It sounds far-fetched - sticking needles in women to help them become pregnant but a scientific review suggests that acupuncture might improve the odds of conceiving if done right before or after embryos are placed in the womb.
The surprising finding is far from proven, and there are only theories for how and why acupuncture might work. However, some fertility specialists say they are hopeful that this relatively inexpensive and simple treatment might ultimately prove to be a useful add-on to traditional methods.
"It is being taken more seriously across our specialty," and more doctors are training in it, said Dr. William Gibbons, who runs a fertility clinic in Baton Rouge, La., and is past president of the Society for Assisted Reproductive Technology. "I have not seen proof ... but we wouldn't mind at all" if it turned out to work, he said.
The analysis was led by Eric Manheimer, a researcher at the University of Maryland School of Medicine, and paid for by a federal agency, the National Center for Complementary and Alternative Medicine. Results were published Friday in the British medical journal, BMJ.
Acupuncture involves placing very thin needles at specific points on the body to try to control pain and reduce stress. In fertility treatment, it is thought to increase blood flow to the uterus, relax the cervix and inhibit "fight or flight" stress hormones that can make it tougher for an embryo to implant, Manheimer said.
The analysis pools results from seven studies on 1,366 women in the United States, Germany, Australia and Denmark who are having in vitro fertilization, or IVF. It involves mixing sperm and eggs in a lab dish to create embryos that are placed in the womb.
Women were randomly assigned to receive IVF alone, IVF with acupuncture within a day of embryo transfer, or IVF plus sham acupuncture, in which needles were placed too shallowly or in spots not thought to matter.
Individually, only three of the studies found acupuncture beneficial, three found a trend toward benefit and one found no benefit. When results of these smaller studies were pooled, researchers found that the odds of conceiving went up about 65 percent for women given acupuncture.
Experts warn against focusing on that number, because this type of analysis with pooled results is not proof that acupuncture helps at all, let alone by how much. IVF results in pregnancy about 35 percent of the time. Adding acupuncture might boost that to around 45 percent, the researchers said.
The authors include doctors from the Netherlands and Georgetown University in Washington, D.C. One is an acupuncturist but had no role in any studies that were analyzed.
The American Society for Reproductive Medicine has no policy on acupuncture. "There's been a lot of conflicting research" on its usefulness, said spokeswoman Eleanor Nicoll.
"It looks like, from the body of evidence out there, that some patients benefit," said Dr. James Grifo, head of the infertility program at New York University.
However, Dr. Zev Rosenwaks, director of infertility treatment at New York-Presbyterian Hospital/Weill Cornell Medical Center, said other studies, reported at recent medical meetings and not included in the published analysis, did not find it helped.
"The jury is still out," he said, but added, "It's unlikely that acupuncture does any harm."
Dr. Ann Trevino, a 37-year-old family physician who recently moved to Houston, is pregnant, and a believer. She had three unsuccessful pregnancy attempts with intrauterine insemination before trying acupuncture with IVF at a fertility clinic in San Antonio where she used to live.
"I had been reading about acupuncture, probably like every other patient on the Internet. I was just willing to do anything possible to improve our chances," she said. With acupuncture, "I just felt very warm and relaxed" when the embryos were placed.
Dr. Francisco Arredondo, who runs Reproductive Medicine Associates of Texas where Trevino was treated, said he started offering acupuncture in October, after patients requested it and because some studies suggested it helped.
Acupuncturist Kirsten Karchmer said she places about a dozen needles in the ears, hands, feet, lower legs, abdomen and sometimes the lower back. It costs $500 a month for treatments twice a week, and patients typically go for three months, she said.
IVF costs around $12,000 per attempt, so a treatment that improves its effectiveness might save money in the long run, Manheimer said.
(China Daily/Agencies February 8, 2008)