Can IVF acupuncture improve live birth rates, aka take home babies?

Despite 20 years of vigorous IVF research, we still are trying to find an answer. When you browse our blog you will read many IVF studies where acupuncture group had higher numbers of pregnancies or live births. But there are a few studies that show no effect on pregnancy rates. However, they often have other benefits, like improved embryo quality or better blood flow in the uterus or reduced stress. All in all, IVF acupuncture research may seem a bit hard to draw clear conclusions.

If you think that evidence is a bit confusing, here is a perfect study to clear things up.

Our ABORM colleague Lee Hullender Rubin in December 2019 published an article diving deep into current IVF acupuncture situation. She took two latest and most rigorous systematic reviews and meta-analysis; picked them apart and came up with a pretty neat overview.

Here you have it, a summary on what acupuncture can do during your next IVF, according to data of 1980 women.

The summary of the current evidence on how acupuncture influences IVF outcomes

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Are you labelled as a poor IVF responder? Is there a way you can up your chances of making a baby? You know there are not many options. Can acupuncture help?

IVF is the numbers game. The important part of IVF is for your ovaries to safely produce as many follicles as possible. And poor IVF responders’ ovaries, as the name suggests, don’t grow many follicles. This means these IVF cycles are often cancelled. If you are lucky you may end up with a couple of oocytes. Furthermore, those eggs are less likely to turn into embryos.

The poor ovarian response (POR) is a diagnosis no one wants when trying to conceive. IVF clinics can’t do much to help you respond better. There are several IVF protocols you can try, but unfortunately, they are seldom successful.

So, what does poor IVF response diagnosis mean? Let’s take it apart.

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In this post, we’ll discuss the article published in JAMA “The Effects of Acupuncture vs Sham Acupuncture on Live Birth Rates Among Women Undergoing In Vitro Fertilization” (1).

I know, these comments may include technical jargon, which may be hard to understand for a lay person. This post is mostly for healthcare providers helping them understand this particular study.

This new study questions acupuncture’s effects on IVF pregnancy outcomes, but when you peruse the paper carefully the validity of it comes into the red zone for several reasons: Read more

Do you find yourself scrolling through endless pages of conflicting advice on fertility diet? Do you feel like after all that googling you haven’t found the answer?

Is dairy good or bad for fertility? Pineapples? Gluten? Go vegan?  What about Keto diet?

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How many acupuncture treatments do you need to improve IVF outcomes?

Our own analysis of IVF acupuncture studies has shown that the treatment protocol for IVF patients needs to take into account your specific situation.

Furthermore, the results can be significantly improved when we use the comprehensive approach of TCM diagnosis and make use of both acupuncture and herbal medicines 3+ months leading to IVF. And our colleagues who did their research agree. Furthermore, below is a study published this month suggesting that three acupuncture sessions around the day of embryo transfer are insufficient intervention.

There are situations where you will not have enough notice, or you will learn about acupuncture late in the IVF process. It may be not too late. You can still benefit from a shorter course of treatment. As an example, studies have shown that when done correctly, even four acupuncture sessions can improve uterine blood flow. If you’re willing to benefit from this treatment, please get in touch with us as early as possible. If you started IVF and you feel like it’s too late don’t worry. There are still ways how we may help improve your chances of success. When we apply the correct approach, we can make a difference even after you’ve started IVF.

If your fertility is on the rapid decline because of your age, or other factors, delaying IVF to boost your fertility may not be wise. We take every aspect of your reproductive and general health into consideration. During your initial appointment, we discuss all options with you so you can choose.

We’ve prepared a lecture on the strategies of designing optimal individualised acupuncture protocol. This lecture soon will be available via a leading continuing medical education provider shortly.

Get in touch if you’re interested to learn about the optimal protocol for IVF Acupuncture.

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ohss This study shows acupuncture in IVF patients decreases the risk of ovarian hyperstimulation. And while it has some limitations, we need to take the results into account while choosing the right acupuncture protocol for each IVF patient.

The study was published in Chinese Journal of Integrated Traditional and Western Medicine.

