Effects of Acupuncture on the Outcome of in Vitro Fertilisation and Intracytoplasmic Sperm Injection in Women with Polycystic Ovarian Syndrome

Abstract

Background

Different mechanisms have been described for the effects of acupuncture on fertility. Acupuncture may mediate neurotransmitter release, which results in the stimulation of gonadotrophin-releasing hormone secretion. The production of neurotransmitters such as endogenous opioids may also inhibit central nervous system outflow and biological stress response. Acupuncture may also stimulate blood flow to the uterus by inhibiting uterine central sympathetic nerve activity. Despite some evidence suggesting beneficial effects of acupuncture on in vitro fertilisation (IVF) success rates, recent clinical trials could not duplicate these effects, especially in patients who are infertile with polycystic ovarian syndrome (PCOS) who are undergoing IVF.

Methods

A total of 62 women with PCOS undergoing IVF/intracytoplasmic sperm injection (ICSI) at Shayamehr IVF Clinic in Tehran (Iran) participated in a randomised, controlled trial. Participants were randomly allocated to one of two groups: there were 31 women each in the acupuncture (group I) and control groups (group II). Acupuncture based on traditional Chinese medicine was performed in group I versus no adjunctive treatment in group II. All acupuncture procedures were performed in five sessions: start of downregulation, start of stimulation, 2 days before ovum pick-up, and immediately before and after embryo transfer. We measured the rate of oocytes in metaphase II, the fertilisation rate and the quality of embryos.

Results

Our results showed a statistically higher mean of good quality embryos in group I compared with group II (p=0.044). However, the mean number of metaphase II oocytes retrieved and fertilisation rate were similar between the two groups. We also could not find any significant differences among clinical, biochemical or ongoing pregnancy rates.

Conclusions

Acupuncture at an early stage of oocyte recruitment may have a beneficial effect on embryo quality. However, it seems to have no significant effect on other IVF/ICSI outcomes of women with PCOS.

Trial Registration Number

(IRCT ID: 201011275181N4)

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References

El-Toukhy

, Sunkara

S.K.

, Khairy

A systematic review and meta-analysis of acupuncture in in vitro fertilization. BJOG 2008; 115: 1203–13.

Hayhoe

, Box

A questionnaire on medical acupuncture practice. Acupunct Med 1997; 15: 96–9.

Thomas

, Nicholl

, Coleman

Use and expenditure on complementary medicine in England: a population based survey. Complement Ther Med 2001; 9: 2–11.

Rayner

J.A.

, McLachlan

H.L.

, Forster

D.A.

Australian women's use of complementary and alternative medicines to enhance fertility: exploring the experiences of women and practitioners. BMC Complement Altern Med 2009; 9: 52.

Stener-Victorin

, Waldenstrom

, Andersson

S.A.

Reduction of blood flow impedance in uterine arteries of infertile women with electroacupuncture. Hum Reprod 1996; 11: 1314–17.

Kim

, Shin

, Na

Effect of acupuncture treatment on uterine motility and cyclooxygenase-2 expression in pregnant rates. Gynecol Obstet Invest 2000; 50: 225–30.

Lim

C.E.

, Wong

W.S.

Current evidence of acupuncture on polycystic ovarian syndrome. Gynecol Endocrinol 2010; 26: 473–8.

Semenova

I.I.

Adrenergic innervation of the ovaries in Stein-Leventhal syndrome. Vestn Akad Med Nauk SSSR (Abstract in English) 1969; 24: 58–62.

Heider

, Pedal

, Spanel-Borowski

Increase in nerve fibers andloss of mast cells in polycystic and postmenopausal ovaries. Fertil Steril 2001; 75: 1141–7.

10.

Brännström

, Löfman

, Mikuni

Morphological and vascular changes during ovulation in vivo in rat. Biol Reprod 1997; 56(Supp 1): 178 (Abstract).

11.

Zackrisson

, Mikuni

, Peterson

M.C.

Evidence for the involvement of blood flowrelated mechanisms in the ovulatory process of the rat. Hum Reprod 2000; 5: 264–72.

12.

Owman

, Stjernquist

Origin, distribution, and functional aspects of aminergic and peptidergic nerves in the male and female reproductive tracts. In: Björklund

, Hökfelt

, Owman

, eds. Handbook of chemical neuroanatomy volume 6: the peripheral nervous system. Amsterdam: Elsevier, 1988: 445–544.

13.

Stener-Victorin

, Jedel

, Manneras

Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence. J Neuroendocrinol 2008; 20: 290–8.

14.

Lanham

M.S.

, Lebovic

D.I.

, Domino

S.E.

Contemporary medical therapy for polycyctic ovary syndrome. Int J Gynecol Obstet 2006; 95: 236–41.

15.

Stener-Victorin

, Waldenstorm

, Lundeberg

Effects of electroacupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2000; 79: 180–8.

16.

Mayer

D.J.

, Price

D.D.

, Rafii

Antagonism of acupuncture analgesia in man by the narcotic antagonist naloxone. Brain Res 1977; 121: 368–72.

17.

Ferin

, Vande Wiele

Endogenous opioid peptides and the control of the menstrual cycle. Eur J Obstet Gynecol Reprod Biol 1984; 18: 365–73.

18.

Cabioğrlu

M.T.

, Cetin

B.E.

Acupuncture and immunomodulation. Am J Chin Med 2008; 36: 25–36.

19.

Stener-Victorin

, Wu

Effects and mechanisms of acupuncture in the reproductive system. Auton Neurosci 2010; 28: 46–51.

20.

Westergaard

L.G.

, Mao

, Krogslund

Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril 2006; 85: 1341–6.

21.

Paulus

W.E.

, Zhang

, Strehler

Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002; 77: 721–4.

22.

Dieterle

, Ying

, Hatzmann

Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril 2006; 85: 1347–51.

23.

Domar

A.D.

, Meshay

, Kelliher

The impact of acupuncture on in vitro fertilization outcome. Fertil Steril 2009; 91: 723–6.

24.

Smith

, Coyle

, Norman

R.J.

Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril 2006; 85: 1352–8.

25.

Andersen

, Lossl

, Andersen

A Nyboe

Acupuncture on the day of embryo transfer: a randomized controlled trial of 635 patients. Reprod Biomed Online 2010; 21: 366–72.

26.

Gerhard

, Postneek

Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol 1992; 6: 171–81.

27.

MacPherson

, Altman

, Hammerschlag

Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. Acupunct Med 2010; 28: 83–93.

28.

Stener-Victorin

, Wikland

, Waldenstorm

Alternative treatments in reproductive medicine: lack of evidence of an effect does not equal evidence of the lack of effect. Hum Reprod 2002; 17: 1942–6.

29.

Humaidan

, Stener-Victorin

Pain relief during oocyte retrieval with a new short term duration electroacupuncture technique—an alternative to conventional analgesic methods. Hum Reprod 2004; 19: 1367–72.

30.

Raja-Khan

, Stener-Victorin

, Wu

The physiological basis. Am J Physiol Endocrinol Metab online 2011; 301: 1–10.

31.

Cui

, Li

, Sun

Effect of electroacupuncture on oocyte quality and pregnancy for patients with PCOS undergoing invitrofertilization and embryo transfer. Zhongguo Zhen Jiu 2011; 31: 687–91.