Some couples might choose to try complementary and alternative medicines before they commence infertility treatment or might choose to use it as an adjunct while undergoing infertility treatment. Acupuncture has long been used for gynecological and obstetric problems, such as amenorrhea, menorrhagia, morning sickness, and problems during labour and delivery (1), and is one complementary and alternative medicine considered by some women to assist with infertility treatment. Classic acupuncture refers to the insertion of fine needles into specific points of the body. This treatment has a history dating back 2,500 years and treats illness by restoring a balance in the flow of Qi (energy) in the human body. Acupuncture today involves modes of stimulation, such as acupressure, transcutaneous electrical nerve stimulation, moxibustion, ear acupuncture, and the use of lasers.
There have been few randomized controlled trials of acupuncture in the area of reproductive medicine. Two studies of acupuncture for male infertility (2, 3) concluded that acupuncture might be a useful treatment for men with poor sperm density; however, these studies were small and uncontrolled. Successful IVF and ET require optimal endometrial receptivity at the time of implantation. Blood flow impedance in the uterine arteries as measured by transvaginal ultrasonography expressed as a resistance index, the pulsatility index, is considered to be a useful method for assessing uterine receptivity. In one small, uncontrolled study of electro-acupuncture, lower pulsatility index values were found after acupuncture treatment (4).
There have been two randomized controlled trials of acupuncture administered to women undergoing IVF (5, 6). In the trial undertaken by Paulus et al. (5), 160 healthy women undergoing IVF or intracytoplasmic sperm injection (ICSI) in Germany were randomized to receive acupuncture or no acupuncture. Acupuncture was administered 25 minutes before and after ET. Needles were inserted, and the Deqi needling sensation was obtained. Needles were retained for 25 minutes before and after the transfer, and acupuncture points were used to move Chi and Blood and calm Chi. Treatment used a fixed combination of body and auricular acupuncture points. A higher pregnancy rate was found in the acupuncture group compared with the control group (42.5% vs. 26.3%, P<.03). However, bias might have arisen from inadequate blinding, and insufficient details were reported on the sample and effect size.
Quintero (6) evaluated the effectiveness of acupuncture as an adjunct to IVF. Seventeen women were randomized to receive acupuncture or sham acupuncture in a double-blind, crossover trial; however, only seven women completed the study. Two women in each group achieved an ongoing pregnancy. Of the seven who crossed over to the other treatment arm, two women in the acupuncture group achieved an ongoing pregnancy, compared with one in the sham acupuncture group. Although the investigators found that acupuncture significantly reduced the amount of gonadotropin used (P<.05), no effect on the pregnancy rate was found.
In two retrospective clinical studies (7, 8), Magarelli et al. explored the effects of acupuncture on IVF outcomes, using the protocols reported by Sterner-Victorin et al. (4) and Paulus et al. (5). Magarelli et al. (7) reported higher pregnancy rates (51% vs. 36%, P<.05) and lower miscarriage rates (8% vs. 20%, P<.05) among those subjects receiving acupuncture compared with subjects in the comparison group. The second study explored the influence of acupuncture stimulation among subjects described as “poor responders to IVF.” Fifty-seven subjects received acupuncture, and 94 received no acupuncture. A significant increase in the pregnancy rate was found for subjects receiving acupuncture (53% vs. 38%, P<.01) (8). Methodological limitations, such as selection bias, might have influenced the study findings.
The research to date suggests that acupuncture might have a role in increasing pregnancy rates among women undergoing IVF. There is clearly a need for a larger, pragmatic, well-designed, randomized controlled trial to determine the effectiveness of acupuncture on pregnancy rates among women undergoing IVF. In this article we report the findings from a randomized controlled trial evaluating the effect of acupuncture on pregnancy rates for women undergoing ET.