Mark Henderson, Science Editor in Barcelona
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Infertile women who spend hundreds of pounds on acupuncture during IVF treatment are doing nothing to improve their chances of having a baby, the most extensive review of the evidence yet conducted has found.
Acupuncture has no effect at all on pregnancy rates following IVF, according to a study that has examined all the high-quality trials to investigate its use by fertility clinics.
The findings, from a team at Guy's and St Thomas's Hospital in London, will dismay thousands of infertility patients, among whom acupuncture has become the most popular complementary therapy.
While no official figures on its use are kept, demand is so great that several fertility clinics, such as Hammersmith Hospital in London, have set up on-site acupuncture services for their patients. Costs vary, but the Hammersmith unit charges £240 for an “IVF package” of four acupuncture sessions.
The new research, led by Sesh Sunkara, is a meta-analysis, in which the results of many high-quality randomised controlled trials are pooled to provide a more complete picture of a medical procedure's effectiveness.
She said that while she had been open-minded about acupuncture before starting the investigation, she felt that she could not recommend it to patients.
“If women come to me and ask if they should have acupuncture, I have to say there is no evidence that it helps,” she told the European Society of Human Reproduction and Embryology conference in Barcelona. “Women are investing hope, energy and time in something that has not shown a definite benefit.
“The reason we chose to do this was that in our IVF clinic, every day we have patients who ask whether they should have acupuncture to improve their success rate. There have been all sorts of papers saying that sticking pins and needles increases the pregnancy rate, which have been widely reported in the media, and we are looking at women who are very vulnerable, who want to do everything possible to increase their pregnancy chances.
“We wanted to look at this in an unbiased, open-minded way, to help us advise our patients. We wanted to know whether we should be doing acupuncture routinely and setting up a service in our clinic, or whether we should be advising people that there is no evidence that it works.”
In the study, Dr Sunkara identified 83 trials in the medical literature, of which 13 were found to be of suitable quality to be included in the meta-analysis. The others were rejected either because they were commentary articles that did not include data, or because they were inappropriately designed.
Pregnancy rate and live birth rate were the only outcomes considered, and the results showed that acupuncture had no effect on either, whether it was used during embryo transfer or for pain relief while eggs were collected.
The research contradicts a similar meta-analysis that was published in the British Medical Journal in February, which suggested that acupuncture can improve pregnancy rates by as much as 65 per cent if performed when embryos are transferred to the womb.
Scientists behind the new work said that the BMJ study had overlooked a number of good studies that reached negative conclusions. Professor Peter Braude, who supervised the Guy's and St Thomas' team, said: “The BMJ paper didn't include all the studies, and if you include the negative ones there is no effect. We can't turn around and say it does not work, but there is no evidence it does and hand on heart we can't come out and recommend it.”
Dr Sunkara said that more large randomised clinical trials of acupuncture in IVF were needed to settle the issue.
Paul Robin, the chairman of the Acupuncture Society, said: “I'm really surprised by these findings. I've been treating people for 20 years and in my experience treatment does seem to improve their chances of becoming pregnant. This study has shown that there's no proof that acupuncture can help - so that suggests that there should be lots more studies to examine the question. I'm convinced it can help.”
Other studies that have claimed a benefit for acupuncture have hypothesised that it helps with relaxation during embryo transfer, which may boost the chances of a successful implantation and pregnancy. It has also been suggested that the therapy may increase blood flow to the womb.
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