Study: Placebo Acupuncture Associated with Higher Pregnancy Rate

Acupuncture is often used during in vitro fertilization (IVF) treatments, despite the limited evidence of effectiveness. In a recent study, however, placebo acupuncture was unexpectedly linked to a higher rate of pregnancy than real acupuncture.

In the study, 370 women undergoing IVF were randomly assigned to receive 25 minutes of either real acupuncture or placebo acupuncture before and after embryo transfer. During the placebo treatment, an acupuncturist used a needle seemingly identical to a real acupuncture needle. However, the placebo needles did not actually enter the skin. Instead, they retracted back into the handle when pressed on the skin.

Before and after the acupuncture sessions, the authors measured the receptivity of the uterus, cortisol levels in the blood and anxiety levels.

The researchers found that the overall pregnancy rate was significantly higher in the placebo acupuncture group (55.1 percent) than the real acupuncture group (43.8 percent). Both receptivity of the uterus and stress levels decreased significantly in both groups, but these changes were not statistically different between the groups.

The authors concluded that placebo acupuncture may have actual effects on the body. It is also possible that real acupuncture may have a negative effect of pregnancy, although there is a lack of evidence to support this claim. Additional studies are needed in this area. 

Acupuncture has been used to treat many conditions related to pregnancy. For example, there is good evidence that acupuncture may improve nausea and back strain in pregnant women. For more information about acupuncture, please visit Natural Standard’s Health & Wellness database.

Comments

[wendy]

It would have been interesting if they also performed the "placebo" acupuncture at a non-acupuncture point.

[Steve Winnen]

Maybe it was more calming to not get injected with a needle but still receive arguably a pleasurable massage (they say placebo?) leading to the body saying “Hey, it’s safe, let’s multiply.” Although the blood levels and cortisol levels were similar, the experienced comfort is doubtfully similar. When I get acupuncture I can certainly double-blindedly tell you when a needle is piercing my skin. Conversely, who’s body would prefer to release an egg when being pierced versus not? These results are not exciting.

[domenick]

Wow. This is really interesting. Here, acupuncture has been used to stimulate fertility, and along comes a study that reports increased fertility with placebo acupuncture, relative to real acupuncture. Any ideas as to what might be going on here?

[EthicsCommittee]

More data are definitely required, but if there is any concern that there exists a negative relationship between acupuncture and pregnancy, how is it ethical to conduct studies on these pregnant women? Is it somehow OK because they are IVF and already have issues getting pregnant, so no one will notice a few more miscarriages? This is upsetting.

[Spaguy]

I find it interesting that stress levels and cortisol levels dropped in both groups. I sometimes think acupuncture (and in this case placebo) is like getting a haircut. Someone gives you precise and attentive tactile stimulation, which feels pretty great and involves just paying attention to something that feels great and relaxing. I want to design a study where we have three treatment arms with pregnant women: group 1 receives acupuncture, group 2 receives placebo acupuncture and group 3 receives a professional haircut. I think the data would be groundbreaking! What if the haircut group got pregnant the most?

[Kristen]

Having had worked for an acupuncturist and also receiving acupuncture as a patient, this study does not surprise me at all. Acupuncture is known to get the blood flow in the body to "get moving." Acupuncture is compared many times to massage for its therapeutic qualities. There are rarely any side effects to acupuncture, and it has been studied for many years. I found it to be not only very relaxing but also very healing. A wonderful article for women!

[Lauren]

It would have been helpful to compare these two groups (i.e., acupuncture and placebo acupuncture) to a third group that received just IVF by itself. That way, one could see if there was an acupuncture (real or placebo) effect. In other words, maybe just the notion of getting acupuncture is sufficient to increase fertility.

[Steve S]

Even though acupuncture doesn't hurt, per se, there are inflammatory mediators released at the site of needle entry. I wonder if these are somehow translated (through a complex signal transduction pathway) as a sign that a pregnancy perhaps isn't "safe." On the other hand, a placebo needle will lead to relaxation and decreased anxiety, but doesn't lead to actual tissue injury, however small.

[Bret F.]

It would be interesting to see a third arm of the study comparing women with no treatment at all to really see if real acupuncture had a negative on pregnancy and if placebo acupuncture had a positive effect. What is the normal success rate of IVF? What are the reasons for failure?

[Randy M.]

How exactly is uterus receptivity measured? What were the results of the anxiety levels? Where exactly on the body was the needles used for acupuncture? Does it really feel the same when a needle pokes the skin without penetrating and when it really penetrates?

