Acupuncture: A Clinical Review

Victor S. Sierpina, MD; Moshe A. Frenkel, MD

Family Medicine Department, University of Texas Medical Branch, Galveston, TX

This article summarizes the research base, probable mechanism of actions, and clinical
applications of acupuncture. It offers the clinician a deeper understanding of appropriate
conditions for which acupuncture may be useful, outlines how to integrate acupuncture into a
clinical practice, and describes referral and training issues.
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Auricular acupuncture in the treatment of female infertility

Auricular acupuncture in the treatment of female infertility

Gerhard I; Postneek F Department of Gynecological Endocrinology and Reproduction, Women’s Hospital, University of Heidelberg, Germany.

Gynecol Endocrinol 1992 Sep;6(3):171-81 (ISSN: 0951-3590)

Following a complete gynecologic–endocrinologic workup, 45 infertile women suffering from oligoamenorrhea (n = 27) or luteal insufficiency (n = 18) were treated with auricular acupuncture. Results were compared to those of 45 women who received hormone treatment. Both groups were matched for age, duration of infertility, body mass index, previous pregnancies, menstrual cycle and tubal patency. Women treated with acupuncture had 22 pregnancies, 11 after acupuncture, four spontaneously, and seven after appropriate medication. Women treated with hormones had 20 pregnancies, five spontaneously, and 15 in response to therapy. Four women of each group had abortions. endometriosis (normal menstrual cycles) was seen in 35% (38%) of the women of each group who failed to respond to therapy with pregnancy. Only 4% of the women who responded to acupuncture or hormone treatment with a pregnancy had endometriosis, and 7% had normal cycles. In addition, women who continued to be infertile after hormone therapy had higher body mass indices and testosterone values than the therapy responders from this group. Women who became pregnant after acupuncture suffered more often from menstrual abnormalities and luteal insufficiency with lower estrogen, thyrotropin (TSH) and dehydroepiandrosterone sulfate (DHEAS) concentrations than the women who achieved pregnancy after hormone treatment. Although the pregnancy rate was similar for both groups, eumenorrheic women treated with acupuncture had adnexitis, endometriosis, out-of-phase endometria and reduced postcoital tests more often than those receiving hormones. Twelve of the 27 women (44%) with menstrual irregularities remained infertile after therapy with acupuncture compared to 15 of the 27 (56%) controls treated with hormones, even though hormone disorders were more pronounced in the acupuncture group. Side-effects were observed only during hormone treatment. Various disorders of the autonomic nervous system normalized during acupuncture. Based on our data, auricular acupuncture seems to offer a valuable alternative therapy for female infertility due to hormone disorders.

Acupuncture and ART

Controlled trial of acupuncture effects in assisted reproduction therapy
Paulus W.E.1, Zhang M.2, Strehler E.1, Seybold B.1 and Sterzik K.Christian-Lauritzen-Institut, Reproductive Medicine, Ulm, Germany and 2Tongji Medical University, Department of Traditional Chinese Medicine, Wuhan, China

Introduction: In a former published prospective randomized study we demonstrated the benefitt of acupuncture on the pregnancy rate in assisted reproduction therapy by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer, with a control group receiving no acupuncture. To rule out the possibility that acupuncture produces only psychological or psychosomatic effects, we used a placebo needle set as a control in the present study.

Materials and Methods:Two hundred patients undergoing ICSI or IVF in our fertility centre were included in this prospective, randomized, placebo controlled trial. Only patients with good embryo quality were admitted. They were divided into two groups by random selection: embryo transfer with verum acupuncture (n = 100) and embryo transfer with placebo needling (n = 100). Verum acupuncture was performed in 100 patients 25 min before and after embryo transfer. In the control group (n = 100) a placebo needle set was used without penetrating the skin, but at the same acupoints and after the same scheme. Before embryo transfer we used the following locations: Cx6 (Neiguan), Sp8 (Diji), Liv3 (Taichong), Gv20 (Baihui) and S29 ( Guilai). After embryo transfer, the sterile disposable stainless steel needles (0.25 3 25 mm) were inserted at the following points: S36 (Zusanli), Sp6 (Sanyinjiao), Sp10 (Xuehai) and Li4 (Hegu). After 10 min the needles were rotated. The main outcome measure was clinical pregnancy defined by the presence of a fetal sac at ultrasound examination 6 weeks after embryo transfer. The Chi-squared test was used for comparison of both groups.

