Gynecologic and Obstetric Investigation

Review

Editor's Choice - Free Access

The Role of Acupuncture in in vitro Fertilization: A Systematic Review and Meta-Analysis

Shen C.a · Wu M.b · Shu D.a · Zhao X.a · Gao Y.a

Author affiliations

aDepartment of Obstetrics and Gynecology, and bInstitute of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Corresponding Author

Ying Gao

Department of Obstetrics and Gynecology, Union Hospital

Tongji Medical College, Huazhong University of Science and Technology

Wuhan, Hubei 430022 (China)

E-Mail gying13@163.com

Keywords: AcupunctureIn vitro fertilizationClinical pregnancy rateEmbryo transferSystematic review

Related Articles for ""
Gynecol Obstet Invest 2015;79:1-12
https://doi.org/10.1159/000362231

Abstract

Background/Aims: In recent years, acupuncture has become more and more popular in the management of subfertility. The aim of this study was to evaluate the impact of acupuncture during in vitro fertilization (IVF) treatment on the outcomes of clinical pregnancy in published randomized studies. Methods: This is a systematic review and meta-analysis. Data sources used were MEDLINE, Embase, Web of Knowledge and the Chinese Biomedical Database. Results: There was no statistically significant difference between the acupuncture group and no acupuncture (intervention) controls around the time of embryo transfer (ET; risk ratio, RR, 1.24, 95% confidence interval, CI, 1.02-1.50) or in unblinded trials, trials blinded to physicians and double-blind trials (95% CI 1.26-1.88, 0.82-1.33 and 0.89-1.25, respectively). This was also the case when comparing acupuncture with sham acupuncture controls around the time of ET (RR, 1.03, 95% CI 0.87-1.22) or when restricting to unblinded trials, trials blinded to physicians and double-blind trials (95% CI 0.80-2.02, 0.82-1.18 and 0.77-1.17, respectively). There was a statistically significant difference when performed at 30 min after ET and implantation phase (RR 1.76, 95% CI 1.22-2.55). There was also a statistically significant difference when performed at follicle phase and 25 min before and after ET (RR 1.56, 95% CI 1.04-2.33). Conclusion: Our study showed that acupuncture did not significantly improve the IVF clinical pregnancy rate when performed only at the time of ET, while we found pooled benefit of acupuncture for IVF when performed at follicle phase and 25 min before and after ET, as well as 30 min after ET and implantation phase.

© 2014 S. Karger AG, Basel



Related Articles:

