Research

Click on the links below to open research abstracts outlining the benefits of acupuncture during IVF. Also be sure and read this entry evaluating the efficacy and costs of Traditional Chinese medicine vs. In Vitro Fertilization (IVF) in the treatment of infertility.

Acupuncture and embryo transfer

Women who receive acupuncture on the day of their embryo transfer significantly increase their chances of pregnancy and live birth.

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.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

OBJECTIVE: To evaluate the effects of acupuncture on clinical pregnancy rates for women undergoing ET.

DESIGN: Single-blind, randomized controlled trial using a noninvasive sham acupuncture control.

SETTING: Repromed, The Reproductive Medicine Unit of The University of Adelaide.

PATIENT(S): Women undergoing IVF.

INTERVENTION(S): Women were randomly allocated to acupuncture or noninvasive sham acupuncture with the placebo needle. All women received three sessions, the first undertaken on day 9 of stimulating injections, the second before ET, and the third immediately after ET.

MAIN OUTCOME MEASURE(S): The primary outcome was pregnancy. Secondary outcomes were implantation, ongoing pregnancy rate at 18 weeks, adverse events, and health status.

RESULT(S): Two hundred twenty-eight subjects were randomized. The pregnancy rate was 31% in the acupuncture group and 23% in the control group. For those subjects receiving acupuncture, the odds of achieving a pregnancy were 1.5 higher than for the control group, but the difference did not reach statistical significance. The ongoing pregnancy rate at 18 weeks was higher in the treatment group (28% vs. 18%), but the difference was not statistically significant.

CONCLUSION(S): There was no significant difference in the pregnancy rate between groups; however, a smaller treatment effect can not be excluded. Our results suggest that acupuncture was safe for women undergoing ET.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

OBJECTIVE: To evaluate the effect of acupuncture on reproductive outcome in patients treated with IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on the day of ET, another group on ET day and again 2 days later (i.e., closer to implantation day), and both groups were compared with a control group that did not receive acupuncture.

DESIGN: Prospective, randomized trial.

SETTING: Private fertility center.

PATIENT(S): During the study period all patients receiving IVF or ICSI treatment were offered participation in the study. On the day of oocyte retrieval, patients were randomly allocated (with sealed envelopes) to receive acupuncture on the day of ET (ACU 1 group, n = 95), on that day and again 2 days later (ACU 2 group, n = 91), or no acupuncture (control group, n = 87).

INTERVENTION(S): Acupuncture was performed immediately before and after ET (ACU 1 and 2 groups), with each session lasting 25 minutes; and one 25-minute session was performed 2 days later in the ACU 2 group.

MAIN OUTCOME MEASURE(S): Clinical pregnancy and ongoing pregnancy rates in the three groups.

RESULT(S): Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the ACU 2 group (36% and 26%) were higher than in controls, but the difference did not reach statistical difference.

CONCLUSION(S): Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2 provided no additional beneficial effect.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF / intracytoplasmic sperm injection (ICSI).

DESIGN: Randomized, prospective, controlled clinical study.

SETTING: University IVF center.

PATIENT(S): Two hundred twenty-five infertile patients undergoing IVF/ICSI.

INTERVENTION(S): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture.

MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancy rates.

RESULT(S): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%).

CONCLUSION(S): Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

OBJECTIVE: The study was conducted to examine several adjunct treatment regimens administered before and after embryo transfer and determine if one treatment was more efficacious than any of the alternative regimens on in vitro fertilization (IVF) outcome. We compared two different acupuncture stimulation modes, needle and laser acupuncture, with sham laser acupuncture, relaxation, or no intervention treatment on implantation and pregnancy rates in women undergoing IVF.

DESIGN: Prospective single blind randomized trial. MATERIALS AND METHODS: Patients (n258) who had been scheduled for embryo transfer (ET), signed informed consent and were randomly assigned to one of 5 study treatment regimens; needle acupuncture (AC; 53), laser acupuncture (LZ AC; n53), sham laser acupuncture (placebo)(LZ sham; n52), relaxation (RX; n50), or no intervention treatment (NT; n50). All treatments were administered 25 minutes before ET and immediately after ET. The patient and acupuncturist were unaware of whether the laser system was active which allowed for a double-blind control group for the laser acupuncture treatment. Comparisons of various parameters between groups were conducted by 2 tests and one-way ANO- As.. Multinomial logistic regression analysis was used to control for the potentially confounding effects of day of embryo transfer (day 3 vs.5) and number of embryos transferred which are known to relate to IVF outcome, to further analyze the impact of adjunct treatment regimens on implantation and pregnancy rates. Probability of P 0.05 was considered to be statistically significant.

RESULTS: No differences in terms of cycle type, day of embryo transfer, or physician performing transfer were found between treatment groups. Neither day of transfer (p0.079) or egg number (P 0.082) were significant independent redictors of implantation or conception when interactions between parameters were considered in all 5 groups. All acupuncture treatments were well tolerated.

CONCLUSION: Conception and implantation rates were highest with traditional needle acupuncture. IVF treatment outcomes did not differ between patients treated with laser or sham laser acupuncture. This study did not have the statistical power to detect treatment differences in pregnancy rates between needle acupuncture and no treatment (i.e., at least 200 subjects are needed to detect differences in CP rates of 54.7 and 44% with 80% power) which may be due to sample size, transfer of embryos of varying quality and variations in stimulation protocols. However, while not statistically significant, needle acupuncture produced a clinically significant effect (greater than 10% increase in clinical pregnancy rate) compared with relaxation or no treatment which warrants further investigation.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

OBJECTIVE: The aim of this study was to evaluate the effects of acupuncture on embryo transfer by comparing the rates of clinical pregnancy.

DESIGN: Retrospective, interventional and longitudinal study.

MATERIALS AND METHODS: Study with a total of 111 cycles of patients who underwent assisted reproduction techniques: in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) from June/2005 to January/ 2007: 52 cycles with acupuncture and 59 cycles without acupuncture. Acupuncture was performed, in specific points of the body including the ear, immediately before and after the embryo transfer procedure and the needles were retained for 30 minutes per session. The embryo transfer was carried out under ultrasound guidance and luteal phase support was given by trans-vaginal progesterone administration (Utrogestan) and intramuscular progesterone. Outcome measure was clinical pregnancy rate.

RESULTS: The clinical pregnancy rate per cycle was observed in 27 of 52 (51.9%) patients in the acupuncture group and 21 of 59 (35.6%) patients in the control group (P 1⁄40,083). The mean age was 36.1 6.1 years in the control group and 36.4 years in the acupuncture group (P1⁄40.785). The mean number of embryo transferred was 3.3 in the control group and 3.6 in the acupuncture group (P1⁄40.462). The technique of embryo transfer was 5 cycles of IVF and 54 cycles of ICSI in the control group and 5 cycles IVF and 47 cycles of ICSI in the acupuncture group (P 1⁄41.000). Both groups did not show statistics difference in the mean age, number of embryo transferred and the technique procedure.

CONCLUSIONS: Although there was a higher pregnancy rate in the acupuncture group, this difference was not statistically significant, probably because of the small number of patients in both group. Acupuncture seems to be an important coadjuvant in the treatment of infertility with IVF or ICSI, and further research is needed to demonstrate its precisely effect.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Objective: The purpose of the study was to determine the influence of two acupuncture protocols on IVF outcomes and secondly to identify the appropriate patient groups that would most benefit from this adjunctive therapy.

Materials and Methods: In this retrospective study, data was extracted from medical records of patients RE&I clinic & acupuncture clinics between January 2001 and November 2003. All patients completing an IVF cycle with transfer were included. One RE&I provided the IVF care and a consortium of acupuncturists overseen by the author provided the strict acupuncture protocols. PR per transfer were the endpoints measured. Data was analyzed by student’s t test and Multiregression with Wilcox ranking (MRW).

Results: 147 patients were included in the study and of those 53 had Acupuncture (Ac) and 94 did not (Non-Ac group). Demographic data between these Ac and Non-Ac groups respectively indicated remarkable equity (Table 1). Fertility Factors also demonstrated equity and there were no differences in Diagnoses, IVF Protocols and type of Gonadatrophin protocols used.

Factors that demonstrated significance were: Length of time infertile, Peak FSH, PI for total group without MRW; PI for MRW groups reversed this (Table 2) and finally average: Sperm Morphology, Peak E2, Peak P4 prior to HcG: and endometrial thickness. PR before Wilcox ranking were the same: 40% v 38%. MRW analysis revealed FSH, Length of time trying to get pregnant, Sperm Morphology and E2 levels as significant: 6.5, 4.1, 4.0 and 1.6 respectively. When the Ac group was modified (15 Ac patient dropped), PI was elevated from 1.76 to 1.94 resulting in a significant elevation compared to the Non-Ac group, p 0.01. Also PR changed from 40% before to 53% after and this value was significantly greater than the Non-Ac group (38%), p 0.01.

Conclusions: Significant increases in pregnancy outcomes were confirmed by this study and the data uniquely supported the advantage of acupuncture in patients with normal PI (prior studies were done on patient with PI). We also demonstrated that both acupuncture treatment protocols could be used together with a synergistic effect. Finally, this study is the first to demonstrate that the use of acupuncture in patients with poor prognoses (elevated Peak FSH, longer history of infertility, poor sperm morphology) can achieve similar pregnancy rates to normal prognosis patients.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

OBJECTIVE: Conflicting evidence exists on whether acupuncture is beneficial for patients undergoing In Vitro Fertilization (IVF) cycles. Therefore, this study was undertaken to determine whether on-site acupuncture, per- formed both before and after embryo transfer, affects clinical outcomes.

