ANCIENT TECHNIQUE COMPLEMENTS A.R.T. by Eldon Schriock, MD

Acupuncture, one of the world's oldest and most established healing practices, is growing in popularity as a way to complement the modern procedures of ART - Assisted Reproductive Technologies. Although the scientific evidence behind acupuncture is scanty, belief in this technique is so strong, some patients having just undergone implantation after IVF will head straight to their TCM (Traditional Chinese Medicine) practitioner for an immediate acupuncture treatment.

Acupuncture is just one component of Traditional Chinese Medicine (TCM), which also involves herbs, pelvic massages and dietary adjustments to garner a "whole body" systems approach to health. Following a track record of over 4000 years, nearly one quarter of the world's population turns to TCM for their primary heath care. In Western societies, acupuncture is frequently cited as providing almost instantaneous relief to debilitating ailments such as bad backs and sports injuries.

Tiny sterilized needles are inserted into key points of the body and left there for 20-60 minutes. Barely felt, the needles reportedly open up Qi (pronounced Chee), which is vital energy defined by increased blood flow and the benefits of the body's systems working together to break down so-called blockages.

Only two scientific research studies have examined the benefits of acupuncture with IVF treatment. The most talked about was reported in the journal Fertility & Sterility, April 2002 (Vol. 77, No.4) involving 160 IVF patients in Germany. Half of them underwent acupuncture before and after embryo transfer and the other half served as the control group. 34 out of the 80 women who received acupuncture revealed clinical pregnancies (42.5 %), whereas, 21 out of 80 women in the control group became clinically pregnant (26.1%). (See article below for more detailed analysis)

Although the physiological mechanisms are not fully understood, it is believed that acupuncture optimizes endometrial receptivity and enhances blood flow to the pelvic area. According to TCM principles, energy flows through the body along pathways, or meridians. Acupuncture is a means of enhancing this energy and coaxing the body's responses to induce a desired physiological effect. Ideally, according to TCM practitioners, women should undergo acupuncture treatment 3-4 months prior to an IVF cycle instead of as a last minute flurry.

We at PFC encourage our patients who inquire about acupuncture to pursue it, and we provide you with a list of Bay Area TCM practitioners who are certified by the National Acupuncture and Oriental Medicine Alliance and licensed by the state of California. However, under no circumstance do we condone the use of herbal supplements that are sometimes provided with acupuncture for women undergoing infertility treatment at PFC. Most TCM practitioners agree with this approach, and will communicate your treatment protocol with our physicians here at PFC.
(Reprinted from Fertility FlashSM Vol 2 Issue 1)

A REALITY CHECK ABOUT ACUPUNCUTRE by Isabelle Ryan, MD

More and more patients undergoing fertility treatment ask about incorporating acupuncture and Chinese herbal medicine treatment with their IVF cycle. Some patients are especially inquisitive after reading Lifang Liang's recently published book Acupuncture and IVF: Increase IVF Success by 40-60%. For most patients going through the struggle of infertility, this title proposes a provocative and enticing claim.

While acupuncture is based on an ancient medical tradition, current studies are trying to clarify the physiological basis for treatment results. Some indicate that the benefits of acupuncture may be mediated by opioid-types of proteins in the central nervous system. Some of the proteins affect gonadotropin secretion from the pituitary (brain), and therefore could impact menstrual cyclicity to help regulate ovulation. Others propose that blood flow to the pelvic organs may be improved through mechanisms other than the central nervous system therefore improving fertility. And yet others propose there might be a psychosomatic benefit.

While all these theories are intriguing, a true understanding of the benefit of acupuncture and its impact on fertility will not be elucidated until the execution of several well designed studies (large numbers of patients, randomized controlled trials).

To date, there is only one such study (Paulus et al, Fertil Steril. 2002 Apr;77(4):721-4), which was conducted in Germany. While this study revealed an improvement in pregnancy rates, there are a number of issues with the study itself, which calls for cautious interpretation of the final results (an improvement in pregnancy rates from 26% to 42% - 61.5% improvement rate). For instance, the study was weakened by a low baseline pregnancy rate (26.3%) in a young patient population (early 30yo). Statistically, it is much easier to show an improvement in pregnancy rate, when the baseline pregnancy rate is so low. This finding may not hold true if this study was performed in an IVF center where the pregnancy rates in young patients was closer to 50% (which is what we expect for patients in their early 30s). More importantly, when studying such complex questions, a clear understanding will not be obtained, and claims of improvement cannot be made, until a number of well-designed studies are performed and the majority of results echo a similar theme (either positive or negative).

In her book, Lifang Liang presents a nice overview of the theories behind Chinese Medicine, as well as various herbal treatments available for fertility patients, and their proposed effects. She then presents a number of "Case Histories", illustrating the use of both herbal therapies and acupuncture. While these are quite interesting, they are anecdotal stories, and do not represent a scientific study to evaluate the role of acupuncture and infertility. The above study by Paulus et al is mentioned in the book, and seems to be the basis for the claim of a 40-60% increase in IVF success rates. As mentioned, this claim should be taken with caution. All of us who serve patients with fertility treatment, whether trained in Western or Chinese medicine, are looking for the best possible outcome for our patients. It would be wonderful if indeed there was a combination of various treatment approaches which, when practiced together, could provide the best "cocktail". However, the exact role that acupuncture plays is currently an unanswered question, until more well-designed studies are performed. We look forward to such studies, to better define the role of acupuncture and herbal remedies in the treatment of infertility.
(Reprinted from Fertility FlashSM: Vol 2, Issue 3)

CHOOSING A TRADITIONAL CHINESE MEDICINE (TCM) PRACTIONER

If you are new to the Bay Area or are in the process of selecting a TCM practitioner, your physician is often a good start. She/he may have a list of licensed practitioners of acupuncture with whom they are familiar.

In the Bay Area it is common to find medical doctors, including neurologists, anesthesiologists, pain specialists and specialists in physical medicine who are also trained in acupuncture and Chinese medicine.

At Pacific Fertility Center we recommend working with TCM practitioners who are licensed and credentialed. This ensures the practitioner has the minimum standards for acupuncture certification.

If you would like a referral to an acupuncturist that works with infertility patients, do not hesitate to call our New Patient Guides at 1-888-834-3095.