[Effect of electro-acupuncture on clinical outcomes and ovarian hyperstimulation syndrome in in vitro fertilization and embryo transplantation].
(PMID:25566616)

Hong YL, Tan Y, Yin YY, Zou YJ, Guo YH, Nie XW
Department of Gynecology, Nanjing University of Chinese Medicine, China.
Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi Jiehe Zazhi = Chinese Journal of Integrated Traditional and Western Medicine / Zhongguo Zhong xi yi jie he xue Hui, Zhongguo Zhong yi yan jiu Yuan zhu ban [2014, 34(11):1292-1296]

OBJECTIVE: To observe the effect of electro-acupuncture (EA) on clinical outcomes and the occurrence of ovarian hyperstimulation syndrome (OHSS) in in vitro fertilization and embryo transplantation.

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Frozen embryo transfer acupuncture

IVF Frozen Embryo Transfer (FET) patients benefit from Acupuncture. This helps us understand how Acupuncture benefits fertility.

Electro stimulation on acupuncture points leading to the IVF transfer improves the quality/receptivity of the uterine lining. A study published in the latest issue of peer-reviewed British Medical Journal (Acupuncture in Medicine) found the rates of embryo implantation, clinical pregnancy and live birth rates were higher in patients who received acupuncture leading to the transfer. They also found significant measurable changes in the endometrium (uterine lining):

  • Acupuncture improved the chances of triple-line pattern endometrial lining. It has been shown in studies that triple-line pattern is associated with good IVF outcome.
  • Endometrial perfusion (blood supply to the uterine lining) is an important factor in the process of implantation. The study found greater endometrial and subendometrial vascularisation following a series of acupuncture treatments leading to embryo transfer.
  • Acupuncture improved HOXA10 expression. Higher HOXA10 is associated with greater endometrial receptivity and good pregnancy outcomes. HOXA10 expression is lower in the uteri of women with hydrosalpinx, PCOS, and endometriosis.

How much acupuncture should you have to see those enhancements to your fertility? Women in this study had six acupuncture sessions per cycle for three menstrual cycles.

See the abstract of the study below. Read more

fertility and sterility acupuncture

Acupuncture has been shown to increase the uterine blood flow (decrease uterine blood impedance). But does the uterine blood flow really matter when you’re having an IVF? This study provides the answer. The researchers used special ultrasound technique to measure uterine blood flow. They found that it had an immense effect on both pregnancy and implantation rates. IVF with women, who had the lowest blood flow (PI>3) on the day of transfer, unfortunately didn’t result in any pregnancies.

Fertil Steril. 1992 Feb;57(2):372-6. Read more

acupuncture-in-medicine-bmj

This study shows that there is a significant benefit to integrate acupuncture with IVF treatment for patients with two or more failed IVF cycles. It is one of the few studies using sham acupuncture to ensure that the effect of acupuncture is real, not just a placebo. The study was published in a reputable, pier-reviewed journal Acupuncture in Medicine, BMJ journals.

Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial.
IVF and acupuncture
Isoyama Manca di Villahermosa D, Dos Santos LG, Nogueira MB, Vilarino FL, Barbosa CP.
Source
Faculty of Medicine of ABC, Clinic for Human Reproduction, , Santo André, São Paulo, Brazil.
Abstract
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.
METHODS:
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 beta human chorionic gonadotrophin (beta hCG) 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).

CONCLUSIONS:
In this study, acupuncture and moxibustion increased pregnancy rates when used as an adjuvant treatment in women undergoing IVF, when embryo implantation had failed.

This systematic review on Acupuncture and IVF is especially interesting. The studies of the well researched German protocol show acupuncture to be effective on the day of embryo replacement. This systematic review shows that acupuncture during ovarian stimulation also plays significant role in increasing the pregnancy outcomes of IVF.


The role of acupuncture in assisted reproductive technology.
Zheng CH, Zhang MM, Huang GY, Wang W.

Abstract
The aim of this paper was to provide reliable evidence by performing a systematic review and meta-analysis for evaluating the role of acupuncture in assisted reproductive technology. All randomized controlled trials that evaluated the effects of acupuncture, including manual, electrical, and laser acupuncture (LA) techniques, on the clinical pregnancy rate (CPR) and live birth rate (LBR) of in vitro fertilization (IVF) or artificial insemination were included. The controlled groups consisted of no acupuncture and sham acupuncture groups. The sham acupuncture included sham acupuncture at acupoints, sham acupuncture at non- or inappropriate points, sham LA, and adhesive tapes. Twenty-three trials (a total of 5598 participants) were included in this paper. The pooled CPR from all acupuncture groups was significantly higher than that from all controlled groups, whereas the LBR was not significantly different between the two groups. However, the results were quite distinct when the type of control and/or different acupuncture times were examined in a sensitivity analysis. The results mainly indicate that acupuncture, especially around the time of the controlled ovarian hyperstimulation, improves pregnancy outcomes in women undergoing IVF. More positive effects from acupuncture in IVF can be expected if a more individualized acupuncture programs are used.

