BACKGROUND AND PURPOSE:

• Acupuncture is used to augment IVF treatments
• Data is inconclusive as to whether or not there is benefit
• Cochrane Review found no benefit but there are recognized methodological problems that affected the quality of the evidence
• Smith et al. (JAMA, 2018) assessed the efficacy of acupuncture in aiding women undergoing IVF

METHODS:

• Single-blind, parallel-group randomized clinical trial (RCT)
• Participants
  • Women 18 to 42 years undergoing a fresh IVF or ICSI cycle
  • Not currently using acupuncture
• Women randomized to
  • Acupuncture
  • Sham treatment (control group): Needle with a retractable needle shaft and a blunt tip placed away from true acupuncture points
• Randomization prior to starting stimulation protocols
• Treatments based on traditional Chinese medicine and acupuncturists were all trained with a minimum of 2 years’ experience
• Treatments
  • First treatment: Between days 6 and 8 of ovarian stimulation
  • 2 treatments were given on the day of embryo transfer
• Primary outcome: Live birth
• Secondary outcome: Clinical pregnancy and miscarriage

RESULTS:

• 809 women were included in the study
  • 405 acupuncture; 404 sham control
  • mean [SD] age: 35.4 [4.3] years
  • 45.0% had undergone more than 2 previous IVF cycles
  • Baseline demographics were the same in the 2 groups
• Live births
  • 18.5% in the acupuncture group vs 17.8% in the sham group
  • There was no significant risk difference between groups
    • Relative risk was 1.02 (95% CI, 0.76 to 1.38)
    • Risk difference was 0.5% (95% CI, −4.9% to 5.8%)
  • Clinical pregnancy
    • 25.7% in the acupuncture group vs 21.7% in the sham group (not statistically different)
  • Miscarriage
    • 11.6% in the acupuncture group vs 22.8% in the sham group (not statistically different)
  • Adverse events were minor and related to acupuncture, such as discomfort and bruising

CONCLUSION:

• Administration of acupuncture at the time of ovarian stimulation and embryo transfer did not significantly increase live birth rates in women undergoing IVF
• Authors identify limitations of the study to include the fact that the planned sample size was not achieved (many women wanted acupuncture and therefore declined randomization)
  • However, the 95% CI for risk difference suggests that the study was not underpowered
  • More blastocyst transfers in the sham group (no explanation for why this occurred)
  • Length of treatment was short

Learn More – Primary Sources:

Effect of Acupuncture vs Sham Acupuncture on Live Births Among Women Undergoing In Vitro Fertilization – A Randomized Clinical Trial

Related ObG Topics:

Does Acupuncture Decrease Incidence of Migraines?

Infertility Treatment and Childhood Development

Does IVF Affect Neonatal Outcomes in Very Low Birth Weight Preterm Infants?