Research



Research

Acupuncture

Results: The RCTs included in these systematic reviews differed in terms of study designs, research questions, treatment protocols and outcome measures, and yielded some conflicting results. It may be inappropriate to include these together in a systematic review, or pooled analysis, of acupuncture for labour with an expectation of an overall conclusion for efficacy. Trials of acupuncture and acupressure in labour show promise, but further studies are required.

The aim of this study is to examine current evidence from systematic reviews on the topic of acupuncture and acupressure for pain management in labour and birth, and to evaluate the methodological and treatment frameworks applied to this evidence. The use of current systematic reviews of the evidence for acupuncture and acupressure for labour and birth may be misleading. Appropriate methods and outcome measures for investigation of acupuncture and acupressure treatment should more carefully reflect the research question being asked, the use of pragmatic trials designs with woman–centred outcomes may be appropriate for evaluating the effectiveness of these therapies.

Methods
A search limited to systematic reviews of the MEDLINE, CINAHL, PUBMED, EMBASE and Cochrane databases was performed in December 2013 using the keywords ‘CAM’, ‘alternative medicine’, ‘complementary medicine’, ‘complementary therapies’, ‘traditional medicine’, ‘Chinese Medicine’, ‘Traditional Chinese Medicine’, ‘acupuncture’, ‘acupressure’, cross–referenced with ‘childbirth’, ‘birth’, labo*r’, and ‘delivery’.
The quality of the evidence is also evaluated in the context of study design.

Levett KM, et al., Complementary Therapies in Medicine, 06/17/2014

Conclusion: The results explained that acupuncture regulated the stress reaction via promoting the combination of glucocorticoids (GC) with GR, and GR protein expression.

It had been indicated in the previous studies that acupuncture relieved the excessive excitation of hypothalamic-pituitary-adrenal cortex axis (HPAA) function induced by stress stimulation. But the changes in glucocorticoid receptor (GR) induced by acupuncture have not been detected clearly. The objective of the study was to observe the impacts of acupuncture on the protein expressions of corticotrophin releasing hormone (CRH), adrenocorticotropic hormone receptor (ACTHR), and GR under the physiological and stress states. The results showed that under the stress state, acupuncture upregulated the protein expression of GR in the hippocampus, hypothalamic paraventricular nucleus (PVN), and pituitary gland, downregulated the protein expression of GR in the adrenal cortex, and obviously reduced the protein expressions of CRH and ACTHR. Under the physiological state, acupuncture promoted GR protein expression in the hippocampus and CRH protein expression in the hippocampus and PVN. The results explained that acupuncture regulated the stress reaction via promoting the combination of glucocorticoids (GC) with GR, and GR protein expression. The increase of GR protein expression induced feedback inhibition on the overexpression of CRH and ACTHR, likely decreased GC level, and caused the reduction of GR protein expression in the adrenal cortex.

Reference
S.J. Wang et al., “Acupuncture relieves the excessive excitation of hypothalamic-pituitary-adrenal cortex axis function and correlates with the regulatory mechanism of GR, CRH and ACTHR.” Evidence-Based Complementary and Alternative Medicine. Volume 2014 (2014), Article ID 495379, 9 pages. http://dx.doi.org/10.1155/2014/495379

*Related blog post: http://www.yinstill.com/blog/science-confirms-what-all-our-clients-alrea…

Conclusion: electroacupuncture could decrease serum FSH and LH levels, and increase estrogen levels in women with ovarian deficiency with little to no side-effects.

To investigate the effects of electroacupuncture (EA) on serum FSH, E2, and LH levels, women with primary ovarian insufficiency (POI) were treated with EA once a day, five times a week for the first four weeks and once every other day, three times a week, for the following two months, and then were followed up for three months. Serum E2, FSH, and LH levels were measured at baseline, at the end of treatment, and during followup. A total of 11 women with POI were included in this prospective consecutive case series study. Compared with baseline, patients’ serum E2 increased, FSH decreased, and LH decreased (P = 0.002, 0.001, and 0.002, resp.) after EA treatment, and these effects persisted during followup. With treatment, 10 patients resumed menstruation (10/11, 90.91%), whereas one patient remained amenorrhea. During followup, two patients, including the one with amenorrhea during treatment, reported absence of menstruation. Temporary pain occurred occasionally, and no other adverse events were found during treatment. The results suggest that EA could decrease serum FSH and LH levels and increase serum E2 level in women with POI with little or no side effects; however, further randomized control trials are needed.

Evid Based Complement Alternat Med. 2013;2013:657234. doi: 10.1155/2013/657234. Epub 2013 Feb 28., Zhou K, Jiang J, Wu J, Liu Z. – Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, No. 5 Bei Xian Ge Street, Xuan Wu District, Beijing 100053, China ; Department of Physical Therapy, Daemen College, 4380 Main Street, Amherst, NY 14226, USA. http://www.ncbi.nlm.nih.gov/pubmed/23533511

Acupuncture and Embryo Transfer

SUMMARY: This study reports an increase in implantation rates (IR) with the use of laser acupuncture, however there was no significant difference in ‘ongoing pregnancy rates (OPR)’ between needle acupuncture and laser acupuncture.

DESIGN: Prospect randomized double blind and placebo controlled.
MATERIALS AND METHODS: On the day of transfer, participants were randomly assigned to a study group; needle acupuncture (AC), laser acupuncture (LZ AC), sham laser acupuncture (LZ sham), relaxation (RX), or no treatment (NT). The AC and LZ AC puncture groups were considered treatment groups, the RX controls for the additional rest before and after transfer, and NT is the non-intervention group. Most significantly, the LZ Sham group provided an important control group. The laser acupuncture device was randomly preprogrammed per case to either fire (and provide LZ AC) or to not fire and thus provide a true double blind control group (LZ sham). It was not possible for the patient or acupuncturist to know if the laser fired. No contact oocurs with the patient in laser acupuncture so there is no acupressure effect or contact with the wrong meridians. All treatments were administered for 25 minutes before and after embryo transfer. Outcomes were compared by Chi-square and multiple logistic regression analysis to control for the potential confounders including female age, embryo quality, and day of transfer (Table 1).
RESULTS: All treatments were well tolerated. No differences in terms of patient demographics, cycle type, stimulation outcomes, embryo number and quality, day of embryo transfer, transferring physician, or acupuncturist were found between the 5 study groups. Implantation rates were significantly improved with laser acupuncture. Traditional needle acupuncture had outcomes equivalent to the 3 control groups. Subanalyses of patient age and embryo transfer day produced similar findings with laser acupuncture enhancing outcome rates.
CONCLUSIONS: This large prospective randomized and well controlled study consistently demonstrated benefit to LZ AC. Treatment was well tolerated and significantly improved implantation rates.

Clinical Outcomes (%) Rates
Needle acupuncture: implantation (28.9), chemical pregnancy (61.5), clinical pregnancy (51.5), ongoing pregnancy (39.0)
Laser acupuncture: implantation (33.7), chemical pregnancy (60.9), clinical pregnancy (54.5), ongoing pregnancy (42.1)
Non-intervention: implantation (30.2), chemical pregnancy (60.4), clinical pregnancy (50.3), ongoing pregnancy (39.6)

Note: it should be emphasized that the non-intervention group did almost as well and in some respects better than needle and laser acupuncture, showing that this is a very high pregnancy rate group of subjects, which evidence seems to be showing that acupuncture does not display significant effect on outcomes. The trend seems to be showing that acupuncture is better suited for advanced maternal age, and poor responders.

Fratterelli JL et al Fertil Steril 2008 Vol 90, Suppl 1,pg S105 – Fertility and Sterility

Objective – Acupuncture performed onsite before and after embryo transfer has been reported to improve in vitro fertilization (IVF) outcome in patients with good quality embryos. The purpose of this investigation was to evaluate whether acupuncture before and after embryo transfer would alter pregnancy rates in patients undergoing IVF regardless of embryo quality if the treatment was performed offsite.

Design – Multi-center, prospective, randomized study.

Materials and methods – 107 patients undergoing IVF were randomized to acupuncture vs. control group. The treatment group received acupuncture by one of two licensed acupuncturists at an offsite location for 25 minutes before and after embryo transfer using a modified Paulus protocol (protocol described by Paulus et. al. 2002 with the addition of Cv6 before and K3 after transfer). The control group underwent embryo transfer without any other intervention. The IVF protocol was determined by the treating physician who was blinded to assigned group. The main outcome measures were a positive quantitative hCG, clinical pregnancy as manifested by fetal cardiac activity, and live birth (data pending). Chi-squared analysis and Student’s t-test were used for statistical analyses. Of the 107 patients randomized, 94 completed the study (10 IVF cycles canceled, 3 patients withdrew).

Results – The proportion of patients with a positive pregnancy test was higher in the control group (36/46) than the acupuncture group (25/48) (78.3% vs. 52.1%, respectively; P≤0.01). More importantly, the clinical pregnancy rate was higher in the control group than in the acupuncture group (69.6% vs. 43.8%, respectively; P≤0.03). The groups were statistically similar with respect to age, peak estradiol, number of oocytes retrieved, fertilization method, fertilization rate, number of embryos transferred, and the proportion with blastocyst transfer (P=NS).

Conclusions – In contrast to previous reports, acupuncture before and after embryo transfer was associated with lower biochemical and clinical pregnancy rates when compared to the control group. The value of acupuncture in pateints undergoing IVF needs to be further examined before recommending it to patients.

L.B. Craig, A.R. Criniti, K.R. Hansen, L.A. Marshall, M.R. Soules – Reproductive Endocrinology & Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Seattle Reproductive Medicine, Seattle, WA; Pacific Northwest Fertility & IVF Specialists, Seattle, WA

Conclusions(s): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

Patient(s): 57 infertile patients undergoing IVF or IVF/ICSI.

Interventions(s): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.
Main outcome measure(s): Perceive Stress Scale scores, pregnancy rates.

Result(s): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status.

Conclusion Acupuncture is a powerful tool for improving pregnancy rate and reducing uterine contractions after assisted reproduction therapy.

Objective To observe the effect of acupuncture on the pregnancy rate in assisted reproduction therapy such as in-vitro-fertilisation (IVF) and intracytoplasmatic spermatozoen injection (ICSI), and mechanisms.

Methods 210 cases undergoing IVF or ICSI were divided randomly into three groups: acupuncture treatment group, placebo group and control group. The acupuncture treatment group and the placebo group were treated respectively with body acupuncture and placebo acupuncture before and after embryo transfer, and in the control group embryos were transferred without any supportive therapy. Contraction frequency of the uterine junctional zone and the pregnancy rate were observed.

Results The contraction frequency before embryo transfer was not significantly different among the three groups, but after embryo transfer in the acupuncture treatment group was lower than that in the placebo group and the control group, respectively. The pregnancy rate was 44.3% (31/70) in the acupuncture treatment group, and 27.1% (19/70) in the placebo group and 24.3% (17/70) in the control group. The pregnancy rate in the acupuncture treatment group was significantly higher than that in the placebo acupuncture group and the control group (P0.05).

Conclusions: Results for women aged 35–39 years and those over 40 years were markedly better than controls suggesting that acupuncture intervention of this type may be more effective in older women. No side effects or complications were experienced by women receiving acupuncture. Acupuncture is a safe, adjunct therapy in IVF and in other randomised clinical trials has been shown to significantly improve outcomes when used at the IVF centre before and after embryo transfer. Our preliminary data are encouraging and suggest that a trial involving older women may be effective.

All IVF cases in which acupuncture was administered before and after embryo transfer at a large private infertility centre were reviewed for a 2 year period. All patients were treated by the same practitioner (NDB) using Traditional Chinese Acupuncture (TCA). Patients received acupuncture to the protocol developed by Paulus, W.E., Zhang, M., Strehler, E., El-Danasouri, I., & Sterzik, K. (2002). Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility & Sterility, 77, 721–724: Liver 3, Spleen 8, Stomach 29, Pericardium 6, GV 20 were manually stimulated five times over a 40-min period, at Bridge, approximately 10–20 minutes prior to embryo transfer. Embryo transfer was carried out under ultrasound guidance as per routine at Bridge. Ten minutes following embryo transfer acupoints Spleen 6, Stomach 36, Spleen 10, Large Intestine 4 were manually stimulated five times over a 40-min period before discharging the patient. Ear points 34, 55 and 58 were used in both treatments and not stimulated.

A total of 71 patients underwent 74 cycles involving acupuncture before and after embryo transfer.

Overall, positive pregnancy rates/ET were 44.6% comparing favourably with the non-acupuncture historic control group.

CONCLUSIONS: Although other studies regarding acupuncture have been inconclusive, perhaps these positive results are related to two important factors. The treatments were performed on-site, eliminating the stress of travelling to another site before and after the embryo transfer. Also, the acupuncture treatment protocol did not follow the traditional Paulus protocol, thereby suggesting there is still more research to be done on how best to treat infertility issues with acupuncture

OBJECTIVE: Conflicting evidence exists on whether acupuncture is beneficial for patients undergoing In Vitro Fertilization (IVF) cycles. Therefore, this study was undertaken to determine whether on-site acupuncture, per- formed both before and after embryo transfer, affects clinical outcomes.

DESIGN: Retrospective data analysis.

MATERIALS AND METHODS: The Acupuncture Group consisted of 49 patients who received acupuncture on-site before and after embryo transfer in 2007. The treatment did not follow the Paulus protocol. The Control Group were 212 patients with no acupuncture undergoing IVF cycles in the same time period. The data was subdivided by SART age classifications to determine if acupuncture differentially benefitted certain age groups. Clinical Pregnancy Rate (CPR) was defined as the presence of fetal cardiac activity. Loss Rate was the percentage of pregnancies that did not proceed from a positive hCG to a clinical pregnancy. Data were analysed using the unpaired t-test and Fisher’s exact test, with significance defined as P < 0.05.

RESULTS: Patients with a positive hCG were significantly higher in the Acupuncture Group for women less than 35 years old (63.3% vs.43.2%, p1⁄4 0.048). The Acupuncture Group also had a higher CPR in the under 35 category (60.0% vs. 34.6%, p 1⁄4 0.01). There were no differences in the other age groups. Combining all the age groups, the cycle parameters between the two Groups were equivalent, while the CPR was higher and the Loss Rate lower for the Acupuncture group (Table 1).

CONCLUSIONS: Although there was a higher pregnancy rate in the acupuncture group, this difference was not statistically significant, probably because of the small number of patients in both group. Acupuncture seems to be an important coadjuvant in the treatment of infertility with IVF or ICSI, and further research is needed to demonstrate its precisely effect.

OBJECTIVE: The aim of this study was to evaluate the effects of acupuncture on embryo transfer by comparing the rates of clinical pregnancy.

DESIGN: Retrospective, interventional and longitudinal study.

MATERIALS AND METHODS: Study with a total of 111 cycles of patients who underwent assisted reproduction techniques: in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) from June/2005 to January/ 2007: 52 cycles with acupuncture and 59 cycles without acupuncture. Acupuncture was performed, in specific points of the body including the ear, immediately before and after the embryo transfer procedure and the needles were retained for 30 minutes per session. The embryo transfer was carried out under ultrasound guidance and luteal phase support was given by trans-vaginal progesterone administration (Utrogestan) and intramuscular progesterone. Outcome measure was clinical pregnancy rate.

RESULTS: The clinical pregnancy rate per cycle was observed in 27 of 52 (51.9%) patients in the acupuncture group and 21 of 59 (35.6%) patients in the control group (P 1⁄40,083). The mean age was 36.1 6.1 years in the control group and 36.4 years in the acupuncture group (P1⁄40.785). The mean number of embryo transferred was 3.3 in the control group and 3.6 in the acupuncture group (P1⁄40.462). The technique of embryo transfer was 5 cycles of IVF and 54 cycles of ICSI in the control group and 5 cycles IVF and 47 cycles of ICSI in the acupuncture group (P 1⁄41.000). Both groups did not show statistics difference in the mean age, number of embryo transferred and the technique procedure.

CONCLUSION: Conception and implantation rates were highest with traditional needle acupuncture. IVF treatment outcomes did not differ between patients treated with laser or sham laser acupuncture.

This study did not have the statistical power to detect treatment differences in pregnancy rates between needle acupuncture and no treatment (i.e., at least 200 subjects are needed to detect differences in CP rates of 54.7 and 44% with 80% power) which may be due to sample size, transfer of embryos of varying quality and variations in stimulation protocols. However, while not statistically significant, needle acupuncture produced a clinically significant effect (greater than 10% increase in clinical pregnancy rate) compared with relaxation or no treatment which warrants further investigation.

OBJECTIVE: The study was conducted to examine several adjunct treatment regimens administered before and after embryo transfer and determine if one treatment was more efficacious than any of the alternative regimens on in vitro fertilization (IVF) outcome. We compared two different acupuncture stimulation modes, needle and laser acupuncture, with sham laser acupuncture, relaxation, or no intervention treatment on implantation and pregnancy rates in women undergoing IVF.

DESIGN: Prospective single blind randomized trial. MATERIALS AND METHODS: Patients (n258) who had been scheduled for embryo transfer (ET), signed informed consent and were randomly assigned to one of 5 study treatment regimens; needle acupuncture (AC; 53), laser acupuncture (LZ AC; n53), sham laser acupuncture (placebo)(LZ sham; n52), relaxation (RX; n50), or no intervention treatment (NT; n50). All treatments were administered 25 minutes before ET and immediately after ET. The patient and acupuncturist were unaware of whether the laser system was active which allowed for a double-blind control group for the laser acupuncture treatment. Comparisons of various parameters between groups were conducted by 2 tests and one-way ANO- As.. Multinomial logistic regression analysis was used to control for the potentially confounding effects of day of embryo transfer (day 3 vs.5) and number of embryos transferred which are known to relate to IVF outcome, to further analyze the impact of adjunct treatment regimens on implantation and pregnancy rates. Probability of P 0.05 was considered to be statistically significant.

RESULTS: No differences in terms of cycle type, day of embryo transfer, or physician performing transfer were found between treatment groups. Neither day of transfer (p0.079) or egg number (P 0.082) were significant independent predictors of implantation or conception when interactions between parameters were considered in all 5 groups. All acupuncture treatments were well tolerated.

CONCLUSION(S): Post-transfer Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF / intracytoplasmic sperm injection (ICSI).

DESIGN: Randomized, prospective, controlled clinical study.

SETTING: University IVF center.

PATIENT(S): Two hundred twenty-five infertile patients undergoing IVF/ICSI.

INTERVENTION(S): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture.

MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancy rates.

RESULT(S): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%).

CONCLUSION(S): Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2 provided no additional beneficial effect.

OBJECTIVE: To evaluate the effect of acupuncture on reproductive outcome in patients treated with IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on the day of ET, another group on ET day and again 2 days later (i.e., closer to implantation day), and both groups were compared with a control group that did not receive acupuncture.

DESIGN: Prospective, randomized trial.

SETTING: Private fertility center.

PATIENT(S): During the study period all patients receiving IVF or ICSI treatment were offered participation in the study. On the day of oocyte retrieval, patients were randomly allocated (with sealed envelopes) to receive acupuncture on the day of ET (ACU 1 group, n = 95), on that day and again 2 days later (ACU 2 group, n = 91), or no acupuncture (control group, n = 87).

INTERVENTION(S): Acupuncture was performed immediately before and after ET (ACU 1 and 2 groups), with each session lasting 25 minutes; and one 25-minute session was performed 2 days later in the ACU 2 group.

MAIN OUTCOME MEASURE(S): Clinical pregnancy and ongoing pregnancy rates in the three groups.

RESULT(S): Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the ACU 2 group (36% and 26%) were higher than in controls, but the difference did not reach statistical difference.

CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after ART.

OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture.

DESIGN: Prospective randomized study.

SETTING: Fertility center.

PATIENT(S): After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80).

INTERVENTION(S): Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy.

MAIN OUTCOME MEASURE(S): Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer.

RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.

Conclusions The data from this meta-analysis suggests that acupuncture performed on the day of ET does increase the clinical pregnancy rate of IVF treatment; however, this could be attributed to placebo effect and the small number of patients included. Further larger RCTs are necessary to confirm the results.

Another group of researchers have analysed updated clinical trial data and have come to the same conclusion as those who published the BMJ meta analysis, namely acupuncture is a useful addition to IVF. It has been published as a Cochrane Review. The Cochrane Collaboration is an international and independent organization dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide.

Introduction: Acupuncture has more recently been studied in assisted reproductive treatment, although its role in reproductive medicine is still debated. This is a meta-analysis to determine the effectiveness of acupuncture in the outcomes of assisted reproductive technologies (ART).

Material & Methods: All reports which described randomised controlled trials of acupuncture in assisted conception were obtained through searches via the Menstrual Disorders and Subfertility Group’s specialised Register of controlled trials, the OVID MEDLINE (1996 to August 2007), CINAHL- cumulative Index to Nursing & Allied Health Literature (1982 to August 2007), EMBASE (1980 -August 2007), AMED, National research Register, US equivalent Clinical Trials register (http://www.clinicaltrials.gov) were searched using the OVID software, the Chinese literature databases were searched from the China Academic Journal Electronic full text Database in the China National Knowledge Infrastructure and Index to Chinese Periodical Literature.

All relevant references were also hand searched.

The selection criteria included randomised controlled trials of acupuncture that included couples who were undergoing ART and/or acupuncture and compared these treatments to each other, placebo or no treatment for the treatment of primary and secondary infertility were included.

Women with medical illness deemed contraindications for ART or acupuncture were excluded. Quality assessment and data extraction were performed independently by two reviewers.

Meta-analysis was performed using odds ratio for dichotomous outcomes. Subgroup analysis and sensitivity analysis were performed where necessary. The outcome measures were the live birth rate, the clinical, ongoing pregnancy rate, miscarriage rate and any reported side effects of treatment.

Results Thirteen randomised controlled trials were identified that involved acupuncture and assisted conception. Ten trials were included and three were excluded.

Acupuncture on the day of ET improves the ongoing pregnancy rate (Odds Ratio = 1.85; 95% confidence interval 1.18-2.91) and the clinical pregnancy rate (Odds ratio = 1.65; 95% confidence interval 1.22-2.24), but there was no evidence of a difference in the miscarriage rate compared to controls. Acupuncture on the day of ET + 2 to 3 days after ET (repeated acupuncture) improves the clinical pregnancy rate (Odds Ratio = 2.23, 95% CI 1.41 – 3.51) but not the ongoing pregnancy rate (Odds Ratio = 1.93, 95% CI 0.86-4.36). Repeated acupuncture did not affect the miscarriage rate.

Acupuncture around the time of oocyte retrieval has no evidence of benefit over the live birth rate (Odds Ratio 0.84, 95% CI 0.50 – 1.42), ongoing pregnancy (Odds Ratio 0.84, 95% CI 0.5 -1.42), clinical pregnancy (Odds ratio 1.07, 95% CI 0.71-1.61), and miscarriage rate (Odds Ratio 0.59, 95% CI 0.14-2.56).

The authors concluded, “The odds ratio of 1.65 suggests that acupuncture increased the odds of clinical pregnancy by 65% compared with the control groups… In absolute terms 10 patients would need to be treated with acupuncture to bring about one additional clinical pregnancy. These are clinically relevant benefits.”

Impressive as these results are they may still be an underestimate, since the authors included women who’s IVF cycles were cancelled before transfer.

Objective – To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation. Design – Systematic review and meta-analysis.

Data sources – Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.

Review methods – Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.

Data synthesis – Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth.

The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).

Conclusions – Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

Conclusion(s):
Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects from using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

Objective
To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.

Design
Systematic review and meta-analysis.

Patient(s)
Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects of acupuncture on IVF outcomes.

Setting
Not applicable.

Intervention(s)
The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture.

Main Outcome Measure(s)
The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.

Result(s)
Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation.

Acupuncture ~~ O Sperm

128 men with low sperm count were treated with acupuncture for 25 days consecutively as one course of treatment. Some men went through 2 courses. Overall, 92.19% of the men involved showed increase is sperm count, and 42 of these men were considered ‘cured’ when compared to WHO criteria. Note: In general, the more the patient felt the needle sensation, the better the outcome. Conversely, the less they felt the needle sensation, the worse the outcome.

Pang Pao-zhen and Zhao Huan-yun. – Hei Long Jiang Zhong Yi Yao (Heilongjiang Chinese Medicine &amp; Medicinals), issue #1, 2004

CONCLUSION: The combined therapy of acupuncture with herbal drugs has definite therapeutic effects on male immune infertility, which can regulate AsAb and raise the immunity of the patients. To study the clinical effects of the combined therapy of acupuncture with herbal medicine on male immune infertility and on antisperm antibody (AsAb), 100 male cases of infertility with positive AsAb were divided randomly into two groups, each consisting of 50 cases. The control group was treated with oral prednisone. The clinical therapeutic effects and the impact on AsAb were observed in the two groups. The results showed that the total effective rate in the acupuncture-herb group was 90%; while that of the control group was 64%, the comparison showing a statistically significant difference (P<0.05).

Fu B, Lun X, Gong Y. – J Tradit Chin Med. 2005 Sep;25(3):186-9. – Department of Acupuncture, Second Guangdong Provincial Worker’s Hospital, Guangzhou 510720, China.

Conclusion: men that manifest higher scrotal temperatures due to genital tract inflammation or poor lifestyle habits can benefit from the scrotal temperature lowering effects of acupuncture.

Poor spermatogenesis in patients with inflammation of the genital tract is associated with scrotal hyperthermia. These patients can benefit from acupuncture treatment. We conducted a study to verify whether the influence of acupuncture treatment on sperm output in patients with low sperm density is associated with a decrease in scrotal temperature. The experimental group included 39 men who were referred for acupuncture owing to low sperm output. The control group, which comprised 18 normal fertile men, was used to define a threshold (30.5 degrees C) above which scrotal skin temperature was considered to be high. Accordingly, 34 of the 39 participants in the experimental group initially had high scrotal skin temperature; the other five had normal values. Scrotal skin temperature and sperm concentration were measured before and after acupuncture treatment. The five patients with initially normal scrotal temperatures were not affected by the acupuncture treatment. Following treatment, 17 of the 34 patients with hyperthermia, all of whom had genital tract inflammation, had normal scrotal skin temperature; in 15 of these 17 patients, sperm count was increased. In the remaining 17 men with scrotal hyperthermia, neither scrotal skin temperature nor sperm concentration was affected by the treatment. About 90% of the latter patients suffered from high gonadotropins or mixed etiological factors. Low sperm count in patients with inflammation of the genital tract seems to be associated with scrotal hyperthermia, and, consequently, acupuncture treatment is recommended for these men.Asian Journal of Andrology (2009) 11: 200-208. doi: 10.1038/aja.2008.4; published online 5 January 2009.

Asian J Androl. 2009 Mar;11(2):200-8. Epub 2009 Jan 5. Siterman S, Eltes F, Schechter L, Maimon Y, Lederman H, Bartoov B.[1] 1Maccabi Fund Complementary Medicine, Kaufman Street, Tel Aviv 68012, Israel [2] 2Refuot-Integrative Medical Centre, Ramat Aviv Gimel, Tel Aviv 69123, Israel.

CONCLUSION(S): The treatment of idiopathic male infertility could benefit from employing acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture, although we did not identify specific sperm pathologies that could be particularly sensitive to this therapy.

A group of infertile men who had pathological semen analyses according to WHO criteria, were treated with acupuncture twice a week for 5 weeks. A statistically significant increase after acupuncture in the percentage and number of sperm with no structural defects was demonstrated compared to the control group of patients who received no treatment. They concluded that male infertility patients could benefit from having acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture.

OBJECTIVE: To evaluate the ultramorphologic sperm features of idiopathic infertile men after acupuncture therapy.

DESIGN: Prospective controlled study.

SETTING: Christian-Lauritzen-Institut, Ulm, IVF center Munich, Germany, and Department of General Biology, University of Siena, Siena, Italy.

PATIENT(S): Forty men with idiopathic oligospermia, asthenospermia, or teratozoospermia. I

NTERVENTION(S): Twenty eight of the patients received acupuncture twice a week over a period of 5 weeks. The samples from the treatment group were randomized with semen samples from the 12 men in the untreated control group.

MAIN OUTCOME MEASURE(S): Quantitative analysis by transmission electron microscopy (TEM) was used to evaluate the samples, using the mathematical formula based on submicroscopic characteristics.

RESULT(S): Statistical evaluation of the TEM data showed a statistically significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects in the total ejaculates. A statistically significant improvement was detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. However, specific sperm pathologies in the form of apoptosis, immaturity, and necrosis showed no statistically significant changes between the control and treatment groups before and after treatment.

– Pei J et al Fertil Steril. 2005 Jul;84(1):141-7 Fertility and Sterility

Conclusion: The Chinese Traditional Medicine acupuncture and moxa techniques significantly increase the percentage of normal-form sperm in infertile patients with oligoastenoteratozoospermia without apparent cause.

In a prospective, controlled and blind study, a group of infertile men (married for 3 – 11 years without children) were randomized into two groups, the treatment group receiving 10 acupuncture treatments and the control group receiving sham acupuncture treatments. The patients in the acupuncture group demonstrated a significant increase in the percentage of normal forms compared to the control group

Aim: To evaluate the effect of Chinese Traditional Medicine, acupuncture and moxa treatment, on the semen quality in patients with semen abnormalities.

Methods: In a prospective, controlled and blind study, nineteen patients, aged 24 years ~ 42 years and married for 3 years ~ 11 years without children with semen abnormalities in concentration, morphology and/or progressive motility without apparent cause, were randomized into two groups and submitted to acupuncture and moxa treatment at the therapeutic (Study Group) and the indifferent points (Control Group), respectively, for 10 weeks. Semen analyses were performed before and after the treatment course.

Results: The patients of the Study Group presented a significant increase in the percentage of normal-form sperm compared to the Control Group (calculated U=16.0, critical U=17.0).

– Gurfinkel E et al Asian J Androl. 2003 Dec;5(4):345-8. Asian Journal of Andrology

Conclusions: After receiving acupuncture twice weekly for 6 weeks motility of sperm (but not overall count) was found to increase significantly.

This recent small clinical trial randomised 57 patients who had extremely low sperm counts, to acupuncture and placebo acupuncture groups. The authors conclude that the results of the present study support the significance of acupuncture in male patients with severe oligoasthenozoospermia. More evidence with larger trials needs to be accumulated before the efficacy and effectiveness of acupuncture in male infertility can be evaluated.

In this first prospective, randomized, single-blind, placebo-controlled study, 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A–C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.

– Dieterle et al Fertil Steril 2009 Oct; 92 (4): 1340–3 Fertility and Sterility

Conclusion(s): For the first time point- and frequency-specific effects of abdominal EA on TBF are shown in humans.

Just as electrocaupuncture can increase blood flow to the ovaries and uterus (see reports above) so it can to the testicles. These authors demonstrate that particular frequencies applied for just 5 minutes are effective in increasing blood flow in the testes, and suggest that such a stimulus may address the damaged microcirculation associated with varicoceles, and with aging. They note that decreased testicular arterial blood flow may result in impaired spermatogenesis from defective metabolism in the microcirculatory bed and suggest that further research is needed to discover if electroacupuncture can improve sperm manufacture in this instance.

Objective: To clarify the role of the abdominal acupuncture points and the frequency of short-term electroacupuncture (EA) stimulation on testicular blood flow (TBF) in humans.

Design: A prospective, randomized study.

Setting: University hospital, Department of Radiology, ultrasound unit.

Patient(s): Eighty healthy male volunteers were randomly allocated to three groups in stage one and to a single group in stage two. In the first stage of the study, the abdominal acupuncture points ST-29 (guilai) were stimulated using simple needle insertion, 2 Hz burst EA or 10 Hz EA, in three different groups. In the second stage of the study, abdominal acupuncture points ST-25 (tianshu) were stimulated with the frequency found to be more effective in stage one. Stimulation was for 5 minutes in each group.

Intervention(s): Electroacupuncture and Doppler flowmeter.

Main Outcome Measure(s): Four groups were compared for volume flow and other related parameters of TBF.

Result(s): The 10-Hz EA stimulation of ST-29 (guilai) increased TBF, but simple needle insertion and 2-Hz burst stimulation did not. The 10-Hz EA stimulation of ST-25 (tianshu) did not result in significant changes in TBF.

Further investigation is required to ascertain whether these findings may be helpful in the clinical treatment of infertile men.

– Cakmak Y et al, Fertil Steril 2008;90:1732–8 Fertility and Sterility

Conclusions: It is concluded that acupuncture may be a useful, nontraumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation.

This pilot study once again showed a positive effect of acupuncture on sperm count – but this time on men with such low sperm counts (or no sperm) that they would usually require a testicular biopsy to extract sperm for use in an IVF cycle. Seven of the 15 men with no sperm at all produced sperm detectable by the light microscope after a course of 10 acupuncture treatments (p < 0.01) ie enough sperm could be produced for ICSI to be performed without recourse to testicular biopsy. The control group with similar semen analysis had no treatment and showed no change after 3 months.

Classic therapies are usually ineffective in the treatment of patients with very poor sperm density. The aim of this study was to determine the effect of acupuncture on these males. Semen samples of 20 patients with a history of azoospermia were examined by light microscope (LM) and scanning electron microscope (SEM), with which a microsearch for spermatozoa was carried out.

These examinations were performed before and 1 month after acupuncture treatment and revealed that the study group originally contained three severely oligoteratoasthenozoospermic (OTA), two pseudoazoospermic and 15 azoospermic patients.

The control group was comprised of 20 untreated males who underwent two semen examinations within a period of 2–4 months and had initial andrological profiles similar to those of the experimental group.

No changes in any of the parameters examined were observed in the control group. There was a marked but not significant improvement in the sperm counts of severely OTA males following acupuncture treatment (average=0.7±1.1×106 spermatozoa per ejaculate before treatment vs. 4.3±3.2×106 spermatozoa per ejaculate after treatment). A

definite increase in sperm count was detected in the ejaculates of 10 (67%) of the 15 azoospermic patients. Seven of these males exhibited post-treatment spermatozoa that were detected even by LM. The sperm production of these seven males increased significantly, from 0 to an average of 1.5±2.4×106 spermatozoa per ejaculate (Z=−2.8, P≤0.01). Males with genital tract inflammation exhibited the most remarkable improvement in sperm density (on average from 0.3±0.6×106 spermatozoa per ejaculate to 3.3±3.2×106 spermatozoa per ejaculate; Z=−2.4, P≤0.02).

Two pregnancies were achieved by the IVF-ICSI procedure.

Siterman S et al Andrologia. 2000 Jan;32(1):31-9. Andrologia

Conclusion: patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment.

A group of infertile men with abnormal semen analysis were randomly divided into 2 groups; one group was given 10 acupuncture treatments over 5 weeks, and the other group, no treatment. Significant improvements (p < 0.05) were demonstrated in the acupuncture group compared to the control group, in particular improved motility and morphology.

The aim of this prospective controlled study was to assess the effect of acupuncture on the sperm quality of males suffering from subfertility related to sperm impairment.

Semen samples of 16 acupuncture-treated subfertile patients were analyzed before and 1 month after treatment (twice a week for 5 weeks). In parallel, semen samples of 16 control untreated subfertile males were examined. Two specimens were taken from the control group at an interval of 2-8 months. The expanded semen analysis included routine and ultramorphological observations.

The fertility index increased significantly (p < or = .05) following improvement in total functional sperm fraction, percentage of viability, total motile spermatozoa per ejaculate, and integrity of the axonema (p < or = .05), which occurred upon treatment. The intactness of axonema and sperm motility were highly correlated (corr. = .50, p < or = .05).

Siterman S et al Arch Androl. 1997 Sep-Oct;39(2):155-61 Archives of Andrology

Conclusions: Acupuncture can improve sperm quality and fertilization rates in assisted reproductive technology. The fertilization rates after acupuncture (66.2%) were significantly higher than that before treatment (40.2%) (P &lt; 0.01).

This trial looks at sperm behaviour in an IVF setting. It was a “before and after” study involving 82 infertile men with pathological semen abnormalities and who’s sperm achieved a poor fertilization rate in at least 2 IVF/ICSI cycles. They were given acupuncture twice a week over 8 weeks and the IVF/ICSI cycles were repeated. The fertilization rates after acupuncture (66.2%) were significantly higher than that before treatment (40.2%) (P &lt; 0.01).

The clinical effects of acupuncture on idiopathic male infertility in sperm parameter and on therapeutic results in assisted reproductive technology were investigated. 22 patients failed in intracytoplasmic sperm injection (ICSI) with idiopathic male infertility were treated with acupuncture twice weekly for 8 weeks, followed by ICSI treatment again. The sperm concentration, motility, morphology, fertilization rates and embryo quality were observed. Quick sperm motility after acupuncture (18.3% +/- 9.6%) was significantly improved as compared with that before treatment (11.0% +/- 7.5%, P &lt; 0.01). The normal sperm ratio was increased after acupuncture (21.1% +/- 10.4% vs 16.2% +/- 8.2%, P &lt; 0.05). The fertilization rates after acupuncture (66.2%) were obviously higher than that before treatment (40.2%, P &lt; 0.01). There was no significant difference in sperm concentration and general sperm motility between before and after acupuncture. The embryo quality after acupuncture was improved, but the difference between them was not significant (P &gt; 0.05).

