Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilization: systematic review and metaanalysis. Manheimer E et al. BMJ 2008;336 pg 545-549 British Medical Journal

The authors concluded,
―The odds ratio of 1.65 suggests that acupuncture increased the odds of clinical pregnancy by
65% compared with the control groups… In absolute terms 10 patients would need to be treated
with acupuncture to bring about one additional clinical pregnancy. These are clinically relevant
benefits.‖

And when they analyzed the 4 trials that measured live births in addition to pregnancy rates,
they found that acupuncture increased the odds by 91% and that the number of patients who
would need to be treated to bring about an additional pregnancy dropped to 9.
Impressive as these results are they may still be an underestimate, since the authors included
women whose IVF cycles were cancelled before transfer.
The accompanying editorial in the BMJ makes the comment that adding acupuncture to IVF
improved pregnancy rates more than any other recent improvement or advance in IVF
technology.

Abstract
Objective - To evaluate whether acupuncture improves rates of pregnancy and live birth when
used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilization.
Design - Systematic review and meta-analysis.

Data sources - Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand
searched abstracts, and reference lists.
Review methods - Eligible studies were randomized controlled trials that compared needle
acupuncture administered within one day of embryo transfer with sham acupuncture or no
adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing
pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed
methodological quality; and extracted outcome data. For all trials, investigators contributed
6 additional data not included in the original publication (such as live births).

Meta-analyses - included all randomized patients.

Data synthesis - Seven trials with 1366 women undergoing in vitro fertilization were included in
the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no
adjuvant treatment as controls were pooled for the primary analysis. Complementing the
embryo transfer process with acupuncture was associated with significant and clinically relevant
improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14;
number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49;
NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials).
Because we were unable to obtain outcome data on live births for three of the included trials,
the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect
from these trials rather than the odds ratio for live birth.

The results were robust to sensitivity analyses on study validity variables. A prespecified
subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the
control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio
1.24, 0.86 to 1.77).

Conclusions - Current preliminary evidence suggests that acupuncture given with embryo
transfer improves rates of pregnancy and live birth among women undergoing in vitro
fertilization.