Full text of the study can be found here.

Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis.

Zheng CH, Huang GY, Zhang MM, Wang W.

Abstract

You can read the full paper here.

OBJECTIVE:
To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.

DESIGN:
Systematic review and meta-analysis.

PATIENT(S):
Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects of acupuncture on IVF outcomes.

INTERVENTION(S):
The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture.

MAIN OUTCOME MEASURE(S):
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.

RESULT(S):
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(S):
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 of using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study

Objective

To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on pregnancy rates (PR) in women undergoing ET.
Design

Prospective, randomized, single-blinded placebo-controlled clinical trial.
Setting

Research and laboratory facilities.
Patient(s)

A total of 309 patients, less than 45 years old, undergoing cryopreservation embryos transplant or fresh cycle IVF with or without intracytoplasmic sperm injection (ICSI).
Intervention(s)

The subjects were randomly allocated to three groups: mock TEAS treatment: 30 minutes after ET (group I, n = 99); single TEAS treatment: 30 minutes after ET (group II, n = 110); and double TEAS treatments: 24 hours before ET and 30 minutes after ET (group III, n = 100).
Main Outcome Measure(s)

Clinical PR, embryos implantation rate, live birth rate.
Result(s)

The clinical PR, embryos implantation rate, and live birth rate of group I (29.3%, 15.0%, and 21.2%, respectively) were significantly lower than those in group II (42.7%, 25.7%, and 37.3%, respectively) and group III (50.0%, 25.9%, and 42.0%, respectively).
Conclusion(s)

Transcutaneous electrical acupoint stimulation, especially double TEAS, significantly improved the clinical outcome of ET.

Key Words: Acupuncture, transcutaneous electrical acupoint stimulation (TEAS), pregnancy rate (PR), in vitro fertilization (IVF), embryo transfer (ET), intracytoplasmic sperm injection (ICSI)

Selecting a control for in vitro fertilization and acupuncture randomized controlled trials (RCTs): how sham controls may unnecessarily complicate the RCT evidence base

Eric Manheimer M.S.Corresponding Author Contact Information, a, E-mail The Corresponding Author

a Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, Maryland
Available online 13 May 2011.

Objective

To examine the theoretical and methodologic rationales for the use of sham acupuncture controls in trials of adjuvant acupuncture for in vitro fertilization (IVF), and to identify the drawbacks of using a sham acupuncture control that may have its own effects on the pregnancy outcome. Read more

Effects of electro-acupuncture on in vitro fertilization-embryo transfer (IVF-ET) of patients with poor ovarian response

[Article in Chinese]

Zhongguo Zhen Jiu. 2009 Oct;29(10):775-9.

Chen J, Liu LL, Cui W, Sun W.

Department of Reproduction, The Second Affiliated Hospital of Shandong University of TCM, Jinan 250001, China. fusantai@126.com
Abstract

OBJECTIVE: To observe the effect of electro-acupuncture therapy on oocyte quality and pregnancy outcome of patients with the poor ovarian response or decreased reserve in the course of in vitro fertilization (IVF).

METHODS: Sixty cases accepting IVF-ET were randomly divided into an observation group and a control group, 30 cases in each group. The two groups were both treated with antagonist scheme for ovulation induction, and the electro-acupuncture intervention was also added in the observation group, Guanyuan (CV 4), Taixi (KI 3), Sanyinjiao (SP 6) etc. were selected. The therapeutic effects in the two groups were compared after treatment.

RESULTS: There was no significant difference between the two groups before treatment. The symptoms of kidney deficiency in the observation group were significantly improved after treatment, and the levels of serum estradiol (E2), fertilization rate, oocyte maturation rate, good quality embryos rate, and implantation rate in the observation group were superior to those in the control group on human Chorionic Gonadotropin (hCG) injection day (all P<0.05); the levels of stem cell factor (SCF) in follicular fluid and serum in the observation group were significantly higher than those in the control group (both P<0.05). The pregnancy rate in the observation group was higher than that in the control group, and the abortion rate in the observation group was lower than that in the control group, but there was no significant difference between the two groups (both P>0.05).

