Cochrane S, Smith CA, Possamai-Inesedy A, Bensoussan A. Acupuncture and women's health: An overview of the role of acupuncture and its clinical management in women's reproductive health. Int J Women's Health. 2014;6: 313-25.
BACKGROUND: Acupuncture and other modalities of Chinese/East Asian medicine have been used to treat women's health for many centuries. Gynecology specialties focus particularly on menstrual and reproductive disorders. Both the adoption of the use of acupuncture outside Asia, and the incorporation of scientific analysis in Asia have challenged biomedical conceptions of what can be achieved with this treatment method. The scale of research activity in relation to acupuncture and women's health has increased over the last 20 years.
OBJECTIVE: This review aims to explore the research evidence in relation to acupuncture use for women's reproductive disorders, focusing on both clinical findings and experimental research on acupuncture's mechanisms of action in relation to women's health.
METHOD: A narrative literature search was undertaken using searches of electronic databases and manual searches of journals and textbooks. The search included all literature published prior to June 2013. The literature was assessed as to the nature of the study it was reporting and findings synthesized into a commentary.
RESULTS: For acupuncture's mechanism of action the search resulted in 114 relevant documents; in relation to clinical reports on the use of acupuncture for women's health 204 documents were found and assessed.
CONCLUSION: There is preliminary data indicating acupuncture may improve menstrual health and coping for women experiencing delays falling pregnant. There is experimental data showing that acupuncture can influence female reproductive functioning, although the actual mechanisms involved are not yet clarified. Further well-conducted clinical research would benefit our understanding of the usefulness of acupuncture to women's health.
Zhou K,Wu J, Liu Z. Electroacupuncture modulates reproductive hormone levels in patients with primary ovarian insufficiency: Results from a prospective observational study.Evid Based Complement Altern Med. 2013;2013:657234.
OBJECTIVE: To investigate the effects of electroacupuncture (EA) on serum FSH, E2, and LH levels, women with primary ovarian insufficiency (POI) were treated with EA once a day, five times a week for the first four weeks and once every other day, three times a week, for the following two months, and then were followed up for three months.
METHOD: Serum E2, FSH, and LH levels were measured at baseline, at the end of treatment, and during followup. A total of 11 women with POI were included in this prospective consecutive case series study.
RESULTS: Compared with baseline, patients' serum E2 increased, FSH decreased, and LH decreased (P = 0.002, 0.001, and 0.002, resp.) after EA treatment, and these effects persisted during followup.
With treatment, 10 patients resumed menstruation (10/11, 90.91%), whereas one patient remained amenorrhea. During followup, two patients, including the one with amenorrhea during treatment, reported absence of menstruation. Temporary pain occurred occasionally, and no other adverse events were found during treatment.
CONCLUSION: The results suggest that EA could decrease serum FSH and LH levels and increase serum E2 level in women with POI with little or no side effects; however, further randomized control trials are needed.
Ernst E, Lee MS, Choi TY. Acupuncture in obstetrics and gynecology: An overview of systematic reviews. Am J Chin Med. 2011;39(3): 423-31.
OBJECTIVE: Acupuncture is often recommended for obstetrical and gynecological conditions but the evidence is confusing. We aim to summarize all recent systematic reviews in this area.
METHOD: Western and Asian electronic databases were searched for systematic reviews of any type of acupuncture for any type of gynecological conditions. Our own files were hand-searched. Systematic reviews of any type of acupuncture for any type of gynecological conditions were included. Non-systematic reviews and systematic reviews published before 2004 were excluded. No language restrictions were applied. Data were extracted according to predefined criteria and analysed narratively.
RESULTS: Twenty-four systematic reviews were included. They relate to a wide range of gynecological conditions: hot flashes, conception, dysmenorrhea, premenstrual syndrome, nausea/vomiting, breech presentation, back pain during pregnancy, and procedural pain.
CONCLUSION: Nine systematic reviews arrived with clearly positive conclusions; however, there were many contradictions and caveats. The evidence for acupuncture as a treatment of obstetrical and gynaecological conditions remains limited.
Tan L, Tong Y, Sze SC, Xu M, Shi Y, Song XY, Zhang TT. Chinese herbal medicine for infertility with anovulation: A systematic review. J Altern Complement Med. 2012;18(12): 1087-1100.
OBJECTIVE: The aim of this systematic review is to assess the effectiveness and safety of Chinese herbal medicine (CHM) in treatment of anovulation and infertility in women.
METHOD: Eight (8) databases were extensively retrieved. The Chinese electronic databases included VIP Information, CMCC, and CNKI. The English electronic databases included AMED, CINAHL, Cochrane Library, Embase, and MEDLINE(®). Randomized controlled trials using CHM as intervention were included in the study selection. The quality of studies was assessed by the Jadad scale and the criteria referred to Cochrane reviewers' handbook. The efficacy of CHM treatment for infertility with anovulation was evaluated by meta-analysis.
RESULTS: There were 692 articles retrieved according to the search strategy, and 1659 participants were involved in the 15 studies that satisfied the selection criteria. All the included trials were done in China. Meta-analysis indicated that CHM significantly increased the pregnancy rate (odds ratio [OR] 3.12, 95% confidence interval [CI] 2.50-3.88) and reduced the miscarriage rate (OR 0.2, 95% CI 0.10-0.41) compared to clomiphene. In addition, CHM also increased the ovulation rate (OR 1.55, 95% CI 1.06-2.25) and improved the cervical mucus score (OR 3.82, 95% CI 1.78-8.21) compared to clomiphene, while there were no significant difference between CHM and clomiphene combined with other medicine.
CONCLUSION: CHM is effective in treating infertility with anovulation. Also, no significant adverse effects were identified for the use of CHM from the studies included in this review. However, owing to the low quality of the studies investigated, more randomized controlled trials are needed before evidence-based recommendation regarding the effectiveness and safety of CHM in the management of infertility with anovulation can be provided.
Ried K, Stuart K. Efficacy of traditional Chinese herbal medicine in the management of female infertility: A systematic review. Complement Ther Med. 2011;19(6): 319-31.
OBJECTIVE: To assess the effect of Traditional Chinese Herbal Medicine (CHM) in the management of female infertility and on pregnancy rates compared with Western Medical (WM) treatment.
METHOD: We searched the Medline and Cochrane databases and Google Scholar until February 2010 for abstracts in English of studies investigating infertility, menstrual health and Traditional Chinese Medicine (TCM). We undertook meta-analyses of (non-)randomised controlled trials (RCTs) or cohort studies, and compared clinical pregnancy rates achieved with CHM versus WM drug treatment or in vitro fertilisation (IVF). In addition, we collated common TCM pattern diagnosis in infertility in relation to the quality of the menstrual cycle and associated symptoms.
RESULTS: Eight RCTs, 13 cohort studies, 3 case series and 6 case studies involving 1851 women with infertility were included in the systematic review. Meta-analysis of RCTs suggested a 3.5 greater likelihood of achieving a pregnancy with CHM therapy over a 4-month period compared with WM drug therapy alone (odds ratio=3.5, 95% CI: 2.3, 5.2, p<0.0001, n=1005). Mean (SD) pregnancy rates were 60 ± 12.5% for CHM compared with 32 ± 10% using WM drug therapy. Meta-analysis of selected cohort studies (n=616 women) suggested a mean clinical pregnancy rate of 50% using CHM compared with IVF (30%) (p<0.0001).
CONCLUSION: Our review suggests that management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to TCM diagnosis, appears to be fundamental to successful treatment of female infertility.
Stener-Victorin E, Kobayashi R, Kurosawa M. Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats. Autonom Neurosc. 2003;108: 50-55.
OBJECTIVE: The purpose of the present study was to investigate changes in ovarian blood flow (OBF) in response to electro-acupuncture (EA) stimulation at different frequencies and intensities in anaesthetized rats.
METHOD: Whether the ovarian sympathetic nerves were involved in OBF responses was elucidated by severance of the ovarian sympathetic nerves. In addition, how changes in the systemic circulation affected OBF was evaluated by continuously recording blood pressure. OBF was measured on the surface of the left ovary using laser Doppler flowmeter. Acupuncture needles with a diameter of 0.3 mm were inserted bilaterally into the abdominal and the hindlimb muscles and connected to an electrical stimulator. Two frequencies-2 Hz (low) and 80 Hz (high)-with three different intensities-1.5, 3, and 6 mA-were applied for 35 s.
RESULTS: Both low- and high-frequency EA at 1.5 mA and high-frequency EA at 3 mA had no effect on OBF or mean arterial blood pressure (MAP). Low-frequency EA at 3 and 6 mA elicited significant increases in OBF. In contrast, high-frequency EA with an intensity of 6 mA evoked significant decreases in OBF, followed by decreases in MAP. After severance of the ovarian sympathetic nerves, the increases in the OBF responses to low-frequency EA at 3 and 6 mA were totally abolished, and the responses at 6 mA showed a tendency to decrease, probably because of concomitant decreases in MAP. The decreased OBF and MAP responses to high-frequency EA at 6 mA remained after the ovarian sympathectomy, and the difference in the responses before and after ovarian sympathectomy was nonsignificant.
CONCLUSION: In conclusion, the present study showed that low-frequency EA stimulation increases OBF as a reflex response via the ovarian sympathetic nerves, whereas high-frequency EA stimulation decreases OBF as a passive response following systemic circulatory changes.
Dieterle S, Chunfang L, Greb R, Bartzsch F, Hatzmann W, Huang D. A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. Fertil Steril. 2009;92(4): 1340-43.
In this first prospective, randomized, single-blind, placebo-controlled study, 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A-C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.
Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, Sterzik K. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertil Steril. 2005;84(1): 141-47.
OBJECTIVE: To evaluate the ultra-morphologic sperm features of idiopathic infertile men after acupuncture therapy.
METHOD: Prospective controlled study. Forty men with idiopathic oligospermia, asthenospermia, or teratozoospermia. Twenty eight of the patients received acupuncture twice a week over a period of 5 weeks. The samples from the treatment group were randomized with semen samples from the 12 men in the untreated control group. Quantitative analysis by transmission electron microscopy (TEM) was used to evaluate the samples, using the mathematical formula based on submicroscopic characteristics.
RESULTS: Statistical evaluation of the TEM data showed a statistically significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects in the total ejaculates. A statistically significant improvement was detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. However, specific sperm pathologies in the form of apoptosis, immaturity, and necrosis showed no statistically significant changes between the control and treatment groups before and after treatment.
CONCLUSION: The treatment of idiopathic male infertility could benefit from employing acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture, although we did not identify specific sperm pathologies that could be particularly sensitive to this therapy.
Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Androlog. 2000;32(1): 31-39.
OBJECTIVE: Classic therapies are usually ineffective in the treatment of patients with very poor sperm density. The aim of this study was to determine the effect of acupuncture on these males.
METHOD: Semen samples of 20 patients with a history of azoospermia were examined by light microscope (LM) and scanning electron microscope (SEM), with which a microsearch for spermatozoa was carried out. These examinations were performed before and 1 month after acupuncture treatment and revealed that the study group originally contained three severely oligoteratoasthenozoospermic (OTA), two pseudoazoospermic and 15 azoospermic patients. The control group was comprised of 20 untreated males who underwent two semen examinations within a period of 2-4 months and had initial andrological profiles similar to those of the experimental group.
RESULTS: No changes in any of the parameters examined were observed in the control group. There was a marked but not significant improvement in the sperm counts of severely OTA males following acupuncture treatment (average = 0.7 +/- 1.1 x 10(6) spermatozoa per ejaculate before treatment vs. 4.3 +/- 3.2 x 10(6) spermatozoa per ejaculate after treatment). A definite increase in sperm count was detected in the ejaculates of 10 (67%) of the 15 azoospermic patients. Seven of these males exhibited post-treatment spermatozoa that were detected even by LM. The sperm production of these seven males increased significantly, from 0 to an average of 1.5 +/- 2.4 x 10(6) spermatozoa per ejaculate (Z = -2.8, P < or = 0.01). Males with genital tract inflammation exhibited the most remarkable improvement in sperm density (on average from 0.3 +/- 0.6 x 10(6) spermatozoa per ejaculate to 3.3 +/- 3.2 x 10(6) spermatozoa per ejaculate; Z = -2.4, P < or = 0.02). Two pregnancies were achieved by the IVF-ICSI procedure.
CONCLUSION: It is concluded that acupuncture may be a useful, nontraumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation.
