MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Acupuncture, like most other alternative therapies, is particular popular for indications that are

  1. chronic,
  2. associated with a high burden of suffering,
  3. not easily treatable with conventional therapies,
  4. are frequently resolved without any intervention.

Infertility or subfertility tick most of these boxes. It is therefore not surprising that acupuncturists the world over claim that acupuncture can cure infertility. But is this claim based on evidence or on wishful thinking?

The objective of this new study was to find out. Specifically, the authors wanted to provide preliminary data to explore whether women with subfertility undergoing a course of acupuncture and lifestyle modification compared with an active control of lifestyle modification alone would demonstrate improved reproductive outcomes, improved menstrual cycles, and increased fertility awareness.

In a pragmatic randomised controlled trial, with the A+B versus B design, sub/infertile women were offered an intervention of acupuncture and lifestyle modification or lifestyle modification only. There was a statistically significant increase in fertility awareness in the acupuncture group (86.4%) compared to 40% of the lifestyle only participants. Changes in menstrual regularity were not statistically significant. There was no statistical difference in the pregnancy rate with seven women achieving pregnancy during the course of the study intervention. Those receiving the acupuncture conceived within an average of 5.5 weeks compared to 10.67 weeks for the lifestyle only group.

The authors concluded that the acupuncture protocol tested influenced women who received it compared to women who used lifestyle modification alone: their fertility awareness and wellbeing increased, and those who conceived did so in half the time.

The first sentences of the authors’ discussion are, I think, revealing: The main findings were that this acupuncture intervention, compared to lifestyle only, resulted in significant increases in fertility awareness and quality of life measures in relation to wellbeing; it increased the ability of the recipients to engage in desired activities, such as exercise or rest, and it shortened the time to conception by half. The findings provide preliminary evidence that the acupuncture intervention is acceptable and is not inert and that acupuncture dose may have a significant influence on outcomes. 

In my view, the main findings of this study are entirely different. Let me propose alternatives:

  • In alternative medicine, if you did a lousy study, you can just call it a ‘pilot study’ and all is forgiven.
  • The infamous A+B vs B design continues to be popular for those who cannot bring themselves to publishing negative findings.
  • It works perfectly for subjective parameters but less convincingly for objective ones, such as pregnancy rates.
  • Doing such research on infertility is good for the cash flow of acupuncturists.
  • Making women aware of fertility increases (surprise, surprise!) fertility awareness.

No need to be so cynical!, some will think. After all, the results showed that women receiving the acupuncture conceived within an average of 5.5 weeks compared to 10.67 weeks for the lifestyle only group. True! But there was no statistically significant difference between these two figures. And that means, the difference was a chance finding (which has no place in an abstract) which probably has no relevance whatsoever.

Or perhaps I am wrong?

I am told to always keep an open mind!

So, let’s keep our minds open to some truly alternative explanations. How about this one: regular acupuncture increases the rate of adultery, which, in turn, decreases the time to conception.

Makes sense, doesn’t it? Has anyone a better idea?

12 Responses to Acupuncture: does it increase the rate of adultery?

  • LOL!

    “…it increased the ability of the recipients to engage in desired activities, such as exercise or rest”. Thank good ness for a modality that increases people’s ability to rest. I think I’ll go get me some acupuncture (after I’ve had a nap).

  • Clinical (including pilot) trials of the senior author Caroline Smith (2016 only), researcher at the National Institute of Complementary Medicine and researcher of the year Western Sydney University for her decades of experience in clinical trials – maybe a contender for your Hall of Fame?

    1. The feasibility of progressive resistance training in women with polycystic ovary syndrome: a pilot randomized controlled trial. Lisa Vizza, Caroline A Smith, Soji Swaraj, Kingsley Agho, Birinder S Cheema

    Conclusion

    A randomized controlled trial of PRT in PCOS would be feasible, and this mode of exercise may elicit a therapeutic effect on clinically important outcomes in this cohort. The success of a large-scale trial required to confirm these findings would be contingent on addressing the feasibility hurdles identified in this study with respect to recruitment, attrition, compliance, and collection of standardized clinical data.

    http://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-016-0039-8

    2. More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture. Michael Armour, Hannah G. Dahlen, Caroline A. Smith

    Conclusions

    Most of the women in this study found improved symptom control and reduced pain. A contributing factor for these improvements may be an increased internal health locus of control and an increase in self-efficacy resulting from the self-care advice given during the clinical trial.

