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Acupuncture: Are Infertile Women in Need of Needles?

Erin Kinney

Date: 11/15/2005

Introduction:

Acupuncture, a part of the ancient practice of Traditional Chinese Medicine is defined in the dictionary as “a procedure used in or adapted from Chinese medical practice in which specific body areas are pierced with fine needles for therapeutic purposes or to relieve pain or produce regional anesthesia.” The ancient therapy of acupuncture is based on what the Chinese refer to as Qi (In English pronounced as ch’i), blood and the concept of yin and yang (the Chinese reference to balance or harmony).

Qi is the basic energy force for all life and is vital to the functioning of the human mind and body. Ch’i flows throughout the body through an intricate web of interconnected pathways called meridians. (Beal, 1999) The direction and movement of the flow of ch’i must be in harmony in order for optimal health to be present. Another important concept in traditional Chinese medicine, pertaining to the practice of acupuncture is the concept of “blood”. The term blood in Chinese medicine differs from that of western medicine. “Blood is a material form of ch'i, distinct from it, but mutually dependent on it.” (Beal, 1999) In simple words, the ch’i is responsible for the production and the placement of blood and the blood is responsible for nourishing the organs that produce and regulate the ch’i.

Yin-Yang The concept of yin and yang is explained by the idea of balance within an individual. Yin and yang are complementary opposites and they both must be in a constant state of balance. Yang is associated with energy that is active. Its manifested qualities are firmness, strength, daylight, fullness and masculinity. In contrast, Yin is associated with energy that is receptive. Its qualities are flexibility, receptivity, night, emptiness and femininity. (Beal, 1999) The model of yin and yang is an integral part of the system of meridians. There are six pairs of yin and yang meridians associated with organs bearing the same name. Any disruption of the flow or change in the movement, results in illness or pain. The role of an acupuncturist is to direct or redirect ch'i and reestablish the harmony between yin and yang. This is accomplished through the use of fine needles on specific acupuncture points. These acupuncture points correspond to specific points and eventually specific organs along the 12 major meridians.

Today the acceptance of acupuncture in western medicine is growing. In fact in according to the 2002 National Health Interview Survey--the largest and most comprehensive survey of complementary and alternative medicine (CAM) use by American adults to date--an estimated 8.2 million U.S. adults had ever used acupuncture, and an estimated 2.1 million U.S. adults had used acupuncture in the previous year. (http://nccam.nih.gov/health/acupuncture/#used) Western medicine claims that acupuncture works by stimulating the central nervous system to release chemicals into the muscles, spinal cord and brain altering certain biochemicals that may relieve pain and or stimulate healing. Western medicine has integrated some of the traditional Chinese medicinal practices and will prescribe this behavior therapy for a number of conditions and symptoms including abdominal pain, diarrhea, indigestion, anxiety, menopause, infertility, chronic pain, arthritis, headaches, Parkinson's disease, bronchitis, smoking cessation, addiction and high blood pressure. (http://www.therapyinfo.org/acupuncture.asp I have chosen to look closely at the effectiveness of acupuncture on infertility problems in women. Many acupuncturists claim they can help women achieve pregnancy despite many of the infertility problems they may encounter.

The Problem:

“Jen Huyck of Salem cried when the infertility clinic called to tell her another ovulation cycle resulted in no viable eggs. She cried when her friends got pregnant and she couldn’t. She got so upset in mid-2001 she gave up on the blood tests, the daily vaginal ultrasounds and the hormone roller coaster ride. The stress of the treatments and her failure to get pregnant were triggering panic attacks, and she felt she wouldn’t be any good for a child even if she could get pregnant. Then it happened. Seemingly by chance, she got pregnant after about four months of weekly acupuncture. Less than three years later, Huyck’s anxiety is under control and she is the proud mother of a 1 year-old daughter and a 2-month-old baby girl.”(http://www.firsthealthofandover.com/AP_female_infertility_eagle_tribune1.shtml)

Jen is among millions of Americans who suffer in all areas of their life due to difficulties in becoming pregnant. Infertility is defined as the inability to become pregnant, despite trying for at least one year. Infertility affects about 6.1 million Americans, or 10 percent of the reproductive age population, according to the American Society for Reproductive Medicine. (http://www.4woman.gov/faq/infertility.htm) It affects both men and women equally and for both sexes there can be numerous causes. Infertility in woman can be caused by problems with ovulation, dysmenorrhea, oligomenorrhea, amenorrhea, hormone imbalances, blockage of the fallopian tubes, structural problems, and a variety of acute syndromes.

