Many of our patients have been told they have poor egg quality or diminished ovarian reserve, or even poor embryo quality and this is the reason why they are having trouble conceiving or carrying a pregnancy to term. While it is true that your egg health diminishes over time, it is not true that there is nothing that can be done to help support your egg health.
Even if you don’t have any specific ovarian or egg quality issues, helping support good egg health will help increase the chances your cycle will be a success!
The total time it takes for one egg to fully mature is about 90 days. It is during this window of time that we are able to have the biggest impact on egg health. So, we recommend that all of our patients looking to plan a treatment cycle take advantage of this time to prepare and consider acupuncture, supplements, diet, and lifestyle changes to help support their egg health.
Some of the main factors affecting egg health are:
Diet and Nutrition
Blood flow to the uterus and ovaries
Oxygenation of your blood
Our three favorite ways to improve all of these factors affecting egg health are acupuncture (of course!), diet and exercise, and specific supplements.
Each of our treatment protocols (IUI, IVF, and medicated cycles) begins with the recommendation of preconception acupuncture. Preconception acupuncture is treatments given weekly in the 1-3 months prior to any fertility cycle specifically designed to support egg health and hormone balance.
By now, you probably know that acupuncture done alongside a fertility cycle can improve the chances of pregnancy for that cycle. What you may not know, is that acupuncture’s effect is cumulative, much like exercise. Each treatment and treatment cycle builds on the previous. Research done on fertility acupuncture supports this idea. Generally, the more acupuncture one receives, the better the pregnancy rates.
The reasons why acupuncture done in the months prior to a fertility cycle can have an impact on your egg health and the overall success of your cycle are:
Dramatically improved blood flow to the uterus and ovaries: This increases the delivery of oxygen and nutrients, and facilities waste product removal, improving overall egg health.
Hormone regulation: Many women notice changes in their cycles during preconception acupuncture: less pain, more regular ovulation, and normalization of menstrual flow.
Reduced stress: Help your body and mind get ready for the upcoming cycle.
2. Diet, Exercise and Lifestyle:
Diet: A healthy diet can dramatically affect one’s fertility (and overall health!). Taking the preconception time period to focus on eating a clean, whole-food, plant-based diet can help improve egg health. Our favorite general fertility diet comes from a Harvard Medical School research study, but many diagnoses related to infertility, such as endometriosis or PCOS, call for some specialized nutrition.
Overall, the basics of a healthy fertility diet include:
Low amounts of saturated fat: Choose plant based fats such as nuts, seeds, avocados, and healthy fats like those found in salmon and other fish.
Local, grass fed, organic meats whenever possible
Fresh fruits and veggies: We suggest eating foods from every color of the rainbow and making sure at least half of your plate is filled with veggies as an easy way to maximize your fruit and vegetable intake
Vegetable protein sources: Try to replace one serving of meat per day with a vegetarian protein source like beans or tofu.
Lots of fresh water: Try to avoid water bottled in plastic and stick to filtered when possible.
Whole grains: brown rice, quinoa, whole wheat bread and pasta, etc instead of simple, white carbs,
Iron rich plants: spinach, pumpkins, beans, tomatoes, and beets.
Full fat dairy instead of low fat varieties.
Minimal (or no) sugar intake: be sure to watch added sugars and high fructose corn syrup as they can hide in many unsuspecting foods as well as sugary drinks and desserts.
For women who have endometriosis, we recommend following an anti-inflammatory diet. For those with PCOS, a low-glycemic index diet is best.
Exercise: Regular aerobic exercise improves the oxygenation of blood and increased blood flow throughout the body. It is also a great stress reliever and helps maintain a healthy BMI, which is associated with higher pregnancy rates. Yoga is also a great way to strengthen your core and help reduce stress.
The preconception time is perfect for implementing a consistent exercise routine as exercise is commonly limited by your doctor during a fertility treatment cycle.
Lifestyle: There are many lifestyle habits that can have an effect on egg health. Our top suggestions are the following:
Allow personal ‘down-time’ to meditate, read, or just relax.
Listen to fertility meditations via Circle Bloom to help de-stress and foster a healthy body/mind connection
Work to reduce stress and overwork as much as possible
Seek counseling or a support group if you feel it is necessary.
3.Supplements and herbs: In addition to a good quality prenatal vitamin, there are some supplements that you can take that will help support egg quality and overall fertility. One supplement that has some evidence showing it’s efficacy is CoQ-10.
CoQ-10 is a vitamin-like substance (meaning our bodies can make some on their own) that functions within the energy production centers, called mitochondria, present in each cell. As we age, the efficiency of the mitochondria declines. The idea is that by supplementing CoQ-10, we can help support this energy production, which is especially needed for high-energy processes like the cellular division involved in egg production and embryo development. There is some preliminary research showing an egg-health benefit in mice and we await further research. CoQ-10 is generally regarded as very safe to take while trying to conceive and most experience no side effects. It also shows some promise in helping support male fertility as well.
Other supplements that we typically recommend are:
Fish Oil: high in omega-3 fatty acids to help reduce inflammation in the body
Probiotics: to support good digestion and absorption of nutrients.