Eshkevari L, Permaul E. Acupuncture blocks cold stress-induced increases in the hypothalamus-pituitary-adrenal axis in the rat. J Endocrinol. 2013;217: 95-104.
BACKGROUND: Electroacupuncture (EA) is used to treat chronic stress; however, its mechanism(s) of action in allaying stress remains unclear. The interplay of stress hormones of the hypothalamus-pituitary-adrenal axis (HPA) and the sympathetic nervous system (SNS) is critical in the stress response.
OBJECTIVE: Our objective was to determine whether EA at acupoint, stomach 36 (EA St36) is effective in preventing chronic cold stress-induced increased hormone levels in the rat by examining four groups of animals, three of which were exposed to cold and one of which was a non-treatment control group.
METHOD: Before exposure to the cold, two groups were treated with either EA St36, or Sham-EA, before 10 days of cold stress.
RESULTS: The EA St36 animals demonstrated a significant decrease in peripheral HP hormones (ACTH and CORT) compared with stress animals (P<0.05). These effects were specific; rats receiving Sham-EA had elevation of these hormones, similar to the stress-only animals. These effects were mirrored centrally in the brain; CRH levels were significantly (P<0.05) reduced in EA St36 animals compared with the other animals. Finally, EA effect on peripheral and adrenal SNS hormones (norepinephrine (NE) and neuropeptide Y (NPY) respectively) was examined, with no significant difference noted in adrenal tyrosine hydroxylase or circulating NE in any of the groups. However, EA St36 was effective in preventing stress-induced elevation is adrenal Npy mRNA.
CONCLUSION: These results indicate that EA St36 blocks the chronic stress-induced elevations in the HPA and the sympathetic NPY pathway, which may be a mechanism for its specific stress-allaying effects.
Kim H, Park HJ, Han SM, Hahm DH, Lee HJ, Kim KS, Shim I. The effects of acupuncture stimulation at PC6 (Neiguan) on chronic mild stress-induced biochemical and behavioral responses. Neurosc Letters. 2009;460(1): 56-60.
OBJECTIVE: In the present study, the effects of acupuncture on the behavioral and physiological responses induced by chronic mild stress (CMS) were evaluated.
METHOD: Sprague-Dawley rats were exposed to a variety of chronic unpredictable, mild stressors for 8 weeks. The effects of acupuncture on stress-induced anxiety and anhedonia were investigated using the elevated plus maze (EPM) and sucrose intake test. In addition, c-fos expression, as an early neuronal marker in the brain was also examined utilizing Fos-like immunohistochemistry (FLI).
RESULTS: CMS rats significantly reduced the consumption of sucrose intake and latency in the open arms of the EPM, and gained body weight more slowly, compared to non-stressed normal rats. Exposure to CMS also significantly increased FLI in the paraventricular nucleus (PVN) of the hypothalamus. Acupuncture stimulation at point PC6 on the pericardium channels (3 min), but not at other point (TE5), restored stress-induced decrease in the latency in the open arms and significantly attenuated FLI in the PVN produced by CMS. Acupuncture stimulation also tended to restore stress-induced decrease in the sucrose intake.
CONCLUSION: The present results demonstrated that acupuncture was effective in restoring CMS-related biochemical and behavioral impairments such as anxiety and anhedonia and that acupuncture point was more effective than non-acupuncture point. These results suggest that acupuncture has a therapeutic effect on chronic stress-related diseases such as depression and anxiety.
Zhang ZJ, Chen HY, Yip K, Ng R, Taam Wong V. The effectiveness and safety of acupuncture therapy in depressive disorders: Systematic review and meta-analysis. J Affect Disord. 2010;124(1-2): 9-21.
BACKGROUND: Although acupuncture has been used as an alternative treatment for depressive disorders, its effectiveness and safety are not well defined.
OBJECTIVE: The purpose of this systematic review with meta-analysis was to evaluate the effectiveness of acupuncture as monotherapy and as an additional therapy in treating various depressive conditions, particularly major depressive disorder (MDD) and post-stroke depression (PSD).
METHOD: Following systematic review, meta-analysis was conducted on high-quality randomized controlled trials (RCTs).
RESULTS: Of 207 clinical studies of acupuncture for various depression retrieved, 113 (54.6%) were on MDD and 76 (36.7%) on PSD. Twenty RCTs of MDD (n=1998) and 15 of PSD (n=1680) identified for high-quality protocol (Jadad score >/=3) were included for meta-analysis. The efficacy of acupuncture as monotherapy was comparable to antidepressants alone in improving clinical response and alleviating symptom severity of MDD, but not different from sham acupuncture. No sufficient evidence favored the expectation that acupuncture combined with antidepressants could yield better outcomes than antidepressants alone in treating MDD. Acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of PSD. The incidence of adverse events in acupuncture intervention was significantly lower than antidepressants.
CONCLUSION: Acupuncture therapy is safe and effective in treating MDD and PSD, and could be considered an alternative option for the two disorders. The efficacy in other forms of depression remains to be further determined.
Wang H, Qi H, Wang BS, Cui YY, Zhu L, Rong ZX, Chen HZ. Is acupuncture beneficial in depression: A meta-analysis of 8 randomized controlled trials? J Affect Dis. 2008;111(2-3): 125-34.
BACKGROUND: Depression is one of the most common mental health disorders. Acupuncture is a popular complementary and alternative medicine intervention suggested in the treatment of depression, but its effectiveness is uncertain.
OBJECTIVE: This updated meta-analysis was conducted to more precisely assess the beneficial effect of acupuncture in depression therapy.
METHOD: The following databases were searched: MEDLINE, EMBASE, BIOSIS, Cochrane Central Register of Controlled Trials, and Chinese Scientific Journal Database. The following terms were used: acupuncture, acupressure, depression, depressive disorder, clinical trial, and randomized controlled trial.
RESULTS: Eight small-randomized controlled trials comparing 477 subjects were included in the meta-analysis. Our results confirmed that acupuncture could significantly reduce the severity of depression, which was indicated by decreased scores of Hamilton rating scale for depression (HAMD) or Beck Depression Inventory (BDI). The pooled standardized mean difference of the 'Improvement of depression' was -0.65 (95% CI -1.18, -0.11; P=0.02) by random effect model. However, no significant effect of active acupuncture was found on the response rate (RR 1.32, 95% CI 0.83 to 2.10; P=0.25) and remission rate (RR 1.30, 95% CI 0.57 to 2.95; P=0.53).
CONCLUSION: Although this meta-analysis might be discounted due to the low quality of individual trials, it supported that acupuncture was an effective treatment that could significantly reduce the severity of disease in the patients with depression. More full-scale randomized clinical trials with reliable designs are recommended to further warrant the effectiveness of acupuncture.
Güçel F, Bahar B, Demirtas C, Mit S, Çevik C. Influence of acupuncture on leptin, ghrelin, insulin and cholecystokinin in obese women: a randomised, sham-controlled preliminary trial. Acupunct Med. 2012;30: 203-07.
BACKGROUND: Obesity is an energy balance problem caused by overeating. Obesity treatment includes diet, exercise, behaviour treatment, pharmacotherapy and surgery; in addition, acupuncture is also an option.
OBJECTIVE: To investigate the effect of acupuncture on weight loss and whether a brief acupuncture treatment of 5 weeks can change circulating levels of leptin, ghrelin, insulin and cholecystokinin (CCK) in obese women.
METHOD: 40 women with a body mass index (BMI)>30 kg/m(2) were equally randomised to either an acupuncture group or a sham (non-penetrating) acupuncture group and received treatment at LI4, HT7, ST36, ST44 and SP6 bilaterally. Both groups had two sessions of 20 min/week for a total of 10 sessions. Serum insulin, leptin, plasma ghrelin and CCK levels were measured by ELISA.
RESULTS: Acupuncture treatment decreased insulin and leptin levels and induced weight loss, together with a decrease in BMI compared with sham acupuncture. Furthermore, between-group analyses demonstrated increases in plasma ghrelin and CCK levels in subjects who received acupuncture treatment.
CONCLUSION: These findings suggest that acupuncture may help to regulate weight owing to its beneficial effects on hormones such as insulin, leptin, ghrelin and CCK in obese subjects even after a few weeks of treatment.
Li MY, Wei DY, Wu JM. Analysis on the interrelation between acupuncture-induced weight reduction and menstruation. Zhen Ci Yan Jiu. 2007;32(2): 142-44.
The effect of acupuncture induced weight reduction on menstrual activity is definitely not a negligible issue. By analyzing the existing materials about the mutual influence of neuroendocrine system and clinical trails, it is known that there exists a close interrelation between acupuncture-induced weight reduction and menstruation. Acupuncture treatment can achieve the effects of weight reduction and menstrual improvement via regulating activities of leptin, thyroid gland system and hypothalamus-pituitary-adrenal cortex axis. Clinical practice has demonstrated that acupuncture stimulation of some commonly-used acupoints for weight reduction also has a favorable regulation on menstrual activity in obesity women.
Cao H, Pan X, Li H, Liu J. Acupuncture for treatment of insomnia: A systematic review of randomized controlled trials. J Altern Complemen Med. 2009;15(11): 1171-86.
BACKGROUND: Acupuncture is commonly used in treating insomnia in China, and clinical studies have shown that acupuncture may have a beneficial effect on insomnia compared with Western medication.
METHOD: We included randomized controlled trials on acupuncture for insomnia. We searched PubMed, the Cochrane Library (2008 Issue 3), China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wan Fang Database. All searches ended in December 2008. Two authors extracted data and assessed the trials' quality independently. RevMan 5.0.17 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI).
RESULTS: Forty-six (46) randomized trials involving 3811 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed a beneficial effect of acupuncture compared with no treatment (MD -3.28, 95% CI -6.10 to -0.46, p = 0.02; 4 trials) and real acupressure compared with sham acupressure (MD -2.94, 95% CI -5.77 to -0.11, p = 0.04; 2 trials) on total scores of Pittsburgh Sleep Quality Index. Acupuncture was superior to medications regarding the number of patients with total sleep duration increased for >3 hours (RR 1.53, 95% CI 1.24-1.88, p < 0.0001). However, there was no difference between acupuncture and medications in average sleep duration (MD -0.06, 95% CI -0.30-0.18, p = 0.63). Acupuncture plus medications showed better effect than medications alone on total sleep duration (MD 1.09, 95% CI 0.56-1.61, p < 0.0001). Similarly, acupuncture plus herbs was significantly better than herbs alone on increase of sleep rates (RR 1.67, 95% CI 1.12-2.50, p = 0.01). There were no serious adverse effects with related to acupuncture treatment in the included trials.
CONCLUSION: Acupuncture appears to be effective in treatment of insomnia. However, further large, rigorous designed trials are warranted.
Chen HY, Shi Y, Ng CS, Chan SM, Yung KK, Zhang QL. Auricular acupuncture treatment for insomnia: A systematic review. J Altern Complement Med. 2007;13(6): 669-76.
OBJECTIVE: To review trials on the efficacy and safety of auricular acupuncture (AA) treatment for insomnia and to identify the most commonly used auricular acupoints for treating insomnia in the studies via a frequency analysis.
METHOD: The international electronic databases searched included: (1) AMED; (2) the Cochrane library; (3) CINAHL; (4) EMBASE; and (5) MEDLINE. Chinese electronic databases searched included: (1) VIP Information; (2) CBMdisc; and (3) CNKI. Any randomized controlled trials using AA as an intervention without using any co-interventions for insomnia were included. Studies using AA versus no treatment, placebo, sham AA, or Western medicine were included. Two (2) independent reviewers were responsible for data extraction and assessment. The efficacy of AA was estimated by the relative risk (RR) using a meta-analysis.
RESULTS: Eight hundred and seventy eight (878) papers were searched. Six (6) trials (402 treated with AA among 673 participants) that met the inclusion criteria were retrieved. A meta-analysis showed that AA was chosen with a higher priority among the treatment subjects than among the controls (p < 0.05). The recovery and improvement rates produced by AA was significantly higher than those of diazepam (p < 0.05). The rate of success was higher when AA was used for enhancement of sleeping hours up to 6 hours in treatment subjects (p < 0.05). The efficacy of using Semen vaccariae ear seeds was better than that of the controls (p < 0.01); while magnetic pearls did not show statistical significance (p = 0.28). Six (6) commonly used auricular acupoints were Shenmen (100%), Heart (83.33%), Occiput (66.67%), Subcortex (50%), Brain and Kidney (each 33.33%, respectively).
