Is acupuncture just some sort of strange healing ritual? Despite for all its popularity, questions about acupuncture’s efficacy have long been commonplace. Are those who swear by it experiencing true relief or the psychological balm of the placebo effect? Below you may read some of the latest fertility research using acupuncture and chinese herbal medicine:
Acupuncture and herbs resolves pelivc inflammatory disease: Acupuncture and Chinese herbs eliminate pelvic inflammatory disease (PID). This disorder is often due to an infection in the uterus, fallopian tubes, or ovaries. PID may cause infertility due to residual scarring or congealed exudate. Chlamydia and gonorrhea are common etiologies but PID may be caused many other pathogenic influences. Zhou, P. Zeng, Z. H. & Xiang, Y. H. (2014). Clinical Study on Chronic Pelvic Inflammatory Disease with Syndrome of Damp-heat and Blood-stasis by Qing-Re Li-Shi Hua-Yu Decoction Combined with Acupuncture Therapy. World Science and Technology – Modernization of Traditional Chinese Medicine. 16 (12).
Moxibustion increases the number of ovarian granulosa cells: Our results showed that mild warm moxibustion (MWM) modulated the circulating levels of estradiol and follicle-stimulating hormone and their receptors and inhibited apoptosis in the ovaries, similar to the effect of estrogen. Further investigation revealed that the effects of MWM on ovary tissues and cultured GCs were mediated by the modulation of the activity of Forkhead box protein O1 and involved the JAK2/STAT3 pathway. Evid Based Complement Alternat Med. 2015;2015:742914. doi: 10.1155/2015/742914. Epub 2015 Oct 13.
Chinese herbs twice as effective as fertility drugs: Our review suggests that management of female infertility with Chinese herbal medicine can improve pregnancy rates 2-fold within a 3–6 month period compared with Western medical fertility drug therapy. In addition, fertility indicators such as ovulation rates, cervical mucus score, biphasic basal body temperature, and appropriate thickness of the endometrial lining were positively influenced by CHM therapy, indicating an ameliorating physiological effect conducive for a viable pregnancy. Chinese herbal medicine for female infertility: An updated meta-analysis. Ried, Karin. Complementary Therapies in Medicine , Volume 23 , Issue 1 , 116 - 128
Acupuncture good for pre-elampsia: Pregnant women with a diagnosis of preeclampsia were offered acupuncture and allocated into groups based on their choice: the acupuncture group (n=11) comprised women electing to receive treatment (up to 10 sessions over 2 weeks). The control group (n=11) was made up of women who declined and was matched for age, gestation at diagnosis, and parity. All women received usual care and underwent measurement of blood pressure (BP) at four time points: at baseline, at the end of the intervention, immediately before delivery, and postpartum (within 24 h). Patients in the acupuncture group had significantly lower BP at time of delivery, and postpartum, than patients in the control group (p<0.05). The individual change in BP between baseline and the end of treatment was significantly greater in the acupuncture group versus the control group for both systolic BP (median (IQR) -8 (-3 to -14) vs +1 (-7 to +9) mm Hg, p=0.007) and diastolic BP (-3 (-1 to -3) vs +2 (-2 to +7) mm Hg. Acupuncture plus usual care was associated with a greater reduction in BP than usual care alone. Acupunct Med. 2015 Oct 29. pii: acupmed-2015-010893. doi: 10.1136/acupmed-2015-010893.
Acupuncture and moxibustion increase testosterone levels: Partial androgen deficiency of the aging male (PADAM) is characterised by a deficiency in serum androgen levels. Both electroacupuncture (EA) and mild moxibustion (MM) can raise serum testosterone levels in PADAM. EA and MM were administered at BL23 and CV4 acupuncture points for 8 weeks. Both EA and mild MM significantly increased serum TT and FT levels with MM displaying superiority. P450scc, 17ß-HSD3 and SF-1 protein expression, and P450c17 and 3ß-HSD1 mRNA expression, were significantly increased and serum LH and FSH levels were significantly decreased. EA and MM at the BL23 and CV4 acupuncture points appear to be effective treatments for PADAM, and MM displays superior efficacy to EA. Acupunct Med. 2015 Oct 27. pii: acupmed-2014-010734. doi: 10.1136/acupmed-2014-010734.
Acupuncture and acupressure reduce labour pain and duration: The purpose of this study was to evaluate the effects of SP6 acupressure on labor pain and delivery time in women in labor. Seventy-five (75) women in labor were randomly assigned to either the SP6 acupressure (n = 36) or SP6 touch control (n = 39) group. The 30-minute acupressure or touch on SP6 acupoint was performed. There were significant differences between the groups in subjective labor pain scores at all time points following the intervention: immediately after the intervention (p = 0.012); 30 minutes after the intervention (p = 0.021); and 60 minutes after the intervention (p = 0.012). The total labor time (3 cm dilatation to delivery) was significantly shorter in the SP6 acupressure intervention group than in the control group (p = 0.006). These findings showed that SP6 acupressure was effective for decreasing labor pain and shortening the length of delivery time. SP6 acupressure can be an effective nursing management for women in labor. Mi Kyeong Lee, Soon Bok Chang, and Duck-Hee Kang. (2004). Effects of SP6 Acupressure on Labor Pain and Length of Delivery Time in Women During Labor. The Journal of Alternative and Complementary Medicine. December, 10(6): 959-965.
