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Wang Y, Shen X, Hu YF, Sodders R. The Limitation of Randomized Control Trials on the Influence of Acupuncture and In Vitro Fertilization: A Literature Review. Med Acupunct 2022; 34:24-33. [PMID: 35251435 PMCID: PMC8886925 DOI: 10.1089/acu.2021.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
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.
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Affiliation(s)
- Yuhsi Wang
- Five Branches University, School of Traditional Chinese Medicine, Santa Cruz, CA, USA
| | - Xiaoxiong Shen
- Five Branches University, School of Traditional Chinese Medicine, Santa Cruz, CA, USA.,Address correspondence to: Xiaoxiong Shen, PhD, LAc, 1328 West Artesia Boulevard, Gardena, CA 90248, USA
| | - Yue-Fen Hu
- Five Branches University, School of Traditional Chinese Medicine, Santa Cruz, CA, USA
| | - Robyn Sodders
- Five Branches University, School of Traditional Chinese Medicine, Santa Cruz, CA, USA
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Wu XK, Stener-Victorin E, Kuang HY, Ma HL, Gao JS, Xie LZ, Hou LH, Hu ZX, Shao XG, Ge J, Zhang JF, Xue HY, Xu XF, Liang RN, Ma HX, Yang HW, Li WL, Huang DM, Sun Y, Hao CF, Du SM, Yang ZW, Wang X, Yan Y, Chen XH, Fu P, Ding CF, Gao YQ, Zhou ZM, Wang CC, Wu TX, Liu JP, Ng EHY, Legro RS, Zhang H. Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial. JAMA 2017; 317:2502-2514. [PMID: 28655015 PMCID: PMC5815063 DOI: 10.1001/jama.2017.7217] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Xiao-Ke Wu
- Committee of Reproductive Medicine, World Federation of Chinese Medicine Societies, Beijing, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Elisabet Stener-Victorin
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Hong-Ying Kuang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Hong-Li Ma
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jing-Shu Gao
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Liang-Zhen Xie
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Li-Hui Hou
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Zhen-Xing Hu
- Outpatient Department, Xuzhou Maternal and Children’s Hospital, Xuzhou, China
| | - Xiao-Guang Shao
- Centre for Reproductive Medicine, Dalian Maternal and Children’s Centre, Dalian, China
| | - Jun Ge
- Department of Infertility, Tanggu District Maternal and Children’s Hospital, Tianjin, China
| | - Jin-Feng Zhang
- Department of Obstetrics and Gynecology, Shanxi Province Hospital of Chinese Medicine, Taiyuan, China
| | - Hui-Ying Xue
- Centre for Reproductive Medicine, Huaian Maternal and Children’s Hospital, Huaian, China
| | - Xiao-Feng Xu
- Department of Gynecology, Suzhou City Hospital of Chinese Medicine, Suzhou, China
| | - Rui-Ning Liang
- Department of Gynecology, Second Hospital, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Hong-Xia Ma
- Department of Chinese Medicine, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hong-Wei Yang
- Department of Infertility, Liwan District Hospital of Chinese Medicine, Guangzhou, China
| | - Wei-Li Li
- Department of Obstetrics and Gynecology, Affiliated Hospital, Anhui University of Chinese Medicine, Hefei, China
| | - Dong-Mei Huang
- Institute of Integrated Traditional and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Sun
- Department of Gynecology, Wenzhou City Hospital of Chinese Medicine, Wenzhou, China
| | - Cui-Fang Hao
- Centre for Reproductive Medicine, Yuhuangding Hospital, Yantai, China
| | - Shao-Min Du
- Department of Obstetrics and Gynecology, Daqing Longnan Hospital, Daqing, China
| | - Zheng-Wang Yang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Hunan University of Chinese Medicine, Changsha, China
| | - Xin Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Liaoning University of Chinese Medicine, Shenyang, China
| | - Ying Yan
- Department of Gynecology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiu-Hua Chen
- Department of Traditional Technology, Guangdong Province Hospital of Chinese Medicine, Guangzhou, China
| | - Ping Fu
- Department of Gynecology, Hangzhou City Hospital of Chinese Medicine, Hangzhou, China
| | - Cai-Fei Ding
- Centre for Reproductive Medicine, Zhejiang Province Hospital of Integrative Medicine, Hangzhou, China
| | - Ya-Qin Gao
- Centre for Reproductive Medicine, Daqing Oilfield General Hospital, Daqing, China
| | - Zhong-Ming Zhou
- Department of Obstetrics and Gynecology, Hubei Province Hospital of Chinese Medicine, Wuhan, China
| | - Chi Chiu Wang
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tai-Xiang Wu
- Chinese Clinical Trial Registry, Shenzhen, China
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ernest H. Y. Ng
- Department of Obstetrics and Gynecology, The University of Hong Kong, Hong Kong, China
| | - Richard S. Legro
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
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Alraek T. Designing clinical studies that take into account traditional East Asian medicine's systems and methods - with focus on pattern identification. Chin J Integr Med 2014; 20:332-5. [PMID: 24788085 DOI: 10.1007/s11655-014-1807-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Terje Alraek
- National Research Center in Complementary and Alternative Medicine, NAFKAM should be in brackets i.e. (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT the Arctic University of Norway, 9037, Tromsø, Norway,
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