Answers to every conceivable question…
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About acupuncture Q&A
What do the needles look like?
Acupuncture needles are made of high grade stainless steel and are extremely fine. Indeed many acupuncture needles can fit down the hollow section of a typical hypodermic needle used to take blood or give injections.
Are the needles sterile?
All the needles are sterile, come in sterile packaging and are disposed of safely after a single use.
Does it hurt?
Insertion of acupuncture needles is done with an insertion tube and is usually painless. The depth of insertion is quite shallow. Sometimes a sensation of a dull heavy feeling, or a tingle is felt around the point.
How long are needles left in for?
Needles stay in for 20 – 25 minutes.
How will I feel?
Most people find that the acupuncture treatment is very pleasant and invokes a deeply relaxed state. It is not unusual for patients to fall asleep during their session. Some people feel a little drowsy after acupuncture but this is transient and is usually remedied by eating and drinking something.
How does acupuncture work in general?
Very fine stainless steel needles are inserted in acupuncture points located along channels (or meridians) and produce specific reactions in the related organ system. In acupuncture terms, the needle influences the flow or movement of qi and blood.
Research shows us that acupuncture increases endorphin output (which accounts for the relaxation patients feel during and after treatment) but clearly there are other mechanisms of action, not yet well understood, which bring about therapeutic benefit.
Sometimes leads are attached to the needles and a small electrical current is passed through them. The sensation may be barely perceptible but the needle is made to vibrate gently and stimulate the underlying blood vessels and tissues. The treatments designed to increase blood flow to the uterus and ovaries often use this approach.
Sometimes laser is used instead of an acupuncture needle. In this case it is the laser beam which stimulates the acupuncture point rather than a needle.
Who will administer the acupuncture?
The acupuncturists who work in the acupuncture IVF support clinic are all hand picked, and trained in this specialty. They are all graduates of universities in Australia, hold a degree in Chinese medicine and are accredited by national professional associations.
These practitioners have a special interest in reproductive medicine, do extra training in this field and attend regular upgrading and mentoring sessions.
I would like to have acupuncture during my IVF cycle, but the thought of more needles is not a pleasant one. Is there any alternative?
Yes, one group of IVF researchers working in the United States found that when they treated women with laser acupuncture (no needles at all), they got a higher implantation rate than with traditional acupuncture. Whether the other benefits of acupuncture (anxiety reduction, and regulation of stress hormones) occur with laser acupuncture, has not yet been tested. We have recently started using laser for its photobiomodulation effects on rejuvenating tissue function.
Should I have acupuncture before or after my embryo transfer, or both?
Most of the clinical trials that demonstrated a significantly increased chance of pregnancy administered 2 acupuncture treatments, one before and one after the embryo transfer. However one of the trials did only one treatment and still showed a positive effect on pregnancy rates. If it is convenient for you to attend the acupuncture clinic both before and after the embryo transfer then that is advisable. However if time or scheduling pressures prevent that then one treatment close to the time of transfer should suffice.
What if my embryo transfer is at 7am ?
The acupuncture IVF support clinic opens at 7.30am (when the building’s security system opens the front doors). So you would come for an acupuncture treatment straight after the transfer. If you have been having acupuncture throughout your IVF cycle it is likely you will have a treatment scheduled the day before transfer as well. If you have not had acupuncture throughout your IVF cycle, you might like to schedule a treatment the day before if your transfer is very early in the morning.
I am having PGD, so my transfer will be later in the day. When can I have acupuncture?
PGD (pre implantation genetic diagnosis) While most fresh and frozen embryo transfers are carried out early in the day, those embryos which are going to be analysed for genetic abnormalities will generally not be chosen til later in the day when the results come back from the lab.
Currently the acupuncture IVF support clinic is operating between 7.30am and 2pm. If your transfer is after these hours please call us (giving us as much notice as possible) and we shall try and accommodate your needs.
Why is it important to have the acupuncture treatments close to the time and place of embryo transfer?
We don’t yet know what exactly is the mechanism behind the observed increase in pregnancy rates of some of the research trials, so it is important at this stage to replicate the trial conditions. In the clinical trials which showed a beneficial effect of acupuncture on embryo transfer day, the treatment was given just before and just after the transfer.
In the only trial to show a negative effect of acupuncture (ie the pregnancy rate of the women who had acupuncture was lower than that of the women who did not) the patients had to drive across town from the IVF clinic to the acupuncture clinic (reference).
If I have more than one embryo transferred and I have acupuncture before and after the transfer, am I more likely to have a multiple pregnancy?
