Acupunture & IVF: Q&A

How does acupuncture work to increase pregnancy rates in IVF patients?

Most of the clinical trials that demonstrated a significantly increased chance of pregnancy administered 2 acupuncture treatments, one before and one after the embryo transfer. However one of the trials did only one treatment and still showed a positive effect on pregnancy rates.

If it is convenient for you and your practitioner to have a treatment before and after the embryo transfer this replicates the way treatment was done on the clinical trials. However, if time, distance or scheduling pressures prevent that, then one treatment close to the time of transfer can also have a positive effect.
Why is it important to have the acupuncture treatments close to the time and place of embryo transfer?

The objective of many of the clinical trials has been to evaluate whether acupuncture improves pregnancy outcomes when used as an adjunct treatment to embryo transfer in women undergoing IVF.

The selection of acupuncture points was designed for the purpose of improving rates of pregnancy rates. According to the principles of Chinese medicine, the treatments can help by:

Increasing blood flow to the uterus and ovaries
Supporting follicle growth and maturity
Enhancing the quality of the endometrium
Enhancing endometrial receptivity
Calming the mind
Relaxing the patient

At this stage, we don’t yet know what the exact mechanisms are behind the observed increase in pregnancy rates of some of the research trials. As such, we try to  replicate the trial conditions as much as possible. In the clinical trials which showed a beneficial effect of acupuncture on embryo transfer day, the treatment was given just before and just after the transfer.

How much treatment will I need? How many times do I have to come?

If there is time, we generally recommend 3 months of pre-conception care, during which time we will also be looking at any lifestyle changes that need to be made. This is particularly important for male factor subfertility as it takes around 100 days for sperm to develop, form and come to maturation.

If you are under 35 and you are well and healthy and not unduly stressed, and do not have a history of failed IVF cycles, then you might choose to have acupuncture just on the day of embryo transfer to increase the chance of embryo implantation.

If you have already embarked on an IVF cycle and would like extra support during it, you can have treatment at any stage

If you would like a bit of extra support during the cycle then come once or twice a week in the month before egg collection. Acupuncture during this time regulates the stress hormones which may have an impact on follicle development and implantation of the embryo (Magarelli, PC, D Cridennda, M Cohen. Fertil Steril. 2009 Dec;92(6):1870-9 Fertility and Sterility. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment).

If you have had previous failed IVF cycles or are over 35, we recommend you spend a few months of preparation with traditional Chinese medicine, before you embark on another IVF cycle. It is often the case that “preparing the soil before planting the seed” can beneficially affect outcomes.

Is it a good idea to have acupuncture after egg collection?

Many IVF patients have found that it is very useful to have acupuncture following the egg collection. IVF side effects are often more marked after this procedure, because even though the eggs have been removed the hormone levels can still very high.

The empty follicles often fill up again with fluid, so the feeling of abdomen fullness may persist. Some women experience cramping in the abdomen for a few days following egg collection; this tends to subside more quickly with acupuncture treatment.

Acupuncture also helps any ovary and abdomen swelling to subside, and by reducing inflammation and tissue trauma helps to prepare a more conducive environment for the arrival of an embryo in a few days.

How does acupuncture help relieve side effects?

One of the mechanisms behind the effectiveness of acupuncture is its capacity to promote the circulation of blood and fluids: this has the effect of reducing tissue swelling and inflammation. Acupuncture can also reduce pain and discomfort by encouraging the Qi to flow better. Thus IVF side effects like abdomen pain and swelling, headaches and breast soreness can be relieved. Regulating the movement of qi can also help level out moods swings and reduce fatigue.

How does acupuncture work to increase pregnancy rates in IVF patients?

This is a topic of much discussion and on-going research. Many doctors think that the acupuncture performed at the time of transfer reduces any uterine contractions which might cause an embryo to be expelled or inhibit an embryo from successfully implanting. Some studies support this theory but others do not. The acupuncture points used after the embryo transfer are points which we know have a moderating effect on the immune system, and this may prevent rejection of embryos in some women. It may be also be the case that a certain type of patient benefits from acupuncture and others don’t. This would explain the variability in the trial results to date. More research is needed to determine the mechanism at work.

Other preliminary studies have shown that a series of acupuncture treatments in the weeks before egg collection, have a beneficial regulatory effect on the serum levels of stress hormones of women taking IVF drugs. It is not yet known whether the beneficial impact is on follicle development or on embryo implantation, but women who received acupuncture in these trials had greater pregnancy rates than those who did not. (Magarelli, PC, D Cridennda, M Cohen. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment, Fertil Steril. 2009 Dec;92(6):1870-9 Fertility and Sterility.)

Can acupuncture help with ‘poor egg quality’?

There is little acupuncture can do in the case of damage to egg quality related to age. However, we do know that acupuncture increases blood flow to the ovaries, thereby enhancing nourishment of the developing follicle and appears to increase responsiveness to IVF drugs (Stener-Victorin E, et al Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture Hum Reprod 1996; 11:1314-1317.Human Reproduction)
In terms of enhancing ovarian responsiveness (or recovery and resilience after repeated IVF cycles) you might like to consider embarking on a more comprehensive treatment programme before your next IVF cycle which includes traditional Chinese medicine diagnosis with the use of acupuncture and relevant lifestyle changes.

I have responded poorly to the IVF medication in my last 3 cycles, and produced few eggs. Can acupuncture help me?

Possibly. One group of researchers found that it was the IVF poor responders who gained the greatest benefit from the acupuncture administered in the month before egg collection (Magarelli P, Cridennda D Acupuncture & IVF Poor Responders: A Cure? Fertil Steril, 2004;81(Supplement 3):S20 Fertility and Sterility)

Will acupuncture help me respond better in an IVF cycle if I have low ovarian reserve, high FSH or a diagnosis of premature menopause?

If you decide to try a cycle or two then including acupuncture can make the IVF experience more pleasant and may increase the responsiveness of the ovaries but it is hard to say whether it will lead to an increased likelihood of pregnancy. If IVF fails then one option is to try a longer term strategy of pre-conception care and preparation over several months. In some, but not all cases of low ovarian reserve and high FSH good results can be achieved with such an approach which includes acupuncture and lifestyle changes.

Treatment for Men

Can acupuncture help with poor sperm count, morphology and motility?

There have been some clinical trials which demonstrate increase in sperm count, motility and decrease in abnormal forms after a course of acupuncture:

Pei. J., Strehler, E., Noss, U., Abt. M , Piomboni, P., Baccetti, B., Sterzik, K. (2004). Fertility and Sterility, 84:1, 141-147Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility

Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. (2000). Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study Andrologia. 32:1, 31

Gurfinkel E, Cedenho P, Yamamura Y, Srougi M. (2003). Effects of acupuncture and moxa treatment in patients with semen abnormalities Asian J Androl. 5:4, 345-8).

We usually recommend a course of weekly treatment over 3 months prior to IVF.

Can I do anything to support me at the time of sperm donation?

Acupuncture around the time of sperm donation can help reduce any anxiety or pressure felt around the need to produce a sperm sample on the day of egg collection. It can also help to increase blood flow to the genital area.

For further details about acupuncture and IVF and the research cited above please see the factsheet published by the British Acupuncture Council at http://www.acupuncture.org.uk/research-fact-sheets/1599-acupuncture-and-infertility-art.html