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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
Friday, 9 March 2018
Having IVF treatment? Acupuncture increases the chance to get pregnant. Any evidence?
The first report was by Stener-Victorin et al. 15 years ago suggesting that acupuncture can increase the IVF clinical pregnancy rate (CPR). Since then application of acupuncture to IVF has attracted considerable interest from clinicians to patients themselves. In recent years, there have been many randomized controlled trials (RCTs) evaluating acupuncture in IVF. There were more positive effects from acupuncture during IVF from these researches if treatment times are appropriate, the treatment course is enough.
Acupuncture performed around embryo transfer increases IVF success rate
A decade ago a research study from Germany investigated the effect of adding acupuncture on IVF or ICSI. This was a very well-done study and it was reported in a very highly regarded medical journal. In this study, acupuncture was added before and after embryo transfer. Patients with good quality embryos were chosen and divided into acupuncture group and control group. A maximum of three embryos were transferred into each woman's uterus using established transfer procedures, with the same procedure used for every patient in both groups. Patients in the acupuncture group received two acupuncture sessions – first treatment before embryo transfer, the second treatment after. Point selection played a key role in acupuncture's success. A total of nine points were used on patients in the acupuncture group. Before embryo transfer, PC6 (nei guan), SP8 (di ji), LR3 (tai chong), GV20 (bai hui) and ST29 (gui lai) were used; after transfer, needles were inserted at ST36 (zu san li), SP6 (san yin jiao), SP10 (xue hai) and LI4 (he gu). Points on the spleen, stomach and colon meridians were chosen because of their ability to provide "better blood perfusion and more energy in the uterus"; PC6, LI20, GV20, and ear points 34 and 55 were used to sedate the patient; ear point 58 was used to "influence the uterus"; and ear point 22 was stimulated to stabilize the endocrine system. This is well known acupuncture ivf german protocol. This protocol would optimize uterine receptivity."Six weeks after the embryo transfers were performed, all of the women were given an ultrasound examination. In the control group, the presence of a fetal sac, the scientists' criteria for a clinical pregnancy, was found in 21 women (26.3%). In the acupuncture group, the pregnancy rate was "considerably higher" - 34 women (42.5%) were carrying a fetal sac at the time of examination.
Acupuncture increased embryo implantation potentials
Kong FY et al investigated the effects of acupuncture on embryo implantation potential for patients with infertility. They allocated 210 patients into three groups according to their symptoms differentiated by traditional Chinese medicine. 82 cases of kidney deficiency was group A; 74 cases of liver qi stagnation was group B and 54 cases of phlegm dampness was group C. These patients with infertility were treated with acupuncture and in vitro fertilization and embryo transplantation (IVF-ET). Acupuncture was applied before controlled ovarian hyperstimulation and during ovarian hyperstimulation. The levels of human leukocytes antigen-G (HLA-G) in the serum were determined for evaluating embryo implantation potentials. HLA-G level was measured on the second day of the menstruation, on the day of human chorionic gonadotropin (hCG) injection and on the day of embryo transfer. HLA-G may play a role in immune tolerance in pregnancy and its presence in embryo is associated with better pregnancy rates. They found that acupuncture can increase HLA-G for the patients undergoing IVF-ET; their HLA-G increased on hCG injection day and on embryo transfer day in group A and group B. This increased embryo implantation potential for patients with infertility. Eventually pregnancy rate was improved.
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. 1 acupuncture group: 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.
Acupuncture increased IVF success rate
Craig L et al performed a research to investigate the effect of acupuncture on in vitro fertilization (IVF) performed offsite. They recruited two groups: acupuncture group and control group. In acupuncture group the women were received acupuncture at offsite location for 25 minutes before and after embryo transfer. The protocol they used was that the following points before ET: GV-20, CV-6, ST-29, SP-8, PC-6, LV-3; Shenmen and Brain on the left ear; and Uterus and Endocrine on the right ear. After transfer the points were LI-4, SP-10, ST-36, SP-6, KI-3; Uterus and Endocrine on the left ear; and Shenmen and Brain on the right ear. They found that the pregnancy rate was higher in control group than in acupuncture group.
