SANTA BARBARA, CALIF. – Acupuncture does not significantly increase pregnancy rates in women undergoing IVF, reanalyses of a prior meta-analysis of 24 studies suggested.
Although the original meta-analysis reported a significant 20% increase in the pregnancy rate with acupuncture, a more rigorous reanalysis that excluded eight lesser-quality studies found no statistically significant difference in IVF pregnancy rates between women who did or did not have acupuncture, Dr. David R. Meldrum said at the UCLA annual in vitro fertilization and embryo transfer update 2013.
Dr. David R. Meldrum
When data were looked at only from six studies that used the Streitberger mock acupuncture technique (a widely accepted control technique in acupuncture studies), the odds ratio for clinical pregnancy in the acupuncture group was 0.89 with the confidence interval crossing 1, "indicating lack of a true effect of acupuncture," he said.
When Dr. Meldrum and his associates compared separate reanalyses of studies that did or did not use Streitberger mock acupuncture, the confidence interval for results in the placebo group straddled 1 in the studies using the Streitberger technique but did not cross 1 in non-Streitberger studies.
"Based on this, we think that at the present time acupuncture appears to have a placebo effect. There are not enough data to say whether it has a specific effect," said Dr. Meldrum, a reproductive endocrinology and infertility specialist in group practice in Redondo Beach, Calif.
Studies since 1996 have reported varying results from acupuncture as part of IVF programs. Although the 2012 meta-analysis of 24 studies reported a significantly higher pregnancy rate with acupuncture compared with placebo or no acupuncture, the birth rate did not differ significantly between groups (Fertil. Steril. 2012;97:599-611).
That report "stimulated me to look at it in more detail," said Dr. Meldrum.
The authors of the meta-analysis also conducted a secondary analysis of the data minus studies that used a widely accepted type of sham control, reasoning that the sham procedure created pressure that might be therapeutic. With this more limited data set, the birth rate was significantly higher with acupuncture than without it, they reported.
That didn’t seem right to Dr. Meldrum, so he and three colleagues with epidemiologic training conducted their own reanalysis of the meta-analysis, excluding at least 8 of the 24 studies in the original data set that they felt "didn’t belong in it," he said.
One of the excluded studies was not randomized. Two studies compared acupuncture to a combination of anesthesia drugs that "we know could have a negative effect," he said. Another excluded study compared acupuncture to general anesthesia. One study compared the control to acupuncture plus "special Chinese medical drug seeds" instead of acupuncture alone. Three excluded studies compared data from multiple arms in the trials rather than just acupuncture versus control.
Without those studies, a redone meta-analysis of 16 studies yielded a statistically nonsignificant odds ratio for pregnancy of 1.14 for acupuncture (Fertil. Steril. 2013;99:1821-4).
He and his associates also reanalyzed data from just the three studies that reported birth rates, and found an odds ratio for birth of 0.74 in the acupuncture groups versus controls (confidence interval, 0.58-0.95), indicating a reduced chance of IVF success, he added. One of these studies "recorded rotating, lifting, and thrusting the needle. I think a lot of our patients might find that stressful," he said.
"We’re not saying that patients should be dissuaded from having acupuncture, because it is widely used, but I think we have to be frank that it’s questionable whether there’s a specific benefit," Dr. Meldrum said.
Most of the acupuncture studies were carried out in IVF centers, so if patients choose to receive acupuncture, it may be best for them to receive it at the IVF center if possible so there is minimal disruption. One study that found a reduced pregnancy rate after acupuncture had subjects who had never undergone acupuncture get the acupuncture at a separate location from the IVF clinic, possibly adding stress, he noted.
It would be helpful to have patients who choose acupuncture follow the techniques used in the studies that reported improved IVF success with acupuncture, but that may be difficult because the acupuncture techniques varied so widely. "I would think that if acupuncture had a specific effect, the placements of the needle would be consistent. They were widely variable in different studies. So, I am somewhat skeptical as to whether acupuncture, even with much larger experience, has a specific effect."
Dr. Meldrum is president of the Sexuality Education Network, which operates the websites erectile-function.com and lifechoicesandfertility.com. He reported having no other relevant financial disclosures.