There are also specific supplements and herbs available for other fertility related conditions such as PCOS, endometriosis, luteal phase defect, male factor infertility, etc and will be recommended as needed.
Please call 865-315-3845 or contact us, we are more than happy to answer your questions or set you up for preconception acupuncture! Good luck with your cycle!
On March 1, 2016 the Tennessee Center for Reproductive Acupuncture finally opened it’s doors to Knoxville and the surrounding areas. We are Knoxville’s first and only acupuncture practice specializing in fertility and prenatal wellness. It was my goal to provide East Tennessee with an integrative option for the treatment of infertility and help each of our patients navigate this complex journey. We have officially been open for our patients for one year (and counting) and I wanted to touch on my thoughts for this first year in practice here.
It was my intention to post this retrospective on the 1 year anniversary of my practice, but I spent the morning driving my husband to and from his wisdom teeth removal appointment. Luckily, all went well, and I was able to fill my afternoon seeing the patents that are truly the heart and soul of TNCRA. Minus the wisdom teeth extraction (who wants to do that!?), I wouldn’t have wanted to spend the one year anniversary of my practice in any other way.
When I think back over the past year, I am completely overwhelmed with a feeling of gratitude. I have been humbled by the reception that Knoxville has given to TNCRA. Over the past year I have met many families struggling with infertility and had a chance to help many of them achieve their dream of pregnancy. I have also met many expectant mothers and had the honor of working with them as they prepare to become mothers for the first, second, third, fourth, or fifth (and more) time. I have also met so many others whose passion for working with families during infertility and pregnancy just bleeds through their work: doctors, doulas, midwives, nurses, massage therapists, craniosacral therapists, nutritionists, chiropractors, photographers, lab technicians, yoga teachers, other acupuncturists, counselors, reproductive endocrinologists, ultrasound technicians, OB/GYN’s, and I’m sure there are few I am forgetting.
One thing I kept hearing in my first year of practice here is that it can be hard for people coming from outside of Tennessee to get a successful business going. I have found this completely and happily untrue. Knoxville has an incredibly welcoming atmosphere and a truly wonderful community to support families of all backgrounds on their journey from trying to conceive to becoming parents. I am honored to be a part of this community and look forward to many years of practice here.
So, thank you Knoxville for welcoming me with open arms. Thank you to the other practitioners who have taken time to learn about TNCRA and how we may be able to work together to help support our patients. But mostly, thank you to my patients. You have put your trust in my experience and training during the most sensitive of times and I am forever grateful to walk alongside you on this journey.
I am very excited for the years to come and hope to build upon the foundation that has been laid. I look forward to learning more each year and working with more families. Mostly, I look forward to pregnancy announcements, birth announcements, and holding space (or a hand) for those experiencing a loss or a failed cycle. These moments are truly what drives me to come to work each day. I love my job.
Are you currently trying to get pregnant or planning to try in the next few months? Have you considered adding fertility acupuncture to your IVF, IUI, or medicated cycle?
You’ve probably read or heard a little about acupuncture for fertility, but maybe don’t know much about how it can help you. Here are our top five reasons why you should book an acupuncture treatment with your next cycle!
Increases Chances of a Take Home Baby: Research shows that acupuncture not only improves pregnancy rates (up to 60%!), but can reduce miscarriages leading to an overall increase in the chances of a take home baby! After all, this is what everyone facing infertility really wants! This research is typically done on IVF cycles, but the same mechanisms of action can help improve an IUI, medicated, or natural cycle in much the same way.
Improves Blood Flow: Acupuncture has been shown to increase blood flow to the uterus. This improved blood flow is associated with a better chance of embryo implantation in IVF cycles. It can also facilitate better nutrient delivery and waste product removal to potentially increase the the quality of your follicles and endometrial lining.
Hormone Regulation: Over the course of 1-3 months, acupuncture can help to regulate your reproductive hormones. For example, women with PCOS often begin ovulating after treatment with acupuncture. Subtle cycle changes also occur as hormones become more balanced. Changes often noticed during the course of treatment include: increased fertile cervical mucous, a longer luteal phase, reduced PMS symptoms, and even changes in your basal body temperature chart.
Reduced Stress: We all know struggling with infertility is stressful. Acupuncture can help you cope with this stress so you can relax and feel normal while going through treatment cycles. It causes a release of ‘feel-good’ chemical called endorphins in your brain that will…. well, help you feel good! You may also notice that you sleep better or have better digestion after treatment as well.
Treatment of Side effects: Often when we are treating patients during their cycles, we use points to reduce headaches, nausea, bloating, irritability, insomnia, hot flashes, night sweats, constipation, anxiety…. you name it! Making you feel comfortable during treatment is a huge part of what we do. The way we see it is that, for many couples, success can be a matter of time. Time finding the right medication combination that works with your body and time waiting for the right follicle to develop. If we can make that wait easier, you’re more likely to try an additional cycle or two and increase your chances of success! Additionally, we all know you can’t push the pause button on life while you undergo fertility treatment, so we work to help keep you at your best so you can continue to be a wife, co-worker, student, mother, sister, friend, and/or superwoman!
