Are acupuncture and related therapies effective for improving pregnancy success in vitro fertilization with embryo transfer?
Date of publication of randomized controlled trial: December 2013
Design
Randomized controlled trial (RCT).
Participants
113 women (mean age range: 26.9 to 39.2 years) who were undergoing a fresh embryo transfer (ET) and were willing to undergo acupuncture. They were excluded if they had acupuncture within 3 months of ET or they were unwilling to be randomized to the control group underwent ET without further intervention.
Intervention
Manual acupuncture and auricular acupuncture were performed before and after ET by one of the two experienced acupuncturists, each with more than 3 years of experience with a focus on fertility treatment. The treatment session lasted for 25 minutes.
Comparator
Comparison: Acupuncture and related therapies versus no intervention.
Major Outcomes
Outcome 1: Clinical pregnancy measured by the fetal heart beat on ultrasound during the first trimester;
Outcome 2: Positive pregnancy test measured by the positive serum quantitative hCG> 10mIU/mL;
Outcome 3: Live birth occurred in women.
Settings
The trial was performed in an outpatient setting.
Comparison    Acupuncture and related therapies versus no intervention
Main Results
Compared to the group with no intervention, there were fewer women in acupuncture and related therapies group who achieved clinical pregnancy, obtained positive pregnancy test and gave live births. Women receiving acupuncture and related therapies before and after ET had significantly lower odds of clinical pregnancy (odds ratio (OR): 0.42, 95% CI: 0.19 to 0.93) and positive pregnancy test (OR: 0.43, 95% CI: 0.20 to 0.95) than those who did not undergo any intervention. However, the odds of live births occurred in women between two groups was not statistically significant (OR: 0.45, 95% CI: 0.20 to 1.01).
Comparison: Acupuncture and related therapies versus no intervention
Outcomes (units) No. of studies (Total number of participants) No. of participants who experienced the outcome / No. of participants in each group Heterogeneity test (I2) OR (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1(113) 24/55 35/54 Not applicable as there is only one study. 0.42 (0.19 to 0.93) 0.045 High
2 (NA) 1(113) 29/56 40/56 Not applicable as there is only one study. 0.43 (0.20 to 0.95) 0.027 High
3 (NA) 1(113) 18/50 28/50 Not applicable as there is only one study. 0.45 (0.20 to 1.01) 0.033 High
Keys: SD= standard deviation; OR: odds ratio; CI: confidence interval.
Comparison    Acupuncture and related therapies versus no intervention
Main Results
Compared to the group with no intervention, there were fewer women in acupuncture and related therapies group who achieved clinical pregnancy, obtained positive pregnancy test and gave live births. Women receiving acupuncture and related therapies before and after ET had significantly lower odds of clinical pregnancy (odds ratio (OR): 0.42, 95% CI: 0.19 to 0.93) and positive pregnancy test (OR: 0.43, 95% CI: 0.20 to 0.95) than those who did not undergo any intervention. However, the odds of live births occurred in women between two groups was not statistically significant (OR: 0.45, 95% CI: 0.20 to 1.01).
Comparison: Acupuncture and related therapies versus no intervention
Outcomes (units) 1 (NA) 2 (NA) 3 (NA)
No. of studies (Total number of participants) 1(113) 1(113) 1(113)
No. of participants who experienced the outcome / No. of participants in each group Intervention 24/55 29/56 18/50
Comparator 35/54 40/56 28/50
OR (95% CI) 0.42 (0.19 to 0.93) 0.43 (0.20 to 0.95) 0.45 (0.20 to 1.01)
p value 0.045 0.027 0.033
Overall quality of evidence* High High High
Keys: SD= standard deviation; OR: odds ratio; CI: confidence interval.
Conclusion
Benefits
Compared to the group with no intervention, there were fewer women in acupuncture and related therapies group who achieved clinical pregnancy, obtained positive pregnancy test and gave live births. The odds of clinical pregnancy and positive pregnancy test were significantly lower among women receiving acupuncture and related therapies than no intervention. However, there was no statistical difference in the odds of live births occurred in women between two groups. For all outcomes, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
No serious adverse events or side effects were reported in both acupuncture and related therapies group and the group with no intervention.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/24937975
The synopsis is based on the following article:
Craig LB, Rubin LE, Peck JD, Anderson M, Marshall LA, Soules MR. Acupuncture performed before and after embryo transfer: a randomized controlled trial. The Journal of Reproductive Medicine. 2013 Dec;59(5-6):313-20.


* 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.