Dr Maggie Ju helped many couples with their fertility with great success. Women with acupuncture treatment with her either conceived naturally or via IVF.
Recent research has shown that acupuncture helps you conceive naturally
Acupuncture improves fertility for infertile women without undergoing assisted reproductive techniques (ART)
Acupuncture has been popular for decades to help women’s fertility, but the effectiveness is still in debate. What is the latest development of research on this aspect? A paper analysed data up to June 2018 to study the effectiveness of acupuncture for infertile women with natural conception.
22 trials with a total of 2591 participants were included. The participants included were women aged 20–40 years, a husband with semen of normal quality and shape, women who failed to conceive with unprotected sexual life for 1 year, women with a gynecological diagnosis of infertility, women not receiving treatment by assisted reproductive technology. The experimental group received acupuncture or its combined therapy, and the control group received other standard therapies, such as injected Western drugs and oral Western medication. They measured pregnancy rate, which was confirmed with a pregnancy test and ultrasound, ovulation rate, endometrial thickness, endocrine indexes, such as luteinizing hormone (LH) and follicle stimulating hormone (FSH), and adverse events.
The results show that
1, the pregnancy rate is significantly increased with acupuncture treatment with or without other intervention such as Chinese medicine or Western medicine; pregnancy rate is increased with all types of infertility such as ovulation disorders or other types of infertility.
2, ovulation rate is increased with acupuncture treatments.
3, the level of LH is significantly improved with acupuncture treatments.
4, the level of endometrial thickness is significantly improved with acupuncture treatments.
5, fewer side effects occurs with acupuncture treatments.
Yun L et al Medicine (Baltimore). 2019 Jul;98(29):e16463. doi: 10.1097/MD.0000000000016463.
10 reasons why you should try acupuncture to boost your fertility naturally
No1, reduce stress. Stress impacts fertility more than you imagined. If you are stressed, it can make your hormone imbalanced. Many women have experience that when they are stressed, their period arrives earlier than it should; or they have spots break out. Acupuncture can effectively reduce the stress.
No2, improves blood circulation. Good blood circulation is essential for the body to preform including ovaries and uterus. Many researches have shown that acupuncture can improve blood circulation to the body and ovaries and uterus.
No3, reduce inflammation. Metabolism products from inflammation can have toxic effects to the organs include reproductive system. Acupuncture can effectively reduce inflammation and has detoxing effect.
No4, release tension and muscle spasms. Tension and muscle spasm in the body can compromise micro blood circulation in the body including ovaries and uterus. Acupuncture can release all the tensions.
No5, rebalance hormones. Follicle development depends on hormones. Hormones imbalance affects egg qualities. Acupuncture can help rebalance the hormones and improve egg quality.
No6, improves egg quality and ovulation. As mentioned above, acupuncture can improve blood microcirculation and rebalance hormones to improve egg quality.
No7, reduce fallopian tube spasm. Fallopian tube spasm can block the way of eggs, sperms and embryos. Acupuncture can release fallopian tube spasm and help the transportation.
No8, improve uterine lining. Uterine lining is a bed for embryo. It needs to be good and comfortable to embryo to implant in. uterine lining development depends on blood circulation and hormone balance. Acupuncture can help improve uterine lining to its best for embryo implantation.
No9, improve sperm quantity and quality. Acupuncture can help improve sperm’s quality and quantity for women to get pregnant.
No 10, Increase pregnancy rates. Recent research suggested that acupuncture increases pregnancy rates.
Acupuncture helps fertility and increases Live birth rate by 30%.
Acupuncture potentially affect fertility in a few ways suggested by research.
First, acupuncture can induce vasodilation and blood flow to the uterus and ovaries, which are vital to reproduction. By inhibiting central sympathetic nerve tone.
Acupuncture also makes the body produce endorphins relieving the stress response associated with infertility and infertility-related treatment.
Acupuncture balances hormones. The release of neurotransmitters—such as dopamine, serotonin, neuropeptides, and oxytocin initiated by acupuncture could influence the hypothalamus–pituitary–ovarian axis to promote ovulation, regulate menstrual cycles, and increase overall fertility.
Acupuncture could affect glucose uptake in the skeletal tissue, decrease hyperinsulinemia, and might increase insulin clearance in polycystic ovary syndrome.
Recent data-analyses found that Acupuncture has been effective for increasing clinical pregnancy rates by 28%–32%, Ongoing pregnancy rate by 42%, and Live birth rate by 30%, compared to no treatment. Acupuncture does not increase the risk of miscarriage. Some analysis has shown that acupuncture reduced the miscarriage rate by 43%. Additionally, acupuncture was 42% more effective to increase live births when women had previously failed a cycle, and baseline pregnancy rate continues to mediate acupuncture's effects.
