Recommended Treatment of Acupuncture for Fertility

ART with Chinese Medicine "Cultivating the soil before planting the seeds" is an appropriate metaphor and common way of thinking about fertility in Chinese Medicine. The following recommendations are basic guidelines developed in part by Traditional Chinese Medicine theories as well as case studies and modern clinical research. As each individual varies in condition, treatment recommendations may vary as well.

Intrauterine Insemination (IUI) Acupuncture is recommended for once a week, beginning three months prior to and during Assisted Reproductive Therapies. This treatment is designed to improve the quality and quantity of developing follicles as well as the overall quality of the endometrial lining. It also serves as a well rounded and personalized treatment for both physical and emotional based symptoms.

InVitro Fertilization (IVF) Acupuncture is recommended four weeks prior to egg retrieval. These treatments are based on clinical studies to increase follicular development as well as the quality of the endometrial lining. It consists of eight acupuncture treatments within this four week period and includes electro-acupuncture. After stimulation begins this treatment also minimizes discomfort and side effects that may occur during a medicated cycle.

For women with elevated FSH levels, Polycystic Ovarian Syndrome as well as Endometriosis it is also recommended to receive acupuncture two to four months prior to IUI and IVF for optimum benefits.

IVF Retrieval Day One treatment after egg retrieval on this day can minimize discomfort, improve circulation and prepare the body to receive a mature embryo in the days to come.

IVF Embryo Transfer Day This treatment is based strictly on clinical studies. It can calm the mind and relax the uterus, relieve discomfort while at the same time supporting implantation. This treatment consists of acupuncture 30 minutes before the embryo transfer as well as acupuncture immediately following the embryo transfer.

Donor Egg Recipients
Acupuncture is recommended for once a week, two to four months prior to receiving an embryo. This treatment is designed to prepare the uterus and the endometrial lining. On embryo transfer day, pre and post acupuncture is also highly recommended by physicians.

Male Factor
Men should be treated four to five months prior to an IVF cycle to increase both the quality and quantity of sperm considering that sperm productions take three months. Generally speaking, Males should be treated once to twice a week until the day of sperm donation.

Remember too that acupuncture can be safely used after all Assisted Reproductive Therapy to promote implantation and prevent miscarriage throughout the first trimester. During the second trimester it can be safely used to address common symptoms associated with pregnancy.

On Call services for Acupuncture & IVF Procedures

In 2003, Fertility and Sterility published a study that found that adding acupuncture treatment to the IVF protocol increased the success rate of implantation. This brought acupuncture and Traditional Chinese Medicine (TCM) into the consciousness of the fertility community. Since then, there has been much speculation and investigation into how acupuncture can increase fertility. The study in 2003 had 160 women divided into two groups. Both groups underwent the IVF protocol with three day embryo transfers. The success rate of implantation in those who received acupuncture was 42.3% compared to 36.5% for the control group (an increase of 15.8%). In the May, 2006 issue of Fertility and Sterility, two similar studies were reported with the acupuncture group experiencing 13% and 18% greater success rate of achieving pregnancy.

With this clinical research applied, Insight Acupuncture offers you the opportunity to receive treatment that reflects the protocols presented in these studies. Increasing the success rate of implantation is the overall goal of this pre and post IVF transfer procedure. These acupuncture treatments have a soothing effect on the mind and the body. On this important day it is our further goal to create an atmosphere of care and comfort before and after your embryo is transferred.

For optimal scheduling opportunities please call as far in advance as possible to discuss your upcoming IVF procedure. This will help to determine the approximate time frame which your retrieval and transfer is to take place. It is recognized that the scheduling of your transfer time will vary. By discussing your needs in advance, it will help insure your pre and post acupuncture appointment. Scheduling is executed to cater to your needs and the maximum amount of communication concerning you and your timely procedures are most important to Insight Acupuncture. Please call 303-715-1573 to reserve your time to receive pre and post acupuncture treatments on the day of your embryo transfer.