No, in fact in the United States, where it is common for more than one embryo to be transferred, researchers noticed that while the pregnancy rate increased, the percentage of multiples was lower in acupuncture groups than in control groups (reference). We are not sure how to explain this observation, but since the human uterus is designed to gestate one infant at a time acupuncture seemed to support what nature intended.
I don’t know which of all the different acupuncture treatment options to choose?
If you are under 35 and you are well and healthy and not unduly stressed, and do not have a history of failed IVF cycles, then you might choose to have acupuncture just on the day of embryo transfer to increase the chance of embryo implantation.
If you would like a bit of extra support during the cycle then come once or twice a week in the month before egg collection. Acupuncture during this time regulates the stress hormones which may have an impact on follicle development and implantation of the embryo (reference).
If you have had previous failed IVF cycles then think about doing a few months of preparation with traditional Chinese medicine (acupuncture and herbs and lifestyle) at one of the recommended specialist fertility clinics before you embark on another IVF cycle. It is often the case that “preparing the soil before planting the seed” can beneficially affect outcomes.
Is it a good idea to have acupuncture after egg collection?
Yes, many IVF patients have found that it is very useful to have acupuncture following the egg collection. IVF side effects are often more marked after this procedure, because even though the eggs have been removed the hormone levels are still very high.
The empty follicles often fill up again with fluid, so the feeling of abdomen fullness may persist. Some women experience cramping in the abdomen for a few days following egg collection; this tends to quickly subside with acupuncture treatment.
Acupuncture also helps any ovary and abdomen swelling to subside, and by reducing inflammation and tissue trauma helps to prepare a more conducive environment for the arrival of an embryo in a few days.
How does acupuncture help relieve side effects?
One of the things you hear a lot about in acupuncture circles is qi and blood flow. One of the mechanisms behind the effectiveness of acupuncture is its capacity to promote the circulation of blood and fluids which has the effect of reducing tissue swelling and inflammation. And movement of the qi reduces pain and discomfort. Thus IVF side effects like abdomen pain and swelling, headaches and breast soreness can be quickly relieved. Regulating the movement of qi levels out moods swings and reduces fatigue.
How does acupuncture work to increase pregnancy rates in IVF patients?
This is something we want to discover too. Many doctors think that the acupuncture performed at the time of transfer reduces any uterine contractions which might cause an embryo to be expelled or inhibit an embryo from successfully implanting. Some studies support this theory but others do not. The acupuncture points used after the embryo transfer are points which we know have a moderating effect on the immune system, and this may prevent rejection of embryos in some women. It may be also be the case that a certain type of patient benefits from acupuncture and others don’t. This would explain the variability in the trial results to date. More research is needed to determine the mechanism at work.
Other preliminary studies have shown that a series of acupuncture treatments in the weeks before egg collection, have a beneficial regulatory effect on the serum levels of stress hormones of women taking IVF drugs. We don’t yet know whether the beneficial impact is on follicle development or on embryo implantation, but women who received acupuncture in these trials had greater pregnancy rates than those who did not (reference).
Will you be doing any research at the acupuncture IVF support clinic to determine how acupuncture increases IVF success rates?
It is very important to us to not only provide a service which might improve the experience and outcome of IVF patients but also to try and find out exactly how this is achieved.
Collaborations with universities and research institutions are underway. Clinical trials are planned for 2009.
My IVF specialist says my problem is poor quality eggs, can acupuncture help this?
When your specialist talks about poor quality eggs they are usually referring to the condition of the chromosomal or mitochondrial DNA. In women in their late thirties or beyond, this tends to show the effects of many years of accumulated damage. Small defects in the chromosomal DNA can lead to an increased chance of producing an unviable embryo with abnormal chromosomes. Defects in the mitochondrial DNA can lead to inadequate metabolic energy, which might compromise the survival and growth of the embryo in its first few days.
There is little acupuncture can do in the case of DNA damage related to age. However, we do know that acupuncture increases blood flow to the ovaries, thereby enhancing nourishment of the developing follicle and appears to increase responsiveness to IVF drugs (reference).
There is some evidence that mitochondrial function can be improved with antioxidants and Chinese herbs.
In terms of enhancing ovarian responsiveness (or recovery and resilience after repeated IVF cycles) you might like to consider embarking on a more comprehensive treatment programme before your next IVF cycle which includes traditional Chinese medicine diagnosis with the use of acupuncture, chinese herbs and relevant lifestyle changes.
