Infertility and Acupuncture FAQ

Table of Contents

Acupuncture and Reproductive Health

Update November 2014,  by Tim H. Tanaka, Ph.D. R.Ac., R.TCMP

Reproductive-Acupuncture

What are the potential effects of acupuncture on the female reproductive system?


Acupuncture has been reported to promote the circulation of blood in the pelvic cavity and improve ovarian function.1 Studies have suggested that acupuncture treatment can be beneficial in promoting follicle production,2 enhancing uterine blood flow3,4 and improving uterine lining thickness5,6 and increasing endometrial receptivity during the implantation period.7,8

 

Can acupuncture help hormonal imbalances?

 

Many women visit our clinic concerning hormonal issues, including imbalances of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, progesterone, prolactin, anti-Müllerian hormone (AMH), thyroid hormones, etc. Acupuncture has been suggested as a valuable alternative therapy for female infertility due to hormone disorders.9 Studies have also shown improvement of reproductive hormone secretion patterns in women with polycystic ovaries (PCOS).10,11

 

Can you tell me the difference between conventional methods and a traditional acupuncture approach to regulate menstrual cycles?

 

Assisted reproductive technologies (ART) provided by reproductive medical specialists are designed to override menstrual cycle difficulties by artificially controlling a woman’s cycle by administering cycle-altering hormone drugs. Acupuncture does not directly alter the female hormones; rather, it is considered to influence the hormonal regulation centers in the brain and autonomic nervous system such as the hypothalamic-pituitary-ovarian/gonadal  (HPG) axis and hypothalamic-pituitary-adrenal (HPA) axis.  As a result, a woman’s menstrual cycle can be better regulated over time.

 

Why is improving blood flow to my ovaries and uterus important?

 

Increased blood flow to the ovaries and uterus is considered to enhance ovarian responsiveness and the development of adequate uterine lining for embryo implantation. Blood-thinning medications such as low-dose aspirin, often prescribed by fertility specialists, are an example of a therapeutic attempt to increase blood flow in the uterine lining.12 Some specialists have also been prescribing vaginal sildenafil citrate (Viagra), in order to augment blood flow to female organs for women with thin uterine lining.13  As indicated above, acupuncture has been shown to increase blood flow to the ovaries and uterus without the use of medication.

 

How important is blood flow from a Chinese medicine perspective?

 

In Chinese medicine, proper flow of blood (and qi) is considered the most important factor for the body to freely function without pain or illness. Many female health concerns such as endometriosis, uterine fibroids, ovarian cysts, dysmenorrhea, and amenorrhea are often associated with the Chinese medicine’s diagnostic criteria of blood stasis (stagnation of old blood). Signs and symptoms of potential underlying circulation problems include cold hands and feet, varicose veins, painful menses, and clotting blood in menstrual blood.

 

I am not getting my period after I stopped taking birth control pills. Can acupuncture help restore my cycle?

 

I encounter patients with this situation very frequently in our clinic.  The oral contraceptive pill prevents your body from making the female hormones involved in ovulation and menstruation as the pill artificially mimics the woman’s natural monthly fluctuation of hormones. When you stop taking the pill, it can take some time for your body to return to a normal production of these hormones and generate a natural ovulation and menstruation monthly cycle. Most women experience a return of regular ovulatory cycles soon after stopping the pill. However, if your period does not return for several months, you may have what is known as post-pill amenorrhea.  Acupuncture assists the woman’s natural hormone cycle by influencing the hypothalamic pituitary gonadal axis (HPG axis – ovarian hormone feedback loops).  Studies have also demonstrated the positive effects of acupuncture on ovulation inductions.10,11,14,15

 

I think I’m having trouble getting pregnant due to my age. Does acupuncture reverse the aging process?

 

It is important to remember that there are two types of aging: chronological and biological. While everyone ages at the same speed chronologically, the biological aging process differs greatly among individuals; that is the reason why each woman goes into menopause at a different time in their lives. So while it is generally true that the quality of a woman’s eggs declines as she ages, eggs of some women in their forties can be of excellent quality due to slow biological aging.

Progression of biological aging is mainly determined by genetic and lifestyle factors. While the former cannot be modified, the latter can be modified by each individual and acupuncture can be helpful. While we have reservations in using the statement that acupuncture can reverse the aging process, we have had several cases in our clinic in which women over the age of 50 who were postmenopausal began to have regular menstruation cycles after receiving acupuncture on a regular basis for general health.