– Zhang M et al J Huazhong Univ Sci Tech Med Sci.2002;22(3):228-30 Journal of Huazhong University

Conclusions: Significant increases in pregnancy outcomes were confirmed by this study and the data uniquely supported the advantage of acupuncture in patients with normal PI (prior studies were done on patient with PI). We also demonstrated that both acupuncture treatment protocols could be used together with a synergistic effect. Finally, this study is the first to demonstrate that the use of acupuncture in patients with poor prognoses (elevated Peak FSH, longer history of infertility, poor sperm morphology) can achieve similar pregnancy rates to normal prognosis patients.

Objective: The purpose of the study was to determine the influence of two acupuncture protocols on IVF outcomes and secondly to identify the appropriate patient groups that would most benefit from this adjunctive therapy.

Materials and Methods: In this retrospective study, data was extracted from medical records of patients RE&I clinic & acupuncture clinics between January 2001 and November 2003. All patients completing an IVF cycle with transfer were included. One RE&I provided the IVF care and a consortium of acupuncturists overseen by the author provided the strict acupuncture protocols. PR per transfer were the endpoints measured. Data was analyzed by student’s t test and Multiregression with Wilcox ranking (MRW).

Results: 147 patients were included in the study and of those 53 had Acupuncture (Ac) and 94 did not (Non-Ac group). Demographic data between these Ac and Non-Ac groups respectively indicated remarkable equity (Table 1). Fertility Factors also demonstrated equity and there were no differences in Diagnoses, IVF Protocols and type of Gonadatrophin protocols used.

Factors that demonstrated significance were: Length of time infertile, Peak FSH, PI for total group without MRW; PI for MRW groups reversed this (Table 2) and finally average: Sperm Morphology, Peak E2, Peak P4 prior to HcG: and endometrial thickness. PR before Wilcox ranking were the same: 40% v 38%. MRW analysis revealed FSH, Length of time trying to get pregnant, Sperm Morphology and E2 levels as significant: 6.5, 4.1, 4.0 and 1.6 respectively. When the Ac group was modified (15 Ac patient dropped), PI was elevated from 1.76 to 1.94 resulting in a significant elevation compared to the Non-Ac group, p 0.01. Also PR changed from 40% before to 53% after and this value was significantly greater than the Non-Ac group (38%), p 0.01.

– Magarelli P,Cridennda D, Fertil Steril,2004;81 Suppl 3 S20 Fertility and Sterility

Chinese Herbal Medicine & Sperm

In this study Chinese herbs commonly used in the treatment of male infertility were investigated for relevant biochemical activity. Oxidative stress has been implicated in male infertility with significant levels of reactive oxygen species detected in 25% of infertile males. A total of 37 individual herbs and seven herb decoctions used in the treatment of male factor infertility were therefore tested for endocrine activity. 20 showed strong and 10 weak anti-oestrogenic activity. Oestrogenic responses were elicited for two herbs. Of these 37 herbs, strong (15 herbs), intermediate (7 herbs) and weak/no (15 herbs) antioxidant activity was detected (ranging from 0.912–1.26; 0.6–0.88 and 0–0.468μg ascorbate equivalent/mg dried herb, respectively). The seven decoctions (previously used to treat patients) tested elicited strong (5 herbs) and weak (2 herbs) anti-oestrogenic responses (per g of dried herb tamoxifen equivalents ranged from 1.14–13.23mg and 0.22–0.26mg, respectively), but not oestrogenic, androgenic nor anti-androgenic, consistent with their individual composition.

Helen G. Tempest, Sheryl T. Homa, Edwin J. Routledge, Anthony Garner, Xiao-Ping Zhai and Darren K. Griffin. Systems Biology in Reproductive Medicine. 2008, Vol. 54, No. 4-5 , Pages 185-195 (doi:10.1080/19396360802379073)

90 men with immune infertility were selected as the research subjects and randomly divided into two groups, 60 in the treatment group, treated by Huzhangdanshenyin, and the other 30 in the control, treated by prednisone, both for 3 months. The improvement of clinical symptoms, immunologic indexes (antisperm antibodies in serum and seminal plasma) and sperm indexes (semen liquefied duration, motility, viability, density and abnormal morphology rate) were observed and the results analyzed. CONCLUSION: The Chinese medicine Huzhangdanshenyin works more effectively than prednisone in the treatment of male immune infertility. It could improve the antisperm antibody reversing ratio, clinical symptoms and signs and ameliorate sperm indexes with no obvious advierse effects.

Lu TK, Ouyang HG, Jin GY, Hong YS, Zou Q, Lin ZY, Deng LS, Guo YB. Zhonghua Nan Ke Xue. 2006 Aug;12(8):750-5. Department of Andrology, Xiamen TCM Hospital Affiliated to Fujian TCM College, Xiamen, Fujian 361001, China.

Thirty-seven infertile patients with varicocele were treated with Guizhi-Fuling-Wan (7.5 g/day) for at least 3 months. Before and after the administration, semen qualities such as sperm concentration and motility were examined, and the varicocele was graded. A varicocele disappearance rate of 80% was obtained with 40 out of 50 varicocele, and improvement of sperm concentration and motility were found in 71.4% and 62.1% of patients, respectively. From these results, Guizhi-Fuling-Wan is considered to be effective for circulation disorders in varicocele as well as semen quality.

Ishikawa H; Ohashi M; Hayakawa K; Kaneko S; Hata M Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan. Am J Chin Med, 24(3-4):327-31 1996 (ISSN: 0192-415X)

Eighty-seven cases of male infertility were treated with Bu Shen Sheng Jing Pill, and the comprehensive semen routine analysis score was enhanced significantly (P < 0.001). The result showed that this prescription had a regulatory function in follicle stimulating hormone, luteotropic hormone, testosterone, cortisol (could bring the enhanced or reduced hormone level back to normal range).

Yue GP; Chen Q; Dai N Institute of Acupuncture and Meridians, Anhui College of TCM, Hefei. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih, 16(8):463-6 1996 Aug (ISSN: 1003-5370)

Tai-bao Chinese herbal medicine displayed significantly higher rates of implantation and pregnancy, as well as comparitive rates of lowering effects of antisperm antibodies as prednisone. CONCLUSION: Chinese medicine Tai-bao possesses regulatory effect on reproductive immune function, inhibitory effect on antisperm cytotoxic antibody, and promoting effect on pregnancy.

Lai AN; Song JF; Liu XJ Xiyuan Hospital, China Academy of TCM, Beijing. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih, 17(6):360-2 1997 Jun (ISSN: 1003-5370)

The effects of a Chinese herb, Cornus officinalis, on the motility of human sperm was studied. An aqueous extract was prepared from the dried fruits of the herb and used in this study. The crude extract showed substantial stimulatory effects on sperm motility.

Jeng H; Wu CM; Su SJ; Chang WC Department of Anatomy, Taipei Medical College, Taiwan. Am J Chin Med 1997;25(3-4):301-6 (ISSN: 0192-415X)

Conclusions: 132 men tested positive for antisperm antibodies. They were treated for 1.5-4.5 months with a Chinese herbal formula Ju He Wan. After treatment, 120 (91%) tested negative for antisperm antibodies (compared to only 45% of the group treated with prednisone). 74 of these same men conceived after 1.5-3 months of treatment. From these findings, Chinese herbal medicine could be an effective treatment option for men with antisperm antibodies.

Cheng Ke-jia et al. – pages 39-40 of issue #7, 2007 of Xin Zhong Yi (New Chinese Medicine)

100 cases of male immune infertility in the treatment group were treated with Yikang Decoction, while 100 cases treated with prednisone as the controls. CONCLUSION: The Yikang Decoction has a more stable effect for male immune infertility than prednisone. Antisperm antibodies, percentage of motile sperm, pregnancy rates, and sperm agglutination (clumping) were all significantly better in the group treated with the Chinese herbal fomula Yikang decoction vs the prednisone treatment group.

Sun Z, Bao Y. – J Tradit Chin Med. 2006 Mar;26(1):36-8. – Department of Reproduction, Zhejiang Hospital of Integrated Chinese and Western Medicine, Hangzhou 310003, China.

100 men with low sperm count and poor sperm motility were treated with individulaly modified Chinese herbal formulations combined with clomid and vitamin E daily for 15-60 days (37.3 days average). 82% showed significant increases in both count and motility. This may be a viable treatment option for men with poor sperm motility and low sperm counts.

Shao Chang-jie – Hei Long Jiang Zhong Yi Yao (Heilongjiang Chinese Medicine & Pharmacology), pages 36-37 of issue #3, 2007

156 men with low sperm count and inability to conceive were administered individually modified versions of the Chinese herbal formula Sheng Jing Qiang You Tang for 3-6 months. They were not allowed to drink alcohol, smoke, or have sex. In 98 men their sperm count increased above WHO standards, and 35 men showed an increase in sperm count but did not meet ‘fertile’ WHO criteria.

Zhang Jun. – Shi Yong Zhong Yi Nei Ke Za Zhi (Journal of Practical Chinese Medical Internal Medicine), page 50 of issue #1, 2005

CONCLUSION: Protective effects of Hochuekkito on sperm was suggested on sperm with Anit-sperm Antibodies. Although normal sperm with ASA was used in this report, since the sperm of infertile patients are said to be more fragile, this results imply that direct protective effect is one of the mechanism of Hochuekkito for male infertility

Yamanaka M; Kitamura M; Kishikawa H; Tsuboniwa N; Koga M; Nishimura K; Tsujimura A; Takahara S; Matsumiya K; Okuyama A Department of Urology, Osaka University Medical School – Nippon Hinyokika Gakkai Zasshi, 89(7):641-6 1998 Jul (ISSN: 0021-5287)

Chronic Pelvic Pain Syndrome (CPPS)

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is prevalent in urological practice and has a significant impact on quality of life. Standard therapies often fail to achieve sustainable amelioration of symptoms. This article attempts to show that neuromodulatory treatment in the form of electroacupuncture can be a minimally invasive and effective treatment for CP/CPPS that is refractory to standard therapies. This neuromodulatory therapy lends support to the hypothesis that the end stage of CP/CPPS may be a neuropathic pain syndrome.

Chen RC, Nickel JC. King Street Medical Arts Centre, 71 King Street, W. Suite 400, Mississauga, Ontario, L5B4A2, Canada.

Meta-analysis showed: Chinese herbs can decrease the WBC in the expressed prostatic secretion, improve the pain symptoms and the voiding symptoms.

ProstantTM is a suppository made up of several kinds of Chinese herbs, the main ingredients being Cortex Phellodendri, Fructus Gardeniae, Rhizoma Polygoni Cuspidati, Herba Lycopi and Radix et Rhizoma Rhei, which have been reported to inhibit many kinds of bacteria, fungi and viruses [1, 2].

In our study we used meta-analysis to investigate the effectiveness of ProstantTM on chronic prostatitis. Medline, Embase, CBMdisc and Cochrane Library were searched for randomized case-controlled trials ( RCTs) . The search strategy was made according to the demand of the Cochrane Collaboration. Data were extracted by two reviewers using designed extraction form. RevMan were used for data management and analysis. Thirty-eight relevant trials were searched, of which 4 were included [3-6]. Meta-analysis showed: ProstantTM can decrease the WBC in the expressed prostatic secretion, improve the pain symptoms and the voiding symptoms.The corresponding pooled relative risk (RR) and 95 % confidence interval (CI) was 1.81 (1.29, 2.53), 1.36 (1.14, 1.62) and 2.25 (1.51, 3.37), respectively. The total effective rate of ProstantTM was statistically significant [RR 2.36, 95 % CI (1.79, 3.10), P<0.01]. The occurrence of adverse events were similar in the ProstantTM and placebo-treated men. Limitation of this meta-analysis lies mainly in the way that the 4 included trials collected a small number of cases which may cause publication bias in a certain sort of sense.

CONCLUSION: Combined therapy of medications and traditional Chinese medicine (TCM) can be an effective treatment for the chronic pelvic pain syndrome.

OBJECTIVE: To study the clinical diagnosis and treatment of the chronic pelvic pain syndrome (CPPS).
METHODS: According to National Institute Health (NIH) classification, 165 cases of chronic prostatitis were surveyed by analysis of their laboratory results and clinical history. In addition, the chronic prostatitis symptom index (CPSI) of each patient was evaluated. All patients were treated for 6 to 8 weeks, type III A with antibiotics and alpha1 receptor inhibitor, type III B with alpha1 receptor inhibitor, diazepam diclogenatis and other narcotics. All cases were additionally treated by psychological and physical therapies. Traditional Chinese Medicine was also used in some cases.
RESULTS: Based on the results of CPSI after 6 weeks treatment, 121 (73.3%) significantly improved, 26 (15.8%) slightly improved and only 18(10.9%) did not respond to the therapy.

Xu S, Qi G, Tang P, Li Y. Department of Urology, First Huai’an Hospital, Nanjing Medical University, Huai’an, Jiangsu 223300, China. songx199@yahoo.com.cn

Diet & Sperm

Conclusion(s): This study demonstrates that paternal obesity impairs preimplantation embryo development and implantation but does not influence gross fetal or placental morphology. It highlights the important contribution that paternal health and lifestyle choices have for achieving a viable pregnancy.

Objective
To use a rodent model of male diet-induced obesity (DIO) to examine resultant preimplantation embryo development and implantation rate, as well as fetal and placental growth.

Design
Experimental animal study.

Setting
University research facilities.

Animal(s)
C57BL/6 male and CBAxC57BL/6 female mice.

Intervention(s)
Male mice were fed a standard rodent chow (lean) or a high-fat diet (obese) for up to 13 weeks. After mating, zygotes were collected and cultured to the blastocyst stage, then assessed or transferred into recipient females.

Main Outcome Measure(s)
Embryo morphology and cell number were assessed and pregnancy outcomes determined at postmortem day 18.

Result(s)
Embryos from obese males had reduced cleavage and decreased development to blastocyst stage during culture relative to control males. Blastocysts from obese males implanted at a reduced rate, and the proportion of fetuses that developed was significantly decreased, although fetal and placental weight did not differ between groups.

Megan Mitchell et al – Fertility and Sterility – Volume 95, Issue 4, Pages 1349-1353, 15 March 2011

Conclusion(s)
In a population of healthy young men, carotenoid intake was associated with higher sperm motility and, in the case of lycopene, better sperm morphology. Our data suggest that dietary carotenoids may have a positive impact on semen quality.

Objective
To assess the relationship between dietary antioxidant intake and semen quality in young healthy males.

Design
Cross-sectional study.

Setting
University and college campuses in the Rochester, New York, area.

Patient(s)
One hundred eighty-nine university-aged men.

Intervention(s)
None.

Main Outcome Measure(s)
Semen volume, total sperm count, concentration, motility, total motile count, and morphology.

Result(s)
Progressive motility was 6.5 (95% confidence interval [CI], 0.6, 12.3) percentage units higher among men in the highest quartile of β-carotene intake compared with men in the lowest quartile. Similar results were observed for lutein intake. Lycopene intake was positively related to sperm morphology. The adjusted percentages (95% CI) of morphologically normal sperm in increasing quartiles of lycopene intake were 8.0 (6.7, 9.3), 7.7 (6.4, 9.0), 9.2 (7.9, 10.5), and 9.7 (8.4, 11.0). There was a nonlinear relationship between vitamin C intake and sperm concentration, with men in the second quartile of intake having, on average, the highest sperm concentrations and men in the top quartile of intake having the lowest concentrations.

Fertility and Sterility – Volume 100, Issue 6 , Pages 1572-1579, December 2013 – Piotr Zareba, M.D., M.P.H., Daniela S. Colaci, M.D., M.Sc., Myriam Afeiche, Ph.D., M.P.H., Audrey J. Gaskins, B.S.E., Niels Jørgensen, M.D., Ph.D., Jaime Mendiola, Ph.D., M.P.H., Shanna H. Swan, Ph.D., Jorge E. Chavarro, M.D., Sc.D

DNA Fragmentation

Conclusion(s): The DNA fragmentation of morphologically normal sperm negatively impacts embryo quality and probability of pregnancy in ICSI cycles.

Objective
To evaluate DNA fragmentation in morphologically normal sperm recovered from the same sample used for intracytoplasmic sperm injection (ICSI) and to correlate DNA damage with embryo quality and pregnancy outcome.

Design
Prospective study.

Setting
Academic center.

Patient(s)
36 infertile men participating in the ICSI program.

Intervention(s)
Terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate-fluorescein nick end labeling (TUNEL) assay and morphologic assessment by phase contrast.

Main Outcome Measure(s)
Simultaneous assessment of sperm morphology and DNA fragmentation by TUNEL assay was performed in the same cell, then the percentage of normal sperm with fragmented DNA (normal SFD) was correlated with embryo quality and pregnancy outcomes.

Result(s)
A highly statistically significant negative correlation was found between the percentage of normal SFD and embryo quality. This association was confirmed for the transferred embryos and for the total embryo cohort. The receiver operating characteristics curve analysis demonstrated that the percentage of normal SFD and embryo quality were statistically significant predictors of pregnancy. When the percentage of normal SFD was ≤17.6 %, the likelihood of pregnancy was 3.5 times higher. No correlation was found between the percentage of total sperm with fragmented DNA (morphologically normal and abnormal) and ICSI outcomes.

Fertility and Sterility – Volume 94, Issue 2 , Pages 549-557, July 2010 – Conrado Avendaño, M.S., Anahí Franchi, Ph.D., Hakan Duran, M.D., Sergio Oehninger, M.D., Ph.D. – The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia

Effects with IVF Medications

Conclusions: Our study shows a significantly lower amount of gonadotropins used when IVF is combined with standard acupuncture. A 70% pregnancy rate was also achieved with standard acupuncture and IVF, compared to 25%. Larger prospective trials are necessary.

Objective: The purpose of this study was to determine if there are benefits of standard acupuncture compared to sham acupuncture as an adjunct to IVF.

Materials and Methods: A randomized, controlled, double-blind, cross over pilot trial was performed using a needle-like device (sham acupuncture) as a control. Approval from GAMC’s Investigational Review Board was acquired. Inclusion criteria were women aged 18 to 42 years with a history of failed IVF cycle(s); the presence of both ovaries; and a normal uterine cavity. Exclusion criteria was Kruger morphology <4%.

Results: Seventeen subjects were enrolled and seven subjects completed both arms of the study. The mean age was 36.2 years (range 28-41 years). The mean Day 3 FSH=3 D6.8 IU (range 3-13 IU). There were four ongoing pregnancies after the first cycle, equally distributed. Seven subjects were crossed over after the first cycle. Of these, four from the standard acupuncture group and one from the sham acupuncture group attained pregnancy. Two subjects of the standard acupuncture group were on-going pregnancies and one from the sham group. Only the sham group had two IVF cancellations. An unpaired Mann-Whitney Test using a two-sided p value was performed.

Erectile Dysfunction (Impotence)

The results of our pilot study indicate that acupuncture can be an effective treatment option in more than two-thirds of patients with psychogenic erectile dysfunction.

In a prospective study, we investigated the potentially curative effect of acupuncture in patients with psychogenic erectile dysfunction (pED). A total of 22 patients with pED were randomized into two groups. They were either treated with acupuncture specific against ED (treatment group) or acupuncture specific against headache (placebo group). Nonresponders of the placebo group were crossed over to the treatment group. Prior to acupuncture, serum sexual hormone levels, IIEF score, nocturnal penile tumescence testing for three nights (Rigiscan) and the erectile response to 50 mg sildenafil were evaluated. Out of 21 patients, 20 completed the study, including 10 patients after crossover. A satisfactory response was achieved in 68.4% of the treatment group and in 9% of the placebo group (P=0.0017). Another 21.05% of the patients had improved erections, that is, sufficient rigidity under simultaneous treatment with 50 gm sildenafil. The results of our pilot study indicate that acupuncture can be an effective treatment option in more than two-thirds of patients with psychogenic erectile dysfunction.

Engelhardt PF, Daha LK, Zils T, Simak R, Konig K, Pfluger H. Department of Urology and Ludwig-Boltzmann-Institute of Andrology and Urology, Lainz Hospital, Vienna, Austria. paul.engelhardt@aon.at

Conclusion: Cnidium Monnieri (Shi Chuang Zi) naturally increases nitric oxide release, which powerfully increases the production of cGMP. Cyclic Guanosine Monophosphate (cGMP) is the key in obtaining and sustaining a powerful erection. cGMP relaxes the muscles around the penis, which makes it possible for the cells in the penis to take in blood, thus allows you to experience a proper erection.

Chen J, Chiou WF, Chen CC, Chen CF. Institute of Clinical Medicine, National Yang-Ming University, and National Research Institute of Chinese Medicine, Taipei, Taiwan, Republic of China.

PURPOSE: We investigated the cavernosal relaxant effect of osthole, a coumarin isolated from Cnidium monnier (L.) Cusson which has been long used in China as a herbal medicine to improve male sexual dysfunction. MATERIALS AND METHODS: Strips of rabbit corpus cavernosum were precontracted with phenylephrine. Corporal relaxation evoked by osthole was then determined in the absence and presence of nitric oxide synthase inhibitor (L-NAME), soluble guanylate cyclase inhibitor (ODQ), cyclooxygenase inhibitor (indomethacin), tetradotoxin, and after endothelium deprivation. RESULTS: Corpus cavernosal strips showed relaxation in response to osthole (0.1 approximately 30 microM) in a dose-dependent manner. These effects were reduced partially but significantly by pretreatment with L-NAME, ODQ and by endothelial disruption. However, they were not affected by indomethacin and tetradotoxin treatment. Osthole pretreatment (from 1 to 30 microM) enhanced the sodium nitroprusside (0.3 microM)-induced relaxation of corpus cavernosum in a dose-dependent manner to a maximum of 3 times the pretreatment level at 30 microM osthole. However, this effect was abolished in the presence of zaprinast. Additionally, a higher concentration of osthole (30 microM) also enhanced forskolin-induced relaxation. CONCLUSION: The data suggested that osthole possesses a relaxant effect on rabbit corpus cavernosal tissues which is attributable to the release of NO from sinusoidal endothelium and to the potentiation of the cGMP and/or cAMP signal mediating relaxation of cavernosal smooth muscle by inhibiting phosphodiesterase.

Conclusion: Tetrandrine, the main active ingredient in the Chinese herb Fen Fang Ji (the safe Fang Ji), has shown to relax penis muscles for enhanced blood flow to erectile tissue. It’s mode of action is through Ca channel blocking, not nitric oxide pathways (which is the mechanism of viagra).

Nat Prod Res. 2009;23(2):112-21. Chen J, Liu J, Wang T, Xiao H, Yin C, Yang J, Chen X, Ye Z.Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

The relaxation mechanisms of tetrandrine (Tet) on the rabbit corpus cavernosum tissue in vitro were investigated. Strips of rabbit corpus cavernosum were mounted in organ chambers. The effects of Tet were examined on isolated muscle strips pre-contracted with phenylephrine (PE) alone, in the presence of N(W)-nitro-L-arginine (LNNA, a nitric oxide synthase inhibitor), 1-H-[1,2,4]oxadiazolo[4,3-alpha]quinoxalin-1-one(ODQ, a guanylyl cyclase inhibitor), indomethacin (cyclooxygenase inhibitor), tetraethylammonium (TEA, Ca(2+)-activated K(+) channel blocker), 4-aminopiridine (4-AP, voltage dependent K(+) channel blocker) and glibenclamide (ATP sensitive K(+)channel blocker). The effects of Tet on KCl-induced contraction of isolated muscle strips were also investigated. The procedure of calcium absence-calcium addition was designed to observe the effect of Tet on the two components of the contractile responses to PE based on the source of Ca(2+) (extracellular vs. intracellular). Corpus cavernosum strips showed relaxation in response to Tet (10(-8) approximately 10(-3) mol L(-1)) in a concentration-dependent manner with an IC(50) of 3.73 x 10(-5) mol L(-1). However, they were not affected by LNNA, ODQ, indomethacin and K(+)-channel blockers. Tet (10 micromol L(-1), 30 micromol L(-1)) concentration dependently reduced the maximal contraction response of isolated strips induced by KCl to (73.0 +/- 3.8) and (41.5 +/- 3.4)%, respectively (p < 0.01). In the procedure of calcium absence-calcium addition, Tet 100 micromol L(-1) inhibited both intracellular calcium-dependent and extracellular calcium-dependent contraction induced by PE (20 micromol L(-1)) (p < 0.05). The inhibition ratios were (23.8 +/- 7.1) and (40.7 +/- 11.2)%, respectively. The results of the present study suggest that Tet possesses a relaxant effect on rabbit corpus cavernosum tissues, which is attributable to the inhibition of extracellular Ca(2+) influx and the inhibition of release of intracellular-stored Ca(2+), but not mediated by the release of nitric oxide, prostaglandins or by the activation of potassium channels.

The purported effects of “circulation-improving” herbs used in traditional Chinese medicine (TCM) show striking similarities with the vascular actions of nitric oxide (NO) produced by the endothelial NO synthase (eNOS). We have previously reported that Salviae miltiorrhizae radix (Dan Shen) and Zizyphi spinosae semen (da zao) upregulate eNOS expression. In the present study, we studied the effect on eNOS gene expression of 15 Chinese herbs with potential effects on the vasculature, and identified Prunella vulgaris L. (PVL) (flowering spike, xia ku cao) as a potent eNOS-upregulating agent. In EA.hy 926 cells, a cell line derived from human umbilical vein endothelial cells (HUVEC), an aqueous extract of PVL increased eNOS promoter activity, eNOS mRNA and protein expressions, as well as NO production in concentration- and time-dependent manners. We have previously shown that ursolic acid (a constituent of Salviae miltiorrhizae radix), betulinic acid (a compound present in Zizyphi spinosae semen), luteolin and cynaroside (ingredients of artichoke, Cynara scolymus L.) are capable of enhancing eNOS gene expression. These compounds are also present in significant quantities in PVL. Thus, PVL contains active principles that stimulate human eNOS gene expression, and such compounds may have therapeutic potential against cardiovascular diseases.

Am J Chin Med. 2010;38(3):599-611. Xia N, Bollinger L, Steinkamp-Fenske K, Förstermann U, Li H. Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.

Fertility Diet

Conclusion(s): A moderate reduction in dietary carbohydrate reduced the fasting and postchallenge insulin concentrations among women with PCOS, which, over time, may improve reproductive/endocrine outcomes.

Objective
To determine whether eucaloric diets either enriched with monounsaturated fatty acids (MUFA; 17% energy) or low in carbohydrates (Low CHO; 43% energy) would increase insulin sensitivity (Si) and decrease circulating insulin concentrations, relative to a standard diet (STD; 56% CHO, 31% fat, 16% protein), among women with polycystic ovary syndrome (PCOS).

Design
Crossover.

Setting
Academic research environment.

Patient(s)
Healthy women with PCOS not on hormonal or insulin-sensitizing therapy.

Intervention(s)
Subjects consumed three, 16-day, eucaloric diets, each separated by a 3-week washout period. A frequently sampled, intravenous, glucose tolerance test was administered at baseline and following each diet.

Main Outcome Measure(s)
Fasting glucose, insulin, the acute insulin response to glucose (AIRg), Si, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), total testosterone (T), free T, A4, total cholesterol, high-density lipoprotein cholesterol (HDL-C), tryglycerides (TG), and free fatty acids (FFA).

Result(s)
Fasting insulin was lower following the Low CHO diet relative to the STD diet; AIRg was lower following the Low CHO diet relative to the MUFA diet. Fasting glucose, Si, and the circulating concentrations of reproductive hormones were not significantly affected by the intervention.

Crystal C. Douglas, Ph.D., R.D.email address, Barbara A. Gower, Ph.D., Betty E. Darnell, M.S., R.D., Fernando Ovalle, M.D., Robert A. Oster, Ph.D., Ricardo Azziz, M.D., M.P.H., M.B.A. – Fertility and Sterility, Volume 85, Issue 3 , Pages 679-688, March 2006 – http://www.fertstert.org/article/S0015-0282(05)03974-9/abstract

 

Conclusion(s): Shorter TTP was observed among women with BMI <25 kg/m2 with increasing vitamin C, women with BMI ≥25 kg/m2 with increasing β-carotene, women <35 y with increasing β-carotene and vitamin C, and women ≥35 y with increasing vitamin E.

Objective
To determine whether increased antioxidant intake in women is associated with shorter time to pregnancy (TTP) among a cohort of couples being treated for unexplained infertility.

Design
Secondary data analysis of a randomized controlled trial.

Setting
Academic medical center associated with a private infertility center.

Patients
Females with unexplained infertility.

Interventions
None.

Main Outcome Measure(s)
The time it took to establish a pregnancy that led to a live birth.

Result(s)
Mean nutrient intake exceeded the estimated average requirement (EAR) for vitamins C and E. No differences in mean intake of any of the antioxidants were noted between women who delivered a live-born infant during the study period vs. those who did not. In multivariable models, intake of β-carotene from dietary supplements was associated with shorter TTP among women with body mass index (BMI) ≥25 kg/m2 (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.09–1.53) and women <35 y (HR 1.19, 95% CI 1.01–1.41). Intake of vitamin C from dietary supplements was associated with shorter TTP among women with BMI <25 kg/m2 (HR 1.09, 95% CI 1.03–1.15) and women <35 y (HR 1.10, 95% CI 1.02–1.18). Intake of vitamin E from dietary supplements among women ≥35 y also was associated with shorter TTP (HR 1.07, 95% CI 1.01–1.13).

Elizabeth H. Ruder, Ph.D., M.P.H.email address, Terryl J. Hartman, Ph.D., M.P.H., Richard H. Reindollar, M.D., Marlene B. Goldman, Sc.D. – Fertility and Sterility Volume 101, Issue 3 , Pages 759-766, March 2014

Fertility Meta-Analysis & Systematic Reviews

Conclusions The data from this meta-analysis suggests that acupuncture performed on the day of ET does increase the clinical pregnancy rate of IVF treatment; however, this could be attributed to placebo effect and the small number of patients included. Further larger RCTs are necessary to confirm the results.

Another group of researchers have analysed updated clinical trial data and have come to the same conclusion as those who published the BMJ meta analysis, namely acupuncture is a useful addition to IVF. It has been published as a Cochrane Review. The Cochrane Collaboration is an international and independent organization dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide.

Introduction: Acupuncture has more recently been studied in assisted reproductive treatment, although its role in reproductive medicine is still debated. This is a meta-analysis to determine the effectiveness of acupuncture in the outcomes of assisted reproductive technologies (ART).

Material & Methods: All reports which described randomised controlled trials of acupuncture in assisted conception were obtained through searches via the Menstrual Disorders and Subfertility Group’s specialised Register of controlled trials, the OVID MEDLINE (1996 to August 2007), CINAHL- cumulative Index to Nursing & Allied Health Literature (1982 to August 2007), EMBASE (1980 -August 2007), AMED, National research Register, US equivalent Clinical Trials register (http://www.clinicaltrials.gov) were searched using the OVID software, the Chinese literature databases were searched from the China Academic Journal Electronic full text Database in the China National Knowledge Infrastructure and Index to Chinese Periodical Literature.

All relevant references were also hand searched.

The selection criteria included randomised controlled trials of acupuncture that included couples who were undergoing ART and/or acupuncture and compared these treatments to each other, placebo or no treatment for the treatment of primary and secondary infertility were included.

Women with medical illness deemed contraindications for ART or acupuncture were excluded. Quality assessment and data extraction were performed independently by two reviewers.

Meta-analysis was performed using odds ratio for dichotomous outcomes. Subgroup analysis and sensitivity analysis were performed where necessary. The outcome measures were the live birth rate, the clinical, ongoing pregnancy rate, miscarriage rate and any reported side effects of treatment.

Results Thirteen randomised controlled trials were identified that involved acupuncture and assisted conception. Ten trials were included and three were excluded.

Acupuncture on the day of ET improves the ongoing pregnancy rate (Odds Ratio = 1.85; 95% confidence interval 1.18-2.91) and the clinical pregnancy rate (Odds ratio = 1.65; 95% confidence interval 1.22-2.24), but there was no evidence of a difference in the miscarriage rate compared to controls. Acupuncture on the day of ET + 2 to 3 days after ET (repeated acupuncture) improves the clinical pregnancy rate (Odds Ratio = 2.23, 95% CI 1.41 – 3.51) but not the ongoing pregnancy rate (Odds Ratio = 1.93, 95% CI 0.86-4.36). Repeated acupuncture did not affect the miscarriage rate.

Acupuncture around the time of oocyte retrieval has no evidence of benefit over the live birth rate (Odds Ratio 0.84, 95% CI 0.50 – 1.42), ongoing pregnancy (Odds Ratio 0.84, 95% CI 0.5 -1.42), clinical pregnancy (Odds ratio 1.07, 95% CI 0.71-1.61), and miscarriage rate (Odds Ratio 0.59, 95% CI 0.14-2.56).

The authors concluded, “The odds ratio of 1.65 suggests that acupuncture increased the odds of clinical pregnancy by 65% compared with the control groups… In absolute terms 10 patients would need to be treated with acupuncture to bring about one additional clinical pregnancy. These are clinically relevant benefits.”

Impressive as these results are they may still be an underestimate, since the authors included women who’s IVF cycles were cancelled before transfer.

Objective – To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation. Design – Systematic review and meta-analysis.

Data sources – Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.

Review methods – Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.

Data synthesis – Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth.

The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).

Conclusions – Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

Conclusion(s):
Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects from using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

Objective
To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.

Design
Systematic review and meta-analysis.

Patient(s)
Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects of acupuncture on IVF outcomes.

Setting
Not applicable.

Intervention(s)
The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture.

Main Outcome Measure(s)
The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.

Result(s)
Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation.

High FSH

Conclusion: electroacupuncture could decrease serum FSH and LH levels, and increase estrogen levels in women with ovarian deficiency with little to no side-effects.

To investigate the effects of electroacupuncture (EA) on serum FSH, E2, and LH levels, women with primary ovarian insufficiency (POI) were treated with EA once a day, five times a week for the first four weeks and once every other day, three times a week, for the following two months, and then were followed up for three months. Serum E2, FSH, and LH levels were measured at baseline, at the end of treatment, and during followup. A total of 11 women with POI were included in this prospective consecutive case series study. Compared with baseline, patients’ serum E2 increased, FSH decreased, and LH decreased (P = 0.002, 0.001, and 0.002, resp.) after EA treatment, and these effects persisted during followup. With treatment, 10 patients resumed menstruation (10/11, 90.91%), whereas one patient remained amenorrhea. During followup, two patients, including the one with amenorrhea during treatment, reported absence of menstruation. Temporary pain occurred occasionally, and no other adverse events were found during treatment. The results suggest that EA could decrease serum FSH and LH levels and increase serum E2 level in women with POI with little or no side effects; however, further randomized control trials are needed.

Evid Based Complement Alternat Med. 2013;2013:657234. doi: 10.1155/2013/657234. Epub 2013 Feb 28., Zhou K, Jiang J, Wu J, Liu Z. – Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, No. 5 Bei Xian Ge Street, Xuan Wu District, Beijing 100053, China ; Department of Physical Therapy, Daemen College, 4380 Main Street, Amherst, NY 14226, USA.

Conclusions: Significant increases in pregnancy outcomes were confirmed by this study and the data uniquely supported the advantage of acupuncture in patients with normal PI (prior studies were done on patient with PI). We also demonstrated that both acupuncture treatment protocols could be used together with a synergistic effect. Finally, this study is the first to demonstrate that the use of acupuncture in patients with poor prognoses (elevated Peak FSH, longer history of infertility, poor sperm morphology) can achieve similar pregnancy rates to normal prognosis patients.

Objective: The purpose of the study was to determine the influence of two acupuncture protocols on IVF outcomes and secondly to identify the appropriate patient groups that would most benefit from this adjunctive therapy.

Materials and Methods: In this retrospective study, data was extracted from medical records of patients RE&I clinic & acupuncture clinics between January 2001 and November 2003. All patients completing an IVF cycle with transfer were included. One RE&I provided the IVF care and a consortium of acupuncturists overseen by the author provided the strict acupuncture protocols. PR per transfer were the endpoints measured. Data was analyzed by student’s t test and Multiregression with Wilcox ranking (MRW).

Results: 147 patients were included in the study and of those 53 had Acupuncture (Ac) and 94 did not (Non-Ac group). Demographic data between these Ac and Non-Ac groups respectively indicated remarkable equity (Table 1). Fertility Factors also demonstrated equity and there were no differences in Diagnoses, IVF Protocols and type of Gonadatrophin protocols used.

Factors that demonstrated significance were: Length of time infertile, Peak FSH, PI for total group without MRW; PI for MRW groups reversed this (Table 2) and finally average: Sperm Morphology, Peak E2, Peak P4 prior to HcG: and endometrial thickness. PR before Wilcox ranking were the same: 40% v 38%. MRW analysis revealed FSH, Length of time trying to get pregnant, Sperm Morphology and E2 levels as significant: 6.5, 4.1, 4.0 and 1.6 respectively. When the Ac group was modified (15 Ac patient dropped), PI was elevated from 1.76 to 1.94 resulting in a significant elevation compared to the Non-Ac group, p 0.01. Also PR changed from 40% before to 53% after and this value was significantly greater than the Non-Ac group (38%), p 0.01.

– Magarelli P,Cridennda D, Fertil Steril,2004;81 Suppl 3 S20 Fertility and Sterility

Hormones

CONCLUSION(S): Stress significantly reduced the probability of conception each day during the fertile window, possibly exerting its effect through the sympathetic medullar pathway.

OBJECTIVE: To assess salivary stress biomarkers (cortisol and alpha-amylase) and female fecundity.