Lee E. Hullender Rubin, Med Acupunct. December 2019; 31(6): 329–333.
Acupuncture can help IVF success.
IVF is one of the most successful infertility treatments and this treatment brings hope for pregnancy for many people. However, the majority of IVF cycles do not result in pregnancy. It is important to maximize the chance to succeed. Many patients have turned to acupuncture treatments to increase the success rate of IVF. The first report was by Stener-Victorin et al. 15 years ago suggesting that acupuncture can increase the IVF clinical pregnancy rate (CPR). In recent years, there have been many randomized controlled trials (RCTs) evaluating acupuncture in IVF. There were more positive effects from acupuncture during IVF from these researchers.
Acupuncture increases pregnancy success rates of IVF
A recent research studied the effectiveness of acupuncture on pregnancy success rates for women undergoing in vitro fertilization. In this study, women with unexplained infertility were recruited. 36 women were in acupuncture group and they received 3 sessions of acupuncture treatment during IVF procedure. Pregnancy rates and anxiety levels were measured. The result has shown that clinical pregnancy, ongoing pregnancy, and live birth rates were higher in acupuncture group (23) compared to control group (12) which was nearly doubled; anxiety levels were lower in acupuncture group compared to control group. The conclusion is that three sessions of acupuncture before and after embryo transfer significantly increased the pregnancy rates in women with unexplained infertility and significantly reduced anxiety levels that occurred before embryo transfer.
Guven PG et al Taiwan J Obstet Gynecol. 2020 Mar;59(2):282-286. doi: 10.1016/j.tjog.2020.01.018.
10 Reasons why you should have acupuncture as an adjunct treatment of your IVF.
About 1 in 6 couples have difficulty conceiving and seek specialist fertility treatment. There are various treatments available depending on the causes of the infertility. In vitro fertilisation (IVF) is one of the most successful treatments for couples with infertility, however it is still not 100% success. Some treatments that can increase the success rate of IVF would be preferable to support IVF. Acupuncture is one of the candidates. Here is a list of
10 reasons why you should have acupuncture as an adjunct treatment of your IVF.
No1 There are no side effects of acupuncture treatment. It does not cause any harm and does not interact with any medications for whatever protocols you have for IVF.
No2 IVF is a very stressful procedure. It makes women anxious about it. Stress and anxiety could affect IVF success. Acupuncture that is proved by research can reduce stress and anxiety score during IVF treatment.
No3 Acupuncture reduce inflammation. If there is inflammation around the abdominal region, it makes the toxic environment affecting fertility.
No4 Acupuncture improves blood circulation to help provide enough nutrients and oxygen to the ovaries and uterus.
No5 Acupuncture can help balance hormones. Balanced hormones are essential for pregnancy to occur and stay.
No6 Acupuncture can help improve egg quality. It reduces inflammation and improves blood circulation to the ovaries. This helps to supply oxygens and nutrients to the eggs and take the toxins away from the eggs.
No7 Acupuncture improves the uterine lining by improving blood circulation to the uterus and helps the lining to grow. Uterine lining is where the embryo to implant and grow.
No8 Acupuncture relax the uterus and help embryo implantation too.
No9 Acupuncture can increase sperm counts and improve sperm quality. The evidence for the effect of acupuncture on sperm counts and sperm quality is emerging in research.
No10 Based above step by step help. Acupuncture can help increase IVF success eventually. It is a good candidate to assist IVF.
Acupuncture can help, if you had miscarriage
A miscarriage is the loss of a pregnancy during the first 23 weeks. About 1 in 5 of all recognised pregnancies is miscarried usually before the 13th week of pregnancy. The loss of pregnancy at ≤13 weeks’ pregnancy is defined as an early miscarriage. About one in four pregnancies, where a woman has missed a menstrual period and has a positive pregnancy test, ends in early miscarriage. Nearly 125 000 early miscarriages occur annually in the UK, accounting for 50 000 hospital admissions.
The most common cause of early pregnancy loss is chromosomal abnormalities. Collagen vascular disease is one of the causes. Early miscarriage is usually diagnosed by pelvic ultrasound after a woman has experienced vaginal bleeding or abdominal pain. Women with a complete miscarriage, where expulsion of pregnancy tissue is complete, are managed conservatively without further intervention. Women with a missed or incomplete miscarriage may require further intervention.