CONCLUSION: Electro-acupuncture therapy has a good clinical effect for IVF patients with poor ovarian reserve, and can improve oocyte (egg) quality and pregnancy outcome.

PMID: 19873910 [PubMed – indexed for MEDLINE]

Complement Ther Clin Pract. 2010 Aug;16(3):154-7. Epub 2009 Dec 24.
The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: a pilot study.

Balk J, Catov J, Horn B, Gecsi K, Wakim A.

University of Pittsburgh, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA. jbalk@magee.edu
Abstract

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

PATIENT(S): 57 infertile patients undergoing IVF or IVF/ICSI. INTERVENTIONS(S): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.

MAIN OUTCOME MEASURE(S): Perceive Stress Scale scores, pregnancy rates.

RESULT(S): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased their perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status. CONCLUSIONS(S): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

PMID: 20621276 [PubMed – in process]PMCID: PMC2904299 [Available on 2011/8/1]

IVF is stressful. And Acupuncture offsets the effects of stress on some reproductive hormones during the in vitro fertilisation.

fertility and sterility acupuncture Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment

Paul C. Magarelli, M.D.aCorresponding Author Informationemail address, Diane K. Cridennda, L.Acb, Mel Cohen, Ph.D.a

Received 22 May 2008; received in revised form 24 October 2008; accepted 28 October 2008. published online 31 December 2008.
Corrected Proof
Objective

To determine whether changes in serum cortisol (CORT) and PRL are affected by acupuncture (Ac) in Ac-treated IVF patients.
Design

Prospective cohort clinical study.
Setting

Private practice reproductive endocrinology and infertility clinic and private practice acupuncture consortium.
Patient(s)

Sixty-seven reproductive-age infertile women undergoing IVF.
Intervention(s)

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.
Main Outcome Measure(s)

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.
Result(s)

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(s)

In this study, there appears to be a beneficial regulation of CORT and PRL in the Acupuncture group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics.

fertility and sterility acupuncture The Role of Acupuncture in the Management of Subfertility

Ng E H et al Fertil Steril. 2008 Jul;90(1):1-13.
Fertility and Sterility

Abstract

OBJECTIVE: To review systematically the use of acupuncture in the management of subfertility.

DESIGN: A computer search was performed via several English and Chinese databases to identify journals relevant to the subject.

RESULT(S): 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(S): Although acupuncture has gained increasing popularity in the management of subfertility, its effectiveness has remained controversial.

bmj-infertility-acupuncture1 Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis

Eric Manheimer, research associate1, Grant Zhang, assistant professor1, Laurence Udoff, assistant professor2, Aviad Haramati, professor3, Patricia Langenberg, professor and vice-chair4, Brian M Berman, professor1, Lex M Bouter, professor and vice chancellor (rector magnificus)5

1 Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207, USA, 2 Department of Obstetrics, Gynecology and Reproductive Services, University of Maryland School of Medicine, 3 Department of Physiology and Biophysics and Medicine, Georgetown University School of Medicine, Washington, DC, 4 Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 5 VU University Amsterdam De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands

Correspondence to: E Manheimer emanheimer@compmed.umm.edu
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.

Design Systematic review and meta-analysis.

Data sources Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.

Review methods 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.

Data synthesis 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).

Conclusions Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

fertility and sterility acupuncture Acupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection
Sandra L. Emmons, MD
Phillip Patton, MD

Source: Medical Acupuncture, A Journal For Physicians By Physicians
Spring / Summer 2000- Volume 12 / Number 2
“Aurum Nostrum Non Est Aurum Vulgi”

Table 1. Outcomes for Acupuncture vs Non-Acupuncture Cycles Among 6 Women Undergoing ICSI*
Patient No.
Age, y
Non-Acupuncture Cycles
AcupunctureCycles
Follicles Cycles Follicles Cycles
Mean No. No. Mean No. No. Outcome
1 29 4.7 3 8 1 IUP
2 34 2 1 10 2 SAB twice
3 36 3 2 14 1 SAB
4 37 8 1 6 1 No pregnancy
5 38 1 1 4 1 Cycle canceled
6 41 2 1 6 1 SAB
Mean (SD) 3.7 (1.0) 8.4 (1.3)
*ICSI indicates intracytoplasmic sperm injection; IUP, intrauterine pregnancy; and SAB, early spontaneous abortion. P=.02 for overall acupuncture follicles vs non-acupuncture follicles.

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