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.

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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.

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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.

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.

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.

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.

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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.

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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.

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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.

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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.

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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