Abstract
Background The effects of acupuncture on female infertility remain controversial. Also, the variation in the participant, interventions, outcomes studied, and trial design may relate to the efficacy of adjuvant acupuncture. The aim of the study is to systematically evaluate the efficacy and safety of acupuncture for female with infertility and hopefully provide reliable guidance for clinicians and patients. Methods We searched digital databases for relevant studies, including EMBASE, PubMed, Cochrane Library, and Web of Science, and the Cochrane Library up to April 2021, for randomized controlled trials (RCTs) evaluating the effects of acupuncture on women undergoing IVF and other treatment. We included studies with intervention groups using acupuncture and control groups consisting of no acupuncture or sham (placebo) acupuncture. Primary outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Meta-regression and subgroup analysis were conducted on the basis of ten prespecified covariates to investigate the variances of the effects of adjuvant acupuncture on pregnancy rates and the sources of heterogeneity. Results: Twenty-seven studies with 7676 participants were included. The results showed that the intervention group contributes more in outcomes including live birth rate (RR = 1.34; 95% CI (1.07, 1.67); P < 0.05), clinical pregnancy rate (RR = 1.43; 95% CI (1.21, 1.69); P < 0.05), biochemical pregnancy rate (RR = 1.42; 95% CI (1.05, 1.91); P < 0.05), ongoing pregnancy rate (RR = 1.25; 95% CI (0.88, 1.79); P < 0.05), adverse events (RR = 1.65; 95% CI (1.15, 2.36); P < 0.05), and implantation rate (MD = 1.19; 95% CI (1.07, 1.33); P < 0.05) when compared with the control group, and the difference is statistically significant. In terms of the number of oocytes retrieved, good-quality embryo rate, miscarriages, and ectopic pregnancy rate, the difference between the acupuncture group and the control group was not statistically significant. Conclusions: Our analysis finds a benefit of acupuncture for outcomes in women with infertility, and the number of acupuncture treatments is a potential influential factor. Given the poor reporting and methodological flaws of existing studies, studies with larger scales and better methodologies are needed to verify these findings. More double-blind RCTs equipped with high quality and large samples are expected for the improvement of the level of evidence.
Highlights
Infertility is explicitly defined as a failure to become pregnant within 12 months of having regular, unprotected, heterosexual intercourse [1]; it affects approximately 48.5 million couples worldwide [2]
In the subgroup analysis, we included the availability of placebo as a grouping criterion, which has not been attempted in other systematic reviews
We employed Medical Subject Heading terms and relevant keywords for the search. e retrieval formula was as follows: (Title/Abstract): female infertility/sterility, assisted reproduction, embryo transfer, in vitro fertilization, polycystic ovary syndrome, acupuncture, pharmacopuncture, electroacupuncture, and needle; we searched for previous systematic reviews on this topic and reviewed their reference lists [20,21,22,23]
Summary
Infertility is explicitly defined as a failure to become pregnant within 12 months of having regular, unprotected, heterosexual intercourse [1]; it affects approximately 48.5 million couples worldwide [2]. Was first reported in 1988 [1], showing effects similar to those of auricular acupuncture and drug-based therapy for achieving pregnancy, increasing research interest in this method [2,3,4]. Systematic reviews have produced conflicting findings [11,12,13,14,15,16,17], likely due to patient and method heterogeneity or small sample sizes; some studies lacked a placebo control group, which is essential to distinguish the impact of an intervention from that of other factors [18]. We aimed to conduct a systematic review and meta-analysis of RCTs, including subgroup analyses and meta-regressions, to examine the impact of acupuncture on female infertility
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