Journal of Traditional Chinese Medicine ›› 2024, Vol. 44 ›› Issue (4): 830-838.DOI: 10.19852/j.cnki.jtcm.20240515.006
• Original articles • Previous Articles Next Articles
SUN Junjian1,2, XIE Henghui3, LI Huanhuan4, TIAN Xiangming4, FANG Yigong5(), ZHOU Wenhui4()
Received:
2024-11-18
Accepted:
2024-03-14
Online:
2024-08-15
Published:
2024-05-15
Contact:
Prof. FANG Yigong, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China. SUN Junjian, XIE Henghui, LI Huanhuan, TIAN Xiangming, FANG Yigong, ZHOU Wenhui. Acupuncture improves the live birth of patients with repeated implantation failure: a retrospective cohort study[J]. Journal of Traditional Chinese Medicine, 2024, 44(4): 830-838.
Figure 1 Flow chart IVF: in vitro fertilization; ICSI: intracytoplasmic sperm injection; CET: cryo-thawed embryo transfer; ET: embryo transfer; TESE: testicular sperm extraction; TESA: testicular sperm aspiration; RIF: repeated implantation failure; BMI: body mass index; PCOS: polycystic ovary syndrome; APS: Antiphospholipid syndrome; PTS: Pre-thrombolic state.
Characteristic | Acu (n = 55) | Con (n = 244) | P value |
---|---|---|---|
Age at OPU (years) | 33.0 (30.0-36.0) | 33.0 (30.0-35.8) | 0.519 |
Age during ET (years) | 34.0 (30.0-37.0) | 33.0 (31.0-36.0) | 0.701 |
BMI (kg/m2) | 22.2 ± 0.4 | 22.1 ± 0.2 | 0.854 |
Basal FSH (IU/L) | 7.1 (5.8-8.5) | 6.3 (5.4-7.7) | 0.030 |
Basal E2 (pg/mL) | 47.2 ± 2.1 | 50.2 ± 1.6 | 0.480 |
Antral follicle count | 12.0 (10.0-15.0) | 14.0 (10.0-19.0) | 0.034 |
Causes of infertility [(n) %] Female Male Mixes Unexplained | (27) 49.1 (1) 1.8 (16) 29.1 (11) 20.0 | (136) 55.7 (15) 6.1 (40) 16.4 (53) 21.7 | 0.114 |
Infertility type [(n) %] Primary Secondary | (39) 70.9 (16) 29.1 | (158) 64.8 (86) 35.2 | 0.384 |
No. of ET-failure cycles [(n) %] Twice Three times More than three times | (42) 76.4 (8) 14.5 (5) 9.1 | (153) 62.7 (61) 25.0 (30) 12.3 | 0.149 |
Table 1 Baseline clinical information of patients according to acupuncture therapy
Characteristic | Acu (n = 55) | Con (n = 244) | P value |
---|---|---|---|
Age at OPU (years) | 33.0 (30.0-36.0) | 33.0 (30.0-35.8) | 0.519 |
Age during ET (years) | 34.0 (30.0-37.0) | 33.0 (31.0-36.0) | 0.701 |
BMI (kg/m2) | 22.2 ± 0.4 | 22.1 ± 0.2 | 0.854 |
Basal FSH (IU/L) | 7.1 (5.8-8.5) | 6.3 (5.4-7.7) | 0.030 |
Basal E2 (pg/mL) | 47.2 ± 2.1 | 50.2 ± 1.6 | 0.480 |
Antral follicle count | 12.0 (10.0-15.0) | 14.0 (10.0-19.0) | 0.034 |
Causes of infertility [(n) %] Female Male Mixes Unexplained | (27) 49.1 (1) 1.8 (16) 29.1 (11) 20.0 | (136) 55.7 (15) 6.1 (40) 16.4 (53) 21.7 | 0.114 |
Infertility type [(n) %] Primary Secondary | (39) 70.9 (16) 29.1 | (158) 64.8 (86) 35.2 | 0.384 |
