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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
Sunday, 12 February 2017
Fertility acupuncture for women and men
Infertility is a disorder of reproductive system and it is when a couple failed to achieve a clinical pregnancy after 12 months or more of regular unprotected sex. Getting pregnant for some couples is natural, but for others it becomes difficult. Due to delayed child bearing age, environmental changes, and other reasons, one in seven couples have difficulty to conceive in the UK. After years of trying and no cause found, they could be put on IVF treatment straight away. In 2011, 48,147 women had a total of 61726 cycles of IVF or ICSI in the UK. Is there any other less invasive treatment available to help these couples to conceive?
Acupuncture is an alternative way to treat couples with infertility. Acupuncture is called ancient art. The use of acupuncture treatment in couples seeking fertility care is dramatically increased in last decades. A survey in the US has shown that one in five couples with infertility have tried acupuncture over 18 months of observation period. In the UK treatment for infertility with acupuncture increased fivefold in 10 years time. In Switzerland, Germany and Austria, one third of the fertility centres offer acupuncture treatments. If you are seeking IVF treatment for your fertility, acupuncture treatment as an adjunct treatment helps you to achieve best IVF success rate.
Fertility acupuncture, how does it work?
Is there scientific ground for the application of acupuncture on infertility treatment? Or is it only based on ancient theory? Or is it like some people thinks: acupuncture will work, if I believe it. As a matter of fact, there were many research data available to support this application. Since 1990s, much research has been done in animal experiments and clinical trials. Based on recent research evidences, it is suggested that for women acupuncture mediates endogenous opioid peptides in the central nervous system affecting fertility hormone balance; it increases uterine artery blood flow; it reduces inflammation; and it reduces stress which affects fertility hormone balance. Acupuncture also relaxes fallopian tubes. As a result, it could help improving egg production and egg quality and improving uterine receptivity and embryo implantation. Consequently reproductive health is improved and there is better chance to get pregnant. Acupuncture also helps improving men’s fertility. Research data on this aspect start emerging and suggested that acupuncture can increase sperm counts and improve sperm quality by improving testicular blood flow and reducing inflammation.
If you are interested in TCM (Traditional Chinese Medicine) idea, any blockage of Qi in the body will cause illness in TCM theory. Acupuncture acts at the specific acupuncture points in the meridians and clears off the blockage and makes Qi flowing freely in the body, as a result the organs will function well again. This improves your fertility as well as your overall health.
Acupuncture helps your fertility return after stop contraception methods
Women are fighting not to get pregnant and then fighting to get pregnant. When you start using contraception methods do you ever think about that your fertility will return when you stop? What is the chance to get pregnant, if you want to? A research has shown that women who stopped using a barrier method to achieve a planned pregnancy conceived most quickly: 54% were delivered after one year vs 39% of intrauterine device and 32% of oral contraceptive users. There was no association between fertility and duration of oral contraceptive use: However, short term intrauterine device users (< 42 months) showed a fertility pattern more favourable than seen in those discontinuing oral contraceptives, with increasing duration of intrauterine device use being associated with decreasing fertility. The fertility of women who had used the intrauterine device for 78 + months was the most impaired (28% were delivered by 12 months vs 46% of short term users). What is the chance to get pregnant, if you don’t have fertility problem? 92% will get pregnant during one year at ages 19-26 and 82% will get pregnant during one year at ages 35-39.
Do you know that acupuncture improves ovarian and uterine blood circulation and helps with your return of fertility, after you stop discontinuing contraception methods?
Stress affects fertility in both female and male and acupuncture reduces infertility related stress
Psychological stress is strongly associated with infertility. Infertility itself is stressful, due to the pressures, testing, diagnosis, treatments, failures, endless waitings and associated economic costs. There is an association between stress and infertility. Infertility causes stress and stress (both acute and chronic) may cause infertility. Stress can increase after diagnosis of infertility, follow-up appointments, and failed IVF treatments. Coping with various life styles also affects fertility.
