Fertility Acupuncture for IVF – 4 Ways to Include Acupuncture in Your IVF Journey
Acupuncture treatments should preferably begin 3 months leading up to embryo transfer because ovarian follicles go through a 90-120 day development period before they mature for ovulation.
These treatments possibly increase ovarian response to IVF medications by increasing blood flow to the uterine lining and the ovaries. The treatments also relieve the effects of stress and anxiety.
A 2005 randomized trial was carried out in the IVF center of China Medical University Hospital in Taiwan found that electroacupuncture reduces uterine artery blood flow impedance in women. When blood circulation is improved, the uterus is better nourished, making it a more ideal environment for implantation.
Increasing blood circulation to the ovaries and uterus, can in turn improve the quality of the follicular fluids that nourish the developing eggs.
In a 2009 paper published in Fertility and Sterility, women going through IVF were given acupuncture to increase blood flow through the uterine arteries in the immediate weeks before egg collection. The researchers found that the women who had acupuncture showed beneficial changes in serum levels of stress hormones compared to the control group of women who did not have acupuncture. The acupuncture treatments appeared to have normalized levels of cortisol and prolactin which had been artificially depressed by the IVF drugs. This may have implications for both egg quality and implantation. In addition the pregnancy and live birth rate was significantly higher in the acupuncture group.
In addition, acupuncture plays a role in keeping your body in balance, physically and mentally. Stress is one of the main contributing factor towards infertility in modern women. It puts us into a “defense” mode by sending a message from the hypothalamus to the pituitary gland that starts the ‘flight or fight’ response. This response activates our adrenal glands to produce adrenaline, cortisol and DHEA (dehydroepiandrosterone) which interferes with the overall balance of hormones. This can have a profound effect if you are trying to conceive.
Scientists found that those with high levels of stress hormone stop ovulating and are therefore unable to conceive. This is why it is common enough that when you go for a business trip or are having a stressful week, ovulation is actually delayed until you settle back into a less stressful routine.
Acupuncture has been known to help reduce stress levels and keep the hormones in check for natural ovulation to occur. When the body and mind are relaxed, the endocrine system can resume its work unobstructed.
While time is of essence for many women in their 30s, there are benefits to preparing the womb ahead of time too. It is recommended that you start coming in for regular treatments at least 2-3 months prior to the next IVF cycle.
Reference:
- Ho M, Huang LC, Chang YY, Chen HY, Chang WC, Yang TC, Tsai HD. Electroacupuncture reduces uterine artery blood flow impedance in infertile women. Taiwan J Obstet Gynecol. 2009 Jun;48(2):148-51.
- Magarelli PC, Cridennda DK, Cohen M. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization-embryo transfer treatment. Fertil Steril. 2009 Dec;92(6):1870-9.
Preparation Ahead of the IVF Cycle
Every cycle counts for the patient. Not just because her clock is ticking, but also because every cycle costs a hefty sum. There is also substantial emotional and physical stress to go through each time.
Some patients do not respond well to gonadotropin stimulation e.g. Follistim, Gonal-F, Menopur. Others produce an adequate number of follicles but few that are viable. For those with successful fertilization, the chosen ones may not implant. For those who implant, there is then the fear of possible miscarriage during the first trimester.
The issue here is physical condition of the IVF candidates. Modern day technology is able to help us do what was impossible in the past. We can bypass obstructed fallopian tubes with IVF. We can even facilitate fertilization via ICSI. But for your body to work at a more optimal state, we need other resources.
The most important are lifestyle changes. If you continue working hectic hours, then decide that the technology is going to do the job for you, then you may be in for disappointment. Many more women all over the world who decide that IUI or IVF is their preferred mode of treatment also realize that they are responsible for everything else. They learn to slow down, go for massages, eat well and invest in herbs and acupuncture for preparing themselves for the cycle.
Acupuncture can be very helpful for poor-responders to stimulation. Not to mention its effects on the body as a whole, acupuncture will help reduce stress and improve blood flow to the reproductive regions.
Fertility Acupuncture for IVF – Two Big Reasons Why
IVF is the best-known treatment for infertility due to tubal dysfunction. Its technology also makes it useful in treating other causes of infertility, for example poor sperm quality and unexplained infertility. There is research out there telling us that by integrating acupuncture with IVF, the patient will feel better as well as have a higher chance of improved clinical pregnancy rates.
Stress
IVF involves the retrieval of a woman’s eggs, fertilizing them in a laboratory and then transferring back into her uterus. Most women who undergo fertility treatments already possess high levels of anxiety. Each additional IVF cycle often adds to the existing levels of stress.