Additional Benefits of Acupuncture & Assisted Reproductive Therapy

Optimizes uterine endometrial lining
Increases uterine arterial blood flow
Increases follicle production in a stimulated cycle
Normalizes Hormone Levels
Regulates Menstrual Cycles
Decrease side effects of fertility medications
Relieves pain
Reduces stress
Decrease miscarriage rates
Increase quality and quantity of sperm

Acupuncture & Fertility
Jeanie Lee Bussell, L.Ac., MSOM and Jason Bussell, L.Ac.

In 2003, Fertility and Sterility published a study that found that adding acupuncture treatment to the IVF protocol increased the success rate of implantation. This brought acupuncture and Traditional Chinese Medicine (TCM) into the consciousness of the fertility community. Since then, there has been much speculation and investigation into how acupuncture can increase fertility. The study in 2003 had 160 women divided into two groups. Both groups underwent IVF protocol with three day embryo transfer. The success rate of implantation in those who received acupuncture was 42.3% compared to 36.5% for the control group (an increase of 15.8%). In the May, 2006 issue of Fertility and Sterility, two similar studies were reported with the acupuncture group experiencing 13% and 18% greater success rate of achieving pregnancy.

Other reported studies have shown that electro-acupuncture (the application of electro stimulation with acupuncture) treatments significantly decreased the pulsatility index of the uterine artery, increasing uterine receptivity. Electro-acupuncture to the ear has been shown to relieve pain after oocyte retrieval. Several studies have shown improvement in sperm quality, quantity, and morphology with acupuncture. It has also been shown to increase beta-endorphins, leaving patients with a sense of calm and well being. Chronic stress can increase cortisol; which the in turn impairs the reproductive system. Increasing endorphins can relieve stress and should therefore enhance fertility. Considering the high monetary, emotional and physical cost of these procedures, anything we can do to increase a patient's comfort and chances of success should be welcomed.

More research is showing acupuncture's efficacy, but there is a fundamental problem with using Western techniques to evaluate Eastern therapies. The gold standard of the Western scientific method is the randomized, double blind, controlled study. In this model, everyone in each group is treated exactly the same. TCM's forte is its ability to treat everyone individually. When we treat everyone the same, we are not practicing TCM. Many clinical trials of acupuncture yield disappointing results due to this incompatibility. Anecdotally, we have seen acupuncture: normalize hormone levels, regulate menstrual cycles, increase the number of follicles produced in the stimulated cycle, decrease the effects of fertility medications, relieve pain, reduce stress, and decrease miscarriage rates. These comparisons are based on couples who have tried ART without acupuncture and then underwent a subsequent procedure with the addition of acupuncture. So, how does it work? Western science has tried to understand acupuncture in Western terms. It has been postulated that it works on the nervous system, endocrine system and lymphatic system, but all of these explanations have been insufficient. While acupuncture can cause a change in these systems, it is considered more of a side effect than the main effect. TCM is a medical system that incorporates acupuncture, herbs, diet and exercise. It is based on a different understanding of the body and its relationship with its environment. Since it is largely a foreign paradigm, we should first explain some of its basic tenets.

CHINESE MEDICAL THEORY
TCM centers on the concept of balance. Achieving and maintaining balance s the goal of life. Restoring balance is the goal of medical intervention. Balance can be synonymous with health. When one is in balance, everything should function normally, the organs and glands should work properly, appetite and attitudes should be moderate and appropriate, and the reproductive capacity should be optimal.

The concept of balance is expressed with Yin-Yang theory, which understands all phenomena as lying somewhere between two extremes. Yin represents dark, quiet, soft, inward and feminine. Yang is brought, loud, hard and masculine. Just as day turns to night and back into day, so too should our yin and yang be in a dynamic balance.