DESIGN: Retrospective data analysis.

MATERIALS AND METHODS: The Acupuncture Group consisted of 49 patients who received acupuncture on-site before and after embryo transfer in 2007. The treatment did not follow the Paulus protocol. The Control Group were 212 patients with no acupuncture undergoing IVF cycles in the same time period. The data was subdivided by SART age classifications to determine if acupuncture differentially benefitted certain age groups. Clinical Pregnancy Rate (CPR) was defined as the presence of fetal cardiac activity. Loss Rate was the percentage of pregnancies that did not proceed from a positive hCG to a clinical pregnancy. Data were analysed using the unpaired t-test and Fisher’s exact test, with significance defined as P < 0.05.

RESULTS: Patients with a positive hCG were significantly higher in the Acupuncture Group for women less than 35 years old (63.3% vs.43.2%, p1⁄4 0.048). The Acupuncture Group also had a higher CPR in the under 35 category (60.0% vs. 34.6%, p 1⁄4 0.01). There were no differences in the other age groups. Combining all the age groups, the cycle parameters between the two Groups were equivalent, while the CPR was higher and the Loss Rate lower for the Acupuncture group (Table 1).

CONCLUSIONS: Although other studies regarding acupuncture have been inconclusive, perhaps these positive results are related to two important factors. The treatments were performed on-site, eliminating the stress of travelling to another site before and after the embryo transfer. Also, the acupuncture treatment protocol did not follow the traditional Paulus protocol, thereby suggesting there is still more research to be done on how best to treat infertility issues with acupuncture

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

The London Bridge Fertility, Gynaecology and Genetics Centre, London, UK

All IVF cases in which acupuncture was administered before and after embryo transfer at a large private infertility centre were reviewed for a 2 year period. All patients were treated by the same practitioner (NDB) using Traditional Chinese Acupuncture (TCA). Patients received acupuncture to the protocol developed by Paulus, W.E., Zhang, M., Strehler, E., El-Danasouri, I., & Sterzik, K. (2002). Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility & Sterility, 77, 721–724: Liver 3, Spleen 8, Stomach 29, Pericardium 6, GV 20 were manually stimulated five times over a 40-min period, at Bridge, approximately 10–20 minutes prior to embryo transfer. Embryo transfer was carried out under ultrasound guidance as per routine at Bridge. Ten minutes following embryo transfer acupoints Spleen 6, Stomach 36, Spleen 10, Large Intestine 4 were manually stimulated five times over a 40-min period before discharging the patient. Ear points 34, 55 and 58 were used in both treatments and not stimulated.

A total of 71 patients underwent 74 cycles involving acupuncture before and after embryo transfer.

Overall, positive pregnancy rates/ET were 44.6% comparing favourably with the non-acupuncture historic control group.

When analysed by maternal age at time of treatment, biochemical pregnancy results for acupuncture treated women were as follows: <35 years−52%; 35–39 years – 45%; 40–45 years – 35%.

Results for women aged 35–39 years and those over 40 years were markedly better than controls suggesting that acupuncture intervention of this type may be more effective in older women. No side effects or complications were experienced by women receiving acupuncture. Acupuncture is a safe, adjunct therapy in IVF and in other randomised clinical trials has been shown to significantly improve outcomes when used at the IVF centre before and after embryo transfer. Our preliminary data are encouraging and suggest that a trial involving older women may be effective.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Objective To observe the effect of acupuncture on the pregnancy rate in assisted reproduction therapy such as in-vitro-fertilisation (IVF) and intracytoplasmatic spermatozoen injection (ICSI), and mechanisms.

Methods 210 cases undergoing IVF or ICSI were divided randomly into three groups: acupuncture treatment group, placebo group and control group. The acupuncture treatment group and the placebo group were treated respectively with body acupuncture and placebo acupuncture before and after embryo transfer, and in the control group embryos were transferred without any supportive therapy. Contraction frequency of the uterine junctional zone and the pregnancy rate were observed.

Results The contraction frequency before embryo transfer was not significantly different among the three groups, but after embryo transfer in the acupuncture treatment group was lower than that in the placebo group and the control group, respectively. The pregnancy rate was 44.3% (31/70) in the acupuncture treatment group, and 27.1% (19/70) in the placebo group and 24.3% (17/70) in the control group. The pregnancy rate in the acupuncture treatment group was significantly higher than that in the placebo acupuncture group and the control group (P0.05).

Conclusion Acupuncture is a powerful tool for improving pregnancy rate after assisted reproduction therapy.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

Patient(s): 57 infertile patients undergoing IVF or IVF/ICSI.

Interventions(s): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.
Main outcome measure(s): Perceive Stress Scale scores, pregnancy rates.

Result(s): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status.

Conclusions(s): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Acupuncture and in vitro fertilization

The various ways which research has shown acupuncture to be helpful during In Vitro Fertilization (IVF)

OBJECTIVE: To develop a protocol that could be used in future studies to evaluate whether acupuncture improves pregnancy and delivery rates in patients undergoing IVF. DESIGN: Randomized, sham treatment controlled pilot study.

MATERIALS AND METHODS: Patients planning to undergo IVF who meet inclusion/exclusion criteria (age 40 years old at start of stimulation, highest basal FSH 10mIU/mL, 3 prior failed IVF attempts, acupuncture naıeve) were randomly assigned to an acupuncture treatment group or a sham treatment group.

Treatment sessions occurred before the start of gonadotropin stimulation, the day before the oocyte retrieval, the day before the embryo transfer and the day after the embryo transfer. Acupuncture was performed using manual manipulation at 6 to 10 points depending on the timing of the acupuncture treatment. Sham treated patients had needles placed in non meridian points at a shallow depth. Patients were also given a questionnaire regarding their impressions of acupuncture treatment and were asked to guess their group assignment.

Data was analyzed using chi-squared for dichotomous outcome variables (e.g. clinical pregnancy rate, number of take home babies) and t-tests for continuous outcomes (e.g. age).

RESULTS: Twenty-two IVF cycles (19 patients) were randomized with thirteen patients completing the study (14 cycles). Five cycles were not completed due to poor response to ovarian stimulation (4 in the sham group,one in the real group). Other reasons for incomplete cycles (all in the sham group) included a persistent ovarian cyst, no viable embryos for transfer and personal reasons. The overall cycle cancellation rate was 32% compared to a 22% cycle cancellation rate for non study patients of a similar age treated at this center during a similar time period (p.05).

In the 13 patients analyzed, the mean age was 35 years old (SD4.03). There was no statistical difference between true and sham acupuncture groups with respect to age (Sham: Mean35, SD4.6, Real: Mean34, SD4.6). Additionally, there was no significant difference between groups in highest basal FSH, number of oocytes retrieved, or number of embryos transferred. There was a significantly higher chemical pregnancy rate (80% versus 11.0%) in patients receiving true acupuncture compared to sham acupuncture (p.05). The clinical pregnancy rates and the take home baby rates showed a strong trend towards a higher rate with acupuncture treatment though the difference was not statistically significant (60% real treatment vs. 11% sham treatment, p.05.).

Regarding the questionnaire, only one patient correctly guessed their group assignment (real acupuncture). All patients rated their experience as very positive or positive.

CONCLUSION: It is feasible to conduct a randomized, blinded, sham control trial to study the impact of acupuncture on IVF success rates. Such a protocol is well accepted by patients. Preliminary data shows a statistically significant improvement in the biochemical pregnancy rate with acupuncture treatment. Additionally, acupuncture was associated with a strong trend towards higher clinical pregnancy rates and take home baby rates, though more patients will need to be studied to reach any final conclusions.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Objective: The purpose of this study was to determine if there are benefits of standard acupuncture compared to sham acupuncture as an adjunct to IVF.

Materials and Methods: A randomized, controlled, double-blind, cross over pilot trial was performed using a needle-like device (sham acupuncture) as a control. Approval from GAMC's Investigational Review Board was acquired. Inclusion criteria were women aged 18 to 42 years with a history of failed IVF cycle(s); the presence of both ovaries; and a normal uterine cavity. Exclusion criteria was Kruger morphology <4%.

Results: Seventeen subjects were enrolled and seven subjects completed both arms of the study. The mean age was 36.2 years (range 28-41 years). The mean Day 3 FSH=3 D6.8 IU (range 3-13 IU). There were four ongoing pregnancies after the first cycle, equally distributed. Seven subjects were crossed over after the first cycle. Of these, four from the standard acupuncture group and one from the sham acupuncture group attained pregnancy. Two subjects of the standard acupuncture group were on-going pregnancies and one from the sham group. Only the sham group had two IVF cancellations. An unpaired Mann-Whitney Test using a two-sided p value was performed.

Conclusions: Our study shows a significantly lower amount of gonadotropins used when IVF is combined with standard acupuncture. A 70% pregnancy rate was also achieved with standard acupuncture and IVF, compared to 25%. Larger prospective trials are necessary.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

BACKGROUND: Acupuncture has been used during IVF treatment as it may improve outcome, however, there are concerns about the true efficacy of this approach. This randomized double blind study aimed to compare real acupuncture with placebo acupuncture in patients undergoing IVF treatment.

