Category Archives: IVF
IVF has now become relatively common and in 2013, over 49000 women underwent around 65000 IVF or ICSI treatment cycles. The overall live birth rate has been steady in recent years, at around 25%. This compares to just 14% in 1991.
What I have written below, is intended to help couples who are planning to embark on IVF treatment, and who are considering the use of acupuncture to improve their chances of success. You may already have read some of the remarkably positive research findings in the last few years (more articles below). You will probably know less about what would be involved in receiving acupuncture during IVF treatment, and about the full scope of what we might hope to achieve.
At the end of 2015, some significant research was published, indicating that in the UK, two-thirds of patients will finally have a baby after six or more cycles. The researchers, lead by the Universities of Bristol and Glasgow, emphasised that patients should therefore try to prepare themselves for multiple cycles of treatment. In the light of this, anything such as acupuncture, which has been shown to be capable of improving success rates, should be probably be considered.
The causes of infertility frequently defy clear western medical explanation. However, a traditional Chinese medical consultation may point towards one or more causes. These can translate in non-medical terminology, to factors such as stress or overwork, or sometimes other, more subtle disharmonies of body, mind or spirit, are identified. In all cases though, the cause from a Chinese medical perspective, allows me to devise a treatment plan.
In general terms, my preference would usually be to see you weekly for at least three menstrual cycles before IVF treatment begins. This is in order to prepare your body for IVF. This might not be possible if you are on the brink of beginning your IVF cycle and have only just heard about the benefits of acupuncture. In this case, do not be put off and at least arrange some acupuncture to improve your chances of success, and to help with any stress and anxiety you may be feeling.
Bear in mind IVF may circumvent ovulation problems and failure of sperm to fertilise the egg, but it still relies on the embryo then successfully implanting. For this to happen, your womb lining must be receptive and sufficiently thick. My treatment approach is therefore to try to encourage a thick womb lining, whilst also trying to put you into the best possible state of overall health in the time available. It makes sense to me that an embryo is more likely to implant into a receptive womb within a healthy body.
Once IVF treatment begins, your acupuncture treatment can where appropriate, include specifics for each stage of the IVF cycle. Our aims can, in chronological order, include: 1) help with any side-effects (eg. flushes, sweating, palpitations, headaches) of the down-regulation drugs (northisterone, buserelin); 2) help with any side-effects (eg. mood swings, abdominal distension) of ovarian stimulation injections (puregon); 3) production of more useable follicles, guided sometimes by the results of your first scan; 4) reduction of stress levels just prior to egg collection; 5) after embryo transfer, support of a possible pregnancy.
In the two week period while you wait to perform a pregnancy test, I can offer acupuncture once a week if you wish. This phase can sometimes feel a bit of an anti-climax, when after all the attention of preceding weeks, you are left on your own and trying to take your mind off the outcome of it all.
There is no denying that IVF treatment can be a stressful experience for couples, and I feel this can be an in-built counterproductive feature. It is here though that acupuncture can really score, by keeping stress levels lower and by providing a regular opportunity to offload concerns. I am hopeful that the new trend certainly at the Exeter fertility clinic, towards “gentle IVF” might offset some of this stress; coupled with this, a smaller quantity of higher quality eggs might improve outcomes.
Although the emphasis in this short article has been on women, male partners too can benefit from acupuncture in several ways. About 50% of IVF procedures are now performed due to some problem with the sperm. Poor sperm characteristics and unsuccessful vasectomy reversals have been common reasons in my practice. Men with a low sperm count, motility or morphology, may benefit from a course of acupuncture, ideally commencing at least three months prior to egg retrieval for IVF. For more on male fertility, please see my Fertility article.
There is just one other aspect of IVF and assisted reproduction techniques which is worth mentioning here, and that is recurrent implantation failure. This is where the embryo repeatedly fails to implant in the uterus of an otherwise healthy woman. Such women might undergo three IVF cycles, each of which produces promising embryos, but none of which results in pregnancy. From a fertility clinic’s perspective, this is thought to be due to egg quality (and therefore a woman’s age), a thin endometrium (11 to 12mm at ovulation is optimal), uterine scarring (from a previous caesarean section or a D&C), and/or sperm quality.
