Poor ovarian reserve and acupuncture

Zhongguo Zhen Jiu. 2009 Oct;29(10):775-9.
[Effects of electro-acupuncture on in vitro fertilization-embryo transfer (IVF-ET) of patients with poor ovarian response]

[Article in Chinese]

Chen J, Liu LL, Cui W, Sun W.

Department of Reproduction, The Second Affiliated Hospital of Shandong University of TCM, Jinan 250001, China. fusantai@126.com
Abstract

OBJECTIVE: To observe the effect of electro-acupuncture therapy on oocyte quality and pregnancy outcome of patients with poor ovarian response or decreased reserve in the course of in vitro fertilization (IVF).

METHODS: Sixty cases accepting IVF-ET were randomly divided into an observation group and a control group, 30 cases in each group. The two groups were both treated with antagonist scheme for ovulation induction, and the electro-acupuncture intervention was also added in the observation group, Guanyuan (CV 4), Taixi (KI 3), Sanyinjiao (SP 6) etc. were selected. The therapeutic effects in the two groups were compared after treatment.

RESULTS: There was no significant difference between the two groups before treatment. The symptoms of kidney difficiency in the observation group were significantly improved after treatment, and the levels of serum estradiol (E2), fertilization rate, oocyte maturation rate, good quality embryos rate, and implantation rate in the observation group were superior to those in the control group on human Chorionic Gonadotropin (hCG) injection day (all P<0.05); the levels of stem cell factor (SCF) in follicular fluid and serum in the observation group were significantly higher than those in the control group (both P<0.05). The pregnancy rate in the observation group was higher than that in the control group, and the abortion rate in the observation group was lower than that in the control group, but there was no significant difference between the two groups (both P>0.05).

CONCLUSION: Electro-acupuncture therapy has a good clinical effect for IVF patients with poor ovarian reserve, and can improve oocyte (egg) quality and pregnancy outcome.

PMID: 19873910 [PubMed – indexed for MEDLINE]

IVF + Acupuncture = lower stress, higher pregnancy rate

Complement Ther Clin Pract. 2010 Aug;16(3):154-7. Epub 2009 Dec 24.
The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: a pilot study.

Balk J, Catov J, Horn B, Gecsi K, Wakim A.

University of Pittsburgh, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA. jbalk@magee.edu
Abstract

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

PATIENT(S): 57 infertile patients undergoing IVF or IVF/ICSI. INTERVENTIONS(S): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.

MAIN OUTCOME MEASURE(S): Perceive Stress Scale scores, pregnancy rates.

RESULT(S): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased their perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status. CONCLUSIONS(S): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

PMID: 20621276 [PubMed – in process]PMCID: PMC2904299 [Available on 2011/8/1]

Acupuncture improves sperm motilty

In this study acupuncture effectively helped patients suffering from both reduced sperm motility and low sperm count. This kind of condition is called oligoasthenozoospermia. The study showed that acupuncture significantly improved percentage of motile sperm.

sperm-motility

Fertil Steril. 2009 Oct;92(4):1340-3. doi: 10.1016/ j.fertnstert. 2009.02.041. Epub 2009 Apr 25.
A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia.
Dieterle S, Li C, Greb R, Bartzsch F, Hatzmann W, Huang D.
Source
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Witten/Herdecke, Dortmund, Germany. dieterle@ivf-dortmund.de
Abstract
In this first prospective, randomized, single-blind, placebo-controlled study, 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A-C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.

PCOS: Acupuncture and Sympathetic Nerve Activity in Polycystic Ovary Syndrome

Acupuncture PCOS

Acupuncture PCOS

Low-frequency Electro-Acupuncture and Physical Exercise Decrease High Muscle Sympathetic Nerve Activity in Polycystic Ovary Syndrome
Elisabet Stener-Victorin1*, Elizabeth Jedel2, Per Olof Janson, and Yrsa Bergmann Sverrisdottir3

1 Institution of Neuroscience and Physiology
2 Osher Center for Integrative Medicine
3 inst. neuroscience and physiology

* To whom correspondence should be addressed. E-mail: elisabet.stener-victorin@neuro.gu.se.