Results: Clinical pregnancies were documented in 43 of 100 patients (43.0%) in the acupuncture group, whereas pregnancy rate reached 37.0% (37 out of 100 patients) in the control group. A significant difference between verum acupuncture and placebo needling could not be demonstrated (P = 0.39).

Conclusion:The missing advantage of verum acupuncture versus placebo needling may be due to the methodical problem that real placebo models for acupuncture are lacking. Our placebo needle set induces an acupressure effect thus leading to a higher pregnancy rate than in our population without any complementary treatment.

Acupuncture and IVF embryo transfer, ART and PCOS

Acupunct Med. 2006 Dec;24(4):157-63.

Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer.

Stener-Victorin E, Humaidan P.

Institute of Neuroscience and Physiolopgy, Sahlgrenska Academy, Goteborg University, Sweden.

During the last five years the use of acupuncture in female infertility as an adjuvant to conventional treatment in assisted reproductive technology (ART) has increased in popularity. The present paper briefly discusses clinical and experimental data on the effect of acupuncture on uterine and ovarian blood flow, as an analgesic method during ART, and on endocrine and metabolic disturbances such as polycystic ovary syndrome (PCOS). Further it gives a summary of recent studies evaluating the effect of acupuncture before and after embryo transfer on pregnancy outcome. Of the four published RCTs, three reveal significantly higher pregnancy rates in the acupuncture groups compared with the control groups. But the use of different study protocols makes it difficult to draw definitive conclusions. It seems, however, that acupuncture has a positive effect and no adverse effects on pregnancy outcome.

Improvement of IVF Outcomes by Acupuncture: Are egg and embryo qualities involved?

fertility and sterility acupunctureImprovement of IVF Outcomes by Acupuncture: Are egg and embryo qualities involved?

Paul C. Magarelli, M.D., Ph.D., a Diane Cridennda, L.Ac. b, Mel Cohen, MBA a
a Reproductive Medicine & Fertility Center, Colorado Springs, CO b East Winds Acupuncture, Colorado Springs, CO

FERTILITY AND STERILITY®, May 2005, VOL 83, SUP 2, Proceeding from the 2005 Pacific Coast Reproductive Society annual meeting in Palm Springs

Objective: In this study, we examine the impact of Acupuncture on the embryology characteristics of IVF patients, i.e., are there changes in the numbers of eggs generated, embryos fertilized, embryos transferred or remaining embryos for freezing in those patients receiving acupuncture therapy.

Design: Retrospective clinical study

Setting: Private infertility practice and Traditional Chinese Medicine practice

Patients: Two hundred eight IVF cycles were reviewed, 95 received acupuncture (Ac) and 113 were controls (C).

Interventions: Patients randomly chose Ac to complement their IVF treatments. Two published Ac protocols were used. Standard IVF protocols were used and done in one clinic by one physician. The MD was not aware of who received Ac in addition to their IVF. After three years the data were collected and analyzed.

Main Outcome Measures: Number of eggs retrieved, number of eggs fertilized normally, number of embryos implanted, number of embryos frozen, number of embryos transferred, day of transfer, number of prior IVF cycles, Day 3 FSH, Pulsatility Indices, weight, infertility diagnoses, IVF treatment protocols, pregnancy rates, SAB rates, ectopic rates, and multiple pregnancy rates.

Results: Number of prior IVF cycles, Day 3 FSH, Pulsatility Indices, Weight, Infertility diagnoses, IVF treatment protocols were statistically similar. Pregnancy rates for the Ac group were statistically significantly higher than the C group (P ≤ 0.05), SAB rates were lower and multiple pregnancy rates were lower (P < 0.06, not statistically significant). Ectopic pregnancy rates were statistically lower in the Ac group (P ≤ 0.05). There were no statistically significant differences between the C and Ac treated groups for the following embryology parameters: number of eggs retrieved, number of eggs fertilized normally, number of embryos implanted, number of embryos frozen, number of embryos transferred, and day of transfer. Conclusions: There were no discernable statistical differences between embryology characteristics in patients treated with or without Acupuncture. These data suggests that the mechanism of action of Acupuncture on IVF outcomes may be related to affects in the host (the egg provider and the embryo recipient) rather than in direct changes to the eggs retrieved and the embryos created. Key Words: IVF, acupuncture, adjuvant therapies, electro stimulation acupuncture, embryology, eggs

Acupuncture and In Vitro Fertilization: Does the Number of Treatments Impact Reproductive Outcomes?

