Acupuncture to Support Fertility and IVF

Some gynaecologists support the view that acupuncture may be of benefit to the patient who has chosen to undergo an IVF cycle.  There are studies that have shown there may be added benefit to the success of your IVF outcome when combining acupuncture with IVF.  Studies report that patients experience a significant reduction in stress and anxiety around the time of the embryo transfer, this is thought to be one of the ways acupuncture can contribute to a more successful outcome. 
Various studies have been done and continue to be done to show the benefits of acupuncture during the IVF process. 

Below are some useful references: 

 

Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy

Wolfgang E. Paulus, M.D.,a Mingmin Zhang, M.D.,b Erwin Strehler, M.D.,a Imam El-Danasouri, Ph.D.,a and Karl Sterzik, M.D.a Christian-Lauritzen-Institut, Ulm, Germany

 

 Objective

To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy

(ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo

transfer with a control group receiving no acupuncture

 

Conclusion(s):

Acupuncture seems to be a useful tool for improving pregnancy rate after ART. (Fertil Steril_

2002;77:721– 4. ©2002 by American Society for Reproductive Medicine.)

https://www.ncbi.nlm.nih.gov/pubmed/?term=Influence+of+acupuncture+on+the+pregnancy+rate+in+patients+who+undergo+assisted+reproduction+therapy

 

Transcutaneous electrical acupuncture point stimulation improves pregnancy outcomes in patients with recurrent implantation failure undergoing in vitro fertilisation and embryo transfer: a prospective, randomised trial

Chenhong Shuai et al, Acup Med, Vol 37 issue 1, 33-39

Acupuncture In Medicine BMJ

Stimulation of acupuncture points on the abdomen and legs with TEAS (transcutaneous electrical acupuncture stimulation) improved implantation and pregnancy outcomes in women who had previous repeated implantation failure, in this randomised trial involving 122 IVF patients.

Objective:

To evaluate the effect of transcutaneous electrical acupuncture stimulation (TEAS) on pregnancy outcomes in patients with recurrent implantation failure (RIF) undergoing in vitro fertilisation (IVF).

Methods:

A total of 122 women with RIF undergoing fresh embryo transfer cycle IVF were randomly allocated to a TEAS or mock TEAS (MTEAS) group. Gonadotrophin therapy using a long protocol was provided in both groups. TEAS consisted of 30 min of stimulation (9–25 mA, 2 Hz) at SP6, CV3, CV4 and Zigong from day 5 of the ovarian stimulation cycle once every other day until the day of embryo transfer. The patients in the control group received MTEAS. Implantation, clinical pregnancy and live birth rates were compared.

Results:

In the TEAS group, the implantation rate, clinical pregnancy rate and live birth rate (24.3%, 32.8% and 27.9%, respectively) were significantly higher than in the MTEAS group (12.1%, 16.4% and 13.1%, respectively).

Conclusions:

TEAS significantly improves the clinical outcomes of subsequent IVF cycles among women who have experienced RI

https://www.ncbi.nlm.nih.gov/pubmed/30864824 

 

Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study

Stefan Dieterle, M.D.,a Gao Ying, M.D.,a,b Wolfgang Hatzmann, M.D.,a and Andreas Neuer, M.D.a  Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Witten/ Herdecke, Dortmund, Germany; and b Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Objective: 

To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI).

Conclusion(s): 

Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI. (Fertil Steril_ 2006; 85:1347–51. ©2006 by American Society for Reproductive Medicine.)

https://www.ncbi.nlm.nih.gov/pubmed/16616748

 

The Effect of Complementary and Alternative Medicine on Subfertile Women with In Vitro Fertilization

Yuehui Zhang, Yiman Fu, Fengjuan Han, Hongying Kuang, Min Hu, and Xiaoke Wu

At present, several CAM methods have been used in infertile couples with IVF, which has achieved obvious effects. However, biologically plausible mechanisms of the action of CAM for IVF have not been systematically reviewed. This review briefly summarizes the current progress of the impact of CAM on the outcomes of IVF and introduces the mechanisms.

https://www.ncbi.nlm.nih.gov/pubmed/?term=The+Effect+of+Complementary+and+Alternative+Medicine+on+Subfertile+Women+with+In+Vitro+Fertilization

 

Effect of transcutaneous electrical acupuncture point stimulation on endometrial receptivity in women undergoing frozen-thawed embryo transfer: a single-blind prospective randomised controlled trial

Zhenhong Shuai, Fang Lian, Pengfei Li, Wenxiu Yang

Abstract

Objective To evaluate the effect of transcutaneous electrical acupuncture point stimulation (TEAS) on endometrial HOXA10 protein expression and three-dimensional (3D) power Doppler ultrasound parameters as markers of endometrial receptivity in women undergoing frozen-thawed embryo transfer (FET).

