scholarly journals The Role of Acupuncture in Assisted Reproductive Technology

2012 ◽  
Vol 2012 ◽  
pp. 1-15 ◽  
Author(s):  
Cui Hong Zheng ◽  
Ming Min Zhang ◽  
Guang Ying Huang ◽  
Wei Wang

The aim of this paper was to provide reliable evidence by performing a systematic review and meta-analysis for evaluating the role of acupuncture in assisted reproductive technology. All randomized controlled trials that evaluated the effects of acupuncture, including manual, electrical, and laser acupuncture (LA) techniques, on the clinical pregnancy rate (CPR) and live birth rate (LBR) of in vitro fertilization (IVF) or artificial insemination were included. The controlled groups consisted of no acupuncture and sham acupuncture groups. The sham acupuncture included sham acupuncture at acupoints, sham acupuncture at non- or inappropriate points, sham LA, and adhesive tapes. Twenty-three trials (a total of 5598 participants) were included in this paper. The pooled CPR from all acupuncture groups was significantly higher than that from all controlled groups, whereas the LBR was not significantly different between the two groups. However, the results were quite distinct when the type of control and/or different acupuncture times were examined in a sensitivity analysis. The results mainly indicate that acupuncture, especially around the time of the controlled ovarian hyperstimulation, improves pregnancy outcomes in women undergoing IVF. More positive effects from acupuncture in IVF can be expected if a more individualized acupuncture programs are used.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nakeisha A. Lodge-Tulloch ◽  
Flavia T. S. Elias ◽  
Jessica Pudwell ◽  
Laura Gaudet ◽  
Mark Walker ◽  
...  

Abstract Background Caesarean section rates are higher among pregnancies conceived by assisted reproductive technology (ART) compared to spontaneous conceptions (SC), implying an increase in neonatal and maternal morbidity. We aimed to compare caesarean section rates in ART pregnancies versus SC, overall, by indication (elective versus emergent), and by type of ART treatment (in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), fresh embryo transfer, frozen embryo transfer) in a systematic review and meta-analysis. Methods We searched Medline, EMBASE and CINAHL databases using the OVID Platform from 1993 to 2019, and the search was completed in January 2020. The eligibility criteria were cohort studies with singleton conceptions after in-vitro fertilization and/or intracytoplasmic sperm injection using autologous oocytes versus spontaneous conceptions. The study quality was assessed using the Newcastle Ottawa Scale and GRADE approach. Meta-analyses were performed using odds ratios (OR) with a 95% confidence interval (CI) using random effect models in RevMan 5.3, and I-squared (I2) test > 75% was considered as high heterogeneity. Results One thousand seven hundred fifty studies were identified from the search of which 34 met the inclusion criteria. Compared to spontaneous conceptions, IVF/ICSI pregnancies were associated with a 1.90-fold increase of odds of caesarean section (95% CI 1.76, 2.06). When stratified by indication, IVF/ICSI pregnancies were associated with a 1.91-fold increase of odds of elective caesarean section (95% CI 1.37, 2.67) and 1.38-fold increase of odds of emergent caesarean section (95% CI 1.09, 1.75). The heterogeneity of the studies was high and the GRADE assessment moderate to low, which can be explained by the observational design of the included studies. Conclusions The odds of delivering by caesarean section are greater for ART singleton pregnancies compared to spontaneous conceptions. Preconception and pregnancy care plans should focus on minimizing the risks that may lead to emergency caesarean sections and finding strategies to understand and decrease the rate of elective caesarean sections.


2020 ◽  
Author(s):  
Nakeisha A Lodge-Tulloch ◽  
Flavia T. S. Elias ◽  
Jessica Pudwell ◽  
Laura Gaudet ◽  
Mark Walker ◽  
...  

