Acupuncture and In Vitro Fertilisation: Recent Research and Clinical Guidelines

The use of acupuncture to improve the outcome of in vitro fertilisation (IVF) has become widespread over the past five years. Three of four randomised controlled trials (RCT) published since 2002 have shown that acupuncture significantly increases pregnancy rates. Although the research has a number of methodological limitations, it does strongly endorse the use of acupuncture during IVF. Protocols for IVF are complex, involving multiple phases with specific physiological aims. Correspondingly, acupuncture treatments before and during IVF need to be carefully considered in relation to the biomedical aspects that are being manipulated. This article summarises recent research in this area, and provides an explanation of the IVF process and associated acupuncture treatment guidelines. Introduction Recent estimates suggest that 10-15% of couples in the US experience infertility, with the prevalence higher in women over age 34 (Wright et al, 2001). In vitro fertilisation (IVF) is the most successful of the infertility treatments, and for many people is the last possibility for pregnancy. In 2001 (the most recent year for which national data were published) there were 29,344 deliveries from IVF, which resulted in the birth of 40,687 infants. This represents 1% of all U.S. births in that year (Wright et al, 2001). Three to six cycles of standard IVF can now result in over 65% of patients ultimately delivering a baby (Kovacs et al, 2001; Olivius et al, 2002). However the average delivery rate of IVF per single initiated cycle using fresh, non-donor oocytes was still only 33% (2001 Assisted Reproductive Technology Success Rates; CDC Reproductive Health; 2003). Therefore, the majority of IVF cycles do not result in pregnancy, and there is generally the need for multiple IVF cycles for pregnancy to be achieved. Due to the relatively low success rate of IVF per cycle, as well as the high emotional and financial costs associated with IVF, many patients have turned to complementary and alternative medical (CAM) treatments to enhance the success of IVF treatment (Beal et al, 1998). Among CAM treatments acupuncture is a frequently used adjunctive therapy. Infertility from a biomedical perspective A growing body of research has begun to identify a number of physiological and psychological mechanisms that may underlie female infertility and explain the limited success of IVF treatments. The causes of female infertility can be broadly grouped into four major categories (Strauss et al, 2002): 1. Abnormalities in oocyte production; 2. Anatomic abnormalities leading to obstruction of transport of the sperm, oocyte, and/or embryo through the reproductive tract (i.e., tubal, uterine, cervical and peritoneal factors); 3. Abnormalities in the implantation process, including early defects in embryo development, and embryo-endometrial interaction; and 4. Numerous other factors that are probably most important in women with unexplained infertility (e.g. age, body weight, cigarette smoking, alcohol and caffeine intake, psychological and emotional factors, immunological abnormalities and borderline hormonal imbalances). The IVF procedure can overcome many of the conditions that cause infertility by artificially modifying oocyte production, fertilising oocytes invitro, and ensuring delivery of one or more embryos into a hormonally stimulated endometrium. For these reasons, combined with the superior success of IVF compared to other assisted reproductive technologies, IVF is now widely used for the treatment of infertility of known and unexplained aetiology. The IVF process The IVF process has several phases that must all be very carefully coordinated and precisely timed. There are several different protocols, the details of which are beyond the scope of this paper, and these protocols are constantly being refined, creating some variability in procedures among different women, IVF centres and physicians. A diagram of the basic timeline is shown in Figure 1. By: Lara