    http://www.hindawi.com/journals/ecam/2016/3467067/abs

    3. Effect of acupuncture on house dust mite specific IgE, substance P, and symptoms in persistent allergic rhinitis. John Leslie McDonald, Peter K. Smith, Caroline A. Smith, Charlie Changli Xue, Brenda Golianu, Allan W. Cripps, Mucosal Immunology Research Group. – (discussed extensively on your Blog last week)

    Conclusions

    Acupuncture modulated mucosal immune response in the upper airway in adults with persistent allergic rhinitis. This modulation appears to be associated with down-regulation of allergen specific IgE for house dust mite, which this study is the first to report. Improvements in nasal itch, eye itch, and sneezing after acupuncture are suggestive of down-regulation of transient receptor potential vanilloid 1.

    http://www.sciencedirect.com/science/article/pii/S1081120616301260

    4. Prior to Conception: The Role of an Acupuncture Protocol in Improving Women’s Reproductive Functioning Assessed by a Pilot Pragmatic Randomised Controlled Trial. Suzanne Cochrane, Caroline A. Smith, Alphia Possamai-Inesedy, Alan Bensoussan

    Those receiving the acupuncture conceived within an average of 5.5 weeks compared to 10.67 weeks for the lifestyle only group. The acupuncture protocol tested influenced women who received it compared to women who used lifestyle modification alone: their fertility awareness and wellbeing increased, and those who conceived did so in half the time.

    http://www.hindawi.com/journals/ecam/2016/3587569/abs

    5. INDIVIDUALIZED YOGA FOR REDUCING DEPRESSION AND ANXIETY, AND IMPROVING WELL-BEING: A RANDOMIZED CONTROLLED TRIAL. Michael de Manincor, Alan Bensoussan, Caroline A. Smith, Kylie Barr, Monica Schweickle, Lee-Lee Donoghoe, Suzannah Bourchier, Paul Fahey

    Conclusion

    Yoga plus regular care was effective in reducing symptoms of depression compared with regular care alone. Further investigation is warranted regarding potential benefits in anxiety. Individualized yoga may be particularly beneficial in mental health care in the broader community.

    http://onlinelibrary.wiley.com/doi/10.1002/da.22502/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=

  • “It works perfectly for subjective parameters but less convincingly for objective ones, such as pregnancy rates.”

    According to the author, objective parameters is not all that important!! Why? because “women find the use of acupuncture empowering, whether or not pregnancy is achieved.”

    Acupuncture and Infertility Treatment: Is There More to the Outcome for Women than Pregnancy?
    Sheryl de Lacey and Caroline Smith.

    Conclusions:

    The qualitative information presented in this review suggests that women find the use of acupuncture empowering, whether or not pregnancy is achieved. This indicates that acupuncture can play an important role in strategies for enhancing women’s health.

    http://online.liebertpub.com/doi/abs/10.1089/acu.2012.0903

  • No comments about sticking things in places where they don’t belong?

  • The correlation between the divorce rate in Maine and per capita consumption of margarine is 0.992558.
    (http://www.tylervigen.com/view_correlation?id=1703).

    The conclusion?
    For a happy marriage, butter is better. Marlon Brando agreed.
    Belonetherapy is better still.
    (Greek: ‘belone’ a surgeon’s needle. See ‘Real Secrets of Alternative Medicine’ (Amazon or Kindle) p.201, 202.)

  • LOL indeed. Who would think that being asked each week about where in your menstral cycle you were and when you were going to ovulate, with the answer affecting what acupuncture you get would affect someone’s awareness of their menstral cycle and ovulation?

    The study title is strange when the primary outcomes are all to do with menstruation. It looks like it was originally for women with menstrual problems and pain, a classic acupuncture cohort.

    The statistics seem very honestly done although I did not notice corrections for multiple comparisons. Emphasizing in the conclusions and the abstract the p=.422 shorter time to conceive seems very dubious especially when this was only a secondary outcome and the non-accupuncture group had a 50% longer prior duration of infertility p=0.08
    Using full intention to treat analysis is laudible. I’d have accepted dropping out the patients who withdrew before starting, although it’s not clear to me if the woman who got pregnant before the start was counted in the acupuncture group pregnancy statistics.

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