As you can see, combining acupuncture to your fertility treatment plan is a great way to, not only, increase your chances of pregnancy, but to feel more comfortable, relaxed and get a more regulated cycle!
We work with both men and women to find a treatment protocol that works with the timing of their cycles to give you the maximum benefit of acupuncture. Please give us a call or contact us online and we’ll walk you through what is best for your situation. Or, if you’re ready, you can schedule an appointment online now!
A 33 year old woman came to our office after experiencing infertility for 7 years. She had a history of endometriosis and low progesterone. Her husband had a history of low motility. She had never been pregnant and was feeling very frustrated.
Her previous fertility treatment included multiple medicated cycles using both clomid and letrozole and two previous IUI cycles. She had undergone two laparoscopies to treat endometriosis. She began fertility treatment in another state before moving to Tennessee, where she began seeing Dr. Doody in Knoxville.
We saw her a total of three times during her IUI cycle.
The first treatment was done on cycle day 6 to support follicle growth and reduce the side effects from the clomid. Supporting the first phase of the cycle and making it as healthy as possible sets up the rest of the cycle for optimal fertility and can help treat luteal phase defect.
The second treatment of the cycle was done the morning of the IUI itself. This treatment helped to facilitate ovulation. Acupuncture has been shown to be an effective means of ovulation induction and we like to use it along with the trigger shot.
The points used for the first and second treatments followed a modified Stener-Victorin protocol. This protocol has been specifically shown to increase blood flow to the uterus and is used successfully to improve IVF cycle success and regulate hormones.
The third treatment of the cycle was done 6 days following the IUI to support implantation, reduce uterine contractions, ease stress and support healthy progesterone levels. The points used for this treatment followed a modified Paulus protocol. The Paulus protocol is commonly used before and after embryo transfer during an IVF cycle and has been shown to improve pregnancy rates.
She received a positive pregnancy test about a week later. Her HCG levels rose an appropriate amount between her tests. The pregnancy was confirmed by ultrasound, and has been going well for mom and baby.
We are very excited for her success and hope the rest of her pregnancy goes well!
If you’d like to add acupuncture to your upcoming IUI cycle, call or contact us and we will find a protocol that is best for your cycle! 865-315-3845
Last week, I had the opportunity to share how fertility acupuncture can benefit those undergoing IUI and IVF with Dr. Donesky and the staff at the Fertility Center. The Fertility Center has offices in Knoxville and Chattanooga.
First off, Knoxville is so lucky to have Dr. Donesky and crew. They truly love their work, and it shows. Although, I have to say that all of the clinics, doctors, and staff in Knoxville that I have met with are really wonderful. We are a very fortunate community!
At my presentation, I explained how acupuncture can be utilized as a complement to any fertility cycle. We went over our IUI and IVF protocols and I presented some of the research that our protocols are based off of.
My main job as an acupuncturist to someone going through fertility treatment is to support the doctors’ efforts. When done in combination with IVF/IUI, acupuncture can improve pregnancy (and live birth rates), reduce miscarriages, reduce side effects of medications, and lessen the feelings of stress. The protocols are all based on each patient’s cycle timing and unique situation.
We talked about acupuncture’s safety during pregnancy and it’s usefulness during the first trimester for morning sickness and even, possibly, miscarriage prevention.
It was a really fun meeting and I am looking forward to working more closely with them and the other clinics here in town. I am grateful to them for having me!
It is my hope that more cycles will be done using acupuncture as a complementary therapy!
If you are struggling with infertility, please consider getting a work up from a reproductive endocrinologist. Having answers will help you make an educated decision on your best path towards parenthood.
Finally seeing those two lines on a pregnancy test is a long-awaited, and rightfully celebrated, moment for all of my patients! This joy can quickly become sadness if the pregnancy is not viable. Miscarriage is a very common occurrence with 10-25% of all pregnancies ending in miscarriage. The most common cause of miscarriage is genetic abnormalities that cause the embryo to be non-viable. Other causes of miscarriage can include:
Lifestyle issues: smoking, excessive alcohol use, excessive caffeine, drug use,exposure to toxic substances, etc
Maternal age: the prevalence of genetic abnormalities increase with age
Thin or low quality endometrial lining
Immune system issues
Trauma: generally only very severe trauma leads to miscarriage
Structural abnormalities in the uterus: adhesions, polyps, septum, etc
Blood clotting: anti-phospholipid syndrome
For less than 1% women, miscarriages can become recurrent. This is typically diagnosed after having 3 miscarriages. A thorough workup is done to try and find out the cause and determine what treatment is appropriate. Fortunately, many causes of recurrent miscarriage are treatable. Even in the case of genetic abnormalities, like chromosome translocation, preimplantation genetic diagnosis (PGD) can be utilized in combination with IVF to help decrease the chance of miscarriage.
What can I do to prevent miscarriage?
There is a lot you can do on your own to help prevent miscarriage. Much of this work involves managing chronic illness or hormonal imbalances and modifying complicating lifestyle factors. For example:
Quit smoking as soon as possible in your conception journey
Limit coffee and tea to 1-2 cups daily
Maintain a healthy BMI
Seek the help of your physician in managing diabetes, PCOS, or other health problems
Eat a healthy whole-foods diet high in fruits, veggies, and protein and low in sugar and processed foods
Limit exposure to toxic chemicals or environments
Avoid dangerous situations or activities where severe trauma may occur.