METHODS: On the day of embryo transfer (ET), 370 patients were randomly allocated to either real or placebo acupuncture according to a computer-generated randomization list in sealed opaque envelopes. They received 25 min of real or placebo acupuncture before and after ET. The endometrial and subendometrial vascularity, serum cortisol concentration and the anxiety level were evaluated before and after real and placebo acupuncture. RESULTS: The overall pregnancy rate was significantly higher in the placebo acupuncture group than that in the real acupuncture group (55.1 versus 43.8%, respectively, P 5 0.038; Common odds ratio 1.578 95% confidence interval 1.047–2.378). No significant differences were found in rates of ongoing pregnancy and live birth between the two groups. Reduction of endometrial and subendometrial vascularity, serum cortisol concentration and the anxiety level were observed following both real and placebo acupuncture, although there were no significant differences in the changes in all these indices between the two groups.

CONCLUSIONS: Placebo acupuncture was associated with a significantly higher overall pregnancy rate when compared with real acupuncture. Placebo acupuncture may not be inert.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Objective
To observe the effect and mechanism of acupuncture on infertility of rats with polycystic ovarian syndrome (PCOS).

Methods
PCOS rat model was induced by subcutaneous injection of oil solution of dehydroepiandrosterone (DHEA) in immature (24-day-old) female rats for continuous 20 days. Rats in the control group were given the same dose of DHEA oil.
PCOS rats were randomly divided into the control group (untreated) and the acupuncture group treated by needling acupoints of Guanyuan (CV4), Zhongji (CV3), Sanyinjiao (SP6) and Zigong (CX-CA1), 15 min once a day for 5 continuous days, starting from the 80th day after birth.
All rats were sacrificed at termination of the treatment, their uterus and ovaries were dissected for observation and blood levels of sex hormones were measured.

Results
Compared with the control group, the number of implanted blastocysts and the blastocyst implantation rate were higher and the blood levels of testosterone (T) and estradiol (E2) were lower in the acupuncture group (P<0.05); but the difference between groups in serum levels of follicular stimulating hormone, luteinzing hormone and progesterone were of statistical insignificance (P>0.05).

Moreover, the wet weight of the ovaries was lower and the equipotent diameter and area of glandular organ and cavity area ratio of gland and the stroma and mean thickness of endometria were higher in the acupuncture group than those in the control group (P<0.05).

Conclusion
Acupuncture can significantly down-regulate the expressions of serum levels of T and E2, improve the development of ovaries and uterus, promote ovulation, enhance endometrial receptivity, and advance blastocyst implantation.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Objective: To determine whether changes in serum cortisol (CORT) and PRL are affected by acupuncture (Ac) in Ac-treated IVF patients.

Design: Prospective cohort clinical study.

Setting: Private practice reproductive endocrinology and infertility clinic and private practice acupuncture consortium.
Patient(s): Sixty-seven reproductive-age infertile women undergoing IVF.

Intervention(s): Blood samples were obtained from all consenting new infertility patients and serum CORT and serum PRL were obtained prospectively. Patients were grouped as controls (IVF with no Ac) and treated (IVF with Ac) according to acupuncture protocols derived from randomized controlled trials.

Main Outcome Measure(s): Serum levels of CORT and PRL were measured and synchronized with medication stimulation days of the IVF cycle (e.g., day 2 of stimulation, day 3, etc.). Reproductive outcomes were collected according to Society for Assisted Reproductive Technology protocols, and results were compared between controls and those patients treated with Ac.

Result(s): CORT levels in Ac group were significantly higher on IVF medication days 7, 8, 9, 11, 12, and 13 compared with controls. PRL levels in the Ac group were significantly higher on IVF medication days 5, 6, 7, and 8 compared with controls.

Conclusion(s): In this study, there appears to be a beneficial regulation of CORT and PRL in the Ac group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics. (Fertil Steril 2008; 2008 by American Society for Reproductive Medicine.)

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Conclusion: electroacupuncture could decrease serum FSH and LH levels, and increase estrogen levels in women with ovarian deficiency with little to no side-effects.

To investigate the effects of electroacupuncture (EA) on serum FSH, E2, and LH levels, women with primary ovarian insufficiency (POI) were treated with EA once a day, five times a week for the first four weeks and once every other day, three times a week, for the following two months, and then were followed up for three months. Serum E2, FSH, and LH levels were measured at baseline, at the end of treatment, and during followup. A total of 11 women with POI were included in this prospective consecutive case series study. Compared with baseline, patients' serum E2 increased, FSH decreased, and LH decreased (P = 0.002, 0.001, and 0.002, resp.) after EA treatment, and these effects persisted during followup. With treatment, 10 patients resumed menstruation (10/11, 90.91%), whereas one patient remained amenorrhea. During followup, two patients, including the one with amenorrhea during treatment, reported absence of menstruation. Temporary pain occurred occasionally, and no other adverse events were found during treatment. The results suggest that EA could decrease serum FSH and LH levels and increase serum E2 level in women with POI with little or no side effects; however, further randomized control trials are needed.

Evid Based Complement Alternat Med. 2013;2013:657234. doi: 10.1155/2013/657234. Epub 2013 Feb 28., Zhou K, Jiang J, Wu J, Liu Z. - Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, No. 5 Bei Xian Ge Street, Xuan Wu District, Beijing 100053, China ; Department of Physical Therapy, Daemen College, 4380 Main Street, Amherst, NY 14226, USA. http://www.ncbi.nlm.nih.gov/pubmed/23533511

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Acupuncture and blood flow to uterus and ovaries

Encouraging blood flow to the uterus and ovaries is the cornerstone to effective treatment of infertility, aiding in IVF success, and preventing miscarriage.

In order to assess whether electro-acupuncture (EA) can reduce a high uterine artery blood flow impedance, 10 infertile but otherwise healthy women with a pulsatility index (PI) ≥3.0 in the uterine arteries were treated with EA in a prospective, non-randomized study. Before inclusion in the study and throughout the entire study period, the women were down-regulated with a gonadotrophin-releasing hormone analogue (GnRHa) in order to exclude any fluctuating endogenous hormone effects on the PL The baseline PI was measured when the serum oestradiol was ≤0.1 nmol/1, and thereafter the women were given EA eight times, twice a week for 4 weeks. The PI was measured again closely after the eighth EA treatment, and once more 10–14 days after the EA period. Skin temperature on the forehead (STFH) and in the lumbosacral area (STLS) was measured during the first, fifth and eighth EA treatments. Compared to the mean baseline PI, the mean PI was significantly reduced both shortly after the eighth EA treatment (P < 0.0001) and 10–14 days after the EA period (P < 0.0001). STFH increased significantly during the EA treatments. It is suggested that both of these effects are due to a central inhibition of the sympathetic activity.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

The utility of acupuncture in the treatment of infertility has been demonstrated in two controlled studies. The first study determined the effect of reducing the Pulsatility Index (PI) of the uterine artery on reproductive outcomes; the second study described a Pre/Post embryo transfer protocol that enhanced overall pregnancy rates (PR).

There are no studies that have utilized both techniques.

Objective: The purpose of the study was to determine the influence of these two acupuncture protocols on IVF outcomes and secondly to identify the appropriate patient groups that would most benefit from this adjunctive therapy.

Materials and Methods: In this retrospective study, data was extracted from medical records of patients RE&I clinic & acupuncture clinics be- tween January 2001 and November 2003. All patients completing an IVF cycle with transfer were included.

One RE&I provided the IVF care and a consortium of acupuncturists overseen by the author provided the strict acupuncture protocols. PR per transfer were the endpoints measured. Data was analyzed by student’s t test and Multiregression with Wilcox ranking (MRW).

Results: 147 patients were included in the study and of those 53 had Acupuncture (Ac) and 94 did not (Non-Ac group). Demographic data between these Ac and Non-Ac groups respectively indicated remarkable equity (Table 1). Fertility Factors also demonstrated equity and there were no differences in Diagnoses, IVF Protocols and type of Gonadatrophin protocols used.

Factors that demonstrated significance were: Length of time infertile, Peak FSH, PI for total group without MRW; PI for MRW groups reversed this (Table 2) and finally average: Sperm Morphology, Peak E2, Peak P4 prior to HcG: and endometrial thickness. PR before Wilcox ranking were the same: 40% v 38%. MRW analysis revealed FSH, Length of time trying to get pregnant, Sperm Morphology and E2 levels as significant: 6.5, 4.1, 4.0 and 1.6 respectively.

When the Ac group was modified (15 Ac patient dropped), PI was elevated from 1.76 to 1.94 resulting in a significant elevation compared to the Non-Ac group, p

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

The purpose of the present study was to investigate changes in ovarian blood flow (OBF) in response to electro-acupuncture (EA) stimulation at different frequencies and intensities in anaesthetized rats. Whether the ovarian sympathetic nerves were involved in OBF responses was elucidated by severance of the ovarian sympathetic nerves. In addition, how changes in the systemic circulation affected OBF was evaluated by continuously recording blood pressure. OBF was measured on the surface of the left ovary using laser Doppler flowmeter. Acupuncture needles with a diameter of 0.3 mm were inserted bilaterally into the abdominal and the hindlimb muscles and connected to an electrical stimulator.

