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--- acupuncture:evaluation:gyneco-obstetrique:09. fecondation in vitro [11 Dec 2020 07:44]
Nguyen Johan Replacement automatique de 'Ø negative recommendation' par 'Ø negative recommendation '
+++ acupuncture:evaluation:gyneco-obstetrique:09. fecondation in vitro [04 Jun 2025 18:05] (Version actuelle)
Nguyen Johan [1.1.1. Fu 2025]
@@ Ligne 1: / Ligne 1: @@
-====== in vitro fertilization ======
+/*English:In Vitro Fertilization*/
+====== in vitro fertilization: ======
 ====== Fécondation in vitro : évaluation de l'acupuncture ======
 ===== Systematic Reviews and Meta-Analysis=====
-| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture |
-| ☆☆ | Evidence for effectiveness of acupuncture |
-| ☆ |Limited evidence for effectiveness of acupuncture |
-| Ø |No evidence or insufficient evidence |
-==== Acupuncture générique ====
+==== Generic Acupuncture ====
+=== Fu 2025 ===
+Fu QW, Zhu SM, Chen J, Liu YQ, Liang CH, Song LJ, Zhuang J, Tan X, Liu LZ, Luo L, Yin HY, Yeung WF, Chen SC, Liu WT, Zhang QX, Tang Y. Acupuncture for women undergoing in vitro fertilization: An updated systematic review and meta-analysis with trial sequential analysis. Int J Nurs Stud. 2025 Apr 24;168:105097.  https://doi.org/10.1016/j.ijnurstu.2025.105097
+^Backgound| In vitro fertilization (IVF) is a widely utilized assisted reproductive technology, but its success rates remain suboptimal due to various physiological and psychological factors. Acupuncture, as a complementary therapy, has been proposed to improve reproductive outcomes and alleviate associated pain and anxiety.|
+^Objective| To evaluate the effectiveness and safety of acupuncture as an adjunctive treatment for women undergoing IVF, focusing on reproductive outcomes, pain reduction, and anxiety alleviation.|
+^Methods| Five English databases were searched up to June 20th, 2024. Manual acupuncture or electro-acupuncture was used solely as a complementary adjuvant in the experimental groups, and control interventions were sham acupuncture or blank (wait-list) control. Systematic reviews and meta-analyses were conducted based on the Cochrane systematic review method, and trial sequential analyses were performed. Meta-influence analyses, meta-regression and subgroup-analyses were performed for exploration of heterogeneity and related variables. Egger's together with trim and fill tests were conducted for evaluation of publication bias. The quality of the results was assessed, and correlation coefficient and cluster analyses were also performed.|
+^Results| Finally, 42 trials identified from** 37 published articles, involving 7400 participants**, were included, representing diverse populations worldwide. Compared to sham acupuncture and blank controls, acupuncture significantly (P < 0.05) improved biochemical pregnancy rate (RR = 1.28, 95 % CI: 1.04-1.57) and clinical pregnancy rates (RR = 1.19, 95 % CI: 1.06-1.34). Additionally, acupuncture was associated with better pain management during surgery and reduced anxiety levels. Acupuncture-specific adverse events were reported in eight of 42 trials, primarily mild to moderate local reactions. However, a significantly higher early miscarriage rate was observed in the acupuncture groups (RR = 1.51, 95 % CI: 1.10-2.08).|
+^Conclusions| Acupuncture may improve certain reproductive outcomes and alleviate pain and anxiety in women undergoing IVF. However, the potential risk of early miscarriage warrants caution, and further rigorous trials are needed to confirm these findings.|
+=== Liu 2025 ===
+Liu KX, Wu YY, Zhang M, Jia M, Wang D, Zhang CX, Guan YC, Tian PL. Effectiveness of non-pharmacological interventions on pregnancy rates in infertile individuals undergoing IVF/ICSI: a systematic review and network meta-analysis. Arch Public Health. 2025 Apr 22;83(1):110.  https://doi.org/10.1186/s13690-025-01571-x
+^Aim|To assess the impact of various non-pharmacological interventions on the likelihood of achieving pregnancy in individuals undergoing IVF/ICSI.|
+^Backgound| Despite significant advancements in assisted reproductive technology, the strategic utilization of non-pharmacological interventions to enhance clinical outcomes continues to pose a significant challenge in the field of reproductive medicine.|
+^Methods| Relevant studies published in English or Chinese were comprehensively selected from databases including CNKI, Wanfang Data, VIP Database, PubMed, Web of Science, and Embase up to December 2023. Studies that examined various non-pharmacological interventions during IVF/ICSI treatment, and reported subsequent pregnancy outcomes, were included. The control group received standard treatment. Study quality was assessed based on the methodology and criteria outlined in the Cochrane Collaboration Handbook. This review protocol was registered with PROSPERO (CRD42023414729).|
+^Results| Out of the initial 28,688 studies identified, 43 trials involving 5,779 women were included. When compared to the control treatment, cognitive-behavioral therapy, **acupuncture**, lifestyle intervention, health education, and music therapy were associated with a significantly increased likelihood of clinical pregnancy (OR 1.44, 95% CI 1.21 to 1.72; 1.89, 1.46 to 2.43; 1.75, 1.18 to 2.57; 2.10, 1.57 to 2.80; 1.52, 1.08 to 2.13, respectively). Among the non-pharmacological treatments studied, cognitive-behavioral therapy and lifestyle intervention were associated with the highest number of oocytes retrieved (OR 0.31, 95% CI 0.11 to 0.86; 0.15, 95% CI 0.04 to 0.58, compared to controls). No significant differences were observed among non-pharmacological interventions and the control group. Cognitive-behavioral therapy and health education led to the highest rate of high-quality embryos (OR 0.41, 95% CI 0.20 to 0.84; 0.52, 95% CI 0.28 to 0.97, compared to controls).|
+^Conclusions| Non-pharmacological treatments such as cognitive-behavioral therapy, health education, lifestyle intervention, **acupuncture**, and music therapy showed trends suggesting better clinical outcomes in terms of pregnancy achievement compared to the control group. More high-level RCT studies are clearly necessary for future meta-analyses to better guide clinical practice.|
+^Implications for nursing and/or health policy|Policymakers should promote non-pharmacological programs for infertile population and develop standard guidelines. This will ensure that non-pharmacological interventions are implemented responsibly, protecting patient rights and enhancing healthcare outcomes.|
+=== Wang 2024 ===
+Wang X, Xu HM, Wang QL, Zhu XY, Zeng YM, Huang L, Feng X, Chen S. The Timing and Dose Effect of Acupuncture on Pregnancy Outcomes for Infertile Women Undergoing In Vitro Fertilization and Embryo Transfer: A Systematic Review and Meta-Analysis. J Integr Complement Med. 2024 Nov;30(11):1031-1046.  https://doi.org/10.1089/jicm.2023.0478
+^Backgound| Women undergoing in vitro fertilization and embryo transfer (IVF-ET) often utilize acupuncture to enhance pregnancy outcomes. Yet, the optimal timing for acupuncture sessions and the relationship between dosage and effect remain uncertain. |