Conclusions

In patients undergoing FET, TEAS may have beneficial effects on endometrial HOXA10 expression and ultrasound markers of

endometrial receptivity. These findings may explain the improvement in clinical outcome of FET associated with the use of TEAS.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Effect+of+transcutaneous+electrical+acupuncture+point+stimulation+on+endometrial+receptivity+in+women+undergoing+frozen-thawed+embryo+transfer%3A+a+single-blind+prospective+randomised+controlled+trial

 

Relationship between psychological stress and reproductive outcome in women undergoing in vitro fertilization treatment: Psychological and neurohormonal assessment

Yuan An et al, J Assist Reprod Genet. 2013 Jan; 30(1): 35–41

Journal of Assisted Reproduction and Genetics

264 women undergoing IVF were tested periodically for cortisol and noradrenaline status. Additionally they completed assays to determine anxiety and depression. Lower levels of the stress hormones were found in women who were successful in conceiving and having a live birth. This is possibly one of the mechanisms whereby acupuncture may help to improve IVF outcomes.

Purpose

To evaluate whether psychological stress, as well as changes in hypothalamus-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) at different time points during a first in vitro fertilization (IVF) cycle, correlates with the reproductive outcome.

Methods

A prospective study was conducted in 264 women undergoing IVF or intracytoplasmic sperm injection (ICSI) treatment between January 2009 and March 2010. Standardized psychological questionnaires were used to assess anxiety and depression. Norepinephrine and cortisol in serum were measured with specific assays.

Results

The non-pregnant women reported higher anxiety and depression scores at the pregnancy detection day compared with the pregnant group. Lower levels of norepinephrine and cortisol at the time of oocyte retrieval and lower levels of cortisol at the time of pregnancy test were found in women with successful treatment. Significant increases in serum norepinephrine and cortisol values were observed during ovarian stimulation. State Anxiety scores were negatively correlated with live birth rate, and positively associated with serum norepinephrine and cortisol values.

Conclusions

State anxiety is associated with both pregnancy rate and live birth rate in IVF patients, an effect that is partly mediated by activities in the HPA and SNS

 

A Comparison of Stress Levels in Women Undergoing Single Versus Multiple Acupuncture Session Prior to Embryo Transfer

  1. Sutton, MD et al, 2015 Fert Stert, Vol 103, Issue 2, Supplement, Pages e36–e37 Fertility and Sterility

This report is a retrospective study done on 78 women undergoing IVF, who had acupuncture for more than a month prior to, or only on the day of, embryo transfer. A standardised questionnarie (the Perceived Stress Scale) found that women who had acupuncture in the lead up to embryo transfer had significantly lower stress scores than those who had acupuncture on the day of transfer.

This is not a randomised controlled trial, and therefore does not provide sufficient evidence for claims about stress management of IVF patients. However it indicates the way for future trials. And is of particular interest in showing the effect of dose in acupuncture treatments.

Background

Stress associated with the process of in vitro fertilization (IVF) has well recognized effects on outcomes of these treatments [1-4]. Acupuncture is one of several stress-lowering treatments that has been studied for the improvement of IVF outcomes. Stress is difficult to quantify and various tests range from standardized questionnaires, to endocrine assays as biomarkers of stress [5,6]. In this study, we employed a validated questionnaire, the perceived stress scale (PSS), to quantify stress [7].

Objective

The objective of this study was to compare stress on the day of embryo transfer (ET) for IVF in women undergoing single versus multiple acupuncture session prior to IVF.

Materials and Methods

This retrospective cohort study included 87 women undergoing IVF at a private fertility clinic. Women were divided into three groups: one session of acupuncture on the ET day (n=32), >1 month of acupuncture at a Traditional Chinese Medicine (TCM) reproductive clinic prior to ET (n=20), and >1 month of acupuncture at a non-reproductive acupuncture clinic prior to ET (n=35). All women completed PSS on the ET day. PSS scores were then compared using the two-tailed T-test and the one-way ANOVA with post-hoc analyses using the Bonferroni criterion for significance.

