Objective
Since Paulus et al (Fertil.Steril.2002) found in a prospective randomized study a significant improvement of the pregnancy rate in IVF when it is combined with acupuncture we were interested in the possible origin of this improvement.
Design
A retrospective analysis of all cycles from 2002 to august 2005. 1473 cycles were performed without TCM and 127 cycles with TCM.
Materials and methods
Since 2002 we offered our patients the opportunity to combine IVF with TCM. The IVF procedure is a standard procedure with a long down regulation protocol and a hMG stimulation. The oocytes were fertilized by conventional IVF in cases of tubal factor or by intracytoplasmic sperm injection(ICSI). 3 zygotes were left in culture for transfer, the surplus were frozen. In accordance with swiss law a maximum of 3 embryos were transferred on day 2 or 3. The luteal phase was generally supported by estrogen and progesterone. The TCM treatment consisted of a minimum of 3 acupuncture treatments, some with chinese herbal treatment, before and after embryo transfer. The choice of acupuncture points and the composition of the chinese herbal remedies were based on the individual TCM differential diagnosis. Following data were analyzed: age, primary vs secondary infertility, monofactorial vs multifactorial infertility, IVF with or without ICSI, fertilisation rate, no. of transfered embryos, clinical pregnancies per transfer and implantation rate. Statistical analysis was performedwith SPSS 14.0 for windows and Chi-Square and Student’s t-test were used to compare the two groups.
Results
We found no differences in patients characteristics except in age.It was 36.6 y in the TCM group and 35.3y in the non-TCM group (p=0.001).We analyzed the cycle data in different age groups of < 35 (A), 35-39(B) and 40+ (C). We analyzed fresh embryo and frozen embryo transfers separately without vs with TCM. Fresh tansfers: GroupA: 420 cycles vs 21. Fertilization rate: 69.2% vs 71.7%. Transferred embryos: 2.20 vs 2.24. Clinical pregnacies: 40.2% vs 33.3%, implantation rate: 23.1% vs 18.3% (n.s.). Group B:405 vs 36 cycles. Fertilization rate:67.8% vs 82.2%(p<0.001). Transferred embryos: 2.25 vs 2.67. (p= 0.001).Clinical pregnacies: 31.6% vs 44.4% and implantation rate: 15.5% vs 23.6% (n.s.). GroupC:163 cycles vs 19. Fertilization rate:63.7% vs 75.1% (p=0.042).Transferred embryos: 1.85 vs 2.42 (p=0.035). Clinical pregnacies: 12.9% vs 26.3%, implantation rate: 5.5% vs 7.0% (n.s.). Frozen embryo transfers: GroupA: 219 cycles vs 14. Transferred embryos: 2.03 vs 2.43. Clinical pregancies: 22.8% vs 35.7%. Implantation rate: 11% vs 14.3%(n.s.). GroupB: 208 cycles vs 29. Transferred embryos: 2.23 vs 2.45. Clinical pregancies: 25% vs 37.9% (n.s.).Implantation rate: 9.8% vs 24.1%(p=0.046). Group C: 58 cycles vs 8. Transferred embryos: 2.16 vs 2.00. Clinical pregancies: 12.1% vs 0%. Implantation rate: 8.1%vs 0%(n.s.).
Conclusion
TCM improves the fertilization rate in fresh cycles of IVF/ICSI. This improvement is statistically significant in the age groups > 35 years. The significant improvement of No of transfered embryos in the age groups over 35 years may be due to the higher fertilization rate but also to other bias. The results in the frozen embryo transfer groups showed a statistically significant improvement of the implantation rate between 35 and 39. We speculate a positive modulation of the age related oocyte quality and the endometrium at the time of implantation.