The effects of acupuncture on the secondary outcomes of anxiety and quality of life for women undergoing IVF: A randomized controlled trial

Efficacy of acupuncture in animal models of various ovarian dysfunctions: a systematic review and meta-analysis

Objective

This study aims to assess the comprehensive and integrated modulatory effects of acupuncture and electroacupuncture on various ovarian dysfunctions.

Methods

We systematically searched for articles on animal experiments related to polycystic ovary syndrome (PCOS), premature ovarian failure (POF), premature ovarian insufficiency (POI), and perimenopausal syndrome (PMS) across multiple databases, including PubMed, Web of Science, Cochrane Library, Embase, and four Chinese language databases. The search covered the period from inception to November 2023. We conducted a comparative analysis between the acupuncture group and the model group (untreated) based on eligible literature. Our primary outcomes encompassed serum sex hormones (Luteinizing hormone, Follicle-stimulating hormone, Testosterone, Estradiol, Progesterone, and Anti-Müllerian hormone) and ovarian weight. Dichotomous data were synthesized to establish the relative risk (RR) of notable post-treatment improvement, while continuous data were pooled to determine the standardized mean difference (SMD) in post-treatment scores between the groups. Statistical analyses, including sensitivity analysis, Egger's test, and the trim-and-fill method, were executed using Stata 15.0 software.

Results

The meta-analysis encompassed 29 articles involving a total of 623 rats. In comparison to rat models of PCOS, the experimental group exhibited a reduction in serum levels of LH, T and LH/FSH ratio. However, no statistically significant differences were observed in AMH, FSH, E2 levels, and ovarian weight between the two groups. In the ovarian hypoplasia model rats, both acupuncture and electroacupuncture interventions were associated with an increase in E2 levels. However, the levels of LH and FSH did not exhibit a significant difference between the two groups.

Conclusions

Acupuncture or electroacupuncture facilitates the restoration of ovarian function primarily through the modulation of serum sex hormones, exerting regulatory effects across various types of ovarian dysfunction disorders.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022316279.

Effects and mechanisms of acupuncture on women related health

Globally, public health interventions have resulted in a 30-year increase in women's life expectancy. However, women's health has not increased when socioeconomic status is ignored. Women's health has become a major public health concern, for those women from developing countries are still struggling with infectious and labor-related diseases, and their counterparts in developed countries are suffering from physical and psychological disorders. In recent years, complementary and alternative medicine has attracted wide attentions with regards to maintaining women's health. Acupuncture, a crucial component of traditional Chinese medicine, has been used to treat many obstetric and gynecological diseases for thousands of years due to its analgesic and anti-inflammatory effects and its effects on stimulating the sympathetic/parasympathetic nervous system. To fully understand the mechanism through which acupuncture exerts its effects in these diseases would significantly extend the list of available interventions and would allow for more reasonable advice to be given to general practitioners. Therefore, by searching PubMed and CNKI regarding the use of acupuncture in treating obstetric and gynecological diseases, we aimed to summarize the proven evidence of using acupuncture in maintaining women's health by considering both its effectiveness and the underlying mechanisms behind its effects.

Acupuncture Treatment for Emotional Problems in Women with Infertility: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to evaluate the efficacy and safety of acupuncture in treating emotional problems in women with infertility. We searched for randomized controlled trials using acupuncture treatment for emotional problems in women with infertility using 11 databases from their inception to 30 June 2023. The control intervention included no treatment, sham acupuncture treatment, and conventional treatment. The primary outcome was emotion-related rating scales, and the secondary outcomes were total effectiveness rate, quality of life, clinical pregnancy rate, and adverse events. Twelve randomized controlled trials involving 1930 participants were included. A meta-analysis of these studies indicated that, as compared to the control treatment, acupuncture significantly improved the State-Trait Anxiety Inventory, Self-rating Anxiety Scale, Amsterdam Preoperative Anxiety and Information Scale, and Self-rating Depression Scale scores, which were the primary emotion-related outcomes. Furthermore, the meta-analysis demonstrated that acupuncture treatment had a significant effect on the clinical pregnancy rate, which was the secondary outcome. No adverse events were reported in any of the studies. Our findings demonstrate the potential of acupuncture for treating emotional problems in women with infertility. However, well-designed and high-quality randomized clinical trials are required to confirm the effectiveness and safety of acupuncture treatment. The protocol of the current study was registered in PROSPERO (registration number: CRD42020166119).

Effects of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

Acupuncture or similar needling therapy has long been used to improve well-being, but its effectiveness in management of chronic ankle instability (CAI) is unclear. To investigate the efficacy of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with CAI.

METHODS

Nine databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, WanFang, and CQVIP) were systematically searched from inception to April 2023. This study included randomized controlled trials involving acupuncture or similar needling therapy as an intervention for individuals with CAI. Data were extracted independently by two assessors using a standardized form. Literature quality and risk bias were assessed by using the PEDro scale.

