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 …..

If you are young, and healthy and doing IVF only because of male factors 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.

Here is all the latest information about Acupuncture and 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

There is a lot to think about and analyze……

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.

Clinical Trials

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

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

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 of acupuncture points

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

Electro-stimulation of acupuncture points

Some used electro-stimulation on acupuncture points instead of needles

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

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

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?

Medical journal reports on IVF and acupuncture trials

A majority 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

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?

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

Some meta-analyses have graphed the results as Forest plots to help us compare different styles of trials.

Zheng CH et al, doi:10.1155/2012/543924

Forest Plot 1

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 in this forest plot there is a small trend to improved outcomes with acupuncture treatment. However when more recent trial data is added, this trend is lost and there does not appear to be any improvement in outcomes when the patient has acupuncture on the day of embryo transfer.

Forest plot 2

Trials which did acupuncture during whole IVF cycle.

When examining the pregnancy rate in the trials that did a number (up to 12) acupuncture treatments before or during the whole IVF cycle (not just at embryo transfer), and compared to usual care, the trend toward favouring acupuncture treatment is stronger.

Now lets go back to the clinic, to look more closely at what actually happens there ….

If you are planning IVF, or doing IVF there are some specific protocols we will apply at certain times of your cycle. But equally important will be the individualised approach that involves asking you about yourself, your situation, your symptoms ….. and using traditional Chinese medicine diagnostic techniques.

Stimulation phase (with FSH)

Electro-acupuncture

During the stimulation phase, we use treatments which aim to increase blood supply to the ovaries and uterus and to relax you.

Embryo Transfer day

On the day of embryo transfer, it is ideal if you are calm and relaxed and can enjoy this special occasion. Having an acupuncture treatment on this day helps you to stay relaxed and receptive.

Waiting for the pregnancy test

Acupuncture during the two week wait can be very useful in helping you to maintain a calm and unstressed demeanor – inside and out.

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 may affect fertility

We don’t really know the full story about how stress might affect fertility but some researchers are looking at these areas ……..

• implantation of embryos may be negatively affected by stress, and immune factors
• fertility may be compromised if stress hormones are elevated

Acupuncture creates a feeling of relaxation

Some early stage research has indicated that ……..

• electro-acupuncture may affect levels of pro and anti inflammatory cytokines
• electro-acupuncture increases levels of endogenous opioids, such as endorphins, enkephalins
• and affects the serotonergic mechanism
• and reduces cortisol  levels

Acupuncture usually makes you feel very relaxed.

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. Patients having acupuncture find it 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.

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?

The research, and our own experience, tells us that acupuncture treatment of IVF patients can often be beneficial, but it appears to confer 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) and those who are feeling stressed.

Final recommendations for IVF patients?

• The evidence indicates that if you are going to use acupuncture it may be advisable for to have it before and during the stimulation phase of the IVF cycle.
• IVF patients may also consider having acupuncture on the day of embryo transfer, particularly if their stress levels are high. Continuing this approach in the two week wait is also helpful for these women.
• It may be useful for women to consider acupuncture treatment in the menstrual cycles before their IVF cycle, or before a frozen embryo cycle to improve the uterine lining.

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..

Good luck and may you achieve your dream ……

We have highly qualified AHPRA-registered Chinese Medicine Practitioners dedicated to reproductive health, women’s health and pregnancy care ready to support you!

Acupuncture Pregnancy Clinic is a national network offering acupuncture and Traditional Chinese Medicine to support fertility, IVF cycles, pregnancy and general reproductive health. Visit us at Westmead, Sydney CBD, Alexandria, Gosford, Melbourne, and Mornington. We also offer naturopathy and nutrition support for fertility, pregnancy and women’s health, and osteopathy at Alexandria.

Author:

Jane Lyttleton