Miscarriage can be a physical and emotional challenge. It is a major life event and can have a potentially devastating psychological impact on the woman in addition to the physical effects such as bleeding and pain.
There is a good chance that you will give birth to a healthy baby in the future. Only about 20% of women who have had a miscarriage have another miscarriage the next time they become pregnant.
What would you do to help for the recovery from a miscarriage?
After miscarriage, the women’s body need to recover from the event, get hormones rebalanced, get rid of the inflammation from the miscarriage, recover from the psychological impact that it caused.
Tried acupuncture? Acupuncture can help reduce stress and release the emotions, rebalance hormones, reduce inflammation to get you ready to get pregnant again. Some women have difficulty to conceive after miscarriage and acupuncture can help to get pregnant faster.
Recurrent miscarriage is the spontaneous loss of three or more consecutive pregnancies in the first trimester. It affects 1-2% of women, half of whom have no identifiable cause.
Uterine blood flow changes can be seen in the uterus and ovaries during the menstrual cycle and uterine blood flow affects uterine receptivity and an important factor in achieving a normal pregnancy. Differences in uterine blood flow impedance between fertile and infertile women and reduced uterine blood flow may be one cause of unexplained infertility. Recent research also has suggested that impaired uterine blood flow is associated with recurrent pregnancy loss. In women with recurrent miscarriage their blood flow resistance in uterine artery was elevated which means the blood flow was reduced. As we can see that reduced blood circulation in endometrium and placenta is the reason for many miscarriages.
Acupuncture was applied to treat miscarriage in China. There was a case report by Zhang in Tianjin gynecology hospital showing effectiveness of acupuncture in women with recurrent miscarriage. This report is involved 558 cases with recurrent miscarriage. 86.6-93% cases were successful.
In early pregnancy your body starts to change because of the hormonal changes in the body. For example, the uterine and vaginal lining becomes ticker and breast becomes tender. When miscarriage occurred, your body has to go back to normal from the pregnancy loss, physically and emotionally.
Acupuncture can help you recover from miscarriage and get your body ready for next pregnancy. Acupuncture stimulates nerve endings to helps hormone balance; improves ovarian and uterine blood flow; reduces inflammation and reduces stress. All of these could help prevent miscarriage from happening again and have a successful pregnancy.
Here is a case report. Sophia had two miscarriges in 6 weeks and 12 weeks before. After this, she had been trying to get pregnant for a year without success. She started acupuncture treatment, after three cycles, she got pregnant and this time the pregnancy stayed to full term and she had a lovely girl.
Duckitt K and Qureshi A Clin Evid (Online) 2008 pii:1409
Alexandros Sotiriadis BMJ 2004
Low AMH to get pregnant ? how can acupuncture help?
What is AMH? AMH is short for anti-mullerian hormone. It is a substance made by small follicles called antral follicles in women’s ovaries. These follicles are in early stage of follicle development. Once the follicles grow bigger than 8 mm, they no longer produce AMH. The more small follicles are developing, the higher AMH levels are. Vice versa, the higher AMH means there are more small follicles in the ovaries. Since AMH is produced only in smaller follicles and its blood levels are constant, AMH has been used to measure the size of the pool of growing follicles in women. AMH blood levels reflect the size of the remaining egg supply.
If your AMH is low, there are less small follicles developing in the ovaries which means your egg supply is poor. With increasing women’s age, the size of their pool of remaining small follicles decreases. Low AMH reflects poor egg supply and less chance to get pregnant naturally. Low AMH value means poor response to ovarian stimulation and low IVF success rate. Some women may have problems of recruitment and development of follicles; in this case they have fewer follicles developed and their AMH tends to be low. Women with low AMH would have less chance to have good quality eggs. So they may have difficulty to conceive naturally. Women with low AMH level are likely to have poor response to ovarian stimulation for IVF and have fewer eggs retrieved. This reduces their chance to conceive via IVF.
Low AMH is caused by recruitment problem in follicles development. All eggs in women’s ovaries are at rest, they must be recruited for developing and maturing. If the follicles do not recruit enough there are less follicles developing. For example, in the case of premature ovary failure (POF) the ovary function is damaged and there are less follicles developing, AMH value is low in women with POF. What is important factor in follicle recruitment and development? Ovary microcirculation is the key factor in follicle recruitment and development. Good circulation helps bring nutrients to the follicles and take away the wastes produced in the follicles.
