Should you ask for acupuncture for pain relief during your next egg collection? Can acupuncture replace powerful drugs like alfentanil?

This study authors think that electro-acupuncture stands a good chance to relieve pain during egg collection. It proved to be as good as alfentanil.

Furthermore, compared with the alfentanil group, women in the electro-acupuncture group had a higher implantation rate, more pregnancies. But, what matters the most, they had more babies per embryo transfer as well.

This study was not designed to measure pregnancy rates, we need to be a bit careful with these outcomes. However, it gave an obvious proof that acupuncture can replace drugs during the egg collection.

A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization

Elisabet Stener-Victorin, Urban Waldenstra, Lars Nilsson, Matts Wikland and Per Olof Janson

Abstract:

The aim of the present study was to evaluate the anaesthetic effect during oocyte aspiration of a paracervical block (PCB) in combination with either electro-acupuncture (EA) or intravenous alfentanil.

In all, 150 women undergoing in-vitro fertilization (IVF) and embryo transfer were randomized to receive either EA plus PCB or alfentanil plus PCB. Visual analogue scales (VAS) were used to evaluate subjective experiences during oocyte aspiration, and IVF outcome parameters were recorded.

No differences in pain directly related to oocyte aspiration, adequacy of anaesthesia during oocyte aspiration, abdominal pain, or degree of nausea were found between the two groups in the VAS ratings. Before oocyte aspiration, the level of stress was significantly higher in the EA group than in the alfentanil group (P < 0.05), and the EA group experienced discomfort for a significantly longer period during oocyte aspiration (P < 0.01). Compared with the alfentanil group, the EA group had a significantly higher implantation rate (P < 0.05), pregnancy rate (P < 0.05), and take home baby rate (P < 0.05) per embryo transfer.

Conclusion:

In conclusion, EA has been shown to be as good an anaesthetic method as alfentanil during oocyte aspiration, and we suggest that EA may be a good alternative to conventional anaesthesia during oocyte aspiration.

Pain relief during oocyte retrieval with a new short duration electro-acupuncture technique–an alternative to conventional analgesic methods.
Humaidan P, Stener-Victorin E.

The Fertility Clinic, Skive Sygehus, DK 7800 Skive, Denmark.

BACKGROUND: Acupuncture previously has proved its pain-relieving effect for ovum pick-up (OPU). The analgesic effect of electro-acupuncture (EA) was evaluated when EA was applied for only a few minutes prior to OPU in an attempt to make EA more attractive for clinical use. METHODS: Two hundred patients undergoing OPU were randomized prospectively using sealed, unlabelled envelopes, to receive pain relief with either EA in combination with a paracervical block (PCB) (n = 100) or conventional medical analgesia (CMA) in combination with a PCB (n = 100). A visual analogue scale (VAS) was used to evaluate pain and anxiety before, during and after OPU. The primary outcome measure was pain relief; secondary end-points were costs, time to discharge and clinical outcome parameters. RESULTS: There were no differences in any VAS ratings before the procedure. Directly after OPU, the EA group reported significantly higher mean and maximum pain, and ‘pain now’ than the CMA group. At 30 min after OPU and thereafter, no significant differences were found between the groups regarding abdominal pain. Time to discharge and costs were significantly lower in the EA group compared with the CMA group. No differences in clinical outcome parameters were seen. CONCLUSION: A significant difference was found between the EA and the CMA groups regarding pain during the OPU, probably due to the fact that the CMA group was pre-medicated as part of the study design. Despite a per-operative difference in pain rating, EA, given a few minutes prior to OPU, is a good alternative to CMA. The procedure is well tolerated by the patients, with a shorter hospitalization time and lower costs.

Hum Reprod. 2004 Jun;19(6):1367-72. Epub 2004 Apr 22.

Acupuncture: Impact on Pregnancy Outcomes in IVF Patients

12th World Congress on Human Reproduction, Venice Italy March 2005

Paul C. Magarelli, M.D., Ph.D., Diane Cridennda, L.Ac.  Mel Cohen, MBA

Abstract

Take-Home babies rates (THB) have been the single most important IVF outcome. Pregnancy rates (PR) can overestimate the expected success of a high-technology treatment for patients and many clinics use PR as a means of marketing their practices. This has caused disillusionment in patients and government regulation (especially in the U.S.).

Each IVF program strives to improve reproductive outcomes (low ectopic rates, low miscarriage rates and improved take-home baby rates – live births). Usually the approach to these improvements changes in IVF protocols, media adjustments in the IVF lab, patient selection, and subtle nudges towards egg donors for poor responders.