DESIGN: Prospective cohort design.

SETTING: United Kingdom.

PATIENT(S): 274 women aged 18 to 40 years who were attempting pregnancy.

INTERVENTION(S): Observation for six cycles or until pregnancy: women collected basal saliva samples on day 6 of each cycle, and used fertility monitors to identify ovulation and pregnancy test kits for pregnancy detection.

MAIN OUTCOME MEASURE(S): Salivary cortisol (mug/dL) and alpha-amylase (U/mL) concentration measurements; fecundity measured by time-to-pregnancy and the probability of pregnancy during the fertile window as estimated from discrete-time survival and Bayesian modeling techniques, respectively.

RESULT(S): Alpha-amylase but not cortisol concentrations were negatively associated with fecundity in the first cycle (fecundity odds ratio = 0.85; 95% confidence interval 0.67, 1.09) after adjusting for the couples’ ages, intercourse frequency, and alcohol consumption. Statistically significant reductions in the probability of conception across the fertile window during the first cycle attempting pregnancy were observed for women whose salivary concentrations of alpha-amylase were in the upper quartiles in comparison with women in the lower quartiles (highest posterior density: -0.284; 95% interval -0.540, -0.029).

Conclusion: electroacupuncture could decrease serum FSH and LH levels, and increase estrogen levels in women with ovarian deficiency with little to no side-effects.

To investigate the effects of electroacupuncture (EA) on serum FSH, E2, and LH levels, women with primary ovarian insufficiency (POI) were treated with EA once a day, five times a week for the first four weeks and once every other day, three times a week, for the following two months, and then were followed up for three months. Serum E2, FSH, and LH levels were measured at baseline, at the end of treatment, and during followup. A total of 11 women with POI were included in this prospective consecutive case series study. Compared with baseline, patients’ serum E2 increased, FSH decreased, and LH decreased (P = 0.002, 0.001, and 0.002, resp.) after EA treatment, and these effects persisted during followup. With treatment, 10 patients resumed menstruation (10/11, 90.91%), whereas one patient remained amenorrhea. During followup, two patients, including the one with amenorrhea during treatment, reported absence of menstruation. Temporary pain occurred occasionally, and no other adverse events were found during treatment. The results suggest that EA could decrease serum FSH and LH levels and increase serum E2 level in women with POI with little or no side effects; however, further randomized control trials are needed.

Evid Based Complement Alternat Med. 2013;2013:657234. doi: 10.1155/2013/657234. Epub 2013 Feb 28., Zhou K, Jiang J, Wu J, Liu Z. – Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, No. 5 Bei Xian Ge Street, Xuan Wu District, Beijing 100053, China ; Department of Physical Therapy, Daemen College, 4380 Main Street, Amherst, NY 14226, USA.

Conclusion(s): In this study, there appears to be a beneficial regulation of CORTISOL and PROLACTIN in the Acupuncture group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics.

Objective: To determine whether changes in serum cortisol (CORT) and PRL are affected by acupuncture (Ac) in Ac-treated IVF patients.

Design: Prospective cohort clinical study.

Setting: Private practice reproductive endocrinology and infertility clinic and private practice acupuncture consortium.
Patient(s): Sixty-seven reproductive-age infertile women undergoing IVF.

Intervention(s): Blood samples were obtained from all consenting new infertility patients and serum CORT and serum PRL were obtained prospectively. Patients were grouped as controls (IVF with no Ac) and treated (IVF with Ac) according to acupuncture protocols derived from randomized controlled trials.

Main Outcome Measure(s): Serum levels of CORT and PRL were measured and synchronized with medication stimulation days of the IVF cycle (e.g., day 2 of stimulation, day 3, etc.). Reproductive outcomes were collected according to Society for Assisted Reproductive Technology protocols, and results were compared between controls and those patients treated with Ac.

Result(s): CORT levels in Ac group were significantly higher on IVF medication days 7, 8, 9, 11, 12, and 13 compared with controls. PRL levels in the Ac group were significantly higher on IVF medication days 5, 6, 7, and 8 compared with controls.

Conclusion: electroacupuncture could decrease serum FSH and LH levels, and increase estrogen levels in women with ovarian deficiency with little to no side-effects.

To investigate the effects of electroacupuncture (EA) on serum FSH, E2, and LH levels, women with primary ovarian insufficiency (POI) were treated with EA once a day, five times a week for the first four weeks and once every other day, three times a week, for the following two months, and then were followed up for three months. Serum E2, FSH, and LH levels were measured at baseline, at the end of treatment, and during followup. A total of 11 women with POI were included in this prospective consecutive case series study. Compared with baseline, patients’ serum E2 increased, FSH decreased, and LH decreased (P = 0.002, 0.001, and 0.002, resp.) after EA treatment, and these effects persisted during followup. With treatment, 10 patients resumed menstruation (10/11, 90.91%), whereas one patient remained amenorrhea. During followup, two patients, including the one with amenorrhea during treatment, reported absence of menstruation. Temporary pain occurred occasionally, and no other adverse events were found during treatment. The results suggest that EA could decrease serum FSH and LH levels and increase serum E2 level in women with POI with little or no side effects; however, further randomized control trials are needed.

Evid Based Complement Alternat Med. 2013;2013:657234. doi: 10.1155/2013/657234. Epub 2013 Feb 28., Zhou K, Jiang J, Wu J, Liu Z. – Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, No. 5 Bei Xian Ge Street, Xuan Wu District, Beijing 100053, China ; Department of Physical Therapy, Daemen College, 4380 Main Street, Amherst, NY 14226, USA. http://www.ncbi.nlm.nih.gov/pubmed/23533511

Implantation

Conclusion
Acupuncture can significantly down-regulate the expressions of serum levels of T and E2, improve the development of ovaries and uterus, promote ovulation, enhance endometrial receptivity, and advance blastocyst implantation.

Objective
To observe the effect and mechanism of acupuncture on infertility of rats with polycystic ovarian syndrome (PCOS).

Methods
PCOS rat model was induced by subcutaneous injection of oil solution of dehydroepiandrosterone (DHEA) in immature (24-day-old) female rats for continuous 20 days. Rats in the control group were given the same dose of DHEA oil.
PCOS rats were randomly divided into the control group (untreated) and the acupuncture group treated by needling acupoints of Guanyuan (CV4), Zhongji (CV3), Sanyinjiao (SP6) and Zigong (CX-CA1), 15 min once a day for 5 continuous days, starting from the 80th day after birth.
All rats were sacrificed at termination of the treatment, their uterus and ovaries were dissected for observation and blood levels of sex hormones were measured.

Results
Compared with the control group, the number of implanted blastocysts and the blastocyst implantation rate were higher and the blood levels of testosterone (T) and estradiol (E2) were lower in the acupuncture group (P<0.05); but the difference between groups in serum levels of follicular stimulating hormone, luteinzing hormone and progesterone were of statistical insignificance (P>0.05).

Moreover, the wet weight of the ovaries was lower and the equipotent diameter and area of glandular organ and cavity area ratio of gland and the stroma and mean thickness of endometria were higher in the acupuncture group than those in the control group (P<0.05).

Infertility

CONCLUSION(S): Stress significantly reduced the probability of conception each day during the fertile window, possibly exerting its effect through the sympathetic medullar pathway.

OBJECTIVE: To assess salivary stress biomarkers (cortisol and alpha-amylase) and female fecundity.

DESIGN: Prospective cohort design.

SETTING: United Kingdom.

PATIENT(S): 274 women aged 18 to 40 years who were attempting pregnancy.

INTERVENTION(S): Observation for six cycles or until pregnancy: women collected basal saliva samples on day 6 of each cycle, and used fertility monitors to identify ovulation and pregnancy test kits for pregnancy detection.

MAIN OUTCOME MEASURE(S): Salivary cortisol (mug/dL) and alpha-amylase (U/mL) concentration measurements; fecundity measured by time-to-pregnancy and the probability of pregnancy during the fertile window as estimated from discrete-time survival and Bayesian modeling techniques, respectively.

RESULT(S): Alpha-amylase but not cortisol concentrations were negatively associated with fecundity in the first cycle (fecundity odds ratio = 0.85; 95% confidence interval 0.67, 1.09) after adjusting for the couples’ ages, intercourse frequency, and alcohol consumption. Statistically significant reductions in the probability of conception across the fertile window during the first cycle attempting pregnancy were observed for women whose salivary concentrations of alpha-amylase were in the upper quartiles in comparison with women in the lower quartiles (highest posterior density: -0.284; 95% interval -0.540, -0.029).

Conclusions: .Previous unpublished work at BCRM showed that 85% of the patients found the named nurse system important as a coping mechanism to support them by providing continuity of care through stressful treatment. The responses to the questionnaires indicate a clear demand for acupuncture and suggest that acupuncture may be valuable to improve the general wellbeing of women during infertility investigations and treatments. If acupuncture provides an effective coping mechanism, this could support patients to persevere with increased numbers of ART(Assisted Reproductive Technologies) cycles, thereby increasing their ultimate chance of a successful pregnancy.

Introduction.Despite a lack of studies clearly demonstrating clinical efficacy complementary medicine is frequently used by couples undergoing infertility treatment (Coulson 2005). In Bristol, acupuncture has become very popular among patients undergoing infertility treatment, thus this study sought to quantify this and examine the reasons why patients choose acupuncture.

Methods.Two hundred questionnaires were given to patients who attended the Bristol Centre for Reproductive Medicine (BCRM) for investigation or treatment of infertility in August 2009. Patients were asked to complete the questionnaire while waiting to see their doctor or nurse and 194 responses were returned. The questionnaires asked if patients had or wished to have acupuncture or other complementary medicine, and to indicate on a scale of one to ten (10 being the best) the relative importance of acupuncture in comparison to values such as pregnancy rates and continuity of care.

Results.Out of 58 respondents who use complementary medicine, 43 used acupuncture. 40 respondents use acupuncture regularly and 17 of those lived outside of Bristol. A further 52 respondents had considered using acupuncture. In terms of very high importance (score of 10) 135 respondents felt pregnancy rates scored 10, 84 felt having the same doctor scored 10, 71 scored 10 for having the same nurse, 31 felt in house acupuncture scored 10 and 21 scored 10 for other complementary medicine. Overall, 43 respondents felt acupuncture should be available at Bristol Centre for Reproductive Medicine. Thirty four respondents gave more importance to acupuncture than seeing the same doctor or nurse, and 32 deemed it equally important. In addition, 29 patients scored acupuncture as equally important to pregnancy rates and 5 scored acupuncture higher than pregnancy rates.

Conclusion
This preliminary exploration, whilst confined to a small sample of women, confirms that acupuncture is indeed perceived by infertile women to have an impact to their health. All findings outlined here are reported cautiously because they are limited by the size of the sample. They suggest that further studies of acupuncture as an adjunct to IVF should systematically explore the issues of wellbeing, anxiety, personal and social resilience and women’s identity in relation to sexuality and reproduction.

Background
In Vitro Fertilisation (IVF) is now an accepted and effective treatment for infertility, however IVF is acknowledged as contributing to, rather than lessening, the overall psychosocial effects of infertility. Psychological and counselling interventions have previously been widely recommended in parallel with infertility treatments but whilst in many jurisdictions counselling is recommended or mandatory, it may not be widely used. Acupuncture is increasingly used as an adjunct to IVF, in this preliminary study we sought to investigate the experience of infertile women who had used acupuncture to improve their fertility.

Methods
A sample of 20 women was drawn from a cohort of women who had attended for a minimum of four acupuncture sessions in the practices of two acupuncturists in South Australia. Eight women were interviewed using a semi-structured questionnaire. Six had sought acupuncture during IVF treatment and two had begun acupuncture to enhance their fertility and had later progressed to IVF. Descriptive content analysis was employed to analyse the data.

Results
Four major categories of perceptions about acupuncture in relation to reproductive health were identified: (a) Awareness of, and perceived benefits of acupuncture; (b) perceptions of the body and the impact of acupuncture upon it; (c) perceptions of stress and the impact of acupuncture on resilience; and (d) perceptions of the intersection of medical treatment and acupuncture.

Conclusion; Acupuncture is an effective and low intensity procedure for increasing women’s resilience in the repetitive and stress inducing time of pregnancy attempts, with or without medical treatment. The instrumental role of the acupuncture therapist in increasing resilience is a finding that has not emerged in previous studies and has implications for patient management.

Aim: There is interest in the use of acupuncture as an adjunct to fertility treatment. this study aimed to examine women’s attitudes and beliefs in relation to the use of acupuncture for enhancing fertility or as an adjunct to ART.

Results: Participants all expressed confidence in the ability of acupuncture to contibute to their reproductive decision in a positive way. They described acupuncture as an adjunct to pregnancy attempts that was positive since it gave them a sense of control and a strategy for improving their chances. Women were unable to locate acupuncture as a causative factor in a resulting pregnancy however all women described acupuncture as instrumental in an increased sense of well being, self confidence, emotional balance and reduced anxiety. All experienced increased resilience.

Conclusion: electroacupuncture could decrease serum FSH and LH levels, and increase estrogen levels in women with ovarian deficiency with little to no side-effects.

To investigate the effects of electroacupuncture (EA) on serum FSH, E2, and LH levels, women with primary ovarian insufficiency (POI) were treated with EA once a day, five times a week for the first four weeks and once every other day, three times a week, for the following two months, and then were followed up for three months. Serum E2, FSH, and LH levels were measured at baseline, at the end of treatment, and during followup. A total of 11 women with POI were included in this prospective consecutive case series study. Compared with baseline, patients’ serum E2 increased, FSH decreased, and LH decreased (P = 0.002, 0.001, and 0.002, resp.) after EA treatment, and these effects persisted during followup. With treatment, 10 patients resumed menstruation (10/11, 90.91%), whereas one patient remained amenorrhea. During followup, two patients, including the one with amenorrhea during treatment, reported absence of menstruation. Temporary pain occurred occasionally, and no other adverse events were found during treatment. The results suggest that EA could decrease serum FSH and LH levels and increase serum E2 level in women with POI with little or no side effects; however, further randomized control trials are needed.

Evid Based Complement Alternat Med. 2013;2013:657234. doi: 10.1155/2013/657234. Epub 2013 Feb 28., Zhou K, Jiang J, Wu J, Liu Z. – Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, No. 5 Bei Xian Ge Street, Xuan Wu District, Beijing 100053, China ; Department of Physical Therapy, Daemen College, 4380 Main Street, Amherst, NY 14226, USA. http://www.ncbi.nlm.nih.gov/pubmed/23533511

IVF Acupuncture Research

SUMMARY: This study reports an increase in implantation rates (IR) with the use of laser acupuncture, however there was no significant difference in ‘ongoing pregnancy rates (OPR)‘ between needle acupuncture and laser acupuncture.

DESIGN: Prospect randomized double blind and placebo controlled.
MATERIALS AND METHODS: On the day of transfer, participants were randomly assigned to a study group; needle acupuncture (AC), laser acupuncture (LZ AC), sham laser acupuncture (LZ sham), relaxation (RX), or no treatment (NT). The AC and LZ AC puncture groups were considered treatment groups, the RX controls for the additional rest before and after transfer, and NT is the non-intervention group. Most significantly, the LZ Sham group provided an important control group. The laser acupuncture device was randomly preprogrammed per case to either fire (and provide LZ AC) or to not fire and thus provide a true double blind control group (LZ sham). It was not possible for the patient or acupuncturist to know if the laser fired. No contact oocurs with the patient in laser acupuncture so there is no acupressure effect or contact with the wrong meridians. All treatments were administered for 25 minutes before and after embryo transfer. Outcomes were compared by Chi-square and multiple logistic regression analysis to control for the potential confounders including female age, embryo quality, and day of transfer (Table 1).
RESULTS: All treatments were well tolerated. No differences in terms of patient demographics, cycle type, stimulation outcomes, embryo number and quality, day of embryo transfer, transferring physician, or acupuncturist were found between the 5 study groups. Implantation rates were significantly improved with laser acupuncture. Traditional needle acupuncture had outcomes equivalent to the 3 control groups. Subanalyses of patient age and embryo transfer day produced similar findings with laser acupuncture enhancing outcome rates.
CONCLUSIONS: This large prospective randomized and well controlled study consistently demonstrated benefit to LZ AC. Treatment was well tolerated and significantly improved implantation rates.

Clinical Outcomes (%) Rates
Needle acupuncture: implantation (28.9), chemical pregnancy (61.5), clinical pregnancy (51.5), ongoing pregnancy (39.0)
Laser acupuncture: implantation (33.7), chemical pregnancy (60.9), clinical pregnancy (54.5), ongoing pregnancy (42.1)
Non-intervention: implantation (30.2), chemical pregnancy (60.4), clinical pregnancy (50.3), ongoing pregnancy (39.6)

Note: it should be emphasized that the non-intervention group did almost as well and in some respects better than needle and laser acupuncture, showing that this is a very high pregnancy rate group of subjects, which evidence seems to be showing that acupuncture does not display significant effect on outcomes. The trend seems to be showing that acupuncture is better suited for advanced maternal age, and poor responders.

Fratterelli JL et al Fertil Steril 2008 Vol 90, Suppl 1,pg S105 – Fertility and Sterility

Objective – Acupuncture performed onsite before and after embryo transfer has been reported to improve in vitro fertilization (IVF) outcome in patients with good quality embryos. The purpose of this investigation was to evaluate whether acupuncture before and after embryo transfer would alter pregnancy rates in patients undergoing IVF regardless of embryo quality if the treatment was performed offsite.

Design – Multi-center, prospective, randomized study.

Materials and methods – 107 patients undergoing IVF were randomized to acupuncture vs. control group. The treatment group received acupuncture by one of two licensed acupuncturists at an offsite location for 25 minutes before and after embryo transfer using a modified Paulus protocol (protocol described by Paulus et. al. 2002 with the addition of Cv6 before and K3 after transfer). The control group underwent embryo transfer without any other intervention. The IVF protocol was determined by the treating physician who was blinded to assigned group. The main outcome measures were a positive quantitative hCG, clinical pregnancy as manifested by fetal cardiac activity, and live birth (data pending). Chi-squared analysis and Student’s t-test were used for statistical analyses. Of the 107 patients randomized, 94 completed the study (10 IVF cycles canceled, 3 patients withdrew).

Results – The proportion of patients with a positive pregnancy test was higher in the control group (36/46) than the acupuncture group (25/48) (78.3% vs. 52.1%, respectively; P≤0.01). More importantly, the clinical pregnancy rate was higher in the control group than in the acupuncture group (69.6% vs. 43.8%, respectively; P≤0.03). The groups were statistically similar with respect to age, peak estradiol, number of oocytes retrieved, fertilization method, fertilization rate, number of embryos transferred, and the proportion with blastocyst transfer (P=NS).

Conclusions – In contrast to previous reports, acupuncture before and after embryo transfer was associated with lower biochemical and clinical pregnancy rates when compared to the control group. The value of acupuncture in pateints undergoing IVF needs to be further examined before recommending it to patients.

L.B. Craig, A.R. Criniti, K.R. Hansen, L.A. Marshall, M.R. Soules – Reproductive Endocrinology & Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Seattle Reproductive Medicine, Seattle, WA; Pacific Northwest Fertility & IVF Specialists, Seattle, WA

Conclusions: .Previous unpublished work at BCRM showed that 85% of the patients found the named nurse system important as a coping mechanism to support them by providing continuity of care through stressful treatment. The responses to the questionnaires indicate a clear demand for acupuncture and suggest that acupuncture may be valuable to improve the general wellbeing of women during infertility investigations and treatments. If acupuncture provides an effective coping mechanism, this could support patients to persevere with increased numbers of ART(Assisted Reproductive Technologies) cycles, thereby increasing their ultimate chance of a successful pregnancy.

Introduction.Despite a lack of studies clearly demonstrating clinical efficacy complementary medicine is frequently used by couples undergoing infertility treatment (Coulson 2005). In Bristol, acupuncture has become very popular among patients undergoing infertility treatment, thus this study sought to quantify this and examine the reasons why patients choose acupuncture.

Methods.Two hundred questionnaires were given to patients who attended the Bristol Centre for Reproductive Medicine (BCRM) for investigation or treatment of infertility in August 2009. Patients were asked to complete the questionnaire while waiting to see their doctor or nurse and 194 responses were returned. The questionnaires asked if patients had or wished to have acupuncture or other complementary medicine, and to indicate on a scale of one to ten (10 being the best) the relative importance of acupuncture in comparison to values such as pregnancy rates and continuity of care.

Results.Out of 58 respondents who use complementary medicine, 43 used acupuncture. 40 respondents use acupuncture regularly and 17 of those lived outside of Bristol. A further 52 respondents had considered using acupuncture. In terms of very high importance (score of 10) 135 respondents felt pregnancy rates scored 10, 84 felt having the same doctor scored 10, 71 scored 10 for having the same nurse, 31 felt in house acupuncture scored 10 and 21 scored 10 for other complementary medicine. Overall, 43 respondents felt acupuncture should be available at Bristol Centre for Reproductive Medicine. Thirty four respondents gave more importance to acupuncture than seeing the same doctor or nurse, and 32 deemed it equally important. In addition, 29 patients scored acupuncture as equally important to pregnancy rates and 5 scored acupuncture higher than pregnancy rates.

Conclusion
This preliminary exploration, whilst confined to a small sample of women, confirms that acupuncture is indeed perceived by infertile women to have an impact to their health. All findings outlined here are reported cautiously because they are limited by the size of the sample. They suggest that further studies of acupuncture as an adjunct to IVF should systematically explore the issues of wellbeing, anxiety, personal and social resilience and women’s identity in relation to sexuality and reproduction.

Background
In Vitro Fertilisation (IVF) is now an accepted and effective treatment for infertility, however IVF is acknowledged as contributing to, rather than lessening, the overall psychosocial effects of infertility. Psychological and counselling interventions have previously been widely recommended in parallel with infertility treatments but whilst in many jurisdictions counselling is recommended or mandatory, it may not be widely used. Acupuncture is increasingly used as an adjunct to IVF, in this preliminary study we sought to investigate the experience of infertile women who had used acupuncture to improve their fertility.

Methods
A sample of 20 women was drawn from a cohort of women who had attended for a minimum of four acupuncture sessions in the practices of two acupuncturists in South Australia. Eight women were interviewed using a semi-structured questionnaire. Six had sought acupuncture during IVF treatment and two had begun acupuncture to enhance their fertility and had later progressed to IVF. Descriptive content analysis was employed to analyse the data.

Results
Four major categories of perceptions about acupuncture in relation to reproductive health were identified: (a) Awareness of, and perceived benefits of acupuncture; (b) perceptions of the body and the impact of acupuncture upon it; (c) perceptions of stress and the impact of acupuncture on resilience; and (d) perceptions of the intersection of medical treatment and acupuncture.

Conclusion; Acupuncture is an effective and low intensity procedure for increasing women’s resilience in the repetitive and stress inducing time of pregnancy attempts, with or without medical treatment. The instrumental role of the acupuncture therapist in increasing resilience is a finding that has not emerged in previous studies and has implications for patient management.

Aim: There is interest in the use of acupuncture as an adjunct to fertility treatment. this study aimed to examine women’s attitudes and beliefs in relation to the use of acupuncture for enhancing fertility or as an adjunct to ART.

Results: Participants all expressed confidence in the ability of acupuncture to contibute to their reproductive decision in a positive way. They described acupuncture as an adjunct to pregnancy attempts that was positive since it gave them a sense of control and a strategy for improving their chances. Women were unable to locate acupuncture as a causative factor in a resulting pregnancy however all women described acupuncture as instrumental in an increased sense of well being, self confidence, emotional balance and reduced anxiety. All experienced increased resilience.

Conclusions: Acupuncture can improve sperm quality and fertilization rates in assisted reproductive technology. The fertilization rates after acupuncture (66.2%) were significantly higher than that before treatment (40.2%) (P < 0.01).

This trial looks at sperm behaviour in an IVF setting. It was a “before and after” study involving 82 infertile men with pathological semen abnormalities and who’s sperm achieved a poor fertilization rate in at least 2 IVF/ICSI cycles. They were given acupuncture twice a week over 8 weeks and the IVF/ICSI cycles were repeated. The fertilization rates after acupuncture (66.2%) were significantly higher than that before treatment (40.2%) (P < 0.01).

The clinical effects of acupuncture on idiopathic male infertility in sperm parameter and on therapeutic results in assisted reproductive technology were investigated. 22 patients failed in intracytoplasmic sperm injection (ICSI) with idiopathic male infertility were treated with acupuncture twice weekly for 8 weeks, followed by ICSI treatment again. The sperm concentration, motility, morphology, fertilization rates and embryo quality were observed. Quick sperm motility after acupuncture (18.3% +/- 9.6%) was significantly improved as compared with that before treatment (11.0% +/- 7.5%, P < 0.01). The normal sperm ratio was increased after acupuncture (21.1% +/- 10.4% vs 16.2% +/- 8.2%, P < 0.05). The fertilization rates after acupuncture (66.2%) were obviously higher than that before treatment (40.2%, P < 0.01). There was no significant difference in sperm concentration and general sperm motility between before and after acupuncture. The embryo quality after acupuncture was improved, but the difference between them was not significant (P > 0.05).

– Zhang M et al J Huazhong Univ Sci Tech Med Sci.2002;22(3):228-30 Journal of Huazhong University

Conclusion: electroacupuncture could decrease serum FSH and LH levels, and increase estrogen levels in women with ovarian deficiency with little to no side-effects.

To investigate the effects of electroacupuncture (EA) on serum FSH, E2, and LH levels, women with primary ovarian insufficiency (POI) were treated with EA once a day, five times a week for the first four weeks and once every other day, three times a week, for the following two months, and then were followed up for three months. Serum E2, FSH, and LH levels were measured at baseline, at the end of treatment, and during followup. A total of 11 women with POI were included in this prospective consecutive case series study. Compared with baseline, patients’ serum E2 increased, FSH decreased, and LH decreased (P = 0.002, 0.001, and 0.002, resp.) after EA treatment, and these effects persisted during followup. With treatment, 10 patients resumed menstruation (10/11, 90.91%), whereas one patient remained amenorrhea. During followup, two patients, including the one with amenorrhea during treatment, reported absence of menstruation. Temporary pain occurred occasionally, and no other adverse events were found during treatment. The results suggest that EA could decrease serum FSH and LH levels and increase serum E2 level in women with POI with little or no side effects; however, further randomized control trials are needed.

Evid Based Complement Alternat Med. 2013;2013:657234. doi: 10.1155/2013/657234. Epub 2013 Feb 28., Zhou K, Jiang J, Wu J, Liu Z. – Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, No. 5 Bei Xian Ge Street, Xuan Wu District, Beijing 100053, China ; Department of Physical Therapy, Daemen College, 4380 Main Street, Amherst, NY 14226, USA.

Conclusion(s): In this study, there appears to be a beneficial regulation of CORTISOL and PROLACTIN in the Acupuncture group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics.

Objective: To determine whether changes in serum cortisol (CORT) and PRL are affected by acupuncture (Ac) in Ac-treated IVF patients.

Design: Prospective cohort clinical study.

Setting: Private practice reproductive endocrinology and infertility clinic and private practice acupuncture consortium.
Patient(s): Sixty-seven reproductive-age infertile women undergoing IVF.

Intervention(s): Blood samples were obtained from all consenting new infertility patients and serum CORT and serum PRL were obtained prospectively. Patients were grouped as controls (IVF with no Ac) and treated (IVF with Ac) according to acupuncture protocols derived from randomized controlled trials.

Main Outcome Measure(s): Serum levels of CORT and PRL were measured and synchronized with medication stimulation days of the IVF cycle (e.g., day 2 of stimulation, day 3, etc.). Reproductive outcomes were collected according to Society for Assisted Reproductive Technology protocols, and results were compared between controls and those patients treated with Ac.

Result(s): CORT levels in Ac group were significantly higher on IVF medication days 7, 8, 9, 11, 12, and 13 compared with controls. PRL levels in the Ac group were significantly higher on IVF medication days 5, 6, 7, and 8 compared with controls.

Conclusion
Acupuncture can significantly down-regulate the expressions of serum levels of T and E2, improve the development of ovaries and uterus, promote ovulation, enhance endometrial receptivity, and advance blastocyst implantation.

Objective
To observe the effect and mechanism of acupuncture on infertility of rats with polycystic ovarian syndrome (PCOS).

Methods
PCOS rat model was induced by subcutaneous injection of oil solution of dehydroepiandrosterone (DHEA) in immature (24-day-old) female rats for continuous 20 days. Rats in the control group were given the same dose of DHEA oil.
PCOS rats were randomly divided into the control group (untreated) and the acupuncture group treated by needling acupoints of Guanyuan (CV4), Zhongji (CV3), Sanyinjiao (SP6) and Zigong (CX-CA1), 15 min once a day for 5 continuous days, starting from the 80th day after birth.
All rats were sacrificed at termination of the treatment, their uterus and ovaries were dissected for observation and blood levels of sex hormones were measured.

Results
Compared with the control group, the number of implanted blastocysts and the blastocyst implantation rate were higher and the blood levels of testosterone (T) and estradiol (E2) were lower in the acupuncture group (P<0.05); but the difference between groups in serum levels of follicular stimulating hormone, luteinzing hormone and progesterone were of statistical insignificance (P>0.05).

Moreover, the wet weight of the ovaries was lower and the equipotent diameter and area of glandular organ and cavity area ratio of gland and the stroma and mean thickness of endometria were higher in the acupuncture group than those in the control group (P<0.05).

Conclusions: Our study shows a significantly lower amount of gonadotropins used when IVF is combined with standard acupuncture. A 70% pregnancy rate was also achieved with standard acupuncture and IVF, compared to 25%. Larger prospective trials are necessary.

Objective: The purpose of this study was to determine if there are benefits of standard acupuncture compared to sham acupuncture as an adjunct to IVF.

Materials and Methods: A randomized, controlled, double-blind, cross over pilot trial was performed using a needle-like device (sham acupuncture) as a control. Approval from GAMC’s Investigational Review Board was acquired. Inclusion criteria were women aged 18 to 42 years with a history of failed IVF cycle(s); the presence of both ovaries; and a normal uterine cavity. Exclusion criteria was Kruger morphology <4%.

Results: Seventeen subjects were enrolled and seven subjects completed both arms of the study. The mean age was 36.2 years (range 28-41 years). The mean Day 3 FSH=3 D6.8 IU (range 3-13 IU). There were four ongoing pregnancies after the first cycle, equally distributed. Seven subjects were crossed over after the first cycle. Of these, four from the standard acupuncture group and one from the sham acupuncture group attained pregnancy. Two subjects of the standard acupuncture group were on-going pregnancies and one from the sham group. Only the sham group had two IVF cancellations. An unpaired Mann-Whitney Test using a two-sided p value was performed.

CONCLUSION: It is feasible to conduct a randomized, blinded, sham control trial to study the impact of acupuncture on IVF success rates. Such a protocol is well accepted by patients. Preliminary data shows a statistically significant improvement in the biochemical pregnancy rate with acupuncture treatment. Additionally, acupuncture was associated with a strong trend towards higher clinical pregnancy rates and take home baby rates, though more patients will need to be studied to reach any final conclusions.

OBJECTIVE: To develop a protocol that could be used in future studies to evaluate whether acupuncture improves pregnancy and delivery rates in patients undergoing IVF. DESIGN: Randomized, sham treatment controlled pilot study.

MATERIALS AND METHODS: Patients planning to undergo IVF who meet inclusion/exclusion criteria (age 40 years old at start of stimulation, highest basal FSH 10mIU/mL, 3 prior failed IVF attempts, acupuncture naıeve) were randomly assigned to an acupuncture treatment group or a sham treatment group.

Treatment sessions occurred before the start of gonadotropin stimulation, the day before the oocyte retrieval, the day before the embryo transfer and the day after the embryo transfer. Acupuncture was performed using manual manipulation at 6 to 10 points depending on the timing of the acupuncture treatment. Sham treated patients had needles placed in non meridian points at a shallow depth. Patients were also given a questionnaire regarding their impressions of acupuncture treatment and were asked to guess their group assignment.

Data was analyzed using chi-squared for dichotomous outcome variables (e.g. clinical pregnancy rate, number of take home babies) and t-tests for continuous outcomes (e.g. age).

RESULTS: Twenty-two IVF cycles (19 patients) were randomized with thirteen patients completing the study (14 cycles). Five cycles were not completed due to poor response to ovarian stimulation (4 in the sham group,one in the real group). Other reasons for incomplete cycles (all in the sham group) included a persistent ovarian cyst, no viable embryos for transfer and personal reasons. The overall cycle cancellation rate was 32% compared to a 22% cycle cancellation rate for non study patients of a similar age treated at this center during a similar time period (p.05).

In the 13 patients analyzed, the mean age was 35 years old (SD4.03). There was no statistical difference between true and sham acupuncture groups with respect to age (Sham: Mean35, SD4.6, Real: Mean34, SD4.6). Additionally, there was no significant difference between groups in highest basal FSH, number of oocytes retrieved, or number of embryos transferred. There was a significantly higher chemical pregnancy rate (80% versus 11.0%) in patients receiving true acupuncture compared to sham acupuncture (p.05). The clinical pregnancy rates and the take home baby rates showed a strong trend towards a higher rate with acupuncture treatment though the difference was not statistically significant (60% real treatment vs. 11% sham treatment, p.05.).

Regarding the questionnaire, only one patient correctly guessed their group assignment (real acupuncture). All patients rated their experience as very positive or positive.

Conclusions(s): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

Patient(s): 57 infertile patients undergoing IVF or IVF/ICSI.

Interventions(s): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.
Main outcome measure(s): Perceive Stress Scale scores, pregnancy rates.

Result(s): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status.

Conclusion Acupuncture is a powerful tool for improving pregnancy rate and reducing uterine contractions after assisted reproduction therapy.

Objective To observe the effect of acupuncture on the pregnancy rate in assisted reproduction therapy such as in-vitro-fertilisation (IVF) and intracytoplasmatic spermatozoen injection (ICSI), and mechanisms.

Methods 210 cases undergoing IVF or ICSI were divided randomly into three groups: acupuncture treatment group, placebo group and control group. The acupuncture treatment group and the placebo group were treated respectively with body acupuncture and placebo acupuncture before and after embryo transfer, and in the control group embryos were transferred without any supportive therapy. Contraction frequency of the uterine junctional zone and the pregnancy rate were observed.

Results The contraction frequency before embryo transfer was not significantly different among the three groups, but after embryo transfer in the acupuncture treatment group was lower than that in the placebo group and the control group, respectively. The pregnancy rate was 44.3% (31/70) in the acupuncture treatment group, and 27.1% (19/70) in the placebo group and 24.3% (17/70) in the control group. The pregnancy rate in the acupuncture treatment group was significantly higher than that in the placebo acupuncture group and the control group (P0.05).

Conclusions: Results for women aged 35–39 years and those over 40 years were markedly better than controls suggesting that acupuncture intervention of this type may be more effective in older women. No side effects or complications were experienced by women receiving acupuncture. Acupuncture is a safe, adjunct therapy in IVF and in other randomised clinical trials has been shown to significantly improve outcomes when used at the IVF centre before and after embryo transfer. Our preliminary data are encouraging and suggest that a trial involving older women may be effective.

All IVF cases in which acupuncture was administered before and after embryo transfer at a large private infertility centre were reviewed for a 2 year period. All patients were treated by the same practitioner (NDB) using Traditional Chinese Acupuncture (TCA). Patients received acupuncture to the protocol developed by Paulus, W.E., Zhang, M., Strehler, E., El-Danasouri, I., & Sterzik, K. (2002). Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility & Sterility, 77, 721–724: Liver 3, Spleen 8, Stomach 29, Pericardium 6, GV 20 were manually stimulated five times over a 40-min period, at Bridge, approximately 10–20 minutes prior to embryo transfer. Embryo transfer was carried out under ultrasound guidance as per routine at Bridge. Ten minutes following embryo transfer acupoints Spleen 6, Stomach 36, Spleen 10, Large Intestine 4 were manually stimulated five times over a 40-min period before discharging the patient. Ear points 34, 55 and 58 were used in both treatments and not stimulated.

A total of 71 patients underwent 74 cycles involving acupuncture before and after embryo transfer.

Overall, positive pregnancy rates/ET were 44.6% comparing favourably with the non-acupuncture historic control group.

When analysed by maternal age at time of treatment, biochemical pregnancy results for acupuncture treated women were as follows:

CONCLUSIONS: Although other studies regarding acupuncture have been inconclusive, perhaps these positive results are related to two important factors. The treatments were performed on-site, eliminating the stress of travelling to another site before and after the embryo transfer. Also, the acupuncture treatment protocol did not follow the traditional Paulus protocol, thereby suggesting there is still more research to be done on how best to treat infertility issues with acupuncture

OBJECTIVE: Conflicting evidence exists on whether acupuncture is beneficial for patients undergoing In Vitro Fertilization (IVF) cycles. Therefore, this study was undertaken to determine whether on-site acupuncture, per- formed both before and after embryo transfer, affects clinical outcomes.

DESIGN: Retrospective data analysis.

MATERIALS AND METHODS: The Acupuncture Group consisted of 49 patients who received acupuncture on-site before and after embryo transfer in 2007. The treatment did not follow the Paulus protocol. The Control Group were 212 patients with no acupuncture undergoing IVF cycles in the same time period. The data was subdivided by SART age classifications to determine if acupuncture differentially benefitted certain age groups. Clinical Pregnancy Rate (CPR) was defined as the presence of fetal cardiac activity. Loss Rate was the percentage of pregnancies that did not proceed from a positive hCG to a clinical pregnancy. Data were analysed using the unpaired t-test and Fisher’s exact test, with significance defined as P < 0.05.

