IVF

According to the National Center for Health Statistics, 9.3 million American women are currently using assisted reproductive technology (ART) services to help them cope with fertility issues. One of the most widely used ART is in-vitro fertilization or IVF and or Intracytoplasmic Sperm Injection (ICSI). This consists of harvesting a woman’s eggs (called “egg retrieval”) and then combining the eggs with sperm and thus, fertilizing the eggs in a lab where they can grow the resulting embryo for several days. Once the embryo that results from this fertilization hits a certain stage of maturity, it is then introduced into the woman’s uterus to develop as a normal pregnancy.  During ICSI, the sperm are manually injected into the harvested eggs to fertilize the egg.  ICSI is widely utililized in scenarios where there is Male Factor complicating the picture.  However, recently, it is becoming the norm to utilize ICSI for all “IVF” procedures.

IVF-ICSI is used in cases such as: fallopian tube blockage, low sperm count, abnormal cervical factors, immunologic factors affecting either partner, infertility after a tubal surgery, infertility after treatment for endometriosis, and for un-expalined infertility. This procedure was first successfully used in the United States in 1981. Truly an amazing medical feat.

However, despite how amazing this technology is, only about a third of people on average undergoing IVF will get pregnant. If you are over 40 your chances can be much lower than that. In addition, even if you get pregnant, you have a 20% or higher chance of miscarrying.

This is where acupuncture can be extremely helpful. For thousands of years acupuncture has been used to treat reproductive disorders and to help prevent miscarriages. Now, modern medicine is finding that acupuncture can indeed improve IVF outcomes (increasing pregnancy rates) and simultaneously decreasing miscarriage rates and helping to maintain a healthy pregnancy.

Studies have demonstrated that acupuncture can greatly increase IVF pregnancy rates. Women who receive properly timed and properly performed acupuncture have demonstrated up to a 106% increase in ongoing pregnancies. Studies have also demonstrated a number of other benefits including substantial increases in implantation rates and increases in both uterine and ovarian blood flow. [1] [2] [3]

Acupuncture also has a significant impact on “poor responders”, whose bodies do not respond well to standard IVF medications or protocols. In one study, poor responders that had acupuncture achieved the same pregnancy rates as normal responders. [4]

A widely published recent German study found that using acupuncture with IVF achieved a 42% clinical pregnancy rate compared to only a 26% in the control group that did not receive acupuncture. When acupuncture and Chinese Medicine are used in conjunction with IVF, both clinical studies and experience suggests the overall pregnancy rate can be raised to at least 60%. [1]

Recently there have been several meta-analyses done lumping together all of the good quality studies on acupuncture and IVF. The meta-analysis published in the most prestigous medical journal (British Medical Journal) found that for patients undergoing IVF, acupuncture increased the odds of a live birth by 91%. In other words, when you average all the studies available, you find that the odds of having a live birth are almost doubled. [6]

How Does Chinese Medicine Help Improve IVF Success Rates?

  • It improves the function of the ovaries to produce better quality eggs-improving Mitochondrial capacity of eggs.
  • It regulates the hormones to produce a larger number of follicles.
  • It increases the blood flow to the uterus and increases the thickness of the uterine lining.
  • It relaxes the patient and decreases her stress.
  • It helps prevent uterine contractions.
  • It lessens the sides effects of the Western drugs used in IVF.
  • It strengthens and regulates the patient’s Immune system.
  • It Improves male semen to create better quality and quantity of embryos.
  • It decreases the chance of miscarriage.

When to use Chinese Medicine with IVF:

For best results, Chinese medicine, including acupuncture, Chinese herbs and Chinese Dietary & Lifestyle therapy, should be used before, during, and after IVF. Chinese medicine can help prepare both partners before IVF in order to improve the function of the ovaries, improve quality of uterine lining, improve egg quality, strengthen and regulate the immune system, reduce stress, and improve the quantity and quality of the sperm and the quality of the seminal fluid.

This is accomplished in the female partner by treating any menstrual irregularities, such as amenorrhea, PMS, endometriosis, uterine myomas (a.k.a. fibroids under 2 cm), or heavy bleeding during or outside the menses. Such preparatory treatment usually lasts 3-6 months, but can take longer. Specific acupuncture and Chinese Herbal protocols exist for the treatment and support of the above mentioned menstrual irregularities and gynecological problems. Specific Chinese Medical protocols also exist for low sperm count, low sperm motility, and abnormal sperm morphology (or shape), and problems with seminal fluid liquefaction.  Please see Male factor section for more information on Male factor and treatment.

Once the woman’s menstrual cycle and period are normal according to the guidelines of Chinese medicine, Acupuncture and Chinese herbs can be used during the IVF procedure itself. This typically begins during the month prior to the IVF when the woman is placed on oral contraceptives or other down regulators such as Lupron (GnRH agonist) or Antagon (GnRH antagonist) in order to give her ovaries a rest.  Step-by-step protocols are then used at every phase of the IVF procedure. For instance, certain acupuncture points and Chinese herbs are used to stimulate the ovaries, others are used before the transfer of the embryo, and yet others are used after the transfer has been accomplished. Not only are different methods used at these different stages, but each treatment is also individualized to fit each patient’s personal Chinese Medical Diagnosis.

