Women’s Health Studies
Acupuncture and IVF Success Rates
Success rates in IVF with Acupuncture
In a study published in Fertility and Sterility in 2009 by Paul Magarelli, Diane Cridennda and Mel Cohen acupuncture was shown to have a benefit for many difference outcomes in IVF. Pregnancy and birth rates where higher. Miscarriage , ectopic pregnancy and multiples births were all lower in the acupuncture group.
It is from this study, and others, that we get the protocol of doing 9 acupuncture consecutive treatments before the embryo transfer and 2 treatments on the transfer day itself.
The researchers had already seen in their clinics that acupuncture was beneficial to success rates of women under going IVF, in the study they also tried to figure out why acupuncture helps. In this study they looked at cortisol and prolactin levels in the patients blood to see what acupuncture did to these normally occurring hormones.
Here is the full study. Look at table 2 for the pregnancy success rate results
Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment
Paul C. Magarelli, M.D., Diane K. Cridennda, L.Ac., and Mel Cohen, Ph.D.
Reproductive Medicine and Fertility Centers and East Winds Acupuncture, Colorado Springs, Colorado
Objective: To determine whether changes in serum cortisol (CORT) and PRL are affected by acupuncture (Ac) in Ac-treated IVF patients.
Design: Prospective cohort clinical study.
Setting: Private practice reproductive endocrinology and infertility clinic and private practice acupuncture consortium.
Patient(s): Sixty-seven reproductive-age infertile women undergoing IVF.
Intervention(s): Blood samples were obtained from all consenting new infertility patients and serum CORT and serum PRL were obtained prospectively. Patients were grouped as controls (IVF with no Ac) and treated (IVF with Ac) according to acupuncture protocols derived from randomized controlled trials.
Main Outcome Measure(s): Serum levels of CORT and PRL were measured and synchronized with medication stimulation days of the IVF cycle (e.g., day 2 of stimulation, day 3, etc.). Reproductive outcomes were collected according to Society for Assisted Reproductive Technology protocols, and results were compared between controls and those patients treated with Ac.
Result(s): CORTlevelsinAcgroupweresignificantlyhigheronIVFmedicationdays7,8,9,11,12,and13com- pared with controls. PRL levels in the Ac group were significantly higher on IVF medication days 5, 6, 7, and 8 compared with controls.
Conclusion(s): In this study, there appears to be a beneficial regulation of CORT and PRL in the Ac group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics. (Fertil SterilÒ 2008;-:-–-. Ó2008 by American Society for Reproductive Medicine.)
Key Words: IVF, acupuncture, cortisol, prolactin, pregnancy, traditional Chinese medicine, TCM
IVF represents the culmination of medical, scientific, and so- cial evolution. It can be linked to over 2,000,000 babies world- wide and is the treatment of choice for over 1,000,000 infertile couples each year (1). If we track the improvements in repro- ductive outcomes (pregnancy rates) and or if we look at the percent of improvement in numbers of cycles of treatment in the United States, we observe a steady growth since data were first collected (1986). In 1996, Harlow et al. (2) pre- sented their work showing a higher state of anxiety in women undergoing gonadotropin-stimulated IVF treatments and cor- related it to levels of PRL and cortisol (CORT). In the same year, Stener-Victorin et al. (3) demonstrated positive effects of traditional Chinese medicine (TCM) in the form of acu- puncture (Ac) on the pulsatility indices (PIs) of IVF patients. This was followed by Paulus et al. (4), whose pioneering work on the impact of Ac on reproductive outcomes of IVF patients has been verified by numerous large randomized controlled
Received May 22, 2008; revised October 24, 2008; accepted October 28, 2008.
P.C.M. has nothing to disclose. D.K.C. has nothing to disclose. M.C. has nothing to disclose.
Trials (RCTs) (5–8) and numerous cohort studies (9–15). Recently, Manheimer et al. (16) demonstrated, in a meta-analysis of the world’s literature on Ac and IVF, a 10% improvement in reproductive outcomes when IVF patients added Ac to their treatment regimens.
When comparing these and other studies, the average im- provement in pregnancy outcomes (ongoing or take home babies [THBs]) was 12%–14% for patients treated with IVF plus Ac (4–15). In the United States, to demonstrate a similar increase in reproductive outcomes with IVF alone, we would have to compare 1986 data with 1996 data (15% improvement) and 1996 data with 2003 data (8% improve- ment).
What remains a mystery is the biologic mechanism of the action of Ac on reproductive outcomes in patients treated with supraphysiologic levels of pharmaceuticals.
Recent studies have demonstrated how stress affects preg- nancy rates. In one study by Gallinelli et al. (17), 40 infertile women were studied who were undergoing IVF-ET in a uni- versity hospital. Blood sampling was used. Gallinelli et al. correlated stress and immunity with human fertility. Women with functional chronic anovulation had higher serum CORT and cerebrospinal fluid corticotrophin-releasing hormone concentrations than healthy controls. This CORT hypersecretion has been reported in women undergoing IVF and ET who fail to achieve implantation. Moreover, a significant correlation between low adaptation to cognitive stress and poor out- comes has been reported in couples. Gallinelli et al. (17) concluded that a prolonged condition of stress caused a de- creased ability to adapt; a transitory anxious state is associated with a high proportion of activated T cells in the peripheral blood, and such a condition reduces the embryo implantation rate. In another study, Smeenk et al. (18) examined urinary levels of stress hormones, adrenaline, noradrenalin, and CORT during treatment for self-reported stress to investigate the mechanism of the previously observed negative association for anxiety and depression with the outcomes of IVF/intracytoplasmic sperm injection. This was a prospective cohort study. Nocturnal urine samples were collected pretreatment, pre–oocyte retrieval, and before ET. Two questionnaires were administered to measure anxiety and depression. There was a significant positive correlation between urinary adrenaline concentrations at baseline and day of ET and the scores on depression at baseline. Women who had successful treatment had a lower concentration of adrenaline at oocyte retrieval and lower concentrations of adrenaline and noradrenalin at ET compared with the unsuccessful women. Smeenk et al. concluded that the association of adrenal hormone may be one of the links in the complex relationship be- tween psychosocial stress and IVF outcomes. Klonoff-Cohen et al. (19) reported on the trauma associated with infertility. IVF contains a number of stressful aspects: daily injections, blood draws, ultrasound, laparoscopic surgery, and the possibility of failure at any of the various phases. He defined successful IVF as one gestational sac detected on the ultrasound. This cohort study consisted of 221 (151 completed the study) women undergoing gamete intrafallopian transfer (GIFT). Women completed two stress questionnaires, one at the first visit (baseline) and one at the time of their procedure. The baseline stressor was assessed by the positive and negative affect scale and bipolar profile of moods states; the investigators noted that there was a significant change in the perceived stress at baseline before and after hormone use. The women were categorized as having good levels of social support systems. Outcomes were interesting: for each unit increase in a woman’s chronic negative-effect score on the stress survey, there was a 2% decrease in the number of oocytes retrieved. Similarly, when a woman’s chronic negative-effect score was high, one to two fewer embryos were transferred. Stress and anxiety had an effect on successful pregnancies and live births. A 1-point increase in positive affect on the stress scale increased the live-birth delivery rate by 7 percent. Facchinetti et al. (20) demonstrated that an increased vulnerability to stress is associated with a poor outcome of IVF-ET treatment.