A 2009 study by Balk et al explored whether acupuncture could affect the perceived level of stress at the time of embryo transfer, and whether these perceived stress levels play a role in the outcome of an IVF cycle. Women who received acupuncture in this study had both higher rates of pregnancy and lower reported levels of stress.
Although a 2010 study of Buck et al involved neither IVF nor acupuncture, it did look at the relationship between stress and fertility. It found that a positive stress response, as measured by salivary alpha-amylase levels, significantly reduced the probability of conception. This reflects another way how acupuncture, which reduces stress hormones, may improve fertility.
Blood Flow
Good blood flow to the uterus ensures a healthy endometrial lining. The Pulsitility Index (PI), as measured by transvaginal Doppler ultrasound is used to measure uterine blood flow. A high PI indicates diminished blood flow, which entails reduced endometrial receptivity. Steer et al demonstrated that a high PI in the uterine arteries could predict clinical pregnancy failures.
Research shows that poor blood flow of the uterine arteries is associated with reduced rates of clinical pregnancy following an IVF embryo transfer. In a 1996 study by Stener-Victorin et al, reported in “Human Reproduction” (the official journal of the European Society of Human Reproduction and Embryology), blood impedance to the uterus was significantly reduced after 8 acupuncture treatments over the span of 1 month. This effect of reduce blood impedance was present up to two weeks after completion of the 8 treatments. The acupuncture protocol employed by Stener-Victorin was replicated in 2004 by a group of IVF clinics in California, USA. It turns out that acupuncture as adjunct therapy significantly improved pregnancy rates.
Stener-Victorin et al demonstrated again in 2003 that acupuncture can significantly increase blood flow to the ovaries. Although this study was done on rats, we can imagine a similar mechanism playing out in women too.
The Stats
Whatever the mechanism of action, three out of four randomised controlled trials revealed significantly higher pregnancy rates in the acupuncture groups compared with the control groups. Take for example the 2002 study by Paulus et al on 160 patients, half of whom used acupuncture for implantation assistance – the results showed an improvement in clinical pregnancy rates from 42.5% in the acupuncture group versus 26.3% in the control group, a very significant result for a couple of needles put into the body before and after embryo transfer.
Women in Singapore are embracing this tool to help them during a trying time, and so are many IVF centres hoping to raise their clinical pregnancy rates. It appears that acupuncture has a positive effect in IVF support and has not shown adverse effects on pregnancy outcome.
Four Ways to Structure my Fertility Acupuncture Treatments
What kinds of adjunct therapy with acupuncture can be considered based on the research that has been done out there?
Option 1: Preparing the womb based on research done
A retrospective clinical study compiled data regarding a group of 216 infertile patients using IVF over a span of four years. The study determined that there was significant improvement in IVF outcomes when patients were treated with acupuncture. Data were analyzed to determine the optimal number of acupuncture treatments, and they concluded that “patients who received more than 8 e-Stim treatments appeared to have the maximum benefit for IVF outcomes: pregnancy (p < 0.05).”
Suggested treatment:
– Bi-weekly treatments for the last 4 weeks before egg retrieval
Option 2: Preparing the womb in the final stages of folliculogenesis
While folliculogenesis is a process lasting more than a year, it take a little more than 2 months for a preantral follicle to be continue growing until it is ready for ovulation. For those hoping to prepare for an IVF cycle, this treatment plan is researched based with the intent of reducing pulsatility index (PI), hence improving blood flow to the reproductive organs and generating a thick and healthy uterine lining. It would also reduce stress and aid in the final stages of folliculogenesis.
The aim is so that, in preparation for egg retrieval and embryo transfer, the eggs retrieved and your reproductive organs are at the best quality possible.
Suggested treatment:
– Weekly treatments starting 3 months before IVF medications begin
– Bi-weekly treatments for the last 4 weeks before egg retrieval
Option 3: Stimulation Phase
Acupuncture during the stimulation phase can help reduce side effects of stimulation, prevent OHSS and help the body adapt better during this time.
Suggested treatment:
– During the stimulation phase during the week before embryo transfer
Option 4: Transfer & Implantation Assistance
Again, this protocol has is mapped after a study in 2002 that showed an improvement in clinical pregnancy rates from 42.5% in the acupuncture group versus 26.3% in the control group.
Suggested treatment:
– Before retrieval and after transfer of embryo
If you find all this information useful, do read about reference to our clinic in Vogue Magazine.
