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NEW YORK (Reuters Health) – Women who are trying to conceive may get a push in the right direction from acupuncture, according to a new report.
A review of medical literature regarding the benefits of acupuncture to women's fertility reveals that the ancient technique can help reduce stress, increase blood flow to the reproductive organs and help normalize ovulation--all of which can help a woman conceive.
As such, women struggling to get pregnant may want to add acupuncture to their roster of fertility-boosting treatments, according to study author Dr. Raymond Chang of Cornell University and Meridian Medical in New York City, a private clinic that offers acupuncture treatment.
People trying to conceive will try a number of different techniques, Chang noted, and acupuncture "is certainly one good alternative that has been proven." An ancient therapy that arose in China more than 2,000 years ago, acupuncture involves inserting fine needles at specific points on the body. Traditional Chinese medicine theory holds that these points connect with energy pathways, or meridians, that run through the body, and acupuncture helps keep this natural energy flow running smoothly.
Many previous studies examined the benefits of acupuncture when added to other fertility treatments. For example, one report found that women who incorporate acupuncture into their in-vitro fertilization (IVF) treatment are more likely to become pregnant than those who use IVF alone. IVF involves harvesting a woman's eggs, which are then fertilized with a man's sperm in the laboratory. The resulting embryos are transferred into the uterus.
Chang noted in an interview with Reuters Health that one previous study has also shown that women who used acupuncture without any other fertility treatments were just as likely to conceive in the same period of time as women who took a fertility drug. This finding indicates that acupuncture "can be done as a stand-alone treatment," he said.
Chang and his team summarize recent studies on acupuncture and fertility in the December issue of Fertility and Sterility.
In terms of Western explanations for how acupuncture might affect fertility, investigators have discovered that acupuncture may exert an influence over the centers in the brain that affect ovulation, and can also work on the brain to reduce stress.
Stress and the brain play an important role in fertility, Change explained, because stress can prevent a woman from ovulating entirely, while a lack of stress often promotes fertility. This trend explains why women under extreme stress often stop menstruating, and why couples often conceive while on a cruise or other relaxing holiday.
Researchers have also discovered that acupuncture can boost blood flow to women's reproductive organs, providing them with better nourishment. In addition, acupuncture appears to improve the lining of the uterus, the place where the embryo becomes embedded after conception. This lining is like "the soil in a garden," Chang explained--if it is undernourished, the embryo won't attach itself, and the pregnancy will not continue.
Chang noted that many patients are already adding acupuncture to other treatments to aid conception. "More and more, I think patients are doing it because they figure they might as well try everything," he said. Despite the current evidence, Chang said he believes additional research is needed to assess the benefits of acupuncture in fertility for women. He noted that he and his colleagues are planning a clinical trial to compare women undergoing IVF plus acupuncture to those using IVF alone in order to conceive, to determine whether the ancient treatment helps as an additional technique.
SOURCE: Fertility and Sterility 2002;78:1149-1153.
April 16 — Pairing an ancient Chinese medicine technique with in-vitro fertilization treatments can tip the odds in favor of women waiting to get pregnant, a new German medical study has found.
The study, published in the April edition of the medical journal Fertility and Sterility, found that acupuncture, an important element in the 4,000-year-old tradition of Chinese medicine, increases the chance of pregnancy for women undergoing in-vitro fertilization (IVF).
It does not identify how acupuncture may affect the uterus and reproductive system, but the researchers found the technique enhanced the chances of becoming pregnant for a significant number of the women in their small study population. Though the reason that acupuncture helps may be somewhat of a mystery, it is a serious study that deserves attention, ABCNEWS' Dr. Nancy Snyderman said.
"We know that acupuncture, when the needles are placed correctly, can affect the nervous system of the body," ABCNEWS Dr. Nancy Snyderman said. "So the question always is, can you make the uterus a better receiving place for embryos?"
Researchers included 160 patients undergoing in-vitro fertilization for the study. The patients, who were all required to have good quality embryos, were evenly and randomly divided into two groups similar in age and diagnosis. When the patients were examined using ultrasound six weeks after their IVF procedures, the differences in pregnancy rates were notable. In the control group, 26 percent of the women, or 21 out of 80 patients, became pregnant. Of the patients who had received acupuncture treatments, 42 percent of the women, 34 out of 80, became pregnant.
