Increasing Efficacy of IVF with Acupuncture A Deep Dive into the Latest Research

In the world of fertility, we’ve spent considerable time exploring how acupuncture can enhance reproductive outcomes. New research from China’s Tongji Hospital offers fresh insights into the effects of acupuncture on pregnancy outcomes in women undergoing in vitro fertilisation (IVF).

The study conducted by Xu, Zhu, and Zheng (Arch Gynecol Obstet, 2023) is a thorough and systematic review of 25 previous trials, involving a total of 4,757 participants. The volume of information contained in these trials gives us a clearer picture of the potential benefits of acupuncture in the context of IVF, and the results are incredibly promising.

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If you feel anxious when trying to conceive, you’re not alone.

Picture yourself on an emotional rollercoaster, gripping the safety bar for dear life as your heart races and your breath turns shallow. This is what countless individuals experience when trying to conceive through in-vitro fertilisation (IVF).  And eventually you may stop noticing those tense shoulders, increased heart rate and shallow breathing, and the physical toll on your body and mind might go unnoticed.

In addition to the toll on your health, infertility stress may affect your life and relationships so much so that you may feel discouraged about pursuing treatment. In fact, the most common reason why patients discontinue IVF is the psychological burden.  Despite studies showing stress reduces your chances of conception, unfortunately, IVF clinics don’t always offer the support you need to manage that stress. Yes, some clinics, like the ones Auckland NZ, do offer a couple of counselling sessions, but stress management mostly falls on already exhausted patients.

 

What can you do to manage your IVF and infertility stress and anxiety?

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Can IVF acupuncture improve live birth rates, aka take home babies?

Despite 20 years of vigorous IVF acupuncture research, further studies are ceaselessly coming in. Browsing our website you will find evidence IVF acupuncture benefits pregnancy or live birth rates. And there are also studies that do not show the effect on pregnancy rates, but highlight other acupunctures’ benefits, like improved embryo quality or better blood flow in the uterus or reduced stress. And sometimes it may seem like it is bit challenging to clearly understand the benefits and draw conclusions on IVF acupuncture. This maybe due to differences study methodologies and due to the variety of protocols used – not all reproductive acupuncture is effective.

If you think that fertility acupuncture evidence is somewhat confusing, here is a study to clear things up.

Our ABORM colleague, Dr Lee Hullender Rubin recently embarked on a mission to provide clarity on the role of acupuncture in IVF treatments.  She analysed the two latest and most rigorous systematic reviews and meta-analyses resulting in an insightful overview in her recent study.

Here we present to you a summary of the key findings on how this time-tested therapy can help during your next IVF, based on data from nearly 2000 women.

The the current evidence on the effect of acupuncture on IVF outcomes

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Are you labelled as a poor IVF responder? Is there a way you can up your chances of making a baby? You know there are not many options. Can acupuncture help?

IVF is the numbers game. The important part of IVF is for your ovaries to safely produce as many follicles as possible. And poor IVF responders’ ovaries, as the name suggests, don’t grow many follicles. This means these IVF cycles are often cancelled. If you are lucky you may end up with a couple of oocytes. Furthermore, those eggs are less likely to turn into embryos.

The poor ovarian response (POR) is a diagnosis no one wants when trying to conceive. IVF clinics can’t do much to help you respond better. There are several IVF protocols you can try, but unfortunately, they are seldom successful.

So, what does poor IVF response diagnosis mean? Let’s take it apart.

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In this post, we’ll discuss the article published in JAMA “The Effects of Acupuncture vs Sham Acupuncture on Live Birth Rates Among Women Undergoing In Vitro Fertilization” (1).

I know, these comments may include technical jargon, which may be hard to understand for a lay person. This post is mostly for healthcare providers helping them understand this particular study.

This new study questions acupuncture’s effects on IVF pregnancy outcomes, but when you peruse the paper carefully the validity of it comes into the red zone for several reasons: Read more

Do you find yourself scrolling through endless pages of conflicting advice on a fertility diet? Do you feel like after all that googling you haven’t found the answer?

