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In the USA about 50% women have acupuncture treatment during IVF treatment

Updated: Feb 17


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, the success rate of IVF is still not satisfactory. IVF also is expensive, lengthy and stressful. It also affects physical and mental health. To improve IVF success rate, reduce stress, anxiety and depression, acupuncture became a popular IVF assistant technique for women undergoing IVF. A survey to study the state of acupuncture treatments in assisted reproductive technology in fertility centers in Swiss, German and Austrian fertility centers has shown 40% fertility centers offer acupuncture treatments. In these centers acupuncture points selected were standardized and acupuncture was performed by physician-acupuncturist.

Today there are over 6 million children that have been conceived through assistant reproductive technologies including IVF. Although IVF is a well-established treatment over past decades, each step of IVF is complex with a possibility of failure. It is desirable for women to seek an assist treatment to increase their chances of achieving a pregnancy and live birth and to improve their health, quality of life and to reduce stress whilst undergoing treatment cycles. Acupuncture is a top candidate for this purpose. In the USA, 30% of patients had acupuncture prior to IVF treatment and 47% during IVF treatment. A recent study has just published and analysed 20 trials involving 5130women globally. It has found that acupuncture may have significantly increased clinical pregnancy rates and reduced miscarriages in in vitro fertilization (IVF) patients comparing with no treatment group. The findings suggest that “acupuncture may have a significant effect on clinical pregnancy rates, independent of comparator group, when used in women who have had multiple previous IVF cycles, or where there was a low baseline pregnancy rate.” “Three or more treatments and the use of a modified treatment protocol were significant effect modifiers on clinical pregnancy. The timing of treatment was also a significant modifier, with treatments post the day of embryo transfer showing no benefit on clinical pregnancy.”

The main causes of infertility in the UK are unexplained infertility (no identified male or female cause) (25%), ovulatory disorders (25%), tubal damage (20%), factors in the male causing infertility (30%), uterine or peritoneal disorders (10%). In about 40% of cases disorders are found in both the man and the woman.

In 2011, 48,147 women had a total of 61,726 cycles of IVF or intracytoplasmic sperm injection (ICSI) and 2,087 women had a total of 4,091 cycles of donor insemination. A total of 89,648 embryos were transferred during the course of fertility treatment which started in 2011. A total of 13,703 pregnancies were reported as a result of IVF treatment which started in 2011. In the UK, 201,811 babies have been born after IVF treatment between 1991 and 2010. Of the women who received fertility treatment during 2011, they were, on average, 35-years-old and had been trying to conceive for around 4 years (4.6 for IVF, 4 for donor insemination). Four in ten (40.3%) IVF treatment cycles were funded by the NHS in 2011. Acupuncture for infertility treatment is increased from 2.5% in 2002 to 13% in 2009.

Acupuncture improves uterine receptivity and helps implantation

When an egg is fertilised by a sperm, an embryo is formed and developing. At the same time, there are also changes in the uterus to prepare the arrival of the embryo. When an embryo arrives at the uterus, it will implant into uterine wall. A successful implantation depends on the synchronous development of both the endometrium and embryo. Uterine inner lining gets thicker, uterine smooth muscles are relaxed after ovulation. There is also communication between the uterine cells and the embryo to get the best time of implantation. Delayed implantation time will lead to implantation failure or miscarriage. During the development of uterine inner lining uterine blood circulation is the key factor to get ready for implantation. After embryo implanted, the embryo initially takes nutrients and oxygen from maternal blood circulation system and removes the waste via maternal blood circulation system. Good uterine blood circulation is essential for early stage of embryo development. If It goes cyclic changes responding to ovarian hormone oestrogen and progesterone levels and sheds off each month with new endometrial lining replaced, if the egg is not fertilised.