Abstract Background: Caesarean section rates are higher among pregnancies conceived by assisted reproductive technology (ART) compared to spontaneous conceptions (SC), implying an increase in neonatal and maternal morbidity. We aimed to compare caesarean section rates in ART pregnancies versus SC, overall, by indication (elective versus emergent), and by type of ART treatment (in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), fresh embryo transfer, frozen embryo transfer) in a systematic review and meta‐analysis.Methods: We searched Medline, EMBASE and CINAHL databases using the OVID Platform from 1993-2019, and the search was completed in January 2020. The eligibility criteria were cohort studies with singleton conceptions after in-vitro fertilization and/or intracytoplasmic sperm injection using autologous oocytes versus spontaneous conceptions. The study quality was assessed using the Newcastle Ottawa Scale. Meta-analyses were performed using odds ratios (OR) with a 95% confidence interval (CI) using random effect models in RevMan 5.3, and I-squared (I2) test > 75% was considered as high heterogeneity.Results: 1750 studies were identified from the search of which 34 met the inclusion criteria. Compared to spontaneous conceptions, IVF/ICSI pregnancies were associated with a 1.93-fold increase of odds of caesarean section (95% CI 1.78, 2.09). When stratified by indication, IVF/ICSI pregnancies were associated with a 2.12-fold increase of odds of elective caesarean section (95% CI 1.63, 2.77) and 1.57-fold increase of odds of emergent caesarean section (95% CI 1.27, 1.95). Conclusions: The odds of delivering by caesarean section are greater for ART singleton pregnancies compared to spontaneous conceptions. Preconception and pregnancy care plans should focus on minimizing the risks that may lead to emergency caesarean sections and finding strategies to understand and decrease the rate of elective caesarean sections.


GYNECOLOGY ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 36-40
Author(s):  
Anna G. Burduli ◽  
Natalia A. Kitsilovskaya ◽  
Yuliya V. Sukhova ◽  
Irina A. Vedikhina ◽  
Tatiana Y. Ivanets ◽  
...  

The review presents data on metabolites in the follicular fluid (FF) from the perspective of reproductive medicine and their use in order to predict outcomes of assisted reproductive technology (ART) programs. It considers various components of this biological medium (hormones, lipids, melatonin, etc.) with an assessment of their predictive value in prognosis of the effectiveness of in vitro fertilization (IVF) programs. The data on experimental directions in this field and the prospects for their use in clinical practice are presented. The article emphasizes that the growing clinical need and the unsolved problem of increasing the effectiveness of ART programs determine the need for further studies of the FF composition. Materials and methods. The review includes data related to this topic from foreign and Russian articles found in PubMed which were published in recent years. Results. Given the established fact of a direct effect of FF composition on growth and maturation of oocytes, and further, on the fertilization process, various FF metabolites are actively investigated as non-invasive markers of quality of oocytes/embryos. The article provides data on the experimental directions in this field and the prospects for their use in clinical practice. However, clinical studies of a relation between various FF metabolites levels and outcomes of IVF programs are contradictory. Conclusion. Owing large economic cost for treatment of infertility with IVF, there is need for expansion and intensification of studies to identify and use reliable predictors in prognosis of ART programs outcomes.


2009 ◽  
Vol 19 (1) ◽  
pp. 147-151 ◽  
Author(s):  
Aera R. Han ◽  
Yong-Soon Kwon ◽  
D. Y. Kim ◽  
J. H. Kim ◽  
Y. M. Kim ◽  
...  

Objectives:To evaluate the outcomes of pregnancy in young women (<40 years old) with early endometrial cancer or atypical complex hyperplasia who were treated by conservative management followed by assisted reproductive technology (ART).Materials and Methods:Medical charts of 11 patients treated from January 1997 to October 2007 at Asan Medical Center were retrospectively reviewed. These patients had all been treated with progestin and serial dilatation and curettage as primary fertility-preserving therapies.Results:After pathological remission of disease, 10 patients tried to become pregnant by ART, 4 by in vitro fertilization and embryo transfer, and 6 by controlled ovarian hyperstimulation, with or without intrauterine insemination. Eight women had intrauterine pregnancies, and 6 patients had live births. Patients have been followed up for 9 to 51 months (mean, 21 months) after delivery, with no evidence of tumor recurrence.Conclusions:Fertility-preserving therapy followed by ART can be a good option in well-selected patients with early endometrial cancer who want to become pregnant.


Author(s):  
Marie Boltz ◽  
Holly Rau ◽  
Paula Williams ◽  
Holly Rau ◽  
Paula Williams ◽  
...  

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
N Sermondade ◽  
C Sonigo ◽  
M Pasquier ◽  
N Yata-Ahdad ◽  
E Fraison ◽  
...  

