FERTILITY RESEARCH (© JCM Ltd)

ACUPUNCTURE FOR ASSISTED REPRODUCTION
A UK based systematic review has concluded that acupuncture does not improve in-vitro fertilisation outcome. The analysis included five trials (877 patients) that evaluated acupuncture performed around the time of oocyte retrieval and nine trials (1993 patients) in which acupuncture was performed around the time of embryo transfer. No significant difference in the clinical pregnancy rate was found for either procedure. (The impact of acupuncture on assisted reproductive technology outcome. Curr Opin Obstet Gynecol. 2009 Mar 5).

ACUPUNCTURE REGULATES HORMONES DURING IVF PREPARATION
American researchers have investigated the effects of acupuncture on serum cortisol and prolactin in IVF patients undergoing drug-induced ovarian hyperstimulation. Sixty-seven women were randomised to receive either IVF alone or IVF plus acupuncture, according to protocols derived from randomised controlled trials. Serum levels of cortisol and prolactin were measured and synchronised with medication stimulation days of the IVF cycle. Cortisol levels in the acupuncture group were significantly higher on IVF medication days 7, 8, 9, 11, 12, and 13 compared with controls. Prolactin levels in the acupuncture group were significantly higher on IVF medication days 5, 6, 7, and 8 compared with controls. The authors conclude that there appears to be beneficial regulation of cortisol and prolactin in the acupuncture group during the medication phase of the IVF treatment, with a trend toward more normal fertile cycle dynamics. (Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization-embryo transfer treatment. Fertil Steril. 2008 Dec 30. [Epub ahead of print]).

ACUPUNCTURE INCREASES IVF SUCCESS
The beneficial effect of acupuncture on fertility treatment has once again been highlighted by the results of a major scientific study. The research found that women undergoing IVF treatment were much more likely to have a successful pregnancy if they also had acupuncture treatment on the day of embryo transfer. Acupuncture carried out on the day of embryo transfer was found to increase the chances of having live birth from one in five to one in three. The systematic review and meta-analysis, published as part of the Cochrane Database of Systematic Reviews, and carried out by a team from the University of Southampton, identified a total of 16 trials involving acupuncture and assisted conception, of which 13 were considered high enough quality to be included in the study. These involved a total of more than 2000 IVF patients. Analysis of the pooled results led the authors to conclude that acupuncture around the time of embryo transfer achieved a higher live birth rate of 35% compared with 22% without active acupuncture. They found no evidence of benefit when acupuncture was performed in the days after embryo transfer, nor at the time of egg retrieval. (Acupuncture and assisted conception. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006920).

ACUPUNCTURE IMPROVES IVF SUCCESS RATE
A meta-analysis of seven clinical trials in which acupuncture was used to support embryo transfer during IVF has concluded that it improves rates of pregnancy and live birth. Dutch and American researchers analysed results from seven clinical trials (selected as eligible from a total of 108), all published since 2002 and carried out in four Western countries. They included data on 1366 women and compared acupuncture given within one day of embryo transfer, with sham acupuncture or no additional treatment. All except one used a similar acupuncture protocol (based on Paulus et al). The analysis showed that combining real acupuncture with embryo transfer was associated with significant and clinically relevant improvements in clinical pregnancy rate. Women who underwent acupuncture were 65% more likely to have a successful embryo transfer procedure and 91% more likely to have a live birth. On the basis of ‘number needed to treat’, this means that ten women undergoing IVF would need to be treated with acupuncture to bring about one additional pregnancy. (Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008 Mar 8;336(7643):545-9).

ACUPUNCTURE AND IN VITRO FERTILISATION
A literature review from the USA provides an overview of the use of acupuncture as an adjunctive therapy for in vitro fertilisation (IVF). The authors used biomedical and acupuncture databases cross-referenced with published data, personal libraries and Chinese medicine textbooks. They concluded that limited but supportive evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life of patients undergoing the process. They urged caution in interpreting study results, due to design limitations and commented that the acupuncture described was often not consistent with traditional Chinese medical principles. Acupuncture was judged to be a safe adjunctive therapy. The reviewed literature suggested four possible mechanisms by which acupuncture could improve IVF outcomes: modulation of neuroendocrine factors; improvement of blood flow to the uterus; modulation of cytokines; and reduction of stress, anxiety and depression. The need for more high-quality studies was noted. (In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern Ther Health Med. 2007 May-Jun;13(3):38-48).