How Can Acupuncture Help?
Acupuncture can be a very useful for assisting in the prevention of miscarriage when not related to chromosomal abnormalities by treating many of the common causes of miscarriage. Acupuncture can be helpful in the following ways:
Increasing the thickness and quality of the endometrial lining
Improving uterine blood flow to help prevent blood clots
Regulating the immune system
What does the research say?
Research on acupuncture and miscarriage is very promising. One recent study on acupuncture done along with IVF showed a 50% decrease in the miscarriage rate.
Another studysuggests acupuncture may even be a potential supportive treatment for threatened or recurrent miscarriages due to its beneficial effects on serum cortisol and prolactin levels during IVF.
Acupuncture’s known effects on stress are also a possible mechanism by which miscarriage rates could be reduced. According this same study, it is possible that stress in very early pregnancy may cause overactivity of the hypothalamus-pituitary-ovarian axis leading to reduced progesterone levels. In reducing this stress, progesterone levels may stay higher.
When should I start acupuncture?
Acupuncture can be started at any point along your journey. Some basic recommendations are here:
If you are pregnant: We recommend acupuncture weekly through the first trimester to support blood flow to the uterus, reduce stress, and support progesterone levels before the placenta is fully developed.
If you are trying to conceive: Generally, it is recommended to begin acupuncture 3 months prior to conception for most causes of recurrent miscarriage. This allows the treatments to affect overall cycle health, hormone balance, and egg quality as it takes 90 days for an egg to prepare for ovulation. However, the effects of acupuncture are beneficial at any stage of your journey, and accumulate over time. We see many women while they are actively trying to conceive naturally or with fertility treatment. We have protocols for IVF, IUI, medicated cycles and couples trying naturally.
Please give our office a call to discuss your specific situation or to schedule an appointment. We are more than happy to answer any questions you may have. We wish you the best of luck!!
Infertility is often seen as something only women have to be concerned about. The reality is that infertility is due to female factors 30% of the time, male factors 30% of the time, and both partners or unexplained infertility 30% of the time.
Male infertility can even go undiagnosed by some practitioners not experienced in treating fertility. A semen analysis should be part of your initial workup with your reproductive endocrinologist. It is a non-invasive, low cost test that can really have an impact on your best course of action.
Common causes of male factor infertility include:
Blockage of sperm flow
Many times, varicoceles or blockages can be corrected with surgery. Follow up semen analysis will ensure that fertility has been restored. Other causes can be treated with medication or lifestyle changes. Sperm can sometimes even be removed from the testical directly to be used in an IVF cycle in a minor surgical procedure if needed.
Optimizing male fertility is an often overlooked part of a coupleâ€™s journey and, yet, there is so much you can do. Various lifestyle changes, complementary medicine, and supplements can have a big impact on male fertility.
ACUPUNCTURE AND MALE FACTOR INFERTILITY
Acupuncture has been used successfully to help treat male infertility. Research studies showed both an increase in the total number of sperm present and an increase in the number of sperm present without structural abnormalities. Acupuncture can also be used to help regulate hormonal imbalances.
At the Tennessee Center for Reproductive Acupuncture, we would like to treat both the male and female partners to help them optimize their fertility. Our recommendations for male factor fertility depend on the timing of the cycle. Sperm go through a 3 month growth and maturation process before they are ready to fertilize and egg. Because of this we like to see men 3 months before their fertility cycle, if possible. However, benefit has been seen from much shorter treatment windows and you can start treatment at any time during your journey. Feel free to call us for a recommendation on your situation.
SUPPLEMENTS TO TREAT MALE FACTOR INFERTILITY
We carry Conception XR supplements for male fertility. There are two versions of this supplement, detailed below. Their primary ingredients are antioxidants and other nutrients shown to increase pregnancy and birth rates and improve sperm motility.
Reproductive Health Formula: This formula is designed to support normal male fertility and is recommended for any man trying to conceive. You can think of it as a prenatal vitamin for men! It is also recommended for IVF cycles, when motility support is not necessary.
Motility Support: This formula has an added ingredient, L-carnitine, that is specifically helpful with sperm motility. It is recommended for low motility or when trying to conceive naturally or through IUI or medicated cycles.
LIFESTYLE CHANGES TO SUPPORT MALE FERTILITY
Smoking has been shown to be very detrimental to sperm health. Please see your doctor about quitting.
Alcohol: Limit to 1 drink per day.
Keep your testicles cool: Avoid hot tubs, laptops on your lap, high temperature work areas, or prolonged baths.
Diet: Increase your fruit and veggie intake and stay hydrated.
Exercise: Aim for 30 minutes of moderate exercise per day.
Harmful supplements: Some supplements containing DHEA or other ingredients, often used for muscle building, can impair sperm development.
Environmental Hazards: Avoid working with radiation, pesticides, solvents, or other fumes when possible.
Polycystic Ovarian Syndrome (PCOS) is a common diagnosis that affects approximately 7 million women, although it is thought that less than half of all cases are properly diagnosed. Many women with PCOS will experience some degree of difficulty in getting pregnant and many will use fertility treatments to conceive.
