Women and couples come to me at various stages of their journey to conception. Sometimes they have been trying for years and others they are just starting out. While conceiving naturally is everyone’s first choice, alternatives that garner the same results; a baby, should not be overlooked. It is for this reason that I have written this blog.
Assisted Reproductive Technology (ART) is a term used to describe the current western medical treatments available for women and couples having difficulty conceiving and desiring or requiring medical aid such as In Vitro Fertilization.
With current changes in cultural perceptions regarding IVF, and consistent advancement including better freezing techniques, better embryo culture, ways to choose embryos, pre-implantation genetic diagnosis (PGD), and new drugs, IVF is becoming more and more common. I am happy to work with women that choose this route and to implement treatment that aids in their success.
Forward thinking IVF clinics (such as PCRM & Genesis Fertility in Vancouver) are forming strong alliances with TCM practitioners (with the integration of procedures such as acupuncture). They realize that in addition to successful IVF outcomes, traditional practices enhance the patient’s experience by managing stress and cultivating emotional balance.
I love the integration and kinship that has grown between my practice and that of the local IVF clinics and I am glad to hear of similar relationships being formed elsewhere. We all share the goal of building happy families and by working together the patient is looked at as a whole and better supported along their journey. This is the growth of good medicine.
A recent article by Michael Fiorani and Dr Paul Magarelli reviewed the mechanisms and published clinical trials supporting the use of acupuncture with ART and determined that acupuncture should be considered as a viable adjunct therapy for IVF. Their conclusion states;
“The use of acupuncture for infertility as an adjunct therapy to conventional treatment in ART (mainly as an adjunct to IVF) has continued to increase in popularity through evidence-based publications demonstrating clinical efficacy. Although acupuncture is based on ancient medical theory, an increasing number of published scientific studies show that acupuncture positively impacts fertility and IVF success rates due to possible mechanisms influencing the menstrual cycle through B-endorphin secretion, affecting gonadotropin secretion through their action on GnRH. These possible mechanisms also impact uterine and ovarian blood flow; cytokines; and depression, anxiety, and stress. Retrospective and randomized controlled trials have found that acupuncture has a statistically significant positive impact on IVF success rates, including implantation, pregnancy, and live birth rates, while reducing the number of miscarriages and ectopic pregnancies.”
The article also clearly summarized possible mechanisms of how acupuncture positively impacts fertility and IVF success rates;
- affects the hypothalamus-pituitary-ovarian hormonal axis causing changes in the menstrual cycle (through the secretion of b-endorphins which affect gonadotropin-releasing hormone [GnRH]).
- improving uterine and ovarian blood flow.
- secreting cytokines and regulating the immune system.
- relief of depression, anxiety, and stress.
Supporting ART treatments with TCM is advantageous in many ways for the patient. Below is evidence (made up of over 5000 women in various trials) that shows how acupuncture administered on the day of embryo transfer immediately before and after the procedure can significantly improve success rates.
- Oxford Journals Human Reproduction: Acupuncture administered on the day of embryo transfer is most advantageous for those patients who's chance of success with IVF is not high (Manheimer, 2013).
- Fertility and Sterility: Acupuncture improves clinical pregnancy rates and live birth rates among women undergoing IVF. increased positive effects from using acupuncture in IVF can be expected if more reasonable acupuncture programs are used (Zheng, 2012).
- Cochrane Database of Systematic Reviews: Acupuncture on the day of Embryo Transfer improves the ongoing pregnancy rate and the clinical pregnancy rate (Cheong, 2008).
- British Medical Journal: Current preliminary evidence suggests that acupuncture increased the odds of clinical pregnancy by 65%, and improved live birth rates when compared with the control groups (Manhheimer, 2008).
Time permitting, researchers Magarelli/Cridennda found that it is optimal to work with TCM for a period of at least 9 consecutive acupuncture treatments before embarking on western medical reproductive treatments. The appropriate time frame for pre-IVF/TCM care depends on the pre-existing conditions the woman or couple has. By helping women regulate their menstrual cycle, lose weight, reduce stress, regulate hormones (Zhou 2013, Magarelli/Cridennda 2009), and increase blood flow (nutrition, oxygen, and medications) to the ovaries, eggs, and uterine lining (Stener-Victorin, 1996 & 2003) TCM plays an important role in the optimization of overall reproductive health and well-being.
An assessment of patient demand and importance of acupuncture to patients of a IVF fertility clinic in the UK during lead up, procedures, and treatment published in 'Human Fertility' surveyed 200 patients (Hinks, 2010). They discovered that there was a clear demand for acupuncture and that this treatment may be valuable in improving the general well-being of women during infertility and IVF lead up, procedures, and treatment. They also felt that patient resilience may be increased by the use of acupuncture when used in conjunction with their IVF treatment such that patients would persevere with increased numbers of IVF cycles, thereby increasing their ultimate chance of starting or expanding their family.
“Acupuncture could benefit IVF patients beyond potentially improving rates of IVF pregnancy success, noting that it is safe and inexpensive and may aid these patients in coping with the emotional and psychological challenges related to IVF and fertility.” – Excerpted from the Oxford Journals Human Reproduction Meta-analysis by Manheimer et al, 2013.
References:
1. Cheong, Y et al. Acupuncture and Assisted Conception. Cochrane Database of Systematic Reviews 2008 Issue 4.
2. Hinks, J et al. An assessment of the demand and importance of acupuncture to patients of a fertility clinic during investigations and treatment. Human Fertility 2010, Vol 13, S1 Pg 3-21
3. Magarelli/Cridennda et al. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment. Fertility Sterility. 2009 Dec;92(6):1870-9
4. Manheimer, E et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. British Medical Journal 2008;336 pg 545-549
5. Manheimer, E et al. The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Oxford Journals Human Reproduction. Update (2013)
6. Stener-Victorin, E et al. Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats. Autonomic Neuroscience 2003, Vol 108, Issues 1-2, Pg 50-55
7. Stener-Victorin, E et al. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Oxford Journals Human Reproduction 1996; 11:1314-1317.
8. Zheng, CH et al. Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis. Fertility & Sterility, Volume 97, Issue 3 , Pages 599-611, March 2012
9. Zhou, K et al. Acupuncture changes reproductive hormone levels in patients with ovarian deficiency – prospective observational study. Evidence Based Complementary Alternative Medicine. 2013; 2013:657234.