Acupuncture or acupressure reduces labour pain: Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence supporting the use of acupuncture and acupressure for pain management in labour We included 13 trials with data reporting on 1986 women. Nine trials reported on acupuncture and four trials reported on acupressure. Acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management. Smith, C, Collins, C, Crowther, C, Levett, K. (2011). Acupuncture or acupressure for pain management in labour. Cochrane Database of Systematic Reviews, Issue 7.
Acupuncture and Chinese herbs helps infertility: Acupuncture and Chinese herbs prevent infertility after emergency ectopic pregnancy surgery. Ectopic pregnancies occur when a fertilized egg does not implant in the uterus. Qihai (CV5) and Tianshu (ST25) are depicted in this photograph. A common form of ectopic pregnancy is a tubal pregnancy wherein the fertilized egg remains in one of the fallopian tubes. The fertilized egg cannot survive. It is a life-threatening condition that may require emergency surgery or an injection of methotrexate to stop cell growth. Unfortunately, this may lead to residual blockage of the fallopian tubes and subsequent infertility. Li XR, Zhang GF, Zhang MW, Chang CF & Zhang D. (2014). Clinical Observations on the Effect of Combined Treatment with Acupuncture and Medicine on Tubal Patency after Ectopic Pregnancy Surgery. Shanghai Journal of Acupuncture and Moxibustion. 33(9).
Acupuncture better than western medicine at improving sperm quality: A total of 12 studies involving 2,177 patients were included, the quality of which was evaluated as mediocre. For the treatment of male infertility, acupuncture is reported to be equally effective as TMC and more effective than Western medicine, and its effectiveness is enhanced when applied in combination with either TCM or Western medicine. Acupuncture is distinctively efficacious in improving sperm quality. Zhonghua Nan Ke Xue. 2015 Jul;21(7):637-45.
Acupuncture very safe in pregnancy: Although the safety of acupuncture per se in pregnancy is reasonably well accepted, there remains debate regarding needling at points historically considered to be 'forbidden' during pregnancy. This article reviews the scientific literature on this topic. These findings are reassuring and will help individualised risk:benefit assessment before treating pregnant women. Given the numerous evidence-based indications for obstetric acupuncture and lack of evidence of harm, risk:benefit assessments will often fall in favour of treatment. Acupunct Med. 2015 Oct;33(5):413-9. doi: 10.1136/acupmed-2015-010936. Epub 2015 Sep 11.
Acupressure ripens cervix: Cervical ripening is one of the main stages of initiation labor. Acupressure in Chinese medicine is considered as an invasive technique, which through reliving oxytocin ripens the cervix. Acupoint Sanyinjiao (SP6) was selected in this study because it is the acupoint selected in gynecology and it is easy for women to locate and apply pressure without medical assistance. There was a significant difference between mothers' educations in the three groups. Most of the mothers (59.5%) in the researcher-performed acupressure group had secondary education. Cervical ripening was significantly different between the three groups after 48 hours (P = 0.05), yet there was no significant difference after 96 hours and at the time of admission. Mean Bishop score was enhanced after 48 hours in the researcher-performed acupressure group (P = 0.021) and the self-performed acupressure group (P = 0.007) in comparison to the control group. The results showed that acupressure is a safe technique and leads to cervical ripening. Thus, regarding the desired results that were achieved when mothers applied acupressure themselves, it could be suggested that it is beneficial for mothers to be trained to apply this method at home. Iran Red Crescent Med J. 2015 Aug 24;17(8):e28691. doi: 10.5812/ircmj.28691. eCollection 2015.
Acupuncture reduces labour duration: Nowadays, acupuncture is widely used to manage pain, and childbirth is a condition requiring appropriate pain management interventions. In this study, we investigated the effects of acupuncture on labor pain, serum cortisol level, and duration of labor. We conducted a randomized, single-blind, controlled trial that included 63 nulliparous women: 32 in the study group and 31 in the control group. Acupuncture was performed at the SP-6 and the LI-4 points in the study group, and sham acupuncture was performed at the same points in the control group. Our results show that acupuncture is significantly associated with a decreased duration of labour. J Acupunct Meridian Stud. 2015 Oct;8(5):249-54. doi: 10.1016/j.jams.2015.08.003. Epub 2015 Sep 11.
