Recent Research on Acupuncture and IVF

In Vitro FertilizationThe evidence of effects of acupuncture on IVF (in vitro fertilization) is growing. I recently read an article from the December 2009 issue of Fertility and Sterility. The article, written by a Reproductive Endocrinologist Paul Magarelli and Diane Cridennda, licensed acupuncturist, looked at levels of two hormones, prolactin and cortisol, during IVF cycles in 67 women.


The researchers divided the subjects about to undergo IVF treatment into 2 groups. One group got acupuncture and the other did not. The groups were essentially the same in terms of their ages, FSH levels, type of ovarian stimulation they would receive, and many other aspects. They collected blood samples from all the women at varying points of their IVF process. They measured serum (blood) levels of two hormones: prolactin and cortisol. They also assessed pregnancy rates after the embryo transfer.


They found that both the prolactin levels and the cortisol levels increased at a certain stage of the cycle in the acupuncture group. This appears to be the first research to attempt to measure hormones in response to acupuncture. There has been a fair bit of research measuring the affect of acupuncture on IVF success, but no one has ever attempted to measure whether or not the acupuncture affects hormones.


They found that the acupuncture group had a statistically significant improvement in pregnancy rates compared to the non-acupuncture group.  The article goes into much discussion of how that might relate to the changes in the hormone levels, and reviews the scientific understanding of how cortisol and prolactin impact fertility.


Some of what they found seems a little paradoxical. Cortisol is a hormone that increases when we are under stress. How does an increase in cortisol square with our idea that acupuncture relieves stress?


I had always understood that elevated prolactin inhibits ovulation, and thus, I would have thought, who wants more prolactin? But, the science shows that low prolactin at certain points in the cycle is associated with pregnancy loss. So slightly higher prolactin levels enhance pregnancy. In contrast, greatly elevated prolactin occurs naturally while women breastfeed, and prevents ovulation and pregnancy too soon after you have delivered a baby. Some women have greatly elevated prolactin for no good reason, and these women have trouble ovulating. The prolactin elevations measured in the acupuncture group were slight, but significant, and may indeed have been a reason for the improved rate of pregnancy. The acupuncture group had a statistically significant higher pregnancy rate, as well as less miscarriages and no ectopic pregnancies.


Dr. Magarelli has also done some fascinating analysis of his case files, looking back over several years. He has found that particularly in women identified as “low responders” – i.e. women who do not make many eggs in response to ovarian stimulation – acupuncture significantly improves their outcome. In reviewing 576 charts in his clinic, he sees a 50 % increase in THBs (that’s the acronym for Take Home Baby) in the poor responder women who got acupuncture compared to poor responders who did not get acupuncture.


Overall, among both normal and poor responders, their analysis shows that acupuncture improves pregnancy rates by 26 %.


It is important to note that Dr. Magarelli and Diane Cridennda have developed a specific plan of acupuncture treatment, which they have named the “Cridennda-Magarelli protocol”. This protocol involves 8 or 9 acupuncture treatments during the 4 weeks prior to egg retrieval. They suggest that these treatments have a cumulative affect, with the real measureable improvements happening after the 6th treatment. This acupuncture treatment is based on the research of Dr. Stener-Victorin, and is a face-down treatment with some points being stimulated by a milli-amp electro-acupuncture device. Then on the day of embryo transfer, they use the protocol designed and studied by Dr. Paulus.


Most of the research on acupuncture and infertility has studied either the Stener-Victorin or the Paulus protocol, but not both in combination. Using both protocols makes a lot of sense to me. The 8 or 9 acupuncture sessions prior to egg retrieval really improves uterine lining, reduces side effects from the ovarian stimulation drugs, and, now we know, improves the levels of cortisol and prolactin to enhance pregnancy rates. The acupuncture done on the day of embryo transfer has been shown to improve pregnancy rates as well, although we are not sure by what mechanism.


I now have some scientific evidence to support the idea that investing in at least 6 acupuncture sessions, plus the day of embryo transfer protocol, is a good way to improve your chances of success with IVF.


I encourage you to read the articles presented at Diane Cridennda’s website to gain further understanding. Click here to read more…

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