If pregnancy occurs, the endometrium will retain. After ovulation, the uterine endometrium becomes thicker to prepare for embryo implantation. If endometrium is not thick enough (less than 6 cm), implantation does not occur. If the thickness of endometrium is greater than 12 cm, there were three times more chances to get pregnant. To get embryo implanted, there must be a receptive uterus. Ovarian hormones oestrogen and progesterone are involved in regulating uterine receptivity. Uterine smooth muscles tend to contract especially at low progesterone level. Increased progesterone level makes uterus more relaxed. The thickness of endometrium and contractility of uterine smooth muscles are the key factors for the uterus becomes receptive.

To improve uterine blood circulation, acupuncture is the best candidate. Since a decade ago, acupuncture was suggested that it increases uterine blood flow. This will help embryo implantation and embryo development in the uterus. Acupuncture can help uterine receptivity by regulating hormone balance, increasing uterine blood flow, improving uterine lining and relaxing the uterine smooth muscles.

Acupuncture increases embryo implantation potential for patients with infertility. There was a study involved in 210 patients with infertility. These patients with infertility were treated with acupuncture and in vitro fertilization and embryo transplantation (IVF-ET). Acupuncture was applied before controlled ovarian hyperstimulation and during ovarian hyperstimulation. The levels of human leukocytes antigen-G (HLA-G) in the serum were determined for evaluating embryo implantation potentials. HLA-G may play a role in immune tolerance in pregnancy and its presence in embryo is associated with better pregnancy rates. They found that acupuncture can increase HLA-G for the patients undergoing IVF-ET; their HLA-G increased on hCG injection day and on embryo transfer day which indicated increased embryo implantation potential for patients with infertility.

IVF starts from stimulating ovaries, how can acupuncture help?

Women have natural menstrual cycles. In a natural monthly cycle, the ovaries normally produce 1 egg. If this egg is fertilized by a sperm, an embryo will be formed; if the embryo is implanted in the uterus and pregnancy occurs. In IVF treatment, more eggs are needed to increase success rate. This ovary stimulating process starts from day 1 to encourage the follicles growing. The medications used to stimulate follicles are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Both hormones are produced naturally in the body. The eggs are already there; the medication boosts the hormone levels to encourage more eggs to develop. Blood tests and ultrasound scan will be used to monitor follicles growing. This first step of IVF is the same as egg freezing and embryo freezing.

What do you do to help the follicles (eggs) develop? Having acupuncture treatment is a good way to help eggs development. Acupuncture reduces sympathetic nerve activities and release tension of the body; this will facilitate blood flow to the ovaries to provide more oxygen and nutrients for the fast-growing egg’s needs and also take toxins away from the ovaries.

Acupuncture helps IVF step by step.

Before egg collection, acupuncture helps follicles (egg) development improving egg quality and uterine lining. Research has shown that IVF egg maturation rate, fertilization rate and good quality embryo rate and implantation rate and the pregnancy rate was increased with acupuncture treatment.

After egg collection, acupuncture continues to help uterine lining development to get ready for embryo implantation. Research has shown that IVF implantation rate and pregnancy rate was higher with acupuncture treatment.

More research evidence

The first report that acupuncture increased IVF success rate was from Stener-Victorin et al in 1999. They applied acupuncture before occytes collection. They found that women in acupuncture group had significantly higher implantation rate, pregnancy rate and live birth rate in IVF embryo transfer. Eric Manheimer et al did first systematic review published in BMJ to investigate the effects of acupuncture on pregnancy rates and live birth rates among women with infertility undergoing IVF. They analysed seven trials involved in 1366 women undergoing IVF. All trials were conducted in four different Western countries and published in English since 2002. In all trials, women received acupuncture immediately before or immediately after the embryo transfer. The acupuncture points selected in all trials are fixed and the acupuncture sessions lasted 25-30 minutes. Clinical pregnancy, ongoing pregnancy and live birth rates were improved. There was no side effect found. Recently a new review found that there were 5 studies involved 463 women who were undergoing IVF. They were given acupuncture twice a week for 2 weeks during the controlled ovarian hyperstimulation period for IVF. The pregnant rate was higher in acupuncture group than that in control group for women undergoing IVF.