The purpose of this study was to investigate whether there are changes in the stress hormones (CORT and PRL) that are known to influence reproductive outcomes (i.e., pregnancy rates), in IVF patients treated with Ac. We also sought to
determine in what direction the resultant stress hormones vary (more versus less).
MATERIALS AND METHODS
All patients seen at the Reproductive Medicine and Fertility Centers (RMFC) were invited to participate in our clinical tri- als by agreeing to have a vial of blood drawn during the nor- mal standard times (7 A.M. to 9 A.M.). Thus, an extra vial of blood was collected on the following days: new patient visit, day 3 blood work, day of down-regulation, days of IVF med- ication for detection of IVF treatment effects (that is, stimu- lation days), day of hCG trigger, day 1 post-hCG trigger, and day of pregnancy detection. Each data point represents a nor- malized number standardized to start of stimulation. Demo- graphic data on all aspects of patients and their partners as part of our routine computerized databases were collected, and these were used to derive demographic characteristics of patients in this study. Only those patients deemed eligible for IVF were included in this study. All patients completed IVF stimulation, egg retrieval, ET, and resultant pregnancy tests. Blood serum levels for CORT and PRL detection were by Immulite from DPC/Siemens (Princeton, NJ) (PRL intra-assay coefficient of variation [CV] 1⁄4 6.8%; interassay CV 1⁄4 9.6%; CORT intra-assay CV 1⁄4 8.8%; inter-assay CV 1⁄4 10%). Normal FSH (i.e., in female patients considered to have normal ovarian reserve) in our lab ranged from 2 to 10 mIU/mL.
Multiple variables can impact serum PRL and CORT levels (e.g., fasting state, medications, E2 levels, etc.). To re- duce these variables, the following steps were taken: all pa- tients had serum levels checked before 8 A.M. as is the standard in our clinic and were not fasting; all patients re- ceived gonadotropins, baby aspirin, and GnRH agonist in the standard IVF protocol as stated; control and test patient demographics were consistent and statistically the same over 80 parameters as presented in prior publications (9–14).
This prospective cohort clinical trial of IVF patients was based on the following principals:  all new infertility pa- tients signed informed consent forms (as part of their initial intake) to be part of a study that required a blood draw;  only lab personnel tracked participants;  neither the acu- puncturist nor the medical staff knew which patients had agreed to be in the study;  all samples of blood were frozen for later analysis (analyses were done monthly to retain con- sistency of hormone levels);  the decision to have IVF was based solely on clinical evaluations;  the decision to have Ac was based solely on patient preference;  the statistician did not know who was in the study until after all bloods were collected, hormones analyzed, and IVF cycles completed be- fore data analysis;  data were collected, stored, and then analyzed after all patients’ birth outcomes were recorded, ap- proximately 12 months from start of study;  data represent completed IVF cycle. The primary outcomes were detection of CORT and PRL serum levels at various stages of IVF
Demographics of study patients and treatment cycle characteristics.
Ac (n [ 34) Control (n [ 33)
No. of prior IVF treatments 1.32 0.4 (1–4)
Age, years 34.6 3.7 (25–41)
1.44 0.5 (1–4) 34.7 3.6 (23–40) 10.1 1.8 (5–14) 33.2 8.6 (22–48)
65.5 18.1 (45–100) 3811 153 (2315–6002)
1.54 .24 (1.2–3.9) 9.4 1.9 (8.1–14)
12.6 þ 2.0 (7–20) 5.2 0.7 (0–8) 2.9 0.3 (2–5)
77 9 (56–88) 15.6
Day3 FSH, IU/mL 10.2 1.8 (4–12)
BMI, kg/m2 32.6 8.5 (18–45)
Weight, kg 67.3 18.4 (48–95)
E onhCGday,pg/mL 3417104(2201–5697)
P on hCG day, ng/mL 1.51 .21 (1.2–3.9)
Endometrial thickness on hCG day, mm 10.6 1.1 (7.9–13)
Oocytes retrieved 13.1 2.2 (6–21)
Frozen embryos 5.4 0.7 (0–9)
Transferred embryos 2.8 0.3 (2–5)
Fertilization rate, % 79 8 (66–94)
Implantation rate, % 18.3
Note: Data are presented as mean SD (range). P 1⁄4 not significant (NS) for all comparisons (P>.05). All patients are IVF patients who underwent IVF medication stimulation, egg retrieval, and medication stimulation with comparisons between controls (IVF alone, n 1⁄4 33) and treated patients (IVF plus Ac, n 1⁄4 34). It is the trend in hormone secretions that are being com- pared. Each data point represents patients with that stimulation day blood draw. This does not assume that every patient has Ac on the same days of the stimulation cycles. The secondary study outcomes were pregnancy rates, miscarriage rates (spontaneous abortion), ectopic pregnancies, multiple pregnancy rates, and births per pregnancy, that is, take home babies (THBs). The study was not Institutional Review Board approved: all patients in our clinic are offered at the onset of their first visit the option to have their blood stored for research purposes; no additional blood was obtained from patients that was different from their normal course of care; patients consented, questions were answered, and pa- tients had the option of not having their blood stored.
Treatment with Ac followed strict guidelines based on our previously published work (10–15) All acupuncturists who participated in our Acupuncture Consortium have a contrac- tual obligation to provide Ac according to a strict protocol. This is not the usual method for TCM differentiation of syn- dromes treatment; however, to reduce treatment variability we conducted our study using only the following two modi- fied protocols: Stener-Victorin (2) and Paulus (4); we define this unique combination as the Cridennda/Magarelli proto- col. Patients are treated with the electrostimulation procedure (nine treatments) before egg retrieval and are treated with the pre-ET Ac within 24 hours before and 1 hour after ET. Data were collected and put into our computerized Ac database, and only those patients who met our strict Ac treatment cri- teria were included in this study. The strict criteria are defined as nine electrostimulation Ac treatments before egg retrieval and one pre- and one post-ET Ac treatment—for a total of 11 treatments (10–15).
Patients were treated at one center for IVF protocols, RMFC; however, the Ac was given by members of the contracted consortium (all of who were National Certifica- tion Commission for Acupuncture and Oriental Medicine [NCCAOM] certified and licensed acupuncturists) and oc- curred close to the residence of the patients. Most of the pa- tients had already completed their IVF treatments with the subsequent blood tests for pregnancy before the data were made available for analysis.
For statistical analysis, t-test, c2, log rank analysis, and analysis of variance were used as appropriate. A power anal- ysis was done based on a 26% difference in reproductive out- comes that was expected between the IVF and IVF þ Ac group (based on our database of over 500 IVF cycles done over the last 5 years using the same Ac protocol). The anal- ysis revealed that a minimum of 20 patients per arm of the study were needed.
Sixty-seven patients fulfilled the criteria for inclusion in the study. Table 1 demonstrates similar demographics including age, male and female fertility parameters, and embryology. No difference between FSH levels in the Ac and control groups were noted, but the average FSH for the study was el- evated, suggesting decreased ovarian reserve, although this was not expressed by oocyte number, fertilization, or embryo development.
Reproductive outcomes are presented in Table 2, with noted statistically significant improvements when patients were treated with Ac for clinical pregnancies, miscarriage rates, THBs, and reduction in multiple pregnancies. These data are in keeping with our previously presented studies (10–15).