After successful implantation of the embryo has taken place, Chinese Medicine can also be used to help prevent miscarriage. In general, Chinese Medicine is extremely effective for preventing miscarriage when threatened miscarriage is due to hormonal imbalances, such as low progesterone or immune factors. For this purpose, it may be used either preventively when the woman is asymptomatic or even after symptoms of threatened miscarriage has happened.

The best of Both Worlds:

When one combines the high tech power of modern assisted reproductive technologies with the holistic wisdom of centuries of Chinese medicine, one makes use of “the best of both worlds.” While Western medicine is capable of micromanaging human physiology, Chinese medicine addresses the bigger picture, thus insuring that the whole organism is brought back to a state of dynamic balance and vibrant health.

How Many Sessions Are Recommended?

There are a number of protocols that we use depending on the history and condition of the patient.  If you are already beginning your IVF cycle, we typically recommend 4-10 treatments or beginning weekly leading up to the transfer. If there are complicating factors, more may be required.  Please keep in mind that specific treatments must be done at very specific times during the cycle.

If you are not yet beginning your IVF cycle, it is a good idea to have a consultation as soon as possible so that we can evaluate your specific needs. During the visit, your practitioner will perform a non-invasive physical exam and, based on the results, make recommendations as to the duration and frequency of treatments. Dealing with any imbalances prior to your cycle can help enhance all parameters of your cycle and greatly increase your health and your chances of a successful IVF pregnancy.

It is also advisable, as well as, being very helpful if the patients bring their medical exam data/results (including a basal body temperature charting, ALL labwork – Blood chemistry panels, hormone panels, etc.) when visiting our clinic. A defined Western medical diagnosis, if available, will also be valuable for us in evaluating and treating the case even within the paradigm of the Traditional Chinese Medical system.

For many women, the optimal treatment course to fully prepare for an IVF-ICSI cycle which will consist of acupuncture treatments, and/or herbal therapy, dietary therapy and lifestyle changes, normally ranges from 4 to 6+ menstrual cycles/months depending on the individual case, to improve fertility markers and increase the chances of fertilization, conception and healthy pregnancy and birth. Some difficult cases may need a longer period of treatment in order to encourage the ovaries to produce optimal and high quality eggs and therefore embryos, as well as, prepare the body to conceive and ultimately achieve pregnancy.

  • This length of this process is due to a woman’s reproductive biology in which Chinese Medicine, must work “within”.  The egg a woman is ovulating in any given month, began developing literally 120 days prior.  120 days prior to any given ovulation, a cohort or group of follicles began to develop, grow and mature into mature follicles, eventually yielding one dominant follicle which develops and ovulates an egg on that given month.  This 120 day cycle is called the “Tonic Growth Phase” and it is during this time that the body’s environment subjects its influences on the developing follicles which contain the developing eggs.  If the body is in a state of health and balance this will positively influence the environment in which the developing follicles and thus eggs are maturing, yielding eggs which are of “High Quality”.  High quality eggs yield optimal fertility potential and therefore increased pregnancy and birth rates.  Yielding “High Quality” eggs is of the upmost importance during the IVF Process, as a higher quality egg will yield a higher grade embryo which in turn yields higher success rates for that IVF cycle.  Higher quality and stronger embryos (ie: day 5 embryo vs. day 3 embryos) have a better chance of survival over a lower quality or weaker (ie: day 3) embryo.  Therefore, it is important that the eggs which are harvested during the egg retrieval during an IVF cycle are of high quality.
  • One of our main goals in the Fertility & IVF preparation treatment process at our clinic is to focus on positively influencing the Tonic Growth Phase via Acupuncture, Chinese Herbal Medicine, Nutrition-Dietary-Lifestyle modifications & recommendations.  We effect the quality of the eggs by improving the egg’s energy capacity, aka, the egg’s mitochondrial capacity.  The Mitochondria of any given cell, in which the egg is the largest in the human body, is the area of the cell that produces energy or ATP for that given cell and its functions.  In order to effectively and positively influence and change a women’s cycle and therefore also the Tonic Growth phase, which is the deeper, longer cycle underlying and superimposing the 28 day menstrual cycle, we recommend patients commit to at least 4-6 months of treatment prior to a potential IVF Cycle to ensure adequate and effective preparation.  Again, if there is a complicated menstrual and or fertility history, or history of  failed ART (Assisted Reproductive Technology), the preparation process may very well require a longer course (ie: 6-12+ Months).  Likewise, it takes roughly 90 days to generate new sperm in a man.  If he has a history of drug and alcohol abuse or urological complications, it may take longer to regenerate his reproductive capacity.

