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Research articles

We would like to thank Brandon Horn, PhD from www.herbalroom.com for providing the following research and commentaries, and also the other researchers/practitioners who did great jobs in this field.

-Michael Ma Dr.TCM

• Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis: Manheimer E, et.al. British Medical Journal 2008 Feb 7; [Epub ahead of print]
This was a meta-analysis looking at all the available, high quality acupuncture research. When taking all factors into account the investigators found that "acupuncture increased the odds of clinical pregnancy by 65% compared with the control groups." What the authors did not mention was that the analysis was biased AGAINST acupuncture (see the upcoming June 2008 issue of the Journal of Chinese Medicine for a publication written by Judith Balk, MD, MPH and Brandon Horn, PhD, JD, LAc for detials). Therefore, the true effects of acupuncture are even higher than this.

• A Pilot Study Evaluating the Combination of Acupuncture with Sildenafil on Endometrial Thickness: Yu et.al. Presented at the Pacific Coast Reproductive Society Meeting 2007 Apr 20
This was an interesting study utilizing a dynamic acupuncture protocol that changed according to the patients'individual needs. Participants in the study all had poor uterine linings in prior cycles (less than 8 mm). Although it was only a pilot study, all subjects achieved lining thickness of 10 mm or greater. Lining thicknesses of 8mm or less have been shown to have substantially lower pregnancy rates than those over 9mm so this is a very significant finding and may be another mechanism by which acupuncture is improving pregnancy rates.

• Acupuncture and IVF: New Evidence for an Unlikely Duo. Horn, B. Alternative Therapies in Women's Health. 2007 Vol. 9(2)81-88.
This is an excellent article :-) that analyses the current acupuncture literature related to IVF. It points out a number of fallacies that have been perpetuated by commentators that are not familiar with acupuncture. When filtering out studies that had improper study design or improper use of acupuncture (such as the use of acupuncture points that are contraindicated during pregnancy), this article certainly reinforces others that properly conducted acupuncture can greatly improve IVF outcomes.

• Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study.: Dieterle S, et.al. Fertility and Sterility 2006; Vol. 85: 1347-51
This is the most recent study once again demonstrating that acupuncture increases ongoing pregnancies by 106% when compared to control subjects. It is important to emphasize that getting pregnant is only part of the story. We want HEALTHY pregnancies. To have the best chances to achieve a healthy pregnancy requires a comprehensive approach to your health. We cannot emphasize how important addressing your health comprehensively is for giving your baby the best chance at having a healthy and happy life.

• Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective,randomized trial: Westergaard LG, et.al. Fertility and Sterility 2006 Apr 4; [Epub ahead of print]
This study once again demonstrates that properly applied acupuncture results in IVF ongoing pregnancy increases of over 60%.

• Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer.: Smith C, et.al.Fertility and Sterility 2006 Apr 4; [Epub ahead of print]
This study examined 228 IVF patients. The group that received true acupuncture showed improvements in ongoing pregnancies of over 50% compared to subjects that received a sham acupuncture treatment. This is very clinically significant, though it did not rise to the level of statistical significance.

• Positive effects of acupuncture in ART are not mediated by changes in ovarian and endometrial production of estradiol, progesterone, and placental protein 14: Westergaard LG, et.al.Fertility and Sterility 2006 Apr 4; [Epub ahead of print]
This is a discussion of the use of acupuncture in IVF relative to the authors' most recent study. Though they are not exactly sure how it is working, the authors state: “The present data corroborate previous studies demonstrating a significant beneficial effect of acupuncture in IVF”

• Influence of Acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy: Paulus,et.al.Fertility and Sterility Vol: 77, No. 4, APRIL 2002
This landmark study published in one of the most prestigious medical journals in reproductive medicine demonstrated that women undergoing acupuncture treatments had an increase in ongoing pregnancy rates of over 60%, compared to control subjects that did not receive acupuncture.

• A Randomized, Double-Blind, Controlled Cross-Over Study Evaluating Acupuncture as an Adjunct to In-Vitro Fertilization: Quintero et.al. Fertility and Sterility Vol: 81, Supplement 3, April, 2004
This was a pilot study where researchers used a completely different acupuncture protocol than the Paulus protocol, but found that in addition to duplicating the 60% increase in ongoing pregnancies of the Paulus study, there was a 180% increase in implantation rates and a significant reduction in the amount of gonadotrophins used (for an average cost savings greater than the cost of acupuncture for the cycle).

• Acupuncture & IVF poor responders: a cure?: Magarelli et.al. Fertility and Sterility Vol: 81, Supplement 3, April, 2004
This was an interesting retrospective study that found a significant increase in IVF pregnancy rates with acupuncture (40% increase). Though these increases were not as high as in the Paulus and Quintero studies, this study did not have exclusion criteria. Of particular interest in this study was that poor responders that received acupuncture had the same pregnancy rates as normal prognosis patients. In this study, poor responders were defined as those with elevated Peak FSH, longer history of infertility or poor sperm morphology.

