Acupuncture & Research

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Just to follow up on my previous post:

 

 

I listed the studies that I did solely for information's sake and to

answer the specific question - " have their been any studies/research

done that show acupuncture decreases IVF success rates " .

 

For example, the study cited below (Craig, et al) was never finally

accepted for full publication in Fertility & Sterility due to problems

with their data collection. It was only selected for pre-publication.

However, the results of this study did get out into the web-world, and

this study could be quoted in a conversation with an RE. I didn't cite

it because I agree with its' conclusions, nor because I think it's a

robust study, but simply because it's out there. Kristin, you are

absolutely right, that the clinical pregnancy rates in the craig study

are off the charts, and therefore probably subject to selection bias

in the non-acupuncture arm of this study.

 

It's just as important for us to be up-to-date on the studies that

show negative outcomes for Acupuncture (whether that's related to

Infertility & IVF, or Low Back Pain, or Migraines, or whatever), and

why they might show negative outcomes, as it is for us to up-to-date

on the studies that show positive outcomes for acupuncture. When we

evaluate research, we should be able to point out the strengths and

weaknesses of studies, whether or not they are favorable or

unfavorable to our particular medicine.

 

For example, In 2009, Wing, et al carried out a randomized, double

blind study of 370 patients undergoing IVF treatment by allocating

them to either a placebo acupuncture group, or a verum acupuncture

group, utilizing the Paulus (2002) acupuncture protocol. The clinical

pregnancy rate was significantly higher in the placebo acupuncture

group, than in the verum acupuncture group (55.1% vs. 43.8%

respectively, P = 0.038. There was no statistical difference in

ongoing pregnancies or live birth rates. The authors suggest in the

discussion that the placebo acupuncture (blunt needle that appears to

disappear into administration handle but still pricks the skin) was

probably not inert, and that this study would have been more robust

had there been a non-treatment IVF group.

(Wing, E., Hung, E., Wong, Y., Lau, E., Yeung, W., & Ho, P. (2008). “A

randomized double-blind comparison of real and placebo Acupuncture in

IVF treatment”. Human Reproduction, advanced access e-published

October 21, 2008).

 

So, here again, we have a peer-reviewed, published study, which seems

to show that placebo acupuncture (which is different than sham

acupuncture) had higher clinical pregnancy rates than verum (true)

acupuncture. First of all, as the authors noted, it's distinctly

likely that the " placebo " acupuncture (i.e. no penetration of skin on

a real acupuncture point), was not inert at all. Duh.

 

I don't know about any of you, but I have had Toyo Hari acupuncture

done on me, and it is extremely effective and extremely potent. I have

also seen and felt the placebo needles that were used in the Wing

study, and it actually feels like the gentle stimulation used in Toyo

Hari (obviously minus the pulse diagnosis and channel differentiation

used in that system).

 

Also, in the Wing study, there was no non-acupuncture treatment

control group. So, it's very likely that had there been a non-

acupuncture treatment (placebo and verum) control group, then both the

placebo, and the verum acupuncture groups would have had higher

clinical pregnancy rates than the non-treatment group.

 

 

There is still so much more to learn, and study, and research from

both a western biomedical point of view, and from a TCM point of view.

Acupuncture does not lend itself easily to the placebo-control model

of research, (because it's difficult to create an effective, inert

control - with the unique exception of laser acupuncture), and because

it does not fit well with protocol-type treatments (i.e. we favor

pattern-based treatments). However, there are very robust and exciting

discussions being taken up by the TCM Community regarding better

methods of research suited to our medicine. I encourage everyone

interested in this topic to join the Society for Acupuncture Research

as a professional member (http://acupunctureresearch.org). They are

really leading the way in this discussion.

 

Ray Rubio, D.A.O.M. (FABORM)

President/CEO ABORM

Chair: Reproductive Medicine Specialty/Yo San DAOM Program

 

Westlake Complementary Medicine

910 Hampshire Road, Suite A

Westlake Village, CA 91361

Phone: (805) 497-1335

Fax: (805) 497-1336

email: rtoo

 

 

On Aug 19, 2009, at 2:39 PM, kwisgirda wrote:

 

>

> Hello,

>

> The second study that Ray cites (2007, Craig, et al) looks

> suspicious to me. 69% pregnancy rate for the control group looks too

> good to be true.

>

> For most ivf clinics, isn't the average pregnancy rate for the under

> 35 crowd 45-50%, precipitously dropping as the patients get older?

>

> These studies need to be looked at closely and then taken with a

> grain of salt.

>

> Kristin

>

> Kristin Wisgirda

> Lic. Acupuncturist

> Posture Alignment Specialist, Egoscue Certified

> 508-427-6575

>

>

>

> Rich/Valerie, etc.

>

> 1. Westergaard, et al 2006, tried replicating the Paulus, et al

> study from 2002 which involved acupuncture given just before and

> after Embryo Transfer. However, Westergard added a new wrinkle to

> this protocol by having two different acupuncture treatment groups:

> one group received the standard Paulus Protocol on the day of Embryo

> Transfer, the 2nd group also received Acupuncture 2 days later

> after, and in addition to the Embryo Transfer treatment. The control

> group received no acupuncture at all. Clinical pregnancy rates and

> live birth rates were significantly higher in the first group, but

> the 2nd group receiving acupuncture 2 days after Embryo Transfer had

> 33% higher miscarriage rates than the control (non-acupuncture-

> treatment) group.

>

> (Westergaard, L., Mao, Q., Krogslund, M., Sandrini, S., Lenz, S.,

> and Grinstead, J. (2006). “Acupuncture on the day of embro-transfer

> significantly improves the reproductive outcome of infertile women:

> a prospective randomized trial”. Fertility & Sterility, 85(5),

> 1341-1346).

>

> Of course, the upshot of this study, is that the contra-indicated

> pregnancy points (Spleen 6/Large Intestine 4) included in the

> original Paulus Protocol (Paulus, et al, 2002) actually do cause

> miscarriage . In the original Paulus Protocol, and in the 1st

> treatment arm of the Westergaaard Study above, Spleen 6 and Large

> Intestine 4 are used for the post-embryo-transfer treatment. This

> has always caused some consternation amongst acupuncturists.

> However, we have to remember that whether it's a day-3 embryo

> transfer, or a day-5 blastocyst transfer, pregnancy/conception/

> implantation will not have taken place yet by the time these points

> are being used immediately after the Embryo Transfer. Therefore,

> they are not contraindicated. Conversely, when Westergaard used

> these points 2 days after Embryo Transfer - when implantation/

> conception/clinical pregnancy might have already occurred, then

> these points (Sp 6/LI 4) did result in higher miscarriage rates.

>

> 2. In 2007, Craig, et al, modified the 2002 Paulus protocol in both

> the selection of acupoints used, and in the timing of the treatments

> (treatments were performed off-site, and patients often had to drive

> an hour or more after the embryo transfer in order to receive

> acupuncture. Pregnancy rates were greatly reduced in the acupuncture

> treatment group vs the non-treatment control group (43% vs 69%

> respectively. The authors postulated that the modified acupoint

> protocol and/or the driving stress may have adversely effected the

> outcome of the trial.

>

> (Craig, L., Criruti, A., Hansen, K., Marshall, L., & Soules, M.

> (2007). “Acupuncture lowers pregnancy rates when performed before

> and after embryo transfer”. Fertility & Sterility, 88 supplemental).

> .

>

>