Acupuncture group (n[34) control group with no acupuncture (n[33)
Pregnancy rate 18 (53) 14 (41) <.05 (þhCG)
Clinical pregnancy 51 37 <.05 rate (þfetal heart beat [FHB]), %
Miscarriages 0 (0) 2 (6) <.05
Ectopic pregnancies 1 (3) 3 (8) NS
Birth per pregnancy 17 (94) 9 (64) <.05
Multiple births 2 (11) 5 (33) <.05
Note: Data are presented as n (%) unless otherwise specified. NS 1⁄4 not significant (P>.05). All patients are IVF patients who underwent IVF medication stim- ulation, egg retrieval, and ET. N 1⁄4 67.
Impact of Ac on CORT levels during an IVF cycle.
stimulation Ac Controls c2 start (n [ 34) (n [ 33) Analysis
þ2 14.1 1.5 16.2 1.7 NS
þ3 16.2 1.5 15.3 1.4 NS
þ4 13.9 1.7 14.6 1.9 NS
þ5 12.0 1.6 14.0 1.6 NS
þ6 13.9 1.8 13.9 1.7 NS
þ7 16.2 1.9 9.8 1.2 <.05
þ8 14.3 1.4 9.7 1.2 <.05
þ9 14.1 1.4 8.4 1.1 <.05
þ10 11.5 1.2 7.8 1.2 NS
þ11 9.9 1.3 4.3 0.8 <.05
þ12 8.4 0.9 1.9 0.2 <.01
þ13 7.8 1.0 1.8 0.3 <.05
þ14 3.0 0.4 0 NS
þ15 2.9 0.4 0 NS
Note: Date are mean SD. Log rank comparison (a comparison of curves over time including all points) shows that there is a statistical difference between the curves (P<.05). Data represent the overall blood collection days for the IVF treatment cycle stimulation start þ 2 days to ET. Gonadotropins were adminis- tered throughout the stimulation days until the day of hCG trigger that usually occurred at day 10 of the treatment cycle. (IVF timings vary from patient to pa- tient, and the figure illustrates the typical timing of events.) Each data point represents a normalized number standardized to start of stimulation. Data rep- resent the completed IVF cycle. All patients are IVF patients who underwent IVF medication stimulation, egg retrieval, and ET.
When serum data were analyzed during the IVF cycles, there were variations in stimulation starts based on individual patient menstrual cycles. We standardized the data points col- lected by using the stimulation start date as day 1. All subse- quent dates were relative to that date. Based on our observations (Tables 3 and 4), there were significant differ- ences in CORT and PRL levels in the IVF-treated controls and Ac group (see Fig.1A and 1B)The PRL levels during the gonadotropins stimulation phase of an IVF treatment cy- cle rose above normal values then returned to normal values at the time of hCG administration (Fig. 1A, range 5–37 ng/ mL; however, the follicular phase day 1–14 average was 12–17 ng/mL according to the Immulite ZPLKPR-1 informa- tion bulletin). CORT values remained in the normal range throughout the IVF treatment cycle studied (Fig. 1B, 5–25 ng/mL for morning values).
This study demonstrates biochemical differences in serum levels of CORT and PRL in patients receiving Ac along with their IVF treatments. We believe this is the first time a correlation between serum hormone levels and the use of Ac in an IVF cycle has been reported. We observed increased pregnancy rates in Ac-treated IVF patients and hypothesize that the increase in pregnancies is the result of the impact of Ac on PRL and CORT levels during the gonadotropins stimulation in the IVF treatment cycle.
The data regarding reproductive outcomes reported in this study are consistent with many RCTs and cohort studies that have been published since 1996 (4–15) and are consistent with a recently reported meta-analysis (16). This study sup- ports one possible mechanism of action of Ac on IVF out-
comes, that is, Ac induced biochemical changes in CORT and PRL during the gonadotropins stimulation in the IVF treatment cycle.
Many investigators have discussed the role of stress on re- productive failure (Nakumura et al. has a nice review; 21). There have been reports on how stress levels across stages of the IVF treatment cycle vary between pregnant and non- pregnant women (22). We suspected based on patient obser- vations (Ac-treated patients ‘‘seemed’’ less stressed) and our own understanding of Ac’s affects on the central nervous sys- tem (analgesia) that there would be changes (suppression) in these hormones. Our results demonstrated statistically signif- icant changes; however, the results were different than we ex- pected.
Osaki et al. (23) studied the relationship between PRL and prognosis for pregnancy in IVF-ET patients. Their study help in this process and produce better reproductive out- comes?
Merari et al. (24) addressed the issues of psychological and hormonal changes in the course of IVF. They believed both PRL and CORT were indicators of stress. They tested serum levels on day 3, day of retrieval, and day of ET. CORT levels were unchanged at these three points, and there were no differ- ences in conception cycles versus nonconception cycles. In our data, on day 3 of stimulation and certainly on the day of ET there were similar, insignificant differences, in CORT levels. However, on the day of retrieval, there were significant elevations in CORT levels in the Ac group. It would be impos- sible to prove whether there were changes in CORT levels in the Merari et al. (24) study based on the data in their publica- tion. We found significant improvements in IVF outcomes when patients were treated with Ac, but whether they were at- tributed to PRL or CORT levels is hard to decipher in this study. With regard to PRL, Merari et al. (24) found no differ- ences at the time points measured. A slightly lower, not signif- icant, reduction in PRL in the conception group was found in our study. This is in contrast to Osaki et al.’s data.
Merari et al. (24) also correlated psychological tests and hormonal levels and found that the CORT and PRL levels were significantly positively correlated in the conception cy- cles in women just before pregnancy tests. They found that the conception group was characterized by a negative signif- icance for the states of anxiety and depression with both PRL and CORT. Merari et al. (24) suggested that PRL ‘‘might have served as an indicator of the stress level.’’ In the nonconcep- tion cycles, the trend of no relationship between psychologi- cal measures and PRL and CORT levels was found and is reflected in our PRL data; no real changes in PRL in controls (non-Ac-treated groups) were noted in our study. However, there remains the observation that in our data, significantly lower levels of CORT were observed in controls.
Gonen and Casper (25) and Pattinson et al. (26) ap- proached the role of PRL in IVF treatments by determining whether transient hyperprolactinemia (samples obtained be- fore IVF treatments) had a negative effect on IVF parameters such as oocyte recovery, fertilization rates, and E2 levels. They found that transient hyperprolactinemia had no negative effects (25, 26). Although not statistically significantly differ- ent, the number of ova retrieved and the fertilization rates were numerically higher in the transient hyperprolactinemic groups. The samples obtained in the Pattinson et al. study (26) were at the start of stimulation (stimulation day 1) and at the time of hCG. Three groups were created: PRL I had a PRL level on stimulation day 1 of <20 mg/L at the start with a rise over baseline of %200%; PRL II had a PRL level on stimulation day 1 of %20 with a rise over baseline of >200%; and PRL III had a PRL level on stimulation day 1 of >20 at the start. The group that started with the higher PRL level had a 57% pregnancy rate compared with either of the other two groups: the pregnancy rate of PRL I was 25%, and of PRL II it was 21% (there were too few patients
Impact of Ac on PRL levels during an IVF cycle.
stimulation Ac Controls c2 start (n [ 34) (n [ 33) Analysis
þ2 13.3 1.4 15.1 1.9 NS
þ3 16.3 1.5 17.0 2.3 NS
þ4 19.4 1.7 18.2 2.0 NS
þ5 26.0 3.2 21.1 2.5 <.05
þ6 28.5 4.6 21.2 2.4 <.05
þ7 34.9 3.7 17.6 2.1 <.001
þ8 28.0 3.2 16.9 2,2 <.001
þ9 19.4 2.7 15.3 1.7 NS
þ10 14.6 1.1 13.9 1.4 NS
þ14 9.7 10.9 NS
Note: Log rank comparison (a comparison of curves over time including all points) shows that there is a statistical difference between the curves (P< .034). Data represent the overall blood collection days for the IVF treatment cycle stimulation start to post-hCG day. Gonadotropins were administered throughout the stimulation days until the day of hCG trigger that usually occurred at day 10 of the treat- ment cycle. Few data points existed for post-hCG trigger, and the results are included to confirm trends only. (IVF timings vary from patient to patient, and the figure illustrates the typical timing of events.) Each data point represents a normalized number standard- ized to start of stimulation. Data represent the com- pleted IVF cycle. All patients are IVF patients who underwent IVF medication stimulation, egg retrieval, and ET.
