How Acupuncture can influence Fertility

At the Northside Holistic Center, a large part of my practice involves helping families conceive when fertility has been elusive. Although so much as already been written in both the scientific, as well as the popular literature, about using acupuncture and herbology to influence both women and mens' reproductive health I wanted to touch upon how we approach this issue at the Northside Holistic Center.

The crux of any Chinese medical treatment is an evaluation of the whole patient. This includes asking questions about issues which may not immediately seem relevant to fertility, such as inquiries into digestive health, the client's energy, skin, respiratory health, and temperature sensitivities. From there, a practitioner will ask deeper questions about the menstrual cycle and what outcome previous attempts at pregnancy have resulted in since, for example, we often see clients who conceive with little difficulty but are prone to miscarriages and we can very often dramatically help with this as well.

Research and Other Articles:

• A new article citing research published in the Journal of Clinical Acupuncture found that acupuncture and Chinese herbology was more than twice as effective as IVF and drug therapies for helping couple conceive a child.  

  The alternative treatment was compared to popular drugs used to boost ovulation with scientists finding acupuncture increased the chance of pregnancy to 43.3 per cent compared to 20 per cent through the medication.

  Women who struggle with infertility caused by hyperprolactinemia can be helped by acupuncture, a new study has found

  Dr Zhiguang Hu, who led the research conducted at the Mawangdui Hospital of Hunan Province in China, said: “One important mechanism responsible for the fertility treatment success with acupuncture is hormonal regulation.

• An Australian government funded study, which can be read about here, found that Chinese medicine (acupuncture and herbal therapy) essentially double the likelihood of fertility within a given menstrual cycle over a typical IVF treatment cycle. The study, which assembled a cohort of almost 2000 women found that acupuncture and Chinese medicine,

can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to TCM diagnosis [Traditional Chinese Medicine], appears to be fundamental to successful treatment of female infertility. 

 A Brazilian study, evaluating IVF success when implantation had failed, found that acupuncture and an adjunctive Chinese medical treatment called moxabustion, dramatically increased the clinical pregancy rate in those that received acupuncture. The researchers concluded that,

...acupuncture and moxibustion increased pregnancy rates when used as an adjuvant treatment in women undergoing IVF, when embryo implantation had failed.

• A recent article in the Times cited research from the University of Southampton demonstrating higher conception rates with women who used regular acupuncture treatment versus those who didn't. You can read the Times article here. 

• From an article on Acufinder.com, comes an overview of Chinese medicine and acupuncture and how it related to fertility, both unassisted and IVF and IUI. It also cites some of the available research which has been published on the subject. The whole article and the research summary can be seen at: www.acufinder.com. However two parts worth excerpting here are: 1. Mechanisms of action of acupuncture and Chinese medicine, 2. Things that the client can do. The Acufinder article begins by talking about what biomedical fertility experts think might be the mechanism of acupuncture on fertility:

"Acupuncture provides better circulation and better blood flow to the womb,” said Dr. Raymond Chang, director of New York's Meridian Medical Group, who has been incorporating acupuncture into fertility treatments for the past decade. "It will give a better chance for the eggs to be nourished and therefore carried." Acupuncture seems to help some women because it improves circulation to your ovaries and to your uterus. It aids ovarian stimulation, improves the thickness of uterine lining, and therefore can help with implantation. Acupuncture is relaxing, which helps to lower your cortisol levels and increase progesterone output, important factors in decreasing your chance of having a miscarriage.

 Western medicine works with an eye on the numbers. The main goal is to increase the quantity of eggs or sperm, thereby increasing your chances of a viable pregnancy. In contrast, Traditional Chinese Medicine is holistic and cumulative. It will likely include suggestions about diet and lifestyle as well as acupuncture. TCM is very personalized. Your practitioner will needle specific points and may suggest specific herbs, all depending on your body and your situation. When your body is healthy and balanced, you increase your chances of getting pregnant and producing a healthy child. The goal of acupuncture is to return your body to a state of health. The effects take time; the results get better over time. Even if your Western doctor does not understand the benefits of acupuncture, most physicians now agree that it does not cause harm.

• The article continues with good self help information which, from a Chinese medical perspective can change one's probablity of conceiving:

"Nourish the Soil before Planting the Seed”

Plan ahead. The ideal time to begin preparing your body for a baby is three months before conception or an IVF cycle. This is the time to begin acupuncture treatments, but many couples wait until they are actively trying to conceive. In my practice, I recommend twice weekly treatments until we get a positive pregnancy test and once a week for the first trimester to reduce the risk of miscarriage.

