Acupuncture Research for Female Fertility

Acupuncture on the day of Embryo Transfer
A number of studies have now shown acupuncture given around the time of embryo transfer to have a positive effect on clinical pregnancy rates. The first and best known study produced a protocol for pre and post embryo transfer which is used in many fertility clinics:

Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproductive therapy
Paulus, W E, Zhang, M, Strehler, E, El-Danasouri, I, & Sterzik, K. Fertil Steril. 2002; 77(4)721-724.

A randomised study (n=80+80) To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment 25 minutes before and after embryo transfer with a control group receiving no acupuncture.
RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.

Use of Acupuncture before and after embryo transfer
Dalton-Brewer N et al, Hum Fert. 2010; 12 (4) 212 – 255

This most recent study describes outcomes for all IVF patients who had acupuncture before and after embryo transfer using the Paulus protocol at The London Bridge Fertility, Gynaecology and Genetics Centre in London over a 2 year period.  In the acupuncture group positive pregnancy rates/ET were 44.6%, comparing favourably with the non-acupuncture historic control group. Results for women aged 35–39 years and those over 40 years were markedly better than controls suggesting that acupuncture intervention of this type may be more effective in older women.


Systematic Reviews of Research

Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis
Manheimer E et al. BMJ. 2008;336 545-549.

This review published in the BMJ concluded,  “The odds ratio of 1.65 suggests that acupuncture increased the odds of clinical pregnancy by 65% compared with the control groups… In absolute terms 10 patients would need to be treated with acupuncture to bring about one additional clinical pregnancy. These are clinically relevant benefits.”

And when the 4 trials that measured live births in addition to pregnancy rates were analysed, the review team found that acupuncture increased the odds by 91% and that the number of patients who would need to be treated to bring about an additional pregnancy dropped to 9.

Acupuncture and Assisted Conception
Cheong Y et al, Cochrane Database of Systematic Reviews. 2009; Issue 1
A Cochrane review concluded that there is an increase in live birth rate when acupuncture is performed on day of embryo transfer (35% compared to 22% for non acupuncture groups).

Acupuncture and herbal medicine in IVF: a review of the evidence for clinical practice.
Cheong, Y., et al. Hum Fert. 2010; 13, (1) 3-12

This review included a study which was omitted from previous reviews, showing a birth rate for IVF with acupuncture  of 33% compared to 29% for control groups.


Acupuncture increases blood flow to the uterus and ovaries

Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture.
Stener-Victorin E, et al Hum Reprod. 1996; 11, 1314-1317.
Many studies have shown that reduced blood flow in the uterine arteries is associated with a decreased pregnancy rate following IVF-embryo transfer. In this small study 10 infertile healthy women were treated with electro-acupuncture. After 8 acupuncture treatments blood flow to the uterus was markedly increased.

Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment
Magarelli, PC, D Cridennda, M Cohen. Fertil Steril. 2009; Dec, 92(6):1870-9.

This study found that women who had acupuncture showed beneficial changes in serum levels of stress hormones compared to a control group of women who did not have acupuncture. The cortisol and prolactin levels which have been artificially depressed by the IVF drugs appear to be regulated to more normal levels in the acupuncture group. This may have implications for both egg quality and implantation. In addition the pregnancy and live birth rate was significantly higher in the acupuncture group.

Acupuncture & IVF Poor Responders: A Cure?
Magarelli P, Cridennda D. Fertil Steril, 2004;81(Supplement 3):S20

This clinical trial combined the acupuncture protocol used on the day of embryo transfer with the acupuncture treatment protocol designed to increase blood flow to the uterus. The authors report that “Significant increases in pregnancy outcomes were confirmed by this study which demonstrated that both acupuncture treatment protocols could be used together with a synergistic effect.” They add that “this study is the first to demonstrate that the use of acupuncture in patients with poor prognoses (elevated Peak FSH, longer history of infertility, poor sperm morphology) can achieve similar pregnancy rates to normal prognosis patients.”


