Acupuncture, fertility and pregnancy
Overview and research findings
Acupuncture can be helpful for those wishing to conceive who may be experiencing difficulties, or undergoing Assisted Reproductive Technology (ART). A large number of patients use acupuncture for fertility reasons in the UK (Bovey et al, 2010) the same is true here at Shaftesbury Clinic. There is a great deal of scientific evidence to support the use of acupuncture in fertility and ART.
Acupuncture can also help support pregnancy, by relieving morning sickness (hyperemesis gravidarum), lower back pain, post-caesarian pain and by also giving the mother-to-be emotional support through a time of transition and new life (Smith et al, 2002, Khorram et al, 2005; Xu, et al, 2012; Manber et al, 2010). Acupuncture may also be helpful in labour induction (Lim et al, 2009) and in the correction of breech presentation (Vas et al, 2009; Li et al, 2009; Van den Berg et al, 2008)
We have a great deal of experience in the use of acupuncture for couples trying to conceive, both naturally, and via ART – including IVF, ICSI and IMSI. Many of our patients are local in Bedfordshire but some also travel from further afield, and many undergo ART treatment at Bourn Hall, Lister and other clinics, with us supporting them with acupuncture here in Bedford. Acupuncture has been very popular for centuries in China for this purpose, but in the West it had only been in the past few decades that it has become recognised for its benefits in the fertility field.
In 2001 researchers found that acupuncture improved the changes of conception in IVF, stating that “Acupuncture seems to be a powerful tool to improve pregnancy rates in assisted reproduction therapy” (Zhang et al, 2001: pp1). Numerous research studies followed, and Magarelli et al, 2004 stated that acupuncture for fertility was gaining popularity, their study showed acupuncture to significantly increase birth outcomes, and significantly decrease the rates of ectopic pregnancy and of miscarriage in IVF patients, (see also Khorram et al, 2005). Acupuncture improves the clinical pregnancy rate (CPR) and live birth rate (LBR) with IVF (Zheng, Huang, Zhang & Wang 2012).
Research and media interest rose after a landmark study which appeared in the British Medical Journal (the Journal of the British Medical Association) in 2008. That study concluded current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation. (Manheimer et al, 2008)
After the BMJ study; a large, peer-reviewed and scientifically stringent study in the world-renowned medical press; this led to a further increase in the number of patients seeking acupuncture for fertility reasons.
Further research followed, and continues; to understand biologically how these affects are achieved, and also to deduce the best acupuncture points and protocols to use, and the best timings for these. This is one of the reasons why continual professional training is so important for our practitioners – they can keep on top of the latest developments and research to give our patients the best treatment. More resent meta-analyses of studies have corroborated findings on acupuncture’s positive effect in IVF outcomes (Qian et al, 2016; Shen at al, 2015; Hullender Robin et al, 2018; Schwarze et al, 2018)
Acupuncture close to the time of embryo transfer has been studied a great deal, and found to be beneficial to a positive outcome. Outside of IVF, acupuncture has been used and studied for other fertility issues, which we will cover later in this article, including:
- Polycysticovarian syndrome (PCOS) (Zheng et al, 2013; Jedel et al 2010; Ren et al, 2014; Aquino et al, 2014; Stener-Victorin et al 2011, Stener-Victorin et al 2014; Lim et al, 2010))
- Endometriosis (Xiang,D et al, 2002; Jin et al, 2009; Chen at al, 2010)
- Endocrine dysfunctional infertility (Yang et al, 2005)
- Irregular menstrual cycles
- Absent periods (amenorrhoea)
- Painful periods (Dymenorroea) (Xiang,D et al, 2002; Jin et al, 2009; Chen at al, 2010; Tsenov 1996)
- Heavy periods (menorrhagia)
- Ovulation problems (onovulation) (Hung et al, 2008, Huang et al, 2008, Stener-Victorin, 2000))
- Hormone imbalances (Stener-Victorin et al, 2000; Gerhard et al, 1992)
- Emotional factors; stress, depression(Huang et al, 2008)
- Male factors; acupuncture can help men with sperm count, mobility, motility and vitality (Pei et al, 2005; Dieterle et al, 2009; Sierman et al, 2009)
- Thin endometrial lining (Yu et al, 2007)
In the case of endocrine dysfunctional infertility (hormonal imbalance), a randomised controlled trial found a statistically significant improvement in pregnancy rates with acupuncture over medication (Yang et al, 2005).