Acupuncture reduces FSH levels and increases antral follicle count, AMH levels and pregnancy rates: The aim of this study was to investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on ovarian reserve in patients with diminished ovarian reserve undergoing in vitro fertilization and embryo transfer. A total of 240 patients were randomly divided into the Han's acupoint nerve stimulator TEAS treatment (TES), comforting false Han's placebo (FHP), artificial endometrial cycle treatment (AEC), and control (CON) groups. TEAS and AEC treatments could improve basal endocrine levels in patients, and increase the number of oocytes retrieved and high-quality embryos. TEAS treatment could improve the clinical pregnancy rate in patients with decreased ovarian reserve during in vitro fertilization and embryo transfer cycles. J Obstet Gynaecol Res. 2015 Oct 12. doi: 10.1111/jog.12810.
TCM to increase IUI success rates: In the first study that measures the effectiveness of both herbs and acupuncture in combination with IUI infertility treatment, Dr. Shahar Lev-Ari and Keren Sela of TAU's Sackler Faculty of Medicine and the Tel Aviv Medical Center say that the results, which have been published in the Journal of Integrative Medicine, show a significant increase in fertility when the therapies are administered side-by-side. In terms of both conception and take-home baby rates, the test group fared far better than the control group. Out of the 29 women in the test group, 65.5 percent conceived, and 41.4 percent delivered healthy babies. In the control group, only 39.4 percent conceived and 26.9 percent delivered. The vast difference in success rates is even more surprising when the age of the average participant was taken into account, Dr. Lev-Ari and Sela note. "The average age of the women in the study group was 39.4, while that of the control group was 37.1. Normally, the older the mother, the lower the pregnancy and delivery rates," they explain.
Reduced fertility stress: Acupuncture may be a useful intervention to assist with the reduction of infertility-related stress. At the end of the 8-week intervention, women in the acupuncture group reported significant changes on two domains on the Fertility Problem Inventory with less social concern (mean difference [MD] -3.75, 95% confidence interval [CI] -7.58 to 0.84, p=0.05), and less relationship concern (MD -3.66, 95% CI -6.80 to -0.052, p=0.02). There were also trends toward a reduction of infertility stress on other domains, and a trend toward improved self-efficacy (MD 11.9, 95% CI -2.20 to 26.0, p=0.09) and less anxiety (MD -2.54, 95% CI -5.95 to 0.86, p=0.08) in the acupuncture group compared with the wait-list control. (Journal of Alternative and Complementary Medicine, 2011 Oct;17(10):923-30. Epub 2011 Oct 6.
Increase embryo transfer rates in IVF: Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation. Group 3 had TEAS treatments: 24 hours before ET and 30 minutes after ET and had a clinical PR, embryos implantation rate, and live birth rate of (50.0%, 25.9%, and 42.0%, respectively), which was significantly higher than the control group. (Fertility and Sterility Volume 96, Issue 4, Pages 912-916, October 2011).
Regulating fertility hormones: stress and other factors can disrupt the function of the hypothalamic pituitary-ovarian axis (HPOA), causing hormonal imbalances that can negatively impact fertility. Acupuncture has been shown to affect hormone levels by promoting the release of beta-endorphin in the brain, which affects the release of gonadotrophin releasing hormone by the hypothalamus, follicle stimulating hormone from the pituitary gland, and oestrogen and progesterone levels from the ovary (Ng EH, So WS, Gao J, Wong YY, Ho PC. The role of acupuncture in the management of subfertility. Fertil Steril. 2008 Jul;90(1):1-13., Huang ST, Chen AP. Traditional Chinese medicine and infertility. Curr Opin Obstet Gynecol. 2008 Jun;20(3):211-5., Lim CE, Wong WS. Current evidence of acupuncture on polycystic ovarian syndrome. Gynecol Endocrinol. 2010 Mar 16. [Epub ahead of print], Stener-Victorin E, Wu X. Effects and mechanisms of acupuncture in the reproductive system. Auton Neurosci. 2010 Mar 27. [Epub ahead of print]).
Increasing blood flow to the reproductive organs: stress also stimulates the sympathetic nervous system, which causes constriction of ovarian arteries. Acupuncture inhibits this sympathetic activity, improving blood flow to the ovaries (Stener-Victorin E, Humaidan P. Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med. 2006 Dec;24(4):157-63., Lim CE, Wong WS. Current evidence of acupuncture on polycystic ovarian syndrome.Gynecol Endocrinol. 2010 Mar 16. [Epub ahead of print]), enhancing the environment in which ovarian follicles develop. It also increases blood flow to the uterus (Stener-Victorin E, Waldenström U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod. 1996 Jun;11(6):1314-7., Huang ST, Chen AP. Traditional Chinese medicine and infertility. Curr Opin Obstet Gynecol. 2008 Jun;20(3):211-5.), improving the thickness of the endometrial lining and increasing the chances of embryo implantation.
