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

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

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 likely one of the mechanisms whereby acupuncture can help to improve IVF outcomes.

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ACUPUNCTURE, STRESS AND FERTILITY; Auricular Acupressure Reduces Anxiety Levels and Improves Outcomes of in Vitro Fertilization

sr_nature-228x300Fan Qu et al, Sci Rep Nature, (2014), 4, Article number: 5028

Scientific Reports, Nature Publishing

300 women who were doing IVF due to blocked tubes, were randomised into groups that received stimulation to auricular acupuncture points (small seeds were taped onto 3 points related to nervous system or ovary and uterus function) or to sham points or no treatment. The women in the active treatment group had a markedly higher pregnancy rate than did those in the sham or control groups. Additionally they reported less stress and anxiety.

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Perceptions among infertile couples of lifestyle behaviors and in vitro fertilization (IVF) success

Hawkins LK et al, J Assist Repro Genet (2014) 31: 255-260.
Journal of Assisted Reproduction and Genetics

Acupuncture was one of several factors investigated in the surveys that 200 IVF patients in the USA completed recently.
63% of them considered that acupuncture was helpful for women having IVF.

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Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial

MacPherson H et al, DOI: 10.1371/journal.pmed.1001518
PLOS Medicine

Women (and men) who are preparing themselves to have a baby, often wish to avoid taking medication, including antidepressants. Recognising such an interest in non-pharmacological therapies, the investigators in this trial examined the effect of acupuncture and counseling on patients with depression. They found that ten sessions of acupuncture alongside usual care, showed a significant reduction of depression 3 months later compared to those who did not have acupuncture. They found that counseling added a similar benefit.

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Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study

Lynch CD et al, Hum. Reprod. (2014) 29 (5): 1067-1075. Human Reproduction
When 400 women who were trying to conceive offered samples of saliva for stress marker analysis (alpha amylase) over a period of a year, it was found that those with the highest levels were twice as likely as those with the lowest levels to experience infertility. It is not clear exactly how stress reduces fertility but this study was able to show that it was not reduced sexual intercourse or interference with ovulation. However it is possible that there may be stress induced alterations in gamete transport or the development of an autoimmune state unfavourable for implantation. Higher levels of alpha amylase occur when there is elevated adrenalin in the blood stream.


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Acupuncture for the Mental and Emotional Health of Women Undergoing IVF Treatment: A Comprehensive Review

 Grant LE, Cochrane S, AJACM 2014, vol 9 Issue 1, pg 5
Australian Journal of Acupuncture and Chinese medicine

This comprehensive review indicates the acupuncture helps to reduce the anxiety and stress experienced by IVF patients and improves the way that IVF cycles are managed, and that better outcomes may be a result.

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Effect of Acupuncture on Symptoms of Anxiety in Women Undergoing In Vitro Fertilisation

Isoyama D et al, Acupunct Med. 2012 Jun;30(2):85-8. Acupuncture in Medicine (BMJ)
Using acupuncture points that specifically reduce stress, significantly lowered anxiety levels of women undergoing IVF (as measured on the Hamilton Anxiety Rating Scale) when they were treated once a week before and during the IVF cycle. Other women who were also treated with acupuncture once a week but with non acupuncture points did not experience the same benefit.  


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The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer

Friedler S et al, Fertility and Sterility 2011, Vol 95, Issue 6 , Pg 2127 Fertility and Sterility 
Dr. Friedler and colleagues tracked 219 women undergoing IVF treatment and, over a period of a year, treated half of them to a medical clown's 15-minute routine of jokes, magic tricks and other clowning immediately after their embryos were implanted. Those women who's stress was relieved with a good laugh after their transfer fell pregnant more often than did the control group.


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Stress reduces conception probabilities across the fertile window: evidence in support of relaxation.

Buck Louis GM et al, Fertil Steril. 2011, 95, 7, pg 2184 - 2189 Fertility and Sterility
While this study did not involve IVF patients its conclusions nevertheless have relevance to women trying to fall pregnant with IVF. The study showed a clear relationship with higher stress levels and reduced conception rates. This may be one of the ways that acupuncture, which reduces stress hormones, can improve fertility.


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The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: A pilot study

Balk J et al, Complement Ther Clin Pract. 2010 Aug;16(3):154-7). Complementary Therapies in Clinical Practice
These investigators aimed to determine if acupuncture affects the levels of perceived stress at the time of embryo transfer, and whether either acupuncture or changes in stress levels play a role in the success rate in IVF.  The patients who received acupuncture in this study had both higher rates of pregnancy, and lower levels of stress both before and after embryo transfer. They postulated that reducing stress at the time of embryo transfer could result in less vasoconstriction and improved uterine receptivity.


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Mucuna pruriens Reduces Stress and Improves the Quality of Semen in Infertile Men

Shukla K et al, eCAM, Vol 7 (2010), Issue 1, Pages 137-144 Evidence-Based Complementary and Alternative Medicine
This study examined 120 men attending an infertility clinic, and after measurement of cortisol levels and completion of the State Anxiety Inventory test, half of them were found to be suffering significant stress. The men who were stressed had lower sperm counts and motility and reduced seminal plasma glutathione. Also antioxidant levels (ascorbic acid and superoxide dismutase) were reduced. Using a chinese herb (Li Dou) over 3 months improved sperm count and motility in this group of men and at the same time the levels of ascorbic acid, SOD, glutathione were restored and the men felt less stressed. They concluded that this herb not only reactivates the anti-oxidant defense system of infertile men but it also helps in the management of stress. These authors have also found similar beneficial effects on semen with another herb which is used to manage stress - Withania Somnifera.


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