Another approach has been the inclusion of alternative medical modalities: acupuncture, massage therapy, stress reduction techniques, herbal medicine. We, and others, have chosen to incorporate Acupuncture into our IVF treatment protocols.

Recently we presented two studies that demonstrated improvements in pregnancy rates in Good and Poor IVF Responders with the inclusion of two specific Acupuncture Protocols (Steiner-Victorin and Paulus et. Al).

In the poor responders’ group we demonstrated a positive adjustment to Poor Responders pregnancy rates (PR) with improvements in PR in the Poor Responders group equivalent to good responders.

In the Good Responders study, we demonstrated a trend towards improved PR (5% above controls, not significant at p < 0.05).

With these observations noted we have continued our investigation and are reporting on reproductive outcomes in all IVF patients treated with Acupuncture compared to those untreated.

Materials and Methods:

In this study, 130 IVF cycles were reviewed in a retrospective fashion. Patients demographics, years infertile, age of male partners, sperm parameters, Day 3 FSH, Pulsatility Indices, Weight, BMI, infertility diagnoses, IVF treatment protocols were statistically similar for both the Controls (C) and Acupuncture (Ac) treatment groups.

All patients that completed an IVF cycle (retrieval, transfer) were included. There were 82 in the C group (non-acupuncture) and 48 in the Ac group. For the C vs. Ac groups, a summary of their statistics are as follows: Mean Age was 32.6 vs. 32.7, Day 3 FSH was 5.5 vs. 6.4, Pulsatility Indices for right and left uterine arteries were 1.5 and 1.2 vs. 1.4 and 1.0; Sperm counts were 69 vs. 67 million/ml; Sperm motility (%) were 48 vs. 53%, and Sperm morphologies were 6 % normal vs. 7%.

Results:

Pregnancy rates for the Ac group were statistically similar, although numerically higher, versus C (50% v 45% at P < 0.05). Ac miscarriage rates (SAB) were statistically lower than the C (8 % vs. 11% at p <0.01). There were no ectopic pregnancies in the Ac group ( P < 0.01). Live Births were significantly better in the Ac v C groups (42% v 38%). A surprising observation was that multiples pregnancies were significantly lower in the Ac vs. C groups (17 % vs. 22%). Average eggs retrieved were statistically similar to 15 vs. 15 for Ac and C respectively.

Conclusions:

IVF programs can significantly improve their IVF outcomes ( PR, THB, SAB and Ectopic) by adding acupuncture protocols, specifically Steiner Victorin and Paulus. Further studies of Traditional Chine Medicine modalities of treatment are underway. We are organizing a multicenter prospective study to confirm our observations.

fertility and sterility acupuncture Fertil Steril. 2002 Apr;77(4):721-4.

Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy.
Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K.

Department of Reproductive Medicine, Christian-Lauritzen-Institut, Ulm, Germany. paulus@reprotox.de

OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture. DESIGN: Prospective randomized study. SETTING: Fertility center. PATIENT(S): After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80). INTERVENTION(S): Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy. MAIN OUTCOME MEASURE(S): Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer.

RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.

CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after ART.

FALLOPIAN TUBE DYSFUNCTION AND CHINESE HERBAL MEIDCINE

A study was carried out in Guangzhou, China, to find an effective treatment for tubal obstruction. The results of 120 women divided into three treatment groups were compared. One group received a combination of Western medical treatment and Chinese herbal medicine, one group received Chinese herbal medicine only and another group received Western medical treatment only. After treatment, the fallopian tube patency rate 86.7% and the pregnancy rate 85.0% in the TCM/ WM group, 66.7% and 63.3% in the TCM group and 53.3% and 50% in the WM group respectively. The effectiveness in the combination group was significant. The authors conclude that the combination of western and Chinese medicine is the most effective method in treating tubal obstruction.
Kang JL, XIa W, He QY.'[Clinical study on treatment of oviduct obstruction by integrative traditional Chinese and Western medicine]. Zhongguo Zhong Xi Yi Jie He ZaZhi. 2001, 21 (6): 416-8.

fertility and sterility acupuncture Dieterle S, Ying G, Hatzmann W, Neuer A.

Fertil Steril. 2006 May;85(5):1347-51. Epub 2006 Apr 17.

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Witten/Herdecke, Dortmund, Germany. Dieterle@IVF-Dortmund.de

OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI). DESIGN: Randomized, prospective, controlled clinical study.

SETTING: University IVF center.

PATIENT(S): Two hundred twenty-five infertile patients undergoing IVF/ICSI.

INTERVENTION(S): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture. MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancy rates.

