The Role of Acupuncture in Assisted Reproductive Technology

Table 2

Forest plots of IVF outcomes as compared by types of control.

(i) Acupuncture versus all controls
CPR
Study or subgroup	Acupuncture		Control		Weight	Odds ratio M-H, random, 95% CI	Odds ratio M-H, random, 95% CI
	Events	Total	Events	Total
Paulus et al. [21]	34	80	21	80	4.1%	2.08 [1.07, 4.04]
Paulus et al. [22]	43	100	37	100	4.8%	1.28 [0.73, 2.26]
Smith et al. [23]	34	110	27	118	4.6%	1.51 [0.84, 2.72]
Westergaard et al. [24]	70	200	21	100	4.8%	2.03 [1.15, 3.55]
Dieterle et al. [25]	39	116	17	109	4.3%	2.74 [1.44, 5.22]
Benson et al. [26]	54	106	67	152	5.3%	1.32 [0.80, 2.17]
Craig et al. [27]	21	48	32	46	3.1%	0.34 [0.15, 0.79]
Cui et al. [28]	22	47	16	47	3.2%	1.71 [0.74, 3.92]
Fratterelli et al. [29]	213	402	278	598	7.4%	1.30 [1.01, 1.67]
Chen et al. [30]	9	28	6	27	1.9%	1.66 [0.50, 5.53]
Domar et al. [31]	24	78	23	68	3.9%	0.87 [0.43, 1.74]
Ho et al. [32]	9	30	4	14	1.5%	1.07 [0.26, 4.34]
So et al. [33]	72	185	91	185	6.1%	0.66 [0.44, 0.99]
So et al. [34]	41	113	50	113	5.1%	0.72 [0.42, 1.22]
Andersen et al. [35]	101	314	112	321	6.8%	0.88 [0.64, 1.23]
Madaschi et al. [36]	84	208	67	208	6.1%	1.43 [0.95, 2.13]
Moy et al. [38]	39	86	39	74	4.4%	0.74 [0.40, 1.39]
Arnoldi et al. [37]	22	102	10	102	3.3%	2.53 [1.13, 5.66]
Stener-Victorin et al. [3]	28	75	19	74	3.9%	1.72 [0.86, 3.48]
Stener-Victorin et al. [40]	43	136	49	138	5.3%	0.84 [0.51, 1.39]
Humaidan and Stener-Victorin [41]	46	100	50	100	4.9%	0.85 [0.49, 1.48]
Sator-Katzenschlager et al. [42]	30	64	7	30	2.6%	2.90 [1.09, 7.71]
Cui et al. [39]	14	34	11	32	2.5%	1.34 [0.49, 3.63]
Total (95% CI)		2762		2836	100.0%	1.21 [1.00, 1.46]
Total events	1092		1054
Heterogeneity: Tau^2 = 0.11; Chi^2 = 52.23, df = 22 (𝑃=0.0003); 𝐼^2=58%
Test for overall effect: 𝑍=1.97; (𝑃=0.05)
LBR
Study or subgroup	Acupuncture		Control		Weight	Odds ratio M-H, random, 95% CI	Odds ratio M-H, random, 95% CI
	Events	Total	Events	Total
Andersen et al. [35]	79	314	96	321	20.1%	0.79 [0.56, 1.12]
Fratterelli et al. [29]	163	402	70	198	20.0%	1.25 [0.88, 1.77]
Madaschi et al. [36]	70	208	57	208	18.0%	1.34 [0.88, 2.04]
So et al. [33]	55	185	71	185	17.6%	0.68 [0.44, 1.05]
So et al. [34]	33	113	40	113	14.3%	0.75 [0.43, 1.32]
Stener-Victorin et al. [3]	25	75	13	74	10.1%	2.35 [1.09, 5.05]
Total (95% CI)		1297		1099	100.0%	1.03 [0.76, 1.40]
Total events	425		347
Heterogeneity: Tau^2 = 0.09; Chi^2 =14.00 df = 5 (𝑃=0.02); 𝐼^2=64%
Test for overall effect: 𝑍=0.17 (𝑃=0.86)
(ii) Acupuncture versus sham acupuncture at acupoints
CPR
Study or subgroup	Acupuncture		Control		Weight	Odds ratio M-H, random, 95% CI	Odds ratio M-H, random, 95% CI
	Events	Total	Events	Total
Paulus et al. [22]	43	100	37	100	11.5%	1.28 [0.73, 2.26]
So et al. [33]	72	185	91	185	30.3%	0.66 [0.44, 0.99]
So et al. [34]	41	113	50	113	17.3%	0.72 [0.42, 1.22]
Andersen et al. [35]	101	314	112	321	40.9%	0.88 [0.64, 1.23]
Total (95% CI)		712		719	100.0%	0.83 [0.67, 1.03]
Total events	257		290
Heterogeneity: Tau^2 = 3.92, df = 3 (𝑃=0.27) 𝐼^2=23%
Test for overall effect: 𝑍=1.67 (𝑃=0.09)
LBR
Study or subgroup	Acupuncture		Control		Weight	Odds Ratio M-H, Random, 95% CI	Odds ratio M-H, random, 95% CI
	Events	Total	Events	Total
So et al. [33]	55	185	71	185	33.4%	0.68 [0.44, 1.05]
So et al. [34]	33	113	40	113	19.0%	0.75 [0.43, 1.32]
Andersen et al. [35]	79	314	96	321	47.6%	0.79 [0.56, 1.12]
Total (95% CI)		612		619	100.0%	0.74 [0.58, 0.95]
Total events	167		207
Heterogeneity: Chi^2 = 0.27, df = 2 (𝑃=0.87); 𝐼^2=0%
