Infertility

Female Infertility

In recent years, increasing numbers of infertility patients are using acupuncture during their IVF to increase the rate of pregnancy. The tremendous growth began with the publication of Dr. Paulaus Wolfgang’s ground breaking clinical study in 2002.

Groundbreaking Study

The study found that clinical pregnancy rate was 41.5% higher in treatment group when patients received pre and post ET (embryo transfer) acupuncture. Two subsequent clinical studies, conducted by Lars Westergaard et al and Stefan Dieterle et al also demonstrated that acupuncture around ET increased the clinical pregnancy rate by 33.3% and 55.5%, respectively. That is an impressive 43.43% average improvement for a 2% of incremental cost of the IVF, assuming $200 for pre and post IVF acupuncture, and $10,000 for an IVF.

Increased Awareness & Acceptance

The proliferation of Internet technologies, such as Google and chart-room, provided easy access to aforementioned clinical studies and a platform for infertility patients to share their positive experience with acupuncture among IVF patients.

In 2010, acupuncture, as a viable alternative and complementary therapy to western ART (Assisted Reproductive Technology), received a major boost when celebrities, such as Julie Snyder, and international super star Celine Dion, publicly endorsed acupuncture in their successful pursuit of parenthood.

The year 2012 marks another turning point – half of the Montreal’s infertility clinics are either offering on-site, pre and post embryo transfer acupuncture or planning to do so in the near future, due to an ever increase amount of support from recent clinical studies and patients’ demand.

Finding an experienced acupuncturist and faithfully following the requirements – whether it’s drinking bitter herbal teas, changing your lifestyle or receiving regular acupuncture treatments – are the keys to successful fertility treatment.

Chinese Medicine treatment

Like western medicine, the first step to successful treatment with TCM is proper diagnosis. Once the syndromes (the nature of illness) are diagnosed, the TCM practitioner has already formed an opinion on the pathogenic factors, pathogenesis, location, and prognosis.

In my practice, I pay more attention to the syndromes than the disease itself. This means that if I find the same disease in a number of patients and determine that they have different syndromes, I treat each case differently. For example, two female patients each have polycystic ovarian syndromes (PCOS), but one patient’s PCOS is caused by Spleen and Kidney Deficiency, and the other by Liver Qi Stagnation. In treating each of these patients, I would use very different acupuncture points and herbs.

When the diseases presented in different patients are different, but the syndromes are the same, I treat the patients similarly. For example, if I have three infertility patients, one with PCOS, another with endometriosis and a third with premature ovarian failure (POF), and I find that they are all caused by Kidney Deficiency, then I would use very similar acupuncture points and herbs to treat these three patients.

Depending on the diagnosed syndromes, the patient’s personal constitution and diagnosis from the fertility clinic, I then outline a treatment objective. To achieve the treatment objective, I often use a combination of acupuncture and Chinese herbal medicine. Sometimes, nutritional supplements and dietary regulation are also used

Chinese Medicine Pathology

As you can imagine, the pathology of female infertility in Traditional Chinese Medicine (TCM) can be very complex. The terms used in TCM, such as Kidney, Liver and Blood, have different meanings from those of Western medicine, and are capitalized here to show that the meaning isn’t the same. They are widely used for lack of better translations. If you’d like to learn more about TCM and infertility, refer to the books recommended in Resource – Book – Infertility section of our website.

According to a study published in the Journal of Traditional Chinese Medicine, liver Qi (vital energy) Stagnation and Kidney Deficiencies account for 51.7% and 22.4% of female infertility patients. This conclusion is hardly surprising when you consider current lifestyles and the demography of many female infertility patients. Liver Qi Stagnation is often associated with stress, a sedentary lifestyle, and a greasy diet. Kidney (whether Yin, Yang or Essence) Deficiency on the other hand is often the result of a very demanding lifestyle and the natural process of aging.

These percentages confirm my own clinical observation which is that younger infertility patients tend to have Liver Qi Stagnation and older (over 40) patients tend to have Kidney Deficiency. However, it’s important to understand that this finding is just one piece of the puzzle as almost all fertility patients show more than one pattern.

