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.

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.

 

Read More

Effectiveness of Acupuncture on Pregnancy Success Rates for Women Undergoing in Vitro Fertilization: A Randomized Controlled Trial

Cayir Y et al,  JAMS, 11(4):224-225 · August 2018

Journal of Acupuncture and Meridian Studies

A randomly selected and controlled trial (RCT) found that acupuncture improved pregnancy rates in women who had acupuncture before and on the day of embryo transfer compared to a similar group of women who did not have acupuncture. This trial did not use sham acupuncture as a control, but rather used “usual care” as a control. This finding is at odds with larger trials using sham acupuncture as a control.

This trial also reported a reduced anxiety level in the women who had acupuncture.

Read More

Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization: a randomized clinical trial

Caroline Smith et al, JAMA, 2018 DOI: 10.1001/jama.2018.5336

Journal of the American Medical Association.

In a large RCT, 848 women at 16 different IVF centres in Australia and New Zealand were given acupuncture (with real or sham needles)  by 80 different acupuncturists. A standardised protocol was delivered on Day 6 of the drug stimulation phase and another before and after the embryo transfer. The data indicated that at this dose of acupuncture, and using these protocol points, there was no significant difference in live births between those who received the real or the sham needles.

The authors admit that ” the lack of frequent treatments was a limitation of our trial” since in real clinical practice acupuncture treatment is individualised with variation in dosing, including more frequent treatment prior to and during the IVF cycle.

They also noted that while a very short course of acupuncture may statistically be no better than sham at improving live birth and pregnancy outcomes, a psycho-social benefit from acupuncture was reported by women undergoing IVF.

Read More

Electroacupuncture for reproductive hormone levels in patients with diminished ovarian reserve: a prospective observational study

Yang Wang et al, 2016, BMJ Acup Med, Vol 34, Issue 5

BMJ Acupuncture in Medicine

This prospective observational study (Level IV) from Beijing examined the effect of electro-acupuncture on women who were diagnosed with poor ovarian reserve, indicated by their baseline FSH level being elevated on Day 2 or 3 of their menstrual cycle, ie between and 11 and 40 mIU/ml.

After 12 weeks of treatment mean FSH levels dropped by nearly a half, a highly significant result. While no firm conclusions can be drawn at this stage, this result indicates that further research is warranted on larger numbers of patients to determine if electro-acupuncture is useful tool for women with low ovarian reserve.

Read More

Effects of “menstrual cycle-based acupuncture therapy” on IVF-ET in patients with decline in ovarian reserve

Zhou L et al, Zhongguo Zhen Jiu. 2016 Jan;36(1):25-8.
Chinese Acupuncture and Moxabustion Journal
A small randomised controlled study of patients who had low ovarian reserve preparing to do IVF and receiving acupuncture based on the different stages of the menstrual cycle showed significantly improved responses at all stages of the subsequent IVF cycle. Clinical pregnancy rates were improved in the acupuncture group compared to the control group. Live birth rates were not reported.

Read More

Effects of transcutaneous electrical acupoint stimulation on ovarian reserve of patients with diminished ovarian reserve in in vitro fertilization and embryo transfer cycles.

Zheng Y et al, J Obstet Gynaecol Res. 2015 Dec;41(12):1905-11

The Journal of Obstetric and Gynecological Research

In this large controlled non randomised trial (Level III) , 240 women either over the age of 35 or with poor ovarian reserve, who were undergoing IVF treatment for tubal blockage, were divided into a group that received electrostimulation to acupuncture points or into one of three control groups. Women who received hormonal treatment or had TEAS applied to acupuncture points had reduced FSH levels and higher antral follicle counts. The study showed that the 56 women who received the electrostimulation (TEAS) to acupuncture points had a significantly higher clinical pregnancy rate than the other groups. It is often thought that not much can be done to improve the chances of IVF patients with low ovarian reserve hence more high level trials are necessary to test this result.

 

Read More

Prior to Conception: The Role of an Acupuncture Protocol in Improving Women’s Reproductive Functioning

Cochrane S et al,  Evid Based Comp and Alt Med, 2016, Article ID 3587569, 11 pages

Evidence-Based Complementary and Alternative Medicine

 

Acupuncture as a modality to improve fertility in women who had been trying to conceive for a year or more without success, was assessed in this pragmatic RCT. It shows that women receiving acupuncture tend to conceive more rapidly than those in a control group who followed lifestyle advice. Read More

Effects of traditional Korean medicine on anti-Mullerian hormone inpatients with diminished ovarian reserve: A retrospective study

Acupuncture-Pregnancy-307Junyoung Jo et al, Comp  Ther  Med  24 (2016) 118–122

Complementary Therapies in Medicine, Elsevier

This Pilot study examined the effect of taking traditional herbal formulas in 22 women who had very low ovarian reserve (measured as AMH <1.1ng/ml). They found that 2 months of taking the herbal formulas increased the AMH significantly (double)  in women below 38 years of age, but not over this age. This study now needs to be repeated with a larger number of women to confirm this result.

Read More

Effect of Zishen Yutai Pill on Embryo Implantation Rate in Patients Undergoing Embryo Transfer

Acupuncture-Pregnancy-369

ZHU Wen-jie et al, C JIM (Chin) 2002;22(10) ‘ 729

Chinese Journal of Integrative Medicine

In a RCT involving 140 IVF patients 70 were given Zi Shen Yu Tai pills (a famous traditional remedy) after their embryo transfer and pregnancy rates were compared with 70 women who received usual care. The group receiving the Chinese herb formula had a significantly higher implantation and pregnancy rate.

 

Read More

Traditional Chinese Medicine, the Zishen Yutai Pill, Ameliorates Precocious Endometrial Maturation

Acupuncture-Pregnancy-401Qi Gao et al, EB Comp and Alt Med, 2015, Article ID 317586, 10 pages

Evidence-Based Complementary and Alternative Medicine

 

Following on from earlier research which indicated that Zi Shen Yu Tai pill ( a well known Chinese herbal formula) may improve implantation rates in IVF patients, these researchers decided to investigate the mechanism. They found that this formula reduced precocious endometrial development in mice whose ovaries were being stimulated, and  increased the expression of HOXA10, an important marker of uterine receptivity. This may be describe a mechanism of action for this formula although this study has not been replicated on humans (for ethical reasons)

Read More

Transcutaneous electrical acupoint stimulation improves outcomes of in vitro fertilization by increasing neuropeptide Y levels: A RCT

1-s2.0-S1876382015X00023-cov150hFan Qu et al, EuJIM, 2015 Vol 7, Suppl 1, p 18

European Journal of Integrative Medicine,

Electrical stimulation of acupuncture points (TEAS) has been shown to improve success rates of frozen embryo transfer cycles in previous clinical trials, with evidence of improvement in the structure of the uterine lining. In this large RCT the levels of a certain neuropeptide (NPY) was increased in the follicles of IVF patients who received electro-stimulation (frequency alternating 2/100Hz) and in the same women, the pregnancy rate was significantly improved. Other stimulation freqencies did not alter the neuropeptide Y levels or the pregnancy rate.

Read More