Abstract Study question To investigate the relationship between the number of oocytes and both the live birth rate after fresh embryo transfer and the cumulative live birth rate. Summary answer Above a 15-oocyte threshold, live birth rate (LBR) following fresh transfer plateaus, whereas a continuous increase in cumulative live birth rate (CLBR) is observed. What is known already Several lines of evidence indicate that number of oocytes represents a key point for in vitro fertilization (IVF) success. However, consensus is lacking regarding the optimal number of oocytes for expecting a live birth. This is a key question because it might impact the way practitioners initiate and adjust COS regimens. Study design, size, duration A systematic review and meta-analysis was performed. MEDLINE, EMBASE, and Cochrane Library were searched for studies published between January 01, 2004, and August 31, 2019 using the search terms: “(intracytoplasmic sperm injection or icsi or ivf or in vitro fertilization or fertility preservation)” and “(oocyte and number)” and “(live birth)”. Participants/materials, setting, methods Two independent reviewers carried out study selection, quality assessment using the adapted Newcastle-Ottawa Quality Assessment Scales, bias assessment using ROBIN-1 tools, and data extraction according to Cochrane methods. Independent analyses were performed according to the outcome (LBR and CLBR). The mean-weighted threshold of optimal oocyte number was estimated from documented thresholds, followed by a one-stage meta-analysis on articles with documented or estimable relative risks. Main results and the role of chance After reviewing 843 records, 64 full-text articles were assessed for eligibility. A total of 36 studies were available for quantitative syntheses. Twenty-one and 18 studies were included in the meta-analyses evaluating the relationship between the number of retrieved oocytes and LBR or CLBR, respectively. Given the limited number of investigations considering mature oocytes, association between the number of metaphase II oocytes and IVF outcomes could not be investigated. Concerning LBR, 7 (35.0%) studies reported a plateau effect, corresponding to a weighted mean of 14.4 oocytes. The pooled dose-response association between the number of oocytes and LBR showed a non-linear relationship, with a plateau beyond 15 oocytes. For CLBR, 4 (19.0%) studies showed a plateau effect, corresponding to a weighted mean of 19.3 oocytes. The meta-analysis of the relationship between the number of oocytes and CLBR found a non-linear relationship, with a continuous increase in CLBR, including for high oocyte yields. Limitations, reasons for caution Statistical models show a high degree of deviance, especially for high numbers of oocytes. Further investigations are needed to assess the generalization of those results to frozen mature oocytes, especially in a fertility preservation context, and to evaluate the impact of female age. Wider implications of the findings Above a 15-oocyte threshold, LBR following fresh transfer plateaus, suggesting that the freeze-all strategy should probably be performed. In contrast, the continuous increase in CLBR suggests that high numbers of oocytes could be offered to improve the chances of cumulative live births, after evaluating the benefit–risk balance. Trial registration number Not applicable


2019 ◽  
Vol 01 (04) ◽  
pp. 193-201
Author(s):  
I-Ferne Tan ◽  
Audrey J. R. Lim ◽  
Inthrani R. Indran ◽  
Michael S. Kramer ◽  
Eu-Leong Yong

Background: Polycystic ovarian syndrome (PCOS) is a common cause of infertility in women. In-vitro fertilization (IVF) is required in 20–30% of women with PCOS trying to conceive. This is associated with increased risk of multiple gestation and ovarian hyperstimulation syndrome. Improvements in IVF techniques, safety standards, and the increased use of frozen embryos in recent years have lead to improved outcomes for women with PCOS. We performed a systematic review and meta-analysis to compare these outcomes with women without PCOS. Search Methods: A search of PubMed, EMBASE, the Cochrane Central Register of clinical trials, and Scopus databases for all articles published until November 16th, 2017 identified 21 studies comparing IVF outcomes in PCOS and non-PCOS women. Inclusion criteria were Rotterdam criteria PCOS, comparable IVF regimes, immediate IVF outcomes, and pregnancy outcomes. Studies were excluded if the control group included any PCOS criteria, donor oocytes, or in-vitro maturation. Outcomes: No difference was observed in live birth rate per cycle in women with vs. without PCOS (RR [Formula: see text] 1.01 [0.89, 1.16]; [Formula: see text] 82%), but the live birth rate per first cycle in PCOS cycles (RR [Formula: see text] 0.93 [0.88, 0.99]) was slightly lower. There was also no difference in the clinical pregnancy rate (RR 1.02 [0.89, 1.17]) or biochemical pregnancy rate (RR 1.03 [0.99, 1.08]) observed between the two groups. PCOS was associated with a significantly higher number of oocytes retrieved (mean difference [Formula: see text] 3.6; 95% CI [2.8, 4.4]), risk of miscarriage (RR 2.90 [2.09, 4.02]), and risk of ovarian hyperstimulation syndrome (RR 3.42 [2.28, 5.13]) per cycle. Conclusion: Despite a widespread perception of poor reproductive potential, women with PCOS experience IVF outcomes similar to those without PCOS. Although there is a slightly lower live birth rate during their first stimulation cycle, success rates are similar after multiple cycles. PCOS is associated with a higher risk of ovarian hyperstimulation syndrome. Further studies are required to mitigate this risk.


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