Traditional Chinese medicine patterns and recommended acupuncture points in infertile and fertile women

The Limitation of Randomized Control Trials on the Influence of Acupuncture and In Vitro Fertilization: A Literature Review

Objective: Acupuncture has gained popularity among patients undergoing in vitro fertilization (IVF). However, the beneficial effect of acupuncture for improving IVF success is controversial and debatable. Given that different meta-analyses have come to different conclusions, it is crucial to explore the clinical trials in more detail. This literature review examined the limitation of randomized controlled trials (RCTs) on the influence of acupuncture in IVF. Methods: This review began with 844 studies. The inclusion criteria were studies that had acupuncture treatments in conjunction with IVF. After exclusion criteria were applied, the final number of peer-reviewed studies was 10. Results: There were substantial variations in the results of the 10 RCTs. This seemed to suggest that acupuncture was not effective in conjunction with IVF treatment. However, limitations emerged that might explain these variations in results. Such limitations include timing of acupuncture and point selections; acupuncture not performed by experienced licensed acupuncturists; lack of Traditional Chinese Medicine diagnoses and fixed protocols causing biases; acupuncture dosages; and using sham acupuncture as a control. Conclusions: There is an urgent need for further research into the effectiveness of acupuncture for improving IVF outcomes. This review provides insight into this complex and controversial topic, revealing limitations of the clinical trials that led to different conclusions. If future research can examine acupuncture treatment carefully to resemble real-world clinical practice-having appropriate controls and individualized acupuncture treatments-increasingly positive effects from acupuncture in IVF may be expected.

Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial

IMPORTANCE

Acupuncture is used to induce ovulation in some women with polycystic ovary syndrome, without supporting clinical evidence.

OBJECTIVE

To assess whether active acupuncture, either alone or combined with clomiphene, increases the likelihood of live births among women with polycystic ovary syndrome.

DESIGN, SETTING, AND PARTICIPANTS

A double-blind (clomiphene vs placebo), single-blind (active vs control acupuncture) factorial trial was conducted at 21 sites (27 hospitals) in mainland China between July 6, 2012, and November 18, 2014, with 10 months of pregnancy follow-up until October 7, 2015. Chinese women with polycystic ovary syndrome were randomized in a 1:1:1:1 ratio to 4 groups.

INTERVENTIONS

Active or control acupuncture administered twice a week for 30 minutes per treatment and clomiphene or placebo administered for 5 days per cycle, for up to 4 cycles. The active acupuncture group received deep needle insertion with combined manual and low-frequency electrical stimulation; the control acupuncture group received superficial needle insertion, no manual stimulation, and mock electricity.

MAIN OUTCOMES AND MEASURES

The primary outcome was live birth. Secondary outcomes included adverse events.

RESULTS

Among the 1000 randomized women (mean [SD] age, 27.9 [3.3] years; mean [SD] body mass index, 24.2 [4.3]), 250 were randomized to each group; a total of 926 women (92.6%) completed the trial. Live births occurred in 69 of 235 women (29.4%) in the active acupuncture plus clomiphene group, 66 of 236 (28.0%) in the control acupuncture plus clomiphene group, 31 of 223 (13.9%) in the active acupuncture plus placebo group, and 39 of 232 (16.8%) in the control acupuncture plus placebo group. There was no significant interaction between active acupuncture and clomiphene (P = .39), so main effects were evaluated. The live birth rate was significantly higher in the women treated with clomiphene than with placebo (135 of 471 [28.7%] vs 70 of 455 [15.4%], respectively; difference, 13.3%; 95% CI, 8.0% to 18.5%) and not significantly different between women treated with active vs control acupuncture (100 of 458 [21.8%] vs 105 of 468 [22.4%], respectively; difference, -0.6%; 95% CI, -5.9% to 4.7%). Diarrhea and bruising were more common in patients receiving active acupuncture than control acupuncture (diarrhea: 25 of 500 [5.0%] vs 8 of 500 [1.6%], respectively; difference, 3.4%; 95% CI, 1.2% to 5.6%; bruising: 37 of 500 [7.4%] vs 9 of 500 [1.8%], respectively; difference, 5.6%; 95% CI, 3.0% to 8.2%).

CONCLUSIONS AND RELEVANCE

Among Chinese women with polycystic ovary syndrome, the use of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births. This finding does not support acupuncture as an infertility treatment in such women.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01573858.