The Science of Acupuncture in Fertility
Further research taken place on various aspects of acupuncture and fertility, to work out the mechanisms of action – or how exactly the effects were occurring in the body following acupuncture.
Acupuncture has also been shown to improve uterine lining measurements (Yu et al, 2007), experimental studies show it improves blood flow toÂ the uterus and ovaries (Khorram et al, 2005, Stener-Victorin et al, 1996) which may be part of how acupuncture influences endometrial thickness.
Research also indicatesthat acupuncture canmodulate many of the body’s regulatory systems, including the nervous system; and influence the levels of different hormones and neurotransmitters (chemical signals) in the body, blood stream and brain (Stener-Victorin, 2006; Gerhard et al, 1992).
Acupuncture has also been shown to affect certain areas of the brain, which influence particular hormones involved in the menstrual cycle. It is thought that acupuncture balances the hormonal system by controlling the hypothalamic-pituitary-adrenal (HPA) axis. The hormones and neurotransmitters that have been shown to be thus influenced in scientific studies include:
- Gonadotrophin releasing hormone (GnRH)
- Lutenising hormone (LH)
- Follicle Stimulaitng Hormone (FSH)
- Prolactin (PRL)
- Oestrogen uptake
- Testosterone levels
- Beta-endorphin levels
During ovarian stimulation, acupuncture has the effect of normalising levels of the hormones cortisone and prolactin within the bloodstream (Magarelli et al, 2009). Magarelli et al (2006) theorise that acupuncture may be improving IVF outcomes by lowering the prolactin (PRL) levels before egg retrieval, (increased prolactin can interfere with ovulation).
Subsequently acupuncture raises the PRL levels in the luteal phase, helping to maintain a pregnancy(as PRL encourages the pituitary gland to secrete the correct amount of luteinizing hormone). LH and progesterone have been found to be raised by acupuncture, (He et al, 2009) and this up-regulation of reproductive hormones and growth factor may account for the improved success rates seen in studies.
Research shows that acupuncture can regulate gonadotrophin releasing hormone (GnRH), stimulating ovulation and improving blood supply to the uterus (Huang et al, 2008). Acupuncture also improves LH/FSH ratios, testosterone and beta-endorphin levels, benefitting fertility (Stener-Victorin, 2010, Zhang et al, 2009))
In improving the implantation of blastocysts, acupuncture’s influence on a protein called Connexin 43 – which is crucial for heart muscle and nervous system formation – is thought to be involved with positive influence (Huang et al, 2009, Zhang et al, 2009))
In the case of PCOS, hormone levels, insulin and glucose responses have been improved with acupuncture, as shown in studies, this is thought to occur as acupuncture significantly increases beta-endorphin levels which in turn regulate FSH, LH and androgens via the hypothalamic-pituitary-adrenal axis. Also, by lowering cortisol, and improving insulin sensitivity and thus decreasing glucose levels, acupuncture may also help weight loss in PCOS (Lim et al, 2010). It is also thought that increasing blood to the ovaries with acupuncture may reduce ovarian volume and the number of cysts.Acupuncture has been shown in studies to lower stress:both because of its effects on the brain, circulatory and nervous system, and because it is generally a very relaxing treatment. Studies have found levels of perceived stress,and stress scores are significantly lower in patients who receive acupuncture before and after embryo transfer, potentially contributing to the higher pregnancy rates in those who received acupuncture. (Balk et al, 2010; Sutton et al, 2015). Patients often feel very calm after acupuncture – and this effect can last between treatments. Studies suggest the calming effects of acupuncture are brought about by positive effects on the central nervous system, acupuncture significantly increases levels of beta-endorphin (feel-good hormones) and reduces levels of the stress hormone cortisol(Lim, et al 2010; Hung et al, 2008). This, in turn can benefit sleep and energy levels.
You may also wish to look at the following resources, our Scoop.it pages which we curate to bring together information and research on Fertility Acupuncture and also our our acupuncture pregnancy and childbirth resource page: Acupuncture in Pregnancy and Childbirth.
We are always happy to talk about what we do and how we work, happy to call you back at a convenient time you can arrange by speaking to our secretaries, or you can book a free 20 minute consultation with an acupuncturist to see our working environment and ask any questions you have.
The following are the references and bibliography from which this article has been written.
- Bibliography and References
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