[Tom B.]

Did the same amount of women in both groups receive the acupuncture before and after in vitro fertilization treatments? If not, that could play a factor in the results. I wonder if there is a difference receiving acupuncture before or after embryo transfer.

[Mike]

What an interesting study! I’ve always been fascinated by acupuncture and how it works. I am very surprised with the results of this study. Patients with placebo acupuncture had a higher rate of pregnancy compared to the patients who received acupuncture! This leads me to think that acupuncture may have a negative effect on pregnancy. It would be interesting to conduct a study to also include patients who did not receive any acupuncture so we could have a natural ground to compare to!

[dave]

Before we jump to the gun and say that placebo acupuncture may have a beneficial therapeutic effect in inducing pregnancy, we need to look at whether or not acupuncture plays a beneficial role in pregnancy. If acupuncture has a negative affect on pregnancy, then anything that it will be compared to will show a greater overall rate of pregnancy, even if it has no therapeutic effect!

[Nicole]

This study result has me really confused! I am having a really difficult time reasoning out the concluded findings. There might be some confounding variables, which would lead to false and conflicting results. Were any of patients on any medications for IVF therapy? Who sponsored the study? What were the estrogen and progesterone levels?

[Mary Mothlit]

Interesting study. I didn't know that acupuncture, which is of course used to ease other things like back pain and stress, was also used for fertility. I wonder if the pressure from the placebo acupuncture produced a similar "massage-like" effect on the body for these pregnant women?

This also made me think of the "placebo" study reported recently by Natural Standard, where docs gave patients placebos instead of real medications without their knowledge.

[Phil]

Dave, I think you bring up a great point! Personally, I don't see how acupuncture could have a great enough effect to actually help someone become pregnant, but with that aside, it is hard to distinguish the therapeutic effect here if anything works better than the test treatment! We need to first better understand how acupuncture affects pregnancy. Only then will the placebo results make any sense.

[Joanne]

What type of negative effects have been commonly associated with acupuncture and pregnancy? Does anyone know if acupuncture is a safe treatment to receive once you are pregnant?

[Jane Marie]

How is receptivity of the uterus usually measured during IVF treatments? Are cortisol levels usually measured in women undergoing IVF treatments? From this study, it seems like lower cortisol levels are a contributing factor to increasing the chance of pregnancy.

[SUMA]

After reading this article, the first question that comes to mind is how many of these women had acupuncture prior to this trial? I have never had acupuncture, and while I am open to trying it, I must say the thought of doing it for the first time makes me a little anxious. Did prior acupuncture experience play a role in these results? The study did state that that the anxiety level decreased in both groups and there were not any significant differences between the two. However, I still feel that subjects who had prior experience with acupuncture would be more relaxed, which could have contributed to their pregnancy rates. The abstract does not indicate if this confounder was taken into account. The results of this study contradict the results of a systematic review and meta-analysis that were published in March of this year in BMJ. In that review, the authors concluded that the “current preliminary evidence suggested that acupuncture given with embryo transfer improved rates of pregnancy and live birth among women undergoing in vitro fertilization.” The authors stated that “ the results were robust to sensitivity analyses on study validity variables. A pre-specified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24).” The results of these two studies alone indicate the need for continued research regarding acupuncture, as long as there is not any violation of ethical standards.

[Joseph N.]

I have never had acupuncture myself or sought IVF treatments, but I do understand the placebo effect. But from the sounds of this study, even though the acupuncture needle did not pierce the skin, there was still pressure applied, and so some form of treatment, say acupressure, was being given, right?

As for the negative effects of real acupuncture on fertility, I think much more data are needed to be conclusive. I agree with what Lauren said about having a control group who did not undergo any form of acupuncture, real or not, before IVF treatments.

[liz]

Could it be that the women who received the placebo acupuncture had a more relaxing experience than the women who received real acupuncture? I do not think real acupuncture had a negative effect in pregnancy since 43.8 percent got pregnant, and the therapy been used to treat conditions related to pregnancy safely.

[Kel]

If placebo acupuncture really works, then there is finally a way to help those who need IVF without having to take drugs, which have their own side effects. This study should be run again. If results are the same, and the pregnancy rate is statistically significant for the placebo, then don’t let the women know it’s a placebo, or you may lose its psychological impact.

[Lisa]

How many times have we heard of women struggling to get pregnant, and as soon as they give up, it happens? Perhaps the relaxing atmosphere of the acupuncturist’s office and the idea of treatment are enough to calm the incredible physical and emotional stress of IVF.