AMH is associated with menopause
Anti-mullerian hormone (AMH) is produced in small antral follicles. AMH concentration reflects ovarian aging. Can it be used to predict age at menopause (AMP)? If AMH falls below a critical threshold which corresponds to follicle depletion, will this leads to menopause? There was a large population study to investigate the relationship between AMH and AMP. In this study, there were 27563 women participated. AMH was measured in these women who attended fertility clinics. They found that the critical AMH threshold vary among women; AMH became undetectable about 5 years before the occurrence of menopause. This indicates that declining population average of AMH is associated with menopause.
Does low AMH means that you cannot have children? It is certainly not. Some women with immeasurable AMH still can get pregnant.
Do you need help if your AMH is low? Yes, though low AMH does not mean that you cannot conceive at all, you chance to conceive naturally and via IVF is indeed very low. Some women are trying for years without success.
Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved. Generally, having more eggs with IVF has a higher success rate via IVF.
Contraception pills decrease AMH levels
Women are trying not to get pregnant by different approaches. Contraception pills are one of the popular options. When taking the pills, does anyone ever think how the pills work? Are there any side effects of the pills? Recently Kallio S et al from Oulu University Finland studied the effect of combined contraception on antimulleria hormone (AMH) levels. There were 54 healthy women completed the study. They received combined contraception treatment for 9 weeks. The drugs were given by oral, transdermal and vaginal methods. Blood samples were taken before, at 5 weeks and 9 weeks of the treatments. They found that AMH, FSH, inhibin B, LH and E2 levels had decreased significantly in all study groups after 9 weeks of treatment. Significant reductions were already detected after 5 weeks use of combined contraceptives. This study suggests that the decrease of AMH during the use of all combined contraceptives indicates that follicle development is arrested independently of administration route of the contraceptives.
There was another study by Bentzen JG et al from Copenhagen University Hospital who compared ovarian reserve parameters between users and non-users of hormonal contraception. They compared the AMH value, the antral follicle count (AFC) and the ovarian volume in 228 users versus 504 non-users of hormonal contraception. Users of hormonal contraception had 29.8% lower AMH concentration, 30.4% lower AFC and 42.2% lower ovarian volume than non-users. AFC in all follicle size was lower in user than non-user of hormonal contraception. These findings were more pronounced with increasing duration of hormonal contraception. No dose-response relation was found.
Does acupuncture help follicles recruitment and development? During the follicle recruitment and development process, ovarian blood supply is the key. Good blood supply to follicles helps the process, because this helps provide enough nutrition to follicles and take away waste produced in the follicles. As we have already known that acupuncture improves ovarian blood flow to produce high quality of follicles and increased numbers of follicles and egg quality. This will improve the chance of conceivingnaturally or via IVF.
Case report: Low AMH, conceived naturally with the help of acupuncture
When you heard that your AMH is low and it is not possible to conceive with your own eggs. Is this really that bad? Actually a low AMH value does not necessarily mean that you cannot get pregnant naturally. You need to make more efforts than anyone else. Here is a story that a woman got pregnant naturally with low AMH. This is a simple story, but you can see the efforts that she made under the pressure of uncertainty and the lack of time.
There was a 39 year old woman who had been trying to conceive for a year without success. A fertility test found out that her AMH was very low (below 1) which was nearly immeasurable. She was determined to get pregnant naturally. She had paid attention to her diet and made sure her diet was healthy. She also had moderate exercise to keep healthy. By chance she found out that acupuncture could help and she kept going to acupuncture treatments on weekly basis. She made great effort and really believed herself. By the end of six months of acupuncture treatments, she got pregnant naturally.
Kallio S et al Fertil Steril (2013) 99:1305-10
Bentzen JG et al Reprod Biomed Online (2012) 25: 612-9
Dolleman M et al J Clin Endocrinol Metab (2013) 98:1946-53
High FSH to get pregnant ?Acupuncture can help
What is Follicle stimulating hormone (FSH)?
There are three organs that are directly involved in producing hormones for reproduction: the hypothalamus, pituitary gland (in the brain) and ovary (in the pelvis). Five hormones are produced by these organs including GnRH, FSH, LH, oestrogen and progesterone. GnRH is produced by the hypothalamus; FSH and LH are produced by the pituitary gland; oestrogen and progesterone are produced by the ovary. The FSH production is determined mainly by the levels of oestrogen and progesterone. At the start of menstrual cycle when oestrogen level is low, FSH is produced. FSH acts at the ovary to stimulate follicles growth in the ovary. FSH level can be checked in the blood test. This is a part of the fertility check.
If FSH level is elevated, what does that mean? In circumstances, if the ovary does not respond to FSH, the follicles don’t grow well and then the pituitary gland will produce more FSH for the ovary. As a result FSH level becomes higher than normal. This indicates the ovary does not function normally. The egg quality and quantity could be poor and the chance to get pregnant is low and the chance to succeed for IVF treatment is also low because of poor response to ovary stimulation and poor egg quality.
