Studies on the Effectiveness of TCM and Acupuncture on both Male and Female Infertility

Studies on Women

This study aimed to evaluate whether acupuncture improves therates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation. Eligible studies where randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth were compared. Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation by up to 65%.¹

Swedish researchers looked at the role that acupuncture can play in the treatment of infertility and in particular its effect on uterine blood flow.² The pool of women used as test subjects had infertility problems and were diagnosed with decreased blood flow into the uterus which affects endometrial receptivity. When there is a decreased flow of blood into the uterus, treatment options are few and conception is difficult. Using specific points which correspond to the innervation of the uterus, researchers measured the amount of blood flow in women undergoing in vitro fertilization (IVF) treatment. The results showed that there was a significant increase in the blood flow into the uterus with the acupuncture treatment. Researchers attributed the effect of acupuncture to its influence on increased uterine arterial blood flow into the uterus which in turn would increase the chance for oocyte implantation.

Researchers in Germany looked at the traditional methods of acupuncture to determine its efficacy with the use of traditional points based on Traditional Chinese Medicine combined with assisted reproductive techniques with embryo transfer (in vitro fertilization or IVF).³ The acupoints chosen were used to relax the uterus. The main purpose of the study was to evaluate whether acupuncture accompanying embryo transfer increases clinical pregnancy rates.

A total of 160 patients participated in the study, 80 patients receiving acupuncture and assisted reproductive techniques and 80 patients undergoing assisted reproductive techniques without acupuncture. Treatment consisted of an acupuncture treatment before and after IVF. The results showed that the pregnancy rate for the acupuncture group was considerably higher than the control (42.5% acupuncture group versus 26.3% control group). Acupuncture is a useful tool for improving the pregnancy rate after ART.

The purpose of this study was to provide an overview of the use of acupuncture as an adjunct therapy for in vitro fertilization (IVF), including an evidence-based evaluation of its efficacy and safety and an examination of possible mechanisms of action. Evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life of patients undergoing IVF and that it is a safe adjunct therapy. The reviewed literature suggests 4 possible mechanisms by which acupuncture could improve the outcome of IVF: modulating neuroendocrinological factors; increasing blood flow to the uterus and ovaries; modulating cytokines; and reducing stress, anxiety, and depression.⁴

Some centres across North America now use assisted reproductive techniques combined with acupuncture. A fertility centre in Colorado Springs, Colorado utilizes both techniques.⁵ The protocol used combines both techniques reported on in the Swedish and German research papers. Initially, the patient undergoes two treatments a week for four weeks of treatment before the IVF transfer which prepares the uterus’ endometrium for implantation by increasing arterial blood flow using acupoints based on the Swedish study. Pre- and post-embryo transfer, the patient is given acupuncture to relax the uterus as outlined in the German study.

There, results show that 16% more women get pregnant and 23% are having births. This combined technique of acupuncture with IVF is superior to IVF alone.

Researchers attempted to evaluate the effectiveness of acupuncture on the reproductive outcome in patients treated with IVF or intracytoplasmic sperm injection (ICSI). Clinical and ongoing pregnancy rates were significantly higher in the group that received acupuncture as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). Researchers concluded that acupuncture significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture.⁶

Acupuncture and Poor IVF Responders; A further study in April 2004 confirmed a significant increase in the number of pregnancies in patients who demonstrated elevated peak FSH and a longer history of infertility. This study had an IVF pregnancy rate of 53% in the acupuncture group compared to 38% in the non-acupuncture control group.⁷

Acupuncture Reduces Pain After IVF. In this study, 286 women were randomly assigned to receive either electroacupuncture plus para-cervical block or alfentanil (a powerful analgesic) plus paracervical block during oocyte aspiration (egg retrieval). Both interventions induced adequate analgesia, however the electroacupuncture group reported significantly less abdominal pain, other pain, nausea and stress than the medication group, and required significantly less additional analgesic medication.⁸

A clinical and experimental study of integrated traditional Chinese and western medicine in the past 45 years. The study included observations on the induction of ovulation with acupuncture, and the treatment of polycystic ovary syndrome (PCOS) using acupuncture and herbal remedies. Acupuncture and herbs successfully promoted ovulation, affected serum FSH, and resolved the PCOS, resulting in ovulation.⁹

This study was designed to evaluate if electro-acupuncture (EA) could affect oligo-/anovulation and related endocrine and neuroendocrine parameters in women with polycystic ovary syndrome (PCOS). Repeated EA treatments induced regular ovulations in more than one third of the women with PCOS. Electro-acupuncture offers an alternative to pharmacological ovulation induction.¹⁰

This study was designed to determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI). The clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher in the group that received acupuncture than in the control group (15.6% and 13.8%). The study concluded that luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.¹¹