Symptoms associated with PCOS are:
Irregular periods or having very long cycles
Weight gain (or having a hard time losing weight)
Unusual hair loss
Hair growth on face or body (hirsutism)
Dark Patches of Skin
Anovulation (not ovulating)
PCOS is a complex diagnosis and women will not necessarily have all of the above symptoms. Insulin resistance is a common factor in the disease and can lead to the development of type-2 diabetes. Other factors include the presence of multiple ovarian cysts, high testosterone levels, high blood pressure, high cholesterol and high triglycerides. A combination of these factors leads to reduced egg quality, irregular cycles, and infertility.
As you can see, the early detection and treatment of PCOS is extremely important! Luckily, PCOS is generally a treatable condition and responds well to many different types of treatment including fertility treatments. Many, many women with PCOS will go on to have healthy babies.
ACUPUNCTURE: Treatment with acupuncture has been shown to promote ovulation and, over time, regulate FSH/LH levels back to normal. In one study, a single acupuncture treatment was shown to work as well as an injection of HCG in inducing ovulation. Studies on longer courses of acupuncture treatment have shown a normalization of hormone levels, cycle length, and ovulation. These results could still be seen 3 months after finishing acupuncture treatment. In our clinic, we have seen great results in treating PCOS both for women trying naturally or using some form of fertility treatment.
SUPPLEMENTS: Supplementation with inositol has been shown to promote menstrual regularity and normal ovarian function in women. Additionally, it will reduce insulin resistance, and improve hormone levels. Inositol is a nutrient found in fruits, beans, grains, and nuts. It is also produced by the body. There are a couple of different types of inositol commonly available: D-chiro inositol and myo-inositol. Recent research has shown the greatest benefit from supplements containing a 40:1 of myo to D-chiro inositol. We recommend a supplement with this ratio called Ovasitol by Theralogix for our PCOS patients. It is recommended to take this for at least three consecutive months to see an improvement in hormone levels and menstrual cycles. And continued use will ensure these results continue.
LIFESTYLE/DIET: For many women, diet and lifestyle changes are enough to promote regular cycles. Regular exercise combined with a low-glycemic index diet can help to reduce insulin resistance and regulate the menstrual cycle. Working to maintain a healthy BMI is also helpful with studies showing an improvement of insulin and testosterone levels with just a 5% reduction in body weight. Some women can eliminate any signs of PCOS by working to improve their diet and lifestyle.
So, as you can see, PCOS, while a very frustrating diagnosis, is usually very treatable with very good outcomes using integrative care. Most of our PCOS patients go on to have healthy, pregnancies and healthy babies.
Please call us with any questions. We are very happy to help!
Below you will find a research study written by our acupuncturist, Sarah Prater (under her maiden name, Fredrickson) for the journal American Acupuncturist. This was published in the Winter 2014 edition.
By Sarah .J. Fredrickson, MSOM, Dipl OM (NCCAOM), LAc; David B. Youran, Dipl Ac (NCCAOM), LAc; Glen K. Adaniya, PhD; Bradford L. Bopp, MD; Robert M. Colver, MD; Laura M. Reuter, MD
Conflicting evidence exists on whether acupuncture is beneficial for patients undergoing in vitro fertilization (IVF) cycles. This retrospective cohort study was undertaken to determine whether a unique protocol of a combined Chinese and Japanese style on-site acupuncture, performed both before and after embryo transfer, affects clinical outcomes.
Design and Setting
Forty-nine patients received a previously untested acupuncture protocol on-site before and after embryo transfer at Midwest Fertility Specialists, Indianapolis, Indiana, in 2007. The acupuncture treatment was performed 45 minutes before and 15 minutes after embryo transfer. The control group consisted of 212 patients who did not receive acupuncture and who underwent IVF cycles in the same time period. All cycles were fresh, non-donor successful embryo transfers. The clinical pregnancy rate (CPR) was defined as the presence of fetal cardiac activity. Data were analyzed using the unpaired t-test and Fisherâ€™s exact test, with significance defined as P < 0.05.
Results and Conclusion
It was found that patients with a positive hCG were slightly higher in the acupuncture group than in the control group (57.1% vs.45.8%, p = 0.16). The acupuncture group also had a higher CPR (55.1% vs. 34.4%, p = 0.01). The miscarriage rate was lower for the acupuncture group compared to the control group (3.6% vs. 22.7%, p= 0.02). These results support the use of acupuncture in conjunction with IVF.
Keywords: TCM, acupuncture, infertility, IVF, embryo transfer
Infertility affects roughly 1.5 million women in the United States..1 Many of these women will seek out various fertility treatments, and, of these, in-vitro fertilization is becoming more and more common, with 154,412 IVF â€œcyclesâ€ performed in 2011 versus 112,988 in 2003.2 IVF involves the retrieval and subsequent fertilization of a womanâ€™s eggs,Â produced by stimulating the ovaries with medications. The resulting embryos are grown in a laboratory setting and then transferred back into the uterus; this whole process takes approximately two weeks.3 Because of the significant cost, time commitment, and emotional impacts required for each cycle, there is great incentive to improve pregnancy and live birth rates. These rates have improved greatly from 14% of all IVF cycles resulting in a live birth in 1989 to 35% in 2008.4 Despite these profound advances, clinics are still searching for ways to improve this live birth rate.