• A matched controlled study to evaluate the efficacy of acupuncture for improving pregnancy rates following in-vitro fertilization - embryo transfer.Wang et al. Fertility and Sterility Vol: 83, issue 5, Supplement ,May 005
This study further demonstrates the importance of proper acupoint selection and proper administration of acupuncture protocols. The point protocol in this study varied greatly from previous studies that demonstrated positive pregnancy outcomes. This particular acupoint selection did not produce any increases in pregnancy rates.

• Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats: Stener-Victorin et.al. Auton Neurosci. 2003 Oct 31;108(1-2):50-6.
This study demonstrated that acupuncture can significantly increase ovarian blood flow It also demonstrated that, even using the same acupuncture protocol, by a small modification in manipulation, you get the exact opposite effects. That is, you can decrease the ovarian blood flow. This study, therefore, is very important to illustrate the importance of using acupuncturists that have very thorough training in both acupuncture and infertility. Unfortunately, most patients are unaware of this and many medical professions practice acupuncture with as little as a weekend course. You should look for an acupuncturist that has extensive training (in California, for example, Licensed Acupuncturists must complete a four year program of study). It is best to find an acupuncturist with specialized training in infertility. If you are undergoing IVF, it is imperative that your acupuncturist have significant experience with the IVF process. IVF is a subspecialty and there are many issues that will not be apparent to those without significant experience with IVF.

• Auricular acupuncture in the treatment of female infertility: Gerhard et.al. Gynecol Endocrinol 1992 Sep;6(3):171-81
This study compared acupuncture to standard hormone therapy in the treatment of infertility. For women with menstrual irregularities (a subgroup of the patients in the study), acupuncture increased pregnancies by 28% over hormone therapy. There were no side effects in the acupuncture group but there were in the hormone group. Taking all women in the study into account, combined acupuncture and hormone therapy achieved the best results, producing 10% more pregnancies than hormone therapy alone.

• Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture Stener-Victorin et.al. Hum Reprod. 1996 Jun;11(6):1314-7
Successful in-vitro fertilization (IVF) and embryo transfer require optimal endometrial receptivity at the time of implantation. The amount of blood flow to the uterus is considered valuable in assessing endometrial receptivity. This study showed that acupuncture treatments performed twice per week for four weeks significantly increase blood flow to the uterus and may explain one mechanism for the substantial increases in pregnancies when acupuncture is incorporated.

• Clinical studies on the mechanism for acupuncture stimulation of ovulation: Mo et.al. J Tradit Chin Med 1993 Jun;13(2):115-9
This study examined the effects of acupuncture on stimulating ovulation and regulating ovulatory problems. The researchers concluded that acupuncture seems to increase progesterone levels and regulate FSH, LH and E2 levels. This study involved 30 acupuncture treatments and had an 82.35% effective rate.

• Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality: Siterman et.al. Arch Androl,39(2):155-61 1997 Sep-Oct
This study demonstrated that acupuncture can increase both sperm quality and quantity

• Effects of acupuncture and moxa treatment in patients with semen abnormalities. Gurfinkel et.al. Asian J Androl. 2003 Dec;5(4):345-8
This study showed that men receiving acupuncture had significant increases in the percentage of normal-form sperm relative to controls.

• Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Pei J. et.al. Fertil Steril. 2005 Jul;84(1):141-7.
This study showed that men receiving acupuncture had statistically significant improvements in sperm morphology

• The pain-relieving effect of electro-acupuncture and conventional medical analgesic methods during oocyte retrieval: a systematic review of randomized controlled trial.Stener-Victorin E. Hum Reprod. 2004 Nov 11
This review demonstrated that acupuncture analgesic effects are equal to conventional analgesic medication for oocyte retrieval. This is an important alternative for patients who are allergic or sensitive to analgesic medications.

• Possibilities of therapy by ear acupuncture in female sterility. Gerhard, et al. Geburtshilfe Frauenheilkd. 1988 Mar;48(3):165-71.
A simple application of ear acupuncture was shown to be as effective as drug therapy in improving fertility.

• Acupuncture for reproductive disorders. Lin J. et al. Probl Vet Med. 1992 Mar;4(1):155-61.
This article notes the excellent results achieved in improving reproductive outcomes with mammals and proposes that acupuncture influences the hypothalamic-pituitary-gonadal axis as well as steroidogenesis.

• Controlled study on acupuncture for treatment of endocrine dysfunctional infertility Yang JR, et. al. Zhongguo Zhen Jiu 2005 May;25(5):299-300
In this study, acupuncture was compared to Clomid administration in the treatment of endocrine dysfunction infertility. The study found acupuncture to have significantly higher pregnancy rates than Clomid administration (65% versus 45%). The study concluded that acupuncture is an effective treatment for infertility secondary to endocrine dysfunction.

• Clinical observation and study of mechanisms of needle-picking therapy for primary infertility of abnormal sperm. Dong C, et al. Zhongguo zhen jiu 2006;26:389-91
Although the actual abnormalities of the sperm were not mentioned in the abstract, this study is important to show how acupuncture can lower cadmium levels and increase activity of superoxide dismutase. It can also increase zinc levels in semen. The researchers stated that they achieved an effective rate of 83.5% and a subsequent pregnancy rate of 78.8%.