By Dr. Meghan van Drimmelen, ND | Naturopath Victoria BC

When you are trying to start or expand your family, there is nothing more heart breaking then not achieving your intended goal. In Canada, 1 in 6 couples trying to conceive experience fertility challenges. Having said this, many people are turning to acupuncture to help achieve their family building goals.  Acupuncture can be used to enhance your natural fertility, or can provide adjunctive support to assisted reproductive technologies such as IVF (in vitro fertilization) and IUI (intrauterine insemination).  Here’s why I use acupuncture regularly in my clinical practice as part of a comprehensive fertility treatment plan:

Acupuncture regulates reproductive hormones

Regular menstrual cycles depend on the fine balance of reproductive hormones that are regulated by a feedback loop, called the hypothalamic-pituitary-ovarian axis. The hypothalamus is the conductor of the hormonal orchestra, and is responsible for signaling the pituitary gland to produce hormones that stimulate the ovaries to produce follicles and the release of an egg from one follicle at ovulation. These pituitary hormones also regulate the rise and fall of estrogen and progesterone throughout the menstrual cycle. If this feedback loop is disrupted by negative outside influences at any stage of the loop, it can lead to irregular menstruation, anovulation, and infertility. Research has shown that acupuncture can regulate reproductive hormones through 3 main mechanisms:

1)   Normalizing the dysfunction of the hypothalamic-pituitary-ovarian axis, which is key for menstrual regularity.[i]

2)   Reducing pituitary hormone follicle stimulating hormone (FSH), which is associated with declining ovarian function and menopause.[ii]

3)   Reducing hormones that can inhibit ovulation, including androgens (ie. testosterone)[iii], insulin[iv] [v]and inhibin.[vi]

Acupuncture promotes ovulation

Acupuncture promotes optimal ovulation by regulating the reproductive hormones as mentioned above, and decreasing insulin resistance.[vii] [viii] Insulin resistance is thought to be one of the underlying causes of polycystic ovarian syndrome (PCOS), which is a disorder that results in anovulation, irregular menstruation, ovarian cysts, high androgens (ie. testosterone), and fertility challenges.  By reducing insulin resistance in PCOS patients, ovulation can be restored, and fertility outcomes are improved.

Acupuncture improves blood flow to the ovaries and uterus

Acupuncture improves blood flow to the pelvic region, uterus, and ovaries.[ix]  For some women this blood flow may be compromised due to stress (ie. sympathetic tone) and other factors, but acupuncture may help to reverse it. Adequate blood flow to the ovaries and uterus is crucial for fertility, as it carries vital hormones and nutrients that are needed for ovulation, conception, implantation, healthy pregnancy, and live birth delivery.

By improving blood flow to the uterus, acupuncture may help with the thickening of the uterine lining. A thick uterine lining is more likely to accept an embryo for implantation and maintain a pregnancy to term. Ideally a uterine lining should have 3 layers (trilaminar), and be at least 8cm thick.  If the uterine lining does not thicken appropriately, or does not develop it’s 3 layers, it’s less likely to support a viable pregnancy. Acupuncture may help to increase a thin uterine lining to support a healthy pregnancy.[x]

Acupuncture reduces stress

Stress and anxiety are very common in couples faced with fertility challenges, especially for those undergoing IVF. Unfortunately this higher perceived level of stress may negatively impact fertility outcomes.[xi]  Acupuncture is very effective in reducing the stress response. It has not only been shown to be effective in the treatment of anxiety[xii] and depression[xiii], but also has been found to improve IVF outcomes by reducing levels of perceived stress.[xiv]

Acupuncture can increase your likelihood of IVF success

Research shows that acupuncture increases pregnancy rates,[xv],[xvi],[xvii] ,[xviii]and live birth rates in women undergoing IVF.[xix] ,[xx]

The main ways acupuncture may contribute to IVF success are through:

• Improving your response to IVF medications

• Increasing endometrial thickness

• Reducing stress

• Reducing IVF medication side effects

• Improving your chance of live birth

• Reducing miscarriage

Ideally acupuncture should be started 2-3 months before your IVF cycle, if time is available. In my practice, additional dietary and lifestyle recommendations, as well as nutritional supplementation may be given at the initial consultation.

References:

[i] Chen BY. “ Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis”. Acupunct Electrother Res.  1997;22(2):97-108

[ii] Zhou K. et al. “Electroacupuncture modulates reproductive hormone levels in patients with primary ovarian insufficiency: results from a prospective observational study”.  Evid Based Complement Alternat Med. 2013;2013:657234.

[iii] Jadel E. et al. “Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome : a randomized controlled trial”. Am J Physiol Endocrinol Metab. 2011 Jan;300(1):E37-45.

[iv] Zheng, YH. et al. “Effectiveness of abdominal acupuncture for patients with obesity-type polycystic ovary syndrome: a randomized controlled trial”. J Altern Complement Med.  2013 Sep;19(9):740-5. doi: 10.1089/acm.2012.0429.

 

[v] Johansson J. et al.  “Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial”. Journal of Physiology - Endocrinology and Metabolism 1 May 2013 Vol. 304 no. 9, E934-E943

[vi] Johansson J. et al.  “Acupuncture for ovulation induction in polycystic ovary syndrome : a randomized controlled trial”. Journal of Physiology - Endocrinology and Metabolism 1 May 2013 Vol. 304 no. 9, E934-E943

[vii] Johansson J. et al.  “Acupuncture for ovulation induction in polycystic ovary syndrome” : a randomized controlled trial”. Journal of Physiology - Endocrinology and Metabolism 1 May 2013 Vol. 304 no. 9, E934-E943

[viii] Zheng, YH. et al. “Effectiveness of abdominal acupuncture for patients with obesity-type polycystic ovary syndrome : a randomized controlled trial”. J Altern Complement Med.  2013 Sep;19(9):740-5. doi: 10.1089/acm.2012.0429.

[ix] Stener-Victorin E. et al. “Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture”. Hum Reprod.   1996 Jun;11(6):1314-7.

[x] Stener-Victorin E. et al. “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.

[xi] Quant HS. et al. “Reproductive implications of psychological distress for couples undergoing IVF”. J Assist Reprod Genet. 2013 Nov;30(11):1451-8.

[xii] ArvidsdotterT. et al. “Effects of an integrative treatment”, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients - a pragmatic randomized controlled trial” (ISCMR).  7 November 2013

[xiii] MacPherson H. et al. “Acupuncture and Counselling for Depression in Primary Care” : A Randomised Controlled Trial”. PLoS Med.  September 24, 2013

[xiv] Balk J. et al. “The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: a pilot study”. HHS Author Manuscripts  2009 Dec 24. doi:  10.1016/j.ctcp.2009.11.004

[xv]  Paulus We. et al. “Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy”. Fertil Steril.2002 Apr;77(4):721-4

[xvi] Dieterie S. et al. “Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study”. Fertil Steril.   2006 May;85(5):1347-51. 

[xvii] 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 May;85(5):1341-6.

[xviii] Smith C. et al. “Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer”. Fertil Steril. 2006 May;85(5):1352-8.

[xix] Lee E.Hullender R. et al.  “Impact of Whole Systems Traditional Chinese Medicine on In Vitro Fertilization Outcomes”. HHS Author Manuscripts  2015 Feb 24.

[xx]  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 Mar 8;336(7643):545-9.