After failed IVF to get pregnant, What to do to improve?

Infertility and treatment

If you are having difficulty to get pregnant, you are not alone. It is estimated that infertility affects 1 in 7 couples in the UK and this prevalence is increasing.

The main causes of infertility in the UK are unexplained infertility (no identified male or female cause) (25%), ovulatory disorders (25%), tubal damage (20%), factors in the male causing infertility (30%), uterine or peritoneal disorders (10%). In about 40% of cases disorders are found in both the man and the woman.

In 2011, 48,147 women had a total of 61,726 cycles of IVF or intracytoplasmic sperm injection (ICSI) and 2,087 women had a total of 4,091 cycles of donor insemination. A total of 89,648 embryos were transferred during the course of fertility treatment which started in 2011. A total of 13,703 pregnancies were reported as a result of IVF treatment which started in 2011. In the UK, 201,811 babies have been born after IVF treatment between 1991 and 2010. Of the women who received fertility treatment during 2011, they were, on average, 35-years-old and had been trying to conceive for around 4 years (4.6 for IVF, 4 for donor insemination). Four in ten (40.3%) IVF treatment cycles were funded by the NHS in 2011.

Acupuncture for infertility treatment is increased from 2.5% in 2002 to 13% in 2009.

Current status of Assisted Reproductive Technology (ART) in the US

Since the first infant conceived with Assisted Reproductive Technology (ART) was born in 1981 in the US, the usage of ART for fertility treatment and the ART service provided by fertility clinics are increasing. Senderam S et al in the US did a survey from the data in 2009. A total 146,244 ART procedures were reported. These procedures resulted in 45,870 live-birth deliveries and 60,190 infants. The largest numbers of ART procedures performed were from six states which were California (18,405), New York (14,539), Illinois (10,192), Massachusetts (9,845), New Jersey (9,146) and Texas (8,244). Nationawide the average number of ART procedures performed per 1 million women of reproductive age (15-44 year old). ART contributed to 1.4% of US births. In Massachusetts it was greater than 4%. Infants conceived wit ART accounted for 20% of all multiple-birth infants, 19% of all twin births and 34% of triplet or higher order births. Among infants conceived with ART, 47% were born as multiple-birth infants while among the general birth population it was 3%. Infants conceived wit ART contributed to about 6% of all low birthweight infants. Among ART-conceived infants, 32% were low birthweight, while among general population there was 8% low birth weight. Infants conceived with ART accounted for 3.9% of all preterm and 4.5% of all very preterm births. Among infants conceived with ART, 33.4% were born preterm, while among general population there was only 12.2% preterm. 6.1% of ART infants were very preterm birth, while only 2% among general population.

40% fertility centers offer acupuncture treatments

Women undergoing in vitro fertilization (IVF) commonly use alternative therapies to improve IVF outcomes and reduce stress, anxiety and depression. Acupuncture is a popular choice for women undergoing IVF. Recently Nedeljkovic M et al conducted a survey to study the state of acupuncture treatments in assisted reproductive technology in fertility centers in Swiss, German and Austrian fertility centers. There were 86 fertility center responded the study. 33 of them offered acupuncture treatments which was about 40%. 39.4% acupuncture points selected were standardized. Body acupuncture using needle stimulation was most frequently applied which was 84.8%. Treatments were mainly by physician-acupuncturist.

Acupuncture helps succeed in first round IVF

A 39 year old woman has been trying to conceive for a year and half. Her husband’s sperm was good. She was very stressed from this. Also she worked very hard and work stress was enormous too. Her fertility test was absolutely normal. Her period was 28-29 days. However she did ovulate a bit early in about day 11 checked by ovulation kit test. Her period was light lasting for 3 days. She also had chronic diarrhea about two to three times a day. She decided to try acupuncture to help with conceiving. She had acupuncture treatment on weekly basis. With the treatment progress, her ovulation was changed to day 12 and then day 13. Her diarrhea was disappeared. Her bowel movement was once a day and no longer loose. Her period last 5 days. Her stress level was decreased and she felt more relaxed. After three month acupuncture treatment, she felt a lot better, but she was still not pregnant. She decided to go ahead for IVF, because age was not on her side and she did not want to wait to get pregnant naturally. She was continuing another two month acupuncture treatment while planning IVF. During the IVF procedure, everything was going smoothly. She had 12 eggs retrieved and 11 of them were fertilised. One of the embryo was transferred and pregnancy test was positive after two weeks waiting.