Counteracting the effects of polycystic ovarian syndrome (PCOS): PCOS is one of the most common causes of female infertility. By reducing sympathetic nerve activity and balancing hormone levels, acupuncture has been shown to reduce the number of ovarian cysts, stimulate ovulation, enhance blastocyst implantation and regulate the menstrual cycle in women with PCOS (Stener-Victorin E, Waldenström U, Tägnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome Acta Obstet Gynecol Scand. 2000 Mar;79(3):180-8., Stener-Victorin E, Jedel E, Mannerås L. Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence. J Neuroendocrinol. 2008 Mar;20(3):290-8., Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB. Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol. 2009 Aug;297(2):R387-95., Zhang WY, Huang GY, Liu J. [Influences of acupuncture on infertility of rats with polycystic ovarian syndrome] [in Chinese] Zhongguo Zhong Xi Yi Jie He Za Zhi. 2009 Nov;29(11):997-1000.). It may also help to control secondary effects such as obesity and anorexia (Lim 2010).
Reducing miscarriage: A randomised controlled trial comparing acupuncture (plus moxibustion) to medication (oral clomiphene) in 120 women with infertility due to ovulatory disturbance. After treatment for 3 menstrual cycles women in both groups showed similar increases in ovulation rates. However, the pregnancy rate in the acupuncture group was significantly higher than that in the medication group (p<0.05), due to lower levels of miscarriage. (Song FJ. Zheng SL. Ma DZ. [Clinical observation on acupuncture for treatment of infertility of ovulatory disturbance]. [Chinese] Zhongguo Zhenjiu. 28(1):21-3, 2008 Jan.)
Regulating endocrine system: A randomised controlled trial with 240 women with endocrine dysfunctional infertility, 160 receiving acupuncture and 80 clomiphene. The pregnancy rate was 65% in the acupuncture group and 45% for the medication, a statistically significant difference (p<0.5) (Yang JR, Ma YY, Liu YL, Wang HL, Liu Z. [Controlled study on acupuncture for treatment of endocrine dysfunctional infertility] [Chinese]. Zhongguo Zhenjiu. 2005;25(5):299-300)
Regulating ovulation: Prospective, longitudinal non-randomized clinical study investigating the effect of acupuncture on ovulation in 24 women with PCOS and oligo-/amenorrhea. Found that electro-acupuncture induced regular ovulation in 38% of women. In addition, acupuncture influenced neruoendocrine and endocrine parameters indicative of PCOS, such as LH/FSH ratios, mean testosterone concentrations, and beta-endorphin concentrations. (Stener-Victorin E, Waldenström U, Tägnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome Acta Obstet Gynecol Scand. 2000 Mar;79(3):180-8.)
Acupuncture during embryo transfer: A systematic review that looked at the effectiveness of acupuncture in the outcomes of assisted reproductive treatment (ART). A total of 13 randomised controlled trials were included of acupuncture for couples who were undergoing ART comparing acupuncture treatment alone or acupuncture with concurrent ART versus no treatment, placebo or sham acupuncture plus ART for the treatment of primary and secondary infertility. These found evidence of benefit when acupuncture is performed on the day of embryo transfer on the live birth rate (OR 1.86, 95%CI 1.29 to 2.77), but not when it is performed two to three days after embryo transfer (OR 1.79, 95%CI 0.93 to 3.44). There was no evidence of benefit on pregnancy outcomes when acupuncture was performed around the time of oocyte retrieval. The reviewers concluded that acupuncture performed on the day of embryo transfer shows a beneficial effect on the live birth rate. (Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted conception. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006920. DOI: 10.1002/14651858.CD006920.pub2.)
Acupuncture during embryo transfer: A systematic review that evaluated whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation. It included a total of 7 randomised controlled trials with 1,366 women Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (OR 1.65, 95%CI 1.27 to 2.14; number needed to treat [NNT] 10, 95%CI 7 to 17), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 95%CI 1.39 to 2.64; NNT 9, 95%CI 6 to 17). The reviewers concluded that current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation. (Manheimer E et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ 2008;336(7643):545-9.)