Equally, from the Chinese medical perspective, there are also explanations, and if you have already experienced recurrent implantation failure prior to considering acupuncture, then we can look to see whether these factors might be at work. A course of acupuncture combined with changes of approach which your fertility clinic will discuss with you (eg assisted hatching, blastocyst culture), might improve your chances of success. This is an area where we should again consider treatment for a male partner.
For facts and figures on IVF in the UK, see the HFEA’s report.
Overall, I hope this has provided a helpful introduction to how I work, but as always, you are welcome to telephone and discuss things further. Acupuncture for IVF is also a lively research area, and below you will find some examples.
“Robin has treated me throughout 18 months’ fertility treatment. This has been supportive both physically and emotionally. I attribute the success of my progress to Robin’s holistic approach and the caring ethos and values he promotes in his practice. I will continue to see Robin during my pregnancy to support my emotional health and wellbeing.” – Sam, Exeter
A study undertaken in Sao Paulo, Brazil suggests acupuncture and moxibustion can improve the chances of becoming pregnant, in women for whom IVF has previously not worked. Eighty-four patients who had experienced at least two unsuccessful IVF cycles, were randomly allocated to receive either no treatment, sham acupuncture (superficial needling of the arm and thigh at points not associated with reproduction), or true acupuncture with moxibustion. Acupuncture was given four times: on the first and seventh days of ovulation induction; on the day before egg collection; and on the day after embryo transfer.
The pregnancy rate of 36% in the acupuncture group was significantly higher than in either of the two control groups, which were 7% and 11%.
(Influence of Acupuncture on the Outcomes of In Vitro Fertilisation when Embryo Implantation has Failed: A Prospective Randomised Controlled Clinical Trial. Acupuncture in Medicine, on-line 2013: http://aim.bmj.com/content/31/2/157.abstract?sid=6ccf0453-31c9-4285-9d55-6445cf01f3cc)
Results from a meta-analysis by Chinese authors, indicate that acupuncture, especially around the time of controlled ovarian stimulation, improves pregnancy outcomes in women undergoing IVF. The research also suggests that a more positive outcome is likely when the acupuncture is given according to an individualised treatment plan for the patient, as is the case with traditional Chinese acupuncture.
A total of 23 trials, covering 5598 women, were included in the study; the trials had been conducted across nine different countries, including Germany, the US, Australia and Sweden. The pooled clinical pregnancy rate from all groups treated with acupuncture, was found to be significantly higher than that in the control groups. The live birth rate was not significantly different.
(The Role of Acupuncture in Assisted Reproductive Technology. Evidence-Based Complementary and Alternative Medicine, epub 2 July 2012.)
Researchers in Brazil have concluded that acupuncture can reduce the symptoms of anxiety in women undergoing a course of IVF treatment. A total of 43 women were randomly allocated to receive either true acupuncture, or sham acupuncture using needles inserted in the vicinity of, but not actually at, acupuncture points. Treatment comprised four weekly sessions, after which the mean anxiety score in the acupuncture group was significantly lower compared to the sham treatment group.
(Effect of Acupuncture on Symptoms of Anxiety in Women undergoing In Vitro Fertilisation: A Prospective Randomised Controlled Study. Acupuncture in Medicine, April 2012, epub ahead of print.)
American researchers have investigated the effects of acupuncture on cortisol and prolactin levels in patients undergoing drug treatment in preparation for IVF.
Sixty-seven women were randomised to receive either standard IVF alone or IVF plus acupuncture. Levels of cortisol and prolactin in the blood, were measured regularly during the treatment cycle. Cortisol levels in the acupuncture group were significantly higher on IVF medication days 7, 8, 9, 11, 12 & 13, compared with the control group. Prolactin levels in the acupuncture group were significantly higher on IVF medication days 5 ,6, 7 & 8, compared with the control group.
The authors of the study conclude that acupuncture appears to achieve beneficial regulation of these hormones during the medication phase of the IVF process, and a trend towards more normal fertile cycle characteristics.
(Changes in Serum Cortisol & Prolactin Associated with Acupuncture during Controlled Ovarian Hyperstimulation in Women undergoing in vitro fertilisation-embyro transfer Treatment. Fert Steril.2008 Dec 30 Epub ahead of print)