Photo from Unsplash

Originally Posted On: https://metroacupuncture.com/the-role-of-acupuncture-in-enhancing-ivf-success-a-comprehensive-review/

 

Infertility is defined as the inability to conceive after at least one year of unprotected sexual intercourse. According to the World Health Organization (WHO), around 1 in every 6 individuals worldwide–or about 17.5% of the global adult population–is affected by this condition. According to Tedros Adhanom Ghebreyesus, the director general of the United Nations, this statistic regarding infertility only proves that there is a need to improve access to individuals to fertility care and ensure that it is made a priority in health research and policy.

There is very little difference when comparing various parts of the world in terms of rates of infertility; however, in society, it does tend to take a toll on women, considering that the role of childbearing is more associated with females. In fact, if women are unable to produce an offspring, they often end up getting excluded, stigmatized, or isolated.

What are the causes of infertility?

There are cases where the root cause is not known, in which case it is called “unexplained infertility” and around 30% of couples worldwide have been diagnosed with this condition. The most common causes of infertility, however, include endometriosis, blocked or damaged fallopian tubes, ovulatory dysfunction, and male factor infertility. Other contributory factors include obesity, age, and vices such as smoking or alcohol usage.

Treatment Options for Infertility

Fortunately, for those who are trying to get pregnant but have been diagnosed as infertile, it does not mean that they can’t ever have children.

Prescription Medication

Health professionals could offer them several treatment options, one of which is taking medications such as clomiphene citrate (Clomid) or letrozole (Femara), both of which can help induce ovulation.

Laparoscopy

In cases wherein the issue lies in the anatomical structures in the woman’s reproductive system, minimally invasive surgery such as laparoscopy may be done in order to check for and correct abnormalities that could be causing infertility.

Assisted Reproductive Technology (ARTs)

Another option is assisted conception–or more commonly known as assisted reproductive technology (ARTs)–through either intrauterine insemination (IUI), where fertilization is allowed to take place internally after injection of the sperm into the woman’s uterus, and in vitro fertilization (IVF), where fertilization is induced in a laboratory setting.

ARTs do have a higher degree of success achieving pregnancy than timed intercourse; however, they are not always successful. Fortunately there are complementary therapies available which could be beneficial for those who are trying to get pregnant through ARTs. One of these techniques is acupuncture. In this article, we are going to explore the scientific evidence available on the benefits of acupuncture for women undergoing IVF.

Acupuncture Therapy

Acupuncture therapy is a medical treatment that is often associated with East-Asian Medicine. It involves placing thin needles in various parts of the body that are called acupuncture points. Acupuncture needles are then retained in the body for as short as twenty minutes to as long as forty-five minutes. The common duration is thirty minutes. It is through these points that the central nervous system is accessed and then, consequently, stimulated. The stimulation of the nervous system by acupuncture needles creates biochemical changes that accelerate the body’s natural ability to heal. Simply put, acupuncture can promote physical and emotional well-being.

The Role of Acupuncture in IVF

Numerous studies have proven the benefits of acupuncture. Its efficacy could be associated with the fact that it works by activating local receptors that bring neural impulses to the central nervous system, hence modulating physiologic functions, which in effect leads to its health benefits, including enhanced blood flow, faster healing, and analgesia or pain relief.

How Acupuncture Works for IVF

As mentioned earlier, acupuncture therapy has also been found to be beneficial for individuals who are trying to conceive. But how exactly does it work to produce better effects for individuals undergoing in IVF? How can these very thin needles used for acupuncture help in increasing one’s chances of getting pregnant?

The Benefits of Acupuncture for IVF

According to Huang et al. (2011), one way by which acupuncture may help is through the regulation of both the central and peripheral nervous systems in order to promote ovulation. In addition, acupuncture promotes the proper functioning of the endocrine system and helps bring reproductive hormones to normal levels. This is essential considering that ovulation is controlled by the hypothalamic-pituitary-ovarian axis. Acupuncture also promotes blood flow to reproductive organs such as the ovaries.

Another mechanism by which acupuncture may benefit couples undergoing IVF is through stress reduction. The diagnosis of infertility is stressful, and stress is often a part of one’s fertility journey. High levels of stress could increase one’s risk of infertility and in turn, getting diagnosed as an infertile can further increase one’s stress levels. It can be a vicious circle.

