Acupuncture has become, for many women, an accepted part of their infertility journey. Several studies, including a meta-analysis of 24 studies published in the journal Fertility Sterility in 2012, indicated higher pregnancy rates among women who had undergone acupuncture as part of their treatment protocol compared with women who had no acupuncture or a sham procedure. Any improvement in outcomes is welcome considering the emotional and financial drain of each cycle.
However, there are significant methodological problems many acupuncture studies, several of which were included in that 2012 meta-analysis. Unfortunately publication, even peer-reviewed publication, does not guarantee quality. An old professor of mine used to say the only reason someone didn’t get a study published was they didn’t have enough stamps. The equivalent today would be the only reason someone doesn’t get published was they didn’t hit send enough times. I’m all for open-access, the sheer number of bad studies that get out into the ether is frightening.
So, with that in mind two different groups have revisited acupuncture and assisted reproduction discarding studies that should never have been included (never mind published) in the first place. One is a Cochrane review (July 2013) that found 20 studies of sufficient quality to analyze and the other published in Fertility Sterility (June 2013) that felt 16 studies were worth reviewing. Two groups of investigators independently reviewing the literature and publishing in different sources reached the same conclusion, “There is no evidence that acupuncture improves live birth or pregnancy rates in assisted conception.”
What if acupuncture makes someone feel better, thereby reducing stress? Wouldn’t that be of value? Well, some studies do suggest (small studies, I might add) that women undergoing IVF who are getting acupuncture report score lower anxiety levels, however, how much that is a physiologic reaction to acupuncture and how much is the false belief that acupuncture is going to help is unknown. The small studies that look at acupuncture and stress reduction didn’t ask the participants if they believed the acupuncture would help them conceive or if they were told by their doctor acupuncture would help. I wonder what the effect of acupuncture would be on anxiety associated with assisted reproduction if participants were told the medical evidence suggests that acupuncture is no more effective than placebo and does not improve pregnancy rates?
I understand the stress of infertility therapies on a personal level and I understand the desperation to do everything. When acupuncture was offered to me in 2002 when I was pursuing assisted reproduction I declined. I read the few studies that were available at the time and they did not seem robust at all.
Acupuncture doesn’t seem to help with the desired outcome of pregnancy, so imbuing women with a false sense of hope seems the wrong way to go about reducing stress. There are wonderful mind-body techniques to lower anxiety and so infertility providers are better off steering patients to more evidence based (and less expensive) practices than jumping on the we-offer-acupuncture-so-come-to-our-clinic bandwagon.
Current medical evidence suggests acupuncture does not improve pregnancy rates. Offering it outside of a well-designed, prospective, large clinical trial seems unjustified and women seeking infertility therapy could probably use the money and hope they were planning to spend on acupuncture elsewhere.
Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.
