Acupuncture given with embryo transfer is associated with a significant 65% increase in the clinical pregnancy rate of women undergoing in vitro fertilization, according to a meta-analysis published online.
The number needed to treat to achieve an extra clinical pregnancy through acupuncture performed within 1 day of embryo transfer is 10; the odds ratio was 1.65. The number needed to treat to achieve an additional ongoing pregnancy (OR 1.87) or an additional live birth (OR 1.91) was 9 in both cases, reported Eric Manheimer, director of database and evaluation for the Center for Integrative Medicine at the University of Maryland, Baltimore, and his colleagues in a British Medical Journal report.
The researchers reviewed data from seven controlled trials they deemed to have been properly conducted, with a total of 1,366 women undergoing in vitro fertilization (IVF). In all trials, the acupuncture was performed within 1 day of embryo transfer, usually 25 minutes before transfer. In some trials, control women received sham acupuncture. In others, they received nothing (BMJ 2008 [doi:10.1136/bmj.39471.430451.BE]).
The way in which the acupuncture was performed varied somewhat among the trials, though in all but one trial the fixed selection of acupuncture points was similar. In all trials, the acupuncture sessions lasted 25–30 minutes.
Three trials also included one additional acupuncture session in addition to the sessions immediately before and after transfer; six trials also used ear acupuncture to supplement body acupuncture.
The analysis should not be construed as the last word on the subject, however, according to Dr. LaTasha B. Craig of the department of obstetrics and gynecology at Oklahoma University, Oklahoma City. Dr. Craig was not involved with the meta-analysis. “I think more research needs to be done,” she said in an interview.
Most of the studies used in the review, and in the medical literature generally, have used different protocols and had different types of control groups, making it difficult to compare or combine them, she noted.
In addition, Dr. Craig herself reported a trial at the American Society for Reproductive Medicine last October in which she found acupuncture was associated with a reduction in clinical pregnancies and live births. Her study comprised 113 subjects randomized to receive acupuncture before and after embryo transfer, using the same acupuncture points used in the trials in the review plus two additional points, or to a control group. The control subjects received no treatment.
The difference in her trial was that the acupuncturist was not on site at the fertility clinic, and so study participants had to drive back and forth between the acupuncturist and the clinic, a requirement that might have been stressful.
Her study recorded a clinical pregnancy rate of 46% in the acupuncture group vs. 72% in the control group, and a live birth rate of 39% with acupuncture versus 65% without treatment.
Dr. Craig also said that, given the way Chinese acupuncture is usually performed, it might be better to do it one or two times in the week before transfer rather than on the same day, and that approach needs to be explored.
According to Mr. Manheimer and his colleagues, the strengths of their review include the number of trials they were able to include and each of the trial's relatively large sample size. In addition, his group contacted the studies' investigators to get supplemental information and to ensure they were handling the data properly.
Regarding the fact that not all trials in the analysis included sham acupuncture, Mr. Manheimer and colleagues argued that sham procedures are not considered important in trials where there is an objective outcome.
On the other hand, one limitation of their review is that there were big differences in the baseline pregnancy and birth rates, they acknowledged.
If acupuncture does indeed increase the likelihood of pregnancy, and therefore reduces the need for costly repeat cycles, then it probably is cost effective, they added. Each IVF cycle costs an average of $12,400 in the United States.
Mr. Manheimer and his colleagues reported no financial conflicts of interest.