In a paper by Rooney (2018), it was stated that around 25-60% of individuals who are infertile have higher levels of anxiety and depression in comparison to fertile controls. Another study shows that higher amounts of cortisol, the stress hormone, is related to lower pregnancy rates. High maternal cortisol levels may also lead to newborns with low birth weights (Nepomnaschy et al., 2006; Stewart et al., 2015).

In simpler terms, acupuncture promotes the release of endorphins, which are feel-good hormones in the body that at the same time can have an analgesic effect. In addition to that, acupuncture can help the body regulate cortisol levels (Pirnia et al, 2019).

Acupuncture is also beneficial when it comes to the implantation of the embryo as it helps reduce the immune response of the female against the embryo, which may be tagged by the immune system as a foreign body during the early days of pregnancy.

Clinical Studies on Acupuncture and IVF

After going through some mechanisms by which acupuncture works in order to increase the probability of conception, let us go through several randomized control trials that have been completed in order to determine if acupuncture is indeed effective in enhancing the results of IVF in a clinical setting.

Perhaps one of the most widely known studies on the effects of acupuncture on individuals undergoing IVF is the one that was spearheaded by Dr. Wolfgang Paulus, a German physician, in 2002.

In this study, which was presented in the Fertility and Sterility journal in April 2002, a prospective randomized trial was done, which involved two groups of subjects, each of which was composed of 80 individuals. In the first group, women had acupuncture and IVF while the other group had no extra treatment given aside from IVF and was considered as the control group. The specific acupuncture points utilized in the study were chosen to promote blood flow to the female reproductive system and eliminate blockages that might affect conception. The outcome in the study was pregnancy diagnosed via ultrasound 6 weeks after embryo transfer.

Results of the study showed that 34 women out of the 80 (equivalent to 43%) who received the combination treatment had successful embryonic implantation while for the control group, only 21 out of 80 had successful embryonic implantation (26%). This may be attributed to the enhanced blood flow resulting from acupuncture therapy, which increases responsiveness of an individual to fertility medications and helps maintain a thick uterine lining as well as an environment that is ideal for implantation to occur.

The success of acupuncture as a complementary therapy that was discovered through this study led to the creation of the Paulus protocol, which is a set of acupuncture points that have been found to be optimal for those who wish to have better IVF results. This protocol also inspired further clinical trials on IVF and acupuncture therapy.

In a study by Gillerman et al. (2018), 157 women were randomized into two groups. One group received acupuncture therapy that is based on the Delphi consensus protocol three times during their treatment cycle in addition to a standardized in vitro fertilization protocol, while the other group received only IVF with no acupuncture therapy. The ages of the participants in the study ranged from 23 to 43 years old and another inclusion criteria was having a body mass index below 30. The number of positive pregnancy tests and resulting live births were then counted and used as a measure to determine which among the treatment groups yielded the most benefits. It was found that the rate of live births and positive pregnancy tests were higher in the group that had acupuncture.

In another study by Kim et al. (2021), they conducted a randomized control trial in Pusan National University Hospital, an institution in South Korea, from 2017 to 2020. The aim of the study was to determine the effect of acupuncture + in vitro fertilization in women with poor ovarian reserve. There were two groups in the study. The subjects were greater than 37 years old, since it is known that oocyte loss tends to begin at around 37 years of age.

In the study, one group received only IVF as treatment, while the other group received both IVF and acupuncture therapy, particularly 16 acupuncture sessions prior to IVF. Results of the study show that there were more mature oocytes retrieved from those who received both acupuncture and IVF than in those received IVF alone.

This study has certain limitations, despite its positive results. One limitation is that it involves a small sample size. Hence, the authors mentioned in the paper that they intend to conduct another study with at least 23 subjects in each treatment group. The authors also figured that the treatment period of two menstrual cycles was too short to allow maturation of follicles. Hence, they are recommending that future studies be conducted for greater than two months.

There are also systematic reviews and meta-analyses that show that acupuncture is indeed beneficial when combined with IVF.