Specifically addressed midluteal PRL levels and found that lowered PRL levels at this point in an IVF cycle resulted in early pregnancy loss in those patients who became pregnant with IVF. This reduction in miscarriage rates is consistent with our studies that revealed a lower miscarriage rate in those patients treated with Ac (10, 11, 12, 14). In this study, Ac enhances PRL levels (above normal) before hCG trigger in an IVF treatment cycle (see Fig. 1A, PRL), and there were no differences in serum PRL levels after hCG trigger (see Fig. 1A, although few data points were available and the information was averaged).
A possible mechanism whereby PRL would improve IVF outcomes was postulated by Osaki et al. (23) They noted that PRL suppresses the immune response and that T-cell im- munocompetence is maintained with PRL. They also noted that PRL is detected in the endometrium after day 23 of the menstrual cycle and that it increases with additional decidu- alization of the cavity, which roughly corresponds to the time at which implantation normally would occur. Could our ‘‘maintenance’’ of PRL levels in the Ac-treated IVF patients
Changes in serum levels of PRL (A) and CORT (B) associated with Ac (solid diamonds) in women undergoing COH for IVF-ET. Acupuncture was associated with a significant increase in PRL levels (solid diamonds) on stimulation days 4, 5, 6, and 7. On the other hand, CORT levels were significantly higher on stimulation days 7, 8, 9 and 11, 12, 13 in association with the Ac-treated group. All patients are IVF patients who underwent IVF medication stimulation, egg retrieval, and ET. Cridennda/Magarelli Ac protocol: electrostimulation Ac (nine treatments) occurred usually 4 weeks before the day of hCG. Pre-/post-Ac occurred within 24 hours before ET (one treatment) and 1 hour after ET (one treatment). (IVF timings vary from patient to patient, and the figure illustrates the typical timing of events.) Each data point represents a normalized number standardized to start of stimulation. Data represent the completed IVF cycle.
Magarelli. Changes in cortisol and PRL with acupuncture. Fertil Steril 2008.
to do a statistical analysis; the increase was about 28%–31%). In our study, those Ac-treated patients with PRL levels greater than those of controls during the stimulation phase of their IVF cycles had significantly higher pregnancy rates (in our most recent overview of over 576 IVF cycles, the overall improvement in IVF pregnancy rates were similar at 26%). It is interesting to note that in our study, the PRL levels observed in the Ac-treated patients after the start of stimulation and before the time of hCG trigger demonstrated no differences from controls; it was only during days 3–10 of the medications that significant differences arose. It is important to note that at the time of their IVF cycle, the patients would have had on average over nine Ac treatments. The authors believe that this suggests that there may be a cumulative effect of Ac on IVF outcomes and this may explain the consistency in improved reproductive outcomes in patients treated with the Cridennda/Magarelli protocol, consisting of 11 Ac treatments, nine before hCG plus pre and post ET. (10–15).
A curious aside, although there were very few participants in the Pattinson et al. study (26), those patients in the PRL III group (transient hyperprolactinemia group) had only sin- gleton pregnancies, whereas the other two treatments groups both had multiple pregnancy rates of 31% and 50%, respec- tively (26). In our previously reported studies (13–15) and in the present study (Table 2), reductions in multiple pregnancies rates were noted in Ac-treated patients of up to 22% (P<.05).
In a murine model, levels of PRL and E2 were found by Randall et al. (27) to correlate with improved polar body ex- trusion and overall improvements in oocyte maturity, fertil- ization, and embryo development. Mature follicles that produced fertilizable oocytes were found to contain higher follicular fluid PRL levels. In our Ac-treated patients, the se- rum levels of PRL just before hCG administration were sta- tistically significantly higher (Table 4 and Fig. 1A). Although not a direct correlation to follicular levels, PRL is not formed in the follicles and would thereby require serum elevations to result in follicular increases. We are currently designing protocols to collect follicular fluids to confirm our hypothesis.
Stimulation protocols for IVF treatments have changed over the years. Historically, clomiphene citrate (CC) was used to stimulate controlled ovarian hyperstimulation (COH) in IVF cycles. Nilsson et al. (28) reported on the use of follicle size as a sole index of follicular maturity. In their study, they compared PRL levels in CC-treated patients (a now defunct method for COH for IVF) with hMG stimula- tion (this is the current standard treatment for IVF stimula- tion). In the CC-treated patients there were significantly diminished serum PRL levels at the time of hCG trigger com- pared with in the hMG-treated group. The average number of follicles developed and number of eggs retrieved demon- strated a twofold improvement in the hMG-treated patients for average number of follicles and a 137% increase for the number of eggs retrieved. Emmons and Patton (29) noted a similar response for poor responders when they were treated with Ac. Follicular fluid levels of PRL were numeri-
cally lower in the CC group compared with in the hMG group (28). Although this report more likely reflects the earliest stages in the development of IVF stimulation protocols, it is interesting to note that the PRL levels appeared to be sup- pressed and may have contributed to the overall poorer re- sponses to CC versus hMG. Our data suggest that PRL level suppression may not be beneficial in IVF patients or conversely that elevations in PRL levels in the weeks just be- fore egg retrieval may play a beneficial role.
Reinthaller et al. (30, 31) found an inverse correlation be- tween follicular PRL levels and oocyte maturation. The more mature oocytes have lower levels of PRL and higher levels of P, T, and E2 at the time of egg retrieval. Reinthaller et al. (30, 31) hypothesize that PRL inhibits the aromatization of andro- gens to estrogens in counterpoint to FSH stimulatory effects. PRL appears to exert a regulatory influence upon the estro- gen-androgen metabolism in granulosa cells within the devel- oping follicle, specifically on the aromatase enzyme. The recent advent of aromatase inhibitors for the treatment of in- fertility suggests that inhibition of aromatase during follicu- logenesis may result in improved pregnancy outcomes in low-responder patients (32). In our first study comparing the impact of Ac on low responders, we found an over 50% improvement in THBs (live births) that was subsequently found to be numerically better in a review of over 576 pa- tients in our database (10, and unpublished data). Could it be that the maintenance of PRL levels (intrafollicular) in our low-responder Ac-treated patients results in better out- comes via an aromatase inhibitor–like mechanism?
