The role of acupuncture in patients at unfavourable reproductive prognosis in IVF: a prospective randomised study
Arnoldi M et al
Introduction: Acupuncture is an ancient therapeutic art, which has been given renewed attention in light of recent scientific research and current integration with modern medical practice in the treatment of a wide range of diseases, including infertility. Recently certain studies have suggested that acupuncture might have a role in increasing pregnancy rates among women undergoing IVF.
Objective: of the study was to evaluate the effects of acupuncture in a population of women with a reduced ovarian reserve.
To clarify this issue, we have set-up a case-control study comparing patients who underwent acupuncture during the controlled ovarian hyperstimulation to those who did not receive acupuncture.
Material and Methods: Between May 2007 and December 2009 204 patients selected for IVF-ICSI with an unfavourable reproductive prognosis were assigned randomly to two groups. Inclusion criteria were as follow: 1) at least two previous poor responses to ovarian stimulation and/or recurrent implantation failure (for ≥ 2 cycles) 2) ovarian and/or pelvic endometriosis 3) raised early follicular phase FSH (> 10 IU/l).
The population of the study consisted of women selected for IVF-ICSI cycles who underwent acupuncture during the IVF cycle. Acupuncture sessions were given during the ovarian stimulation and immediately before and after embryo transfer in according to diagnostic and therapeutic criteria of Traditional Chinese Medicine. The control group did not receive acupuncture at the time of the cycle. No more than three oocytes were fertilized at one time in according to the 2004 italian law. The primary outcome was pregnancy rate. The secondary outcome was ovarian responsiveness to hyperstimulation.
Results: One hundred two cases and 102 controls were recruited. The two groups did not differ in terms of age, basal FSH, dosage of gonadotropins, days of stimulation, peak estradiol at hCG. No difference was observed between the study and control group in terms of oocytes retrieved (6.4 versus 4.8; p> 0.05) and number of embryos obtained (2.1 versus 2.1; p> 0.05).
Embryo transfer was not performed in 6 and 20 women in the study and control groups, respectively (p < 0.01). Overall, the number of pregnancies was 22 and 10, respectively. Pregnancy rate per starting cycle was 22% and 10%, respectively (p < 0.05). Pregnancy rate per embryo transfer was 23% and 12%, respectively (p = 0.06). The implantation rate was 13% and 8%, respectively (p = 0.17).
Conclusions: This is the first prospective randomised study that investigates acupuncture’s effects in a population of women with poor reproductive prognosis. Analysis of these preliminary data is encouraging. Even if the number of cases is small, this study demonstrates that acupuncture prior to and at embryo transfer improves the reproductive outcome in women undergoing IVF-ICSI with poor prognosis. Larger series are required to draw definite conclusions regarding the impact on the ovarian responsiveness to hyperstimulation and the chances of pregnancy.
fonte: Human Reprod 2010.