In a paper by Quan et al. (2022), it was found after analysis of twenty-seven different studies that individuals who received the intervention (acupuncture combined with IVF) resulted in higher implantation and pregnancy rates, as well as live birth rates. These are enticing findings; however, it is recommended that studies with larger sample sizes and enhanced methodologies be done in order to confirm and increase reliability of these findings.

In an article by Xie et al. (2019), a total of twenty-seven studies were analyzed and these studies had 6,116 participants in total. Xie and colleagues found that acupuncture therapy was highly beneficial as a complementary therapy for women who had a history of having unsuccessful IVF attempts and in addition to that, the number or frequency of acupuncture treatments was another contributing factor to the success of the IVF.

Timing of Acupuncture in IVF

Having gone through studies and reviews that show that the beneficial effects of acupuncture are indeed evidence-based, one might ask, what about timing? When is the best time to do acupuncture? Is it prior to or after embryo transfer?

In a randomized control study by Deghani et al. (2020), there were 186 participants who were divided into three different treatment groups. One group had acupuncture 25 minutes prior to embryo transfer, another group had acupuncture 25 minutes before and after embryo transfer, and the last group underwent only embryo transfer without acupuncture. It was found that those in the first group–the ones who received acupuncture only once, 25 minutes before embryo transfer–had significantly higher rates of clinical pregnancy than the two other treatment groups.

In some reviews, it has been found that acupuncture must ideally be done around three to six months prior to IVF (Zou et al., 2020).

Risks and Precautions of Acupuncture

Of course, the combination therapy discussed here does not come without its own drawbacks. Just like any other treatment available out there, it has its own set of risks. However, most of these are relatively minor. One way the risks of acupuncture could be reduced is by making sure that you consult only a qualified acupuncturist specializing in fertility and IVF support, such as those who are fellows of The Acupuncture and TCM Board of Reproductive Medicine (ABORM). Acupuncturists who are fellows of this organization have graduated from a board-approved Acupuncture/East Asian medical school, have completed a minimum of 2625 educational hours and passed the national acupuncture board exam. In addition to that, they have been licensed for a minimum of two years and have completed at least 45 hours of board-approved postgraduate training specifically in reproductive medicine, and completed and passed the ABORM examination.

Future Research and Recommendations for Acupuncture and IVF

While many studies have proven the beneficial effects of acupuncture therapy as a complementary therapy for individuals undergoing IVF, further research is still needed regarding this treatment combination. In previously conducted research, the authors have offered their own recommendations for future research. For example, they recommended longer study periods, increased sample sizes, cost-effectiveness assessment, and better treatment protocols.

In summary, indeed, it can be said that it is beneficial to use acupuncture therapy as a complementary procedure for couples trying to conceive in order to increase the success rate of IVF. This has been proven by the various randomized control trials, systematic reviews, and meta-analyses that have been discussed.

The benefits of acupuncture for women undergoing IVF may be attributed to its ability to regulate both the nervous system and endocrine system, promote blood flow to the female reproductive system, as well as its ability to reduce stress and improve ovarian function.

However, just like most other studies, the various trials that have tested the combination of IVF and acupuncture have certain limitations, which could be lessened by enhancements in future studies.

It must be noted, however, that these limitations do not change the fact that acupuncture therapy has been proven to have a highly beneficial role in enhancing pregnancy rates for the IVF patient and thus, making it a reasonable and safe complementary procedure for the IVF patient.

Ready to Explore the Benefits of Acupuncture in Enhancing Your IVF Journey?

Schedule a consultation with our experienced acupuncturists specializing in fertility and IVF support today. Book online, or give us a call at (404) 255-8388. Take the next step towards improving your chances of success and realizing your dream of starting a family. Don’t wait, book your appointment now!