Acupuncture during IVF: An overview of the use of acupuncture as an adjunct therapy for in vitro fertilization (IVF). There is limited but supportive evidence suggesting that acupuncture may improve the success rate of IVF and the quality of life of patients undergoing IVF and that it is a safe adjunct therapy. Most studies reviewed had design limitations, and the acupuncture interventions employed often were not consistent with traditional Chinese medical principles. The reviewed literature suggested 4 possible mechanisms by which acupuncture could improve the outcome of IVF: modulating neuroendocrinological factors; increasing blood flow to the uterus and ovaries; modulating cytokines; and reducing stress, anxiety, and depression. They concluded that more high-quality randomized, controlled trials were required. (Anderson et al. In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern. Ther. Health Med. 2007;13(3):38-48)
Acupuncture during IVF: A randomised controlled trial that compared three acupuncture methods to evaluate which method is most effective for IVF. A total of 52 IVF patients were randomly assigned to receive traditional Chinese acupuncture plus electroacupuncture, acupuncture alone (control), or electroacupuncture alone (second control). Comparisons of IVF effectiveness rates were made for each method. All three acupuncture methods increased the success rate for IVF, and there was a marked increase with the combination treatment (81.8% success, which is twice the US average for IVF alone; p0.05). The researchers concluded that their results suggest the combination of acupuncture and electroacupuncture is a promising new technique for the treatment of infertility with a higher IVF success rate than that of either treatment alone. (Kong S, Hughes A. Acupuncture as an adjunct to in vitro fertilization: A randomized trial. Medical Acupuncture 2009;21:179-82.)
Acupuncture for stress during embryo transfer in IVF: A randomised controlled trial to assess the efficacy of acupuncture on pregnancy rates in 150 women undergoing IVF. The women were allocated to acupuncture before and after embryo transfer, while the control group lay quietly. All the women then completed questionnaires on anxiety and optimism. There were no significant differences in pregnancy rates between the two groups, but the acupuncture patients reported significantly less anxiety post-transfer and reported feeling more optimistic about their cycle and enjoyed their sessions more than the control subjects. The researchers concluded that the use of acupuncture in patients undergoing IVF was not associated with an increase in pregnancy rates but did help women feel more relaxed and more optimistic. (Domar AD et al. The impact of acupuncture on in vitro fertilization outcome. Fertil Steril 2009;91:723-6.)
Acupuncture during embryo transfer in IVF: A randomised controlled trial of 228 women receiving 3 sessions (one either side of embryo transfer and one earlier in the process) of acupuncture or non-invasive sham needling. The clinical pregnancy rates were 31% for acupuncture, 23% control. Pregnancy rates at 18 weeks were 28% and 18% respectively. The differences were not statistically significant but would be clinically significant. Authors conclusions: there was no significant difference in the pregnancy rate between groups; however, a smaller treatment effect cannot be excluded. (Smith C et al. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril. 2006; 85(5):1352-8.)
Acupuncture for IVF and ICSI: A randomised controlled trial that evaluated the effect of acupuncture on reproductive outcome in 273 women undergoing IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on the day of embryo transfer, another group on embryo transfer day and again 2 days later (i.e. closer to implantation day), and both groups were compared with a control group that did not receive acupuncture. Clinical and ongoing pregnancy rates were significantly higher in the first acupuncture group compared with controls (39% vs. 26% and 36% vs. 22%, respectively). The clinical and ongoing pregnancy rates in the second acupuncture group (36% and 26%, respectively) were higher than in controls, but the difference did not reach statistical difference. The researchers concluded that acupuncture on the day of embryo transfer significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture, but repeating acupuncture two days later provides no additional beneficial effect. (Westergaard LG et al. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril 2006;85:1341-6.)
Regulation of cortisol and prolactin during IVF: A study that looked at whether changes in serum cortisol and prolactin are affected by acupuncture in IVF patients. In all, 67 infertile women undergoing IVF were grouped as controls (IVF with no acupuncture) and treated (IVF with acupuncture) according to acupuncture protocols derived from randomized controlled trials. Cortisol levels in the acupuncture group were significantly higher on IVF medication days 7, 8, 9, 11, 12, and 13 compared with controls. Prolactin levels in the acupuncture group were significantly higher on IVF medication days 5, 6, 7, and 8 compared with controls. The researchers concluded that there appears to be a beneficial regulation of cortisol and prolactin with acupuncture during the medication phase of the IVF treatment. (Magarelli PC et al. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization-embryo transfer treatment. Fertil Steril 2008; 92(6):1870-9.)
Reducing labour pain: A systematic review that critically evaluated the evidence on acupuncture for labour pain management. Ten randomised controlled trials involving 2,038 women receiving acupuncture alone, or as an adjunct to conventional analgesia, for pain relief in labour were included. Pain intensity on a 100-mm visual analogue scale and uptake of other analgesic methods were used as primary outcomes. VAS for pain intensity data were available in seven studies, and pooling of this data showed that acupuncture was not superior to minimal acupuncture at 1 hour and at 2 hours. Patients reported significantly reduced pain by 4% and 6% during electroacupuncture (EA) treatment at 15 and 30 minutes compared with placebo EA. Compared with no intervention, acupuncture reduced pain by 11% for the first 30 minutes. In trials where acupuncture was compared with conventional analgesia, women receiving acupuncture required less meperidine and other analgesic methods. No acupuncture-related adverse events were reported. (Cho SH et al. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 2010;117(8):907-20.)
