Introduction
Methods
Search strategy
Study selection
Data extraction
Quality assessment
Outcome measures
Statistical analysis
Subgroup analyses
Publication bias
Sensitivity analyses
Results
Study | Country | Main objective | Acupuncture location | No. randomised | Acupuncture sessions | Acupuncture type | De qi sensation | Controla | IVF outcomes |
---|---|---|---|---|---|---|---|---|---|
Andersen 2010 [65] | Denmark | IVF outcome | On-site | 635 | Two sessions: (1) 30 m before ET; (2) immediately after ET (n = 314) | MA | Yes | The Streitberger placebo needlesb placed on the same acupoints which the true acupuncture used (n = 321) | BPR、CPR、OPR、LBR、MR、IR |
Arnoldi 2010 [18] | Italy | IVF outcome | On-site | 204 | Three sessions: (1) d 5 of ovarian stimulation; (2) 30 m before ET; (3) immediately after ET (n = 102) | MA | Yes | No adjuvant treatment (n = 102) | CPR、LBR、MR、IR |
Craig 2014 [59] | USA | IVF outcome | Off-site | 113 | Two sessions: (1) within 1–2 h before ET; (2) within 1–2 h after ET (n = 57) | MA | Yes | No adjuvant treatment (n = 56) | BPR、CPR、LBR、MR |
Dieterle 2006 [15] | Germany | IVF outcome | On-site | 225 | Two sessions: (1) immediately after ET; (2) 3 days after ET (n = 116) | MA | Yes | Needles inserted in real acupoints which were designed not to influence fertility (n = 109) | BPR、CPR、OPR、LBR、MR、IR |
Domar 2009 [29] | USA | IVF outcome | On-site | 150 | Two sessions: (1) 25 m before ET; (2) immediately after ET (n = 78)d | MA | Unclear | No adjuvant treatment (n = 68)d | BPR、CPR |
Feliciani 2011 [62] | Italy | IVF outcome | On-site | 46 | Three sessions: (1) 5–7d before OA; (2) 2–3 d before OA; (3) within 1 h after ET (n = 23) | MA | Yes | No adjuvant treatment (n = 23) | CPR、OPR、LBR、MR、IR |
Gillerman 2016 [58] | UK | IVF outcome | On-site | 127 | Three sessions: (1) between days 6 and 8 of ovarian stimulation; (2) before egg retrieval; (3) before and after embryo transfer (n = 67) | MA | Yes | No adjuvant treatment (n = 60) | CPR |
Ho 2009 [17] | Taiwan | IVF outcome | On-site | 56 | Four sessions: twice a week for 2 weeks, from d2 to the day before oocyte retrieval (n = 30) | EA | Yes | No adjuvant treatment (n = 26)j | CPR |
Humaidan 2004 [69] | Denmark | Pain-relieving effect | On-site | 200 | One session: a few minutes before OA and terminated directly after OA (n = 75) | EA | No | Alfentanil + PCB (n = 100) | BPR、CPR |
Villahermosa 2012 [20] | Brazil | anxiety-relieving efffects | On-site | 43 | Four sessions: once a week over a 4-week period, comprised the whole IVF process from induction of ovulation to the result of β-human chorionic gonadotrophin, the last treatment was given after embryo transfer (n = 22) | MA | Yes | Needles inserted in the sites which close to but not on (n = 21) | CPR |
Villahermosa 2013 [21] | Brazil | IVF outcome | On-site | 84 | Four sessions: (1)D1 (first day of ovulation induction); (2)D7 (seventh day of ovulation induction); (3)on the day before the day of ovarian puncture; (4)on the day after the day of embryo transfer (n = 28) | MA | Yes | Needles inserted in the arm and thigh, which are known not to correspond with classically described acupuncture points (n = 46) | BPR、CPR |
