Is acupuncture beneficial for subfertility patients who are receiving assisted reproductive treatment?
Date of Publication of the systematic review: October 2008
Design
Systematic review of 8 randomized controlled trials (RCTs).
Participants
1341 patients with primary or secondary subfertility who are receiving assisted reproductive treatment (ART) (mean age range: 32 to 37 years. Among all 8 included studies, three studies did not report age).
Intervention
Acupuncture at around the time of embryo transfer and/or two to three days after the embryo transfer. The most commonly used acupuncture points were: GV20, LI4, SP6 and ST29.
Comparator
Comparison 1: Verum acupuncture plus ART versus sham acupuncture plus ART;
Comparison 2: Verum acupuncture plus ART versus ART only.
Baseline treatment for both groups was ART, including controlled ovarian stimulation with or without artificial stimulation by husband, in vitro fertilization, or frozen-thawed embryo transfer treatment.
Major Outcomes
Outcome 1: Successful delivery of live births (follow-up time not specified by the reviewers);
Outcome 2: Pregnancy rate (follow-up time not specified by the reviewers).
Settings
Among all 8 included trials, 3 trials were conducted in Germany, 3 in the United States, and 1 each from Australia and Denmark. The reviewers did not state whether the trials were conducted in inpatient or outpatient settings. Acupuncture was performed by acupuncturists or trained examiners whose qualification and experiences were not clearly stated.
Comparison    Verum acupuncture plus ART versus sham acupuncture plus ART
Main Results
Compared to sham acupuncture plus ART, verum acupuncture plus ART significantly increased rate of successful delivery of live births (pooled relative risk increase (pooled RRI): 61%, 95% CI: 6% to 144%) and pregnancy rate (pooled RRI: 45%, 95% CI: 3% to 105%) among subfertility patients who are receiving ART.
Comparison 1: Verum acupuncture plus ART versus sham acupuncture plus ART in subfertility women who are receiving ART
Outcomes (units) No. of studies (Total number of participants) No. of events/No. of participants Heterogeneity test (I2) Pooled RRI (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 2 (425) 68/216 41/209 32% 61% (6% to 144%) Moderate
2 (NA) 3 (625) 110/325 81/327 50% 45% (3% to 105%) Moderate
Keys: RRI: relative risk increment; CI: confidence interval.
Comparison    Verum acupuncture plus ART versus ART only
Main Results
Compared to no extra treatment, verum acupuncture plus ART showed significant, homogeneous improvement on successful delivery of live births (pooled RRI: 76%, 95% CI: 22% to 153%) among subfertility patients who are receiving ART, but improvement of pregnancy rate is not significant (pooled RRI: 15%, 95% CI: -5% to 39%).
Comparison 2: Verum acupuncture plus ART versus ART only in subfertility women who are receiving ART
Outcomes (units) No. of studies (Total number of participants) No. of events/No. of participants Heterogeneity test (I2) Pooled RRI (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 2 (342) 61/175 33/167 0% 76% (22% to 153%) Moderate
2 (NA) 5 (689) 145/357 118/332 74% 15% (-5% to 39%) Low
Keys: RRI: relative risk increment; CI: confidence interval.
Comparison    Verum acupuncture plus ART versus sham acupuncture plus ART
Main Results
Compared to sham acupuncture plus ART, verum acupuncture plus ART significantly increased rate of successful delivery of live births (pooled relative risk increase (pooled RRI): 61%, 95% CI: 6% to 144%) and pregnancy rate (pooled RRI: 45%, 95% CI: 3% to 105%) among subfertility patients who are receiving ART.
Comparison 1: Verum acupuncture plus ART versus sham acupuncture plus ART in subfertility women who are receiving ART
Outcomes (units) 1 (NA) 2 (NA)
No. of studies (Total number of participants) 2 (425) 3 (625)
No. of events/No. of participants Intervention 68/216 110/325
Comparator 41/209 81/327
Pooled RRI (95% CI) 61% (6% to 144%) 45% (3% to 105%)
Overall quality of evidence* Moderate Moderate
Keys: RRI: relative risk increment; CI: confidence interval.
Comparison    Verum acupuncture plus ART versus ART only
Main Results
Compared to no extra treatment, verum acupuncture plus ART showed significant, homogeneous improvement on successful delivery of live births (pooled RRI: 76%, 95% CI: 22% to 153%) among subfertility patients who are receiving ART, but improvement of pregnancy rate is not significant (pooled RRI: 15%, 95% CI: -5% to 39%).
Comparison 2: Verum acupuncture plus ART versus ART only in subfertility women who are receiving ART
Outcomes (units) 1 (NA) 2 (NA)
No. of studies (Total number of participants) 2 (342) 5 (689)
No. of events/No. of participants Intervention 61/175 145/357
Comparator 33/167 118/332
Pooled RRI (95% CI) 76% (22% to 153%) 15% (-5% to 39%)
Overall quality of evidence* Moderate Low
Keys: RRI: relative risk increment; CI: confidence interval.
Conclusion
Benefits
Compared to sham acupuncture, verum acupuncture plus ART can benefit subfertility patients who are receiving ART on the following outcomes: successful delivery of live birth and pregnancy rate. For outcomes in this comparison, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. Compared to no extra treatment, verum acupuncture plus ART can benefit subfertility patients who are receiving ART on the critical outcome of successful delivery of live births. The overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. However, verum acupuncture plus ART did not show clear benefit on pregnancy rate. The overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse effects arising from the use of acupuncture were reported in the included trials.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/18843737
The synopsis is based on the following article:
Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted conception. Cochrane Database of Systematic Reviews
2008, Issue 4. Art. No.: CD006920. DOI: 10.1002/14651858.CD006920.pub2.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.