About 1 in 6 couples have difficulty conceiving and seek specialist fertility treatment. There are various treatments available depending on the causes of the infertility. In vitro fertilisation (IVF) is one of the most successful treatments for couples with infertility. Since IVF technique was developed 30 years ago, it helped many couples to achieve pregnancy. In 2003 over 120000 IVF treatment cycles were carried out in clinics in the USA. According to the European Society of Human Reproduction and Embryology, over 300000 treatment cycles of IVF and intracytoplasmic sperm injection (ICSI) were performed each year in Europe. In 2000, about 200000 babies worldwide were conceived through IVF. However, the success rate of IVF is still not satisfactory. IVFalso is expensive, lengthy and stressful. It also affects physical and mental health. To improve IVF success rate, reduce stress, anxiety and depression, acupuncture is a technique used by clinicians. Acupuncture became a popular choice for women undergoing IVF. A survey to study the state of acupuncture treatments in assisted reproductive technology in fertility centers in Swiss, German and Austrian fertility centers has shown40% fertility centers offer acupuncture treatments. In these centers acupuncture points selected were standardized and acupuncture was performed by physician-acupuncturist.
How can acupuncture help IVF?
First of all, IVF with acupuncture support has higher live birth rate. The first report that acupuncture increased IVF success rate was from Stener-Victorin et al in 1999. They applied acupuncture before occytes collection. They found that women in acupuncture group had significantly higher implantation rate, pregnancy rate and live birth rate in IVF embryo transfer. Eric Manheimer et al did first systematic review published in BMJ to investigate the effects of acupuncture on pregnancy rates and live birth rates among women with infertility undergoing IVF. 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 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. Clinical pregnancy, ongoing pregnancy and live birth rates were improved. There was no side effect found. Recently a new review 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. The pregnant rate was higher in acupuncture group than that in control group for women undergoing IVF.
Secondly, acupuncture increases embryo implantation potential for patients with infertility. There was a study involved in 210 patients with infertility. These patients with infertility were treated with electroacupuncture and in vitro fertilization and embryo transplantation (IVF-ET). Electroacupuncture 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 may play a role in immune tolerance in pregnancy and its presence in embryo is associated with better pregnancy rates. They found that electroacupuncture can increase HLA-G for the patients undergoing IVF-ET; their HLA-G increased on hCG injection day and on embryo transfer day which indicated increased embryo implantation potential for patients with infertility.
Thirdly, acupuncture improves egg quality. There was a study from Zhongguo Zhen Jiu – an acupuncture journal in China. They studied 60 patients with infertility with poor ovarian response and poor ovarian reserve undergoing IVF-ET. 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. Most importantly the pregnancy rate was increased. Another study investigated the effects of acupuncture on egg quality and pregnancy for patients with polycystic ovary syndrome (PCOS) undergoing IVF. In this study there were 66 patients with PCOS and infertility and undergoing IVF-ET. All fertilization rate, cleavage rate and high quality embryos were higher in acupuncture group than that for control group. There was a study showing Luteal phase acupuncture increased pregnancy rate in women undergoing IVF. 109 patients received luteal phase acupuncture had higher pregnancy rate than those without acupuncture intervention.
Fourthly, acupuncture helps reducing stress and anxiety in women undergoing IVF. Research studied the effect of acupuncture on symptoms of anxiety in women undergoing IVF. 43 patients participated in the study. After 4 week treatment the anxiety score for acupuncture group was significantly lower than for the control group. There is perceived stress on the day of embryo transfer (ET). There was a study on the 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. 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.
Finally, acupuncture can help after failed IVF. Recently a research paper has shown that acupuncture increased pregnancy rate in women with previous failed IVF cycles. In this study, there were 84 patients participated the study. These patients had at least two unsuccessful attempts of IVF cycles. The predicted success rate for these patients was 10% for this group of patients. Acupuncture was performed on the first and seventh day of ovulation induction, on the day before egg collection and on the day after embryo transfer. The result has shown that the clinical pregnancy rate in the acupuncture group was significantly higher than that in the control and sham groups (35.7%, 7.1% and 10.7% respectively).
References
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Manheimer E et al (2008) BMJ 8: 545-549
Zheng CH et al Evid Based Complement Alternat Med (2012)2012:543924
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Zhang J et al J Tradit Chin Med (2013) 33:294-7
Steward RG et al Fertil Steril (2014) S0015-0282
Ji J et al Hum Reprod (2013) Jul 25
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