According to reports in the media today, Guardian, Sky, Radio 4, BBC, Independent and The Human Fertilisation and Embryology Authority (HFEA) has issued a warning to those undergoing IVF about “unproven extras” to increase their chances of having a baby. Acupuncture is highlighted as one of these “unproven extras”. However, recent systematic reviews indicate that acupuncture may increase the likelihood of having a baby [1, 2]. It is very important that people are given the information they need to help them make an informed decision. There are a number of issues that need to be explored.
The evidence-base for acupuncture supporting IVF
Recent systematic reviews indicate that acupuncture may well be beneficial for those undergoing IVF.
- The findings suggest acupuncture may be effective when compared with no adjunctive treatment with increased clinical pregnancies, but is not an efficacious treatment when compared with sham controls [1]
- Although the evidence of acupuncture in IVF-ET is insufficient, acupuncture appears to be beneficial to increase the clinical pregnancy rate in women undergoing IVF-ET [2]
The conclusions are cautious because of the challenges of an active placebo control (sham acupuncture) and the general lack of high-quality evidence.
The quality of acupuncture used in clinical trials
Many clinical trials that investigated acupuncture to support IVF treatment have used inappropriate points or have provided too few treatments. The points used and the number of treatments can be referred to as the ‘treatment protocol’. Many trials repeat the protocol used by Paulus et al [5]. This is a fixed protocol which means the same points we used for every patient. A traditional acupuncturist will tailor the treatment to the individual. Importantly, Paulus et al used points such as hegu LI 4 – which is contraindicated in early pregnancy. A traditional acupuncturist will normally recommend a course of treatment prior to embryo transfer. Clinical trials are often limited to a single treatment before and after embryo transfer. Consequently, the acupuncture delivered in clinical trials may well not be as effective as that delivered by traditional practitioner.
British Acupuncture Council member acupuncturists have a minimum three year degree-level training enabling them to tailor their treatments to their patients.
Acupuncture for support
The reasons for people seeking acupuncture whilst having IVF are not limited to increasing the chances of having a baby. Acupuncture can support people in their general well-being which can be very important during what can be a particularly stressful time.
Acupuncture safety
HFEA also raised concerns regarding safety. There may be significant can safety concerns in respect to some of the additional treatments on offer, however, acupuncture has been shown to be a safe intervention when delivered by a properly trained practitioner [6-8].
A lack of quality research
In the UK and many Western countries there is very little funding available to undertake acupuncture research. This means for many conditions there is a lack of high-quality research to support a firm conclusion. However, this does not mean acupuncture is ineffective. Twenty years ago, the evidence that acupuncture could help those with chronic pain was not strong. A series of high-quality research, conducted mostly in Germany, significantly improved the quantity and quality of evidence available. This was combined into a large-scale systematic review with meta-analysis which demonstrated that acupuncture is effective for chronic pain. Moreover, this study also demonstrated that acupuncture is not a placebo and the benefits last for at least a year [3].
What is proof: placebo-controlled trials or pragmatic trials?
Placebo-controlled trials are seen as the gold standard for clinical research. It is relatively easy to create a placebo pill that looks and feels just like the medication. This is not the case for acupuncture. There are so-called sham acupuncture procedures that have been used in clinical trials. However, unlike placebo pills these are not inert [4]. Therefore, acupuncture is being tested against an active therapy in the placebo-controlled trials. This means the benefits of acupuncture will be underestimated. It is not a level playing field.
Further reading
If you would like to know more, please read An integrated approach to IVF by Colette Assor, Fellow of the British Acupuncture Council, who discuss how acupuncture can work alongside IVF with Professor Tim Child, one of the world’s leading fertility experts.
For a more in-depth understanding of the research please see the following articles
The British Acupuncture Council Factsheet: Infertility IVF
L.E. Hullender Rubin, Point of Influence: What is the Role of Acupuncture in In Vitro Fertilization Outcomes?, Medical Acupuncture 31(6) (2019) 329-333.
L.E. Hullender Rubin, B.J. Anderson, L.B. Craig, Acupuncture and in vitro fertilisation research: Current and future directions, Acupuncture in Medicine 36(2) (2018) 117-122.
L.E. Hullender Rubin, M.S. Opsahl, K.E. Wiemer, S.D. Mist, A.B. Caughey, Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes, Reproductive BioMedicine Online 30(6) (2015) 602-612.
Find a trusted traditional acupuncturist from the British Acupuncture Council
The British Acupuncture Council (BAcC) guarantees high standards of training, safe practice and professional conduct. By choosing a BAcC member you ensure that you will find an acupuncturist who has:
- extensive training – minimum three years degree level – with relevant western medicine including anatomy and physiology and thorough training in the traditional approach
- adherence to the BAcC codes of safe practice and professional conduct
- compliance with current health and safety legislation
- full cover for medical malpractice and public/products liability
- mandatory continuing professional development to keep knowledge and skills up to date
The BAcC is an Accredited Register with the Professional Standards Authority for Health & Social Care (PSA). The PSA protects the public by overseeing the regulation and registration of healthcare professionals – including statutorily regulated professions, such as the Nursing and Midwifery Council, and Accredited Registers like the BAcC. This offers a quality mark for high standards of training, safe practice, and professional conduct. Statutory regulated healthcare professionals, such as member of the General Medical Council, can use Accredited Register status as an assurance the safety and quality of care provided when making referrals.
You can find a BAcC member acupuncturist by searching the practitioner directory.
References
[1] C.A. Smith, M. Armour, Z. Shewamene, H.Y. Tan, R.J. Norman, N.P. Johnson, Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis, Reproductive BioMedicine Online 38(3) (2019) 364-379.
[2] X. Wang, Y. Wang, S. Wei, B. He, Y. Cao, N. Zhang, M. Li, An Overview of Systematic Reviews of Acupuncture for Infertile Women Undergoing in vitro Fertilization and Embryo Transfer, Frontiers in Public Health 9 (2021).
[3] A.J. Vickers, E.A. Vertosick, G. Lewith, H. MacPherson, N.E. Foster, K.J. Sherman, D. Irnich, C.M. Witt, K. Linde, C. Acupuncture Trialists, Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis, J Pain 19(5) (2018) 455-474.
[4] I. Appleyard, T. Lundeberg, N. Robinson, Should systematic reviews assess the risk of bias from sham–placebo acupuncture control procedures?, European Journal of Integrative Medicine 6(2) (2014) 234-243.
[5] W.E. Paulus, M. Zhang, E. Strehler, I. El-Danasouri, K. Sterzik, Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy, Fertility and Sterility 77(4) (2002) 721-724.
[6] P. Bäumler, W. Zhang, T. Stübinger, D. Irnich, Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies, BMJ Open 11(9) (2021) e045961.
[7] C.M. Witt, D. Pach, B. Brinkhaus, K. Wruck, B. Tag, S. Mank, S.N. Willich, Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form, Forschende Komplementärmedizin 16(2) (2009) 91-97.
[8] H. MacPherson, A. Scullion, K.J. Thomas, S. Walters, Patient reports of adverse events associated with acupuncture treatment: a prospective national survey, Quality and Safety in Health Care 13(5) (2004) 349.
