Akupunktura izboljšuje uspešnost postopka zunajtelesne oploditve (IVF)

Študija, ki je bila objavljena v British Medical Journal, je po pregledu dokazov pokazala, da lahko akupunktura poveča možnost zanositve pri ženskah, ki se zdravijo zaradi neplodnosti za 65%. Akupunktura, vstavljanje tankih igel pod kožo na določene točke v telesu, mesto kjer se igla vstavi je odvisno od bolezni, ki se zdravi. Akupunkture za uravnavanje ženskega razmnoževalnega sistema je na Kitajskem ena najdlje uporabljenih metod.

Eric Manheimer, raziskovalni sodelavec centra za integrativno medicino na medicinski fakulteti Univerze v Marylandu, je s sodelavci preučil sedem študij. Vse so bile objavljene v angleškem jeziku od leta 2002 in izvedene v štirih različnih zahodnih državah. Raziskave so vključevale 1.366 žensk, ki so se udeležile postopka zunajtelesne oploditve (in vitro fertility - IVF), pri katerem se odvzamejo jajčeca in spermij. V laboratoriju se jajčece pod mikroskopom oplodi z odvzetim spermijem. Nato se eden ali več zarodkov vstavi v maternico.

Ker je vsak cikel drag, dolgotrajen in stresen, so bila razvita nova zdravila in tehnologije za izboljšanje uspešnosti, vendar je bil napredek omejen. Čeprav se je izkazalo, da uporaba nekaterih postopkov, ki se začnejo pred ciklusom, izboljša stopnjo nosečnosti pri ženskah s slabšo prognozo zaradi posebnih pogojev, se je za splošno učinkovitost pri ženskah izkazalo le malo pomožnih postopkov.

Akupunkturo na Kitajskem že stoletja uporabljajo za uravnavanje ženskega reproduktivnega sistema. Predpostavljeni so bili trije možni mehanizmi njenega vpliva na plodnost. Prvič, akupunktura lahko posreduje pri sproščanju nevrotransmiterjev, ki lahko spodbudijo izločanje sproščevalnega hormona gonadotropina in tako vplivajo na menstrualni cikel, ovulacijo in plodnost. Drugič, akupunktura lahko spodbuja pretok krvi v maternico z zaviranjem centralne simpatične živčne aktivnosti maternice. Tretjič, akupunktura lahko spodbuja nastajanje endogenih opioidov, ki lahko zavirajo iztekanje iz centralnega živčnega sistema in biološki odziv na stres.

Rezultati študije so pokazale, da je bila dopolnitev postopka prenosa zarodka z akupunkturo povezana s pomembnim in klinično relevantnim izboljšanjem klinične nosečnosti. Razmerje možnosti 1,65 kaže, da je akupunktura povečala možnosti za klinično nosečnost za 65 % v primerjavi s kontrolnimi skupinami. Vendar je potrebno opozoriti, da razmerje kvot v tem kontekstu, v katerem je dogodek (nosečnost) razmeroma pogost, znatno precenjuje razmerje pogostosti. V absolutnem smislu je bilo število potrebnih zdravljenj 10, kar pomeni, da bi bilo treba z akupunkturo zdraviti 10 pacientk, da bi prišlo do ene dodatne klinične nosečnosti.

Postopek zunajtelesne oploditve (IVF) je drag postopek, ki v ZDA v povprečju stane 12.400 dolarjev (8480 EUR) na cikel. Če bi akupunktura povečala verjetnost uspeha posameznega cikla, bi se zmanjšala potreba po naslednjem ciklu, posledično bi se zmanjšali skupni stroški. Tudi če bi bilo takšno povečanje majhno in bi bilo na primer za eno dodatno nosečnost treba z akupunkturo zdraviti 17 bolnikov (to je najnižji razpon 95-odstotnega intervala zaupanja), bi bila sočasna intervencija z akupunkturo še vedno lahko stroškovno učinkovita, če upoštevamo zanemarljive stroške dveh do štirih seans akupunkture v primerjavi z visokimi stroški oploditve in vitro.

Raziskovalci navajajo, da trenutni predhodni dokazi kažejo, da akupunktura, ki se izvaja ob prenosu zarodka, izboljša stopnjo nosečnosti in živorojenih otrok pri ženskah, ki so bile oplojene s pomočjo zunajtelesne oploditve zarodka (IVF).


Literatura:

Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39471.430451.BE (Published 06 March 2008)


 

IVF Success Rates improved by acupuncture

A study showed that acupuncture can increase the chances of getting pregnant for women undergoing fertility treatment by 65%, a review of the evidence published in the British Medical Journal showed. Acupuncture, which involves inserting fine needles under the skin at particular points in the body depending on the condition being treated, has long been used in China to help with a range of diagnoses, including regulating female reproduction.

Eric Manheimer, research associate at the centre for integrative medicine at the University of Maryland school of medicine and colleagues looked at seven studies. All had been published in English since 2002 and conducted in four different western countries. The trials involved 1,366 women undergoing in vitro fertility treatment - where eggs and sperm are removed and mixed in the laboratory and one or more resulting embryos returned to the womb.

Because each cycle is expensive, lengthy, and stressful, new drugs and technologies have been developed to improve success rates. Progress, however, has been limited. Although use of some procedures, initiated before the cycle, have been shown to improve pregnancy rates in women with a poorer prognosis because of specific conditions, few adjuvant procedures have been shown to be effective for women in general.

Acupuncture has been used in China for centuries to regulate the female reproductive system. Three potential mechanisms for its effects on fertility have been postulated. Firstly, acupuncture may mediate the release of neurotransmitters, which may in turn stimulate secretion of gonadotrophin releasing hormone, thereby influencing the menstrual cycle, ovulation, and fertility. Secondly, acupuncture may stimulate blood flow to the uterus by inhibiting uterine central sympathetic nerve activity.Thirdly, acupuncture may stimulate the production of endogenous opioids, which may inhibit the central nervous system outflow and the biological stress response.

The study results showed that complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy. The odds ratio of 1.65 suggests that acupuncture increased the odds of clinical pregnancy by 65% compared with the control groups. It is important to note, however, that the odds ratio significantly overestimates the rate ratio in this context, in which the event (pregnancy) is relatively frequent. In absolute terms, the number needed to treat was 10, suggesting that 10 patients would need to be treated with acupuncture to bring about one additional clinical pregnancy.

In vitro fertilization is an expensive procedure, costing an average of $12 400 (€8480) per cycle in the United States. If acupuncture increased the likelihood of success of an individual cycle, then the need for a subsequent cycle would be reduced, and overall costs would be decreased. Even if such increases were small, and, for example, 17 patients needed to be treated with acupuncture to bring about one additional pregnancy (that is, the lowest range of our 95% confidence interval), an acupuncture cointervention may still be cost effective, considering the negligible costs of two to four sessions of acupuncture, relative to the high costs of in vitro fertilization.

The researchers suggest that current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilization.


Reference:

Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39471.430451.BE (Published 06 March 2008)