I have responded poorly to the IVF medication in my last 3 cycles, and produced few eggs. Can acupuncture help me?
Possibly. One group of researchers found that it was the IVF poor responders who gained the greatest benefit from the acupuncture administered in the month before egg collection (reference).
The last time I did IVF my ovaries were overstimulated and my cycle was cancelled. Could acupuncture prevent this happening in future IVF cycles?
One trial found that acupuncture given during an IVF cycle reduced the incidence of ovarian hyperstimulation syndrome (OHSS). Most patients who have acupuncture regularly during the IVF cycle find that they experience less abdominal swelling and discomfort.
I have been diagnosed with polycystic ovarian syndrome (PCOS). Should I have acupuncture on the day of transfer and/or during my IVF cycle?
Once you reach the day of embryo transfer your situation is no different from any other IVF patient’s, so in order to increase chance of successful embryo implantation acupuncture is advised.
During the stimulation phase of IVF you may be slightly more at risk of ovarian hyperstimulation.
Some women with PCOS produce many eggs but this does not necessarily translate into many viable embryos. If you have had repeated failed cycles of IVF you could consider doing a comprehensive programme of traditional Chinese medicine and lifestyle factors for several months as a preparation for any future cycles or as an alternative to IVF.
I have been unable to conceive because of endometriosis. Is acupuncture appropriate for me?
In terms of acupuncture treatment during your IVF cycle, your case would be treated no differently to anyone else’s. To encourage good response to the IVF drugs and to reduce side effects we would recommend that you have acupuncture in the 4 weeks before egg collection, and then again on the day of embryo transfer.
If repeated IVF cycles are not successful then an alternative approach to combating the endometriosis would be a useful thing to try. Chinese medicine, in particular Chinese herbal medicine, has a strong history of effective treatment in this area.
Will acupuncture help me respond better in an IVF cycle if I have low ovarian reserve, high FSH or a diagnosis of premature menopause?
Chances are your IVF specialist has told you that you are not the best candidate for IVF but if you decide to try a cycle or two then including acupuncture might make the IVF experience more pleasant and may increase the responsiveness of the ovaries but it is hard to say whether it will lead to an increased likelihood of pregnancy. If IVF fails then one option is to try a longer term strategy with a comprehensive treatment plan over several months. In some, but not all cases of low ovarian reserve and high FSH good results can be achieved with such an approach which includes acupuncture, Chinese herbs and lifestyle changes.
I am 45 years of age. Will acupuncture help IVF produce better results for me?
Sadly, no. Few viable pregnancies occur at this age and those IVF successes at age 45 and beyond that we hear about in the celebrity pages are usually the product of donor eggs.
Some women, particularly those who’s mothers and female relatives had babies late in life, have ovaries with more longevity than the average. These women will often succeed in having a baby in their forties without the help of IVF.
Most reputable IVF clinics will tell you that once you reach 43, providing your tubes are OK and the sperm are in good shape, that you have the same or better chance of falling pregnant with the “at home” methods as you do with IVF.
When should I look for an alternative to IVF in my quest for treatment for infertility?
This is a question for you and your IVF specialist to discuss. Most reputable assisted reproduction clinics will counsel you to discontinue IVF treatment if you have completed 3 cycles and had a poor response each time (meaning that there have been few eggs or embryos produced). In this case, and if you have functional fallopian tubes,it might be appropriate to consider another approach.
The IVF specialist says it doesn’t matter that my sperm are mostly the wrong shape and cant swim well or fertilise the egg, because the embryologist will choose a sperm and fertilise the egg using ICSI. So why should I have acupuncture?
There are a number of IVF clinics that use intracytoplasmic sperm injection (ICSI) routinely now, dispensing with any normal sperm fertilization at all. However some scientists feel that letting the most vigorous sperm in the Petri dish fertilise the egg, or letting the egg choose a sperm, preserves the last vestige of natural selection that is left in this brave new world of reproductive technology.
There is some evidence that babies born as a result of ICSI have a slightly higher incidence of certain birth defects. So if you can improve your sperm function with lifestyle changes and acupuncture (and often you can) then it is well worth the 3 months preparation time (reference).
Laboratory analysis shows that my semen contains virtually no sperm at all. My specialist tells me I must have a biopsy taken from one of my testicles to see if they can find any sperm to be used in an IVF/ICSI cycle. Can acupuncture help me avoid a biopsy?