CONCLUSION: AA appears to be effective for treating insomnia. Because the trials were low quality, further clinical trials with higher design quality, longer duration of treatment, and longer follow-up should be conducted.
Qian Y, Xia XR, Ochin H, Huang C, Gao C, Gao L, Cui YG, Liu JY, Meng Y. Therapeutic effect of acupuncture on the outcomes of in vitro fertilization: A systematic review and meta-analysis. Arch Gynecol Obstet. 2017; 295(3): 543–58.
BACKGROUND: Controversial results have been reported concerning the effect of acupuncture on in vitro fertilization (IVF) outcomes. The current review was conducted to systematically review published studies of the effects of acupuncture on IVF outcomes.
METHOD: Women undergoing IVF in randomized controlled trials (RCTs) were evaluated for the effects of acupuncture on IVF outcomes. The treatment groups involved traditional, electrical, laser, auricular, and other acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture. The PubMed, Embase, and Web of Science databases were searched. The pregnancy outcomes data are expressed as odds ratios (ORs) with 95% confidence intervals (CIs) based on a fixed model or random model depending on the heterogeneity determined by the Q test and I2 statistic. The major outcomes were biochemical pregnancy rate (BPR), clinical pregnancy rate (CPR), live birth rate (LBR), and ongoing pregnancy rate (OPR). Heterogeneity of the therapeutic effect was evaluated by a forest plot analysis, and publication bias was assessed by a funnel plot analysis.
RESULTS: Thirty trials (a total of 6344 participants) were included in this review. CPR data showed a significant difference between the acupuncture and control groups (OR 1.26, 95% CI 1.06–1.50, p = 0.01), but there was significant statistical heterogeneity among the studies (p = 0.0002). When the studies were restricted to Asian or non-Asian area trials with a sensitivity analysis, the results significantly benefited the CPR in Asian group (OR 1.51, 95% CI 1.04–2.20, p = 0.03). Based on the area subgroup analysis, we found that in the Asian group, the IVF outcomes from the EA groups were all significantly higher than those from the control groups (CPR: OR 1.81, 95% CI 1.20–2.72, p = 0.005; BPR: OR 1.84, 95% CI 1.12–3.02, p = 0.02; LBR: OR 2.36, 95% CI 1.44–3.88, p = 0.0007; OPR: OR 1.94, 95% CI 1.03–3.64, p = 0.04). Meanwhile, compared with other acupuncture time, the IVF outcome results were significantly superior in the acupuncture group when acupuncture was conducted during controlled ovarian hyperstimulation (COH) (CPR: OR 1.71, 95% CI 1.27–2.29, p = 0.0004; LBR: OR 2.41, 95% CI 1.54–3.78, p = 0.0001; BPR: OR 1.50, 95% CI 1.02–2.20, p = 0.04; OPR: OR 1.88, 95% CI 1.06–3.34, p = 0.03). However, when acupuncture was conducted at the time of embryo transfer, the BPR and OPR from the acupuncture groups were significantly lower than those of the controls in the Asian group (BPR: OR 0.67, 95% CI 0.48–0.92, p = 0.01; OPR: OR 0.68, 95% CI 0.49–0.96, p = 0.03).
CONCLUSION: Based on an analysis of the studies, acupuncture improves the CPR among women undergoing IVF. When the studies were restricted to Asian or non-Asian area patients, compared with traditional acupuncture and other methods, electrical acupuncture yielded better IVF outcomes. Optimal positive effects could be expected using acupuncture in IVF during COH, especially in Asian area. However, as a limitation of this review, most of the included studies did not mention the number of embryos transferred.
Villahermosa DI, Santos LG, Nogueira MB, Vilarino FL, Barbosa CP. Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: A prospective randomised controlled clinical trial. Acupunct Med. 2013;31(2): 157-61.
OBJECTIVE: To evaluate the effectiveness of acupuncture and moxibustion as an adjuvant treatment in women undergoing in vitro fertilisation (IVF) when embryo implantation has failed.
METHOD: A prospective, randomised controlled clinical trial was conducted with 84 infertile patients who had had at least two unsuccessful attempts of IVF. The patients were randomised in three groups: control (n=28), sham (n=28) and acupuncture (n=28). The sample size was calculated by assuming a pregnancy rate of 10% when embryo implantation had failed. The pregnancy rates of the current IVF cycle were evaluated by measurement of blood ß human chorionic gonadotrophin (ßhCG) and subsequent transvaginal ultrasound. Acupuncture was performed on the first and seventh day of ovulation induction, on the day before ovarian puncture and on the day after embryo transfer. In the acupuncture group, patients were treated with moxibustion at nine acupuncture points (BL18, BL22, BL23, BL52, CV3, CV4, CV5, CV7, GV4) and needling at 12 points. In the sham group needles were inserted in eight areas that did not correspond to known acupuncture points.
RESULTS: The clinical pregnancy rate in the acupuncture group was significantly higher than that in the control and sham groups (35.7% vs 7.1% vs 10.7%; p=0.0169).
CONCLUSION: In this study, acupuncture and moxibustion increased pregnancy rates when used as an adjuvant treatment in women undergoing IVF, when embryo implantation had failed.
Zheng CH, Huang GY, Zhang MM, Wang W. Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: A systematic review and meta-analysis. Fert Steril. 2012;97(3): 599-611.
OBJECTIVE: To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.
METHOD: Systematic review and meta-analysis. Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects of acupuncture on IVF outcomes. The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture. The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.
RESULTS: Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation.
CONCLUSION: Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects from using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.
Huang DM, Huang GY, Lu FE, Stefan D, Andreas N, Robert G. Acupuncture for infertility: Is it an effective therapy? Chin J Integr Med. 2011;17(5): 386-95.
BACKGROUND: Acupuncture has been used to treat infertility extensively, including ovulatory dysfunction, in vitro fertilization and embryo transfer (IVF-ET), and male infertility. This review summarizes the recent studies which investigated the role of acupuncture in infertility.
CONCLUSION: In conclusion, most of the existing studies suggest a positive effect of acupuncture in infertility treatment. Firstly, acupuncture may improve ovulation by modulating the central and peripheral nervous systems, the neuroendocrine and endocrine systems, the ovarian blood flow, and metabolism. Secondly, acupuncture can improve the outcome of IVF-ET, and the mechanisms may be related to the increased uterine blood flow, inhibited uterine motility, and the anesis of depression, anxiety and stress. Its effect on modulating immune function also suggests helpfulness in improving the outcome of IVF-ET. Finally, the studies suggest that acupuncture plays a positive role in male infertility, the mechanism of which is not yet clear. Even though a positive effect of acupuncture in infertility has been found, well-designed multi-center, prospective randomized controlled studies are still needed to provide more reliable and valid scientific evidence. Furthermore, it is urgent and necessary to clarify the mechanism of acupuncture for infertility.
Stener-Victorin E, Humaidan P. Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med. 2006;24(4): 157-63.
BACKGROUND: During the last five years the use of acupuncture in female infertility as an adjuvant to conventional treatment in assisted reproductive technology (ART) has increased in popularity. The present paper briefly discusses clinical and experimental data on the effect of acupuncture on uterine and ovarian blood flow, as an analgesic method during ART, and on endocrine and metabolic disturbances such as polycystic ovary syndrome (PCOS). Further it gives a summary of recent studies evaluating the effect of acupuncture before and after embryo transfer on pregnancy outcome.
RESULTS: Of the four published RCTs, three reveal significantly higher pregnancy rates in the acupuncture groups compared with the control groups. But the use of different study protocols makes it difficult to draw definitive conclusions.
CONCLUSION: It seems, however, that acupuncture has a positive effect and no adverse effects on pregnancy outcome.
Magarelli P, Cridennda D. Acupuncture & IVF poor responders: A cure? Fert Steril. 2004;81(3): S20.
BACKGROUND: The utility of acupuncture in the treatment of infertility has been demonstrated in two controlled studies. The first study determined the effect of reducing the Pulsatility Index (PI) of the uterine artery on reproductive outcomes; the second study described a Pre/Post embryo transfer protocol that enhanced overall pregnancy rates (PR). There are no studies that have utilized both techniques.
OBJECTIVE: The purpose of the study was to determine the influence of two acupuncture protocols on IVF outcomes and secondly to identify the appropriate patient groups that would most benefit from this adjunctive therapy.
METHOD: In this retrospective study, data was extracted from medical records of patients RE&I clinic & acupuncture clinics between January 2001 and November 2003. All patients completing an IVF cycle with transfer were included. One RE&I provided the IVF care and a consortium of acupuncturists overseen by the author provided the strict acupuncture protocols. PR per transfer were the endpoints measured. Data was analyzed by student's t test and Multiregression with Wilcox ranking (MRW).
RESULTS: 147 patients were included in the study and of those 53 had Acupuncture (Ac) and 94 did not (Non-Ac group). Demographic data between these Ac and Non-Ac groups respectively indicated remarkable equity (Table 1). Fertility Factors also demonstrated equity and there were no differences in Diagnoses, IVF Protocols and type of Gonadatrophin protocols used. Factors that demonstrated significance were: Length of time infertile, Peak FSH, PI for total group without MRW; PI for MRW groups reversed this (Table 2) and finally average: Sperm Morphology, Peak E2, Peak P4 prior to HcG: and endometrial thickness. PR before Wilcox ranking were the same: 40% v 38%. MRW analysis revealed FSH, Length of time trying to get pregnant, Sperm Morphology and E2 levels as significant: 6.5, 4.1, 4.0 and 1.6 respectively. When the Ac group was modified (15 Ac patient dropped), PI was elevated from 1.76 to 1.94 resulting in a significant elevation compared to the Non-Ac group, p 0.01. Also PR changed from 40% before to 53% after and this value was significantly greater than the Non-Ac group (38%), p 0.01.
CONCLUSION: Significant increases in pregnancy outcomes were confirmed by this study and the data uniquely supported the advantage of acupuncture in patients with normal PI (prior studies were done on patient with PI>3). We also demonstrated that both acupuncture treatment protocols could be used together with a synergistic effect. Finally, this study is the first to demonstrate that the use of acupuncture in patients with poor prognoses (elevated Peak FSH, longer history of infertility, poor sperm morphology) can achieve similar pregnancy rates to normal prognosis patients.
Magarelli PC, Cridennda D, Cohen M. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization-embryo transfer treatment. Fertil Steril. 2009;92(6): 1870-79.
OBJECTIVE: To determine whether changes in serum cortisol (CORT) and PRL are affected by acupuncture (Ac) in Ac-treated IVF patients.
METHOD: Prospective cohort clinical study. Sixty-seven reproductive-age infertile women undergoing IVF. Blood samples were obtained from all consenting new infertility patients and serum CORT and serum PRL were obtained prospectively. Patients were grouped as controls (IVF with no Ac) and treated (IVF with Ac) according to acupuncture protocols derived from randomized controlled trials. Serum levels of CORT and PRL were measured and synchronized with medication stimulation days of the IVF cycle (e.g., day 2 of stimulation, day 3, etc.). Reproductive outcomes were collected according to Society for Assisted Reproductive Technology protocols, and results were compared between controls and those patients treated with Ac.
RESULTS: CORT levels in Ac group were significantly higher on IVF medication days 7, 8, 9, 11, 12, and 13 compared with controls. PRL levels in the Ac group were significantly higher on IVF medication days 5, 6, 7, and 8 compared with controls.
CONCLUSION: In this study, there appears to be a beneficial regulation of CORT and PRL in the Ac group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics.
Zhang J, Wang X, Lü R. Analgesic effect of acupuncture at Hegu (LI 4) on transvaginal oocyte retrieval with ultrasonography. J Trad Chin Med. 2013;33a (3): 294-97.
OBJECTIVE: To observe the analgesic effect of acupuncture at Hegu (LI 4) in vitro fertilization-embryo transfer (IVF-ET) transvaginal oocyte retrieval using ultrasonography and explore its mechanism.
METHOD: Ninety patients undergoing IVF-EF oocyte retrieval were randomly divided into three groups: an acupuncture group with needles inserted into bilateral Hegu (LI 4) points, a placebo group given placebo needles, and a control group with routine oocyte retrieval. Each group had an indometacin enema 30 min before the operation. We compared the pain-rated index (PRI), visual analogy scale (VAS), and present pain intensity (PPI) immediately after operation and 1 h after operation. We also determined the neuropeptide Y (NPY) level of the follicular fluid.
