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Acupuncture for IVF Revisited – More Tooth Fairy Science?

Posted in Science Based Medicine by Skepdude on April 28, 2009

I read this Reuters Health article on MedlinePlus, and then I read the study the article referred to (The impact of acupuncture on in vitro fertilization) and now my head hurts. The study found that acupuncture was not effective in increasing the pregnancy rate (PR) during in vitro fertilization (IVF). As quoted on MedlinePlus, the lead author, Alice Domar, seems to blame her patients (the presumably poor quality of their embryos) rather than acupuncture for the lack of success, and then she recommends using acupuncture even if it doesn’t work. That was bad enough, but “poor quality embryos” is a hypothesis that was actually tested and rejected in the study itself. Has Domar forgotten?

The headline of the MedlinePlus article says “acupuncture doesn’t boost IVF success for all” – suggesting that it boosts success for some? Then the first sentence says the study suggested that acupuncture doesn’t work, period. But wait…

The lead researcher says acupuncture may not have worked in her study because, unlike past research, her investigation wasn’t limited to women who had good quality embryos available for transfer. “I’m wondering if my sample was just not a good sample, in that most of the patients in my study were probably not the best-prognosis patients,”
Domar and her team say the most likely explanation for the lack of an acupuncture effect in their study was the fact that they included many women who didn’t have good quality embryos available for transfer. While acupuncture may help a woman become pregnant after the transfer of a healthy embryo, the researcher noted in an interview, it can’t repair an embryo with chromosomal defects or other abnormalities.

Hold the boat!! In the Discussion section of the paper itself, Domar et al point out that previous research has included mostly patients with good quality embryos. They ask if perhaps acupuncture only works for good quality embryos? They test that hypothesis by separately analyzing the subjects in this study who had good quality embryos. There was no increase in PR with acupuncture in this sub-group; the results were the same as for the entire sample.

This study not only had an objective endpoint (pregnancy) but it also had several subjective psychological endpoints (optimism, confidence, and anxiety as measured by perceived relaxation). The women who received acupuncture felt more relaxed and enjoyed the IVF procedure more, the researchers found. They were also more optimistic about getting pregnant, but not more confident that they would get pregnant.”

Despite the results of my own study, I still recommend acupuncture to women going through IVF because there’s no downside,” Domar added, aside from the $150 an acupuncturist would typically charge — a small fraction of the $12,000 to $14,000 couples typically spent on a single round of IVF.

It seems to me this translates as: Acupuncture works. It didn’t work in this study, but that can’t be the fault of acupuncture, because acupuncture works. So it must be the fault of the patients for producing poor quality embryos, (our data don’t support that hypothesis, but let’s just ignore that). Acupuncture is harmless and people like it, so let’s use it on every patient whether it works or not. Patients will have to pay $150 extra, but I’m willing to decide for them that the expense is worth it. What?!

READ THE REST OF THIS ENTRY AT “SCIENCE BASED MEDICINE”

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