 

Do you treat underlying gynecological conditions that are preventing me from getting pregnant?

 

We have many women who come to our clinic with a variety of health issues that create a potential barrier to becoming pregnant including endometriosis, uterine fibroids, ovarian cysts, hypothyroid, and various autoimmune conditions. Responses to acupuncture can vary depending on each individual’s health history and severity of the condition.

 

I read somewhere that the success rate of acupuncture is 75 percent.  Is it true?

 

Please keep in mind that claims and statistics are totally different animals.

Infertility is caused by a variety of factors and it is well-known that fertility rates vary significantly depending on various factors such as the age of the patient and co-existing medical conditions. Statistics can be easily manipulated and the success rate can vary greatly depending on the criteria and rules used when calculating the statistics, as well as the patients population treated in the particular acupuncture clinic. Accordingly, the “success rate” of one acupuncture clinic can be significantly lower or higher than 75 percent depending on patient demographics and how the numbers are generated. Since no guideline exists for producing the success rates of acupuncture clinics, consumers are advised to read those claims cautiously.

 

What about acupuncture and male factor infertility?

 

There are studies that have reported effectiveness of acupuncture on male sub fertility.16-18

We have treated a number of cases concerning male fertility issues such as low sperm count, low motility, poor morphology, high DNA fragmentation etc., and we have observed cases of impressive sperm quality improvement in those parameters. We usually recommend the treatment on a trial basis for a period of three months. It is worth noting that Japanese studies (randomized control trial and clinical case series) have indicated a significant improvement in sperm concentration and motility following administrations of certain Kampo formulations.19

(Original version of this FAQs was posted on acupuncture-treatment.com in 2002 by Tim H. Tanaka, Ph.D.)

Fertility Treatment Procedures using Acupuncture and Moxibustion

Updated November 2014 by Tim H. Tanaka, Ph.D. R.Ac., R.TCMP.

In which parts of the body are fertility acupuncture points located?

Some of the most well-known acupuncture points traditionally used for infertility are located on the lower back, sacrum, lower abdomen, and the back and inner part of the lower legs. Those regions are also considered very important from a neuroanatomical perspective. The regions are within the spinal nerve segmental innervations of the ovaries and uterus (T10-L2 and S2-S4 dermatomes).20 Series of laboratory studies on rats demonstrated that stimulating acupuncture points located within the T10-L2 and S2-S4 dermatomes significantly influenced ovarian and uterine blood flow via a physiological mechanism called somato-visceral reflex.21-27 Some of the most commonly used acupuncture points for infertility and female reproductive problems are shown on this page.

My previous acupuncturist always treated only one side of the body. 

Our specialized fertility protocol always involves acupuncture stimulation on both the front and back of the body.  As indicated above, there are essential fertility points located in both the front and back part of the body.  Treating a patient in one position severely limits the usage of effective acupuncture points.

Do you use other points besides fertility points?

Besides the fertility points, there are points on the head, neck, upper back, legs and arms that may be used in order to modulate the autonomic nervous system and further induce the relaxation response.

We believe any natural fertility treatment program should address the whole body instead of just reproductive organs. Our comprehensive fertility acupuncture treatment always includes a holistic acupuncture approach, which intends to optimize a patient’s entire organic system, produce a relaxation response, decrease stress and anxiety, and improve overall health. As a result, fertility can be greatly enhanced.

What else besides the acupuncture points determines the effect of the treatment?

In North America, most students learn to treat a patient by matching the condition with prescribed acupuncture points in a textbook. Thus, there are many practitioners who tend to only focus on the selection of acupuncture points, and do not pay enough attention to other equally (if not more) important variables in providing effective acupuncture. Consistent efficacy cannot be expected by simply inserting needles at specific points in the body. Research experiments28-30 demonstrate that even when the same acupuncture point is stimulated, the physiological response varies greatly (sometimes even in opposite directions) depending on how the point is stimulated (the depth of the needle, the intensity, etc.).

