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In a meta-analysis of seven randomized trials, acupuncture was associated with higher rates of pregnancy. In vitro fertilization is a stressful and expensive procedure with pregnancy success rates rarely reaching 40% per cycle. Given these drawbacks, adjuvant therapies that increase the proportion of pregnancies are advantageous. Investigators reviewed the published medical literature and conducted a meta-analysis of seven randomized clinical trials comparing adjuvant acupuncture (performed on the day of embryo transfer) to increase pregnancy rates with sham acupuncture or no adjuvant treatment in 1366 women. The trials were conducted between 2002 and 2006 in four Western countries. Acupuncture was associated significantly with improved clinical pregnancy rates compared with sham or no intervention (odds ratio, 1.65), with a number needed to treat (NNT) of 10. Likewise, acupuncture was associated with higher rates of ongoing pregnancy (OR, 1.87; NNT, 9) and live birth (OR, 1.91; NNT, 9) in the studies that evaluated these outcomes. No adverse effects of acupuncture were identified in the two trials that reported this outcome. Comment: The authors are careful to point out that the odds ratio overestimates the benefit of acupuncture in this analysis (because pregnancy was a relatively common outcome of IVF); they go on to suggest that the number needed to treat is the more appropriate measure of clinical benefit. Nonetheless, the effect of acupuncture was consistent across the trials, and the procedure is benign and relatively inexpensive, especially compared with the cost of IVF procedures. Thus, even if we don’t understand the mechanism behind its benefit, clinicians can be comfortable recommending acupuncture to women undergoing IVF — while also emphasizing the importance of finding an appropriately credentialed and skilled acupuncturist. — Anna Wald, MD, MPH Published in Journal Watch Women's Health March 27, 2008 Citation(s): Manheimer E et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: Systematic review and meta-analysis. BMJ 2008 Mar 8; 336:545.
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IVF
