I have a particular interest in fertility. Having devoted nearly all of my postgraduate study to fertility, I have put together some information to help you learn about some of the ways that acupuncture may help men and women with fertility issues.
Research has repeatedly demonstrated that acupuncture increases blood flow to the uterus and ovaries, regulates the hormones involved in follicular development and implantation, and reduces stress and anxiety. In men it can increase the number of normal sperm.
IVF/ICSI
The good news for IVF is that clinical trials have repeatedly shown increased pregnancy rates when acupuncture is given just prior and just post embryo replacement.
A study of 114 women at the Reproductive medicine and fertility Clinic in Colorado Springs, half the women received acupuncture before and after embryo replacement. The women who received acupuncture had:
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A 51% pregnancy rate compared to 36% in the control group.
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An 8% miscarriage rate compared to 20% in the control group.
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Acupuncture was also found to reduce the risk of tubal pregnancy and increase the live birth rate. The birth rate in the acupuncture group was 23% higher than the control group.
A larger German trial that involved 225 women showed that the acupuncture group had:
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A 36.6% Clinical pregnancy resulted compared to 15.6 in the control group.
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Ongoing pregnancy rate of 28.4% compared to 18.4% in the control group.
Fertility and Sterility 2006;85(5):1347-51
http://www.acupunctureivf.com.au/ has some good research and reviews and has a great Q & A tab.
Sperm function can also be influenced by acupuncture. Fewer studies have been done on male fertility and I can find only two small studies to mention.
In a German study involving 40 men with sperm abnormalities, acupuncture was used on 28 men twice a week for 5 weeks and compared to the men who received no treatment. 12 of these men’s sperm samples were randomly chosen and compared with the 12 samples in the control group.
Following acupuncture, a significant increase in both the sperm count and of sperm without structural defects was observed (in comparison with controls). The average percentage of motility doubled and the number of healthy sperm increased fourfold. (Fertility and Sterility. 2005;84:141-147)
I do treat men, but very many as it is believed that ICSI will get around the problem of low count, or poor swimmers. This is true, but unfortunately doesn’t address the underlying problem that is causing these unhealthy abnormalities.
In a pilot study in Tel Aviv, men that were producing no sperm received a course of acupuncture treatment that resulted in seven of the fifteen men producing enough sperm to receive IVF treatment without requiring a testicular biopsy, and two pregnancies were achieved. In the control group that received no acupuncture treatment not one man demonstrated an increase in sperm production.(Andrologia 2000 Jan;32(1)31-9)
A final word on male fertility is to keep in mind that 40% of fertility problems are male factor. Get the sperm checked. If the man is over the age of 42, has been in contact with chemicals, had a cortisone injection, is taking SSRI’s, get a sperm DNA fragmentation test (SCSA test). This costs about $200 and is available at Fertility associates. Sperm within the normal WHO parameters can still be too fragmented to use. More information on this at http://www.scsadiagnostics.com/
Treating women involves careful timing, and changes with the phases of the menstrual cycle, or IVF cycle.
During a bleed, the aim is to promote as complete a shedding of the old endometrial lining as possible so that a fresh and uniform new lining can be built up.
Following the bleed, points are used to encourage blood flow to the uterus to create a rich, velvety uterine lining. This will directly influence how well the embryo does post implantation. IVF women's uterine linings are scanned and the thickness is measured. Those women who have had acupuncture leading up to ovulation will generally display a very good lining. Hormone balancing promotes a healthy amount of fertile mucus which is needed by sperm to nourish and guide them to the egg. Genetic material cannot be influenced acupuncture, but is seems that egg quality can be improved, probably due to acupunctures influence on blood flow and increase nutritional supply to the egg.
Post bleed, or while you are on the stimulating phase of IVF, the aim is to encourage blood and fluids to flow freely the ovaries. On a natural cycle I add a point that assists the communication between the brain and ovaries, known as the hypothalamic-pituitary-ovarian axis.
Every treatment involves the selection of points that decrease stress, calm the mind, and balance serotonin to keep your spirits up.
Treatment changes following the time when an embryo may be nesting in the uterine lining. Now the goal is to keep stress down, stop the uterus from contracting, and generally support this important next phase.