I am afraid of needles

Our Japanese acupuncture treatment techniques are distinctively gentle and painless. The needles are inserted typically to no more than one or two millimeters in depth. This painless and gentle needling technique is crucial to increase peripheral blood flow and for the relaxation response to occur. Furthermore, because the procedure is virtually non-invasive, the treatment can be applied safely during luteal phase and early pregnancy. Please visit our acupuncture clinic page for more information about our acupuncture treatment.

During which part of my cycle should I get acupuncture done? Should I come just before ovulation?

It is generally recommended that you receive acupuncture treatments on a regular basis, one to two times a week throughout your cycle, especially during an initial treatment period (the first two to three months) in order to correct underlying imbalances. The cumulative effect from regular acupuncture treatments can produce significant long-lasting benefits. Following the initial period, certain patients may be advised to focus the treatment on a specific phase of their menstrual cycle. Our specialized ferrtility protocol31 utilizes different acupuncture procedures depending on the phase of menstrual cycle (during menstruation, pre-ovulation, ovulation/pre-implantation and luteal phases), in order to further potentiate the therapeutic effect and safety of the treatment. For patients undergoing in vitro fertilization (IVF), acupuncture treatment will be modified according to the IVF protocol and phases (pre-stimulation, during stimulation, between egg retrieval and embryo transfer, post transfer). Read more about acupuncture during IVF or IUI

What if I unknowingly become pregnant while I am receiving acupuncture?

As indicated, we utilize different acupuncture procedures depending on the phase of menstrual cycle (during menstruation, pre-ovulation, ovulation/pre-implantation and luteal phases).

After the potential implantation period (usually six to nine days post ovulation), we always consider the possibility of pregnancy and modify our protocol accordingly. The treatment during the later part of the cycle (the Phase 4 approach) is extremely gentle, intended to induce relaxation and minimize the release of harmful stress hormones, which can also help decrease the unwanted uterine contractions. I consider that our Phase 4 approach is not only absolutely safe, but it also helps stabilize the implantation of embryo.  Therefore, I usually recommend those patients, especially those who have histories of recurrent early miscarriages, to continue the treatment during the first trimester.

Unfortunately, many people (including health professionals and acupuncturists) frequently discuss acupuncture in generic terms.  It is important to remember that there are many ways of doing acupuncture, and potential risks and benefits vary greatly depending on who does the treatment and when and what kind of acupuncture methods are used. Please keep in mind this important issue when you read about acupuncture in any media or discuss your acupuncture treatment with your reproductive medicine specialists.

What is moxibustion treatment?

Moxibustion is a form of fire heat treatment that stimulates specific acupuncture points of the body. Moxibustion has been used in tandem with acupuncture to treat a variety of diseases throughout Asia for thousands of years. Most women who have difficulty conceiving have symptoms of cold hands and feet even in the summertime and sufficient blood flow to their reproductive organs is often compromised. The heat stimulation applied on selected acupuncture points helps to increase blood circulation to the uterus and pelvic area. The gentle soothing heat provided by moxa also induces a deep relaxation response that aids fertility as well.

I would like to know more about your acupuncture treatment

 

I live very far away. Do you have any other locations?

 

We only have one location at 80 Bloor Street West, Toronto, Ontario.

Because of our reputation and the quality of acupuncture service we offer, many of our patients are not from our neighborhood, but in fact, come from very far.  Whatever the reason, if it is difficult for you to come to our clinic in Toronto, you can try to find a practitioner in your local area. Here are some resources and tips on how to find an acupuncturist for fertility issues in your area.

(Original version of this FAQs was posted on acupuncture-treatment.com in 2002 by Tim H. Tanaka, Ph.D.)

Acupuncture and Assisted Reproductive Technologies

Update November 2014,  by Tim H. Tanaka, Ph.D. R.Ac., R.TCMP

A number of patients have been receiving acupuncture at The Pacific Wellness Institute while receiving medical fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF). Our acupuncture protocols are adjusted based on the phase of IUI or IVF cycles

Acupuncture-and-IVF

I will be undergoing IVF. When should I start acupuncture and how often should I receive treatment?

 

The recommended treatment schedule is based on consideration of various factors in your specific case. In many cases, we recommend that you start acupuncture treatment at least one to two months prior to the commencement of the IVF cycle and that you continue for one to two times a week until the day of the transfer. This acupuncture IVF schedule is also consistent with the recommendation and protocols used by American32 and Japanese33 advanced reproductive medicine centers.