[PK]

I wonder what the overall pregnancy success rate is for IVF patients in general. Nicole, you wondered about confounding variables such as medications. All IVF patients receive medications to stimulate follicle maturation and to control the normal menstrual cycle.

[doctormanstan]

This reminds me of Reiki and energy healing stuff. Some people seem to be affected by the power of touch, and usually for the better (if better means pregnant in this case). I really wonder if the placebo-retractable patient had no clue, or if they could tell they were not being pierced and became more relaxed? Also, sample size although not so low, could easily explain the % difference in pregnancy rates between the two groups, even if "statistically significant."

[Mike]

What is going on with this study? How could doing “nothing” lead to better results? The only way this would be possible is if acupuncture had a negative effect on pregnancy. However, with that being said, how ethical is it to conduct a study that promotes miscarriages?

[Mike]

I am not familiar with acupuncture and its indications, so it is hard for me to understand how planting needles on different parts of one's body can have therapeutic effects. Are there any published documentations discussing the use of acupuncture in inducing pregnancy? If not, is it ethical for the authors to conduct such a study? What if it has negative affects on pregnancy; should legal actions be taken against the authors who conducted this study?

[Chester]

Wouldn't the women be able to tell that there is no needle stuck in their body? When the women get acupuncture, the needles stay in their bodies while they lay there in the acupuncturist's office, so I think they would still be able to feel the needles. If there are no needles there, they would feel nothing and they could tell they are getting placebo! It is strange that they have higher pregnancy rates.

[Mike]

I talked to an acupuncturist the other day and he says his success rate for fertility in women is about 50 percent, which is very close to the placebo group's rate in this study. I wonder what the success rate is of each acupuncturist in his/her own practice settings and if it coincides with this study or not. It would be interesting to see if there is variability among practitioners.

[C.M.]

Doctormanstan,

This is just another example of a finding that is statistically significant but clinically insignificant. Only time (and subsequent studies) will tell, but if you flip a coin 78 times, and that coin is a different random IVF female with specific and individual conflicts, it’s highly unlikely you will get extremely close to 50/50. Forget the procedure, let’s look at the patients, let alone all the possible confounding differences among these women. Females seeking IVF are generally not the most uniform physiologically.

[PK]

The pregnancy rate in the placebo acupuncture group was 55.1 percent, whereas it was 43.8 percent in the real acupuncture group. It is notable that the authors failed to address their results in the context of the EXPECTED pregnancy fate after two cycles of IVF. It seems that both of these numbers are a bit on the high side, as I was under the impression that IVF had a somewhat lower success rate.

[Linus]

On a related note, I recently had the opportunity to shadow an acupuncturist. Interestingly, one of his patients was a woman suffering from infertility. I didn't know if the woman was getting IVF. In hindsight,that would have been useful information -- although at the same time, it would have been improper to mention it to either the practitioner or patient.

[Becca]

Kel, I understand what you are saying about losing the "psychological impact," but that leads into a whole other set of issues. The placebo study story that was on Natural Standard talked about many of the problems related to not letting patients know about placebo treatments. After reading many of the comments, I think placebo treatments should be used in studies only.

[Becca]

Holistic centers believe that all women should be treated as individuals to restore their balance. Acupuncture treatment in IVF may be questionable. IVF acupuncture has been shown to affect the levels of pituitary and ovarian hormones. Electro-acupuncture may help improve blood flow in the uterine arteries of infertile women. Acupuncture relaxes the uterus around the time of the transfer. Several studies have shown that the uterus has contractions and that these contractions could cause expulsion of the transferred IVF embryo. If the contractions were reduced by acupuncture treatment, then the pregnancy rate may increase. However, other studies showed that acupuncture did not decrease uterine contractions.

Many women have been promised that acupuncture treatment coupled with IVF will cure specific problems like increased FSH levels and miscarriage. But there is no objective data to back this up. To make this topic even more confusing, other studies have shown that there is an increased risk of miscarriage after the second acupuncture treatment. There are other factors studies need to address such as embryo quality or other health issues that may be affecting a woman's ability to become pregnant. Plus, are these studies using placebos indicating that it may be more psychological? I think more studies need to be done.

[Anna H.]

The findings demonstrated in this study clearly indicate the ineffectiveness and probably detrimental effects of acupuncture. Acupuncture has become the fad nowadays for in-vitro fertilization, with a poor level of effectiveness as proven in this study. Release of cortisol was probably by a stimulant - i.e. the false needle that was used, and it explains that nature has its own course. It's only a psychological trigger that placebo played in the release of cortisol. Hormones released by anxiety in a natural manner are more effective than any acupuncture.

