College of Preschool Education, Beijing Youth Politics College, Beijing, 100102, China.
School of Acupuncture, Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China.
Chin J Integr Med. 2023 Nov;29(11):1021-1032. doi: 10.1007/s11655-023-3748-3. Epub 2023 Oct 10.
Currently, more and more infertility couples are opting for combined acupuncture to improve success rate of in vitro fertilization (IVF). However, evidence from acupuncture for improving IVF pregnancy outcomes remains a matter of debate.
To quantitatively summarized the evidence of the efficacy of acupuncture among women undergoing IVF by means of systematic review and meta-analysis.
Four English (PubMed, Web of Science, EMBASE, and Cochrane Register of Controlled Clinical Trials) and Four Chinese databases (Wanfang Databases, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and SinoMed) were searched from database inception until July 2, 2023. Randomized controlled trials (RCTs) that evaluated the acupuncture's effects for women undergoing IVF were included. The subgroup analysis was conducted with respect to the age of participants, different acupuncture types, type of control, acupuncture timing, geographical origin of the study, whether or not repeated IVF failure, and acupuncture sessions. Sensitivity analyses were predefifined to explore the robustness of results. The primary outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR), and the secondary outcomes were ongoing pregnancy rate and miscarriage rate. Random effects model with I statistics were used to quantify heterogeneity. Publication bias was estimated by funnel plots and Egger's tests.
A total of 58 eligible RCTs representing 10,968 women undergoing IVF for pregnant success were identifified. Pooled CPR and LBR showed a signifificant difference between acupuncture and control groups [69 comparisons, relative risk (RR) 1.19, 95% confifidence intervals (CI) 1.12 to 1.25, I=0], extremely low evidence; 23 comparisons, RR 1.11, 95%CI 1.02 to 1.21, I=14.6, low evidence, respectively). Only transcutaneous electrical acupoint stimulation showed a positive effect on both CPR (16 comparisons, RR 1.17, 95%CI 1.06 to 1.29; I=0, moderate evidence) and LBR (9 comparisons, RR 1.20, 95%CI 1.04 to 1.37; I=8.5, extremely low evidence). Heterogeneity across studies was found and no studies were graded as high-quality evidence.
Results showed that the convincing evidence levels on the associations between acupuncture and IVF pregnant outcomes were relatively low, and the varied methodological design and heterogeneity might inflfluence the fifindings. (Registration No. PROSPERO CRD42021232430).
目前，越来越多的不孕夫妇选择联合针灸来提高体外受精（IVF）的成功率。然而，针灸对改善 IVF 妊娠结局的证据仍存在争议。
通过系统评价和荟萃分析定量总结针灸对接受 IVF 治疗的女性的疗效证据。
检索了四个英文数据库（PubMed、Web of Science、EMBASE 和 Cochrane 对照临床试验登记册）和四个中文数据库（万方数据库、中国知网、中国科技期刊数据库和中国生物医学文献数据库），检索时间从数据库建立到 2023 年 7 月 2 日。纳入评估针灸对接受 IVF 治疗的女性影响的随机对照试验（RCT）。根据参与者的年龄、不同的针灸类型、对照类型、针灸时机、研究的地理来源、是否重复 IVF 失败以及针灸疗程进行亚组分析。预先定义敏感性分析以探索结果的稳健性。主要结局指标为临床妊娠率（CPR）和活产率（LBR），次要结局指标为持续妊娠率和流产率。采用 I ² 统计量的随机效应模型来量化异质性。使用漏斗图和 Egger 检验估计发表偏倚。
共纳入 58 项符合条件的 RCT，涉及 10968 名接受 IVF 治疗以实现妊娠的女性。CPR 和 LBR 的汇总结果显示，针灸组与对照组之间存在显著差异[69 项比较，相对风险（RR）1.19，95%置信区间（CI）1.12 至 1.25，I=0]，证据水平极低；23 项比较，RR 1.11，95%CI 1.02 至 1.21，I=14.6，低证据水平]。只有经皮电穴位刺激对 CPR（16 项比较，RR 1.17，95%CI 1.06 至 1.29；I=0，中等证据）和 LBR（9 项比较，RR 1.20，95%CI 1.04 至 1.37；I=8.5，极低证据）均显示出阳性影响。研究之间存在异质性，没有一项研究被评为高质量证据。
结果表明，针灸与 IVF 妊娠结局之间关联的证据水平相对较低，且不同的方法学设计和异质性可能会影响研究结果。（注册号：PROSPERO CRD42021232430）。
