OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture.

DESIGN: Prospective randomized study.

SETTING: Fertility Center.

PATIENT(S): After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80).

INTERVENTION(S): Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy.

MAIN OUTCOME MEASURE(S): Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer.

RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.

CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after ART.

OBJECTIVE: To evaluate the effects of acupuncture on clinical pregnancy rates for women undergoing ET.

DESIGN: Single-blind, randomized controlled trial using a noninvasive sham acupuncture control.

SETTING: Repromed, The Reproductive Medicine Unit of The University of Adelaide.

PATIENT(S): Women undergoing IVF.

INTERVENTION(S): Women were randomly allocated to acupuncture or noninvasive sham acupuncture with the placebo needle. All women received three sessions, the first undertaken on day 9 of stimulating injections, the second before ET, and the third immediately after ET.

MAIN OUTCOME MEASURE(S): The primary outcome was pregnancy. Secondary outcomes were implantation, ongoing pregnancy rate at 18 weeks, adverse events, and health status.

RESULT(S): Two hundred twenty-eight subjects were randomized. The pregnancy rate was 31% in the acupuncture group and 23% in the control group. For those subjects receiving acupuncture, the odds of achieving a pregnancy were 1.5 higher than for the control group, but the difference did not reach statistical significance. The ongoing pregnancy rate at 18 weeks was higher in the treatment group (28% vs. 18%), but the difference was not statistically significant.

CONCLUSION(S): There was no significant difference in the pregnancy rate between groups; however, a smaller treatment effect can not be excluded. Our results suggest that acupuncture was safe for women undergoing ET.

OBJECTIVE: To evaluate the effect of acupuncture on reproductive outcome in patients treated with IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on the day of ET, another group on ET day and again 2 days later (i.e., closer to implantation day), and both groups were compared with a control group that did not receive acupuncture.

DESIGN: Prospective, randomized trial.

SETTING: Private fertility center.

PATIENT(S): During the study period all patients receiving IVF or ICSI treatment were offered participation in the study. On the day of oocyte retrieval, patients were randomly allocated (with sealed envelopes) to receive acupuncture on the day of ET (ACU 1 group, n = 95), on that day and again 2 days later (ACU 2 group, n = 91), or no acupuncture (control group, n = 87).

INTERVENTION(S): Acupuncture was performed immediately before and after ET (ACU 1 and 2 groups), with each session lasting 25 minutes; and one 25-minute session was performed 2 days later in the ACU 2 group.

MAIN OUTCOME MEASURE(S): Clinical pregnancy and ongoing pregnancy rates in the three groups.

RESULT(S): Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the ACU 2 group (36% and 26%) were higher than in controls, but the difference did not reach statistical difference.

CONCLUSION(S): Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2 provided no additional beneficial effect.

OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF / intracytoplasmic sperm injection (ICSI).

DESIGN: Randomized, prospective, controlled clinical study.

SETTING: University IVF center.

PATIENT(S): Two hundred twenty-five infertile patients undergoing IVF/ICSI.

INTERVENTION(S): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture.

MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancy rates.

RESULT(S): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%).

CONCLUSION(S): Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

OBJECTIVE: The study was conducted to examine several adjunct treatment regimens administered before and after embryo transfer and determine if one treatment was more efficacious than any of the alternative regimens on in vitro fertilization (IVF) outcome. We compared two different acupuncture stimulation modes, needle and laser acupuncture, with sham laser acupuncture, relaxation, or no intervention treatment on implantation and pregnancy rates in women undergoing IVF.

DESIGN: Prospective single blind randomized trial. MATERIALS AND METHODS: Patients (n258) who had been scheduled for embryo transfer (ET), signed informed consent and were randomly assigned to one of 5 study treatment regimens; needle acupuncture (AC; 53), laser acupuncture (LZ AC; n53), sham laser acupuncture (placebo)(LZ sham; n52), relaxation (RX; n50), or no intervention treatment (NT; n50). All treatments were administered 25 minutes before ET and immediately after ET. The patient and acupuncturist were unaware of whether the laser system was active which allowed for a double-blind control group for the laser acupuncture treatment. Comparisons of various parameters between groups were conducted by 2 tests and one-way ANO- As.. Multinomial logistic regression analysis was used to control for the potentially confounding effects of day of embryo transfer (day 3 vs.5) and number of embryos transferred which are known to relate to IVF outcome, to further analyze the impact of adjunct treatment regimens on implantation and pregnancy rates. Probability of P 0.05 was considered to be statistically significant.

RESULTS: No differences in terms of cycle type, day of embryo transfer, or physician performing transfer were found between treatment groups. Neither day of transfer (p0.079) or egg number (P 0.082) were significant independent redictors of implantation or conception when interactions between parameters were considered in all 5 groups. All acupuncture treatments were well tolerated.

