6419/37 Aim21(3)

Paulus WE, Zhang M, Strehler E, El Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002;77(4):721-4. Summary The objective of this study was 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. This was a prospective randomized study, performed within a fertility centre. After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were randomly divided into the following two groups: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80). Acupuncture was performed in 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any additional therapy. The main outcome measure was clinical pregnancy – defined as the presence of a fetal sac during an ultrasound examination six weeks after embryo transfer. Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, and in 21 out of 80 patients (26.3%) in the control group. The authors concluded that acupuncture seems to be a useful tool for improving pregnancy rate after ART. Comment In this study the authors chose points that, according to TCM principles, 'relax the uterus'. Before embryo transfer the points used were: CV6, SP8, LR3, GV20 and ST29. After embryo transfer the points used were: ST36, SP6, SP10 and LI4. In addition to these, four auricular points were used, two in the right and two in the left. The side used for individual points was changed after embryo transfer. CV6, SP6, SP8 and ST29 all stimulate myotomes that are segmentally relevant to the uterus T11 to L1 and S2 to S4, although that was not the expressed intention of the authors. This seems to be a straight-forward and positive study, however, the results should be interpreted with caution as the statistics for the fertility centre are not given, and the pregnancy rate in the control group appears to be lower than might be expected. The pregnancy rate for this sample, given the parameters of the IVF, would be expected in many western centres to be 35 to 40%, i.e. the rate in the acupuncture group. The lower rate observed in the control group could be a result of chance (a type 1 statistical error); or, as this study was open, the patients randomised to control may have suffered some degree of stress as a result of the disappointment at not getting acupuncture. It is highly speculative, but this minor level of stress may have caused suboptimal conditions for implantation in the control group. Whilst the pregnancy rate at six weeks is important, the crutial outcome is the 'take home baby rate'. It is hoped that the authors will publish this data. Following this the next step for the group might be to repeat the study with a non-penetrating sham control, and an adequate power calculation. Research reviews