RESULTS: Patients with a positive hCG were significantly higher in the Acupuncture Group for women less than 35 years old (63.3% vs.43.2%, p1⁄4 0.048). The Acupuncture Group also had a higher CPR in the under 35 category (60.0% vs. 34.6%, p 1⁄4 0.01). There were no differences in the other age groups. Combining all the age groups, the cycle parameters between the two Groups were equivalent, while the CPR was higher and the Loss Rate lower for the Acupuncture group (Table 1).

Conclusions: Significant increases in pregnancy outcomes were confirmed by this study and the data uniquely supported the advantage of acupuncture in patients with normal PI (prior studies were done on patient with PI). We also demonstrated that both acupuncture treatment protocols could be used together with a synergistic effect. Finally, this study is the first to demonstrate that the use of acupuncture in patients with poor prognoses (elevated Peak FSH, longer history of infertility, poor sperm morphology) can achieve similar pregnancy rates to normal prognosis patients.

Objective: The purpose of the study was to determine the influence of two acupuncture protocols on IVF outcomes and secondly to identify the appropriate patient groups that would most benefit from this adjunctive therapy.

Materials and Methods: In this retrospective study, data was extracted from medical records of patients RE&I clinic & acupuncture clinics between January 2001 and November 2003. All patients completing an IVF cycle with transfer were included. One RE&I provided the IVF care and a consortium of acupuncturists overseen by the author provided the strict acupuncture protocols. PR per transfer were the endpoints measured. Data was analyzed by student’s t test and Multiregression with Wilcox ranking (MRW).

Results: 147 patients were included in the study and of those 53 had Acupuncture (Ac) and 94 did not (Non-Ac group). Demographic data between these Ac and Non-Ac groups respectively indicated remarkable equity (Table 1). Fertility Factors also demonstrated equity and there were no differences in Diagnoses, IVF Protocols and type of Gonadatrophin protocols used.

Factors that demonstrated significance were: Length of time infertile, Peak FSH, PI for total group without MRW; PI for MRW groups reversed this (Table 2) and finally average: Sperm Morphology, Peak E2, Peak P4 prior to HcG: and endometrial thickness. PR before Wilcox ranking were the same: 40% v 38%. MRW analysis revealed FSH, Length of time trying to get pregnant, Sperm Morphology and E2 levels as significant: 6.5, 4.1, 4.0 and 1.6 respectively. When the Ac group was modified (15 Ac patient dropped), PI was elevated from 1.76 to 1.94 resulting in a significant elevation compared to the Non-Ac group, p 0.01. Also PR changed from 40% before to 53% after and this value was significantly greater than the Non-Ac group (38%), p 0.01.

– Magarelli P,Cridennda D, Fertil Steril,2004;81 Suppl 3 S20 Fertility and Sterility

CONCLUSIONS: Although there was a higher pregnancy rate in the acupuncture group, this difference was not statistically significant, probably because of the small number of patients in both group. Acupuncture seems to be an important coadjuvant in the treatment of infertility with IVF or ICSI, and further research is needed to demonstrate its precisely effect.

OBJECTIVE: The aim of this study was to evaluate the effects of acupuncture on embryo transfer by comparing the rates of clinical pregnancy.

DESIGN: Retrospective, interventional and longitudinal study.

MATERIALS AND METHODS: Study with a total of 111 cycles of patients who underwent assisted reproduction techniques: in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) from June/2005 to January/ 2007: 52 cycles with acupuncture and 59 cycles without acupuncture. Acupuncture was performed, in specific points of the body including the ear, immediately before and after the embryo transfer procedure and the needles were retained for 30 minutes per session. The embryo transfer was carried out under ultrasound guidance and luteal phase support was given by trans-vaginal progesterone administration (Utrogestan) and intramuscular progesterone. Outcome measure was clinical pregnancy rate.

RESULTS: The clinical pregnancy rate per cycle was observed in 27 of 52 (51.9%) patients in the acupuncture group and 21 of 59 (35.6%) patients in the control group (P 1⁄40,083). The mean age was 36.1 6.1 years in the control group and 36.4 years in the acupuncture group (P1⁄40.785). The mean number of embryo transferred was 3.3 in the control group and 3.6 in the acupuncture group (P1⁄40.462). The technique of embryo transfer was 5 cycles of IVF and 54 cycles of ICSI in the control group and 5 cycles IVF and 47 cycles of ICSI in the acupuncture group (P 1⁄41.000). Both groups did not show statistics difference in the mean age, number of embryo transferred and the technique procedure.

CONCLUSION: Conception and implantation rates were highest with traditional needle acupuncture. IVF treatment outcomes did not differ between patients treated with laser or sham laser acupuncture.

This study did not have the statistical power to detect treatment differences in pregnancy rates between needle acupuncture and no treatment (i.e., at least 200 subjects are needed to detect differences in CP rates of 54.7 and 44% with 80% power) which may be due to sample size, transfer of embryos of varying quality and variations in stimulation protocols. However, while not statistically significant, needle acupuncture produced a clinically significant effect (greater than 10% increase in clinical pregnancy rate) compared with relaxation or no treatment which warrants further investigation.

OBJECTIVE: The study was conducted to examine several adjunct treatment regimens administered before and after embryo transfer and determine if one treatment was more efficacious than any of the alternative regimens on in vitro fertilization (IVF) outcome. We compared two different acupuncture stimulation modes, needle and laser acupuncture, with sham laser acupuncture, relaxation, or no intervention treatment on implantation and pregnancy rates in women undergoing IVF.

DESIGN: Prospective single blind randomized trial. MATERIALS AND METHODS: Patients (n258) who had been scheduled for embryo transfer (ET), signed informed consent and were randomly assigned to one of 5 study treatment regimens; needle acupuncture (AC; 53), laser acupuncture (LZ AC; n53), sham laser acupuncture (placebo)(LZ sham; n52), relaxation (RX; n50), or no intervention treatment (NT; n50). All treatments were administered 25 minutes before ET and immediately after ET. The patient and acupuncturist were unaware of whether the laser system was active which allowed for a double-blind control group for the laser acupuncture treatment. Comparisons of various parameters between groups were conducted by 2 tests and one-way ANO- As.. Multinomial logistic regression analysis was used to control for the potentially confounding effects of day of embryo transfer (day 3 vs.5) and number of embryos transferred which are known to relate to IVF outcome, to further analyze the impact of adjunct treatment regimens on implantation and pregnancy rates. Probability of P 0.05 was considered to be statistically significant.

RESULTS: No differences in terms of cycle type, day of embryo transfer, or physician performing transfer were found between treatment groups. Neither day of transfer (p0.079) or egg number (P 0.082) were significant independent predictors of implantation or conception when interactions between parameters were considered in all 5 groups. All acupuncture treatments were well tolerated.

CONCLUSION(S): Post-transfer Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF / intracytoplasmic sperm injection (ICSI).

DESIGN: Randomized, prospective, controlled clinical study.

SETTING: University IVF center.

PATIENT(S): Two hundred twenty-five infertile patients undergoing IVF/ICSI.

INTERVENTION(S): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture.

MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancy rates.

RESULT(S): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%).

CONCLUSION(S): Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2 provided no additional beneficial effect.

OBJECTIVE: To evaluate the effect of acupuncture on reproductive outcome in patients treated with IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on the day of ET, another group on ET day and again 2 days later (i.e., closer to implantation day), and both groups were compared with a control group that did not receive acupuncture.

DESIGN: Prospective, randomized trial.

SETTING: Private fertility center.

PATIENT(S): During the study period all patients receiving IVF or ICSI treatment were offered participation in the study. On the day of oocyte retrieval, patients were randomly allocated (with sealed envelopes) to receive acupuncture on the day of ET (ACU 1 group, n = 95), on that day and again 2 days later (ACU 2 group, n = 91), or no acupuncture (control group, n = 87).

INTERVENTION(S): Acupuncture was performed immediately before and after ET (ACU 1 and 2 groups), with each session lasting 25 minutes; and one 25-minute session was performed 2 days later in the ACU 2 group.

MAIN OUTCOME MEASURE(S): Clinical pregnancy and ongoing pregnancy rates in the three groups.

RESULT(S): Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the ACU 2 group (36% and 26%) were higher than in controls, but the difference did not reach statistical difference.

CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after ART.

OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture.

DESIGN: Prospective randomized study.

SETTING: Fertility center.

PATIENT(S): After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80).

INTERVENTION(S): Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy.

MAIN OUTCOME MEASURE(S): Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer.

RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.

Conclusions The data from this meta-analysis suggests that acupuncture performed on the day of ET does increase the clinical pregnancy rate of IVF treatment; however, this could be attributed to placebo effect and the small number of patients included. Further larger RCTs are necessary to confirm the results.

Another group of researchers have analysed updated clinical trial data and have come to the same conclusion as those who published the BMJ meta analysis, namely acupuncture is a useful addition to IVF. It has been published as a Cochrane Review. The Cochrane Collaboration is an international and independent organization dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide.

Introduction: Acupuncture has more recently been studied in assisted reproductive treatment, although its role in reproductive medicine is still debated. This is a meta-analysis to determine the effectiveness of acupuncture in the outcomes of assisted reproductive technologies (ART).

Material & Methods: All reports which described randomised controlled trials of acupuncture in assisted conception were obtained through searches via the Menstrual Disorders and Subfertility Group’s specialised Register of controlled trials, the OVID MEDLINE (1996 to August 2007), CINAHL- cumulative Index to Nursing & Allied Health Literature (1982 to August 2007), EMBASE (1980 -August 2007), AMED, National research Register, US equivalent Clinical Trials register (http://www.clinicaltrials.gov) were searched using the OVID software, the Chinese literature databases were searched from the China Academic Journal Electronic full text Database in the China National Knowledge Infrastructure and Index to Chinese Periodical Literature.

All relevant references were also hand searched.

The selection criteria included randomised controlled trials of acupuncture that included couples who were undergoing ART and/or acupuncture and compared these treatments to each other, placebo or no treatment for the treatment of primary and secondary infertility were included.

Women with medical illness deemed contraindications for ART or acupuncture were excluded. Quality assessment and data extraction were performed independently by two reviewers.

Meta-analysis was performed using odds ratio for dichotomous outcomes. Subgroup analysis and sensitivity analysis were performed where necessary. The outcome measures were the live birth rate, the clinical, ongoing pregnancy rate, miscarriage rate and any reported side effects of treatment.

Results Thirteen randomised controlled trials were identified that involved acupuncture and assisted conception. Ten trials were included and three were excluded.

Acupuncture on the day of ET improves the ongoing pregnancy rate (Odds Ratio = 1.85; 95% confidence interval 1.18-2.91) and the clinical pregnancy rate (Odds ratio = 1.65; 95% confidence interval 1.22-2.24), but there was no evidence of a difference in the miscarriage rate compared to controls. Acupuncture on the day of ET + 2 to 3 days after ET (repeated acupuncture) improves the clinical pregnancy rate (Odds Ratio = 2.23, 95% CI 1.41 – 3.51) but not the ongoing pregnancy rate (Odds Ratio = 1.93, 95% CI 0.86-4.36). Repeated acupuncture did not affect the miscarriage rate.

Acupuncture around the time of oocyte retrieval has no evidence of benefit over the live birth rate (Odds Ratio 0.84, 95% CI 0.50 – 1.42), ongoing pregnancy (Odds Ratio 0.84, 95% CI 0.5 -1.42), clinical pregnancy (Odds ratio 1.07, 95% CI 0.71-1.61), and miscarriage rate (Odds Ratio 0.59, 95% CI 0.14-2.56).

The authors concluded, “The odds ratio of 1.65 suggests that acupuncture increased the odds of clinical pregnancy by 65% compared with the control groups… In absolute terms 10 patients would need to be treated with acupuncture to bring about one additional clinical pregnancy. These are clinically relevant benefits.”

Impressive as these results are they may still be an underestimate, since the authors included women who’s IVF cycles were cancelled before transfer.

Objective – To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation. Design – Systematic review and meta-analysis.

Data sources – Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.

Review methods – Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.

Data synthesis – Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth.

The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).

Conclusions – Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

Conclusion(s):
Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects from using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

Objective
To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.

Design
Systematic review and meta-analysis.

Patient(s)
Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects of acupuncture on IVF outcomes.

Setting
Not applicable.

Intervention(s)
The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture.

Main Outcome Measure(s)
The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.

Result(s)
Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation.

Laser for Embryo Transfer

SUMMARY: This study reports an increase in implantation rates (IR) with the use of laser acupuncture, however there was no significant difference in ‘ongoing pregnancy rates (OPR)‘ between needle acupuncture and laser acupuncture.

DESIGN: Prospect randomized double blind and placebo controlled.
MATERIALS AND METHODS: On the day of transfer, participants were randomly assigned to a study group; needle acupuncture (AC), laser acupuncture (LZ AC), sham laser acupuncture (LZ sham), relaxation (RX), or no treatment (NT). The AC and LZ AC puncture groups were considered treatment groups, the RX controls for the additional rest before and after transfer, and NT is the non-intervention group. Most significantly, the LZ Sham group provided an important control group. The laser acupuncture device was randomly preprogrammed per case to either fire (and provide LZ AC) or to not fire and thus provide a true double blind control group (LZ sham). It was not possible for the patient or acupuncturist to know if the laser fired. No contact oocurs with the patient in laser acupuncture so there is no acupressure effect or contact with the wrong meridians. All treatments were administered for 25 minutes before and after embryo transfer. Outcomes were compared by Chi-square and multiple logistic regression analysis to control for the potential confounders including female age, embryo quality, and day of transfer (Table 1).
RESULTS: All treatments were well tolerated. No differences in terms of patient demographics, cycle type, stimulation outcomes, embryo number and quality, day of embryo transfer, transferring physician, or acupuncturist were found between the 5 study groups. Implantation rates were significantly improved with laser acupuncture. Traditional needle acupuncture had outcomes equivalent to the 3 control groups. Subanalyses of patient age and embryo transfer day produced similar findings with laser acupuncture enhancing outcome rates.
CONCLUSIONS: This large prospective randomized and well controlled study consistently demonstrated benefit to LZ AC. Treatment was well tolerated and significantly improved implantation rates.

Clinical Outcomes (%) Rates
Needle acupuncture: implantation (28.9), chemical pregnancy (61.5), clinical pregnancy (51.5), ongoing pregnancy (39.0)
Laser acupuncture: implantation (33.7), chemical pregnancy (60.9), clinical pregnancy (54.5), ongoing pregnancy (42.1)
Non-intervention: implantation (30.2), chemical pregnancy (60.4), clinical pregnancy (50.3), ongoing pregnancy (39.6)

Note: it should be emphasized that the non-intervention group did almost as well and in some respects better than needle and laser acupuncture, showing that this is a very high pregnancy rate group of subjects, which evidence seems to be showing that acupuncture does not display significant effect on outcomes. The trend seems to be showing that acupuncture is better suited for advanced maternal age, and poor responders.

Fratterelli JL et al Fertil Steril 2008 Vol 90, Suppl 1,pg S105 – Fertility and Sterility

CONCLUSION: Conception and implantation rates were highest with traditional needle acupuncture. IVF treatment outcomes did not differ between patients treated with laser or sham laser acupuncture.

This study did not have the statistical power to detect treatment differences in pregnancy rates between needle acupuncture and no treatment (i.e., at least 200 subjects are needed to detect differences in CP rates of 54.7 and 44% with 80% power) which may be due to sample size, transfer of embryos of varying quality and variations in stimulation protocols. However, while not statistically significant, needle acupuncture produced a clinically significant effect (greater than 10% increase in clinical pregnancy rate) compared with relaxation or no treatment which warrants further investigation.

OBJECTIVE: The study was conducted to examine several adjunct treatment regimens administered before and after embryo transfer and determine if one treatment was more efficacious than any of the alternative regimens on in vitro fertilization (IVF) outcome. We compared two different acupuncture stimulation modes, needle and laser acupuncture, with sham laser acupuncture, relaxation, or no intervention treatment on implantation and pregnancy rates in women undergoing IVF.

DESIGN: Prospective single blind randomized trial. MATERIALS AND METHODS: Patients (n258) who had been scheduled for embryo transfer (ET), signed informed consent and were randomly assigned to one of 5 study treatment regimens; needle acupuncture (AC; 53), laser acupuncture (LZ AC; n53), sham laser acupuncture (placebo)(LZ sham; n52), relaxation (RX; n50), or no intervention treatment (NT; n50). All treatments were administered 25 minutes before ET and immediately after ET. The patient and acupuncturist were unaware of whether the laser system was active which allowed for a double-blind control group for the laser acupuncture treatment. Comparisons of various parameters between groups were conducted by 2 tests and one-way ANO- As.. Multinomial logistic regression analysis was used to control for the potentially confounding effects of day of embryo transfer (day 3 vs.5) and number of embryos transferred which are known to relate to IVF outcome, to further analyze the impact of adjunct treatment regimens on implantation and pregnancy rates. Probability of P 0.05 was considered to be statistically significant.

RESULTS: No differences in terms of cycle type, day of embryo transfer, or physician performing transfer were found between treatment groups. Neither day of transfer (p0.079) or egg number (P 0.082) were significant independent predictors of implantation or conception when interactions between parameters were considered in all 5 groups. All acupuncture treatments were well tolerated.

Male Factor Infertility

Conclusion(s): Men who feel stressed have fewer, slower sperm — which may diminish fertility. In this first study to examine all three domains of stress, perceived stress and stressful life events but not work-related stress were associated with semen quality.

Objective
To evaluate associations between work-related stress, stressful life events, and perceived stress and semen quality.

Design
Cross-sectional analysis.

Setting
Northern California.

Patient(s)
193 men from the Child Health and Development Studies evaluated between 2005–2008.

Intervention(s)
None.

Main Outcome Measure(s)
Measures of stress including job strain, perceived stress, and stressful life events; outcome measures of sperm concentration, percentage of motile sperm, and percentage of morphologically normal sperm.

Result(s)
We found an inverse association between perceived stress score and sperm concentration (estimated coefficient b = −0.09 × 103/mL; 95% confidence interval [CI] = −0.18, −0.01), motility (b = −0.39; 95% CI = −0.79, 0.01), and morphology (b= −0.14; 95% CI, −0.25, −0.04) in covariate-adjusted linear regression analyses. Men who experienced two or more stressful life events in the past year compared with no stressful events had a lower percentage of motile sperm (b= −8.22; 95% CI, −14.31, −2.13) and a lower percentage of morphologically normal sperm (b = −1.66; 95% CI, −3.35, 0.03) but a similar sperm concentration. Job strain was not associated with semen parameters.

Reference
1. Teresa Janevic, Linda G. Kahn, Paul Landsbergis, Piera M. Cirillo, Barbara A. Cohn, Xinhua Liu, Pam Factor-Litvak. Effects of work and life stress on semen quality. Fertility and Sterility, 2014; DOI: 10.1016/j.fertnstert.2014.04.021
2. http://www.eurekalert.org/pub_releases/2014-05/cums-sds052914.php

Conclusion(s): This study demonstrates that paternal obesity impairs preimplantation embryo development and implantation but does not influence gross fetal or placental morphology. It highlights the important contribution that paternal health and lifestyle choices have for achieving a viable pregnancy.

Objective
To use a rodent model of male diet-induced obesity (DIO) to examine resultant preimplantation embryo development and implantation rate, as well as fetal and placental growth.

Design
Experimental animal study.

Setting
University research facilities.

Animal(s)
C57BL/6 male and CBAxC57BL/6 female mice.

Intervention(s)
Male mice were fed a standard rodent chow (lean) or a high-fat diet (obese) for up to 13 weeks. After mating, zygotes were collected and cultured to the blastocyst stage, then assessed or transferred into recipient females.

Main Outcome Measure(s)
Embryo morphology and cell number were assessed and pregnancy outcomes determined at postmortem day 18.

Result(s)
Embryos from obese males had reduced cleavage and decreased development to blastocyst stage during culture relative to control males. Blastocysts from obese males implanted at a reduced rate, and the proportion of fetuses that developed was significantly decreased, although fetal and placental weight did not differ between groups.

Megan Mitchell et al – Fertility and Sterility – Volume 95, Issue 4 , Pages 1349-1353, 15 March 2011

Conclusion(s)
In a population of healthy young men, carotenoid intake was associated with higher sperm motility and, in the case of lycopene, better sperm morphology. Our data suggest that dietary carotenoids may have a positive impact on semen quality.

Objective
To assess the relationship between dietary antioxidant intake and semen quality in young healthy males.

Design
Cross-sectional study.

Setting
University and college campuses in the Rochester, New York, area.

Patient(s)
One hundred eighty-nine university-aged men.

Intervention(s)
None.

Main Outcome Measure(s)
Semen volume, total sperm count, concentration, motility, total motile count, and morphology.

Result(s)
Progressive motility was 6.5 (95% confidence interval [CI], 0.6, 12.3) percentage units higher among men in the highest quartile of β-carotene intake compared with men in the lowest quartile. Similar results were observed for lutein intake. Lycopene intake was positively related to sperm morphology. The adjusted percentages (95% CI) of morphologically normal sperm in increasing quartiles of lycopene intake were 8.0 (6.7, 9.3), 7.7 (6.4, 9.0), 9.2 (7.9, 10.5), and 9.7 (8.4, 11.0). There was a nonlinear relationship between vitamin C intake and sperm concentration, with men in the second quartile of intake having, on average, the highest sperm concentrations and men in the top quartile of intake having the lowest concentrations.

Fertility and Sterility – Volume 100, Issue 6 , Pages 1572-1579, December 2013 – Piotr Zareba, M.D., M.P.H., Daniela S. Colaci, M.D., M.Sc., Myriam Afeiche, Ph.D., M.P.H., Audrey J. Gaskins, B.S.E., Niels Jørgensen, M.D., Ph.D., Jaime Mendiola, Ph.D., M.P.H., Shanna H. Swan, Ph.D., Jorge E. Chavarro, M.D., Sc.D

Conclusions: The OSA test is a novel assay that directly assesses end damage to semen from oxidative stress and appears to identify approximately 30% of men from infertile couples as having elevated scores. The OSA test may provide a means of quantifying the role of ROS-related semen damage in infertility and potentially aid in the evaluation in men from infertile couples.

Objective: Oxidative stress damage is thought to occur through the high formation of adducts, molecules of lipids, DNA, and protein in semen that have been covalently modified by reactive oxygen species (ROS). The oxidative stress adduct (OSA) test, a novel biomarker assay, directly quantifies ROS damage by measuring the levels of molecules in semen covalently modified by ROS. The goal of this study is to characterize OSA scores in a large number of men from infertile couples.

Design: Under IRB approval, OSA test results were obtained in a multicenter, retrospective study using semen specimens obtained during a clinical fertility evaluation in 774 men from infertile couples and were compared OSA scores from 20 fertile male controls.

Methodology: The raw semen sample was divided into a frozen aliquot and an OSA test was run, with each adduct measured independently after acid treatment using chemiluminescence followed by optical density measurements. The results were combined into a single score. Statistical analysis was run using an unpaired two tailed t test to compare the two distributions.

Results: The distribution of the OSA scores in the men from fertile and infertile couples were significantly different (P<0.05). Infertile males had a mean OSA score of 3.72 (SD 2.84) opposed to a mean score of 2.41 for fertile males (SD 0.68). 29.3% of the 774 men from infertile couples had OSA scores which were above 3 standard deviations (4.44 uM)from the mean value of the OSA scores in the 20 men with confirmed fertility, and 6.3% were above 2 standard deviations (3.8 uM).

B. Berookhim, B. Leader, A. Copperman, B. McElyea, E. Tirado, N. Bar-Chama. (Urology, Mount Sinai School of Medicine, New York, NY; Reproductive Medicine Associates of New York, New York, NY; Reprosource, Inc., Woburn, MA.) – Publication: ASRM 2011 Poster Abstract (P-196)

What is oxidative stress? http://en.wikipedia.org/wiki/Oxidative_stress

Conclusion(s): The DNA fragmentation of morphologically normal sperm negatively impacts embryo quality and probability of pregnancy in ICSI cycles.

Objective
To evaluate DNA fragmentation in morphologically normal sperm recovered from the same sample used for intracytoplasmic sperm injection (ICSI) and to correlate DNA damage with embryo quality and pregnancy outcome.

Design
Prospective study.

Setting
Academic center.

Patient(s)
36 infertile men participating in the ICSI program.

Intervention(s)
Terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate-fluorescein nick end labeling (TUNEL) assay and morphologic assessment by phase contrast.

Main Outcome Measure(s)
Simultaneous assessment of sperm morphology and DNA fragmentation by TUNEL assay was performed in the same cell, then the percentage of normal sperm with fragmented DNA (normal SFD) was correlated with embryo quality and pregnancy outcomes.

Result(s)
A highly statistically significant negative correlation was found between the percentage of normal SFD and embryo quality. This association was confirmed for the transferred embryos and for the total embryo cohort. The receiver operating characteristics curve analysis demonstrated that the percentage of normal SFD and embryo quality were statistically significant predictors of pregnancy. When the percentage of normal SFD was ≤17.6 %, the likelihood of pregnancy was 3.5 times higher. No correlation was found between the percentage of total sperm with fragmented DNA (morphologically normal and abnormal) and ICSI outcomes.

Fertility and Sterility – Volume 94, Issue 2 , Pages 549-557, July 2010 – Conrado Avendaño, M.S., Anahí Franchi, Ph.D., Hakan Duran, M.D., Sergio Oehninger, M.D., Ph.D. – The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia

Conclusions: Vitamin B9 (folate, folic acid) and B12 are important for sperm production.

Mild hyperhomocysteinemia is caused by B vitamin deficiencies. We hypothesize that these biochemical derangements detrimentally affect spermatogenesis. Therefore, the aim of this study was to investigate the folate, cobalamin, pyridoxine, and homocysteine concentrations in blood and seminal plasma and the associations between these biomarkers and semen parameters in men participating in an in vitro fertilization or intracytoplasmic sperm injection program. From 73 men (median age [range]: 37 years [28-53]), blood and semen samples were obtained for the determination of serum and red blood cell (RBC) folate, serum total cobalamin, whole-blood pyridoxal-5′-phosphate, plasma total homocysteine (tHcy), and serum total testosterone. Semen analysis included sperm concentration, motility, and morphology according to World Health Organization criteria. The B vitamins and tHcy concentrations were significantly correlated in blood but not in seminal plasma. The serum and RBC folate concentrations were significantly correlated also with the total folate concentration in seminal plasma (r = .44; P < .001 and r = .39; P < .001, respectively). Likewise, the total cobalamin concentration in serum and seminal plasma was significantly correlated (r = .55; P = .001). Of interest is that the total cobalamin concentration in seminal plasma was significantly correlated with the sperm concentration (r = .42; P < .001). This is in contrast to the absence of significant associations between the other vitamins and tHcy in blood and seminal plasma and any of the semen parameters. These findings suggest that folate and cobalamin are transferred from the blood to the male reproductive organs and emphasize the role of cobalamin in spermatogenesis in human.

J Androl. 2007 Jul-Aug;28(4):521-7. – Boxmeer JC, Smit M, Weber RF, Lindemans J, Romijn JC, Eijkemans MJ, Macklon NS, Steegers-Theunissen RP. – Department of Obstetrics and Gynecology/Division of Obstetrics and Reproductive Medicine, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands. http://www.ncbi.nlm.nih.gov/pubmed/19228759

CONCLUSIONS: Coenzyme Q10 supplementation resulted in a statistically significant improvement in sperm concentration, motility, and morphology.

PURPOSE:
We determined the efficacy of coenzyme Q10 supplementation on semen parameters, sperm function and reproductive hormone profiles in infertile men.
MATERIALS AND METHODS:
A total of 212 infertile men with idiopathic oligoasthenoteratospermia were randomly assigned to receive 300 mg coenzyme Q10 (Kaneka, Osaka, Japan) orally daily (106 in group 1) or a similar placebo regimen (106 in group 2) during a 26-week period, followed by a 30-week treatment-free phase. Two semen analyses, acrosome reaction test, immunobead test for antisperm antibody, and determination of resting levels of luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone and inhibin B were done in all participants. Blood and seminal plasma total coenzyme Q10 was also assessed.
RESULTS:
Significant improvement in sperm density and motility was evident with coenzyme Q10 therapy (each p = 0.01). Using the Kruger classification sperm morphology evaluation revealed an increase in the percent of normal forms in the coenzyme Q10 group (p = 0.07). A positive correlation was found between treatment duration with coenzyme Q10 and sperm count (r = 0.46, p = 0.03) as well as with sperm motility (r = 0.45, p = 0.04) and sperm morphology (r = 0.34, p = 0.04). The coenzyme Q10 group had a significant decrease in serum follicle-stimulating hormone and luteinizing hormone at the 26-week treatment phase (each p = 0.03). By the end of the treatment phase the mean +/- SD acrosome reaction had increased from 14% +/- 8% and 15% +/- 8% to 31% +/- 11% and 16% +/- 10% in the coenzyme Q10 and placebo groups, respectively (p = 0.01).
CONCLUSIONS:
Coenzyme Q10 supplementation resulted in a statistically significant improvement in certain semen parameters. However, further studies are needed to draw a final conclusion and evaluate the effect of coenzyme Q10 supplementation on the pregnancy rate.

J Urol. 2009 Jul;182(1):237-48. – Safarinejad MR. – Urology and Nephrology Research Center, Shahid Beheshti University, Tehran, Iran. http://www.ncbi.nlm.nih.gov/pubmed/19447425

CONCLUSION(S): administration of coenzyme Q(10) increases sperm motility in patients with idiopathic asthenozoospermia.

OBJECTIVE:
To evaluate the effectiveness of coenzyme Q(10) treatment in improving semen quality in men with idiopathic infertility.
DESIGN:
Placebo-controlled, double-blind randomized trial.
PATIENT(S):
Sixty infertile patients (27-39 years of age) with the following baseline sperm selection criteria: concentration >20 x 10(6)/mL, sperm forward motility <50%, and normal sperm morphology >30%; 55 patients completed the study.
INTERVENTION(S):
Patients underwent double-blind therapy with coenzyme Q(10), 200 mg/day, or placebo; the study design was 1 month of run-in, 6 months of therapy or placebo, and 3 months of follow-up.
MAIN OUTCOME MEASURE(S):
Variations in semen parameters used for patient selection and variations of coenzyme Q(10) and ubiquinol concentrations in seminal plasma and spermatozoa.
RESULT(S):
Coenzyme Q(10) and ubiquinol increased significantly in both seminal plasma and sperm cells after treatment, as well as spermatozoa motility. A weak linear dependence among the relative variations, baseline and after treatment, of seminal plasma or intracellular coenzyme Q(10) and ubiquinol levels and kinetic parameters was found in the treated group. Patients with a lower baseline value of motility and levels of coenzyme Q(10) had a statistically significant higher probability to be responders to the treatment.
CONCLUSION(S): The exogenous administration of coenzyme Q(10) increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia.

Fertil Steril. 2009 May;91(5):1785-92. – Balercia G, Buldreghini E, Vignini A, Tiano L, Paggi F, Amoroso S, Ricciardo-Lamonica G, Boscaro M, Lenzi A, Littarru G. – Department of Internal Medicine and Applied Biotechnologies, Andrology Unit, Endocrinology, Umberto I Hospital, School of Medicine, Polytechnic University of Marche, Ancona, Italy. http://www.ncbi.nlm.nih.gov/pubmed/18395716

CONCLUSION(S): 74% increase in total normal sperm count after combined zinc sulfate (66mg) and folic acid (5mg) treatment for 26 weeks (6 months) in both subfertile and fertile men.

OBJECTIVE:
To study the effects of folic acid and zinc sulfate treatment on semen variables in fertile and subfertile men.
DESIGN:
Double-blind, placebo-controlled interventional study.
SETTING:
Two outpatient fertility clinics and nine midwifery practices in The Netherlands.
PARTICIPANT(S):
One hundred eight fertile and 103 subfertile men.
INTERVENTION(S):
Both groups were randomly assigned to receive one of four treatments for 26 weeks: folic acid and placebo, zinc sulfate and placebo, zinc sulfate and folic acid, and two placebos. Folic acid was given at a daily dose of 5 mg, and zinc sulfate was given at a daily dose of 66 mg.
MAIN OUTCOME MEASURE(S):
Before and after treatment, standardized semen and blood samples were obtained for determinations of sperm concentration, motility, and morphology according to World Health Organization guidelines; semen morphology according to strict criteria; and blood folate and zinc concentrations. Effects of the four interventions were evaluated separately in subfertile and fertile men.
RESULT(S):
Subfertile men demonstrated a significant 74% increase in total normal sperm count and a minor increase of 4% abnormal spermatozoa. A similar trend was observed in fertile men. Pre-intervention concentrations of folate and zinc in blood and seminal plasma did not significantly differ between fertile and subfertile men.

Fertil Steril. 2002 Mar;77(3):491-8. – Wong WY, Merkus HM, Thomas CM, Menkveld R, Zielhuis GA, Steegers-Theunissen RP.- Department of Obstetrics and Gynecology, University Medical Centre Nijmegen, Nijmegen, The Netherlands.

CONCLUSION(S): Low concentrations of folate (folic acid, B9) in seminal plasma may be detrimental for sperm DNA stability, and total homocysteine (B6, 9, 12) correlated with sperm count.

OBJECTIVE:
To determine associations between vitamin B status, homocysteine (tHcy), semen parameters, and sperm DNA damage.
DESIGN:
Observational study.
SETTING:
A tertiary referral fertility clinic.
PATIENT(S):
Two hundred fifty-one men of couples undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment, with subgroups of fertile (n = 70) and subfertile men (n = 63) defined according to semen concentration and proven fertility.
INTERVENTION(S):
None.
MAIN OUTCOME MEASURE(S):
The DNA fragmentation index (DFI) as marker of sperm DNA damage determined using the sperm chromatin structure assay (SCSA), and semen parameters assessed according to World Health Organization criteria; tHcy, folate, cobalamin, and pyridoxine concentrations determined in seminal plasma and blood.
RESULT(S):
In the total group of fertile and subfertile men, all biomarkers in blood were statistically significantly correlated with those in seminal plasma. No correlation was found between the biomarkers in blood and the semen parameters. In seminal plasma, both tHcy and cobalamin positively correlated with sperm count. Folate, cobalamin, and pyridoxine were inversely correlated with ejaculate volume. In fertile men, seminal plasma folate showed an inverse correlation with the DNA fragmentation index.

Fertil Steril. 2009 Aug;92(2):548-56. – Boxmeer JC, Smit M, Utomo E, Romijn JC, Eijkemans MJ, Lindemans J, Laven JS, Macklon NS, Steegers EA, Steegers-Theunissen RP. – Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. http://www.ncbi.nlm.nih.gov/pubmed/18722602

ALSO READ: http://www.cbc.ca/news/technology/birth-defect-risk-affected-by-father-s…

CONCLUSIONS: Lipoic Acid (antioxidant) may protect sperm producing cells (Sertoli) when male fertility damaging inflammatory reactions occur.

Inflammatory reactions to microbial infections may cause male infertility. The mechanisms of inhibition of spermatogenesis can be studied in vitro using rat Sertoli cells. Bacterial lipopolysaccharides (LPS) induce acute inflammations. So LPS treated Sertoli cells can be used to test for new therapeutic compounds. The present study aimed to investigate the protective efficacy of dl-alpha-lipoic acid (LA) on lipopolysaccharide (LPS)-induced oxidative stress in adult rat Sertoli cells. Sertoli cells were divided into 4 groups. Group I served as a control incubated with water (vehicle). Groups II and IV were incubated with 100 microM LA for 24h before incubating Groups III and IV with 50 microg/ml lipopolysaccharide (LPS) for 12h. In Group III cells (LPS-treated, no LA) the lactate concentration was decreased whereas hydrogen peroxide production and lipid peroxidation were significantly increased. Moreover, the activities of antioxidant enzymes such as superoxide dismutase, glutathione peroxidase, catalase, glutathione-S-transferase, glutathione reductase were reduced. The concentrations of antioxidant molecules such as reduced glutathione and vitamin C were significantly decreased. The activities of enzymes normally elevated in Sertoli cells, gamma-glutamyl transpeptidase and beta-glucuronidase, were significantly decreased. Treatment with LA (100 microM) for 24h before LPS-treatment (Group IV), prevented these changes in enzyme activities and metabolite concentrations. Therefore, LA may have a cyto-protective role during LPS-induced inflammation in adult rat Sertoli cells.

Aly HA, Lightfoot DA, El-Shemy HA. – Chem Biol Interact. 2009 Dec 10;182(2-3):112-8. – Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt.

CONCLUSIONS: All couples whose male partners accepted antioxidant supplementation achieved a successful pregnancy. This study demonstrates the benefits of an increased intake of antioxidant-rich food or antioxidant supplements by men who show high levels of sperm DNA fragmentation or lipid peroxidation, which could result in an improvement in gestational outcomes in couples with history of recurrent pregnancy loss (RPL).