ACUPUNCTURE HAS POSITIVE EFFECT ON IVF
A randomised prospective controlled clinical study examined the effect of luteal-phase acupuncture on the outcome of in vitro fertilisation/intracytoplasmic sperm injection. 116 patients receiving acupuncture according to the principles of traditional Chinese medicine were compared with a group of 109 receiving placebo acupuncture. In both groups, acupuncture was carried out immediately after embryo transfer. The TCM acupuncture group received needling at Guanyuan REN-4, Qihai REN-6, Guilai ST-29, Neiguan P-6, Diji SP-8 and Xuehai SP-10 with ear seeds placed at auricular points Shenmen, Zigong, Neifenmi and Pizhixia (left in place for two days and pressed twice daily for 10 minutes). The placebo group received acupuncture designed not to influence fertility (Sidu SJ-9, Xiaoluo SJ-12, Fengshi GB-31, Zhongdu GB-32, Yanglingquan GB-34; ear seeds at Shangzhi, Fengsi, Shisheng, Jian). Three days after embryo transfer, all patients received a second acupuncture treatment. For the placebo group, needling was the same as previously, while the TCM acupuncture group were needled at  Hegu L.I.-4,  Sanyinjiao SP-6, Zusanli ST-36, Taixi KID-3 and Taichong LIV-3. Both groups had ear seeds placed on the other ear at the same points as previously (again pressed twice daily for two days). Clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4% in the TCM acupuncture group were significantly higher than in the placebo acupuncture group (15.6% and 13.8%). (Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril. 2006 May;85(5):1347-51).

ACUPUNCTURE & IVF/1
In a Danish study to investigate the befits of acupuncture in assisted reproduction (IVF and ICSI), women were randomly assigned to three groups. One received acupuncture only on the day of embryo transfer (immediately before and immediately after transfer), one received additional acupuncture two days later, and a control group received no acupuncture. Clinical and ongoing pregnancy rates were significantly higher in the acupuncture groups than the controls, but the additional treatment given two days after transfer appeared to confer no additional benefit. (Westergaard LG et al. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril. 2006 May;85(5):1341-6).

ACUPUNCTURE & IVF/2
Over a period of three years in a private practice 22 patients entering assisted reproduction therapy were given acupuncture. Treatment was given, usually weekly, during the IVF cycle and immediately before and after embryo transfer. Treatment during the cycle emphasised points such as Baihui DU-20, Taichong LIV-3, Sanyinjiao SP-6, Zusanli ST-36, Neiguan P-6, Guilai ST-29 and Hegu L.I.-4 and ear points Shenmen, Neifenmi, Zhigong and Naodian. Pre-transfer treatment was Baihui DU-20, Taichong LIV-3, Diji SP-8, Neiguan P-6, Guilai ST-29 and the four ear points. Post-transfer treatment was Sanyinjiao SP-6, Xuehai SP-10, Zusanli ST-36, Hegu L.I.-4 and the four ear points. The success rate was 57.7% compared to 45.3% for patients in the IVF unit not treated with acupuncture. (Johnson D. Acupuncture prior to and at embryo transfer in an assisted conception unit – a case series. Acupuncture in Medicine (2006) 24; 1: 23-28).

ACUPUNCTURE IMPROVES SPERM QUALITY
A study of the effect of acupuncture on sperm quality in men suffering infertility of unknown cause, found that after twice weekly treatment for five weeks, there were fewer structural sperm defects (acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibres of sperm organelles) and an increase in the number of normal sperm ejaculated. Other sperm abnormalities such as immature or dead sperm were not affected. Acupuncture was given at Guanyuan REN-4, Shenshu BL-23, Ciliao BL-32 and Taixi KID-3 with Zusanli ST-36, Xuehai SP-10, Sanyinjiao SP-6, Guilai ST-29 and Baihui DU-20 as secondary points. Deqi was obtained at all needling sites and aimed to be transmitted from Shenshu BL-23 and Ciliao BL-32 to the sacral or perineal area and the anterior hypogastric region. (Fertility and Sterility, Volume 84, Issue 1 , July 2005, Pages 141-147). Meanwhile there is evidence that infertility may now be affecting more men than women. Intra-cytoplasmic sperm injection (ICSI), in which a single sperm is injected straight into an egg and is normally used in cases where the sperm is of too poor quality to permit conventional fertilisation has become the most commonly used technique in Europe and now outnumbers conventional IVF. (European Society of Human Reproduction and Embryology annual conference, Copenhagen, 2005). And in the Merseyside and Cheshire health districts in Britain, the number of men seeking treatment for infertility has risen by nearly 70% in the past four years with ICSI now accounting for 60% of the ICSI/IVF treatments carried out at the Liverpool Women’s Hospital.

ACUPUNCTURE, IVF & PREGNANCY
A German study reported in NEWS 69, June 2002 showed that adding IVF to the treatment protocol of patients receiving IVF increased their chances of becoming pregnant by 50%. Now a further study carried out at the Reproductive Medicine and Fertility Centre in Colorado Springs, USA, has compared the pregnancy rates of 114 women, half of whom received acupuncture before and after embryo transfer, whilst the other half underwent transfer without acupuncture (control group). The acupuncture group obtained a 51% pregnancy rate and an 8% miscarriage rate compared to 36% and 20% respectively in the control group. Acupuncture also was found to reduce the risk of tubal pregnancy and increase the live birth rate. (October 2004 meeting of the American Society for Reproductive Medicine).

ACUPUNCTURE REDUCES PAIN AFTER IVF
In this study, 286 women were randomly assigned to receive either electroacupuncture plus para-cervical block or alfentanil (a powerful analgesic) plus para-cervical block during oocyte aspiration (egg retrieval). Both interventions induced adequate analgesia, however the electroacupuncture group reported significantly less abdominal pain, other pain, nausea and stress than the medication group, and required significantly less additional analgesic medication. (Hum Reprod 2003; 18: 1454-60).

