Part 1 of 4
There has been increasing interest in alternative and natural therapies for infertility and acupuncture is one that has been receiving attention recently. As an Eastern modality however, it remains somewhat mysterious and concerns remain as to its potential use and effectiveness. Following are some frequently asked questions about acupuncture.
Acupuncture is an ancient Asian healing technique involving the insertion of thin needles into energy points. Chinese medicine believes that health is maintained by a balance of energy ("qi"} and its movement along byways of energy ("meridians") in the body which can be regulated by placing needles at special points ("acupoints"} on the surface of the body. Manipulating the energy traffic thus restores and maintains the balance of energy essential to health. Modem science is attempting to establish the validity of acupuncture but meanwhile in 1979, the World Health Organization (WHO) already identified 47 conditions ranging from headaches to hiccups amenable to acupuncture treatment.
Acupuncture can be used to help women and men with infertility. In women, acupuncture can be used to improve ovarian reserve, enhance cervical mucus, improve the endometrial lining and implantation, and reduce the likelihood of miscarriage. In general, acupuncture can be effective in relieving stress. In men, it can serve to increase virility by strengthening the related kidney meridian, and research (S. Siterman et. al. "Effect of Acupuncture on Sperm Parameters of Males suffering from Subfertility related to low Sperm Quality" (Arch Androl volume 39, 1997, pages 155-161) has also shown that acupuncture can increase sperm count as well as motility.
Acupuncture can be used with traditional treatment for women with fertility issues. Women who wish to try a less invasive treatment and who are young, with good ovarian reserve and without known correctable causes of infertility, could try acupuncture before attempting hormones or in-vitro fertilization (IVF). Otherwise, women with known thin uterine lining, poor cervical mucus, or poor ovarian reserve (elevated cycle day 3 FSH levels) may consider acupuncture as part of their treatment. It may also be used as an adjunct to IVF. Here are two specific cases we have treated that illustrate the effective use of acupuncture in otherwise difficult patients:
A woman who was under 35, but had been infertile for 11 years after marriage, was diagnosed with secondary endometriosis, premature ovarian failure as well as a male factor. She had a failed IVF and was recommended by major fertility programs to pursue egg donation because of a high FSH, but decided to try acupuncture instead. She subsequently normalized her acupuncture within eight weeks of treatment and went on to IVF with a successful pregnancy and the birth of a healthy daughter. (As reported in A T.I.M.E., #33, 2002 pages 16-17, see http://www.atime.org/ newsletters-pg/ news-frames.html)
A woman with stage-four endometriosis and borderline FSH who had failed three previous NFS and whose husband had testicular cancer is now pregnant with twins (a boy and a girl) after combined acupuncture and JVF treatment (As reported by Mary Murphy on WPIX - News at Ten" on May 19,2003).
In the case of men, it is not usually the first line of treatment because sperm problems are treatable with herbal, supplemental and intracytoplasmic sperm injection (ICSI) in conjunction with IVF.
There are a small number of studies on acupuncture improving sperm quality in some men. In the case of female infertility, several clinical trials have demonstrated usefulness. One study from the University of Heidelberg showed that acupuncture worked as well as clomiphene in inducing pregnancy in infertile women, while a more recent randomized controlled study from Germany, involving one hundred and sixty women, showed that acupuncture improved the clinical pregnancy rates from IVF by 60% (WE Paulus et al., "Influence of Acupuncture on the Pregnancy Rate in Patients who undergo Assisted Reproduction Therapy, Fertility and Sterility, volume 77, April 2002, pages 721- 724). The recent landmark review ("Role of Acupuncture in the treatment of Female Infertility" in Fertility and Sterility, Volume 78, December 2002 pages 1149-1153) by the author, along with Drs. Chung and Rosenwaks from Cornell-Weill, identified that acupuncture can normalize the hypothalamic-pituitary-ovarian axis, improve ovulation, and enhance pelvic blood flow which may help with implantation. Acupuncture may also help older women achieve pregnancy who have otherwise failed an average of two IVFS.
After reviewing the patient's medical situation and history and taking his/her pulse and an exam to determine his/her internal energy state, thin sterile and disposable acupuncture needles are inserted into the skin along the energy channels based on the patient's diagnosis. The patient then lies still for fifteen to thirty minutes with the needles in place, and the needles are stimulated manually or with low voltage direct electric current and/or infrared heat. Treatments are usually once or twice a week and treatment cycles are optimally three months at a time depending on circumstances.
Acupuncture is a very safe procedure, although placing the needle can potentially cause infection, bleeding, bruising, pain, or even organ puncture when performed by inexperienced person. The published complication rate is somewhere between 1 in 10,000 to 1 in 100,000, which is very low. Some patients have an idiosyncratic fainting reaction to needles and/or are fearful of needles. In these cases, the patients should be evaluated individually in order to determine if they should be candidates for this treatment.
Using acupuncture on the wrong points can have the opposite results (as an example, acupuncture can be used to induce miscarriage), making it necessary to use only an experienced acupuncturist. Someone who advertises the treatment for quitting smoking or back pains only should not be used. An MD supervised acupuncture program is often preferable, and one can start with recommendations from one's local reproductive gynecologist physician. It's always prudent to ensure that the acupuncturist is licensed and carries liability insurance. The acupuncturist's membership in the American Academy of Medical Acupuncturist (www.medicalacupuncture.org) can also be a starting point. One can also ask the acupuncturist how many infertility cases he/she has treated in the past year and if applicable, if they understand the protocol of IVF.
Insurance frequently does not cover acupuncture, and even if it does, it may not cover acupuncture as a treatment for infertility. You should contact your insurer first to clarify.
In conclusion, acupuncture is a safe and effective adjunct for the treatment of infertility, but ultimately it is an option that needs to be weighed individually in order to consider the benefits versus cost.
Part 1 of 4