Acupuncture in IVF Linked to Lower Miscarriage and Ectopic Rates

PHILADELPHIA — 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.

“Other studies have looked at pregnancy rates, but what is really important is whether or not there is a baby,” said Paul C. Magarelli, M.D., who reported his findings at the annual meeting of the American Society for Reproductive Medicine.

The retrospective study included 131 women who were undergoing standard in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). All of these women were considered good prognosis candidates for IVF/ICSI and were given the choice of having acupuncture.

A total of 83 women declined (controls) and 48 accepted.

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There were no significant differences between the two groups in terms of infertility diagnoses, demographics, and treatment protocols, except that sperm morphology was slightly better in the partners of women receiving acupuncture (7.3% vs. 5.9 % normal forms with strict criteria evaluation), and the average uterine artery pulsatility index was lower in the acupuncture group (1.57 vs. 1.72), said Dr. Magarelli of the department of ob.gyn. at the University of New Mexico, Albuquerque.

The study found that pregnancy rates per embryo transfer were not significantly different between the two groups (50% in the acupuncture group and 45% in controls).

The miscarriage rate was almost halved in the acupuncture group (8% vs. 14%).

In addition, the rate of ectopic pregnancies was significantly lower in the acupuncture group—0 of 24 pregnancies (0%) vs. 2 of 37 pregnancies (9%), said Dr. Magarelli, who is also in private practice in Colorado Springs and Albuquerque.

Thus, the live-birth rate per IVF/ICSI cycle was significantly higher in the acupuncture group than in controls (21% vs. 16%).

“The live-birth rate per pregnancy is an even more telling number, since some cycles get cancelled. There was a 42% live-birth rate per pregnancy in the acupuncture group, compared to a 35% rate in the nonacupuncture group,” Dr. Magarelli said in an interview with this newspaper.

“We believe that what we are doing is improving the uterine environment such that implantation is improved,” he added.

The study used two acupuncture protocols.

The Stener-Victorin electrostimulation protocol—which has been shown to reduce high uterine artery blood flow impedence, or pulsatility index (Hum. Reprod. 1996;11:1314-7)—was used for eight treatments during ovarian stimulation.

The second acupuncture technique—the Paulus protocol, which has been associated with improved pregnancy rates (Fertil. Steril. 2002;77:721-4)—was used within 24 hours before the embryo transfer and 1 hour after.

“This protocol has demonstrated reductions in uterine contractility, so by relaxing the uterus before the embryo transfer and immediately after, we felt we were setting up a better environment for implantation,” Dr. Magarelli said.

For more information on IVF and acupuncture, visit www.berkleycenter.com

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Study Shows Acupuncture Treatment May Help Male Infertility Problems

Acupuncture may help some men overcome infertility problems by improving the quality of their sperm, according to a new study.

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Researchers found that acupuncture treatment reduced the number of structural abnormalities in sperm and increased the overall number of normal sperm in a group of men with infertility problems.
They say the results suggest that acupuncture may complement traditional infertility treatments and help men reach their full reproductive potential.

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Acupuncture May Ease Male Infertility
The male partner is a factor in up to 50% of infertile couples, write the researchers. In many cases, the cause of male infertility is unknown.
Previous studies of acupuncture and male infertility have suggested that acupuncture can improve sperm production and motility and count.
In this study, researchers looked at the effects of acupuncture on the structural health of sperm in men with infertility of unknown cause. The findings appear in the July issue of Fertility and Sterility.
Twenty-eight infertile men received acupuncture treatments twice a week for five weeks, and 12 received no treatment and served as a comparison group.
Researchers analyzed sperm samples at the beginning and end of the study and found significant improvements in sperm quality in the acupuncture group compared with the other group.
Acupuncture treatment was associated with fewer structural defects in the sperm and an increase in the number of normal sperm in ejaculate.
But other sperm abnormalities, such as immature sperm or sperm death, were unaffected by acupuncture.
The researchers write that acupuncture treatment is a simple, noninvasive method that can improve sperm quality.


SOURCE: Pei, J. Fertility and Sterility, July 2005; vol 84: pp 141-147.

