• The effects of acupuncture on in vitro fertilization outcomes: a systematic review of the literature and an update to the Cochrane Collaboration review

      Drake, Melissa; The University of Arizona College of Medicine - Phoenix; Campos-Outcalt, Douglas (The University of Arizona., 2011-10)
      Background Infertility, or impaired fecundity, affects 11.8% of women between the ages of 15 and 44, which translates to 7.3 million women. The use of assisted reproductive techniques has doubled over the past decade, with 148,055 cycles performed during 2008 resulting in 46,326 live births and the delivery of 61,426 infants. Acupuncture has been used in China to treat numerous and disparate medical conditions for thousands of years. Many anecdotal reports and non-randomized studies have claimed that acupuncture improves fertility, but the number of high-quality randomized controlled clinical trials and cohorts is much thinner. Objectives To determine whether the use of acupuncture results in higher pregnancy rates in patients undergoing in vitro fertilization compared with placebo acupuncture or no treatment. Search strategy All randomized controlled trials and prospective cohort reports of acupuncture and assisted reproductive technology were obtained through a systematic search of Medline and the MeSH database (1996 to February 2011). Selection criteria Prospective, randomized controlled trials comparing acupuncture treatment versus no treatment, placebo acupuncture, sham acupuncture at non-acupoints, and sham acupuncture at non-fertility-related acupoints during IVF treatment with or without intracytoplasmic sperm injection (ICSI). Inclusion criteria: - primary or secondary subfertility - undergoing IVF with or without ICSI - timing of acupuncture for before and after embryo transfer Exclusion criteria: - frozen embryo transfer - acupuncture used as adjunct to analgesia - electroacupuncture - donor oocytes - non-randomized trials, case-controls, case studies - studies included in the 2009 Cochrane review Data collection and analysis Thirteen randomized controlled trials were identified that involved acupuncture and in vitro fertilization with embryo transfer. Trials were analyzed for the following methodological details and quality criteria: study characteristics (randomization, blinding, power analysis, intention-to-treat analysis), patient characteristics (demographics, inclusion and exclusion criteria), interventions (IVF stimulation protocols, timing of acupuncture or control, acupoints chosen), and outcomes (ongoing pregnancy rates, live birth rates). Main results Only one of the trials demonstrated a result that achieved statistical significance. So 2009 showed that placebo acupuncture resulted in significantly higher overall birth rate when compared to true acupuncture. Even with adequate power, none of the other trials showed a difference that achieved statistical significance in pregnancy rate or live birth rates between acupuncture and control groups. Conclusions Acupuncture does not improve IVF outcomes and should not be offered routinely as an adjunct to fertility treatment. The evidence from the current literature suggests a positive effect of sham and placebo acupuncture on IVF outcomes, and therefore merits further study with adequately powered RCTs.
    • The Test Tube Baby: Out of Reach or Out of Luck? A Retrospective Look at the Impact of Basal FSH and Age on In Vitro Fertilization Success in a Clinic Operating Without Laboratory Value Thresholds or Age Limits?

      Padrnos, Leslie; The University of Arizona College of Medicine - Phoenix; McGaughey, Robert (The University of Arizona., 2011-03)
      Objective: To assess the impact of age and FSH on IVF outcomes in an assisted reproductive technology clinic that does not have treatment thresholds based on age or laboratory FSH values. Design: Retrospective cohort study Setting: The Arizona Center For Fertility Studies in Phoenix, AZ Patient(s): Women who sought fertility treatment (with the exclusion of patients using donor or frozen oocytes) ages 18-50, representing a total of 1388 IVF cycles Intervention(s): IVF using nondonor embryos Main Outcome Measure(s): Live-birth rate per cycle started Result(s): A total of 1388 IVF cycles with autologous oocytes were analyzed to determine the impact of basal FSH and age on therapy outcomes. The pregnancy rates for individuals 18-34 years old were not significantly different and ranged from 41.1% to 34%. Pregnancy rates for individuals aged 35-39 years old exhibited a reduced pregnancy rate that ranged from 24.7% to 19.8%. For the eldest patients, a significant reduction in pregnancy rates was demonstrated with patients over the age of 40 having a pregnancy rate of 14.3%, and for those 41 years old and 42 and older having pregnancy rates of 7% and 6% respectively. The live birth rate also mirrored this trend with the youngest age group having a live birth rate of 38.9% and the eldest group of individuals aged 42-50 years having a live birth rate of 3.4%. While increasing FSH levels were associated with reduced numbers of oocytes retrieved and transferred during the IVF procedures, there was no statistically significant reduction in pregnancy rate or live birth rate in those with elevated basal FSH levels. Conclusion: The data analysis revealed that increasing age in this population does correlate with decreasing successful outcomes in IVF. At ages 36 and 40 years, there are significant reductions in pregnancy rate. At ages 38 and 40, there are significant reductions in live birth rate. Interestingly, there were no significant differences in pregnancy rate or live birth rate based on basal FSH level.