A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background Infertility, or impaired fecundity, affects 11.8% of women between the ages of 15 and 44, which translates to 7.3 million women. The use of assisted reproductive techniques has doubled over the past decade, with 148,055 cycles performed during 2008 resulting in 46,326 live births and the delivery of 61,426 infants. Acupuncture has been used in China to treat numerous and disparate medical conditions for thousands of years. Many anecdotal reports and non-randomized studies have claimed that acupuncture improves fertility, but the number of high-quality randomized controlled clinical trials and cohorts is much thinner. Objectives To determine whether the use of acupuncture results in higher pregnancy rates in patients undergoing in vitro fertilization compared with placebo acupuncture or no treatment. Search strategy All randomized controlled trials and prospective cohort reports of acupuncture and assisted reproductive technology were obtained through a systematic search of Medline and the MeSH database (1996 to February 2011). Selection criteria Prospective, randomized controlled trials comparing acupuncture treatment versus no treatment, placebo acupuncture, sham acupuncture at non-acupoints, and sham acupuncture at non-fertility-related acupoints during IVF treatment with or without intracytoplasmic sperm injection (ICSI). Inclusion criteria: - primary or secondary subfertility - undergoing IVF with or without ICSI - timing of acupuncture for before and after embryo transfer Exclusion criteria: - frozen embryo transfer - acupuncture used as adjunct to analgesia - electroacupuncture - donor oocytes - non-randomized trials, case-controls, case studies - studies included in the 2009 Cochrane review Data collection and analysis Thirteen randomized controlled trials were identified that involved acupuncture and in vitro fertilization with embryo transfer. Trials were analyzed for the following methodological details and quality criteria: study characteristics (randomization, blinding, power analysis, intention-to-treat analysis), patient characteristics (demographics, inclusion and exclusion criteria), interventions (IVF stimulation protocols, timing of acupuncture or control, acupoints chosen), and outcomes (ongoing pregnancy rates, live birth rates). Main results Only one of the trials demonstrated a result that achieved statistical significance. So 2009 showed that placebo acupuncture resulted in significantly higher overall birth rate when compared to true acupuncture. Even with adequate power, none of the other trials showed a difference that achieved statistical significance in pregnancy rate or live birth rates between acupuncture and control groups. Conclusions Acupuncture does not improve IVF outcomes and should not be offered routinely as an adjunct to fertility treatment. The evidence from the current literature suggests a positive effect of sham and placebo acupuncture on IVF outcomes, and therefore merits further study with adequately powered RCTs.

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Thesis (Ph. D.)--University of Chicago, 1916. / "A Private edition distributed by the University of Chicago Libraries." "Reprinted from Biological bulletin, Vol. XXXI, No. 3, Sept., 1916." "Literature cited": p. 177-179. Also available on the Internet.

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Successful establishment of boreal tree seedlings like trembling aspen (Populus tremuloides Michx) and white spruce (Picea glauca (Moench) Voss.) in reclaimed oil sands mining sites is often limited by low nutrient availability and competition from the ground cover vegetation like planted cover crops and weeds. Competing vegetation can adversely affect seedling establishment by augmenting the impacts of moisture and nutrient stress. Despite high potential of barley (Hordeum vulgare L.) and oats (Avena sativa) as cover crops in oil sands reclamation, it was not well known how these crops interact with fertilization to influence early survival and growth of tree seedlings. This study evaluated the potential of fertilization and other silvicultural practices to improve revegetation success in oil sands sites reclaimed with peat-mineral mixture. Fertilizer application significantly increased height and root collar diameter (RCD) of tree seedlings in controlled environment greenhouse conditions, but not at a field research site near Fort McMurray, Alberta. In a greenhouse study, alleviating soil moisture stress significantly increased height, RCD, and biomass of tree seedlings. Vigorous growth of ground cover vegetation stimulated by fertilizer addition in both the greenhouse and field, largely controlled survival and growth responses of tree seedlings. Survival rates of tree seedlings were significantly decreased with increased fertilizer application rates, and no positive growth responses were observed in the field. Maximum seedlings survival (92%) was recorded without fertilization. Trembling aspen was sensitive to ground cover competition, whereas white spruce was unaffected. The inherent fertility of the peat-mineral mixture appeared sufficient for establishment and early growth of planted tree seedlings in recently reclaimed oil sands sites. Fertilization appeared to increase competition between tree seedlings and cover vegetation by promoting increased growth and competition for other resources like water. Effects on growth over the longer term (several years) should be evaluated in future studies.

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