Acupuncture increases the success of assisted reproductive therapies

in-vitro-fertilization-2Acupuncture can be used quite successfully with assisted reproductive therapy (ART), including in vitro fertilization (IVF) and intrauterine insemination (IUI). Research and clinical trials over the last five years have demonstrated that acupuncture can be of significant benefit to patients undergoing IVF.

In one study, the IVF success rate jumped from 25% to 42% using acupuncture on the day of embryo transfer. There are also acupuncture protocols for many disorders seen during ART including thin endometrial lining, luteal phase defect and others. For women with unexplained fertility, acupuncture can help with ovulation and to attain an unassisted pregnancy.

In cases where there is male factor infertility, acupuncture can be quite useful in improving sperm morphology.  It takes some time (approximately 70 days) to make a sperm, so it is important for all patients to allow time for acupuncture to change the body’s function. Six to eight weeks prior to embryo transfer is best, if possible.

There are basically five steps in the IVF and embryo transfer process which include the following:

  1. Monitor and stimulate the development of healthy egg(s) in the ovaries.
  2. Collect the eggs.
  3. Secure the sperm.
  4. Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.
  5. Transfer embryos into the uterus.

Step 1:

Western Medicine (WM): Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the woman’s cycles. This is often referred to as ovulation induction. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Egg development is monitored using ultrasound to examine the ovaries and urine or blood test samples to check hormone levels.

Traditional Chinese Medicine (TCM): Helps with circulation to the uterus. Even if you are not yet ready to consider IVF, circulation to your uterus will aid implantation. Your acupuncturist can assist you in lifestyle changes that will be useful to promote a uterine environment that is not hostile to the coming fetus. For example, most people know to avoid nicotine and alcohol, but other important things to know include the role of Essential Fatty Acids and eating enough alkaline foods to prevent the cervical mucus from hyperacidity. Acupuncture helps men’s fertility by improving sperm quality including motility, morphology and count. It also reduces the anxiety associated with infertility. Stress is often a large factor leading to a decrease in pregnancy rate. Prednidalone is the chemical precursor to both progesterone (the hormone necessary for pregnancy to occur and be sustained), and cortisol, the ‘stress’ hormone. When the body is under stress, prednidalone is ‘stolen’ from the production of progesterone and redirected into the production of cortisol, resulting in decreased chances of fertility. Regular acupuncture sessions can help reset this ‘prednidalone steal’.

Step 2:

WM: Your eggs are retrieved through a minor surgical procedure which uses ultrasound imaging to guide a hollow needle through the pelvic cavity. Sedation and local anesthesia are provided to remove any discomfort that you might experience. The eggs are removed from the ovaries using the hollow needle, which is called follicular aspiration. Some women may experience cramping on the day of retrieval, which usually subsides the following day; however, a feeling of fullness or pressure may last for several weeks following the procedure.

TCM: Most women going through in-vitro fertilization (IVF) aren’t told prior to egg retrieval that the anesthesia will most likely cause constipation. Because of the constipation created by the anesthesia and the bloated feeling that can be experienced from the egg retrieval, some women feel miserable the day after.  Acupuncture and Chinese dietary therapy can help ease those side effects.

Step 3: WM: Sperm, usually obtained by ejaculation is prepared for combining with the eggs.

Step 4: WM: In a process called insemination, the sperm and eggs are placed in incubators located in the laboratory which enables fertilization to occur. In some cases where fertilization is suspected to be low, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.

Step 5:

WM: The embryos are usually transferred into the uterus anywhere from one to six days later, but most commonly it occurs between two to three days following egg retrieval. At this point, the fertilized egg has divided to become a two-to-four cell embryo. The transfer process involves a speculum which is inserted into the vagina to expose the cervix. A predetermined number of embryos are suspended in fluid and gently placed through a catheter into the womb. This process is often guided by ultrasound. The procedure is usually painless, but some women experience mild cramping.

TCM: In general acupuncture treatments at the time of embryo transfer help to promote uterine blood flow, enhance positive implantation, prevent uterine contractions, reduce overall stress, promote relaxation and increase successful pregnancy.

Step 6:

WM: These steps are followed by rest and watching for early pregnancy symptoms. A blood test and potentially an ultrasound will be used to determine if implantation and pregnancy has occurred.

TCM: Although conception is our first goal, we look at fertility as the ability to carry a healthy pregnancy to full term. Our focus is to create an optimal environment for embryo.  We recommend following up with another acupuncture treatment 5-7 days after embryo transfer to further assist implantation and embryo development. When pregnancy occurs we highly recommend acupuncture through the first trimester to prevent miscarriage. Research is confirming our clinical evidence that acupuncture can reduce miscarriage and ectopic pregnancies, and to increase the rate of live birth.

If you are considering acupuncture, we encourage you to get in for your initial visit as soon as you can. That way you and your acupuncturist can develop a treatment plan that best suits you, even if you don’t start the treatment plan until later. Getting that first appointment under your belt also allows you the opportunity to determine if acupuncture is right for you and if it is something you want to continue to pursue.

If supplementation or herbs are needed, they take time to work, so beginning earlier is best. Even if you decide to wait to start acupuncture, don’t wait to start supplementation. It takes 4 – 5 months for an egg to mature. If you can get started on a good quality preconception formula 3 – 6 months prior to conception/transfer, your eggs are going to have the opportunity to grow and mature in a nutrient rich environment.