OBJECTIVE:
To evaluate whether increasing antioxidant intake in men with high levels of DNA damage or lipid peroxidation improves gestational results in couples with history of recurrent embryo loss.
PATIENT(S):
Seventeen men whose spouses had a history of two or more embryo losses before 12 weeks of gestation.
INTERVENTION(S):
Male partners with increased DNA fragmentation index (%DFI) or high thiobarbituric acid reactive substances (TBARS) were instructed to consume a diet rich in antioxidants or commercial multivitamins containing beta-carotene, vitamin C, vitamin E, and zinc for at least 3 months.
MAIN OUTCOME MEASURE(S):
Pregnancy outcome was recorded in the spouses of men with increased %DFI or TBARS who received antioxidant supplementation.
RESULTS:
Of the 17 men, 9 (53%) presented with an increased %DFI or TBARS. They were started on an antioxidant supplementation regimen. Of these nine men, six of their spouses became pregnant. All couples whose male partners accepted antioxidant supplementation achieved a successful pregnancy.

Fertil Steril. 2009 Aug;92(2):565-71. – Gil-Villa AM, Cardona-Maya W, Agarwal A, Sharma R, Cadavid A. – Reproduction Group, University of Antioquia, Medellín, Colombia. http://www.ncbi.nlm.nih.gov/pubmed/18829003

CONCLUSION(S): Frequent intake of lipophilic foods like meat products or milk may negatively affect semen quality in humans, whereas some fruits or vegetables may maintain or improve semen quality.

OBJECTIVE:
To compare dietary habits in normospermic and oligoasthenoteratospermic patients attending a reproductive assisted clinic.
DESIGN:
An observational, analytical case-control study.
SETTING:
Private fertility clinics.
PATIENT(S):
Thirty men with poor semen quality (cases) and 31 normospermic control couples attending our fertility clinics.
INTERVENTION(S):
We recorded dietary habits and food consumption using a food frequency questionnaire adapted to meet specific study objectives. Analysis of semen parameters, hormone levels, Y microdeletions, and karyotypes were also carried out.
MAIN OUTCOME MEASURE(S):
Frequency of intake food items were registered in a scale with nine categories ranging from no consumption to repeated daily consumption.
RESULT(S):
Controls had a higher intake of skimmed milk, shellfish, tomatoes, and lettuce, and cases consumed more yogurt, meat products, and potatoes. In the logistic regression model cases had lower intake of lettuce and tomatoes, fruits (apricots and peaches), and significantly higher intake of dairy and meat processed products.

Mendiola J, Torres-Cantero AM, Moreno-Grau JM, Ten J, Roca M, Moreno-Grau S, Bernabeu R. – Fertil Steril. 2009 Mar;91(3):812-8 – Department of Reproductive Biology and Medicine, Instituto Bernabeu, Alicante, Spain. http://www.ncbi.nlm.nih.gov/pubmed/18314116

Conclusions: treatment with L-carnitine and Coenzyme Q10 significantly increased total antioxidant, LH and testosterone levels. Treatment with L-carnitine and Coenzyme Q10 also improved semen parameters and organs weight. L-carnitine and Coenzyme Q10 could protect spermatogenesis.

The aim of the present study was to investigate the protective role of coenzyme Q10 and L-Carnitine pretreatment in the impaired spermatogenesis caused by isoproterenol (ISO) in male rats.Thirty-two male Wistar rats were allocated in 4 groups. ISO was injected for 2 consecutive days (100 mg/kg) in ISO treated groups. Before ISO administration, pretreatment with Coenzyme Q10 (10 mg/kg/day) and L-Carnitine (350 mg/kg/day) were conducted for 20 consecutive days. Sex hormones level, malondialdehyde (MDA) and total antioxidant concentration as well as testis, epididymis and seminal vesicle weight were investigated.Increase in the concentration of MDA and decrease in total antioxidant level was observed following ISO administration. Accordingly, the sperm viability as well as testis, epididymis and seminal vesicle weights were decreased. In the case of sex hormones, the testosterone and LH levels were decreased and the concentration of FSH was increased. Pretreatment with L-carnitine and Coenzyme Q10 significantly decreased the MDA level and increased total antioxidant, LH and testosterone levels. Pretreatment with L-carnitine and Coenzyme Q10 also improved semen parameters and organs weight which were impaired by ISO administration.L-carnitine and Coenzyme Q10 pretreatment could protect spermatogenesis in male rats with ISO administration.

Ghanbarzadeh S, Garjani A, Ziaee M, Khorrami A. – Research Center for Pharmaceutical Nanotechnology and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran. – Drug Research, 2013 Nov 27. http://www.ncbi.nlm.nih.gov/pubmed/24285403

In this study Chinese herbs commonly used in the treatment of male infertility were investigated for relevant biochemical activity. Oxidative stress has been implicated in male infertility with significant levels of reactive oxygen species detected in 25% of infertile males. A total of 37 individual herbs and seven herb decoctions used in the treatment of male factor infertility were therefore tested for endocrine activity. 20 showed strong and 10 weak anti-oestrogenic activity. Oestrogenic responses were elicited for two herbs. Of these 37 herbs, strong (15 herbs), intermediate (7 herbs) and weak/no (15 herbs) antioxidant activity was detected (ranging from 0.912–1.26; 0.6–0.88 and 0–0.468μg ascorbate equivalent/mg dried herb, respectively). The seven decoctions (previously used to treat patients) tested elicited strong (5 herbs) and weak (2 herbs) anti-oestrogenic responses (per g of dried herb tamoxifen equivalents ranged from 1.14–13.23mg and 0.22–0.26mg, respectively), but not oestrogenic, androgenic nor anti-androgenic, consistent with their individual composition.

Helen G. Tempest, Sheryl T. Homa, Edwin J. Routledge, Anthony Garner, Xiao-Ping Zhai and Darren K. Griffin. Systems Biology in Reproductive Medicine. 2008, Vol. 54, No. 4-5 , Pages 185-195 (doi:10.1080/19396360802379073)

90 men with immune infertility were selected as the research subjects and randomly divided into two groups, 60 in the treatment group, treated by Huzhangdanshenyin, and the other 30 in the control, treated by prednisone, both for 3 months. The improvement of clinical symptoms, immunologic indexes (antisperm antibodies in serum and seminal plasma) and sperm indexes (semen liquefied duration, motility, viability, density and abnormal morphology rate) were observed and the results analyzed. CONCLUSION: The Chinese medicine Huzhangdanshenyin works more effectively than prednisone in the treatment of male immune infertility. It could improve the antisperm antibody reversing ratio, clinical symptoms and signs and ameliorate sperm indexes with no obvious advierse effects.

Lu TK, Ouyang HG, Jin GY, Hong YS, Zou Q, Lin ZY, Deng LS, Guo YB. Zhonghua Nan Ke Xue. 2006 Aug;12(8):750-5. Department of Andrology, Xiamen TCM Hospital Affiliated to Fujian TCM College, Xiamen, Fujian 361001, China.

Thirty-seven infertile patients with varicocele were treated with Guizhi-Fuling-Wan (7.5 g/day) for at least 3 months. Before and after the administration, semen qualities such as sperm concentration and motility were examined, and the varicocele was graded. A varicocele disappearance rate of 80% was obtained with 40 out of 50 varicocele, and improvement of sperm concentration and motility were found in 71.4% and 62.1% of patients, respectively. From these results, Guizhi-Fuling-Wan is considered to be effective for circulation disorders in varicocele as well as semen quality.

Ishikawa H; Ohashi M; Hayakawa K; Kaneko S; Hata M Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan. Am J Chin Med, 24(3-4):327-31 1996 (ISSN: 0192-415X)

Eighty-seven cases of male infertility were treated with Bu Shen Sheng Jing Pill, and the comprehensive semen routine analysis score was enhanced significantly (P < 0.001). The result showed that this prescription had a regulatory function in follicle stimulating hormone, luteotropic hormone, testosterone, cortisol (could bring the enhanced or reduced hormone level back to normal range).

Yue GP; Chen Q; Dai N Institute of Acupuncture and Meridians, Anhui College of TCM, Hefei. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih, 16(8):463-6 1996 Aug (ISSN: 1003-5370)

Tai-bao Chinese herbal medicine displayed significantly higher rates of implantation and pregnancy, as well as comparitive rates of lowering effects of antisperm antibodies as prednisone. CONCLUSION: Chinese medicine Tai-bao possesses regulatory effect on reproductive immune function, inhibitory effect on antisperm cytotoxic antibody, and promoting effect on pregnancy.

Lai AN; Song JF; Liu XJ Xiyuan Hospital, China Academy of TCM, Beijing. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih, 17(6):360-2 1997 Jun (ISSN: 1003-5370)

The effects of a Chinese herb, Cornus officinalis, on the motility of human sperm was studied. An aqueous extract was prepared from the dried fruits of the herb and used in this study. The crude extract showed substantial stimulatory effects on sperm motility.

Jeng H; Wu CM; Su SJ; Chang WC Department of Anatomy, Taipei Medical College, Taiwan. Am J Chin Med 1997;25(3-4):301-6 (ISSN: 0192-415X)

Conclusions: 132 men tested positive for antisperm antibodies. They were treated for 1.5-4.5 months with a Chinese herbal formula Ju He Wan. After treatment, 120 (91%) tested negative for antisperm antibodies (compared to only 45% of the group treated with prednisone). 74 of these same men conceived after 1.5-3 months of treatment. From these findings, Chinese herbal medicine could be an effective treatment option for men with antisperm antibodies.

Cheng Ke-jia et al. – pages 39-40 of issue #7, 2007 of Xin Zhong Yi (New Chinese Medicine)

100 cases of male immune infertility in the treatment group were treated with Yikang Decoction, while 100 cases treated with prednisone as the controls. CONCLUSION: The Yikang Decoction has a more stable effect for male immune infertility than prednisone. Antisperm antibodies, percentage of motile sperm, pregnancy rates, and sperm agglutination (clumping) were all significantly better in the group treated with the Chinese herbal fomula Yikang decoction vs the prednisone treatment group.

Sun Z, Bao Y. – J Tradit Chin Med. 2006 Mar;26(1):36-8. – Department of Reproduction, Zhejiang Hospital of Integrated Chinese and Western Medicine, Hangzhou 310003, China.

100 men with low sperm count and poor sperm motility were treated with individulaly modified Chinese herbal formulations combined with clomid and vitamin E daily for 15-60 days (37.3 days average). 82% showed significant increases in both count and motility. This may be a viable treatment option for men with poor sperm motility and low sperm counts.

Shao Chang-jie – Hei Long Jiang Zhong Yi Yao (Heilongjiang Chinese Medicine & Pharmacology), pages 36-37 of issue #3, 2007

156 men with low sperm count and inability to conceive were administered individually modified versions of the Chinese herbal formula Sheng Jing Qiang You Tang for 3-6 months. They were not allowed to drink alcohol, smoke, or have sex. In 98 men their sperm count increased above WHO standards, and 35 men showed an increase in sperm count but did not meet ‘fertile’ WHO criteria.

Zhang Jun. – Shi Yong Zhong Yi Nei Ke Za Zhi (Journal of Practical Chinese Medical Internal Medicine), page 50 of issue #1, 2005

CONCLUSION: Protective effects of Hochuekkito on sperm was suggested on sperm with Anit-sperm Antibodies. Although normal sperm with ASA was used in this report, since the sperm of infertile patients are said to be more fragile, this results imply that direct protective effect is one of the mechanism of Hochuekkito for male infertility

Yamanaka M; Kitamura M; Kishikawa H; Tsuboniwa N; Koga M; Nishimura K; Tsujimura A; Takahara S; Matsumiya K; Okuyama A Department of Urology, Osaka University Medical School – Nippon Hinyokika Gakkai Zasshi, 89(7):641-6 1998 Jul (ISSN: 0021-5287)

128 men with low sperm count were treated with acupuncture for 25 days consecutively as one course of treatment. Some men went through 2 courses. Overall, 92.19% of the men involved showed increase is sperm count, and 42 of these men were considered ‘cured’ when compared to WHO criteria. Note: In general, the more the patient felt the needle sensation, the better the outcome. Conversely, the less they felt the needle sensation, the worse the outcome.

Pang Pao-zhen and Zhao Huan-yun. – Hei Long Jiang Zhong Yi Yao (Heilongjiang Chinese Medicine & Medicinals), issue #1, 2004

CONCLUSION: The combined therapy of acupuncture with herbal drugs has definite therapeutic effects on male immune infertility, which can regulate AsAb and raise the immunity of the patients. To study the clinical effects of the combined therapy of acupuncture with herbal medicine on male immune infertility and on antisperm antibody (AsAb), 100 male cases of infertility with positive AsAb were divided randomly into two groups, each consisting of 50 cases. The control group was treated with oral prednisone. The clinical therapeutic effects and the impact on AsAb were observed in the two groups. The results showed that the total effective rate in the acupuncture-herb group was 90%; while that of the control group was 64%, the comparison showing a statistically significant difference (P<0.05).

Fu B, Lun X, Gong Y. – J Tradit Chin Med. 2005 Sep;25(3):186-9. – Department of Acupuncture, Second Guangdong Provincial Worker’s Hospital, Guangzhou 510720, China.

Conclusion: men that manifest higher scrotal temperatures due to genital tract inflammation or poor lifestyle habits can benefit from the scrotal temperature lowering effects of acupuncture.

Poor spermatogenesis in patients with inflammation of the genital tract is associated with scrotal hyperthermia. These patients can benefit from acupuncture treatment. We conducted a study to verify whether the influence of acupuncture treatment on sperm output in patients with low sperm density is associated with a decrease in scrotal temperature. The experimental group included 39 men who were referred for acupuncture owing to low sperm output. The control group, which comprised 18 normal fertile men, was used to define a threshold (30.5 degrees C) above which scrotal skin temperature was considered to be high. Accordingly, 34 of the 39 participants in the experimental group initially had high scrotal skin temperature; the other five had normal values. Scrotal skin temperature and sperm concentration were measured before and after acupuncture treatment. The five patients with initially normal scrotal temperatures were not affected by the acupuncture treatment. Following treatment, 17 of the 34 patients with hyperthermia, all of whom had genital tract inflammation, had normal scrotal skin temperature; in 15 of these 17 patients, sperm count was increased. In the remaining 17 men with scrotal hyperthermia, neither scrotal skin temperature nor sperm concentration was affected by the treatment. About 90% of the latter patients suffered from high gonadotropins or mixed etiological factors. Low sperm count in patients with inflammation of the genital tract seems to be associated with scrotal hyperthermia, and, consequently, acupuncture treatment is recommended for these men.Asian Journal of Andrology (2009) 11: 200-208. doi: 10.1038/aja.2008.4; published online 5 January 2009.

Asian J Androl. 2009 Mar;11(2):200-8. Epub 2009 Jan 5. Siterman S, Eltes F, Schechter L, Maimon Y, Lederman H, Bartoov B.[1] 1Maccabi Fund Complementary Medicine, Kaufman Street, Tel Aviv 68012, Israel [2] 2Refuot-Integrative Medical Centre, Ramat Aviv Gimel, Tel Aviv 69123, Israel.

Conclusion: daily ejaculation improves sperm DNA health.

Objective
To evaluate the relationship between duration of sexual abstinence and sperm selection on sperm DNA fragmentation (SDF).

Design
Prospective study based on normozoospermic individuals.

Setting
Fertility and IVF unit and university unit for research.

Patient(s)
Two cohorts of normozoospermic individuals: 21 men (aged 25–35 years) attending a clinic and with clearly adverse female factors; and a group of 12 selected donors (aged 20–25 years).

Intervention(s)
SDF assessment using the sperm chromatin the dispersión test (Halosperm) in two cohorts of normozoospermic men.

Main Outcome Measure(s)
SDF assessment after 24 hours of abstinence with recurrent ejaculation (one every 24 hours) using neat sperm samples; and SDF assessment before and after sperm selection with abstinence of 3 hours.

Result(s)
Lower baseline levels of SDF were observed after shorter periods of abstinence between ejaculations (24 hours and 3 hours) than those recommended. This effect is much more marked after quick repetitive ejaculation (3 hours of abstinence) and sperm selection.

– Jaime Gosálvez et al, Spain – Fertility & Sterility

CONCLUSION(S): The treatment of idiopathic male infertility could benefit from employing acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture, although we did not identify specific sperm pathologies that could be particularly sensitive to this therapy.

A group of infertile men who had pathological semen analyses according to WHO criteria, were treated with acupuncture twice a week for 5 weeks. A statistically significant increase after acupuncture in the percentage and number of sperm with no structural defects was demonstrated compared to the control group of patients who received no treatment. They concluded that male infertility patients could benefit from having acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture.

OBJECTIVE: To evaluate the ultramorphologic sperm features of idiopathic infertile men after acupuncture therapy.

DESIGN: Prospective controlled study.

SETTING: Christian-Lauritzen-Institut, Ulm, IVF center Munich, Germany, and Department of General Biology, University of Siena, Siena, Italy.

PATIENT(S): Forty men with idiopathic oligospermia, asthenospermia, or teratozoospermia. I

NTERVENTION(S): Twenty eight of the patients received acupuncture twice a week over a period of 5 weeks. The samples from the treatment group were randomized with semen samples from the 12 men in the untreated control group.

MAIN OUTCOME MEASURE(S): Quantitative analysis by transmission electron microscopy (TEM) was used to evaluate the samples, using the mathematical formula based on submicroscopic characteristics.

RESULT(S): Statistical evaluation of the TEM data showed a statistically significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects in the total ejaculates. A statistically significant improvement was detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. However, specific sperm pathologies in the form of apoptosis, immaturity, and necrosis showed no statistically significant changes between the control and treatment groups before and after treatment.

– Pei J et al Fertil Steril. 2005 Jul;84(1):141-7 Fertility and Sterility

Conclusion: The Chinese Traditional Medicine acupuncture and moxa techniques significantly increase the percentage of normal-form sperm in infertile patients with oligoastenoteratozoospermia without apparent cause.

In a prospective, controlled and blind study, a group of infertile men (married for 3 – 11 years without children) were randomized into two groups, the treatment group receiving 10 acupuncture treatments and the control group receiving sham acupuncture treatments. The patients in the acupuncture group demonstrated a significant increase in the percentage of normal forms compared to the control group

Aim: To evaluate the effect of Chinese Traditional Medicine, acupuncture and moxa treatment, on the semen quality in patients with semen abnormalities.

Methods: In a prospective, controlled and blind study, nineteen patients, aged 24 years ~ 42 years and married for 3 years ~ 11 years without children with semen abnormalities in concentration, morphology and/or progressive motility without apparent cause, were randomized into two groups and submitted to acupuncture and moxa treatment at the therapeutic (Study Group) and the indifferent points (Control Group), respectively, for 10 weeks. Semen analyses were performed before and after the treatment course.

Results: The patients of the Study Group presented a significant increase in the percentage of normal-form sperm compared to the Control Group (calculated U=16.0, critical U=17.0).

– Gurfinkel E et al Asian J Androl. 2003 Dec;5(4):345-8. Asian Journal of Andrology

Conclusions: After receiving acupuncture twice weekly for 6 weeks motility of sperm (but not overall count) was found to increase significantly.

This recent small clinical trial randomised 57 patients who had extremely low sperm counts, to acupuncture and placebo acupuncture groups. The authors conclude that the results of the present study support the significance of acupuncture in male patients with severe oligoasthenozoospermia. More evidence with larger trials needs to be accumulated before the efficacy and effectiveness of acupuncture in male infertility can be evaluated.

In this first prospective, randomized, single-blind, placebo-controlled study, 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A–C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.

– Dieterle et al Fertil Steril 2009 Oct; 92 (4): 1340–3 Fertility and Sterility

Conclusion(s): For the first time point- and frequency-specific effects of abdominal EA on TBF are shown in humans.

Just as electrocaupuncture can increase blood flow to the ovaries and uterus (see reports above) so it can to the testicles. These authors demonstrate that particular frequencies applied for just 5 minutes are effective in increasing blood flow in the testes, and suggest that such a stimulus may address the damaged microcirculation associated with varicoceles, and with aging. They note that decreased testicular arterial blood flow may result in impaired spermatogenesis from defective metabolism in the microcirculatory bed and suggest that further research is needed to discover if electroacupuncture can improve sperm manufacture in this instance.

Objective: To clarify the role of the abdominal acupuncture points and the frequency of short-term electroacupuncture (EA) stimulation on testicular blood flow (TBF) in humans.

Design: A prospective, randomized study.

Setting: University hospital, Department of Radiology, ultrasound unit.

Patient(s): Eighty healthy male volunteers were randomly allocated to three groups in stage one and to a single group in stage two. In the first stage of the study, the abdominal acupuncture points ST-29 (guilai) were stimulated using simple needle insertion, 2 Hz burst EA or 10 Hz EA, in three different groups. In the second stage of the study, abdominal acupuncture points ST-25 (tianshu) were stimulated with the frequency found to be more effective in stage one. Stimulation was for 5 minutes in each group.

Intervention(s): Electroacupuncture and Doppler flowmeter.

Main Outcome Measure(s): Four groups were compared for volume flow and other related parameters of TBF.

Result(s): The 10-Hz EA stimulation of ST-29 (guilai) increased TBF, but simple needle insertion and 2-Hz burst stimulation did not. The 10-Hz EA stimulation of ST-25 (tianshu) did not result in significant changes in TBF.

Further investigation is required to ascertain whether these findings may be helpful in the clinical treatment of infertile men.

– Cakmak Y et al, Fertil Steril 2008;90:1732–8 Fertility and Sterility

Conclusions: It is concluded that acupuncture may be a useful, nontraumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation.

This pilot study once again showed a positive effect of acupuncture on sperm count – but this time on men with such low sperm counts (or no sperm) that they would usually require a testicular biopsy to extract sperm for use in an IVF cycle. Seven of the 15 men with no sperm at all produced sperm detectable by the light microscope after a course of 10 acupuncture treatments (p < 0.01) ie enough sperm could be produced for ICSI to be performed without recourse to testicular biopsy. The control group with similar semen analysis had no treatment and showed no change after 3 months.

Classic therapies are usually ineffective in the treatment of patients with very poor sperm density. The aim of this study was to determine the effect of acupuncture on these males. Semen samples of 20 patients with a history of azoospermia were examined by light microscope (LM) and scanning electron microscope (SEM), with which a microsearch for spermatozoa was carried out.

These examinations were performed before and 1 month after acupuncture treatment and revealed that the study group originally contained three severely oligoteratoasthenozoospermic (OTA), two pseudoazoospermic and 15 azoospermic patients.

The control group was comprised of 20 untreated males who underwent two semen examinations within a period of 2–4 months and had initial andrological profiles similar to those of the experimental group.

No changes in any of the parameters examined were observed in the control group. There was a marked but not significant improvement in the sperm counts of severely OTA males following acupuncture treatment (average=0.7±1.1×106 spermatozoa per ejaculate before treatment vs. 4.3±3.2×106 spermatozoa per ejaculate after treatment). A

definite increase in sperm count was detected in the ejaculates of 10 (67%) of the 15 azoospermic patients. Seven of these males exhibited post-treatment spermatozoa that were detected even by LM. The sperm production of these seven males increased significantly, from 0 to an average of 1.5±2.4×106 spermatozoa per ejaculate (Z=−2.8, P≤0.01). Males with genital tract inflammation exhibited the most remarkable improvement in sperm density (on average from 0.3±0.6×106 spermatozoa per ejaculate to 3.3±3.2×106 spermatozoa per ejaculate; Z=−2.4, P≤0.02).

Two pregnancies were achieved by the IVF-ICSI procedure.

Siterman S et al Andrologia. 2000 Jan;32(1):31-9. Andrologia

Conclusion: patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment.

A group of infertile men with abnormal semen analysis were randomly divided into 2 groups; one group was given 10 acupuncture treatments over 5 weeks, and the other group, no treatment. Significant improvements (p < 0.05) were demonstrated in the acupuncture group compared to the control group, in particular improved motility and morphology.

The aim of this prospective controlled study was to assess the effect of acupuncture on the sperm quality of males suffering from subfertility related to sperm impairment.

Semen samples of 16 acupuncture-treated subfertile patients were analyzed before and 1 month after treatment (twice a week for 5 weeks). In parallel, semen samples of 16 control untreated subfertile males were examined. Two specimens were taken from the control group at an interval of 2-8 months. The expanded semen analysis included routine and ultramorphological observations.

The fertility index increased significantly (p < or = .05) following improvement in total functional sperm fraction, percentage of viability, total motile spermatozoa per ejaculate, and integrity of the axonema (p < or = .05), which occurred upon treatment. The intactness of axonema and sperm motility were highly correlated (corr. = .50, p < or = .05).

Siterman S et al Arch Androl. 1997 Sep-Oct;39(2):155-61 Archives of Andrology

This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates an inverse relationship between semen quality and specific aspects of psychological stress.

Robert N. Clarke1, Susan C. Klock2,4, Anne Geoghegan3 and David E. Travassos1
Oxford JournalsMedicine Human Reproduction Volume 14, Issue 3Pp. 753-758 – 1998
http://humrep.oxfordjournals.org/content/14/3/753

Increased levels of both state and trait anxiety were associated with lower semen volume, sperm concentration and count, reduced sperm motility, and increased sperm DNA fragmentation of IVF patients, thus influencing seminal parameters at the macroscopic and cellular/subcellular levels. Similar results were obtained in the controls. Our data confirm previous observations with state anxiety and show that trait anxiety also is negatively associated with male fertility.

Fertility and Sterility – Volume 99, Issue 6 , Pages 1565-1572.e2, May 2013
Elisa Vellani, Ph.D., Alessandro Colasante, Ph.D., Luciana Mamazza, Ph.D., Maria Giulia Minasi, M.Sc., Ermanno Greco, M.D., Arturo Bevilacqua, Ph.D.
http://www.fertstert.org/article/S0015-0282(13)00141-6/abstract

A significant correlation showed that low egg numbers were associated with higher Depression. Sperm motility was weakly correlated with Depression scores. Women with high State Anxiety score on the egg retrieval day had significant lower pregnancy rates, as did those with higher Depression.

Psychological Reports: Volume 104, Issue , pp. 796-806. June 2009
NERMIN GÜRHAN, AYGÜL AKYÜZ, DERYA ATICI, and SEZER KISA
http://www.amsciepub.com/doi/abs/10.2466/pr0.104.3.796-806

These results suggest that stressful life events may be associated with decreased semen quality in fertile men. The experience of psychosocial stress may be a modifiable factor in the development of idiopathic infertility.

Fertility and Sterility – Volume 93, Issue 4 , Pages 1104-1111, 1 March 2010
Audra L. Gollenberg, Ph.D., Fan Liu, M.S., Charlene Brazil, B.S., Erma Z. Drobnis, Ph.D., David Guzick, M.D., Ph.D., James W. Overstreet, M.D., Ph.D., James B. Redmon, M.D., Amy Sparks, Ph.D., Christina Wang, M.D., Shanna H. Swan, Ph.D
http://www.fertstert.org/article/S0015-0282(08)04660-8/abstract

The relationship between psychosocial variables and seminal status has been confirmed by comparing a group of oligozoospermic (poor sperm) and normozoospermic (normal sperm) men.

Fertility and Sterility – Volume 79, Supplement 3 , Pages 1571-1576, June 2003
Luigi De Gennaro, Ph.D.email address, Simona Balistreri, Ph.D., Andrea Lenzi, M.D., Francesco Lombardo, M.D., Michele Ferrara, Ph.D., Loredana Gandini, B.Sc
http://www.fertstert.org/article/S0015-0282(03)00374-1/abstract

Conclusions: Acupuncture can improve sperm quality and fertilization rates in assisted reproductive technology. The fertilization rates after acupuncture (66.2%) were significantly higher than that before treatment (40.2%) (P < 0.01).

This trial looks at sperm behaviour in an IVF setting. It was a “before and after” study involving 82 infertile men with pathological semen abnormalities and who’s sperm achieved a poor fertilization rate in at least 2 IVF/ICSI cycles. They were given acupuncture twice a week over 8 weeks and the IVF/ICSI cycles were repeated. The fertilization rates after acupuncture (66.2%) were significantly higher than that before treatment (40.2%) (P < 0.01).

The clinical effects of acupuncture on idiopathic male infertility in sperm parameter and on therapeutic results in assisted reproductive technology were investigated. 22 patients failed in intracytoplasmic sperm injection (ICSI) with idiopathic male infertility were treated with acupuncture twice weekly for 8 weeks, followed by ICSI treatment again. The sperm concentration, motility, morphology, fertilization rates and embryo quality were observed. Quick sperm motility after acupuncture (18.3% +/- 9.6%) was significantly improved as compared with that before treatment (11.0% +/- 7.5%, P < 0.01). The normal sperm ratio was increased after acupuncture (21.1% +/- 10.4% vs 16.2% +/- 8.2%, P < 0.05). The fertilization rates after acupuncture (66.2%) were obviously higher than that before treatment (40.2%, P < 0.01). There was no significant difference in sperm concentration and general sperm motility between before and after acupuncture. The embryo quality after acupuncture was improved, but the difference between them was not significant (P > 0.05).

– Zhang M et al J Huazhong Univ Sci Tech Med Sci.2002;22(3):228-30 Journal of Huazhong University

Conclusions: Significant increases in pregnancy outcomes were confirmed by this study and the data uniquely supported the advantage of acupuncture in patients with normal PI (prior studies were done on patient with PI). We also demonstrated that both acupuncture treatment protocols could be used together with a synergistic effect. Finally, this study is the first to demonstrate that the use of acupuncture in patients with poor prognoses (elevated Peak FSH, longer history of infertility, poor sperm morphology) can achieve similar pregnancy rates to normal prognosis patients.

Objective: The purpose of the study was to determine the influence of two acupuncture protocols on IVF outcomes and secondly to identify the appropriate patient groups that would most benefit from this adjunctive therapy.

Materials and Methods: In this retrospective study, data was extracted from medical records of patients RE&I clinic & acupuncture clinics between January 2001 and November 2003. All patients completing an IVF cycle with transfer were included. One RE&I provided the IVF care and a consortium of acupuncturists overseen by the author provided the strict acupuncture protocols. PR per transfer were the endpoints measured. Data was analyzed by student’s t test and Multiregression with Wilcox ranking (MRW).

Results: 147 patients were included in the study and of those 53 had Acupuncture (Ac) and 94 did not (Non-Ac group). Demographic data between these Ac and Non-Ac groups respectively indicated remarkable equity (Table 1). Fertility Factors also demonstrated equity and there were no differences in Diagnoses, IVF Protocols and type of Gonadatrophin protocols used.

Factors that demonstrated significance were: Length of time infertile, Peak FSH, PI for total group without MRW; PI for MRW groups reversed this (Table 2) and finally average: Sperm Morphology, Peak E2, Peak P4 prior to HcG: and endometrial thickness. PR before Wilcox ranking were the same: 40% v 38%. MRW analysis revealed FSH, Length of time trying to get pregnant, Sperm Morphology and E2 levels as significant: 6.5, 4.1, 4.0 and 1.6 respectively. When the Ac group was modified (15 Ac patient dropped), PI was elevated from 1.76 to 1.94 resulting in a significant elevation compared to the Non-Ac group, p 0.01. Also PR changed from 40% before to 53% after and this value was significantly greater than the Non-Ac group (38%), p 0.01.

– Magarelli P,Cridennda D, Fertil Steril,2004;81 Suppl 3 S20 Fertility and Sterility

Nutrition & Sperm

Conclusion(s): This study demonstrates that paternal obesity impairs preimplantation embryo development and implantation but does not influence gross fetal or placental morphology. It highlights the important contribution that paternal health and lifestyle choices have for achieving a viable pregnancy.

Objective
To use a rodent model of male diet-induced obesity (DIO) to examine resultant preimplantation embryo development and implantation rate, as well as fetal and placental growth.

Design
Experimental animal study.

Setting
University research facilities.

Animal(s)
C57BL/6 male and CBAxC57BL/6 female mice.

Intervention(s)
Male mice were fed a standard rodent chow (lean) or a high-fat diet (obese) for up to 13 weeks. After mating, zygotes were collected and cultured to the blastocyst stage, then assessed or transferred into recipient females.

Main Outcome Measure(s)
Embryo morphology and cell number were assessed and pregnancy outcomes determined at postmortem day 18.

Result(s)
Embryos from obese males had reduced cleavage and decreased development to blastocyst stage during culture relative to control males. Blastocysts from obese males implanted at a reduced rate, and the proportion of fetuses that developed was significantly decreased, although fetal and placental weight did not differ between groups.

Megan Mitchell et al – Fertility and Sterility – Volume 95, Issue 4 , Pages 1349-1353, 15 March 2011

Conclusion(s)
In a population of healthy young men, carotenoid intake was associated with higher sperm motility and, in the case of lycopene, better sperm morphology. Our data suggest that dietary carotenoids may have a positive impact on semen quality.

Objective
To assess the relationship between dietary antioxidant intake and semen quality in young healthy males.

Design
Cross-sectional study.

Setting
University and college campuses in the Rochester, New York, area.

Patient(s)
One hundred eighty-nine university-aged men.

Intervention(s)
None.

Main Outcome Measure(s)
Semen volume, total sperm count, concentration, motility, total motile count, and morphology.

Result(s)
Progressive motility was 6.5 (95% confidence interval [CI], 0.6, 12.3) percentage units higher among men in the highest quartile of β-carotene intake compared with men in the lowest quartile. Similar results were observed for lutein intake. Lycopene intake was positively related to sperm morphology. The adjusted percentages (95% CI) of morphologically normal sperm in increasing quartiles of lycopene intake were 8.0 (6.7, 9.3), 7.7 (6.4, 9.0), 9.2 (7.9, 10.5), and 9.7 (8.4, 11.0). There was a nonlinear relationship between vitamin C intake and sperm concentration, with men in the second quartile of intake having, on average, the highest sperm concentrations and men in the top quartile of intake having the lowest concentrations.

Fertility and Sterility – Volume 100, Issue 6 , Pages 1572-1579, December 2013 – Piotr Zareba, M.D., M.P.H., Daniela S. Colaci, M.D., M.Sc., Myriam Afeiche, Ph.D., M.P.H., Audrey J. Gaskins, B.S.E., Niels Jørgensen, M.D., Ph.D., Jaime Mendiola, Ph.D., M.P.H., Shanna H. Swan, Ph.D., Jorge E. Chavarro, M.D., Sc.D

Conclusions: Vitamin B9 (folate, folic acid) and B12 are important for sperm production.

Mild hyperhomocysteinemia is caused by B vitamin deficiencies. We hypothesize that these biochemical derangements detrimentally affect spermatogenesis. Therefore, the aim of this study was to investigate the folate, cobalamin, pyridoxine, and homocysteine concentrations in blood and seminal plasma and the associations between these biomarkers and semen parameters in men participating in an in vitro fertilization or intracytoplasmic sperm injection program. From 73 men (median age [range]: 37 years [28-53]), blood and semen samples were obtained for the determination of serum and red blood cell (RBC) folate, serum total cobalamin, whole-blood pyridoxal-5′-phosphate, plasma total homocysteine (tHcy), and serum total testosterone. Semen analysis included sperm concentration, motility, and morphology according to World Health Organization criteria. The B vitamins and tHcy concentrations were significantly correlated in blood but not in seminal plasma. The serum and RBC folate concentrations were significantly correlated also with the total folate concentration in seminal plasma (r = .44; P < .001 and r = .39; P < .001, respectively). Likewise, the total cobalamin concentration in serum and seminal plasma was significantly correlated (r = .55; P = .001). Of interest is that the total cobalamin concentration in seminal plasma was significantly correlated with the sperm concentration (r = .42; P < .001). This is in contrast to the absence of significant associations between the other vitamins and tHcy in blood and seminal plasma and any of the semen parameters. These findings suggest that folate and cobalamin are transferred from the blood to the male reproductive organs and emphasize the role of cobalamin in spermatogenesis in human.

J Androl. 2007 Jul-Aug;28(4):521-7. – Boxmeer JC, Smit M, Weber RF, Lindemans J, Romijn JC, Eijkemans MJ, Macklon NS, Steegers-Theunissen RP. – Department of Obstetrics and Gynecology/Division of Obstetrics and Reproductive Medicine, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands. http://www.ncbi.nlm.nih.gov/pubmed/19228759

CONCLUSIONS: Coenzyme Q10 supplementation resulted in a statistically significant improvement in sperm concentration, motility, and morphology.

PURPOSE:
We determined the efficacy of coenzyme Q10 supplementation on semen parameters, sperm function and reproductive hormone profiles in infertile men.
MATERIALS AND METHODS:
A total of 212 infertile men with idiopathic oligoasthenoteratospermia were randomly assigned to receive 300 mg coenzyme Q10 (Kaneka, Osaka, Japan) orally daily (106 in group 1) or a similar placebo regimen (106 in group 2) during a 26-week period, followed by a 30-week treatment-free phase. Two semen analyses, acrosome reaction test, immunobead test for antisperm antibody, and determination of resting levels of luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone and inhibin B were done in all participants. Blood and seminal plasma total coenzyme Q10 was also assessed.
RESULTS:
Significant improvement in sperm density and motility was evident with coenzyme Q10 therapy (each p = 0.01). Using the Kruger classification sperm morphology evaluation revealed an increase in the percent of normal forms in the coenzyme Q10 group (p = 0.07). A positive correlation was found between treatment duration with coenzyme Q10 and sperm count (r = 0.46, p = 0.03) as well as with sperm motility (r = 0.45, p = 0.04) and sperm morphology (r = 0.34, p = 0.04). The coenzyme Q10 group had a significant decrease in serum follicle-stimulating hormone and luteinizing hormone at the 26-week treatment phase (each p = 0.03). By the end of the treatment phase the mean +/- SD acrosome reaction had increased from 14% +/- 8% and 15% +/- 8% to 31% +/- 11% and 16% +/- 10% in the coenzyme Q10 and placebo groups, respectively (p = 0.01).
CONCLUSIONS:
Coenzyme Q10 supplementation resulted in a statistically significant improvement in certain semen parameters. However, further studies are needed to draw a final conclusion and evaluate the effect of coenzyme Q10 supplementation on the pregnancy rate.

