Thursday, March 11

IVF & Acupuncture -repsonse to new challenge to efficacy

It's a Meta Analysis of already published RCT's on Acupuncture/IVF. I'm sure that it includes the "usual suspects", i.e. the same RCT's or at lest most of the ones, that have been looked at in the previous Meta Analysis, i.e. Mannheimer, etc. What's curious of course, is how different PI's can look at the same RCT's for Meta Analysis, and come out of the number crunching with vastly different conclusions.

This has to do with the fact that the strength of any given Meta Analysis relates to the homogeneity of the RCT's looked at within it. Because the published RCT's in Acupuncture and IVF are not very homogeneous in terms of their inclusion criteria, exclusion criteria, controls, STRICTA guidelines, etc., it is very difficult to say for sure whether or not their is a positive, negative, or no effect from Acupuncture in IVF patients. Even Professor Adam Balen (co-author of one of the ABORM Reference Texts (Balen and Jacobs) noted, " patients needed to be aware of the lack of evidence on acupuncture and herbs before signing up to a course of treatment.There was a a great deal of discrepancy, he added, in the way in which the trials were designed and the type of acupuncture used".

Dr. Balen goes on to say, "Any future randomised controlled trials in this area need to ensure that they use a standardised acupuncture method, have a large sample size and include adequate controls to account for any placebo effects".

Therein lies the "rub". Acupuncture is notoriously difficult to control or blind for, and both placebo acupuncture (fake acupuncture needles in real acupoints), and sham acupuncture (real acupuncture needles in "sham" off-channel points) are undoubtedly not inert controls, and therefore the outcomes are muddy.

Perhaps the greatest insight - and one that might point a motivation for this Meta Analysis - was the quote, "But this sometimes comes at a cost which could buy a couple a further cycle of IVF"

Let's face it, there is increasing competition among REI's for patients as the field has increased in number, so any non-conventional therapy or treatment that might compete with that revenue source is going to put under the microscope.

Ray Rubio, DAOM, L. Ac. (FABORM)
Reproductive Medicine Department Chair/Yo San University DAOM Program

Westlake Complementary Medicine
910 Hampshire Road, Suite A
Westlake Village, CA 91361
Phone: (805) 497-1335
FAX: (805) 497-1336

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