References

  1. Ng EH, So WS, Gao J, Wong YY, Ho PC: The role of acupuncture in the management of subfertility. Fertil Steril 2008;90:1-13.
    External Resources
  2. Dalton-Brewer N, Gillott D, Atalla N, Menabawey M, Wright P, Thornhill A: Use of acupuncture before and after embryo transfer. Hum Fertil 2009;12:247.
  3. Chen J, Liu LL, Cui W, Sun W: Effects of electroacupuncture on in vitro fertilization-embryo transfer (IVF-ET) of patients with poor ovarian response. Zhongguo Zhen Jiu 2009;29:775-779.
    External Resources
  4. Cavalla H: Acupuncture and electroauriculotherapy treatment for infertility. Med Acupunct 2010;22:49-52.
    External Resources
  5. Sun L, Tao F, Hao J, Su P, Xu R, Liu F: Vaginal bleeding in early pregnancy and associations with physical, psychological and environmental factors among Chinese women: from the C-ABC cohort study. Gynecol Obstet invest 2012;73:330-336.
    External Resources
  6. Balk J, Catov J, Horn B, Gecsi K, Wakim A: The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: a pilot study. Complement Ther Clin Pract 2010;16:154-157.
    External Resources
  7. Cakmak YO: Electroacupuncture reduces uterine artery blood flow impedance. Taiwan J Obstet Gynecol 2010;49:390, author reply 391.
    External Resources
  8. Guo J, Li D, Zhang QF: Acupuncture intervention combined with assisted reproductive technology: its different effects at different time points during the in vitro fertilization-embryo transfer course (in Chinese). Zhong Xi Yi Jie He Xue Bao 2008;6:1211-1216.
    External Resources
  9. Rashidi BH, Tehrani ES, Hamedani NA, Pirzadeh L: Effects of acupuncture on the outcome of in vitro fertilisation and intracytoplasmic sperm injection in women with polycystic ovarian syndrome. Acupunct Med 2013;31:151-156.
    External Resources
  10. Craig LB, Criniti AR, Hansen KR, Marshall LA, Soules MR: Acupuncture lowers pregnancy rates when performed before and after embryo transfer. Fertil Steril 2007;88(suppl 1):S40.
    External Resources
  11. Madaschi C, Braga DP, Figueira Rde C, Iaconelli A Jr, Borges E Jr: Effect of acupuncture on assisted reproduction treatment outcomes. Acupunct Med 2010;28:180-184.
    External Resources
  12. El-Toukhy T, Sunkara SK, Khairy M, Dyer R, Khalaf Y, Coomarasamy A: A systematic review and meta-analysis of acupuncture in in vitro fertilisation. BJOG 2008;115:1203-1213.
    External Resources
  13. Manheimer E, van der Windt D, Cheng K, Stafford K, Liu J, Tierney J, Lao L, Berman BM, Langenberg P, Bouter LM: The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Hum Reprod Update 2013;0:1-10.
    External Resources
  14. Zheng CH, Zhang MM, Huang GY, Wang W: The role of acupuncture in assisted reproductive technology. Evid Based Complement Alternat Med 2012;2012:1-15.
    External Resources
  15. El-Toukhy T, Khalaf Y: The impact of acupuncture on assisted reproductive technology outcome. Curr Opin Obstet Gynecol 2009;21:240-246.
    External Resources
  16. Stener-Victorin E: The pain-relieving effect of electro-acupuncture and conventional medical analgesic methods during oocyte retrieval: a systematic review of randomized controlled trials. Hum Reprod (Oxford) 2005;20:339-349.
    External Resources
  17. Andersen D, Lossl K, Nyboe Andersen A, Furbringer J, Bach H, Simonsen J, Larsen EC: Acupuncture on the day of embryo transfer: a randomized controlled trial of 635 patients. Reprod Biomed Online 2010;21:366-372.
    External Resources
  18. Domar AD, Meshay I, Kelliher J, Alper M, Powers RD: The impact of acupuncture on in vitro fertilization outcome. Fertil Steril 2009;91:723-726.
    External Resources
  19. Moy I, Milad MP, Barnes R, Confino E, Kazer RR, Zhang X: Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization. Fertil Steril 2011;95:583-587.
    External Resources
  20. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K: Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002;77:721-724.
    External Resources
  21. So EW, Ng EH, Wong YY, Lau EY, Yeung WS, Ho PC: A randomized double blind comparison of real and placebo acupuncture in IVF treatment. Hum Reprod 2009;24:341-348.
    External Resources