Madaschi 2010 [64] | Brazil | IVF outcome | On-site | 455g | Two sessions: (1) 25 m before ET; (2) immediately after ET (n = 230) | MA | Yes | No adjuvant treatment (n = 225) | CPR、LBR、MR、IR |
Morin 2017 [59] | USA | IVF outcome | On-site | 424 | Two sessions: (1) 25 m before ET; (2) after ET (n = 210)e | MA | Unclear | No adjuvant treatment (n = 210)f | BPR、CPR、OPR、LBR、MR、IR |
Moy 2011 [61] | USA | IVF outcome | On-site | 161 | Two sessions: (1) 25 m before ET; (2) immediately after ET (n = 87) | MA | Yes | Needles inserted in the sites which close to, but not on, the real acupoints (n = 74) | BPR、CPR |
Omodei 2010 [19] | Italy | IVF outcome | On-site | 168h | Two sessions: (1) 25 m before ET; (2) immediately after ET (n = 44)h | MA | Unclear | No adjuvant treatment (n = 124)h | CPR、OPR、LBR、MR |
Paulus 2002 [14] | Germany | IVF outcome | On-site | 160 | Two sessions: (1) 25 m before ET; (2) immediately after ET (n = 80) | MA | Yes | No adjuvant treatment (n = 80) | CPR、OPR、LBR、MR |
Paulus 2003 [71] | Germany | IVF outcome | On-site | 200 | Two sessions: (1) 25 m before ET; (2) immediately after ET (n = 100) | MA | Yes | The Streitberger placebo needlesb placed on the same acupoints which the true acupuncture used (n = 100) | CPR、OPR、LBR、MR |
Peyvandi 2016 [22] | Iran | IVF and FET outcomes | On-site | 164 | Three sessions: (1)oocyte puncture day; (2)2 days after puncture; (3)one cycle before embryo transfer (n = 82) | EA | No | No adjuvant treatment (n = 82) | BPR、CPR、OPR |
Rashidi 2013 [60] | Iran | IVF outcome | On-site | 62 | Five sessions: (1)30 m on the 21st day of the previous cycle (start of downregulation); (2) the first day of stimulation; (3)2 days before OPU; (4) 30 m before ET; (5) immediately after ET (n = 31) | EA | Yes | No adjuvant treatment (n = 31) | BPR、CPR、OPR |
Sator-K 2006 [68] | Australia | Pain-relieving effect | On-site | 94 | One session:30 m before OA and lasted until 1 h after OA (n = 64)i | EA/MA | No | PCA + an adhesive tape over the whole ear connected to the P-Stim™ without electrical stimulation (n = 30) | CPR |
Smith 2006 [67] | Australia | IVF outcome | On-site | 228 | Three sessions: (1) d9 of stimulating injections; (2)25 m before ET; (3) immediately after ET (n = 110) | MA | Yes | The Streitberger placebo needlesb placed close to but not on the real acupuncture points (n = 118) | CPR、OPR |
Smith 2018 [56] | Australia and New Zealand | IVF outcome | On-site at the IVF centers or nearby | 848 | Three sessions: (1) between d6 and d8 of ovarian stimulation; (2) 1 h before ET; (3) immediately after ET (n = 424)k | MA | Yes | Park sham needlesc placed away from known acupuncture points (n = 424)k | |
So 2009 [66] | Hong Kong | IVF outcome | On-site | 370 | Two sessions: (1) 25 m before ET; (2) immediately after ET (n = 185) | MA | Yes | The Streitberger placebo needlesb placed on the same acupoints which the true acupuncture used to give patients a pricking, penetrating sensation (n = 185) | BPR、CPR、OPR、LBR、MR、IR |
