Does acupuncture improve IVF success rates?

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Quoted From:

"When trying to conceive, patients want to improve their chances of success. Many turn to acupuncture to support them during their IVF cycle. A reasonable question is: does acupuncture improve IVF success rates? Before I answer this full disclaimer, I am an acupuncturist and clinical researcher by training. I have published several studies on acupuncture as a treatment to support IVF patients. I've also written a couple of papers critiquing the research. It is my conclusion that the answer to whether acupuncture improves IVF outcomes boils down to two things:

1. the dose or number of acupuncture sessions attended during an IVF cycle, and

2. what acupuncture was compared with in a randomized, controlled trial (RCT).

When patients attend at least 6 acupuncture sessions (including two at embryo transfer), they may benefit from acupuncture to improve their chances of pregnancy and live births from:

Fresh IVF with one"s own eggs[1]

Fresh IVF with donor eggs [1]

Frozen ETs with embryos that were not genetically tested [2]

Frozen ETs with genetically screened normal embryos[3]

These were cycles where acupuncture was associated with better outcomes when compared with only two sessions on the day of embryo transfer [1-3] or no additional treatment at all. [1]. The limitations to this data are that these studies were not randomized, so the results observed are only associations of benefit. A follow up RCT is needed.

However, and here is where things get confusing, the data from RCTs usually looks at two sessions of acupuncture provided around the embryo transfer (immediately before and after). In that smaller "dose," acupuncture added to IVF (fresh and frozen) improves the chances of live birth by about 30% when compared with no treatment. [4, 5] Still, there is no clinically meaningful improvement with acupuncture when compared with "sham" acupuncture. [4, 5] If taken on its face and applying the research method, one would naturally conclude acupuncture doesn't help because it is not superior to placebo. But, herein lies the paradox!

First, IVF success rates continue to improve year by year. The first studies of acupuncture added to IVF were when the baseline pregnancy rate was in the low 30% range. According to the latest CDC SART data, the national average is in the low 50% range, with some clinics' live birth rates in the mid-70% range. As an acupuncturist, I am not sure I would expect two stand-alone acupuncture sessions as a reasonable intervention to improve IVF success rates. One injection of gonadotropins is not enough to adequately stimulate one's ovaries; a series of injections over a short period is more effective. This is also true with acupuncture. It is not a one-and-done treatment. While one session was enough to improve markers of glucose metabolism in one study of women with PCOS,[6] a series of eight sessions over four weeks was needed to improve blood flow to the uterus.[7] Of note, acupuncture on the day of embryo transfer does appear to help reduce IVF-related anxiety.[8]

Second, sham acupuncture is intended to be a placebo aka inert, nothing, nada, zilch, zip! Unfortunately, there is reasonable evidence demonstrating sham acupuncture is, in fact, not inert. One study found sham acupuncture's effectiveness was about 20% more than a typical placebo, aka sugar pill, used in research.[9]Another study found sham needling caused the body to release endorphins into the bloodstream to the same degree as real acupuncture. [10] These findings suggests that sham acupuncture is likely not inert and instead benefits study participants who receive it. In many of the trials using sham needles, study authors often refer to the possibility that the sham needles may not be inert.[11, 12]"

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