RESULTS: PRI, VAS, and PPI after operation and 1 h after operation in the acupuncture group were significantly lower than those in the control group (P < 0.01). No obvious difference (P > 0.05) was observed in PRI, VAS, and PPI after operation and 1 h after operation between the placebo group and the control group. The NPY level of the follicular fluid in the acupuncture group was significantly higher than that in the control group (P < 0.01). No obvious difference (P > 0.05) was observed in the NPY level of the follicular fluid between the placebo group and the control group.
CONCLUSION: The analgesic effect of acupuncture at Hegu in transvaginal oocyte retrieval using ultrasonography may be related to the increase in the NPY level of the follicular fluid.
Ng EH, So WS, Gao J, Wong YY, Ho PC. The role of acupuncture in the management of subfertility. Fertil Steril. 2008;90(1): 1-13.
OBJECTIVE: To review systematically the use of acupuncture in the management of subfertility.
METHOD: A computer search was performed via several English and Chinese databases to identify journals relevant to the subject.
RESULTS: The positive effect of acupuncture in the treatment of subfertility may be related to the central sympathetic inhibition by the endorphin system, the change in uterine blood flow and motility, and stress reduction. Acupuncture may help restore ovulation in patients with polycystic ovary syndrome, although there are not enough randomized studies to validate this. There is also no sufficient evidence supporting the role of acupuncture in male subfertility, as most of the studies are uncontrolled case reports or case series in which the sample sizes were small. Despite these deficiencies, acupuncture can be considered as an effective alternative for pain relief during oocyte retrieval in patients who cannot tolerate side effects of conscious sedation. The pregnancy rate of IVF treatment is significantly increased, especially when acupuncture is administered on the day of embryo transfer.
CONCLUSION: Although acupuncture has gained increasing popularity in the management of subfertility, its effectiveness has remained controversial.
Sator-Katzenschlager SM, Wölfler MM, Kozek-Langenecker SA, Sator K, Sator PG, Li B, Heinze G, Sator MO. Auricular electro-acupuncture as an additional perioperative analgesic method during oocyte aspiration in IVF treatment. Hum Reprod. 2006;21(8): 2114-20.
OBJECTIVE: The aim of this study was to compare the pain-relieving effect and the subjective well-being between auricular electro-acupuncture (EA) analgesia, auricular acupuncture (A) and conventional analgesia with remifentanil (CO).
METHOD: A total of 94 women undergoing IVF were randomized to auricular acupuncture with (EA, n = 32) or without (A, n = 32) continuous 1 Hz auricular stimulation (using a battery-powered miniaturized stimulator, P-Stim) or with adhesive tapes instead of needles and no electrical stimulation (control group, CO, n = 30) at the auricular acupuncture points 29, 55 and 57. All patients received patient-controlled analgesia (PCA) with remifentanil. Pain intensity and psychological well-being were assessed by means of visual analogue scales (VAS); tiredness, nausea and vomiting and analgesic drug consumption were documented.
RESULTS: Pain relief and subjective well-being were significantly greater in group EA during and after the procedure as compared with groups A and CO (P < 0.001). The patients were significantly more tired in group CO than in groups A and EA (P < 0.001). Consumption of the opioid remifentanil was significantly lower in group EA, comparable nausea (P < 0.001).
CONCLUSION: Auricular EA significantly reduces pain intensity and analgesic consumption of the opioid remifentanil during oocyte aspiration in IVF treatment.
Humaidan P, Stener-Victorin E. Pain relief during oocyte retrieval with a new short duration electro-acupuncture technique - an alternative to conventional analgesic method. Hum Reprod. 2004;19(6): 1367-72.
BACKGROUND: Acupuncture previously has proved its pain-relieving effect for ovum pick-up (OPU). The analgesic effect of electro-acupuncture (EA) was evaluated when EA was applied for only a few minutes prior to OPU in an attempt to make EA more attractive for clinical use.
METHOD: Two hundred patients undergoing OPU were randomized prospectively using sealed, unlabelled envelopes, to receive pain relief with either EA in combination with a paracervical block (PCB) (n = 100) or conventional medical analgesia (CMA) in combination with a PCB (n = 100). A visual analogue scale (VAS) was used to evaluate pain and anxiety before, during and after OPU. The primary outcome measure was pain relief; secondary end-points were costs, time to discharge and clinical outcome parameters.
RESULTS: There were no differences in any VAS ratings before the procedure. Directly after OPU, the EA group reported significantly higher mean and maximum pain, and 'pain now' than the CMA group. At 30 min after OPU and thereafter, no significant differences were found between the groups regarding abdominal pain. Time to discharge and costs were significantly lower in the EA group compared with the CMA group. No differences in clinical outcome parameters were seen.
CONCLUSION: A significant difference was found between the EA and the CMA groups regarding pain during the OPU, probably due to the fact that the CMA group was pre-medicated as part of the study design. Despite a per-operative difference in pain rating, EA, given a few minutes prior to OPU, is a good alternative to CMA. The procedure is well tolerated by the patients, with a shorter hospitalization time and lower costs.
Fu H, He Y, Gao Y, Man Y, Liu W, Hao H. Acupuncture on the endometrial morphology, the serum estradiol and progesterone levels, and the expression of endometrial leukaemia-inhibitor factor and osteopontin in rats. Evid Based Complement Alternat Med. 2011;2011: 606514.
BACKGROUND: Although it is well known that acupuncture has beneficial effects on a variety of medical conditions especially in pain relief, nausea, and vomiting, it remains controversial whether it has positive impact on the female reproduction.
OBJECTIVE: The present study aimed to evaluate whether the following endometrial receptivity factors: the endometrial morphology, the hormone concentrations, and the protein expression of endometrial leukaemia-inhibitory factor (LIF) and osteopontin (OPN) could be improved by the acupuncture in clomiphene citrate(CC)-induced rat model during implantation period.
RESULTS: Results showed that, compared with the CC group, glandular development advanced, the serum estradiol levels decreased significantly, and the glandular area and endometrial LIF and OPN expression were significantly higher in acupuncture group. There were no significant differences in serum progesterone levels, endometrial thickness, and stromal area between groups.
CONCLUSION: These results suggest that acupuncture can improve certain aspects of endometrial receptivity in CC-induced rat model during implantation period, which might result in endometrial state better to female reproduction.
Manheimer E, Zhang G, Udoff L, Haramati L, Langenberg P, Berman BM, Boulter LM. Effects of acupuncture on rates of pregnancy and live births among women undergoing in vitro fertilization: Systematic review and meta-analysis. BMJ. 2008;336(7643): 545-49.
OBJECTIVE: To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation.
METHOD: Systematic review and meta-analysis. Data sources were Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists. Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.
RESULTS: Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth. The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).
CONCLUSION: Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.
Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. Acupuncture on the day of embryo transfer significantly improves reproductive outcome in infertile women: A prospective randomized trial. Fert Steril. 2006;85: 1341-46.
OBJECTIVE: To evaluate the effect of acupuncture on reproductive outcome in patients treated with IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on the day of ET, another group on ET day and again 2 days later (i.e., closer to implantation day), and both groups were compared with a control group that did not receive acupuncture.
METHOD: Prospective, randomized trial. During the study period all patients receiving IVF or ICSI treatment were offered participation in the study. On the day of oocyte retrieval, patients were randomly allocated (with sealed envelopes) to receive acupuncture on the day of ET (ACU 1 group, n = 95), on that day and again 2 days later (ACU 2 group, n = 91), or no acupuncture (control group, n = 87). Acupuncture was performed immediately before and after ET (ACU 1 and 2 groups), with each session lasting 25 minutes; and one 25-minute session was performed 2 days later in the ACU 2 group.
RESULTS: Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the ACU 2 group (36% and 26%) were higher than in controls, but the difference did not reach statistical difference.
CONCLUSION: Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2 provided no additional beneficial effect.
Dieterle S, Ying G, Hatzmann W, Neuer A. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: A randomized, prospective, controlled clinical study. Fert Steril. 2006;85: 1347-51.
OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI).
METHOD: Randomized, prospective, controlled clinical study. Two hundred twenty-five infertile patients undergoing IVF/ICSI. In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture.
RESULTS: In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%).
CONCLUSION: Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.
Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on pregnancy rate in patients who undergo assisted reproduction therapy. Fert Steril. 2002;77(4): 721-24.
OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture.
METHOD: Prospective randomized study. After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80). Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy.
RESULTS: Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer. Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.
CONCLUSION: Acupuncture seems to be a useful tool for improving pregnancy rate after ART.
Grant LE, Cochrane S. Acupuncture for the mental and emotional health of women undergoing IVF treatment: A comprehensive review. Aust J Acupunct Chin Med. 2014;9(1): 5-12.
BACKGROUND: One in six Australian couples currently struggle with impaired fertility. In vitro fertilisation (IVF) has become the assisted reproductive technology (ART) of choice. The IVF process has inherent stresses: the invasive procedures; medication; knowledge that it might be the last possibility for pregnancy; and the high cost. Both authors have observed in different settings (one clinical and the other during a clinical trial) that women often reported an improved sense of wellbeing and emotional health due to the acupuncture intervention.
METHOD: This paper summarises the reported benefits of acupuncture treatment for mental and emotional health during IVF identified in published peer-reviewed research papers - both theoretically (pathogenesis and physiology) and clinically (with reference to acupuncture treatment and the therapeutic encounter).
RESULTS: The trials reviewed, investigating mental and emotional health during IVF treatment, indicate acupuncture had positive outcomes including: reduced anxiety; reduced stress; less social and relationship concern and improved psychological coping.
CONCLUSION: This paper suggests that reflecting on and valuing the therapeutic alliance, including its collaborative nature, the patient feeling cared for and a perception that practitioners are empathetic, could improve fertility outcomes and the emotional health of infertile women through the process of IVF treatment.
Isoyama D, Cordts EB, de Souza van Niewegen AM, de Almeida Pereira de Carvalho W, Matsumura ST, Barbosa CP. Effect of acupuncture on symptoms of anxiety in women undergoing in vitro fertilisation: A prospective randomised controlled study. Acupunct Med. 2012;30(2): 85-88.
OBJECTIVE: To determine if acupuncture improves symptoms of anxiety in infertile women undergoing in vitro fertilisation (IVF) treatment.
METHOD: A randomised clinical trial was performed in 43 patients undergoing IVF. The patients were randomised into two groups: test group (n=22) and control group (n=21). The anxiety level of each patient was analysed before and after treatment using the Hamilton Anxiety Rating Scale (HAS). Treatment sessions consisted of four weekly sessions. In the test group, needles were inserted at points HT7, PC6, CV17, GV20 and Yintang. In the control group, needles were inserted in areas near but not corresponding to acupuncture points.
RESULTS: The mean HAS score after the 4-week experimental period was significantly lower in the test group than in the control group (19.4 ± 3.2 vs 24.4 ± 4.2; p=0.0008).
CONCLUSION: The results indicate that acupuncture can reduce anxiety symptoms observed by the reduction of psychological parameters of women undergoing IVF. Further evidence should be sought as to whether acupuncture might be a complementary option for patients undergoing IVF.
Liu F, Luo SP. Effect of Chinese herbal treatment on Th1- and Th2-type cytokines, progesterone and beta-human chorionic gonadotropin in early pregnant women of threatened abortion. Chin J Integr Med. 2009;15(5): 353-58.
OBJECTIVE: To study the clinical effects of Prescription Zhuyun-III (ZYIII) on early pregnant women diagnosed as threatened abortion, and its mechanism in immunity and endocrine by determining serum Th1- and Th2-type cytokines, progesterone, and beta-human chorionic gonadotropin (beta-HCG).
METHOD: The treatment group comprised 30 early pregnant women diagnosed as threatened abortion of deficiency syndrome of Pi, Shen, or both. The control group consisted of 20 normal early pregnant women of similar gestational age. Patients in the treatment group were administered with ZYIII for 4 weeks. Peripheral blood samples were collected pre- and post-treatment from both the treatment and the control groups. Serum Th1-type cytokine [interleukin-2 (IL-2)] and Th2-type cytokine [interleukin-10 (IL-10)] were determined by flow cytometry, and serum progesterone and beta-HCG were determined by ELISA.
RESULTS: (1) The treatment was effective in 26 and ineffective in 4 patients of the treatment group. Therefore, the cure percentage was 86.67%. (2) In the treatment group before the treatment, IL-2 was significantly higher, IL-10 tended to be less, and the Th1/Th2 balance shifted toward Th1 compared with those in the control group. (3) After the treatment, IL-2 was decreased, IL-10 was increased, and IL-2/IL-10 was decreased. Both progesterone and beta-HCG were increased. Changes of progesterone were positively correlated with changes of IL-10, whereas changes of beta-HCG were negatively correlated with changes of IL-2.