So 2010 [63] | Hong Kong | FET outcome | On-site | 226 | One session: immediately after ET (n = 113) | MA | Yes | The Streitberger placebo needlesb placed on the same acupoints which the true acupuncture used to give patients a pricking, penetrating sensation (n = 113) | BPR、CPR、OPR、LBR、MR、IR |
Stener-Victorin 1999 [72] | Sweden | Pain-relieving effect | On-site | 150 | One session: 30 m before OA and terminated directly after OA (n = 75) | EA | Yes | Alfentanil + PCB (n = 75) | CPR、LBR、MR、IR |
Stener-Victorin 2003 [70] | Sweden | IVF outcome | On-site | 286 | One session: 30 m before OA and terminated directly after OA (n = 141) | EA | Yes | Alfentanil + PCB (n = 145) | CPR、OPR、IR |
Westergaard 2006 [16] | Denmark | IVF outcome | On-site | 300 | Acupuncture group 1:Two sessions: (1)25 m before ET; (2)immediatelyafter ET (n = 100); Acupuncture group 2: Three sessions: (1) 25 m before ET; (2)immediately after ET; (3) 2 d after ET (n = 100)i | MA | Yes | No adjuvant treatment (n = 100) | BPR、CPR、OPR、LBR、MR、IR |
Inclusion criteria
Acupuncture interventions
Controls
IVF outcomes
Methodological quality of the studies
Effects of interventions
Subgroup analysis
Study | Age (years) | Duration of infertility (years) | Repeated IVF cycles(%) | No. of embryos transferred | Primary infertility(%) | No. of acupuncture sessions | Acupuncture type | Control |
---|---|---|---|---|---|---|---|---|
Andersen 2010 [65] | 31.0 | 2.5 | 42.4% | 1.39 | 71% | 1 | MA | SC |
Arnoldi 2010 [18] | 100% | 2.10 | 2 | MA | NC | |||
Craig 2014 [59] | 33.1 | 2.10 | 1 | MA | NC | |||
Dieterle 2006 [15] | 34.9 | 5.4 | 83.6%a | 2.60 | 80% | 2 | MA | SC |
Domar 2009 [29] | 36.1 | 2.51 | 1 | MA | NC | |||
Feliciani 2011 [62] | 34.9 | 1.84 | 3 | MA | NC | |||
Gillerman 2016 [58] | 3 | MA | NC | |||||
Ho 2009 [17] | 35.0 | 3.56 | 4 | EA | NC | |||
Humaidan 2004 [69] | 31.0 | 1 | EA | NC | ||||
Madaschi 2010 [64] | 35.0 | 2.15 | 1 | MA | NC | |||
Morin 2017 [59] | 34.5 | 2.57 | 1 | MA | NC | |||
Moy 2011 [61] | 33.2 | 2.15 | 63% | 1 | MA | SC | ||
Omodei 2010 [19] | 35.7 | 2.05 | 1 | MA | NC | |||
Paulus 2002 [14] | 32.5 | 2.15 | 1 | MA | NC | |||
Paulus 2003 [71] | 32.6 | 1 | MA | SC | ||||
Peyvandi 2016 [22] | 3 | EA | NC | |||||
Rashidi 2013 [60] | 31.6 | 9.3 | 2.55 | 76% | 4 | EA | NC | |
Sator-K 2006 [68] | 33.8 | 77.7% | 1 | EA/MA | SC | |||
Smith 2006 [67] | 36.0 | 2.9 | 52.2% | 76% | 2 | MA | SC | |
Smith 2018 [56] | 35.4 | 70% | 1.32 | 74% | 2 | MA | SC | |
So 2009 [66] | 36.0 | 4.0 | 30.5% | 1.89 | 61% | 1 | MA | SC |
So 2010 [63] | 36.0 | 5.0 | 1.93 | 38% | 1 | MA | SC | |
Stener-Victorin 1999 [72] | 33.4 | 60.4% | 2.03 | 1 | EA | NC | ||
Stener-Victorin 2003 [70] | 32.9 | 47.8% | 1.92 | 1 | EA | NC | ||
Villahermosa 2012 [20] | 34.2 | 4.0 | 4 | MA | SC | |||
Villahermosa 2013 [21] | 36.2 | 4.5 | 100% | 2.13 | 82% | 4 | MA | SC/OCb |
Westergaard 2006 [16] | 37.0 | 3.7 | 73.6% | 2.07 | 42% | 1/2c | MA | NC |
Characteristic | Subgroup analyses | Meta-regression | |||||||
---|---|---|---|---|---|---|---|---|---|
No. of subjects | No. of studies | Random-effects RR (95% CI) | Heterogeneity | Coefficient | p-value | I2resid | Adj R2 | ||
I2 |
P
| ||||||||
Clinical pregnancy
| |||||||||
Age | |||||||||
