You don’t have to look far to find stories of women doing IVF reporting that acupuncture was the reason they got their take home baby. Acupuncture has many possible benefits to an IVF cycle including increasing egg quality, uterine blood flow and implantation(1) as well as reducing stress and it is certainly worth considering.
Back in 2014 Nandi and colleagues summed it up perfectly when they said
basically, the evidence regarding the efficacy of acupuncture to improve clinical pregnancy rate is controversial. In spite of 40 clinical trials and nine systematic reviews, the debate still continues.’
If you are going to stop reading now, overall, that still stands.
If you are thinking about spending your hard earned cash on acupuncture, it pays to drill down a little more.
>>>If you are about to do an IVF cycle and are looking for evidence based ways to increase your success rates, make sure you check out Eat Think Grow.
Is it a sham?
In randomized control trials, when researchers are trying to ‘prove’ that a treatment, such as acupuncture, has an effect, it will often be compared to a control. The control could be receiving no treatment at all or in this case it could be the use of sham or placebo needles.
When placebo or sham needles are used the person receiving the treatment, in this case the woman doing IVF, really thinks they are having proper acupuncture. It might be that the needles just don’t penetrate the skin the same way or they are put in just slightly away from known acupoints and therefore aren’t doing what they should.
One recent systematic review looked at all the studies that examined the difference in IVF outcomes (such as clinical pregnancy or live birth) depending on whether they had placebo or actual acupuncture around the day of embryo transfer. What they found was that there was no statistical difference in clinical pregnancy rate, ongoing pregnancy rate or live birth rate between placebo or sham acupuncture and real traditional acupuncture.
When the control though was changed from being placebo to having no treatment at all there was a significant difference, in this case there was an increase in the live birth rates of those women having acupuncture when compared to those that did not. Those women that had the acupuncture were 1.15 times more likely than those that did not have the acupuncture to have a live birth (1). Interestingly it was not associated with clinical pregnancy rate or ongoing pregnancy rate.
Before rushing out to have acupuncture there are a number of things to consider.
Firstly, an odds ratio of 1.15 is still kind of small in the scheme of things. But hey, if that was a definite, I’d try it. Secondly, it’s not a definite. The research is not water tight and there remains lots of conflicting studies and also sometimes the studies they use to get to such numbers can be of low quality.
What is interesting though is that it may not be the actual acupuncture – that is the insertion of needles on the acupoints making the difference- it may be the experience. It might be the stress relieving properties of lying down for 30 minutes while the needles are in, or the placebo effect of really feeling as if you are making a difference to your next cycle or even just the chat with the practitioner.
Building on this theory, if you are thinking about acupuncture but aren’t so sure or can’t afford it, in the first instance I would a) find an activity that you genuinely enjoy and relaxes you and b) find an activity that you genuinely feel is going to make a difference to your cycle (you may find the mindfulness activities in Eat. Think. Grow! fits this bill ;)) It can’t hurt and just might get you some of the side benefits of acupuncture without the actual acupuncture. It would be interesting to see studies in the future that compared the IVF success rates between those that used acupuncture and those that used general relaxation strategies and determine what the difference to IVF success rates is.
It should be noted that other reviews have evaluated the impact of acupuncture in comparison to no treatment and found that it statistically increased the chances of an ongoing pregnancy but not clinical pregnancy rate or live birth rate to any statistical significance (Manheimer as cited in 3). Just to further highlight the fact that the evidence around this one really is conflicted.
Timing and dosage of acupuncture
Many women doing acupuncture will typically go to the acupuncturist once or twice around embryo transfer and call it a day. Generally speaking this is insufficient to increase the possibility of live birth rates – though they are associated with reducing stress (3). This finding was also supported when a systematic review was completed of studies that when combined looked at the cycles of over 6300 women (4).
This finding was similar when studies looked at women who had acupuncture around the time of egg retrieval – there was no difference in live birth rates between those that had acupuncture around the time of egg retrieval and those that didn’t (4). To be fair though, acupuncture done around the time of egg retrieval is generally more focused on pain relief being the goal of the treatment rather than increasing live birth rates, so that is reasonable.
First two weeks of cycle
The next grouping when looking at the timing of acupuncture and its impact on take home baby rates looks at women who have acupuncture during ovarian hyperstimulation – so those having acupuncture in the first half of their cycles while on gonal f, menopur or whichever follicle stimulating drug you are taking. These ladies typically had at least four sessions and it was found that overall, the pooled pregnancy rates were higher for those having acupuncture than those that were not. Specifically those that had the acupuncture throughout ovarian hyperstimulation where 2.41 times more likely to have a live birth than those that did not (4). To reach this figure there was only three studies that used the data from 435 women so it is not a large pool of women in the scheme of things and therefore, again, should be interpreted with caution. But it’s still interesting.
