Table 1.
Characteristics of the studies included in this review
| 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 |
Note:Acupoints Acupuncture points, OA oocyte aspiration, ET embryo transfer, COH controlled ovarian hyperstimulation, MA manual acupuncture, EA electro acupuncture, d day, h hour, m minute, BPR biochemical pregnancy rate, CPR clinical pregnancy rate, OPR ongoing pregnancy rate, LBR live birth rate, MR miscarriage rate
aFor all sham-controlled trials, the sham acupuncture procedure was given on the same schedule as that used for the true acupuncture group
bThe tip of the Streitberger placebo needle is blunted, skin penetration did not occur
cPark sham needle has a retractable needle shaft and a blunt tip
dThe treatment assignment and the outcomes for 4/150 randomized participants were not recorded by the trial authors
eThere are two invention groups in the trial:needle acupuncture (AC) and laser acupuncture (LZ AC),and our meta-analysis only included the AC group
fThere are three control groups in the trial:sham laser acupuncture (LZ sham), relaxation (RX) and no treatment (NT),and our meta-analysis only included the NT group
gThe 39 participants (22 acupuncture; 17 control) who did not proceed to embryo transfer were excluded from the trial authors’ analysis (Manheimer, et al., 2013). Our meta-analysis was to re-include these participants and assumed the these participants failure to achieve the clinical pregnancy outcome
hThe number of each group were not available from the publishing information, but other review reported it (Manheimer, et al., 2013)
iThere are two intervention arms in the trial, and we combined them together for the meta-analysis
j8/26 patients in the control group excluded from the study (cancel to participate further after randomization)
k9/424 in acupuncture group and 15/424 in control group excluded from analysis (withdrawal consent for data to be used)