16/10/2011
Women who have an electro-acupuncture session as part of their infertility treatment may have a better chance of ultimately having a baby, a new clinical trial suggests.

The study, of 309 women undergoing in vitro fertilization (IVF), found that those who had electro-acupuncture at the time that their embryos were implanted were more likely to give birth.

Just over 37 percent had a baby (or babies), versus 21 percent of women who underwent a "sham" version of electro-acupuncture. A third study group, where the women received an additional electro-acupuncture session the day before embryo implantation, had an even higher birth rate, at 42 percent.

But that difference from the one-session group could have been a statistical fluke, researchers warn. The findings, reported in the journal Fertility and Sterility, add to a conflicting body of evidence on whether acupuncture can boost IVF success.

In 2002, a study in Germany was the first to report that traditional needle acupuncture seemed to improve pregnancy rates in women undergoing IVF. (The study did not look at birth rates.) But studies since then have turned up mixed results, and the role of acupuncture in IVF, if any, remains controversial.

For the latest study, researchers in China examined the effects of electro-acupuncture, which uses electrodes on the skin, rather than needles, to deliver an electrical current to traditional acupuncture points.

The researchers, led by Rong Zhang of the Peking University Health Science Center, divided their 309 IVF patients into three groups. In one, women received one electro-acupuncture session 30 minutes after having their embryos implanted in the uterus; in a second group, the women had two sessions, with the additional one taking place the day before embryo implantation.

The third group received "sham" electro-acupuncture 30 minutes after embryo implantation. Electrodes were placed on the body at traditional acupuncture sites, but only a weak current came through -- enough that the women could feel a sensation, but not enough to have a physiological effect, according to Zhang's team. In the end, women in the two electro-acupuncture groups had higher birth rates.

The results, Zhang's team writes, suggest that larger clinical trials, at multiple treatment centers, are now "warranted." An infertility expert not involved in the study said that conclusion is "very sensible." Large-scale trials are needed before electro-acupuncture should be adopted as part of infertility treatment, according to Dr. Tarek El-Toukhy, a reproductive medicine specialist at Guy's and St. Thomas' Hospital in London.

El-Toukhy and his colleagues recently published a meta-analysis of the dozen-plus clinical trials that have looked at acupuncture and IVF. A meta-analysis pools the results from several studies to try to get an overall idea of the evidence on a therapy. El-Toukhy's team concluded that there is no strong evidence that acupuncture improves IVF results - whether it's done at the time of embryo transfer or when a woman's eggs are collected. In an email, El-Toukhy told Reuters Health that the new study was "reasonably well-conducted," but that it also needs to be considered within the context of all the research that has been done on acupuncture and IVF.

He pointed to a U.S. study published earlier this year that looked at the effects of needle acupuncture at the time of embryo implantation. Researchers found that 45 percent of the women given true acupuncture became pregnant, versus 53 percent of those given a sham version. That study did not look at birth rates. As for electro-acupuncture in particular, this appears to be the first study to look at its effects during embryo implantation.

And El-Toukhy said it's not something that's commonly available during IVF. Zhang's team acknowledges that if acupuncture, or its electrode version, do affect IVF outcomes, it's not clear how. But a couple studies, they say, have suggested it may improve uterine blood flow. Other research is looking at whether electro-acupuncture might affect the "receptivity" of the uterine lining to implanted embryos, the researchers note.

Dr. Peter Lipson, an internal medicine specialist in southeastern Michigan, was more critical of the study. For one, he told Reuters Health in an email, the study was not really "blinded" -- that is, the electro-acupuncture operators knew which therapy they were delivering, and all of the women in the study knew they were receiving electrical stimulation because they could feel it. Having both the patient and the provider blinded as to who is receiving the real treatment is considered key to maintaining objectivity in a clinical trial.

Lipson also pointed out that there was no clear difference between the one-session electro-acupuncture group and the sham-acupuncture group when it came to the percentage of women who had a positive pregnancy test. There's no clear explanation for why one electro-acupuncture session would have no effect on pregnancy test results, but ultimately affect birth rates, according to Lipson. And in general, he said, the fact that studies have come to conflicting findings on acupuncture and IVF suggests that there are no real effects.

REUTERS