J Urol. 2009 Jul;182(1):237-48. – Safarinejad MR. – Urology and Nephrology Research Center, Shahid Beheshti University, Tehran, Iran. http://www.ncbi.nlm.nih.gov/pubmed/19447425

CONCLUSION(S): administration of coenzyme Q(10) increases sperm motility in patients with idiopathic asthenozoospermia.

OBJECTIVE:
To evaluate the effectiveness of coenzyme Q(10) treatment in improving semen quality in men with idiopathic infertility.
DESIGN:
Placebo-controlled, double-blind randomized trial.
PATIENT(S):
Sixty infertile patients (27-39 years of age) with the following baseline sperm selection criteria: concentration >20 x 10(6)/mL, sperm forward motility <50%, and normal sperm morphology >30%; 55 patients completed the study.
INTERVENTION(S):
Patients underwent double-blind therapy with coenzyme Q(10), 200 mg/day, or placebo; the study design was 1 month of run-in, 6 months of therapy or placebo, and 3 months of follow-up.
MAIN OUTCOME MEASURE(S):
Variations in semen parameters used for patient selection and variations of coenzyme Q(10) and ubiquinol concentrations in seminal plasma and spermatozoa.
RESULT(S):
Coenzyme Q(10) and ubiquinol increased significantly in both seminal plasma and sperm cells after treatment, as well as spermatozoa motility. A weak linear dependence among the relative variations, baseline and after treatment, of seminal plasma or intracellular coenzyme Q(10) and ubiquinol levels and kinetic parameters was found in the treated group. Patients with a lower baseline value of motility and levels of coenzyme Q(10) had a statistically significant higher probability to be responders to the treatment.
CONCLUSION(S): The exogenous administration of coenzyme Q(10) increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia.

Fertil Steril. 2009 May;91(5):1785-92. – Balercia G, Buldreghini E, Vignini A, Tiano L, Paggi F, Amoroso S, Ricciardo-Lamonica G, Boscaro M, Lenzi A, Littarru G. – Department of Internal Medicine and Applied Biotechnologies, Andrology Unit, Endocrinology, Umberto I Hospital, School of Medicine, Polytechnic University of Marche, Ancona, Italy. http://www.ncbi.nlm.nih.gov/pubmed/18395716

CONCLUSION(S): 74% increase in total normal sperm count after combined zinc sulfate (66mg) and folic acid (5mg) treatment for 26 weeks (6 months) in both subfertile and fertile men.

OBJECTIVE:
To study the effects of folic acid and zinc sulfate treatment on semen variables in fertile and subfertile men.
DESIGN:
Double-blind, placebo-controlled interventional study.
SETTING:
Two outpatient fertility clinics and nine midwifery practices in The Netherlands.
PARTICIPANT(S):
One hundred eight fertile and 103 subfertile men.
INTERVENTION(S):
Both groups were randomly assigned to receive one of four treatments for 26 weeks: folic acid and placebo, zinc sulfate and placebo, zinc sulfate and folic acid, and two placebos. Folic acid was given at a daily dose of 5 mg, and zinc sulfate was given at a daily dose of 66 mg.
MAIN OUTCOME MEASURE(S):
Before and after treatment, standardized semen and blood samples were obtained for determinations of sperm concentration, motility, and morphology according to World Health Organization guidelines; semen morphology according to strict criteria; and blood folate and zinc concentrations. Effects of the four interventions were evaluated separately in subfertile and fertile men.
RESULT(S):
Subfertile men demonstrated a significant 74% increase in total normal sperm count and a minor increase of 4% abnormal spermatozoa. A similar trend was observed in fertile men. Pre-intervention concentrations of folate and zinc in blood and seminal plasma did not significantly differ between fertile and subfertile men.

Fertil Steril. 2002 Mar;77(3):491-8. – Wong WY, Merkus HM, Thomas CM, Menkveld R, Zielhuis GA, Steegers-Theunissen RP.- Department of Obstetrics and Gynecology, University Medical Centre Nijmegen, Nijmegen, The Netherlands.

CONCLUSIONS: Lipoic Acid (antioxidant) may protect sperm producing cells (Sertoli) when male fertility damaging inflammatory reactions occur.

Inflammatory reactions to microbial infections may cause male infertility. The mechanisms of inhibition of spermatogenesis can be studied in vitro using rat Sertoli cells. Bacterial lipopolysaccharides (LPS) induce acute inflammations. So LPS treated Sertoli cells can be used to test for new therapeutic compounds. The present study aimed to investigate the protective efficacy of dl-alpha-lipoic acid (LA) on lipopolysaccharide (LPS)-induced oxidative stress in adult rat Sertoli cells. Sertoli cells were divided into 4 groups. Group I served as a control incubated with water (vehicle). Groups II and IV were incubated with 100 microM LA for 24h before incubating Groups III and IV with 50 microg/ml lipopolysaccharide (LPS) for 12h. In Group III cells (LPS-treated, no LA) the lactate concentration was decreased whereas hydrogen peroxide production and lipid peroxidation were significantly increased. Moreover, the activities of antioxidant enzymes such as superoxide dismutase, glutathione peroxidase, catalase, glutathione-S-transferase, glutathione reductase were reduced. The concentrations of antioxidant molecules such as reduced glutathione and vitamin C were significantly decreased. The activities of enzymes normally elevated in Sertoli cells, gamma-glutamyl transpeptidase and beta-glucuronidase, were significantly decreased. Treatment with LA (100 microM) for 24h before LPS-treatment (Group IV), prevented these changes in enzyme activities and metabolite concentrations. Therefore, LA may have a cyto-protective role during LPS-induced inflammation in adult rat Sertoli cells.

Aly HA, Lightfoot DA, El-Shemy HA. – Chem Biol Interact. 2009 Dec 10;182(2-3):112-8. – Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt.

CONCLUSIONS: All couples whose male partners accepted antioxidant supplementation achieved a successful pregnancy. This study demonstrates the benefits of an increased intake of antioxidant-rich food or antioxidant supplements by men who show high levels of sperm DNA fragmentation or lipid peroxidation, which could result in an improvement in gestational outcomes in couples with history of recurrent pregnancy loss (RPL).

OBJECTIVE:
To evaluate whether increasing antioxidant intake in men with high levels of DNA damage or lipid peroxidation improves gestational results in couples with history of recurrent embryo loss.
PATIENT(S):
Seventeen men whose spouses had a history of two or more embryo losses before 12 weeks of gestation.
INTERVENTION(S):
Male partners with increased DNA fragmentation index (%DFI) or high thiobarbituric acid reactive substances (TBARS) were instructed to consume a diet rich in antioxidants or commercial multivitamins containing beta-carotene, vitamin C, vitamin E, and zinc for at least 3 months.
MAIN OUTCOME MEASURE(S):
Pregnancy outcome was recorded in the spouses of men with increased %DFI or TBARS who received antioxidant supplementation.
RESULTS:
Of the 17 men, 9 (53%) presented with an increased %DFI or TBARS. They were started on an antioxidant supplementation regimen. Of these nine men, six of their spouses became pregnant. All couples whose male partners accepted antioxidant supplementation achieved a successful pregnancy.

Fertil Steril. 2009 Aug;92(2):565-71. – Gil-Villa AM, Cardona-Maya W, Agarwal A, Sharma R, Cadavid A. – Reproduction Group, University of Antioquia, Medellín, Colombia. http://www.ncbi.nlm.nih.gov/pubmed/18829003

CONCLUSION(S): Frequent intake of lipophilic foods like meat products or milk may negatively affect semen quality in humans, whereas some fruits or vegetables may maintain or improve semen quality.

OBJECTIVE:
To compare dietary habits in normospermic and oligoasthenoteratospermic patients attending a reproductive assisted clinic.
DESIGN:
An observational, analytical case-control study.
SETTING:
Private fertility clinics.
PATIENT(S):
Thirty men with poor semen quality (cases) and 31 normospermic control couples attending our fertility clinics.
INTERVENTION(S):
We recorded dietary habits and food consumption using a food frequency questionnaire adapted to meet specific study objectives. Analysis of semen parameters, hormone levels, Y microdeletions, and karyotypes were also carried out.
MAIN OUTCOME MEASURE(S):
Frequency of intake food items were registered in a scale with nine categories ranging from no consumption to repeated daily consumption.
RESULT(S):
Controls had a higher intake of skimmed milk, shellfish, tomatoes, and lettuce, and cases consumed more yogurt, meat products, and potatoes. In the logistic regression model cases had lower intake of lettuce and tomatoes, fruits (apricots and peaches), and significantly higher intake of dairy and meat processed products.

Mendiola J, Torres-Cantero AM, Moreno-Grau JM, Ten J, Roca M, Moreno-Grau S, Bernabeu R. – Fertil Steril. 2009 Mar;91(3):812-8 – Department of Reproductive Biology and Medicine, Instituto Bernabeu, Alicante, Spain. http://www.ncbi.nlm.nih.gov/pubmed/18314116

Conclusions: treatment with L-carnitine and Coenzyme Q10 significantly increased total antioxidant, LH and testosterone levels. Treatment with L-carnitine and Coenzyme Q10 also improved semen parameters and organs weight. L-carnitine and Coenzyme Q10 could protect spermatogenesis.

The aim of the present study was to investigate the protective role of coenzyme Q10 and L-Carnitine pretreatment in the impaired spermatogenesis caused by isoproterenol (ISO) in male rats.Thirty-two male Wistar rats were allocated in 4 groups. ISO was injected for 2 consecutive days (100 mg/kg) in ISO treated groups. Before ISO administration, pretreatment with Coenzyme Q10 (10 mg/kg/day) and L-Carnitine (350 mg/kg/day) were conducted for 20 consecutive days. Sex hormones level, malondialdehyde (MDA) and total antioxidant concentration as well as testis, epididymis and seminal vesicle weight were investigated.Increase in the concentration of MDA and decrease in total antioxidant level was observed following ISO administration. Accordingly, the sperm viability as well as testis, epididymis and seminal vesicle weights were decreased. In the case of sex hormones, the testosterone and LH levels were decreased and the concentration of FSH was increased. Pretreatment with L-carnitine and Coenzyme Q10 significantly decreased the MDA level and increased total antioxidant, LH and testosterone levels. Pretreatment with L-carnitine and Coenzyme Q10 also improved semen parameters and organs weight which were impaired by ISO administration.L-carnitine and Coenzyme Q10 pretreatment could protect spermatogenesis in male rats with ISO administration.

Ghanbarzadeh S, Garjani A, Ziaee M, Khorrami A. – Research Center for Pharmaceutical Nanotechnology and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran. – Drug Research, 2013 Nov 27. http://www.ncbi.nlm.nih.gov/pubmed/24285403

On Site Acupuncture

Objective – Acupuncture performed onsite before and after embryo transfer has been reported to improve in vitro fertilization (IVF) outcome in patients with good quality embryos. The purpose of this investigation was to evaluate whether acupuncture before and after embryo transfer would alter pregnancy rates in patients undergoing IVF regardless of embryo quality if the treatment was performed offsite.

Design – Multi-center, prospective, randomized study.

Materials and methods – 107 patients undergoing IVF were randomized to acupuncture vs. control group. The treatment group received acupuncture by one of two licensed acupuncturists at an offsite location for 25 minutes before and after embryo transfer using a modified Paulus protocol (protocol described by Paulus et. al. 2002 with the addition of Cv6 before and K3 after transfer). The control group underwent embryo transfer without any other intervention. The IVF protocol was determined by the treating physician who was blinded to assigned group. The main outcome measures were a positive quantitative hCG, clinical pregnancy as manifested by fetal cardiac activity, and live birth (data pending). Chi-squared analysis and Student’s t-test were used for statistical analyses. Of the 107 patients randomized, 94 completed the study (10 IVF cycles canceled, 3 patients withdrew).

Results – The proportion of patients with a positive pregnancy test was higher in the control group (36/46) than the acupuncture group (25/48) (78.3% vs. 52.1%, respectively; P≤0.01). More importantly, the clinical pregnancy rate was higher in the control group than in the acupuncture group (69.6% vs. 43.8%, respectively; P≤0.03). The groups were statistically similar with respect to age, peak estradiol, number of oocytes retrieved, fertilization method, fertilization rate, number of embryos transferred, and the proportion with blastocyst transfer (P=NS).

Conclusions – In contrast to previous reports, acupuncture before and after embryo transfer was associated with lower biochemical and clinical pregnancy rates when compared to the control group. The value of acupuncture in pateints undergoing IVF needs to be further examined before recommending it to patients.

L.B. Craig, A.R. Criniti, K.R. Hansen, L.A. Marshall, M.R. Soules – Reproductive Endocrinology & Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Seattle Reproductive Medicine, Seattle, WA; Pacific Northwest Fertility & IVF Specialists, Seattle, WA

CONCLUSIONS: Although other studies regarding acupuncture have been inconclusive, perhaps these positive results are related to two important factors. The treatments were performed on-site, eliminating the stress of travelling to another site before and after the embryo transfer. Also, the acupuncture treatment protocol did not follow the traditional Paulus protocol, thereby suggesting there is still more research to be done on how best to treat infertility issues with acupuncture

OBJECTIVE: Conflicting evidence exists on whether acupuncture is beneficial for patients undergoing In Vitro Fertilization (IVF) cycles. Therefore, this study was undertaken to determine whether on-site acupuncture, per- formed both before and after embryo transfer, affects clinical outcomes.

DESIGN: Retrospective data analysis.

MATERIALS AND METHODS: The Acupuncture Group consisted of 49 patients who received acupuncture on-site before and after embryo transfer in 2007. The treatment did not follow the Paulus protocol. The Control Group were 212 patients with no acupuncture undergoing IVF cycles in the same time period. The data was subdivided by SART age classifications to determine if acupuncture differentially benefitted certain age groups. Clinical Pregnancy Rate (CPR) was defined as the presence of fetal cardiac activity. Loss Rate was the percentage of pregnancies that did not proceed from a positive hCG to a clinical pregnancy. Data were analysed using the unpaired t-test and Fisher’s exact test, with significance defined as P < 0.05.

RESULTS: Patients with a positive hCG were significantly higher in the Acupuncture Group for women less than 35 years old (63.3% vs.43.2%, p1⁄4 0.048). The Acupuncture Group also had a higher CPR in the under 35 category (60.0% vs. 34.6%, p 1⁄4 0.01). There were no differences in the other age groups. Combining all the age groups, the cycle parameters between the two Groups were equivalent, while the CPR was higher and the Loss Rate lower for the Acupuncture group (Table 1).

Ovulation

Conclusion
Acupuncture can significantly down-regulate the expressions of serum levels of T and E2, improve the development of ovaries and uterus, promote ovulation, enhance endometrial receptivity, and advance blastocyst implantation.

Objective
To observe the effect and mechanism of acupuncture on infertility of rats with polycystic ovarian syndrome (PCOS).

Methods
PCOS rat model was induced by subcutaneous injection of oil solution of dehydroepiandrosterone (DHEA) in immature (24-day-old) female rats for continuous 20 days. Rats in the control group were given the same dose of DHEA oil.
PCOS rats were randomly divided into the control group (untreated) and the acupuncture group treated by needling acupoints of Guanyuan (CV4), Zhongji (CV3), Sanyinjiao (SP6) and Zigong (CX-CA1), 15 min once a day for 5 continuous days, starting from the 80th day after birth.
All rats were sacrificed at termination of the treatment, their uterus and ovaries were dissected for observation and blood levels of sex hormones were measured.

Results
Compared with the control group, the number of implanted blastocysts and the blastocyst implantation rate were higher and the blood levels of testosterone (T) and estradiol (E2) were lower in the acupuncture group (P<0.05); but the difference between groups in serum levels of follicular stimulating hormone, luteinzing hormone and progesterone were of statistical insignificance (P>0.05).

Moreover, the wet weight of the ovaries was lower and the equipotent diameter and area of glandular organ and cavity area ratio of gland and the stroma and mean thickness of endometria were higher in the acupuncture group than those in the control group (P<0.05).

Oxidative Stress

Conclusions: The OSA test is a novel assay that directly assesses end damage to semen from oxidative stress and appears to identify approximately 30% of men from infertile couples as having elevated scores. The OSA test may provide a means of quantifying the role of ROS-related semen damage in infertility and potentially aid in the evaluation in men from infertile couples.

Objective: Oxidative stress damage is thought to occur through the high formation of adducts, molecules of lipids, DNA, and protein in semen that have been covalently modified by reactive oxygen species (ROS). The oxidative stress adduct (OSA) test, a novel biomarker assay, directly quantifies ROS damage by measuring the levels of molecules in semen covalently modified by ROS. The goal of this study is to characterize OSA scores in a large number of men from infertile couples.

Design: Under IRB approval, OSA test results were obtained in a multicenter, retrospective study using semen specimens obtained during a clinical fertility evaluation in 774 men from infertile couples and were compared OSA scores from 20 fertile male controls.

Methodology: The raw semen sample was divided into a frozen aliquot and an OSA test was run, with each adduct measured independently after acid treatment using chemiluminescence followed by optical density measurements. The results were combined into a single score. Statistical analysis was run using an unpaired two tailed t test to compare the two distributions.

Results: The distribution of the OSA scores in the men from fertile and infertile couples were significantly different (P<0.05). Infertile males had a mean OSA score of 3.72 (SD 2.84) opposed to a mean score of 2.41 for fertile males (SD 0.68). 29.3% of the 774 men from infertile couples had OSA scores which were above 3 standard deviations (4.44 uM)from the mean value of the OSA scores in the 20 men with confirmed fertility, and 6.3% were above 2 standard deviations (3.8 uM).

B. Berookhim, B. Leader, A. Copperman, B. McElyea, E. Tirado, N. Bar-Chama. (Urology, Mount Sinai School of Medicine, New York, NY; Reproductive Medicine Associates of New York, New York, NY; Reprosource, Inc., Woburn, MA.) – Publication: ASRM 2011 Poster Abstract (P-196)

What is oxidative stress? http://en.wikipedia.org/wiki/Oxidative_stress

PCOS

Conclusion(s): A moderate reduction in dietary carbohydrate reduced the fasting and postchallenge insulin concentrations among women with PCOS, which, over time, may improve reproductive/endocrine outcomes.

Objective
To determine whether eucaloric diets either enriched with monounsaturated fatty acids (MUFA; 17% energy) or low in carbohydrates (Low CHO; 43% energy) would increase insulin sensitivity (Si) and decrease circulating insulin concentrations, relative to a standard diet (STD; 56% CHO, 31% fat, 16% protein), among women with polycystic ovary syndrome (PCOS).

Design
Crossover.

Setting
Academic research environment.

Patient(s)
Healthy women with PCOS not on hormonal or insulin-sensitizing therapy.

Intervention(s)
Subjects consumed three, 16-day, eucaloric diets, each separated by a 3-week washout period. A frequently sampled, intravenous, glucose tolerance test was administered at baseline and following each diet.

Main Outcome Measure(s)
Fasting glucose, insulin, the acute insulin response to glucose (AIRg), Si, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), total testosterone (T), free T, A4, total cholesterol, high-density lipoprotein cholesterol (HDL-C), tryglycerides (TG), and free fatty acids (FFA).

Result(s)
Fasting insulin was lower following the Low CHO diet relative to the STD diet; AIRg was lower following the Low CHO diet relative to the MUFA diet. Fasting glucose, Si, and the circulating concentrations of reproductive hormones were not significantly affected by the intervention.

Crystal C. Douglas, Ph.D., R.D.email address, Barbara A. Gower, Ph.D., Betty E. Darnell, M.S., R.D., Fernando Ovalle, M.D., Robert A. Oster, Ph.D., Ricardo Azziz, M.D., M.P.H., M.B.A. – Fertility and Sterility, Volume 85, Issue 3 , Pages 679-688, March 2006 – http://www.fertstert.org/article/S0015-0282(05)03974-9/abstract

Conclusion
Acupuncture can significantly down-regulate the expressions of serum levels of T and E2, improve the development of ovaries and uterus, promote ovulation, enhance endometrial receptivity, and advance blastocyst implantation.

Objective
To observe the effect and mechanism of acupuncture on infertility of rats with polycystic ovarian syndrome (PCOS).

Methods
PCOS rat model was induced by subcutaneous injection of oil solution of dehydroepiandrosterone (DHEA) in immature (24-day-old) female rats for continuous 20 days. Rats in the control group were given the same dose of DHEA oil.
PCOS rats were randomly divided into the control group (untreated) and the acupuncture group treated by needling acupoints of Guanyuan (CV4), Zhongji (CV3), Sanyinjiao (SP6) and Zigong (CX-CA1), 15 min once a day for 5 continuous days, starting from the 80th day after birth.
All rats were sacrificed at termination of the treatment, their uterus and ovaries were dissected for observation and blood levels of sex hormones were measured.

Results
Compared with the control group, the number of implanted blastocysts and the blastocyst implantation rate were higher and the blood levels of testosterone (T) and estradiol (E2) were lower in the acupuncture group (P<0.05); but the difference between groups in serum levels of follicular stimulating hormone, luteinzing hormone and progesterone were of statistical insignificance (P>0.05).

Moreover, the wet weight of the ovaries was lower and the equipotent diameter and area of glandular organ and cavity area ratio of gland and the stroma and mean thickness of endometria were higher in the acupuncture group than those in the control group (P<0.05).

PCOS & Acupuncture

Conclusions: This study is the first to demonstrate that acupuncture reduces serum AMH-levels and ovarian volume. Physical exercise did not influence circulating AMH or ovarian volume. Despite a within-group decrease in AFC, exercise did not lead to a between-group difference.

Objective
To investigate whether electro-acupuncture or physical exercise influence serum anti-Müllerian hormone (AMH), antral follicle count (AFC) or ovarian volume in women with polycystic ovary syndrome (PCOS).

Design
Secondary analyses of a prospective, randomized controlled clinical trial.

Setting
University Hospital, Sweden.

Patients
Seventy-four women with PCOS recruited from the general population.

Interventions
Women with PCOS were randomized to 16 weeks of electro-acupuncture (14 treatments), exercise (at least 3 times/week), or no intervention.

Main outcome measures
Serum AMH recorded at baseline, after 16 weeks of intervention, and at follow-up at 32 weeks. AFC, and ovarian volume assessed by magnetic resonance imaging at baseline and at follow-up at 32 weeks.

Results
After 16 weeks of intervention, serum levels of AMH were significantly decreased in the electro-acupuncture group by 17.5% (P<0.001), and differed from the change in the exercise group. AMH remained decreased by 15% (P=0.004) also at follow-up at 32 weeks, but did not differ from the exercise or the no intervention groups. There was a decrease by 8.5% (p=0.015) in ovarian volume between baseline and follow-up in the electro-acupuncture group, and by 11.7% (p=0.01) in AFC in the physical exercise group. No other variables were affected.

Henrik Leonhardt1, Mikael Hellström1, Berit Gull2, Anna-Karin Lind2, Lars Nilsson2, Per Olof Janson2 andElisabet Stener-Victorin3, – *Serum anti-Müllerian hormone and ovarian morphology assessed by magnetic resonance imaging in response to acupuncture and exercise in women with polycystic ovary syndrome: Secondary analyses of a randomized controlled trial – Acta Obstetricia et Gynecologica Scandinavica, 2014. http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291600-0412/accepted DOI: 10.1111/aogs.12571

CONCLUSIONS: Electro-acupuncture down regulated fat tissue gene expression. Our observations give support to the theory that an increased sympathetic activity may be involved in the development and maintenance of PCOS, and that non-pharmacological treatment may be useful.

OBJECTIVE: Altered activity of the sympathetic nervous system has been suggested as a potential actor in polycystic ovary syndrome (PCOS) etiology. Electro-acupuncture (EA) and physical exercise has the potential to decrease high activity in sympathetic nervous system via stimulation of ergoreceptors and somatic afferents in the muscles. The aim of this study was to study sympathetic activity in adipose tissue by measuring mesenteric adipose tissue gene expression of sympathetic markers (β3-adrenergic receptor [β3-AR], nerve growth factor [NGF], low affinity p75 neurotrophin receptor [p75NTR] and neuropeptide Y [NPY]) in PCOS rats. Moreover, the effect of low-frequency EA and exercise on gene expression of these markers were evaluated.

DESIGN: Female rats were given vehicle (control) or a continuous dose of dihydrotestosterone (PCOS groups), starting prepubertally (21 d). At 69 d of age, the PCOS group was sub-divided into three groups: physical exercise, low-frequency EA, and untreated PCOS.

MATERIALS AND METHODS: EA was given to conscious rats every second weekday for 4-5 wk and the rats in the PCOS exercise group had free access to a wheel for 4-5 wk. Gene expression analysis was carried out with real time-RT-PCR using TaqMan low density arrays.

RESULTS: Mesenteric adipose tissue gene expression of β3-AR, NGF and NPY were up-regulated in untreated PCOS rats compared with controls. Both low-frequency EA and exercise down-regulated the expression of NGF and NPY, and EA also down-regulated the expression of β3-AR, compared with untreated PCOS rats. Gene expression of p75NTR was not influenced.

L. Mannerås, M. Lönn, E. Stener-Victorin – Fertility and Sterility – Volume 90, Supplement , Page S133, September 2008, Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Gothenburg, Sweden; Wallenberg Laboratory, Institute of Medicine, Gothenburg, Sweden

Post-transfer Luteal Phase Acupuncture

CONCLUSION(S): Post-transfer Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF / intracytoplasmic sperm injection (ICSI).

DESIGN: Randomized, prospective, controlled clinical study.

SETTING: University IVF center.

PATIENT(S): Two hundred twenty-five infertile patients undergoing IVF/ICSI.

INTERVENTION(S): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture.

MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancy rates.

RESULT(S): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%).

Pregnancy Labour Birth

Results: The RCTs included in these systematic reviews differed in terms of study designs, research questions, treatment protocols and outcome measures, and yielded some conflicting results. It may be inappropriate to include these together in a systematic review, or pooled analysis, of acupuncture for labour with an expectation of an overall conclusion for efficacy. Trials of acupuncture and acupressure in labour show promise, but further studies are required.

The aim of this study is to examine current evidence from systematic reviews on the topic of acupuncture and acupressure for pain management in labour and birth, and to evaluate the methodological and treatment frameworks applied to this evidence. The use of current systematic reviews of the evidence for acupuncture and acupressure for labour and birth may be misleading. Appropriate methods and outcome measures for investigation of acupuncture and acupressure treatment should more carefully reflect the research question being asked, the use of pragmatic trials designs with woman–centred outcomes may be appropriate for evaluating the effectiveness of these therapies.

Methods
A search limited to systematic reviews of the MEDLINE, CINAHL, PUBMED, EMBASE and Cochrane databases was performed in December 2013 using the keywords ‘CAM’, ‘alternative medicine’, ‘complementary medicine’, ‘complementary therapies’, ‘traditional medicine’, ‘Chinese Medicine’, ‘Traditional Chinese Medicine’, ‘acupuncture’, ‘acupressure’, cross–referenced with ‘childbirth’, ‘birth’, labo*r’, and ‘delivery’.
The quality of the evidence is also evaluated in the context of study design.

Levett KM, et al., Complementary Therapies in Medicine, 06/17/2014

Prostatitis

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is prevalent in urological practice and has a significant impact on quality of life. Standard therapies often fail to achieve sustainable amelioration of symptoms. This article attempts to show that neuromodulatory treatment in the form of electroacupuncture can be a minimally invasive and effective treatment for CP/CPPS that is refractory to standard therapies. This neuromodulatory therapy lends support to the hypothesis that the end stage of CP/CPPS may be a neuropathic pain syndrome.

Chen RC, Nickel JC. King Street Medical Arts Centre, 71 King Street, W. Suite 400, Mississauga, Ontario, L5B4A2, Canada.

Meta-analysis showed: Chinese herbs can decrease the WBC in the expressed prostatic secretion, improve the pain symptoms and the voiding symptoms.

ProstantTM is a suppository made up of several kinds of Chinese herbs, the main ingredients being Cortex Phellodendri, Fructus Gardeniae, Rhizoma Polygoni Cuspidati, Herba Lycopi and Radix et Rhizoma Rhei, which have been reported to inhibit many kinds of bacteria, fungi and viruses [1, 2].

In our study we used meta-analysis to investigate the effectiveness of ProstantTM on chronic prostatitis. Medline, Embase, CBMdisc and Cochrane Library were searched for randomized case-controlled trials ( RCTs) . The search strategy was made according to the demand of the Cochrane Collaboration. Data were extracted by two reviewers using designed extraction form. RevMan were used for data management and analysis. Thirty-eight relevant trials were searched, of which 4 were included [3-6]. Meta-analysis showed: ProstantTM can decrease the WBC in the expressed prostatic secretion, improve the pain symptoms and the voiding symptoms.The corresponding pooled relative risk (RR) and 95 % confidence interval (CI) was 1.81 (1.29, 2.53), 1.36 (1.14, 1.62) and 2.25 (1.51, 3.37), respectively. The total effective rate of ProstantTM was statistically significant [RR 2.36, 95 % CI (1.79, 3.10), P<0.01]. The occurrence of adverse events were similar in the ProstantTM and placebo-treated men. Limitation of this meta-analysis lies mainly in the way that the 4 included trials collected a small number of cases which may cause publication bias in a certain sort of sense.

Sperm

Conclusions: The OSA test is a novel assay that directly assesses end damage to semen from oxidative stress and appears to identify approximately 30% of men from infertile couples as having elevated scores. The OSA test may provide a means of quantifying the role of ROS-related semen damage in infertility and potentially aid in the evaluation in men from infertile couples.

Objective: Oxidative stress damage is thought to occur through the high formation of adducts, molecules of lipids, DNA, and protein in semen that have been covalently modified by reactive oxygen species (ROS). The oxidative stress adduct (OSA) test, a novel biomarker assay, directly quantifies ROS damage by measuring the levels of molecules in semen covalently modified by ROS. The goal of this study is to characterize OSA scores in a large number of men from infertile couples.

Design: Under IRB approval, OSA test results were obtained in a multicenter, retrospective study using semen specimens obtained during a clinical fertility evaluation in 774 men from infertile couples and were compared OSA scores from 20 fertile male controls.

Methodology: The raw semen sample was divided into a frozen aliquot and an OSA test was run, with each adduct measured independently after acid treatment using chemiluminescence followed by optical density measurements. The results were combined into a single score. Statistical analysis was run using an unpaired two tailed t test to compare the two distributions.

Results: The distribution of the OSA scores in the men from fertile and infertile couples were significantly different (P<0.05). Infertile males had a mean OSA score of 3.72 (SD 2.84) opposed to a mean score of 2.41 for fertile males (SD 0.68). 29.3% of the 774 men from infertile couples had OSA scores which were above 3 standard deviations (4.44 uM)from the mean value of the OSA scores in the 20 men with confirmed fertility, and 6.3% were above 2 standard deviations (3.8 uM).

B. Berookhim, B. Leader, A. Copperman, B. McElyea, E. Tirado, N. Bar-Chama. (Urology, Mount Sinai School of Medicine, New York, NY; Reproductive Medicine Associates of New York, New York, NY; Reprosource, Inc., Woburn, MA.) – Publication: ASRM 2011 Poster Abstract (P-196)

What is oxidative stress? http://en.wikipedia.org/wiki/Oxidative_stress

Conclusion(s): The DNA fragmentation of morphologically normal sperm negatively impacts embryo quality and probability of pregnancy in ICSI cycles.

Objective
To evaluate DNA fragmentation in morphologically normal sperm recovered from the same sample used for intracytoplasmic sperm injection (ICSI) and to correlate DNA damage with embryo quality and pregnancy outcome.

Design
Prospective study.

Setting
Academic center.

Patient(s)
36 infertile men participating in the ICSI program.

Intervention(s)
Terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate-fluorescein nick end labeling (TUNEL) assay and morphologic assessment by phase contrast.

Main Outcome Measure(s)
Simultaneous assessment of sperm morphology and DNA fragmentation by TUNEL assay was performed in the same cell, then the percentage of normal sperm with fragmented DNA (normal SFD) was correlated with embryo quality and pregnancy outcomes.

Result(s)
A highly statistically significant negative correlation was found between the percentage of normal SFD and embryo quality. This association was confirmed for the transferred embryos and for the total embryo cohort. The receiver operating characteristics curve analysis demonstrated that the percentage of normal SFD and embryo quality were statistically significant predictors of pregnancy. When the percentage of normal SFD was ≤17.6 %, the likelihood of pregnancy was 3.5 times higher. No correlation was found between the percentage of total sperm with fragmented DNA (morphologically normal and abnormal) and ICSI outcomes.

Fertility and Sterility – Volume 94, Issue 2 , Pages 549-557, July 2010 – Conrado Avendaño, M.S., Anahí Franchi, Ph.D., Hakan Duran, M.D., Sergio Oehninger, M.D., Ph.D. – The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia

Conclusions: treatment with L-carnitine and Coenzyme Q10 significantly increased total antioxidant, LH and testosterone levels. Treatment with L-carnitine and Coenzyme Q10 also improved semen parameters and organs weight. L-carnitine and Coenzyme Q10 could protect spermatogenesis.

The aim of the present study was to investigate the protective role of coenzyme Q10 and L-Carnitine pretreatment in the impaired spermatogenesis caused by isoproterenol (ISO) in male rats.Thirty-two male Wistar rats were allocated in 4 groups. ISO was injected for 2 consecutive days (100 mg/kg) in ISO treated groups. Before ISO administration, pretreatment with Coenzyme Q10 (10 mg/kg/day) and L-Carnitine (350 mg/kg/day) were conducted for 20 consecutive days. Sex hormones level, malondialdehyde (MDA) and total antioxidant concentration as well as testis, epididymis and seminal vesicle weight were investigated.Increase in the concentration of MDA and decrease in total antioxidant level was observed following ISO administration. Accordingly, the sperm viability as well as testis, epididymis and seminal vesicle weights were decreased. In the case of sex hormones, the testosterone and LH levels were decreased and the concentration of FSH was increased. Pretreatment with L-carnitine and Coenzyme Q10 significantly decreased the MDA level and increased total antioxidant, LH and testosterone levels. Pretreatment with L-carnitine and Coenzyme Q10 also improved semen parameters and organs weight which were impaired by ISO administration.L-carnitine and Coenzyme Q10 pretreatment could protect spermatogenesis in male rats with ISO administration.

Ghanbarzadeh S, Garjani A, Ziaee M, Khorrami A. – Research Center for Pharmaceutical Nanotechnology and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran. – Drug Research, 2013 Nov 27. http://www.ncbi.nlm.nih.gov/pubmed/24285403

In this study Chinese herbs commonly used in the treatment of male infertility were investigated for relevant biochemical activity. Oxidative stress has been implicated in male infertility with significant levels of reactive oxygen species detected in 25% of infertile males. A total of 37 individual herbs and seven herb decoctions used in the treatment of male factor infertility were therefore tested for endocrine activity. 20 showed strong and 10 weak anti-oestrogenic activity. Oestrogenic responses were elicited for two herbs. Of these 37 herbs, strong (15 herbs), intermediate (7 herbs) and weak/no (15 herbs) antioxidant activity was detected (ranging from 0.912–1.26; 0.6–0.88 and 0–0.468μg ascorbate equivalent/mg dried herb, respectively). The seven decoctions (previously used to treat patients) tested elicited strong (5 herbs) and weak (2 herbs) anti-oestrogenic responses (per g of dried herb tamoxifen equivalents ranged from 1.14–13.23mg and 0.22–0.26mg, respectively), but not oestrogenic, androgenic nor anti-androgenic, consistent with their individual composition.

Helen G. Tempest, Sheryl T. Homa, Edwin J. Routledge, Anthony Garner, Xiao-Ping Zhai and Darren K. Griffin. Systems Biology in Reproductive Medicine. 2008, Vol. 54, No. 4-5 , Pages 185-195 (doi:10.1080/19396360802379073)

90 men with immune infertility were selected as the research subjects and randomly divided into two groups, 60 in the treatment group, treated by Huzhangdanshenyin, and the other 30 in the control, treated by prednisone, both for 3 months. The improvement of clinical symptoms, immunologic indexes (antisperm antibodies in serum and seminal plasma) and sperm indexes (semen liquefied duration, motility, viability, density and abnormal morphology rate) were observed and the results analyzed. CONCLUSION: The Chinese medicine Huzhangdanshenyin works more effectively than prednisone in the treatment of male immune infertility. It could improve the antisperm antibody reversing ratio, clinical symptoms and signs and ameliorate sperm indexes with no obvious advierse effects.

Lu TK, Ouyang HG, Jin GY, Hong YS, Zou Q, Lin ZY, Deng LS, Guo YB. Zhonghua Nan Ke Xue. 2006 Aug;12(8):750-5. Department of Andrology, Xiamen TCM Hospital Affiliated to Fujian TCM College, Xiamen, Fujian 361001, China.