The use of acupuncture has been regarded as a possible treatment to benefit IVF success rates. It has had obstetric and gynecological usage in China for many centuries. Following the 2002 Paulus study that reported increased pregnancy rates in patients receiving acupuncture before and after embryo transfer,5 many groups examined the impact of varied styles of acupuncture on pregnancy rates before and after embryo transfer. Modern research on this topic has shown mixed results. Some researchers found that groups that had sham or placebo acupuncture had higher pregnancy rates than the true acupuncture groups, although the difference between the two groups was not statistically significant.6,7,8
Complications in varied treatment styles and the effective sham and placebo treatments in acupuncture infertility discussed literature studies are visible in recent searches. This research questions the necessity of using sham or placebo acupuncture when examining the role acupuncture can play in pregnancy rates following IVF. This is due to the objective nature of a pregnancy test and the possibility of an acupuncture-induced stress reduction as the mechanism by which pregnancy rates are increased and thus considered as a therapeutic effect.9 Other research and meta-analysis shows inconclusive results that, during an IVF cycle, acupuncture can improve pregnancy rates. At this time there is not enough evidence to recommend it clinically for all patients.12,13,14
Nevertheless, experts in acupuncture and infertility continue to support more studies on the use of acupuncture before and after embryo transfer to improve pregnancy rates.10 Possible mechanisms of action might be the increased blood flow to the uterus, stimulation of the release of endogenous opioids, and the mediation of neurotransmitter release affecting gonadatropin-releasing hormone and its effect on the menstrual cycle10 or the regulation of cortisol and prolactin during the medication phase of the IVF treatment.11
The purpose of this review of individual cases was to examine the influence of acupuncture before and after embryo transfer on pregnancy rates in patients undergoing IVF. The objective was to determine if acupuncture treatment given before and after embryo transfer (ET) would improve pregnancy rates.
A retrospective review of charts was done at an Indianapolis fertility clinic on 261 patients who received IVF in 2007. Charts were chosen based on the successful completion of a fresh, non-donor embryo transfer in 2007 with or without acupuncture. No exclusions were made in the acupuncture group, but some statistical outliers within the control group were eliminated to ensure the groups were statistically similar in oocytes per patient, embryo cell count, and embryo fragmentation score. No exclusions were made specifically regarding diagnosis, age, or other factors.
Forty-nine patients received acupuncture by a single board certified licensed acupuncturist on-site before and after embryo transfer. The treatments were given in the same location as the ET to reduce traveling induced stress, which seems to improve results in other studies.12 The 212 patients who did not receive acupuncture served as the control group for this analysis. The charts in both the acupuncture and no acupuncture groups were reviewed retrospectively for beta pregnancy and clinical pregnancy by D.Y and G.A.
Controlled ovarian hyperstimulation was achieved by use of a standard gonadotropin releasing hormone agonist and recombinant follicle stimulating hormone (rFSH) protocol with the dosage varying for each patient. Antral follicle count and E2 levels were not collected for this study. Following human chorionic gonadotropin administration and oocyte retrieval after 36 hours; oocytes were inseminated 2 to 4 hours later by either standard insemination or by intracytoplasmic sperm injection (ICSI). Embryos were scored using standard morphological criteria on the morning of the Day 3 embryo transfer (ET). Embryos were assigned a fragmentation score of 4 if there was no fragmentation, a 3 if less than 10% of the embryo exhibited fragmentation, a 2 if between 10% and 50% of the embryo was fragmented, and a 1 if the embryo had greater than 50% fragmentation.
Acupuncture points were selected according to a combination of traditional Chinese and Japanese acupuncture for the treatment of infertility and through consensus of 4 experts in the field. The points were chosen to harmonize the Kidney and Spleen qi according to Japanese and Chinese theories. Acupuncture treatment was performed 45 minutes before embryo transfer and 15 minutes after embryo transfer. Acupuncture points used before the embryo transfer were Qihai CV-6, Guanyuan CV-4, Sanyinjiao SP-6, Taixi KI-3, Zhongfeng LR-4, Zusanli ST-36 and Yanglingquan GB-34. Acupuncture points used after the embryo transfer were Yinlingquan SP-9, Taichong LR-3, Taixi KI-3, Zusanli ST-36, and Yanglingquan GB-34. All points were needled bilaterally without the elicitation of the de qi sensation and the needle depth varied form 0.25 cun to 0.50 cun.. Needles were retained for 35 minutes. Seirin 0.20 x 30 mm acupuncture needles were used.
The beta pregnancy rate was the percentage of patients who had an initial hCG level, drawn 12 days after the embryo transfer, of 10 mIU/ml or greater. The clinical pregnancy rate (CPR) was defined as the percentage of patients with fetal cardiac activity. The miscarriage rate was the percentage of patients that had a positive hCG level but that failed to develop a fetal heart rate. Data was analyzed using the unpaired t-test and Fisherâ€™s exact test, with significance defined as P < 0.05. The results are expressed as mean standard deviation or percentages as appropriate.
