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PETBioNewsCommentUse of acupuncture before and after embryo transfer

BioNews

Use of acupuncture before and after embryo transfer

Published 30 July 2010 posted in Comment and appears in BioNews 569

Author

Nick Dalton-Brewer

Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
CC0 1.0
Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.

Sarah Guy's bold statement 'acupuncture does not increase the chance of IVF success' is based on the conclusions of a study which is arguably flawed in many ways...

Sarah Guy's bold statement 'acupuncture does not increase the chance of IVF success' is based on the conclusions of a study which is arguably flawed in many ways.

Good trial design is particularly important for acupuncture due to the nature of the therapy. The gold standard for drugs trials is double blinding. However, acupuncture is a procedure, not a pill. The Institute of Medicine considers the problems of designing acupuncture trials to be very similar to those of designing surgery trials. Sham acupuncture is a particularly thorny issue. A sham control should be physiologically inert.

There are different types of 'sham' or 'placebo' acupuncture. Some styles involve pressing on acupuncture points, essentially acupressure. Others involve superficial needle insertion, either on the same acupuncture points used in the trial, or on points considered to be non-acupuncture points. Another 'sham' technique is to provide acupuncture stimulation to points considered irrelevant to the aims of the intervention. However, since acupuncture modulates physiological activity, how would the authors know that those points would not affect the patient?

The fact is that stimulation of the skin and modulation of acupuncture points, even superficially, also modulates physiological activity. Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture. Thus, sham acupuncture may not be inert, as So and colleagues (1) believe.

Three out of the four meta analyses published in 2008 found patients benefit from acupuncture when acupuncture is performed around embryo transfer (2). At the London Bridge Fertility, Gynaecology and Genetics Centre we demonstrated that acupuncture does improve pregnancy rates, as previously demonstrated by the review by Manheimer and colleagues (2008) (3).

Acupuncture is among the most popular complementary therapies and its use is both supported and encouraged by WHO as a simple, inexpensive and effective therapeutic option for certain conditions. There are several different forms of acupuncture in use worldwide. The use of acupuncture is claimed to be effective in treating or ameliorating the symptoms in a wide range of medical conditions. Traditional Chinese Acupuncture (TCA) has long been used to modulate the autonomic nervous system to increase relaxation and, more recently, to influence uterine receptivity in IVF patients. Several studies describe the use of various forms of acupuncture as an adjunct therapy in IVF treatment with some promising results. As a result of patient requests, Bridge has made acupuncture available to patients undergoing embryo transfer since 2006.

We conducted a retrospective review of the effect of acupuncture intervention, both before and after embryo transfer, on IVF treatment outcome in terms of chemical and clinical pregnancy rates per embryo transfer for treatments performed between Nov 2006 and Aug 2008.

Patients received TCA over a 40-minute period before and after embryo transfer to several acupoints. Pre-embryo Transfer Acupuncture (ETA) was delivered not more than one hour before embryo transfer, and post-ETA delivered not more than 20 minutes after embryo transfer. In both pre- and post-ETA treatments, ear acupuncture was applied to points to calm the mind and nervous system. During the pre-ETA treatment, body TCA was applied to acupoints to stimulate the channels of the spleen, stomach, liver, pericardium and governing vessel. Post-ETA treatment, body acupuncture was applied to the spleen, stomach and large intestine channels. All body acupoints were stimulated five times at five-minute intervals.

65 patients underwent 70 cycles of IVF involving acupuncture before and after embryo transfer. Outcomes were compared with 70 cycles of IVF involving randomly selected age-matched controls. Overall, after ETA, positive pregnancy rates (PPR) and clinical pregnancy rates (CPR) per embryo transfer compared well with a randomly-selected age-matched control group.

Acupuncture is a safe, adjunct therapy in IVF and results suggest that it may increase positive pregnancy rates when used before and after embryo transfer in agreement with a number of recent studies.  Pregnancy rates for women aged between 35 and 39 yrs and those over 40 years were more than 10 per cent better than control groups of the same ages, indicating the treatment may have more benefits for older women undergoing IVF.  No side effects or complications were experienced by women who received acupuncture, suggesting its application in IVF is safe and may be beneficial, particularly in older patients.

These preliminary data are encouraging, although a placebo effect cannot yet be ruled out. However, further trials involving older women to include additional objective measurements of the effect of acupuncture (such as ultrasound assessment of increased blood flow and changes in hormone levels) may help to distinguish a real effect from placebo and identify those patient groups most likely to benefit from acupuncture treatment.

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Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
CC0 1.0
Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
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19 July 2010 • 1 minute read

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Women given acupuncture during IVF treatment are no more likely to become pregnant than their counterparts who undergo needle stimulation to body areas not used in acupuncture, a US study has shown...

Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
CC0 1.0
Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
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1 April 2010 • 1 minute read

Acupuncture tried by 22 per cent of infertile Californians

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Alternative therapies - especially acupuncture - are employed by a substantial proportion of Americans trying to get pregnant, say researchers. Nearly a third of couples followed in a Californian study tried acupuncture, herbal therapy and massage....

Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
CC0 1.0
Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
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15 March 2010 • 2 minutes read

Acupuncture does not increase IVF success rate: new guidelines

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Acupuncture and Chinese herbal medicine do not provide any benefit to women trying to become pregnant, the British Fertility Society (BFS) has found after reviewing the available evidence. The new guidelines, published in the journal Human Fertility, state that there is 'currently no evidence' that these methods increase the success rate of assisted conception, when used in conjunction with IVF (in vitro fertilisation)....

Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
CC0 1.0
Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
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9 June 2009 • 2 minutes read

Acupuncture does not increase chance of IVF conception: further evidence

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By Katy Sinclair Two new studies have found that acupuncture does not increase the chances of conception through IVF. The first study was conducted by Prentice Women's Hospital in Chicago, and was presented at the American Society for Reproductive Medicine conference in San Francisco, and the second was published in...

Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
CC0 1.0
Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
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9 June 2009 • 2 minutes read

Acupuncture aids IVF success

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Researchers at the University of Southampton and Princess Anne Hospital in Southampton, UK, have found that women undergoing acupuncture at the same time as IVF increased their chances of having a baby from one in five to one in three. The research, published on the Cochrane Library's...

Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
CC0 1.0
Image by Alan Handyside via the Wellcome Collection. Depicts a human egg soon after fertilisation, with the two parental pronuclei clearly visible.
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9 June 2009 • 2 minutes read

Study casts doubt over the use of acupuncture to improve IVF success rates

by Dr Antony Starza-Allen

Scientists have failed to establish a link between the use of acupuncture on fertility patients and IVF success rates. In what is said to be one of the most thorough studies into the issue, close to 2,500 women were studied across 13 clinical trials looking into the...

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