CONCLUSION: Our study suggests that ZYIII has an evident function of protecting the fetus, and one of its mechanisms is inhibiting the secretion of Th1 cytokines, promoting the secretion of Th2 cytokines, and recovering the pathological shift of the Th1/Th2 balance. The other possible mechanism is increasing serum progesterone and beta-HCG concentrations. Moreover, there are some correlations between the above two effects.
Liu Y, Wu JZ. Effect of Gutai decoction on the abortion rate of in vitro fertilization and embryo transfer. Chin J Integr Med. 2006;12(3): 189-93.
OBJECTIVE: To study the effect of Chinese herbal medicine Gutai Decoction (GTD) on the abortion rate of in vitro fertilization and embryo transfer (IVF-ET).
METHOD: Observed were two hundred and forty-seven women having received IVF-ET and with beta-human chorionic gonadotropin (beta-HCG) > 25 IU/L on the 14th day after transferring. All were treated conventionally with progesterone 20 - 80 mg per day after transferring and if necessary the treatment was supplemented with Progynova 2 - 4 mg per day, with the medication withdrawn gradually from the 9th week of pregnancy till stopped completely. Among them 131 cases received GTD medication additionally, for 109 cases of whom the medication started from the 2nd day of transferring (taken as Group A) and for the other 22 cases from the 14th day after transferring (taken as Group B), the other 116 cases with no additional GTD treatment given were taken as the control group, with the medication lasting to the 12th week. The abortion rate in them was observed.
RESULTS: The abortion rate in Group A, Group B and the control group was 12.84%, 13.64% and 23.28%, respectively, the difference between the GTD treated groups and the control group was significant (P < 0.05).
CONCLUSION: Chinese medicine GTD could reduce abortion rate in women receiving IVF-ET.
Smith C, Crowther C, Beilby J. Acupuncture to treat nausea and vomiting in early pregnancy: A randomized controlled trial. Birth. 2002;29(1): 1-9.
OBJECTIVE: Nausea and vomiting in early pregnancy are troublesome symptoms for some women. We undertook a single blind randomized controlled trial to determine whether acupuncture reduced nausea, dry retching, and vomiting, and improved the health status of women in pregnancy.
METHOD: The trial was undertaken at a maternity teaching hospital in Adelaide, Australia, where 593 women less than 14 weeks' pregnant with symptoms of nausea or vomiting were randomized into 4 groups: traditional acupuncture, pericardium 6 (p6) acupuncture, sham acupuncture, or no acupuncture (control). Treatment was administered weekly for 4 weeks. The primary outcomes were nausea, dry retching, vomiting, and health status. Comparisons were made between groups over 4 consecutive weeks.
RESULTS: Women receiving traditional acupuncture reported less nausea (p < 0.01) throughout the trial and less dry retching (p < 0.01) from the second week compared with women in the no acupuncture control group. Women who received p6 acupuncture (p < 0.05) reported less nausea from the second week of the trial, and less dry retching (p < 0.001) from the third week compared with women in the no acupuncture control group. Women in the sham acupuncture group (p < 0.01) reported less nausea and dry retching (p < 0.001) from the third week compared with women in the no acupuncture group. No differences in vomiting were found among the groups at any time.
CONCLUSION: Acupuncture is an effective treatment for women who experience nausea and dry retching in early pregnancy. A time-related placebo effect was found for some women.
Carlsson CP, Axemo P, Bodin A, Carstensen H, Ehrenroth B, Madegård-Lind I, Navander C. Manual acupuncture reduces hyperemesis gravidarum: A placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage. 2000;20(4): 273-79.
BACKGROUND: Hyperemesis gravidarum, severe vomiting, develops in about 1-2% of all pregnancies. Acupuncture on the point PC6 above the wrist on the palmar side has been found to prevent some types of nausea and vomiting.
OBJECTIVE: The purpose of the present study was to see if acupuncture, in addition to standard treatment, could hasten the improvement of hyperemesis gravidarum.
METHOD: Thirty-three women with hyperemesis were evaluated in a randomized, single-blind, crossover comparison of two methods of acupuncture, active (deep) PC6 acupuncture or placebo (superficial) acupuncture. The women estimated their degree of nausea on a visual analogue scale (VAS).
RESULTS: The daily number of emesis episodes were documented. Crossover analyses showed that there was a significantly faster reduction of nausea VAS and more women who stopped vomiting after active acupuncture than after placebo acupuncture.
CONCLUSION: This study suggests that active PC6 acupuncture, in combination with standard treatment, could make women with hyperemesis gravidarum better faster than placebo acupuncture.
Sniezek DP Siddiqui IJ. Acupuncture for treating anxiety and depression in women: a clinical systematic review. Med Acupunct. 2013;25(3): 164-72.
BACKGROUND: Anxiety and depression are high in prevalence, especially in the female population, whose incidence is approximately double that of the male population. In addition, these conditions are difficult to treat and have high relapse rates and medication side-effects. There is evidence to suggest that acupuncture may be an effective treatment modality.
OBJECTIVE: The aim of this review is to summarize the existing evidence on acupuncture as a therapy for anxiety and depression in women and to present a novel method for assessing acupuncture trial quality.
METHOD: Published randomized controlled trials were included, whereby acupuncture was compared with any control procedure in subjects with anxiety and/or depression. Two authors extracted data independently. A novel acupuncture trial quality-assessment tool was developed to analyze the literature quality.
RESULTS: Six articles used the desired inclusion and exclusion criteria. The quality of research varied heavily. Five studies were properly randomized. Three were double-blinded. Three used individualized acupuncture. Four studies were of at least reasonable quality. One was of marginal quality, and one was of poor quality. There was a significant difference between acupuncture and at least one control in all six trials.
CONCLUSION: With respect to six reviewed studies, there is high-level evidence to support the use of acupuncture for treating major depressive disorder in pregnancy.
Manber R, Schnyer RN, Lyell D, Chambers AS, Caughey AB, Druzin MC, Celio C, Gress JL, Huang MI, Kalista T, Martin-Okada R, Allen J. Acupuncture for depression during pregnancy: A randomized controlled trial. Obstet & Gynecol. 2010;115(3): 511-20.
OBJECTIVE: To estimate the efficacy of acupuncture for depression during pregnancy in a randomized controlled trial.
METHOD: A total of 150 pregnant women who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for major depressive disorder were randomized to receive either acupuncture specific for depression or one of two active controls: control acupuncture or massage. Treatments lasted 8 weeks (12 sessions). Junior acupuncturists, who were not told about treatment assignment, needled participants at points prescribed by senior acupuncturists. All treatments were standardized. The primary outcome was the Hamilton Rating Scale for Depression, administered by masked raters at baseline and after 4 and 8 weeks of treatment. Continuous data were analyzed using mixed effects models and by intent to treat.
RESULTS: Fifty-two women were randomized to acupuncture specific for depression, 49 to control acupuncture, and 49 to massage. Women who received acupuncture specific for depression experienced a greater rate of decrease in symptom severity (P<.05) compared with the combined controls (Cohen's d=0.39, 95% confidence interval [CI] 0.01-0.77) or control acupuncture alone (P<.05; Cohen's d=0.46, 95% CI 0.01-0.92). They also had significantly greater response rate (63.0%) than the combined controls (44.3%; P<.05; number needed to treat, 5.3; 95% CI 2.8-75.0) and control acupuncture alone (37.5%; P<.05: number needed to treat, 3.9; 95% CI 2.2-19.8). Symptom reduction and response rates did not differ significantly between controls (control acupuncture, 37.5%; massage, 50.0%).
CONCLUSION: The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments of similar length and could be a viable treatment option for depression during pregnancy.
Guerreiro da Silva JB. Acupuncture for mild to moderate emotional complaints in pregnancy- a prospective, quasi-randomised, controlled study. Acupunct Med. 2007;25(3): 65-71.
OBJECTIVE: The aim of this study was to describe the effects of acupuncture under real life conditions, in the treatment of emotional complaints during pregnancy.
METHOD: A group of 51 conventionally treated pregnant women (with counselling by their physicians and nurses) was allocated by chance into two groups to be either treated or not by acupuncture. Both groups (28 in the study group and 23 in the control group) presented emotional complaints such as anxiety, depression and irritability. They reported the severity of symptoms using a Numerical Rating Scale (NRS) from 0 to 10; and they rated how much the symptoms disturbed five aspects of their lives: mood, sleep, relationships, social activities, sexual life and joy of living. Traditional acupuncture was used. In order to facilitate protocols we used pre-programmed points. Up to four points were permitted as optional points.
RESULTS: Three women from the acupuncture group and four from the control group dropped out of the study. Over the study period, the NRS scores of intensity of emotional distress decreased by at least half in 15/25 (60%) of patients in the study group and in 5/19 (26%) of those in the control group (P=0.013). The impact of the distress on three out of the five aspects of life was significantly less in the acupuncture group when compared with the control group (P<0.05).
CONCLUSION: Emotional complaints are very common in pregnancy and medication is always a risk. In this study, acupuncture seems to be an efficacious means of reducing symptoms and improving the quality of life of women with emotional complaints during pregnancy. Large randomised studies are recommended to confirm these results.
Manber R, Schnyer RN, Allen J, Rush AJ, Blasey CM. Acupuncture: A promising treatment for depression during pregnancy. J Affect Disord. 2004;83(1): 89-95.
OBJECTIVE: Few medically acceptable treatments for depression during pregnancy are available. The aim of this randomized controlled pilot study was to determine whether acupuncture holds promise as a treatment for depression during pregnancy.
METHOD: Sixty-one pregnant women with major depressive disorder and a 17-item Hamilton Rating Scale for Depression (HRSD17) score >or=14 were randomly assigned to one of three treatments, delivered over 8 weeks: an active acupuncture (SPEC, N=20), an active control acupuncture (NSPEC, N=21), and massage (MSSG, N=20). Acupuncture treatments were standardized, but individually tailored, and were provided in a double-blind fashion. Responders to acute phase treatment (HRSD17 score<14 and >or=50% reduction from baseline) continued the treatment they were initially randomized to until 10 weeks postpartum.
RESULTS: Response rates at the end of the acute phase were statistically significantly higher for SPEC (69%) than for MSSG (32%), with an intermediate NSPEC response rate (47%). The SPEC group also exhibited a significantly higher average rate of reduction in BDI scores from baseline to the end of the first month of treatment than the MSSG group. Responders to the acute phase of all treatments combined had significantly lower depression scores at 10 weeks postpartum than nonresponders. Generalizability is limited by the small sample and its relative homogeneity.
CONCLUSION: Acupuncture holds promise for the treatment of depression during pregnancy.
Smith CA, Cochrane S. Does acupuncture have a place as an adjunct treatment during pregnancy? A review of randomized controlled trials and systematic reviews. Birth. 2009;36(3): 246-53.
BACKGROUND: Complementary medicine has become popular throughout many Western countries and is widely used by women across all stages of their life cycle. Acupuncture is used by women during their pregnancy, and research suggests that acupuncture may be used as an adjunct to their existing conventional care.
OBJECTIVE: The aim of this paper was to summarize the evidence examining the effectiveness of acupuncture during pregnancy and birthing, and to discuss its role as an adjunct treatment.
METHOD: We conducted a systematic literature search using several electronic databases. We included all placebo-controlled randomized trials of parallel design, and systematic reviews that evaluated the role of acupuncture during pregnancy and birthing. A critical appraisal of clinical trials and systematic reviews was undertaken.
RESULTS: The summarized findings indicated a small but growing body of acupuncture research, with some evidence suggesting a benefit from acupuncture to treat nausea in pregnancy. Findings from the review also highlighted promising evidence for the effectiveness of acupuncture to manage back and pelvic pain, acupuncture-type interventions to induce change in breech presentation, and pain relief in labor. The methodological quality of recent trials has improved, and the quality of systematic reviews was high.
CONCLUSION: Interest is growing in the use of acupuncture to treat some complaints during pregnancy and childbirth, and evidence is beginning to consolidate that acupuncture may assist with the management of some complaints during pregnancy. However, definitive conclusions about its effectiveness cannot be reached and further research is justified.
Ee C, Manheimer E Pirotta M White A. Acupuncture for pelvic and back pain in pregnancy: A systematic review. Am J Obstet Gynecol. 2008;198(3): 254-59.