All the above information does not only apply to IVF, it also shows how acupuncture may help with anovulation, delayed ovulation, reproductive hormonal imbalance as well as unexplained infertility.
At our clinic, we treat patients coming in for Preconception, Pregnancy as well as Postpartum using Chinese Medicine as well as other treatment modalities.
The Case for Acupuncture When There is Unexplained Infertility
Infertility is defined as the inability to conceive after one year of regular unprotected intercourse. It has become more endemic as more and more couples decide to wait to they are in their 30s to start a family. About 15 percent of couples in Singapore do not get pregnant successfully within 12 months of trying to conceive. This can heartbreaking for both the husband and wife. Fortunately, modern medicine allows us to pinpoint any physiological and anatomical hindrance in the body. For example, a vaginal ultrasound can help us discover abnormalities within the uterus, fallopian tubes or ovaries while a blood test can track the necessary hormonal levels. With that, causes of female infertility such as tubal obstruction, polycystic ovaries, luteal phase insufficiency, oligomenorrhoea, irregular ovulation, resistant ovarian syndrome, thyroid disorder, endometriosis and so on can be ruled out and treated. But why you are still not pregnant?
There are often circumstances where the couple is healthy and trying, yet the results are disappointing. Before you proceed to try anything more invasive, its worth considering Chinese medicine for help. Acupuncture is the most commonly recognized alternative treatment for infertility today.
Does it really work?
Acupuncture intervenes in two ways and they are backed up by evident research. Firstly, acupuncture has been shown to affect hormone levels by stimulating the release of beta-endorphin in the brain. This affects the release of gonadotrophin releasing hormone (GnRH) by the hypothalamus, follicle stimulating hormone (FSH) from the pituitary gland, and oestrogen and progesterone from the ovaries. These are essential hormones in operating the body’s reproductive system. Secondly, it promote blood flow towards the uterus, hence, removing any constriction of the ovarian arteries. This improves the thickness of the endometrium which increase the chances of embryo implantation.
In this modern era, many women have multiple roles to play and responsibilities to uphold, leaving them drained emotionally and physically. Moreover, the polluted hectic environment and genetically modified food everywhere contributes to their unhealthy lifestyles. One of the other ways acupuncture treatment for fertility increases chance of conception is through stress reduction, which is often the hidden cause of infertility. When a person is under stress, cortisol levels are elevated, altering the brain’s neurochemical balance, thus changing the levels of other hormones and disrupting the signaling of the HPO axis that is vital to reproductive function. Once this delicate hormonal balance is off kilter, your ovulatory mechanism can also be disrupted. Furthermore, stress can also cause spasms in both the fallopian tubes and the uterus, which can interfere with movement and implantation of a fertilized egg. Acupuncture can increase fertility by reducing stress, increasing blood flow to the uterus and ovaries whilst balancing the endocrine system.
Traditionally, the menstrual cycle is the most detectable external hint explaining your body’s resistance towards conception. The observations of the timing and nature of the menstrual blood are signs your Chinese physician will make a diagnosis upon. Together with relevant details of on-site presentation and past history, looking at the tongue and taking the pulse, the pieces of the puzzle will usually reveal your body type. This information is put together as a TCM diagnosis in designing the treatment you will receive.
On top of that, treating the kidneys is key towards fertility according to the traditional TCM gynecology text. Your kidneys governs your fertility and sexuality and requires a rich supply of blood and Qi to the reproductive organs. They will be well nourished to ensure that the future seeds are cultivated in the fertile ground.
Recommendations
From clinical observations, the most effective fertility treatments involve a combination of acupuncture and herbal medicine. Be assured there are minimal risks in using acupuncture for fertility treatment. Those choosing to include acupuncture in their treatment regimen should only be treated by an acupuncturist who is knowledgeable in the treatment of fertility disorders. We advise patients to come in to regulate any menstrual disorder for at least three continual cycles before embarking on fertility treatment on a bi-weekly basis.
References:
- Stener-Victorin E, Wu X. Effects and mechanisms of acupuncture in the reproductive system. Auton Neurosci. 2010 Mar 27.
- Ng EH, So WS, Gao J, Wong YY, Ho PC. The role of acupuncture in the management of subfertility. Fertil Steril. 2008 Jul;90(1):1-13.
- Huang ST, Chen AP. Traditional Chinese medicine and infertility. Curr Opin Obstet Gynecol. 2008 Jun;20(3):211-5.
- Stener-Victorin E, Humaidan P. Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med. 2006 Dec;24(4):157-63.