Acupuncture can help, if FSH is elevated.
Acupuncture improves ovarian blood supply to improve ovarian function and egg quality. Once the ovary function is improved and it responds to FSH, pituitary gland will not produce excessive FSH. This will decrease FSH level, increase egg quality and improve the chance to get pregnant.
Here is some example of research that acupuncture decreases FSH in patients with high FSH.
In a study, twenty-one patients with high FSH were received 12 weeks acupuncture treatment. Mean FSH levels fell from 19.33±9.47 mIU/mL at baseline to 10.58±6.34 mIU/mL at week 12 and 11.25±6.68 mIU/mL at week 24. Change in mean FSH from baseline was -8.75±11.13 mIU/mL at week 12 (p=0.002) and -8.08±9.56 mIU/mL at week 24 (p=0.001). Mean E2 and LH levels, FSH/LH ratios and irritability scores were improved at weeks 12 and/or 24. Approximately 30% patients reported subjective increases in menstrual volume after treatment.
Acupuncture helps IVF success in women with declined ovarian reserve
Recently there was a study about acupuncture on IVF/ICSI involved in 63 women with declined ovarian reserve. They were divided into two groups: acupuncture group and control group. In acupuncture group acupuncture was given twice a week until second menstrual cycle of oocyte retrieval. The patients in the control group were treated with IVF-ET but no acupuncture. The ovarian reserve function, including basic follicle-stimulating hormone (FSH), estradiol (E2), antral follicle count (AFC), number of retrieved oocytes, number of fertilization and number of high quality embryo, were compared and analyzed before and after acupuncture in the acupuncture group. The differences of outcomes of IVF-ET, including the cycle cancellation rate, implantation rate, the clinical pregnancy rate, were compared between the two groups. Their result has shown that Compared before acupuncture, the E2, AFC, number of retrieved oocytes, number of high quality embrgo and number of fertilization were all increased after acupuncture in acupuncture group. Compared with the control group, levels of the E2, the number of retrieved oocytes, number of fertilization and number of high quality embryo were all increased in acupuncture group. Also, the implantation rate, the clinical pregnancy rate were improved and cycle cancellation rate was reduced.
Wang Y et al Acupunct Med (2016) May 13. pii: acupmed-2015-011014. doi: 10.1136/acupmed-2015-011014.
Zhou L et al Zhongguo Zhen Jiu (2016) 36:25-8
Low progesterone level to get pregnant? acupuncture can help
If you are trying to conceive, you may already be familiar with the term progesterone. Progesterone is an essential hormone for pregnancy. Without it there would be no successful pregnancy.
In women progesterone is mainly made in the ovary. The production of progesterone is increasing rapidly after ovulation. Its level is highest during luteal phase especially from day 19 to day 22 of the menstrual cycle. Progesterone prepares uterine inner lining for implantation; it prevents further ovulation and it makes mucus thicker to prevent sperm to penetrate. If fertilization does not occur, progesterone level drops and menstruation takes place. If fertilization happens, much more progesterone is produced during pregnancy by the placenta. During this period, progesterone prevents miscarriage, because it decreases the maternal immune response to accept the pregnancy; it also reduces uterine smooth muscle contractility. It contributes to the survival and development of the embryo and fetus.
Progesterone is also made in adrenal gland under normal physiological condition. It is also a precursor to oestrogen, testosterone and cortisol- an adrenal cortical hormone. Cortisol is essential for stress response, sugar and electrolyte balance, blood pressure and general survival. During chronic stress condition, progesterone secretion is reduced because the body made more cortisol responding to stress using progesterone.
Low progesterone is very common. The symptoms include infertility, miscarriage, spotting, premenstrual syndrome (PMS), breast tenderness, insomnia, unexplained weight gain and anxiety. Blood test will show progesterone level is lower than normal.
Why progesterone level is lower the chance to get pregnant? Low progesterone level is a sign of poor egg quality. Progesterone is produced in follicles (eggs) and corpus luteum which is developed later on from the follicles. Poor quality follicles and corpus luteum will not produce enough progesterone to reach normal level.
Acupuncture can help ovarian circulation to improve egg quality and corpus luteum quality, as a result progesterone production is increased. Acupuncture can improve adrenal gland function and reduce stress to reduce progesterone usage. This will improve the chance to get pregnant.
