Effects of acupuncture during in vitro fertilization or intracytoplasmic sperm injection: An updated systematic review and meta-analysis

Introduction: Systematic reviews need constantly updating as new evidence emerges. The aim of this comprehensive systematic review/meta-analysis focused on trials that provided acupuncture during in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) which were compared with routine care for a range of outcomes - implantation rate, biochemical pregnancies (presence of a positive urinary pregnancy test or a positive serum human chorionic gonadotrophin test), clinical pregnancies, ongoing pregnancies, and rates of miscarriage and live birth. Methods: A systematic search of MEDLINE and EMBASE databases for randomized controlled trials (RCTs) on acupuncture treatment during IVF or ICSI was carried out from database inception until July 31, 2017. Study selection, data extraction, quality assessment and bias assessment were carried out by 2 researchers independently, with adjudication by the third researcher when necessary. A meta-analysis was performed to compare outcomes between women receiving acupuncture and those receiving routine care, and pooled relative risks (RR) were calculated. Results: Statistically significant differences were observed in rates of clinical pregnancy (RR = 1.19, 95% confidence intervals (CI): 1.06-1.34 p = 0.002), live birth (RR = 1.36, 95% CI: 1.09-1.69 p = 0.006), and implantation rate (RR = 1.31, 95% CI: 1.08-1.59 p = 0.006) between the acupuncture and the control groups. No significant differences were found for biochemical pregnancies (RR = 1.12, 95% CI: 0.92-1.35 p = 0.268), ongoing pregnancies (RR = 1.21, 95% CI: 0.95-1.55 p = 0.130), or miscarriage (RR = 0.89, 95% CI: 0.67-1.20 p = 0.447) between the two groups. Adverse events were described in 4 studies. Conclusions: Acupuncture may have an impact on the outcome rates of implantation, clinical pregnancy, and live birth; however, well-designed RCTs are warranted to further validate its effects.