When looking at how many treatments you would need to during a cycle, one study suggested that eleven acupuncture treatments during an IVF cycle was associated with significantly improved IVF birth outcomes and fewer miscarriages and another suggested 13–14 sessions was associated with significantly more live births compared with no treatment or embryo transfer day only acupuncture (3).
14 sessions in one cycle though is a lot! That is nearly once session of acupuncture every two days. I wonder if there are other forces at play in this group that weren’t measured in the study. For example, it would take a particular type of woman to go to acupuncture every second day during an IVF cycle. Presumably she wouldn’t work (or have a very flexible work situation), has the finances to attend all these sessions and clearly has some firm beliefs that acupuncture and/ or Chinese medicine is going to make an impact and therefore might also engage in other beneficial health practices also. Maybe these other hypothetical situations are also contributing to the increased success rates?
Like all things in fertility, it seems likely that the ultimate dosage will differ person to person (3), from what I have read though, highlighting the ineffectiveness of acupuncture on transfer day only towards live birth rates does seem more or less consistent across the research.
Types of acupuncture
The type of acupuncture can also make a difference to the likelihood of success. There is traditional acupuncture which is where needles are inserted into acupoints (usually around 4 to 10) along meridians in your body (this is the type you are probably most aware of). When these needles are stimulated by a small electrical current it then becomes electroacupuncture. There is also auricular acupuncture and laser acupuncture, which as the name suggests uses small laser beams to effect the acupoints instead of needles (4).
Essentially, out of all these types, electroacupuncture seemed to have the most affect. Those women that had electroacupuncutre in comparison to a control group were statistically more likely to have a clinical pregnancy and live birth. But noteworthy, they did not have higher ongoing pregnancy rates.
As stated earlier, acupuncture is generally believed to do no harm to an IVF cycle. I am only aware of one study where they found acupuncture to lower IVF success rates when done around transfer day. One theory for the reason for this result was that the acupuncturist was not ‘on site’ where the embryo transfer was being completed. It is thought that driving to this extra appointment timed just before and just after the transfer, added stress in an already stressful day and this extra stress helped explain this difference (5). It should also be noted that the group not receiving acupuncture had a freakishly high success rate – nearly double of what it would be expected to be. This in turn would make anything in comparison look bad.
Another point to take into consideration, and this assumes that you believe acupuncture does have the potential to have an impact, is that there are some acupoints that are believed to be associated with miscarriage or at the very least contra-indicated to pregnancy (3). This serves as another reminder to make sure that you are visiting an experienced practitioner.
Things to keep in mind
You can see the research is mixed. Although it may be simply that acupuncture does not work, one of the other reasons the research didn’t indicate any benefit (assuming there is one to reflect in the first place!) is that there was is so many differences in the methodology of administering acupuncture. There is simply too many variances in the methods acupuncture practitioners would use including acupuncture point selection, number of sessions, timing of when sessions are administered, type of needling control and location of treatment (1).
The Final word
As I started off saying the evidence is controversial. I believe that it is an all or nothing thing. If you are only going to go on transfer day because a friend of a friend did and she got a positive result on a pregnancy test, I’d probably give it a miss. If though you believe in Chinese medicine philosophy and are willing to integrate it into your life as well as attend as many as 14 sessions over the course of your cycle, then I think it might be worth a shot.
Also, just because the evidence that says acupuncture increases IVF success rates isn’t necessarily solid, that also doesn’t necessarily mean it doesn’t and with further study, well, who knows?
1. Cheong, Y.C., Dix, S., Hung Yu Ng, E., Ledger, W. & Farquhar, C. (2013). Acupuncture and assisted reproductive technology (Review). The Cochrane Library, Issue 7
2. Nandi, A., Shah, A., Gudi, A. & Homburg, R. (2014). Acupuncture in IVF: A review of current literature. Journal of Obstetrics & Gynaecology 34 (7) 555-561
3. Hullender Rubin, L., Anderson, B. & Craig, L. (2018). Acupuncture and in vitro fertilisation research: current and future directions. Acupuncture Medicine 36 (2) 119 – 122.
4. Qian, W, Xia, X-R., Ochin, H., Huang, C., Gao, C., Gao, L., Cui, Y-G., Liu, J-Y. & Meng, Y. (2017). Therapeutic effect of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics 295, 543–558.
5. Stener-Victorin, E. & Manheimer, E. 2011. Commentary on the Cochrane Review of acupuncture and assisted conception. Explore (NY). 2011 ; 7(2): 120–123. doi:10.1016/j.explore.2010.12.01