N. M. Khorram et al. / Open Journal of Obstetrics and Gynecology 2 (2012) 283-286 285
endorphin secretion [14]. At the time of embryo transfer
uterine contraction frequency is increased [15], and acu-
puncture has been shown to reduce uterine contractions
[16] and thereby increase pregnancy rates [17]. The re-
duction of uterine contractions might be another potential
mechanism for reduction of miscarriage rates found in
our study. In a systematic online review and meta-ana-
lysis of seven trials involving 1366 women undergoing
IVF and IVF in conjunction with acupuncture treatments
on day of embryo transfer [18] an increase in clinical
pregnancy (odds ratio 1.65, 95% confidence interval 1.27
to 2.14; number needed to treat (NNT) 10 (7 to 17);
seven trials), ongoing pregnancy (1.87, 1.40 to 2.49;
NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to
2.64; NNT 9 (6 to 17); four trials) was reported. While
the miscarriage rates were not specified, live birth rates
were determined to be higher in the acupuncture group.
Stener et al. [19] also reported a higher take home baby
rate per embryo transfer in the acupuncture group (41%
versus 19.4%, P < 0.05). The miscarriage rate in this
study was determined to be non-significantly lower in
the acupuncture group, (10.7% vs 31.6%). Magarelli et
al. [20] found statistically lower ectopic pregnancy rates
in the acupuncture group (P ≤ 0.05) with no differences
in implantation and fertilization rates or number of
oocytes retrieved. Stener-Victorin et al. [19] also showed
a significantly higher implantation rate per embryo
transfer (27.2% vs 16.3%, P < 0.05) in the acupuncture
group. The reason for the lower number of oocytes
retrieved in the acupuncture group in our study is
unknown. If acupuncture increases blood flow to the
ovary we would have expected to retrieve higher number
of oocytes in the acupuncture group. The reported dif-
ferences in outcomes in the various acupuncture studies
are related to heterogeneity of the patients studied, the
timing and manner of acupuncture administered. To con-
trol for these variables multi-center randomized pro-
spective trials using the same protocols will be needed to
address the beneficial or lack of effect of acupuncture as
an adjunct to IVF/ICSI. The effects of acupuncture on
uterine blood flow, contractions and correlation with
stress level will need to be assessed in such trials.
5. ACKNOWLEDGEMENTS
The authors thank Ms. Hye Jin Park for manuscript preparation.
REFERENCES
[1] Dieterle, S., Ying, G., Hatzmann, W. and Neuer, A. (2006)
Effect of acupuncture on the outcome of in vitro fertiliza-
tion and intracytoplasmic sperm injection: A randomized,
prospective, controlled clinical study. Fertility Sterility,
85, 1347-1351. doi:10.1016/j.fertnstert.2006.01.008
[2] Westergaard, L.G., Mao, Q., Krogslund, M., Sandrini, S.,
Lenz, S. and Grinsted, J. (2006) Acupuncture on the day
of embryo transfer significantly improves the reproduc-
tive outcome of infertile women: A prospective, random-
ized trial. Fertility and Sterility, 85, 1341-1346.
doi:10.1016/j.fertnstert.2005.08.070
[3] Anderson, B.J., Haimovici, F., Ginsburg, E.S., Schust,
D.J. and Wayne, P.M. (2007) In vitro fertilization and
acupuncture: Clinical efficacy and mechanistic basis. Al-
ternative Therapeutic Health Medicine, 13, 38-48.
[4] Paulus, W.E., Zhang, M., Strehler, E., El-Danasouri, I.
and Sterzik, K. (2002) Influence of acupuncture on the
pregnancy rate in patients who undergo assisted repro-
duction therapy. Fertility and Sterility, 77, 721-724.
doi:10.1016/S0015-0282(01)03273-3
[5] White, A.R. (2003) A review of controlled trials of acu-
puncture for women’s reproductive health care. Journal
of Family Planning and Reproductive Health Care, 29,
233-236. doi:10.1783/147118903101197863
[6] Magarelli, P.C. and Cridenda, D.K. (2004) Acupuncture
and IVF poor responders a cure? Fertility and Sterility, 81,
S20. doi:10.1016/j.fertnstert.2004.02.045
[7] Magarelli, P.C., Cridenda, D.K. and Cohen, M. (2004)
Acupuncture and good prognosis IVF patients: Synergy.
Fertility and Sterility, 82, S80-S81.
doi:10.1016/j.fertnstert.2004.07.205
[8] Wang, W., Check, J.H., Liss, J.R. and Choe, J.K. (2007) A
matched, controlled study to evaluate the efficacy of
acupuncture for improving pregnancy rates following in
vitro fertilization-embryo transfer. Clinics Experimental
Obstetetrics & Gynecology, 34, 137-138.
[9] Csemiczky, G., Landgren, B.M. and Collins, A. (2000)
The influence of stress and state anxiety on the outcome
of IVF-treatment: Psychological and endocrinological
assessment of Swedish women entering IVF-treatment.
Acta Obstetrics & Gynecology Scandinivia, 79, 113-118.
doi:10.1034/j.1600-0412.2000.079002113.x
[10] Repromed (2007) Pregnancy rates.
http://www.repromed.com.au/question5.html
[11] Middlekauff, H.R. (2004) Acupuncture in the treatment of
heart failure. Cardiology Review, 12, 171-173.
doi:10.1097/01.crd.0000103650.71735.f0
[12] Ernst, E. and White, A.R. (2001) Prospective studies of
the safety of acupuncture: A systematic review. American
Journal of Medicine, 110, 481-485.
doi:10.1016/S0002-9343(01)00651-9
[13] Chan, C.H., Ng, E.H., Chan, C.L., Ho and Chan, T.H.
(2006) Effectiveness of psychosocial group intervention
for reducing anxiety in women undergoing in vitro fer-
tilization: A randomized controlled study. Fertility and
Sterility, 85, 339-346.
doi:10.1016/j.fertnstert.2005.07.1310
[14] Dong, J.T. (1993) Research on the reduction of anxiety
and depression with acupuncture. American Journal of
Acupuncture, 21, 327-330.
[15] Ayoubi, J.M., Epiney, M., Brioschi, P.A., Fanchin, R.,
Chardonnens, D. and de Ziegler, D. (2003) Comparison
of changes in uterine contraction frequency after ovula-
tion in the menstrual cycle and in in vitro fertilization cy-
cles. Fertility and Sterility, 79, 1101-1105.
Copyright © 2012 SciRes. OPEN ACCESS