Some good reasons why you should think about having acupuncture before and during your IVF cycle

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 …..

young happy woman croppedIf you are young, and healthy and doing IVF only because of male factor or blocked tubes, acupuncture might not benefit you as much as it could other IVF patients.

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

 

 

 

The evidence for acupuncture during IVF

Evidence for acupuncture & 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 ……….

 

 

 

Weighing up the evidence

Weighing up the evidence

There is a lot to think about and analyse  ……

 

 

 

Clinical trials published in medical journals

Clinical trials published in medical journals

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.

 

 

 

Acupuncture on the day of embryo transfer

Acupuncture on the day of embryo transfer

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.

 

 

 

Clinical pregnancy

Clinical pregnancy

The trials examined the effect of acupuncture on the outcome of embryo transfer, measured as one or more of these end points;

  • implantation
  • clinical pregnancy
  • ongoing pregnancy
  • or live birth

 

 

Day 3 and Day 5 embryos

Day 3 and Day 5 embryos

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).

 

 

 

Laser treatment for acupuncture points

Laser treatment of acupuncture points

Most trials used traditional acupuncture needles in the treatment group, but some used laser ….

 

 

 

Electro-stimulation of acupuncture points

Electro-stimulation of acupuncture points

Some used electro-stimulation on acupuncture points instead of needles

 

 

 

Control group provides the comparison

Control groups provide a comparison

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.

 

 

 

Sham acupuncture needles

Sham acupuncture needles

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.

 

 

 

 

Acupuncture on the foot

Acupuncture on the foot

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.

 

 

 

 

Keep Calm

 

 

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?

Medical journal reports on IVF and acupuncture trials

Medical journal reports on IVF and acupuncture trials

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.

Meta analyses examining acupuncture and IVF trials

Meta analyses examining acupuncture and IVF trials

A Metaanalysis 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?

Meta analyses of IVF and acupuncture trials

Meta analyses of IVF and acupuncture trials

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.

 

 

 

Forest Plots

Forest Plots

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

Acupuncture and embryo transfer

Acupuncture and embryo transfer trials – all controls

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

Trials comparing acupuncture to no intervention.

Trials comparing acupuncture to no intervention.

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

Trials which examined acupuncture during whole IVF cycle.

Trials which did acupuncture during whole IVF cycle.

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

 

 

 

Acupuncture on the day of embryo transfer

Acupuncture on the day of embryo transfer

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.

 

 

 

Acupuncture before embryo transfer

Acupuncture before embryo transfer

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.

 

 

 

Acupuncture after embryo transfer

Acupuncture after embryo transfer

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.

 

 

 

How does it work?

How does it work?

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 …….

 

 

 

Stress negatively affects fertility

Stress negatively affects fertility

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.

 

 

 

Acupuncture creates a feeling of relaxation

Acupuncture creates a feeling of relaxation

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.

 

 

 

uterine contractions and preg rate

Increased numbers of contractions is associated with reduced implantation.

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

 

 

 

Keeping the abdomen warm with gentle heat

Keeping the abdomen warm with mild heat

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).

 

 

 

Conclusions?

Conclusions?

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 ……