A new study published in the British Medical Journal suggests that acupuncture performed in IVF cycles around the time that the embryos are placed in the uterus may result in a higher live birth rate.

Acupuncture: possible effects on fertility

Acupuncture has been used in China for centuries to regulate the female reproductive system. Three potential mechanisms for its effects on fertility have been postulated.

• Acupuncture may mediate the release of neurotransmitters which may in turn stimulate secretion of hormones from the pituitary which stimulate the ovaries. ,
• Acupuncture may stimulate blood flow to the uterus
• Acupuncture may stimulate the production of opioids -the natural opiates of the brain, which may decrease biological stress.

"New" Acupuncture study combines the results of several smaller studies

The authors of this study looked through several databases to identify studies in which acupuncture was used as an adjunct to IVF. In order to be selected, the study must have had the acupuncture performed on the day of embryo transfer. They included only studies in which acupuncture involved the insertion of needles into traditional meridian points. They excluded studies using laser acupuncture and electro-acupuncture without needle insertion because most authorities believe acupuncture involves needle insertion.

A variety of statistical tests were done to try to validate the results. In particular, they looked at whether acupuncture had a benefit in IVF in three specific conditions.

• Use of extra acupuncture sessions in addition to the sessions before and after the embryo transfer
• In studies where only women with good quality embryos were enrolled
• A comparison of studies in which the pregnancy rates without acupuncture were below or above 28%, (the European average).

Results of the Acupuncture in IVF Study

Ultimately, the study looked at seven randomized controlled trials with a total of 1366 participants. Based on the results, the authors determined that acupuncture improved IVF pregnancy rates.

Acupuncture effect on

• Clinical pregnancy rates (a fetus seen on ultrasound) -- 65% improvement with acupuncture
• Ongoing pregnancy rates (ultrasound showed viable fetus after the 12th week of pregnancy) -- 87% improvement with acupuncture
• Live birth - 91% better with acupuncture

Stated another way, acupuncture would have to be performed on as few as 6 to as many as 17 embryo transfers to get one additional live birth. The average number of transfers needed would be 9.

However, when only the studies that had a pregnancy rate without acupuncture that was greater than 28% were analyzed, there was no benefit seen to acupuncture.

There were no significant adverse effects of acupuncture reported in the two trials that reported on this outcome.

Summary: Should I have acupuncture with IVF or not?

Prior to 2007, all studies looking at the impact of acupuncture on IVF success rates showed either an improvement in pregnancy rates or no difference in pregnancy rates. At the annual meeting of the American Society for Reproductive Medicine in 2007, a study was presented that showed lower chances for pregnancy when acupuncture was used with IVF. This study was not included in this analysis. It is very likely that if this study had been included, that acupuncture would

not

have been demonstrated to have any beneficial effect.

Without the most recent data, the information from this study must be interpreted with caution!

At the very best, we can say the following about acupuncture and IVF:

• There may only be a benefit if your IVF success rate without acupuncture is less than 28% per transfer
• Only acupuncture performed on the day of embryo transfer can be said to have an effect. When additional days of acupuncture were analyzed, there was no further benefit seen
• Only acupuncture performed at established meridian points was studied.
• Roughly 9 embryo transfer need to be performed to see one additional pregnancy