IVF + acup success rate 42.5%

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Here is the full text of the article : “The analysis shows that the

pregnancy rate for the acupuncture group is considerably higher than for

the control group (42.5% vs 26.3%; P=.03).”

Pamela Zilavy

 

 

 

I would be surprised if the actual success rate is >25%. A review

article in that same issue concludes that no conclusive research on

acupuncture and IVF has yet beendone:

 

Role of acupuncture in the treatment of female infertility.

Chang R, Chung PH, Rosenwaks Z.

The Institute of East-West Medicine, New York, New York 10021, USA

 

 

Fertility and Sterility

Volume 77, Issue 4 , April 2002, Pages 721-724

doi:10.1016/S0015-0282(01)03273-3 Cite or link using doi

2002 American Society for Reproductive Medicine. Published by

Elsevier Science Inc.

In vitro fertilization

Influence of acupuncture on the pregnancy rate in patients who undergo

assisted reproduction therapy

Wolfgang E. Paulus M.D, Mingmin Zhang M.D, Erwin Strehler M.D, Imam

El-Danasouri Ph.D. and Karl Sterzik M.D

 

a Department of Reproductive Medicine, Christian-Lauritzen-Institut, Ulm,

Germany

b Department of Traditional , Tongji Hospital, Tongji

Medical University, Wuhan, People's Republic of China

 

Received 5 June 2001; revised 16 October 2001; accepted 16 October

2001. Available online 31 March 2002.

 

Abstract

Objective: To evaluate the effect of acupuncture on the pregnancy rate in

assisted reproduction therapy (ART) by comparing a group of patients

receiving acupuncture treatment shortly before and after embryo transfer

with a control group receiving no acupuncture.

Design: Prospective randomized study.

Setting: Fertility center.

Patient(s): After giving informed consent, 160 patients who were

undergoing ART and who had good quality embryos were divided into the

following two groups through random selection: embryo transfer with

acupuncture (n = 80) and embryo transfer without acupuncture (n = 80).

Intervention(s): Acupuncture was performed in 80 patients 25 minutes

before and after embryo transfer. In the control group, embryos were

transferred without any supportive therapy.

Main Outcome Measure(s): Clinical pregnancy was defined as the presence

of a fetal sac during an ultrasound examination 6 weeks after embryo transfer.

Result(s): Clinical pregnancies were documented in 34 of 80 patients

(42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3%

(21 out of 80 patients) in the control group.

Conclusion(s): Acupuncture seems to be a useful tool for improving

pregnancy rate after ART.

Author Keywords: Acupuncture; assisted reproduction; embryo transfer;

pregnancy rate

 

Article Outline

Acupuncture is an important element of traditional Chinese medicine

(TCM), which can be traced back for at least 4,000 years. Acupuncture has

been shown to alleviate nausea and vomiting, dental pain, addiction,

headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain,

osteoarthritis, carpal tunnel syndrome, and asthma. Both physiologic and

psychological benefits of acupuncture have been scientifically

demonstrated in recent years.

However, so far there have been only a few serious trials concerning the

use of acupuncture in reproductive medicine. Publications focus primarily

on acupuncture therapy for male infertility [1 and 2]. Electroacupuncture

may reduce blood flow impedance in the uterine arteries of infertile

women [3]. A positive impact of electroacupuncture on endocrinologic

parameters and ovulation in women with polycystic ovary syndrome has been

demonstrated [4]. In addition, auricular acupuncture was successfully

used in the treatment of female infertility [5].

In the present study, we chose acupuncture points that relax the uterus

according to the principles of TCM. Because acupuncture influences the

autonomic nervous system, such treatment should optimize endometrial

receptivity [6]. Our main objective was to evaluate whether acupuncture

accompanying embryo transfer increases clinical pregnancy rate.

Materials and methods

This study was a prospective randomized trial at the

Christian-Lauritzen-Institut in Ulm, Germany. It was approved by the

ethics committee of the University of Ulm.

A total of 160 healthy women undergoing treatment with in vitro

fertilization (IVF; N = 101) or intracytoplasmic sperm injection (ICSI; N

= 59) were recruited into the study. The age of the patients ranged from

21 to 43 (mean age: 32.5 ± 4.0 years). The cause of infertility was the

same for both groups (Table 1). Only patients with good embryo quality

were included in the study. Using a computerized randomization method,

patients were assigned into either the acupuncture group or the control group.