Herbal Therapy and IVF:

When properly used, herbs can be powerful adjuncts in preparing patients for IVF procedures, as they can enhance fertility treatments in many ways including restoring hormonal balance and improving circulation to the uterus and ovaries. However, if you are undergoing conventional fertility treatments such as IVF they can potentially interfere with your cycle. This can happen in a number of ways so it is important that your herbalist has a thorough understanding of whatever procedure you are undergoing, works closely with your IVF doctor and understands and knows how to spot the potential herb/drug interactions. Herbal therapy is primarily reserved for the months leading up the potential IUI or IVF procedure (ie: 4-6 monts leading  up to procedure) to help support and prepare the body for the upcoming prodecures, as well as, optimize follicular health and egg quality which will potentiate more optimal outcomes from these reproductive procedures.

The potnetial need for herbal medicine is individually evaluated during the initial consultation.

Diet and Nutrition as it Relates to IVF and Fertility Treatment:

Nutrition is of utmost importance. However, most couples believe that if they are taking prenatal vitamins, they are getting everything they need for a healthy fetus. Consuming a healthy, anyt-iinflammatory and balanced diet will supoprt in the proper development of a fetus.

Consuming a healthy diet will also support and encourage healthy gastrointestinal function which is vitally important.  However, sometimes the gut, especially during times of stress such as during an IVF cycle can become compormised.  The gut lininng is but one cell thick and stressors such as medical procecures and poor diet can initiate increased permeability within the gut lining, meaning holes develop in the intestinal lining, so to speak.  With increased permeability, come less absoorption of nutrients by the intestine. Food particles can also slip through these holes potentially contributing to or igniting unwanted immune reactions within the body. 

Unlesss their is a healthy gut lining combined with a GI environment containing balanced intestinal bacteria, it will be very difficult to absorb and/or produce key vitamins and minerals (ie: B Vitamins, Folate) necessary for the proper function of the reproductive organs and the proper growth and development of a fetus.

It will be very important to assess your individual needs so that a custom prenatal nutrition plan can be set up for you.

Acupuncture Studies

Additional Acupuncture Studies:

  • Hullender Rubin, L. E., Opsahl, M. S., Wiemer, K. E., Mist, S. D., & Caughey, A. B. (2018). Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes. Reproductive BioMedicine Online, 30(6), 602–612. http://doi.org/10.1016/j.rbmo.2015.02.005.
    http://www.rbmojournal.com/article/S1472-6483(15)00092-9/fulltext 
  • Paulus, et.al. Influence of Acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy: Fertility and Sterility Vol: 77, No. 4, APRIL 2002; Quintero et.al A Randomized, Double-Blind, Controlled Cross-Over Study Evaluating Acupuncture as an Adjunct to In-Vitro Fertilization: Fertility and Sterility Vol: 81, Supplement 3, April, 2004; Dieterle S, et.al. Fertility and Sterility 2006 Apr 7.
  • 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 -7.; Stener-Victorin E, et al, Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats: Auton Neurosci. 2003 Oct 31;108(1-2):50-6.
  • Quintero et.al A Randomized, Double-Blind, Controlled Cross-Over Study Evaluating Acupuncture as an Adjunct to In-Vitro Fertilization: Fertility and Sterility Vol: 81, Supplement 3, April, 2004
  • Magarelli et.al. Acupuncture & IVF poor responders: a cure?: Fertility and Sterility Vol: 81, Supplement 3, April, 2004
  • Gurfinkel et al., Effects of acupuncture and moxa treatment in patients with semen abnormalities. Asian J Androl. 2003 Dec;5(4):345-8.
  • Manheimer E et al. BMJ 2008;336 pg 545-549 – Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilization: systematic review and meta-analysis.

Chinese Herbal Medicine Studies

References & Resources:

  • Blue Poppy Press
  • Damone, B, Principles of Chinese Medical Andrology: An Integrated Approach to Male Reproductive & Urological Health, 2008
  • Fritz, M., Speroff, L., Clinical Gynecologic Endocrinology and Infertility, Eighth Edition, 2011
  • Liang, L, Acupucnture & IVF, February 2005
  • Lyttleton, J, Treatment of Infertilty with Chinese Medicne, 2004
  • Magarelli, P – Western Reproductive Endocrinology Course – Prod Seminars
  • Rizk, B, et. al, Infertility and Assisted Reproduction, 2008
  • Notes from the following Courses:
    • Acupuncture and Herbal Treatments with IVF – Presented by Richard Blitstein, M.S.O.M., L.Ac., Pro D Seminars
    • Acupuncture strategies to dramatically improve IVF success, Presented by Brandon Horn, PhD, JD, LAc (FABORM), Pro D Seminars
    • Treatment of Infertility – The Complete Course presented by: Jane Lyttleton, L.Ac, Pro D Seminars
    • Introduction to Men’s Health & Fertility – presented by Peter Deadman, L.Ac., Pro D Seminars
    • The Treatment of Male Infertility – An Integrative TCM Approach – Presented by: Chris Axelrad, L.AC, Dipl. NCCAOM, ABORM, Pro D Seminars