Two frequencies—2 Hz (low) and 80 Hz (high)—with three different intensities—1.5, 3, and 6 mA—were applied for 35 s. Both low- and high-frequency EA at 1.5 mA and high-frequency EA at 3 mA had no effect on OBF or mean arterial blood pressure (MAP). Low-frequency EA at 3 and 6 mA elicited significant increases in OBF. In contrast, high-frequency EA with an intensity of 6 mA evoked significant decreases in OBF, followed by decreases in MAP. After severance of the ovarian sympathetic nerves, the increases in the OBF responses to low-frequency EA at 3 and 6 mA were totally abolished, and the responses at 6 mA showed a tendency to decrease, probably because of concomitant decreases in MAP.

The decreased OBF and MAP responses to high-frequency EA at 6 mA remained after the ovarian sympathectomy, and the difference in the responses before and after ovarian sympathectomy was nonsignificant.

In conclusion, the present study showed that low-frequency EA stimulation increases OBF as a reflex response via the ovarian sympathetic nerves, whereas high-frequency EA stimulation decreases OBF as a passive response following systemic circulatory changes.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Endometrial thickness has been shown to be an important prognostic factor of successful embryo implantation. If the endometrial thickness is less than 9 mm there is a significant reduction in live birth rates. Though there is conflicting data, preliminary evidence suggests that the administration of vaginal Sildenafil can markedly improve endometrial thickness and result in increased live IVF births.

Our clinical observations are consistent with this. However, other clinics report inconsistent results. Therefore, we hypothesized that the difference in response between clinics may involve other factors. When we looked into this, we found that many of our patients were simultaneously receiving acupuncture treatments.

Studies on acupuncture have demonstrated positive effects on implantation rates, ongoing pregnancy rates and the number of live births. Acupuncture has also been shown, via measurements of pulsatility index, to significantly increase blood flow to the uterus. Decreases in pulsatility index have been shown to significantly improve pregnancy rates.

Researchers have also found that acupuncture has direct effects on the endometrium. Some of these include increases in progesterone receptor concentration, a reduction in COX-2, and an increase in the activity of nitric oxide synthase.

Therefore, the purpose of our investigation was to evaluate the effects of combining acupuncture and Sildenafil suppositories on endometrial lining.

Results All four subjects achieved endometrial lining thickness of greater than or equal to 10 mm following the administration of the combination of acupuncture and Sildenafil: including one patient whose lining did not exceed 5 mm in a previous cycle. Another patient, who had not responded to Sildenafil alone in a prior IVF cycle, responded to the combination of Sildenafil and acupuncture. We also noted that endometrial thickness in most patients continued to increase post-hCGadministration.

Conclusions This pilot study is consistent with previous reports that acupuncture improves uterine lining measurements over previous cycles. This preliminary data supports the potential for a synergistic action between acupuncture and Sildenafil. We hypothesize these effects may be due to acupuncture’s ability to upregulate nitric oxide synthase. However, we cannot rule out other mechanisms of action since acupuncture has also been shown to affect many other parameters. The results of this preliminary data may also suggest a role for a similar combination in treating erectile dysfunction. Further testing and data is necessary to verify these results.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

This pilot study showed that a significantly lower amount of gonadotropins (IVF drugs) was used when IVF was combined with standard acupuncture, ie the acupuncture appeared to make the ovaries more responsive to the drugs possibly due to increased blood supply to the ovaries. Increased ovarian responsiveness could be a useful effect for women who produce small numbers of eggs. This trial needs to be repeated with larger numbers of patients.

Objective: The purpose of this study was to determine if there are benefits of standard acupuncture compared to sham acupuncture as an adjunct to IVF.

Materials and Methods: A randomized, controlled, double-blind, cross- over pilot trial was performed using a needle-like device (sham acupuncture) as a control. Approval from GAMC's Investigational Review Board was acquired. Inclusion criteria were women aged 18 to 42 years with a history of failed IVF cycle(s); the presence of both ovaries; and a normal uterine cavity. Exclusion criteria was Kruger morphology <4%.

Results: Seventeen subjects were enrolled and seven subjects completed both arms of the study. The mean age was 36.2 years (range 28-41 years). The mean Day 3 FSH=3D6.8 IU (range 3-13 IU). There were four ongoing pregnancies after the first cycle, equally distributed. Seven subjects were crossed over after the first cycle. Of these, four from the standard acupuncture group and one from the sham acupuncture group attained pregnancy.

Two subjects of the standard acupuncture group were on-going pregnancies and one from the sham group. Only the sham group had two IVF cancellations. An unpaired Mann-Whitney Test using a two-sided p value was performed.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

This trial (also included above in the Embryo Transfer trials) examined the effect of acupuncture using real or placebo needles on blood flow to the lining of the uterus and found that when certain acupuncture points were stimulated whether by pricking or by penetration the blood flow increased significantly.

BACKGROUND: Acupuncture has been used during IVF treatment as it may improve outcome, however, there are concerns about the true efficacy of this approach. This randomized double blind study aimed to compare real acupuncture with placebo acupuncture in patients undergoing IVF treatment.

METHODS: On the day of embryo transfer (ET), 370 patients were randomly allocated to either real or placebo acupuncture according to a computer-generated randomization list in sealed opaque envelopes. They received 25 min of real or placebo acupuncture before and after ET. The endometrial and subendometrial vascularity, serum cortisol concentration and the anxiety level were evaluated before and after real and placebo acupuncture. RESULTS: The overall pregnancy rate was significantly higher in the placebo acupuncture group than that in the real acupuncture group (55.1 versus 43.8%, respectively, P 5 0.038; Common odds ratio 1.578 95% confidence interval 1.047–2.378). No significant differences were found in rates of ongoing pregnancy and live birth between the two groups. Reduction of endometrial and subendometrial vascularity, serum cortisol concentration and the anxiety level were observed following both real and placebo acupuncture, although there were no significant differences in the changes in all these indices between the two groups.

CONCLUSIONS: Placebo acupuncture was associated with a significantly higher overall pregnancy rate when compared with real acupuncture. Placebo acupuncture may not be inert.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

This pilot studied is included here because it is the first of many studies which followed in subsequent years examining the effects of acupuncture on IVF patients. In this case several women were referred for acupuncture as a last resort after very poor response to high doses of FSH. More eggs were collected and more pregnancies were recorded in the acupuncture cycles compared to the non acupuncture cycles, possibly due to increased blood supply to the ovaries.

Background Little information exists regarding the use of acupuncture in combination with allopathic treatment of infertility.

Objective To describe the use of acupuncture to stimulate follicle development in women undergoing in vitro fertilization.


Design, Setting, and Patients Prospective case series of 6 women receiving intracytoplasmic sperm injection and acupuncture along with agents for ovarian stimulation.

Main Outcome Measures Number of follicles retrieved, conception, and pregnancy past the 1st trimester before and after acupuncture treatment.


Results No pregnancies occurred in the non-acupuncture cycles. Three women produced more follicles with acupuncture treatment (mean, 11.3 vs 3.9 prior to acupuncture; P=.005). All 3 women conceived, but only 1 pregnancy lasted past the 1st trimester.


Conclusion Acupuncture may be a useful adjunct to gonadotropin therapy to produce follicles in women undergoing in vitro fertilization.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Acupuncture and sperm

The health of the sperm plays a major role in the outcome of IVF cycles, prevention of miscarriage, and fertility in general.

A group of infertile men who had pathological semen analyses according to WHO criteria, were treated with acupuncture twice a week for 5 weeks. A statistically significant increase after acupuncture in the percentage and number of sperm with no structural defects was demonstrated compared to the control group of patients who received no treatment. They concluded that male infertility patients could benefit from having acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture.

OBJECTIVE: To evaluate the ultramorphologic sperm features of idiopathic infertile men after acupuncture therapy.

DESIGN: Prospective controlled study.

SETTING: Christian-Lauritzen-Institut, Ulm, IVF center Munich, Germany, and Department of General Biology, University of Siena, Siena, Italy.

PATIENT(S): Forty men with idiopathic oligospermia, asthenospermia, or teratozoospermia. I

NTERVENTION(S): Twenty eight of the patients received acupuncture twice a week over a period of 5 weeks. The samples from the treatment group were randomized with semen samples from the 12 men in the untreated control group.

MAIN OUTCOME MEASURE(S): Quantitative analysis by transmission electron microscopy (TEM) was used to evaluate the samples, using the mathematical formula based on submicroscopic characteristics.

RESULT(S): Statistical evaluation of the TEM data showed a statistically significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects in the total ejaculates. A statistically significant improvement was detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. However, specific sperm pathologies in the form of apoptosis, immaturity, and necrosis showed no statistically significant changes between the control and treatment groups before and after treatment.

CONCLUSION(S): The treatment of idiopathic male infertility could benefit from employing acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture, although we did not identify specific sperm pathologies that could be particularly sensitive to this therapy.

A group of infertile men with abnormal semen analysis were randomly divided into 2 groups; one group was given 10 acupuncture treatments over 5 weeks, and the other group, no treatment. Significant improvements (p < 0.05) were demonstrated in the acupuncture group compared to the control group, in particular improved motility and morphology.

The aim of this prospective controlled study was to assess the effect of acupuncture on the sperm quality of males suffering from subfertility related to sperm impairment.

Semen samples of 16 acupuncture-treated subfertile patients were analyzed before and 1 month after treatment (twice a week for 5 weeks). In parallel, semen samples of 16 control untreated subfertile males were examined. Two specimens were taken from the control group at an interval of 2-8 months. The expanded semen analysis included routine and ultramorphological observations.

The fertility index increased significantly (p < or = .05) following improvement in total functional sperm fraction, percentage of viability, total motile spermatozoa per ejaculate, and integrity of the axonema (p < or = .05), which occurred upon treatment. The intactness of axonema and sperm motility were highly correlated (corr. = .50, p < or = .05).

