Does Acupuncture Improve Outcomes?

Quick Summary

We believe the medical literature is frankly inconclusive on whether acupuncture helps women to deliver a healthy baby. Acupuncture is inherently hard to study and as a result we’ve seen a spectrum of conflicting results from trials. That said, it appears that acupuncture is:

  • Effective at mitigating patient anxiety during treatment

  • Useful compared to “no acupuncture” but not versus a “sham” or “placebo”

  • “Dose dependent” and more likely to be effective the more often it’s administered

  • More useful when started months before stimulation begins and continued through to embryo transfer

Why Acupuncture Is Hard to Study

Before we dive into whether acupuncture improves a woman's chances to have a baby, we should get familiar with the reasons acupuncture is hard to study according to western best practices. We’ll refer back to this when we consider what each study tells us or doesn’t tell us. Here are the issues in order of importance.

Confusion Around Control Arm (Most Important):
In assessing whether acupuncture “works,” we need to compare it to an alternative. Compared to doing no acupuncture (“usual care”), acupuncture generally rates favorably. But compared to something patients perceive to be acupuncture (but is not), known as a “sham” or “placebo” acupuncture, acupuncture often looks ineffective. There is real debate as to which should be our comparator arm.

Inconsistent Timing & Volume of Treatment:
During an IVF cycle, treatment can be performed at many phases (e.g. leading up to a transfer, around the time of transfer, in the weeks after) and lining up the clinical data based on when treatment occurred is both important and hard. Most studies involve a total of 2 treatments performed on the day of embryo transfer, which is less treatment than many experts consider necessary.

Not "Real-World" Treatment:
Acupuncturists typically have a lot of leeway in where they place their needles. In the majority of these studies, the acupuncture treatment points were placed as per the specific protocol the investigators chose. Fixed protocols do not take into account the unique needs of an individual patient and thus do not reflect the full impact of a tailored approach patients would receive outside of a study.

Old Data:
The available data is old and comes from an era when IVF success rates were lower. That matters because when acupuncture shows a benefit, it’s often in studies where IVF patients not given acupuncture had poor results. Today, many of those same patients might have fared better making it harder for acupuncture to show additional benefit.

Inferior Endpoints:
We believe patients should be focused on whether doing acupuncture helps them have a live birth. Unfortunately, many acupuncture studies only look at whether acupuncture improves “pregnancy rates” (or some version thereof), which is useful but falls short of what we all truly care about: taking home a baby.

More Detail

While the impact of acupuncture has been widely studied (over 40 studies and 10 meta-analysis) we do not believe it’s been well-studied (for the reasons mentioned above). With the data we currently have, this is how we’d summarize the findings:

  • Acupuncture clearly lowers patient anxiety and duress during fertility treatment

  • Greater volumes of treatment are more like to improve outcomes rather than treatment just around embryo transfer

  • Acupuncture is more likely to show benefit versus “no acupuncture” but not versus a “sham” or “placebo” approach

Anxiety Reduction

Undergoing acupuncture during fertility treatment clearly mitigates stress. This is true regardless of whether acupuncture was administered just around the time of embryo transfer or during a longer duration of time. Below we list the better run studies on the subject and most come to a similar conclusion.

Stress

Anxiety and stress and can be excruciating and addressing this alone may make acupuncture “effective.” Psychological anxiety also impedes a patient’s ability to get more treatment.

This can limit a patient's likelihood of eventually deliverying, especially if she discontinues treatment at an early age or in the first few cycles.

Benefit of More Treatment

One single-center study measured the impact of doing acupuncture solely around the time of embryo transfer and compared that with results from patients who underwent 12 or more treatments (in additional to herbal therapy). Investigrators noted significantly higher live birth rates associated with greater treatment. While this study has challenges (single center, not prospectively randomized) we think its endpoint (live birth), sample size (500+ patients) and level of statistical significance (P < .03) make it noteworthy. A broader meta-analysis showed patients who undergo as few as 3 treatments see a statistically-significant impact in live birth rates.

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