NYC Community Event for Endometriosis and Infertility

Community Presentation on Endometriosis

 Thursday, April 17, 2014

 7:00pm-8:00pm

 The Berkley Center 

16 E 40th Street, 2nd Floor

New York, NY 10016

This is an open event to the community to join us for an intimiate Q&A with Director and Founder of the Berkley Center, Mike Berkley about the topic of Endometriosis.

CLICK TO RSVP

March is Endometriosis Awareness Month

                       

Acupuncture has been shown to help idiopathic couples, women with PCOS, endometriosis and poor egg quality due to advanced maternal age. 


Let's start with PCOS. These patients typically have double the miscarriage rate of patients in the non pcos population and are often infertile; the etiology of both of these dynamics occurs as a result of poor egg quality as a result of ovarian hyperandrogenism.

Acupuncture improves hemodynamics to the uterus and to the ovaries there by facilitating an improved excretion of androgen from the ovaries leaving the ovaries with a less challenged estrogenic milieu. This can, in some case, improve egg quality and therefore help to improve pregnancy outcomes while simultaneously reducing miscarriage due to aneuploides.

Furthermore, acupuncture, along with exercise and life-style counseling can often improve weight loss, which, in and of itself, lowers the androgen profile of these patients.

Acupuncture has also been shown to facilitate ovulation in some of these patients but I believe that an east meets west approach to care is best as clomiphine citrate (clomid) or injectables can almost guarantee ovulation - but not improved egg quality. The utilization of both modalities therefore potentiates the effect of both with a concomitant advantage to the patient.





On to endometriosis: this is an autoimmune, inflammatory disorder that is mostly (though not always) diagnosed via laparoscopic intervention. When laparoscopy is performed fertility quotients often improve even in cases where there is no tubal pathology. Why is this? It is because when endometriotic implants are resected, the origin of pro-inflammatory cytokines is eliminated and the uterine milieu is improved and perhaps (I don't know for sure) pinopode behavior and manifestation is improved.

It is a fact that even though endometriosis in inherently a disease that is not of the uterus, uterine linings in woman with endometriosis are often clinically or sub-clinically affected. So not only are there uterine inflammatory processes occurring but implantation failure may also be a contributing factor. None of this has anything to do with the tubes. When a laparoscopy is executed it is probable that not all of the endometriosis is resected because 1)some endometriosis has the same color as normal tissue and 2) some endometriosis is located in areas that are either unavailable to the surgeon or are hidden behind various pelvic structures. As a result, some pro inflammatory cytokine activity may sill be manifest even after laparoscopic intervention. Since acupuncture improves hemodynamics, once again the utilization of acupuncture may serve to help excrete these unwanted cytokines improving uterine receptivity and environment creating a more hospitable environment for an embryo.

Some woman status-post resection still have severe pelvic pain and remain infertile (and I am taking age and other confounding pathologies out of the equation). Why is this? Probably because there remain ectopic endometrium with concomitant pathology at the level of the uterus. Acupuncture often helps these patients for the reason(s) I stated above.

In the case of the idiopathic patient, the acupuncturist, through his or her diagnostic evaluation will often uncover factors that are not taken into consideration during the Western medical evaluation. These issues (clots in the menstruate, severe pelvic pain with menses, night sweats, cold pelvis, severe stress and more) lead the practitioner of traditional Chinese medicine to arrive at what is known as a 'pattern of disharmony' and that pattern is then treated. Often, pregnancy results. Though the language and paradigm of traditional Chinese medicine are different from this of Western medicine there must be some biological, metabolic, endocrinological, neurologic effect occurring in response to the acupuncture which often, though certainly not always results in pregnancy.

                       

Stranger stories have been told. For example: take the patient who has undergone 6 IUI's and 6 IVF's (even with PGD or CGH) and have never conceived and the couple gives up. Four years later, she conceives with intercourse and has a live birth of a healthy baby.

The point is, as you can imagine, Western diagnostic capabilities are excellent but not complete nor all encompassing. Certainly fertility evaluations will be different 50 years from now. There are reasons for infertility that none of us are aware of and only a few that we are.

The use of acupuncture may be touching upon areas that Western medicine is not looking at or paying attention to. This is not a criticism but a scientific fact. We know what we know, we don't know what we don't know, but we must know that we don't know; in time, we will know more but never all.



I hope this helped to elucidate the use and mechanism-of-action of acupuncture in the setting of the infertile patient. 


Best wishes. 
Mike Berkley, L.Ac.