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Study Questions Benefit of Acupuncture in IVF


 

WASHINGTON — Acupuncture performed on site before and after embryo transfer has been shown to improve in vitro fertilization success rates in patients with good-quality embryos, but the same finding did not hold true in a recent study conducted in a “real world” setting, in which acupuncture was associated with a reduced success rate, Dr. LaTasha B. Craig reported at the annual meeting of the American Society for Reproductive Medicine.

In a 2002 landmark study by Paulus et al. showing a benefit with acupuncture in patients undergoing IVF (Fertil. Steril. 2002;77:721–4), acupuncture was associated with increased pregnancy rates in 80 treated patients, compared with 80 controls who received no treatment (43% vs. 26% pregnancy rates in the groups, respectively).

But that study, which was conducted in Germany, included only patients with good-quality embryos, and involved on-site acupuncture treatments, which aren't typically available at IVF centers in the United States, Dr. Craig, of the University of Oklahoma, Oklahoma City, explained in an interview.

For her study (prompted by curiosity about whether the benefits of acupuncture in IVF patients would hold up in this country, where pregnancy rates with IVF are higher than in Germany) 113 women were randomized to undergo acupuncture using a modified Paulus protocol (involving two additional acupoints) for 25 minutes before and after embryo transfer by one of two licensed acupuncturists at an off-site location or to receive no intervention before or after embryo transfer.

Patients were included in the study regardless of embryo quality.

Acupuncture in her study, which was conducted in Seattle while she was with the University of Washington, was associated with lower clinical and live birth pregnancy rates, compared with no intervention (46% vs. 72%, and 39% vs. 65%, respectively).

Clinical pregnancy was defined as a positive fetal heart rate on ultrasound at 6–7 weeks' gestation.

Live birth delivery was defined as delivery at 24 weeks or greater.

Patients in the treatment and control groups were statistically similar in regard to age, peak estradiol level, number of oocytes retrieved, fertilization method and rate, number of embryos transferred, and the proportion of blastocyst transfer, she noted.

“I expected to find no difference between the groups—not a reversal of the Paulus findings,” she said during the interview.

The fact that patients traveled to and from the IVF center in busy Seattle traffic for the acupuncture, thus possibly increasing stress levels and negating the effects of the acupuncture, may prove to be an important factor in her findings, she commented.

Of note, there were three studies of acupuncture and IVF in 2006, with two of the three showing a benefit with acupuncture, and one showing no difference.

“Now mine shows possible detriment [with acupuncture],” she said, adding that the conflicting findings suggest additional study is needed.

However, acupuncture can be very difficult to study, in part because of the lack of a good acupuncture control method.

“My belief is that acupuncture 1–2 times a week leading up to IVF is probably going to prove more effective than just providing acupuncture the day of the embryo transfer,” she added.

That's because the theory behind traditional Chinese acupuncture methods is whole-person medicine. They don't effect a change in 1 day, and the idea that every patient would be treated the same way goes against their basic training, she explained.

Dr. Craig is working to obtain funding to begin a study at the University of Oklahoma. The ideal study would compare on-site acupuncture before and after embryo transfer, off-site acupuncture before and after embryo transfer, and no treatment, she said.

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