A new study was published on May 15 2018 looking at acupuncture performed three times during a stimulated IVF cycle to see if this type of acupuncture would improve live birth rates (Smith et al, 2018).
The study included 824 women with an average age of 35.4 years old. It looked at acupuncture performed once during ovarian stimulation (between day 6-8), and then before and after embryo transfer. The participants were split into two groups, a) true acupuncture and b) sham acupuncture (fake acupuncture so to speak).
Not to my surprise, the results showed that there was not a significant change in outcome between the two groups. The pregnancy rate was 25% in the true acupuncture group vs 21% in the sham acupuncture group. The live birth rate was 18.3% in the true acupuncture group vs 17.8% in the sham acupuncture group. Although there was slight improvements in the true acupuncture group over the sham, these were not considered statistically significant (strong enough).
The conclusion is that two to three acupuncture sessions during an IVF cycle have very little to no effects on improving IVF outcomes. Whats interesting about this is that all acupuncturists would agree with this. The true value of acupuncture, herbal medicine, or natural medicine, is in changing the uterine environment BEFORE an IVF cycle begins. Once an IVF cycle has begun, it is almost too late to have any effect on IVF outcomes.
An analogy of this study would be if a trial was conducted where patients with headaches took 1/2 a paracetamol (ie. Panadol) tablet while the other half of the patients took 1/2 a placebo tablet, the results would show that there was no major improvement in headaches amongst the groups. This is simply because the dosage of the paracetamol was too low to have a clinical effect, and not because paracetamol does not work for mild to moderate headache pain. Those who have taken paracetamol for pain are aware that their doctors often recommend that two tablets are to be taken every 4-6 hours, and not 1/2 a tablet once daily. This simply does not work as the dosage is too low, much like the dosage of the acupuncture in this study was too low.
More research should be conducted to reflect actual clinical practice. Future research should look at acupuncture/herbal medicine in the months/weeks BEFORE an IVF cycle begins, and then through the IVF cycle (Hullender Rubin, Anderson & Craig, 2018).
Systematic reviews such as those performed by Shen et al 2015 and Qian et al 2017 that have shown improvements in IVF outcome, have pointed out that acupuncture performed leading into transfer is the most important, not once transfer is actually taking place.
More well designed research into acupuncture that reflects best clinical practice is required to access the role that acupuncture and Chinese medicine may play in improving IVF outcomes.
References
Hullender Rubin, L.E., Anderson, B.J. & Craig, L.B. (2018). Acupuncture and in vitro fertilisation research: current and future directions. Acupuncture in Medicine, BMJ Journals. Published Online First: 10 February 2018. doi: 10.1136/acupmed-2016-011352
Qian, Y., Xia, X.R., Ochin, H., Huang, C., Gao, C., Gao, L., et al (2017). Effect of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis. Arch Gynecol Obstet, 295(3), 543-558.
Shen, C., Wu, M., Shu, D., Zhao, X. & Gao, Y. (2015). The role of acupuncture in in vitro fertilization: a systematic review and meta-analysis. Gynecol Obstet Invest, 79 (1), 1-12.
Smith, C.A., De Lacey, S., Chapman, M., et al (2018). Effect of Acupuncture vs Sham Acupuncture on Live Births Among Women Undergoing In Vitro FertilizationA Randomized Clinical Trial. JAMA. 2018;319(19):1990–1998. doi:10.1001/jama.2018.5336
