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Maggie Ju (2014) Current opinion in acupuncture on stroke rehabilitation
The Journal of Chinese Medicine And Acupuncture Volume 21 Issue 2 September 2014 P9
Maggie Ju. (2015) What Part Does Acupuncture Play in IVF?
The Journal of Chinese Medicine And Acupuncture Volume 22 Issue 1 March 2015 P21
Maggie Ju (2020) The Potentiality of COVID-19 Treatment with Chinese Herbal Medicine in the UK
The Journal of Chinese Medicine And Acupuncture Volume 27 Issue 2 November 2020 P9
Thursday, 1 March 2018
IVF embryo transfer, acupuncture helps embryo implantation
If an egg is fertilised, it will be transported to the uterus and it will be implanted into uterine endometrium. Within the uterus, the foetus develops during pregnancy.
Endometrium is the inner lining of uterus. It goes cyclic changes responding to ovarian hormone oestrogen and progesterone levels and sheds off each month with new endometrial lining replaced, if the egg is not fertilised. If pregnancy occurs, the endometrium will retain. After ovulation, the uterine endometrium becomes thicker to prepare for embryo implantation. If endometrium is not thick enough (less than 6 cm), implantation does not occur. If the thickness of endometrium is greater than 12 cm, there were three times more chances to get pregnant. To get embryo implanted, there must be a receptive uterus. Ovarian hormones oestrogen and progesterone are involved in regulating uterine lining and receptivity. Uterine smooth muscles tend to contract especially at low progesterone level. Increased progesterone level makes uterus more relaxed. The thickness of endometrium and contractility of uterine smooth muscles are the key factors for the uterus becomes receptive.
When an egg is fertilised by a sperm, an embryo is formed and developing. At the same time, there are also changes in the uterus to prepare the arrival of the embryo. When an embryo arrives at the uterus, it will implant into uterine wall. A successful implantation depends on the synchronous development of both the endometrium and embryo. Uterine inner lining gets thicker, uterine smooth muscles are relaxed after ovulation. There is also communication between the uterine cells and the embryo to get the best time of implantation. Delayed implantation time will lead to implantation failure or miscarriage. During the development of uterine inner lining uterine blood circulation is the key factor to get ready for implantation. After embryo implanted, the embryo initially takes nutrients and oxygen from maternal blood circulation system and removes the waste via maternal blood circulation system. Good uterine blood circulation is essential for early stage of embryo development. To improve uterine blood circulation, acupuncture is the best candidate. Since a decade ago, acupuncture was suggested that it increases uterine blood flow. This will help embryo implantation and embryo development in the uterus. Acupuncture can help uterine receptivity by regulating hormone balance, increasing uterine blood flow, improving uterine lining and relaxing the uterine smooth muscles. Whether you like to get pregnant naturally or via IVF, acupuncture can help your uterine receptivity to increase your chance to get pregnant and stay in pregnancy.
Age and uterine receptivity
Women’s fertility is declining with advanced age which is attributed to declining of egg quality. A significant low success rate in IVF is an example. Success rate could be 48.8% for women younger than 30 years old while in comparison to 13.6% in women with 42 years old. Embryo implantation rates also decline in a linear fashion, from 29% in women younger than 34 years to approximately 5% at age 42. Apart from egg quality what other factors contribute to this change? This could be because of poor uterine receptivity in women with advanced age. This was suggested that in the case of egg donation, there was also low pregnancy rate in women with increased age.
Conditions of the uterus that affect uterine receptivity
Luteal phase deficiency (LPD) is a condition in which there is either no enough progesterone production or poor endometrial response. This is a major cause of infertility and recurrent pregnancy loss. In luteal phase defect, there is no enough progesterone produced which shows either low progesterone or too much fluctuation of progesterone levels. Or the uterine endometrium does not respond well to the progesterone stimulation because of lack of progesterone receptors or lack of cell surface adhesive proteins. There is poor endometrial development or delayed endometrial development, as a consequence, uterine receptivity is poor and the embryo loses its chance to implant.
Uterine endometrial tissues grow outside of uterus. Women with endometriosis were found to have decreased fertility. Poor egg development and poor egg quality, impaired fertilization lower the embryo ability to implant. Also failing to respond to progesterone well makes their uterine endometrium less receptive.
Hydrosalpinx is distally blocked, dilated, fluid-filled fallopian tube caused by infectious diseases. Women with haydrosalpinx have difficulty to get pregnant. Tube blockage is not the only factor that is contributed to the cause. Women with hydrosalpinx have lower implantation, pregnancy and delivery rates and a higher incidence of spontaneous miscarriage after IVF–embryo transfer compared with women with tubal infertility of other causes. The inflammation of the tubes could spread to the uterus and make inflammatory environment in the uterus.
Uterine fibroids are the most common uterine benign tumours in women of reproductive age. They can distort the uterine cavity or obstruct the fallopian tubes or cervical canal affecting women’s fertility. They may also change uterine receptivity and cause infertility.
Endometrial polyps are benign, localized overgrowths of endometrium. It may affect infertility by mechanically disrupting the transport of sperm and embryo and making endometrium not responding to progesterone.
Polycystic ovarian syndrome (PCOS)
PCOS is a common endocrinological disorder in women of reproductive age. Infertility associated with PCOS is mainly because there is no ovulation or less frequent ovulation. When ovulation was introduced by drugs in women with PCOS, implantation rates are lower than fertile controls and early pregnancy loss rates are increased which suggested that implantation failure is also contributing to the causes. The hormone imbalance in women with PCOS makes the endometrium less receptive.
Chronic endometritis causes prolonger inflammation in endometrium and affects endometrial receptivity which is associated with infertility and implantation failure.
Acupuncture assists IVF to improve live birth rate
In vitro fertilization (IVF) is a costly treatment option for those with infertility. Acupuncture as a complementary technique is applied to assist IVF and increase its success rate. Many researches assessing the effect of acupuncture during IVF were performed. They showed that acupuncture increased pregnancy rate and live birth rate by supporting IVF. But the methods used were varied. Recently a clinical trial protocol of effectiveness of acupuncture to improve live birth rate for women undergoing IVF was published. Smith CA et al conducted a randomized controlled trial to evaluate the effectiveness of acupuncture on assisting IVF. They will recruit women with infertility younger than 43 years of age undergoing IVF or intracytoplasmic sperm injection (ICSI). The treatment protocol will be used. The initial diagnosis and treatment will take 60-90 minutes on days 6-8 of the stimulated IVF cycle. Two treatments will be given immediately before and after embryo transfer (ET). Patients are divided into three groups. 2 plaebo control: This group will be given placement of non-invasive sham needles. Duration of needling and treatment session is the same as for the acupuncture group. 3 usual care only group: they will receive standard care only. Live birth and pregnancy outcome will be analysed. The research will provide significant evidence for evaluate the effectiveness of acupuncture for assisting IVF.
Luteal phase acupuncture increased pregnancy rate
Dieteril S et al studied the effect of acupuncture on the outcome of in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Patients with infertility undergo IVF/ICSI. 116 patients received luteal phase acupuncture and 109 patients were in control group receiving placebo acupuncture. They found that the clinical pregnancy rate and ongoing pregnancy rate in acupuncture group were 33.6% and 28.4% respectively which was significantly higher than those for the control group (15.6% and 13.8% respectively). Receiving luteal phase acupuncture is positive for increasing pregnancy rate of IVF and ICSI.
Smith CA et al Trials (2012) 18:13:60
Dieterle S et al Fertil Steril (2006) 85:1347-51
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