Is dairy good or bad for fertility? Pineapples? Gluten? Go vegan?  What about the Keto diet?

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How many acupuncture treatments do you need to improve IVF outcomes?

Our own analysis of IVF acupuncture studies has shown that the treatment protocol for IVF patients needs to take into account your specific situation.

Furthermore, the results can be significantly improved when we use the comprehensive approach of TCM diagnosis and make use of both acupuncture and herbal medicines 3+ months leading to IVF. And our colleagues who did their research agree. Furthermore, below is a study published this month suggesting that three acupuncture sessions around the day of embryo transfer are insufficient intervention.

There are situations where you will not have enough notice, or you will learn about acupuncture late in the IVF process. It may be not too late. You can still benefit from a shorter course of treatment. As an example, studies have shown that when done correctly, even four acupuncture sessions can improve uterine blood flow. If you’re willing to benefit from this treatment, please get in touch with us as early as possible. If you started IVF and you feel like it’s too late don’t worry. There are still ways how we may help improve your chances of success. When we apply the correct approach, we can make a difference even after you’ve started IVF.

If your fertility is on the rapid decline because of your age, or other factors, delaying IVF to boost your fertility may not be wise. We take every aspect of your reproductive and general health into consideration. During your initial appointment, we discuss all options with you so you can choose.

We’ve prepared a lecture on the strategies of designing optimal individualised acupuncture protocol. This lecture soon will be available via a leading continuing medical education provider shortly.

Get in touch if you’re interested to learn about the optimal protocol for IVF Acupuncture.

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ohss

This recent study highlights how acupuncture, specifically electro-acupuncture (EA), can reduce the risk of ovarian hyperstimulation in IVF patients. Despite some limitations, the findings are crucial for tailoring acupuncture protocols to each IVF patient’s needs.

Published in the Chinese Journal of Integrated Traditional and Western Medicine, the research by Hong YL and colleagues from the Department of Gynecology at Nanjing University of Chinese Medicine examined the effects of EA on clinical outcomes and the occurrence of ovarian hyperstimulation syndrome (OHSS) in in vitro fertilization and embryo transplantation.

The study involved 109 patients at a Reproductive Center, divided into a control group and an EA group based on their appointment dates. While the control group underwent standard ovarian stimulation protocols, the EA group received additional electro-acupuncture from the start of their Gn injection until the day of embryo transfer.

Key findings from the study include:

  • Significantly lower estradiol levels on the day of ovum pick up (OPU) and embryo transfer (ET) in the EA group.
  • Decreased levels of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6), which are linked to the severity of OHSS, on key treatment days.
  • A notable reduction in the occurrence of OHSS and the cancellation rate of the transplant cycle in the EA group.

These results suggest that electro-acupuncture could be a valuable adjunct therapy in IVF treatments, potentially reducing the risk of OHSS. This study underscores the importance of integrating traditional techniques like acupuncture with modern reproductive technologies, offering a holistic approach to fertility treatments.

[Effect of electro-acupuncture on clinical outcomes and ovarian hyperstimulation syndrome in in vitro fertilization and embryo transplantation].
(PMID:25566616)

Hong YL, Tan Y, Yin YY, Zou YJ, Guo YH, Nie XW
Department of Gynecology, Nanjing University of Chinese Medicine, China.
Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi Jiehe Zazhi = Chinese Journal of Integrated Traditional and Western Medicine / Zhongguo Zhong xi yi jie he xue Hui, Zhongguo Zhong yi yan jiu Yuan zhu ban [2014, 34(11):1292-1296]

OBJECTIVE: To observe the effect of electro-acupuncture (EA) on clinical outcomes and the occurrence of ovarian hyperstimulation syndrome (OHSS) in in vitro fertilization and embryo transplantation.

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Frozen embryo transfer acupuncture

IVF Frozen Embryo Transfer (FET) patients benefit from Acupuncture. This helps us understand how Acupuncture benefits fertility.

