Acupuncture improves the live birth of patients with repeated implantation failure: a retrospective cohort study

doi:10.19852/j.cnki.jtcm.20240515.006

Abstract

Abstract:

OBJECTIVE: To explore the therapeutic efficacy of acupuncture treatment on repeated implantation failure (RIF) patients with cryo-thawed embryo transfer (CET).

METHODS: In a retrospective cohort study, all eligible women undergoing RIF were recruited in our center from January 1, 2018 to December 31, 2021. The patients were grouped by whether an acceptance of acupuncture treatment before CET, including the acupuncture group (Acu-group, 55 cycles) and control group (Con-group, 244 cycles). Data were analyzed by using binary logistic regression to explore the relationship of acupuncture treatment with pregnancy outcomes.

RESULTS: The Acu-group had higher live-birth rate (LBR) [54.5% vs41.0%, respectively; odds ratio (OR) = 1.105, 95% confidence interval (CI) (1.029, 1.187), P =0.006] and ongoing pregnancy rate (OPR) [56.4% vs43.0%, respectively; OR= 1.100, 95% CI(1.025, 1.181), P =0.008] than the Con-group. There were no significant between-group differences in the rates of implantation [OR= 1.070, 95% CI(0.996, 1.149), P =0.064], clinical pregnancy [OR= 1.065, 95% CI(0.997, 1.138), P =0.061], biochemical pregnancy [OR= 1.002, 95% CI(0.903, 1.112), P =0.967], or miscarriage [OR= 0.778, 95% CI(0.551, 1.099), P =0.155]. Perinatal outcomes did not differ significantly between the two groups.

CONCLUSIONS: Acupuncture treatment could improve the LBR and OPR in RIF patients with CET cycles, suggesting a potential adjuvant therapy of acupuncture to improve the pregnancy outcomes in RIF patients.

Key words: acupuncture, repeated implantation failure, cryo-thawed embryo transfer, live birth rate

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.

Figures/Tables 7

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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
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

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 Adjusted^a OR (95% CI)	Fine Adjusted^b 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)

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