+^Objectives| To investigate the impact of the timing and dosage of acupuncture on pregnancy outcomes, drawing on existing research. |
+^Methods| A comprehensive search of eight databases was conducted from their inception to January 14th, 2023, without restrictions on language. Only randomized controlled trials comparing acupuncture with either sham acupuncture or no adjuvant treatment were selected for inclusion. This meta-analysis assessed the efficacy of acupuncture in IVF-ET, analyzing the influence of varied timing and dosage on pregnancy outcomes. Subgroup analyses were undertaken to address any heterogeneity across the studies. |
+^Results| A total of **38 RCTs involving 5,991 participants** were analyzed. In infertile women undergoing IVF fresh cycles, acupuncture performed during controlled ovarian hyperstimulation (COH) significantly increased the clinical pregnancy rate (CPR) (relative risk [RR] = 1.33, 95% confidence interval [CI]: 1.07-1.65, p = 0.01), whereas acupuncture administered either before COH or on the day of ET did not demonstrate reproductive benefits. Regarding frozen cycles, acupuncture before freeze-thaw embryo transfer (FET) significantly enhanced the CPR (RR = 1.71, 95% CI: 1.36-2.16, p < 0.00001) and live birth rate (LBR) (RR = 2.40, 95% CI: 1.20-4.79, p = 0.01). Improvements in CPR were observed across all dosage groups, but only the high-dosage group showed a significant increase in LBR (RR = 1.75, 95% CI: 1.05-2.92, p = 0.03). |
+^Conclusions| Timing and dosage of acupuncture are crucial factors affecting pregnancy outcomes in IVF-ET. For women undergoing IVF fresh cycles, acupuncture during COH yielded more significant reproductive benefits. In addition, acupuncture before freeze-thaw embryo transfer (FET) was associated with improved pregnancy outcomes in frozen cycles. Furthermore, higher dosages of acupuncture were linked to more favorable outcomes.|
+=== Xu 2024 ===
+Xu M, Zhu M, Zheng C. Effects of acupuncture on pregnancy outcomes in women undergoing in vitro fertilization: an updated systematic review and meta-analysis. Arch Gynecol Obstet. 2024 Mar;309(3):775-788.  https://doi.org/10.1007/s00404-023-07142-1
+^Purpose| To evaluate the effects of acupuncture on IVF-ET outcomes.|
+^Methods| Digital databases, including Pubmed, Embase, the Cochrane Library, the Web of Science and ScienceDirect, were searched from their inception to July 2022. The MeSH terms we used included: acupuncture, in vitro fertilization, assisted reproductive technology and randomized controlled trial. The reference lists of relevant documents were also searched. The biases of included studies were assessed by the Cochrane Handbook 5.3. The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). The pregnancy outcomes reported in these trials were pooled and expressed as risk ratios (RR) with 95% confidence interval (CI) in the Review Manager 5.4 meta-analysis software. Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.|
+^Results| **Twenty-five trials (a total of 4757 participants)** were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (25 trials) of all the acupuncture groups (43.6%) was significantly higher than that of all the control groups (33.2%, P < 0.00001), and the pooled LBR (11 trials) of all the acupuncture groups (38.0%) was significantly higher than that of all the control groups (28.7%, P < 0.00001). Different acupuncture methods (manual acupuncture, electrical acupuncture and transcutaneous acupoint electrical stimulation), acupuncture time (before or during the time of controlled ovarian hyperstimulation and around the time of embryo transfer), and acupuncture courses (at least 4 sessions and less than 4 sessions) have respectively positive effects on IVF outcomes.|
+^Conclusion| Acupuncture can significantly improve CPR and LBR among women undergoing IVF. Placebo acupuncture can be a relatively ideal control measure.|
+=== Zhang 2023 ===
+Zhang HR, Zhang C, Ma PH, Sun CY, Sun CY, Liu XY, Pu ZQ, Lin YH, Liu BY, Liu CZ, Yan SY. Pregnancy Benefit of Acupuncture on in vitro Fertilization: A Systematic Review and Meta-Analysis. Chin J Integr Med. 2023 Nov;29(11):1021-1032.  https://doi.org/10.1007/s11655-023-3748-3
+^Background| Currently, more and more infertility couples are opting for combined acupuncture to improve success rate of in vitro fertilization (IVF). However, evidence from acupuncture for improving IVF pregnancy outcomes remains a matter of debate.|
+^Objective| To quantitatively summarized the evidence of the efficacy of acupuncture among women undergoing IVF by means of systematic review and meta-analysis.|
+^Methods| Four English (PubMed, Web of Science, EMBASE, and Cochrane Register of Controlled Clinical Trials) and Four Chinese databases (Wanfang Databases, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and SinoMed) were searched from database inception until July 2, 2023. Randomized controlled trials (RCTs) that evaluated the acupuncture's effects for women undergoing IVF were included. The subgroup analysis was conducted with respect to the age of participants, different acupuncture types, type of control, acupuncture timing, geographical origin of the study, whether or not repeated IVF failure, and acupuncture sessions. Sensitivity analyses were predefifined to explore the robustness of results. The primary outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR), and the secondary outcomes were ongoing pregnancy rate and miscarriage rate. Random effects model with I2 statistics were used to quantify heterogeneity. Publication bias was estimated by funnel plots and Egger's tests.|
+^Results| A total of **58 eligible RCTs representing 10,968 women** undergoing IVF for pregnant success were identifified. Pooled CPR and LBR showed a signifificant difference between acupuncture and control groups [69 comparisons, relative risk (RR) 1.19, 95% confifidence intervals (CI) 1.12 to 1.25, I2=0], extremely low evidence; 23 comparisons, RR 1.11, 95%CI 1.02 to 1.21, I2=14.6, low evidence, respectively). Only transcutaneous electrical acupoint stimulation showed a positive effect on both CPR (16 comparisons, RR 1.17, 95%CI 1.06 to 1.29; I2=0, moderate evidence) and LBR (9 comparisons, RR 1.20, 95%CI 1.04 to 1.37; I2=8.5, extremely low evidence). Heterogeneity across studies was found and no studies were graded as high-quality evidence.|
+^Conclusion| Results showed that the convincing evidence levels on the associations between acupuncture and IVF pregnant outcomes were relatively low, and the varied methodological design and heterogeneity might influence the findings. |
+=== Masoud 2022 Ø ===
+Masoud A, Elsayed F, Abu-Zaid A, Marchand G, Lowe R, Liang B, Jallad M. Systematic review and meta-analysis of the efficacy of acupuncture as an adjunct to IVF cycles in China and the world. Turk J Obstet Gynecol. 2022 Dec 13;19(4):315-326.  https://doi.org/10.4274/tjod.galenos.2022.04752.
+^Background|Acupuncture has been introduced as an adjuvant therapy to in vitro fertilization (IVF) cycles in many randomized controlled trials (RCTs). However, there has been a debate among trials regarding the effectiveness and safety of the procedure. To determine how effective and safe acupuncture is as an adjunct to IVF cycles for primary and secondary female infertility.|
+^Methods|We conducted a literature search for relevant RCTs and ultimately included nine studies. The main selected outcomes included the rates of clinical pregnancy, ongoing pregnancy, miscarriage, live birth, and side effects. Patients receiving acupuncture were grouped together regardless of the acupuncture points used or the protocol for the insertion of needles. We performed a subgroup analysis according to whether studies originated inside and outside China to investigate the results of the different RCTs. We pooled outcomes as a risk ratio (RR) with 95% confidence interval (CI).|
+^Results| The analysis revealed that in China, acupuncture led to lower clinical [RR=0.80, 95% CI (0.66, 0.97), p=0.02] and ongoing [RR=0.78, 95% CI (0.63, 0.97), p=0.03] pregnancy rates than placebo. Outside China, acupuncture increased clinical pregnancy rates [RR=1.38, 95% CI (1.11, 1.71), p=0.003] and ongoing [RR=1.73, 95% CI (1.29, 2.31), p<0.001] pregnancy rates. Rates of live birth and miscarriage did not significantly differ between the arms. Regarding side effects, acupuncture groups had a significantly higher rate of puncture site itching compared to control groups [RR=1.51, 95% CI (1.12, 2.04), p=0.007]. |
+^Concusions|Overall analysis does not show a statistically significant increase in clinical pregnancy rates worldwide when using acupuncture as an adjunct therapy to IVF. There were no issues regarding patient safety from any included study. Subgroup results indicated that better rates for clinical pregnancy seem to be occurring more often in RCTs performed outside China than within.|
+=== Tyler 2022 Ø ===
+Tyler B, Walford H, Tamblyn J, Keay SD, Mavrelos D, Yasmin E, Al Wattar BH. Interventions to optimize embryo transfer in women undergoing assisted conception: a comprehensive systematic review and meta-analyses. Hum Reprod Update. 2022 Jun 30;28(4):480-500.  https://doi.org/10.1093/humupd/dmac009. https://pubmed.ncbi.nlm.nih.gov/35325124.
+^Background|Several interventions and techniques are suggested to improve the outcome of embryo transfer (ET) in assisted conception. However, there remains no consensus on the optimal practice, with high variations among fertility specialists.|
+^Objective and rationale| We conducted a comprehensive systematic review and meta-analyses of randomized controlled trials (RCTs) aiming to identify effective interventions that could be introduced around the time of ET to improve reproductive outcomes.|
+^Search methods| We searched the electronic databases (MEDLINE, EMBASE and Cochrane CENTRAL) from inception until March 2021 using a multi-stage search strategy of MeSH terms and keywords, and included all RCTs that evaluated an intervention in the 24-h period before/after ET in women undergoing IVF/ICSI. Our primary outcome was clinical pregnancy rate post-ET confirmed as viable pregnancy on ultrasound scan. We assessed the risk of bias in included trials and extracted data in duplicate. We pooled data using a random-effect meta-analysis and reported using risk ratio (RR) with 95% CI. We explored publication bias and effect modifiers using subgroup analyses.|
+^Outcomes| Our search yielded 3685 citations of which we included 188 RCTs (38 interventions, 59 530 participants) with a median sample size of 200 (range 26-1761). The quality of included RCTs was moderate with most showing a low risk of bias for randomization (118/188, 62.8%) and attrition (105/188, 55.8%) but there was a significant risk of publication bias (Egger's test P = 0.001). Performing ET with ultrasound guidance versus clinical touch (n = 24, RR 1.265, 95% CI 1.151-1.391, I2 = 38.53%), hyaluronic acid versus routine care (n = 9, RR 1.457, 95% CI 1.197-1.261, I2 = 46.48%) and the use of a soft versus hard catheter (n = 27, RR 1.122, 95% CI 1.028-1.224, I2 = 57.66%) led to higher clinical pregnancy rates. Other pharmacological add-ons also showed a beneficial effect including granulocyte colony-stimulating factor (G-CSF: n = 4, RR 1.774, 95% CI 1.252-2.512, I2 = 0), Atosiban (n = 7, RR 1.493, 95% CI 1.184-1.882, I2 = 68.27%) and hCG (n = 17, RR 1.232, 95% CI 1.099-1.382, I2 = 57.76%). Bed rest following ET was associated with a reduction in clinical pregnancy (n = 6, RR 0.857, 95% CI 0.741-0.991, I2 = 0.01%). Other commonly used interventions, such as non-steroidal anti-inflammatory drugs, prophylactic antibiotics, **acupuncture** and cervical mucus removal, did not show a significant benefit on reproductive outcomes. Our effect estimates for other important outcomes, including miscarriage and live birth, were limited by the varied reporting across included RCTs.|
+^Wider implications|Using ultrasound guidance, soft catheters and hyaluronic acid at the time of ET appears to increase clinical pregnancy rates. The use of Atosiban, G-CSF and hCG showed a trend towards increased clinical pregnancy rate, but larger trials are required before adopting these interventions in clinical practice. Bed rest post-ET was associated with a reduction in clinical pregnancy and should not be recommended.|
+=== Zhou 2022 ★===
+Zhou X, Li X, Ding H, Lu Y. Acupuncture effects on in-vitro fertilization pregnancy outcomes: A meta-analysis. Complement Ther Clin Pract. 2022 Feb;46:101525.  https://doi.org/10.1016/j.ctcp.2021.101525
+^Background| The effects of acupuncture on in-vitro fertilization outcomes remain controversial. This study aimed to perform a meta-analysis to assess the effectiveness of acupuncture as an adjuvant therapy to embryo transfer compared to sham-controls or no adjuvant therapy controls on improving pregnancy outcomes in women undergoing in-vitro fertilization.|
+^Methods|A systematic literature search up to January 2021 was performed and 29 studies included 6623 individuals undergoing in-vitro fertilization at the baseline of the study; 3091 of them were using acupuncture as an adjuvant therapy to embryo transfer, 1559 of them were using sham-controls, and 1441 of them were using no adjuvant therapy controls. They reported a comparison between the effectiveness of acupuncture as an adjuvant therapy to embryo transfer compared to sham-controls or no adjuvant therapy controls on improving pregnancy outcomes in women undergoing in-vitro fertilization. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated assessing the effectiveness of acupuncture as an adjuvant therapy to embryo transfer compared to sham-controls or no adjuvant therapy controls using the dichotomous method with a random or fixed-effect model.|
+^Results| Significantly higher outcomes with acupuncture were observed in biochemical pregnancy (OR, 1.98; 95% CI, 1.55-2.53, p < 0.001); clinical pregnancy (OR, 1.70; 95% CI, 1.46-1.98, p < 0.001); ongoing pregnancy (OR, 1.78; 95% CI, 1.41-2.26, p < 0.001); and live birth (OR, 1.58; 95% CI, 1.15-2.18, p = 0.005) compared to no adjuvant therapy controls. However, no significant difference were found between acupuncture and no adjuvant therapy controls in miscarriage (OR, 0.96; 95% CI, 0.48-1.92, p = 0.91). No significant difference was observed with acupuncture in biochemical pregnancy (OR, 1.16; 95% CI, 0.65-2.08, p = 0.62); clinical pregnancy (OR, 1.13; 95% CI, 0.83-1.54, p = 0.43); ongoing pregnancy (OR, 1.04; 95% CI, 0.66-1.62, p = 0.87); live birth (OR, 1.02; 95% CI, 0.73-1.42, p = 0.90), and miscarriage (OR, 1.16; 95% CI, 0.86-1.55, p = 0.34) compared to sham-controls.|
+^Conclusions| Using acupuncture as an adjuvant therapy to embryo transfer may improve the biochemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth outcomes compared to no adjuvant therapy controls. However, no significant difference was found between acupuncture as an adjuvant therapy to embryo transfer and sham-controls in any of the measured outcomes. This relationship forces us to recommend the use of acupuncture as adjuvant therapy in women undergoing in-vitro fertilization and inquire further studies comparing acupuncture and sham-controls to reach the best procedure.|
+=== Zhu 2022 ☆ ===
+Zhu C, Xia W, Huang J, Zhang X, Li F, Yu X, Ma J, Zeng Q. Effects of acupuncture on the pregnancy outcomes of frozen-thawed embryo transfer: A systematic review and meta-analysis. Front Public Health. 2022 Sep 9;10:987276.  https://doi.org/10.3389/fpubh.2022.987276.
+^Background| Acupuncture is increasingly used as adjuvant therapy for infertile women undergoing frozen-thawed embryo transfer (FET); however, its effects and safety are highly controversial. This study aimed to evaluate the pooled effects of adjuvant acupuncture on FET pregnancy outcomes.|
+^Methods| We considered only randomized controlled trials (RCTs) that compared acupuncture with sham acupuncture or no adjuvant treatment during FET and the primary outcome was clinical pregnancy rate. Two authors separately selected studies, extracted data, and performed a risk of bias assessment. Pooled data were expressed as risk ratio (RR) or mean difference (MD), with a 95% confidence interval (CI). In addition, we conducted subgroup and sensitivity analyses to investigate the sources of heterogeneity, and we also constructed funnel plots to assess the likelihood of publication bias. Finally, Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) was applied to evaluate the quality of evidence.|
+^Results| A total of **14 RCTs** with a total of **1,130 participants** were included in the study. We found significant effects of acupuncture adjuvant to FET on the outcomes of clinical pregnancy rate (RR = 1.54, 95% CI [1.28, 1.85], I 2 = 34%; 14 trials), biochemical pregnancy rate (RR = 1.51, 95% CI [1.21, 1.89]; 5 trials), endometrial thickness (MD = 0.97, 95% CI [0.43, 1.51]; 12 trials), and endometrial pattern (RR = 1.41, 95% CI [1.13, 1.75]; 7 trials). For live birth rate (RR = 1.48, 95% CI [0.90, 2.43], 4 trials), there were no statistical effectiveness. For subgroup analyses, most variables had tolerable heterogeneity (I 2 = 0%) except for trials that were sham-controlled, performed acupuncture only after FET, or <5 times, which appeared to interpret most of the heterogeneity. Additionally, the quality of evidence of all outcomes in this review ranged from low to moderate.|
+^Conclusion| Acupuncture could be instrumental in the pregnancy outcomes of FET, and has very few risks of severe adverse events; however, the quality of evidence is unsatisfactory. Further research with rigorous methodological quality should be considered, and the protocols of acupuncture also need more investigations (e.g., appropriate control groups, sessions, and times).|
+=== Coyle 2021 Ø ===
+Coyle ME, Stupans I, Abdel-Nour K, Ali H, Kotlyarsky M, Lie P, Tekin S, Thrimawithana T. Acupuncture versus placebo acupuncture for in vitro fertilisation: a systematic review and meta-analysis. Acupuncture in Medicine. 2021;39(1):20-29.   [218571]. [[https://doi.org/10.1177/0964528420958711|doi]]
+^Objective| To evaluate the efficacy of acupuncture compared to placebo acupuncture for women undergoing in vitro fertilisation (IVF) in a systematic review and meta-analysis. |
+^Methods| A search was conducted in seven English-language biomedical databases from their inception to 3 April 2019 to identify studies evaluating acupuncture as an adjunct to IVF treatment. Randomised controlled trials (RCTs) that compared acupuncture with placebo acupuncture using a non-invasive placebo acupuncture device in women undergoing a fresh or frozen IVF cycle were eligible, as were studies that tested placebo acupuncture as the intervention. Outcomes were clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, live birth rate and adverse events. |
+^Results| Eight RCTs involving 3607 women were included. Studies were judged to be low risk for most of the risk of bias domains. Acupuncture around the time of embryo transfer was not significantly different to placebo acupuncture in terms of the clinical pregnancy rate (6 RCTs, 2473 women, risk ratio (RR) = 0.99 (95% confidence interval (CI) = 0.88, 1.11), I2 = 51%, moderate certainty evidence), ongoing pregnancy rate (4 RCTs, 1459 women, RR = 0.88 (95% CI = 0.75, 1.02), I2 = 50%, moderate certainty evidence), miscarriage rate (4 RCTs, 502 women, RR = 1.23 (95% CI = 0.89, 1.71), I2 = 30%, high certainty evidence) or live birth rate (4 RCTs, 1835 women, RR = 0.87 (95% CI = 0.75, 1.01), I2 = 0%, high certainty evidence). Outcomes with placebo acupuncture were not significantly different to usual care. Adverse events relating to acupuncture, such as discomfort and bruising, were mild to moderate. |
+^Conclusion| Acupuncture administered around the time of embryo transfer did not have a statistically significant effect on IVF outcomes compared with placebo acupuncture.|
+=== Liu 2021 ☆ ===
+Li M, Liu Y, Wang H, Zheng S, Deng Y, Li Y. The Effects of Acupuncture on Pregnancy Outcomes of Recurrent Implantation Failure: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2021.   [217100]. [[https://doi.org/10.1155/2021/6661235|doi]]
+^ Objective |To systematically evaluate the efficacy and safety of acupuncture for patients with recurrent implantation failure (RIF) undergoing in vitro fertilization-embryo transfer (IVF-ET) and hopefully provide reliable guidance for clinicians and patients. |
+^ Methods|Through searching domestic and foreign medical journals, the literature of randomized controlled trials (RCTs) of acupuncture for RIF undergoing IVF-ET was collected. RevMan 5.3 software was used for meta-analysis and Cochrane's risk of bias assessment tool was used to evaluate the quality of the included studies. |
+^Results|**Seven documents** meeting the criteria were finally included. The results showed that the intervention group contributes more in outcomes including clinical pregnancy rate (RR = 1.90, 95% CI (1.51, 2.40), P < 0.05), biochemical pregnancy rate (RR = 1.59, 95% CI (1.27, 1.99), P < 0.05), embryo implantation rate (RR = 1.89, 95% CI (1.47, 2.45), P < 0.05), and endometrial thickness (MD = 1.11, 95% CI (0.59, 1.63), P < 0.05) when compared with the control group, and the difference is statistically significant. In terms of the number of embryo transfers and the type of endometrium, the difference between the acupuncture group and the control group was not statistically significant. |
+^ Conclusion|Acupuncture therapy on patients with RIF can improve the pregnancy outcome of patients. It is a relatively effective treatment with satisfactory safety and suitable for clinical application. However, as the quality of the included studies is not good enough, the conclusion of this meta-analysis should be treated with caution. More double-blind RCTs equipped with high quality and large samples are expected for the improvement of the level of evidence. |
 === Gu 2019 ===
@@ Ligne 21: / Ligne 127: @@
 ^Conclusions|Additional Traditional Chinese Medicine (TCM) theory-based, standardized, large-size, randomized, and multicenter trials are necessary prior to any conclusions being drawn on whether TCM can improve IVF outcome|
-=== Smith 2019 ===
+=== Smith 2019 ☆ ===
 Smith CA, Armour M, Shewamene Z, Tan HY, Norman RJ, Johnson NP. Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis. Reprod Biomed Online. 2019;38(3):364-379.   {{:medias securises:acupuncture:evaluation:gyneco-obstetrique:smith-207929.pdf|[207929]}}. [[https://linkinghub.elsevier.com/retrieve/pii/S1472-6483(18)30675-8|doi]]
@@ Ligne 199: / Ligne 305: @@
 Stener-Victorin E, Humaidan P. Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupuncture in Medicine. 2006;24(4):157-163. {{:medias securises:acupuncture:evaluation:gyneco-obstetrique:stener-143845.pdf|[143845]}}.  <wrap lo>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. 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. It seems, however, that acupuncture has a positive effect and no adverse effects on pregnancy outcome.
 </wrap>
-==== Formes cliniques particulières ====
+==== Special Acupuncture Techniques ====
+=== Comparison of Acupuncture techniques ===
+== Bin 2025 ==
+Bin C, Zhong H, Zhang S, Luo Y, Su J, Li M, Wei S. Effects of acupuncture-related therapies on pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer: a Bayesian network meta-analysis. J Assist Reprod Genet. 2025 May 9.  https://doi.org/10.1007/s10815-025-03489-3
+^Backgound| This network meta-analysis aimed to assess the efficacy of different acupuncture-related therapies in improving pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer (IVF-ET).|
+^Methods| Randomized controlled trials (RCTs) examining acupuncture-related therapies as adjuncts to IVF-ET were systematically searched in eight databases from inception until January 15, 2025. Dichotomous outcomes concerning efficacy were evaluated as odds risk (OR) and continuous data as mean difference (MD) and 95% credible intervals (CrI) utilizing R 4.1.2 and Stata 16.1.|
+^Results| Through a comprehensive literature search, we ultimately identified **96 RCTs that involved 14,736 participants** and 15 interventions in this systematic analysis. Based on the clinical pregnancy rate outcome, warm acupuncture for three menstrual cycles before oocyte retrieval (WA-TTP, OR 3.56, 95% CrI 2.05 to 6.25, low certainty, SUCRA = 89.54%), acupuncture combined with moxibustion for three menstrual cycles before oocyte retrieval (AC + M-TTP, OR 3.31, 95% CrI 1.05 to 11.77, low certainty, SUCRA = 78.70%), and acupuncture for one menstrual cycle before oocyte retrieval (AC-OTP, OR 2.69, 95% CrI 1.76 to 4.09, moderate certainty, SUCRA = 77.98%) demonstrated potential superiority compared to false acupuncture or no treatment (F/N). Significant subgroup differences between clinical pregnancy rates were observed by subgroup analysis.|
+^Conclusion| Acupuncture-related therapies can potentially enhance clinical pregnancy rates among women undergoing IVF-ET, with WA-TTP, AC + M-TTP, and AC-OTP demonstrating potential superiority. AC-TTP demonstrated a greater efficacy in improving live birth rates, increasing endometrial thickness, and reducing pulsation index. Our findings emphasize that acupuncture-related therapies with a limited number of sessions before or after embryo transfer show minimal clinical benefit except auricular acupressure.|
+== Luo 2024 ==
+Luo MH, Tan Y, Zuo YC, Shi WY, Wang X, Zhang W. Effect of acupuncture and moxibustion as the adjuvant therapy on frozen-thawed embryo transfer: A network meta-analysis: 针灸辅助改善冻融胚胎移植疗效的网状Meta分析. World J Acupunct Moxibustion. 2024 Apr;34(2):103-116.
+^Objective| To evaluate the clinical effect of acupuncture- moxibustion as the adjuvant therapy on frozen-thawed embryo transfer (FET) using network meta-analysis.|
+^Methods| In PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Wanfang database (WanFang), VIP database and Chinese Biomedical Literature Database (SinoMed), the randomized controlled trials (RCTs) of the adjuvant therapy of acupuncture-moxibustion for FET were retrieved, from database inception to April 1, 2021. Cochrane risk of bias assessment tool was used to screen and evaluate the quality of the included studies, and RevMan 5.3, GeMTC0.14.3 and Stata16.0 software were adopted to complete the network meta-analysis.|
+^Results| **Twenty-nine RCTs comprising 2880 patients** were finally included, involving 17 interventions and 4 outcome measures. The results of network meta-analysis showed that the top three therapies under each outcome based on the magnitude of SUCRA values were: ① Clinical pregnancy rate (CPR, %): “transcutaneous electrical acupoint stimulation + herbal medicine” (76.4), “moxibustion + herbal medicine” (74.7), “acupuncture + moxibustion” (73.3); ②Biochemical pregnancy rate (BPR): “moxibustion + herbal medicine” (89.3), “acupuncture + moxibustion” (82.1), “acupuncture + herbal medicine” (78.7); ③Endometrial thickness: “acupoint injection + Western medicine” (87.2), auricular therapy (76.8), “acupuncture + herbal medicine” (73.5); ④Type A endometrial morphology rate: “acupoint injection + Western medicine ”(78.3), “moxibustion + herbal medicine” (58.0) and “acupuncture + moxibustion” (52.6).|
+^Conclusion| The combined treatment of acupuncture-moxibustion was superior to single therapy for FET patients. The combined therapy of transcutaneous electrical acupoint stimulation and herbal medicine had the best effect for improving CPR, “moxibustion + herbal medicine” obtained the best average comprehensive effect, and “acupoint injection + Western medicine” was conductive to ameliorate the endometrial thickness and morphology. Due to the limitations of existing studies, more high-quality RCTs are needed in the future to further verify these conclusions.|
+=== Electroacupuncture ===
+== Yang 2022 ★==
+Yang H, Hu WH, Xu GX, Yin ZH, Yu SY, Liu JJ, Xiao ZY, Zheng XY, Yang J, Liang FR. Transcutaneous electrical acupoint stimulation for pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer: A systematic review and meta-analysis. Front Public Health. 2022 Aug 11;10:892973.  https://doi.org/10.3389/fpubh.2022.892973.
+^Background|Infertility is a common health problem affecting couples of childbearing age. The proposal of in vitro fertilization-embryo transfer (IVF-ET) solves the problem of infertility to a certain extent. However, the average success rate of IVF-ET is still low. Some studies conclude that transcutaneous electrical acupoint stimulation (TEAS) could improve pregnancy outcomes in women undergoing IVF-ET, however, there is a lack of comprehensive synthesis and evaluation of existing evidence.|
+^Objective|To conduct a systematic review and meta-analysis to assess whether TEAS is effective and safe to improve the pregnancy outcomes for women undergoing IVF-ET.|
+^Methods|Eight online databases were searched from inception to 19 November 2021. In addition, four clinical trial registries were also searched, relevant references were screened, and experts were consulted for possible eligible studies. Randomized controlled trials (RCTs) that included patients with infertility who underwent IVF and used TEAS as the main adjuvant treatment vs. non-TEAS or mock intervention controls were included. The clinical pregnancy rate (CPR) was considered the primary outcome. High-quality embryo rate (HQER), live birth rate (LBR), biochemical pregnancy rate (BPR), ongoing pregnancy rate (OPR), early miscarriage rate (EMR), birth defects rate (BDR), and adverse events related to interventions were regarded as secondary outcomes. The selection, data extraction, risk of bias assessment, and data synthesis were conducted by two independent researchers using Endnote software V.9.1 and Stata 16.0 software. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the evidence quality of each outcome.|
+^Results|There were **19 RCTs involving 5,330 participants** included. The results of meta-analyses showed that TEAS can improve CPR [RR = 1.42, 95% CI (1.31, 1.54)], HQER [RR = 1.09, 95% CI (1.05, 1.14)], and BPR [RR = 1.45, 95% CI (1.22, 1.71)] of women underwent IVF-ET with low quality of evidence, and improve LBR [RR = 1.42, 95% CI (1.19, 1.69)] with moderate quality of evidence. There was no significant difference in EMR [RR = 1.08, 95% CI (0.80, 1.45)] and BDR [RR = 0.93, 95% CI (0.13, 6.54)] with very low and moderate quality of evidence, respectively. A cumulative meta-analysis showed that the effective value of TEAS vs. controls was relatively stable in 2018 [RR = 1.52, 95% CI (1.35, 1.71)]. In addition, no serious adverse events associated with TEAS were reported.|
+^Conclusion|Our findings suggest that TEAS may be an effective and safe adjuvant treatment for women undergoing IVF-ET to improve pregnancy outcomes. However, the current evidence quality is considered to be limited, and more high-quality RCTs are needed for further verification in the future.|
+== Zhan 2021 ==
+Zhan XX, Cai HC, Wang Y, Zhao J, Gou J, Qu W, Mo DS. [Transcutaneous electrical acupoint stimulation improves pregnancy outcomes of in vitro fertilization- embryo transfer : A meta-analysis of randomized controlled trials]. Zhonghua Nan Ke Xue. 2021 Sep;27(9):825-832. https://pubmed.ncbi.nlm.nih.gov/34914260/
+^Objective|To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on the pregnancy outcomes of in vitro fertilization-embryo transfer (IVF-ET) based on the available clinical evidence.|
+^Methods| We searched PubMed, MEDLINE, EMBASE, Cochrane Library, CNKI, VIP, CBM and Wanfang Database up to February 2021 for published randomized controlled trials (RCT) relevant to TEAS for the improvement of the pregnancy outcomes of IVF-ET. We performed literature screening, data extraction and quality evaluation according to the inclusion and exclusion criteria, followed by a meta-analysis with the RevMan 5.3 software.|
+^Results| A total of **2 206 cases of IVF-ET from 9 RCTs were included**, 1 018 in the TEAS group and 1 188 in the control. The clinical pregnancy rate was significantly higher in the TEAS than in the mock TEAS and non-TEAS control groups (RR = 1.85, 95% CI: 1.42－2.42, P < 0.001; RR = 1.23, 95% CI: 1.10－1.39, P = 0.0004), and so was it before and after oocyte retrieval (RR = 1.50, 95% CI: 1.03－2.17, P = 0.03; RR = 1.47, 95% CI: 1.12－1.92, P = 0.005). The TEAS group also showed dramatically improved embryo implantation rate (RR = 1.49, 95% CI: 1.24－1.79, P < 0.0001) and live birth rate (RR = 1.44, 95% CI: 1.04－1.98, P = 0.03) compared with the control.|
+^Conclusions|As a safe and non-invasive treatment, TEAS can significantly improve the pregnancy outcomes of IVF-ET, with definite effectiveness. .|
+==== Specific outcomes ====
+=== Anxiety and/or depression during IVF ===
+== Hullender Rubin 2022 ☆==
+Hullender Rubin LE, Smith CA, Schnyer RN, Tahir P, Pasch LA. Effect of acupuncture on IVF-related anxiety: a systematic review and meta-analysis. Reprod Biomed Online. 2022 Jul;45(1):69-80.  https://doi.org/10.1016/j.rbmo.2022.02.002
+^Background| Patients undergoing IVF experience high levels of IVF-related state anxiety. Non-pharmacological interventions such as acupuncture may provide support, but its effect on IVF-related anxiety is unclear. |
+^Objective|This was a systematic review and meta-analysis to examine the effect of acupuncture on IVF-related state anxiety. The primary outcome was state anxiety after embryo transfer or oocyte retrieval as assessed by the State-Trait Anxiety Inventory, Hamilton Anxiety Scale, visual analogue scale or Standard Form 36. |
+^Results| **Eight trials** with **2253 participants** were reviewed, and 1785 participants completed an anxiety assessment. Using the random effects model, the meta-analysis found small but significant effects on state anxiety with acupuncture versus any control (standardized mean difference -0.21, 95% confidence interval -0.39 to -0.04, representing very low certainty evidence). Evidence was limited by the moderate number of included studies of an intermediate median sample size (n = 191). There was also a high risk of performance bias and substantial heterogeneity across trials. |
+^Conclusion|Acupuncture is a drug-free and safe treatment that may benefit those who are burdened with IVF-related anxiety, but more investigation is needed for confirmation.|
+== Ye 2021 ==
+Jia-Yu Ye, Yi-Jing He, Ming-Jie Zhan, Fan Qu. Effects of acupuncture on the relief of anxiety and/or depression during in vitro fertilization: A systematic review and meta-analysis European Journal of Integrative Medicine. 2021;42. [218119]. [[https://www.sciencedirect.com/science/article/pii/S1876382021000056|doi]]
+^Introduction| Although effects of acupuncture on pregnancy outcomes among women undergoing in vitro fertilization (IVF) have been analyzed Using systematic reviews and meta-analysis, few have been focused on psychological issues. The present systematic review and meta-analysis was designed to evaluate the efficacy of acupuncture on relieving anxiety and/or depression during IVF treatment. |
+^Methods |As of November 2020, randomized controlled trials (RCTs) and quasi-RCTs to observe the therapeutic effects of acupuncture used to relieve anxiety and/or depression during IVF treatment were identified from the following databases: Pubmed, Embase, the Cochrane Library, Web of Science; China National Knowledge Infrastructure, Wanfang, VIP and Chinese Biomedicine database. Study selection, data collection and quality assessment were carried out. Study characteristics, results on anxiety and/or depression relief, IVF outcomes and adverse events were summarized. Meta-analysis was performed using Review Manager 5.3 software. |
+^Results| **Twelve studies with 2867 participants** were included. A significant difference (3 studies, 547 participants, MD -9.26, 95%CI −12.01 to -6.51, P<0.01) was observed for the relief of anxiety comparing acupuncture with controls during IVF treatment. No significant difference (9 studies, 1896 participants, RR=1.30, 95%CI 1.03 to 1.64; P=0.02) was found for clinical pregnancy rate. Only 2 out of 12 studies assessed remission of depression but there was no clear effect shown for acupuncture. |
+^Conclusions| Acupuncture may have a positive effect on anxiety relief during IVF treatment, while its effect on depression relief is inconclusive. More standardized, large-size, randomized and multicenter studies should be carried out on whether acupuncture can alleviate the anxiety and/or depression during IVF treatment.|
+==== Special Clinical Forms ====
 === Poor Ovarian Response ===
@@ Ligne 215: / Ligne 396: @@
 === Polycystic Ovarian Syndrome ===
+== Li 2024 ==
+Li YT, Li CL, Yang H, Huang L, Liu JJ, Zheng XY, Tao XY, Yu Z, Liang FR, Tian XP, Yang J. Correlation between acupuncture dose and pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization-embryo transfer: a systematic review. BMC Complement Med Ther. 2024 Nov 26;24(1):407.  https://doi.org/10.1186/s12906-024-04695-9
+^Backgound| Increasing studies focused on the efficacy of acupuncture on pregnancy outcomes in patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization-embryo transfer (IVF-ET). However, debatable conclusions have been drawn from different randomized controlled trials (RCTs), which might be related to different doses of acupuncture.|
+^Objective| To evaluate whether acupuncture has a dose-dependent effect on pregnancy outcomes in patients with PCOS undergoing IVF-ET in systematically reviewing.|
+^Methods| Seven electronic databases were searched from inception to October 10th, 2024. The Cochrane Collaboration's tool ROB 2.0 (ROB 2.0) provided an assessment for the risk of bias. The acupuncture dose was extracted, then categorized into high, medium, and low dose according to the scoring system results, the evidence was assessed by Slavin's qualitative best-evidence synthesis approach in a rigours methodological way. Clinical pregnancy rate (CPR) was regarded as the primary outcome.|
+^Results| A total of **953 subjects** met the eligibility criteria in **12 RCTs** were included, among which two studies were low dose, four were medium dose, and six were high dose. The overall quality of included studies was low, 50.00% (6/12) studies were low risk, 16.67% (2/12) studies were some concerns, and 33.33% (4/12) studies were high risk. Comparing the results, the consistent high-dose result among high-quality trials provides strong evidence for a positive correlation between high-dose acupuncture and pregnancy outcomes.|
+^Conclusion| A trend indicates that higher acupuncture doses yield better outcomes for PCOS patients undergoing IVF-ET. Further confirmation through direct comparisons of different doses was needed|
 == Yin 2020 ☆☆ ==
@@ Ligne 235: / Ligne 426: @@
 ^ Conclusions  | **Acupuncture may increase the CPR and OPR and decrease the risk of OHSS in women with PCOS undergoing IVF or ICSI**. Further studies are needed to confirm the efficacy and safety of acupuncture as an adjunct to assisted reproductive technology in this particular population.  |
-===== Revues de revues =====
+===== Overviews of Systematic Reviews =====
+==== Hu 2023 ====
+Hu XY, Xiu WC, Shi LJ, Jiao RM, Tian ZY, Hu XY, Ming TY, Gang WJ, Jing XH. [Acupuncture for in vitro fertilization-embryo transfer: an overview of systematic reviews]. Zhongguo Zhen Jiu. 2023 Sep 19;43(11):1315-1323.