Acupuncture increased sperm count and sperm quality
40 patients have low sperm count or abnormal sperm shapes. 28 of them received acupuncture treatment twice a week for 5 weeks while other 12 patients did not receive treatment as control. At the end of the treatment, sperm counts were significantly increased and sperm shapes were significantly improved in acupuncture group compared to control group.
Pei J et al Fertil Steril (2005) 84:141-7
3 weeks of acupuncture increased sperm quality
A study about effect of acupuncture on male infertility was published in 1984 in German. There were 28 males with infertility. They received 10 treatments for 3 weeks. Sperm count, concentration and motility were evaluated before and after acupuncture treatment. Result showed that in all cases sperm quality was improved.
Fischl F et al Geburtshilfe Frauenheilkd (1984) 44:510-2
Acupuncture helps fertilisation of ICSI in male infertility
There was a case report that acupuncture improves sperm quality and the outcome of intracytoplasmic sperm injection (ICSI). 22 male patients with infertility who failed ICSI participated the study. They received acupuncture treatment twice a week for 8 weeks followed by ICSI. At the end of the treatment, sperm motility and normality was improved. The fertilisation rates after acupuncture treatment were 66.2% significantly higher than that before the treatment (40.2%). Embryo quality was also improved. Acupuncture has a positive prospect for men with infertility undergoing ICSI treatment.
Zhang M et al J Huazhong Uni Sci Technology Med Sci (2002) 22:228-30
How can acupuncture help IUI?
What is intrauterine insemination (IUI)? IUI is a procedure which is used to help people with infertility. In this procedure, good quality of sperm is selected and placed into the woman’s uterus in the middle of the monthly cycle when egg is released from ovary. In order to process IUI unblocked tubes are essential. IUI may be one of the options for you if you have unexplained infertility or you have ovulation problems or your partner experiences impotence or premature ejaculation or you don’t have a male partner and are trying for a baby using donated sperm. For women, each cycle of IUI is timed to fit with the woman’s natural menstrual cycle. You will only be able to receive one cycle of IUI treatment a month. If you have ovulation problems, you can choose to use fertility drugs to stimulate ovulation. The sperm sample will be taken on the day of the treatment and washed. Good quality of sperm will be selected and placed in the uterus through a thin, flexible tube called a catheter. This process is mostly painless, although some women may experience mild cramping, similar to period pains. The success rate per cycle is up to 15% depending on women’s age. As with most other types of fertility treatment, the younger a woman is, the greater her chance of having a successful pregnancy. Other things that can affect the success of IUI include sperm count and sperm quality – using fresh sperm is associated with higher conception rates than frozen and thawed sperm; technical aspects of IUI, such as working out the time of ovulation correctly.
How age affects fertility? Acupuncture can help.
Age affects fertility in women
Women are born with all the eggs they ever have. Women are most fertile between the ages of 18 and 31. When women are getting older, their egg quantity and quality are declining. They become less fertile. There is clear evidence of an age-related decline in female fertility. By the time women reach 35 years of age, their fertility is declining markedly. This presents that the number and quality of eggs decrease; also genetic abnormalities and spontaneous abortion increase noticeably with female age. A study involved in 1000 women in pregnancy showed that 71% of women aged 30 conceived within 3 months whereas only 41% of women aged 36 conceived within 3 months. A negative effect of increasing male age particularly in the late 30s was also found. A study involved 2112 women in pregnancy showed that increasing age for both men and women take longer time to conceive. There were some other studies presented similar results.
There is a significant decline in clinical pregnancy rate, implantation rate and delivery rate per embryo transfer associated with increasing female age in assist reproductive treatment. A recent study of all IVF clinic in Netherland found that the overall live birth rate per cycle decreased by 2% for each additional year of female age. Another study involved in 36483 treatment cycles in assist reproductive treatment reported that women aged 25-29 achieved a live birth rate of 25.9% while women aged 40-44 only achieved 6.1% live birth rate. The poor live birth rate in older women greatly attributes to spontaneous abortion
What is the best marker of reproductive age in women?
Research suggested that genetic factor contributes to women’s fertility. Women whose mothers had an early menopause had much fewer eggs in their ovaries than those mothers had a later menopause. These women with fewer eggs have fewer chances to conceive. At present there is no test that can predict women’s fertility accurately. There are many tests that are used to measure ovary function. What is the best marker to measure reproductive age? GJ Scheffer et al compared several markers. These include that antral follicle counts (2-10mm), total ovarian volume, total follicular volume, mean follicular volume, and volume of either the smallest or largest ovary; FSH, estradiol and inhibin B and the response of estradiol and inhibin B to exogenous GnRH agonist. They tested these markers on 162 healthy female volunteers aged 25-46 years. These women were proved with normal fertility and regular menstrual cycles. All marker tested excerpt inhibin B were correlated with age, but the number of antral follicles was highly correlated with age. Their conclusion is that the number of antral follicles has the closest association with age in normal women with proven fertility.
