obstet. doi:10.1007/s00404-016-4163-1

    PubMed  Google Scholar 

  17. 17.

    Dundee JW, Ghaly RG, Fitzpatrick KT, Abram WP, Lynch GA (1989) Acupuncture prophylaxis of cancer chemotherapy-induced sickness. J R Soc Med 82:268–271

    CAS  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC (1998) Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA 280:1569–1575

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    El-Toukhy T, Khalaf Y (2010) A new study of acupuncture in IVF: pointing in the right direction. Reprod Biomed Online 21:278–279. doi:10.1016/j.rbmo.2010.06.024

    Article  PubMed  Google Scholar 

  20. 20.

    Fratterelli J, Leondires M, Fong K, Theall A, Locatelli S, Scott R (2008) Laser acupuncture before and after embryo transfer improves art delivery rates: results of a prospective randomized double-blinded placebo controlled five-armed trial involving 1000 patients. Fertil Steril 90:S105

    Article  Google Scholar 

  21. 21.

    Gejervall AL, Stener-Victorin E, Moller A, Janson PO, Werner C, Bergh C (2005) Electro-acupuncture versus conventional analgesia: a comparison of pain levels during oocyte aspiration and patients’ experiences of well-being after surgery. Hum Reprod 20:728–735. doi:10.1093/humrep/deh665

    Article  PubMed  Google Scholar 

  22. 22.

    Goh KL (2011) Clinical and epidemiological perspectives of dyspepsia in a multiracial Malaysian population. J Gastroenterol Hepatol 26(Suppl 3):35–38. doi:10.1111/j.1440-1746.2011.06648.x

    Article  PubMed  Google Scholar 

  23. 23.

    Griesinger G, Dafopoulos K, Schultze-Mosgau A, Felberbaum R, Diedrich K (2004) What is the most relevant standard of success in assisted reproduction? Is BESST (birth emphasizing a successful singleton at term) truly the best? Hum Reprod 19:1239–1241. doi:10.1093/humrep/deh237

    Article  PubMed  Google Scholar 

  24. 24.

    Guricci S, Hartriyanti Y, Hautvast JG, Deurenberg P (1999) Prediction of extracellular water and total body water by multifrequency bio-electrical impedance in a Southeast Asian population. Asia Pac J Clin Nutr 8:155–159

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Harris P, Rees R (2000) The prevalence of complementary and alternative medicine use among the general population: a systematic review of the literature. Complement Ther Med 8:88–96. doi:10.1054/ctim.2000.0353

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    He D, Berg JE, Hostmark AT (1997) Effects of acupuncture on smoking cessation or reduction for motivated smokers. Prev Med 26:208–214. doi:10.1006/pmed.1996.0125

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. doi:10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Ho M, Huang LC, Chang YY, Chen HY, Chang WC, Yang TC, Tsai HD (2009) Electroacupuncture reduces uterine artery blood flow impedance in infertile women. Taiwan J Obstet Gynecol 48:148–151. doi:10.1016/S1028-4559(09)60276-X

    Article  PubMed  Google Scholar 

  29. 29.

    Humaidan P, Stener-Victorin E (2004) Pain relief during oocyte retrieval with a new short duration electro-acupuncture technique—an alternative to conventional analgesic methods. Hum Reprod 19:1367–1372. doi:10.1093/humrep/deh229

    Article  PubMed  Google Scholar 

  30. 30.

    Hunt KJ, Coelho HF, Wider B, Perry R, Hung SK, Terry R, Ernst E (2010) Complementary and alternative medicine use in England: results from a national survey. Int J Clin Pract 64:1496–1502. doi:10.1111/j.1742-1241.2010.02484.x

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Madaschi C, Braga DP, Figueira Rde C, Iaconelli A Jr, Borges E Jr (2010) Effect of acupuncture on assisted reproduction treatment outcomes. Acupunct Med 28:180–184. doi:10.1136/aim.2009.002022

    Article  PubMed  Google Scholar 

  32. 32.

    Magarelli PC, Cridennda DK, Cohen M (2009) Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment. Fertil Steril 92:1870–1879. doi:10.1016/j.fertnstert.2008.10.067

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Manheimer E, van der Windt D, Cheng K, Stafford K, Liu JP, Tierney J, Lao LX, Berman BM, Langenberg P, Bouter LM (2013) The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Hum Reprod Update 19:696–713. doi:10.1093/humupd/dmt026

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM (2008) Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ 336:545–549. doi:10.1136/bmj.39471.430451.BE

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Moy I, Milad MP, Barnes R, Confino E, Kazer RR, Zhang X (2011) Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization. Fertil Steril 95:583–587. doi:10.1016/j.fertnstert.2010.05.024

    Article  PubMed  Google Scholar 

  36. 36.

    Ng EH, So WS, Gao J, Wong YY, Ho PC (2008) The role of acupuncture in the management of subfertility. Fertil Steril 90:1–13. doi:10.1016/j.fertnstert.2008.02.094

    Article  PubMed  Google Scholar 

  37. 37.

    Omodei U, Piccioni G, Tombesi S, Dordoni D, Fallo L, Ghilardi F (2010) Effect of acupuncture on rates of pregnancy among women undergoing in vitro fertilization. Fertil Steril 94:S170–S170

    Article  Google Scholar 

  38. 38.

    Paulus WE, Zhang M, Strehler E, Seybold B, Sterzik K (2003) Placebo-controlled trail of acupuncture effects in assisted reproduction therapy. Hum Reprod 18:18–19

    Google Scholar 

  39. 39.

    Paulus WE, Zhang MM, Strehler E, El-Danasouri I, Sterzik K (2002) Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 77:721–724. doi:10.1016/S0015-0282(01)03273-3

    Article  PubMed  Google Scholar 

  40. 40.