[jw]

Acupuncture studies generally use placebo acupuncture or sham acupuncture to test the effects of "true" acupuncture.

Sham acupuncture uses regular acupuncture needles. However, they are placed in non-acupoints. So even though a needle is piercing the skin, it's not supposed to have a medical effect.

Placebo acupuncture does not involve acupuncture needles, but it IS performed on acupoints. If I had to guess, I'd say that the placebo acupuncture in this case didn't serve as a real placebo. Instead, maybe it acted similarly to acupressure.

[Ammy]

Acupuncture is a best way get cured. Tablets can have side effects. Are there any side effects of acupuncture?

[RZD]

A friend of mine who was trying to get pregnant via IVF told me that she had a few sessions of acupuncture prior to the procedure to prepare her uterus and calm her nerves. She said that it really didn't do anything for her, although, she did end up pregnant. What is it about acupuncture that elicits such effects?

[Chantal]

Interesting study! This is new to me. However, the results may have been more valuable if they also compared the two groups to placebo acupunture (but in a non-acupoint).

Also, I find it highly unethical to conduct such a study if there may be data out there indicating the negative effects of acupunture on fertility. It's emotionally, spiritually and physically exhausting enough for these women as it is.

[vln]

What I would like to know is why acupuncture is performed when IVF is being done, and if because of these findings, they would stop doing the real procedure on women?

[Luce]

This is very confusing -- another study using the same technique as the study referred here (that is performed acupuncture during IVF on the day of embryo transfer) but had one arm that did not receive acupuncture (control) and another that received acupuncture on the day of ET and two days later. This study found that acupuncture on the day of embryo transfer (ET) significantly improved the reproductive outcomes of IVF compared to no acupuncture, and there was no additional benefit in the group that received acupuncture two days after ET.

[Lisa]

I find this very intriguing. These results further my theory on the power of the mind. In other words, the patients in the placebo group had no idea they weren't getting the actual treatment but they BELIEVED they were, and so the treatment was successful. I wonder if the results would be different if they were led to believe that they were in fact in the placebo group, but actually received treatment.

[Lory]

I just met a lady with amenorrhea who was trying to conceive. She tried fertility programs and still couldn't get pregnant. She decided to do acupuncture, and within two months she started her menstrual cycle again and soon after became pregnant. She stated that she was very stressed before, and the acupuncture relaxed her. Whether stress was the only factor that it affected, no one knows, but that acupuncture helped her become pregnant two times is a fact.

[Samantha]

Interesting study! Wow, I had no idea that acupuncture may be beneficial in this area. I will definitely forward this information. Would this be used as a form of complementary medicine or as an alternative modality?

[Linda W.]

Dr. Rabinowitz, who has been in private practice since 1986, is licensed to practice medicine and acupuncture in New York and Colorado, and is a NCCA (National Commission for the Certification of Acupuncturists) diplomate. She stated that it is important to receive acupuncture with a well-trained practitioner because there are some acupuncture points that are traditionally forbidden to do during the nine months of gestation. These points are the ones that are known to strongly move qi (energy) and blood through the pelvis, including obvious points like those on the lower abdomen and also the famous points we use to treat gynecological disorders: LI4 and SP6.

[Lydia]

I wonder how placebo acupuncture really works. I recently tried acupuncture, and it is pretty obvious if there are needles in your skin. I definitely would like to see this method compared to other methods such as massage and reiki.

[Cayden]

It is interesting that cortisol and stress levels dropped in both groups. Just the idea of acupuncture having positive results is enough to help!

[Marley]

Acupuncture has been known to cure a variety of illnesses in the eastern world for centuries. The American Acupuncture Association claims that acupuncture can treat infertility by increasing blood flow to the endometrium. When this is done, it promotes the creation of a thick, blood-rich lining that is conducive to a healthy reproductive environment. So the fact that this study found a higher success rate with placebo acupuncture is very interesting to me. I know that a placebo effect exists for pharmaceutical treatments, but did not know it could extend to alternative therapies as well.

[Sean Appleby]

This is an interesting finding that most certainly could use further testing to verify the unexpected result. Perhaps the effectiveness of the placebo acupuncture was caused by the technique of acupressure. Needles were not necessarily inserted into the patients, but pressure at the specific points was likely applied. Acupressure can be used for various ailments and simply stimulating chi flow along certain meridians and channels could possibly have caused the observed results.