Acupuncture, fertility and pregnancy

Overview and research findings

Acupuncture is a very popular approach helpful for those wishing to conceive who may be experiencing difficulties, or who are 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, where our practitioners have a wealth of experience working with patients in this field since 2008. 

Our practitioners have built up through additional training and experience a knowledge of the issues around IVF, ICSI and the processed involved in the process, and their training encompasses the traditional protocols based upon aspects and timings within these processes.  There is a growing body of scientific evidence to support the use of acupuncture alongside ART.

A scholarly search on articles containing “acupuncture” + “fertility” gives over 17,000 results, 1,200 of which are “RCT” or Randomised Controlled Trails, and 43% of these RCT’s date since 2017, showing an active area of research and an increasing pace of research studies being carried out in recent years.

Acupuncture is also a safe and popular choice in pregnancy, and our practitioners have experience in having seen a large number of pregnant patients, and we always ask that in this case you liaise with your midwife/obstetrician to ensure they are onboard and happy with this approach to any symptoms you are looking to address.  A number of patients are in fact referred or recommended acupuncture and come to us via their midwife for acupuncture (or moxibustion as appropriate).

The BAcC has a factsheet on the research and use of acupuncture in Obstetrics, as well as one on Childbirth, and on Puerperium (immediate birth/post natal period).  We also have a page on research for IVF, ICSI and fertility research and acupuncture.

We have a great deal of experience in having given acupuncture to couples who are 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 and many clinics advocating acupuncture use as an adjunct to their care. 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 popular and recognised due to some large and well-reported studies in the field which made the press from around 2008.

Studies and News Coverage

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 meta-analysis of 7 trials (number of participants; n=1366) study concluded that complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in pregnancy rates, ongoing 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 support in this respect.

Further research followed, and continues; to understand biologically (on a physiological  level) what acupuncture treatment does to the body’s systems, and also to try to deduce the optimum acupuncture points and protocols to use, along with 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.  

Outside of IVF, acupuncture has been used and studied in other physiological aspects that relate to the complex process of fertility and conception, shining some light on what underlies these processes.  Manheimer et al (2008) in their BMJ meta-analysis discuss the background of this approach, and give three potential mechanisms postulated for acupuncture to affect the female reproductive system, which are mediating the release of neurotransmitters, which may in turn stimulate gonadotrophin releasing hormone to be secreted, which in turn could influence the cycle of menstruation and ovulation.

The Science of Acupuncture in the Reproductive System

As per the researchers’ (Manheimer et al, 2008) remarks in the BMJ article as per above, research has taken place on various aspects of acupuncture and the female reproductive system, to examine measurable effects occurring in the body following acupuncture, these look at levels of certain hormones and neurotransmitters (chemical messengers) in the blood, scans of the brain in action (fMRI) and other objective measures that can be compared on a before- and after- basis.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  It is very important to note that “sham” acupuncture where needles are placed other than in acupuncture points it not an inert process and that comparing sham and “true acupuncture” may therefore not give a clear picture alone, but and form a part of a research body where acupuncture versus no treatment, conventional treatment or a different approach also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment.  When you are reading about a trial/study the “p” value is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

A large number of resources are available in the References and Bibliography below, as well as in the BAcC’s factsheets.  When reading the research it is important to know that systematic reviews or meta analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the randomised controlled study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control” of no treatment).  As mentioned above, the control group is of particular interest in how acupuncture trials are carried out as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher to this.  In the case of animal studies (as discussed below) it is easier to make more objective measures and avoid placebo effect.

Research into mechanisms of action indicates that acupuncture can modulate activity in many of the body’s regulatory systems, including the nervous system; endocrine system and influence the levels of different hormones and neurotransmitters (chemical signals) in the body, blood stream and brain (Stener-Victorin, 2006; Stener-Victorin and Wu, 2010; Gerhard et al, 1992).

Experimental studies have shown acupuncture to improves blood flow to the uterus and ovaries (Stener-Victorin et al, 1996 (n=10 women’s uterine artery blood flow impedance was measured after electro-acupuncture treatment).  Khorram et al, (2005) in the Journal of Fertility and Sterility looked at 238 patients, 127 of whom had received acupuncture during IVF, and found fewer first trimester miscarriages in patients having undergone acupuncture, and they stated this may be due to relaxation, stress relief and wellbeing, or related to improved uterine blood flow as previously reported.

Another type of research commonly carried out is in animal models, primarily rats, where measurements can be made as to the effects of acupuncture.  Here, any placebo effect and subjectivity on outcomes is overcome by the fact that objective measures of levels of hormones in the blood, etc can be made.  The hormones and neurotransmitters that have been shown to be thus influenced in physiological studies include:

• Gonadotrophin releasing hormone (GnRH) increased in the hypothalamus in a rat model using specific acupuncture points and channels,  (Wang et al, 2010; Zhu et al, 2019 – points used SP6 and ST36); electroacupuncture normalised circulating gonadotrophin levels in a rat model (Maliqueo et al, 2015)
• LH (luteinizing hormone) and progesterone blood levels have been found to be significantly raised by true acupuncture treatment at points ST36 and SP6 in a rat model, (He et al, 2009), the same study also found vascular endothelial growth factor levels in the ovaries to be raised in the rats which received true acupuncture (versus sham acupuncture at nearby non-points
• Blood Cortisol and Prolactin (PRL) levels were normalised in acupuncture patients a study of 67 women undergoing IVF during ovarian stimulation (Magarelli et al, 2009, Magarelli et al, 2006), prolactin levels influenced by acupuncture in laboratory rat models (Sheng and Xie, 1989; Xiong et al, 2015; Liu et al, 2007) 
• Testosterone and Estradiol – in a rat model the use of CV4, CV3, SP6 and Zigong points downregulated testosterone and estradiol (in females) and improved the development of their reproductive organs (Zhang et al, 2009)

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 (Balk et al, 2010; Sutton et al, 2015). Patients often feel very calm after acupuncture – and this effect can last between treatments.

The British Acupuncture Council has a factsheet on female fertility, as well as a briefing paper on the same, and one on infertility and the use of ART (IVF/ICSI) as well as one on male fertility, and a PCOS factsheet.  Each of those factsheets looks at the research into acupuncture that has been carried out in that specific field.  In addition, they also list a few recent trials in male and female infertility in a their research digest (roughly 2/3 of the way down the page).

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom)” we are not able to give a simple yes or no response, and recommend booking a callback to discuss your specific circumstances with an acupuncturist to help you decide if this is the approach for you.

Our acupuncturists have between them decades of experience which enables them to tell you if they have seen in similar cases, and give you an idea of our level of experience and knowledge in that area.  Acupuncture looks at the whole patient in a holistic view, which is similar to the idea of the bio-psychosocial view in medicine, understanding that symptoms and conditions are not the whole story for each unique person.  An acupuncturist can discuss this with you, answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide in a free consultation where you have no obligation to book a treatment afterward.

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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