Polycystic Ovarian Syndrome is a very complex disorder and due to multiple hormonal imbalances. Women with PCOS may ovulate irregularly or not at all. This results from elevated insulin levels that stimulate excess androgen production by the ovaries. The androgens cause premature follicular wasting which causes inconsistent or absent ovulation. PCOS is not thoroughly understood, but it is thought to be due to hypersensitivity-sensitivity of the sympathetic nervous system. Acupuncture moderates the sympathetic nervous system and has been seen to help women with PCOS ovulate. Clomid is the drug of choice to create ovulation, but it fails to address the underlying problems such as an androgen rich surrounding environment. Also, high insulin levels can create poor quality eggs. The side effects of Clomid are a thinning of the uterine lining which means you can’t nourish an embryo, and a drying of the fertile mucus that is required for sperm to transport themselves to and egg. If you are using Clomid, be careful to monitor your body for unwelcome side effects. Acupuncture may help in this.
Unfortunately very few clinical studies have been done in PCOS women with ovulation problems. The results however were very good, except in the more severe cases of obesity and high testosterone and insulin levels.
The following study demonstrated that low frequency electro acupuncture (EA) used twice a week over a course of 16 weeks helped women regain ovulation and also lower testosterone levels. For very stubborn cases 3-4 times a week would be necessary.
Endometriosis is another area without clearly understood origins. Acupuncturists treat Endo all the time. We aim to clear the rogue endometrial tissue at the time of bleeding, so that it can be reabsorbed by the body. At other times of the cycle we focus on the associated aspects of endometriosis such as stress, autoimmune problems, inflammation, and aspects that in Chinese medical terms are called Damp, Cold, Qi stagnation etc. A laparoscopy can create a fantastic window of opportunity for women wanting to conceive, but it doesn’t address the above mentioned underlying causes, so the autoimmune system can attack the embryo, and stress which inhibits the natural production of hormones that support a pregnancy are still there, and miscarriage may occur.
Miscarriage is heartbreaking. Many women will come to me for the first time following miscarriage. For many, simply relieving the stress, grief, and anxiety will be enough for them to get pregnant quickly enough and carry a full term baby.
Unfortunately there is a close link between infertility, unsuccessful IVF cycles, miscarriage and later pregnancy complications such as premature labor and pre-eclampsia. The miscarriage rate in a pregnancy that has reached at least 8 weeks gestation is less than 2% and it is therefore unusual to miscarry after this time point. Ideally, consideration should be given to investigate couples who have experienced even only 1 miscarriage after 10 weeks gestation.
Whilst the most common cause for any single miscarriage or unsuccessful IVF cycle is a random genetic abnormality in the embryo which increases with age, the rationale for investigation is either to confirm or to exclude the presence of an underlying treatable cause for pregnancy loss. This is particularly important as couples who lose 3 or more pregnancies, at any gestation, tend to lose genetically normal pregnancies. Miscarriage is therefore not always due to ‘bad luck’ alone.
Blood tests can be performed to investigate genetic, hormonal, blood clotting and immune causes of miscarriage. In addition, an ultrasound scan is performed to determine any structural abnormalities of the uterus that may be associated with miscarriage and an infection screen performed if indicated.
After investigation a plan of management for the next pregnancy is made.
It may be that our team at City Osteopaths http://www.cityosteopaths.com/can help eliminate some of the causes of miscarriage. Our osteopaths can help you structurally and hormonally. You may not be aware of problems to the pelvis and lower back that are preventing your ability to carry a baby full term.
Kimberly is a fertility naturopath with strong strengths in Nutrition and western herbalism. You can check her out on http://www.zestnaturalhealth.co.nz/. Kimberley can address a wide range of issues such as immune system problems, thyroid function, mineral deficiencies and toxins in the body that damage sperm and effect egg quality. It's best that you let her website speak for her.
A large study at a frequent miscarriage clinic in England gave 50% of the woman reassurance and sent them home, The other 50% received acupuncture once a week for the first 12 weeks of pregnancy, and other relaxation techniques. The acupuncture group went on to have an 80% ongoing pregnancy compared to 50% in the control group.
There is a wonderful miscarriage support website to help not only couples who have experienced this loss, but also help their friends and family understand. http://www.miscarriagesupport.org.nz/index.html
Finally, for anyone just beginning to try and make sense of their bodies in regards to fertility, Kimberley and I can help. We are able to teach you about the phases of you cycle and explain what your hormones are doing along the way. We can teach you how to chart your cycle and recognise when you are ovulating. For those who are new to IVF, We can help you understand what is going to happen, what the drugs are, and what the tests all mean. I have worked onsite at Wellington’s Fertility Associates since early 2009 so understand the goings on there.
For the friends and family of couples going experiencing fertility problems, have a look at Fertility NZ's webpage http://www.fertilitynz.org.nz/index.cfm/1,54,html/Emotional-Minefield
Please email me Janine [at] cityacupuncture [dot] co [dot] nz if you have any questions or feedback on this page. It can be added to or tweaked .
Best wishes on your fertility journey!
Janine