Of course, making good nutritional choices is always important for both mother and child. Specific suggestions can be found in one of my previous articles, “The ABCs of Fertility: Acupuncture, Babies, Chinese Medicine” which can be read on Acufinder.com and on tcm007.com

You can also help your body’s readiness by attending to the following suggestions:

1. Caffeine: Reduce or cut out coffee from your diet. A joint US/Swedish study of 562 women found that 1-3 cups of coffee increased miscarriage rate by 30% and more than 5 cups increased it by 40%. Also, in another study conducted during the first trimester of pregnancy, women who had a high caffeine intake showed an increased risk of repeated miscarriage.
2. Stress: Stress has been linked to irregularieties in ovulation and abnormal sperm development. When you can lower your levels of physiological stress, you have increased your chances of conception.
3. Sleep: Treatment in Chinese medicine always aims to improve your sleeping pattern. Lack of sleep has long been recognized as influencing fertility. It leads to physiological disruptions including the inhibition of growth hormones.
4. Alcohol: Women who drink alcohol may delay conception because it is poorly metabolised and can lead to a disturbance of the oestrogen/ progesterone balance. During IVF, men and women are both advised to avoid alcohol because, in women, it can lead to reduced egg production and, in men, it may reduce the number of healthy sperm.
5. Weight: Being too thin or too heavy can have an impact on how quickly you conceive. Excessive thinness is known to interfere with menstrual periods. Now, it is also believed that if both partners are overweight or obese, conception will take longer.
6. Smoking: Smokers have an increased rate of repeated miscarriage. Women smokers have been shown to have lower levels of oestrogen which may delay conception. Smoking is also thought to influence tubal factor infertility, and can cause early menopause. In men, smoking may damage sperm. When men stop smoking, their sperm count increases quickly.

References

1. Paulus, W., et al. Fertility and Sterility. April, Vol. 77 (4):721-724, 2002.
2. Dieterle,S., Ying, G., Hatzmann, W., Neuer, A. Fertility and Sterility, May, Vol. 85 (5):1347-135, 2006.
3. Westergaard, L., Mao, Q., et al. Fertility and Sterility, May, Vol. 85 (5): 1341-1346, 2006.
4. Smith, C., Coyle, M., et al. Fertility and Sterility, May, Vol. 85 (5) 1352-1358, 2006.
5. Pei, J., Strehler, E., Noss, U. et al. Fertility and Sterility, July, Vol. 84 (1), pgs. 141-7, 2005.
6. Cnattingius, S. et al, New England Journal of Medicine Vol.343(25):1839-1845, Dec., 2000.
7. George, L., et al. Paediatric and Perinatal Epidemiology, Vol. 20 (2): 119-126, March, 2006.
8. Ibid.

•  A Brazilian medical journal published the results of a study asessing the success rates of IVF with and without acupuncture, which can be read here, that found,

... acupuncture and moxibustion increased pregnancy rates when used as an adjuvant treatment in women undergoing IVF, when embryo implantation had failed.

• Tel Aviv University researchers have published an study in the Journal of Integrative Medicine, which can be read about here, finding that there was

... a significant increase in fertility when the therapies [acupuncture/herbology and IVF] are administered side-by-side.

In a retrospective study, Dr. Lev-Ari and Sela followed the progress of 29 women between the ages of 30 and 45 who were receiving IUI treatment combined with TCM therapy, and compared their results to a control group of 94 women between the ages of 28 and 46 who were undergoing IUI treatment alone. In addition to their IUI treatments, the 29 women in the first group received weekly sessions of acupuncture and a regime of Chinese medicinals, which consisted of powdered or raw Chinese herbs such as Peonia Albae and Chuanxiong, designed to meet each woman's specific needs. All herbal preparations were approved by the Israeli Health Ministry.

In terms of both conception and take-home baby rates, the test group fared far better than the control group. Out of the 29 women in the test group, 65.5 percent conceived, and 41.4 percent delivered healthy babies. In the control group, only 39.4 percent conceived and 26.9 percent delivered. The vast difference in success rates is even more surprising when the age of the average participant was taken into account, Dr. Lev-Ari and Sela note. "The average age of the women in the study group was 39.4, while that of the control group was 37.1. Normally, the older the mother, the lower the pregnancy and delivery rates," they explain.