RESULTS

Twelve trials (n = 571) were found, of which the final meta-analysis was conducted with eight. Different studies employ varying treatments, including specific needle types, techniques, and therapeutic frameworks. Compared to control without acupuncture or similar needling therapy, acupuncture or similar needling intervention resulted in improved pain (WMD 1.33, 95 % CI 0.14-2.52, I²=90 %, p = 0.03), proprioception (active joint position sense, WMD 1.71, 95 % CI 0.95-2.48, I²=0 %, p < 0.0001), balance (SMD 0.54, 95 % CI 0.03-1.04, I²=46 %, p = 0.04), and self-reported function (Cumberland Ankle Instability Tool (WMD 2.92, 95 % CI 0.94-4.90, I²=78 %, p = 0.004); American Orthopedic Foot and Ankle Society (WMD 9.36, 95 % CI 6.57-12.15, I²=0 %, p < 0.001); Foot and Ankle Ability Measure: activities of daily living (WMD 5.09, 95 % CI 1.74-8.44, I²=0 %, p = 0.003)) for individuals with CAI.

CONCLUSIONS

The available evidence suggests that acupuncture or similar needling therapy may improve pain, proprioception, balance, and self-reported function in individuals with CAI, but more trials are needed to verify these findings. Furthermore, various needles and techniques using in different studies have resulted in methodologic limitations that should be addressed in the future.

Infertility clinics and acupuncture: a qualitative web-based study

The increasing demand for fertility treatments has led to the rise of private clinics offering complementary and alternative medicine (CAM) treatments. The most frequently offered CAM infertility treatment is acupuncture. However, there is no good evidence to support the effectiveness of acupuncture in treating infertility. This study evaluates the scope of information provided by CAM fertility clinics in the UK. A content analysis was conducted on 200 websites of CAM fertility clinics in the UK that offer acupuncture as a treatment for infertility. Of the 48 clinics that met the eligibility criteria, the majority of the websites did not provide sufficient information on the efficacy, risks and success rates of acupuncture for infertility. This has the potential to infringe on patient autonomy, provide false hope and reduce the chances of pregnancy ever being achieved as fertility declines during the time course of ineffective acupuncture treatment.

Acupuncture Decreases Risk of Hypertension in Patients with Chronic Spontaneous Urticaria in Taiwan: A Nationwide Study

Patients with chronic spontaneous urticaria (CSU) have a higher risk of developing hypertension. This study aimed to determine whether acupuncture could decrease the risk of hypertension in patients with CSU. We enrolled patients newly diagnosed with CSU between 1 January 2008, and 31 December 2018, from the Taiwanese National Health Insurance Research Database. The claims data were assessed from the index date to 31 December 2019. A Cox regression model was used to compare the hazard ratios (HRs) of the two cohorts. The cumulative incidence of hypertension was estimated using the Kaplan-Meier method. After propensity score matching with a 1:1 ratio, 43,547 patients with CSU who received acupuncture were matched with 43,547 patients with CSU who did not receive acupuncture in this study. After considering potential confounding factors, patients who received acupuncture had a significantly lower risk of hypertension than those in the control group (adjusted hazard ratio = 0.56, 95% confidence interval = 0.54-0.58). Patients who received medications combined with acupuncture tended to have the lowest risk of hypertension. This study revealed that acupuncture decreases the risk of hypertension in patients with CSU in Taiwan. The detailed mechanisms can be further clarified through prospective studies.

Research progress on the impact of anxiety and depression on embryo transfer outcomes of in vitro fertilization

Infertile women who receive in vitro fertilization-embryo transfer (IVF-ET) often present psychological distress such as anxiety, depression and perceived stress. This adverse psychological state can affect the immune homeostasis at the mother-fetus interface, the incubation of blastula and the receptivity of the maternal endometrium through the psycho-neuro-immuno-endocrine network, which in turns affect the proliferation, invasion and vascular remodeling of the embryo trophoblast, and reduces the success rate of embryo transfer. This adverse outcome of embryo transfer will further aggravate the psychological pain of patients, forming a vicious circle. The positive partner effect between husband and wife or the use of cognitive behavioral therapy, acupuncture, yoga and other measures for psychological intervention before and after IVF-ET, may break the vicious cycle and improve clinical pregnancy rate, continuous pregnancy rate and live birth rate after IVF-ET by alleviating anxiety and depression. This article reviews the research progress on anxiety and depression states in women receiving IVF-ET and the impact on outcome of IVF-ET and related mechanisms, as well as the application of psychological intervention for alleviating anxiety and depression, so as to provide insights in improving the outcome of IVF-ET.