Kidney – One of the major functions of the Kidney is to store the Kidney Jing (the Essence of life), which includes Prenatal Jing (inherited from parents, and not replaceable) and Postnatal Jing (acquired from food and replaceable). The Kidney Jing can be transformed into Blood and Kidney Qi, which becomes the source of human growth, development and reproduction.

According to Chinese medicine, the variation of Kidney Jing supply produces significant physiological changes in a woman’s life every seven years. At 7, a girl starts to mature into a young woman; at 14, she has her first menstruation and is able to conceive; at 21 and 28, she reaches her most fertile years; at 35, her fertility starts to diminish; at 42, her fertility is mostly lost and at 49, a woman’s Kidney Jing is depleted, and therefore, she has her menopause.

Liver – two of the major functions of the Liver are to regulate Qi and Blood and to store Blood

Spleen – The main functions of the spleen are to transform food nutrients to Qi, Blood and Postnatal Jing, to maintain proper humidity in the body and to keep the Blood circulating within the Vessels.

According to TCM theory, the Liver plays a vital role in the reproductive system. Liver Qi moves the Blood and stagnation of Liver Qi is likely to cause Blood Stasis. In time, Blood Stasis may cause endometriosis, uterine fibroids and ovarian cysts, dysmenorrhoea, irregular menstruation and scanty menstruation, which are all known contributors to female infertility.

The Kidney is the most important organ in the reproductive system, and any aspect of Kidney deficiency, whether Yin, Yang or Essence Deficiency often leads to amenorrhea, anovulation, a small uterus, thin endometrium, low ova quality and premature ovarian failure.

The Spleen is also a very important organ in the reproductive system. Unfortunately, over eating of cold, uncooked food, cold climate, unrestrained consumption of sweet food, overactive mind and not active body life style all negatively affected Spleen health. It is very common in clinical setting to see patients with various level of Spleen deficiency. A deficient Spleen is likely to cause scanty or abundant menstruation, spotting, prolonged menstruation, repeated miscarriages etc.

Safety and Controversy

The safe practice of acupuncture and herbal medicine has been meticulously recorded over two millennia in China. Today, well-developed acupuncture treatment protocols used to complement modern ART have been tested in clinical studies to ensure their efficacy and safety.

Chinese herbal medicine is also safe and even more versatile and potent than acupuncture. It is much less known and therefore much less used, even by many acupuncturists in Quebec.

Some patients and fertility doctors have unfounded fears of these herbs interfering with fertility procedures and drugs. If used expertly in conjunction with acupuncture, they are truly a powerful tool in the treatment of female infertility. Personally, I have been using herbal powders in my clinic since 1995 and have never found any adverse reactions.

Success Rate

I have been asked countless times about the success rate of acupuncture to treat female infertility. Unfortunately, I can’t offer a straight and definitive answer to this question. Presently, there aren’t any sizable, randomized and controlled clinical studies available to prove the efficacy of acupuncture in the treatment of female infertility. The absence of such studies is probably due to a lack of funding.

Currently, many infertility patients come for acupuncture treatment after they have exhausted all other options, and these are often the most difficult cases to treat. Until there are randomized, controlled studies to make a fair comparison between the efficacy of acupuncture and various ART techniques, no meaningful comparison can be made. In my clinical observation, although the numbers below are not statistically significant, they do show that acupuncture treatment certainly does not lack for success in the treatment of female infertility. For an example, from May to June 2006, I am pleased to report that there were eighteen pregnancies in my clinic. Eleven of these patients used acupuncture and herbal medicine exclusively and were treated from a few weeks to over a year. The other seven patients received ART treatment, mostly IVF, in addition to acupuncture and herbal medicine.

In addition, successful treatments also largely depend on the knowledge and experience of the individual practitioner. In Quebec, the minimum requirement for an acupuncturist is a three-year CEGEP degree, which is only offered at Rosemont College, but Chinese herbal medicine is not part of the curriculum. Personally, I think that it takes minimum five years of full time clinical practice in TCM gynecology, for a TCM university graduate to be reasonably proficient in infertility treatment. To increase the level of expertise of acupuncturists in this field, L’ordre des acupuncteurs du Quebec has mandated me to conduct an educational seminars, named “Treating female infertility with acupuncture”, in April of 2011.

