The Use of Acupuncture with In Vitro Fertilization as a Treatment for Female Subfertility

Dear Editor:

Acupuncture, one of the most widely researched forms of complementary and alternative medicine, is currently being investigated as a tool to increase the effectiveness of in vitro fertilization (IVF). IVF was introduced in the treatment of subfertility and infertility in 1978 ¹ and has become a widely accepted treatment for unexplained infertility. Four (4) research articles were reviewed that examined the effects of IVF with acupuncture on pregnancy rate.

Paulus et al. ² found statistically significant differences in pregnancy rates in patients who underwent a combination of acupuncture and IVF (42.5%) versus a control group (26.3%). Using the acupuncture treatment protocol described by Paulus et al., ² a 2006 study conducted by Smith et al. ³ examined the influence of acupuncture on pregnancy rates for women undergoing embryo transfer. Study design included female participants who were undergoing IVF and who were divided into 2 treatment groups consisting of acupuncture versus sham acupuncture. Three (3) treatment sessions were administered to each group. The first treatment was on day 9 of stimulating injections and immediately before and after embryo transfer. Sham acupuncture points used were close to, but not on real acupuncture points. The pregnancy rate was 31% in the acupuncture group and 23% in the control group. The results were not statistically significant.

In 2009, Domar et al. ⁴ replicated the Paulus et al. ² study to examine the impact of acupuncture on IVF outcome. Patients included in the study either received 25 minutes of acupuncture or lay quietly for 25 minutes, then underwent embryo transfer, followed by a 25-minute session identical to the initial 25-minute session. There were 78 participants in the acupuncture group and 68 participants in the control group. The acupuncture patients had a 42% clinical pregnancy rate, while the control group had a 47% rate. These results were not statistically significant.

Westergaard et al. ⁵ hypothesized that acupuncture influenced female infertility via two mechanisms: (1) central stimulation of β-endorphin secretions, which in turn impacts gonadotropin and steroid secretions; and (2) increased blood flow to the uterus and ovaries, resulting in favorable uterine conditions for implantation. Three (3) groups were included: 1 without therapy, 1 with acupuncture on the day of embryo transfer, and 1 with acupuncture on the day of embryo transfer and 2 days later. Although the patients receiving a single acupuncture treatment reported the highest number of pregnancies, the results were not significantly significant.

Acupuncture as an adjuvant treatment with IVF in the treatment of female subfertility continues to gain popularity. Despite the many studies completed to date evaluating its effectiveness, there are not enough significant data to fully support the mainstream use of acupuncture to improve pregnancy rates in the female subfertility population. Further research is needed before physicians can confidently incorporate acupuncture into standard subfertility treatment practices.