Thus, patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment.

This pilot study once again showed a positive effect of acupuncture on sperm count - but this time on men with such low sperm counts (or no sperm) that they would usually require a testicular biopsy to extract sperm for use in an IVF cycle. Seven of the 15 men with no sperm at all produced sperm detectable by the light microscope after a course of 10 acupuncture treatments (p < 0.01) ie enough sperm could be produced for ICSI to be performed without recourse to testicular biopsy. The control group with similar semen analysis had no treatment and showed no change after 3 months.

Classic therapies are usually ineffective in the treatment of patients with very poor sperm density. The aim of this study was to determine the effect of acupuncture on these males. Semen samples of 20 patients with a history of azoospermia were examined by light microscope (LM) and scanning electron microscope (SEM), with which a microsearch for spermatozoa was carried out.

These examinations were performed before and 1 month after acupuncture treatment and revealed that the study group originally contained three severely oligoteratoasthenozoospermic (OTA), two pseudoazoospermic and 15 azoospermic patients.

The control group was comprised of 20 untreated males who underwent two semen examinations within a period of 2–4 months and had initial andrological profiles similar to those of the experimental group.

No changes in any of the parameters examined were observed in the control group. There was a marked but not significant improvement in the sperm counts of severely OTA males following acupuncture treatment (average=0.7±1.1×106 spermatozoa per ejaculate before treatment vs. 4.3±3.2×106 spermatozoa per ejaculate after treatment). A

definite increase in sperm count was detected in the ejaculates of 10 (67%) of the 15 azoospermic patients. Seven of these males exhibited post-treatment spermatozoa that were detected even by LM. The sperm production of these seven males increased significantly, from 0 to an average of 1.5±2.4×106 spermatozoa per ejaculate (Z=−2.8, P≤0.01). Males with genital tract inflammation exhibited the most remarkable improvement in sperm density (on average from 0.3±0.6×106 spermatozoa per ejaculate to 3.3±3.2×106 spermatozoa per ejaculate; Z=−2.4, P≤0.02).

Two pregnancies were achieved by the IVF-ICSI procedure. It is concluded that acupuncture may be a useful, nontraumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation.

In a prospective, controlled and blind study, a group of infertile men (married for 3 - 11 years without children) were randomized into two groups, the treatment group receiving 10 acupuncture treatments and the control group receiving sham acupuncture treatments. The patients in the acupuncture group demonstrated a significant increase in the percentage of normal forms compared to the control group

Aim: To evaluate the effect of Chinese Traditional Medicine, acupuncture and moxa treatment, on the semen quality in patients with semen abnormalities.

Methods: In a prospective, controlled and blind study, nineteen patients, aged 24 years ~ 42 years and married for 3 years ~ 11 years without children with semen abnormalities in concentration, morphology and/or progressive motility without apparent cause, were randomized into two groups and submitted to acupuncture and moxa treatment at the therapeutic (Study Group) and the indifferent points (Control Group), respectively, for 10 weeks. Semen analyses were performed before and after the treatment course.

Results: The patients of the Study Group presented a significant increase in the percentage of normal-form sperm compared to the Control Group (calculated U=16.0, critical U=17.0).

Conclusion: The Chinese Traditional Medicine acupuncture and moxa techniques significantly increase the percentage of normal-form sperm in infertile patients with oligoastenoteratozoospermia without apparent cause.

This trial looks at sperm behaviour in an IVF setting. It was a “before and after” study involving 82 infertile men with pathological semen abnormalities and who’s sperm achieved a poor fertilization rate in at least 2 IVF/ICSI cycles. They were given acupuncture twice a week over 8 weeks and the IVF/ICSI cycles were repeated. The fertilization rates after acupuncture (66.2%) were significantly higher than that before treatment (40.2%) (P < 0.01).

This recent small clinical trial randomised 57 patients who had extremely low sperm counts, to acupuncture and placebo acupuncture groups. After receiving acupuncture twice weekly for 6 weeks motility of sperm (but not overall count) was found to increase significantly. The authors conclude that the results of the present study support the significance of acupuncture in male patients with severe oligoasthenozoospermia. More evidence with larger trials needs to be accumulated before the efficacy and effectiveness of acupuncture in male infertility can be evaluated.

In this first prospective, randomized, single-blind, placebo-controlled study, 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A–C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.

Just as electrocaupuncture can increase blood flow to the ovaries and uterus (see reports above) so it can to the testicles. These authors demonstrate that particular frequencies applied for just 5 minutes are effective in increasing blood flow in the testes, and suggest that such a stimulus may address the damaged microcirculation associated with varicoceles, and with aging. They note that decreased testicular arterial blood flow may result in impaired spermatogenesis from defective metabolism in the microcirculatory bed and suggest that further research is needed to discover if electroacupuncture can improve sperm manufacture in this instance.

Objective: To clarify the role of the abdominal acupuncture points and the frequency of short-term electroacupuncture (EA) stimulation on testicular blood flow (TBF) in humans.

Design: A prospective, randomized study.

Setting: University hospital, Department of Radiology, ultrasound unit.

Patient(s): Eighty healthy male volunteers were randomly allocated to three groups in stage one and to a single group in stage two. In the first stage of the study, the abdominal acupuncture points ST-29 (guilai) were stimulated using simple needle insertion, 2 Hz burst EA or 10 Hz EA, in three different groups. In the second stage of the study, abdominal acupuncture points ST-25 (tianshu) were stimulated with the frequency found to be more effective in stage one. Stimulation was for 5 minutes in each group.

Intervention(s): Electroacupuncture and Doppler flowmeter.

Main Outcome Measure(s): Four groups were compared for volume flow and other related parameters of TBF.

Result(s): The 10-Hz EA stimulation of ST-29 (guilai) increased TBF, but simple needle insertion and 2-Hz burst stimulation did not. The 10-Hz EA stimulation of ST-25 (tianshu) did not result in significant changes in TBF.

Conclusion(s): For the first time point- and frequency-specific effects of abdominal EA on TBF are shown in humans.
Further investigation is required to ascertain whether these findings may be helpful in the clinical treatment of infertile men.

Acupuncture and well being of IVF patients

The importance of how a woman feels while preparing and going through an IVF cycle is intimately connected to fertility potential, positive IVF outcomes, and healthy pregnancies.

Objective: To replicate previous research on the efficacy of acupuncture in increasing pregnancy rates (PR) in patients undergoing IVF and to determine whether such an increase was due to a placebo effect. Design: Prospective, randomized, controlled, single blind trial.

Setting: Private, academically affiliated, infertility clinic.

Patient(s): One hundred fifty patients scheduled to undergo embryo transfer.

Intervention(s): Subjects were randomized to either the acupuncture or control group. Acupuncture patients received the protocol, as first described by Paulus and his colleagues, for 25 minutes before and after embryo transfer. Control subjects laid quietly. All subjects then completed questionnaires on anxiety and optimism. The IVF staff remained blind to subject assignment.

Main Outcome Measure(s): Clinical PRs, anxiety, optimism.

Result(s): Before randomization both groups had similar demographic characteristics including age and psycho- logical variables. There were no significant differences in PRs between the two groups. Acupuncture patients reported significantly less anxiety post-transfer and reported feeling more optimistic about their cycle and enjoyed their sessions more than the control subjects.

Conclusion(s): The use of acupuncture in patients undergoing IVF was not associated with an increase in PRs but they were more relaxed and more optimistic.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Aim: There is interest in the use of acupuncture as an adjunct to fertility treatment. this study aimed to examine women's attitudes and beliefs in relation to the use of acupuncture for enhancing fertility or as an adjunct to ART.

Results: Participants all expressed confidence in the ability of acupuncture to contibute to their reproductive decision in a positive way. They described acupuncture as an adjunct to pregnancy attempts that was positive since it gave them a sense of control and a strategy for improving their chances. Women were unable to locate acupuncture as a causative factor in a resulting pregnancy however all women described acupuncture as instrumental in an increased sense of well being, self confidence, emotional balance and reduced anxiety. All experienced increased resilience.

Conclusion; Acupuncture is an effective and low intensity procedure for increasing women's resilience in the repetitive and stress inducing time of pregnancy attempts, with or without medical treatment. The instrumental role of the acupuncture therapist in increasing resilience is a finding that has not emerged in previous studies and has implications for patient management.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Background
In Vitro Fertilisation (IVF) is now an accepted and effective treatment for infertility, however IVF is acknowledged as contributing to, rather than lessening, the overall psychosocial effects of infertility. Psychological and counselling interventions have previously been widely recommended in parallel with infertility treatments but whilst in many jurisdictions counselling is recommended or mandatory, it may not be widely used. Acupuncture is increasingly used as an adjunct to IVF, in this preliminary study we sought to investigate the experience of infertile women who had used acupuncture to improve their fertility.

Methods
A sample of 20 women was drawn from a cohort of women who had attended for a minimum of four acupuncture sessions in the practices of two acupuncturists in South Australia. Eight women were interviewed using a semi-structured questionnaire. Six had sought acupuncture during IVF treatment and two had begun acupuncture to enhance their fertility and had later progressed to IVF. Descriptive content analysis was employed to analyse the data.