OBJECTIVE: The objective of our study was to review the effectiveness of needle acupuncture in treating the common and disabling problem of pelvic and back pain in pregnancy.
METHOD: Two small trials on mixed pelvic/back pain and 1 large high-quality trial on pelvic pain met the inclusion criteria.
RESULTS: Acupuncture, as an adjunct to standard treatment, was superior to standard treatment alone and physiotherapy in relieving mixed pelvic/back pain. Women with well-defined pelvic pain had greater relief of pain with a combination of acupuncture and standard treatment, compared to standard treatment alone or stabilizing exercises and standard treatment. We used a narrative synthesis due to significant clinical heterogeneity between trials. Few and minor adverse events were reported.
CONCLUSION: We conclude that limited evidence supports acupuncture use in treating pregnancy-related pelvic and back pain. Additional high-quality trials are needed to test the existing promising evidence for this relatively safe and popular complementary therapy.
Kvorning N, Holmberg C, Grennert L, Aberg A, Akeson J. Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstet Gynecol Scand. 2004;83(3): 246-50.
OBJECTIVE: The study was designed to evaluate the analgesic effect and possible adverse effects of acupuncture for pelvic and low-back pain during the last trimester of pregnancy.
METHOD: Following individual informed consent, 72 pregnant women reporting pelvic or low-back pain were randomized during pregnancy weeks 24-37 to an acupuncture group (n = 37) or to a control group (n = 35) at three maternity wards in southern Sweden. Traditional acupuncture points and local tender points (TP) were chosen according to individual pain patterns and stimulated once or twice a week until delivery or complete recovery in acupuncture patients. Control patients were given no sham stimulation. Throughout the study period each patient made weekly visual analog scale (VAS) evaluations of maximal and minimal pain intensity as well as three-point assessments of pain intensity during various activities.
RESULTS: During the study period, VAS scorings of pain intensity decreased over time in 60% of patients in the acupuncture group and in 14% of those in the control group (p < 0.01). At the end of the study period, 43% of the acupuncture patients were less bothered than initially by pain during activity compared with 9% of control patients (p < 0.01). No serious adverse effects of acupuncture were found in the patients, and there were no adverse effects at all in the infants.
CONCLUSION: Acupuncture relieves low-back and pelvic pain without serious adverse effects in late pregnancy.
Vas J, Aranda-Regules JM, Modesto M, Ramos-Monserrat M, Baron M, Aguilar I, Benitez-Parejo N, Ramirez-Carmona C, Rivas-Ruiz F. Using moxibustion in primary healthcare to correct non-vertex presentation: A multicentre randomised controlled trial. Acupunct Med. 2013;31(1): 31-38.
OBJECTIVE: To compare the effectiveness of additional moxibustion at point BL67 with moxibustion at a non-specific acupuncture point and with usual care alone to correct non-vertex presentation.
METHOD: This was a multicentre randomised controlled trial in which 406 low-risk pregnant women with a fetus in ultrasound breech presentation, with a gestational age of 33-35 weeks, were assigned to (1) true moxibustion at point BL67 plus usual care; (2) moxibustion at SP1, a non-specific acupuncture point (sham moxibustion) plus usual care; or (3) usual care alone. The primary outcome was cephalic presentation at birth. Women were recruited at health centres in primary healthcare.
RESULTS: In the true moxibustion group, 58.1% of the full-term presentations were cephalic compared with 43.4% in the sham moxibustion group (RR 1.34, 95% CI 1.05 to 1.70) and 44.8% of those in the usual care group (RR 1.29, 95% CI 1.02 to 1.64). The reduction in RR of the primary outcome in women allocated to the true moxibustion group compared with the usual care group was 29.7% (95% CI 3.1% to 55.2%) and the number needed to treat was 8 (95% CI 4 to 72). There were no severe adverse effects during the treatment.
CONCLUSION: Moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. We believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus.
Vas J, Aranda JM, Nishishinya B, Mendez C, Martin MA, Pons J, Liu JP, Wang CY, Perea-Milla E. Correction of nonvertex presentation with moxibustion: A systematic review and meta analysis. Am J Obstet Gynecol. 2009;201: 241-59.
METHOD: We searched systematically for randomized controlled trials, comparing moxibustion with a nonmoxibustion control group or other methods such as external cephalic version, postural methods, and acupuncture in databases, both Western and Chinese, up to June 2007.
RESULTS: Six studies, with 1087 subjects and a high degree of heterogeneity, compared moxibustion vs observation or postural methods and reported a rate of cephalic version among the moxibustion group of 72.5% vs 53.2% in the control group (relative risk, 1.36; 95% confidence interval, 1.17-1.58); the number needed to treat was 5 (95% confidence interval, 4-7). In terms of safety, no significant differences were found in the comparison of moxibustion with other techniques.
CONCLUSION: Moxibustion at acupuncture point BL67 has been shown to produce a positive effect, whether used alone or in combination with acupuncture or postural measures, in comparison with observation or postural methods alone, for the correction of nonvertex presentation, although these results should be viewed with caution, given the considerable heterogeneity found among studies.
Van den Berg I, Bosch JL, Jacobs B, Bouman I, Duvekot JJ, Hunink MG. Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: A systematic review. Complement Ther Med. 2008;16(2): 92-100.
OBJECTIVE: A systematic review of studies assessing the effectiveness of acupuncture-type interventions (moxibustion, acupuncture, or electro-acupuncture) on acupuncture point BL 67 to correct breech presentation compared to expectant management, based on controlled trials.
METHOD: Articles published from 1980 to May 2007 in databases of Medline, EMBASE, the Cochrane Central Register of Controlled Trials, AMED, NCCAM, Midirs and reference lists. Studies included were original articles; randomised controlled trials (RCT) or controlled cohort studies; acupuncture-type intervention on BL 67 compared with expectant management; ultrasound confirmed breech presentation and position of the fetus after treatment confirmed with ultrasound, position at delivery, and/or the proportion of caesarean sections reported. Three reviewers independently extracted data. Disagreements were resolved by consensus.
RESULTS: Of 65 retrieved citations, six RCT's and three cohort studies fulfilled the inclusion criteria. Data were pooled using random-effects models. In the RCT's the pooled proportion of breech presentations was 34% (95% CI: 20-49%) following treatment versus 66% (95% CI: 55-77%) in the control group (OR 0.25 95% CI: 0.11-0.58). The pooled proportion in the cohort studies was 15% (95% CI: 1-28%) versus 36% (95% CI: 14-58%), (OR 0.29, 95% CI: 0.19-0.43). Including all studies the pooled proportion was 28% (95% CI: 16-40%) versus 56% (95% CI: 43-70%) (OR 0.27, 95% CI: 0.15-0.46).
CONCLUSION: Our results suggest that acupuncture-type interventions on BL 67 are effective in correcting breech presentation compared to expectant management. Some studies were of inferior quality to others and further RCT's of improved quality are necessary to adequately answer the research question.
Neri I, De Pace, VivianaDe Pace V, Venturini, PaoloVenturini P, Facchinetti, Fabio Facchinetti F. Effects of three different stimulations (acupuncture, moxibustion, acupuncture plus moxibustion) of BL.67 acupoint at small toe on fetal behavior of breech presentation. Amer J Chin Med. 2007;35(1): 27-33.
OBJECTIVE: The aim of the study was to evaluate cardiovascular effects and fetal behavior during moxibustion, acupuncture or acupuncture plus moxibustion applied on the BL.67 acupoint of women (beside the outer corner of the 5th toenail) in fetal breech presentation.
METHOD: During the acupoint stimulation (20 min, two times a week), the women were submitted to computerized non-stress test. Fourteen cases were treated by both acupuncture and moxibustion, 15 cases by moxibustion and 10 cases by acupuncture.
RESULTS: In 56% of cases, fetal position was converted from breech position to cephalic one; the success share was 80% for moxibustion, 28% for acupuncture, 57% for acupuncture plus moxibustion; the conversion, on average, was achieved after 3 sessions. Statistical analysis indicated that acupuncture plus moxibustion was able to reduce fetal heart rate during the application of stimuli while acupuncture and moxibustion separately did not affect such parameter. Moreover, moxibustion and acupuncture with moxibustion reduced fetal movements while acupuncture only appears ineffective.
CONCLUSION: The present study suggests that fetal movements were reduced by both acupuncture plus moxibustion and moxibustion and that fetal heart rate was reduced just by acupuncture plus moxibustion. The mechanisms leading the effect on fetal heart rate and fetal movements remain to be clarified. Even though further studies are needed, such preliminar report mainly investigated the impact of different stimula on the BL.67 acupoint. Unfortunately these small series of data do not allow us to draw any conclusion about the effectiveness of the different treatments.
Habek D, Cerkez Habek J, Jagust M. Acupuncture conversion of fetal breech presentation. Fetal Diagn Ther. 2003;18(6): 418-21.
OBJECTIVE: The aim of this study was to assess the value of acupuncture (AP) in the conversion of fetal breech presentation into vertex presentation.
METHOD: A randomized prospective controlled clinical study included 67 pregnant women with fetal breech presentation: 34 women with singleton pregnancies treated with manual AP (urinary bladder 67, Zhiyin) and a control group which included 33 women with singleton pregnancies without AP treatment. The AP treatment lasted 30 min a day, and was conducted during and after 34 weeks of pregnancy with simultaneous cardiotocography.
RESULTS: The success rate of the AP correction of fetal breech presentation is 76.4% (26 women), and spontaneous conversion without AP in vertex presentation is observed in 15 women (45.4%; p<0.001).
CONCLUSION: We believe that AP correction of fetal malpresentation is a relatively simple, efficacious and inexpensive method associated with a lower percentage of operatively completed deliveries, which definitely reflects in improved parameters of vital and perinatal statistics.
Betts D, Lennox S. Acupuncture for prebirth treatment: an observational study of its use in midwifery practice. Med Acup. 2006;17(3): 16-19.
BACKGROUND: Midwives in Wellington, New Zealand, observed that women receiving prebirth acupuncture consistently experienced efficient labors, reporting a reduction in the length of labor and medical intervention, specifically the use of epidurals, medical inductions, and cesarean deliveries.
OBJECTIVE: To undertake a naturalistic observational study of women receiving acupuncture as part of their antenatal care.
METHOD: Design, Setting, and Patients Practices of 14 midwives recorded their prebirth acupuncture treatments over a 4-month period in 2004 in 169 New Zealand women who received prebirth acupuncture. Main Outcome Measures Gestation at onset of labor, incidence of medical induction, length of labor, use of analgesia, and type of delivery.
RESULTS: When compared with the local population rates, there was an overall 35% reduction in the number of inductions (for primigravida women, this was a 43% reduction); 31% reduction in the epidural rate; 32% reduction in emergency cesarean delivery; and a 9% increase in normal vaginal birth.
CONCLUSION: Prebirth acupuncture appeared to provide some promising therapeutic benefits in assisting women to have a normal vaginal birth. A further randomized controlled study is warranted.
Gribel G, Coca-Velarde LG, Moreira Sa RA. Electroacupuncture for cervical ripening prior to labor induction: A randomized clinical trial. Arch Gynecol Obstet 2011;283: 1233-38.
OBJECTIVE: The present study was aimed to compare the effects of the use of electroacupuncture and misoprostol in inducing labor in patients with Bishop score < 7 and to observe the characteristics of labor in both methods.
METHOD: As much as 67 pregnant women with Bishop score < 7, single cephalic presentation with gestational age confirmed by first-trimester ultrasound, reactive cardiotocography, and amniotic fluid volume and estimated fetal weight within the respective normal ranges for gestational age were selected. They were randomized into 2 groups: electroacupuncture (AC) or misoprostol (M).
RESULTS: There were no significant differences regarding age, gestational age, fetal weight, parity, Bishop score, or indication for induction. Labor was the main outcome, which was obtained in both groups without significant difference regarding frequency (p = 0.07) and time of induction (p = 0.29). Absence of obstetric complication, higher duration of labor (p = 0.036), and tendency to a higher satisfaction of the patients (p = 0.046) were observed among patients of group AC. Higher frequency of cesarean sections (p = 0.014) and obstetric complications (9.3%) were observed among patients of group M.
CONCLUSION: Our results showed that electroacupuncture can be used to obtain cervical ripening, with similar results as compared with misoprostol, with a significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications.
Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P. Acupuncture for cervical ripening and induction of labor at term: A randomized controlled trial. Wien Klin Wochenschr. 2001;113(23-24): 942-46.
OBJECTIVE: The aim of this study was to evaluate whether acupuncture at term can influence cervical ripening, induce labor and thus reduce the need for postdates induction.
METHOD: On the estimated date of confinement (EDC) women were prospectively randomized to an acupuncture group (AG) or a control group (CG). Data of 45 women were evaluated (AG, n = 25; CG, n = 20). Inclusion criteria were as follows: confirmed EDC, uncomplicated course of pregnancy, singleton pregnancy in cephalic presentation. Exclusion criteria were as follows: cervical dilation > 3 cm, active labor, premature rupture of membranes, previous cesarean section, pathologies in mother or fetus. Women were examined at 2-day intervals. The cervical length was measured with vaginal ultrasonography, cervical mucus was obtained for a fetal Fibronectin test and the cervical status was assessed according to the Bishop score. In the AG, the points Hegu (Large Intestine 4) and Sanyinjiao (Spleen 6) were pierced on both sides every second day. If women were not delivered 10 days after EDC, labor was induced by administering vaginal prostaglandin tablets.
RESULTS: The cervical length in the AG was shorter than that in the CG on day 6 and day 8 after EDC (P = 0.04 for both). In the AG the time period from the first positive Fibronectin test to delivery was 2.3 days, while that in the CG was 4.2 days (P = 0.08). The time period from EDC to delivery was on average 5.0 days in the AG and 7.9 days in the CG (P = 0.03). Labor was induced in 20% of women in the AG (n = 5) and in 35% in the CG (n = 7) (P = 0.3). Overall duration of labor, and first and second stage of labor were not different in the two groups. In 56% of women who underwent acupuncture (n = 14) and in 65% of controls (n = 13), Oxytocin was used to augment labor. (P = 0.54).
CONCLUSION: Acupuncture at points LI4 and SP 6 supports cervical ripening at term and can shorten the time interval between the EDC and the actual time of delivery.
Chung KF, Yeung WF, Zhang ZJ, Yung KP, Man SC, Lee CP, Lam SK, Leung TW, Leung KY, Ziea ET, Taam Wong V. Randomized non-invasive sham-controlled pilot trial of electroacupuncture for postpartum depression. J Affect Disord. 2012;142(1-3): 115-21.
OBJECTIVE: Postpartum depression affects 10-15% of mothers. Although acupuncture was efficacious for major depressive disorder in pregnancy and in women outside the perinatal period, there has been no randomized controlled study on the feasibility, tolerability, and efficacy of acupuncture for postpartum depression.
METHOD: This was a randomized, subject- and assessor-blind, parallel-group, sham-controlled trial. Twenty women within six months postpartum with DSM-IV-diagnosed major depressive disorder of mild severity, defined as a 17-item Hamilton Depression Rating Scale (HDRS(17)) score of 12 to 19, were randomly assigned to either electroacupuncture or non-invasive sham acupuncture two sessions weekly for four weeks.
RESULTS: There was significant reduction in HDRS(17) score from baseline to 4-week posttreatment in both groups, with an effect size 1.4 and 1.8 for electroacupuncture and sham acupuncture, respectively. Improvement was observed as early as two weeks after commencing acupuncture. The response and remission rate in the electroacupuncture group at 4-week posttreatment was 33% and 44%, respectively; for the sham acupuncture group, it was 60% and 50%, respectively. There was no significant between-group difference in all outcome measures, including the HDRS(17), Edinburgh Postnatal Depression Scale, Hospital Anxiety and Depression Scale, Clinical Global Impression, and Sheehan Disability Scale. Treatment credibility, success of blinding, and adverse events were similar between groups.
CONCLUSION: Both electroacupuncture and non-invasive sham acupuncture were effective for postpartum depression. Further studies utilizing larger sample size, better recruitment strategies, and home-based acupuncture treatment are warranted.
Neri I, Allais G, Vaccaro V, Minniti S, Airola G, Schiapparelli P, Benedetto C, Facchinetti F. Acupuncture treatment as breastfeeding support: Preliminary data. J Altern Complement Med. 2011;17(2): 133-37.
OBJECTIVE: This article investigates the efficacy of acupuncture for the maintenance of breastfeeding during the first 3 months of a newborn's life.
METHOD: After written informed consent was obtained, 90 women were randomly divided into two groups: acupuncture treatment or observation. Acupuncture sessions were performed twice weekly for 3 weeks (total six sessions). The control group made weekly visits to the clinic and the midwife observed their breastfeeding, giving routine care. In both groups, a semistructured clinical assessment of breastfeeding quality was carried out by the midwife at enrollment and after 3 weeks. Moreover, in both groups a telephone interview was conducted by the midwife at the third month of the infants' lives, regarding the continuation of breastfeeding.
RESULTS: No significant difference in the exclusive breastfeeding rate before treatment was observed between acupuncture and observation groups (51.2% versus 48.8%). However, at 3 weeks post-enrollment, exclusive breastfeeding was significantly lower in the observation group than in the acupuncture group (60% versus 100%; p?0.03). At the third month of the newborns' lives, breastfeeding was reported in 35% of the acupuncture group, compared to 15% of the observation group (p?0.03).
CONCLUSION: Such preliminary data suggest that 3 weeks of acupuncture treatment were more effective than observation alone in maintaining breastfeeding until the third month of the newborns' lives.
Wei L, Wang H, Han Y, Li C. Clinical observation on the effects of electroacupuncture at Shaoze (SI 1) in 46 cases of postpartum insufficient lactation. J Tradit Chin Med. 2008;28(3): 168-72.
OBJECTIVE: To evaluate the clinical therapeutic effects of electroacupuncture at Shaoze (SI 1) for insufficient lactation after delivery, and further study the influence of this method on the different types of syndromes and on such patients of different ages.
METHOD: The 92 cases of postpartum insufficient lactation were randomly divided into the treatment group (46 cases) and the control group (46 cases). The former was treated by electroacupuncture at bilateral Shaoze (SI 1), and the latter by electroacupuncture at bilateral Shangyang (LI 1). Both groups were treated for 2 courses, each course consisting of 5 times of treatment, and followed up for 1 month.
RESULTS: The total effective rate of the treatment group and control group was 100% and 69.6% respectively, showing a significant difference (P < 0.01). For different types of syndromes and different ages of patients, the treatment group obtained a better effect than the control group in increasing lactation quantity and maintaining prolactin level with a significant difference (P < 0.01).
CONCLUSION: Electroacupuncture at Shaoze (SI 1) was obviously effective for postpartum insufficient lactation.
Xu J, MacKenzie IZ. The current use of acupuncture during pregnancy and childbirth. Curren Opin Obstet Gynecol. 2012;24(2): 65-71.
BACKGROUND: Acupuncture has a growing clientele during pregnancy, delivery and the puerperium for an ever increasing list of indications. Objective evidence for its benefit is necessary to establish its roles in current practice.
RESULTS: For many of the current uses, randomized studies when conducted using at least one control group have not established any clear advantages from treatment. Those areas which rely upon subjective assessment of symptoms are particularly difficult to investigate without rigorous blinding strategies, separating those who provide the acupuncture from those assessing outcome. Studies investigating the possible therapeutic benefit of acupuncture for managing intrapartum care require outcomes for nulliparae and multiparae to be analysed separately.
CONCLUSION: Acupuncture therapy may offer some advantage over conventional treatment in the management of hyperemesis gravidarum and postcaesarean section pain and these areas warrant further study. Rigorous randomized studies, particularly those using objective measures, have failed to identify any obvious benefits from acupuncture for many of the other conditions studied.
Zheng YH, Wang XH, Lai MH, Yao H, Liu H, Ma HX. Effectiveness of abdominal acupuncture for patients with obesity-type polycystic ovary syndrome: A randomized controlled trial. J Altern Complem Med. 2013;19(9): 740-45.
OBJECTIVE: To assess the effectiveness of abdominal acupuncture at the endocrine and metabolic level in patients with obesity-type polycystic ovary syndrome (PCOS).
METHOD: Eighty-six women from the First Affiliated Hospital of Guangzhou Medical College with a diagnosis of PCOS (body-mass index [BMI] =25 kg/m(2)) were randomly assigned to receive 6 months of abdominal acupuncture (once a day) or oral metformin (250?mg three times daily in the first week, followed by 500?mg three times daily thereafter). BMI, waist-to-hip ratio (WHR), ovarian volume, menstrual frequency, homeostasis model assessment for insulin resistance (HOMA-IR), and Ferriman-Gallwey score were measured at the beginning of the study and after 6 months of treatment. Luteotrophic hormone (LH), testosterone, follicle-stimulating hormone (FSH), fasting blood glucose, 2-hour Postprandial blood glucose, fasting insulin, 2-hour postprandial blood insulin, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were also assessed.
RESULTS: According to the results at baseline and 6 months, BMI, WHR, Ferriman-Gallwey score, ovarian volume, luteotrophic hormone, ratio of luteotrophic hormone to follicle-stimulating hormone, testosterone, LDL-C, triglycerides, total cholesterol, fasting blood glucose, 2-hour postprandial blood glucose, fasting insulin, 2-hour postprandial blood insulin, and HOMA-IR were reduced significantly in the two groups (p<0.05). Menstrual frequency and HDL-C (p<0.05) increased significantly in both groups; follicle-stimulating hormone also increased in both groups, but the change was not significant (p>0.05). The acupuncture group showed considerable advantages over the metformin group in terms of reduced BMI and WHR and increases in menstrual frequency (p<0.05).
CONCLUSION: Abdominal acupuncture and metformin improved the endocrine and metabolic function of patients with obesity-type PCOS. Abdominal acupuncture may be more effective in improving menstrual frequency, BMI, and WHR, with few adverse effects.
Johansson J, Redman L, Veldhuis PP, Sazonova A, Labrie F, Holm G, Johannsson G, Stener-Victorin E. Acupuncture for ovulation induction in polycystic ovary syndrome: A randomized controlled trial. Am J Physiol Endocrinol Metab. 2013;304(9): 934-43.
OBJECTIVE: Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome (PCOS). Our aim was to investigate whether acupuncture affects ovulation frequency and to understand the underlying mechanisms of any such effect by analyzing LH and sex steroid secretion in women with PCOS.
METHOD: This prospective, randomized, controlled clinical trial was conducted between June 2009 and September 2010. Thirty-two women with PCOS were randomized to receive either acupuncture with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10-13 wk. Main outcome measures were changes in LH secretion patterns from baseline to after 10-13 wk of treatment and ovulation frequency during the treatment period. Secondary outcomes were changes in the secretion of sex steroids, anti-Müllerian hormone, inhibin B, and serum cortisol.
RESULTS: Ovulation frequency during treatment was higher in the acupuncture group than in the control group. After 10-13 wk of intervention, circulating levels of estrone, estrone sulfate, estradiol, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, testosterone, free testosterone, dihydrotestosterone, androsterone glucuronide, androstane-3a,17ß-diol-3-glucuronide, and androstane-3a,17ß-diol-17-glucuronide decreased within the acupuncture group and were significantly lower than in the control group for all of these except androstenedione.
CONCLUSION: We conclude that repeated acupuncture treatments resulted in higher ovulation frequency in lean/overweight women with PCOS and were more effective than just meeting with the therapist. Ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion.
Jedel E, Labrie F, Odén A, Holm G, Nilsson L, Janson PO, Lind AK, Ohlsson C, Stener-Victorin E. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: A randomized controlled trial. Am J Physiol Endocrinol Metab. 2011;300(1): 37-45.
BACKGROUND: Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, is characterized by hyperandrogenism, oligo/amenorrhea, and polycystic ovaries.
OBJECTIVE: We aimed to determine whether low-frequency electro-acupuncture (EA) would decrease hyperandrogenism and improve oligo/amenorrhea more effectively than physical exercise or no intervention.
METHOD: We randomized 84 women with PCOS, aged 18-37 yr, to 16 wk of low-frequency EA, physical exercise, or no intervention. The primary outcome measure changes in the concentration of total testosterone (T) at week 16 determined by gas and liquid chromatography-mass spectrometry was analyzed by intention to treat. Secondary outcome measures were changes in menstrual frequency; concentrations of androgens, estrogens, androgen precursors, and glucuronidated androgen metabolites; and acne and hirsutism. Outcomes were assessed at baseline, after 16 wk of intervention, and after a 16-wk follow-up.
