• 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.
    • Impact of the Integrative Medicine Elective on Medical Students

      Wright, Courtney A.; The University of Arizona College of Medicine - Phoenix; Maizes, Victoria (The University of Arizona., 2011-03)
      Background: Integrative Medicine offers an approach to medical practice which addresses the public’s increasing use of complementary and alternative medicine (CAM), personal, professional, and federal calls for more patient-centered care, and medical professionals’ deficiencies in self-care and reflection. Though the need for exposure to IM in medical school has been well articulated and many schools offer exposure to the field, the impact of such experiences is largely unknown. The University of Arizona’s Center for Integrative Medicine (AxCIM) re-designed its month-long elective in 2004 to better introduce students to the discipline. This paper reports the preliminary findings of a study examining changes in medical students’ attitudes about IM after participation in this elective. Methods: The Integrative Medicine Attitudes Questionnaire (IMAQ) was administered to medical students participating in the AzCIM’s bi-annual, month long IM elective at the beginning of the elective, at the end, 6 months after completion and 1 year after the elective. Results: 66 complete IMAQ scores were collected at baseline, 36 six months post-elective and 23 1 year after. Post-elective scores were significantly higher than at baseline. No difference from baseline was found in scores 6 months and 12 months post-elective. Conclusions: The preliminary results are encouraging regarding the elective’s improving attitudes toward IM immediately after its completion. This study serves as a resource and encouragement for IM education assessment and evaluation.