Induction of labour: A systematic review of the existing scientific evidence on the potential role of acupuncture for induction of labour during pregnancy. Ten studies were identified. The duration of labour as a result of acupuncture treatment ranged from 10 hours 20 minutes to 29.1 hours. All of the studies demonstrated labour induction by acupuncture treatment. However, because two (of the five) randomised controlled trials reported that there was no statistically significant effect of acupuncture, these results are more suggestive than definitive. The reviewers concluded that, although the definitive role of acupuncture in inducing labour is still yet to be established, the existing studies suggest that acupuncture may be beneficial in labour induction. (Lim CE et al. Effect of acupuncture on induction of labor. J Altern Complement Med 2009;15:1209-14.)
Moxibustion for breech: A systematic review including 6 randomised controlled trials and a total of 1,087 pregnant women that assessed moxibustion for breech presentation. The rate of cephalic version among the moxibustion group was 72.5% versus 53.2% in the control group (relative risk, 1.36; 95% CI 1.17-1.58). In terms of safety, no significant differences were found in the comparison of moxibustion with other techniques. The reviewers concluded that moxibustion at acupuncture point BL67 has been shown to produce a positive effect, whether used alone or in combination with acupuncture or postural measures, in comparison with observation or postural methods alone, for the correction of breech presentation. (Vas J et al. Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis. Am J Obstet Gynecol 2009;201:241-59.)
Breech: A systematic review that evaluated the efficacy and safety of moxibustion to treat breech presentation. Ten randomised controlled trials involving 2,090 women and 7 controlled clinical trials involving 1,409 women were included. Meta-analysis of randomised controlled trials showed significant differences between moxibustion and no treatment (RR 1.35, 95% CI 1.20 to 1.51; 3 RCTs), but not between moxibustion and knee-chest position. Moxibustion plus other therapeutic methods showed significant beneficial effects (RR 1.36, 95% CI 1.21 to 1.54; 2 RCTs). For nonrandomised controlled trials, moxibustion was more effective than no treatment (RR 1.29, 95% CI 1.17 to 1.42; 2 CCTs) but not more effective than the knee-chest position treatment. The reviewers concluded that moxibustion, acupuncture and laser acupoint stimulation tend to be effective in the correction of breech presentation. (Li X et al. Moxibustion and other acupuncture point stimulation methods to treat breech presentation: a systematic review of clinical trials. Chin Med 2009;4:4.)
Breech: A systematic review of studies that assessed the effectiveness of acupuncture-type interventions (moxibustion, acupuncture, or electro-acupuncture) on acupuncture point BL 67 to correct breech presentation compared to expectant management. Six randomised controlled trials and three cohort studies fulfilled the inclusion criteria. In the former, the pooled proportion of breech presentations was 34% following treatment versus 66% in the control group (OR 0.25, 95% CI 0.11-0.58). The pooled proportion in the cohort studies was 15% versus 36% (OR 0.29, 95% CI 0.19-0.43). The reviewers concluded that their results suggest that acupuncture-type interventions on BL 67 are effective in correcting breech presentation compared to expectant management. (van den Berg I et al. Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: a systematic review. Complement Ther Med 2008;16:92-100.)
Breech: A modelling study to estimate the effectiveness and costs of breech version with acupuncture-type interventions, including moxibustion, on BL67 compared to expectant management for women with a foetal breech presentation at 33 weeks gestation. The results suggested that such an intervention would reduce the number of breech presentations at term, thus reducing the number of caesarean sections, and so would be cost-effective compared to expectant management, including external cephalic version. (van den Berg I e tal. Cost-effectiveness of breech version by acupuncture-type interventions on BL 67, including moxibustion, for women with a breech foetus at 33 weeks gestation: a modelling approach. Complement Ther Med 2010;18:67-77.)
Reducing labour pain: A systematic review that examined currently available evidence supporting the use of alternative and complementary therapies for pain management in labour. It included three trials of acupuncture involving 496 women. These showed a decreased need for pain relief. The reviewers concluded that acupuncture may be beneficial for the management of pain during labour, but the small number of women studied was a limitation. (Smith CA et al. Complementary and alternative therapies for pain management in labour. Cochrane Database Syst Rev 2006 Oct 18;(4):CD003521.)
Depression during pregnancy: A randomised controlled trial that assessed the efficacy of acupuncture for depression during pregnancy in 150 pregnant women given acupuncture specific for depression or one of two active controls: control acupuncture or massage. Treatments lasted 8 weeks (12 sessions). The primary outcome was the Hamilton Rating Scale for Depression, at baseline and after 4 and 8 weeks of treatment. Women who received acupuncture specific for depression experienced a greater rate of decrease in symptom severity (p<0.05) compared with the combined controls (Cohen's d=0.39, 95% CI 0.01-0.77) or control acupuncture alone (p<0.05; Cohen's d=0.46, 95% CI 0.01-0.92). They also had significantly greater response rate (63.0%) than the combined controls (44.3%; and control acupuncture alone (37.5%; p<0.05). Symptom reduction and response rates did not differ significantly between controls. The researchers concluded that acupuncture specific for depression reduces symptoms and increases response rate in similar amounts to those observed with standard depression treatments and could be a viable treatment option for depression during pregnancy. (Manber R et al. Acupuncture for depression during pregnancy: a randomized controlled trial. Obstet Gynecol 2010;115:511-20.)
