Infertility is defined as failure to achieve pregnancy after 12 months of regular and unprotected sexual intercourse. Approximately 15% of couples worldwide are affected by infertility which is caused by various factors. In vitro fertilization (IVF) is one of the therapeutic options for couples with infertility, however IVF success rate is not 100%. Acupuncture can activate nerve fibers and peripheral afferent receptors, produce sensory interactions at various levels of the central nervous system, and release various transmitters and modulators, thus producing anti-inflammatory signals as well as neuroendocrine and neuroimmune signals. Acupuncture is one of the candidates that applied during IVF procedure to increase its success rates.
The mechanisms of acupuncture related to application of IVF is
1, modulating neuroendocrine factors. Acupuncture improves female infertility through modulation of the hypothalamic–pituitary– ovarian (HPO) axis, estrogen regulation, and increased ß-endorphins to correct the imbalance of the endocrine system. Acupuncture can stimulate ovulation through modulation of the HPO axis in women with anovulatory infertility.
2, increasing blood flow to the uterus and ovaries. As a result, acupuncture increases endometrial and follicular receptivity, and also helps repair the endometrial lining; it improves the quality of oocytes produced by the follicles. Acupuncture can reduce uterine contractility to prevent embryo expulsion after ET. Therefore, Acupuncture increases pregnancy rates in patients undergoing IVF.
3, modulating immune factors. Acupuncture moudlates immune system. I-helper cells are a type of immune cells which is related to pregnancy and is affected strongly by pregnancy hormones. If there is a dysregulation of T-helper cells systemically and locally, pregnancy failure will occur. Acupuncture has been reported to increase T-helper cells both locally and systemically, thus, increasing pregnancy rates.
4, reducing stress, anxiety. During IVF procedure, a woman’s psychological status affects the IVF success rate greatly. Acupuncture is very effective for reducing stress and anxiety caused by changes in the cortisol hormone and the psychologic effects of IVF itself. This is because acupuncture modulates neuropeptide in the amygdala, increasing ß-endorphin production, suppressing the system’s sympathetic nerves, increasing vagus-nerve activity, and increasing levels of neurotropic factors in the hippocampus. In addition, acupuncture affects the hypothalamic–pituitary– adrenal axis so to change the physiologic response to stress.
Recent research provided more evidences for acupuncture supporting IVF
Acupuncture for in vitro fertilization in women with poor ovarian response
Poor ovarian response (POR) is one reason for infertility. Poor ovarian response (POR) has been accepted as a predictor of delivery in women over 40 undergoing IVF. The criteria of diagnosis of POR are: 1) advanced maternal age (≥40 years) or any other risk factor for POR; 2) a previous POR (≤3 oocytes after a conventional stimulation protocol); or 3) an abnormal ovarian reserve test (i.e., antral follicle count (AFC) <5-7 follicles or anti-Mullerian hormone (AMH) <0.5-1.1 ng/ml). AMH is used as a predictor for ovarian reserve, and a higher level of AMH tends to increase during natural pregnancy. Low AFC is the basis for diagnosing POR, and AFC testing is more accurate than basal follicle stimulating hormone (FSH) testing for women aged over 44 years in predicting IVF outcome.
Acupuncture has been used to treat infertility and has been very popular in assist IVF. This is because it improves the endometrium, promotes ovulation, and reduces pain during egg retrieval, and improves fertilization rates. Consequently it increases pregnancy rates in women undergoing IVF. A study evaluated the effectiveness of acupuncture in improving clinical pregnancy rate (CPR) after IVF, in women with POR from randomized controlled trials (RCTs). Their result has shown that clinical pregnancy rate is 37.8% in acupuncture group vs 24.3% in control group. This study suggests that acupuncture may improve CPR, AMH, AFC and the number of retrieved oocytes in women with POR undergoing IVF.
Research shows that acupuncture combined with medication improves endocrine hormone levels and ovarian reserve function in poor ovarian response patients undergoing in vitro fertilization-embryo transplantation
This research has studied the clinical effect of acupuncture plus medication in the treatment of poor ovarian response (POR) patients.
