This article is a response to recently published research (Journal of American Medical Association 2018) on outcomes for IVF patients having acupuncture.
One of our practitioners (Amy Forth) discusses this study done by personnel working at Western Sydney University and various IVF clinics in Australia and New Zealand into the effectiveness of acupuncture in relation to IVF success.
This trial is an important one that we can learn from, however its results contradict some of the other IVF and acupuncture studies published in recent years.
What this recent study really confirms is that DOSE matters!
What did the study in JAMA measure?
In a nutshell, the study measured the effectiveness of three acupuncture treatments over two days. One treatment was given a few days before embryo transfer (ET) and two more on the same day as ET. Effectiveness was measured by live birth rates for the group given acupuncture in comparison to a group that was given sham acupuncture (whereby a sham acupuncture needle appears to be inserted but in fact only pricks the skin).
The Acupuncture and IVF journey
ET acupuncture treatments became very popular from 2003 onwards, after the Paulus Study 2002 showed promising results in the use of acupuncture to increase pregnancy rates. In that study, clinical pregnancy rates were 42.5% in the acupuncture group, whereas pregnancy rate was only 26.3% in the control group.
The Paulus finding, and others that followed, were a catalyst for clinics like the Acupuncture Pregnancy Clinic (originally the Acupuncture IVF Support clinic) to offer support to IVF patients, however acupuncture on the day of embryo transfer was never all that was recommended. Our clinics and others like us, of course did, and still do, offer acupuncture on the day of embryo transfer and use treatment protocols based on the original research. However, the clinics also followed other IVF and acupuncture studies in which it had became clear that what Traditional Chinese Medicine had to offer IVF patients was so much more than ET acupuncture. As new research continued to emerge, The Acupuncture Pregnancy Clinic treatments and recommendations evolved, alongside the wealth of experience we had in traditional approaches to gynecology and fertility, learned from specialists in hospitals in China. The benefit of a higher dose of acupuncture quickly became apparent to practitioners and their patients, as the clinic began to recommend that patients focus on treatment before and during the stimulating phase of the IVF cycle.
Is acupuncture a magic bullet?
As this recent JAMA study found…well No.
Acupuncture, quite like IVF, is far from a magic bullet. It is however a therapy that influences physiology over time. Usually a course of treatment is required for noticeable effect.
In fact, based on more current research, we could say the Paulus 2002 study was unusual in that it showed an effect of just two acupuncture treatments, when most acupuncture research, outside of the IVF field, would typically examine the effect of a course of acupuncture treatment that ranges between approximately 8-16 treatments. This is because the dose of the acupuncture matters.
Clinical Practice suggests that the dose of acupuncture matters.
What we see clinically, is that to help our patients and really bring about change – dose really matters. And of course, it does. Would you take three pills out of a course of medication that usually requires twelve pills and expect it to have significant and lasting effects? Acupuncture is no different. It’s NOT a magic bullet but a therapy that needs to be administered in the correct dose for the presenting condition and is unlikely to be effective if it is not. This is supported by a lot of acupuncture research in diverse areas.
So how do we know what the correct dose is?
A quick look at the Meta-analyses done examining acupuncture done only at Embryo transfer time (ET acupuncture) and those done examining acupuncture done before and during the IVF cycle (IVF Acupuncture) shows that while results are mixed for the former, they are consistently showing a benefit for the latter.
The trials that were included in the IVF Acupuncture analyses used between 9 and 12 treatments. Dose has also been a consideration in some of the trials looking at PCOS patients (16 – 20 treatments) and dysmenorrhoea patients (more than 4 treatments).
One review that looked at whole systems Chinese Medicine, is particularly relevant to what happens in our clinics.
Such a whole systems approach is the approach we take at the Acupuncture Pregnancy clinics. We might include Chinese herbs (before the IVF cycle) and may also include lifestyle advice. The review included more than 1000 IVF cycles and found that there was a significant benefit to the group that included Chinese medicine.
What about this recent study?
As participants in the JAMA study were only given three acupuncture treatments, it falls short of the dose needed to have a significant therapeutic effect. While some early ET and acupuncture research (10 years or more ago) did find an effect with 2-3 treatments, this latest study which was much larger, concluded that the effect was not significant and perhaps put to bed the idea that this small dose does have a significant effect on IVF live birth rates.
It is important we don’t accept at face value the media headlines announcing that acupuncture for IVF and fertility does not have a significant effect. The true conclusion of this study is that just three treatments may not significantly increase IVF success to such an extent that it increases live birth rate.
Where do we go from here?
It is time to re-examine what acupuncture dose means and how it works (or doesn’t work). Although some of acupuncture’s effects are quick (eg an acute sprained ankle), more commonly they are cumulative in order to make significant and lasting changes.
In summary – acupuncture is a therapy that works via administering a therapeutic dose. As the JAMA study highlights, acupuncture is not a magic bullet. It is however a very valuable therapy that has an effect when administered in the correct way and in the correct dose.