Context: We have recently shown that polycystic ovary syndrome (PCOS) is associated with high muscle sympathetic nerve activity. Animal studies support the concept that low-frequency electro-acupuncture (EA) and physical exercise, via stimulation of ergoreceptors and somatic afferents in the muscles, may modulate the activity of the sympathetic nervous system. Objective: The aim of the present study was to investigate the effect of these interventions on sympathetic nerve activity in women with PCOS. Design: Randomized controlled trial. Setting: Sahlgrenska University Hospital, Gothenburg, Sweden. Outcome Measures and Subjects: Twenty women with PCOS were randomly allocated to one of three groups; low-frequency EA (n=9), physical exercise (n=5) or to an untreated control (n=6) group during 16 weeks. Direct recordings of multiunit efferent postganglionic muscle sympathetic nerve activity (MSNA) in a muscle fascicle of the peroneal nerve before and following 16 weeks of treatment. Biometric, hemodynamic, endocrine and metabolic parameters were measured. Results: Low-frequency EA (P = 0.036) and physical exercise (P = 0.030) decreased MSNA burst frequency compared to the untreated control group. Low-frequency EA group reduced sagittal diameter (P = 0.001), while physical exercise group reduced body weight (P = 0.004) and body mass index (BMI) (P = 0.004) as compared to the untreated control group. Sagittal diameter was related to MSNA burst frequency (Rs = 0.58, P < 0.005) in the EA group. No correlation was found for BMI and MSNA in the exercise group. There were no differences between the groups in hemodynamic, endocrine and metabolic variables. Conclusions: For the first time we demonstrate that low-frequency EA and physical exercise lowers high sympathetic nerve activity in women with PCOS. Thus, treatment with low-frequency EA or physical exercise with the aim to reduce MSNA may be of importance for women with PCOS. Am J Physiol Regul Integr Comp Physiol (June 3, 2009). doi:10.1152/ajpregu.00197.2009

Acupuncture benefits cortisol and prolactin levels in IVF patients

fertility and sterility acupunctureChanges in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment

Paul C. Magarelli, M.D.aCorresponding Author Informationemail address, Diane K. Cridennda, L.Acb, Mel Cohen, Ph.D.a

Received 22 May 2008; received in revised form 24 October 2008; accepted 28 October 2008. published online 31 December 2008.
Corrected Proof
Objective

To determine whether changes in serum cortisol (CORT) and PRL are affected by acupuncture (Ac) in Ac-treated IVF patients.
Design

Prospective cohort clinical study.
Setting

Private practice reproductive endocrinology and infertility clinic and private practice acupuncture consortium.
Patient(s)

Sixty-seven reproductive-age infertile women undergoing IVF.
Intervention(s)

Blood samples were obtained from all consenting new infertility patients and serum CORT and serum PRL were obtained prospectively. Patients were grouped as controls (IVF with no Ac) and treated (IVF with Ac) according to acupuncture protocols derived from randomized controlled trials.
Main Outcome Measure(s)

Serum levels of CORT and PRL were measured and synchronized with medication stimulation days of the IVF cycle (e.g., day 2 of stimulation, day 3, etc.). Reproductive outcomes were collected according to Society for Assisted Reproductive Technology protocols, and results were compared between controls and those patients treated with Ac.
Result(s)

CORT levels in Ac group were significantly higher on IVF medication days 7, 8, 9, 11, 12, and 13 compared with controls. PRL levels in the Ac group were significantly higher on IVF medication days 5, 6, 7, and 8 compared with controls.

Conclusion(s)

In this study, there appears to be a beneficial regulation of CORT and PRL in the Acupuncture group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics.