Thirty-seven infertile patients with varicocele were treated with Guizhi-Fuling-Wan (7.5 g/day) for at least 3 months. Before and after the administration, semen qualities such as sperm concentration and motility were examined, and the varicocele was graded. A varicocele disappearance rate of 80% was obtained with 40 out of 50 varicocele, and improvement of sperm concentration and motility were found in 71.4% and 62.1% of patients, respectively. From these results, Guizhi-Fuling-Wan is considered to be effective for circulation disorders in varicocele as well as semen quality.

Ishikawa H; Ohashi M; Hayakawa K; Kaneko S; Hata M Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan. Am J Chin Med, 24(3-4):327-31 1996 (ISSN: 0192-415X)

Eighty-seven cases of male infertility were treated with Bu Shen Sheng Jing Pill, and the comprehensive semen routine analysis score was enhanced significantly (P < 0.001). The result showed that this prescription had a regulatory function in follicle stimulating hormone, luteotropic hormone, testosterone, cortisol (could bring the enhanced or reduced hormone level back to normal range).

Yue GP; Chen Q; Dai N Institute of Acupuncture and Meridians, Anhui College of TCM, Hefei. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih, 16(8):463-6 1996 Aug (ISSN: 1003-5370)

Tai-bao Chinese herbal medicine displayed significantly higher rates of implantation and pregnancy, as well as comparitive rates of lowering effects of antisperm antibodies as prednisone. CONCLUSION: Chinese medicine Tai-bao possesses regulatory effect on reproductive immune function, inhibitory effect on antisperm cytotoxic antibody, and promoting effect on pregnancy.

Lai AN; Song JF; Liu XJ Xiyuan Hospital, China Academy of TCM, Beijing. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih, 17(6):360-2 1997 Jun (ISSN: 1003-5370)

The effects of a Chinese herb, Cornus officinalis, on the motility of human sperm was studied. An aqueous extract was prepared from the dried fruits of the herb and used in this study. The crude extract showed substantial stimulatory effects on sperm motility.

Jeng H; Wu CM; Su SJ; Chang WC Department of Anatomy, Taipei Medical College, Taiwan. Am J Chin Med 1997;25(3-4):301-6 (ISSN: 0192-415X)

Conclusions: 132 men tested positive for antisperm antibodies. They were treated for 1.5-4.5 months with a Chinese herbal formula Ju He Wan. After treatment, 120 (91%) tested negative for antisperm antibodies (compared to only 45% of the group treated with prednisone). 74 of these same men conceived after 1.5-3 months of treatment. From these findings, Chinese herbal medicine could be an effective treatment option for men with antisperm antibodies.

Cheng Ke-jia et al. – pages 39-40 of issue #7, 2007 of Xin Zhong Yi (New Chinese Medicine)

100 cases of male immune infertility in the treatment group were treated with Yikang Decoction, while 100 cases treated with prednisone as the controls. CONCLUSION: The Yikang Decoction has a more stable effect for male immune infertility than prednisone. Antisperm antibodies, percentage of motile sperm, pregnancy rates, and sperm agglutination (clumping) were all significantly better in the group treated with the Chinese herbal fomula Yikang decoction vs the prednisone treatment group.

Sun Z, Bao Y. – J Tradit Chin Med. 2006 Mar;26(1):36-8. – Department of Reproduction, Zhejiang Hospital of Integrated Chinese and Western Medicine, Hangzhou 310003, China.

100 men with low sperm count and poor sperm motility were treated with individulaly modified Chinese herbal formulations combined with clomid and vitamin E daily for 15-60 days (37.3 days average). 82% showed significant increases in both count and motility. This may be a viable treatment option for men with poor sperm motility and low sperm counts.

Shao Chang-jie – Hei Long Jiang Zhong Yi Yao (Heilongjiang Chinese Medicine & Pharmacology), pages 36-37 of issue #3, 2007

156 men with low sperm count and inability to conceive were administered individually modified versions of the Chinese herbal formula Sheng Jing Qiang You Tang for 3-6 months. They were not allowed to drink alcohol, smoke, or have sex. In 98 men their sperm count increased above WHO standards, and 35 men showed an increase in sperm count but did not meet ‘fertile’ WHO criteria.

Zhang Jun. – Shi Yong Zhong Yi Nei Ke Za Zhi (Journal of Practical Chinese Medical Internal Medicine), page 50 of issue #1, 2005

CONCLUSION: Protective effects of Hochuekkito on sperm was suggested on sperm with Anit-sperm Antibodies. Although normal sperm with ASA was used in this report, since the sperm of infertile patients are said to be more fragile, this results imply that direct protective effect is one of the mechanism of Hochuekkito for male infertility

Yamanaka M; Kitamura M; Kishikawa H; Tsuboniwa N; Koga M; Nishimura K; Tsujimura A; Takahara S; Matsumiya K; Okuyama A Department of Urology, Osaka University Medical School – Nippon Hinyokika Gakkai Zasshi, 89(7):641-6 1998 Jul (ISSN: 0021-5287)

128 men with low sperm count were treated with acupuncture for 25 days consecutively as one course of treatment. Some men went through 2 courses. Overall, 92.19% of the men involved showed increase is sperm count, and 42 of these men were considered ‘cured’ when compared to WHO criteria. Note: In general, the more the patient felt the needle sensation, the better the outcome. Conversely, the less they felt the needle sensation, the worse the outcome.

Pang Pao-zhen and Zhao Huan-yun. – Hei Long Jiang Zhong Yi Yao (Heilongjiang Chinese Medicine & Medicinals), issue #1, 2004

CONCLUSION: The combined therapy of acupuncture with herbal drugs has definite therapeutic effects on male immune infertility, which can regulate AsAb and raise the immunity of the patients. To study the clinical effects of the combined therapy of acupuncture with herbal medicine on male immune infertility and on antisperm antibody (AsAb), 100 male cases of infertility with positive AsAb were divided randomly into two groups, each consisting of 50 cases. The control group was treated with oral prednisone. The clinical therapeutic effects and the impact on AsAb were observed in the two groups. The results showed that the total effective rate in the acupuncture-herb group was 90%; while that of the control group was 64%, the comparison showing a statistically significant difference (P<0.05).

Fu B, Lun X, Gong Y. – J Tradit Chin Med. 2005 Sep;25(3):186-9. – Department of Acupuncture, Second Guangdong Provincial Worker’s Hospital, Guangzhou 510720, China.

Conclusion: men that manifest higher scrotal temperatures due to genital tract inflammation or poor lifestyle habits can benefit from the scrotal temperature lowering effects of acupuncture.

Poor spermatogenesis in patients with inflammation of the genital tract is associated with scrotal hyperthermia. These patients can benefit from acupuncture treatment. We conducted a study to verify whether the influence of acupuncture treatment on sperm output in patients with low sperm density is associated with a decrease in scrotal temperature. The experimental group included 39 men who were referred for acupuncture owing to low sperm output. The control group, which comprised 18 normal fertile men, was used to define a threshold (30.5 degrees C) above which scrotal skin temperature was considered to be high. Accordingly, 34 of the 39 participants in the experimental group initially had high scrotal skin temperature; the other five had normal values. Scrotal skin temperature and sperm concentration were measured before and after acupuncture treatment. The five patients with initially normal scrotal temperatures were not affected by the acupuncture treatment. Following treatment, 17 of the 34 patients with hyperthermia, all of whom had genital tract inflammation, had normal scrotal skin temperature; in 15 of these 17 patients, sperm count was increased. In the remaining 17 men with scrotal hyperthermia, neither scrotal skin temperature nor sperm concentration was affected by the treatment. About 90% of the latter patients suffered from high gonadotropins or mixed etiological factors. Low sperm count in patients with inflammation of the genital tract seems to be associated with scrotal hyperthermia, and, consequently, acupuncture treatment is recommended for these men.Asian Journal of Andrology (2009) 11: 200-208. doi: 10.1038/aja.2008.4; published online 5 January 2009.

Asian J Androl. 2009 Mar;11(2):200-8. Epub 2009 Jan 5. Siterman S, Eltes F, Schechter L, Maimon Y, Lederman H, Bartoov B.[1] 1Maccabi Fund Complementary Medicine, Kaufman Street, Tel Aviv 68012, Israel [2] 2Refuot-Integrative Medical Centre, Ramat Aviv Gimel, Tel Aviv 69123, Israel.

Conclusion: daily ejaculation improves sperm DNA health.

Objective
To evaluate the relationship between duration of sexual abstinence and sperm selection on sperm DNA fragmentation (SDF).

Design
Prospective study based on normozoospermic individuals.

Setting
Fertility and IVF unit and university unit for research.

Patient(s)
Two cohorts of normozoospermic individuals: 21 men (aged 25–35 years) attending a clinic and with clearly adverse female factors; and a group of 12 selected donors (aged 20–25 years).

Intervention(s)
SDF assessment using the sperm chromatin the dispersión test (Halosperm) in two cohorts of normozoospermic men.

Main Outcome Measure(s)
SDF assessment after 24 hours of abstinence with recurrent ejaculation (one every 24 hours) using neat sperm samples; and SDF assessment before and after sperm selection with abstinence of 3 hours.

Result(s)
Lower baseline levels of SDF were observed after shorter periods of abstinence between ejaculations (24 hours and 3 hours) than those recommended. This effect is much more marked after quick repetitive ejaculation (3 hours of abstinence) and sperm selection.

– Jaime Gosálvez et al, Spain – Fertility & Sterility

CONCLUSION(S): The treatment of idiopathic male infertility could benefit from employing acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture, although we did not identify specific sperm pathologies that could be particularly sensitive to this therapy.

A group of infertile men who had pathological semen analyses according to WHO criteria, were treated with acupuncture twice a week for 5 weeks. A statistically significant increase after acupuncture in the percentage and number of sperm with no structural defects was demonstrated compared to the control group of patients who received no treatment. They concluded that male infertility patients could benefit from having acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture.

OBJECTIVE: To evaluate the ultramorphologic sperm features of idiopathic infertile men after acupuncture therapy.

DESIGN: Prospective controlled study.

SETTING: Christian-Lauritzen-Institut, Ulm, IVF center Munich, Germany, and Department of General Biology, University of Siena, Siena, Italy.

PATIENT(S): Forty men with idiopathic oligospermia, asthenospermia, or teratozoospermia. I

NTERVENTION(S): Twenty eight of the patients received acupuncture twice a week over a period of 5 weeks. The samples from the treatment group were randomized with semen samples from the 12 men in the untreated control group.

MAIN OUTCOME MEASURE(S): Quantitative analysis by transmission electron microscopy (TEM) was used to evaluate the samples, using the mathematical formula based on submicroscopic characteristics.

RESULT(S): Statistical evaluation of the TEM data showed a statistically significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects in the total ejaculates. A statistically significant improvement was detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. However, specific sperm pathologies in the form of apoptosis, immaturity, and necrosis showed no statistically significant changes between the control and treatment groups before and after treatment.

– Pei J et al Fertil Steril. 2005 Jul;84(1):141-7 Fertility and Sterility

Conclusion: The Chinese Traditional Medicine acupuncture and moxa techniques significantly increase the percentage of normal-form sperm in infertile patients with oligoastenoteratozoospermia without apparent cause.

In a prospective, controlled and blind study, a group of infertile men (married for 3 – 11 years without children) were randomized into two groups, the treatment group receiving 10 acupuncture treatments and the control group receiving sham acupuncture treatments. The patients in the acupuncture group demonstrated a significant increase in the percentage of normal forms compared to the control group

Aim: To evaluate the effect of Chinese Traditional Medicine, acupuncture and moxa treatment, on the semen quality in patients with semen abnormalities.

Methods: In a prospective, controlled and blind study, nineteen patients, aged 24 years ~ 42 years and married for 3 years ~ 11 years without children with semen abnormalities in concentration, morphology and/or progressive motility without apparent cause, were randomized into two groups and submitted to acupuncture and moxa treatment at the therapeutic (Study Group) and the indifferent points (Control Group), respectively, for 10 weeks. Semen analyses were performed before and after the treatment course.

Results: The patients of the Study Group presented a significant increase in the percentage of normal-form sperm compared to the Control Group (calculated U=16.0, critical U=17.0).

– Gurfinkel E et al Asian J Androl. 2003 Dec;5(4):345-8. Asian Journal of Andrology

Conclusion: men going through IVF with poor sperm morphology has been correlated to poor embryo cleavage rates, lower IVF embryo transfer rates, decreased pregnancy rates, lower ongoing pregnancy rates, and increased miscarriage. Poor sperm morphology is a good indicator of IVF outcome.

One-hundred-and-twenty-three in-vitro fertilization (IVF) cycles were analysed in order to clarify the influence of strictly normal morphology (SNM) of spermatozoa on IVF outcome. SNM was defined using strict criteria according to Kruger with our modifications. The IVF cycles studied were divided into three groups: %SNM <12% (13 cycles), 12 <40% (68 cycles), ≥40% (42 cycles). The cleavage rates per oocyte were higher in the groups with 12–40% and ≥40% of %SNM than in the group with %SNM <12%. The embryo transfer rate per cycle increased with increasing %SNM. The overall pregnancy rate per cycle increased with increasing %SNM (7.7% in %SNM < 12%, 22.1% in 12–40% of %SNM, and 40.5% in %SNM ≥40%). The ongoing pregnancy rate per cycle also increased with increasing %SNM (7.7% in %SNM <12%, 14.7% in 12–40% of %SNM, and 31.0% in %SNM ≥40%). The miscarriage rate was lower in %SNM ≥40% (23.5%) than in 12–40% of %SNM (33.3%). It was suggested that %SNM is a good predictor of IVF outcome.

– T. Kobayashi et al – Human Reproduction

Conclusions: After receiving acupuncture twice weekly for 6 weeks motility of sperm (but not overall count) was found to increase significantly.

This recent small clinical trial randomised 57 patients who had extremely low sperm counts, to acupuncture and placebo acupuncture groups. The authors conclude that the results of the present study support the significance of acupuncture in male patients with severe oligoasthenozoospermia. More evidence with larger trials needs to be accumulated before the efficacy and effectiveness of acupuncture in male infertility can be evaluated.

In this first prospective, randomized, single-blind, placebo-controlled study, 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A–C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.

– Dieterle et al Fertil Steril 2009 Oct; 92 (4): 1340–3 Fertility and Sterility

Conclusion(s): For the first time point- and frequency-specific effects of abdominal EA on TBF are shown in humans.

Just as electrocaupuncture can increase blood flow to the ovaries and uterus (see reports above) so it can to the testicles. These authors demonstrate that particular frequencies applied for just 5 minutes are effective in increasing blood flow in the testes, and suggest that such a stimulus may address the damaged microcirculation associated with varicoceles, and with aging. They note that decreased testicular arterial blood flow may result in impaired spermatogenesis from defective metabolism in the microcirculatory bed and suggest that further research is needed to discover if electroacupuncture can improve sperm manufacture in this instance.

Objective: To clarify the role of the abdominal acupuncture points and the frequency of short-term electroacupuncture (EA) stimulation on testicular blood flow (TBF) in humans.

Design: A prospective, randomized study.

Setting: University hospital, Department of Radiology, ultrasound unit.

Patient(s): Eighty healthy male volunteers were randomly allocated to three groups in stage one and to a single group in stage two. In the first stage of the study, the abdominal acupuncture points ST-29 (guilai) were stimulated using simple needle insertion, 2 Hz burst EA or 10 Hz EA, in three different groups. In the second stage of the study, abdominal acupuncture points ST-25 (tianshu) were stimulated with the frequency found to be more effective in stage one. Stimulation was for 5 minutes in each group.

Intervention(s): Electroacupuncture and Doppler flowmeter.

Main Outcome Measure(s): Four groups were compared for volume flow and other related parameters of TBF.

Result(s): The 10-Hz EA stimulation of ST-29 (guilai) increased TBF, but simple needle insertion and 2-Hz burst stimulation did not. The 10-Hz EA stimulation of ST-25 (tianshu) did not result in significant changes in TBF.

Further investigation is required to ascertain whether these findings may be helpful in the clinical treatment of infertile men.

– Cakmak Y et al, Fertil Steril 2008;90:1732–8 Fertility and Sterility

Conclusions: It is concluded that acupuncture may be a useful, nontraumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation.

This pilot study once again showed a positive effect of acupuncture on sperm count – but this time on men with such low sperm counts (or no sperm) that they would usually require a testicular biopsy to extract sperm for use in an IVF cycle. Seven of the 15 men with no sperm at all produced sperm detectable by the light microscope after a course of 10 acupuncture treatments (p < 0.01) ie enough sperm could be produced for ICSI to be performed without recourse to testicular biopsy. The control group with similar semen analysis had no treatment and showed no change after 3 months.

Classic therapies are usually ineffective in the treatment of patients with very poor sperm density. The aim of this study was to determine the effect of acupuncture on these males. Semen samples of 20 patients with a history of azoospermia were examined by light microscope (LM) and scanning electron microscope (SEM), with which a microsearch for spermatozoa was carried out.

These examinations were performed before and 1 month after acupuncture treatment and revealed that the study group originally contained three severely oligoteratoasthenozoospermic (OTA), two pseudoazoospermic and 15 azoospermic patients.

The control group was comprised of 20 untreated males who underwent two semen examinations within a period of 2–4 months and had initial andrological profiles similar to those of the experimental group.

No changes in any of the parameters examined were observed in the control group. There was a marked but not significant improvement in the sperm counts of severely OTA males following acupuncture treatment (average=0.7±1.1×106 spermatozoa per ejaculate before treatment vs. 4.3±3.2×106 spermatozoa per ejaculate after treatment). A

definite increase in sperm count was detected in the ejaculates of 10 (67%) of the 15 azoospermic patients. Seven of these males exhibited post-treatment spermatozoa that were detected even by LM. The sperm production of these seven males increased significantly, from 0 to an average of 1.5±2.4×106 spermatozoa per ejaculate (Z=−2.8, P≤0.01). Males with genital tract inflammation exhibited the most remarkable improvement in sperm density (on average from 0.3±0.6×106 spermatozoa per ejaculate to 3.3±3.2×106 spermatozoa per ejaculate; Z=−2.4, P≤0.02).

Two pregnancies were achieved by the IVF-ICSI procedure.

Siterman S et al Andrologia. 2000 Jan;32(1):31-9. Andrologia

Conclusion: patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment.

A group of infertile men with abnormal semen analysis were randomly divided into 2 groups; one group was given 10 acupuncture treatments over 5 weeks, and the other group, no treatment. Significant improvements (p < 0.05) were demonstrated in the acupuncture group compared to the control group, in particular improved motility and morphology.

The aim of this prospective controlled study was to assess the effect of acupuncture on the sperm quality of males suffering from subfertility related to sperm impairment.

Semen samples of 16 acupuncture-treated subfertile patients were analyzed before and 1 month after treatment (twice a week for 5 weeks). In parallel, semen samples of 16 control untreated subfertile males were examined. Two specimens were taken from the control group at an interval of 2-8 months. The expanded semen analysis included routine and ultramorphological observations.

The fertility index increased significantly (p < or = .05) following improvement in total functional sperm fraction, percentage of viability, total motile spermatozoa per ejaculate, and integrity of the axonema (p < or = .05), which occurred upon treatment. The intactness of axonema and sperm motility were highly correlated (corr. = .50, p < or = .05).

Siterman S et al Arch Androl. 1997 Sep-Oct;39(2):155-61 Archives of Andrology

This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates an inverse relationship between semen quality and specific aspects of psychological stress.

Robert N. Clarke1, Susan C. Klock2,4, Anne Geoghegan3 and David E. Travassos1
Oxford JournalsMedicine Human Reproduction Volume 14, Issue 3Pp. 753-758 – 1998
http://humrep.oxfordjournals.org/content/14/3/753

Increased levels of both state and trait anxiety were associated with lower semen volume, sperm concentration and count, reduced sperm motility, and increased sperm DNA fragmentation of IVF patients, thus influencing seminal parameters at the macroscopic and cellular/subcellular levels. Similar results were obtained in the controls. Our data confirm previous observations with state anxiety and show that trait anxiety also is negatively associated with male fertility.

Fertility and Sterility – Volume 99, Issue 6 , Pages 1565-1572.e2, May 2013
Elisa Vellani, Ph.D., Alessandro Colasante, Ph.D., Luciana Mamazza, Ph.D., Maria Giulia Minasi, M.Sc., Ermanno Greco, M.D., Arturo Bevilacqua, Ph.D.
http://www.fertstert.org/article/S0015-0282(13)00141-6/abstract

A significant correlation showed that low egg numbers were associated with higher Depression. Sperm motility was weakly correlated with Depression scores. Women with high State Anxiety score on the egg retrieval day had significant lower pregnancy rates, as did those with higher Depression.

Psychological Reports: Volume 104, Issue , pp. 796-806. June 2009
NERMIN GÜRHAN, AYGÜL AKYÜZ, DERYA ATICI, and SEZER KISA
http://www.amsciepub.com/doi/abs/10.2466/pr0.104.3.796-806

These results suggest that stressful life events may be associated with decreased semen quality in fertile men. The experience of psychosocial stress may be a modifiable factor in the development of idiopathic infertility.

Fertility and Sterility – Volume 93, Issue 4 , Pages 1104-1111, 1 March 2010
Audra L. Gollenberg, Ph.D., Fan Liu, M.S., Charlene Brazil, B.S., Erma Z. Drobnis, Ph.D., David Guzick, M.D., Ph.D., James W. Overstreet, M.D., Ph.D., James B. Redmon, M.D., Amy Sparks, Ph.D., Christina Wang, M.D., Shanna H. Swan, Ph.D
http://www.fertstert.org/article/S0015-0282(08)04660-8/abstract

The relationship between psychosocial variables and seminal status has been confirmed by comparing a group of oligozoospermic (poor sperm) and normozoospermic (normal sperm) men.

Fertility and Sterility – Volume 79, Supplement 3 , Pages 1571-1576, June 2003
Luigi De Gennaro, Ph.D.email address, Simona Balistreri, Ph.D., Andrea Lenzi, M.D., Francesco Lombardo, M.D., Michele Ferrara, Ph.D., Loredana Gandini, B.Sc
http://www.fertstert.org/article/S0015-0282(03)00374-1/abstract

Conclusions: Acupuncture can improve sperm quality and fertilization rates in assisted reproductive technology. The fertilization rates after acupuncture (66.2%) were significantly higher than that before treatment (40.2%) (P < 0.01).

This trial looks at sperm behaviour in an IVF setting. It was a “before and after” study involving 82 infertile men with pathological semen abnormalities and who’s sperm achieved a poor fertilization rate in at least 2 IVF/ICSI cycles. They were given acupuncture twice a week over 8 weeks and the IVF/ICSI cycles were repeated. The fertilization rates after acupuncture (66.2%) were significantly higher than that before treatment (40.2%) (P < 0.01).

The clinical effects of acupuncture on idiopathic male infertility in sperm parameter and on therapeutic results in assisted reproductive technology were investigated. 22 patients failed in intracytoplasmic sperm injection (ICSI) with idiopathic male infertility were treated with acupuncture twice weekly for 8 weeks, followed by ICSI treatment again. The sperm concentration, motility, morphology, fertilization rates and embryo quality were observed. Quick sperm motility after acupuncture (18.3% +/- 9.6%) was significantly improved as compared with that before treatment (11.0% +/- 7.5%, P < 0.01). The normal sperm ratio was increased after acupuncture (21.1% +/- 10.4% vs 16.2% +/- 8.2%, P < 0.05). The fertilization rates after acupuncture (66.2%) were obviously higher than that before treatment (40.2%, P < 0.01). There was no significant difference in sperm concentration and general sperm motility between before and after acupuncture. The embryo quality after acupuncture was improved, but the difference between them was not significant (P > 0.05).

– Zhang M et al J Huazhong Univ Sci Tech Med Sci.2002;22(3):228-30 Journal of Huazhong University

Conclusions: Significant increases in pregnancy outcomes were confirmed by this study and the data uniquely supported the advantage of acupuncture in patients with normal PI (prior studies were done on patient with PI). We also demonstrated that both acupuncture treatment protocols could be used together with a synergistic effect. Finally, this study is the first to demonstrate that the use of acupuncture in patients with poor prognoses (elevated Peak FSH, longer history of infertility, poor sperm morphology) can achieve similar pregnancy rates to normal prognosis patients.

Objective: The purpose of the study was to determine the influence of two acupuncture protocols on IVF outcomes and secondly to identify the appropriate patient groups that would most benefit from this adjunctive therapy.

Materials and Methods: In this retrospective study, data was extracted from medical records of patients RE&I clinic & acupuncture clinics between January 2001 and November 2003. All patients completing an IVF cycle with transfer were included. One RE&I provided the IVF care and a consortium of acupuncturists overseen by the author provided the strict acupuncture protocols. PR per transfer were the endpoints measured. Data was analyzed by student’s t test and Multiregression with Wilcox ranking (MRW).

Results: 147 patients were included in the study and of those 53 had Acupuncture (Ac) and 94 did not (Non-Ac group). Demographic data between these Ac and Non-Ac groups respectively indicated remarkable equity (Table 1). Fertility Factors also demonstrated equity and there were no differences in Diagnoses, IVF Protocols and type of Gonadatrophin protocols used.

Factors that demonstrated significance were: Length of time infertile, Peak FSH, PI for total group without MRW; PI for MRW groups reversed this (Table 2) and finally average: Sperm Morphology, Peak E2, Peak P4 prior to HcG: and endometrial thickness. PR before Wilcox ranking were the same: 40% v 38%. MRW analysis revealed FSH, Length of time trying to get pregnant, Sperm Morphology and E2 levels as significant: 6.5, 4.1, 4.0 and 1.6 respectively. When the Ac group was modified (15 Ac patient dropped), PI was elevated from 1.76 to 1.94 resulting in a significant elevation compared to the Non-Ac group, p 0.01. Also PR changed from 40% before to 53% after and this value was significantly greater than the Non-Ac group (38%), p 0.01.

– Magarelli P,Cridennda D, Fertil Steril,2004;81 Suppl 3 S20 Fertility and Sterility

Stress & Fertility

Conclusion: The results explained that acupuncture regulated the stress reaction via promoting the combination of glucocorticoids (GC) with GR, and GR protein expression.

It had been indicated in the previous studies that acupuncture relieved the excessive excitation of hypothalamic-pituitary-adrenal cortex axis (HPAA) function induced by stress stimulation. But the changes in glucocorticoid receptor (GR) induced by acupuncture have not been detected clearly. The objective of the study was to observe the impacts of acupuncture on the protein expressions of corticotrophin releasing hormone (CRH), adrenocorticotropic hormone receptor (ACTHR), and GR under the physiological and stress states. The results showed that under the stress state, acupuncture upregulated the protein expression of GR in the hippocampus, hypothalamic paraventricular nucleus (PVN), and pituitary gland, downregulated the protein expression of GR in the adrenal cortex, and obviously reduced the protein expressions of CRH and ACTHR. Under the physiological state, acupuncture promoted GR protein expression in the hippocampus and CRH protein expression in the hippocampus and PVN. The results explained that acupuncture regulated the stress reaction via promoting the combination of glucocorticoids (GC) with GR, and GR protein expression. The increase of GR protein expression induced feedback inhibition on the overexpression of CRH and ACTHR, likely decreased GC level, and caused the reduction of GR protein expression in the adrenal cortex.

Reference
S.J. Wang et al., “Acupuncture relieves the excessive excitation of hypothalamic-pituitary-adrenal cortex axis function and correlates with the regulatory mechanism of GR, CRH and ACTHR.” Evidence-Based Complementary and Alternative Medicine. Volume 2014 (2014), Article ID 495379, 9 pages. http://dx.doi.org/10.1155/2014/495379

*Related blog post: http://www.yinstill.com/blog/science-confirms-what-all-our-clients-alrea…

SUMMARY ANSWER Higher levels of stress as measured by salivary alpha-amylase are associated with a longer time-to-pregnancy (TTP) and an increased risk of infertility.

STUDY QUESTION Are women’s stress levels prospectively associated with fecundity and infertility?

WHAT IS KNOWN ALREADY Data suggest that stress and reproduction are interrelated; however, the directionality of that association is unclear.

STUDY DESIGN, SIZE, DURATION In 2005–2009, we enrolled 501 couples in a prospective cohort study with preconception enrollment at two research sites (Michigan and Texas, USA). Couples were followed for up to 12 months as they tried to conceive and through pregnancy if it occurred. A total of 401 (80%) couples completed the study protocol and 373 (93%) had complete data available for this analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS Enrolled women collected saliva the morning following enrollment and then the morning following their first observed study menses for the measurement of cortisol and alpha-amylase, which are biomarkers of stress. TTP was measured in cycles. Covariate data were captured on both a baseline questionnaire and daily journals.

MAIN RESULTS AND THE ROLE OF CHANCE Among the 401 (80%) women who completed the protocol, 347 (87%) became pregnant and 54 (13%) did not. After adjustment for female age, race, income, and use of alcohol, caffeine and cigarettes while trying to conceive, women in the highest tertile of alpha-amylase exhibited a 29% reduction in fecundity (longer TTP) compared with women in the lowest tertile [fecundability odds ratios (FORs) = 0.71; 95% confidence interval (CI) = (0.51, 1.00); P < 0.05]. This reduction in fecundity translated into a >2-fold increased risk of infertility among these women [relative risk (RR) = 2.07; 95% CI = (1.04, 4.11)]. In contrast, we found no association between salivary cortisol and fecundability.

LIMITATIONS, REASONS FOR CAUTION Due to fiscal and logistical concerns, we were unable to collect repeated saliva samples and perceived stress questionnaire data throughout the duration of follow-up. Therefore, we were unable to examine whether stress levels increased as women continued to fail to get pregnant. Our ability to control for potential confounders using time-varying data from the daily journals, however, minimizes residual confounding.

WIDER IMPLICATIONS OF THE FINDINGS This is the first US study to demonstrate a prospective association between salivary stress biomarkers and TTP, and the first in the world to observe an association with infertility.

Reference
C.D. Lynch et al., Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study. Oxford Journals, Human Reproduction Volume 29, Issue 5Pp. 1067-1075. January 2014.

*Also see research on how acupuncture is proven to manage stress: http://www.yinstill.com/faqs/acupuncture-relieves-excessive-excitation-h…

Stress can cause decreased uterine receptivity through an ovarian-independent pathway. The number of implantation sites in the stress group was significantly less than that in the control group. Implantation-related genes and ovarian-hormone-responsive genes were repressed in the stress group despite ovarian hormone supplementation.

Oxford Journals Medicine Human Reproduction Volume 24, Issue 4Pp. 945-953 – 2008
Eiji Kondoh1,2,†, Takako Okamoto1,†, Toshihiro Higuchi1, Keiji Tatsumi1,4, Tsukasa Baba1, Susan K. Murphy2, Kenji Takakura1, Ikuo Konishi1 and Shingo Fujii3
http://humrep.oxfordjournals.org/content/24/4/945

This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates an inverse relationship between semen quality and specific aspects of psychological stress.

Robert N. Clarke1, Susan C. Klock2,4, Anne Geoghegan3 and David E. Travassos1
Oxford JournalsMedicine Human Reproduction Volume 14, Issue 3Pp. 753-758 – 1998
http://humrep.oxfordjournals.org/content/14/3/753

Increased levels of both state and trait anxiety were associated with lower semen volume, sperm concentration and count, reduced sperm motility, and increased sperm DNA fragmentation of IVF patients, thus influencing seminal parameters at the macroscopic and cellular/subcellular levels. Similar results were obtained in the controls. Our data confirm previous observations with state anxiety and show that trait anxiety also is negatively associated with male fertility.

Fertility and Sterility – Volume 99, Issue 6 , Pages 1565-1572.e2, May 2013
Elisa Vellani, Ph.D., Alessandro Colasante, Ph.D., Luciana Mamazza, Ph.D., Maria Giulia Minasi, M.Sc., Ermanno Greco, M.D., Arturo Bevilacqua, Ph.D.
http://www.fertstert.org/article/S0015-0282(13)00141-6/abstract

The biological interaction between stress and infertility is the result of the action of stress hormones at the brain level, especially on the hypothalamus-pituitary and on the female reproductive organs. Stress hormones such as catecholamines (adrenalin, nonadrenaline and dopamine) and the hypothalamic-pituitary-adrenal axis interact with hormones which are responsible for normal ovulatory cycles: i.e., gonadotropin releasing hormone (GnRH), prolactin, LH and FSH. Endogenous opiates and melatonin secretion are altered by stress and interfere with ovulation. Sympathetic innervation of the female reproductive system provides routes by which stress can influence fertility at the sex organs level.

European Journal of Obstetrics & Gynecology and Reproductive Biology – Volume 45, Issue 1 , Pages 1-8, 16 June 1992
Joseph G. Schenker, Dror Meirow, Eran Schenker
http://www.journals.elsevierhealth.com/periodicals/eurold/article/0028-2243(92)90186-3/abstract

First and last treatment cycles were associated with greater anxiety. High levels of confusion and bewilderment found during the initial cycle may indicate the need for better pretreatment information. Services must recognize the presence of high anxiety at intake and provide psychological care for those identified as particularly distressed. Emotional difficulties after failure of IVF treatment can be considered to be iatrogenic effects, and psychological services should be provided to minimize any negative psychological consequences of treatment.

Oxford Journals Medicine Human Reproduction Volume 12, Issue 1Pp. 183-190 – 1997
P Slade, J Emery and B A Lieberman
http://humrep.oxfordjournals.org/content/12/1/183

A significant correlation showed that low egg numbers were associated with higher Depression. Sperm motility was weakly correlated with Depression scores. Women with high State Anxiety score on the egg retrieval day had significant lower pregnancy rates, as did those with higher Depression.

Psychological Reports: Volume 104, Issue , pp. 796-806. June 2009
NERMIN GÜRHAN, AYGÜL AKYÜZ, DERYA ATICI, and SEZER KISA
http://www.amsciepub.com/doi/abs/10.2466/pr0.104.3.796-806

A large number of life-events perceived as having a negative impact on quality of life may indicate chronic stress, and the results of our study indicate that stress may reduce the chances of a successful outcome following IVF, possibly through psychobiological mechanisms affecting medical end-points such as egg retrieval outcome.

Oxford Journals Medicine Human Reproduction Volume 24 2009, Issue 9Pp. 2173-2182
S.M.S. Ebbesen1,3, R. Zachariae1, M.Y. Mehlsen1, D. Thomsen1, A. Højgaard2, L. Ottosen2, T. Petersen2 and H.J. Ingerslev2
http://humrep.oxfordjournals.org/content/24/9/2173

After controlling for the number of treatment cycles, a significant difference was observed in the course of pregnancy over time between depressed and non-depressed women. Depressed women exhibited a lower pregnancy rate for the first treatment cycles than non-depressed women.

Journal of Psychosomatic Research – Volume 37, Issue 5, July 1993, Pages 481–491
P. Thiering, J. Beaurepaire, M. Jones, D. Saunders, C. TennantCorresponding author contact information
http://www.sciencedirect.com/science/article/pii/002239999390004Y

Pre-existing psychological factors (anxiety depression) are independently related to treatment outcome in IVF/ICSI, and should therefore be taken into account in patient counselling. Psychological factors may be improved by intervention

Oxford Journals Human Reproduction Volume 16 2001, Issue 7 Pp. 1420-1423
J.M.J. Smeenk1,6, C.M. Verhaak2, A. Eugster5, A. van Minnen3, G.A. Zielhuis4 and D.D.M. Braat1
http://humrep.oxfordjournals.org/content/16/7/1420

A more `hostile’ mood state and higher trait anxiety were associated with a lower cumulative pregnancy rate. A Cox multiple regression model found previous pregnancy history, trait anxiety, and the POMS agreeable–hostile and elated–depressed scales to be the most important lifestyle and stress variables predictive of pregnancy. The results emphasize the importance of psychosocial stress in treatment outcome.

Oxford Journals Human Reproduction Volume 14 1999, Issue 6 Pp. 1656-1662
K.A. Sanders and N.W. Bruce1
http://humrep.oxfordjournals.org/content/14/6/1656

Women who were concerned about the medical aspects (i.e., side effects, surgery, anesthesia, not enough information, pain, and recovery) of the procedure had 20% fewer eggs retrieved and 19% fewer eggs fertilized. Women who were very concerned about missing work had 30% fewer eggs fertilized. Women who were extremely concerned about the finances associated with the procedure had a very high risk of not achieving a successful live birth delivery.

Fertility and Sterility – Volume 81, Issue 4 , Pages 982-988, April 2004
Hillary Klonoff-Cohen, Ph.D.email address, Loki Natarajan, Ph.D.
http://www.fertstert.org/article/S0015-0282(98)00089-2/abstract

The main findings suggest that infertile women have a different personality profile in terms of more suspicion, guilt and hostility as compared to the fertile controls, perhaps as a response to their infertility. Their stress levels in terms of circulating prolactin and cortisol levels were elevated compared to the fertile controls. Psychological stress may affect the outcome of IVF treatment since state anxiety levels among those who did not achieve pregnancy were slightly higher than among those who became pregnant.

Acta Obstetricia et Gynecologica Scandinavica – Volume 79, Issue 2, pages 113–118, February 2000
GYÖRGY CSEMICZKY, BRITT-MARIE LANDGREN, AILA COLLINS
http://dx.doi.org/10.1034/j.1600-0412.2000.079002113.x

Women with known causes of infertility scored higher on a scale measuring frequency of thought and concerns conceiving and sexual problems than women with undetermined infertility. Men from couples with both known and undetermined causes of infertility had more sexual problems than fertile men.