How old a woman can be to achieve pregnancy with assisted conception approach?
Check JH reported a case that a 46 year old woman with high day 3 estradiol and FSH. She conceived on her third IVF-ET attempt. She delivered a healthy full term baby girl. This was believed to be the first case report of a successful pregnancy in a woman of such an advanced age with diminished ovary reserve using her own eggs. This report showed that pregnancy is possible in similar circumstance.
Fertility declines with aging in men as well
Women are born with all eggs in the ovary which cannot be divided into other cells. The egg numbers are only declining with age. On the contrary, there are gonocytes or primitive germ cells in the normal men’s testes. These cells can split without limitation. The cells split can become another gonocytes which could further divide; or they can become mature sperm cells. Gonocytes supply within testes can be last very long time and mature sperm cells can be produced. This is the main reason why a man’s fertility does not decrease significantly with age as women’s.
However, fertility in men decreases when they reach certain age. In men semen parameters could begin to decline as early as age 35. Semen volume and motility would decrease and morphology could gradually become abnormal. After age 40, there could be notably DNA damage in their sperm; motility and viability continues declining. With an increase in age in men, the time to pregnancy for their partner increases.
Acupuncture can help both men and women to improve their fertility. As a result, this improves their chance to get pregnant.
Check JH Clin Exp Obstet Gynecol (2011) 38:209-10
Check ML Clin Exp Obstet Gynecol (2004) 31:299-301
Fotrman EJ et al Maturitas (2011) 70:216-21
GJ Scheffer et al Human Reproduction 18:700-706
Homan GF et al Human Reproduction Update (2007) 13:209-223
Short luteal phase with infertility and miscarriage? acupuncture can help
Women’s period cycle is divided into two phases: follicular phases when follicles develop and mature. The time for eggs to mature and release may vary between different women and same woman in different period cycle. This is the reason why period cycles vary to a great extent. When one of the eggs becomes mature, it is released from the ovary. As soon as egg is released, luteal phase began. Dwon KA and Gibson M studied body basal temperatures (BBT) charts and the luteal phase defect from three menstrual cycles of 20 normal women and 20 women with luteal phase defect. They found that luteal phase length in the normal women was 13.4 days and that of the women with luteal phase defect was 11.8 days. 30% of the women with luteal phase defect had luteal phases with less than 11 days and 5 of these women had severely endometrial problems. None of the normal women had luteal phase less than 11 days. Luteal phase does not vary much with length of period. It is normally12-14 days. After ovulation, the remaining part of the follicle forms the corpus luteum which continues to grow and produces a hormone called progesterone. Progesterone is very important for making inner lining of womb suitable for fertilized egg to implant and supporting for early pregnancy. The inner lining of womb is like a comfortable bed for the egg. If the luteal phase is shorter than 12 days, the bed is not ready. This may be because the corpus luteum dies earlier than12 days, your body may not produce enough progestone to make a good bed for the embryo. Luteal phase defect affects 10% women with infertility and over 60% women with miscarriage. The symptoms of luteal phase defect include a short period cycle, spotting, low progesterone, disrupted BBT after ovulation, and other nonspecific symptoms such as low back pain, vagina dryness etc.
There are three causes that could lead to luteal phase defect. 1) Poor follicle production: After ovulation, remaining follicle becomes corpus luteum. If follicle development is poor, this would create poor quality of corpus luteum which does not produce enough progesterone, resulting in poor uterine inner lining. 2) Premature failure corpus luteum. Corpus luteum does not last as long as normal corpus luteum does. This can occur even if initial quality of follicle is good. Again this makes poor uterine lining. 3) Failed response from uterine lining. In this case, uterine inner lining does not respond well to normal progesterone level. As a result it is not well developed for implantation.
According to traditional Chinese medicine (TCM) theory, luteal phase defect is caused by kidney or spleen qi deficiency. Or it is caused by liver qi stagnation. Qi deficiency and stagnation cause blood stagnation and blockage of channels. As a result corpus luteum dies earlier. This is agreed with recent research. During corpus luteum formation, it becomes one of the most highly vascularised organs in the body. Blood flow in the corpus luteum is important for the development of the corpus luteum and maintenance of luteal function. It is important for progesterone synthesis and release. The corpus luteum blood flow in women with luteal phase defect is significantly lower than women with normal luteal function. Increasing corpus luteum blood flow improves its function.