Results

Stress appeared to be lower for women receiving >1 month of acupuncture at the TCM reproductive clinic versus those with acupuncture on the ET day only, with a PSS of 13.4 versus 19.3 (p=0.001), 95% CIs [11.1,15.6] and [17.4,21.2], respectively. There was no significant difference between women receiving > 1 month of acupuncture from the non-reproductive based acupuncture clinic and those receiving acupuncture on the ET day only, with a PSS of 17.6 versus 19.3 (p=0.60), 95% CIs [15.6,19.6] and [17.4,21.2], respectively. When all women from the reproductive and non-reproductive acupuncture clinic were combined, stress was significantly lower when compared to those undergoing acupuncture on the ET day only, with a PSS of 16.1 vs. 19.3 (p=0.011), 95% CI [-5.75, -0.76].

Conclusions

Stress remains significantly elevated for women undergoing only one session of acupuncture on the ET day. However, when undergoing multiple acupuncture sessions, stress scores were significantly lower. As demonstrated by a dose-dependent effect, acupuncture appears to be a promising stress-lowering tool for women undergoing IVF. Further research will require a comparison of IVF outcomes with and without acupuncture.

Effects and mechanism of action of transcutaneous electrical acupuncture point stimulation in patients with abnormal semen parameters

Yan Yu et al, Acup Med BMJ, 2019 

Acupuncture in Medicine, British Medical Journal

A randomised controlled trial examined the effect of electrical stimulation of acupuncture points (using TEAS), on sperm parameters. They found that low frequency stimulation significantly improved sperm count and motility in men with abnormal semen analysis.

Objective:

To evaluate the effect of transcutaneous electrical acupuncture point stimulation (TEAS) on sperm parameters and the underlying molecular mechanisms.

Methods:

A total of 121 patients diagnosed with oligozoospermia, asthenozoospermia or oligoasthenozoospermia were randomised into four groups (three treatment groups, one control): the TEAS groups were treated with 2 Hz (n=31), 100 Hz (n=31), or mock stimulation (n=29) at acupuncture points BL23, ST36, CV1 and CV4 for 2 months. The control group (n=30) was provided with lifestyle advice only.

Results:

The changes in total sperm count and motility in the 2 Hz TEAS group were significantly greater than those in the mock group and the control group. The change in neutral α-glucosidase (NAG) and zinc levels in the 2 Hz group were significantly greater than those in the mock group and control group, and the changes in fructose levels of the 2 Hz group were significantly greater than those in the control group. Significant increases in calcium and integrin-binding protein 1 (CIB1) and reduction of cyclin-dependent kinase 1 b (CDK1) were also found after 2 Hz TEAS treatment.

Conclusions:

The present findings suggest that 2 Hz TEAS can improve sperm count and motility in patients with abnormal semen parameters, and is associated with increases in seminal plasma zinc, NAG and fructose. The upregulation of CIB1 and downregulation of CDK1 by TEAS may be associated with its positive effects on sperm motility and count.

Randomised clinical trial comparing the effects of acupuncture and varicocelectomy on sperm parameters in infertile varicocele patients

 

Kucuk EV et al, Andrologia, Vol 48, 10, 1080 – 1085, 2016

Andrologia

A study comparing surgical versus acupuncture treatment of men who were infertile due to varicoceles in the testes, found both methods were successful in improving sperm parameters although acupuncture improved sperm concentration more than surgery. The acupuncture was performed twice a week for 2 months. Pregnancy rates after more than 3 years was similar in both groups.

Abstract

The aim of the study was to evaluate the effect of the acupuncture treatment on sperm parameters and pregnancy rates in patients with primary infertility. Between January 2008 and May 2010, 30 men with the primary infertility (one year of unprotected intercourse, healthy wife) and varicocele with normal hormone levels and abnormal semen analysis were randomised into two groups. Group 1 underwent subinguinal microscopic varicocelectomy, and Group 2 underwent acupuncture treatment twice a week for 2 months. Both groups were evaluated with semen analysis at 6 months after the treatment. Patients in both groups evaluated with telephone calls and e-mail in terms of pregnancy. The mean age of the patients was 27.2, and groups were comparable regarding the age (P = 0.542). The pre-treatment sperm concentration, motility and morphological characteristics were similar in both groups. Sperm concentration and motility improved significantly in both groups after the treatment. Increase in sperm concentration was higher in the acupuncture group compared to the varicocelectomy group (P = 0.039). The average follow-up was 42 months, and pregnancy rates were 33% in both groups. Acupuncture treatment in primary infertile varicocele patients with semen abnormalities seems to be effective and has comparable results with the varicocelectomy treatment.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Kucuk+EV+et+al%2C+Andrologia%2C+Vol+48%2C+10%2C+1080+%E2%80%93+1085%2C+2016+Andrologia