Should IVF patients have acupuncture? It turns out only some of them should.

1. Acupuncture
and embryo transfer….....
Should IVF patients have acupuncture?
Can it really influence the outcome?

2. Is the evidence in?
This is the question our patients,
and their specialists, often ask us.
It’s a good question!

3. Or is the jury out?
There is a lot to think about, and analyse …...

4. There are more than 20 trials published
in medical journals
For all the references and abstracts please see
http://acupuncturepregnancy.com.au/research-reviews/

5. All of these clinical trials examine the
effect of acupuncture on the outcome
of embryo transfer (measured as
implantation, clinical pregnancy,
ongoing pregnancy or live birth)

6. Some trials did acupuncture on the day of
transfer of day 3 embryos and some on the
day of transfer of day 5 embryos

7. Some of the trials did acupuncture
immediately before and immediately after
the embryo transfer, some did
acupuncture only after the transfer or at
another time. Some trials did
acupuncture in the IVF clinic, some did it
in adjacent clinics or across town. Most of
the trials used the same acupuncture
points – but not all.

8. Most trials used traditional acupuncture
needles, but some used laser ….

9. Some used electro-stimulation on
acupuncture points

10. Some used sham needles in the
control group ….
These are to fool patients into thinking they are having real acupuncture, but
the needles only prick and don’t actually penetrate the skin.

11. Some used “wrong acupuncture”
points in the control group
ie they used points that were not on an acupuncture meridian, or
points not relevant to fertility treatment.

12. Some used “usual care” in the
control group
• ie they didn’t
do anything
different to
what they
would
normally do in
an IVF cycle

13. What did they find?
• More than two thirds of these studies
report a statistical benefit of having
acupuncture during an IVF cycle ….....

14. The next step is to do a meta-analysis
A Meta-analysis is a statistical technique for combining the findings from independent
studies, and is used to assess the clinical effectiveness of healthcare interventions.

15. What did this find?
Of 9 meta analyses examining acupuncture treatment of IVF
patients, 2 found no effect at all, 7 found that acupuncture
conferred an advantage in IVF outcomes (in some cases the
advantage was significant only when chances of success were not
high, or when usual care, rather than sham needling, was the
control group).

16. Forest Plots
• The most recent meta-analysis plotted
comparisons of all the different trials
www.ncbi.nlm.nih.gov/pmc/articles/PMC3395377

17. Forest Plot 1
When all the qualifying
trials that examine the
effect of acupuncture at
time of embryo transfer
(compared to all the
different control types
including sham
needling) are plotted,
we can see there is a
trend to improved
outcomes with
acupuncture treatment.
Zheng CH et al, doi:10.1155/2012/543924

18. Forest Plot 2
When the same sort
of analysis compares
trials of patients
having acupuncture
on day of embryo
transfer with a control
group who did not
have “sham
acupuncture”, the
trend favouring
acupuncture is even
more obvious.
Zheng CH et al, doi:10.1155/2012/543924

19. Forest Plot 3
And when we examine
the pregnancy rate in the
trials that did
acupuncture during the
whole IVF cycle (not just
at embryo transfer)
compared to usual care,
the trend toward
favouring acupuncture
treatment is stronger
again.
Zheng CH et al, doi:10.1155/2012/543924

20. But back to the clinic;
what is embryo transfer acupuncture?
Embryo transfer acupuncture is usually two treatments, one applied before the
transfer and one after. The acupuncture points chosen include those shown in
clinical trials to have a beneficial effect on outcomes for some IVF patients

21. Before the transfer
We use acupuncture points on the abdomen as well as points on the limbs, the
head and the ear. Some of these will be those used in clinical trials, and some
will be chosen according to pulses and symptoms.

22. After the transfer
We use acupuncture points on the head, ear and limbs but not on the
abdomen. As before, points are chosen according to pulses and
symptoms as well as research trial protocols.

23. How does acupuncture increase
IVF success rates?
• Well, we don’t really know …..
• But we do have some clues .......

24. Here’s what we do know ….....
• implantation of embryos
is negatively affected by
stress, and auto-immune
factors
• stress can reduce IVF
success rates
• fertility is compromised if
stress hormones are
elevated
For all references; acupuncturepregnancy.com.au/preparing-to-conceive-stress-management

25. And also ….....
• Acupuncture has been
shown to improve certain T-
cell and cytokine levels
• and increase levels of
endogenous opioids eg
endorphins, encephalins and
serotonin.
• and reduce cortisol and
adrenalin levels
• And it makes you feel very
relaxed.
For all references; acupuncturepregnancy.com.au/preparing-to-conceive-stress-management

26. A relaxed uterus might help too…....
Uterine contractions after
embryo transfer appear to
reduce implantation and
pregnancy rates. Acupuncture
settles the body and the mind,
and while we don’t know if it
reduces contractions, most
women report feeling more
comfort in the abdomen after
treatment.
Renato Fanchin et al, Human Reproduction vol.13 no.7 pp.1968–1974, 1998
Pregnancy rate vs uterine contractions per min

27. And coming back to TCM, “Warming the
womb”….....
In traditional Chinese
medicine texts infertility was
sometimes referred to as a
“cold womb”.
What we aim to do with
Chinese medicine treatment
at this time (and later) is to
encourage the flow of “Qi and
Blood” to nourish the embryo.

28. Any conclusions?
• The research and our own experience,
tells us that acupuncture treatment during
an IVF cycle can confer a benefit to
women who’s chance of success with IVF
is 30% or less - ie older women and those
who have done previous failed IVF cycles.