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A systematic review did not show significant improvement in clinical pregnancy rate with acupuncture on the day of embryo transfer, 25 minutes before and after the transfer. It found a pooled benefit when performed 30 minutes after transfer and at implantation (RR 1.76, 95% CI 1.22–2.55; four trials) and also in the follicular phase and 25 minutes before and after transfer (RR 1.56, 95% CI 1.04–2.33; four tri- als) (11). In addition, there was a 3-fold increased rate of pregnancy (95% CI 0.8, 8.0) and lower stress (not significant [NS]) associated with acupuncture in an observational cohort study of 57 women (12).
While there were five RCTs that showed some benefit, seven RCTs showed no benefit to acupuncture (13–19). In a trial of 416 women less than 36 years of age undergoing IVF with ICSI, the treatment group received acupuncture 25 minutes before and after embryo transfer with a pregnancy rate of 40.4% compared with the control group without acupuncture of 32.3% (P1⁄4.652) (15). Four meta- analyses similarly found no difference between acupuncture and control patients (11, 20–22). In addition, a systematic review of eight studies (N1⁄42,505) in which acupuncture was performed on or around the day of embryo transfer showed no evidence that acupuncture improved live-birth rate in ART (OR1⁄41.22, 95% CI 0.87–1.70) (Fig. 1) (23).
Failure to demonstrate a difference in pregnancy rates with acupuncture could be a failure of the actual protocol tested rather than acupuncture itself. There may be some cir- cumstances where pregnancy rates are improved with acupuncture, but there is no consistent evidence that live- birth rates are improved with acupuncture. Overall, the trials
vary in design and have different findings, which make firm conclusions challenging.
Summary statement:
There is fair evidence that acupuncture performed around the time of embryo transfer does not improve live-birth rates in IVF. (Grade B)
Analgesics. Analgesics are occasionally recommended to help improve ART outcomes; however, there were no relevant studies identified through the literature search showing that the use of analgesics are associated with embryo transfer outcomes.
Summary statement:
There is insufficient evidence to recommend for or against analgesics to improve IVF-embryo transfer out- comes. (Grade C)
Anesthesia. In an uncontrolled preliminary study, IVF out- comes were compared for patients who did or did not receive general anesthesia for embryo transfer. In this preliminary analysis, anesthesia showed benefit on the pregnancy rate in patients who received sodium thiopentone and alfentanyl (36%; n1⁄486) vs matched controls who did not receive anes- thesia (21%; n1⁄4131). However, when these investigators sub- sequently analyzed their data for two larger cohorts: one (n1⁄4603 embryo transfers) without anesthesia before the anal- ysis, and a second group (n1⁄4795 embryo transfers) that received general anesthesia after the study, the pregnancy rate was 18% in the embryo transfers without anesthesia,
FIGURE 1
Comparison of live-birth rates in women who received acupuncture around the time of embryo transfer with controls (with or without sham acupuncture). (Used with permission from Cheong 2013, the Cochrane Collection (23).)
ASRM. Embryo transfer guideline. Fertil Steril 2017.
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