The number of oocytes, cell number, fragmentation score, number of embryos frozen and number of embryos transferred in both groups was equivalent. Positive hCG was slightly higher in the acupuncture group versus the control group (57.1% vs. 45.8%). The clinical pregnancy rate for the patients receiving acupuncture was significantly higher than the control group (55.1% vs. 34.4%). In addition, the loss rate was significantly lower in the acupuncture group (3.6% vs. 22.7%). ( Insert Table 1/ and Graph)
All fresh, non-donor IVF cycles that ended in successful embryo transfer were included in the study. No exclusions were made in the acupuncture group, but some statistical outliers within the control group were eliminated to ensure the groups were statistically similar in oocytes per patient, embryo cell count, and embryo fragmentation score. No exclusions were made specifically regarding diagnosis, age, or other factors.
There were no adverse events related to the acupuncture treatment reported.
Although other studies regarding acupuncture and IVF are inconclusive, perhaps the positive results in this study relate to several important factors .12,13,14 Acupuncture attempts to stimulate the bodyâ€™s own reproductive potential, which may help to explain the positive results of this study. In addition, the treatments were performed on-site, eliminating the stress of traveling to another site before and after the embryo transfer.
Because the patients in this study received acupuncture immediately before and after ET, this could also explain the positive results. Studies showing treatment immediately before and after treatment at the same site had higher pregnancy rates in the acupuncture group compared with studies that did not specify time of acupuncture.12,13 The higher clinical pregnancy rate and lower miscarriage rate in the acupuncture group may be due to increased blood flow to the uterus.10
The unique combination of the Chinese and Japanese styles of the acupuncture treatment protocol in this study suggests there is still more research needed on the best protocols to treat infertility issues with acupuncture. This study was limited by its chart review nature and would benefit from having been a randomized controlled trial. The small number of patients in the acupuncture group as compared to the control group reflects that.
Also, considering that patients themselves elected to join either the acupuncture or control group, it is possible that the acupuncture patients had a healthier lifestyle, or some other confounding factor, which could have impacted results. There was no way to account for these factors during the chart analysis as charts were chosen only based upon the patients’ completion of a fresh, non-donor IVF cycle in 2007. Additionally, there was no way to determine if anyone in the control group received acupuncture from another practitioner on the day of ET, which may have affected the results. Due to these limitations, this analysis suggests there is still more research to be done on how best to treat infertility issues with acupuncture.
The results of this study point to the possibility that acupuncture is safe and may increase both clinical pregnancy rates and beta pregnancy rates in women undergoing IVF ET. In addition, this study showed a decrease in the loss rate among women in the acupuncture group. In comparison with the inconclusive results found in the literature, this study had a few key differences, including acupuncture performed on-site, acupuncture being performed immediately before and after ET, and the usage of a unique Chinese- and Japanese-derived type protocol.
A blinded, randomized study containing a larger number ofÂ patients is necessary to determine if these results are clinically useful. Additionally, more research should be done to identify the key factor (or factors) within the methods of this study that led to the positive results.
1. Centers for Disease Control and Prevention [Internet]. Atlanta: CDC; c2013 [cited 2013 June] FastStats. Available from: http://www.cdc.gov/nchs/fastats/fertile.htm
2. Society for Assisted Reproductive Technology [Internet]. Birmingham (AL): SART; c1996-2013 [cited 2013 June] Available from: https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0
3. Society for Assisted Reproductive Technology [Internet]. Birmingham (AL): SART; c1996-2013 [cited 2013 June] Available from: http://www.sart.org/detail.aspx?id=1903
4. Society for Assisted Reproductive Technology [Internet]. Birmingham (AL): SART; c1996-2013 [cited 2013 June] Available from: http://www.sart.org/SART_Success_Rates/
5. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility & Â Sterility. 2002 Apr; 77(4): 721-4.
6. Moy I, Milad MP, Barnes R, Confino E, Kazer RR, Zhang X. Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization. Fertility & Sterility. 2011 Feb; 95(2): 583-7.
7. Andersen D, Lossl K, Nyboe Andersen A, Furbringer J, Bach H, Simonsen J, Larsen EC. Acupuncture on the day of embryo transfer: A randomized controlled trial of 635 patients. Reproductive Biomedicine Online. 2010 Sep; 21(3): 366-72.
8. So EW. Ng EH, Wong YY, Lau EY, Yeung WS, Ho PC. A randomized double blind comparison of real and placebo acupuncture in IVF treatment. Human Reproduction. 2009 Feb; 24(2): 341-8.
9. Manheimer E. Selecting a control for in vitro fertilization and acupuncture randomized controlled trials (RCTs): How sham controls may unnecessarily complicate the RCT evidence base. Fertility & Sterility. 2011 Jun 30; 95(8): 2456-61.
10. Stener-Victorin E, Humaidan P. Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med. 2006 Dec; 24(4):157-63.
11. Magarelli PC, Cridennda DK. Cohen M. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization-embryo transfer treatment. Fertility & Sterility. 2009 Dec; 92(6):1870-9.