Acupuncture helps reducing stress and anxiety in women undergoing IVF.

Research studied the effect of acupuncture on symptoms of anxiety in women undergoing IVF. 43 patients participated in the study. After 4 week treatment the anxiety score for acupuncture group was significantly lower than for the control group. There is perceived stress on the day of embryo transfer (ET). There was a study on the effect of acupuncture on perceived stress and pregnancy rate on the day of ET. In this study, 57 patients with infertility and undergoing IVF or IVF/ISI were involved. Women who received acupuncture treatment achieved 64.7% pregnancy rate while those who didn’t receive acupuncture treatment had 42.5% pregnancy rate. Women with acupuncture had lower stress score both pre-ET and post-ET compared to those without acupuncture. Women with lower stress score had higher pregnancy rate.

Acupuncture helps succeed in first round IVF

A 39 year old woman has been trying to conceive for a year and half. Her husband’s sperm was good. She was very stressed from this. Also she worked very hard and work stress was enormous too. Her fertility test was absolutely normal. Her period was 28-29 days. However she did ovulate a bit early in about day 11 checked by ovulation kit test. Her period was light lasting for 3 days. She also had chronic diarrhea about two to three times a day. She decided to try acupuncture to help with conceiving. She had acupuncture treatment on weekly basis. With the treatment progress, her ovulation was changed to day 12 and then day 13. Her diarrhea was disappeared. Her bowel movement was once a day and no longer loose. Her period last 5 days. Her stress level was decreased and she felt more relaxed. After three month acupuncture treatment, she felt a lot better, but she was still not pregnant. She decided to go ahead for IVF, because age was not on her side and she did not want to wait to get pregnant naturally. She was continuing another two month acupuncture treatment while planning IVF. During the IVF procedure, everything was going smoothly. She had 12 eggs retrieved and 11 of them were fertilised. One of the embryo was transferred and pregnancy test was positive after two weeks waiting.

Acupuncture can help next IVF success after failed IVF.

Recently a research paper has shown that acupuncture increased pregnancy rate in women with previous failed IVF cycles. In this study, there were 84 patients participated the study. These patients had at least two unsuccessful attempts of IVF cycles. The predicted success rate for these patients was 10% for this group of patients. Acupuncture was performed on the first and seventh day of ovulation induction, on the day before egg collection and on the day after embryo transfer. The result has shown that the clinical pregnancy rate in the acupuncture group was significantly higher than that in the control and sham groups (35.7%, 7.1% and 10.7% respectively).

Acupuncture helps decrease ovarian hyperstimulation syndrome during IVF

Ovarian hyperstimulation syndrome (OHSS) is a serious side effect during the procedure of IVF treatment. It occurs in women who are very sensitive to the fertility drugs. Too many eggs develop in the ovaries, which become very large and painful. Abdominal pain, nausea and diarrhoea are common symptoms. Can acupuncture help reduce the chance of OHSS? Recently a research studied the effect of acupuncture on clinical outcomes and the occurrence of OHSS in IVF. 109 patients were divided into two groups: control and acupuncture group. Patients in the control group received controlled ovarian hyperstimulation (COH) referring to GnRH-a long protocol. On the basis of COH, those in the EA group received EA from the day of Gn injection to the day of embryo transfer. Blood tests were monitored on the day of hCG injection, the day of egg collection and the day of embryo transfer. The oocyte retrieval rate, good quality embryo rate, clinical pregnancy rate, the abortion rate, and the occurrence of OHSS were compared between the two groups. Compared with the control group, serum oestrogen E2 levels on the day of egg collection and the day of ET were significantly lower in the EA group. vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) significantly decreased compared with control group on the day of hCG injection, on the day of egg collection and embryo transfer. The occurrence of OHSS and the canceling rate of transplant cycle were significantly lower in the EA group than in the control group. The research suggested that acupuncture as an adjunctive therapy, could reduce the occurrence of OHSS in IVF.

