New research demonstrates a consensus amongst acupuncture experts on best practice treatment protocols for acupuncture enhancement of assisted reproductive technology (ART) fertility treatments. ART includes all fertility treatments in which both the eggs and sperm are handled. ART includes in vitro fertilization (IVF) and intrauterine insemination (IUI).
In this study, researchers set out to determine if a consensus exists on high priority acupuncture points for the enhancement of ART. Acupuncture IVF and IUI ART has been used in the USA since 1981 to help women become pregnant. Although acupuncture and Chinese medicine for the treatment of infertility is a time honored practice, the combination of acupuncture with ART has emerged in recent years as an effective approach for improving pregnancy and live birth rates.
In this study, researchers administered three rounds of questionnaires to fifteen international acupuncture fertility experts to determine if a consensus exists on best practice protocols. The investigation revealed that several key components are central to acupuncture in combination with ART.
The timing of an acupuncture treatment in relation to the menstrual cycle is of great importance. An acupuncture treatment administered between day 6 and 8 of the “stimulated ART cycle” is optimal. In addition, it is ideal to have two acupuncture treatments “on the day of embryo transfer.”
Pre-transfer acupuncture points of high priority are
SP8, SP10, Liv3, ST29 and CV4.
Post-transfer points include
GV20, K3, SP6, P6 and K3.
Auricular acupuncture points Shenmen and Zigong were also determined to be of high priority.
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- BMC Complementary and Alternative Medicine 2012, 12:88 doi 10.1186/1472-6882-12-88. 7 July 2012.
- Development of an acupuncture treatment protocol by consensus for women undergoing Assisted Reproductive Technology (ART) treatment. Caroline A Smith, Suzanne Grant, Jane Lyttleton and Suzanne Cochrane. ?Zhongguo Zhen Jiu. 2012 Feb;32(2):113-6.
- Effects of electroacupuncture on embryo implanted potential for patients with infertility of different symptom complex]. Kong FY, Zhang QY, Guan Q, Jian FQ, Sun W, Wang Y. Department of Reproduction, The Second Affiliated Hospital of Shandong University of TCM, Jinan, China. Fertil Steril. 2005 Jan;83(1):30-6.
- Secretion of human leukocyte antigen-G by human embryos is associated with a higher in vitro fertilization pregnancy rate. Yie SM, Balakier H, Motamedi G, Librach CL.
Lee E. Lee E. Lee E.
Declaration: Support provided by NIH/NCCAM grant R25 AT002879 (Suppl) and 1K23AT006392. LHR owned the acupuncture practice. The authors report no financial or commercial conflicts of interest.
- Whole Systems Traditional Chinese Medicine (WS-TCM) added to IVF may be beneficial.
- WS-TCM and IVF was associated with more live births compared with acupuncture and IVF.
- WS-TCM and IVF was associated with more live births compared with IVF alone.
- WS-TCM is individualized and includes acupuncture and other TCM interventions.
Patients undergoing IVF may receive either acupuncture or whole-systems traditional Chinese medicine (WS-TCM) as an adjuvant IVF treatment. WS-TCM is a complex intervention that can include acupuncture, Chinese herbal medicine, dietary, lifestyle recommendations.
In this retrospective cohort study, 1231 IVF patient records were reviewed to assess the effect of adjuvant WS-TCM on IVF outcomes compared among three groups:
- IVF with no additional treatment;
- IVF and elective acupuncture on day of embryo transfer; or
- IVF and elective WS-TCM.
The primary outcome was live birth.
Of 1069 non-donor cycles, WS-TCM was associated with greater odds of live birth compared with IVF alone (adjusted odds ratio [AOR] 2.09; 95% confidence interval [CI] 1.36 to 3.21), or embryo transfer with acupuncture only (AOR 1.62; 95% CI 1.04 to 2.52). Of 162 donor cycles, WS-TCM was associated with increased live births compared with all groups (odds Ratio [OR] 3.72; 95% CI 1.05 to 13.24, unadjusted) or embryo transfer with acupuncture only (OR 4.09; 95% CI: 1.02 to 16.38, unadjusted).
Overall, IVF with adjuvant WS-TCM was associated with greater odds of live birth in donor and non-donor cycles. These results should be taken cautiously as more rigorous research is needed.
Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic review.
Ried K1, Stuart K. Complement Ther Med. 2011 Dec;19(6):319-31. doi: 10.1016/j.ctim.2011.09.003. Epub 2011 Oct 5.
Review suggests that management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to TCM diagnosis, appears to be fundamental to successful treatment of female infertility.
