Medical experts are finding potential in the use of acupuncture as adjunctive therapy for women undergoing infertility treatment. In a new study testing the feasibility of this alternative approach, doctors compared outcomes between two groups of patients: those who underwent acupuncture combined with IVF, and those who underwent IVF alone.(1)
A Medical Approach with a Long History
Acupuncture is one of the most ancient medical treatments in the world, dating back several millennia, originating in China, but finally becoming popular in more modern times in the United States in the early 1970s. The practice is used not just as an adjunctive infertility treatment, but also a wide variety of medical conditions.
It involves applying a range of procedures that stimulate anatomical points on the body. The technique that has been studied the most scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.
Traditional Chinese medicine holds that there are more than 2,000 acupuncture points on the body, and that these connect with more than a dozen main and secondary pathways known as meridians. Chinese medicine practitioners believe these meridians conduct energy, or qi (chee), throughout the body. Essentially, acupuncture helps maintain the balance between qi and the opposing forces of yin and yang, which in turn regulates spiritual, emotional, mental and physical balance.(2)
"Western medicine takes a very different approach," explained lead study investigator Paul Magarelli, MD, PhD, a practicing reproductive endocrinologist and medical director of the Reproductive Medicine & Fertility Center in Colorado Springs. "We use medications. We override [biological] systems."
Yet while treatment for infertility, such as in-vitro fertilization (IVF), has taken major strides in the last two decades, odds are that couples won't achieve a pregnancy 60% of the time by solely using the Western approach, Magarelli explained. "A lot of the time, the patient gets one try at becoming pregnant, mainly because of the cost," he said.
Considering the Alternative
Thus, patients have begun looking at alternative options, mainly integrative medicine, in hopes of boosting those odds, Magarelli said.
That was one motivation for this study. But Magarelli says he didn't always believe in the potential of complementary approaches like acupuncture. "I just did not feel that the data existed that supported acupuncture," he recalled. Over time, studying the medical literature about the topic intrigued him enough to launch a study of his own.
In a previous analysis, Magarelli recruited patients with the poorest prognoses (over age 35, several male factor, elevated FSH level, or those who failed IVF in the past) in his clinic, who were given acupuncture in combination with IVF, and compared them with the same types of patients who received IVF alone. Two years later, he and his colleagues retrospectively evaluated the data.
"Those patients who were treated with the acupuncture [and] who were poor prognosis had equivalent pregnancies to those [considered] good prognosis patients," Magarelli explained, an outcome he found "amazing".
This led to the latest study involving "good prognosis" patients. Specifically, the researchers wanted to determine the efficacy of electro stimulation or traditional acupuncture combined with auricular (or ear) acupuncture. Electro stimulation acupuncture is the term used to describe the approach that involves electrical stimulation. These approaches are used to either improve uterine bloodflow or help relax the uterus prior to embryo transfer in IVF.
One hundred fourteen patients undergoing in-vitro fertilization after controlled ovarian hyperstimulation were included in the study. Only those women described as having a good response to ovarian hyperstimulation and whose partners' sperm morphology (quality) was also good were analyzed for the research.
Each patient underwent ovarian hyperstimulation using a standard protocol, including the use of gonadotropins and a gonadotropin releasing-hormone (GnRH) agonist or antagonist. Each woman who then responded well to ovulation induction underwent either electro stimulation acupuncture or traditional combined with auricular acupuncture in conjunction with IVF. For this study, 53 underwent acupuncture combined with IVF, and 61 underwent IVF alone.
The investigators then analyzed successful pregnancies in the group of women, as well as the miscarriage rate.
Acupuncture Patients Had Improved Outcomes
Of those in the acupuncture group, 51 percent achieved a successful pregnancy, the research team noted. That compares to 36 percent of those who underwent IVF alone. Comparatively, the miscarriage rate was 8% and 20% in the acupuncture versus non-acupuncture group, respectively.
There were no ectopic (Tubal) pregnancies in the group of women who underwent acupuncture, but 9% of those in the group without acupuncture had a Tubal pregnancy. The investigators also reported 23% more births per pregnancy among those who had acupuncture as part of their infertility treatment.
"In previously published data, acupuncture was reserved for poorer prognosis patients, and enhanced outcomes were observed," wrote Magarelli and his colleagues. "In this study, we demonstrated that good prognosis patients would also benefit from inclusion of published acupuncture protocols."
They say this is the first published study to include birth-related IVF outcome in patients also treated with acupuncture.
Why does acupuncture theoretically work for infertility? Medical experts hypothesize that the ancient approach positively impacts opioid production in the central nervous system, which in turn, positively influences gonadotropin secretion.(3) These naturally-produced opioids, like endorphins, are similar to the actions of opiate drugs. Gonadotropins are the hormones that help promote normal reproductive function in the body. They include follicle-stimulating hormone (FSH), which helps promote follicle maturity prior to the release of an egg in women, and sperm production in men.(4) Experts also suggest acupuncture has a positive effect on uterine bloodflow.
For the Future
The study will likely be expanded early next year, Magarelli study. In the next phase, data will be collected on all patients, regardless of prognosis. "I would suspect that ... we're going to see that, across the board, we can improve anywhere between 5 percent and 15 percent the number of babies successfully created through the process of IVF and acupuncture," he said.
"What blows me away, personally, is how I have absolutely seen things that I didn't think were possible by placing a needle somewhere."