CORT in the form of an elevated CORT:hydrocortisone ra- tio in follicular fluid improves the rate of implantation lead- ing to pregnancy (33). In our study, the Ac group demonstrated elevations of CORT from 4 days before hCG administration, and they remained higher than controls throughout the retrieval process (Fig. 1B, CORT), although the levels remained in the normal range for morning values. Poehl et al. (34) in a careful review of the need for psycho- therapeutic counseling in IVF patients refers to reports that PRL and CORT correlate to higher stress levels in women who actually undergo the IVF stimulation versus those who receive oocyte donation. Although controversial, glucocorti- coid adjuvant therapy for low-responder IVF patients has been reported by many. Ben-Rafael et al. (35) proposed that CORT simulates E2 and P secretion by human granulosa cells and is an independent modulator different from the ef- fects of FSH. Kemeter et al. (36) reported in 1986 that pred- nisolone improved IVF outcomes, while subsequent reviews noted no such positive effects (37). Bider et al. (38) reported that in animals, stimulation by corticosteroids is effective in facilitating the ovulatory responses. He suggested two modes of action: direct action of glucocorticoids on the ovaries and suppressive effects on the adrenal androgens. His study treated low responders with dexamethasone to determine whether there were improved outcomes. A low responder was defined as a patient who did not respond to CC and was 31–41 years of age. These criteria no longer would meet current definitions of a low responder for IVF. The results were less than spectacular in such a small study, and only two of the dexamethasone-treated patients became pregnant out of 20, versus one out of 22; compare this with 5% versus 4.5% versus 0% for the group before dexamethasone therapy (historic controls). This would appear to suggest that a glucocorticoid may improve outcomes. (At that time good responders had only a 20% chance of pregnancy with IVF; see www.cdc.gov.)
Although there does not appear to be an adequate body of knowledge to speculate on the actual impact of CORT and PRL on IVF outcomes based on changes during the menstrual cycle, we believe that the demonstrated changes in PRL and CORT (i.e., supraphysiologic levels of PRL during the go- nadotropin phase of the IVF treatment cycle and significant changes in the CORT levels, still within the normal physio- logic ranges) may be one mechanism of action for the effects demonstrated by our data and other studies in patients using Ac with IVF. There is a paucity of literature regarding CORT levels in IVF-ET treated patients. Keay et al. (33) was the only reference available that reflected a distant, not direct, correlation with our observations.
Any attempt to come up with a global explanation of the impact of Ac on IVF outcomes is premature. Our data would suggest that the nonphysiologic circumstances associated with COH with the added suppression of physiologic mech- anisms for ovulation (E2 triggering ovulation being sup- pressed by GnRH antagonists or agonist) may not reflect our ‘‘normal’’ view of how stress influences reproduction in the natural state. There are many publications suggesting a negative impact of stress on pulsatile GnRH secretion (39), but in all cases the patients (or animal models) were not subject to high doses of gonadotropins or to the suppres- sive effects of GnRH agonists or antagonists. This is the first time to our knowledge that Ac has been demonstrated to im- pact the hormones associated with reproduction in IVF pa- tients. We also note that contrary to natural cycle conception in which pathologic elevations of PRL have been shown to decrease reproductive outcomes (39), we noted improved reproductive outcomes in Ac-treated COH cycle patients, and they were associated with elevated PRL during the gonadotropin phase of the IVF treatment cycles. The CORT data would seem to suggest that changes in the levels that start with the gonadotropins phase and continue into the post-hCG and retrieval phase results in improved re- productive outcomes in our Ac-treated group. This study only reports on our experience in COH IVF cycles.
For the TCM physician, stress plays a major role in our ev- eryday existence. After years of trying to conceive, couples are at their wits’ end and have been in the fight-or-flight mode for quite some time. Stress increases the CORT hor- mones as well as other neurochemicals. In TCM, stress is de- fined as liver Qi stagnation; this is characterized by anger, resentment, and unfulfilled desires. Physiologically, muscles become tight and blood vessels contract; the hyperactive sympathetic nervous system is in a constant state of hypervig- ilance with no mechanism to shut it off. Acupuncture may
‘‘correct’’ the negative effects of IVF medications on PRL as well as the adrenal response, and these effects may reduce stress as perceived by the patient.
There has been much controversy regarding the reported beneficial and potentially harmful impact of Ac on IVF out- comes (40). Some investigators believe (41, 42) that the num- ber and acupoints as well as the timing and geographical location (travel to and from the ET location through city traf- fic) of the Ac treatments may explain the differences in out- comes observed (40). In our study, the Ac treatments were stringently regulated (by legal contract), and the timing of treatments was strictly monitored (again, by legal contract). This type of protocol is rather novel for Ac studies, and we believe the inclusion of these treatment controls plus the use of both electrostimulation and pre-/post-ET Ac treat- ments (Cridennda/Magarelli protocol) represents a unique and useful prototype for future research in this field. Our data suggest that patients receiving Ac weeks before the stim- ulation medications (usually 4 weeks at two treatments per week until day of retrieval) and in the times before egg re- trieval and ET (as is the standard in our protocol, no patients receive electrostimulation Ac after egg retrieval) may benefit more than those patients treated just pre-/post-ET (i.e., the Paulus protocol; 4). We believe this to be true based on a pre- liminary review of those patients treated only with the pre-/ postprotocol having no differences in reproductive outcomes compared with controls (unpublished data). In a recent re- view of over 576 IVF cycles in our database, 26% more preg- nancies occurred when patients were treated with Ac and IVF (this is much greater than the percentage reported in the Man- heimer meta-analysis; 16). Although direct comparisons with other Ac studies are not valid (owing to differences in proto- cols), our theory is that the differences and consistency of our reported pregnancy improvements (10–15) may be due to the cumulative affects of the treatments (nine electrostimulation, plus one pre- and one post-Ac treatment). The Cridennda/ Magarelli protocol includes the Paulus protocol, and we be- lieve that our data support that it may be the changes in the PRL levels during the gonadotropin phase of the IVF treat- ment (days 0–10) that most influence reproductive outcomes in patients treated with Ac (the Paulus protocol begins and ends around ET). This hypothesis also supports the addition of additional Ac treatments before ET since the PRL levels only differed during the gonadotropin phase of the IVF treat- ment cycle and returned to physiologic levels that were equivalent to those of the control patients at the time of hCG (see Fig. 1A). However, it is our theory that all Ac treat- ments in the Cridennda/Magarelli protocol work synergisti- cally to significantly improve reproductive outcomes. The strength of Ac and TCM is that they restore balance or return the body to homeostasis. Our theory is that it may be that Ac neither increases or decreases hormone levels but simply re- turns the body to its natural state (we did note a significantly elevated PRL level in the Ac-treated group, however, above normal nonstimulated levels). The effects of Ac on PRL and CORT levels were noted even in the environment of extreme ovarian hyperstimulation as seen in typical IVF patients. More studies are needed to confirm these observations. We are currently collecting serum and follicular fluid samples to confirm the role of PRL and CORT as the mechanism of action of Ac on the observed improved reproductive outcomes. We believe our accumulated data represent the largest controlled trial measuring the impact of Ac on reproductive outcomes.
The mechanism of action for Ac’s affects on IVF outcomes had been a mystery. With the data presented in this study, there does appear to be biochemical changes associated with the use of Ac in IVF that may explain the demonstrated improvements in reproductive outcomes. Acupuncture has been used for thousands of years, and while modern technol- ogy has assisted many couples to create families, we can ex- pect even greater outcomes when both Eastern and Western medicines are combined. Although many factors were con- trolled for to reduce selection bias in our study, patients did choose to be treated with Ac; therefore, these controls may not eliminate selection bias or completely obviate a placebo effect. Larger RCT studies with additional rigor would help quantify these observations and are underway.
