SAR 2010 - Acupuncture improves in vitro fertilization pregnancy rates

Acupuncture improves in vitro fertilization pregnancy rates - a retrospective chart review

Lee Hullender Rubin and Michael Opsahl

Society for Acupuncture Research - Translational Research in Acupuncture: Bridging Science, Practice and Community (SAR 2010)
Chapel Hill, North Carolina, USA, March 19-21, 2010

Abstract

Purpose: Trials combining standardized acupuncture protocols at or near the time of in vitro fertilization embryo transfer (IVF-ET) are inconclusive. The first randomized control trial (RCT) to apply standardized acupuncture on the same day as embryo transfer (ET) produced significant positive results (Paulus et al, 2002). A modified Paulus protocol significantly lowered pregnancy rates (PR) when acupuncture was performed offsite on the same day as the embryo transfer (Craig et al, 2007). We used the same modified Paulus protocol from 2005-2007 until the findings of Craig et al were presented in late 2007. In 2008, we further modified the Craig acupuncture protocol. This study seeks to compare PR of these two standardized acupuncture protocols, the Craig protocol and a modified Craig protocol, relative to the PR of those who did not receive acupuncture. Materials and Methods: In this retrospective chart review, PR were compared between patients who elected acupuncture treatment before and after ET to those who did not. The Oregon College of Oriental Medicine Institutional Review Board approved this study. Acupuncture was performed at a private infertility clinic the same day as ET by one of five licensed acupuncturists. Eight hundred fifty-five patients had an embryo transfer, of which 370 elected acupuncture. The acupuncture group “A” (Ac A) received the Craig protocol (Paulus protocol plus CV-6 (Qihai) before and KI-3 (Taixi) after ET from 2005-2007 (N=245). In 2008, the acupuncture group “B” (Ac B) received the modified Craig protocol with KI-3 (Taixi) removed after ET (N=125). The main outcome measure was the presence of an intrauterine gestation with fetal cardiac activity by transvaginal ultrasonography continuing beyond eight weeks. Result(s): The Ac B group PR in fresh, non-donor IVF cycles was 62.4% (N=101) relative to a PR of 42.7% (N=143) in those who did not elect acupuncture (p=0.002). Ac B increased the odds of success by 2.23 (95% CI, 1.32 – 3.75, p=0.003) in that cycle type. When controlled for age, Ac B increased PR in every CDC/SART age group 40 or below: <35: 74.5% (N=47) versus 57.5%(N=80) (p=0.05); 35-37:59.3% (N=27) versus 26.7% (N=30)(p=0.01); 38-40: 61.1% (N=18) versus 24.0% (N=25) (p=0.01). Ac A had no significant effect on PR in this group, 52.3% (N=199) vs 55.3% (N=206) (p=0.56), in contrast to a previously reported lowering of PR (Craig et al, 2007). When controlled for age, Ac A did not significantly impact outcomes. In contrast, the Ac A did increase PR in fresh donor cycles 87.0% (N=23) vs 66.0% (N=47) (p=0.06), while Ac B did not, 66.7% (N=9) vs 68.0% (N=25) (p=0.60). Neither non-donor nor donor frozen cycles was impacted by acupuncture. Conclusion(s): The Craig protocol (Ac A) did not significantly harm fresh, non-donor IVF PR, as previously reported, and may be indicated in fresh, donor IVF cycles. The modified Craig protocol (Ac B) significantly improved PR in fresh, non-donor IVF cycles. A large, prospective randomized trial is needed to examine the effectiveness of different acupuncture protocols based on IVF cycle type.

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