Test for overall effect: 𝑍=2.36 (𝑃=0.02)
(iii) Acupuncture versus sham acupuncture at non- or inappropriate points
CPR
Study or subgroup	Acupuncture		Control		Weight	Odds ratio M-H, random, 95% CI	Odds ratio M-H, random, 95% CI
	Events	Total	Events	Total
Dieterle et al. [25]	39	116	17	109	32.7%	2.74 [1.44, 5.22]
Moy et al. [38]	39	86	39	74	33.2%	0.74 [0.40, 1.39]
Smith et al. [23]	34	110	27	118	34.1%	1.51 [0.84, 2.72]
Total (95% CI)		312		301	100.0%	1.45 [0.70, 2.98]
Total events	112		83
Heterogeneity: Tau^2 = 0.31; Chi^2 = 8.15, df = 2 (𝑃=0.02); 𝐼^2=75%
Test for overall effect: 𝑍=1.01 (𝑃=0.31)
(iv) Acupuncture versus non intervention or relaxation control
CPR
Study or subgroup	Acupuncture		Control		Weight	Odds ratio M-H, random, 95% CI	Odds ratio M-H, random, 95% CI
	Events	Total	Events	Total
Arnoldi et al. [37]	22	102	10	102	5.1%	2.53 [1.13, 5.66]
Benson et al. [26]	54	106	43	100	8.2%	1.38 [0.79, 2.38]
Chen et al. [30]	9	28	6	27	2.7%	1.66 [0.50, 5.53]
Craig et al. [27]	21	48	32	46	4.7%	0.34 [0.15, 0.79]
Cui et al. [28]	22	47	16	47	4.9%	1.71 [0.74, 3.92]
Cui et al. [39]	14	34	11	32	3.7%	1.34 [0.49, 3.63]
Domar et al. [31]	24	78	23	68	6.2%	0.87 [0.43, 1.74]
Fratterelli et al. [29]	213	402	191	400	13.7%	1.23 [0.93, 1.63]
Ho et al. [32]	9	30	4	14	2.1%	1.07 [0.26, 4.34]
Humaidan and Stener-Victorin [41]	46	100	50	100	8.1%	0.85 [0.49, 1.48]
Madaschi et al. [36]	84	208	67	208	10.9%	1.43 [0.95, 2.13]
Paulus et al. [21]	34	80	21	80	6.6%	2.08 [1.07, 4.04]
Stener-Victorin et al. [40]	43	136	49	138	9.0%	0.84 [0.51, 1.39]
Stener-Victorin et al. [3]	28	75	19	74	6.2%	1.72 [0.86, 3.48]
Westergaard et al. [24]	70	200	21	100	8.0%	2.03 [1.15, 3.55]
Total (95% CI)		1674		1536	100.0%	1.27 [1.03, 1.58]
Total events	693		563
Heterogeneity: Tau^2 = 0.07; Chi^2 = 24.46, df = 14 (𝑃=0.04); 𝐼^2=43%
Test for overall effect: 𝑍=2.20 (𝑃=0.03)
LBR
Study or subgroup	Acupuncture		Control		Weight	Odds ratio M-H, fixed, 95% CI	Odds ratio M-H, fixed, 95% CI
	Events	Total	Events	Total
Fratterelli et al. [29]	163	402	70	198	54.5%	1.25 [0.88, 1.77]
Madaschi et al. [36]	70	208	57	208	37.0%	1.34 [0.88, 2.04]
Stener-Victorin et al. [3]	25	75	13	74	8.5%	2.35 [1.09, 5.05]
Total (95% CI)		685		480	100.0%	1.38 [1.07, 1.77]
Total events	258		140
Heterogeneity: Chi^2 = 2.17, df = 2 (𝑃=0.34); 𝐼^2=8%
Test for overall effect: 𝑍=2.47 (𝑃=0.01)
(v) Acupuncture versus sham LA
CPR
Study or subgroup	Acupuncture		Control		Weight	Odds ratio M-H, random, 95% CI	Odds ratio M-H, random, 95% CI
	Events	Total	Events	Total
Benson et al. [26]	54	106	45	102	21.1%	1.32 [0.76, 2.27]
Fratterelli et al. [29]	213	402	179	401	78.9%	1.40 [1.06, 1.85]
Total (95%) CI		508		503	100.0%	1.38 [1.08, 1.77]
Total events	267		224
Heterogeneity: Chi^2 = 0.04, df = 1 (𝑃=0.85); 𝐼^2=0%
Test for overall effect: 𝑍=2.55 (𝑃=0.01)
LBR
Study or subgroup	Acupuncture		Control		Weight	Odds ratio M-H, random, 95% CI	Odds ratio M-H, random, 95% CI
	Events	Total	Events	Total
Fratterelli et al. [29]	163	402	70	198	100.0%	1.25 [0.88, 1.77]
Total (95% CI)		402		198	100.0%	1.25 [0.88, 1.77]
Total events	163		70
Heterogeneity: nonapplicable
Test for overall effect: 𝑍=1.23 (𝑃=0.22)
(vi) Acupuncture versus adhesive tapes
CPR
Study or subgroup	Acupuncture		Control		Weight	Odds ratio M-H, random, 95% CI	Odds ratio M-H, random, 95% CI
	Events	Total	Events	Total
Sator-Katzenschlager et al. [42]	30	64	7	30	100.0%	2.90 [1.09, 7.71]
Total (95% CI)		64		30	100.0%	2.90 [1.09, 7.71]
Total events	30		7
Heterogeneity: nonapplicable
Test for overall effect: 𝑍=2.13 (𝑃=0.03)