Acupuncture

and embryo transfer….....

Should IVF patients have acupuncture?

Can it really influence the outcome?

Is the evidence in?

This is the question our patients, and their specialists, often ask us.

It’s a good question!

Or is the jury out?

There is a lot to think about, and analyse …...

There are more than 20 trials published

in medical journals

For all the references and abstracts please see http://acupuncturepregnancy.com.au/research-reviews/

All of these clinical trials examine the effect of acupuncture on the outcome

of embryo transfer (measured as implantation, clinical pregnancy, ongoing pregnancy or live birth)

Some trials did acupuncture on the day of

transfer of day 3 embryos and some on the

day of transfer of day 5 embryos

Some of the trials did acupuncture

immediately before and immediately after

the embryo transfer, some did

acupuncture only after the transfer or at

another time. Some trials did

acupuncture in the IVF clinic, some did it

in adjacent clinics or across town. Most of

the trials used the same acupuncture

points – but not all.

Most trials used traditional acupuncture

needles, but some used laser ….

Some used electro-stimulation on

acupuncture points

Some used sham needles in the

control group ….

These are to fool patients into thinking they are having real acupuncture, but the needles only prick and don’t actually penetrate the skin.

Some used “wrong acupuncture”

points in the control group

ie they used points that were not on an acupuncture meridian, or points not relevant to fertility treatment.

Some used “usual care” in the

control group

• ie they didn’t

do anything

different to

what they

would

normally do in

an IVF cycle

What did they find?

• More than two thirds of these studies

report a statistical benefit of having

acupuncture during an IVF cycle ….....

The next step is to do a meta-analysis

A Meta-analysis is a statistical technique for combining the findings from independent studies, and is used to assess the clinical effectiveness of healthcare interventions.

What did this find? Of 9 meta analyses examining acupuncture treatment of IVF

patients, 2 found no effect at all, 7 found that acupuncture

conferred an advantage in IVF outcomes (in some cases the

advantage was significant only when chances of success were not

high, or when usual care, rather than sham needling, was the

control group).

Forest Plots

• The most recent meta-analysis plotted

comparisons of all the different trials

www.ncbi.nlm.nih.gov/pmc/articles/PMC3395377

Forest Plot 1

When all the qualifying

trials that examine the

effect of acupuncture at

time of embryo transfer

(compared to all the

different control types

including sham

needling) are plotted,

we can see there is a

trend to improved

outcomes with

acupuncture treatment.

Zheng CH et al, doi:10.1155/2012/543924

Forest Plot 2

When the same sort of analysis compares trials of patients having acupuncture on day of embryo transfer with a control group who did not have “sham acupuncture”, the trend favouringacupuncture is even more obvious.

Zheng CH et al, doi:10.1155/2012/543924

Forest Plot 3

And when we examine

the pregnancy rate in the

trials that did

acupuncture during the

whole IVF cycle (not just

at embryo transfer)

compared to usual care,

the trend toward

favouring acupuncture

treatment is stronger

again.

Zheng CH et al, doi:10.1155/2012/543924

But back to the clinic;

what is embryo transfer acupuncture?

Embryo transfer acupuncture is usually two treatments, one applied before the transfer and one after. The acupuncture points chosen include those shown in clinical trials to have a beneficial effect on outcomes for some IVF patients

Before the transfer

We use acupuncture points on the abdomen as well as points on the limbs, the head and the ear. Some of these will be those used in clinical trials, and some will be chosen according to pulses and symptoms.

After the transfer

We use acupuncture points on the head, ear and limbs but not on the abdomen. As before, points are chosen according to pulses and symptoms as well as research trial protocols.

How does acupuncture increase

IVF success rates?

• Well, we don’t really know …..

• But we do have some clues .......

Here’s what we do know ….....

• implantation of embryos

is negatively affected by

stress, and auto-immune

factors

• stress can reduce IVF

success rates

• fertility is compromised if

stress hormones are

elevated

For all references; acupuncturepregnancy.com.au/preparing-to-conceive-stress-management

And also ….....

• Acupuncture has been

shown to improve certain T-

cell and cytokine levels

• and increase levels of

endogenous opioids eg

endorphins, encephalins and

serotonin.

• and reduce cortisol and

adrenalin levels

• And it makes you feel very

relaxed.For all references; acupuncturepregnancy.com.au/preparing-to-conceive-stress-management

A relaxed uterus might help too…....

Uterine contractions after

embryo transfer appear to

reduce implantation and

pregnancy rates. Acupuncture

settles the body and the mind,

and while we don’t know if it

reduces contractions, most

women report feeling more

comfort in the abdomen after

treatment.

Renato Fanchin et al, Human Reproduction vol.13 no.7 pp.1968–1974, 1998

Pregnancy rate vs uterine contractions per min

And coming back to TCM, “Warming the

womb”….....

In traditional Chinese

medicine texts infertility was

sometimes referred to as a

“cold womb”.

What we aim to do with

Chinese medicine treatment

at this time (and later) is to

encourage the flow of “Qi and

Blood” to nourish the embryo.

Any conclusions?

• The research and our own experience,

tells us that acupuncture treatment during

an IVF cycle can confer a benefit to

women who’s chance of success with IVF

is 30% or less - ie older women and those

who have done previous failed IVF cycles.