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Meta-Analysis
. 2019 Jun 14;19(1):131.
doi: 10.1186/s12906-019-2523-7.

The effects of acupuncture on pregnancy outcomes of in vitro fertilization: a systematic review and meta-analysis

Zheng-Yun Xie  1 , Zhi-Hang Peng  2 , Bing Yao  3 , Li Chen  3 , Yan-Yun Mu  4 , Jie Cheng  4 , Qian Li  4 , Xi Luo  5 , Peng-Yan Yang  6 , You-Bing Xia  7
Affiliations
Meta-Analysis

The effects of acupuncture on pregnancy outcomes of in vitro fertilization: a systematic review and meta-analysis

Zheng-Yun Xie et al. BMC Complement Altern Med. .

Abstract

Background: The effects of acupuncture on in vitro fertilization (IVF) outcomes remain controversial. And the variation in participant, interventions, outcomes studied, and trial design may relate to the efficacy of adjuvant acupuncture.

Methods: We searched digital databases for relevant studies, including Embase, PubMed, Cochrane Library and some Chinese databases up to December 2018, for randomized controlled trials (RCTs) evaluating the effects of acupuncture on women undergoing IVF. We included studies with intervention groups using needling, and control groups consisting of no acupuncture or sham (placebo) acupuncture. Primary outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Meta-regression and subgroup analysis were conducted on the basis of eight pre-specified covariates to investigate the variances of the effects of adjuvant acupuncture on pregnancy rates and the sources of heterogeneity.

Results: Twenty-seven studies with 6116 participants were included. The pooled clinical pregnancy rate (CPR) from all of acupuncture groups was significantly greater than that of control groups (RR 1.21, 95% CI: 1.07-1.38), whereas the pooled live birth rate (LBR) was not. Meta-regression subgroup analysis showed a more significant benefit of acupuncture for repeated IVF cycle proportion (number of women with a history of prior unsuccessful IVF attempt divided by number of women included in each trial) ≥ 50% group (CPR: RR 1.60, 95% CI: 1.28-2.00; LBR: RR 1.42, 95% CI: 1.05-1.92), and this covariate explained most of the heterogeneity (CPR and LBR: adjusted R2 = 100 and 87.90%). Similar results were found between CPR and number of acupuncture treatments (CPR: p = 0.002, adjusted R2 = 51.90%), but not LBR.

Conclusions: Our analysis finds a benefit of acupuncture for IVF outcomes in women with a history of unsuccessful IVF attempt, and number of acupuncture treatments is a potential influential factor. Given the poor reporting and methodological flaws of existing studies, studies with larger scales and better methodologies are needed to verify these findings.

Keywords: Acupuncture; Clinical pregnancy rate; In vitro fertilization; Live birth rate; Systematic review.

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Conflict of interest statement

All authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Risk of bias graph (a) and risk of bias summary (b) based on review authors’ judgments about each risk of bias item
Fig. 2
Fig. 2
Effect of acupuncture on the clinical pregnancy rates in women undergoing IVF. Villahermosa 2013 had one acupuncture group and two control groups (sham acupuncture group and no intervention control group), two control groups were grouped separately for relevant subgroup analysis, and when calculated the total pooled risk ratio (RR), we took them together
Fig. 3
Fig. 3
Effect of acupuncture on the live birth rates in women undergoing IVF
Fig. 4
Fig. 4
Meta-regression between the effects of acupuncture on clinical pregnancy rates (a)/ live birth rates (b) and repeated IVF cycle proportion as a single continuous covariate
Fig. 5
Fig. 5
The funnel plot for the 27 eligible studies (Begg’s and Egger’s test, p = 0.006). The studies are separated into two groups by No. of acupuncture treatments either one or more than one
Fig. 6
Fig. 6
The result of cumulative meta-analysis based on sample size
See this image and copyright information in PMC

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