  22. Zhang M, Huang G, Lu F, El-Danasouri I, Sterzik K: Effect of acupuncture on rate of pregnancy among women undergoing embryo transfer. Zhongguo Zhen Jiu 2002;22:507-509.
  23. Zhang M, Huang G, Lu F, El-Danasouri I, Sterzik K: Effect of acupuncture on rate of pregnancy among women undergoing embryo transfer: a prospective randomized placebo controlled trial. Zhongguo Zhen Jiu 2003;23:3-5.
  24. Omodei U, Piccioni G, Tombesi S, Dordoni D, Fallo L, Ghilardi F: Effect of acupuncture on rates of pregnancy among women undergoing in vitro fertilization. Fertil Steril 2010;94(suppl 1):S170.
    External Resources
  25. Benson MR, Elkind-Hirsch KE, Theall A, Fong K, Hogan RB, Scott RT: P-18: impact of acupuncture before and after embryo transfer on the outcome of in vitro fertilization cycles: a prospective single-blind randomized study. Fertil Steril 2006;86:S135.
    External Resources
  26. Fratterelli JL, Leondires MR, Fong K, Theall A, Locatelli S, Scott RT: Laser acupuncture before and after embryo transfer improves art delivery rates: results of a prospective randomized double-blinded placebo controlled five-armed trial involving 1,000 patients. Fertil Steril 2008;90(suppl):S105.
    External Resources
  27. Paulus WE, Zhang M, Strehler E, Seybold B, Sterzik K: Placebo-controlled trial of acupuncture effects in assisted reproduction therapy. Hum Reprod 2003;18:18-19.
  28. Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J: Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril 2006;85:1341-1346.
    External Resources
  29. Cui W, Sun W, Liu L, Wen J: Effects of electroacupuncture on patients undergoing in vitro fertilization and embryo transplantation. Zhongguo Fu You Bao Jian 2006;22:3403-3405.
  30. Ho M, Huang LC, Chang YY, Chen HY, Chang WC, Yang TC, Tsai HD: Electroacupuncture reduces uterine artery blood flow impedance in infertile women. Taiwan J Obstet Gynecol 2009;48:148-151.
    External Resources
  31. di Villahermosa DIM, dos Santos LG, Nogueira MB, Vilarino FL, Barbosa CP: Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial. Acupunct Med 2013;31:157-161.
    External Resources
  32. Smith C, Coyle M, Norman RJ: Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril 2006;85:1352-1358.
    External Resources
  33. Dieterle S, Ying G, Hatzmann W, Neuer A: Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril 2006;85:1347-1351.
    External Resources
  34. Zhang R, Feng XJ, Guan Q, Cui W, Zheng Y, Sun W, Han JS: Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study. Fertil Steril 2011;96:912-916.
    External Resources
  35. So EW, Ng EH, Wong YY, Yeung WS, Ho PC: Acupuncture for frozen-thawed embryo transfer cycles: a double-blind randomized controlled trial. Reprod Biomed Online 2010;20:814-821.
    External Resources
  36. Chiara R, Carolina B, Franco C: Effect of acupuncture on pregnancy rate in selected women undergoing IVF. Eur J Integr Med 2012;4:52.
  37. Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM: Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ 2008;336:545-549.
    External Resources
  38. Humaidan P, Brock K, Bungum L, Stener-Victorin E: Pain relief during oocyte retrieval - exploring the role of different frequencies of electro-acupuncture. Reprod Biomed Online 2006;13:120-125.
    External Resources
  39. Anderson BJ, Rosenthal L: Acupuncture and IVF controversies. Fertil Steril 2007;87:1000.
    External Resources
  40. Brenner Z: Acupuncture and IVF trial. Fertil Steril 2009;92:27, author reply 28.
    External Resources
  41. Kim J, Shin KH, Na CS: Effect of acupuncture treatment on uterine motility and cyclooxygenase-2 expression in pregnant rats. Gynecol Obstet Invest 2000;50:225-230.
    External Resources
  42. Bozdag G, Esinler I, Yarali H: Pretreatment with oral contraceptive pills does not influence the pregnancy rate in the long leuprolide acetate protocol. Gynecol Obstet Invest 2012;73:53-57.
    External Resources
  43. Rosenthal L, Anderson B: Acupuncture and in vitro fertilisation: recent research and clinical guidelines. J Chin Med 2007;84:28-35.
  44. Domar AD, Conboy L, Denardo-Roney J, Rooney KL: Lifestyle behaviors in women undergoing in vitro fertilization: a prospective study. Fertil Steril 2012;97:697-701.
    External Resources