Psychological stress affects 30% of women who attend infertility clinics, possibly due in part to infertility diagnosis and treatments. Women with infertility experience emotional stress. They tend to keep things to themselves and delay starting the treatments because of a desire to conceive naturally. This does not happen and makes them very stressed which turn to have negative impact to their fertility. There is a link between infertility and psychological distress. Greil et al studied the variation of fertility specific distress (FSD) associated with different types of infertility. They found that women with infertility have intention to have a child and seek treatment have higher levels of FSD than those women without intention to have a child and don’t seek treatment. Women with primary infertility (They have no prior pregnancy) have higher level of FSD than those women with secondary infertility (They have had at least once prior pregnancy with or without live birth. Older women with infertility tend to have higher distress level than younger women. General distress doesn’t vary between different types of infertility. A study of 430 couples on association between stress and conception showed that decreased conception occurred in those most stressed women. Women received treatment showed less stress and more hopeful. Fertilization of oocytes also decreased when stress increased. Stress acts through different mechanisms, not only by inhibiting the HPA axis but also by altering the concentration of fertility hormones (FSH, GnRH and LH) as well as other substances such as cortisol, opioids and melatonin. It alters the follicular levels of glucocorticoid hormones. The blood flow in the fallopian tubes could be reduced.
Males who experienced more than two stressful life events before undergoing infertility treatment were more likely to be classified below WHO standards for sperm concentration, motility, and morphology. Stress such as a job, life events, and even social strain were seen to have a significant impact on sperm density, total sperm counts, forward motility and morphology. Semen parameters may potentially be linked to stress. Actively coping with stress, such as being assertive or confrontational, may negatively impact fertility by increasing adrenergic activation, leading to more vasoconstriction in the testes. This vasoconstriction results in lower testosterone levels and decreased sperm production. Stress and depression are linked to reduce testosterone and luteinizing hormone (LH) pulsing, disrupt gonadal function, and ultimately reduce spermatogenesis and sperm parameters.
Very recently there was a study about stress on male fertility. This study evaluated the effect of psychological stress on male fertility hormones and seminal quality in male partner of infertile couples. Seventy male partners of infertile couples were evaluated for level of psychological stress using Hospital Anxiety and Depression Score (HADS) questionnaire, serum total testosterone, luteinising hormone (LH) and follicle-stimulating hormone (FSH) by electrochemiluminescence assay and serum GnRH by ELISA. Seminal analysis was performed. 27% of them had HADS anxiety and depression score ≥8 which was abnormal HADS score showing stress condition. The persons having abnormal HADS had lower serum total testosterone, higher serum FSH and LH than those of persons having normal HADS. Serum total testosterone correlated negatively with HADS. Sperm count, motility and morphologically normal spermatozoa were lower in persons having abnormal HADS. Abnormal sperm motility and morphology were related to lower testosterone and higher LH and FSH levels. This study suggested that psychological stress affects male fertility and sperm quantity and quality.
Stress is also accompanied with fertility treatment. Before start of treatment such as IVF, fear of failure makes women stressed. Unsuccessful treatment raised stress level, while success treatment makes negative emotion disappeared. Studies found that high stress level reduced IVF success rate and live birth rate. Higher stress level during egg collection and embryo transfer was found in women failed IVF cycles than those who achieved pregnancy in IVF cycles. As mentioned above stress affects women’s fertility. Stress affects the hypothalamic-pituitary-adrenal axis (HPA) altering hormones including CRH, ATCH and cortisol production. These hormones also mediate hypothalamic-pituitary-gonadotropic axis (PG) which is an axis regulating sexual hormone secretion. As a result follicle stimulating hormone (FSH) and luteinizing hormone (LH) level decreased which affects fertility. Coyle M and Smith C conducted a survey to study the health status for women undergoing ART and examined the relationship between health status, traditional Chinese medicine (TCM) and Western medicine diagnosis underlying the cause for their infertility. Women with infertility undergoing ART were recruited and health was checked by TCM and western medicine questionnaire. They found that mental health status not physical function for these women was lower than that for general population. For TCM diagnosis, Qi and blood stagnation was common. And these women tend to have low score in the health questionnaire.