 

My IVF cycle has already started.  Is it too late to start acupuncture?

 

It is never too late to start acupuncture. While you would likely obtain more cumulative benefits from the treatment by starting earlier, it would be still beneficial to receive acupuncture in any phase of the IVF cycle.

 

What happens after the embryo transfer?  Shall I continue acupuncture?

 

Many of our IVF patients request continuing their treatments after the transfer. That is because they found our treatment so relaxing and was helping them decrease anxiety while waiting for post IVF pregnancy test results. Our post transfer acupuncture protocol is similar to our gentle Phase 4 approach used during the late luteal phase, mentioned earlier.

 

Shall I come right after the embryo transfer?

 

On the day of the transfer, we usually suggest to our patients that they go home, relax, and do our recommended breathing exercises after the procedure.

 

I would like to get acupuncture according to the protocol used in a German study. What are your thoughts on this method?

 

In April 2002, German researchers reported that they had increased the success rate by nearly 50 percent in women undergoing in vitro fertilization (IVF) using acupuncture.34  As the study was highly publicized, the German protocol quickly became a “gold standard” acupuncture protocol during the IVF cycle and the protocol has been used by many acupuncturists. Following the 2002 study, however, other investigators35-39 as well as the original German group40 failed to replicate their findings. Systematic review studies that analyzed the efficacy of acupuncture (German protocol and its modified protocols) with IVF pregnancy rate showed conflicting results.41-43 We have never used the German protocol and many acupuncturists who are up-to-date in the latest research also no longer follow the German protocol.  (See my earlier comments in 2002, regarding the German study here). It is important to keep in mind that most studies that tested efficacy of acupuncture during IVF are only related to the particular protocols used by the German group and most do not bear any relation to what would now be considered to be the best or most effective acupuncture protocol during IVF or the treatment of infertility.

Update November 2018:  A systematic review study on the German acupuncture protocol has been published in October 2018. Based on the results of meta-analysis of previous clinical trials using the German method, the authors do not recommend using this protocol with IVF procedure as this particular acupuncture protocol might negatively impact the pregnancy rate.

Schwarze JE et al.: Does acupuncture the day of embryo transfer affect the clinical pregnancy rate? Systematic review and meta-analysis. JBRA Assist Reprod. 2018 Nov 1;22(4):363-368

Related Article: Acupuncture Points used in IVF Clinical Trials

 

Is there any additional benefit of receiving acupuncture during IVF cycle?

Acupuncture has been used for pain relief during oocyte (egg) retrieval44-49 and to improve the quality of life of patients undergoing IVF.44,50

(Original version of this FAQs was posted on acupuncture-treatment.com in 2002 by Tim H. Tanaka, Ph.D.)

Fertility Diet, Nutrition, and Lifestyle      

Updated November 2014 by Tim H. Tanaka, Ph.D., R.AC., R.TCMP

Why is a healthy lifestyle so important for reproductive health?

 

Within the modern medical approach to fertility, there still exists a fair amount of controversy and disagreement among reproductive specialists. However, there are two factors that every specialist agrees upon. First, when a woman is younger, the pregnancy rate is significantly higher. Second, when a woman is healthier, the pregnancy rate is also increased.

Accordingly, any natural fertility treatment program should be addressing the whole body instead of only reproductive organs, promoting a healthy lifestyle including diet, nutrition, and stress management.

 

Do I need to modify my diet?

 

A healthy balanced diet is always important. You may be asked to fill out an additional questionnaire to give us an idea about your dietary and nutritional status. Many women who have difficulty conceiving are categorized as having a ‘cold constitution’ according to eastern medical diagnosis (see moxibustion for further explanation). Generally speaking, many young women consume large amounts of foods and drinks that cool down their internal organs, which can potentially interfere with the proper functioning of the reproductive system.

 

Do I need to lose weight?

 

Maintaining a healthy weight is important for proper female hormone function. It has been well known that obesity has been linked to menstrual disorders, ovulatory disturbances, decreased fertility, miscarriages, and an increased rate of pregnancy complications.51 It should be noted that a drastic weight loss within a short period of time is not recommended, especially if you are currently trying to get pregnant. During weight loss, fat soluble toxins are released in the bloodstream, an excessive amount of which can be harmful to your body and fetus.