Electro stimulation on acupuncture points leading to the IVF transfer improves the quality/receptivity of the uterine lining. A study published in the latest issue of peer-reviewed British Medical Journal (Acupuncture in Medicine) found the rates of embryo implantation, clinical pregnancy and live birth rates were higher in patients who received acupuncture leading to the transfer. They also found significant measurable changes in the endometrium (uterine lining):

  • Acupuncture improved the chances of triple-line pattern endometrial lining. It has been shown in studies that triple-line pattern is associated with good IVF outcome.
  • Endometrial perfusion (blood supply to the uterine lining) is an important factor in the process of implantation. The study found greater endometrial and subendometrial vascularisation following a series of acupuncture treatments leading to embryo transfer.
  • Acupuncture improved HOXA10 expression. Higher HOXA10 is associated with greater endometrial receptivity and good pregnancy outcomes. HOXA10 expression is lower in the uteri of women with hydrosalpinx, PCOS, and endometriosis.

How much acupuncture should you have to see those enhancements to your fertility? Women in this study had six acupuncture sessions per cycle for three menstrual cycles.

See the abstract of the study below. Read more

fertility and sterility acupuncture

Acupuncture has been shown to increase the uterine blood flow (decreasing uterine blood impedance). But does this boost to blood flow really matter when you’re having an IVF? This study below provides the answer. The researchers utilised specialised ultrasound method to assess uterine blood flow. They discovered that it had an immense effect on both pregnancy and implantation rates. IVF with women, who had the lowest blood flow below a certain level on the day of transfer, unfortunately didn’t result in any pregnancies.

In this study the blood flow is referred to as uterine blood flow impedance and pulsatility index(PI). The higher the impedance and PI, the lower the blood flow. None of the women who had PI value above 3 conceived.

Fertil Steril. 1992 Feb;57(2):372-6. Read more

acupuncture-in-medicine-bmj

This study shows that there is a significant benefit to integrate acupuncture with IVF treatment for patients with two or more failed IVF cycles. It is one of the few studies using sham acupuncture to ensure that the effect of acupuncture is real, not just a placebo. The study was published in a reputable, pier-reviewed journal Acupuncture in Medicine, BMJ journals.

Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial.
IVF and acupuncture
Isoyama Manca di Villahermosa D, Dos Santos LG, Nogueira MB, Vilarino FL, Barbosa CP.
Source
Faculty of Medicine of ABC, Clinic for Human Reproduction, , Santo André, São Paulo, Brazil.
Abstract
OBJECTIVE:
To evaluate the effectiveness of acupuncture and moxibustion as an adjuvant treatment in women undergoing in vitro fertilisation (IVF) when embryo implantation has failed.
METHODS:
A prospective, randomised controlled clinical trial was conducted with 84 infertile patients who had had at least two unsuccessful attempts of IVF. The patients were randomised in three groups: control (n=28), sham (n=28) and acupuncture (n=28). The sample size was calculated by assuming a pregnancy rate of 10% when embryo implantation had failed. The pregnancy rates of the current IVF cycle were evaluated by measurement of blood beta human chorionic gonadotrophin (beta hCG) and subsequent transvaginal ultrasound. Acupuncture was performed on the first and seventh day of ovulation induction, on the day before ovarian puncture and on the day after embryo transfer. In the acupuncture group, patients were treated with moxibustion at nine acupuncture points (BL18, BL22, BL23, BL52, CV3, CV4, CV5, CV7, GV4) and needling at 12 points. In the sham group needles were inserted in eight areas that did not correspond to known acupuncture points.
RESULTS:
The clinical pregnancy rate in the acupuncture group was significantly higher than that in the control and sham groups (35.7% vs 7.1% vs 10.7%; p=0.0169).

CONCLUSIONS:
In this study, acupuncture and moxibustion increased pregnancy rates when used as an adjuvant treatment in women undergoing IVF, when embryo implantation had failed.

This systematic review on Acupuncture and IVF is especially interesting. The studies of the well researched German protocol show acupuncture to be effective on the day of embryo replacement. This systematic review shows that acupuncture during ovarian stimulation also plays significant role in increasing the pregnancy outcomes of IVF.


The role of acupuncture in assisted reproductive technology.
Zheng CH, Zhang MM, Huang GY, Wang W.