Two Rounds of Acupuncture
Researchers utilized acupuncture on half of the patients in their study. According to the principles of traditional Chinese medicine, energy flows through the body along defined pathways, also called "meridians." Acupuncture is a means of influencing this energy to induce a particular effect in the body.
The group receiving acupuncture treatments had one treatment before the embryos were transferred to their uterus, and another treatment after the transfer. The researchers inserted sterile needles into the patients' bodies at specific points, including along the spleen and the stomach "meridians," in an effort to stimulate blood flow and direct energy to the uterus, and to produce a sedative effect.
"The idea being that if you can stimulate the nerves, you can make the uterus quiet and blood flow," Snyderman said. "It makes it easier for the embryos to take hold."
Researchers inserted additional needles into the patients' ears, both to influence the uterus and stabilize the endocrine system. Needles were left in place for 25 minutes while the patients rested. The control group also rested, lying still for 25 minutes after embryo transfer, as part of the IVF protocol.
The researchers plan to conduct further studies to try to rule out possible psychological or psychosomatic effects.
Snyderman, said the study backs up what doctors have heard anecdotally for years: that by relaxing a woman can increase her chances of becoming pregnant. This may be the evidence to prove it that has been lacking, she said.
"There is no doubt, because this was a very well done study and it was reported in a very highly regarded medical journal, that doctors will sit up and pay attention to it," she said. "This is the first time we may have had a serious marriage between an art and science that is so many, many years old, and what is really cutting-edge technology, in-vitro fertilization."
What Is Acupuncture?
Acupuncture originated in China more than 5,000 years ago. It is based on the belief that a person's health is determined by having a balanced flow of "qi" (also spelled chi), the vital life energy circulating through the body.
When special needles are inserted into acupoints just under the skin, they help correct and rebalance this flow of energy, relieving pain and/or restoring health. It is used as a healing treatment for numerous conditions ranging from the common cold to addiction and chronic fatigue syndrome. It is also used as an adjunctive treatment for AIDS.
Generally, acupuncturists use somewhere between three and 15 needles for treatment. Costs vary, based on location and practitioners' training and experience. In most states, non-physician acupuncturists are required by law to use disposable, one-time-use sterilized needles. Physicians can use reusable sterilized needles because of their backgrounds in infection control.
ABCNEWS.com
ACUPUNCTURE HAS NUMEROUS POTENTIAL FERTILITY-BOOSTING BENEFITS ACCORDING TO NEW YORK WEILL CORNELL PHYSICIAN-SCIENTISTS
Article Calls for Definitive Study of Acupuncture as Fertility Treatment
New York, NY (April 29, 2003) – Physician-scientists at the Center for Reproductive Medicine and Infertility (CRMI) at New York Weill Cornell Medical Center call for a definitive study of acupuncture as a fertility treatment, citing its numerous, promising benefits associated with increasing fertility in women.
An article in a recent issue of Fertility and Sterility – co-authored by Dr. Zev Rosenwaks, Dr. Pak H. Chung, and Dr. Raymond Chang of Weill Cornell – provides a summary of current research that supports acupuncture’s potential benefits for fertility treatment, including the stimulation of increased uterine blood flow and fertility hormones.
“Acupuncture, which is nontoxic and relatively affordable, holds much promise as a complementary or alternative fertility treatment,” said Dr. Raymond Chang of New York Weill Cornell Medical Center.
“Yet, while there are a great number of biological explanations for acupuncture’s benefits to fertility, as well as significant anecdotal evidence, there has yet to be a definitive clinical study,” added Dr. Rosenwaks, Director of CRMI.
“One of the biggest obstacles to any study of acupuncture is a single standard of care,” said Dr. Pak H. Chung of New York Weill Cornell Medical Center. “Only appropriate training and certification of acupuncture practitioners by state agencies can facilitate the integration of acupuncture into the treatment of female infertility, and health care in general.”