ACUPUNCTURE & MALE INFERTILITY
In a small Brazilian study, 19 male patients with sperm abnormalities (sperm count, motility and morphology) were randomly assigned to receive true (treatment group) or sham (control group) acupuncture and moxibustion treatment. The treatment group were needled at Qichong ST-30, Taixi KID-3, Zusanli ST-36, Hegu L.I.-4, Sanyinjiao SP-6, Gongsun SP-4, Taichong LIV-3 and Neiguan P-6 (with deqi), and received moxibustion (until the skin was reddened) at Shenshu BL-23, Zhishi BL-52, Sanjiaoshu BL-22, Mingmen DU-4, Ciliao BL-32, Qihai REN-6, Guanyuan REN-4, Zhongji REN-3, Pishu BL-20, Weishu BL-21, Shimen REN-5, Taiyuan LU-9, Feishu BL-13, Gaohuangshu BL-43, Xinshu BL-15 and Zigong (M-CA-18). Treatment was given twice a week for 10 weeks. The control group received needling and moxibustion at non-points. At the end of treatment, patients in the treatment group showed a significant improvement in sperm morphology ( i.e. normally formed sperm). There was no significant difference between the groups in terms of seminal fluid volume, sperm count or motility. (Asian J Androl 2003 Dec; 5: 345-348).

ACUPUNCTURE BOOSTS FERTILITY
A review of the medical literature on acupuncture and female fertility published in the journal Fertility and Sterility has shown that acupuncture can help reduce stress, increase blood flow to the reproductive organs and normalise ovulation and the menstrual cycle. 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. Stress is known to adversely affect ovulation, and therefore it is logical that acupuncture would assist normal ovulation through the release of beta-endorphins. Many previous studies examined the benefits of acupuncture when added to other fertility treatments. Recent reports have shown that women who incorporate acupuncture into their in-vitro fertilisation (IVF) treatment are more likely to become pregnant than those who use IVF alone (see NEWS 69), and 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. (Fertility and Sterility 2002;78:1149-1153).

ACUPUNCTURE AIDS IVF
A recent study in Germany (the Christian-Lauritzen-Institut in Ulm) has shown that adding acupuncture to the treatment protocol of IVF patients increases their chances of becoming pregnant by nearly 50%. 160 IVF (in vitro fertilisation) patients were randomly assigned to two groups. In the study group, patients received acupuncture on the Spleen, Stomach and Large Intestine channels as well as the ear - a single treatment before transfer and another one after embryos had been transferred. The difference between pregnancy rates for the two groups was notable. When patients were examined using ultrasound six weeks after their IVF procedures, the pregnancy rate in the acupuncture group was 42.5% (34/80), compared to 26.3% (21/80) in the control group (Fertility and Sterility, Vol. 77, No. 4, April 2002).

ACUPUNCTURE & IVF
6 female patients being treated for infertility by in vitro fertilisation were referred to acupuncture due to difficulty with follicle production despite maximum gonadotropin therapy. Acupuncture was given at the same time that they began follicle-stimulating hormone injections: 3 or 4 twice-weekly treatments, on days 1-3, 4-6, 7-9 and in some cases 9-11, with the final treatment on the day of or prior to egg retrieval. Points Mingmen DU-4, Shenshu BL-23 were used at every treatment, whilst points Gongsun SP-4 with Neiguan P-6, and Zhaohai KID-6 with Lieque LU-7 were alternated. Additional points were added on an individual basis, including Taichong LIV-3, Guanyuan REN-4, Qihai REN-6, Ganshu BL-18, Pishu BL-20, Kunlun BL-60 and Shenmai BL-62. Three of the women produced more follicles with acupuncture than prior to acupuncture (mean number of follicles with acupuncture was 11.3 vs 3.9 prior to acupuncture; P=.005). All 3 became pregnant although only 1 continued the pregnancy past the 1st trimester. None of the women became pregnant during the non-acupuncture cycles. The authors conclude that acupuncture may be a useful adjuvant to gonadotropin therapy among women undergoing intracytoplasmic sperm injection. (Acupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection, Emmons, S., Patton, P. Medical Acupuncture, Vol.12 / No.2).

ACUPUNCTURE & IVF
Acupuncture may stimulate follicle development in women undergoing in vitro fertilization (IVF). In a small study of 6 women who all had difficulty with follicle production despite maximum gonadotropin therapy, three produced more ovarian follicles with acupuncture treatment (mean, 11.3 vs 3.9 prior to acupuncture) and all 3 conceived, although only 1 pregnancy lasted past the 1st trimester. Acupuncture also appeared to increase the estradiol levels. Acupuncture was given at Shenshu BL-23 and Mingmen DU-4, plus additional points selected from Gongsun SP-4, Neiguan P-6, Zhaohai KID-6, Lieque LU-7, Taichong LIV-3, Guanyuan REN-4, Qihai REN-6, Ganshu BL-18, Pishu BL-20, Kunlun BL-60 and Shenmai BL-62 (Medical Acupuncture).