 

TABLE 1. Descriptive data on acupuncture and control group (mean ± SD or

total number). (17K)

NS = not significant (P>.05).

Paulus. Acupuncture in ART. Fertil Steril 2002.

 

Ovarian stimulation, oocyte retrieval, and in vitro culture were

performed as previously described [7]. Transvaginal ultrasound-guided

needle aspiration of follicular fluid was performed 36 to 38 hours after

hCG administration. Immediately after follicle puncture, the oocytes were

retrieved, assessed, and fertilized in vitro. Sperm preparation and

culture conditions did not differ for either group.

In cases of severe male subfertility, ICSI was preferred, as described in

the literature [8]. Forty-eight hours after the IVF or ICSI procedure,

embryos were evaluated according to their appearance as type 1 or 2

(good), type 3 or 4 (poor), as described in literature [9].

Just before and after embryo transfer, all patients underwent ultrasound

scans of the uterus using a 7-MHz transvaginal probe (LOGIQ 400 Pro, GE

Medical Systems Ultrasound Europe, Solingen, Germany). Pulsed Doppler

curves of both uterine arteries were measured by one observer. The

pulsatility index (PI) for each artery was calculated electronically from

a smooth curve fitted to the average waveform over three cardiac cycles.

A maximum of three embryos, in accordance with German law, were

transferred into the uterine cavity on day 2 or 3 after oocyte retrieval.

For embryo replacement, the patient was placed in a dorsal lithotomy

position, with an empty bladder. The cervix was exposed with a bivalved

speculum, then washed with culture media prior to embryo transfer.

Labotect Embryo Transfer Catheter Set (Labotect GmbH, Göttingen, Germany)

was used for atraumatic replacement owing to the curved guiding cannula

with a ball end, allowing the set to be used reliably even with difficult

anatomic conditions. The metallic reinforced inner catheter shaft allowed

safe passage through the cervical canal. When the catheter tip lay close

to the fundus, the medium containing the embryos was expelled and the

catheter withdrawn gently. After this procedure, the patient was placed

at bed rest for 25 minutes. All oocyte retrievals and embryo transfers

were performed by one examiner using the same method. The examiner was

not aware of the patient's treatment group (control or acupuncture).

At the time of the embryo transfer, blood samples (10 mL) were obtained

from the cubital vein. Plasma estrogen was determined by an immunometric

method using the IMMULITE 2000 Immunoassay System (DPC Diagnostic Product

Corporation, Los Angeles, CA).

Luteal phase support was given by transvaginal progesterone

administration (Utrogest®, 200 mg, three times per day; Kade, Berlin,

Germany). Progesterone administration was initiated on the day after

oocyte retrieval and was continued until the serum -hCG measurement 14

to 16 days after transfer and, in cases of pregnancy, until gestation week 8.

Each patient in the experimental group received an acupuncture treatment

25 minutes before and after embryo transfer. Sterile disposable stainless

steel needles (0.25 × 25 mm) were inserted in acupuncture point

locations. Needle reaction (soreness, numbness, or distention around the

POINT = Deqi sensation) occurred during the initial insertion. After 10

minutes, the needles were rotated in order to maintain Deqi sensation.

The needles were left in position for 25 minutes and then removed. The

depth of needle insertion was about 10 to 20 mm, depending on the region

of the body undergoing treatment. Before embryo transfer, we used the

following locations: Cx6 (Neiguan), Sp8 (Diji), Liv3 (Taichong), Gv20

(Baihui), and S29 (Guilai).

After embryo transfer, the needles were inserted at the following points:

S36 (Zusanli), Sp6 (Sanyinjiao), Sp10 (Xuehai), and Li4 (Hegu).

In addition, we used small stainless needles (0.2 × 13 mm) for auricular

acupuncture at the following points, without rotation: ear point 55

(Shenmen), ear point 58 (Zhigong), ear point 22 (Neifenmi), and ear point

34 (Naodian). Two needles were inserted in the right ear, the other two

needles in the left ear. The four needles remained in the ears for 25

minutes. The side of the auricular acupuncture was changed after embryo

transfer. The patients in the control group also remained lying still for

25 minutes after embryo transfer. All treatments were performed by the

same well-trained examiner, in the same way.