Possibly. One clinical trial collected a group of men just like yourself and gave them 10 acupuncture treatments over several weeks. Half of the men thus treated produced sperm in their ejaculate. (reference)
While there is no guarantee you would be in the half that appear to respond favourably, you may feel it is worth trying a course of acupuncture using the treatment protocols used in the clinical trial in the hope of avoiding a biopsy.
I find that the pressure of trying to produce a sample on demand at the IVF clinic after my wife has had her eggs collected is enough to stop anything working. Can acupuncture help?
You are certainly not alone. The pressure to perform at a critical time can undo many a man. Sometimes a sperm sample will be collected and frozen ahead of time in case this happens. Some men find that acupuncture before going to the clinic on egg collection day is useful in relieving anxiety and increasing blood supply to the genital organs.
How can I support my wife going through IVF?
Drive her to her appointments and back. Give her neck rubs and massages. Make her chicken soup!
Why do IVF patients need a dedicated acupuncture clinic?
Women doing IVF often need to be able to schedule or change their acupuncture appointments at short notice.
Ovaries are very individual things – the way they will respond to the IVF drugs which stimulate follicles to grow varies from person to person and from cycle to cycle. So the day on which the eggs will be collected can not be determined accurately in advance. Once the eggs are collected, the day an embryo will be transferred can be narrowed down a bit, but not precisely. If there are few embryos, or they do not develop as rapidly as the embryologist might expect, then a transfer might occur on the third day after egg collection. Or if there are plenty of embryos and if they develop well then transfer will likely happen on the 5th day after egg collection. And sometimes schedules at the IVF clinic don’t always go to plan, and your transfer time might be delayed.
The Acupuncture Pregnancy clinic will try to accommodate the particular needs of IVF patients.
Why should I come to the acupuncture IVF support clinic instead of seeing my own acupuncturist whom I’ve been seeing for years?
You shouldn’t – if you are an IVF patient you should see your own acupuncturist if he or she is available at the right times to see you during your IVF cycle and is close to the IVF clinic, and is qualified to provide these treatments. Alternatively if he/she is unable to see you at the right time, you can have treatment at the Acupuncture Pregnancy clinic, then continue to see your own acupuncturist after the embryo transfer.
What if I want to keep having acupuncture in the future after my IVF cycle?
The Acupuncture Pregnancy clinic is dedicated to offering treatment to women or couples who are preparing to conceive, having difficulty conceiving or who are embarking on an IVF cycle. We also see women throughout their pregnancies. If you are interested in having acupuncture for other health related issues please contact the national association for a recommendation to an acupuncturist close to you.
Why would my IVF specialist recommend this clinic?
By recommending the Acupuncture Pregnancy clinic your IVF specialist knows you will receive the treatment based not only on the experience of Traditional Chinese medicine, but also on the findings of clinical trials. And your specialist will know that the practitioners staffing the clinic are accredited, insured and experienced in these protocols.
Should I change my diet when trying to conceive or during the IVF cycle?
When you are taking the IVF medication your body, especially your liver, is experiencing additional physiological demands as it deals with breaking down the drugs and high levels of estrogen. Therefore it is a good idea to give the liver every bit of help it can get at this time. You can do this by avoiding alcohol and rich foods. Of course you should aim to have as balanced a diet as possible at the same time, with adequate protein and plenty of fresh fruits and vegetables.
In terms of overall nourishment of the eggs in the follicles, it is advisable to maximize your nutrition (and your partners) at least 3 or 4 months before you hope to be creating a new baby. Some clinics run formal preconception care programmes which advise strict dietary guidelines and supplementation with vitamins, minerals and antioxidants. The Chinese medicine approach is rather more eclectic and gears dietary advice to the individual. A wide variety of foods which are nutritious, fresh, colourful and pleasing to the palate and eaten in an unhurried manner are the basis of a good diet in Chinese medicine. We know from many studies that organic foods will provide better levels of nutrients, while being free from pesticides and other chemicals.
I have been prescribed herbs by my herbalist. Is it OK to take these during my IVF cycle?
Since we don’t yet know much about the interactions between herbs and IVF medications it is not advisable to combine them. Drug interactions can also occur with over the counter pharmacy products you might be taking – always check before you take anything else while you are taking IVF medications.
What about my husband taking herbs?
If your husband has been prescribed herbs by a qualified herbalist who knows that he is attending an IVF clinic, then there should be no reason for him to discontinue his herbs.
What about nutritional supplements while I am on the IVF drugs?
If your supplements are vitamins and minerals and antioxidants then it is a good idea to continue them. Some supplements also contain herbs and the same proviso would apply to these as to those mentioned above.