There are several good reasons why you should think about having acupuncture before and during your IVF cycle
……..or maybe why you shouldn’t !
Spoiler alert …..
UNLESS you are feeling a bit stressed about the whole thing, then you should definitely consider it.
OR if you are planning a frozen embryo transfer, there is a lot you can do to prepare the uterine lining.
Here is all the latest information about Acupuncture and IVF
We get many queries from IVF patients, or their specialists, or the nursing staff at the IVF clinics
- should IVF patients have acupuncture?
- why should they have acupuncture?
- when should they have acupuncture?
- is there any evidence that it really helps?
all very good questions …….
Lets start with the last one, what is the evidence ……….
There is a lot to think about and analyse ……
There are many reports of clinical trials examining the effect of acupuncture on IVF outcomes. Feel free to browse all the abstracts of these reports here …….
But if trying to work out what it all means for you is confusing (even the experts find this hard given all the different variables) let us try and summarise the trials and their findings for you.
The clinical trials that investigated the effect of acupuncture on IVF outcomes did not all do the same thing.
Most of the trials did acupuncture only on the day of embryo transfer – immediately before and immediately after the transfer, some did acupuncture only after the transfer or at another time. Some trials did acupuncture in the IVF clinic, some did it in nearby clinics or across town. Most of the trials used the same acupuncture points – but not all.
A few of the trials looked at the effect of acupuncture administered during the stimulation phase of the IVF cycle, as well as on the day of embryo transfer.
The trials examined the effect of acupuncture on the outcome of embryo transfer, measured as one or more of these end points;
- clinical pregnancy
- ongoing pregnancy
- or live birth
Some trials did acupuncture on the day of transfer of day 3 embryos (morulas) and some on the day of transfer of day 5 embryos (blastocysts).
Most trials used traditional acupuncture needles in the treatment group, but some used laser ….
Some used electro-stimulation on acupuncture points instead of needles
Different trials used different sorts of control groups.
The control group is comprised of the IVF patients who do not have true acupuncture and provide a benchmark to measure how the treated patients’ results might differ.
Some used sham needles in the control group (ie the group of women not supposed to be having acupuncture)
These needles are to fool patients into thinking they are having real acupuncture, but the needles only prick and don’t actually penetrate the skin.
Some trials used “wrong acupuncture” points in the control group,
ie they used points that were not on an acupuncture meridian, or points that were not relevant to fertility treatment.
Some used “usual care” in the control group, ie these IVF patients didn’t do anything different to what they would normally do in an IVF cycle.
What did the trials find?
More than two thirds of these studies report a statistical benefit of having acupuncture during an IVF cycle.
The next step is to do a meta-analysis.
A Meta–analysis is a statistical technique for combining the findings from independent studies, and is used to assess the clinical effectiveness of healthcare interventions.
What did these find?
Of 9 meta analyses examining acupuncture treatment of IVF patients, 2 found no effect at all, 7 found that acupuncture conferred an advantage in IVF outcomes but note that in some cases the advantage was significant only when chances of success were not high, or when usual care, rather than sham needling, was the control group.
The most recent meta-analyses have graphed the results as Forest plots to help us compare all the different styles of trials. If you have had enough of the science by now please skip the next three images to where we talk about what actually happens in the clinic.
Forest Plot 1
When all the qualifying trials that examine the effect of acupuncture at time of embryo transfer (compared to all the different control types including sham needling) are plotted, we can see there is a trend to improved outcomes with acupuncture treatment.
Zheng CH et al, doi:10.1155/2012/543924
Forest Plot 2
When the same sort of analysis compares trials of patients having acupuncture on day of embryo transfer with a control group who did not have sham acupuncture, the difference is even more obvious.
Zheng CH et al, doi:10.1155/2012/543924
Forest plot 3
And when we examine the pregnancy rate in the trials that did acupuncture during the whole IVF cycle (not just at embryo transfer) compared to usual care, the trend toward favouring acupuncture treatment is stronger again.
Zheng CH et al, doi:10.1155/2012/543924
Now lets go back to the clinic, to look more closely at what actually happens there ….
What does embryo transfer acupuncture refer to?
Embryo transfer acupuncture is usually two treatments, one applied before the transfer and one after. The timing depends on a number of factors but is often close to the time of the actual transfer procedure. The acupuncture points chosen include those shown in clinical trials to have a beneficial effect on outcomes for some IVF patients.
Before the transfer, acupuncture points on the abdomen as well as points on the limbs, the head and the ear are used. These are points that were used in clinical trials, and in some cases extra points chosen according to Chinese medicine diagnosis and symptoms will be added.
After the transfer, acupuncture points on the head, ear and limbs but not on the abdomen, are used. As before, points are chosen according to Chinese medicine diagnosis and symptoms as well as research trial protocols.
But how does acupuncture increase IVF success rates in some patients?
Well, we don’t really know yet ….. But we do have some clues as to how it might be working …….
Here’s what we do know ……..
- implantation of embryos is negatively affected by stress, and auto-immune factors
- stress can reduce IVF success rates
- fertility is compromised if stress hormones are elevated
For all references, please click here.
And we also know that ……..
- acupuncture improves T- cell and cytokine levels
- and increases levels of endogenous opioids, such as endorphins, encephalins, and serotonin.
- and reduces cortisol and adrenalin levels
And makes you feel very relaxed.
For all references please click here.
A “relaxed” uterus might help too…….
Uterine contractions after embryo transfer appear to reduce implantation and pregnancy rates. Acupuncture settles the body and the mind, and while we don’t know if it reduces uterine contractions most women report feeling more comfort and ease in the abdomen after acupuncture.
Renato Fanchin et al, Human Reproduction vol.13 no.7 pp.1968–1974, 1998
And “Warming the womb”……..
In traditional Chinese medicine texts, infertility was sometimes referred to as a “cold womb”.
The aim of Chinese Medicine treatment at this time (and later) is to encourage the flow of “Qi and Blood” to “warm the uterus” and nourish the embryo. (While keeping the abdomen warm is important, it is also important not to over heat this area in early pregnancy).
The research, and our own experience, tells us that acupuncture treatment of IVF patients can often be beneficial, but confers the greatest benefit to women who’s chance of success with IVF is 30% or less.
This includes women over 37 and those who may have done several IVF cycles that have not been successful.
Final recommnedations for IVF patients?
- The evidence indicates it may be advisable for women to have acupuncture during the stimulation phase of the IVF cycle.
- IVF patients should also consider having acupuncture on the day of embryo transfer, particularly if they fall into the category where the expected success rate is not so high.
- It can be useful for women to have acupuncture treatment for 2 to 3 menstrual cycles before their IVF cycle, or before a frozen embryo cycle to improve the uterine lining (you can read more about how this can help implantation here).
But if your IVF specialist has told you you have a good chance of success, then you don’t need to think about having acupuncture. Unless you are feeling pretty stressed, or you are planning a frozen embryo cycle.
Good luck and may you achieve your dream ……