title: A systematic review and meta-analysis of acupuncture in in vitro fertilisation.
abstract: BACKGROUND
  Numerous randomised studies have reported pregnancy outcome in women who received acupuncture during their in vitro fertilisation (IVF) treatment cycle.
  
  
  OBJECTIVE
  The objective of this study was to conduct a systematic review with meta-analysis of the trials of acupuncture during IVF treatment on the outcomes of clinical pregnancy and live birth rates.
  
  
  METHODS
  Searches were conducted in MEDLINE, EMBASE, Cochrane Library, ISI Proceedings and SCISEARCH.
  
  
  METHODS
  All randomised controlled trials that evaluated the effects of acupuncture compared with no treatment or sham acupuncture in women undergoing IVF-intracytoplasmic sperm injection treatment were included.
  
  
  METHODS
  Study selection, quality appraisal and data extraction were performed independently and in duplicate. A sensitivity analysis was conducted where the meta-analysis was restricted to trials in which sham acupuncture was used in the control group. Meta-regression analysis was used to explore the association between study characteristics and pregnancy rates.
  
  
  RESULTS
  Thirteen relevant trials, including a total of 2500 women randomised to either acupuncture or control group, were identified. No evidence of publication bias was found (Begg's test, P = 0.50). Five trials (n = 877) evaluated IVF outcome when acupuncture was performed around the time of transvaginal oocyte retrieval, while eight trials (n = 1623) reported IVF outcome when acupuncture was performed around the time of embryo transfer (ET). Meta-analysis of the five studies of acupuncture around the time of egg collection did not show a significant difference in clinical pregnancy (relative risks [RR] = 1.06, 95% CI 0.82-1.37, P = 0.65). Meta-analysis of the eight studies of acupuncture around the time of ET showed no difference in the clinical pregnancy rate (RR = 1.23, 95% CI 0.96-1.58, P = 0.1). Live birth data were available from five of the eight studies of acupuncture around the time of ET. Meta-analysis of these studies did not show a significant increase in live birth rate with acupuncture (RR = 1.34, 95% CI 0.85-2.11). Using meta-regression, no significant association between any of the studied covariates and clinical pregnancy rate was found (P > 0.05 for all covariates).
  
  
  CONCLUSIONS
  Currently available literature does not provide sufficient evidence that adjuvant acupuncture improves IVF clinical pregnancy rate.
authors.affiliation: Assisted Conception Unit, Guy's and St Thomas' Hospital, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: El-Toukhy
authors.forename: S K
authors.initials: SK
authors.lastname: Sunkara
authors.forename: M
authors.initials: M
authors.lastname: Khairy
authors.forename: R
authors.initials: R
authors.lastname: Dyer
authors.forename: Y
authors.initials: Y
authors.lastname: Khalaf
authors.forename: A
authors.initials: A
authors.lastname: Coomarasamy
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D004624:Embryo Transfer / Q000379:methods; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D050498:Live Birth; D054315:Oocyte Retrieval / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic