Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Complementary Medicine and Therapies
Published in: BMC Complementary Medicine and Therapies 1/2019

Open Access 01-12-2019 | Infertility | Research article

Acupuncture in improving endometrial receptivity: a systematic review and meta-analysis

Authors: Yajing Zhong, Fanzhu Zeng, Wanjun Liu, Jing Ma, Yongge Guan, Yang Song

Published in: BMC Complementary Medicine and Therapies | Issue 1/2019

Login to get access

Abstract

Background

This systematic review aimed at summarizing and evaluating the evidence of randomized controlled trials (RCTs) using acupuncture to improve endometrial receptivity (ER).

Methods

We searched 12 databases electronically through August 2018 without language restrictions. We included RCTs of women of infertility due to low ER, and excluded infertility caused by other reasons or non-RCTs. Two independent reviewers extracted the characteristics of studies and resolved the differences through consensus. Data were pooled and expressed as standard mean difference (SMD) or mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes, with 95% confidence interval (CI).

Results

We found very low to moderate level of evidence that acupuncture may improve pregnancy rate (RR = 1.23 95%CI[1.13, 1.34] P < 0.00001) and embryo transfer rate (RR = 2.04 95%CI[1.13, 3.70] P = 0.02), increase trilinear endometrium (RR = 1.47 95%CI [1.27, 1.70] P < 0.00001), thicken endometrium (SMD = 0.41 95% CI [0.11, 0.72] P = 0.008), reduce resistive index (RI) (MD = -0.08 95% CI [− 0.15, − 0.02] P = 0.01), pulse index (PI) (SMD = -2.39 95% CI [− 3.85, − 0.93] P = 0.001) and peak systolic velocity/ end-diastolic blood velocity (S/D) (SMD = -0.60 95% CI [− 0.89, − 0.30] P < 0.0001), compared with medication, sham acupuncture or physiotherapy. Acupuncture was statistically significant as a treatment approach.

Conclusion

The efficacy and safety of acupuncture on key outcomes in women with low ER is statistically significant, but the level of most evidence was very low or low. More large-scale, long-term RCTs with rigorous methodologies are needed.
Literature
1.
Harper JC, Aittomaki K, Borry P, Cornel MC: Recent developments in genetics and medically assisted reproduction: from research to clinical applications 2018, 26(1):12–33.
2.
Roussos-Ross D, Rhoton-Vlasak AS, Baker KM, Arkerson BJ, Graham G. Case-based care for pre-existing or new-onset mood disorders in patients undergoing infertility therapy. J Assist Reprod Genet. 2018;35(8):1371–6.PubMed
3.
Artini PG, Obino MER, Sergiampietri C, Pinelli S, Papini F, Casarosa E, Cela V. PCOS and pregnancy: a review of available therapies to improve the outcome of pregnancy in women with polycystic ovary syndrome. Expert review of endocrinology & metabolism. 2018;13(2):87–98.
4.
Lisovskaya TV, Zakhezina EA, Filippova GG, Ambartsumyan EM, Portnov IG, Mayasina EN. Mental state assessment of recipients in the IVF donor programs and psychotherapeutic methods of its correction. Gynecological endocrinology : the official journal of the International Society of Gynecol Endocrinol. 2017;33(sup1):28–31.
5.
Siristatidis CS, Vrachnis N, Creatsa M, Maheshwari A, Bhattacharya S. In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction. The Cochrane database of systematic reviews. 2013;(10):Cd006606.
6.
Diedrich K, Fauser BC, Devroey P, Griesinger G. The role of the endometrium and embryo in human implantation. Hum Reprod Update. 2007;13(4):365–77.PubMed
7.
Arredondo F, Noble LS. Endocrinology of recurrent pregnancy loss. Semin Reprod Med. 2006;24(1):33–9.PubMed
8.
Hill MJ, Levens ED, Levy G, Ryan ME, Csokmay JM, DeCherney AH, Whitcomb BW. The use of recombinant luteinizing hormone in patients undergoing assisted reproductive techniques with advanced reproductive age: a systematic review and meta-analysis. Fertil Steril. 2012;97(5):1108–1114.e1101.PubMed
9.
Ishihara O, Adamson D, Dyer S, Jd M, Nygren KG, Sullivan EA, Zegers-Hochschild F, Mansour R. International Committee for Monitoring Assisted Reproductive Technologies: world report on assisted reproductive technologies, 2007. Fertil Steril. 2015;103(2):402–13.PubMed
10.
Schaller MA, Griesinger G, Banz-Jansen C. Women show a higher level of anxiety during IVF treatment than men and hold different concerns: a cohort study. Arch Gynecol Obstet. 2016;293(5):1137–45.PubMed
11.
Norwitz ER, Schust DJ, Fisher SJ. Implantation and the survival of early pregnancy. N Engl J Med. 2001;345(19):1400–8.PubMed
12.
Quinn C, Ryan E, Claessens EA, Greenblatt E, Hawrylyshyn P, Cruickshank B, Hannam T, Dunk C, Casper RF. The presence of pinopodes in the human endometrium does not delineate the implantation window. Fertil Steril. 2007;87(5):1015–21.PubMed
13.
Zhang W: The modern ultrasonic diagnostic manual. 1996, Beijing Medical University, China Union Medical University, Union Press.
14.
Kupesic S, Bekavac I, Bjelos D, Kurjak A. Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures. J ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2001;20(2):125–34.
15.
Singh M, Chaudhry P, Asselin E. Bridging endometrial receptivity and implantation: network of hormones, cytokines, and growth factors. J Endocrinol. 2011;210(1):5–14.PubMed
16.
Cakmak H, Taylor HS. Implantation failure: molecular mechanisms and clinical treatment. Hum Reprod Update. 2011;17(2):242–53.PubMed
17.
Ledee-Bataille N, Lapree-Delage G, Taupin JL, Dubanchet S, Frydman R, Chaouat G. Concentration of leukaemia inhibitory factor (LIF) in uterine flushing fluid is highly predictive of embryo implantation. Human reproduction (Oxford, England). 2002;17(1):213–8.
18.
Jimenez PT, Schon SB, Odem RR, Ratts VS, Jungheim ES. A retrospective cross-sectional study: fresh cycle endometrial thickness is a sensitive predictor of inadequate endometrial thickness in frozen embryo transfer cycles. Reproductive biology and endocrinology : RB&E. 2013;11:35.
19.
Yaman C, Mayer R. Three-dimensional ultrasound as a predictor of pregnancy in patients undergoing ART. J Turkish German Gynecological Assoc. 2012;13(2):128–34.
20.
Beier HM, Beier-Hellwig K, Sterzik K. The implantation receptive luteal phase of the endometrium. On the current status of molecular and cell biology research. Zentralblatt fur Gynakologie. 2001;123(6):319–27.PubMed
21.
Merce LT, Barco MJ, Bau S, Troyano J. Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro fertilization/embryo transfer outcome? Fertil Steril. 2008;89(1):111–7.PubMed
22.
Zhao J, Zhang Q, Li Y. The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles. Reproductive biology and endocrinology: RB&E. 2012;10:100.
23.
Ardaens Y, Gougeon A, Lefebvre C, Thomas P, Leroy M, Leroy JL, Dewailly D. Contribution of ovarian and uterine color Doppler in medically assisted reproduction techniques (ART). Gynecologie, obstetrique & fertilite. 2002;30(9):663–72.
24.
Yang JH, Wu MY, Chen CD, Jiang MC, Ho HN, Yang YS. Association of endometrial blood flow as determined by a modified colour Doppler technique with subsequent outcome of in-vitro fertilization. Human reproduction (Oxford, England). 1999;14(6):1606–10.
25.
Stener-Victorin E, Waldenstrom U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Human reproduction (Oxford, England). 1996;11(6):1314–7.
26.
Ho M, Huang LC, Chang YY, Chen HY, Chang WC, Yang TC, Tsai HD. Electroacupuncture reduces uterine artery blood flow impedance in infertile women. Taiwanese journal of obstetrics & gynecology. 2009;48(2):148–51.
27.
Steer CV, Campbell S, Tan SL, Crayford T, Mills C, Mason BA, Collins WP. The use of transvaginal color flow imaging after in vitro fertilization to identify optimum uterine conditions before embryo transfer. Fertil Steril. 1992;57(2):372–6.PubMed
28.
Cacciatore B, Simberg N, Fusaro P, Tiitinen A. Transvaginal Doppler study of uterine artery blood flow in in vitro fertilization-embryo transfer cycles. Fertil Steril. 1996;66(1):130–4.PubMed
29.
Altmae S, Reimand J, Hovatta O, Zhang P, Kere J, Laisk T, Saare M, Peters M, Vilo J, Stavreus-Evers A, et al. Research resource: interactome of human embryo implantation: identification of gene expression pathways, regulation, and integrated regulatory networks. Molecular endocrinology (Baltimore, Md). 2012;26(1):203–17.
30.
Young SL. Oestrogen and progesterone action on endometrium: a translational approach to understanding endometrial receptivity. Reprod BioMed Online. 2013;27(5):497–505.PubMed
31.
Cui N, Li AM, Luo ZY, Zhao ZM, Xu YM, Zhang J, Yang AM, Wang LL, Hao GM, Gao BL. Effects of growth hormone on pregnancy rates of patients with thin endometrium. J Endocrinol Investig. 2018.
32.
Liang YX, Liu L, Jin ZY, Liang XH, Fu YS, Gu XW, Yang ZM. The high concentration of progesterone is harmful for endometrial receptivity and decidualization. Sci Rep. 2018;8(1):712.PubMedPubMedCentral
33.
Manheimer E, van der Windt D, Cheng K, Stafford K, Liu J, Tierney J, Lao L, Berman BM, Langenberg P, Bouter LM. The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Hum Reprod Update. 2013;19(6):696–713.PubMedPubMedCentral
34.
Shen C, Wu M, Shu D, Zhao X, Gao Y. The role of acupuncture in in vitro fertilization: a systematic review and meta-analysis. Gynecol Obstet Investig. 2015;79(1):1–12.
35.
Weeks K, Gaspard G. The use of acupuncture with in vitro fertilization as a treatment for female subfertility. Journal of alternative and complementary medicine (New York, NY). 2013;19(8):732.
36.
Hullender Rubin LE, Opsahl MS, Taylor-Swanson L, Ackerman DL. Acupuncture and in vitro fertilization: a retrospective chart review. J alternative and complementary medicine (New York, NY). 2013;19(7):637–43.
37.
Qu F, Zhou J, Ren RX. Effects of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis. J alternative and complementary medicine (New York, NY). 2012;18(5):429–39.
38.
Hopton AK, Curnoe S, Kanaan M, Macpherson H. Acupuncture in practice: mapping the providers, the patients and the settings in a national cross-sectional survey. BMJ Open. 2012;2(1):e000456.PubMedPubMedCentral
39.
Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complementary therapies in medicine. 2001;9(1):2–11.PubMed
40.
Stankiewicz M, Smith C, Alvino H, Norman R. The use of complementary medicine and therapies by patients attending a reproductive medicine unit in South Australia: a prospective survey. Aust N Z J Obstet Gynaecol. 2007;47(2):145–9.PubMed
41.
Liu JL, Chen SP, Gao YH. Effect of electroacupuncture of different acupoints on myoelectrical activities of the uterus in rats. Zhen ci yan jiu = Acupuncture research. 2007;32(4):237–42.PubMed
42.
Stener-Victorin E, Waldenstrom U, Tagnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2000;79(3):180–8.PubMed
43.
Stener-Victorin E, Kobayashi R, Kurosawa M. Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats. Autonomic neuroscience : basic & clinical. 2003;108(1–2):50–6.
44.
Stener-Victorin E, Kobayashi R, Watanabe O, Lundeberg T, Kurosawa M. Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries. Reproductive biology and endocrinology : RB&E. 2004;2:16.
45.
Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB. Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J physiology Regulatory, integrative and comparative physiology. 2009;297(2):R387–95.
46.
Liang F, Chen R, Cooper EL. Neuroendocrine mechanisms of acupuncture. Evidence-based complementary and alternative medicine : eCAM. 2012;2012:792793.
47.
Arranz L, Guayerbas N, Siboni L, De la Fuente M. Effect of acupuncture treatment on the immune function impairment found in anxious women. Am J Chinese medicine. 2007;35(1):35–51.
48.
Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril. 2002;77(4):721–4.PubMed
49.
Johnson D. Acupuncture prior to and at embryo transfer in an assisted conception unit--a case series. Acupuncture in medicine : journal of the British Medical Acupuncture Society. 2006;24(1):23–8.
50.
Zhang R, Feng XJ, Guan Q, Cui W, Zheng Y, Sun W, Han JS. Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study. Fertil Steril. 2011;96(4):912–6.PubMed
51.
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. Fertil Steril. 2006;85(5):1347–51.PubMed
52.
Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril. 2006;85(5):1341–6.PubMed
53.
Zhang M, Huang G, Fe L. Effect of acupuncture on pregnancy rate in embryo transfer. Zhongguo zhenjiu. 2002;22(8).
54.
Chen D, Chen S, Shi X. Clinical observation of acupuncture for the treatment of multiple cystic ovary syndrome. Zhongguo zhenjiu. 2007, 27(2):99–102.
55.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J surgery (London, England). 2010;8(5):336–41.
56.
Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions; 2011.
57.
Higgins JP, Green S: “Chapter 9: analyzing data and undertaking meta-analyses,” in Cochrane handbook for systematic reviews of interventions version 5.1.0. 2011.
58.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research ed). 2008;336(7650):924–6.
59.
Chen Q, Hau C. Impacts on pregnancy outcome treated with acupuncture and moxibustion in IVF-ET patients. Zhongguo zhen jiu = Chinese acupuncture & moxibustion. 2015;35(4):313–7.
60.
Zhang L, Lan R, Zheng C. Effect of pricking blood therapy on clinical outcomes of frozen-thawed embryo transfer cycle in patients with thin endometrium. J Reprod Med. 2018;27(05):411–5.
61.
Shuai Z, Lian F, Li P, Yang W. Effect of transcutaneous electrical acupuncture point stimulation on endometrial receptivity in women undergoing frozen-thawed embryo transfer: a single-blind prospective randomised controlled trial. Acupunct Med. 2015;33(1):9–15.PubMed
62.
Zhong J, Zhang L. Transcutaneous electrical acupoint stimulation for pregnancy of in vitro fertilization-embryo transfer. Zhongguo zhenjiu. 2017;37:03.
63.
Chen X, Gao Y. Acupuncture therapy applied to assist reproductive technology to improve endometrial receptivity. J Chengdu Medical College | J Chengdu Med Coll. 2012;7(02Z):106.
64.
Wang X, Tian L, Yuan H, Liu H, Fang L, Zhou Y. Curative observation of warming acupuncture treatment for the impact on receptivity of endometrium of embryo Patients transfer. J Sichuan Traditional Chinese Med. 2017;35(06):184–7.
65.
Luo G, Su W, Ma W, Situ Y, Xie C, Yang M. The effect of warm needling pretreatment for endometrial receptivity of frozen embryo transfer. Zhongguo Zhen Jiu. 2017;37(8):831–5.PubMed
66.
Zhou B, Wang B. Therapeutic effect of acupuncture combined with clomiphene citrate on ovulation. Shandong Journal of Traditional Chinese Medicine. 2012;31(2):121–2.
67.
You X, Yang J, Xu J, Liu Y, Huang J, Lin Q, Zhang J, Dun J, Huang S. Clinical study on warming-needle moxibustion for infertility patients with thin endometrium. World J Acupuncture - Moxibustion. 2018;28(1):25–8.
68.
Yu L, Cao L, Xie J, Shi Y. Therapeutic effects on ovulation and reproduction promotion with acupuncture and clomiphene in polycystic ovary syndrome. Zhongguo zhen jiu = Chinese acupuncture & moxibustion. 2018;38(3):263–8.
69.
Chen Q, Hao C. Effects of acupuncture on the expression of endometrial blood flow and pinocytosis in patients with repeated failure of IVF-ET implantation. Reproduction & Contraception. 2015;35(3):159–65.
70.
Li Y, Dong S, Wei M. To observe the effect of warm acupuncture combined with acupoint injection on endometrium during ovulation induction. Chinese J Hospital Pharmacy. 2018:1–6.
71.
Qu F, Wang F-F, Wu Y, Zhou J, Robinson N, Hardiman PJ, Pan J-X, He Y-J, Zhu Y-H, Wang H-Z, et al. Transcutaneous electrical Acupoint stimulation improves the outcomes of in vitro fertilization: a prospective, randomized and controlled study. Explore. 2017;13(5):307.
72.
Gonen Y, Casper RF. Prediction of implantation by the sonographic appearance of the endometrium during controlled ovarian stimulation for in vitro fertilization (IVF). J in vitro fertilization and embryo transfer : IVF. 1990;7(3):146–52.
73.
Smith CA, de Lacey S, Chapman M, Ratcliffe J, Norman RJ, Johnson NP, Boothroyd C, Fahey P. Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization: a randomized clinical trial. Jama. 2018;319(19):1990–8.PubMed
Metadata
Title
Acupuncture in improving endometrial receptivity: a systematic review and meta-analysis
Authors
Yajing Zhong
Fanzhu Zeng
Wanjun Liu
Jing Ma
Yongge Guan
Yang Song
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2019
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-019-2472-1

Other articles of this Issue 1/2019

BMC Complementary Medicine and Therapies 1/2019 Go to the issue

Research article

Anti-viral activity of culinary and medicinal mushroom extracts against dengue virus serotype 2: an in-vitro study

Research article

The anti-proliferative effect of apricot and peach kernel extracts on human colon cancer cells in vitro

Research article

Thymoquinone-loaded lipid vesicles: a promising nanomedicine for psoriasis

Research article

Crude extract from Libidibia ferrea (Mart. ex. Tul.) L.P. Queiroz leaves decreased intra articular inflammation induced by zymosan in rats

Research article

Critical pharmacokinetic and pharmacodynamic drug-herb interactions in rats between warfarin and pomegranate peel or guava leaves extracts

Research article

Astragaloside IV protects against diabetic nephropathy via activating eNOS in streptozotocin diabetes-induced rats