No. of ET-failure cycles [(n) %] Twice Three times More than three times | (42) 76.4 (8) 14.5 (5) 9.1 | (153) 62.7 (61) 25.0 (30) 12.3 | 0.149 |
Characteristic | Acu (n = 55) | Con (n = 244) | P value |
---|---|---|---|
Transformation a E2 (pg/mL) | 400.2 (240.3-667.2) | 322.5 (215.6-899.5) | 0.440 |
LH (IU/L) | 4.6 (0.5-12.6) | 7.7 (1.2-14.9) | 0.062 |
P (ng/mL) | 0.3 (0.2-0.4) | 0.4 (0.2-0.6) | 0.006 |
Phase of embryos transferred [(n) %] Day 3 Day 3 + Day5-6 D5/D6 | (31) 56.4 (4) 7.3 (20) 36.4 | (87) 35.7 (13) 5.3 (144) 59.0 | 0.010 |
No. of embryos transferred [(n) %] 1 2 | (16) 29.1 (39) 70.9 | (98) 40.2 (146) 59.8 | 0.127 |
No. of High-quality embryos [(n) %] 1 2 | (28) 50.9 (27) 49.1 | (104) 42.6 (140) 57.4 | 0.167 |
Endometrium morphology [(n) %] A A- A-B B | (28) 50.9 (12) 21.8 (9) 16.4 (6) 10.9 | (140) 57.4 (57) 23.4 (25) 10.2 (22) 9.0 | 0.563 |
Endometrial preparation [(n) %] Natural cycle HRT cycle Stimulated cycle Endometrium thickness (mm)a | (8) 14.5 (43) 78.2 (4) 7.3 9.48±0.245 | (41) 16.8 (179) 73.4 (24) 9.8 9.58±0.130 | 0.771 0.983 |
Fertilization method [(n) %] half ICSI IVF | (9) 16.4 (8) 14.5 (38) 69.1 | (24) 9.8 (32) 13.1 (188) 77.0 | 0.471 |
Table 2 Characteristics of patients during CET divided by acupuncture therapy
Characteristic | Acu (n = 55) | Con (n = 244) | P value |
---|---|---|---|
Transformation a E2 (pg/mL) | 400.2 (240.3-667.2) | 322.5 (215.6-899.5) | 0.440 |
LH (IU/L) | 4.6 (0.5-12.6) | 7.7 (1.2-14.9) | 0.062 |
P (ng/mL) | 0.3 (0.2-0.4) | 0.4 (0.2-0.6) | 0.006 |
Phase of embryos transferred [(n) %] Day 3 Day 3 + Day5-6 D5/D6 | (31) 56.4 (4) 7.3 (20) 36.4 | (87) 35.7 (13) 5.3 (144) 59.0 | 0.010 |
No. of embryos transferred [(n) %] 1 2 | (16) 29.1 (39) 70.9 | (98) 40.2 (146) 59.8 | 0.127 |
No. of High-quality embryos [(n) %] 1 2 | (28) 50.9 (27) 49.1 | (104) 42.6 (140) 57.4 | 0.167 |
Endometrium morphology [(n) %] A A- A-B B | (28) 50.9 (12) 21.8 (9) 16.4 (6) 10.9 | (140) 57.4 (57) 23.4 (25) 10.2 (22) 9.0 | 0.563 |
Endometrial preparation [(n) %] Natural cycle HRT cycle Stimulated cycle Endometrium thickness (mm)a | (8) 14.5 (43) 78.2 (4) 7.3 9.48±0.245 | (41) 16.8 (179) 73.4 (24) 9.8 9.58±0.130 | 0.771 0.983 |
Fertilization method [(n) %] half ICSI IVF | (9) 16.4 (8) 14.5 (38) 69.1 | (24) 9.8 (32) 13.1 (188) 77.0 | 0.471 |
Outcome | Acu | Con | Unadjusted OR (95% CI) | Rough Adjusteda OR (95% CI) | Fine Adjustedb OR (95% CI) |
---|---|---|---|---|---|
Live birth Ongoing pregnancy | 54.5 (30/55) 56.4 (31/55) | 41.0 (100/244) 43.0 (105/244) | 1.073 (1.008, 1.144) 1.069 (1.004, 1.139) | 1.103 (1.028, 1.183) 1.100 (1.025, 1.179) | 1.105 (1.029, 1.187) 1.100 (1.025, 1.181) |
Clinical pregnancy | 58.2 (32/55) | 52.5 (128/244) | 1.041 (0.981, 1.105) | 1.063 (0.996, 1.135) | 1.065 (0.997, 1.138) |
