The British Fertility Society has issued new guidelines in the journal Human Fertility on the use of acupuncture and Chinese herbal medicine in fertility treatment. The guidelines found that there is currently no evidence that having acupuncture or Chinese herbal medicine treatment around the time of assisted conception increases the likelihood of subsequent pregnancy.
To determine the effectiveness of acupuncture and Chinese herbal medicine, the guideline authors carried out a thorough review of all published randomised controlled trials that looked at the effectiveness of acupuncture when carried out in conjunction with fertility treatment. They found there are no published randomised controlled trials on the effectiveness of using Chinese herbal medicine in conjunction with fertility treatment and therefore the guidelines conclude there is currently no evidence to support the use of this in fertility treatments.
For studies on the effect of acupuncture, 14 trials (a total of 2670 subjects) were included in the meta-analysis. These trials were split into three categories depending on the time when acupuncture was administered: a) around the time of egg removal; b) on the day of embryo transfer; c) on the day of embryo transfer and again 2-3 days later. The authors examined the effect of acupuncture treatment on the live birth rate, clinical pregnancy rate and the miscarriage rate compared to controls. No matter at which point in the process acupuncture was given, there was no significant difference in the live birth rate, clinical pregnancy rate or miscarriage rate between patients that had received acupuncture and those that had not. The guidelines conclude there is no evidence of benefit or harm to patients from receiving acupuncture around the time of assisted conception.
The guidelines also comment that there is a great deal of variability in the clinical design of studies examining acupuncture effectiveness, in particular in the type of control they employed, the specific acupuncture point studied, the timing of the acupuncture treatment and whether they controlled for the placebo effect. There is as yet no consensus regarding what constitutes a good placebo in trials examining the effects of acupuncture. Any further studies should attempt to explore the potential placebo as well as treatment effect of this complimentary therapy, as it could be that the added time and attention given to the patient as a result of receiving the treatment induces relaxation, which may affect outcomes.
Prof Adam Balen, Chair of the British Fertility Society’s Policy and Practice Committee, said:
“The British Fertility Society wants to ensure that all women receive the safest treatment when undergoing fertility procedures, while also maximising their chances that the treatment will be successful. Before any treatment can be accepted into mainstream medicine and used on patients, it is essential that it has been tested in randomised controlled trials to ensure that it does actually work and does not cause any harmful side-effects.
“Following a thorough analysis of the evidence, the British Fertility Society concludes that there is currently no evidence that acupuncture or Chinese herbal medicine, when used in conjunction with assisted fertility treatment, have any beneficial effect on live birth rate, pregnancy rate or miscarriage rate. Patients should be made aware of this fact before commencing treatment.
“Furthermore, in the studies included in this analysis, there is a great deal of discrepancy in the experimental design and the acupuncture technique used. Any future randomised controlled trials in this area need to ensure that they use a standardised acupuncture method, have a large sample size and include adequate controls to account for any placebo effects.”
One in seven couples in Western countries has difficulty conceiving and many will seek medical help in the form of assisted reproductive technologies, which result in the birth of more than 10,000 children each year in the UK. Traditional Chinese medicine, especially in the form of acupuncture and herbal medicine, is widely used to treat many common conditions and has been explored in assisted reproduction.
In its original form, the use of acupuncture and Chinese herbal remedies was based on the principles of traditional Chinese medicine, which is a 3000-year old holistic system. Traditional Chinese medicine combines medicinal herbs, acupuncture, food therapy, massage and therapeutic exercise for both treatment and prevention of disease. Traditional Chinese medicine drug treatment consists typically of complex prescriptions of a combination of several components and follows a completely different rationale to many conventional treatments. Herbal medicine is the most important part of traditional Chinese medicine. Acupuncture involves the insertion of fine needles into the skin along the meridians and provides a means of altering the flow of energy through the body. In a typical treatment, between four to ten points are needled for 10-30 minutes. Needles can be stimulated by manual twirling or with a small electric current (electro-acupuncture).
Notes for editors
The guidelines will be published in full in the journal Human Fertility 2010 DOI: 10.3109/14647270903438830. (Human Fertility website:http://informahealthcare.com/huf). Human Fertility is the official journal of the British Fertility Society.