Acupuncture provides hope of conceiving for women with premature ovarian failure

When women reach age 45, their ovaries may stop functioning. There is no egg supply and no ovulation. Hormone levels are changing. This is so called menopause. The signal for arrived menopause is stopped period which indicates the end of fertile life in a woman. This is a stage that every woman has to go through. For some women, their ovaries stop working before 40 years old. This is called premature ovarian failure (POF), or primary ovarian insufficiency (POI), or premature menopause or hypergonadotropic hypogonadism. POF is the result of premature exhaustion of the follicle pool or follicular dysfunction, such as due to mutations in the follicle-stimulating hormone (FSH) receptor. This is a common condition, affecting 1-2% women younger than 40 years of age and 0.1% of women younger than 30 years of age. The cause for POF could be genetic, because there is family history found in 10-20% women with POF. It also could be due to poor ovarian blood supply. Autoimmune damage could contribute to the cause of POF. Ovaries could be damaged by cancer therapies.

The main symptoms of POF include no regular periods, low blood oestrogen level and high FSH under the age 40. Anti-Mullerian hormone (AMH) level is low. Oestrogen is produced by follicles and its blood level is low if follicles are short of supply or dysfunctional. FSH is produced in the pituitary gland at the base of the brain and it stimulates follicles growing. If a woman is running out of eggs in ovaries in the case of POF, resulting in low level of oestrogen, the pituitary gland will work hard to produce more FSH in order to stimulate ovaries to make more good eggs. AMH is a substance produced only in small ovarian follicles and its level is quite constant correlating strongly with the number of growing follicles. Since this hormone is not dependent on hypothalamic-pituitary-gonadal axis function and decreased to undetectable level at menopause, it could potentially help assess remaining function of ovaries and egg supply.

Women with POF could experience menopause symptoms, for instance hot flushes, night sweats and vaginal dryness, similar to those going through a natural menopause. POF could result in many health problems, such as osteoporosis, heart diseases etc. Associated with the development of POF is the loss of fertility, which in most cases is due to the absence of follicles, and in other cases the inability of remaining follicles to respond to stimulation. For most women, there are no obvious signs before the stop of periods. Most women have a normal period history, and possibly fertility before the start of POF symptoms. A common presentation is for women to fail to resume period after a pregnancy or after stop of taking oral contraceptive pills. For most of women, it is a deeply upset diagnosis not only with unpleasant symptoms, but also with infertility. It may have a huge psychological impact on those diagnosed this condition. Infertility is a significant issue for most women with POF, though many women may ovulate at some points, this cannot be predicted with any reliability.

There are treatments that can help some of the symptoms; however women with POF are unlikely to get pregnant without treatments because their ovaries do not work properly. There is no proven medicine to improve a woman’s ability to get pregnant, if she is diagnosed with POF. A number of treatment regimens have been evaluated with the aim of restore fertility; however, treatments with clomiphene, gonadotrophins, GNRH agonists or immunosuppressants do not significantly improve the chance of conception and are not used. Use of donor eggs is only a reliable option from Western medicine point of view. Is there really nothing you can do apart from accepting that you will no longer have a chance to have a child naturally with your own eggs? Why not try acupuncture? There is a chance to conceive naturally with acupuncture treatment.

According to traditional Chinese medicine (TCM) theory, POF is mainly caused by kidney qi deficiency. Liver and spleen qi deficiency may also contribute. Qi deficiency causes blood stagnation and blockage of channels resulting in ovaries losing function. Acupuncture unblocks the channels and restores qi flowing and blood supply to ovaries. From western medicine point of view, acupuncture improves function of hypothalamic-pituitary-ovarian axis regulating blood hormone levels; acupuncture increases ovarian blood flow improving ovarian function. Acupuncture also regulates nervous system function.

There was a case report in Chinese acupuncture website about effectiveness of acupuncture treatment for POF. There were 76 patients aged from 26-40 with POF diagnosis for 1-9 years. These cases were treated from 1990-1996. Acupuncture treatment was given for 6 months. 68% patients restored normal period, ovulation or pregnancy. FSH level decreased to normal and oestrogen level increased significantly.

Recently research provided evidence of effectiveness of acupuncture on POF. Kehua Zhou et al investigated the effects of acupuncture on FSH, oestrogen (E2) and LH in women with POF. They also studied the menstruation changes in these women. They recruited 11 women with diagnosed POF for 4 months to 10 years. Ages of these women were from 25-39. These women had no menstrual period for at least four months or longer. They had high FSH over 40 iu/l. Before acupuncture treatment, they stopped all medications that possibly affect hormones. After the treatments, there was three month follow-up. Assessments were done before the treatment, at the end of three month treatment and at the end of three month follow-up. They found that after acupuncture treatment, E2 increased while FSH and LH decreased which last at the end of three month follow-up. 10 out of 11 patients resumed menstruation; 9 of them still had menstruation at the end of follow-up. Other symptoms such as night sweating, hot flashes and mood swings were reduced during acupuncture treatments and at the end of follow-up.

The advantage of acupuncture treatment for women with POF is that it is not only effective for improving symptoms caused by POF, but also increases fertility.

References
http://www.wfas.org.cn/lunwen/wfas10/200709/1055.html
Kehua Zhou et al Evid Based Complement Alternat Med (2013) 2013: 657234 Published on line 2013 Feb 28