Implantation rate | 41.5 (39/94) | 40.8 (159/390) | 1.041 (0.976, 1.110) | 1.067 (0.994, 1.146) | 1.070 (0.996, 1.149) |
Biochemical | 9.1 (5/55) | 7.8 (19/244) | 0.992 (0.893, 1.102) | 0.999 (0.904, 1.103) | 1.002 (0.903, 1.112) |
Miscarriage | 3.6 (2/55) | 11.5 (28/244) | 0.768 (0.535, 1.101) | 0.776 (0.548, 1.099) | 0.778 (0.551, 1.099) |
GW at birth (weeks) Normal, 37+ Preterm, < 37 | 93.3 (28/30) 6.7 (2/30) | 88.0 (88/100) 12.0 (12/100) | 1.00 1.139 (0.898, 1.444) | 1.00 1.138 (0.891, 1.453) | 1.00 1.145 (0.882, 1.486) |
Multiple births Single birth | 23.3 (7/30) 76.7 (23/30) | 24.0 (24/100) 76.0 (76/100) | 1.00 0.973 (0.893, 1.060) | 1.00 0.965 (0.876, 1.064) | 1.00 0.963 (0.861, 1.079) |
Birth weight (kg) Normal, 2.5-4.0 Abnormal | 73.0 (27/37) 27.0 (10/37) | 78.2 (97/124) 21.8 (27/124) | 1.00 0.963 (0.900, 1.030) | 1.00 0.940 (0.873, 1.011) | 1.00 0.929 (0.860, 1.004) |
Sex of baby Male Female | 67.6 (25/37) 32.4 (12/37) | 50.8 (63/124) 49.2 (61/124) | 1.00 1.032 (0.960, 1.110) | 1.00 0.961 (0.896, 1.032) | 1.00 1.027 (0.954, 1.106) |
Delivery way Vaginal CS | 23.3 (7/30) 76.7 (23/30) | 24.0 (24/100) 76.0 (76/100) | 1.00 1.022 (0.957, 1.093) | 1.00 1.019 (0.951, 1.092) | 1.00 1.039 (0.963, 1.120) |
Table 3 Clinical pregnancy outcomes and perinatal outcomes of patients grouped by acupuncture therapy [(%) n]
Outcome | Acu | Con | Unadjusted OR (95% CI) | Rough Adjusteda OR (95% CI) | Fine Adjustedb OR (95% CI) |
---|---|---|---|---|---|
Live birth Ongoing pregnancy | 54.5 (30/55) 56.4 (31/55) | 41.0 (100/244) 43.0 (105/244) | 1.073 (1.008, 1.144) 1.069 (1.004, 1.139) | 1.103 (1.028, 1.183) 1.100 (1.025, 1.179) | 1.105 (1.029, 1.187) 1.100 (1.025, 1.181) |
Clinical pregnancy | 58.2 (32/55) | 52.5 (128/244) | 1.041 (0.981, 1.105) | 1.063 (0.996, 1.135) | 1.065 (0.997, 1.138) |
Implantation rate | 41.5 (39/94) | 40.8 (159/390) | 1.041 (0.976, 1.110) | 1.067 (0.994, 1.146) | 1.070 (0.996, 1.149) |
Biochemical | 9.1 (5/55) | 7.8 (19/244) | 0.992 (0.893, 1.102) | 0.999 (0.904, 1.103) | 1.002 (0.903, 1.112) |
Miscarriage | 3.6 (2/55) | 11.5 (28/244) | 0.768 (0.535, 1.101) | 0.776 (0.548, 1.099) | 0.778 (0.551, 1.099) |
GW at birth (weeks) Normal, 37+ Preterm, < 37 | 93.3 (28/30) 6.7 (2/30) | 88.0 (88/100) 12.0 (12/100) | 1.00 1.139 (0.898, 1.444) | 1.00 1.138 (0.891, 1.453) | 1.00 1.145 (0.882, 1.486) |
Multiple births Single birth | 23.3 (7/30) 76.7 (23/30) | 24.0 (24/100) 76.0 (76/100) | 1.00 0.973 (0.893, 1.060) | 1.00 0.965 (0.876, 1.064) | 1.00 0.963 (0.861, 1.079) |
Birth weight (kg) Normal, 2.5-4.0 Abnormal | 73.0 (27/37) 27.0 (10/37) | 78.2 (97/124) 21.8 (27/124) | 1.00 0.963 (0.900, 1.030) | 1.00 0.940 (0.873, 1.011) | 1.00 0.929 (0.860, 1.004) |