Acupuncture and In Vitro Fertilization: Does the Number of Treatments Impact Reproductive Outcomes?

D.K. Cridennda L.Ac.(1), P.C. Magarelli MD, Ph.D. (2) , and M. Cohen, MBA (2).
.(1), East Winds Acupuncture Colorado Springs, CO; (2) Reproductive Medicine & Fertility Center, Colorado Springs, CO

Objective: The purpose of this study was to determine the optimal number of acupuncture treatments that provide the patient with the best IVF outcomes, i.e., pregnancy.

Materials and Methods: Retrospective clinical study in private practice Acupuncture and IVF center. Data were compiled in a group of infertile patients (n = 216) who received acupuncture during their IVF treatment cycle between 2001 and 2005. Data were analyzed to determine the optimal number of Electrical Stimulation (e-Stim) acupuncture treatments (Stener-Victorin protocol) that would result in a clinical pregnancy. Two hundred sixteen patients over a 4 year period were included in this study. Based on our previous studies, we determined a significant improvement in IVF outcomes when patients were treated with Acupuncture (Ac). We utilized two protocols: Stener-Victorin et al 1996 (reported on uterine blood flow) and Paulus et al. 2002 protocol (reported on acupuncture given just before and just after embryo transfer). Patients received a combination of both protocols. This population was stratified into pregnant and non pregnant groups and then evaluated by Student T=test and Chi-Square analysis for age, FSH levels, weight, BMI and E-2 levels. The pregnant and non-pregnant groups were further subdivided into those that received or did not receive acupuncture and were analyzed by Chi-square analysis. Since all patients received acupuncture consisting of e-Stim, their distribution was analyzed utilizing Kaplan- Meier survival analysis for pregnancy and no pregnancy to determine the number of e-stimulation that would provide the greatest chance for pregnancy.

Results: Patients age, day 3 FSH levels, weight, BMI (body mass index) and E2 (estrogen level at embryo transfer) were not statistically significantly different between the Non Acupuncture (No Ac) and the Acupuncture (Ac) groups. There was a statistically significant improvement (p < 0.01) in pregnancy rates in the group that received Ac (49 patients of 106 (37.4%) in the No Ac became pregnant vs. 77 patients of 111 (61.1%) of the Ac group became pregnant). This is over 23% increase in pregnancy rates in the Ac group. When the data were compared between e-Stim treatments in the Ac only group, an average of 6.5 treatments were found in the non-pregnant Ac group and 5.9 treatments in pregnant Ac group (not statistically significantly different). When the data were plotted comparing pregnant vs. non pregnant Ac patients, there was a trend towards numerically more e-Stim treatments in those who achieved a pregnancy. In order to confirm or refute differences in these two groups, Kaplan Meier’s survival analyses were done. Based on these analyses, the average accumulated affect in the non pregnant Ac group was 5.1 e-Stim treatments and 8.4 e-Stim treatments in the pregnant Ac group. This was statistically significantly different at the p < 0.05. Conclusion: In traditional Chinese medicine the basic theory is that only when the body is balanced will it function at its optimal level. Acupuncture helps restore balance which results in a higher chance of achieving pregnancy. In our study, we found that patients who received more than 8 e-Stim treatments appeared to have the maximum benefit for IVF outcomes: pregnancy (p < 0.05). In our study, we also reviewed the independent effects of the Paulus protocol, however due to small numbers; we could not perform the analyses. In the IVF center included in this study, patients receive Valium (diazepam) to reduce smooth muscle contractility. This treatment may provide all that is needed to reduce uterine contractility and therefore the additional impact of Ac at the pre and post transfer (Paulus protocol) may well be masked by the medication. More study of these and other treatments must be done. We are currently investigating the role of Ac in stress hormone circulating levels. Source : No outside source of funding.