Stress management and stress reduction should be an important part of the infertility management. Lower stress levels improves female and male natural fertility and lower stress levels result in better fertility treatment outcome. Acupuncture is a useful treatment for reducing fertility related stress in female and male.
In vitro fertilisation (IVF) provides great chance for those couples who have difficulty to conceive. However IVF does not always produce pregnancy, actually the success rate is not high. It can be physically and emotionally challenging. Isoyama et al studied the effect of acupuncture on symptoms of anxiety in women undergoing IVF. 43patients participated in the study. 22 patients were in acupuncture group while 21 patients were in the control group. The anxiety level of each patient was analysed before and after treatment. Four weekly sessions were performed. Acupuncture points including HT7, PC6, CV17, GV20 and Yingtang were used for the needling. Their result showed that after 4 week treatment the anxiety score for acupuncture group was significantly lower than for the control group. This indicated that acupuncture can reduce anxiety symptoms in women undergoing IVF.
There is perceived stress on the day of embryo transfer (ET). Balk J et al in University of Pittsburgh studied effect of acupuncture on perceived stress and pregnancy rate on the day of ET. In this study, 57 patients with infertility and undergoing IVF or IVF/ISI were involved. These patients were undergoing ET with or without acupuncture as part of their standard clinical care. The result showed that women who received acupuncture treatment achieved 64.7% pregnancy rate while those who didn’t receive acupuncture treatment had 42.5% pregnancy rate. Women with acupuncture had lower stress score both pre-ET and post-ET compared to those without acupuncture. Women with lower stress score had higher pregnancy rate. They concluded that acupuncture reduced stress both before and after ET and it is the possible reason for improving pregnancy rate. Lower perceived stress on the ET may improve pregnancy rate.
Smith CA et al studied the effect of acupuncture on psychological distress for women with infertility. They run a pilot randomized controlled trial to investigate effectiveness of acupuncture for reducing infertility related stress. They found that 6 sessions over 8 weeks of acupuncture could reduce infertility related stress. Women in acupuncture group have less social and relationship concerns. They have improved self efficacy and less anxiety compared to waiting-list control group. Women described the experience and impact of acupuncture as positive relating to a sense of relaxation and time out, the engagement with the practitioner, and an intervention that had very few negative side-effects. Changes were also perceived after treatment with women describing a physical and psychologic sense of relaxation and calmness, and a changed perspective in relation to coping. This suggested that acupuncture may be a useful intervention to assist with the reduction of infertility-related stress.
Polycystic ovary syndrome (PCOS) is characteristic of polycystic ovaries, hyperandrognism, irregular menstrual cycles, and abnormal metabolism including insulin resistance and obesity. PCOS increases risk of depression and anxiety and negatively affects health-related quality of life. Life style change on diet and exercise is essential and proved that this decreased depression and improved quality of life. E Stener-Victorin et al studied the effect of acupuncture and exercises on depression, anxiety and impaired quality of life in women with PCOS. 72 women with PCOS were recruited in the study. 28 women were offered acupuncture and 29 women were offered physical exercise and 15 women were assigned with no intervention. The treatments were lasted for 16 weeks for different interventions. Acupuncture was given twice a week for 2 weeks, once a week for 6 weeks and once every other week for 8 weeks. Total 14 treatments over 16 weeks were offered. Physical exercise program included regular exercise, such as walking, cycling or any other aerobic exercise at a self-selected pace. The frequency of exercise was at least 30 min and at least 3 times a week. This lasted 16 weeks. The assessment was at the end of 16 week treatment and 16 week follow-up after the last treatment. The results showed that depression and anxiety scores were reduced at the end of the treatment and the follow-up in the acupuncture group; the quality of life such as physical, energy/vitality, general health perception and the mental component was also improved in the acupuncture group. The quality of life such as general health perception, physical functioning and emotion was improved in exercises group.
Doll H et al BJOG (2001) 108:304-14
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Greil AL et al Hum Reprod. (2011) 26:2101-12
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Isoyama D et al Acupunct Med (2012) 30:85-8
Coyle M, Smith C Acupunct Med (2005) 23:62-9
E Stener-Victorin et al BMC Complement Altern Med (2013) 13:131
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