A total of 100 volunteer POR women undergoing in vitro fertilization-embryo transplantation (IVF-ET) were recruited and were randomly divided into control, medication (Climen, composed of estradiol valerate and cyproterone acetate), acupuncture and acupuncture+medication (combined treatment) groups. Patients of the medication group were asked to orally take Climen (1 tablet/d for 21 days) beginning from the 3rd day of the menstruation, which was repeated for 3 menstrual cycles. Patients of the acupuncture group received manual acupuncture stimulation of Guanyuan (CV4), and bilateral Taixi (KI3), Sanyinjiao (SP6) of and Tai-chong (LR3) from day 8 to 15 of menstruation (follicular phase), once daily for 3 menstrual cycles. On the 2nd day of menstruation of the cycle, the ovarian reserve function was detected, including measurement of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) contents. At the end of ovulation induction, the assisted pregnancy indexes and outcomes were studied, including administration of dosage and days of gonadotropin (Gn), the diameter of dominant oocyte, level of E2 on the trigger day, the numbers of ultrasound-guided-retrieved oocyte and the cultivated high-quality embryo (grade 1 and 2).
Their result has shown that after the treatment, the contents of serum FSH, LH and E2 in the medication, acupuncture and combined treatment groups were significantly reduced and the content of serum AMH and ovary AFC in the medication, acupuncture and combined treatment groups were obviously increased in comparison with their own pre-treatment or with the control group. The group with medication plus acupuncture has the lowest levels of FSH, LH and E2. The dosage of Gn in the combined treatment group and the number of Gn administration days in the acupuncture and combined treatment groups were significantly fewer; serum E2 levels on the trigger day in the medication, acupuncture and combined treatment groups, and the high-quality embryo number in the combined treatment group were considerably higher. The high-quality embryo number in the combined treatment group was significantly larger.
Research added evidence that acupuncture increased pregnancy success rates for women with unexplained infertility undergoing IVF.
A recent research studied the effect of acupuncture on pregnancy success rates applied before and after embryo transfer (ET) among women undergoing in vitro fertilization (IVF). Three sessions of acupuncture were offered to the 36 women with unexplained infertility undergoing IVF; another 36 women with unexplained infertility without acupuncture were in the control group. Acupuncture was applied a week before embryo transfer and 30 min before and after embryo transfer. Pregnancy rate and anxiety level were measured in the result. The result has shown that clinical pregnancy, ongoing pregnancy, and live birth rates were significantly higher in the acupuncture group compared to the control group. The anxiety level was significantly lower in the acupuncture group.
Very recently, C Smith group published a review to analyse the research data to study acupuncture performed around the time of embryo transfer. This is a systematic revie and meta-analysis to examine the efficacy, effectiveness and safety of acupuncture as an adjunct treatment to embryo transfer. 20 trials and 5130 women were included in the review which is not a small sample study. The result found that there are increased pregnancies, live births and reduced miscarriage when acupuncture was compared with no adjunctive control, but no significant differences between acupuncture and sham controls. They suggested that acupuncture may have a significant effect on clinical pregnancy rates, independent of comparator group, when used in women who have had multiple previous IVF cycles, or where there was a low baseline pregnancy rate. The findings suggest acupuncture may be effective when compared with no adjunctive treatment with increased clinical pregnancies, but is not an efficacious treatment when compared with sham controls, although non-specific effects may be active in both acupuncture and sham controls.
Djaali W Med Acupunct. 2019 Dec 1;31(6):361-365. doi: 10.1089/acu.2019.1394. Epub 2019 Dec 13.
Guven PG et al Taiwan J Obstet Gynecol. 2020 Mar;59(2):282-286. doi: 10.1016/j.tjog.2020.01.018.
Dong XLet al Zhen Ci Yan Jiu. 2019 Aug 25;44(8):599-604. doi: 10.13702/j.1000-0607.180779.
Jang S et al Integr Med Res. 2020 Jun;9(2) Epub 2020 Feb 27.
Welcome to my blog, discover acupuncture with Dr Maggie Ju
Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.
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