Article / Publication Details

First-Page Preview
Abstract of Review

Received: January 15, 2014
Accepted: March 14, 2014
Published online: May 16, 2014
Issue release date: January 2015

Number of Print Pages: 12
Number of Figures: 4
Number of Tables: 2

ISSN: 0378-7346 (Print)
eISSN: 1423-002X (Online)

For additional information: https://www.karger.com/GOI

References

  1. Ng EH, So WS, Gao J, Wong YY, Ho PC: The role of acupuncture in the management of subfertility. Fertil Steril 2008;90:1-13.
    External Resources
  2. Dalton-Brewer N, Gillott D, Atalla N, Menabawey M, Wright P, Thornhill A: Use of acupuncture before and after embryo transfer. Hum Fertil 2009;12:247.
  3. Chen J, Liu LL, Cui W, Sun W: Effects of electroacupuncture on in vitro fertilization-embryo transfer (IVF-ET) of patients with poor ovarian response. Zhongguo Zhen Jiu 2009;29:775-779.
    External Resources
  4. Cavalla H: Acupuncture and electroauriculotherapy treatment for infertility. Med Acupunct 2010;22:49-52.
    External Resources
  5. Sun L, Tao F, Hao J, Su P, Xu R, Liu F: Vaginal bleeding in early pregnancy and associations with physical, psychological and environmental factors among Chinese women: from the C-ABC cohort study. Gynecol Obstet invest 2012;73:330-336.
    External Resources
  6. Balk J, Catov J, Horn B, Gecsi K, Wakim A: The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: a pilot study. Complement Ther Clin Pract 2010;16:154-157.
    External Resources
  7. Cakmak YO: Electroacupuncture reduces uterine artery blood flow impedance. Taiwan J Obstet Gynecol 2010;49:390, author reply 391.
    External Resources
  8. Guo J, Li D, Zhang QF: Acupuncture intervention combined with assisted reproductive technology: its different effects at different time points during the in vitro fertilization-embryo transfer course (in Chinese). Zhong Xi Yi Jie He Xue Bao 2008;6:1211-1216.
    External Resources
  9. Rashidi BH, Tehrani ES, Hamedani NA, Pirzadeh L: Effects of acupuncture on the outcome of in vitro fertilisation and intracytoplasmic sperm injection in women with polycystic ovarian syndrome. Acupunct Med 2013;31:151-156.
    External Resources
  10. Craig LB, Criniti AR, Hansen KR, Marshall LA, Soules MR: Acupuncture lowers pregnancy rates when performed before and after embryo transfer. Fertil Steril 2007;88(suppl 1):S40.
    External Resources
  11. Madaschi C, Braga DP, Figueira Rde C, Iaconelli A Jr, Borges E Jr: Effect of acupuncture on assisted reproduction treatment outcomes. Acupunct Med 2010;28:180-184.
    External Resources
  12. El-Toukhy T, Sunkara SK, Khairy M, Dyer R, Khalaf Y, Coomarasamy A: A systematic review and meta-analysis of acupuncture in in vitro fertilisation. BJOG 2008;115:1203-1213.
    External Resources
  13. Manheimer E, van der Windt D, Cheng K, Stafford K, Liu J, Tierney J, Lao L, Berman BM, Langenberg P, Bouter LM: The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Hum Reprod Update 2013;0:1-10.
    External Resources
  14. Zheng CH, Zhang MM, Huang GY, Wang W: The role of acupuncture in assisted reproductive technology. Evid Based Complement Alternat Med 2012;2012:1-15.
    External Resources
  15. El-Toukhy T, Khalaf Y: The impact of acupuncture on assisted reproductive technology outcome. Curr Opin Obstet Gynecol 2009;21:240-246.
    External Resources
  16. Stener-Victorin E: The pain-relieving effect of electro-acupuncture and conventional medical analgesic methods during oocyte retrieval: a systematic review of randomized controlled trials. Hum Reprod (Oxford) 2005;20:339-349.
    External Resources
  17. Andersen D, Lossl K, Nyboe Andersen A, Furbringer J, Bach H, Simonsen J, Larsen EC: Acupuncture on the day of embryo transfer: a randomized controlled trial of 635 patients. Reprod Biomed Online 2010;21:366-372.
    External Resources
  18. Domar AD, Meshay I, Kelliher J, Alper M, Powers RD: The impact of acupuncture on in vitro fertilization outcome. Fertil Steril 2009;91:723-726.
    External Resources
  19. Moy I, Milad MP, Barnes R, Confino E, Kazer RR, Zhang X: Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization. Fertil Steril 2011;95:583-587.
    External Resources
  20. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K: Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002;77:721-724.
    External Resources
  21. So EW, Ng EH, Wong YY, Lau EY, Yeung WS, Ho PC: A randomized double blind comparison of real and placebo acupuncture in IVF treatment. Hum Reprod 2009;24:341-348.
