Table I.
Characteristics of included trials.
| Study, Country (reference) | na | Acupuncture | Control typeb |
|---|---|---|---|
| Andersen, Denmark (Andersen et al., 2010) | 635 | Two sessions: (1) 30 m before ET; (2) immediately after ET. [To maintain blinding, needles not manipulated to obtain de qi needling sensation]; (n = 314.) | Non-penetrating blunt needles, placed on the real acupoints [and not manipulated to achieve de qi sensation]; (n = 321) |
| Arnoldi, Italy (Arnoldi et al., 2010) | 204 | Three sessions: (1) d 5 of ovarian stimulation; (2) 30 m before ET; (3) immediately after ET. [Needles stimulated manually by rotating, lifting and thrusting the handle of the needle in order to maintain de qi sensation, both during initial insertion and after 10 m]; (n = 102.) | No adjuvant treatment (n = 102) |
| Craig, USA (Craig et al., 2007) | [113] | Two sessions, both at an off-site location: (1) within 1–2 h before ET; (2) within 1–2 h after ET. [Needles simulated manually at insertion, and then manually rotated after 10 m to maintain de qi]; (n = 57.) | No adjuvant treatment (n = 56) |
| Dieterle, Germany (Dieterle et al., 2006) | 225 | Two sessions: (1) immediately after ET; (2) 3 days after ET. Needles rotated at the start and after 15 m, to evoke de qi (n = 116) | Needle acupuncture, with needles inserted in real acupoints not expected to influence fertility (n = 109)c |
| Domar, USA (Domar et al., 2009) | 150 | Two sessions: (1) 25 m before ET; (2) immediately after ET (n = 78)d | No adjuvant treatment (n = 68) |
| Feliciani, Italy (Feliciani et al., 2011) | 46 | Three sessions: (1) 5–7 d before egg retrieval; (2) 2–3 d before oocyte retrieval; (3) within 1 h after ET. [Needles manipulated to obtain de qi]; (n = 23.) | No adjuvant treatment (n = 23) |
| Fratterelli, USA (Fratterelli et al., 2008) | 397 | Two sessions: (1) 25 m before ET; (2) after ET (n = 200)d | No adjuvant treatment (n = 197)e |
| Madaschi, Brazil (Madaschi et al., 2010) | [455]f | Two sessions: (1) 25 m before ET; (2) immediately after ET. Needles manipulated until de qi sensation obtained (n = 230) | No adjuvant treatment (n = 225) |
| Moy, USA (Moy et al., 2011) | 161 | Two sessions: (1) 25 m before ET; (2) immediately after ET. [Needles rotated to obtain de qi sensation]; (n = 87.) | Needle acupuncture, with body acupuncture insertion sites close to, but not on, the real acupoints, with same manipulation of needles, as performed in true acupuncture group (n = 74) |
| Omodei, Italy (Omodei et al., 2010) | 168 | Two sessions: (1) 25 m before ET; (2) immediately after ET (n = 44)d | No adjuvant treatment (n = 124) |
| Paulus, Germany (Paulus et al., 2002) | 160 | Two sessions: (1) 25 m before ET; (2) immediately after ET. Needles rotated at the start and after 10 m, to evoke de qi (n = 80) | No adjuvant treatment (n = 80) |
| Paulus, Germany (Paulus et al., 2003) | 200 | Two sessions: (1) 25 m before ET; (2) immediately after ET. Needles rotated after 10 m to evoke de qi (n = 100) | Non-penetrating blunt needles, placed on the real acupoints (n = 100)c |
| Smith, Australia (Smith et al., 2006) | 228 | Three sessions: (1) d 9 of stimulating injections; (2) 25 m before ET; (3) immediately after ET. [Needles manually stimulated to obtain de qi sensation]; (n = 110.) | Non-penetrating blunt needles, placed close to, but not on, the real acupoints, with the sham needles manipulated by lifting and thrusting the handle of the needles and running a fingernail along the handle, but de qi not sought (n = 118) |
| So, Hong Kong/China (So et al., 2009) | 370 | Two sessions: (1) 25 m before ET; (2) immediately after ET. Needles stimulated manually by rotating, lifting and thrusting the handle of the needle in order to maintain de qi sensation, both during initial insertion and after 10 m (n = 185) | Non-penetrating blunt needles, placed on the real acupoints, and manipulated in the same way as the true acupuncture needles to give patients a pricking, penetrating sensation (n = 185) |
| So, Hong Kong/China (So et al., 2010) | 226 | One session immediately after ET. Needles stimulated manually by rotating, lifting and thrusting the handle of the needle in order to maintain de qi sensation, both during initial insertion and after 10 m (n = 113) | Non-penetrating blunt needles, placed on the real acupoints, and manipulated in the same way as the true acupuncture needles to give patients a pricking, penetrating sensation (n = 113) |
| Westergaard, Denmark (Westergaard et al., 2006) | 300 | Acupuncture group 1: (1) 25 m before ET; (2) immediately after ET (n = 100); Acupuncture group 2: (1) 25 m before ET; (2) immediately after ET; (3) 2 d after ET. Needles rotated at the start and after 10 m, to evoke de qi (n = 100)g | No adjuvant treatment (n = 100) |
Additional data obtained from RCT authors are enclosed in brackets to allow such data to be differentiated from the data included only in the publications. Acupoints, Acupuncture points; d, day; ET, embryo transfer; h, hour; m, minute.
aNumber randomized.
bFor all sham-controlled trials, the sham acupuncture procedure was given on the same schedule as that used for the true acupuncture group.
cThese two trials did not report whether the sham needles were manipulated in the same way as the true acupuncture needles.
dThese three trials did not report whether or not the needles used in the true acupuncture group were manipulated to achieve the de qi sensation.
eWe excluded from our meta-analysis the following three additional control groups included in this trial: laser acupuncture, sham laser acupuncture and relaxation.
fThe 39 participants (22 acupuncture; 17 control) who did not proceed to embryo transfer were excluded from the trial authors' analysis. The approach for our meta-analysis was to re-include these participants [i.e. acupuncture group = 230 (i.e. 208 + 22) and the no acupuncture group = 225 (i.e. 208 + 17)], because it could be assumed that these participants without an embryo transfer did not achieve the clinical pregnancy outcome.
gFor this trial, acupuncture groups 1 and 2 were combined together for the meta-analysis.