The effect of acupuncture on the day of embryo transfer on the in vitro fertilization outcomes: An RCT

Abstract

Background: Acupuncture is an adjunct therapy to support infertile women received in vitro fertilization (IVF) treatment; however, the efficacy of this approach needs more evaluation.


Objective: This randomized clinical trial (RCT) study aimed to evaluate the influence of acupuncture on reproductive outcomes in women undergoing IVF treatment.


Materials and Methods: The study was carried out on 186 participants who had undergone IVF treatment in the Mother and Child Hospital between September 2015 and February 2016. Subjects were randomly divided into three groups: Acupuncture 25 min before embryo transfer (ET) (ACU1 group, n = 62), acupuncture 25 min before and after ET (ACU2 group, n = 62), and ET without acupuncture (control group, n = 62). Pregnancy rates (biochemical, clinical, and ongoing) were evaluated and compared between groups.


Results: There were significant differences between the ACU1 group and the control group regarding biochemical (p = 0.005), clinical (p = 0.006), and ongoing (p = 0.007) pregnancies. Also, our results showed that two-session acupuncture (ACU2) lead to a significant reduction in frequency of biochemical (p = 0.002), clinical (p = 0.003), and ongoing (p = 0.01) pregnancy rates when compared to the one-session acupuncture (ACU1). No significant difference was found between the ACU2 and control groups regarding the aforementioned terms (p = 0.50).


Conclusion: Acupuncture 25 min before ET significantly increased the IVF outcomes in women undergoing IVF compared with no acupuncture. Repeating acupuncture 25 min after ET did not improve the IVF outcome.


Key words: Acupuncture, Embryo transfer, In vitro fertilization, Pregnancy rate.

References
[1] So EW, Ng EH, Wong YY, Lau EY, Yeung WS, Ho PC. A randomized double blind comparison of real and placebo acupuncture in IVF treatment. Hum Reprod 2009; 24: 341–348.

[2] Gaskins AJ, Afeiche MC, Wright DL, Toth TL, Williams PL, Gillman MW, et al. Dietary folate and reproductive success among women undergoing assisted reproduction. Obstet Gynecol 2014; 124: 801–809.

[3] Zhang X, Lee MS, Smith CA, Robinson N, Zhou Y, Wu Y, et al. Effects of acupuncture during in vitro fertilization or intracytoplasmic sperm injection: An updated systematic review and meta-analysis. Eur J Integr Med 2018; 23: 14– 25.

[4] Sierpina VS, Frenkel MA. Acupuncture: a clinical review. South Med J 2005; 98: 330–337.

[5] Huang DM, Huang GY, Lu FE, Stefan D, Andreas N, Robert G. Acupuncture for infertility: is it an effective therapy? Chin J Integr Med 2011; 17: 386–395.

[6] Ng EH, So WS, Gao J, Wong YY, Ho PC. The role of acupuncture in the management of subfertility. Fertil Steril 2008; 90: 1–13.

[7] Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002; 77: 721–724.

[8] El-Toukhy T, Sunkara SK, Khairy M, Dyer R, Khalaf Y, Coomarasamy A. A systematic review and meta-analysis of acupuncture in in vitro fertilisation. BJOG 2008; 115: 1203–1213.

[9] Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted conception. Cochrane Database of Syst Rev 2008; 4: CD006920.

[10] Stener-Victorin E, Waldenström U, Nilsson L, Wikland M, Janson PO. A prospective randomized study of electroacupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 1999; 14: 2480–24804.

[11] Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril 2006; 85: 1341–1346.

[12] Annan JJ, Gudi A, Bhide P, Shah A, Homburg R. Biochemical pregnancy during assisted conception: a little bit pregnant. J Clin Med Res 2013; 5: 269–274.

[13] Ubaldi F, Anniballo R, Romano S, Baroni E, Albricci L, Colamaria S, et al. Cumulative ongoing pregnancy rate achieved with oocyte vitrification and cleavage stage transfer without embryo selection in a standard infertility program. Hum Reprod 2010; 25: 1199–1205.

[14] Benson MR, Elkind-Hirsch KE, Theall A, Fong K, Hogan RB, Scott RT. Impact of acupuncture before and after embryo transfer on the outcome of in vitro fertilization cycles: A prospective single blind randomized study. Fertil Steril 2006; 86 (Suppl.): S135.

[15] Morin SJ, Frattarelli JL, Franasiak JM, Juneau CR, Scott Jr. laser acupuncture before and after embryo transfer improves in vitro fertilization outcomes: A four-armed randomized controlled trial. Med Acupunct 2017; 29: 56–65.

[16] Stener-Victorin E, Waldenstrom U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod 1996; 11: 1314–1317.

[17] Kim J, Shin KH, Na CS. Effect of acupuncture treatment on uterine motility and cyclooxygenase-2 expression in pregnant rats. Gynecol Obstet Invest 2000; 50: 225–230.

[18] Sniezek DP, Siddiqui IJ. Acupuncture for Treating Anxiety and Depression in Women: A Clinical Systematic Review. Med Acupunct 2013; 25: 164–172.

[19] Smith CA, de Lacey S, Chapman M, Ratcliffe J, Norman RJ, Johnson NP, et al. The effects of acupuncture on the secondary outcomes of anxiety, and quality of life for women undergoing IVF: a randomised controlled trial. Acta Obstet Gynecol Scand 2019; 98: 460–469.

[20] Carneiro ER, Xavier RA, De Castro MA, Do Nascimento CM, Silveira VL. Electroacupuncture promotes a decrease in inflammatory response associated with Th1/Th2 cytokines, nitric oxide and leukotriene B4 modulation in experimental asthma. Cytokine 2010; 50: 335–340.

[21] Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ 2008; 336: 545–549.

[22] Smith C, Coyle M, Norman RJ. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril 2006; 85: 1352–1358. [23] Chen H, Yang M, Lao L. Acupuncture for women undergoing in vitro fertilization. JAMA 2018; 320: 1385.

[24] Lehl K, Pitzer L, Schoolcraft WB, Stevens JM. Elective acupuncture treatment pre and post embryo transfer: Comparison of clinical pregnancy and implantation rates within age groups and in recipients of donor oocyte. Fertil Steril 2006; 86 (Suppl.): S340–S341.

[25] Andersen D, Løssl K, Nyboe Andersen A, Fürbringer J, Bach H, Simonsen J, et al. Acupuncture on the day of embryo transfer: a randomized controlled trial of 635 patients. Reprod Biomed Online 2010; 21: 366–372.