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Acupuncture ineffective in treating infertility

Among Chinese women with polycystic ovary syndrome, the use of acupuncture with or without clomiphene did not increase live births, compared with control acupuncture plus placebo, according to research recently published in JAMA.

Researchers noted this finding does not support acupuncture as an infertility treatment in such women.

“Clomiphene citrate is a first-line, inexpensive treatment to induce ovulation in women with (polycystic ovary syndrome [PCOS]). However, clomiphene had a high failure rate .... Thus new or adjuvant treatments would be desirable for this population,” Xiao-Ke Wu, MD, PhD, department of obstetrics and gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, China, and colleagues wrote. “One such treatment is acupuncture, an integral part of traditional Chinese medicine, which has gained increased popularity. [However], there are few studies indicating the prevalence of use of acupuncture among patients seeking infertility treatment.”

To gather more data, Wu and colleagues conducted a double-blind (clomiphene vs. placebo), single-blind (active vs. control acupuncture) factorial trial among 1,000 women with PCOS in mainland China. The women were randomized in a 1:1:1:1 ratio into one of four groups: active acupuncture plus clomiphene, active acupuncture plus placebo, control acupuncture plus clomiphene, and control acupuncture plus placebo. The women had 10 months of pregnancy follow-up.

Researchers stated that in the active acupuncture protocol, two sets of acupuncture points were alternated every other treatment to minimize soreness at the needle placement, and acupuncture points were located in abdominal muscles and leg muscles. In the control acupuncture protocol, two needles — one in each shoulder and one in each upper arm at nonacupuncture points — were inserted to a depth of less than 5 mm, and needles were not stimulated manually when inserted. The active and control acupuncture were administered twice a week for 30 minutes per treatment and clomiphene or placebo administered for 5 days per cycle, for up to four cycles.

According to Wu and colleagues, 926 women completed the trial. Of these, live births occurred in 69 of the 235 women (29.4%) in the active acupuncture plus clomiphene group; 66 of 236 (28%) in the control acupuncture plus clomiphene group; 31 of 223 (13.9%) in the active acupuncture plus placebo group; and 39 of 232 (16.8%) in the control acupuncture plus placebo group; In addition, the live birth rate was significantly higher in the women treated with clomiphene (28.7%) than with placebo (15.4%) and not significantly different between women treated with active acupuncture (21.8%) vs. control acupuncture (22.4%). Researchers also found that diarrhea and bruising were more common in patients receiving active acupuncture than control acupuncture.

“These findings do not support acupuncture alone or combined with clomiphene as an infertility treatment in patients with PCOS,” Wu and colleagues wrote.

In a related editorial, Josephine P. Briggs, MD, and David Shurtleff, PhD, of NIH’s National Center for Complementary and Integrative Health, wrote that Wu and colleagues’ findings are the latest to show the gaining medical popularity of acupuncture, but some questions remain on how the technique works.

“Recommendations for consideration of acupuncture as a therapeutic option are now included in some clinical practice guidelines, most notably the recently issued guidelines of the [ACP] for management of low back pain,” they wrote. “[This and other] studies shed new light on when and when not to consider using acupuncture, although why and how this procedure may work require further study.” – by Janel Miller

Disclosure: Neither Briggs, Shurtleff, nor Wu report any relevant financial disclosures. Please see the study for a full list of the other researchers’ relevant disclosures.