Ama Fertility Center
Fertility Studies

The following are a variety of articles and abstracts published by the medical community that provide supporting evidence of the effectiveness of oriental medicine in treating a variety of health issues.

 

 

ASSISTED REPRODUCTION THERAPY (IVF) - Continued

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RESULTS

A total of 160 patients was recruited for the study. Patients who failed to conceive during the first treatment cycle were not reentered into the study. According to the randomization, 80 patients were treated with acupuncture, and 80 patients underwent the usual therapy without acupuncture.

 

As Table 1 shows, there were no statistically significant differences between the two groups with respect to the following covariants: age of patient, number of previous cycles, number of transferred embryos, endometrial thickness, plasma estradiol on day of transfer, or method of treatment (IVF or ICSI). Clinical indications for ART were the same for patients of both groups. The blood flow impedance in the uterine arteries (pulsatility index) did not differ between the groups before and after embryo transfer.

 

The analysis shows that the pregnancy rate for the acupuncture group is considerably higher than for the control group (42.5% vs 26.3%; P=.03).

 

DISCUSSION

The acupuncture points used in this study were chosen according to the principles of TCM (10): Stimulation of Taiying meridians (spleen) and Yangming meridians (stomach, colon) would result in better blood perfusion and more energy in the uterus. Stimulation of the body points Cx6, Liv3, and Gv20, as well as stimulation of the ear points 34 and 55, would sedate the patient. Ear point 58 would influence the uterus, whereas ear point 22 would stabilize the endocrine system.

 

The anesthesia-like effects of acupuncture have been studied extensively. Acupuncture needles stimulate muscle afferents innervating ergoreceptors, which leads to increased þ-endorphin concentration in the cerebrospinal fluid (11). The hypothalamic þ-endorphinergic system has inhibitory effects on the vasomotor center, thereby reducing sympathetic activity. This central mechanism, which involves the hypothalamic and brainstem systems, controls many major organ systems in the body (12). In addition to central sympathetic inhibition by the endorphin system, acupuncture stimulation of the sensory nerve fibers may inhibit the sympathetic outflow at the spinal level. By changing the concentration of central opioids, acupuncture may also regulate the function of the hypothalamic-pituitary-ovarian axis via the central sympathetic system (13).

 

Kim et al. (14) suggested that Li4 acupuncture treatment could be useful in inhibiting the uterus motility. In their rat experiments, treatment on the Li4 acupoint suppressed the expression of COX-2 enzyme in the endometrium and myometrium of pregnant and nonpregnant uteri.

 

Stener-Victorin et al. (3) reduced high uterine artery blood flow impedance by a series of eight electroacupuncture treatments, twice a week for 4 weeks. They suggest that a decreased tonic activity in the sympathetic vasoconstrictor fibers to the uterus and an involvement of central mechanisms with general inhibition of the sympathetic outflow may be responsible for this effect. In our study, we could not see any differences in the pulsatility index between the acupuncture and control group before or after embryo transfer. This may be due to a different acupuncture protocol and the selected sample of patients with high blood flow impedance of the uterine arteries (PI ≥ 3.0) in the Stener-Victorin et al. study.

 

As we could not observe any significant differences in covariants between the acupuncture and control groups, the results demonstrate that acupuncture therapy improves pregnancy rate.

 

Further research is needed to demonstrate precisely how acupuncture causes physiologic changes in the uterus and the reproductive system. To rule out the possibility that acupuncture produces only psychological or psychosomatic effects, we plan to use a placebo needle set as a control in a future study.

 

REFERENCES

1. Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia 2000;32:31-9.
2. Bartoov B, Eltes F, Reichart M, Langzam J, Lederman H, Zabludovsky N. Quantitative ultramorphological analysis of human sperm: fifteen years of experience in the diagnosis and management of male factor infertility. Arch Androl 1999;43:13-25.
3. Stener-Victorin E, Waldenstrom U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod 1996;11:1314 -7.
4. Stener-Victorin E, Waldenstrom U, Tagnfors U, Lundeberg T, Lindst-edt G, Janson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2000;79:180 -8.
5. Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol 1992;6:171-81.
6. Stener-Victorin E, Lundeberg T, Waldenstrom U, Manni L, Aloe L, Gunnarsson S, Janson PO: Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol Reprod 2000;63:1497-503.
7. Strehler E, Abt M, El-Danasouri I, De Santo M, Sterzik K. Impact of recombinant follicle-stimulating hormone and human menopausal gonadotropins on in vitro fertilization outcome. Fertil Steril 2001;75: 332-6.
8. Palermo GD, Schlegel PN, Colombero LT, Zaninovic N, Moy F, Rosenwaks Z. Aggressive sperm immobilization prior to intracytoplasmic sperm injection with immature spermatozoa improves fertilization and pregnancy rates. Hum Reprod 1996;11:1023-9.
9. Plachot M, Mandelbaum J: Oocyte maturation, fertilization and embryonic growth in vitro. Br Med Bull 1990;46:675-94.
10. Maciocia G. Obstetrics and gynecology in Chinese medicine. New York: Churchill Livingstone, 1998.
11. Hoffmann P, Terenius L, Thoren P. Cerebrospinal fluid immunoreactive beta-endorphin concentration is increased by voluntary exercise in the spontaneously hypertensive rat. Regul Pept 1990;28:233-9.
12. Andersson SA, Lundeberg T. Acupuncture-from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses 1995;45:271-81.
13. Chen BY, Yu J. Relationship between blood radioimmunoreactive beta-endorphin and hand skin temperature during the electro-acupuncture induction of ovulation. Acupunct Electrother Res 1991;16:1-5.
14. Kim J, Shin KH, Na CS. Effect of acupuncture treatment on uterine motility and cyclooxygenase-2 expression in pregnant rats. Gynecol Obstet Invest 2000;50:225-30