In a retrospective study, Dr. Lev-Ari and Sela followed the progress of 29 women between the ages of 30 and 45 who were receiving IUI treatment combined with TCM therapy, and compared their results to a control group of 94 women between the ages of 28 and 46 who were undergoing IUI treatment alone. In addition to their IUI treatments, the 29 women in the first group received weekly sessions of acupuncture and a regime of Chinese medicinals, which consisted of powdered or raw Chinese herbs such as PeoniaAlbae and Chuanxiong, designed to meet each woman's specific needs. All herbal preparations were approved by the Israeli Health Ministry.

In terms of both conception and take-home baby rates, the test group fared far better than the control group. Out of the 29 women in the test group, 65.5 percent conceived, and 41.4 percent delivered healthy babies. In the control group, only 39.4 percent conceived and 26.9 percent delivered. The vast difference in success rates is even more surprising when the age of the average participant was taken into account, Dr. Lev-Ari and Sela note. "The average age of the women in the study group was 39.4, while that of the control group was 37.1. Normally, the older the mother, the lower the pregnancy and delivery rates," they explain.

• From the fertility jounal, Fertility and Sterility comes a research study demonstrating the effectivenss of using acupuncture to improve the quantity and health of sperm. At the Northside Holistic Center we often work with both the man and the woman in improving the probability of conception. An excerpt from the study: 

Higher sperm numbers and health can greatly enhance the chances of a conception in any given month. However, new research shows that acupuncture can significantly improve the quality and health of sperm. In a study published in Fertility and Sterility, researchers analyzed sperm samples from men with infertility of unknown cause before and after acupuncture treatments. They found that acupuncture was associated with fewer structural defects in sperm and an increase in the number of normal sperm. 

• This link is from a web page on infertility and acupuncture at the American Association of Oriental Medicine's website: www.aaaomonline.org. This  page is more of a listing of  articles by other members of  the American Association of Oriental Medicine on a broad range of topics related to fertility and Chinese Medicine.

• From Fertility and Sterility comes resul t that shows the couples using acupuncture and herbal strategies to conceive have an equal chance of success using such natural means as by using the Western medicine:

Chang noted in an interview with Reuters Health that one previous study has also shown 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. This finding indicates that acupuncture for infertility “can be done as a stand-alone treatment,” he said.

• A research study found in a PubMed search found that, what they term, 'Luteal Phase Acupuncture' (which simply means performing acupuncture during this time in a woman's cycle) results in dramatically higher rates of successful pregnancy during IVF or ICSI.

A USA Today article on Fertility and acupuncture can be read here. 

IVF Drugs (potentially) Linked to Leukemia in Children

The British newspaper, The Telegraph, published a slightly alarmist article whose headline screams about a link between fertility drugs and childhood cancer. However the body of the article is a bit more accurate than the headline, as it reveals the still tenuous nature of that link. The story is about new French research which does suggest that there may be an increase in the likelihood of such leukemia among the children of women using such pharmaceuticals but goes on to say that even if this is proven as a risk factor that the actual increase is relatively small. 

. . . French researchers will tell a conference in London today they believe there is an association between the use of ovarian stimulation drugs and two types of childhood leukaemia.

Specifically, they have calculated that their use is associated with a 2.6-fold increase in the risk of developing the most common form of childhood leukaemia, called acute lymphoblastic leukaemia (ALL), and a 2.3-fold increase in the risk of developing a rarer type, called acute myeloid leukaemia (AML).

However, French researchers will tell a conference in London today they believe there is an association between the use of ovarian stimulation drugs and two types of childhood leukaemia.Specifically, they have calculated that their use is associated with a 2.6-fold increase in the risk of developing the most common form of childhood leukaemia, called acute lymphoblastic leukaemia (ALL), and a 2.3-fold increase in the risk of developing a rarer type, called acute myeloid leukaemia (AML).

From the perspective of acupuncture and Chinese medicine, as well as the fertility work that we do at the Northside Holistic Center, this is quite interesting and wouldn't be too surprising. We counsel our patients to carefully research fertility drugs before using them and encourage them to solely use our methods before resorting to the more drastic Western interventions which may have future negative ramifications. However we also understand that there is a place for such drugs either when time is a factor or when more conservative, natural interventions alone have not been enough. In that case, we work with the client to minimize any damage that these powerful drugs may be causing in her body.

