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In the United States, as many as 15% of all couples are infertile, with higher rates seen in older couples. Although nearly half of all infertile couples have some component of male infertility, only 30% of cases are a result of male infertility alone. Female infertility may be a result of anovulation, pelvic factors such as adhesions and tubal occlusion, and cervical factors.
It usually is the female partner who presents initially for an infertility problem, often in the context of an annual well-women examination. In this situation, the primary care provider may initiate certain diagnostic and treatment options. Given the expense and invasive nature of many conventional treatment options for infertility, complementary and alternative therapies such as acupuncture have begun to receive more attention from physicians and patients. Although there remains a paucity of clinical research in this area, the relative safety of acupuncture makes it a reasonable option as part of an initial intervention or in conjunction with conventional therapies.
Mechanism of Action
The mechanisms of action by which acupuncture may treat female infertility have not been elucidated. One possible mechanism is via hormonal regulation, with acupuncture regulating a dysfunctional hypothalamic-pituitary axis. Another mechanism might be improvement in uterine blood flow, which increases the receptivity of the endometrium to a fertilized egg.
Human Female Studies—Treatment
Infertile patients may seek assisted reproductive techniques such as in vitro fertilization (IVF). Successful IVF depends on adequate endometrial receptivity. Acupuncture has been demonstrated to improve uterine blood flow impedance, which is a measurement of blood flow to the uterus. It has been considered valuable in assessing endometrial receptivity.1 Ten subjects with a high pulsatility index, a measurement made using Doppler transvaginal ultrasound, were treated with twice weekly acupuncture for the month prior to embryo transfer. A high pulsatility index is evidence of decreased uterine artery blood flow. Pulsatility index decreased both at the time of the embryo transfer and again at follow-up approximately two weeks later. The authors suggest that the effects arise from a central inhibition of the sympathetic activity.
Acupuncture also has been studied as analgesia during infertility treatment. A randomized controlled trial compared acupuncture to alfentanil as anesthesia for oocyte aspiration during IVF.2 One hundred fifty women participated in this study. The acupuncture group experienced discomfort for a longer period of time during oocyte aspiration, but no differences between the groups were noted by visual analog scale, adequacy of anesthesia during aspiration, abdominal pain suffered, or degree of nausea. Surprisingly, the acupuncture group had a statistically significantly higher implantation rate, pregnancy rate, and take home baby rate per embryo transfer. Compared with the alfentanil group, the electroacupuncture group’s implantation rate was 27.2% vs. 16.3%; pregnancy rate was 45.9% vs. 28.3%; and take home baby rate was 41% vs. 19.4% per embryo transfer. The same authors are conducting a larger study to corroborate these findings.
A large fibroid may cause infertility. One case report presented a patient with a 13 x 8 x 10 cm fibroid uterus who had secondary infertility, unresponsive to "repeated" cycles of IVF.3 The exact number of IVF cycles was not reported. This patient underwent acupuncture treatment and her uterus decreased to 7 x 8 x 8 cm, after which she had successful IVF and delivered healthy twins.
The studies cited above all used body points, but auricular (or ear) acupuncture also has been used to treat female infertility.4 Forty-five infertile women with either oligomenorrhea or luteal insufficiency were treated with auricular acupuncture. Results of treatment were then compared with matched subjects who were treated with hormones. Pregnancy rate was similar for both groups, whereas side effects were observed only in the hormone group. However, the groups were not equal even though they were matched on several criteria. The authors conclude that auricular acupuncture seems to offer a valuable alternative therapy for female infertility from hormone disorders. However, lack of randomization and differences between the groups limit the ability to make this conclusion.
Human Female Studies—Hormone Levels
Chinese investigators studied 10 anovulatory women and five women with normal menstrual cycles.5 Subjects were treated with electroacupuncture for 30 min/d for three days per month for 13 cycles. Changes in blood hormone concentration were measured. Beta-endorphin, LH, and follicle-stimulating (FSH) normalized in those who ovulated but did not change in those who did not ovulate. However, the determination of ovulation was not described, and other important methodological details are missing.
Another Chinese study was equally difficult to interpret.6 Thirty-four subjects with amenorrhea and dysfunctional uterine bleeding received acupuncture three times per week for three months. The terms that the authors use are unclear. Criteria for the efficacy of therapy for inducing ovulation were defined as markedly effective, effective, or ineffective, based on ultrasound, basal body temperature, and presence or absence of menstruation. Thirty-five percent, 48%, and 18% were markedly effective, effective, and ineffective, respectively. An endocrine profile was performed in 20 subjects before and after treatment. FSH, LH, and estradiol normalized compared to pre-acupuncture values. However, the time during the menstrual cycle at which the blood was drawn was not stated; different timing could greatly skew these results.
Several prospective investigations of the adverse effects associated with acupuncture have supported its relative safety.7-9 The most frequently reported adverse effects were needling pain and hematoma.
1. Stener-Victorin E, et al. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod 1996;11:1314-1317.
2. Stener-Victorin E, et al. A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 1999;14:2480-2484.
3. Sternfeld M, et al. The effect of acupuncture on functional and anatomic uterine disturbances: Case report-secondary infertility and myomas. Am J Acupuncture 1993;21:5-7.
4. Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol 1992;6:171-181.
5. Chen BY. Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis. Acupunct Electrother Res 1997;22:97-108.
6. Mo X, et al. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med 1993;13:115-119.
7. MacPherson H, et al. The York acupuncture safety study: Prospective survey of 34,000 treatments by traditional acupuncturists. BMJ 2001;323:486-487.
8. White A, et al. Adverse events following acupuncture: Prospective survey of 32,000 consultations with doctors and physiotherapists. BMJ 2001;323:485-486.
9. Melchart D, et al. Prospective investigation of adverse effects of acupuncture in 97,733 patients. Arch Intern Med 2004;164:104-105.