Acupuncture Research for Male Fertility

Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality.
Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. Archives of Andrology. 1997; 39(2):155-61
32 subfertile men were randomised into 2 groups. One group received acupuncture treatment twice a week over 5 weeks, and the 2nd group were untreated. Semen samples were analysed before and 1 month after acupuncture. Significant improvements (p < 0.05) were demonstrated in the acupuncture group compared to the control group, in particular in motility and morphology.
Conclusion: patients exhibiting low fertility due to reduced sperm activity may benefit from acupuncture treatment.

Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study.
Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Andrologia, 2000; 32(1):31-9.

This randomised controlled pilot study [n=20+20] showed a positive effect of acupuncture on sperm count in men with such low sperm counts (oligozoospermia) or no sperm (azoospermia) that they would usually require a testicular biopsy to extract sperm for use in an IVF cycle. 20 patients received acupuncture twice a week for five weeks and samples were tested 1 month afterwards. A definite increase in sperm count was detected in 10 (67%) of the 15 azoospermic patients. Seven of these males produced sperm detectable by the light microscope enabling ICSI to be performed without recourse to testicular biopsy. Males with genital tract inflammation exhibited the most remarkable improvement in sperm density (on average from 0.3±0.6×106 spermatozoa per ejaculate to 3.3±3.2×106 spermatozoa per ejaculate; Z=−2.4, P≤0.02). The control group with similar semen analysis had no treatment and showed no change after 3 months.
Conclusion: Acupuncture treatment is simple, non-invasive and inexpensive, and does not require any previous preparation, so seems to be clinically preferable to sperm aspiration and extraction from the testis or epididymis.

Influence of acupuncture on idiopathic male infertility in assisted reproductive technology
Zhang M, Huang G, Lu F, Paulus WE & Sterzik K. J of Huazhong Univ Science and Technology Medical Sciences, 2002; 22 (3):228-30

22 patients with 2 or more unsuccessful ART procedures and idiopathic male infertility received acupuncture twice weekly for eight weeks, followed by ICSI. The quick sperm motility after acupuncture was significantly improved as compared with that before treatment. The normal sperm ration was increased after acupuncture. The fertilization rates after acupuncture (66.2%) were significantly higher than before treatment (40.2%) (P<0.01). The embryo quality after acupuncture was improved, but the difference between them was not significant.
Conclusion: that acupuncture can improve sperm quality and fertilization rates in ART.

A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia
Dieterle et al, Fertil Steril. 2009; Oct 92 (4): 1340–3

In this small randomized, single-blind, placebo-controlled study, 28 infertile patients with severe low count and low motility received acupuncture twice weekly for 6 weeks and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A–C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.
Conclusion:  that the results of the present study support the significance of acupuncture in male patients with severe oligoasthenozoospermia..

Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three-arm randomized trial.
Lee SH, Lee BC. Urology. 2009 May;73(5):1036-41

In the first randomised controlled trial of electro-acupuncture for this condition, 39 men were randomised into three treatment groups: advice and exercise plus 12 sessions of electro-acupuncture (EA); advice and exercise plus 12 sessions of sham EA (SEA); and advice and exercise alone (A&E) for six weeks. At six weeks, prostatitis symptom scores had decreased significantly in the EA group compared with SEA and A&E groups. The EA group showed significant decreases in pain-related symptoms compared with the SEA and A&E groups. All EA participants experienced at least a six-point decrease in prostatitis symptom scores, compared with 16.7% SEA participants and 25% of A&E participants. In addition, levels of proinflammatory prostaglandin E2 in urine samples decreased significantly in the EA group, while it increased in the other two groups. This suggests that EA might be beneficial in the treatment of this condition by reducing inflammation of the prostate. The trial concluded that EA therapy proved to have independent therapeutic effects, particularly for pain relief superior to SEA or A&E therapy."