 

COMMENTARY
The popularity of treatment methods not generally established in Western medicine, such as acupuncture, is increasing in reproductive medicine. Acupuncture is an integral part of the more than 3000-year-old medical tradition known as Traditional Chinese Medicine (TCM). In recent years, the effect of acupuncture on different conditions (pain and diseases) has been studied from a Western scientific perspective, and the results indicate that acupuncture has both a physiological and a psychological impact (1). The mode of action of acupuncture most likely involves the activation of muscle afferents that modulate spinal and segmental reflexes and higher control systems, thereby allowing a neural substrate to influence reproductive functions (1,2).

 

Many infertile women undergo acupuncture in the course of in-vitro fertilization (IVF), hoping it will improve their chance of success. But what scientific evidence do we have to support this? To date, only three published studies have investigated the effect of acupuncture in women undergoing IVF treatment, and the present article is one of them. The earliest study investigated the effect of acupuncture on blood flow impedance in the uterine arteries, known as the pulsatility index (PI) (3). This uncontrolled study showed that repeated electro-acupuncture (EA) reduced a high PI value in the uterine arteries to normal levels. The clinical use of EA to improve blood flow impedance in the uterine arteries in connection with IVF and ET treatment can still only be speculative. Whether the subsequent increase in blood flow influences endometrial receptivity-and, therefore, implantation and pregnancy rates-in women undergoing IVF and embryo transfer (ET) remains to be demonstrated.

 

In the present study, acupuncture during ET in IVF cycles resulted in significantly higher pregnancy rates than no acupuncture (42.5 vs. 26.3%). The authors concluded that, since they could not observe any differences in covariants between the acupuncture group and the control group, the results demonstrate that acupuncture therapy improves pregnancy rate. This is an interesting observation. However, the statistics in the study can be criticized, since no power calculation was presented. Furthermore, a success rate of 26.3% in the group without acupuncture is low, when as many as 2-3 embryos are transferred at one time. One would expect a pregnancy rate between 35% and 40%. Thus, the result may be a type 2 error and must be interpreted with care.

 

However, these results are in line with an observation made in the second of the three studies mentioned above. This study compared EA with alfentanil as anaesthesia during oocyte aspiration, but the number of subjects was also too small for any conclusions concerning pregnancy rate to be drawn (4). The main finding of this study was that EA was as effective as conventional anaesthetics, but without any negative side effects. We have recently competed a study with a larger number of subjects and the results will be published in the near future. In conclusion, whether acupuncture has a positive effect on the pregnancy rate when given as pre-treatment, before oocyte aspiration, during oocyte aspiration, during ET, or in any combination of these stages, remains to be proven. The clinical use of acupuncture as an anaesthetic method during oocyte aspiration in IVF treatment can be recommended. An important clinical issue is that no negative side effects have been observed in any of the studies.

 

REFERENCES

  • Elisabet Stener-Victorin, PhD, RPT
  • G–teborg University, G–teborg, Sweden
  • Andersson S, Lundeberg T. Acupuncture - from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses 1995; 45:271-81.
  • Stener-Victorin E, Wikland M, Waldenstr–m U, Lundeberg T. Alternative treatments in reproductive medicine: much ado about nothing. Acupuncture-a method of treatment in reproductive medicine: lack of evidence of an effect does not equal evidence of the lack of an effect. Hum Reprod 2002; 17:1942-6.
  • Stener-Victorin E, Waldenstr–m U, Andersson SA, Wikland, M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod 1996; 11:1314-7
  • Stener-Victorin E, Waldenstr–m U, Nilsson L, et al. A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 1999; 14:2480-4.

 

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