Chinese herbal medicine for female infertility: an updated meta-analysis.
Ried K1.Complement Ther Med. 2015 Feb;23(1):116-28. doi: 10.1016/j.ctim.2014.12.004. Epub 2015 Jan 3.
We searched the Medline and Cochrane databases until December 2013 for randomized controlled trials and meta-analyses investigating Chinese herbal medicine therapy for female infertility and compared clinical pregnancy rates achieved with CHM versus WM drug treatment.
Forty RCTs involving 4247 women with infertility were included in our systematic review. Meta-analysis suggested a 1.74 higher probability of achieving a pregnancy with CHM therapy than with WM therapy alone (risk ratio 1.74, 95%CI: 1.56-1.94; p<0.0001; odds ratio 3.14; 95%CI: 2.72-3.62; p<0.0001) in women with infertility. Trials included women with PCOS, endometriosis, anovulation, fallopian tube blockage, or unexplained infertility. Mean pregnancy rates in the CHM group were 60% compared with 33% in the WM group.
Our review suggests that management of female infertility with Chinese herbal medicine can improve pregnancy rates 2-fold within a 3-6 month period compared with Western medical fertility drug therapy. In addition, fertility indicators such as ovulation rates, cervical mucus score, biphasic basal body temperature, and appropriate thickness of the endometrial lining were positively influenced by CHM therapy, indicating an ameliorating physiological effect conducive for a viable pregnancy.
Unexplained Infertility Treated with Acupuncture and Herbal Medicine in Korea
Jongbae J. Park, K.M.D., Ph.D.J Altern Complement Med. 2010 Feb; 16(2): 193–198.
The standard therapeutic package for unexplained infertility in women studied here is safe for infants and the treated women, when administered by licensed professionals. While it remains challenging to have the target population complete a 6-month treatment course, during which most patients have to pay out of pocket, the extent of successfully achieved pregnancy in those who received full treatment provides meaningful outcomes, warranting further attention. A future study that includes subsidized treatment costs, encouraging the appropriate compliance rate, is warranted.
Armour, M. (2015). The effectiveness of acupuncture in the treatment of primary dysmenorrhea : a mixed methods study.
TCM acupuncture, irrespective of treatment timing, provided significant clinical benefits for women with primary dysmenorrhea, with reductions in pain severity, duration, secondary menstrual symptoms and analgesic intake.
Mike Armour, etl July 12 2017. The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial.
Conclusion of this research: acupuncture treatment reduced menstrual pain intensity and duration after three months of treatment and this was sustained for up to one year after trial entry. The effect of changing mode of stimulation or frequency of treatment on menstrual pain was not significant. This may be due to a lack of power. The role of acupuncture stimulation on menstrual pain needs to be investigated in appropriately powered randomised controlled trials.
V. Iorno,etl. Acupuncture Treatment of Dysmenorrhea Resistant to Conventional Medical Treatment. Evid Based Complement Alternat Med. 2008 Jun; 5(2): 227–230.
Smith CA, etl.Cochrane Database Syst Rev. 2016 Apr 18; Acupuncture for dysmenorrhoea.
The Cochrane review found there is insufficient evidence to demonstrate whether or not acupuncture or acupressure are effective in treating primary dysmenorrhoea, due to the large volume of low-quality studies.
Altern Ther Health Med. 2010 Nov-Dec;16(6):30-5. Liu H, Li H, Xu M, Chung KF, Zhang SP.
Trigeminal neuralgia (TN) is a commonly seen pain condition with limited treatments available, and acupuncture is widely used for pain conditions, including TN.
To review the efficacy of acupuncture treatment for TN.
English and Chinese databases were searched extensively to identify randomized controlled studies of acupuncture treatment for TN. Selected studies were assessed for methodological quality. Odds ratios (OR) between treatment and control groups were used to assess efficacy.
Twelve studies met the inclusion criteria with 506 people in the acupuncture arm and 414 people in the control arm, in which carbamazepine (CBZ) was used as the control treatment. They were all low-quality studies, hence precluding meta-analysis. Only four trials reported that acupuncture was superior to CBZ, and the remaining eight studies showed no difference between the treatment and control groups. Adverse effects of acupuncture, which were reported in three studies, were mild.
The evidence reviewed previously suggests that acupuncture is of similar efficacy as CBZ but with fewer adverse effects in treatment of TN. However, the evidence is weak because of low methodological quality of the reviewed studies. Further studies with improved methodologies are recommended to support the use of acupuncture for TN.