Acupuncture does not improve the rate of live births among women undergoing in vitro fertilization

1. In this randomized controlled trial, administration of acupuncture at the time of ovarian stimulation and embryo transfer did not improve the rate of live births.

2. There was no statistically significant difference in miscarriage, though discomfort and bruising were higher in the acupuncture group.

Evidence Rating: 1 (Excellent)

Study Rundown: Acupuncture is a frequently used adjunctive treatment during in vitro fertilization (IVF). Early studies suggested a potential benefit from acupuncture in improving IVF outcomes, however, evidence of an effect from acupuncture compared with controls has become less clear. In this randomized clinical trial, acupuncture compared to sham acupuncture at the time of ovarian stimulation and embryo transfer resulted in no significant difference in live birth rates. In addition, while there was no difference in the risk of miscarriage, discomfort and bruising were higher in the acupuncture group.

The main strengths of this study were its size, the multicenter design involving fertility units across Australia and New Zealand, and high rates of follow-up and adherence. However, there were a few limitations to this study that should be noted. First, there was significant unblinding in one group but not the other suggestive of an overall response bias, with participants believing they were more likely to have received an active treatment rather than a sham treatment. Second, the stage of embryo transfer was not balanced between the two arms, with a higher number of blastocyst transfer in the control group, a major limitation given blastocyst stage embryo transfer is associated with higher rates of pregnancy and live birth than cleavage stage transfers. Third, the length of treatment intervention was short, whereas in clinical practice, acupuncture treatment is individualized with variation in the dosing of acupuncture, including more frequent treatment prior to and during the IVF cycle.

Click to read the study, published in JAMA

Relevant Reading: Acupuncture and in vitro fertilization research

In-Depth [randomized clinical trial]: This trial included 848 women intending to undergo a fresh IVF cycle (mean age, 35.4 years). Inclusion criteria were women aged 18 to 43 years undergoing a fresh IVF or intracytoplasmic sperm injection cycle and not using acupuncture. Exclusion criteria were women undergoing a frozen embryo transfer, previous randomization to the study, planning preimplantation genetic diagnosis, or receiving donor eggs. For the acupuncture arm, the first treatment was administered between days 6 and 8 of ovarian stimulation, and 2 treatments were given on the day of embryo transfer. The sham control arm received non-insertive acupuncture, where the sham needle was lightly placed to the surface of the skin with no manipulation of the needle.

74 of 405 women (18.3%) randomized to acupuncture had a live birth compared with 72 of 404 (17.8%) in the sham control (RR, 1.02; CI₉₅ 0.76 to 1.38). Adverse events, which were minor and acupuncture-specific, were reported by 152 women and were significantly greater in the acupuncture group for discomfort (RR 2.11; CI₉₅ 1.16 to 3.82) and bruising (RR 3.82; CI₉₅ 1.28-11.39).

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