Dyspepsia in pregnancy: A randomised controlled trial under real-life conditions that assessed the effects of acupuncture on symptomatic dyspepsia during pregnancy and compared this with a group of patients undergoing conventional treatment alone. A total of 42 conventionally-treated pregnant women were treated, or not, by acupuncture. They reported the severity of symptoms and the disability these were causing in daily aspects of life such as sleeping and eating, using a numerical rating scale. The study also observed the use of medications. Significant improvements in symptoms were found in the acupuncture group. This group also used less medication and had a greater improvement in their disabilities when compared with the control group. The researchers concluded that acupuncture may alleviate dyspepsia during pregnancy. (da Silva JB et al. Acupuncture for dyspepsia in pregnancy: a prospective, randomised, controlled study. Acupunct Med 2009;27:50-3.)
Reducing labour pain: A randomised controlled trial to investigate the effect of moxibustion at Spleen 6 (SP 6) for uterine contraction pain in labour, and evaluate its safety. In all, 174 women with singleton pregnancies and cephalic presentation were allocated to a moxibustion group, a placebo-treated group and ‘blank’ group. Moxibustion was applied for 30 minutes when the cervix was 3cm dilated. The uterine contraction pain was assessed using a Visual Analogue Scale (VAS). The VAS scores in the treatment group were obviously decreased after 15 and 30 minutes of moxibustion (both p<0.05), but there were no obvious changes in VAS scores in placebo treated group and the blank group. VAS scores decreased more with moxibustion than the other two groups (all p<0.05). After 30 minutes of moxibustion, the effective rate of labour analgesia was 69.5% in the moxibustion group (vs. 45.6% in the placebo and 43.1% in the blank group, p<0.05). Postpartum haemorrhage was less, and the Apgar score of newborn was higher, in the moxibustion group than in the placebo group and blank group (all p<0.05). The researchers concluded that moxibustion at Spleen 6 can relieve uterine contraction pain, and is not associated with side effects in either the mother or infant. (Ma SX et al. Effect of moxibustion at Sanyinjiao (SP 6) for uterine contraction pain in labor: a randomized controlled trial [Article in Chinese] Zhongguo Zhen Jiu 2010;30:623-6.)
Oligoasthenozoospermia: A randomised single-blind placebo-controlled trial including 57 infertile men with severe oligoasthenozoospermia, which compared traditional Chinese medicine (TCM) acupuncture with placebo acupuncture. The TCM acupuncture group had a significantly higher percentage of motile sperm (World Health Organization categories A-C) than the placebo acupuncture group. (Dieterle S et al. A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. Fertility and Sterility 2009; 92: 1340-3.)
Low sperm count: A study that assessed the effects of acupuncture treatment on sperm output in patients with low sperm density associated with a high scrotal temperature. A total of 39 men were given acupuncture for a low sperm output. Based on 18 men with normal fertility (the control group), threshold scrotal skin temperature was set at 30.5oC, and temperatures above this were considered to be high. Accordingly, 34 of the 39 participants in the experimental group initially had high scrotal skin temperature; the other five had normal values. Scrotal skin temperature and sperm concentration were measured before and after acupuncture treatment. Following treatment, 17 of the 34 patients with hyperthermia, all of whom had genital tract inflammation, had normal scrotal skin temperature; in 15 of these 17 patients, sperm count increased. In the remaining 17 men with scrotal hyperthermia, neither scrotal skin temperature nor sperm concentration was affected by the treatment; however, 90% had high gonadotrophins or mixed aetiological factors. The five patients with initially normal scrotal temperatures were not affected by the acupuncture treatment. The researchers concluded that low sperm count in patients with inflammation of the genital tract seems to be associated with scrotal hyperthermia, which can be reversed with acupuncture treatment. (Siterman S et al. Success of acupuncture treatment in patients with initially low sperm output is associated with a decrease in scrotal skin temperature. Asian Journal of Andrology 2009; 11: 200-8.)
Unexplained male infertility: A randomised controlled trial that evaluated the ultramorphologic sperm features of idiopathic infertile men after acupuncture therapy. A total of 40 men with idiopathic oligozoospermia, asthenozoospermia, or teratozoospermia took part. Twenty eight of the patients received acupuncture twice a week over a period of 5 weeks. The samples from the treatment group were randomised with semen samples from the 12 men in the untreated control group and evaluated by transmission electron microscopy. The data showed a significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects. However, specific sperm pathologies in the form of apoptosis, immaturity, and necrosis showed no statistically significant changes between the control and treatment groups before and after treatment. The researchers concluded that idiopathic male infertility could benefit from acupuncture treatment, and result in a general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa. (Pei J et al. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertility and Sterility 2005; 84: 141-7.)