IVF with acupuncture support has higher live birth rate
Though the effectiveness is still in debate, as early as 2008, Eric Manheimer et al did first systematic review and mega analysis to investigate the effects of acupuncture on pregnancy rates and live birth rates among women with infertility undergoing IVF. This review was published in BMJ. They analysed seven trials involved in 1366 women undergoing IVF. All trials were conducted in four different Western countries and published in English since 2002 in two of the leading reproductive medicine journals either in full articles or abstracts. In all trials, women received acupuncture immediately before or immediately after the embryo transfer. The acupuncture points selected in all trials are fixed and the acupuncture sessions lasted 25-30 minutes. No acupunture was involved. They showed that clinical pregnancy, ongoing pregnancy and live birth rates were improved. There was no side effect found. Their conclusion is that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing IVF.
There was a new review that just came out by Zheng CH et al (July 2012). They did a systematic review to analyse effect of acupuncture during IVF. They found that there were 5 studies involved 463 women who were undergoing IVF. They were given acupuncture twice a week for 2 weeks during the controlled ovarian hyperstimulation period for IVF. All 5 studies showed that pregnant rate was higher in acupuncture group than that in control group for women undergoing IVF.They also analysed other applications of acupuncture during IVF which did not distinguish IVF success rate between acupuncture group and control group which only had one acupuncture treatment around egg collection or embryo implantation. They suggested that most of the courses of acupuncture treatment during IVF were too short to completely correct infertility states caused by long term imbalance. In addition, the acupuncture programs lacked syndrome differentiation and treatment according to individual characteristics. In conclusion, appropriate acupuncture during IVF with suitable time in the cycle, enough treatment courses and individual program is a promising technique to increase IVF success rate.
Effects of acupuncture on IVF-ET for patients with poor ovarian response
There was a case report from Zhongguo Zhen Jiu – an acupuncture journal in China. They studied 60 patients with infertility with poor ovarian response and poor ovarian reserve undergoing in vitro fertilization-embryo transfer (IVF-ET). These patients were divided into two groups: with acupuncture or without acupuncture; 30 cases were in each group. The effect was compared after treatment. After treatment, in acupuncture group, the symptoms of kidney deficiency were improved; estrdiol (E2) level was higher; egg maturation rate, fertilization rate and good quality embryo rate and implantation rate were higher on the day of human chorionic gonadotropin (hCG) injection. The level of stem cell factor (SCF) in follicular fluid and serum was higher in the acupuncture group as well. More importantly the pregnancy rate was higher and abortion rate was lower in acupuncture group. This is a promising research for patients with poor ovarian response and poor ovarian reserve.
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.
Acupuncture improves egg quality and pregnancy rate for patients with PCOS
Cui W et al investigated effects of acupuncture on egg quality and pregnancy for patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization and embryo transfer (IVF-ET). There were 66 patients with PCOS and infertility and undergoing IVF-ET. These patients were divided into two groups randomly: 34 patients were in acupuncture group and other 32 patients were in control group. Ethinylestradiol and cyproterone acetate tablets and gonadotropin-releasing hormone agonist were applied for long-program superovulation in these patients. Electroacupuncture was applied in the acupuncture group. No intervention was applied in control group. They found that kidney deficiency symptom score was improved better in acupuncture group. All fertilization rate, cleavage rate and high quality embryos were higher in acupuncture group than that for control group. Pregnancy rate and stem cell factor (SCF) level were higher in acupuncture group. SCF is an important factor during embryo development. They concluded that electroacupuncture plays an important role in the pregnant outcomes of patients with PCOS undergoing IVF-ET. It reduces kidney deficiency symptoms and improves clinical pregnant rate by adjusting organic endocrinal system and the local micro-environment of ovary and improving egg quality through the up-regulation of SCF level.
Acupuncture increases live birth in IVF with donor’s eggs
Acupuncture was first reported by Paulus et al to increase clinical pregnancy rate, when a standardized acupuncture protocol was performed immediately before and after fresh, nondonor IVF-ET. 160 patients were participated the study. 80 patients were randomized to the acupuncture group and 80 to the control group. The CPR was higher in the acupuncture group compared to the control group (42.5% versus 26.3%, p=0.03). After this study, similar studies were performed and positive results were also reported to support Paulus et al conclusion. More recently, Hullender Rubin LE et al modified Paulus’s protocol, they found that in donor cycles, live births were higher in the acupuncture group compared with control group.
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