IVF and acupuncture.

In vitro conceptions now account for up to 4% of all pregnancies in developed countries. In Europe alone, some 300 000 treatment cycles are carried out per year, with 90% of them resulting in at least one embryo being transferred. The problem is that only about 25% of all cycles lead to implantation and a live birth.

Clearly, any means to improve the proportion of live births per cycle is attractive, both medically and commercially, and many have been tried--such as using support gonadotrophins with luteinising activity, assisted hatching, and the transfer of 5-day rather than 3-day embryos. All these have their statistical advantages, but other factors such as cost and side-effects have to be taken into account when deciding to incorporate them into standard practice.

An adjunct therapy that has been grabbing attention is acupuncture. It has been used to regulate the reproductive cycle in China for centuries, and Manheimer et al. (BMJ 2008; 336: 545-549) quote possible mechanisms for its mode of action. They also reviewed the world literature and have produced a meta-analysis which suggests that, given with embryo transfer, acupuncture enhances a woman's chances of pregnancy and a live birth. They calculate that 10 women would need to be treated for an additional pregnancy and live birth. Whether these data are reproducible in large prospective trials is for the future, but the order of magnitude of improved outcomes is higher than for more conventional adjunct manoeuvres, so some enthusiasts are likely to be persuaded by the evidence already presented.