The Claim:

Acupuncture can be an enormous help to women who are infertile. This is a broad claim considering that infertility itself can have many different causes, but generally speaking acupuncture seems to increase the pregnancy or fertility rate in women who have difficulty becoming pregnant.

The Evidence:

In order to support the claim that acupuncture has an effect on a woman’s fertility, a basis for the effectiveness of acupuncture on the immune system in general must be shown. One such study looked at the effects of acupuncture on immune response related to opioid-like peptides. Its results showed that acupuncture caused a significant increase in beta endorphin levels during treatment. This increase lasted up to 24 hours.(Petti et al., 1998) The significance of this increase is that β-endorphin is involved in the regulation of GnRH secretion. A review done by Petraglia et al.(1987) showed that measurement of β-endorphin levels in ovarian follicular fluid of healthy ovulatory women revealed much higher levels than that in circulating plasma. The highest level of β-endorphin was noted to be in the preovulatory follicle. In summary, the effect that acupuncture has on β-endorphin levels gives cause to hypothesize or think that acupuncture may be effective in changes to ovulatory cycles and improvements in fertility. (Chang et al., 2002)

Another study looked at the effects of electro acupuncture for ovulation induction in 24 women suffering from oligomenorrhea or amenorrhea due to polycystic ovarian syndrome. The percentage of ovulatory cycles in all of the subjects improved from 15% (measure taken before the study) to 66% (measure taken after 3 months of treatment) which is a very significant increase.(Stener-Victorin et al., 2000) However on a side note, the patients who were responsive to this treatment (i.e who became pregnant) had significantly lower BMI, wait-to-hip ratio, serum T concentration, serum T/sex hormone binding globulin ratio, and serum basal insulin level. This information suggests that the women with polycystic ovarian syndrome would benefit from acupuncture as an adjunct to pharmacological ovulation induction.

When used in conjunction with in-vitro fertilization therapies acupuncture seems to make the IVF more effective and have less side effects. One prospective study compared pregnancy rates in 160 patients going through IVF. Acupuncture was used in conjunction with the IVF in half of the women. The other of the women, the control group only received the IVF treatment. The clinical pregnancy rate for the acupuncture group was 42.5% and the control group was only 26.3 %.( Paulus et al., 2002).

Comparing hormone therapy and acupuncture, i.e. subjecting women to one or the other, the results are more or less the same. A study of female infertility and the effects of auricular acupuncture versus hormone therapy involved 27 women suffering from oligoamenorrhea and 18 women suffering from luteal insufficiency. The women were given a complete gynaecologic-endocrinologic examination for assessment before the treatment. They were then given auricular acupuncture. After treatment, their results were compared with 45 women who had received hormone treatment. Both of the groups were matched for age, durations of infertility, BMI, previous pregnancies, menstrual cycle and tubal patency. Out of the women treated with acupuncture, 22 pregnancies resulted. Out of the women treated with hormones, 20 pregnancies resulted. Taking statistics into account, these results are not significantly different. On a side note, side effects were only experienced by the women who received hormones. This additional information led the study to conclude that “auricular acupuncture seems to offer a valuable alternative therapy for female infertility due to hormone disorders.” (Gerhard et al., 1992) In sum, acupuncture in this case was as effective as hormonal therapy.

