ACUPUNCTURE, HERBS, IVF and PREGNANCY RATE

The collection of papers in this section includes some that examined the role of acupuncture at the time of embryo transfer in an IVF cycle.

  • Acupuncture and IVF; The largest randomised controlled trials in this area found that there was no benefit from  acupuncture on the day of transfer, (and in some cases with an additional treatment before the day of transfer) compared with sham acupuncture.  Two smaller but well designed RCTs examined the effect of administering acupuncture throughout the stimulation phase as well as at, or near embryo transfer on IVF patients with a past history of failed cycles or a poor prognosis. Both of these found that the acupuncture groups pregnancy rate was significantly higher than the control groups. See also Meta-analyses.

Other publications in this section include studies on the impact of acupuncture or chinese herbs on low ovarian reserve, intrauterine insemination, natural fertility, endometrial receptivity and frozen embryo transfer.

  • Low ovarian reserve; Two studies examining electro-acupuncture or TEAS’s impact on responsiveness of ovaries with low reserve reported encouraging findings, as did one where herbal medicine’s effect on ovarian reserve was examined but we await larger randomised controlled trials before firm conclusions can be drawn as to therapeutic efficacy.
  • Endometrial receptivity/FET; Pregnancy rates and endometrium quality were examined in 2 randomised controlled trials that used well known Chinese herbal formulas. In another couple of randomised controlled trials the effect of TEAS acupuncture point stimulation on endometrial receptivity and pregnancy rates was examined in women preparing for frozen or fresh embryo transfers. Promising results are reported in all these trials, and we look forward to further RCTs.
  • Intrauterine insemination; Only one study has been published as far as we know on the effect of Chinese Medicine treatment on the outcomes of Intrauterine insemination. A small controlled but non randomised trial found that the group of women who used Chinese medicine had a markedly higher pregnancy and live birth rate. As with the above, larger RCTs are required before definitive conclusions can be reached.
  • Natural fertility; The logistics of recruitment and funding mean that very few studies of the effect of Chinese medicine on fertility have been published. One small randomised controlled trial found that Chinese medicine treatment halved the time to conception compared to a control group. If this sort of trial can be mounted with larger numbers we may be able to make some claims about the effect of Chinese medicine on fertility.

Acupuncture for Depression: A Systematic Review and Meta-Analysis

Armour M et al J. Clin. Med. 2019, 8(8), 1140

Journal of Clinical Medicine

The authors of this meta-analysis scrutinised more than 1000 reports on the effect of acupuncture on depression in medical journals, and by applying strict clinical trial standards reduced the number of reports down to 29 for analysis. These reports included more than 2000 patients. Their analysis indicates that acupuncture can make a useful contribution to the management of depression, either on its own or alongside medication.  This report did not focus particularly on women, or on women who were pregnant, post partum or infertile. However its findings could find application in these areas where depression has been diagnosed. Read More

Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms − a randomised controlled study

Bergdahl L et al, Eur Jn Int Med, Vol 16, 2017,  15-21
European Journal of Integrative Medicine

Ear Acupuncture was seen to reduce anxiety and depression in this study on 57 participants with insomnia disorder and long term use of hypnotic drugs. 74% of them managed to discontinue their hypnotic drug consumption post-treatment. Future studies could examine whether ear acupuncture could be useful for women suffering anxiety, depression or insomnia related to infertility.

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ACUPUNCTURE and SPERM

There have been a number of randomised controlled trials and pilot studies that have looked at the effect of acupuncture or electro stimulation of acupuncture points, on sperm quality in men with low counts, poor motility and morphology or a varicocele, most with favourable results. Because these trials all had different methodology and measured different outcomes, it is difficult to pool results in a meta-analysis and therefore to make therapeutic recommendations at this stage.

Effects and mechanism of action of transcutaneous electrical acupuncture point stimulation in patients with abnormal semen parameters

Yan Yu et al, Acup Med BMJ, 2019

 

Acupuncture in Medicine, British Medical Journal

A randomised controlled trial examined the effect of electrical stimulation of acupuncture points (using TEAS), on sperm parameters. They found that low frequency stimulation significantly improved sperm count and motility in men with abnormal semen analysis.

 

 

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ACUPUNCTURE AND EMBRYO TRANSFER – published in Fertility and Sterility

The large majority of small randomised controlled trials that examined the effect of acupuncture on IVF outcomes when administered on the day of embryo transfer, found a positive effect. However some more recent large randomised controlled trials (published in other journals) have not replicated this result, concluding that acupuncture on the day of transfer does not increase live birth rates for IVF patients. The more recent reviews of trials examining more extensive use of acupuncture before and during an IVF cycle indicate a benefit, compared to those where only 2-3 treatments were administered.

ACUPUNCTURE, HERBS AND ENDOMETRIOSIS:

To date there is not a lot of research published on the treatment of endometriosis with Chinese medicine that meets the standard required for us to draw firm conclusions on efficacy. One review has analysed findings from 10 small trials that used acupuncture to treat endometriosis pain, and one randomised controlled trial has examined the use of chinese medicine to prevent recurrence after surgery.

Transcutaneous electrical acupuncture point stimulation improves pregnancy outcomes in patients with recurrent implantation failure undergoing in vitro fertilisation and embryo transfer: a prospective, randomised trial

Zhenhong Shuai et al, Acup Med, 2019, Vol 37 issue 1, 33-39

Acupuncture In Medicine BMJ

Stimulation of acupuncture points on the abdomen and legs with TEAS (transcutaneous electrical acupuncture stimulation) improved implantation and pregnancy outcomes in women who had previous repeated implantation failure, in this randomised trial involving 122 IVF patients.

 

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A Comparison of Stress Levels in Women Undergoing Single Versus Multiple Acupuncture Session Prior to Embryo Transfer

C. Sutton, MD et al, 2015 Fert Stert, Vol 103, Suppl2, Pages e36–e37
Fertility and Sterility
This report is a retrospective study done on 78 women undergoing IVF, who had acupuncture for more than a month prior to, or only on the day of, embryo transfer. A standardised questionnarie (the Perceived Stress Scale) found that women who had acupuncture in the lead up to embryo transfer had significantly lower stress scores than those who had acupuncture on the day of transfer.
This is not a randomised controlled trial, and therefore does not provide sufficient evidence for claims about stress management of IVF patients. However it indicates the way for future trials. And is of particular interest in showing the effect of dose in acupuncture treatments.

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Effect of acustimulation on nausea and vomiting and on hyperemesis in pregnancy: a systematic review of Western and Chinese literature.

Van den Heuvel E et al, 2016 Jan 13;16:13

This review of twenty-nine randomised controlled trials (including 3519 patients) found that there was a significant reduction in nausea and vomiting in pregnancy with the application of various acupuncture techniques, when trials reporting dichotomous data (ie symptoms improved or not) were analysed. 73 % fewer patients had symptoms after treatment compared to those who did not have treatment. However when trials reporting continuous data were analysed this difference between treatment and control groups was not found.

The included studies examined acupressure, acupuncture, auricular acupressure and moxibustion. Treatment duration varied from four to ten days in 25 studies. Four studies continued treatment for two to four weeks. Treatment frequency varied from once a day to once every week.

The authors advised that these findings need to be evaluated in future clinical trials with rigorous design and large sample sizes.

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