Acupuncture improves sperm motility

acupuncture sperm motility male infertilityArch Androl. 1997 Sep-Oct;39(2):155-61.

Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality.
Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B.

Institute of Chinese Medicine, Tel Aviv, Israel.

The aim of this prospective controlled study was to assess the effect of acupuncture on the sperm quality of males suffering from subfertility related to sperm impairment. Semen samples of 16 acupuncture-treated subfertile patients were analyzed before and 1 month after treatment (twice a week for 5 weeks). In parallel, semen samples of 16 control untreated subfertile males were examined. Two specimens were taken from the control group at an interval of 2-8 months. The expanded semen analysis included routine and ultramorphological observations. The fertility index increased significantly (p < or = .05) following improvement in total functional sperm fraction, percentage of viability, total motile spermatozoa per ejaculate, and integrity of the axonema (p < or = .05), which occurred upon treatment. The intactness of axonema and sperm motility were highly correlated (corr. = .50, p < or = .05). Thus, patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment.

Acupuncture improves ovarian morphology in PCOS by regulating overactive sympathetic nervous system

Acupuncture and exercise restore adipose tissue expression of sympathetic markers and improve ovarian morphology in rats with dihydrotestosterone-induced PCOS
Louise Mannerås,1 Stefan Cajander,2 Malin Lönn,3 and Elisabet Stener-Victorin1

1Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 2 Department of Pathology and Cytology, Sunderby County Hospital, Luleå, Sweden; and 3 Institute of Medicine, Wallenberg Laboratory, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Submitted 22 November 2008 ; accepted in final form 15 January 2009

Altered activity of the sympathetic nervous system, which innervates adipose and ovarian tissue, may play a role in polycystic ovary syndrome (PCOS). We hypothesize that electro-acupuncture (EA) and physical exercise reduce sympathetic activity by stimulating ergoreceptors and somatic afferent pathways in muscles. Here we investigated the effects of low-frequency EA and physical exercise on mRNA expression of sympathetic markers in adipose tissue and on ovarian morphology in female rats that received dihydrotestosterone (DHT) continuously, starting before puberty, to induce PCOS. At age 11 wk, rats with DHT-induced PCOS were randomly divided into three groups: PCOS, PCOS plus EA, and PCOS plus exercise. The latter two groups received 2-Hz EA (evoking muscle twitches) three times/week or had free access to a running wheel for 4–5 wk. In mesenteric adipose tissue, expression of ?3-adrenergic receptor (ADRB3), nerve growth factor (NGF), and neuropeptide Y (NPY) mRNA was higher in untreated PCOS rats than in controls. Low-frequency EA and exercise downregulated mRNA expression of NGF and NPY, and EA also downregulated expression of ADRB3, compared with untreated rats with DHT-induced PCOS. EA and exercise improved ovarian morphology, as reflected in a higher proportion of healthy antral follicles and a thinner theca interna cell layer than in untreated PCOS rats. These findings support the theory that increased sympathetic activity contributes to the development and maintenance of PCOS and that the effects of EA and exercise may be mediated by modulation of sympathetic outflow to the adipose tissue and ovaries.

sympathetic activity; ?3-adrenergic receptor; androgen receptor; nerve growth factor; neuropeptide Y

Acupuncture for male and female infertility – systematic review

fertility and sterility acupunctureThe Role of Acupuncture in the Management of Subfertility

Ng E H et al Fertil Steril. 2008 Jul;90(1):1-13.
Fertility and Sterility

Abstract

OBJECTIVE: To review systematically the use of acupuncture in the management of subfertility.

DESIGN: A computer search was performed via several English and Chinese databases to identify journals relevant to the subject.

RESULT(S): The positive effect of acupuncture in the treatment of subfertility may be related to the central sympathetic inhibition by the endorphin system, the change in uterine blood flow and motility, and stress reduction. Acupuncture may help restore ovulation in patients with polycystic ovary syndrome, although there are not enough randomized studies to validate this.