Results
Four major categories of perceptions about acupuncture in relation to reproductive health were identified: (a) Awareness of, and perceived benefits of acupuncture; (b) perceptions of the body and the impact of acupuncture upon it; (c) perceptions of stress and the impact of acupuncture on resilience; and (d) perceptions of the intersection of medical treatment and acupuncture.

Conclusion
This preliminary exploration, whilst confined to a small sample of women, confirms that acupuncture is indeed perceived by infertile women to have an impact to their health. All findings outlined here are reported cautiously because they are limited by the size of the sample. They suggest that further studies of acupuncture as an adjunct to IVF should systematically explore the issues of wellbeing, anxiety, personal and social resilience and women's identity in relation to sexuality and reproduction.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

An assessment of the demand and importance of acupuncture to patients of a fertility clinic during investigations and treatment
Julie Hinks & Catherine Coulson

North Bristol NHS Trust, Bristol, United Kingdom

Introduction.Despite a lack of studies clearly demonstrating clinical efficacy complementary medicine is frequently used by couples undergoing infertility treatment (Coulson 2005). In Bristol, acupuncture has become very popular among patients undergoing infertility treatment, thus this study sought to quantify this and examine the reasons why patients choose acupuncture.

Methods.Two hundred questionnaires were given to patients who attended the Bristol Centre for Reproductive Medicine (BCRM) for investigation or treatment of infertility in August 2009. Patients were asked to complete the questionnaire while waiting to see their doctor or nurse and 194 responses were returned. The questionnaires asked if patients had or wished to have acupuncture or other complementary medicine, and to indicate on a scale of one to ten (10 being the best) the relative importance of acupuncture in comparison to values such as pregnancy rates and continuity of care.

Results.Out of 58 respondents who use complementary medicine, 43 used acupuncture. 40 respondents use acupuncture regularly and 17 of those lived outside of Bristol. A further 52 respondents had considered using acupuncture. In terms of very high importance (score of 10) 135 respondents felt pregnancy rates scored 10, 84 felt having the same doctor scored 10, 71 scored 10 for having the same nurse, 31 felt in house acupuncture scored 10 and 21 scored 10 for other complementary medicine. Overall, 43 respondents felt acupuncture should be available at Bristol Centre for Reproductive Medicine. Thirty four respondents gave more importance to acupuncture than seeing the same doctor or nurse, and 32 deemed it equally important. In addition, 29 patients scored acupuncture as equally important to pregnancy rates and 5 scored acupuncture higher than pregnancy rates.

Discussion.Previous unpublished work at BCRM showed that 85% of the patients found the named nurse system important as a coping mechanism to support them by providing continuity of care through stressful treatment. The responses to the questionnaires indicate a clear demand for acupuncture and suggest that acupuncture may be valuable to improve the general wellbeing of women during infertility investigations and treatments. If acupuncture provides an effective coping mechanism, this could support patients to persevere with increased numbers of ART(Assisted Reproductive Technologies) cycles, thereby increasing their ultimate chance of a successful pregnancy.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

BACKGROUND: Acupuncture has been used during IVF treatment as it may improve outcome, however, there are concerns about the true efficacy of this approach. This randomized double blind study aimed to compare real acupuncture with placebo acupuncture in patients undergoing IVF treatment.

METHODS: On the day of embryo transfer (ET), 370 patients were randomly allocated to either real or placebo acupuncture according to a computer-generated randomization list in sealed opaque envelopes. They received 25 min of real or placebo acupuncture before and after ET. The endometrial and subendometrial vascularity, serum cortisol concentration and the anxiety level were evaluated before and after real and placebo acupuncture. RESULTS: The overall pregnancy rate was significantly higher in the placebo acupuncture group than that in the real acupuncture group (55.1 versus 43.8%, respectively, P 5 0.038; Common odds ratio 1.578 95% confidence interval 1.047–2.378). No significant differences were found in rates of ongoing pregnancy and live birth between the two groups. Reduction of endometrial and subendometrial vascularity, serum cortisol concentration and the anxiety level were observed following both real and placebo acupuncture, although there were no significant differences in the changes in all these indices between the two groups.

CONCLUSIONS: Placebo acupuncture was associated with a significantly higher overall pregnancy rate when compared with real acupuncture. Placebo acupuncture may not be inert.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

Patient(s): 57 infertile patients undergoing IVF or IVF/ICSI.

Interventions(s): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.
Main outcome measure(s): Perceive Stress Scale scores, pregnancy rates.

Result(s): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased their perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status.

Conclusions(s): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

OBJECTIVE: To assess salivary stress biomarkers (cortisol and alpha-amylase) and female fecundity.

DESIGN: Prospective cohort design.

SETTING: United Kingdom.

PATIENT(S): 274 women aged 18 to 40 years who were attempting pregnancy.

INTERVENTION(S): Observation for six cycles or until pregnancy: women collected basal saliva samples on day 6 of each cycle, and used fertility monitors to identify ovulation and pregnancy test kits for pregnancy detection.

MAIN OUTCOME MEASURE(S): Salivary cortisol (mug/dL) and alpha-amylase (U/mL) concentration measurements; fecundity measured by time-to-pregnancy and the probability of pregnancy during the fertile window as estimated from discrete-time survival and Bayesian modeling techniques, respectively.

RESULT(S): Alpha-amylase but not cortisol concentrations were negatively associated with fecundity in the first cycle (fecundity odds ratio = 0.85; 95% confidence interval 0.67, 1.09) after adjusting for the couples' ages, intercourse frequency, and alcohol consumption. Statistically significant reductions in the probability of conception across the fertile window during the first cycle attempting pregnancy were observed for women whose salivary concentrations of alpha-amylase were in the upper quartiles in comparison with women in the lower quartiles (highest posterior density: -0.284; 95% interval -0.540, -0.029).

CONCLUSION(S): Stress significantly reduced the probability of conception each day during the fertile window, possibly exerting its effect through the sympathetic medullar pathway.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Background: There is preliminary evidence to suggest an impact of stress on chances of achieving a pregnancy with in-vitro fertilization (IVF). The majority of the available research has focused on stress related to infertility and going through IVF-treatment, and it is still unclear whether non-fertility-related, naturally occurring stressors may influence IVF pregnancy chances.

Our aim was to explore the association between IVF-outcome and negative, i.e. stressful, life-events during the previous 12 months.


Methods: Prior to IVF, 809 women (mean age: 31.2 years) completed the List of Recent Events (LRE) and questionnaires measuring perceived stress and depressive symptoms.


Results: Women who became pregnant reported fewer non-fertility-related negative life-events prior to IVF (Mean: 2.5; SD: 2.5) than women who did not obtain a pregnancy (Mean: 3.0; SD: 3.0) (t(465.28) = 2.390, P = 0.017). Logistic regression analyses revealed that the number of negative life-events remained a significant predictor of pregnancy (OR: 0.889; P = 0.02), when controlling for age, total number of life-events, perceived stress within the previous month, depressive symptoms, and relevant medical factors related to the patient or treatment procedure, including duration of infertility, number of oocytes retrieved and infertility etiology. Mediation analyses indicated that the association between negative life events and IVF pregnancy was partly mediated by the number of oocytes harvested during oocyte retrieval.


Conclusion: A large number of life-events perceived as having a negative impact on quality of life may indicate chronic stress, and the results of our study indicate that stress may reduce the chances of a successful outcome following IVF, possibly through psychobiological mechanisms affecting medical end-points such as oocyte retrieval outcome.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Meta Analyses and Recent Reviews

Research done on all available studies to determine the effectiveness of a particular treatment on a grand scale.

Conclusion(s)
Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects from using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

Objective
To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.

Design
Systematic review and meta-analysis.

Patient(s)
Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects of acupuncture on IVF outcomes.

Setting
Not applicable.

Intervention(s)
The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture.

Main Outcome Measure(s)
The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.

Result(s)
Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation.

The authors concluded, “The odds ratio of 1.65 suggests that acupuncture increased the odds of clinical pregnancy by 65% compared with the control groups… In absolute terms 10 patients would need to be treated with acupuncture to bring about one additional clinical pregnancy. These are clinically relevant benefits.”

Impressive as these results are they may still be an underestimate, since the authors included women who’s IVF cycles were cancelled before transfer.

Objective - To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation. Design - Systematic review and meta-analysis.

Data sources - Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.

Review methods - Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.

Data synthesis - Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth.

The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).

Conclusions - Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Another group of researchers have analysed updated clinical trial data and have come to the same conclusion as those who published the BMJ meta analysis, namely acupuncture is a useful addition to IVF. It has been published as a Cochrane Review. The Cochrane Collaboration is an international and independent organization dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide.

Introduction: Acupuncture has more recently been studied in assisted reproductive treatment, although its role in reproductive medicine is still debated. This is a meta-analysis to determine the effectiveness of acupuncture in the outcomes of assisted reproductive technologies (ART).

Material & Methods: All reports which described randomised controlled trials of acupuncture in assisted conception were obtained through searches via the Menstrual Disorders and Subfertility Group's specialised Register of controlled trials, the OVID MEDLINE (1996 to August 2007), CINAHL- cumulative Index to Nursing & Allied Health Literature (1982 to August 2007), EMBASE (1980 -August 2007), AMED, National research Register, US equivalent Clinical Trials register (http://www.clinicaltrials.gov) were searched using the OVID software, the Chinese literature databases were searched from the China Academic Journal Electronic full text Database in the China National Knowledge Infrastructure and Index to Chinese Periodical Literature.

All relevant references were also hand searched.