Our study demonstrates that Ac treatments (Cridennda/ Magarelli protocol) improve reproductive outcomes in IVF patients. There is very little literature regarding the role of CORT and PRL in patients treated in controlled ovarian stim- ulation conditions such as IVF-ET. We believe that in addi- tion to the understanding that our research brings to a potential mechanism of action of Ac in IVF-ET cycles, the physiologic implications of our observations may well add to our understanding of the conditions responsible for positive IVF outcomes.
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- Paulus WE, Zhang M, Stehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted re- production therapy. Fertil Steril 2002;77:721–4.
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- Quintero R. A randomized, controlled, double-blind, cross-over study evaluating acupuncture as an adjunct to IVF. Fertil Steril 2004;81:S11–2.
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15. Magarelli P, Cridennda D, Cohen M. The demographics of acupuncture’s impact on IVF outcomes: infertility diagnosis and SART/CDC/age groups. Fertil Steril 2007;87:S10–1.
16. Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg B, Berman B, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilization: systematic review and meta- analysis. Br Med J 2008;336:545–9.
17. Gallinelli A, Roncaglia R, Matteo M, Ciaccio I, Volpe A, Facchinetti F. Immunological changes and stress are associated with different implan- tation rates in patients undergoing in vitro fertilization-embryo transfer. Fertil Steril 2001;76:85–91.
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19. Klonoff-Cohen H, Chu E, Natarajan L, Sieber W. A prospective study of stress among women undergoing in vitro fertilization or gamete intrafal- lopian transfer. Fertil Steril 2001;76:675–87.
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Chinese herbal formulas have been tested against common Western medical treatments for endometriosis with some exciting results. One such study, conducted at Osaka City University Medical School in Japan, measured immune factors in the blood of a group of women diagnosed with endometriosis. The women were found to have elevated serum levels of anti-endometrial Immunoglobulin-M (IgM) antibody titers, indicating an immune response to the endometrial tissue. One group of these women received treatment with leuproride acetate (Lupron) to suppress hormonal production. A second group received the herbal formula Gui Zhi Fu Ling Wan, which historically has been used in China to treat bleeding during pregnancy due to Blood stasis in the womb and to prevent miscarriage. In more recent times, it has been used in the treatment of immunologic and inflammatory conditions of the uterus, including dysmenorrhea, uterine fibroids, ovarian cysts, chronic pelvic inflammatory disease, inflammation of the fallopian tubes and endometriosis.
At the conclusion of the study, the Lupron-treated group had lowered levels of estradiol but no change in the IgM antibody titer. The group treated with herbs had no changes in estradiol levels, but the levels of IgM antibody titer were decreased and the patients remained symptom-free for months. It would appear that the herbal formula was able to reduce the body’s immune response to the endometriosis—a hopeful sign when it comes to restoring a woman’s fertility.
Studies done in China treated women with severe menstrual pain. The authors stated that the primary disease mechanism related to dysmenorrhea is blood stasis—the same pattern that often creates endometriosis. A group of 125 women were diagnosed using the principles of traditional Chinese medicine and categorized into four groups depending on the patterns they were exhibiting, as follows:
Group 1: Qi stagnation with Blood stasis
Group 2: Qi stagnation, Blood stasis and cold
Group 3: Qi stagnation, Blood stasis and heat
Group 4: Qi stagnation, Blood stasis and vacuity
The study began by comparing serum levels of various prostaglandins’, a contributing factor in menstrual cramps, in the bloodstreams of all three groups. Then, the women were given either Eastern or Western medical treatment. The women treated with Eastern methods received the herbal formula Jia Wei Mo Jie Tang, whose intended purpose is to invigorate the blood, transform stasis, and move the qi. From a Western medical point of view, the formula achieves its effect by regulating serum prostaglandins. The herbs were taken as a decoction and administered twice a day beginning two weeks before the anticipated start of the period. The other group was given the Western medicine indomethacin, a non-steroidal anti-inflammatory analgesic. In both groups, treatment was administered for three months. In the Jia Wei Mo Jie Tang group, 80.4 percent of women experienced relief from their menstrual pain, compared to 73.3 percent for the indomethacin group. Further, Jia Wei Mo Jie Tang seemed to help balance the reproductive cycle, as indicated by markedly lower levels of a negative type of estrogen. The herbal decoction also increased the content of late phase progesterone secreted by the corpus luteum, which is essential to creating a proper climate for implantation. Indomethacin, on the other hand, had no marked effect on either estrogen or progesterone.
It is clear that Chinese herbal medicines can play an important role in balancing the complex interrelated factors contributing both to the treatment of endometriosis and the promotion of a normal reproductive cycle. But what is most important is to uncover the pattern of imbalance that is the root cause of an individual patient’s problem.
From 1988 – 1994 the authors of this study treated 38 cases of endometriosis with a modified version of the formula Di Dang Tang in a study reported in Yunnan Journal of Chinese Medicine (1994). The patients ranged in age between 28-46 years old. The symptoms were severe lower abdominal pain with menstruation, dry lips, sweating and damp exterior, and blood clots in menstrual blood and subsiding of pain after clots appeared in menstrual blood. An ultrasound examination diagnosed that there was endometriosis in all cases.
Over the course of treatment (which lasted 12-72 days), 26 of the 38 women were cured, meaning the symptoms had disappeared and the follow-up ultrasound was normal. Five of the women had some improvement and the remaining 7 had no result.
In one study reported in the Sichuan Journal of Traditional Chinese Medicine (1993) 40 cases of endometriosis were treated with a modified version of ‘Boost the Qi and Transform Stasis Formula’. The patients included in this study were between the ages of 24 and 48 years old and had endometriosis between 1 and 18 years. The endometriosis was diagnosed by a gynecological examination and laproscopic exploration.
Of this group 25 were infertile and 31 had had previous gynecological surgical procedures. In regards to symptoms, 37 patients experienced intense menstrual pain, 12 had pain with intercourse, 28 had pelvic pain and 18 experienced a heavy distended feeling in the anus.
After a course of treatment, 33 of the 40 women had obvious reduction in endometrial nodules and disappearance of any symptoms and 7 of these women became pregnant afterwards. Four women had a reduction of symptoms and nodules and 3 women had no change.
Between 1992 and 1994 one study treated 89 cases of endometriosis treated with a modified Tao He Cheng Qi Tang formula. Patients were between 23 and 46 years old and had endometriosis from 3 months to 11 years. All 89 women were diagnosed using the standards set at the 3rd Chinese National Integrated Chinese-Western Medicine Gynecology Conference. These criteria included lower abdominal pain and pathological lumps and nodulations in the pelvic cavity in addition to one of the following five symptoms: purple tongue; choppy or bound regularly irregular pulse; fixed pain worse with pressure; blood vessel abnormalities and/or subdermal static macules.
Of the 89 patients, 77 had dysmenorrhea, 24 had pain with intercourse, 39 had pelvic pain, 42 had a heavy distended feeling in the anus, 44 had chocolate ovarian cysts and 30 cases had pelvic nodulations.
After 2 to 6 menstrual cycles of treatment, 31 women experienced complete disappearance of symptoms, 37 had marked reduction of symptoms, 16 had some effect and 5 cases experienced no change. The blood of 36 women was examined before and after treatment, and all 36 showed improvements in red blood cell agglutination, blood sedimentation, and blood serum viscosity. In 41 women prostaglandin levels were measured and were notably higher then normal value before treatment and all were reduced after treatment.
