Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Extraction of Candidate Acupoints for POR Treatment
2.2. Selection of Optimal Acupoint Combination Using Network Analysis
2.3. Study Design
2.4. Safety and Effectiveness
2.5. Statistical Analyses
3. Results
3.1. Extraction of Candidate Acupoints for POR Treatment
3.2. Selection of Optimal Acupoint Combination for POR Treatment Using Network Analysis
3.3. Participant Characteristics
3.4. Effectiveness of Acupuncture by Needling at Eight Acupoints Followed by IVF for POR Treatment
3.5. Inverse Correlation between the Number of Retrieved Mature Oocytes and COH Cycles Disappeared Following the Acupuncture Treatment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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First Author (Year) | Study Design; Sample Size; Age (y); Infertility Periods (y) | Intervention Group (A) Control Group (B, C, D) | Main Outcomes | Intergroup Differences | Acupoint | |
---|---|---|---|---|---|---|
Zhou (2016) [23] | RCT; 63; (A)(35 ± 5)/(B)(36 ± 5); (A)(5.3 ± 4.6)/(B)(6.9 ± 5.2) | (A) AT plus IVF-ET (n = 30) (B) IVF-ET (n = 33) | (1) FSH (2) E2 (3) AFC (4) Number of matured oocytes (5) Fertilization rate | (6) High-quality embryo rate (7) Cycle cancellation rate (8) Implantation rate (9) Clinical pregnancy rate | (1–6) p < 0.05 (7–9) p < 0.01 | SP6, CV4, CV6, GV4, ST36, KI3, KI7, LR3, GB34, BL17, BL23, EX-B8, EX-CA1 |
Xu (2016) [22] | RCT; 56; n.r.; n.r. | (A) AT (n = 28) (B) Estrogen and progesterone therapy (n = 28) | (1) FSH (2) AMH | (1–2) p < 0.05 | SP6, SP10, CV4, GV20, ST36, KI3, LR3, BL20 | |
Fernando (2016) [23] | Prospective observation study; 21; (A)(37.0 ± 5.4); (A)(3.2 ± 3.2) | (A) AT (n = 21) | (1) FSH (2) LH (3) E2 | (4) FSH/LH ratios (5) Symptom scale scores | (1–5) p < 0.05 | SP10, CV4, CV12, GV20, GV24, ST25, ST36, KI3, KI12, LR3, GB1, BL23, BL32, EX-B8 |
Yan (2015) [24] | RCT; 108; (29.8 ± 4.6); (4.9 ± 0.8); | (A) AT (n = 36) (B) Sham AT (n = 36) (C) No treatment (n = 36) | (1) Response rate (2) Planting rate | (3) Clinical pregnancy rate (4) Live birth rate | (1–4) p < 0.05 | SP8, SP10, CV4, ST29, ST36, KI3, BL23, EX-CA1 |
Lian (2015) [25] | RCT; 66; (A)(38 ± 1)/(B)(37 ± 1); (A)(4.1 ± 2.2)/(B)(3.9 ± 1.9) | (A) EA plus IVF-ET (n = 33) (B) Sham EA plus IVF-ET (n = 33) | (1) Kidney deficiency syndrome score (2) High-quality embryo rate | 3) Clinical pregnancy rate 4) IGF-1, IGF-2, β-EP | (1–2) p < 0.05 (3) p > 0.05 (5) p < 0.05 | SP6, CV3, CV4, EX-CA1 |