The primary point of the study was to determine whether acupuncture

improves the clinical pregnancy rate after IVF or ICSI treatment.

Student's t-test was used as a corrective against any possible imbalance

between the two groups regarding the following variables: age of patient,

number of previous cycles, number of transferred embryos, endometrial

thickness, plasma estradiol on day of transfer, method of treatment (IVF

or ICSI), and blood flow impedance in the uterine arteries (pulsatility

index). Chi-square test was used to compare the two groups. All

statistical analyses were carried out using the software package

Statgraphics (Manugistics, Inc., Rockville, MD).

Results

A total of 160 patients was recruited for the study. Patients who failed

to conceive during the first treatment cycle were not reentered into the

study. According to the randomization, 80 patients were treated with

acupuncture, and 80 patients underwent the usual therapy without acupuncture.

As Table 1 shows, there were no statistically significant differences

between the two groups with respect to the following covariants: age of

patient, number of previous cycles, number of transferred embryos,

endometrial thickness, plasma estradiol on day of transfer, or method of

treatment (IVF or ICSI). Clinical indications for ART were the same for

patients of both groups. The blood flow impedance in the uterine arteries

(pulsatility index) did not differ between the groups before and after

embryo transfer.

The analysis shows that the pregnancy rate for the acupuncture group is

considerably higher than for the control group (42.5% vs 26.3%; P=.03).

Discussion

The acupuncture points used in this study were chosen according to the

principles of TCM [10]: Stimulation of Taiying meridians (spleen) and

Yangming meridians (stomach, colon) would result in better blood

perfusion and more energy in the uterus. Stimulation of the body points

Cx6, Liv3, and Gv20, as well as stimulation of the ear points 34 and 55,

would sedate the patient. Ear point 58 would influence the uterus,

whereas ear point 22 would stabilize the endocrine system.

The anesthesia-like effects of acupuncture have been studied extensively.

Acupuncture needles stimulate muscle afferents innervating ergoreceptors,

which leads to increased -endorphin concentration in the cerebrospinal

fluid [11]. The hypothalamic -endorphinergic system has inhibitory

effects on the vasomotor center, thereby reducing sympathetic activity.

This central mechanism, which involves the hypothalamic and brainstem

systems, controls many major organ systems in the body [12]. In addition

to central sympathetic inhibition by the endorphin system, acupuncture

stimulation of the sensory nerve fibers may inhibit the sympathetic

outflow at the spinal level. By changing the concentration of central

opioids, acupuncture may also regulate the function of the

hypothalamic-pituitary-ovarian axis via the central sympathetic system [13].

Kim et al. [14] suggested that Li4 acupuncture treatment could be useful

in inhibiting the uterus motility. In their rat experiments, treatment on

the Li4 acupoint suppressed the expression of COX-2 enzyme in the

endometrium and myometrium of pregnant and nonpregnant uteri.

Stener-Victorin et al. [3] reduced high uterine artery blood flow

impedance by a series of eight electroacupuncture treatments, twice a

week for 4 weeks. They suggest that a decreased tonic activity in the

sympathetic vasoconstrictor fibers to the uterus and an involvement of

central mechanisms with general inhibition of the sympathetic outflow may

be responsible for this effect. In our study, we could not see any

differences in the pulsatility index between the acupuncture and control

group before or after embryo transfer. This may be due to a different

acupuncture protocol and the selected sample of patients with high blood

flow impedance of the uterine arteries (PI 3.0) in the Stener-Victorin

et al. study.

As we could not observe any significant differences in covariants between

the acupuncture and control groups, the results demonstrate that

acupuncture therapy improves pregnancy rate.

Further research is needed to demonstrate precisely how acupuncture

causes physiologic changes in the uterus and the reproductive system. To

rule out the possibility that acupuncture produces only psychological or

psychosomatic effects, we plan to use a placebo needle set as a control

in a future study.

 

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Reprint requests: Wolfgang E. Paulus, M.D., Christian-Lauritzen-Institut,

Frauenstr. 51, D-89073, Ulm