Electroacupuncture Reduces Anxiety Associated With Inflammatory Bowel Disease By Acting on Cannabinoid CB1 Receptors in the Ventral Hippocampus in Mice

The therapeutic effects of electroacupuncture (EA) on the comorbidity of visceral pain and anxiety in patients with inflammatory bowel disease (IBD) is well known. It has been known that the ventral hippocampus (vHPC) and the cannabinoid type 1 receptors (CB1R) are involved in regulating anxiety and pain. Therefore, in this study, we determined whether EA reduces visceral pain and IBD-induced anxiety via CB1R in the vHPC. We found that EA alleviated visceral hyperalgesia and anxiety in TNBS-treated IBD mice. EA reversed over-expression of CB1R in IBD mice and decreased the percentage of CB1R-expressed GABAergic neurons in the vHPC. Ablating CB1R of GABAergic neurons in the vHPC alleviated anxiety in TNBS-treated mice and mimicked the anxiolytic effect of EA. While ablating CB1R in glutamatergic neurons in the vHPC induced severe anxiety in wild type mice and inhibited the anxiolytic effect of EA. However, ablating CB1R in either GABAergic or glutamatergic neurons in the vHPC did not alter visceral pain. In conclusion, we found CB1R in both GABAergic neurons and glutamatergic neurons are involved in the inhibitory effect of EA on anxiety but not visceral pain in IBD mice. EA may exert anxiolytic effect via downregulating CB1R in GABAergic neurons and activating CB1R in glutamatergic neurons in the vHPC, thus reducing the release of glutamate and inhibiting the anxiety circuit related to vHPC. Thus, our study provides new information about the cellular and molecular mechanisms of the therapeutic effect of EA on anxiety induced by IBD.

Improving the health and treatment success rates of in vitro fertilization patients with traditional Chinese medicine: Need for more robust evidence and innovative approaches

Maximising access to and the success of fertility treatments should be a priority for global reproductive health, as should overall patient well-being. The demand for in vitro fertilization (IVF) and other assisted fertility treatments has increased over the past decade and is likely to further increase in years to come. Nevertheless, there is still considerable unmet demand for infertility support worldwide. Moreover, the high emotional, physical and financial burden experienced by individuals undergoing IVF cycles can be a risk for their mental and physical health, which in turn can influence treatment continuation and the likelihood of IVF success. Studies from various parts of the world show that most individuals undergoing IVF also use adjunct alternative medicines and procedures, the most common being traditional Chinese medicine (TCM). The complementary and synergistic role of TCM for individuals undergoing IVF is an area that merits further attention and research, both for its potential positive effects on IVF success rates and for its broader physical and mental health benefits. However, much of the existing evidence is not sufficiently robust or consistent for findings to be adopted with confidence. This commentary argues that much work must be done to understand the efficacy and clinical best practices for these integrated approaches. This can be achieved in part by developing more robust and clinically relevant randomized controlled trial protocols, collecting and triangulating evidence through a variety of study designs and methods, and strengthening the collection and pooling of clinic-level data.

IVF, acupuncture and mental health: a qualitative study of perceptions and experiences of women participating in a randomized controlled trial of acupuncture during IVF treatment

Infertility treatments such as in-vitro fertilization (IVF) are stressful and challenging to mental health and well-being. The use of alternative therapies adjunct to IVF treatment, such as acupuncture, is common and women hope to improve their chance of pregnancy and live birth. While many women engage in acupuncture adjunct to IVF in Australia, few qualitative studies of women's motivations and experiences have been conducted in this field. A qualitative study was nested within a randomized controlled trial of acupuncture during IVF treatment in order to explore women's perceptions of acupuncture, its effects in the context of IVF treatment, and how acupuncture is perceived in relation to the outcome of IVF. Fifty women randomized into both acupuncture and sham acupuncture groups were interviewed using a semi-structured format. In-depth interviews were transcribed, coded and categorized in a theoretical thematic analysis. Two primary themes emerged: 'psychological benefit' and 'perceived influence of acupuncture on fertility/medical outcome'. Regardless of randomization, women in both groups described similar psychological effects suggesting that a placebo effect was present. They were not convinced that acupuncture could enhance their treatment outcome through biomedical pathways. Rather, they perceived that acupuncture or sham acupuncture gave them a psychological advantage through increased relaxation, reduced psychological stress, and enhanced well-being and self-efficacy. In conclusion, there are significant features associated with a placebo effect in acupuncture that might be exploited to provide psychological benefit for women undertaking IVF.

A randomized pilot study of electro-acupuncture treatment for hysterosalpingography pain relief and related anxiety

Objective:

To investigate the effect of acupuncture on reducing pain and anxiety related to hysterosalpingography (HSG).

