Abstract
BackgroundAssisted reproductive technologies (ART) are increasingly utilised for resolving difficulties conceiving. These technologies are expensive to both the public purse and the individual consumers. Acupuncture is widely used as an adjunct to ART with indications that it may assist reducing the time to conception and increasing live birth rates. Heterogeneity is high between treatment protocols.The aim of this study was to examine what fertility acupuncturists consider key components of best practice acupuncture during an ART cycle, and to establish an acupuncture protocol by consensus.MethodsFifteen international acupuncturists with extensive experience treating women during ART interventions participated in 3 rounds of Delphi questionnaires. The first round focused on identifying the parameters of acupuncture treatment as adjunct to ART, the second round evaluated statements derived from the earlier round, and the third evaluated specific parameters for a proposed trial protocol. Consensus was defined as greater than 80% agreement.ResultsSignificant agreement was achieved on the parameters of best practice acupuncture, including an acupuncture protocol suitable for future research. Study participants confirmed the importance of needling aspects relating to the dose of acupuncture, the therapeutic relationship, tailoring treatment to the individual, and the role of co-interventions. From two rounds of the Delphi a consensus was achieved on seven treatment parameters for the design of the acupuncture treatment to be used in a clinical trial of acupuncture as an adjunct to ART. The treatment protocol includes the use of the traditional Chinese medicine acupuncture, use of manual acupuncture, a first treatment administered between day 6–8 of the stimulated ART cycle which is individualised to the participant, two treatments will be administered on the day of embryo transfer, and will include points SP8, SP10, LR3, ST29, CV4, and post transfer include: GV20, KD3, ST36, SP6, and PC6. Auricular points Shenmen and Zigong will be used. Practitioner intent or yi will be addressed in the treatment protocol.ConclusionsDespite a lack of homogeneity in the research and clinical literature on ART and acupuncture, a consensus amongst experts on key components of a best practice treatment protocol was possible. Such consensus offers guidance for further research.
Highlights
Assisted reproductive technologies (ART) are increasingly utilised for resolving difficulties conceiving
The aim of this study was to examine what experts in fertility acupuncture consider key aspects and components of best practice acupuncture during an ART cycle, and to establish an acupuncture protocol by consensus
The criteria used to identify potential participants included a history of publishing on acupuncture and fertility, or previous experience of having undertaken or currently undertaking research on acupuncture and fertility, or a minimum of ten years experience of using acupuncture treatment for fertility enhancement or sub-fertility and consider themselves specialists in fertility acupuncture; or recommended from participants meeting the above criteria
Summary
Assisted reproductive technologies (ART) are increasingly utilised for resolving difficulties conceiving. Randomised controlled trials, and several systematic reviews and meta-analyses have examined whether acupuncture as an adjunct to ART treatment improves reproductive outcomes. Stener-Victorin and Manheimer commenting on these early reviews and a further four meta-analyses, concluded that the evidence that acupuncture improves clinical pregnancies or live birth rates is unclear due to significant heterogeneity between trials [5]. This relates to both clinical and methodological heterogeneity such as the use of different study questions, use of controls ranging from usual care alone to invasive and non invasive procedures, and use of different treatment protocols
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