Treatment of Premature Ovarian Failure With Acupuncture and Traditional Chinese Medicine

This article presents the way in which acupuncturist conceptualize and treat premature ovarian failure (POF) within the framework of traditional Chinese medicine (TCM). It is common to have women present with POF in our clinic as a reason for infertility and it responds very well to acupuncture intervention. The author concludes by saying:

TCM is the most effective and beneficial treatment for POF, which relies on precise diagnosis and differentiation, appropriate acupuncture and herbal prescription. However, we must individualise the treatment programme according to their conditions in order to achieve the best results.

Once the women’s ovarian function is restored, and FSH dropped to normal level, they generally have great chances of conceiving naturally if they continue TCM treatment . . .

Women with PCOS Benefit from Acupuncture, Studies Reveal

In a recent study in the American Journal of Physiology-Endocrinology and Metabolism, reported  on here, it was demonstrated that women who used acupuncture therapy and exercise in combination experienced much greater hormonal regulation and consequent normalization in their menstrual cycle than those who used conventional therapies. Other hormone dependent symptoms such as inappropriate hair growth and acne were also dramatically lessened.

I have always enjoyed treating PCOS because the improvements in women's lives can be so dramatic. Often, women come to the clinic solely to be treated for the irregular period or other discomfort associated with the disorder; while other times it is a significant factor interfering in their ability to conceive and thus forms a part of my work with them on infertility.

Chinese medicine has its own unique diagnostic methods with which to determine the best means of using acupuncture and Chinese herbs to get to the root of PCOS and make gradual and progressive changes that are usually long lasting and satisfying to the client. 

Research and Articles:

A study, which was published in Experimental Physiology and entitled Electrical and manual acupuncture stimulation affects estrous cyclicity and neuroendocrine function in a DHT-induced rat polycystic ovary syndrome model, [read about it here] found that, 

. . . both electrical and manual acupuncture “improve menstrual frequency and decrease circulating androgens in women with polycystic ovary syndrome (PCOS).” PCOS is a common female endocrine disorder with side-effects including irregular menstruation, amenorrhea, anovulation, infertility, polycystic ovaries and excess quantities of androgenic hormones. Excess androgens may lead to acne, obesity due to insulin resistance, high cholesterol and hirsutism (excess facial and body hair).

Researchers have discovered that both electrical and manual acupuncture “improve menstrual frequency and decrease circulating androgens in women with polycystic ovary syndrome (PCOS).” PCOS is a common female endocrine disorder with side-effects including irregular menstruation, amenorrhea, anovulation, infertility, polycystic ovaries and excess quantities of androgenic hormones. Excess androgens may lead to acne, obesity due to insulin resistance, high cholesterol and hirsutism (excess facial and body hair).

The researchers induced PCOS in rats using 5α-dihydrotestosterone (DHT) to determine whether or not electrical or manual acupuncture was superior in the regulation of menstruation. The rats received acupuncture five times per week for 4-5 weeks. The electroacupuncture group received 2 Hz stimulation at the acupuncture points. Untreated rats served as the control group.

The manual and electroacupuncture groups showed normalization of estrogen activity and a decrease in androgens. In addition, the electroacupuncture group showed changes in the central opioid receptors of the hypothalamus suggesting that electroacupuncture may be “mediated by central opioid receptors….” The manual acupuncture group showed changes in the steroid receptors of the hypothalamus suggesting that manual acupuncture “may involve regulation of steroid hormone/peptide receptors.”

Yet another study, published in The American Journal of Physiology – Endocrinology and Metabolism, [read about it here]

. . . concluded that low frequency electro-acupuncture improved menstrual frequency and balanced sex steroid levels in women with PCOS, polycystic ovarian syndrome.b This study measured blood changes in human female participants. Hyperandrogenism was measured in this study by determining the total concentration of testosterone, androgens, estrogens, androgen precursors, and glucuronidated androgen metabolites. The study measured that electro-acupuncture improved menstrual regularity in women with PCOS. The sex steroid levels in the electro-acupuncture group improved significantly and acne markedly decreased. The study measured improvements in a wide range of endocrine variables such that the researchers concluded that electro-acupuncture may help induce ovulation in women attempting to conceive since participants showed significant improvement in monthly menstrual frequency.