Acupuncture support for fertility and pregnancy

Many patients seek acupuncture support with their fertility and pregnancy. Some come to try to promote their natural fertility, others come as they are experiencing problems conceiving and some come as they are preparing for IUI, IVF or ICSI.

Fertility is an area I specialise in and I have undertaken post-graduate training in and fertility/IVF courses. I know from personal experience how heartbreaking and stressful infertility can be. I have been fortunate enough to give birth to twin girls after undergoing IVF treatment.

Oriental Medicine has the phrase “Cultivate the soil before you plant the seed.” This is a cornerstone to Chinese Medicine’s approach to fertility treatment. The optimum time to treat someone is prior to their conception; in other words, both parents should be brought to optimum health prior to conceiving. Chinese Medicine holds the view that this period will determine the health of the sperm and the egg and that optimising both parents health prior to conception delivers maxim constitutional health to the new born child. For the mother-to-be, treatment also occurs during the pregnancy for this same reason.

I often support patients through their IVF treatment and in particular on the day of embryo transfer. Several clinical studies have shown that acupuncture dramatically increases the success rate of IVF cycles.

The following article was published in the Guardian Newspaper
February 8, 2008.

"Acupuncture can increase the chances of getting pregnant for women undergoing fertility treatment by 65%, a review of the evidence concludes today. Acupuncture, which involves inserting fine needles under the skin at particular points in the body depending on the condition being treated, has long been used in China to help with a range of diagnoses, including regulating female reproduction. To establish how effective the treatment is, doctors in the US collated evidence from all relevant, well-conducted studies and published their conclusions in today's British Medical Journal.

Eric Manheimer, research associate at the centre for integrative medicine at the University of Maryland school of medicine and colleagues looked at seven studies. All had been published in English since 2002 and conducted in four different western countries. The trials involved 1,366 women undergoing in vitro fertility treatment - where eggs and sperm are removed and mixed in the laboratory and one or more resulting embryos returned to the womb. In the trials some women were given genuine acupuncture, others "sham" acupuncture, such as putting needles in the wrong places, and some no treatment at all. Overall the genuine acupuncture improved a woman's chances of pregnancy by 65%.

All the acupuncture took place within a day or so of embryo transfer. Not all the pregnancies would have resulted in a live birth. In trials where the clinic's pregnancy rate was already high, there was a smaller, non-significant increase. Manheimer said the results were not necessarily a reason for every infertile woman to seek out acupuncture. "I think the findings should be regarded as somewhat preliminary," he said. "Acupuncture can improve the rates of pregnancy and live birth. Some couples might want to choose acupuncture but others might want to wait until further research has been done." But Edzard Ernst, professor of complementary medicine at the Peninsula medical school, Exeter, urged caution. "IVF may not seem to be 'placebo-prone' but it probably is: if women expect it to be helpful they are more relaxed, which in turn would affect pregnancy rates." Manheimer argued a placebo response was unlikely, arguing that acupuncture may stimulate the body to produce neurotransmitters which influence the menstrual cycle, ovulation and fertility.

Copyright Guardian Newspapers Limited (8 Feb 2008).

A German study, published in April 2002 found that just 2 acupuncture treatments on the day of embryo transfer increased the chances of becoming pregnant through IVF by a staggering 62%.

The first written evidence of acupuncture’s use in the treatment of fertility dates back over two thousand years to 3AD. In more recent times, Western science has established the following proven benefits that acupuncture offers to reproductive health:

• Increases the chance of pregnancy for women undergoing in-vitro fertilization (IVF).Encourages embryo implantation and supports IVF and ICSI. It is recommended that women having an embryo transfer receive acupuncture before and after the transfer. See Guardian article above for more details.
• Regulates the menstrual cycle
• Can counteract the effects of polycystic ovaries
• Reduces high FSH levels. Follicular stimulating hormone (FSH) has to reach a certain level to signal the release of an egg for ovulation to occur. As women become older and their ovarian reserve (the number of eggs they have) declines, their level of FSH can increase. Ideal levels for FSH are under 6, 6-8 is normal, 8-10 is fair, 10-12 suggests lower than normal ovarian reserve, 12-17 indicates lower still reserves, and more than 17 generally suggests a very poor response to assisted conception techniques. However anecdotal evidence from acupuncture practitioners such as Zita West and Randine Lewis, suggests that women with high FSH levels have gone on to have successful pregnancies.
• Eases the symptoms of endometriosis and aids successful conception
• Invigorates sperm, enhancing both sperm count and motility.
• Strengthens the immune system and enhances general health.
• Reduce stress, control anxiety, enhance sleep and increase energy level.
• Balances endocrine system, regulates hormones and improves egg quality.
• Increases blood flow to the uterus, improving endometrial lining (implantation). Improves blood flow to the ovaries, increasing ovarian response - more follicles and better egg production.
• Lessens the side effects associated with hormonal treatment.
• Reduces risk of miscarriage and increase live birth rate. Treatment is usually offered up to 12-14 weeks and also helps the woman manage her anxiety and stress around the pregnancy. An American study found that women who conceived through IVF who had acupuncture had a 0.8% miscarriage rate compared to 20% of women who did not have acupuncture. The live birth rate for each IVF cycle was 23% higher than in the control group. (American Society for Reproductive Medicine, Oct 2004).

Those who suffer from functional infertility make excellent candidates for acupuncture. Fertility issues associated with hormonal problems, immune disorders, irregular menstruation, amenorrhoea and age related issues all fall within the category of functional infertility.

Stress has been proven to dramatically decrease fertility for both men and women and consequently acupuncture and Chinese herbal medicine can dramatically increase fertility by reducing stress if this is a prevailing factor.

It is however surprising how many patients become pregnant after commencing treatment. I believe that in many of these cases stress had been a significant factor. The process of trying to conceive is in itself very stressful for many couples and the patient’s active involvement in the whole treatment process delivers a greater sense of control, which had previously seemed unattainable. This increased sense of control, combined with acupuncture is often enough to bring about a successful conception.

Self Help

These are some of the things you can do, in addition to having acupuncture, to encourage fertility:

• Come off the contraceptive pill some time before you start trying for a child. Even though there is a suggestion that fertility increases in the first one or two months immediately after coming off the contraceptive pill, it is recommended that you allow one month off for each year that you have been on the pill.
• Stop smoking – smoking can cause irreversible effects on ovarian function by accelerating the loss of eggs. It also increases the risk of miscarriage and ectopic pregnancy, significantly reduces the chances of a successful outcome of IVF, and lowers male fertility (sperm count, motility and increased abnormalities). Passive smoking is also seriously damaging to female fertility. Visit Infertility Health Information website for some good advice and information about optimal sperm health.
• Significantly reduce alcohol intake. Alcohol inhibits ovulation and impairs the sperm’s ability to move through the fallopian tubes.
• Cut out marijuana. Even moderate consumption of marijuana has a toxic effect on the developing egg and impairs ovulation.
• Eat a healthy, well balanced diet. Make sure you get enough Vitamin E and B including folic acid.