RESULTS: After 16 wk of intervention, circulating T decreased by -25%, androsterone glucuronide by -30%, and androstane-3a,17ß-diol-3-glucuronide by -28% in the EA group (P = 0.038, 0.030, and 0.047, respectively vs. exercise); menstrual frequency increased to 0.69/month from 0.28 at baseline in the EA group (P = 0.018 vs. exercise). After the 16-wk follow-up, the acne score decreased by -32% in the EA group (P = 0.006 vs. exercise).
CONCLUSION: Both EA and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-wk follow-up compared with no intervention. Low-frequency EA and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Low-frequency EA was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea.
Lim C, Wong WU. Current evidence of acupuncture on polycystic ovarian syndrome. Gynecol Endocr. 2010;26(6): 473-78.
OBJECTIVE: This paper aims to provide a literature review on evaluating the efficacy of acupuncture therapy in the treatment of polycystic ovarian syndrome (PCOS) by reviewing clinical trials; randomised and non-randomised and observational studies on PCOS. The paper will also determine the possible mechanism of acupuncture treatment in PCOS, limitations of recruited studies and suggest further improvements in future studies.
METHOD: A comprehensive literature search was conducted through the databases Medline, PubMed, EMBASE, Cochrane, AMED (Allied and Complementary Medicine), NCCAM (The National Centre for Complementary and Alternative Medicine) to identify relevant monographs.
RESULTS: Four studies were recruited. Several studies showed that acupuncture significantly increases beta-endorphin levels for periods up to 24 h and may have regulatory effect on FSH, LH and androgen. beta-endorphin increased levels secondary to acupuncture affects the hyperthalamic-pituitary-adrenal (HPA) axis through promoting the release of ACTH through stimulation of its precursor pro-opiomelanocortin synthesis.
CONCLUSION: Acupuncture is a safe and effective treatment to PCOS as the adverse effects of pharmacologic interventions are not expected by women with PCOS. Acupuncture therapy may have a role in PCOS by: increasing of blood flow to the ovaries, reducing of ovarian volume and the number of ovarian cysts, controlling hyperglycaemia through increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia. However, well-designed, randomised controlled trials are needed to elucidate the true effect of acupuncture on PCOS.
Stener-Victorin E, Jedel E, Mannerås L. Acupuncture in polycystic ovary syndrome: Current experimental and clinical evidence. J Neuroendocrinol. 2008:20(3); 290-98.
BACKGROUND: This review describes the aetiology and pathogenesis of polycystic ovary syndrome (PCOS) and evaluates the use of acupuncture to prevent and reduce symptoms related with PCOS. PCOS is the most common female endocrine disorder and it is strongly associated with hyperandrogenism, ovulatory dysfunction and obesity. PCOS increases the risk for metabolic disturbances such as hyperinsulinaemia and insulin resistance, which can lead to type 2 diabetes, hypertension and an increased likelihood of developing cardiovascular risk factors and impaired mental health later in life. Despite extensive research, little is known about the aetiology of PCOS. The syndrome is associated with peripheral and central factors that influence sympathetic nerve activity. Thus, the sympathetic nervous system may be an important factor in the development and maintenance of PCOS. Many women with PCOS require prolonged treatment. Current pharmacological approaches are effective but have adverse effects. Therefore, nonpharmacological treatment strategies need to be evaluated.
CONCLUSION: Clearly, acupuncture can affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system. Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS suggest that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation.
Smith CA, Zhu X, He L, Song J. Acupuncture for dysmenorrhoea. Cochrane Data Syst Rev. 2011.
BACKGROUND: This review examined the currently available evidence supporting the use of acupuncture to treat primary dysmenorrhoea.
OBJECTIVE: To determine the efficacy and safety of acupuncture in the treatment of primary dysmenorrhoea when compared with a placebo, no treatment, or conventional medical treatment (for example oral contraceptives and non-steroidal anti-inflammatory medication (NSAIDs)).
METHOD: The following databases were searched (from inception until March 2010): the Cochrane Menstrual Disorders and Subfertillity Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), PubMed, CINAHL, PsycINFO, Chinese Biomedical Literature Database (CBM), Chinese Medical Current Content (CMCC), China National Knowledge Infrastructure (CNKI), VIP database, Dissertation Abstracts International, BIOSIS, AMED (The Allied and Complementary Medicine Database), Acubriefs, and Acubase. Inclusion criteria included all published and unpublished randomised controlled trials comparing acupuncture with placebo control, usual care, and pharmacological treatment. The following modes of treatment were included: acupuncture, electro-acupuncture, and acupressure. Participants were women of reproductive age with primary dysmenorrhoea during the majority of the menstrual cycles or for three consecutive menstrual cycles, and moderate to severe symptoms. Meta-analyses were performed using odds ratios (OR) for dichotomous outcomes and mean differences or standard mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CI). Primary outcomes were pain relief and improved menstrual symptoms, measured by self-rating scales. Other outcomes included use of analgesics, quality of life, and absence from school or work.
RESULTS: Ten trials were included in the review with data reporting on 944 participants. Six trials reported on acupuncture (n = 673) and four trials (n = 271) reported on acupressure. There was an improvement in pain relief from acupuncture compared with a placebo control (OR 9.5, 95% CI 21.17 to 51.8), NSAIDs (SMD -0.70, 95% CI -1.08 to -0.32) and Chinese herbs (SMD -1.34, 95% CI -1.74 to -0.95). In two trials acupuncture reduced menstrual symptoms (for example nausea, back pain) compared with medication (OR 3.25, 95% CI 1.53 to 6.86); in one trial acupuncture reduced menstrual symptoms compared with Chinese herbs (OR 7.0, 95% CI 2.22, 22.06); and in one trial acupuncture improved quality of life compared with usual care.There was an improvement in pain relief from acupressure compared with a placebo control (SMD -0.99, 95% CI -1.48 to -0.49), and in one trial acupressure reduced menstrual symptoms compared with a placebo control (SMD -0.58, 95% CI -1.06 to -0.10). The risk of bias was low in 50% of trials.
CONCLUSION: Acupuncture may reduce period pain, however there is a need for further well-designed randomised controlled trials.
Cho SH, Hwang EW. Acupuncture for primary dysmenorrhoea: A systematic review. Brit J Gynecol. 2010;117(5): 509-21.
BACKGROUND: The effectiveness of acupuncture in primary dysmenorrhoea is not fully understood.
OBJECTIVE: To assess the effectiveness of acupuncture for the symptomatic treatment of primary dysmenorrhoea from randomised controlled trials (RCTs).
METHOD: Nineteen electronic databases, including English, Korean, Japanese and Chinese databases, were systematically searched for RCTs investigating acupuncture for primary dysmenorrhoea up to July 2008 with no language restrictions. All RCTs that evaluated the effects of acupuncture compared with controls were included. Studies that assessed the effect of moxibustion or body acupressure were excluded. The study abstraction and quality assessment of all studies were undertaken following the detailed descriptions of these categories as described in the Cochrane Handbook for Systematic Reviews of Interventions.
RESULTS: Twenty-seven RCTs were systematically reviewed. Only nine of the 27 trials clearly described their methods of randomisation and none of the trials stated the methods of allocation concealment. Compared with pharmacological treatment or herbal medicine, acupuncture was associated with a significant reduction in pain. Three studies reported reduced pain within groups from baseline; however, two RCTs did not find a significant difference between acupuncture and sham acupuncture.
CONCLUSION: The review found promising evidence in the form of RCTs for the use of acupuncture in the treatment of primary dysmenorrhoea compared with pharmacological treatment or herbal medicine. However, the results were limited by methodological flaws. The evidence for the effectiveness of acupuncture for the treatment of primary dysmenorrhoea is not convincing compared with sham acupuncture. Further rigorous nonpenetrating placebo-controlled RCTs are warranted.
Rubi-Klein K , Kucera-Sliutz E, Nissel H, Bijak M, Stockenhuber D, Fink M, Wolkenstein E. Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis?: A randomised controlled cross-over trial. Euro J Obstet Gynecol Reprod Biol. 2010;153(1): 90-93.
OBJECTIVE: The aim of the study was to examine whether acupuncture is an effective additional pain treatment for endometriosis.
METHOD: One hundred and one women aged 20-40 years participated and were randomised into two groups, each receiving two units of 10 acupuncture treatments, twice a week over a period of five weeks. Group 1 (n = 47) received verum-acupuncture during the first series, and group 2 (n = 54) received non-specific acupuncture. After the first unit of 10 treatments, an observation period of at least two menstruation cycles was set, followed by a second unit, according to a cross-over design. Prior to the study (during a two-week run-in period) the patients' actual pain intensity was surveyed. Throughout the study period, participants were asked to keep a 'pain protocol', in which they defined and recorded their pain according to the 10-point visual analogue scale (VAS).
RESULTS: Eighty-three out of a total of 101 patients finished the study. Group 1 showed a significant reduction of pain intensity after the first 10 treatments. In comparison, group 2 showed significant pain relief only after the cross-over.
CONCLUSION: Acupuncture treatment on specific acupuncture points appears to be an effective pain treatment for endometriosis, but this has to be confirmed in further study.
Yu YP, Ma LX, Ma YX, Ma YX, Liu YQ, Liu CZ, Xie JP, Gao SZ, Zhu J. Immediate effect of acupuncture at Sanyinjiao (SP6) and Xuanzhong (GB39) on uterine arterial blood flow in primary dysmenorrhea. J Altern Complement Med. 2010;16(10): 1073-78.
OBJECTIVE: The objective of this study was to compare immediate effect of acupuncture at SP6 on uterine arterial blood flow in primary dysmenorrhea with that of GB39.
METHOD: This was a prospective, randomized clinical trial. Sixty-six (66) patients with primary dysmenorrhea from the Affiliated Hospital of Shangdong University of Traditional Chinese Medicine were recruited. The SP6 group (n =32) was treated with manual acupuncture at bilateral SP6 for 5 minutes after obtaining needling sensation (de qi) during the period of menstrual pain, whereas the control group (n = 34) was needled at GB39 of both sides for 5 minutes when they suffered menstrual pain. Differences in pulsatility index (PI), resistance index (RI), and ratio of systolic peak and diastolic peak (A/B) in uterine arteries were the main outcome measures.
RESULTS: Highly significant reductions were observed in the SP6 treatment group 5 minutes after treatment in menstrual pain scores (8.17 ± 1.90 versus 11.20 ± 2.66; p < 0.001), values of PI (1.75 ± 0.48 versus 2.32 ± 0.70; p < 0.001), RI (0.72 ± 0.11 versus 0.78 ± 0.07; p < 0.001), and A/B (4.33 ± 1.37 versus 5.23 ± 1.67; p < 0.001). Compared with the GB39 control group, patients in the SP6 treatment group showed significant reductions in 5 minutes after treatment in the changes of menstrual pain scores (3.03 ± 2.36 versus 0.00 ± 0.29; p < 0.001), values of PI (0.57 ± 0.42 versus -0.10 ± 0.58; p < 0.001), RI (0.06 ± 0.08 versus -0.03 ± 0.15; p < 0.01), and A/B (0.90 ± 0.87 versus 0.23 ± 1.02; p < 0.01). There were no significant changes in menstrual pain scores, values of PI, RI, or A/B before and after treatment in the GB39 control group (p > 0.05). No adverse events from treatment were reported.
CONCLUSION: This study suggests that needling at SP6 can immediately improve uterine arterial blood flow of patients with primary dysmenorrhea, while GB39 does not have these effects.
Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN. Acupuncture in patients with dysmenorrhea: A randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008;198: 166e1-8.
OBJECTIVE: To investigate the clinical effectiveness and cost-effectiveness of acupuncture in patients with dysmenorrhea.
METHOD: In a randomized controlled trial plus non-randomized cohort, patients with dysmenorrhea were randomized to acupuncture (15 sessions over three months) or to a control group (no acupuncture). Patients who declined randomization received acupuncture treatment. All subjects were allowed to receive usual medical care.
RESULTS: Of 649 women (mean age 36.1 +/- 7.1 years), 201 were randomized. After three months, the average pain intensity (NRS 0-10) was lower in the acupuncture compared to the control group: 3.1 (95% CI 2.7; 3.6) vs. 5.4 (4.9; 5.9), difference -2.3 (-2.9; -1.6); P<.001. The acupuncture group had better quality of life and higher costs. (overall ICER 3,011 euros per QALY).
CONCLUSION: Additional acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life as compared to treatment with usual care alone and was cost-effective within usual thresholds.