Unexplained Infertility Research
The aim of this study was to determine the relationship between female fertility indicators and the administration of Chinese herbal medicine (CHM). This research project was a prospective cohort clinical study to measure accepted bio-medical factors that affect female fertility and to determine if CHM can improve these factors as well as pregnancy outcome.
The study took place between November 2003 and December 2004 at a private clinic specializing in the treatment of infertility with TCM. Included in the study were fifty women with the Western medical diagnosis of unexplained infertility.
Each patient’s menstrual cycle was monitored for one menstrual cycle to measure pre-treatment fertility factors. This monitoring was then followed by treatment with Chinese herbal medicine and subsequent measurement of the changes in the same fertility factors.
The results observed showed significant differences between the two time points for the majority of factors measured. Pregnancies in the sample group recorded 6 months after commencement of the last treatment were 28, with 11 live births and 7 miscarriages. The study outcome demonstrates that using Chinese herbal medicine results in higher success rates of pregnancy, with no patient side effects and a reduction in the category of patients conventionally classified as having unexplained infertility.
PCOS - Polysystic Ovarian Syndrome Research
Acupuncture in Polycystic Ovary Syndrome: Current Experimental and Clinical Evidence.
This review describes the etiology and pathogenesis of polycystic ovary syndrome (PCOS) and evaluates the use of acupuncture to prevent and reduce symptoms related with PCOS. PCOS is strongly associated with hyperandrogenism, ovulatory dysfunction and obesity. PCOS increases the risk for metabolic disturbances such as hyperinsulinaemia and insulin resistance, which can lead to type 2 diabetes, hypertension and an increased likelihood of developing cardiovascular risk factors and impaired mental health later in life. Despite extensive research, little is known about the etiology of PCOS. The syndrome is associated with peripheral and central factors that influence sympathetic nerve activity. Thus, the sympathetic nervous system may be an important factor in the development and maintenance of PCOS. Many women with PCOS require prolonged treatment. Current pharmacological approaches are effective but have adverse effects. Therefore, nonpharmacological treatment strategies need to be evaluated. Clearly, acupuncture can affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system. Experimental observations and clinical data from studies in women with PCOS suggest that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation.
Journal of Neuroendocrinology. 20(3):290-298, March 2008.Stener-Victorin, E. *; Jedel, E. +; Manneras, L. *
Prevent Recurrent Miscarriage Research
Clinical trails for women with unexplained miscarriage have shown that regular monitoring and anxiety reducing techniques reduce miscarriage rates.
In New Zealand research 86% of women receiving supportive care(monitoring and stress reduction techniques) went on to have a successful pregnancy compared with 33% of those who received standard care .
Acupuncture has been proven to reduce cortisol levels.
The mechanism currently being investigated for the effect of stress on early pregnancy is twofold – raised levels of the stress hormone cortisol may suppress progesterone (necessary for pregnancy) and may also make the immune system hostile to the developing embryo.
Acupuncture is also presently being used by practitioners at the Sydney (Australia) IVF clinic in early pregnancy to enhance microcirculation in the uterine lining and the newly developing placenta .
Acupuncture can be used as a proactive supportive treatment once a week until twelve weeks gestation.
Liddell H. Pattison N. Zanderigo A. Recurrent Miscarriage – Out come
After Supportive Care in Early pregnancy. Aust NZ J Obstet Gynaecol
Clifford K. Rai R. Regan L.1997. Future pregnancy outcome in
unexplained recurrent first trimester miscarriage. Human reproduction.
Vol 12 (2) 387- 389
Amenorrhea/ No Periods Research
In Chinese Medicine, fertility is a bi-product of a healthy menstrual cycle. Once healthy menstruation is restored fertility flows naturally from this. To that end the study “The Treatment of 25 Cases of Post Artificial Abortion Blocked Menstruation by Quickening the Blood & Transforming Stasis” by Sang Hai-li found in Blue Poppy Recent Research Report looked specifically at how effective Chinese Medicine is at starting a woman’s period after experiencing secondary amenorrhea. This small study looked at 25 woman from the ages of 22 – 38 who had had an abortion at 50 days gestation. They had not had a period from 2 – 4 months since the abortion. This study showed that Chinese Medicine is extremely effective at getting the menses started after experiencing amenorrhea. After different variations of the formula Sheng Hua Tang where taken 92% had normal menstruation return and the other 8% had menses return with light menstrual flow.
Another study “Hypothalamic-Central Nervous System Amenorrhea
(From “Experiences in the Treatment of 98 Cases of Hypothalamic-Central Nervous [System] Amenorrhea with Li Chong Wan ” by Gao Ting-she & Wu Xing-cai found translated in Blue Poppy Research Reports shows not just how well Chinese medicine starts the periods of woman experiencing amenorrhea but also how it helps them achieve pregnancy as well. This larger study looked at 98 women between the ages of 22 – 36 who had experienced amenorrhea from 3 months to 2 years. Of these women 86 had done hormone controlled cycles for 3 months. The women were all treated with variation of the Chinese herbal formula Li Chong Wan. For this study cure was defined as the start of normal menstrual within 1-3 months of treatment and the cycle remaining normal after the woman stopped taking the herbal formula. Using these criteria 62 % of the women were cured and of these women 68% conceived on their own after 6 months.
Anovulation/ No Ovulation Research
The small study “The Acupuncture Treatment of 11 Cases of Noneruption of Matured Eggs” found in the Blue Poppy Press Research Reports looked at 11 women between the ages of 25 – 35 who had not been able to conceive for 4 – 13 years. They were all diagnosed with anovulatory infertility.
In this study acupuncture was performed on Day 10 of the cycle. An ultrasound was performed 24 hours later to confirm ovulation. If ovulation did not occur then acupuncture was repeated the next day. The same process was repeated up to 3 times.
Using the above protocol, five cases ovulated after a single treatment, two cases ovulated after two treatments, and two cases ovulated after three treatments. Two cases failed to ovulate after three treatments. Of the 9 women who ovulated 4 conceived. Therefore 36% conceived and 82% ovulated after only 1 – 3 acupuncture treatments.
The great part about this study is that it shows the effectiveness of acupuncture for helping anovulatory woman ovulate and more important successfully conceive. Clinical experience in my practise also shows that we are able to help the vast majority of woman ovulate again thereby moving them a big step forward on their way to a successful pregnancy.
Thin Uterine/Endometrial Linings Research
Check out this link for a Pilot study on Acupuncture and Sildenafil and Uterine linings.
Blocked Fallopian Tubes Research
In this study by J. Huang of the Shenzhen Municipal Hospital of Traditional Chinese Medicine looked at the external application of Chinese herbs on an acupuncture point on the abdomen combined with tubal surgery and just the tubal surgery on its own in clearing blocked fallopian tubes. The study group consisted of 75 women who were divided into the two groups. In the just surgery group 46% were cured, 23% improved and 30% failed for a combined effectiveness rate of 70%. The herb and surgery group had 58% cured, 24% improved and 18% failed for a combined effectiveness rate of 82%. So as you can see the use of Chinese herbs can increase the effectiveness of surgery to correct fallopian tube blockages.