Failed IVF cycle, acupuncture can help.

In vitro fertilization (IVF) is an important treatment option for couples with infertility problems. However the success rate is low and Average IVF success rate is 30% and lower if you are over 35 year old. Many couple have to repeat the IVF cycles to achieve pregnancy. And the success rate after failed IVF cycle is even lower. Acupuncture was used to treat different conditions for thousands years. Can acupuncture help IVF to achieve higher success rate after failed IVF? many scientists found promising results to show that acupuncture can help IVF after failure of IVF in some way. Recently a research investigated the effectiveness of acupuncture and moxibustion as an additional treatment in women with failed embryo implantation from IVF and has shown that acupuncture increased pregnancy rate in women with previous failed IVF cycles. In this study, there were 84 patients involved. These patients had at least two unsuccessful attempts of IVF cycles. The predicted success rate for these patients was 10% for this groups of patients. In current cycle, they were divided into three groups: acupuncture, control and sham groups with each group 28 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. Acupuncture and moxibustion were applied. In sham acupuncture group needles were inserted in the area that did not correspond to known acupuncture points. 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). This research has shown that acupuncture is an effective treatment for those women who had previously failed IVF cycles.

Acupuncture performed around embryo transfer increases IVF success rate

The most common assisted reproduction therapy is in vitro fertilization (IVF). In IVF a woman's eggs are harvested and fertilized with a man's sperm in a laboratory. intracytoplasmic sperm injection (ICSI) is used where sperm counts are low. In ICSI, sperm is injected into eggs. Embryos obtained from IVF or ICSI are grown from the sperm and eggs and then transferred into the woman's uterus. IVF and ICSI were used for about 40 years to help with couples with difficulty to conceive, but the success rate is still not satisfactory. Other techniques are used to tend to increase their success rate. Acupuncture has been chosen for this purpose. 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.

How does acupuncture help to achieve higher success rate? A woman's uterus typically undergoes several contractions while an embryo is being transferred, which reduces the chances of successful implantation significantly. Relaxing the uterus during embryo transfer could increase a woman's chances of becoming pregnant. Acupuncture seems to be a useful tool for improving pregnancy rate performed around the time of embryo transfer, mainly by relaxing uterus.

Acupuncture helps reducing anxiety in women undergoing IVF

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.

Acupuncture helps decrease ovarian hyperstimulation syndrome during IVF

Ovarian hyperstimulation syndrome (OHSS) is a serious side effect during the procedure of IVF treatment. It occurs in women who are very sensitive to the fertility drugs. Too many eggs develop in the ovaries, which become very large and painful. Abdominal pain, nausea and diarrhoea are common symptoms. Can acupuncture help reduce the chance of OHSS? Recently a research studied the effect of acupuncture on clinical outcomes and the occurrence of OHSS in IVF. 109 patients were divided into two groups: control and acupuncture group. Patients in the control group received controlled ovarian hyperstimulation (COH) referring to GnRH-a long protocol. On the basis of COH, those in the EA group received EA from the day of Gn injection to the day of embryo transfer. Blood tests were monitored on the day of hCG injection, the day of egg collection and the day of embryo transfer. The oocyte retrieval rate, good quality embryo rate, clinical pregnancy rate, the abortion rate, and the occurrence of OHSS were compared between the two groups. Compared with the control group, serum oestrogen E2 levels on the day of egg collection and the day of ET were significantly lower in the EA group. vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) significantly decreased compared with control group on the day of hCG injection, on the day of egg collection and embryo transfer. The occurrence of OHSS and the canceling rate of transplant cycle were significantly lower in the EA group than in the control group. The research suggested that acupuncture as an adjunctive therapy, could reduce the occurrence of OHSS in IVF.

References

http://www.nice.org.uk/guidance/CG156

Hopton AK et al BMJ Open (2012)2:e000456

Senderam S et al MMWR surveil Summ (2012) 61:1-23

Nedeljkovic M et al Forsch Komplementmed (2013) 20:112-8

Villahemosa et al Acupunct Med 2013 31:157-62

Paulus et al Fertil Steril (2002) 77:721-4

Hong YL et al Zhongguo Zhong Xi Yi Jie He Za Zhi (2014) 34:1292-6

Isoyama D et al Acupunct Med (2012) 30:85-8