Women/couples across all age groups, undergoing IVF or other forms of Assisted Reproduction, come to the clinic seeking information on the use of acupuncture as an IVF support treatment.
It is common for many health practitioners working in this area to recommend acupuncture as a support treatment for IVF. Research is ongoing and there is a lot of interest in how effective acupuncture is in relation to IVF. For example, a 2017 and 2016 Systemic Review and Meta-Analysis and a 2017 and 2016 Clinical Trial:
The promising 2017 study by Benrick et al. involving the use of electro acupuncture on 21 woman with PCOS suggests that acupuncture may have a role in lowering blood glucose levels in overweight women. Many women with PCOS with weight issues undergo IVF, ICSI, IUI or ovulation induction treatment.
The 2017 systematic review and meta-analysis by Jo & Lee on Asian women with PCOS undergoing IVF or ICSI involving 430 women concluded that acupuncture may be used as an adjunct therapy and may increase the clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR) and decrease the risk of ovarian hyperstimulation syndrome (OHSS) that PCOS sufferers are at risk of. The authors recommended further studies to be more confident and advised caution when interpreting the seemingly positive results.
An August 2016 systemic review and meta-analysis by Qian et al. published in Arch Gynecol Obstet in December 2016 investigated some of the controversy surrounding Acupuncture-IVF outcomes research. The study concluded that ‘Acupuncture improves the CPR (clinical pregnancy rate) in women undergoing IVF.’ The review covered 30 trials with a total of 6344 participants. It further noted ‘… optimal positive effects could be expected using Acupuncture in IVF during COH (controlled ovarian hyperstimulation).’
The 2016 randomised controlled clinical trial sought to address the heterogeneity of previous studies and provide an evidence based conclusion by adopting the Delphi consensus protocol. The protocol was reached in 2012 via 15 international acupuncturists highly experienced in treating women undergoing IVF. This is the first time this protocol has been used:
In 2016, scientists (Gillerman et al) at Homerton University Hospital studied 127 couples with women aged between 23 and 43 years undergoing their first or second round of IVF. The women were assigned to either the ‘acupuncture group’ or the ‘non-acupuncture group’. The acupuncture group received 4 acupuncture sessions while doing IVF, the non-acupuncture group received none. Acupuncture was done before egg pick-up and before and after embryo transfer. In the acupuncture treatment group, 46.2% conceived – more than twice as many than the non-acupuncture group where 21.7% conceived. The live birth rate in the acupuncture group was higher than the non-acupuncture group. Gillerman suggested that stimulating nerves at particular points around the ovaries increased the blood flow and helped the development of the follicles which is where the eggs grow and mature. One of the researchers in the Study was Roy Homburg, Professor of Reproductive Medicine at Queen Mary University of London said ‘Being a cynical conventional doctor, I didn’t believe it was going to work …… having seen these results I’m completely converted’. (The Times UK July 5 2016).
Acupuncture’s ability to induce a relaxed state and reduce stress and anxiety has been identified in several studies, and it may be this affect that makes the difference. The authors admitted it may be due to a placebo effect, for example, the extra level of support the acupuncture group received compared to the control group produced a positive psychological influence. The study was presented in July 2016 at European Society of Human Reproduction and Embryology (ESHRE). It was also reported in The Times UK and other UK newspapers.
Besides reducing the stress associated with IVF, other effects of having several acupuncture sessions as an adjunct treatment to prepare for assisted reproduction that could be beneficial for those undergoing IVF/ICSI/IUI/ovulation induction are improving endometrial lining and patient satisfaction. Although the role acupuncture plays in IVF is unclear Hullender, Anderson & Craig reviewed relevant and current research up to 2017, and as well as the improvement in uterine lining and patient satisfaction, the authors also claim observational studies suggest more acupuncture sessions are associated with increases in clinical pregnancy rates and live birth rates compared to fewer acupuncture sessions or just the pre and post transfer session on day of transfer.
When should I come for treatment?
The focus at East West Fertility in relation to using acupuncture as a compliment IVF support treatment is on preparing you for your IVF or ICSI. With that in mind coming about 3 cycles before you undergo IVF is recommended to reduce your stress levels and increase the receptivity of the uterine lining. Coming once or twice a week is recommended.
Long term pill use may mask reproductive status
A Danish study, presented at the 2014 European Society of Human Reproduction and Embryology (ESHRE) annual meeting, pointed to the masking of true ovarian reserve and shrinkage of ovaries by long-term pill use, especially for women between 19 to 29.9 years.
Fortunately, the researchers don’t believe the effect is permanent, nor for the most part will affect future fertility in most women. However, according to the data, one percent (1%) of women who take the pill long term will go into early menopause and the pill can mask this tendency. This study is important as 1.6 million of the 160 million women throughout the world who take the pill will experience early menopause.
If you have been taking the pill long term and on stopping find your doctor tells you you have a low ovarian reserve due to low Anti-Mullerian Hormone (AMH) and Atrial Follicular Count (AFC) you should repeat the test in 6 months to determine whether the pill was responsible and merely giving the appearance of a trend towards early menopause or if in fact you are at risk of an early menopause. If you are not at risk of an early menopause, then your AMH should increase and size of ovaries improve. If you are at risk of an early menopause then the second test should show results similar to the first one.