Therapeutic Effect Of Acupuncture On In Vitro Fertilization:Meta-analysis And Data-mining

Objective To evaluate the clinical efficacy of acupuncture on the in vitro fetilization and embryo transfer(IVF-ET)using evidence-based medicine approach.The clinical outcomes including the following indicators:number of oocytes retireved,oocyte cleavage rate,fertilisation rate(FR),live birth rate(LBR),high-quality embryos rate(HQER),implantation rate(IR),cycle cancellation rate,miscarriage rate(MR),embryo transfer rate(ETR),clinical pregnancy rate,OHHS incidence rate,biochemical pregnancy rate(BPR).And then analyze the composition principles of acupuncture for IVF based on data ming and applied to clinical cases.Methods A systematic literature search for clinical controlled trials(CCTs)or randomized controlled trials(RCTs)from their inception until September1,2017 was conducted using four databases:Chinese National Knowledge Infrastructure(CNKI),VIP database,Wanfang and Pub Med.Women undergoing IVF were evaluated for the effects of acupuncture on IVF.The treatment groups involved traditional acupuncture,electrical acupuncture,auricular acupuncture,paracervical block and acupuncture sequential therapy.The control groups consisted of no,sham,and placebo acupuncture.Methodological quality of included studies were assessed by the Jadad score and Cochrane.All statistical analyses were conducted using Rev Man V.5.3 software.The acupuncture points of clinical triials were extracted and the acupoints characteristics were data-mining by the Traditional Chinese Medicine inheritance support system(TCMISS).At last,we analyze the clinical application of acupuncture on IVF.ResultsEighteen trials were included in this meta-analysis.1.The electrical acupuncture can increase the FR[WMD=9.91,95%Cl(3.31,16.51),P=0.003],oocyte cleavage rate[WMD=4.19,95%Cl(1.45,6.93),P=0.003],and HQER[WMD=9.65,95%Cl(2.40,16.90),P=0.009] of IVF-ET.2.The electrical acupuncture can not reduce the incidence of OHHS[RR=0.88,95%Cl(0.45,1.72),P=0.71],cycle cancellation rate[RR=2.64,95%Cl(0.69,10.07),P=0.15] in patients with IVF-ET.3.The traditional acupuncture can not improve the ETR[WMD=0.02,95%Cl(-0.17,0.21),P=0.83],IR[RR=0.93,95%Cl(0.78,1.12),P=0.46],BPR[RR=1.03,95%Cl ?(0.76,1.40),P=0.86],LBR[RR=0.97,95%Cl ?(0.62,1.53),P=0.91] of IVF-ET.4.The electrical acupuncture,traditional acupuncture plus auricular acu puncture,traditional acupuncture,acupuncture sequential therapy,parac upricular block plus electrical acupuncture can not improve the clinica l pregnancy rate[RR=1.12,95%Cl(0.96,1.31),P=0.14] of IVF-ET.5.The electrical acupuncture and traditional acupuncture can not reduc e the MR[RR=0.99,95%Cl(0.70,1.40),P=0.94],and can not increase t he number of oocytes retireved[WMD=0.11,95%Cl(-0.08,0.30),P=0.28]of IVF-ET.In the results of data-mining study:A total of 78 prescriptions,including47 acupoints,were analyzed.Ten acupoints were most frequently used,including Sanyinjiao(SP 6),Neiguan(P 6),Zusanli(ST 36),Guanyuan(RN 4),Taichong(LR 3),Qihai(CV 6),Hegu(LI 4),Shenshu(BL 23),Baihui(ZV 20),and Zigong(EX-CA 1).At the same time,a total of 38 commonly used acupoint combinations and 9 new prescriptions were excavated.In the Chinese clinical trials,there were 61 prescriptions and 34 acupuncture points were used.The10 acupoints,which were most frequently used,were RN 4,SP 6,ST 36,BL 23,EX-CA 1,LR 3,Neiguan(PC 6),CV 6,Taixi(KI 3),and LI 4.The correlation network core acupoints were SP 6,BL 23,ST 36,RN 4,EX-CA 1,LR 3,CV 6,and LI 4.A total of 17 commonly used acupoint combinations were excavated.In the foreign clinical trials,there were 17 prescriptions and 33 acupuncture points were used.Ten acupoints were most frequently used,including SP 6,LI 4,Guilai(ST 29),Baihui(GV 20),ST 36,LR 3,Diji(SP 8),Xuehai(SP 10),P 6 and RN 4.The correlation network core acupoints were SP 6,ST 36,ST 29,LI 4.A total of 5 commonly used acupoint combinations were excavated.Clinical case : Acupuncture could improve the pregnancy outcomes of patients who undergoing IVF-ET.Conclusion1.The electrical acupuncture can increase the FR,oocyte cleavage rate,a nd HQER of IVF-ET.2.The electrical acupuncture can not reduce the incidence of OHHS,and cycle cancellation rate in patients with IVF-ET.3.The traditional acupuncture can not improve ETR,IR,BPR,LBR in pati ents with IVF-ET.4.The electrical acupuncture,traditional acupuncture plus auricular acu puncture,traditional acupuncture,acupuncture sequential therapy,paracu pricular block plus electrical acupuncture can not improve the clinical pregnancy rate of IVF-ET.5.The electrical acupuncture and traditional acupuncture can not reduc e the MR of IVF-ET,and can not increase the number of oocytes reti reved.6.The clinical treatment of acupuncture on in vitro fertilization and embryo transplantation was based on the spleen meridian of foot-taiyin(SP),stomach meridian of foot-yangming(ST),liver meridian of foot-jueyin(LR)and conception vessel(CV).The law of treatment is moving Qi and activating blood,as well as regulating thoroughfare and conception vessel.core acupoints were SP 6,LR 3,ST 36,RN 4,EX-CA 1 and LI 4.At the same time,the Chinese clinical studies pay more attention to replenishing the kidney and smoothing the liver,as well as tonifying qi and blood,while the foreign clinical studies focus on activating blood and resolving stasis,regulating qi and blood,as well as smoothing the liver.7.Acupuncture could improve the clinical pregnancy outcome of patients with IVF-ET,but the number of successful cases is small,and it is necessary to further expand the sample for verification.