Over a period of three years, acupuncture was offered to patients entering assisted reproduction therapy. Acupuncture sessions were given at varying, but usually weekly, intervals during the in vitro fertilisation (IVF) cycle, and immediately before and after embryo transfer. Twenty two patients (average age 36.2 years) were treated over a total of 26 IVF cycles and 15 pregnancies were achieved, as determined by presence of foetal heartbeat on ultrasound at four weeks post embryo transfer. There was a success rate of 57.7% in the acupuncture group compared with 45.3% for patients in the IVF unit not treated with acupuncture (P > 0.05). Relaxing effects were noted following acupuncture and it is speculated that this may have contributed to the increase in pregnancy rate for the acupuncture group.¹²

This study aimed to compare the therapeutic effects of acupuncture and Western medicine for promoting ovulation on endocrine dysfunctional infertility. Two hundred and forty cases of infertility were randomly divided into an acupuncture group (n = 160) and a Western medicine group (n = 80). They were treated with acupuncture and clomiphene respectively and their therapeutic effects were compared. The pregnancy rate was 65.0% in the acupuncture group and 45.0% in the Western medicine group with a significant difference between the two groups (P < 0.05).¹³

Research on Acupuncture during Pregnancy

Acupuncture treatment reduces pelvic and back pain in pregnancy. In this Swedish study, 72 pregnant women suffering from pelvic or low back pain were randomly assigned to an acupuncture group or a control group. Traditional acupuncture points were needled in individualised treatments, once or twice a week until the disappearance of symptoms or delivery in the acupuncture group. Treatment was given for at least three weeks, twice weekly for the first two weeks, then once a week. The control group received no treatment. During the study period the pain decreased in 60% of patients in the acupuncture group compared to 14% of the controls, dropping to 43% and 9% respectively at the end of the study.¹⁴

Moxibustion aids in the correction of breech presentation. Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. 130 subjects were randomized to the intervention group received stimulation of acupoint BL 67 by moxa (Japanese term for Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech presentation. The 130 subjects randomized to the control group received routine care but no interventions for breech presentation. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks' gestation and delivery. Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.¹⁵

In many Western countries breech presentation is an indication for elective Cesarean section. In order to correct fetal presentation, the stimulation of the acupoint BL67 by moxibustion, acupuncture or both has been proposed. Since no studies had previously been carried out on Western populations, pregnant Italian women at 33–35 weeks gestational age carrying a fetus in breech presentation were enrolled in a randomized, controlled trial involving an active BL67 point stimulation and an observation group.A total of 240 women at 33–35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. The study concluded that acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.¹⁶

The objective of this study was to review the effectiveness of needle acupuncture in treating the common and disabling problem of pelvic and back pain in pregnancy. Acupuncture, as an adjunct to standard treatment, was superior to standard treatment alone and physiotherapy in relieving mixed pelvic/back pain. Women with well-defined pelvic pain had greater relief of pain with a combination of acupuncture and standard treatment, compared to standard treatment alone or stabilizing exercises and standard treatment. Evidence supports the proposition that acupuncture useful in treating pregnancy-related pelvic and back pain.¹⁷

Studies on Men

The aim of this controlled study was to assess the effectiveness of acupuncture on the sperm quality of males suffering from subfertility related to sperm impairment. Semen samples of 16 acupuncture-treated subfertile patients were analyzed before and one month after treatment (twice a week for 5 weeks). In parallel, semen samples of 16 control untreated subfertile males were examined. Two specimens were taken from the control group at an interval of two-eight months. The fertility index increased significantly (p .05) following improvement in total functional sperm fraction, percentage of viability, total motile spermatozoa per ejaculate, and integrity of the axonema (p .05), which occurred upon treatment. The intactness of axonema and sperm motility were highly correlated (corr. = .50,p .05). This study strongly suggests patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment.¹⁸

Forty men with idiopathic oligospermia, asthenospermia, or teratozoospermia were studied.¹⁹ Twenty eight of the patients received acupuncture twice a week over a period of 5 weeks. The samples from the treatment group were randomized with semen samples from the 12 men in the untreated control group. Statistical evaluation using transmission electron microscopy data showed a statistically significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects in the total ejaculates. A statistically significant improvement was detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. The treatment of idiopathic male infertility could benefit from employing acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture, although we did not identify specific sperm pathologies that could be particularly sensitive to this therapy.

Researchers searched for the best method for increasing the quality of abnormal sperm. One hundred and sixty-eight cases of infertility were randomly divided into a treatment group of 85 cases and a control group of 83 cases. The treatment group were treated with needle-picking (acupuncture) at specific bilateral points. Their therapeutic effects were observed in 3 hospitals. The study resulted in a total effectiveness rate of 83.5% and a pregnancy rate of the patient's partner of 78.8% in the treatment group, and a corresponding rate of 54.2% and 43.4% in the control group, which represents a very significant difference between the two groups (P < 0.01). Reproductive hormones improved significantly after treatment (P < 0.01); after treatment, superoxide dismulase (SOD) activity and Zn content in semen were elevated and cadmium level decreased significantly in the treatment group (P < 0.05).