Poor egg quality? Acupuncture can help

Women’s follicles are stored in ovaries and whenever they are picked up to develop, they grow to a matured egg and are released from the ovary. If the egg is fertilized by a sperm, it becomes an embryo. Follicle development is a long process requiring almost a year from being recruited to the ovulatory stage. Ovarian local blood circulation is the key factors for follicle and egg development and egg quality. Initially follicles don’t have their own blood vessels inside follicles. They have to rely on blood vessels nearby to get nutrients that are needed for growing. Those follicles closed to blood vessels were recruited first and they start to grow as soon as they are recruited. With the growth follicles build up their own blood vessels which bring nutrients and hormones to and waste from the follicles. At the late stage follicles development also rely on the hormones, such as FSH.

Signs of poor egg quality: The abnormal menstrual cycles are the signs of poor egg quality, such as irregular periods, spotting, short menstrual cycles or long menstrual cycles, short luteal phase, abnormal hormones, such as high FSH, low eostrogen, low progesterone, low AMH, low antral follicle count are also indicating poor egg quality; poor response to IVF stimulation is another sign of poor egg quality. IVF result has hown poor egg quality. Women’s age: Women over age 35 with difficulty to conceive or miscarriage would have good quality of eggs.

Healthy food can help to improve egg quality which many women have already known and had healthy diet.

As mentioned above the key step to improve egg quality is the blood supply to the follicles. Whatever nutrients you take, they need to reach the follicles via blood circulation. If the circulation is poor, the nutrients cannot reach the follicles.

Research data has shown that acupuncture can help to improve blood circulation to the follicles, as a result this improves egg quality. For example, there was a study involved 60 patients with infertility with poor ovarian response and poor ovarian reserve undergoing IVF-ET. After treatment, in acupuncture group, egg maturation rate, fertilization rate and good quality embryo rate and implantation rate were higher than control group. Most importantly the pregnancy rate was increased. In another study there were 66 patients with PCOS and infertility and undergoing IVF-ET. All fertilization rate and high quality embryos were higher in acupuncture group than that for control group.

Acupuncture performed around embryo transfer increases IVF success rate

A decade ago a research study from Germany investigated the effect of adding acupuncture on IVF or ICSI. This was a very well-done study and it was reported in a very highly regarded medical journal. In this study, acupuncture was added before and after embryo transfer. Patients with good quality embryos were chosen and divided into acupuncture group and control group. A maximum of three embryos were transferred into each woman's uterus using established transfer procedures, with the same procedure used for every patient in both groups. Patients in the acupuncture group received two acupuncture sessions – first treatment before embryo transfer, the second treatment after. Point selection played a key role in acupuncture's success. A total of nine points were used on patients in the acupuncture group. Before embryo transfer, PC6 (nei guan), SP8 (di ji), LR3 (tai chong), GV20 (bai hui) and ST29 (gui lai) were used; after transfer, needles were inserted at ST36 (zu san li), SP6 (san yin jiao), SP10 (xue hai) and LI4 (he gu). Points on the spleen, stomach and colon meridians were chosen because of their ability to provide "better blood perfusion and more energy in the uterus"; PC6, LI20, GV20, and ear points 34 and 55 were used to sedate the patient; ear point 58 was used to "influence the uterus"; and ear point 22 was stimulated to stabilize the endocrine system. This is well known acupuncture ivf german protocol. This protocol would optimize uterine receptivity."Six weeks after the embryo transfers were performed, all of the women were given an ultrasound examination. In the control group, the presence of a fetal sac, the scientists' criteria for a clinical pregnancy, was found in 21 women (26.3%). In the acupuncture group, the pregnancy rate was "considerably higher" - 34 women (42.5%) were carrying a fetal sac at the time of examination.

