Acupuncture, Infertility and IVF.
Acupuncture is now frequently used by Irish women as an adjunct to IVF fertility treatment. Many women use acupuncture to help maximise their chances of conceiving, either before, during or indeed independently of IVF.
Recently, research has been published to demonstrate acupuncture’s role in helping increase success rates of IVF. The research, which was published in the British Medical Journal of 7/2/08, stated that “acupuncture increased the odds of clinical pregnancy by 65% compared to the control groups”. The study looked at 1366 women who were undergoing IVF infertility treatment and had acupuncture treatments around the time of embryo transfer.
It seems logical to assume that if acupuncture can benefit a couple’s chances of conceiving while undergoing IVF, it should also be beneficial to fertility generally. Indeed, in my own practice more and more women are using acupuncture to help with fertility and fertility related issues without necessarily being on an IVF programme.
My own approach is to use acupuncture and Chinese herbs to enhance the chances of conception by preparing the body as much as possible, in the weeks and months prior to conception. To do this the acupuncture points are selected during each treatment in accordance with the menstrual cycle. For example coming up to the period, points will be used that will encourage the gentle movement of blood and qi (energy), while after the period, points that are aimed at replacing the ‘lost menstrual blood’ may be used. This approach is then modified depending on the particular imbalances seen in the individual person and her particular circumstances (e.g. perhaps there may be menstrual irregularities to address like heavy or light periods or clots etc.). Other specific protocols can also be used when someone is undergoing IVF treatment. Chinese herbal medicine may also be used.
Promote an efficient menstrual bleed
In traditional Chinese medicine the menstrual bleeding reflects the quality of the uterine lining. This lining appears important for implantation as women with poor endometrial development have an association with IVF failure or recurrent miscarriage.
Chinese medicine aims to increase the thickness and quality of this lining, it does this through promoting corpus luteal function (which in turn produces progesterone) and through its documented action of increasing blood flow to the. Ideally it is expected that a woman will experience menstrual bleeding for at least 3 to 5 days and that this blood flow will be red in colour without any clotting or flooding.
Enhance egg development.
While the genetic material for a woman’s eggs are created when the woman is herself an embryo, the process of the egg maturing comes under the influence of her hormones.
Clinically it also appears possible to influence the integrity of the eggs released following acupuncture treatment, this may be due to increasing the blood supply to the developing follicles or by increasing the nutritional supply to the egg via the fluids that surround and nourish it.
Enhance the internal environment of the fallopian tubes.
Traditional Chinese medicine aims to improve the elasticity and the secretions of the fallopian tubes, facilitating the passage of the fertilised egg into the uterus.
Promote embryo implantation
In a study acupuncture used during IVF at the time of egg retrieval and embryo resulted in a significantly higher viable pregnancy rate. (Fertility and Sterility 74(4):721-72). In this study 160 women undergoing IVF were monitored. The success rate in the acupuncture group was 42.5% compared to a 26.3% success rate in the group of women that did not receive acupuncture.
In a study of 114 women at the Reproductive Medicine and Fertility Centre in Colorado Springs (American Society for Reproductive Medicine (ASRM) October 2004) half of the women received acupuncture prior to and following embryo replacement.
The women who received acupuncture had a 51% pregnancy rate compared to 36% in control group and a 08% miscarriage rate compared to 20% in control group.
Acupuncture also was found to reduce the risk of tubal pregnancy and increase the live birth rate. The live birth rate for each IVF cycle was 23 % higher than the cycles for the control group.
Promote a viable pregnancy
Traditional Chinese medicine can be used in the early stages of pregnancy to help promote maternal and fetal well being. There are treatments to aid with any problems during pregnancy (such as morning sickness, breech presentation, anemia, babies that are small for their gestational age, blood pressure problems and muscular skeletal pain), as well as treatment protocols to prepare for childbirth and if necessary to promote induction.
Preconception fertility care is based on helping your body produce the healthiest eggs and sperm possible. In a woman it takes approximately 100 days for the egg to develop towards ovulation and in the male it’s approximately 116 days for sperm production to be completed. A proactive way to utilize this time involves couples adapting a healthy diet and environment in the months prior to a possible conception. Although the focus is often on women in fertility issues, the reality is that men share 50% of the responsibility in the creation of a healthy embryo.
25 % of infertility is calculated to be directly due to the male partner
It is important to note that a population study looking at men’s fertility found that those men that succeeded in fathering a child had a motility rate of more than 63%.
Sperm is evaluated into the following categories;
- aspermia (absence of ejaculate)
- asthenospermia (poor motility and forward movement)
- azoospermia (absence of sperm in semen)
- oligospermia (lowered sperm density)
- teratospermia (containing bizarre and immature forms)
- antisperm antibodies
The role of the male partner also needs be taken into account and any of his deficiencies or imbalances may also need to be addressed. This can also be done with acupuncture and or herbs. The main aim is to have both partners as healthy as possible in order to produce healthy sperm and eggs, before conception.
Improve sperm quality
Normal sperm count values are currently given as;
- Greater than 20 million sperm per ml
- greater than 50% of sperm moving vigorously (motility)
- greater than 14 % with no deformities (morphology).
A population study looking at men’s fertility found that those men that succeeded in fathering a child had;
- Greater than 48 million sperm per ml
- a motility of more than 63%
- a normal morphology of 12% (New England Journal of Medicine 345(19):1388-1393).
This study indicates the importance of men achieving the highest sperm count and motility possible.
Acupuncture & Sperm problems
In a study involving 40 men with sperm problems of unknown origin (oligospermia, asthenospermia, or teratozoospermia) acupuncture was used on 28 men twice a week for 5 weeks and compared to the men who received no treatment. Quantitative analysis by transmission electron microscopy (TEM) was used to evaluate the samples.
Following acupuncture, a statistically significant increase in the percentage and number of sperm in the total ejaculate was observed (in comparison with controls), with improvements in the shape of the acrosome and nucleus.
The median percentage of progressive motility in ejaculate increased from 44.5% to 55% following acupuncture treatment.
No change in specific pathologies, such as apoptosis (cell death), necrosis (dead or motionless spermatozoa) or sperm immaturity, however, was apparent.
The authors concluded that “In conjunction with ART or even for reaching natural fertility potential, acupuncture treatment is a simple, noninvasive method that can improve sperm quality.”