Abstract
The aim of this paper was to provide reliable evidence by performing a systematic review and meta-analysis for evaluating the role of acupuncture in assisted reproductive technology. All randomized controlled trials that evaluated the effects of acupuncture, including manual, electrical, and laser acupuncture (LA) techniques, on the clinical pregnancy rate (CPR) and live birth rate (LBR) of in vitro fertilization (IVF) or artificial insemination were included. The controlled groups consisted of no acupuncture and sham acupuncture groups. The sham acupuncture included sham acupuncture at acupoints, sham acupuncture at non- or inappropriate points, sham LA, and adhesive tapes. Twenty-three trials (a total of 5598 participants) were included in this paper. The pooled CPR from all acupuncture groups was significantly higher than that from all controlled groups, whereas the LBR was not significantly different between the two groups. However, the results were quite distinct when the type of control and/or different acupuncture times were examined in a sensitivity analysis. The results mainly indicate that acupuncture, especially around the time of the controlled ovarian hyperstimulation, improves pregnancy outcomes in women undergoing IVF. More positive effects from acupuncture in IVF can be expected if a more individualized acupuncture programs are used.

Full text of the study can be found here.

Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis.

Zheng CH, Huang GY, Zhang MM, Wang W.

Abstract

You can read the full paper here.

OBJECTIVE:
To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.

DESIGN:
Systematic review and meta-analysis.

PATIENT(S):
Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects of acupuncture on IVF outcomes.

INTERVENTION(S):
The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture.

MAIN OUTCOME MEASURE(S):
The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.

RESULT(S):
Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation.

CONCLUSION(S):
Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects of using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study

Objective

To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on pregnancy rates (PR) in women undergoing ET.
Design

Prospective, randomized, single-blinded placebo-controlled clinical trial.
Setting

Research and laboratory facilities.
Patient(s)

A total of 309 patients, less than 45 years old, undergoing cryopreservation embryos transplant or fresh cycle IVF with or without intracytoplasmic sperm injection (ICSI).
Intervention(s)

The subjects were randomly allocated to three groups: mock TEAS treatment: 30 minutes after ET (group I, n = 99); single TEAS treatment: 30 minutes after ET (group II, n = 110); and double TEAS treatments: 24 hours before ET and 30 minutes after ET (group III, n = 100).
Main Outcome Measure(s)

Clinical PR, embryos implantation rate, live birth rate.
Result(s)

The clinical PR, embryos implantation rate, and live birth rate of group I (29.3%, 15.0%, and 21.2%, respectively) were significantly lower than those in group II (42.7%, 25.7%, and 37.3%, respectively) and group III (50.0%, 25.9%, and 42.0%, respectively).
Conclusion(s)

Transcutaneous electrical acupoint stimulation, especially double TEAS, significantly improved the clinical outcome of ET.

Key Words: Acupuncture, transcutaneous electrical acupoint stimulation (TEAS), pregnancy rate (PR), in vitro fertilization (IVF), embryo transfer (ET), intracytoplasmic sperm injection (ICSI)

Selecting a control for in vitro fertilization and acupuncture randomized controlled trials (RCTs): how sham controls may unnecessarily complicate the RCT evidence base

Eric Manheimer M.S.Corresponding Author Contact Information, a, E-mail The Corresponding Author

a Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, Maryland
Available online 13 May 2011.

Objective

To examine the theoretical and methodologic rationales for the use of sham acupuncture controls in trials of adjuvant acupuncture for in vitro fertilization (IVF), and to identify the drawbacks of using a sham acupuncture control that may have its own effects on the pregnancy outcome. Read more

Effects of electro-acupuncture on in vitro fertilization-embryo transfer (IVF-ET) of patients with poor ovarian response

[Article in Chinese]

Zhongguo Zhen Jiu. 2009 Oct;29(10):775-9.

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 the 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 deficiency 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]

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.

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]

IVF is stressful. And Acupuncture offsets the effects of stress on some reproductive hormones during the in vitro fertilisation.

fertility and sterility acupuncture Changes 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.

fertility and sterility acupuncture The 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.