Acupuncture increased embryo implantation potentials

Kong FY et al investigated the effects of acupuncture on embryo implantation potential for patients with infertility. They allocated 210 patients into three groups according to their symptoms differentiated by traditional Chinese medicine. 82 cases of kidney deficiency was group A; 74 cases of liver qi stagnation was group B and 54 cases of phlegm dampness was group C. These patients with infertility were treated with acupuncture and in vitro fertilization and embryo transplantation (IVF-ET). Acupuncture was applied before controlled ovarian hyperstimulation and during ovarian hyperstimulation. The levels of human leukocytes antigen-G (HLA-G) in the serum were determined for evaluating embryo implantation potentials. HLA-G level was measured on the second day of the menstruation, on the day of human chorionic gonadotropin (hCG) injection and on the day of embryo transfer. HLA-G may play a role in immune tolerance in pregnancy and its presence in embryo is associated with better pregnancy rates. They found that acupuncture can increase HLA-G for the patients undergoing IVF-ET; their HLA-G increased on hCG injection day and on embryo transfer day in group A and group B. This increased embryo implantation potential for patients with infertility. Eventually pregnancy rate was improved.

Acupuncture assists IVF to improve live birth rate

In vitro fertilization (IVF) is a costly treatment option for those with infertility. Acupuncture as a complementary technique is applied to assist IVF and increase its success rate. Many researches assessing the effect of acupuncture during IVF were performed. They showed that acupuncture increased pregnancy rate and live birth rate by supporting IVF. But the methods used were varied. Recently a clinical trial protocol of effectiveness of acupuncture to improve live birth rate for women undergoing IVF was published. Smith CA et al conducted a randomized controlled trial to evaluate the effectiveness of acupuncture on assisting IVF. They will recruit women with infertility younger than 43 years of age undergoing IVF or intracytoplasmic sperm injection (ICSI). The treatment protocol will be used. The initial diagnosis and treatment will take 60-90 minutes on days 6-8 of the stimulated IVF cycle. Two treatments will be given immediately before and after embryo transfer (ET). Patients are divided into three groups. 1 acupuncture group: 2 plaebo control: This group will be given placement of non-invasive sham needles. Duration of needling and treatment session is the same as for the acupuncture group. 3 usual care only group: they will receive standard care only. Live birth and pregnancy outcome will be analysed. The research will provide significant evidence for evaluate the effectiveness of acupuncture for assisting IVF.

Acupuncture increased IVF success rate

Craig L et al performed a research to investigate the effect of acupuncture on in vitro fertilization (IVF) performed offsite. They recruited two groups: acupuncture group and control group. In acupuncture group the women were received acupuncture at offsite location for 25 minutes before and after embryo transfer. The protocol they used was that the following points before ET: GV-20, CV-6, ST-29, SP-8, PC-6, LV-3; Shenmen and Brain on the left ear; and Uterus and Endocrine on the right ear. After transfer the points were LI-4, SP-10, ST-36, SP-6, KI-3; Uterus and Endocrine on the left ear; and Shenmen and Brain on the right ear. They found that the pregnancy rate was higher in control group than in acupuncture group.

IVF with acupuncture support has higher live birth rate

Though the effectiveness is still in debate, as early as 2008, Eric Manheimer et al did first systematic review and mega analysis to investigate the effects of acupuncture on pregnancy rates and live birth rates among women with infertility undergoing IVF. This review was published in BMJ. They analysed seven trials involved in 1366 women undergoing IVF. All trials were conducted in four different Western countries and published in English since 2002 in two of the leading reproductive medicine journals either in full articles or abstracts. In all trials, women received acupuncture immediately before or immediately after the embryo transfer. The acupuncture points selected in all trials are fixed and the acupuncture sessions lasted 25-30 minutes. No acupunture was involved. They showed that clinical pregnancy, ongoing pregnancy and live birth rates were improved. There was no side effect found. Their conclusion is that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing IVF.