There is also no sufficient evidence supporting the role of acupuncture in male subfertility, as most of the studies are uncontrolled case reports or case series in which the sample sizes were small. Despite these deficiencies, acupuncture can be considered as an effective alternative for pain relief during oocyte retrieval in patients who cannot tolerate side effects of conscious sedation.

The pregnancy rate of IVF treatment is significantly increased, especially when acupuncture is administered on the day of embryo transfer.

CONCLUSION(S): Although acupuncture has gained increasing popularity in the management of subfertility, its effectiveness has remained controversial.

Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence.

pcos acupuncture - journal of neuroendocrinology

pcos acupuncture

J Neuroendocrinol. 2008 Mar;20(3):290-8. Epub 2007 Nov 28.
Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence.

Stener-Victorin E, Jedel E, Mannerås L.

Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden. elisabet.stener-victorin@neuro.gu.se
Abstract

This review describes the aetiology and pathogenesis of polycystic ovary syndrome (PCOS) and evaluates the use of acupuncture to prevent and reduce symptoms related with PCOS. PCOS is the most common female endocrine disorder and it is strongly associated with hyperandrogenism, ovulatory dysfunction and obesity. PCOS increases the risk for metabolic disturbances such as hyperinsulinaemia and insulin resistance, which can lead to type 2 diabetes, hypertension and an increased likelihood of developing cardiovascular risk factors and impaired mental health later in life. Despite extensive research, little is known about the aetiology of PCOS. The syndrome is associated with peripheral and central factors that influence sympathetic nerve activity. Thus, the sympathetic nervous system may be an important factor in the development and maintenance of PCOS. Many women with PCOS require prolonged treatment. Current pharmacological approaches are effective but have adverse effects. Therefore, nonpharmacological treatment strategies need to be evaluated. Clearly, acupuncture can affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system. Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS suggest that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation.

Systematic review: Acupuncture and IVF: Acupuncture improves rates of pregnancy and live birth

bmj-infertility-acupuncture1Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis

Eric Manheimer, research associate1, Grant Zhang, assistant professor1, Laurence Udoff, assistant professor2, Aviad Haramati, professor3, Patricia Langenberg, professor and vice-chair4, Brian M Berman, professor1, Lex M Bouter, professor and vice chancellor (rector magnificus)5

1 Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207, USA, 2 Department of Obstetrics, Gynecology and Reproductive Services, University of Maryland School of Medicine, 3 Department of Physiology and Biophysics and Medicine, Georgetown University School of Medicine, Washington, DC, 4 Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 5 VU University Amsterdam De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands

Correspondence to: E Manheimer emanheimer@compmed.umm.edu
Objective To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation.

Design Systematic review and meta-analysis.

Data sources Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.

Review methods Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.

Data synthesis Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth. The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).

Conclusions Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

Electro acupunture increases ovarian blod flow (PCOS)

fertility and sterility acupunctureEffect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries
Elisabet Stener-Victorin1 ,2 , Rie Kobayashi3 , Orie Watanabe3 , Thomas Lundeberg4 and Mieko Kurosawa3
1Department of Physiology, Sahlgrenska Academy, Göteborg University, Box 432, SE-405 30 Göteborg, Sweden
2Department of Obstetrics and Gynecology, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital, Sahlgrenska, SE-413 45 Göteborg, Sweden
3Basic Medical Research Centre, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara, Tochigi 324-8501, Japan
4Department of Rehabilitation Medicine, Karolinska Hospital, SE-171 77 Stockholm, Sweden

Abstract

Background

Maintenance of ovarian blood flow (OBF) is suggested to be important for regular ovulation in women with polycystic ovaries (PCO). The purpose of the present study was to investigate whether electro-acupuncture (EA) of different frequencies and intensities can improve the OBF of anaesthetized rat in the animal model of PCO.