Materials and Methods:

A total of 107 patients planned to undergo HSG were randomly separated into 3 groups; the acupuncture group (n=36), intramuscular diclofenac sodium group (n=35), and control group (n=37). In the acupuncture group, electro-acupuncture was applied to specified points for 20 mins before the procedure. In the intramuscular diclofenac sodium group, an intramuscular injection of 75 mg diclofenac sodium was applied 30 mins before the procedure. No analgesics were administered to the patients in the control group before intervention. Pain was evaluated with a Visual Analog scale (VAS) and anxiety with the State-trait Anxiety inventory -state (STAI-S), preoperatively and at specified times postoperatively.

Results:

The VAS scores at 1 and 5 minutes after HSG were similar in acupuncture group and intramuscular diclofenac sodium group, and significantly lower than in the control group. At 30 mins postoperatively, there was no significant difference between the 3 groups in respect of the VAS scores. The STAI-S scores at 1 hour preoperatively were similar in all the groups (p=0.563). In the comparisons of the STAI-S values at preoperative 5 mins, following acupuncture in acupuncture group and the diclofenac injection in intramuscular diclofenac sodium group, and at postoperative 30 mins, the acupuncture group values were determined to be statistically significantly lower than those of the other groups (p<0.001, p<0.001).

Conclusion:

Acupuncture has similar effects on the reduction of pain as other analgesics and reduces anxiety. It can therefore be used in HSG in suitable clinics.

Safety and effectiveness of acupuncture for POSEIDON patients in IVF/ICSI: A protocol for systematic review and meta-analysis

INTRODUCTION

The purpose of this paper is to evaluate the efficacy and safety of acupuncture for POSEIDON patients undergoing IVF/ICSI.

METHODS

and analysis We will electronically search Pubmed, Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database and Wan-fang Database from their inception. Also, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and grey literature. The clinical randomized controlled trials or quasi randomized controlled trials related to acupuncture treatment for POSEIDON patients in IVF/ICSI will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by two researchers. Data were synthesized by using a fixed effect model or random effect model depend on the heterogeneity test. The clinical pregnancy rate (CPR) and live birth rate (LBR) will be the primary outcomes. The ongoing pregnancy, miscarriage rate (MR) and adverse events will also be assessed as secondary outcomes. RevMan V.5.3 statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals (CIs), while dichotomous data will be expressed in the form of relative risk with 95% CIs.

ETHICS AND DISSEMINATION

The protocol of this systematic review (SR) does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and presented at relevant conferences.

SYSTEMATIC REVIEW REGISTRATION

OSF Registries, DOI: 10.17605/OSF.IO/6WP2F (https://osf.io/6wp2f).

General Issues in Clinical Research of Acupuncture and In Vitro Fertilization

In vitro fertilization-embryo transfer (IVF-ET), a well-developed technology, provides the last possibility or hope for infertile women. However, the live birth rate per IVF cycle is still not satisfactory. Acupuncture is a frequently used adjunctive therapy drawing wide attention on improvement of IVF. Although so many randomized controlled trials have been evaluating the effect of acupuncture on IVF in the past 20 years, the exact efficacy of acupuncture on IVF is still controversy mainly because of no consensus on placebo control and acupuncture scheme. This paper focused on the general issues in clinical research of acupuncture and IVF and gave some suggestions for future directions.

The effect of acupuncture on the day of embryo transfer on the in vitro fertilization outcomes: An RCT

Background

Acupuncture is an adjunct therapy to support infertile women received in vitro fertilization (IVF) treatment; however, the efficacy of this approach needs more evaluation.

Objective

This randomized clinical trial (RCT) study aimed to evaluate the influence of acupuncture on reproductive outcomes in women undergoing IVF treatment.

Materials and Methods

The study was carried out on 186 participants who had undergone IVF treatment in the Mother and Child Hospital between September 2015 and February 2016. Subjects were randomly divided into three groups: Acupuncture 25 min before embryo transfer (ET) (ACU1 group, n = 62), acupuncture 25 min before and after ET (ACU2 group, n = 62), and ET without acupuncture (control group, n = 62). Pregnancy rates (biochemical, clinical, and ongoing) were evaluated and compared between groups.

Results

There were significant differences between the ACU1 group and the control group regarding biochemical (p = 0.005), clinical (p = 0.006), and ongoing (p = 0.007) pregnancies. Also, our results showed that two-session acupuncture (ACU2) lead to a significant reduction in frequency of biochemical (p = 0.002), clinical (p = 0.003), and ongoing (p = 0.01) pregnancy rates when compared to the one-session acupuncture (ACU1). No significant difference was found between the ACU2 and control groups regarding the aforementioned terms (p = 0.50).

Conclusion

Acupuncture 25 min before ET significantly increased the IVF outcomes in women undergoing IVF compared with no acupuncture. Repeating acupuncture 25 min after ET did not improve the IVF outcome.