Acupuncture and IVF – How might it work?
Acupuncture and IVF – Study Number 1
Published in the Journal of the American Medical Association (JAMA) in May 2018. This study is hailed as the most definitive evidence yet that acupuncture has no benefit in terms of increasing the chance for a live birth with IVF.
Acupuncture IVF Patient Groups- Study Number 1
The study was performed in 16 IVF programs in Australia and New Zealand, the randomized clinical trial involved 848 women aged 18 to 42 undergoing an IVF cycle using fresh embryos. Treatments occurred between 2011 and 2015. Participants were given either acupuncture or a sham acupuncture control (a non-insertive needle placed away from the true acupuncture points).
Acupuncture and IVF Treatment – Study Number 1
Women were recruited at the time of the decision to undergo an IVF or ICSI cycle, and randomization occurred prior to starting medication. Following randomization, women made an appointment with the study acupuncturist onsite at the IVF centers or nearby. The first treatment was administered between days 6 and 8 of ovarian stimulation, and 2 treatments were given on the day of embryo transfer.
The acupuncturists had a minimum of 2 years clinical experience, held membership with a national professional association, and in Australia, were registered with the national Australian Health Practitioner Regulation Agency.
Acupuncture and IVF Pregnancy Rates and Results – Study Number 1
The frequency of live births did not differ between groups: 74 of 405 women (18.3%) randomized to acupuncture had a live birth compared with 72 of 404 (17.8%) in the sham acupuncture group. The likelihood of a live birth was not different between the 2 groups after adjusting for age, number of previous IVF cycles, and participating IVF center. there was also no difference in the rate of miscarriage.
Acupuncture and IVF – Study Number 2
Acupuncture IVF Patient Groups- Study Number 2
Conclusions from Study Number 1
These findings do not support the use of acupuncture to improve the rate of live births among women undergoing IVF.
Acupuncture and IVF Treatment – Study Number 2
- Better blood perfusion and “energy” in the uterus
- Sedation of the patient
- “Stabilization” of the endocrine system
Acupuncture and IVF Pregnancy Rates and Results – Study Number 2
In this study, IVF patients who had acupuncture had a 42% pregnancy rate. IVF patients who did not have acupuncture had a 26% rate.
There was no difference between the two groups in the thickness of the uterine lining or indexes of blood flow through the uterine arteries either before or after the embryo transfer. Hormone levels were not measured during this study.
One of the criticisms of this study is that the results could be due to the placebo effect. To counter these criticisms, one year after publishing the original study, the authors presented a placebo-controlled study at the annual meeting of the European Society for Human Reproduction and Embryology. Two hundred patients with good embryo quality were randomized to receive either real or sham acupuncture for 25 minutes before and after ET. There were clinical pregnancies in 43% of the real and 37% of the sham acupuncture patients. Statistical analysis of the results determined there was no significant difference between the groups. In other words, in this study, conducted by the same investigators and performed in the same way as the original study, acupuncture was not found to improve pregnancy rates.
Conclusions from Study Number 2
Acupuncture and IVF – Study Number 3
Acupuncture and IVF Treatment Protocol- Study Number 3
Acupuncture IVF Pregnancy Rates and Results – Study Number 3
There was no difference between the three groups in the number of eggs retrieved or the number of embryos available to transfer to the uterus.
The ongoing pregnancy rate was higher in both of the acupuncture groups compared to the control group. The ongoing pregnancy rate in the group which received acupuncture once was 36%, in the group that received acupuncture twice, the rate was 33% and in the group that did not receive acupuncture at all it was 22%. Statistical analysis was performed to determine whether these results might have been due to random chance. The analysis determined that the improvement in pregnancy rates in the single acupuncture group was unlikely to be due to chance but that the improvement in the double acupuncture group may have been due to chance.
Interestingly, the miscarriage rate in the group that received acupuncture twice was 33%. This is higher than the miscarriage rate in the group that had acupuncture once 21% or the control group — 15%. Statistical analysis showed that these results might have occurred by random chance however.
The results of this study are somewhat confusing. If acupuncture was beneficial in increasing pregnancy rates, then why weren’t two acupuncture sessions better than one? What was the reason for the seemingly higher miscarriage rate in the group that received acupuncture twice?
Acupuncture and IVF – Study Number 4
Acupuncture and IVF Pregnancy Rates and Results – Study Number 4
Both groups were similar in terms of age, weight, duration of infertility, cause of infertility, and number of previous IVF attempts. No differences were found in the specifics of the ovarian stimulation, the number of eggs retrieved, the fertilization rate, or the number of embryos transferred.
The success rates were looked at in a few ways. The implantation rate is the number of pregnancies produced divided by the number of embryos transferred. The real acupuncture group had an implantation rate of 14.2% whereas the phony acupuncture group’s implantation rate was only 5.9%. The ongoing pregnancy rate was 28.4% in the real acupuncture group compared to 13.8% in the phone group.
Acupuncture and IVF – Conclusions from Study Number 4
This study introduced a number of variables that make it difficult to interpret the results. First, a Chinese medicine was administered in addition to the acupuncture. There is no way to determine, therefore, whether the results were the result of the acupuncture or the medicine.
The “control group” had acupuncture performed at sites that were not thought to improve fertility. It is possible however, that these sites actually had a negative effect. The way the study was designed, there is no way to determine which is correct.
Acupuncture and IVF – Study Number 5
Acupuncture IVF Patient Groups- Study Number 5
Acupuncture and IVF Treatment Pregnancy Rates – Study Number 5
Of the 228 subjects randomized, 15% were unable to complete the treatment protocol because their IVF cycle was cancelled prior to the embryo transfer. No difference in the grading of embryos was found between groups. The pregnancy rate, defined as fetal heart rate on ultrasound scan, was 31% in the acupuncture group and 23% in the control group. Statistical analysis demonstrated that the difference seen was likely the result of chance and not the acupuncture itself.
The pregnancy rate was also not found to differ between groups if the women studies were under age 35.
No difference was found between groups for other study endpoints: number of eggs retrieved, fertilization rate or number of embryos transferred.
To examine whether the attempts to conceal from the patients the treatments they were receiving was successful, subjects were asked which group they thought they had been allocated to. Twenty-six subjects (11%) correctly guessed which group they were in. 16 subjects were in the treatment group and 10 were in the control group.