In order to achieve this balance, the body must maintain proper circulation. We all know how the blood flows and circulates since it can be seen. We all know how the blood flows and circulate since it can be seen. The more esoteric concept with which we are concerned is Qi (pronounced chee). Qi loosely translates as "vital energy". It flows within us. It flows around us. It gives all things life, animation, warmth and containment. Over many generations, Chinese physicians have mapped the way that the Qi flows in the body. They have found that it flows in 14 main channels, like arteries, in closed circuit. Smaller capillary vessels carry the Qi to every cell in the body. When Qi is flowing in harmony, the body is in balance and good health results. For a variety of reasons, however, we get out of balance and our Qi flow becomes disrupted. Acupuncture is the practice of inserting hair-thin, sterile needles into the channels to affect and re-balance the flow of Qi. Electro-acupuncture is the same with the addition of a mild electric current to the needles.

While one may not expect it, acupuncture, and even electro-acupuncture, are very relaxing procedures. Many patients fall asleep during treatment. Needles are left in place for about 20-40 minutes while the patient lies in a quiet room. After the needles are removed, the patient is fine to return to his or her daily activities.

In TCM, each patient is treated individually according to his or her particular imbalance. While it is helpful to know the Western diagnosis, the TCM practitioner must acquire more information. By examining each patient's unique presentation: body shape, complexion, voice, appearance of the tongue and the quality of the pulse, a TCM practitioner may diagnose the patient's internal state according to the Chinese paradigm. Along with observations, the TCM evaluation involves a very detailed inquiry of the patient's history and current functioning. The diagnosis will determine the type and frequency of treatments used.

Chinese physicians have been treating fertility in men and women using acupuncture and herbs for centuries. In China and many Asian countries, the ability to have a child (particularly a son) was of utmost importance. This was especially true in the case of the emperor needing an heir. Therefore, reproductive medicine and OB/GYN were highly developed areas of specialty in Chinese Medicine.

TREATMENT RECOMMENDATIONS
Whether trying to conceive naturally or with ART, it is recommended that couples receive at least three months of weekly treatments to prepare for conception. This is considered "Cultivating the soil before planting the seeds". Herbal therapies may be utilized at this time. It is recommended that both males and females be treated. Even if a male's sperm parameters are within normal limits, acupuncture may increase the percentage of sperm that are normal, increasing the chances that a healthy sperm will fertilize the egg.

Herbal therapies may be recommended during the preparatory phase, but they are usually discontinued at the onset of hormone therapy. This is not due to any known complications, but rather due to what is not known about the possible interactions with new medications. Herbs can be powerful medicines and, if improperly prescribed, could have a negative effect to the hormone therapy.

Once a patient begins the stimulation phase, treatment frequency is dependant on the ovarian response. Sometimes once a week is sufficient, but patients who do not respond well may need several treatments a week to maximize follicular development. Hyper-stimulated patients can benefit from reduction of side effects and pain. One treatment is recommended after the egg retrieval to minimize discomfort, improve circulation, and prepare the body to receive the embryo. Then two treatments before and after embryo transfer, and once more a week after transfer to support implantation and prevent miscarriage. Once a woman is pregnant, it is recommended she receive treatments weekly through her first trimester. Acupuncture can be safely used during second and third trimester to address many common conditions associated with pregnancy. Males should be treated once or twice weekly until the day of sperm donation.

TCM can be used to help get patients back into balance, but our greater challenge is to teach our patients to live I the balance. Sometimes a patient's environment and habits can impair their fertility as much as their age does. The three greatest factors that contribute to our getting out of balance are our diet, lifestyle, and attitudes. All of these should be balanced and moderate. If we are not balanced, our bodies do not want us to become pregnant.

Once thought of as "alternative medicine, TCM should be regarded and utilized as "complementary". In China, they refer to the use of Eastern and Western technique as "walking on two legs". The analogy being that, while one can get somewhere hopping on one leg, once can get there much faster and easier by walking on two. The best of both worlds involves using both the latest technologies of the West and the time tested therapies on the East.