RESULT(S): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%). CONCLUSION(S): Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial
National Institute of Environmental Health Sciences

Vienna, Austria: There was heartening news today (Wednesday 3 July) for would-be parents worried because they had difficulty conceiving. A new study being presented to Europe’s leading reproductive medicine conference shows that most healthy couples concerned because the woman was not pregnant after a year of trying will conceive during the second year.

A US team from the National Institute of Environmental Health Sciences in North Carolina who analysed data on 782 couples from seven European cities1, concluded that even when the woman was aged between 35 and 39, fewer than 1 in 10 failed to conceive after 2 years unless the male partner was over 40.

Lead investigator Dr David Dunson suggested that couples should be patient and doctors should not intervene too fast with assisted reproductive techniques unless there are known reasons for a couple not conceiving naturally within a year.

He told the annual conference of the European Society of Human Reproduction and Embryology that recent research undertaken by his team showed that fertility in women started to decline as early as the late 20s and for men from their late 30s2 . But, this was due primarily to declines in the per menstrual cycle conception rate and not to an increase in the proportion of couples unable to achieve an unassisted pregnancy.

Now his team has extended their research using data from the European Fecundability Study to see what the implications are for fertility rates overall.

“On average the time to pregnancy increases with the age of the woman. The percentage failing to conceive within a year ranged from 8% for 19-26-year-olds to 13 to 14% for 27 to 34-year-olds to 18% for 35-39-year-olds.”

“But, regardless of age, most of the women who failed to conceive within the first 12 cycles conceived in the next 12. Only 3% of 19 to 26-year-olds, 6% of 27 to 34-year-olds and 9% of 35 to 39-year-olds failed to conceive in the second year, provided the male partner was aged under 40. Starting in the late 30s though, male age was also important: it meant that the percentage of failures after one year for women aged 35 to 39 rose from 18% to 28% if the male partner was over 40. After the second year the figure was 9% with male partners under 40 and 16% with male partners over 40.”

Dr Dunson said there were clear increases with age in the number of menstrual cycles needed to achieve pregnancy and in the probability of being classified as clinically infertile – a definition applied after a year of trying to conceive.

But, their research had clearly shown that among outwardly healthy couples with no known conditions associated with infertility, most who failed to conceive naturally within the first year will conceive naturally in the second year – regardless of age.

“So, in the absence of clinical indicators of infertility in addition to a long time to pregnancy, it may be appropriate to delay assisted reproduction until the couple has failed to conceive naturally in 18 to 24 months. There is a large amount of normal variability in fertility and many couples having below average, but normal fertility may fail to conceive within a year. This is particularly true for older couples, many of whom fail to conceive within the first year but are successful in the second.”

He said it was important for doctors to avoid recommending assisted reproduction too soon due to well-documented side effects. “Fertility treatment, such as IVF and ICSI, can result in an increased risk of multiple pregnancies, pregnancy complications, low birth weight, major birth defects and long-term disability among surviving infants. In addition, the chance of success with ART decreases with age, while the side effects increase in prevalence.”

1 Data were drawn from a large multinational study – the European Study of Daily Fecundability. It enrolled 782 women aged between 18 and 40 from seven centres – Milan, Verona, Lugano, Dusseldorf, Paris, London and Brussels. The participants kept daily records of basal body temperature and recorded the days on which intercourse and menstrual bleeding occurred. Data on 7,288 menstrual cycles contributed to the study.

2 Changes with age in the level and duration of fertility in the menstrual cycle. Human Reproduction. D. Dunson et al. Vol. 17. No 5. pp 1399-1403

Acupunct Med. 2006 Mar;24(1):23-8.

Acupuncture prior to and at embryo transfer in an assisted conception unit–a case series.
Johnson D.

Chobham Acupuncture Clinic, Chobham, Surrey. info@acupuncture-chobham.co.uk

Over a period of three years, acupuncture was offered to patients entering assisted reproduction therapy. Acupuncture sessions were given at varying, but usually weekly, intervals during the in vitro fertilisation (IVF) cycle, and immediately before and after embryo transfer. Twenty two patients (average age 36.2 years) were treated over a total of 26 IVF cycles and 15 pregnancies were achieved, as determined by presence of foetal heartbeat on ultrasound at four weeks post embryo transfer. This was a success rate of 57.7% compared with 45.3% for patients in the IVF unit not treated with acupuncture (P > 0.05). Relaxing effects were noted following acupuncture and it is speculated that this may have contributed to the increase in pregnancy rate for the acupuncture group.

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.

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. elisabet.stener-victorin@neuro.gu.se

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.

fertility and sterility acupuncture Improvement 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?

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.