The selection criteria included randomised controlled trials of acupuncture that included couples who were undergoing ART and/or acupuncture and compared these treatments to each other, placebo or no treatment for the treatment of primary and secondary infertility were included.

Women with medical illness deemed contraindications for ART or acupuncture were excluded. Quality assessment and data extraction were performed independently by two reviewers.

Meta-analysis was performed using odds ratio for dichotomous outcomes. Subgroup analysis and sensitivity analysis were performed where necessary. The outcome measures were the live birth rate, the clinical, ongoing pregnancy rate, miscarriage rate and any reported side effects of treatment.

Results Thirteen randomised controlled trials were identified that involved acupuncture and assisted conception. Ten trials were included and three were excluded.

Acupuncture on the day of ET improves the ongoing pregnancy rate (Odds Ratio = 1.85; 95% confidence interval 1.18-2.91) and the clinical pregnancy rate (Odds ratio = 1.65; 95% confidence interval 1.22-2.24), but there was no evidence of a difference in the miscarriage rate compared to controls. Acupuncture on the day of ET + 2 to 3 days after ET (repeated acupuncture) improves the clinical pregnancy rate (Odds Ratio = 2.23, 95% CI 1.41 - 3.51) but not the ongoing pregnancy rate (Odds Ratio = 1.93, 95% CI 0.86-4.36). Repeated acupuncture did not affect the miscarriage rate.

Acupuncture around the time of oocyte retrieval has no evidence of benefit over the live birth rate (Odds Ratio 0.84, 95% CI 0.50 - 1.42), ongoing pregnancy (Odds Ratio 0.84, 95% CI 0.5 -1.42), clinical pregnancy (Odds ratio 1.07, 95% CI 0.71-1.61), and miscarriage rate (Odds Ratio 0.59, 95% CI 0.14-2.56).

Conclusions The data from this meta-analysis suggests that acupuncture performed on the day of ET does increase the clinical pregnancy rate of IVF treatment; however, this could be attributed to placebo effect and the small number of patients included. Further larger RCTs are necessary to confirm the results.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Purpose of review: The present review gives an overview of the potential use of traditional Chinese medicine in the treatment of infertility, including an evidence-based evaluation of its efficacy and tolerance.

Recent findings: Recent studies demonstrated that traditional Chinese medicine could regulate the gonadotropin-releasing hormone to induce ovulation and improve the uterus blood flow and menstrual changes of endometrium.

In addition, it also has impacts on patients with infertility resulting from polycystic ovarian syndrome, anxiety, stress and immunological disorders.

Although study design with adequate sample size and appropriate control for the use of traditional Chinese medicine is not sufficient, the effective studies have already indicated the necessity to explore the possible mechanisms, that is, effective dose, side effect and toxicity of traditional Chinese medicine, in the treatment of infertility by means of prospective randomized control trial.

Summary: The growing popularity of traditional Chinese medicine used alone or in combination with Western medicine highlights the need to examine the pros and cons of both Western and traditional Chinese medicine approaches. Integrating the principle and knowledge from well characterized approaches and quality control of both traditional Chinese medicine and Western medical approaches should become a trend in existing clinical practice and serve as a better methodology for treating infertility.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Another review of the literature from a group in Hong Kong concludes that the positive effect of acupuncture in the treatment of subfertility may be related to the central sympathetic inhibition by the endorphin system, the change in uterine blood flow and motility, and stress reduction.

OBJECTIVE: To review systematically the use of acupuncture in the management of subfertility.

DESIGN: A computer search was performed via several English and Chinese databases to identify journals relevant to the subject.

RESULT(S): The positive effect of acupuncture in the treatment of subfertility may be related to the central sympathetic inhibition by the endorphin system, the change in uterine blood flow and motility, and stress reduction. Acupuncture may help restore ovulation in patients with polycystic ovary syndrome, although there are not enough randomized studies to validate this.

There is also no sufficient evidence supporting the role of acupuncture in male subfertility, as most of the studies are uncontrolled case reports or case series in which the sample sizes were small. Despite these deficiencies, acupuncture can be considered as an effective alternative for pain relief during oocyte retrieval in patients who cannot tolerate side effects of conscious sedation.

The pregnancy rate of IVF treatment is significantly increased, especially when acupuncture is administered on the day of embryo transfer.

CONCLUSION(S): Although acupuncture has gained increasing popularity in the management of subfertility, its effectiveness has remained controversial.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

A newer version of this data base by the same authors as the one listed above concluded that there is an increase in live birth rate when acupuncture is performed on day of embryo transfer.

Background
Acupuncture has recently been studied in assisted reproductive treatment (ART) although its role in reproductive medicine is still debated.

Objectives
To determine the effectiveness of acupuncture in the outcomes of ART.

Search strategy
All reports which describe randomised controlled trials of acupuncture in assisted conception were obtained through searches of the Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL, Ovid MEDLINE (1996 to August 2007), EMBASE (1980 to August 2007), CINAHL (Cumulative Index to Nursing & Allied Health Literature) (1982 to August 2007), AMED, National Research Register, Clinical Trials register (www.clinicaltrials.gov), and the Chinese database of clinical trials.

Selection criteria
Randomised controlled trials of acupuncture for couples who were undergoing ART comparing acupuncture treatment alone or acupuncture with concurrent ART versus no treatment, placebo or sham acupuncture plus ART for the treatment of primary and secondary infertility. Women with medical illness deemed contraindications for ART or acupuncture were excluded.

Data collection and analysis
Sixteen randomised controlled trials were identified that involved acupuncture and assisted conception. Thirteen trials were included in the review and three were excluded. Quality assessment and data extraction were performed independently by two review authors. Meta-analysis was performed using odds ratio (OR) for dichotomous outcomes. The outcome measures were live birth rate, clinical ongoing pregnancy rate, miscarriage rate, and any reported side effects of treatment.

Main results
There is evidence of benefit when acupuncture is performed on the day of embryo transfer (ET) on the live birth rate (OR 1.86, 95% CI 1.29 to 2.77) but not when it is performed two to three days after ET (OR 1.79, 95% CI 0.93 to 3.44). There is no evidence of benefit on pregnancy outcomes when acupuncture is performed around the time of oocyte retrieval.

Authors' conclusions
Acupuncture performed on the day of ET shows a beneficial effect on the live birth rate; however, with the present evidence this could be attributed to placebo effect and the small number of women included in the trials. Acupuncture should not be offered during the luteal phase in routine clinical practice until further evidence is available from sufficiently powered RCTs.

Plain language summary

Acupuncture and assisted conception
The data from this meta-analysis suggests that acupuncture does increase the live birth rate with in vitro fertilisation (IVF) treatment when performed around the time of embryo transfer. However, this could be attributed to placebo effect and the small number of trials included in the review. Larger studies are necessary to confirm the results. Acupuncture may have potential harmful effects in early pregnancy and hence clinicians should be cautious when giving advice regarding the use of acupuncture in early pregnancy.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

The objectives of this systematic review were to determine the effectiveness of (a) acupuncture and (b) Chinese herbal medicine on the treatment of male and female subfertility by assisted reproductive technologies (ART). All reports from RCTs of acupuncture and/or Chinese herbal medicine in ART were obtained via searches through The Cochrane Menstrual Disorders and Sub-fertility Group's Specialised Register of controlled trials, and other major databases. The outcome measures were determined prior to starting the search, and comprised: live birth rate, ongoing pregnancy rate, clinical pregnancy rate, the incidence of ovarian hyperstimulation syndrome and multiple pregnancy, miscarriage rate and adverse effects arising from treatment. Overall, 14 trials (a total of 2670 subjects) were included in the meta-analysis. The results provided no evidence of benefit in the use of acupuncture during assisted conception. Further studies should attempt to explore the potential placebo, as well as treatment, effects of this complimentary therapy. Essential elements for a quality RCT will be the size of the trial, the use of a standardised acupuncture method and of placebo needles.

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Jane Lyttleton "Finally, a tongue in cheek analysis of meta-analyses, randomised, placebo controlled trials and evidence based medicine. These authors very cleverly make a strong case for the fact that some interventions do NOT lend themselves to randomised blinded trials.But can still have a place in medicine simply because they have been seen to work. While not for a minute purporting to compare an acupuncture treatment to the life saving action of a parachute, we nevertheless would like to point out that there are some aspects of a discipline like acupuncture which will never be able to be squeezed onto the confines of a double blind randomised trial, without losing something of its essence. Other aspects of acupuncture, like some of its known physiological effects, can be measured in a trial setting - however the results of these trials should never be taken to be telling the WHOLE story!"

Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.

Design Systematic review of randomised controlled trials.

Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.

Study selection: Studies showing the effects of using a parachute during free fall.

Main outcome measure Death or major trauma, defined as an injury severity score > 15.

Results We were unable to identify any randomised controlled trials of parachute intervention.

Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

They conclude their discussion with a call to arms .......

"Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions.

The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial. The dependency we have created in our population may make recruitment of the unenlightened masses to such a trial difficult. If so, we feel assured that those who advocate evidence based medicine and criticise use of interventions that lack an evidence base will not hesitate to demonstrate their commitment by volunteering for a double blind, randomised, placebo controlled, crossover trial."

Click here for more information on IVF acupuncture in Vancouver, and the IVF Acupuncture Group founder Dr. Spence Pentland

Acupuncture and pregnancy

Continued care throughout pregnancy has been shown to help prevent miscarriage, manage pain and nausea, treat hypertension, hasten and facilitate labour and delivery, as well as decrease chances of post-partum depression.