Comparison of abdominal skin temperature between fertile and infertile women by infrared thermography: A diagnostic approach

This retrospective study aimed to evaluate the differences in abdominal temperature (AT) between fertile (n=206; age) and infertile (n=250) women between the ages of 30 and 39 years. We evaluated the differences in two distinctive skin temperatures by thermography: ΔT₁ (CV8 index) - difference in temperature between the mid-abdomen (CV8 acupuncture area) and ventral upper arm (VUA) and ΔT₂ (CV4 index) - difference in temperature between the lower abdomen (CV4 acupuncture area) and VUA. The results indicated that the ΔT₁ and ΔT₂ of infertile women were significantly lower (by 1.05°C and 0.79°C, respectively; p<0.001, both) compared to those of fertile women. Additionally, the area under the curve of ΔT₁ (0.78) was greater compared to that of ΔT₂ (0.736), and its threshold was set at 0.675°C, by which, the sensitivity and specificity of ΔT₁ for determination of fertility were found to be 80.8% and 68.4%, respectively. In conclusion, infertility is associated with lower AT. The decrease in AT in infertile women might be due to poor blood perfusion to the core muscles and tissues of the body. These findings provide a basis for further research for evaluation of clinical feasibility of thermography for analysis of infertility in women. Further evaluation of the influence of AT on fertility outcomes is required to determine the causal relationship between AT and infertility.

Closed-form fiducial confidence intervals for some functions of independent binomial parameters with comparisons

Approximate closed-form confidence intervals (CIs) for estimating the difference, relative risk, odds ratio, and linear combination of proportions are proposed. These CIs are developed using the fiducial approach and the modified normal-based approximation to the percentiles of a linear combination of independent random variables. These confidence intervals are easy to calculate as the computation requires only the percentiles of beta distributions. The proposed confidence intervals are compared with the popular score confidence intervals with respect to coverage probabilities and expected widths. Comparison studies indicate that the proposed confidence intervals are comparable with the corresponding score confidence intervals, and better in some cases, for all the problems considered. The methods are illustrated using several examples.

Designing clinical studies that take into account traditional East Asian medicine's systems and methods - with focus on pattern identification

This article is based on two presentations held at Chinese medicine conference in Rothenburg (2013), Germany and at the 19th Anniversary of Korean Institute of Oriental Medicine (KIOM) International Symposium of Current Research Trends in Traditional Medicine - Pattern of Identification (2013). In designing clinical studies, it is a research question that leads to appropriate study design. However, they are mostly diagnostic procedures and techniques that are the key points to reflect the application of systems and methods in all forms of medicine - traditional East Asian medicine (TEAM) is no exception. The challenges within TEAM based on research reflect in different systems of medicine/theories such as traditional Japanese acupuncture, traditional Korean acupuncture and traditional Chinese acupuncture. This diversity of medical systems and methods applied in East Asia seems to have been fruitful within the different countries and traditional medicines have found their places within the respective countries health systems. The existing diversity, from a clinician's point of view, may be viewed as a treasure when dealing with patients in the 'real world'. On the other hand, this diversity seems to challenge the scientific mind worldwide, especially when it comes to research. Hence, there is a gap between clinical practice and research.

Acupuncture in practice: investigating acupuncturists' approach to treating infantile colic

Infantile colic is common, but no safe and effective conventional treatment exists. The use of acupuncture has increased despite weak evidence. This practitioner survey explores and discusses how infantile colic is regarded and treated in Traditional Chinese Medicine (TCM). The study is based on personal communication with 24 acupuncturists from nine countries. These acupuncturists specialize in pediatric acupuncture and represent different styles of acupuncture. Their experiences are discussed and related to relevant books and articles. Informants claimed good results when treating infants with colic. The TCM patterns commonly described by informants matched the textbooks to a great extent. The most common syndromes were "stagnation of food" and "Spleen Qi Xu." Regarding treatment, some informants followed the teachers' and the textbook authors' advice on differentiated treatment according to syndrome. The points used most often were LI4, ST36, and Sifeng. Other informants treated all infants alike in one single point, LI4. The results demonstrate the diversity of TCM. The use of acupuncture for infantile colic presents an interesting option, but further research is needed in order to optimize the effects and protect infants from unnecessary or less effective treatment.