Acupuncture improves ovarian and corpus luteum blood flow. It is very effective to regulate period cycle and restore normal luteal phase. There was a report in Chinese Journals showing effectiveness of acupuncture on luteal phase defect with infertility. 50 patients were diagnosed luteal phase defect. Their age range is from 26 to 42 and average age 32. The history of difficulty to conceive is from 6 months to 4 years. Patients were received acupuncture. Pregnancy rate was calculated. Blood eostrogen and progesterone level was tested; egg development, ovulation and inner lining of womb were checked to measure the effectiveness of acupuncture. Result showed that 40% women achieved pregnancy during 3-6 months. In remaining 53% women, dominant matured egg size was increased, womb inner lining was thicker, blood oestrogen and progesterone level was increased comparing to those before the treatment. Follow up study with those pregnant showed that there was no miscarriage occurred.
Another report from China was about effectiveness of acupuncture treatment on patient with recurrent miscarriage. There were 558 cases with recurrent miscarriage 4 times. 211 cases were treated with acupuncture between 1973-1976; success rate was 86%; 347 cases were treated with acupuncture between 1982-1984, success rate was 93.4%.
Takasaki A et al J Ovarian Res. (2009) 14:2:1
Hongwei Yang and Xueyan Huang Shanghai Journal of Acupuncture and Moxibustion (2010) 10:626-628
Downs KA and Gibson M Fertil (1983) 40:466-8
Study suggested that stress has negative impact on women’s fertility
In North America, 20%–25% of women and 18%–21% of men of reproductive age report daily psychological stress. A study has assessed the association of stress and fertility in couples from the general population.
The data used in this study was from Pregnancy Study Online, a web-based preconception cohort study of pregnancy planners from the United States and Canada (2013–2018), to examine the association between women’s and men’s perceived stress levels prior to conception and fertility. Women (aged 21–45 years) and their male partners (aged ≥21 years) who were attempting conception without fertility treatment were chosen.
Perceived stress was measured using the 10-item Perceived Stress Scale (PSS). Pregnancy information was checked using bimonthly follow-up questionnaires of female participants. 4,769 couples participated the study until self-reported pregnancy, initiation of fertility treatment, loss to follow-up, or 12 menstrual cycles of attempt time, whichever came first.
Higher PSS scores among the women, not men associated with slight reductions in fertility was found in this study.
Amelia K Wesselink American Journal of Epidemiology, Volume 187, Issue 12, December 2018, Pages 2662–2671
Research added evidence that acupuncture increased pregnancy success rates for women with unexplained infertility undergoing in vitro fertilization.
A recent research studied the effect of acupuncture on pregnancy success rates applied before and after embryo transfer (ET) among women undergoing in vitro fertilization (IVF). Three sessions of acupuncture were offered to the 36 women with unexplained infertility undergoing IVF ; another 36 women with unexplained infertility without acupuncture were in the control group. Acupuncture were applied a week before embryo transfer and 30 min before and after embryo transfer. Pregnancy rate and anxiety level were measured in the result. The result has shown that clinical pregnancy, ongoing pregnancy, and live birth rates were significantly higher in the acupuncture group compared to the control group. The anxiety level was significantly lower in the acupuncture group.
Guven PG et al Taiwan J Obstet Gynecol. 2020 Mar;59(2):282-286. doi: 10.1016/j.tjog.2020.01.018.
Acupuncture for subchorionic hematoma
Subchorionic hematoma or subchorionic hemorrhage is bleeding beneath the chorion membranes that enclose the embryo in the uterus due to partial detachment of the chorion membranes from the wall of the uterus. They are the most common cause of vaginal bleeding in 9-20 weeks pregnancy. Most women present with light vaginal bleeding, but some are asymptomatic with incidental ultrasound findings. The causes of subchorionic hematoma are not clear. The presence of a uterine malformation, a history of recurrent pregnancy loss, or pelvic infections are all possible risk factors to subchorionic hematoma. The symptoms of subchorionic hematoma are vaginal bleeding without abdominal pain; some patients may experience cramping. The increased pregnancy loss includes the volume of the bleeding, location and pregnancy weeks.
There was a paper that reported acupuncture for threatened miscarriage with subchorionic hematoma. They found that acupuncture combined with dextroprogesterone can improve the effective rate of patients with threatened abortion in early pregnancy complicated with subchorionic hematoma.
Jia-Man Wu et al Zhongguo Zhen Jiu 2019 Oct 12;39(10):1046-50.