Level 1: Likely reliable evidence
A systematic review of seven randomized trials evaluated needle acupuncture within one day of embryo transfer compared with sham acupuncture or no adjuvant treatment in 1,366 women having one round of in vitro fertilization (BMJ. 2008;336:545-549; full-text available online free of charge at: www.bmj.com/cgi/content/full/336/7643/545; accessed May 9, 2008). Comparing acupuncture vs. control (sham acupuncture and no treatment combined), the rates of clinical pregnancy (more than one gestational sac or fetal heartbeat confirmed by transvaginal ultrasound) were 32% vs. 26.7% in a meta-analysis of seven trials with 1,366 women (P=.0002, NNT 10); there was some heterogeneity in this outcome based on one trial finding no differences. Ongoing pregnancy (pregnancy beyond 12 weeks’ gestation confirmed by fetal heart activity on ultrasound) was 30% vs. 18.9% (five trials with 690 women; P<.0001, NNT 9). The rates of live birth were 30.6% vs. 19% (four trials with 226 women; P<.0001, NNT 9).