---

Sources

Carson, S. A., & Kallen, A. N. (2021). Diagnosis and Management of Infertility: A Review. JAMA, 326(1), 65–76. https://doi.org/10.1001/jama.2021.4788

Dehghani, A. S., Homayouni, K., Kanannejad, Z., & Kanannejad, Z. (2020). The effect of acupuncture on the day of embryo transfer on the in vitro fertilization outcomes: An RCT. International journal of reproductive biomedicine, 18(3), 209–214. https://doi.org/10.18502/ijrm.v18i3.6719

Feng, J., He, H., Wang, Y., Zhang, X., Zhang, X., Zhang, T., Zhu, M., Wu, X., & Zhang, Y. (2022). The efficacy and mechanism of acupuncture in the treatment of male infertility: A literature review. Frontiers in endocrinology, 13, 1009537. https://doi.org/10.3389/fendo.2022.1009537

Gillerman, K., Kulkarni, A., Shah, A., Gudi, A., & Homburg, R. (2018). The impact of acupuncture on IVF success rates: A randomised controlled trial. Fertility Science and Research, 5(2), 48. https://link.gale.com/apps/doc/A585545124/AONE?u=anon~eddd1bf6&sid=googleScholar&xid=dd45e9b0

Huang DM, Huang GY, Lu FE, Stefan D, Andreas N, Robert G. Acupuncture for infertility: is it an effective therapy? Chin J Integr Med. 2011 May;17(5):386-95. doi: 10.1007/s11655-011-0611-8. Epub 2011 May 25. PMID: 21611904.

Kawakita, K., & Okada, K. (2014). Acupuncture therapy: mechanism of action, efficacy, and safety: a potential intervention for psychogenic disorders?. BioPsychoSocial medicine, 8(1), 4. https://doi.org/10.1186/1751-0759-8-4

Kim, J., Lee, H., Choi, T. Y., Kim, J. I., Kang, B. K., Lee, M. S., Joo, J. K., Lee, K. S., & You, S. (2021). Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial. Journal of clinical medicine, 10(10), 2182. https://doi.org/10.3390/jcm10102182

Lin, J. G., Kotha, P., & Chen, Y. H. (2022). Understandings of acupuncture application and mechanisms. American journal of translational research, 14(3), 1469–1481.

Nepomnaschy, P. A., Welch, K. B., McConnell, D. S., Low, B. S., Strassmann, B. I., & England, B. G. (2006). Cortisol levels and very early pregnancy loss in humans. Proceedings of the National Academy of Sciences of the United States of America, 103(10), 3938–3942. https://doi.org/10.1073/pnas.0511183103

Paulus, W. E., Zhang, M., Strehler, E., El-Danasouri, I., & Sterzik, K. (2002). Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and sterility, 77(4), 721–724. https://doi.org/10.1016/s0015-0282(01)03273-3

Pirnia, B., Mohammadzadeh Bazargan, N., Hamdieh, M., Pirnia, K., Malekanmehr, P., Maleki, F., & Zahiroddin, A. (2019). The Effectiveness of Auricular Acupuncture on the Levels of Cortisol in a Depressed Patient. Iranian journal of public health, 48(9), 1748–1750.

Rooney, K. L., & Domar, A. D. (2018). The relationship between stress and infertility. Dialogues in clinical neuroscience, 20(1), 41–47. https://doi.org/10.31887/DCNS.2018.20.1/klrooney

Stewart, C. P., Oaks, B. M., Laugero, K. D., Ashorn, U., Harjunmaa, U., Kumwenda, C., Chaima, D., Maleta, K., Ashorn, P., & Dewey, K. G. (2015). Maternal cortisol and stress are associated with birth outcomes, but are not affected by lipid-based nutrient supplements during pregnancy: an analysis of data from a randomized controlled trial in rural Malawi. BMC pregnancy and childbirth, 15, 346. https://doi.org/10.1186/s12884-015-0793-8

Xu, J. Y., Zhao, A. L., Xin, P., Geng, J. Z., Wang, B. J., & Xia, T. (2022). Acupuncture for Female Infertility: Discussion on Action Mechanism and Application. Evidence-based complementary and alternative medicine : eCAM, 2022, 3854117. https://doi.org/10.1155/2022/3854117

Zou, Z., Zheng, Q., Wen, X., Yang, Z., Hou, T., Hao, X., Zhou, S., & Li, Y. (2020). Pregnancy outcomes and the dose-related effects of acupuncture therapies in women undergoing in vitro fertilization: A protocol for systematic review and meta-analysis. Medicine, 99(35), e21815. https://doi.org/10.1097/MD.0000000000021815