#Grand Rounds

Does Acupuncture Help Women Undergoing In Vitro Fertilization Achieve a Live Birth?

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

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

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

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

< Previous

Next >