Methods

PCO was experimentally induced by a single intramuscular (i.m.) injection of estradiol valerate (EV) in rats. Control rats were given i.m. injection of oil. The involvement of the two ovarian sympathetic nerves; superior ovarian nerve (SON) and plexus ovarian nerve (OPN), in OBF responses was elucidated by severance of SON and OPN in both control and PCO rats. How systemic circulatory changes affect OBF was evaluated by continuous recording of the blood pressure. OBF was measured on the surface of the ovary-using laser Doppler flowmetry. Acupuncture needles were inserted bilaterally into the abdominal and hind limb muscles and connected to an electrical stimulator. Two frequencies – 2 Hz (low) and 80 Hz (high) – with three different intensities – 1.5, 3, and 6 mA – were applied for 35 s.

Results

Low-frequency EA at intensities of 3 and 6 mA elicited significant increases in OBF in the Control group compared to baseline. In the PCO group the increases in OBF were significant only when stimulating with low-frequency EA at 6 mA. After severance of the ovarian sympathetic nerves, the increased response of OBF that had been induced by low-frequency EA in both the Control and PCO group was abolished, indicating that the OBF response is mediated via the ovarian sympathetic nerves. High-frequency EA at 6 mA significantly decreased OBF and mean arterial blood pressure (MAP) in the Control group compared to baseline. In the PCO group, the same stimulation produced similar decreases in MAP, but not in OBF.

Conclusion

Low-frequency EA stimulation with a strong intensity (6 mA) increases OBF in rats with steroid-induced PCO whereas less strong intensity (3 mA) induces similar changes in control rats. Severance of the ovarian sympathetic nerves, abolish this OBF increase in both study groups, which suggests that the responses of OBF to EA are mediated via the ovarian sympathetic nerves.
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Acupuncture and Chinese Medicine for Chronic Pelvic Inflammation

Hospital of Integrated Traditional and Western Medicine Affiliated to Zhejiang College of TCM, Hangzhou 31000, China.

OBJECTIVE: To observe the therapeutic effect of acupuncture and moxibustion on chronic pelvic inflammation. METHOD: Thirty-six cases of chronic pelvic inflammation were treated with acupuncture, the ancient recipe of Long Dan Xie Gan Tang ([symbol: see text] Decoction of Radix Gentianae for Purging the Pathogenic Fire of the Liver) and medicinal cake moxibustion. RESULT: The treatment resulted in cure in 9 cases, obvious effect in 16 cases, effect in 7 cases and no effect in 4 cases. CONCLUSION: Acupuncture, moxibustion and the ancient recipe Long Dan Xie Gan Tang used together can enhance the therapeutic effects on chronic pelvic inflammation.

How acupuncture stimulates ovulation (the mechanism)

Clinical studies on the mechanism for acupuncture stimulation of ovulation
Mo X; Li D; Pu Y; Xi G; Le X; Fu Z Zhejiang College of Traditional Chinese Medicine, Hangzhou.

Ovulatory dysfunction is commonly seen in gynecology clinic. It may cause infertility, amenia, functional uterine bleeding and a variety of complications. This research according to TCM theory records treating with acupuncture 34 patients suffering from ovulatory dysfunction. Changes in clinical symptoms and some relative targets are reported, plus findings in animal experiments. The theory concerning the generative and physiologic axis of women, this research involved the following points; Ganshu (UB 18), Shenshu (UB 23), Guanyuan (Ren 4), Zhongji (Ren 3), and Sanyinjiao (Sp 6). The reinforcement and reduction of acupuncture enables it to strengthen liver and kidney. Through the Chong and Ren channels it nourishes uterus to adjust the patient’s axis function and recover ovulation. Treated on an average of 30 times, the patients’ symptoms improved to varying degrees. The marked effective rate was 35.29%, the total effective rate being 82.35%. BBT, VS, CMS, and B ultrasonic picture all improved to some degree. The results also showed that acupuncture may adjust FSH, LH, and E2 in two directions and raise the progesterone level, bringing them to normal. The animal experiments confirmed this result. Results showed that acupuncture may adjust endocrine function of the generative and physiologic axis of women, thus stimulating ovulation. The results of this research will provide some scientific basis for treating and further studying this disorder.