Some women suffer from less severe infertility problems. The reason for their difficulty in becoming pregnant may be cause by any number of small things like diet, weight loss/weight gain, disruptions in sleep, or stress, all of which can have an effect on the menstrual cycle and thus an effect on ovulation and fertility. For these women, the use of acupuncture alone may be helpful simply due to its help with stress reduction. Thus one of the explanations that may be plausible for acupuncture and its effectiveness with infertility in a general sense involves infertility and its relationship with stress. The problem of infertility can cause stress in women, and stress reduction has been shown to improve fertility.(Chang et al. 2002) However the relationship between stress and infertility is a viscous cycle and we do not know all of the factors involved. Social stigmatization, decreased self-esteem, unmet reproductive potential of sexual relationship, physical and mental burden of treatment and the lack of control on treatment outcome are just some of the factors that can lead to psychological stress in any couple pursuing infertility treatment. In turn stress may lead to the release of stress hormones and influence mechanisms responsible for a normal ovulatory menstrual cycle through its impact on the hypothalamic-pituitary-ovarian axis. In short, acupuncture’s ability to reduce stress and anxiety shown through its impact on β-endorphin levels and its sympathoinhibitory properties may prove to be very effective for women suffering from less severe infertility problems.(Chang et al. 2002)

Conclusion:

The benefits of acupuncture seem to be credible, especially when used in conjunction with western medicine In fact the most important benefit of acupuncture (compared to other infertility treatments) is the lack of side effects. It is non toxic and affordable compared to therapies such as IVF or ART. There seems to be more evidence concerning the use of acupuncture as an adjunct to other reproductive therapies, more specifically for women who suffer from severe infertility problems. In many of the clinical trials discussed, there were increases in pregnancies or fertility rates for the groups receiving acupuncture therapy, however the increases were not so significant to suggest using acupuncture as the sole treatment. “Although the definitive role of acupuncture in the treatment of female infertility is yet to be established, its neuroendocrine effect on the hypothalamic-pituitary-ovarian axis and the preliminary clinical data reviewed here justifies further clinical trials to systematically examine the efficacy of acupuncture in treating various conditions related to female infertility.” (Chang et al. 2002) I wholly agree with this statement. Acupuncture does seem to be effective in improving fertility rates in women. The preliminary research, which may or may not be enough to make a conclusive argument, only points us in the right direction which is to continue to study how this ancient practice can be of help to women of today’s society.

Glossary of terms:

IVF: fertilization of an egg in a laboratory dish or test tube; specifically : mixture usually in a laboratory dish of sperm with eggs which have been surgically removed from an ovary that is followed by implantation of one or more of the resulting fertilized eggs into a female's uterus

ART: Assisted Reproduction Technology

Oligomenorrhea: abnormally infrequent or scanty menstrual flow

Amenorrhea: abnormal absence or suppression of menstruation or the temporary or permanent cessation of menstruation in a woman who has previously experienced normal menses

Dysmenorrhea: painful menstruation

Polycystic ovarian syndrome: variable disorder that is marked especially by amenorrhea, hirsutism, obesity, infertility, and ovarian enlargement and is usually initiated by an elevated level of luteinizing hormone, androgen, or estrogen which results in an abnormal cycle of gonadotropin release by the pituitary gland -- abbreviation PCOS

Auricular acupuncture: acupuncture focusing on points located on the ear.

References

Beal M.W. Acupuncture and acupressure. Applications to women's reproductive health care. J Nurse Midwifery. 1999 May-Jun;44(3):217-30. Review.

Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril. 2002 Dec;78(6):1149-53. Review.

Gerhard I, Postneek F (1992, September) Auricular acupuncture in the treatment of female infertility. Department for Gynecological Endocrinology and Reproduction, Women's Hospital, University of Heidelberg, Germany.Gynaecol Endocrinol (ENGLAND) 6 (3) p171

WE Paulus, M Zhang, E Strehler, I El-Danasouri, K Sterzik. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy.
Fertil Steril. 2002 Apr;77(4):721-4.

F. Petraglia, G. DiMeo, R. Storchi, A. Segre, F. Facchinette, S. Szalay et al., Proopiomelanocortin-related peptides and methionine enkephalin in human follicular fluid: changes during the menstrual cycle. Am J Obstet Gynecol 157 (1987), pp. 142–146.

F. Petti, A. Bangrazi, A. Liguori, G. Reale and F. Ippoliti , Effects of acupuncture on immune response related to opioid-like peptides. J Tradit Chin Med 18 (1998), pp. 55–63.

E. Stener-Victorin, U. Waldenstrom, U. Tagnfors, T. Lundeberg, G. Lundstedt and P.O. Janson , Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 79 (2000), pp. 180–188.

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