 

Do you have any recommendations regarding supplements?

 

Many experts recommend a good vitamin/mineral supplementation program during the entire pregnancy and nursing periods. However, an excellent nutritional supplementation program (especially supplementing with folic acid) should be started as soon as you plan to become pregnant. Most commercially available prenatal vitamins are designed to meet the unique nutritional demand during pregnancy and nursing period; therefore, they are high in calcium, magnesium, iron, folic acid, and other essential nutrients. Most patients who are having difficulty conceiving, however, have different nutritional demands, and a more specific supplementation program may be required. For example, it is known that the quality of eggs declines with age as a result of oxidative stress. A more bioavailable multivitamin with a high antioxidant potential may be recommended. One study suggested an association between oxidative stress and early miscarriage.52

 

What about taking Coenzyme Q10?

 

The CoQ10 has been shown to significantly increase the number of ovulated eggs in older mice.53  Accordingly, some fertility specialists are recommending CoQ10 and other antioxidants, especially for women with poor ovarian reserve and/or advanced maternal age.54 The CoQ10 supplementation has also been found to be effective in improving male sperm parameters.55,56  The CoQ10 is available in many health food stores in two different forms: Ubiquinone and Ubiquinol. For more information regarding the type of CoQ10 and antioxidant potential, please read my blog article.

 

What about taking herbs?

 

A variety of herbs have been traditionally used to improve the health of reproductive organs.57 In recent years, Japanese Kampo formulas in particular have been studied for various reproductive and gynecological applications.58 Accordingly, a growing number of Japanese physicians and specialists have been prescribing Kampo formulations on a routine basis for their patients.

 

Why is having a good night’s sleep is so important?

 

Insomnia and poor quality sleep often result in the disruption of the circadian rhythm, the approximately 24 hour cyclic rhythm of our “biological clock”. This “biological clock” helps regulate breathing and heart rate, body temperature, blood pressure, hormone production, menstruation, and other vital bodily functions. An irregular lifestyle can disrupt the normal circadian rhythmic pattern.59 Having regular quality sleep is extremely important for fertility, as studies show low fertility rates and early pregnancy losses among shift workers.60-65 Regular, quality sleep is particularly important if a woman is suffering from an irregular menstrual cycle, anovulation, amenorrhea, or PCOS, all of which can be considered as biological rhythm (infradian) disorders. Regular acupuncture treatment combined with our specific breathing exercise technique creates a specific heart rate variability pattern (coherent HRV rhythm), which can greatly influence hypothalamic activity, helping restore a normal biological rhythm.

 

Is there a link between stress and infertility?

 

The role of stress and reproductive failure has been well documented.66 There are studies indicating the relationship between stress and infertility.67,68 Stress has also been suggested to be linked with unsuccessful IVF.69-71

Stress hormones such as catecholamines (adrenalin, noradrenalin, and dopamine) and the hypothalamic-pituitary-adrenal axis interact with hormones that are responsible for normal ovulatory cycles (i.e., GnRH, prolactin, LH, and FSH).72  Furthermore, some hormones that are released during times of stress can cause the uterus to contract and/or negatively interact with immune cells, both of which will interfere with proper implantation.70,73 Despite the well-known link between stress and infertility,66-69,74 the importance of stress management and relaxation is often underestimated. Regular practice of stress management and relaxation exercises is very important, especially considering the fact that the medical tests and treatments for infertility are some of the major sources of stress for many women with infertility.68,72,74,75

 

What else is important in addition to receiving acupuncture?

 

Abusive lifestyle factors such as poor diet, smoking, stress, and insufficient sleep all accelerate the cell oxidation and the biological aging process. Practicing a healthy lifestyle in addition to regular acupuncture treatments will have a positive impact on fertility.

In addition, research studies suggest that the continuous mechanical pressure on the body by tight-fitting underwear can negatively affect the physiological homeostatic balance (i.e. hormones and body temperature regulation)76,77 and digestive motility.78,79  This occurs by altering the autonomic nervous system, a coordinator of the internal environment in the human body. It is important not to wear tight-fitting underwear in order not to obstruct efficient blood flow to your reproductive organs.

(Original version of this FAQs was posted on acupuncture-treatment.com in 2002 by Tim H. Tanaka, Ph.D.)

Infertility and Acupuncture References    

 

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