In anovulatory infertility cases the hyperactive sympathetic system can be depressed by electro acupuncture and the function of the hypothalamus-pituitary-ovarian axis can be regulated by electro acupuncture via central sympathetic system

Relationship Between Blood Radioimmunoreactive Beta-Endorphin and Hand Skin Temperature During The Electro-Acupuncture Induction of Ovulation

By Chen Bo Ying M.D. Lecturer of Neurobiology
Institute of Acupuncture Research, and Yu Jin, MD., Prof of Gynecology Obstetricus and Gynecology Hospital Shanghai Medical University Shanghai, People’s Republic of China

Abstract:

Thirteen cycles of anovulation menstruation in 11 cases were treated with Electro-Acupuncture (EA) ovulation induction. In 6 of these cycles which showed ovulation, the hand skin temperature (HST) of these patients was increased after EA treatment. In the other 7 cycles ovulation was not induced. There were no regular changes in HST of 5 normal subjects. The level of radioimmunoreactive beta-endorphin (rß-E) fluctuated, and returned to the preacupunctural level in 30 min. after withdrawal of needles in normal subjects. After EA, the level of blood rß-E in cycles with ovulation declined or maintained the range of normal subjects. But the level of blood rß-E and increase of HST after EA (r=-0.677, P <0.01). EA is able to regulate the function of the hypothalamic pituitary-ovarian axis. Since a good response is usually accompanied with the increase of HST, monitoring HST may provide a rough but simple method for prediciting the curative effect of EA. The role of rß-E in the mechanism of EA ovulation induction was discussed.

KEYWORDS: Electro-Acupuncture (EA), Hand Skin Temperature (HST), radioimmunoreactive beta-endorphin (rß-E), ovulation, radioimmunoassay (RIA).
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Acupuncture, IVF/ICSI and follicle development

fertility and sterility acupunctureAcupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection
Sandra L. Emmons, MD
Phillip Patton, MD

Source: Medical Acupuncture, A Journal For Physicians By Physicians
Spring / Summer 2000- Volume 12 / Number 2
"Aurum Nostrum Non Est Aurum Vulgi"

Table 1. Outcomes for Acupuncture vs Non-Acupuncture Cycles Among 6 Women Undergoing ICSI*
Patient No.
Age, y
Non-Acupuncture Cycles
AcupunctureCycles
Follicles Cycles Follicles Cycles
Mean No. No. Mean No. No. Outcome
1 29 4.7 3 8 1 IUP
2 34 2 1 10 2 SAB twice
3 36 3 2 14 1 SAB
4 37 8 1 6 1 No pregnancy
5 38 1 1 4 1 Cycle canceled
6 41 2 1 6 1 SAB
Mean (SD) 3.7 (1.0) 8.4 (1.3)
*ICSI indicates intracytoplasmic sperm injection; IUP, intrauterine pregnancy; and SAB, early spontaneous abortion. P=.02 for overall acupuncture follicles vs non-acupuncture follicles.

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Acupuncture – natural labour pain relief

ugelscriftforlaeger-infertility-acupuncturelA retrospective analysis of the results of obstetric acupuncture at Frederiksberg Hospital
[Article in Danish]
Spellerberg E, Smidt-Jensen SL.