The lead review article reports that acupuncture treatment has the following potential fertility-boosting benefits:
- Increased blood flow to the uterus and therefore uterine wall thickness, an important marker for fertility
- Increased endorphin production, which, in turn, has been shown to effect the release of a gonadotropin-releasing hormone (GnRH), a decapeptide involved in regulating reproduction
- Lower stress hormones responsible for infertility
- Impact on plasma levels of the fertility hormones: follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and Progesterone (P)
- Normalization of the hypothalamic-pituitary-ovarian axis, a key process in fertility
A positive effect for women with polycystic ovarian syndrome, a hormonal imbalance present in three percent of adolescents and adults.
Acupuncture is the manipulation of thin metallic needles inserted into anatomically defined locations on the body to affect bodily function. These so-called acupoints correspond to areas on the surface of the body that have been shown to have greater electrical conductance due to the presence of a higher density of gap junctions along cell borders. A greater metabolic rate, temperature, and calcium ion concentration are also observed at these points.
Dr. Rosenwaks, Director of the Center for Reproductive Medicine and Infertility, and Dr. Chung treat infertility patients at Weill Cornell Medical Center at New York-Presbyterian Hospital. Dr. Rosenwaks is the Revlon Professor of Reproductive Medicine in Obstetrics and Gynecology, Co-Director of the Institute for Reproductive Medicine, and Attending Obstetrician and Gynecologist at Weill Cornell. Dr. Chung is Assistant Professor of Reproductive Medicine, Assistant Professor of Obstetrics and Gynecology, and Assistant Attending Obstetrician and Gynecologist at Weill Cornell. Dr. Chang is Clinical Assistant Professor of Medicine at Weill Cornell, where he teaches courses on alternative and complementary medicine. He is also affiliated with Meridian Medical.
www.HealthNewsDigest.com
Gynecol Endocrinol, September 1, 1992; 6(3): 171-81
Department for Gynecological Endocrinology and Reproduction, Women's Hospital, University of Heidelberg, Germany
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.
Adding acupuncture to the treatment regimen of women having in vitro fertilization (IVF) may boost the chances of pregnancy. In a study of 160 women getting IVF, researchers from the Christian Lauritzen Institute in Ulm, Germany, used acupuncture before and after the embryo transfers in half the patients and found it helped increased the number of pregnancies.
The acupuncture-treated group received a treatment 25 minutes before and after the embryo transfer, with needles placed in stomach and colon meridians, as well as the ear meridians, to try to increase blood flow and energy to the uterus, and provide a sedative effect and stabilize the endocrine system. The control group had just the embryo transfer. The women in both groups were on average 32 years old and had undergone an average of two previous IVF cycles.
In the IVF-only group, 21 of the 80 patients (26.3 percent) became pregnant; in the IVF-plus-acupuncture group, 34 of 80 (42.5 percent) became pregnant, the researchers report in this month's Fertility and Sterility, the journal of the American Society for Reproductive Medicine. Exactly why the acupuncture boosted the pregnancy rates is not known for sure, but study author Wolfgang E. Paulus speculates the chosen acupoints may reduce the uterine contractions that typically occur with embryo transfer and may inhibit implantation. "Therefore," Paulus says, "we try to reduce the contractions by acupuncture in order to improve implantation."
The German study "could be a fluke," says Ingrid Rodi, a fertility specialist and gynecologist at the Santa Monica-UCLA Medical Center. Yet, she finds it scientifically sound. "This study is an impetus for others [researchers] to look at it," she says. Traditional Chinese medicine has employed acupuncture to boost fertility for years. For the past decade or so, Rodi says, many of her patients have told her they have acupuncture treatments before seeing her for traditional infertility treatments, hoping the acupuncture will restore their energy balance and make their body more receptive to the IVF treatments. Rodi isn't sure acupuncture will catch on in the United States with fertility specialists as an adjunct to fertility treatments, but she doesn't dismiss the possibility.
However, she points out the U.S. pregnancy rates with IVF are already higher than they are in Europe. The overall pregnancy rate for women under age 35, the age of the women in the German study, is already almost 40 percent, she says. Whether adding acupuncture to IVF treatments for U.S. women would boost the success rate higher remains to be seen, she adds. If more studies find a benefit in acupuncture coupled with IVF treatments, it might be possible to transfer fewer embryos per treatment, she says. However, acupuncture won't solve the problem of chromosomal abnormalities, which Rodi says are the biggest source of IVF failures in women over age 35.
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