Introduction
Infertility is an important public health issue and approximately from
9% to 18% of couples worldwide suffering from infertility (1-3). For
achieving pregnancy, in vitro fertilization (IVF) has become a
widespread treatment option. Despite many recent technological advances,
the average success rate of IVF was only 36% reported by the Centers
for Disease Control and Prevention of USA at 2016 (4). Acupuncture has
been used as an attractive and most frequently adjuvant therapy based on
its low side-effects and convenience (5). A study conducted in USA
showed that 22% couples had used acupuncture
(6). However, evidence from
acupuncture in improving IVF birth outcomes still remains a matter of
debate.
Since the first randomized clinical trial (RCT) was published in 1999
(7), nearly 50 RCTs have emerged to explore acupuncture’s impact on IVF
outcomes. However, the conclusions in inconclusive. Even if many
systematic reviews and meta-analyses still revealed both positive
effects (8-15) and negative benefits of acupuncture assisting IVF
success (16-24). Different searching databases and literature selection
criteria may partly contribute to the unconfirmed results. For example,
some analyses (11, 14, 16, 17) just included English language
literature. Several analyses did not cover all the acupuncture types or
control (12, 14, 22). In addition, most of meta-analyses considered
clinical pregnancy rate (CPR) as a primary outcome and neglected the
live birth rate (LBR). LBR was an accepted primary outcome in IVF trials
(25, 26) and its related results need to be further updated. The
conflicted results might be not due to the ineffectiveness of
acupuncture but rather to the methodological flaws confound acupuncture
IVF RCTs. Therefore, taken together with the continuously added new
evidence, this study aimed to evaluate the impact of acupuncture on IVF
outcomes for both CPR and LBR based on RCTs by conducting a
comprehensive literature covered English and Chinese involving all
common acupuncture methods.