Effects of Electro-Acupuncture on Nerve Growth Factor and Ovarian Morphology in Rats with Experimentally Induced Polycystic Ovaries


Effects of Electro-Acupuncture on Nerve Growth Factor and Ovarian Morphology in Rats with Experimentally Induced Polycystic Ovaries


Elisabet Stener-Victorin

2,a, Thomas Lundebergb, Urban Waldenströma, Luigi Mannic, Luigi Aloec, Stefan Gunnarssond, and Per Olof Jansona

a Department of Obstetrics and Gynecology, Göteborg University, SE-413 45 Göteborg, Sweden b Department of Physiology and Pharmacology, Karolinska Institutet, SE-164 01 Stockholm, Sweden c Institute of Neurobiology (CNR), Rome, Italy d Department of Evolutionary Biology, SE-752 36 Uppsala, Sweden


Despite extensive research on the pathogenesis of polycystic ovary syndrome (PCOS), there is still disagreement on the underlying mechanisms. The rat model for experimentally induced polycystic ovaries (PCO)—produced by a single injection of estradiol valerate—has similarities with human PCOS, and both are associated with hyperactivity in the sympathetic nervous system. Nerve growth factor (NGF) is known to serve as a neurotrophin for both the sympathetic and the sensory nervous systems and to enhance the activity of catecholaminergic and possibly other neuron types. Electro-acupuncture (EA) is known to reduce hyperactivity in the sympathetic nervous system. For these reasons, the model was used in the present study to investigate the effects of EA (12 treatments, approximately 25 min each, over 30 days) by analyzing NGF in the central nervous system and the endocrine organs, including the ovaries. The main findings in the present study were first, that significantly higher concentrations of NGF were found in the ovaries and the adrenal glands in the rats in the PCO model than in the control rats that were only injected with the vehicle (oil or NaCl). Second, that repeated EA treatments in PCO rats resulted in concentrations of NGF in the ovaries that were significantly lower than those in non-EA-treated PCO rats but were within a normal range that did not differ from those in the untreated oil and NaCl control groups. The results in the present study provide support for the theory that EA inhibits hyperactivity in the sympathetic nervous system.

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Natural depression relief – Electro-acupuncture

Comparative study of electro-acupuncture and maprotiline in treating depression
[Article in Chinese]
Han C, Li XW, Luo HC.

Acupuncture and Moxibustion School, Beijing University of Chinese Medicine, Beijing 100029.

OBJECTIVE: To compare the effect of electro-acupuncture (EA) and maprotiline (Map) in treating depression. METHODS: Thirty patients of depression were treated with EA and 31 patients with Map orally taken respectively. The therapeutic effect and side-effect were evaluated by measurement of Hamilton Depression Rating Scale (HAMD), Self-Rating Scale for Depression (SDS), Self-Rating Scale for Anxiety (SAS), Clinical Global Impression Scale (CGI) and Asberg Rating Scale for side-effects (ARS) before treatment and on the day 14, 28 and 42 of the therapeutic course. RESULTS: After treatment, the scores of HAMD and SDS lowered significantly (P < 0.01) than before treatment, and with insignificant difference between the group (P > 0.05). For patients with somatic syndrome, the HAMD score decrease rate was obviously higher in the Map group than that in the EA group. However, for the patients with anxiety somatization syndrome, the score of SAS, ARS in the EA group were significantly lower than those in the Map group (P < 0.05). Moreover, the efficacy index was higher in the EA group (P < 0.01). CONCLUSION: Both EA and Map are effective in treating depression. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2002 Jul;22(7):512-4, 521.

Auricular (ear) acupuncture decreases the anxiety

Auricular acupuncture: a potential treatment for anxiety.
Wang SM, Kain ZN.

Department of Anesthesiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut 06521, USA.

