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Grand Rounds

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

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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

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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?

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