Fodeafdelingen, H:S Frederiksberg Hospital, DK-2000 Frederiksberg. eileen@spellerberg.net

INTRODUCTION: The use of obstetric acupuncture in Denmark is increasing but its use in routine clinical practice has not been evaluated. MATERIAL AND METHODS: This retrospective uncontrolled study comprises 691 women who attended Frederiksberg Hospital during pregnancy and delivery. Their mean age was 30.5 +/- 4.3 year, mean parity 1.3 +/- 0.6 (71.8% were primiparous), and the mean gestational age was 39 +/- 3.7 weeks. A total of 563 of the women (81.5%) were in labour. The effect of acupuncture was evaluated by the pregnant women alone for the pregnancy-related indications and by both women and midwifes for labour-related indications. RESULTS: The women had acupuncture based on 997 individual indications (mean 1.4 +/- 0.5). Twenty-two indications were used. 78.8% of all treatments were for pain relief or anxiety. The scores were highly correlated between women and midwives as 42.2 and 40.6%, respectively, indicated “full effect” and 33.3 and 33.4% indicated “some effect”. The midwives’ scores were independent of the women’s age, parity, gestational age and indication(s). One possible side effect was observed (temporary dropfoot). DISCUSSION: In this study, routine obstetric acupuncture was perceived as equally effective by the women and midwifes. The method is simple, inexpensive and without significant adverse effects. It deserves a place in the midwives’ armamentarium.

Ugeskr Laeger. 2003 Mar 3;165(10):1023-7.

Health care practitioners need to be proactive in acquiring and documenting use of complimentary therapies for infertility

ajo-infertility-acupuncture1The use of complementary medicine and therapies by patients attending a reproductive medicine unit in South Australia: A prospective survey
Marcin STANKIEWICZ 1, Caroline SMITH 2, Helen ALVINO 3 and Robert NORMAN 4

1Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders Medical Centre, 2Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, The University of Adelaide, 3Adelaide Hormone and Menopause Centre, Adelaide Fertility Centre Pty Ltd, and 4Discipline of Obstetrics and Gynaecology, Medical School North, The University of Adelaide, South Australia, Australia
Correspondence: Dr Marcin Stankiewicz, Flinders Reproductive Medicine Unit, Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia. Email: marcin.stankiewicz@fmc.sa.gov.au
Key words : complementary therapies, reproductive techniques assisted, in vitro fertilisation, female infertility, male infertility, vitamins.

DOI: 10.1111/j.1479-828X.2007.00702.x
Abstract

Background: There is limited research describing the use of complementary medicines (CM) and therapies among patients with infertility.

Objective: (i) To examine the use of CM by subjects attending an infertility clinic at their first consultation and six months later; (ii) to examine men’s and women’s views on the effectiveness and safety of these practices; and (iii) to examine the documentation of the use of CMs and therapies in clinical notes.

Design: A prospective survey of 100 consecutive new patients presenting to an infertility clinic. Subjects were requested to complete a self-administered questionnaire at their first visit and six months later. A retrospective audit of 200 patient records.

Results: A response rate of 72% was obtained. Sixty-six percent of patients attending the infertility clinic in South Australia used CMs. Six months following the initial consultation the use of CMs had declined. The most commonly used CMs included multivitamins, herbs, and mineral supplements, and subjects consulted most frequently with naturopaths, chiropractors and acupuncturists. The use of CMs and therapies was poorly documented by clinical staff.

Conclusion: Complementary medicines and therapies are widely used by patients with infertility. Health-care practitioners and fertility specialists need to be proactive in acquiring and documenting the use of these practices. There is a need to provide further information to patients on the use of CMs and therapies. Further research examining the reasons for use of CMs and therapies is needed.

The Australian and New Zealand Journal of Obstetrics and Gynaecology

Volume 47 Issue 2 Page 145 – April 2007

Marcin STANKIEWICZ, Caroline SMITH, Helen ALVINO, Robert NORMAN (2007)
The use of complementary medicine and therapies by patients attending a reproductive medicine unit in South Australia: A prospective survey
The Australian and New Zealand Journal of Obstetrics and Gynaecology 47 (2), 145–149.
doi:10.1111/j.1479-828X.2007.00702.x

Premenstrual syndrome – PMS and acupuncture

Using acupuncture to treat premenstrual syndrome.
Habek D, Habek JC, Barbir A.

