Acupuncture and in vitro fertilization: updated meta-analysis

Sir, We updated our previously published meta-analysis (El-Toukhy et al., 2008), following the recent publication of another randomized controlled study of acupuncture in IVF at the time of embryo transfer (So et al., 2009). Our updated meta-analysis showed no improvement in clinical pregnancy rates with acupuncture at the time of embryo transfer (Fig. 1). A restricted meta-analysis using high quality studies that employed sham acupuncture in the control group also failed to show improvement in live birth rates (Fig. 2). Meta-analysis of the studies evaluating the effect of acupuncture administered around the time of embryo transfer on the clinical pregnancy rate in women undergoing IVF. Meta-analysis of the studies evaluating the effect of acupuncture administered around the time of embryo transfer on the live birth rate in women undergoing IVF when sham acupuncture technique was used in the control groups. Despite 14 randomized trials of acupuncture in IVF, some of which are of high quality and nearly 3000 women recruited into these studies, acupuncture has not been shown to improve IVF outcome. Many published studies on the role of acupuncture in IVF recommend that further well designed and sufficiently powered randomized trials to evaluate the impact of acupuncture at the time of embryo transfer on IVF outcome are carried out (Cheong et al., 2008; Pinborg et al., 2008). However, based on current evidence, this recommendation is difficult to justify. If further research into the effects of acupuncture as an adjunct to IVF treatment is to be carried out, small studies are unlikely to provide a definitive answer. There are currently five ongoing randomized controlled trials of acupuncture and IVF with a sample size ranging from 100 to 600 women (metaRegister of Controlled Trials; Pinborg et al., 2008). It is unclear what these studies will offer over and above the existing studies. For current practice, we believe that women should be advised that there is no evidence that receiving acupuncture during IVF treatment (whether at the time of oocyte collection or embryo transfer) improves IVF outcome.