Acupuncture can be an effective treatment for chronic anxiety disorders. The purpose of this study was to assess the effectiveness of acupuncture in reducing anxiety in a volunteer population. If found effective, this modality could be introduced as a treatment of anxiety before surgery. Adult volunteers (n = 55), were randomized to three treatment groups: a) Shenmen group–bilateral auricular acupuncture at the “shenmen” point; b) Relaxation group-bilateral auricular acupuncture at a “relaxation” point; and c) Sham group-bilateral auricular acupuncture at a “sham” point. Press-acupuncture needles were inserted at the respective auricular areas for 48 h. State anxiety, blood pressure, heart rate, and electrodermal activity were assessed at 30 min, 24 h, and 48 h after insertion. Analyzing anxiety levels using repeated-measures analysis of variance has demonstrated a significant difference [F (2,51) =8.8, P = 0.001] between the three treatment groups. Post hoc analysis demonstrated that patients in the Relaxation group were significantly less anxious at 30 min (P = 0.007) and 24 h (P = 0.035) as compared with patients in both the Shenmen group and the Sham group, and less anxious at 48 h (P = 0.042) as compared with patients in Shenmen group. Repeated-measures analysis of variance performed for electrodermal activity, blood pressure, and heart rate demonstrated no group differences (P = ns). We conclude that auricular acupuncture at the “relaxation” point can decrease the anxiety level in a population of healthy volunteers.

Anesth Analg. 2001 Feb;92(2):548-53.

Remarkable reduction in anxiety symptoms and depression with acupunture

Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study
[Article in German]
Eich H, Agelink MW, Lehmann E, Lemmer W, Klieser E.

Klinik fur Psychiatrie und Psychotherapie, am Evangelischen Krankenhaus Gelsenkirchen Universitatsklinik der Ruhr-Universitat Bochum.

In a placebo-controlled, randomized, modified double-blind study we investigated the effects of body needle acupuncture (n = 10) in 43 patients with minor depression (ICD 10 F32.0, F32.1) and 13 patients with generalized anxiety disorders (ICD10 F41.1). The severity of the disease was assessed by the Clinical Global Impression Scale (CGI). Treatment response was defined as a significant improvement in CGI. An intent-to-treat analysis was performed to compare treatment responses between verum- and placebo acupuncture. After completing an total of 10 acupuncture sessions the verum acupuncture group (n = 28) showed a significantly larger clinical improvement compared to the placebo group (Mann-Whitney test, p < 0.05). There were significantly more responders in the verum-compared to the placebo group (60.7% vs. 21.4%; chi-square test, p < 0.01). In contrast, no differences in the response rates were evident just after 5 acupuncture sessions. A multivariate analysis with the independent factor acupuncture (verum vs. placebo) and the results of the results of the additional rating scales (total score of HAMA, HAMD, Bf-S, BL) as dependent variables (ANOVA, 1:54 D.F.) revealed a clear trend towards lower HAMA scores in the verum group after completing 10 acupunctures (F3.29, p = 0.075). This corresponds well to the high response rate of 85.7% in patients with generalized anxiety disorders, in whom verum acupuncture was applied. Our results indicate that needle acupuncture (Du.20, Ex.6, He.7, Pe.6, Bl.62) leads to a significant clinical improvement as well as to a remarkable reduction in anxiety symptoms in patients with minor depression or with generalized anxiety disorders. The total sum of acupuncture sessions and the specific location of acupuncture needle insertions might be important factors for bringing about therapeutic success.

Anxiety, depression, somatic and vasomotor symptoms improved by acupuncture

Tumori. 2002 Mar-Apr;88(2):128-30.
Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen.
Porzio G, Trapasso T, Martelli S, Sallusti E, Piccone C, Mattei A, Di Stanislao C, Ficorella C, Marchetti P.

Medical Oncology Unit, University of L’Aquila, Italy.

Fifteen patients were enrolled in a pilot study to evaluate the safety and efficacy of acupuncture for the treatment of menopausal symptoms in tamoxifen-treated patients. Patients were evaluated before treatment and after one, three and six months with the Greene Menopause Index and were treated according to the traditional Chinese medicine. Anxiety, depression, somatic and vasomotor symptoms were improved by the treatment; libido was not modified. Acupuncture seems to be safe and effective for the treatment of menopausal symptoms in women with previous breast cancer taking tamoxifen. Confirmatory studies with a larger number of patients and with a placebo-treated group are warranted.

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