Wang (2016) [26] | Prospective observation study; 21; (A)(37.0 ± 5.4); (A)(3.2 ± 3.2) | (A) EA (n = 21) | (1) FSH (2) LH (3) E2 | 4) FSH/LH ratios 5) Symptom scale scores | (1–5) p < 0.05 | CV4, ST25, BL33, EX-CA1 |
Zhou (2013) [27] | Prospective observation study; 11; (A)25–39; (A) 0.33–10 | (A) EA (n = 11) | (1) E2 (2) FSH (3) LH | (1) p = 0.002 (2) p = 0.001 (3) p = 0.002 | CV4, ST25, ST29, BL33 | |
Chen (2009) [28] | RCT; 60; (A)(34.3 ± 2.7)/(B)(34.6 ± 2.3); (A)(6.2 ± 4.3)/(B)(6.0 ± 4.6) | (A) EA plus IVF-ET (n = 30) (B) IVF-ET (n = 30) | (1) Kidney deficiency syndrome score (2) E2 (3) Fertilization rate (4) Number of matured oocytes | (5) High-quality embryo rate (6) Implantation rate (7) Pregnancy rate | (1–6) p < 0.05 (7) p > 0.05 | SP6, CV4, KI3 |
Liu (2008) [29] | RCT; 60; (A)(34.3 ± 2.7)/(B)(34.6 ± 2.3); (A)(4.3 ± 1.4)/(B)(4.4 ± 1.3) | (A) EA plus GnRH antagonist (n = 30) (B) GnRH antagonist (n = 30) | (1) doses and days of GnRH (2) Thickness of endometrium (3) E2 (4) FSH (5) LH (6) SCF | (7) Fertilization rate (8) Number of matured oocytes (9) High-quality embryo rate (10) Pregnancy rate (11) Abortion rate | (1–2) p > 0.05 (3–11) p < 0.05 | SP6, CV3, CV4, KI3, LR3, EX-CA1 |
Zheng (2015) [30] | RCT; 240; (A)(36.0 ± 5.4)/(B)(36.9 ± 4.3) (C)(36.8 ± 4.6)/(D)(36.8 ± 5.3); (A)(4.4 ± 2.9)/(B)(5.2 ± 3.2) (C)(4.7 ± 2.6)/(D)(4.8 ± 2.4); | (A) TEAS (n = 56) (B) No treatment (n = 60) (C) False Han’s placebo (n = 56) (D) Artificial endometrial cycle treatment (n = 54) | (1) E2 (2) FSH (3) AMH (4) LH (5) Number of matured oocytes (6) Number of embryos transferred | (7) Clinical pregnancy rate (8) Fertilization rate (9) Cleavage rate (10) High-quality embryo rate | (1–4) p < 0.01 (5–10) p < 0.05 | SP6, CV3, CV4, GV4, GV20, ST25, BL23, EX-CA1 |
Lian (2014) [31] | RCT; 66; (A)(36 ± 2)/(B)(37 ± 3); (A)(4.4 ± 2.5)/(B)(4.3 ± 2.6) | (A) TEAS plus IVF-ET (n = 33) (B) Sham AT plus IVF-ET (n = 33) | (1) The kidney deficiency syndrome score (2) HCG E2/follicle count per day (3) High-quality follicle rate | (4) High-quality embryo rate (5) Clinical pregnancy rate | (1) p < 0.01 (2–3) p < 0.05 (4–5) p > 0.05 | SP6, CV3, CV4, EX-CA1 |
Chen (2011) [32] | RCT; 80; (A)(37.1 ± 5.3)/(B)(36.6 ± 4.6); (A)(6.4 ± 4.4)/(B)(6.1 ± 3.0) | (A) TEAS plus IVF-ET (n = 40) (B) IVF-ET (n = 40) | (1) FSH (2) E2 (3) High-quality embryo rate | (4) Cryopreservation of embryo (5) Clinical pregnancy rate | (1–5) p < 0.05 | SP6, CV3, CV4, GV3, GV4, ST25, EX-CA1, |