Semen abnormalities: A randomised controlled treatment that evaluated the effect of acupuncture and moxa treatment on the semen quality in 19 men with semen abnormalities, such as low concentration, abnormal morphology and/or progressive reduced motility without apparent cause. Patients were either given acupuncture and moxa or sham acupuncture for 10 weeks. Semen analyses were performed before and after the treatment course. The patients given acupuncture had a significant increase in the percentage of normally-formed sperm compared to the sham group. (Gurfinkel E et al. Effects of acupuncture and moxa treatment in patients with semen abnormalities. Asian Journal of Andrology 2003; 5: 345-8.)
Low sperm count: Azoospermia. Light microscope (LM) and scanning electron microscope (SEM) were used to examine semen before and 1 month after acupuncture treatment. The study group originally contained three severely oligoteratoasthenozoospermic, two pseudoazoospermic and 15 azoospermic patients. The control group was comprised of 20 untreated males who underwent two semen examinations within a period of 2-4 months and had initial andrological profiles similar to those of the experimental group. No changes in any of the parameters examined were observed in the control group. A definite increase in sperm count was detected in the ejaculates of 10 (67%) of the 15 azoospermic patients, 7 of whom exhibited post-treatment spermatozoa that were detected even by LM. The sperm production of these seven males increased significantly, from 0 to an average of 1.5 x 106 spermatozoa per ejaculate (p=0.01). Males with genital tract inflammation exhibited the most remarkable improvement in sperm density (on average from 0.3 x 106 spermatozoa per ejaculate to 3.3 x 106 spermatozoa per ejaculate; p=0.02). The researchers concluded that acupuncture may be a useful, nontraumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation. (Siterman S et al. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia 200l 32: 31-9.)
IVF: Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group. Acupuncture seems to be a useful tool for improving pregnancy rate after ART. Wolfgang E. Paulus, M.D.,[a] Mingmin Zhang, M.D.,[b] Erwin Strehler, M.D.,[a] mam El-Danasouri, Ph.D.,[a] and Karl Sterzik, M.D.[a] Christian-Lauritzen-Institut, Ulm, Germany
Miscarriage: Women who receive acupuncture during the stimulation phase of an in vitro fertilization cycle and again immediately after embryo transfer have a higher live-birth rate than do controls, according to the first acupuncture study with this end point. The miscarriage rate was almost halved in the acupuncture group (8% vs. 14%). (Magarelli, OB/Gyn News, 2005)
TCM for IUI: In the first study that measures the effectiveness of both herbs and acupuncture in combination with IUI infertility treatment, Dr. Shahar Lev-Ari and Keren Sela of TAU's Sackler Faculty of Medicine and the Tel Aviv Medical Center say that the results, which have been published in the Journal of Integrative Medicine, show a significant increase in fertility when the therapies are administered side-by-side. In terms of both conception and take-home baby rates, the test group fared far better than the control group. Out of the 29 women in the test group, 65.5 percent conceived, and 41.4 percent delivered healthy babies. In the control group, only 39.4 percent conceived and 26.9 percent delivered. The vast difference in success rates is even more surprising when the age of the average participant was taken into account, Dr. Lev-Ari and Sela note. "The average age of the women in the study group was 39.4, while that of the control group was 37.1. Normally, the older the mother, the lower the pregnancy and delivery rates," they explain.
Female fertility: The management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to TCM diagnosis, appears to be fundamental to successful treatment of female infertility. Meta-analysis of RCTs suggested a 3.5 greater likelihood of achieving a pregnancy with CHM therapy over a 4-month period compared with WM drug therapy alone. Meta-analysis of selected cohort studies (n = 616 women) suggested a mean clinical pregnancy rate of 50% using CHM compared with IVF (30%) (p < 0.0001). (Complementary Therapies in Medicine Volume 19, Issue 6 , Pages 319-331, December 2011).
LH defect: Sixty cases of infertility due to luteal phase defect were treated with herbs to tonify the kidney and regulate the menstrual cycle. After the treatment, the hyperthermal phase score of basal body temperature (BBT) was markedly increased (P less than 0.05), the hyperthermal phase 7-8 days after ovulation improved (P less than 0.001), the transitional period of BBT remarkably shortened, and the pregnancy rate in 32 uncomplicated cases of luteal phase defect was 56%. The close relationship between luteal phase defect and the kidney deficiency syndrome in TCM was discussed. The key points of the treatment included coordination of yin and yang, regulation of qi and blood, and combination of tonification with reduction. (J Tradit Chin Med. 1991 Jun;11(2):115-20. Lian F. Nanjing College of Traditional Chinese Medicine.)