Due to increase awareness among potential patients and infertility specialists, there is a growing number of patients seeking acupuncture treatment early in the fertility treatment process rather than making it a solution of last resort, in the last a few years. This change should have a very positive impact on the results offered by acupuncture and Chinese herbs.

Alternative to IVF

For infertility patients, who chose not to use ART for financial, religional, moral, personal reference or health reasons, acupuncture and Chinese herbal medicine is an effective alternative. In my clinic, roughly half of patients got pregnant without using ART.

It seems that younger, better educated infertility patients and whose who had benefited from TCM in their first pregnancy are more likely to use acupuncture and Chinese herbal medicine exclusively.

Complementary to IVF

Doing acupuncture pre and post ET is currently one of the most studied, publicised and well-known form of acupuncture application in infertility treatment. However, by far, it is not the only one.

The protocols for using acupuncture and herbal medicine to support fertility treatment are clearly explained in a book titled Acupuncture & IVF by Lifang Liang (see Resource – Book – Infertility). Treatments complementary to IVF involve three phases: Pre-IVF, During IVF and Post-IVF.

In the Pre-IVF phase, weekly acupuncture is recommended for at least three months to alleviate the side effects of medical treatments, increase the response to hormonal stimulation and improve the patient’s reproductive organs and overall health.
In the 2nd phase, for the duration of the IVF treatment, weekly acupuncture plus pre & post transfer acupuncture is recommended. This will increase blood flow to the uterus and ovaries, reduce the stress response caused by IVF and calm the uterus to facilitate implantation.

In the Post-IVF phase, weekly acupuncture for up to three months is recommended for pregnant patients to reduce their risk of miscarriage and ectopic pregnancy. It is essential for patients with a history of miscarriage and ectopic pregnancy to receive treatment during this phase.

In my clinical practice, the above protocol can easily be modified to accommodate just about any Assisted Reproductive Technologies, such as IVF and IUI procedure.

Clinical Practice

Unlike scenarios presented in these clinical studies, TCM doctors usually want to have a minimum of three month of weekly treatment before IVF.

There are many additional benefits that I have observed during my twenty five years of practice:

  • It is an effective treatment for unexplained infertility.
  • It has many desirable effects, such as a regulated menstrual cycle, reduced premenstrual syndromes (PMS), relieved physical and emotional stresses associated with infertility and subsequent treatment, and improved overall health.
  • It has no short-term or long-term side effects.
  • It offers new hope for patients who are:
    1. unable to conceive with the help of ART alone;
    2. can’t afford ART treatment
    3. unwilling to use ART technique due to religional, moral or health conditions.
  • It is relatively inexpensive and is often covered by private insurance, or even public insurance in British Columbia.

Clinical Studies

As an acupuncturist, who had 8 years of education and over 30 years of clinical experience in both Chinese and Western medicine, I watched these clinical studies with a mixed feeling.

On one hand, they popularized the application of acupuncture in the mainstream medical establishment and raised its credibility and awareness among medical professionals and patients.

On the other hand, most of these clinical studies completely ignored many fundamentals of TCM and only used a very limited sets of acupoints rigidly in the search of some “miracle combination of acupoints” to boost the IVF pregnancy rate. It should not come as a surprise that sometimes these clinical studies produced less-than-optimal results. Consequently, many fertility specialists are still hesitate to recommend acupuncture as a complementary therapy to patients. However, most fertility doctors could agree with the findings of a meta-analysis published in British Medical Journal: Acupuncture around ET is safe, makes patients feel better and may increase the success rate of IVF.

As of 2012, the trend is pretty clear, infertility clinics that encourage patients to do Pre and Post ET acupuncture are increasing. I and my colleagues in Sinocare have performed acupuncture in all six infertility clinics in Montreal and sometimes several times a week.

Ten years ago, I probably saw a handful of infertility patients a year and none of them were referred by fertility clinics. Today, I see the same amount of infertility patients in less than an hour. To me, this is nothing short of monumental change.

If two acupuncture sessions, one before and one after embryo transfer during IVF, are proven to increase pregnancy rate by 43.43%, imaging what long term acupuncture and Chinese herbal medicine treatment could do for you in treating infertility.