Zhu (2012) [33] | RCT; 60; (A)(36.2 ± 1.0)/(B)(36.6 ± 0.8); (A)(4.4 ± 0.3)/(B)(4.5 ± 0.2) | (A) TEAS plus IVF-ET (n = 30) (B) IVF-ET (n = 30) | (1) Kidney symptom scores (2) FSH (3) E2 (4) Number of matured oocytes | (5) High-quality embryo rate (6) Cryopreservation of embryo (7) Clinical pregnancy rate | (1–7) p < 0.05 | SP6, CV3, CV4, GV3, GV4, ST25, BL23, EX-CA1 |
Acupoints | Acupuncture | Electro-Acupuncture | Transcutaneous Electrical Acupoint Stimulation | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Zhou 2016 [23] | Xu 2016 [24] | Fernando 2016 [25] | Yan 2015 [26] | Lian 2015 [27] | Wang 2016 [28] | Zhou 2013 [29] | Chen 2009 [30] | Liu 2008 [31] | Zheng 2015 [32] | Lian 2014 [33] | Chen 2011 [34] | Zhu 2012 [35] | ||
Sanyinjiao | SP 6 | O | O | O | O | O | O | O | O | O | ||||
Diji | SP 8 | O | ||||||||||||
Xuehai | SP 10 | O | O | O | ||||||||||
Zhongji | CV 3 | O | O | O | O | O | O | |||||||
Guanyuan | CV 4 | O | O | O | O | O | O | O | O | O | O | O | O | O |
Qihai | CV 6 | O | ||||||||||||
Zhongwan | CV 12 | O | ||||||||||||
Yaoyangguan | GV 3 | O | O | |||||||||||
Mingmen | GV 4 | O | O | O | O | |||||||||
Baihui | GV 20 | O | O | O | ||||||||||
Shenting | GV 24 | O | ||||||||||||
Tianshu | ST 25 | O | O | O | O | O | O | |||||||
Guilai | ST 29 | O | O | |||||||||||
Zusanli | ST 36 | O | O | O | O | |||||||||
Taixi | KI 3 | O | O | O | O | O | O | |||||||
Fuliu | KI 7 | O | ||||||||||||
Dahe | KI 12 | O | ||||||||||||
Taichong | LR 3 | O | O | O | O | |||||||||
Tongziliao | GB 1 | O | ||||||||||||
Yanglingquan | GB 34 | O | ||||||||||||
Geshu | BL 17 | O | ||||||||||||
Pishu | BL 20 | O | ||||||||||||
Shenshu | BL 23 | O | O | O | O | O | ||||||||
Ciliao | BL 32 | O | ||||||||||||
Zhongliao | BL 33 | O | O | |||||||||||
Shiqizhui | EX-B 8 | O | O | |||||||||||
Zigong | EX-CA1 | O | O | O | O | O | O | O | O | O |
Characteristic | IVF (n = 10) | Ac + IVF (n = 8) | p-Value | |
---|---|---|---|---|
Age (y) | 40.00 ± 3.83 | 37.88 ± 3.87 | p = 0.2279 | |
BMI (kg/m2) | 23.14 ± 3.81 | 20.69 ± 2.99 | p = 0.1728 | |
Duration of infertility (months) | 48.30 ± 36.59 | 33.25 ± 27.06 | p = 0.5310 | |
Number of COH cycles | 3.90 ± 2.56 | 3.38 ± 1.92 | p = 0.6530 | |
Hormone (Basal level) | FSH (mIU/mL) | 8.61 ± 8.25 | 17.62 ± 16.69 | p = 0.2031 |
LH (mIU/mL) | 1.80 ± 0.95 | 7.74 ± 8.63 | p = 0.0155 | |
E2 (pg/mL) | 88.10 ± 69.62 | 120.86 ± 69.47 | p = 0.2370 | |
TSH (µIU/mL) | 2.70 ± 1.44 | 2.19 ± 0.89 | p = 0.6334 | |