There was a new review that just came out by Zheng CH et al (July 2012). They did a systematic review to analyse effect of acupuncture during IVF. They found that there were 5 studies involved 463 women who were undergoing IVF. They were given acupuncture twice a week for 2 weeks during the controlled ovarian hyperstimulation period for IVF. All 5 studies showed that pregnant rate was higher in acupuncture group than that in control group for women undergoing IVF.They also analysed other applications of acupuncture during IVF which did not distinguish IVF success rate between acupuncture group and control group which only had one acupuncture treatment around egg collection or embryo implantation. They suggested that most of the courses of acupuncture treatment during IVF were too short to completely correct infertility states caused by long term imbalance. In addition, the acupuncture programs lacked syndrome differentiation and treatment according to individual characteristics. In conclusion, appropriate acupuncture during IVF with suitable time in the cycle, enough treatment courses and individual program is a promising technique to increase IVF success rate.

Effects of acupuncture on IVF-ET for patients with poor ovarian response

There was a case report from Zhongguo Zhen Jiu – an acupuncture journal in China. They studied 60 patients with infertility with poor ovarian response and poor ovarian reserve undergoing in vitro fertilization-embryo transfer (IVF-ET). These patients were divided into two groups: with acupuncture or without acupuncture; 30 cases were in each group. The effect was compared after treatment. After treatment, in acupuncture group, the symptoms of kidney deficiency were improved; estrdiol (E2) level was higher; egg maturation rate, fertilization rate and good quality embryo rate and implantation rate were higher on the day of human chorionic gonadotropin (hCG) injection. The level of stem cell factor (SCF) in follicular fluid and serum was higher in the acupuncture group as well. More importantly the pregnancy rate was higher and abortion rate was lower in acupuncture group. This is a promising research for patients with poor ovarian response and poor ovarian reserve.

Luteal phase acupuncture increased pregnancy rate

Dieteril S et al studied the effect of acupuncture on the outcome of in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Patients with infertility undergo IVF/ICSI. 116 patients received luteal phase acupuncture and 109 patients were in control group receiving placebo acupuncture. They found that the clinical pregnancy rate and ongoing pregnancy rate in acupuncture group were 33.6% and 28.4% respectively which was significantly higher than those for the control group (15.6% and 13.8% respectively). Receiving luteal phase acupuncture is positive for increasing pregnancy rate of IVF and ICSI.

Acupuncture improves egg quality and pregnancy rate for patients with PCOS

Cui W et al investigated effects of acupuncture on egg quality and pregnancy for patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization and embryo transfer (IVF-ET). There were 66 patients with PCOS and infertility and undergoing IVF-ET. These patients were divided into two groups randomly: 34 patients were in acupuncture group and other 32 patients were in control group. Ethinylestradiol and cyproterone acetate tablets and gonadotropin-releasing hormone agonist were applied for long-program superovulation in these patients. Electroacupuncture was applied in the acupuncture group. No intervention was applied in control group. They found that kidney deficiency symptom score was improved better in acupuncture group. All fertilization rate, cleavage rate and high quality embryos were higher in acupuncture group than that for control group. Pregnancy rate and stem cell factor (SCF) level were higher in acupuncture group. SCF is an important factor during embryo development. They concluded that electroacupuncture plays an important role in the pregnant outcomes of patients with PCOS undergoing IVF-ET. It reduces kidney deficiency symptoms and improves clinical pregnant rate by adjusting organic endocrinal system and the local micro-environment of ovary and improving egg quality through the up-regulation of SCF level.

Acupuncture increases live birth in IVF with donor’s eggs

Acupuncture was first reported by Paulus et al to increase clinical pregnancy rate, when a standardized acupuncture protocol was performed immediately before and after fresh, nondonor IVF-ET. 160 patients were participated the study. 80 patients were randomized to the acupuncture group and 80 to the control group. The CPR was higher in the acupuncture group compared to the control group (42.5% versus 26.3%, p=0.03). After this study, similar studies were performed and positive results were also reported to support Paulus et al conclusion. More recently, Hullender Rubin LE et al modified Paulus’s protocol, they found that in donor cycles, live births were higher in the acupuncture group compared with control group.

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