12. Manheimer E, Zhang G, Udoff L, Haramati A, Langerberg P, Berman BM, Bouter LM. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilization: systemic review and meta-analysis. BMJ. 2008;336:545.
13. El-Toukhy T, Sunkara S, Khairy M, Dyer R, Khalaf Y, Coomarasamy A. A systematic review and meta-analysis of acupuncture in in vitro fertilisation. BJOG: An International Journal of Obstetrics & Gynaecology. 115:Â 1203â€“1213. doi:Â 10.1111/j.1471-0528.2008.01838.x 2008.
14. Cheong Y, Nardo LG, Rutherford T, Ledger W. Acupuncture and herbal medicine in in vitro fertilization: a review of the evidence for clinical practice. Human Fertility. 2010 March; 13(1): 3-12.
Sarah J. Fredrickson, MSOM, Dipl OM (NCCAOM), LAc, completed a BS in biology at Indiana University in 2005 and completed her Masterâ€™s Degree in Acupuncture at Southwest Acupuncture College in Santa Fe, New Mexico, in 2008. She is currently in practice at Indiana Reproductive Acupuncture. Her clinical interests include infertility, prenatal care, and other women’s health issues.
David B. Youran, Dipl AC (NCCAOM), LAc, is the director and founder of Indiana Reproductive Acupuncture. He studied acupuncture and Oriental medicine during a four year apprenticeship program taught by Dr. Thomas Duckworth at the Inochi Institute in St. Louis, Missouri. He is the first acupuncturist in Indiana to specialize solely in treating infertility and pregnancy wellness issues.
Glen Adaniya, PhD, graduated from Northwestern University and earned his MS and PhD in Biomedical Engineering at the University of Illinois in Chicago.
Bradford Bopp, MD, graduated from The Ohio State University, attended medical school at the University of Southern California, completed his residency in obstetrics and gynecology and his fellowship in reproductive endocrinology at Harvard University.
Robert Colver, MD, graduated from Indiana University, obtained his medical degree from the Indiana University School of Medicine, completed his residency in obstetrics and gynecology at St. Vincent Hospital in Indianapolis, and served a fellowship in reproductive endocrinology and infertility at the Medical College of Georgia.
Laura Reuter, MD, graduated from Cornell University, earned her medical degree at the University of Illinois, completed her residency in obstetrics and gynecology at Wayne State University, and completed a fellowship in reproductive endocrinology at the University of Illinois.
For families navigating the world of assisted reproduction, many will find themselves considering an IUI cycle to get pregnant. IUI, or intrauterine insemination, involves a combination of hormones to stimulate a woman’s ovaries and the insertion of prepared sperm directly into the uterus during ovulation to increase chances of conception.
The rates of success of this treatment vary, but hovers, on average, around 10-20% per cycle for most women. Most couples will do 2-4 IUI cycles before additional treatment or IVF is recommended, though there may be reasons to consider an increase or decrease in the number of cycles attempted based on your specific diagnosis or situation.
If you’re like most facing an IUI cycle, you want to know what you can do to help increase your chances of success. Acupuncture treatment during an IUI cycle can help to optimize your body for conception and increase chances of pregnancy. While most of the fertility-acupuncture research is done on IVF, similar principles will apply. Acupuncture works by improving blood flow to the uterus and ovaries, regulating hormones, and helping reduce stress. All of these things together help to increase your chances of a take-home-baby.
RESEARCH: There are only a few research studies examining IUI and acupuncture specifically. One notable study out of Israel showed that women who did a combination of acupuncture and herbs with their IUI cycle had a pregnancy rate of 65.5% vs 39.4% who did the IUI alone, and live birth rates were 41.1% in the acupuncture group vs 26.9% in the IUI alone group. This is incredible news!
TNCRA PROTOCOL: Our protocols are based off the latest research and timed according to your cycle. You can begin treatment at any point during the cycle, but we like to start treatment 1-3 months prior to the IUI when possible to help improve the quality of the eggs and help bring your body into balance to optimize conditions for conception. We also like to work with men 1-3 months prior to the cycle to help improve sperm quality. We typically do not recommend herbs while you are taking any hormones, as the effects in combination with medications are largely unknown, though they may be used in the months or weeks leading up to the cycle.
We will see you about three times during the IUI cycle itself. Each treatment, and itâ€™s timing, is detailed below. The timing of the treatments is important, so we will stay in close communication with you during your cycle to make any needed changes.
First Treatment: Around cycle day 5-9
-improve blood flow to uterus and ovaries
-decrease side effects of medications -increase egg quality and quantity
Second Treatment: Within 24-36 hours of the IUI procedure
-decrease uterine contractions
-support progesterone levels
-increase the thickness and quality of the uterine lining
-improve blood flow to the uterus
Third Treatment: 5-7 days after the IUI
-decrease uterine contractions
-increase implantation rates
-support early pregnancy
Once you have a positive pregnancy test, (fingers crossed!) we strongly recommend acupuncture to help support early pregnancy and reduce any symptoms such as fatigue and morning sickness. You can read more about prenatal acupuncture here.
As always, we are available to answer your questions and we will work with you and your cycle to create a plan that works best for you. Please call or email, we look forward to working with you! And good luck!!