Department of Gynecology and Obstetrics, Health Centre, Bjelovar, Croatia. dubravko.habek@bj.hinet.hr

More than 60% of the women in both groups suffered from premenstrual syndrome (PMS or PMT) symptoms, such as anxiety, mastalgia, insomnia, nausea and gastrointestinal disorders, whereas a smaller number of women suffered from phobic disorders, premenstrual headaches and migraines. There were three women from the first group and seven women from the second group who continued the medication treatment with progestins, whereas one woman from the first group and nine women from the second group continued to take fluoxetine. In the first group, nine women stopped having PMS symptoms after two AP treatments, eight women stopped having them after three treatments and one woman stopped having them after four treatments. In four women from the first group and 16 women from the second group, PMS symptoms appeared during the following period (cycle) or continued even after four treatments, so the medication was continued. In the first group, one woman had a smaller subcutaneous hematoma after the AP acupoint Ren 6. There was a statistical and relevant reduction in PMS symptoms with the AP treatments in the first group (P<0.001), whereas their reduction was irrelevant in the placebo AP group (P>0.05). The success rate of AP in treating PMS symptoms was 77.8%, whereas it was 5.9%. in the placebo group. The positive influence of AP in treating PMS symptoms can be ascribed to its effects on the serotoninergic and opioidergic neurotransmission that modulates various psychosomatic functions. The initial positive results of PMS symptoms with a holistic approach are encouraging and AP should be suggested to the patients as a method of treatment.

Arch Gynecol Obstet. 2002 Nov;267(1):23-6.

How acupuncture works: mechanisms of electro acupuncture and clinical application.

Electroacupuncture: mechanisms and clinical application.
Ulett GA, Han S, Han JS.

University of Missouri-Columbia, School of Medicine, St. Louis 63139, USA.

Acupuncture is an ancient Chinese method to treat diseases and relieve pain. We have conducted a series of studies to examine the mechanisms of this ancient method for pain relief. This article reviews some of our major findings. Our studies showed that acupuncture produces analgesic effect and that electroacupuncture (EA) is more effective than manual acupuncture. Furthermore, electrical stimulation via skin patch electrodes is as effective as EA. The induction and recovering profiles of acupuncture analgesia suggest the involvement of humoral factors. This notion was supported by cross-perfusion experiments in which acupuncture-induced analgesic effect was transferred from the donor rabbit to the recipient rabbit when the cerebrospinal fluid (CSF) was transferred. The prevention of EA-induced analgesia by naloxone and by antiserum against endorphins suggests that endorphins are involved. More recent work demonstrated the release of endorphins into CSF following EA. In addition, low frequency (2 Hz) and high frequency (100 Hz) of EA selectively induces the release of enkephalins and dynorphins in both experimental animals and humans. Clinical studies suggesting its effectiveness for the treatment of various types of pain, depression, anxiety, spinally induced muscle spasm, stroke, gastrointestinal disorders, and drug addiction were also discussed.

Biol Psychiatry. 1998 Jul 15;44(2):129-38.

How to understand studies

Evidence Based Medicine

We are often asked why some studies are better than others.

This is a complex subject. Apart from the quality, design, and other factors, we have to take into account the different levels of evidence. As you can see from this chart, expert opinion is the weakest evidence and systematic reviews are the strongest.

For example, Acupuncture as an adjunct to IVF has been researched extensively. The big majority of the studies that used good methodology showed that acupuncture was effective. Systematic reviews have summarised those studies and confirmed that acupuncture was an effective therapy to improve IVF success rate. Therefore, one could say that there is a strong evidence supporting acupuncture as an adjunct to IVF.