Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysisBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39471.430451.BE (Published 06 March 2008) Cite this as: BMJ 2008;336:545
- Eric Manheimer, research associate1,
- Grant Zhang, assistant professor1,
- Laurence Udoff, assistant professor2,
- Aviad Haramati, professor3,
- Patricia Langenberg, professor and vice-chair4,
- Brian M Berman, professor1,
- Lex M Bouter, professor and vice chancellor (rector magnificus)5
- 1Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207, USA
- 2Department of Obstetrics, Gynecology and Reproductive Services, University of Maryland School of Medicine
- 3Department of Physiology and Biophysics and Medicine, Georgetown University School of Medicine, Washington, DC
- 4Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine
- 5VU University Amsterdam De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
- Correspondence to: E Manheimer
- Accepted 17 December 2007
Objective To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation.
Design Systematic review and meta-analysis.
Data sources Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.
Review methods Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.
Data synthesis Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth. The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).
Conclusions Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.
We thank Laura Benzel and Don Frese, University of Maryland, Baltimore, and Jianping Liu, Beijing University of Chinese Medicine, for assistance with searching for studies. We also thank Jeanette Ezzo, Elizabeth Pradhan, Daniëlle AWM van der Windt, Susan Wieland, and Qi Zhu for useful suggestions during the preparation of the paper, and Kevin Chen for statistical support. Most importantly, we thank Stefan Dieterle, Alice Domar, Wolfgang Paulus, Caroline Smith, Alan Theall (for the Benson et al trial), and Lars Westergaard, who are all coauthors of included randomised controlled trials, for confirming and providing data related to their respective trials.
Contributors: EM and GZ determined inclusion eligibility of trials, extracted data from the trials, and assessed the methodological quality of the trials. AH provided a third assessment of the methodological quality of all the trials. EM entered and organised the data, conducted the analyses, and drafted the manuscript. EM, GZ, LU, AH, PL, BMB, and LMB all contributed to the conception and design. EM, GZ, LU, AH, PL, and LB contributed to the analysis and interpretation of data. EM, GZ, LU, AH, PL, BMB, and LMB critically revised the article for important intellectual content and approved the final version. EM is guarantor.
Funding: EM and BMB were funded by grant No R24 AT001293 from the National Center for Complementary and Alternative Medicine (NCCAM) of the US National Institutes of Health.
Competing interests: None declared.
Ethical approval: Not required.
Provenance and peer review: Not commissioned; externally peer reviewed.