Background Midwives in Wellington, New Zealand, observed that women receiving prebirth acupuncture consistently experienced efficient labors, reporting a reduction in the length of labor and medical intervention, specifically the use of epidurals, medical inductions, and cesarean deliveries.

Objective To undertake a naturalistic observational study of women receiving acupuncture as part of their antenatal care.


Design, Setting, and Patients Practices of 14 midwives recorded their prebirth acupuncture treatments over a 4-month period in 2004 in 169 New Zealand women who received prebirth acupuncture. 


Main Outcome Measures Gestation at onset of labor, incidence of medical induction, length of labor, use of analgesia, and type of delivery. 


Results When compared with the local population rates, there was an overall 35% reduction in the number of inductions (for primigravida women, this was a 43% reduction); 31% reduction in the epidural rate; 32% reduction in emergency cesarean delivery; and a 9% increase in normal vaginal birth.

Conclusions Prebirth acupuncture appeared to provide some promising therapeutic benefits in assisting women to have a normal vaginal birth. A further randomized controlled study is warranted.

Click here for more information on pregnancy care in Vancouver, and the personal website of the IVF Acupuncture Group founder Dr. Spence Pentland

OBJECTIVE: To estimate the efficacy of acupuncture for depression during pregnancy in a randomized controlled trial.

METHODS: A total of 150 pregnant women who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for major depressive disorder were randomized to receive either acupuncture specific for depression or one of two active controls: control acupuncture or massage. Treatments lasted 8 weeks (12 sessions). Junior acupuncturists, who were not told about treatment assignment, needled participants at points prescribed by senior acupuncturists. All treatments were standardized. The primary outcome was the Hamilton Rating Scale for Depression, administered by masked raters at baseline and after 4 and 8 weeks of treatment. Continuous data were analyzed using mixed effects models and by intent to treat.

RESULTS: Fifty-two women were randomized to acupuncture specific for depression, 49 to control acupuncture, and 49 to massage. Women who received acupuncture specific for depression experienced a greater rate of decrease in symptom severity (P<.05) compared with the combined controls (Cohen's d=0.39, 95% confidence interval [CI] 0.01–0.77) or control acupuncture alone (P<.05; Cohen's d=0.46, 95% CI 0.01–0.92). They also had significantly greater response rate (63.0%) than the combined controls (44.3%; P<.05; number needed to treat, 5.3; 95% CI 2.8–75.0) and control acupuncture alone (37.5%; P<.05: number needed to treat, 3.9; 95% CI 2.2–19.8). Symptom reduction and response rates did not differ significantly between controls (control acupuncture, 37.5%; massage, 50.0%).

CONCLUSION: The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments of similar length and could be a viable treatment option for depression during pregnancy.

Click here for more information on pregnancy care in Vancouver, and the personal website of the IVF Acupuncture Group founder Dr. Spence Pentland

OBJECTIVES: To compare the efficacy of standard treatment, standard treatment plus acupuncture, and standard treatment plus stabilising exercises for pelvic girdle pain during pregnancy.

DESIGN: Randomised single blind controlled trial. Settings East Hospital, Gothenburg, and 27 maternity care centres in Sweden.

PARTICIPANTS: 386 pregnant women with pelvic girdle pain.

INTERVENTIONS: Treatment for six weeks with standard treatment (n = 130), standard treatment plus acupuncture (n = 125), or standard treatment plus stabilising exercises (n = 131).

MAIN OUTCOME MEASURES: Primary outcome measure was pain (visual analogue scale); secondary outcome measure was assessment of severity of pelvic girdle pain by an independent examiner before and after treatment.

RESULTS: After treatment the stabilising exercise group had less pain than the standard group in the morning (median difference = 9, 95% confidence interval 1.7 to 12.8; P = 0.0312) and in the evening (13, 2.7 to 17.5; P = 0.0245). The acupuncture group, in turn, had less pain in the evening than the stabilising exercise group (-14, -18.1 to -3.3; P = 0.0130). Furthermore, the acupuncture group had less pain than the standard treatment group in the morning (12, 5.9 to 17.3; P < 0.001) and in the evening (27, 13.3 to 29.5; P < 0.001). Attenuation of pelvic girdle pain as assessed by the independent examiner was greatest in the acupuncture group.

CONCLUSION: Acupuncture and stabilising exercises constitute efficient complements to standard treatment for the management of pelvic girdle pain during pregnancy. Acupuncture was superior to stabilising exercises in this study.

Click here for more information on pregnancy care in Vancouver, and the personal website of the IVF Acupuncture Group founder Dr. Spence Pentland

The objective of our study was to review the effectiveness of needle acupuncture in treating the common and disabling problem of pelvic and back pain in pregnancy. Two small trials on mixed pelvic/back pain and 1 large high-quality trial on pelvic pain met the inclusion criteria. Acupuncture, as an adjunct to standard treatment, was superior to standard treatment alone and physiotherapy in relieving mixed pelvic/back pain. Women with well-defined pelvic pain had greater relief of pain with a combination of acupuncture and standard treatment, compared to standard treatment alone or stabilizing exercises and standard treatment. We used a narrative synthesis due to significant clinical heterogeneity between trials. Few and minor adverse events were reported.

We conclude that limited evidence supports acupuncture use in treating pregnancy-related pelvic and back pain. Additional high-quality trials are needed to test the existing promising evidence for this relatively safe and popular complementary therapy.

Click here for more information on pregnancy care in Vancouver, and the personal website of the IVF Acupuncture Group founder Dr. Spence Pentland

Acupuncture & Polycystic Ovary Syndrome (PCOS)

Electro-acupuncture done regularly has displayed significant improvement on spontaneous ovulation in women with PCOS.

CONCLUSION: This finding indicates that wen-jing-tang is appropriate for use in treating PCOS in women with various constitutions (as determined by the matching theory of eight-principle pattern identification) in clinical practice and may prove to be a potent therapeutic agent with a wide therapeutic spectrum.

The objective of this study was to investigate the effects of switching therapy to wen-jing-tang (unkei-to) from previous selected herbal preparations on endocrine levels and induction of ovulation in women with polycystic ovary syndrome (PCOS). Sixty-four anovulatory women diagnosed with PCOS were enrolled in the study. After Kampo diagnosis, subjects received matched Kampo preparations (43 cases: dang-gui-shao-yao-san, 21 cases: gui-zhi-fu-ling-wan) selected by the matching theory of eight-principle pattern identification and Kampo diagnosis based on concepts of the qi, blood, and fluids as the physiologic activity. Fifty-four women who failed to ovulate after an 8-week treatment were randomly allocated to continuation of treatment with the preceding Kampo prescription (continuation group, n = 27) or treatment with wen-jing-tang (switching group, n = 27). Plasma FSH, LH and estradiol levels were measured and ovulation rates were determined at the beginning and after an 8-week treatment with the preceding Kampo prescription, as well as after the subsequent 8-week treatment with the same preparation or wen-jing-tang. No decrease in mean plasma LH level was observed in the 54 women who failed to ovulate among the 64 treated with a Kampo preparation. After the 8-week treatment with wen-jing-tang, plasma LH levels were decreased by 58.2% (p < 0.0001) and 49.4% (p = 0.0005) in the groups switched from dang-gui-shao-yao-san and gui-zhi-fu-ling-wan, respectively. In the group switched from dang-gui-shao-yao-san, a tendency towards increase in plasma estradiol level was observed (1.51-fold, p = 0.055), which was significant compared with that in the group switched from gui-zhi-fu-ling-wan (p = 0.032). The ovulation rate with switching of treatment to wen-jing-tang was significantly higher (59.3%) than that with continued use of the same preparation (7.4%, p = 0.0036). This study confirmed that wen-jing-tang was effective in improving endocrine condition in the treatment of disturbances of ovulation in patients with PCOS without taking eight-principle pattern identification into consideration.

CONCLUSION: Repeated EA treatments induce regular ovulations in more than one third of the women with PCOS. The group of women with good effect had a less androgenic hormonal profile before treatment and a less pronounced metabolic disturbance compared with the group with no effect. For this selected group EA offers an alternative to pharmacological ovulation induction.

BACKGROUND: The present study was designed to evaluate if electro-acupuncture (EA) could affect oligo-/anovulation and related endocrine and neuroendocrine parameters in women with polycystic ovary syndrome (PCOS).

METHODS: Twenty-four women (between the ages of 24 and 40 years) with PCOS and oligo-/amenorrhea were included in this non-randomized, longitudinal, prospective study. The study period was defined as the period extending from 3 months before the first EA treatment, to 3 months after the last EA treatment (10-14 treatments), in total 8-9 months. The menstrual and ovulation patterns were confirmed by recording of vaginal bleedings and by daily registrations of the basal body temperature (BBT). Blood samples were collected within a week before the first EA, within a week after the last EA and 3 months after EA.

RESULTS: Nine women (38%) experienced a good effect. They displayed a mean of 0.66 ovulations/woman and month in the period during and after the EA period compared to a mean of 0.15 before the EA period (p=0.004). Before EA, women with a good effect had a significantly lower body-mass index (BMI) (p<0.001), waist-to-hip circumference ratio (WHR) (p=0.0058), serum testosterone concentration (p=0.0098), serum testosterone/sex hormone binding globulin (SHBG) ratio (p=0.011) and serum basal insulin concentration (p=0.0054), and a significantly higher concentration of serum SHBG (p=0.040) than did those women with no effect.