CONCLUSION: Conception and implantation rates were highest with traditional needle acupuncture. IVF treatment outcomes did not differ between patients treated with laser or sham laser acupuncture. This study did not have the statistical power to detect treatment differences in pregnancy rates between needle acupuncture and no treatment (i.e., at least 200 subjects are needed to detect differences in CP rates of 54.7 and 44% with 80% power) which may be due to sample size, transfer of embryos of varying quality and variations in stimulation protocols. However, while not statistically significant, needle acupuncture produced a clinically significant effect (greater than 10% increase in clinical pregnancy rate) compared with relaxation or no treatment which warrants further investigation.

OBJECTIVE: The aim of this study was to evaluate the effects of acupuncture on embryo transfer by comparing the rates of clinical pregnancy.

DESIGN: Retrospective, interventional and longitudinal study.

MATERIALS AND METHODS: Study with a total of 111 cycles of patients who underwent assisted reproduction techniques: in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) from June/2005 to January/ 2007: 52 cycles with acupuncture and 59 cycles without acupuncture. Acupuncture was performed, in specific points of the body including the ear, immediately before and after the embryo transfer procedure and the needles were retained for 30 minutes per session. The embryo transfer was carried out under ultrasound guidance and luteal phase support was given by trans-vaginal progesterone administration (Utrogestan) and intramuscular progesterone. Outcome measure was clinical pregnancy rate.

RESULTS: The clinical pregnancy rate per cycle was observed in 27 of 52 (51.9%) patients in the acupuncture group and 21 of 59 (35.6%) patients in the control group (P 1⁄40,083). The mean age was 36.1 6.1 years in the control group and 36.4 years in the acupuncture group (P1⁄40.785). The mean number of embryo transferred was 3.3 in the control group and 3.6 in the acupuncture group (P1⁄40.462). The technique of embryo transfer was 5 cycles of IVF and 54 cycles of ICSI in the control group and 5 cycles IVF and 47 cycles of ICSI in the acupuncture group (P 1⁄41.000). Both groups did not show statistics difference in the mean age, number of embryo transferred and the technique procedure.

CONCLUSIONS: Although there was a higher pregnancy rate in the acupuncture group, this difference was not statistically significant, probably because of the small number of patients in both group. Acupuncture seems to be an important coadjuvant in the treatment of infertility with IVF or ICSI, and further research is needed to demonstrate its precisely effect.

Objective: The purpose of the study was to determine the influence of two acupuncture protocols on IVF outcomes and secondly to identify the appropriate patient groups that would most benefit from this adjunctive therapy.

Materials and Methods: In this retrospective study, data was extracted from medical records of patients RE&I clinic & acupuncture clinics between January 2001 and November 2003. All patients completing an IVF cycle with transfer were included. One RE&I provided the IVF care and a consortium of acupuncturists overseen by the author provided the strict acupuncture protocols. PR per transfer were the endpoints measured. Data was analyzed by student’s t test and Multiregression with Wilcox ranking (MRW).

Results: 147 patients were included in the study and of those 53 had Acupuncture (Ac) and 94 did not (Non-Ac group). Demographic data between these Ac and Non-Ac groups respectively indicated remarkable equity (Table 1). Fertility Factors also demonstrated equity and there were no differences in Diagnoses, IVF Protocols and type of Gonadatrophin protocols used.

Factors that demonstrated significance were: Length of time infertile, Peak FSH, PI for total group without MRW; PI for MRW groups reversed this (Table 2) and finally average: Sperm Morphology, Peak E2, Peak P4 prior to HcG: and endometrial thickness. PR before Wilcox ranking were the same: 40% v 38%. MRW analysis revealed FSH, Length of time trying to get pregnant, Sperm Morphology and E2 levels as significant: 6.5, 4.1, 4.0 and 1.6 respectively. When the Ac group was modified (15 Ac patient dropped), PI was elevated from 1.76 to 1.94 resulting in a significant elevation compared to the Non-Ac group, p 0.01. Also PR changed from 40% before to 53% after and this value was significantly greater than the Non-Ac group (38%), p 0.01.

Conclusions: Significant increases in pregnancy outcomes were confirmed by this study and the data uniquely supported the advantage of acupuncture in patients with normal PI (prior studies were done on patient with PI). We also demonstrated that both acupuncture treatment protocols could be used together with a synergistic effect. Finally, this study is the first to demonstrate that the use of acupuncture in patients with poor prognoses (elevated Peak FSH, longer history of infertility, poor sperm morphology) can achieve similar pregnancy rates to normal prognosis patients.

OBJECTIVE: Conflicting evidence exists on whether acupuncture is beneficial for patients undergoing In Vitro Fertilization (IVF) cycles. Therefore, this study was undertaken to determine whether on-site acupuncture, per- formed both before and after embryo transfer, affects clinical outcomes.