    Pinborg A, Loft A, Andersen AN (2008) Acupuncture with in vitro fertilisation. BMJ 336:517–518. doi:10.1136/bmj.39503.643727.80

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Qu F, Zhou J, Ren RX (2012) Effects of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis. J Altern Complement Med 18:429–439. doi:10.1089/acm.2011.0158

    Article  PubMed  Google Scholar 

  42. 42.

    Rashidi BH, Tehrani ES, Hamedani NA, Pirzadeh L (2013) Effects of acupuncture on the outcome of in vitro fertilisation and intracytoplasmic sperm injection in women with polycystic ovarian syndrome. Acupunct Med 31:151–156. doi:10.1136/acupmed-2012-010198

    Article  PubMed  Google Scholar 

  43. 43.

    Sator-Katzenschlager SM, Wolfler MM, Kozek-Langenecker SA, Sator K, Sator PG, Li B, Heinze G, Sator MO (2006) Auricular electro-acupuncture as an additional perioperative analgesic method during oocyte aspiration in IVF treatment. Hum Reprod 21:2114–2120. doi:10.1093/humrep/del110

    Article  PubMed  Google Scholar 

  44. 44.

    Shlay JC, Chaloner K, Max MB, Flaws B, Reichelderfer P, Wentworth D, Hillman S, Brizz B, Cohn DL (1998) Acupuncture and amitriptyline for pain due to HIV-related peripheral neuropathy: a randomized controlled trial. Terry Beirn Community Programs for Clinical Research on AIDS. JAMA 280:1590–1595

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Smith C, Coyle M, Norman RJ (2006) Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril 85:1352–1358. doi:10.1016/j.fertnstert.2005.12.015

    Article  PubMed  Google Scholar 

  46. 46.

    So EW, Ng EH, Wong YY, Lau EY, Yeung WS, Ho PC (2009) A randomized double blind comparison of real and placebo acupuncture in IVF treatment. Hum Reprod 24:341–348. doi:10.1093/humrep/den380

    Article  PubMed  Google Scholar 

  47. 47.

    So EW, Ng EH, Wong YY, Yeung WS, Ho PC (2010) Acupuncture for frozen-thawed embryo transfer cycles: a double-blind randomized controlled trial. Reprod Biomed Online 20:814–821. doi:10.1016/j.rbmo.2010.02.024

    Article  PubMed  Google Scholar 

  48. 48.

    Stener-Victorin E, Kobayashi R, Kurosawa M (2003) Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats. Auton Neurosci 108:50–56. doi:10.1016/j.autneu.2003.08.006

    Article  PubMed  Google Scholar 

  49. 49.

    Stener-Victorin E, Kobayashi R, Watanabe O, Lundeberg T, Kurosawa M (2004) Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries. Reprod Biol Endocrinol 2:16. doi:10.1186/1477-7827-2-16

    Article  PubMed  PubMed Central  Google Scholar 

  50. 50.

    Stener-Victorin E, Waldenstrom U, Nilsson L, Wikland M, Janson PO (1999) A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 14:2480–2484

    CAS  Article  PubMed  Google Scholar 

  51. 51.

    Stener-Victorin E, Waldenstrom U, Wikland M, Nilsson L, Hagglund L, Lundeberg T (2003) Electro-acupuncture as a peroperative analgesic method and its effects on implantation rate and neuropeptide Y concentrations in follicular fluid. Hum Reprod 18:1454–1460

    CAS  Article  PubMed  Google Scholar 

  52. 52.

    Sun ZG, Lian F, Zhang JW (2012) Effects of acupuncture combined Chinese materia medica for tonifying shen and soothing gan on the anxiety and depression of patients with in vitro fertilization and embryo transplantation and on the treatment outcomes. Zhongguo Zhong Xi Yi Jie He Za Zhi 32:1023–1027

    PubMed  Google Scholar 

  53. 53.

    Wang XY (2008) Influence of different constitution of races on application of acupuncture therapy. Zhongguo Zhen Jiu 28:819–821

    PubMed  Google Scholar 

  54. 54.

    Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J (2006) Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril 85:1341–1346. doi:10.1016/j.fertnstert.2005.08.070

    Article  PubMed  Google Scholar 

  55. 55.

    Yang R, Yang S, Li R, Chen X, Wang H, Ma C, Liu P, Qiao J (2015) Biochemical pregnancy and spontaneous abortion in first IVF cycles are negative predictors for subsequent cycles: an over 10,000 cases cohort study. Arch Gynecol Obstet 292:453–458. doi:10.1007/s00404-015-3639-8

    CAS  Article  PubMed  Google Scholar 

  56. 56.

    Zhang R, Feng XJ, Guan Q, Cui W, Zheng Y, Sun W, Han JS (2011) Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study. Fertil Steril 96:912–916. doi:10.1016/j.fertnstert.2011.07.1093

    Article  PubMed  Google Scholar 

  57. 57.

    Zheng CH, Zhang MM, Huang GY, Wang W (2012) The role of acupuncture in assisted reproductive technology. Evid Based Complement Alternat Med 2012:543924. doi:10.1155/2012/543924

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The present work was supported by grants from the Science Foundation of Jiangsu Province (BK20161067) and Department of Health of China (201302013, 201402004).

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Correspondence to Yan Meng.

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We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled, “Therapeutic effect of acupuncture on the outcomes of in vitro fertilization: systematic review and meta-analysis”.

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Qian, Y., Xia, X., Ochin, H. et al. Therapeutic effect of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis. Arch Gynecol Obstet 295, 543–558 (2017). https://doi.org/10.1007/s00404-016-4255-y

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Keywords

  • Acupuncture
  • In vitro fertilization
  • Clinical pregnancy rate