DHEAS (µg/dL) | 139.87 ± 58.95 | 202.49 ± 144.60 | p = 0.4082 | |
PRL (ng/mL) | 10.34 ± 5.33 | 9.27 ± 5.07 | p = 0.5726 | |
AMH (ng/mL) | 0.44 ± 0.36 | 0.58 ± 0.44 | p = 0.4232 | |
Antral follicle count (Basal level) | 3.80 ± 1.03 | 3.63 ± 0.92 | p = 0.6033 |
Outcome | IVF (n = 10) | Ac + IVF (n = 8) | p-Value |
---|---|---|---|
Number of retrieved mature oocytes | 1.30 ± 1.25 | 2.75 ± 1.91 | p = 0.0916 |
Number of fertilized oocytes | 1.10 ± 0.99 | 2.25 ± 1.39 | p = 0.0714 |
Fertilization rate * (No. of zygotes/No. of oocytes) | 89.29 ± 19.67% (11/13) | 91.67 ± 23.57% (18/22) | p = 0.8320 |
AMH (ng/mL) Antral follicle count | 0.47 ± 0.43 | 0.55 ± 0.36 | p = 0.4232 |
5.60 ± 2.37 | 5.13 ± 1.89 | p = 0.6033 |
Characteristic | IVF (n = 10) | Ac + IVF (n = 8) | p-Value | |
---|---|---|---|---|
Age (y) | 40.67 ± 3.39 | 39.67 ± 2.16 | p = 0.1724 | |
BMI (kg/m2) | 23.45 ± 3.90 | 21.89 ± 2.23 | p = 0.2284 | |
Duration of infertility (months) | 46.67 ± 38.42 | 40.17 ± 27.99 | p = 0.5511 | |
Number of COH cycles | 3.44 ± 2.24 | 3.33 ± 2.07 | p = 0.7933 | |
Hormone (Basal level) | FSH (mIU/mL) | 9.35 ± 8.39 | 11.25 ± 11.54 | p = 0.7982 |
LH (mIU/mL) | 1.83 ± 1.00 | 4.59 ± 3.27 | p = 0.0537 | |
E2 (pg/mL) | 70.83 ± 45.77 | 117.03 ± 64.12 | p = 0.1419 | |
TSH (µIU/mL) | 2.80 ± 1.49 | 2.00 ± 0.96 | p = 0.3450 | |
DHEAS (µg/dL) | 132.73 ± 57.76 | 222.75 ± 165.23 | p = 0.1812 | |
PRL (ng/mL) | 8.90 ± 2.96 | 8.29 ± 5.10 | p = 0.4908 | |
AMH (ng/mL) | 0.40 ± 0.37 | 0.59 ± 0.435.10 | p = 0.3319 | |
Antral follicle count (Basal level) | 3.78 ± 1.09 | 3.67 ± 1.03 | p = 0.9451 |
Outcome | IVF (n = 10) | Ac + IVF (n = 8) | p-Value |
---|---|---|---|
Number of retrieved mature oocytes | 1.33 ± 1.32 | 3.33 ± 1.86 | p = 0.0426 |
Number of fertilized oocytes | 1.11 ± 1.05 | 2.67 ± 1.37 | p = 0.0550 |
Fertilization rate * (No. of zygotes/No. of oocytes) | 87.50 ± 20.92% (9/10) | 88.89 ± 27.22% (16/20) | p = 0.4884 |
AMH (ng/mL) Antral follicle count | 0.51 ± 0.44 | 0.45 ± 0.35 | p = 0.8099 |
5.44 ± 2.46 | 5.67 ± 1.86 | p = 0.5542 |
Characteristic | IVF (n = 10) | Ac + IVF (n = 8) | p-Value | |
---|---|---|---|---|
Age (y) | 40.43 ± 3.87 | 37.88 ± 3.87 | p = 0.3096 | |
BMI (kg/m2) | 24.19 ± 4.16 | 20.69 ± 2.99 | p = 0.1672 | |
Duration of infertility (months) | 43.43 ± 37.84 | 33.25 ± 27.06 | p = 0.5305 | |
Number of COH cycles | 3.86 ± 2.12 | 3.38 ± 1.92 | p = 0.3797 | |
Hormone (Basal level) | FSH (mIU/mL) | 10.45 ± 9.35 | 17.62 ± 16.69 | p = 0.1911 |