+^Objectives| To evaluate the report quality, methodological quality and evidence quality of the systematic reviews and meta-analyses (SRs/MAs) of acupuncture for in vitro fertilization-embryo transfer (IVF-ET).|
+^Methods| The SRs/MAs of acupuncture for IVF-ET were searched electronically from databases of CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, from inception of each database to September 27th, 2022. Two reviewers independently screened the literature and extracted the data. Using PRISMA statement, the AMSTAR 2 scale and the GRADE system, the report quality, methodological quality and evidence quality of the included SRs/MAs were assessed.|
+^Results| A total of **28 SRs/MAs** were included, with PRISMA scores ranging from 8.5 points to 27 points. The problems of report quality focused on protocol and registration, retrieval, risk of bias in studies, additional analysis, limitations and funding. The methodological quality of included studies was generally low, reflecting on items 2, 3, 7, 10, 12 and 16. A total of 85 outcome indexes were included in the GRADE system for evidence grade evaluation. Most of the evidences were low or very low in quality. The reasons for the downgrade were related to study limitations, inconsistency, imprecision and publication bias.|
+^Conclusions| Acupuncture therapy improves the outcomes of IVF-ET, but the methodological quality and evidence quality of related SRs/MAs are low. It is recommended to conduct more high-quality studies in the future to provide more reliable evidences.|
+==== Wang 2021 ====
+Wang X, Wang Y, Wei S, He B, Cao Y, Zhang N, Li M. An Overview of Systematic Reviews of Acupuncture for Infertile Women Undergoing in vitro Fertilization and Embryo Transfer. Front Public Health. 2021. [218694].
+[[https://doi.org/10.3389/fpubh.2021.651811|doi]]
+^Background| Currently, more and more subfertility couples are opting for combined acupuncture to improve the success rate of in vitro fertilization and embryo transfer (IVF-ET). However, the efficacy and safety of acupuncture in IVF-ET is still highly controversial.|
+^Objectives| The purpose of this overview is to summarize evidence of essential outcomes of systematic reviews (SRs) of acupuncture in IVF-ET and evaluate their methodological quality. |
+^Methods| We conducted a comprehensive literature search for relevant SRs in eight databases from inception to July 31, 2020, without language restriction. We evaluated the methodological quality of the included SRs by using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), which was the latest available assessment tool. The Risk of Bias in Systematic Review (ROBIS) tool was used to assess the risk of bias in SRs. We assessed the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) score to determine the strength of evidence. We excluded the overlapping randomized controlled trials (RCTs) and performed a re-meta-analysis of the primary RCTs. |
+^Results| This review included 312 original RCT studies and 65,388 participants. By using AMSTAR-2, we found that the methodological quality of 16 SRs was critically low, because they had more than one critical weakness. Our reviews showed that although the GRADE for quality of evidence profile was suboptimal, acupuncture seemed to be beneficial in increasing the pregnancy rate. Our re-meta-analysis suggested that acupuncture was superior to sham acupuncture in improving the clinical pregnancy rate (CPR) of IVF-ET with substantial heterogeneity (RR = 1.31, 95% CI: 1.13-1.52, p = 0.0004, I 2 = 66%). No statistical difference was observed regarding the outcomes of live birth rate (LBR), ongoing pregnancy rate (OPR), biochemical pregnancy rate (BPR), and miscarriage rate (MR) between two groups. When compared with no adjunctive treatment groups, acupuncture improved CPR (RR = 1. 25, 95% CI: 1.11-1.42, p = 0.0003) and OPR (RR = 1. 38, 95% CI: 1.04-1.83, p = 0.03). Acupuncture was more superior than no adjunctive treatment in reducing MR (OR = 1.42, 95% CI: 1.03-1.95, p = 0.03) and BPR (RR = 1.19, 95% CI: 1.02-1.37, p = 0.02). |
+^Conclusions| Although the evidence of acupuncture in IVF-ET is insufficient, acupuncture appears to be beneficial to increase the clinical pregnancy rate in women undergoing IVF-ET. However, there are severe heterogeneity and methodological quality defects, which limit the reliability of results. Further, high-quality primary studies are still needed.|
 ==== Xi 2018 ====
@@ Ligne 246: / Ligne 460: @@
 ^ Conclusions|The evidence for acupuncture to treat couples with subfertility undergoing ART remains unclear. Further research is needed, with high-quality trials undertaken and reported. |
-===== Guidelines =====
+===== Clinical Practice Guidelines =====
+| ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) |
+=== European Society of Human Reproduction and Embryology (ESHRE) 2023 Ø ===
+ESHRE Add-ons working group; Lundin K, Bentzen JG, Bozdag G, Ebner T, Harper J, Le Clef N, Moffett A, Norcross S, Polyzos NP, Rautakallio-Hokkanen S, Sfontouris I, Sermon K, Vermeulen N, Pinborg A. Good practice recommendations on add-ons in reproductive medicine†. Hum Reprod. 2023 Sep 25:dead184. https://doi.org/10.1093/humrep/dead184
+| **Acupuncture**, Chinese and herbal medicine and other complementary therapies are not recommended.|
-| ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (ou absence de preuve) |
+=== American Society for Reproductive Medicine (ASRM, USA) 2017 Ø   ===
-===  American Society for Reproductive Medicine (ASRM, USA) 2017 ⊕   ===
 Practice Committee of the American Society for Reproductive Medicine. Performing the embryo transfer: a guideline. Fertil Steril. 2017;107(4):882-96.   {{:medias securises:acupuncture:evaluation:gyneco-obstetrique:asrm-182135.pdf|[182135].}}

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