< 33.3 years | 1800 | 8 | 0.96 (0.82, 1.13) | 42.1% | 0.097 | 0.045 | 0.270 | 60.38% | 0.71% |
≥ 33.3 years | 3821 | 16 | 1.27 (1.08, 1.50) | 62% | < 0.005 | ||||
Duration of infertility | |||||||||
< 5. 6 years | 2103 | 8 | 1.27 (0.95, 1.71) | 77.6% | < 0.001 | 0.072 | 0.523 | 76.70% | −5.06% |
≥ 5. 6 years | 62 | 1 | 1.60 (0.59, 4.35) | / | / | ||||
Percentage of primary infertility | |||||||||
< 50% | 518 | 2 | 1.11 (0.59, 2.10) | 82.7% | 0.016 | 1.252 | 0.203 | 71.19% | 2.77% |
≥ 50% | 2588 | 8 | 1.18 (0.92, 1.52) | 73.7% | < 0.001 | ||||
Percentage of repeated IVF cycle | |||||||||
< 50% | 1279 | 3 | 0.86 (0.75, 1.00) | 0% | 0.63 | 1.59 | < 0.001 | 0% | 100% |
≥ 50% | 2099 | 8 | 1.60 (1.28, 2.00) | 39% | 0.12 | ||||
No. of embryos transferred | |||||||||
< 1.9 | 1875 | 4 | 0.96 (0.79, 1.16) | 46% | 0.14 | 0.219 | 0.305 | 65.92% | 0.79% |
≥ 1.9 | 3186 | 16 | 1.24 (1.03, 1.49) | 67.3% | < 0.001 | ||||
Type of acupunture invention | |||||||||
Electroacupuncture | 958 | 7 | 1.30 (0.96, 1.75) | 56.5% | 0.032 | 0.066 | 0.713 | 65.29% | −6.38% |
Manual acupuncture | 5187 | 21 | 1.21 (1.04, 1.40) | 67.8% | < 0.001 | ||||
No. of acupuncture treatments | |||||||||
one session | 3962 | 16 | 1.06 (0.92, 1.21) | 61.1% | 0.001 | 0.248 | 0.002 | 48.40% | 51.90% |
≥ two sessions | 2055 | 12 | 1.60 (1.32, 1.92) | 24.9% | 0.199 | ||||
Type of control group | |||||||||
Sham or placebo acupuncture control | 3060 | 11 | 1.14 (0.94, 1.39) | 66.6% | 0.001 | −0.109 | 0.466 | 62.34% | −0.25% |
No acupuncture invention control | 3084 | 17 | 1.28 (1.08 1.52) | 60.3% | 0.001 | ||||
Live birth
| |||||||||
Age | |||||||||
< 33.3 years | 895 | 3 | 0.96 (0.59, 1.58) | 77% | 0.013 | 0.026 | 0.693 | 68.74% | −13.18% |
≥ 33.3 years | 3179 | 10 | 1.18 (0.96, 1.45) | 63% | 0.003 | ||||
Duration of infertility | |||||||||
< 5. 6 years | 1748 | 5 | 1.03 (0.76, 1.40) | 71.6% | 0.007 | 0.157 | 0.712 | 75.35% | −20.26% |
≥ 5. 6 years | / | / | / | / | / | ||||
Percentage of primary infertility | |||||||||
< 50% | 518 | 2 | 1.07 (0.62, 1.83) | 69.7% | 0.069 | 0.497 | 0.658 | 71.40% | −43.04% |
≥ 50% | 2054 | 4 | 1.00 (0.74, 1.36) | 71.7% | 0.014 | ||||
Percentage of repeated IVF cycle | |||||||||
< 50% | 1005 | 2 | 0.81 (0.67, 1.01) | 0% | 0.673 | 1.256 | 0.046 | 32.78% | 87.90% |
≥ 50% | 1688 | 5 | 1.42 (1.05, 1.92) | 45% | 0.12 | ||||
No. of embryos transferred | |||||||||
< 1.9 | 1865 | 4 | 0.87 (0.74, 1.02) | 0% | 0.604 | 0.386 | 0.163 | 62.55% | 7.83% |
≥ 1.9 | 2397 | 10 | 1. 27 (1.00, 1.62) | 66.0% | 0.002 | ||||
Type of acupunture invention | |||||||||
Electroacupuncture | 149 | 1 | 1.90 (1.05, 3.42) | / | / | 0.534 | 0.226 | 61.92% | 9.04% |
Manual acupuncture | 4323 | 14 | 1.11 (0.93, 1.31) | 62.0% | 0.001 | ||||
No. of acupuncture treatments | |||||||||
one session | 3080 | 11 | 1.13 (0.92, 1.39) | 70.4% | < 0.001 | 0.099 | 0.654 | 64.01% | −7.71% |
≥ two sessions | 1485 | 5 | 1.22 (0.93, 1.60) | 23.2% | 0.266 | ||||
Type of control group | |||||||||
Sham or placebo acupuncture control | 2480 | 6 | 1.01 (0.80, 1.27) | 63.8% | 0.017 | −0.213 | 0.274 | 60.40% | 7.21% |
No acupuncture invention control | 1992 | 9 | 1.26 (0.99, 1.60) | 58.3% | 0.014 |