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."