The research shows that needle-picking therapy (acupuncture) can significantly improve and regulate endocrine function, increase the quality of semen and elevate pregnancy rate of the patient's partner for the patient of primary abnormal sperm. ²⁰

Classic therapies are usually ineffective in the treatment of patients with very poor sperm density. This study aimed to determine the effect of acupuncture on these males. Semen samples of 20 patients with a history of azoospermia were examined by light microscope (LM) and scanning electron microscope (SEM), with which a microsearch for spermatozoa was carried out. These examinations were performed before and 1 month after acupuncture treatment. The control group was comprised of 20 untreated males who underwent two semen examinations within a period of 2–4 months. A definite increase in sperm count was detected in the ejaculates of 10 (67%) of the 15 azoospermic patients. Seven of these males exhibited post-treatment spermatozoa that were detected even by LM. The sperm production of these seven males increased significantly, from 0 to an average of 1.5±2.4×106 spermatozoa per ejaculate (Z=−2.8, P≤0.01). 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). Two pregnancies were achieved by the IVF-ICSI procedure. It is concluded that acupuncture may be a useful, nontraumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation.²¹

The purpose of this study was to assess the clinical effects of the combined therapy of acupuncture with herbal drugs on male immune infertility and on antisperm antibody (AsAb). 100 male cases of infertility with positive AsAb were divided randomly into two groups, each consisting of 50 cases. The results showed that the total effective rate in the acupuncture-drug group was 90%; while that of the control group was 64%, the comparison showing a statistically significant difference (P<0.05). The positive rate of blood serum and/or AsAb in both the two groups decreased in varying degrees, but the negative-turning rate of AsAb in the acupuncture-drug group was more obvious, the comparison showing also a significant difference (P<0.05). The combined therapy of acupuncture with herbal drugs has definite therapeutic effects on male immune infertility, which can regulate AsAb and raise the immunity of the patients.²²

Further studies are available relating to a host of medical ailments. Please contact us for details.

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References:

Most of these studies may be found on MedLine (Pubmed), a free database of medical journals. This list is not exhaustive as studies are ongoing and are published frequently. For a list of present and planned studies, a good place to review is the Cochrane Library online.

1. Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM., Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis., BMJ. 2008 Mar 8;336(7643):545-9. Epub 2008 Feb 7.

2. Stener-Victorin, E., Waldenstrom, U., Andersson, S. and Wikland, M. (1996) Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod Biol., 11:1314-7

3. Paulus, WE., Zhang, M., Strehler, E., El-Danasouri, I and Sterzik, K. (2002) Influence of acupuncture on pregnancy rates in patients who undergo assisted reproduction therapy. Fert Steril., 77:721-4

4. Anderson BJ, Haimovici F, Ginsburg ES, Schust DJ, Wayne PM, In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern Ther Health Med. 2007 May-Jun;13(3):38-48

5. DePow, J. (2004) "East meets West: Acupuncture and Reproductive Medicine." New Mexico Woman

6. Fertility and Sterility. 2006 May;85(5):1341-6. Epub 2006 Apr 5.

7. Fertility and Sterility, Volume 81, Issue (Supplement #), Page 20, (April 2004)

8. Hum Reprod 2003; 18: 1454-60

9. Zhong Xi Yi Jie He Xue Bao, Integrated traditional Chinese and western medicine should make new contribution to the reproductive health of women, 2004 Mar;2(2):83-5.

10. Acta Obstet Gynecol Scand., Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome, 2000 Mar;79(3):180-8

11. Dieterle S, Ying G, Hatzmann W, Neuer A, Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study.Fertil Steril. 2006 May;85(5):1347-51. Epub 2006 Apr 17

12. Johnson D., Acupuncture prior to and at embryo transfer in an assisted conception unit--a case series, Acupunct Med. 2006 Mar;24(1):23-8

13. Zhongguo Zhen Jiu. Controlled study on acupuncture for treatment of endocrine dysfunctional infertility, 2005 May;25(5):299-300.

14. Acta Obstet Gynecol Scand 2004; 83(3): 246-50.

15. JAMA. 1998;280:1580-1584.

16. The Journal of Maternal–Fetal and Neonatal Medicine 2004;15:247–252

17. Ee CC, Manheimer E, Pirotta MV, White AR., Acupuncture for pelvic and back pain in pregnancy: a systematic review., Am J Obstet Gynecol. 2008 Mar;198(3):254-9.

18. Sherman;  F. Eltes;  V. Wolfson;  N. Zabludovsky; B. Bartoov, Institute of Chinese Medicine, Tel Aviv, IsraeMale Fertility Laboratory, Department of Life Sciences, Bar-Ilan University, Ramat Gan, Isreal, Effect of Acupuncture on Sperm Parameters of Males Suffering from Subfertility Related to Low Sperm Quality Systems Biology in Reproductive Medicine, Volume 39, Issue 2 September 1997 , pages 155 - 16S.

19. J. Pei, E. Strehler, U. Noss, M. Abt, P. Piomboni, B. Baccetti, K. Sterzik, Fertility and Sterility, Volume 84, Issue 1, Pages 141-147

20. Zhongguo Zhen Jiu. 2006 Jun;26(6):389-91.

21. S Siterman, F Eltes, V Wolfson, H Lederman, B Bartoov (2000) Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study Volume 32 Issue 1 Page 31-39, January 2000

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