Journal of Psychosomatic Obstetrics & Gynecology – 1996, Vol. 17, No. 2 , Pages 103-118
S. Stoléru1, J. P. Teglas, A. Spira1, F. Magnin1 and J. Fermanian
http://informahealthcare.com/doi/abs/10.3109/01674829609025670

Psychological factors such as depression, state-anxiety, and stress-induced changes in heart rate and cortisol are predictive of a decreased probability of achieving a viable pregnancy. A couple that is trying to conceive will undoubtedly experience feelings of frustration and disappointment if a pregnancy is not easily achieved. However, if the difficulties progress and the man and or woman are labelled as having fertility problems, then this may result in a severe insult to self-esteem, body image, and self-assessed masculinity or femininity. Three types of relationships have been hypothesized between psychological factors and infertility. These include: (1) psychological factors are risk factors of subsequent infertility; (2) the experience of the diagnosis and treatment of infertility causes subsequent psychological distress; (3) a reciprocal relationship exists between psychological factors and infertility. The evidence for these three relationships is reviewed and an alternative approach to the treatment of infertility including stress evaluation that precedes or is concurrent to fertility treatment is suggested.

European Journal of Obstetrics & Gynecology and Reproductive Biology – Volume 117, Issue 2 , Pages 126-131, 1 December 2004
J. Cwikel, Y. Gidron, E. Sheiner
http://www.ejog.org/article/S0301-2115(04)00257-X/abstract

Couples who conceived during their first cycle of IVF had significantly higher measures of need for parenthood and loss of sexual enjoyment, compared with couples who did not conceive. Couples who achieved ongoing pregnancies had higher scores on measures of a negative view of a child-free lifestyle, need for parenthood, and total stress than those who did not.

Fertility and Sterility – Volume 88, Issue 3 , Pages 714-717, September 2007
Brian C. Cooper, M.D.email address, Judith R. Gerber, Ph.D., Amy L. McGettrick, B.S.N., R.N., Julia V. Johnson, M.D.
http://www.fertstert.org/article/S0015-0282(06)04708-X/abstract

Expression of negative emotions predicts depression levels and outcome in IVF. This cause of infertility should be taken into account when investigating the relation between psychologic functioning and outcome in IVF.

Fertility and Sterility – Volume 69, Issue 6 , Pages 1026-1033, June 1998
Koen Demyttenaere, M.D., Ph.D., L Bonte, M.Sc., M Gheldof, M.Sc., M Vervaeke, M.Sc., C Meuleman, M.D., D Vanderschuerem, M.D., Ph.D., T D’Hooghe, M.D., Ph.D.
http://www.fertstert.org/article/S0015-0282(98)00089-2/abstract

The Eastern Body-Mind-Spirit group intervention approach effectively reduces the anxiety level of women undergoing IVF treatment. Compared with the control group, the intervention group had a significant drop in State Anxiety mean score following intervention. A comparable number of embryos were transferred for each group, but there was a nonsignificant trend of a higher pregnancy rate in the intervention group.

Fertility and Sterility – Volume 85, Issue 2 , Pages 339-346, February 2006
Celia H.Y. Chan, M.S.W.email address, Ernest H.Y. Ng, M.D., Cecilia L.W. Chan, Ph.D., P.C., Ho, M.D., Timothy H.Y. Chan, B.Cog.Sc.
http://www.fertstert.org/article/S0015-0282(05)03690-3/abstract

These results suggest that stressful life events may be associated with decreased semen quality in fertile men. The experience of psychosocial stress may be a modifiable factor in the development of idiopathic infertility.

Fertility and Sterility – Volume 93, Issue 4 , Pages 1104-1111, 1 March 2010
Audra L. Gollenberg, Ph.D., Fan Liu, M.S., Charlene Brazil, B.S., Erma Z. Drobnis, Ph.D., David Guzick, M.D., Ph.D., James W. Overstreet, M.D., Ph.D., James B. Redmon, M.D., Amy Sparks, Ph.D., Christina Wang, M.D., Shanna H. Swan, Ph.D
http://www.fertstert.org/article/S0015-0282(08)04660-8/abstract

The relationship between psychosocial variables and seminal status has been confirmed by comparing a group of oligozoospermic (poor sperm) and normozoospermic (normal sperm) men.

Fertility and Sterility – Volume 79, Supplement 3 , Pages 1571-1576, June 2003
Luigi De Gennaro, Ph.D.email address, Simona Balistreri, Ph.D., Andrea Lenzi, M.D., Francesco Lombardo, M.D., Michele Ferrara, Ph.D., Loredana Gandini, B.Sc
http://www.fertstert.org/article/S0015-0282(03)00374-1/abstract

Acute and chronic stress affected biologic end points (i.e., number of eggs retrieved and fertilized), as well as pregnancy, live birth delivery, birth weight, and multiple gestations.

Fertility and Sterility – Volume 76, Issue 4 , Pages 675-687, October 2001
Hillary Klonoff-Cohen, Ph.D.email address, Elaine Chu, M.D., Loki Natarajan, Ph.D., William Sieber, Ph.D.
http://www.fertstert.org/article/S0015-0282(01)02008-8/abstract

Fertility problem stress was associated with a poorer treatment outcome in women and men. Logistic regression indicated that women who reported more marital distress required more treatment cycles to conceive (median 3) than women reporting less marital distress (median 2). The findings provide evidence that infertility-related stress has direct and indirect effects on treatment outcome.

Fertility and Sterility – Volume 83, Issue 6 , Pages 1745-1752, June 2005
Jacky Boivin, Ph.D.email address, Lone Schmidt, Ph.D.
http://www.fertstert.org/article/S0015-0282(05)00408-5/abstract

Infertile women showed significant increases in trait anxiety and depressive symptoms than the fertile women. Anxiety and depression in the in vitro fertilization(IVF)-failed women were significantly higher than the IVF-success women. We must pay an attention to the infertile patient, especially from the initial infertility workup. We recommend psychological counselling for IVF-failed patients.

Journal of Assisted Reproduction and Genetics – 20000900, Volume 17, Issue 8, pp 445-448
BAIK SEOK KEE, BYEONG JUN JUNG, SANG HOON LEE
http://link.springer.com/article/10.1023/A%3A1009417302758

Data validates the concept of a “stressed couple”. Adverse implications of a couple’s psychological distress (i.e. higher pessimism and dysphoria resulted in longer duration of controlled ovarian hyperstimulation and lower fertilization rates) are suggested. Partner’s depressive scores correlated with IVF failure.

Journal of Assisted Reproduction and Genetics – September 2013
Hayley S. Quant, Athena Zapantis, Michael Nihsen, Kris Bevilacqua, Sangita Jindal, Lubna Pal
http://link.springer.com/article/10.1007/s10815-013-0098-7

CONCLUSION(S): Stress significantly reduced the probability of conception each day during the fertile window, possibly exerting its effect through the sympathetic medullar pathway.

OBJECTIVE: To assess salivary stress biomarkers (cortisol and alpha-amylase) and female fecundity.

DESIGN: Prospective cohort design.

SETTING: United Kingdom.

PATIENT(S): 274 women aged 18 to 40 years who were attempting pregnancy.

INTERVENTION(S): Observation for six cycles or until pregnancy: women collected basal saliva samples on day 6 of each cycle, and used fertility monitors to identify ovulation and pregnancy test kits for pregnancy detection.

MAIN OUTCOME MEASURE(S): Salivary cortisol (mug/dL) and alpha-amylase (U/mL) concentration measurements; fecundity measured by time-to-pregnancy and the probability of pregnancy during the fertile window as estimated from discrete-time survival and Bayesian modeling techniques, respectively.

RESULT(S): Alpha-amylase but not cortisol concentrations were negatively associated with fecundity in the first cycle (fecundity odds ratio = 0.85; 95% confidence interval 0.67, 1.09) after adjusting for the couples’ ages, intercourse frequency, and alcohol consumption. Statistically significant reductions in the probability of conception across the fertile window during the first cycle attempting pregnancy were observed for women whose salivary concentrations of alpha-amylase were in the upper quartiles in comparison with women in the lower quartiles (highest posterior density: -0.284; 95% interval -0.540, -0.029).

Conclusions: .Previous unpublished work at BCRM showed that 85% of the patients found the named nurse system important as a coping mechanism to support them by providing continuity of care through stressful treatment. The responses to the questionnaires indicate a clear demand for acupuncture and suggest that acupuncture may be valuable to improve the general wellbeing of women during infertility investigations and treatments. If acupuncture provides an effective coping mechanism, this could support patients to persevere with increased numbers of ART(Assisted Reproductive Technologies) cycles, thereby increasing their ultimate chance of a successful pregnancy.

Introduction.Despite a lack of studies clearly demonstrating clinical efficacy complementary medicine is frequently used by couples undergoing infertility treatment (Coulson 2005). In Bristol, acupuncture has become very popular among patients undergoing infertility treatment, thus this study sought to quantify this and examine the reasons why patients choose acupuncture.

Methods.Two hundred questionnaires were given to patients who attended the Bristol Centre for Reproductive Medicine (BCRM) for investigation or treatment of infertility in August 2009. Patients were asked to complete the questionnaire while waiting to see their doctor or nurse and 194 responses were returned. The questionnaires asked if patients had or wished to have acupuncture or other complementary medicine, and to indicate on a scale of one to ten (10 being the best) the relative importance of acupuncture in comparison to values such as pregnancy rates and continuity of care.

Results.Out of 58 respondents who use complementary medicine, 43 used acupuncture. 40 respondents use acupuncture regularly and 17 of those lived outside of Bristol. A further 52 respondents had considered using acupuncture. In terms of very high importance (score of 10) 135 respondents felt pregnancy rates scored 10, 84 felt having the same doctor scored 10, 71 scored 10 for having the same nurse, 31 felt in house acupuncture scored 10 and 21 scored 10 for other complementary medicine. Overall, 43 respondents felt acupuncture should be available at Bristol Centre for Reproductive Medicine. Thirty four respondents gave more importance to acupuncture than seeing the same doctor or nurse, and 32 deemed it equally important. In addition, 29 patients scored acupuncture as equally important to pregnancy rates and 5 scored acupuncture higher than pregnancy rates.

Conclusion
This preliminary exploration, whilst confined to a small sample of women, confirms that acupuncture is indeed perceived by infertile women to have an impact to their health. All findings outlined here are reported cautiously because they are limited by the size of the sample. They suggest that further studies of acupuncture as an adjunct to IVF should systematically explore the issues of wellbeing, anxiety, personal and social resilience and women’s identity in relation to sexuality and reproduction.

Background
In Vitro Fertilisation (IVF) is now an accepted and effective treatment for infertility, however IVF is acknowledged as contributing to, rather than lessening, the overall psychosocial effects of infertility. Psychological and counselling interventions have previously been widely recommended in parallel with infertility treatments but whilst in many jurisdictions counselling is recommended or mandatory, it may not be widely used. Acupuncture is increasingly used as an adjunct to IVF, in this preliminary study we sought to investigate the experience of infertile women who had used acupuncture to improve their fertility.

Methods
A sample of 20 women was drawn from a cohort of women who had attended for a minimum of four acupuncture sessions in the practices of two acupuncturists in South Australia. Eight women were interviewed using a semi-structured questionnaire. Six had sought acupuncture during IVF treatment and two had begun acupuncture to enhance their fertility and had later progressed to IVF. Descriptive content analysis was employed to analyse the data.

Results
Four major categories of perceptions about acupuncture in relation to reproductive health were identified: (a) Awareness of, and perceived benefits of acupuncture; (b) perceptions of the body and the impact of acupuncture upon it; (c) perceptions of stress and the impact of acupuncture on resilience; and (d) perceptions of the intersection of medical treatment and acupuncture.

Conclusion; Acupuncture is an effective and low intensity procedure for increasing women’s resilience in the repetitive and stress inducing time of pregnancy attempts, with or without medical treatment. The instrumental role of the acupuncture therapist in increasing resilience is a finding that has not emerged in previous studies and has implications for patient management.

Aim: There is interest in the use of acupuncture as an adjunct to fertility treatment. this study aimed to examine women’s attitudes and beliefs in relation to the use of acupuncture for enhancing fertility or as an adjunct to ART.

Results: Participants all expressed confidence in the ability of acupuncture to contibute to their reproductive decision in a positive way. They described acupuncture as an adjunct to pregnancy attempts that was positive since it gave them a sense of control and a strategy for improving their chances. Women were unable to locate acupuncture as a causative factor in a resulting pregnancy however all women described acupuncture as instrumental in an increased sense of well being, self confidence, emotional balance and reduced anxiety. All experienced increased resilience.

Conclusions(s): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

Patient(s): 57 infertile patients undergoing IVF or IVF/ICSI.

Interventions(s): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.
Main outcome measure(s): Perceive Stress Scale scores, pregnancy rates.

Result(s): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status.

Stress & Sperm

Conclusion(s): Men who feel stressed have fewer, slower sperm — which may diminish fertility. In this first study to examine all three domains of stress, perceived stress and stressful life events but not work-related stress were associated with semen quality.

Objective
To evaluate associations between work-related stress, stressful life events, and perceived stress and semen quality.

Design
Cross-sectional analysis.

Setting
Northern California.

Patient(s)
193 men from the Child Health and Development Studies evaluated between 2005–2008.

Intervention(s)
None.

Main Outcome Measure(s)
Measures of stress including job strain, perceived stress, and stressful life events; outcome measures of sperm concentration, percentage of motile sperm, and percentage of morphologically normal sperm.

Result(s)
We found an inverse association between perceived stress score and sperm concentration (estimated coefficient b = −0.09 × 103/mL; 95% confidence interval [CI] = −0.18, −0.01), motility (b = −0.39; 95% CI = −0.79, 0.01), and morphology (b= −0.14; 95% CI, −0.25, −0.04) in covariate-adjusted linear regression analyses. Men who experienced two or more stressful life events in the past year compared with no stressful events had a lower percentage of motile sperm (b= −8.22; 95% CI, −14.31, −2.13) and a lower percentage of morphologically normal sperm (b = −1.66; 95% CI, −3.35, 0.03) but a similar sperm concentration. Job strain was not associated with semen parameters.

Reference
1. Teresa Janevic, Linda G. Kahn, Paul Landsbergis, Piera M. Cirillo, Barbara A. Cohn, Xinhua Liu, Pam Factor-Litvak. Effects of work and life stress on semen quality. Fertility and Sterility, 2014; DOI: 10.1016/j.fertnstert.2014.04.021
2. http://www.eurekalert.org/pub_releases/2014-05/cums-sds052914.php

Conclusion: The results explained that acupuncture regulated the stress reaction via promoting the combination of glucocorticoids (GC) with GR, and GR protein expression.

It had been indicated in the previous studies that acupuncture relieved the excessive excitation of hypothalamic-pituitary-adrenal cortex axis (HPAA) function induced by stress stimulation. But the changes in glucocorticoid receptor (GR) induced by acupuncture have not been detected clearly. The objective of the study was to observe the impacts of acupuncture on the protein expressions of corticotrophin releasing hormone (CRH), adrenocorticotropic hormone receptor (ACTHR), and GR under the physiological and stress states. The results showed that under the stress state, acupuncture upregulated the protein expression of GR in the hippocampus, hypothalamic paraventricular nucleus (PVN), and pituitary gland, downregulated the protein expression of GR in the adrenal cortex, and obviously reduced the protein expressions of CRH and ACTHR. Under the physiological state, acupuncture promoted GR protein expression in the hippocampus and CRH protein expression in the hippocampus and PVN. The results explained that acupuncture regulated the stress reaction via promoting the combination of glucocorticoids (GC) with GR, and GR protein expression. The increase of GR protein expression induced feedback inhibition on the overexpression of CRH and ACTHR, likely decreased GC level, and caused the reduction of GR protein expression in the adrenal cortex.

Reference
S.J. Wang et al., “Acupuncture relieves the excessive excitation of hypothalamic-pituitary-adrenal cortex axis function and correlates with the regulatory mechanism of GR, CRH and ACTHR.” Evidence-Based Complementary and Alternative Medicine. Volume 2014 (2014), Article ID 495379, 9 pages. http://dx.doi.org/10.1155/2014/495379

*Related blog post: http://www.yinstill.com/blog/science-confirms-what-all-our-clients-alrea…

This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates an inverse relationship between semen quality and specific aspects of psychological stress.

Robert N. Clarke1, Susan C. Klock2,4, Anne Geoghegan3 and David E. Travassos1
Oxford JournalsMedicine Human Reproduction Volume 14, Issue 3Pp. 753-758 – 1998
http://humrep.oxfordjournals.org/content/14/3/753

Increased levels of both state and trait anxiety were associated with lower semen volume, sperm concentration and count, reduced sperm motility, and increased sperm DNA fragmentation of IVF patients, thus influencing seminal parameters at the macroscopic and cellular/subcellular levels. Similar results were obtained in the controls. Our data confirm previous observations with state anxiety and show that trait anxiety also is negatively associated with male fertility.

Fertility and Sterility – Volume 99, Issue 6 , Pages 1565-1572.e2, May 2013
Elisa Vellani, Ph.D., Alessandro Colasante, Ph.D., Luciana Mamazza, Ph.D., Maria Giulia Minasi, M.Sc., Ermanno Greco, M.D., Arturo Bevilacqua, Ph.D.
http://www.fertstert.org/article/S0015-0282(13)00141-6/abstract

A significant correlation showed that low egg numbers were associated with higher Depression. Sperm motility was weakly correlated with Depression scores. Women with high State Anxiety score on the egg retrieval day had significant lower pregnancy rates, as did those with higher Depression.

Psychological Reports: Volume 104, Issue , pp. 796-806. June 2009
NERMIN GÜRHAN, AYGÜL AKYÜZ, DERYA ATICI, and SEZER KISA
http://www.amsciepub.com/doi/abs/10.2466/pr0.104.3.796-806

These results suggest that stressful life events may be associated with decreased semen quality in fertile men. The experience of psychosocial stress may be a modifiable factor in the development of idiopathic infertility.

Fertility and Sterility – Volume 93, Issue 4 , Pages 1104-1111, 1 March 2010
Audra L. Gollenberg, Ph.D., Fan Liu, M.S., Charlene Brazil, B.S., Erma Z. Drobnis, Ph.D., David Guzick, M.D., Ph.D., James W. Overstreet, M.D., Ph.D., James B. Redmon, M.D., Amy Sparks, Ph.D., Christina Wang, M.D., Shanna H. Swan, Ph.D
http://www.fertstert.org/article/S0015-0282(08)04660-8/abstract

The relationship between psychosocial variables and seminal status has been confirmed by comparing a group of oligozoospermic (poor sperm) and normozoospermic (normal sperm) men.

Fertility and Sterility – Volume 79, Supplement 3 , Pages 1571-1576, June 2003
Luigi De Gennaro, Ph.D.email address, Simona Balistreri, Ph.D., Andrea Lenzi, M.D., Francesco Lombardo, M.D., Michele Ferrara, Ph.D., Loredana Gandini, B.Sc
http://www.fertstert.org/article/S0015-0282(03)00374-1/abstract

Uterine contractions

Conclusion Acupuncture is a powerful tool for improving pregnancy rate and reducing uterine contractions after assisted reproduction therapy.

Objective To observe the effect of acupuncture on the pregnancy rate in assisted reproduction therapy such as in-vitro-fertilisation (IVF) and intracytoplasmatic spermatozoen injection (ICSI), and mechanisms.

Methods 210 cases undergoing IVF or ICSI were divided randomly into three groups: acupuncture treatment group, placebo group and control group. The acupuncture treatment group and the placebo group were treated respectively with body acupuncture and placebo acupuncture before and after embryo transfer, and in the control group embryos were transferred without any supportive therapy. Contraction frequency of the uterine junctional zone and the pregnancy rate were observed.

Results The contraction frequency before embryo transfer was not significantly different among the three groups, but after embryo transfer in the acupuncture treatment group was lower than that in the placebo group and the control group, respectively. The pregnancy rate was 44.3% (31/70) in the acupuncture treatment group, and 27.1% (19/70) in the placebo group and 24.3% (17/70) in the control group. The pregnancy rate in the acupuncture treatment group was significantly higher than that in the placebo acupuncture group and the control group (P0.05).

Well-Being & IVF

This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates an inverse relationship between semen quality and specific aspects of psychological stress.

Robert N. Clarke1, Susan C. Klock2,4, Anne Geoghegan3 and David E. Travassos1
Oxford JournalsMedicine Human Reproduction Volume 14, Issue 3Pp. 753-758 – 1998
http://humrep.oxfordjournals.org/content/14/3/753

Increased levels of both state and trait anxiety were associated with lower semen volume, sperm concentration and count, reduced sperm motility, and increased sperm DNA fragmentation of IVF patients, thus influencing seminal parameters at the macroscopic and cellular/subcellular levels. Similar results were obtained in the controls. Our data confirm previous observations with state anxiety and show that trait anxiety also is negatively associated with male fertility.

Fertility and Sterility – Volume 99, Issue 6 , Pages 1565-1572.e2, May 2013
Elisa Vellani, Ph.D., Alessandro Colasante, Ph.D., Luciana Mamazza, Ph.D., Maria Giulia Minasi, M.Sc., Ermanno Greco, M.D., Arturo Bevilacqua, Ph.D.
http://www.fertstert.org/article/S0015-0282(13)00141-6/abstract

First and last treatment cycles were associated with greater anxiety. High levels of confusion and bewilderment found during the initial cycle may indicate the need for better pretreatment information. Services must recognize the presence of high anxiety at intake and provide psychological care for those identified as particularly distressed. Emotional difficulties after failure of IVF treatment can be considered to be iatrogenic effects, and psychological services should be provided to minimize any negative psychological consequences of treatment.

Oxford Journals Medicine Human Reproduction Volume 12, Issue 1Pp. 183-190 – 1997
P Slade, J Emery and B A Lieberman
http://humrep.oxfordjournals.org/content/12/1/183

A significant correlation showed that low egg numbers were associated with higher Depression. Sperm motility was weakly correlated with Depression scores. Women with high State Anxiety score on the egg retrieval day had significant lower pregnancy rates, as did those with higher Depression.

Psychological Reports: Volume 104, Issue , pp. 796-806. June 2009
NERMIN GÜRHAN, AYGÜL AKYÜZ, DERYA ATICI, and SEZER KISA
http://www.amsciepub.com/doi/abs/10.2466/pr0.104.3.796-806

A large number of life-events perceived as having a negative impact on quality of life may indicate chronic stress, and the results of our study indicate that stress may reduce the chances of a successful outcome following IVF, possibly through psychobiological mechanisms affecting medical end-points such as egg retrieval outcome.

Oxford Journals Medicine Human Reproduction Volume 24 2009, Issue 9Pp. 2173-2182
S.M.S. Ebbesen1,3, R. Zachariae1, M.Y. Mehlsen1, D. Thomsen1, A. Højgaard2, L. Ottosen2, T. Petersen2 and H.J. Ingerslev2
http://humrep.oxfordjournals.org/content/24/9/2173

After controlling for the number of treatment cycles, a significant difference was observed in the course of pregnancy over time between depressed and non-depressed women. Depressed women exhibited a lower pregnancy rate for the first treatment cycles than non-depressed women.

Journal of Psychosomatic Research – Volume 37, Issue 5, July 1993, Pages 481–491
P. Thiering, J. Beaurepaire, M. Jones, D. Saunders, C. TennantCorresponding author contact information
http://www.sciencedirect.com/science/article/pii/002239999390004Y

Pre-existing psychological factors (anxiety depression) are independently related to treatment outcome in IVF/ICSI, and should therefore be taken into account in patient counselling. Psychological factors may be improved by intervention

Oxford Journals Human Reproduction Volume 16 2001, Issue 7 Pp. 1420-1423
J.M.J. Smeenk1,6, C.M. Verhaak2, A. Eugster5, A. van Minnen3, G.A. Zielhuis4 and D.D.M. Braat1
http://humrep.oxfordjournals.org/content/16/7/1420

A more `hostile’ mood state and higher trait anxiety were associated with a lower cumulative pregnancy rate. A Cox multiple regression model found previous pregnancy history, trait anxiety, and the POMS agreeable–hostile and elated–depressed scales to be the most important lifestyle and stress variables predictive of pregnancy. The results emphasize the importance of psychosocial stress in treatment outcome.

Oxford Journals Human Reproduction Volume 14 1999, Issue 6 Pp. 1656-1662
K.A. Sanders and N.W. Bruce1
http://humrep.oxfordjournals.org/content/14/6/1656

Women who were concerned about the medical aspects (i.e., side effects, surgery, anesthesia, not enough information, pain, and recovery) of the procedure had 20% fewer eggs retrieved and 19% fewer eggs fertilized. Women who were very concerned about missing work had 30% fewer eggs fertilized. Women who were extremely concerned about the finances associated with the procedure had a very high risk of not achieving a successful live birth delivery.

Fertility and Sterility – Volume 81, Issue 4 , Pages 982-988, April 2004
Hillary Klonoff-Cohen, Ph.D.email address, Loki Natarajan, Ph.D.
http://www.fertstert.org/article/S0015-0282(98)00089-2/abstract

The main findings suggest that infertile women have a different personality profile in terms of more suspicion, guilt and hostility as compared to the fertile controls, perhaps as a response to their infertility. Their stress levels in terms of circulating prolactin and cortisol levels were elevated compared to the fertile controls. Psychological stress may affect the outcome of IVF treatment since state anxiety levels among those who did not achieve pregnancy were slightly higher than among those who became pregnant.

Acta Obstetricia et Gynecologica Scandinavica – Volume 79, Issue 2, pages 113–118, February 2000
GYÖRGY CSEMICZKY, BRITT-MARIE LANDGREN, AILA COLLINS
http://dx.doi.org/10.1034/j.1600-0412.2000.079002113.x

Psychological factors such as depression, state-anxiety, and stress-induced changes in heart rate and cortisol are predictive of a decreased probability of achieving a viable pregnancy. A couple that is trying to conceive will undoubtedly experience feelings of frustration and disappointment if a pregnancy is not easily achieved. However, if the difficulties progress and the man and or woman are labelled as having fertility problems, then this may result in a severe insult to self-esteem, body image, and self-assessed masculinity or femininity. Three types of relationships have been hypothesized between psychological factors and infertility. These include: (1) psychological factors are risk factors of subsequent infertility; (2) the experience of the diagnosis and treatment of infertility causes subsequent psychological distress; (3) a reciprocal relationship exists between psychological factors and infertility. The evidence for these three relationships is reviewed and an alternative approach to the treatment of infertility including stress evaluation that precedes or is concurrent to fertility treatment is suggested.

European Journal of Obstetrics & Gynecology and Reproductive Biology – Volume 117, Issue 2 , Pages 126-131, 1 December 2004
J. Cwikel, Y. Gidron, E. Sheiner
http://www.ejog.org/article/S0301-2115(04)00257-X/abstract

Depressive and anxiety disorders were highly prevalent among women who visited an assisted reproduction clinic for a new course of the treatment. Demographic features and a history of previous assisted reproduction treatment were not risk factors for these psychiatric morbidities in the assisted reproduction clinic.

Oxford Journals Medicine Human Reproduction Volume 19, Issue 10Pp. 2313-2318
Chen TH, Chang SP, Tsai CF, Juang KD.
http://humrep.oxfordjournals.org/content/19/10/2313

Couples who conceived during their first cycle of IVF had significantly higher measures of need for parenthood and loss of sexual enjoyment, compared with couples who did not conceive. Couples who achieved ongoing pregnancies had higher scores on measures of a negative view of a child-free lifestyle, need for parenthood, and total stress than those who did not.

Fertility and Sterility – Volume 88, Issue 3 , Pages 714-717, September 2007
Brian C. Cooper, M.D.email address, Judith R. Gerber, Ph.D., Amy L. McGettrick, B.S.N., R.N., Julia V. Johnson, M.D.
http://www.fertstert.org/article/S0015-0282(06)04708-X/abstract

Expression of negative emotions predicts depression levels and outcome in IVF. This cause of infertility should be taken into account when investigating the relation between psychologic functioning and outcome in IVF.

Fertility and Sterility – Volume 69, Issue 6 , Pages 1026-1033, June 1998
Koen Demyttenaere, M.D., Ph.D., L Bonte, M.Sc., M Gheldof, M.Sc., M Vervaeke, M.Sc., C Meuleman, M.D., D Vanderschuerem, M.D., Ph.D., T D’Hooghe, M.D., Ph.D.
http://www.fertstert.org/article/S0015-0282(98)00089-2/abstract

The Eastern Body-Mind-Spirit group intervention approach effectively reduces the anxiety level of women undergoing IVF treatment. Compared with the control group, the intervention group had a significant drop in State Anxiety mean score following intervention. A comparable number of embryos were transferred for each group, but there was a nonsignificant trend of a higher pregnancy rate in the intervention group.

Fertility and Sterility – Volume 85, Issue 2 , Pages 339-346, February 2006
Celia H.Y. Chan, M.S.W.email address, Ernest H.Y. Ng, M.D., Cecilia L.W. Chan, Ph.D., P.C., Ho, M.D., Timothy H.Y. Chan, B.Cog.Sc.
http://www.fertstert.org/article/S0015-0282(05)03690-3/abstract

Acute and chronic stress affected biologic end points (i.e., number of eggs retrieved and fertilized), as well as pregnancy, live birth delivery, birth weight, and multiple gestations.

Fertility and Sterility – Volume 76, Issue 4 , Pages 675-687, October 2001
Hillary Klonoff-Cohen, Ph.D.email address, Elaine Chu, M.D., Loki Natarajan, Ph.D., William Sieber, Ph.D.
http://www.fertstert.org/article/S0015-0282(01)02008-8/abstract

Fertility problem stress was associated with a poorer treatment outcome in women and men. Logistic regression indicated that women who reported more marital distress required more treatment cycles to conceive (median 3) than women reporting less marital distress (median 2). The findings provide evidence that infertility-related stress has direct and indirect effects on treatment outcome.

Fertility and Sterility – Volume 83, Issue 6 , Pages 1745-1752, June 2005
Jacky Boivin, Ph.D.email address, Lone Schmidt, Ph.D.
http://www.fertstert.org/article/S0015-0282(05)00408-5/abstract

Infertile women showed significant increases in trait anxiety and depressive symptoms than the fertile women. Anxiety and depression in the in vitro fertilization(IVF)-failed women were significantly higher than the IVF-success women. We must pay an attention to the infertile patient, especially from the initial infertility workup. We recommend psychological counselling for IVF-failed patients.

Journal of Assisted Reproduction and Genetics – 20000900, Volume 17, Issue 8, pp 445-448
BAIK SEOK KEE, BYEONG JUN JUNG, SANG HOON LEE
http://link.springer.com/article/10.1023/A%3A1009417302758

Data validates the concept of a “stressed couple”. Adverse implications of a couple’s psychological distress (i.e. higher pessimism and dysphoria resulted in longer duration of controlled ovarian hyperstimulation and lower fertilization rates) are suggested. Partner’s depressive scores correlated with IVF failure.

Journal of Assisted Reproduction and Genetics – September 2013
Hayley S. Quant, Athena Zapantis, Michael Nihsen, Kris Bevilacqua, Sangita Jindal, Lubna Pal
http://link.springer.com/article/10.1007/s10815-013-0098-7

CONCLUSION(S): Stress significantly reduced the probability of conception each day during the fertile window, possibly exerting its effect through the sympathetic medullar pathway.

OBJECTIVE: To assess salivary stress biomarkers (cortisol and alpha-amylase) and female fecundity.

DESIGN: Prospective cohort design.

SETTING: United Kingdom.

PATIENT(S): 274 women aged 18 to 40 years who were attempting pregnancy.

INTERVENTION(S): Observation for six cycles or until pregnancy: women collected basal saliva samples on day 6 of each cycle, and used fertility monitors to identify ovulation and pregnancy test kits for pregnancy detection.

MAIN OUTCOME MEASURE(S): Salivary cortisol (mug/dL) and alpha-amylase (U/mL) concentration measurements; fecundity measured by time-to-pregnancy and the probability of pregnancy during the fertile window as estimated from discrete-time survival and Bayesian modeling techniques, respectively.

RESULT(S): Alpha-amylase but not cortisol concentrations were negatively associated with fecundity in the first cycle (fecundity odds ratio = 0.85; 95% confidence interval 0.67, 1.09) after adjusting for the couples’ ages, intercourse frequency, and alcohol consumption. Statistically significant reductions in the probability of conception across the fertile window during the first cycle attempting pregnancy were observed for women whose salivary concentrations of alpha-amylase were in the upper quartiles in comparison with women in the lower quartiles (highest posterior density: -0.284; 95% interval -0.540, -0.029).

Conclusions: .Previous unpublished work at BCRM showed that 85% of the patients found the named nurse system important as a coping mechanism to support them by providing continuity of care through stressful treatment. The responses to the questionnaires indicate a clear demand for acupuncture and suggest that acupuncture may be valuable to improve the general wellbeing of women during infertility investigations and treatments. If acupuncture provides an effective coping mechanism, this could support patients to persevere with increased numbers of ART(Assisted Reproductive Technologies) cycles, thereby increasing their ultimate chance of a successful pregnancy.

Introduction.Despite a lack of studies clearly demonstrating clinical efficacy complementary medicine is frequently used by couples undergoing infertility treatment (Coulson 2005). In Bristol, acupuncture has become very popular among patients undergoing infertility treatment, thus this study sought to quantify this and examine the reasons why patients choose acupuncture.

Methods.Two hundred questionnaires were given to patients who attended the Bristol Centre for Reproductive Medicine (BCRM) for investigation or treatment of infertility in August 2009. Patients were asked to complete the questionnaire while waiting to see their doctor or nurse and 194 responses were returned. The questionnaires asked if patients had or wished to have acupuncture or other complementary medicine, and to indicate on a scale of one to ten (10 being the best) the relative importance of acupuncture in comparison to values such as pregnancy rates and continuity of care.

Results.Out of 58 respondents who use complementary medicine, 43 used acupuncture. 40 respondents use acupuncture regularly and 17 of those lived outside of Bristol. A further 52 respondents had considered using acupuncture. In terms of very high importance (score of 10) 135 respondents felt pregnancy rates scored 10, 84 felt having the same doctor scored 10, 71 scored 10 for having the same nurse, 31 felt in house acupuncture scored 10 and 21 scored 10 for other complementary medicine. Overall, 43 respondents felt acupuncture should be available at Bristol Centre for Reproductive Medicine. Thirty four respondents gave more importance to acupuncture than seeing the same doctor or nurse, and 32 deemed it equally important. In addition, 29 patients scored acupuncture as equally important to pregnancy rates and 5 scored acupuncture higher than pregnancy rates.

Conclusion
This preliminary exploration, whilst confined to a small sample of women, confirms that acupuncture is indeed perceived by infertile women to have an impact to their health. All findings outlined here are reported cautiously because they are limited by the size of the sample. They suggest that further studies of acupuncture as an adjunct to IVF should systematically explore the issues of wellbeing, anxiety, personal and social resilience and women’s identity in relation to sexuality and reproduction.

Background
In Vitro Fertilisation (IVF) is now an accepted and effective treatment for infertility, however IVF is acknowledged as contributing to, rather than lessening, the overall psychosocial effects of infertility. Psychological and counselling interventions have previously been widely recommended in parallel with infertility treatments but whilst in many jurisdictions counselling is recommended or mandatory, it may not be widely used. Acupuncture is increasingly used as an adjunct to IVF, in this preliminary study we sought to investigate the experience of infertile women who had used acupuncture to improve their fertility.

Methods
A sample of 20 women was drawn from a cohort of women who had attended for a minimum of four acupuncture sessions in the practices of two acupuncturists in South Australia. Eight women were interviewed using a semi-structured questionnaire. Six had sought acupuncture during IVF treatment and two had begun acupuncture to enhance their fertility and had later progressed to IVF. Descriptive content analysis was employed to analyse the data.

Results
Four major categories of perceptions about acupuncture in relation to reproductive health were identified: (a) Awareness of, and perceived benefits of acupuncture; (b) perceptions of the body and the impact of acupuncture upon it; (c) perceptions of stress and the impact of acupuncture on resilience; and (d) perceptions of the intersection of medical treatment and acupuncture.

Conclusion; Acupuncture is an effective and low intensity procedure for increasing women’s resilience in the repetitive and stress inducing time of pregnancy attempts, with or without medical treatment. The instrumental role of the acupuncture therapist in increasing resilience is a finding that has not emerged in previous studies and has implications for patient management.

Aim: There is interest in the use of acupuncture as an adjunct to fertility treatment. this study aimed to examine women’s attitudes and beliefs in relation to the use of acupuncture for enhancing fertility or as an adjunct to ART.

Results: Participants all expressed confidence in the ability of acupuncture to contibute to their reproductive decision in a positive way. They described acupuncture as an adjunct to pregnancy attempts that was positive since it gave them a sense of control and a strategy for improving their chances. Women were unable to locate acupuncture as a causative factor in a resulting pregnancy however all women described acupuncture as instrumental in an increased sense of well being, self confidence, emotional balance and reduced anxiety. All experienced increased resilience.

Conclusions(s): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

Patient(s): 57 infertile patients undergoing IVF or IVF/ICSI.

Interventions(s): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.
Main outcome measure(s): Perceive Stress Scale scores, pregnancy rates.

Result(s): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status.