LH (mIU/mL) | 1.68 ± 1.10 | 7.74 ± 8.63 | p = 0.0542 | |
E2 (pg/mL) | 54.17 ± 18.94 | 120.86 ± 69.47 | p = 0.2359 | |
TSH (µIU/mL) | 2.89 ± 1.53 | 2.19 ± 0.89 | p = 0.8884 | |
DHEAS (µg/dL) | 141.37 ± 63.23 | 202.49 ± 144.60 | p = 0.5414 | |
PRL (ng/mL) | 8.74 ± 3.38 | 9.27 ± 5.07 | p = 0.6730 | |
AMH (ng/mL) | 0.39 ± 0.40 | 0.58 ± 0.44 | p = 0.2890 | |
Antral follicle count (Basal level) | 3.71 ± 1.25 | 3.63 ± 0.92 | p = 0.6830 |
Outcome | IVF (n = 10) | Ac + IVF (n = 8) | p-value |
---|---|---|---|
Number of retrieved mature oocytes | 1.00 ± 0.87 | 2.75 ± 1.91 | p = 0.0300 |
Number of fertilized oocytes | 0.71 ± 0.76 | 2.25 ± 1.39 | p = 0.0305 |
Fertilization rate * (No. of zygotes/No. of oocytes) | 87.50 ± 25.00% (8/9) | 91.67 ± 23.57% (18/22) | p = 0.6271 |
AMH (ng/mL) Antral follicle count | 0.31 ± 0.27 | 0.55 ± 0.36 | p = 0.3537 |
4.86 ± 2.34 | 5.67 ± 1.86 | p = 0.9610 |
Number of COH Cycles | Group | Number of Retrieved Mature Oocytes | p-Value | Number of Fertilized Oocytes | p-Value |
---|---|---|---|---|---|
≥1 | IVF (n = 9) | 1.00 ± 0.87 | p = 0.0300 | 0.74 ± 0.76 | p = 0.0305 |
Ac + IVF (n = 8) | 2.75 ± 1.91 | 2.25 ± 1.39 | |||
≥2 | IVF (n = 8) | 0.88 ± 0.83 | p = 0.0389 | 0.75 ± 0.71 | p = 0.0252 |
Ac + IVF (n = 6) | 2.67 ± 1.86 | 2.00 ± 0.89 | |||
≥3 | IVF (n = 6) | 0.67 ± 0.82 | p = 0.0253 | 0.67 ± 0.82 | p = 0.0308 |
Ac + IVF (n = 5) | 3.00 ± 1.87 | 2.20 ± 0.84 | |||
≥4 | IVF (n = 6) | 0.67 ± 0.82 | p = 0.0485 | 0.67 ± 0.82 | p = 0.0599 |
Ac + IVF (n = 4) | 3.00 ± 2.16 | 2.20 ± 0.82 | |||
≥5 | IVF (n = 5) | 0.40 ± 0.55 | p = 0.0600 | 0.40 ± 0.55 | p = 0.0600 |
Ac + IVF (n = 3) | 3.00 ± 2.65 | 1.67 ± 0.58 |
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Kim, J.; Lee, H.; Choi, T.-Y.; Kim, J.I.; Kang, B.-K.; Lee, M.S.; Joo, J.K.; Lee, K.S.; You, S. Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial. J. Clin. Med. 2021, 10, 2182. https://doi.org/10.3390/jcm10102182
Kim J, Lee H, Choi T-Y, Kim JI, Kang B-K, Lee MS, Joo JK, Lee KS, You S. Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial. Journal of Clinical Medicine. 2021; 10(10):2182. https://doi.org/10.3390/jcm10102182
Chicago/Turabian StyleKim, Jihyun, Hoyoung Lee, Tae-Young Choi, Joong Il Kim, Byoung-Kab Kang, Myeong Soo Lee, Jong Kil Joo, Kyu Sup Lee, and Sooseong You. 2021. "Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial" Journal of Clinical Medicine 10, no. 10: 2182. https://doi.org/10.3390/jcm10102182