DESIGN: Retrospective data analysis.

MATERIALS AND METHODS: The Acupuncture Group consisted of 49 patients who received acupuncture on-site before and after embryo transfer in 2007. The treatment did not follow the Paulus protocol. The Control Group were 212 patients with no acupuncture undergoing IVF cycles in the same time period. The data was subdivided by SART age classifications to determine if acupuncture differentially benefitted certain age groups. Clinical Pregnancy Rate (CPR) was defined as the presence of fetal cardiac activity. Loss Rate was the percentage of pregnancies that did not proceed from a positive hCG to a clinical pregnancy. Data were analysed using the unpaired t-test and Fisher’s exact test, with significance defined as P < 0.05.

RESULTS: Patients with a positive hCG were significantly higher in the Acupuncture Group for women less than 35 years old (63.3% vs.43.2%, p1⁄4 0.048). The Acupuncture Group also had a higher CPR in the under 35 category (60.0% vs. 34.6%, p 1⁄4 0.01). There were no differences in the other age groups. Combining all the age groups, the cycle parameters between the two Groups were equivalent, while the CPR was higher and the Loss Rate lower for the Acupuncture group (Table 1).

CONCLUSIONS: Although other studies regarding acupuncture have been inconclusive, perhaps these positive results are related to two important factors. The treatments were performed on-site, eliminating the stress of travelling to another site before and after the embryo transfer. Also, the acupuncture treatment protocol did not follow the traditional Paulus protocol, thereby suggesting there is still more research to be done on how best to treat infertility issues with acupuncture

The London Bridge Fertility, Gynaecology and Genetics Centre, London, UK

All IVF cases in which acupuncture was administered before and after embryo transfer at a large private infertility centre were reviewed for a 2 year period. All patients were treated by the same practitioner (NDB) using Traditional Chinese Acupuncture (TCA). Patients received acupuncture to the protocol developed by Paulus, W.E., Zhang, M., Strehler, E., El-Danasouri, I., & Sterzik, K. (2002). Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility & Sterility, 77, 721–724: Liver 3, Spleen 8, Stomach 29, Pericardium 6, GV 20 were manually stimulated five times over a 40-min period, at Bridge, approximately 10–20 minutes prior to embryo transfer. Embryo transfer was carried out under ultrasound guidance as per routine at Bridge. Ten minutes following embryo transfer acupoints Spleen 6, Stomach 36, Spleen 10, Large Intestine 4 were manually stimulated five times over a 40-min period before discharging the patient. Ear points 34, 55 and 58 were used in both treatments and not stimulated.

A total of 71 patients underwent 74 cycles involving acupuncture before and after embryo transfer.

Overall, positive pregnancy rates/ET were 44.6% comparing favourably with the non-acupuncture historic control group.

When analysed by maternal age at time of treatment, biochemical pregnancy results for acupuncture treated women were as follows: <35 years−52%; 35–39 years – 45%; 40–45 years – 35%.

Results for women aged 35–39 years and those over 40 years were markedly better than controls suggesting that acupuncture intervention of this type may be more effective in older women. No side effects or complications were experienced by women receiving acupuncture. Acupuncture is a safe, adjunct therapy in IVF and in other randomised clinical trials has been shown to significantly improve outcomes when used at the IVF centre before and after embryo transfer. Our preliminary data are encouraging and suggest that a trial involving older women may be effective.

Objective To observe the effect of acupuncture on the pregnancy rate in assisted reproduction therapy such as in-vitro-fertilisation (IVF) and intracytoplasmatic spermatozoen injection (ICSI), and mechanisms.

Methods 210 cases undergoing IVF or ICSI were divided randomly into three groups: acupuncture treatment group, placebo group and control group. The acupuncture treatment group and the placebo group were treated respectively with body acupuncture and placebo acupuncture before and after embryo transfer, and in the control group embryos were transferred without any supportive therapy. Contraction frequency of the uterine junctional zone and the pregnancy rate were observed.

Results The contraction frequency before embryo transfer was not significantly different among the three groups, but after embryo transfer in the acupuncture treatment group was lower than that in the placebo group and the control group, respectively. The pregnancy rate was 44.3% (31/70) in the acupuncture treatment group, and 27.1% (19/70) in the placebo group and 24.3% (17/70) in the control group. The pregnancy rate in the acupuncture treatment group was significantly higher than that in the placebo acupuncture group and the control group (P0.05).

Conclusion Acupuncture is a powerful tool for improving pregnancy rate after assisted reproduction therapy.

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

Patient(s): 57 infertile patients undergoing IVF or IVF/ICSI.

Interventions(s): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.
Main outcome measure(s): Perceive Stress Scale scores, pregnancy rates.

Result(s): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status.

Conclusions(s): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.