In one case study by Peter Deadman published in the Journal of Chinese Medicine he successfully treated a woman that had both of her tubes blocked. A HSP was performed at it showed both of her tubes were complete blocked. This woman was not offered surgery as an option to clear her tubes. After 6 months of acupuncture and Chinese herbs one of her tubes had become unblocked thus restoring the possibility of pregnancy to a woman who was told that because surgery was not an option she would not get pregnant on her own
Men’s Health Studies
Acupuncture can improve sperm quality and fertilization rates in ICSI
J Huangzhong Iniv Sci Technol med Sci 2002;22(3):228-30
Acupuncture can increase sperm motility and the intactness of the azonema
Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B, The effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm motility. Arch Androl 1997, Sep-Oct; 39 (2): 155-61
Effects of acupuncture and moxa treatment in patients with semen abnormalities.
In this study men receiving acupuncture had significant increases in the percentage of normal-form sperm compared to the control group that did not receive acupuncture.
Gurfinkel et.al. Asian J Androl. 2003 Dec;5(4):345-8
A study in treating subfertility by acupuncture was carried out in Germany on 28 men. Each patient received a total of 10 treatments for a period of three weeks. The spermiograms and hormone levels were checked before and after acupuncture. Total count, concentration and motility were evaluated and in all cases the researchers observed a statistically significant improvement of sperm quality. The authors conclude that acupuncture therapy at the time of ovulation might increase the chances of a pregnancy.
Ischl F, Riegler R, Bieglmayer C, Nasr F, Neumark J (Modification of semen quality by acupuncture in subfertile males) Geburtshilfe Frauenheilkd. 1984 Aug; 44 (8): 510-2
Acupuncture has been found to be useful in treating males with very low sperm count, especially those with a history of genital tract infection
Research was carried out in Tel Aviv to observe the effects of acupuncture on males with very low sperm count. 17 of the males were azoospermic, and 3 had severe oligotertoasthenozoospermia (OTA). After a course of acupuncture treatment, the OTA only had a slight increase in sperm count, whilst 67% of the azoospermic patients showed a definite increase in sperm count, seven of them significantly. Males with genital tract inflammation had the most marked improvement in sperm density. The study concludes that acupuncture might be a useful treatment for males with a very low sperm count, especially those with a history of genital tract infection.
Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia 2000 Jan; 32 (1): 31-9.
A Chinese study was carried out on 54 males with impaired fertility. 1-3 months of acupuncture therapy was given, and sperm analysis carried out before and after treatment. 55.5% of patients impregnated their partners in that period of time, and 24% showed a significant improvement in sperm parameters. 20% of patients, previously diagnosed with azoospermia and immune disturbance, did not improve. The best improvement was seen in patients with abnormal sperm.
Qian, Z [Clinical observation of 54 cases of male infertility treated by acupuncture and moxibustion] Journal of Chinese Medicine, 1996 Sep; 52.
Acupuncture Helps Lower Scrotum Temperature, Increase Sperm Count infertility
Conclusion: men that manifest higher scrotal temperatures due to genital tract inflammation or poor lifestyle habits can benefit from the scrotal temperature lowering effects of acupuncture.
Poor spermatogenesis in patients with inflammation of the genital tract is associated with scrotal hyperthermia. These patients can benefit from acupuncture treatment. We conducted a study to verify whether the influence of acupuncture treatment on sperm output in patients with low sperm density is associated with a decrease in scrotal temperature. The experimental group included 39 men who were referred for acupuncture owing to low sperm output. The control group, which comprised 18 normal fertile men, was used to define a threshold (30.5 degrees C) above which scrotal skin temperature was considered to be high. Accordingly, 34 of the 39 participants in the experimental group initially had high scrotal skin temperature; the other five had normal values. Scrotal skin temperature and sperm concentration were measured before and after acupuncture treatment. The five patients with initially normal scrotal temperatures were not affected by the acupuncture treatment. Following treatment, 17 of the 34 patients with hyperthermia, all of whom had genital tract inflammation, had normal scrotal skin temperature; in 15 of these 17 patients, sperm count was increased. In the remaining 17 men with scrotal hyperthermia, neither scrotal skin temperature nor sperm concentration was affected by the treatment. About 90% of the latter patients suffered from high gonadotropins or mixed etiological factors. Low sperm count in patients with inflammation of the genital tract seems to be associated with scrotal hyperthermia, and, consequently, acupuncture treatment is recommended for these men.
Asian Journal of Andrology (2009) 11: 200-208. doi: 10.1038/aja.2008.4; published online 5 January 2009.
Asian J Androl. 2009 Mar;11(2):200-8. Epub 2009 Jan 5. Siterman S, Eltes F, Schechter L, Maimon Y, Lederman H, Bartoov B. 1Maccabi Fund Complementary Medicine, Kaufman Street, Tel Aviv 68012, Israel  2Refuot-Integrative Medical Centre, Ramat Aviv Gimel, Tel Aviv 69123, Israel.
Produce More Sperm - Increasing Ejaculate Volume
By Ben Anderson
New research by Israeli fertility experts has challenged current medical opinion, which holds that refraining from sex for up to a week is beneficial for men prior to undergoing some types of fertility treatment.
Doctors from Soroka University and Ben-Gurion University tested over 7,200 semen samples for semen volume, sperm concentration and shape, and the percentage and total count of motile (active and moving) sperm. The samples were from around 6,000 men being investigated or treated for infertility who had abstained from sex for periods of up to two weeks.
More than 4,500 of the samples had normal sperm counts while the remainder had varying degrees of oligozoospermic (reduced) counts ranging from mild, through moderate, to severe.
The researchers found that while the volume of semen increased up to 11 to 14 days of abstinence, whatever the sperm count was, the morphology (shape and form) of the sperm gradually deteriorated.
In the samples from men with reduced sperm counts the proportion of motile sperm actually fell significantly from day two onwards, reaching a low at day six and remaining low.
Dr. Eliahu Levitas will tell the annual meeting of the European Society of Human Reproduction and Embryology in Madrid: “Semen volume was directly and significantly correlated with duration of abstinence, while sperm motility was inversely and significantly related to abstinence in oligozoospermic samples only. The percentage of normal forms of sperm was inversely and significantly related to abstinence in both moderately oligozoospermic and normal samples.”
Dr. Levitas, a senior physician at the fertility and IVF unit of Soroka University Medical Center, said that most fertility clinics followed the World Health Organisation guidelines of recommending sexual abstinence for two to seven days prior to treatment.
“Our data challenge the role of abstinence in male infertility treatments. What we have found is not so relevant to ICSI, where only a single sperm is injected into the egg, but for those treatments where we are trying to get the best possible sperm quality for intra-uterine insemination. “For these patients we recommend minimal abstinence – ideally no more than two days.”
Dr. Levitas said there was no real consensus among researchers as to why sperm gets damaged and becomes less viable. “It’s possible that there is oxidative DNA damage by, for example, cigarette smoking or other damaging agents. Or perhaps the sperm from oligozoospermic men is more susceptible to detrimental agents and therefore might benefit from spending only a short time in the reproductive tract.”
Ben Anderson – Administrator – GF Lifestyles Article
A Chinese study was carried out on 248 males who suffered from sperm abnormities, absence of ejaculation and impotence. Treatment of acupuncture was given every other day. 20 treatments comprised one course. 2 courses were given (approx 2 months). About half of the patients with abnormal sperm achieved good sperm count and motility. (20-60mill/ml with 20-60% motility and less than 20% deformity). 52 % of patients with abnormal sperm failed to respond, a large percentage of those (40%) who were diagnosed with azoospermia, failed to respond at all.
Zhang J [The Acupuncture treatment of 248 cases of male infertility], Chinese Acupuncture and Moxibustion, Vol 7, 1987.