Sex of baby Male Female | 67.6 (25/37) 32.4 (12/37) | 50.8 (63/124) 49.2 (61/124) | 1.00 1.032 (0.960, 1.110) | 1.00 0.961 (0.896, 1.032) | 1.00 1.027 (0.954, 1.106) |
Delivery way Vaginal CS | 23.3 (7/30) 76.7 (23/30) | 24.0 (24/100) 76.0 (76/100) | 1.00 1.022 (0.957, 1.093) | 1.00 1.019 (0.951, 1.092) | 1.00 1.039 (0.963, 1.120) |
Item | Ongoing pregnancya | Live birtha | ||
---|---|---|---|---|
Fine adjusted OR (95% CI) | P value | Fine adjusted OR (95% CI) | P value | |
Acupuncture | 1.100 (1.025, 1.181) | 0.008 | 1.105 (1.029, 1.187) | 0.006 |
Age at OPU (years) | 0.889 (0.823, 0.962) | 0.003 | 0.907 (0.839, 0.980) | 0.014 |
AFC | 1.029 (0.992, 1.067) | 0.126 | 1.022 (0.985, 1.060) | 0.246 |
Basal FSH | 1.069 (0.960, 1.191) | 0.225 | 1.084 (0.973, 1.209) | 0.144 |
No. of high-quality ET | 1.347 (0.781, 2.324) | 0.284 | 1.561 (0.897, 2.717) | 0.115 |
Embryo stage (blastocyst) | 1.468 (1.082, 1.992) | 0.014 | 1.604 (1.174, 2.190) | 0.003 |
P on transformation day | 0.471 (0.215, 1.033) | 0.060 | 0.411 (0.178, 0.948) | 0.037 |
LH on transformation day | 1.022 (1.000, 1.043) | 0.046 | 1.026 (1.004, 1.048) | 0.019 |
Endometrium (mm) | 1.131 (0.997, 1.283) | 0.056 | 1.141 (1.005, 1.296) | 0.042 |
Table 4 Association of acupuncture therapy with pregnancy outcome by multivariate logistic regression analysis
Item | Ongoing pregnancya | Live birtha | ||
---|---|---|---|---|
Fine adjusted OR (95% CI) | P value | Fine adjusted OR (95% CI) | P value | |
Acupuncture | 1.100 (1.025, 1.181) | 0.008 | 1.105 (1.029, 1.187) | 0.006 |
Age at OPU (years) | 0.889 (0.823, 0.962) | 0.003 | 0.907 (0.839, 0.980) | 0.014 |
AFC | 1.029 (0.992, 1.067) | 0.126 | 1.022 (0.985, 1.060) | 0.246 |
Basal FSH | 1.069 (0.960, 1.191) | 0.225 | 1.084 (0.973, 1.209) | 0.144 |
No. of high-quality ET | 1.347 (0.781, 2.324) | 0.284 | 1.561 (0.897, 2.717) | 0.115 |
Embryo stage (blastocyst) | 1.468 (1.082, 1.992) | 0.014 | 1.604 (1.174, 2.190) | 0.003 |
P on transformation day | 0.471 (0.215, 1.033) | 0.060 | 0.411 (0.178, 0.948) | 0.037 |
LH on transformation day | 1.022 (1.000, 1.043) | 0.046 | 1.026 (1.004, 1.048) | 0.019 |
Endometrium (mm) | 1.131 (0.997, 1.283) | 0.056 | 1.141 (1.005, 1.296) | 0.042 |
Figure 2 Forest plot of the effect of acupuncture on pregnancy outcome LBR: live birth rate; OPR: ongoing pregnancy rate; CPR: clinical pregnancy rate; IR: implantation rate; CS: cesarean section; OR: odds ratio.
Figure 3 Favor of live birth OPU: oocyte pick-up; AFC: total antral follicle count; FSH: follicular stimulation hormone; P: progesterone; LH: luteinizing hormone; P: progesterone; LH: Luteinizing hormone; *: on endometrium-transformation day; OR: odds ratio.
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