    External Resources
  22. Zhang M, Huang G, Lu F, El-Danasouri I, Sterzik K: Effect of acupuncture on rate of pregnancy among women undergoing embryo transfer. Zhongguo Zhen Jiu 2002;22:507-509.
  23. Zhang M, Huang G, Lu F, El-Danasouri I, Sterzik K: Effect of acupuncture on rate of pregnancy among women undergoing embryo transfer: a prospective randomized placebo controlled trial. Zhongguo Zhen Jiu 2003;23:3-5.
  24. Omodei U, Piccioni G, Tombesi S, Dordoni D, Fallo L, Ghilardi F: Effect of acupuncture on rates of pregnancy among women undergoing in vitro fertilization. Fertil Steril 2010;94(suppl 1):S170.
    External Resources
  25. Benson MR, Elkind-Hirsch KE, Theall A, Fong K, Hogan RB, Scott RT: P-18: impact of acupuncture before and after embryo transfer on the outcome of in vitro fertilization cycles: a prospective single-blind randomized study. Fertil Steril 2006;86:S135.
    External Resources
  26. Fratterelli JL, Leondires MR, Fong K, Theall A, Locatelli S, Scott RT: Laser acupuncture before and after embryo transfer improves art delivery rates: results of a prospective randomized double-blinded placebo controlled five-armed trial involving 1,000 patients. Fertil Steril 2008;90(suppl):S105.
    External Resources
  27. Paulus WE, Zhang M, Strehler E, Seybold B, Sterzik K: Placebo-controlled trial of acupuncture effects in assisted reproduction therapy. Hum Reprod 2003;18:18-19.
  28. Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J: Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril 2006;85:1341-1346.
    External Resources
  29. Cui W, Sun W, Liu L, Wen J: Effects of electroacupuncture on patients undergoing in vitro fertilization and embryo transplantation. Zhongguo Fu You Bao Jian 2006;22:3403-3405.
  30. Ho M, Huang LC, Chang YY, Chen HY, Chang WC, Yang TC, Tsai HD: Electroacupuncture reduces uterine artery blood flow impedance in infertile women. Taiwan J Obstet Gynecol 2009;48:148-151.
    External Resources
  31. di Villahermosa DIM, dos Santos LG, Nogueira MB, Vilarino FL, Barbosa CP: Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial. Acupunct Med 2013;31:157-161.
    External Resources
  32. Smith C, Coyle M, Norman RJ: Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril 2006;85:1352-1358.
    External Resources
  33. Dieterle S, Ying G, Hatzmann W, Neuer A: Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril 2006;85:1347-1351.
    External Resources
  34. Zhang R, Feng XJ, Guan Q, Cui W, Zheng Y, Sun W, Han JS: Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study. Fertil Steril 2011;96:912-916.
    External Resources
  35. So EW, Ng EH, Wong YY, Yeung WS, Ho PC: Acupuncture for frozen-thawed embryo transfer cycles: a double-blind randomized controlled trial. Reprod Biomed Online 2010;20:814-821.
    External Resources
  36. Chiara R, Carolina B, Franco C: Effect of acupuncture on pregnancy rate in selected women undergoing IVF. Eur J Integr Med 2012;4:52.
  37. Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM: Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ 2008;336:545-549.
    External Resources
  38. Humaidan P, Brock K, Bungum L, Stener-Victorin E: Pain relief during oocyte retrieval - exploring the role of different frequencies of electro-acupuncture. Reprod Biomed Online 2006;13:120-125.
    External Resources
  39. Anderson BJ, Rosenthal L: Acupuncture and IVF controversies. Fertil Steril 2007;87:1000.
    External Resources
  40. Brenner Z: Acupuncture and IVF trial. Fertil Steril 2009;92:27, author reply 28.
    External Resources
  41. Kim J, Shin KH, Na CS: Effect of acupuncture treatment on uterine motility and cyclooxygenase-2 expression in pregnant rats. Gynecol Obstet Invest 2000;50:225-230.
    External Resources
  42. Bozdag G, Esinler I, Yarali H: Pretreatment with oral contraceptive pills does not influence the pregnancy rate in the long leuprolide acetate protocol. Gynecol Obstet Invest 2012;73:53-57.
    External Resources
  43. Rosenthal L, Anderson B: Acupuncture and in vitro fertilisation: recent research and clinical guidelines. J Chin Med 2007;84:28-35.
  44. Domar AD, Conboy L, Denardo-Roney J, Rooney KL: Lifestyle behaviors in women undergoing in vitro fertilization: a prospective study. Fertil Steril 2012;97:697-701.
    External Resources
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