You’ll read below I’m presenting a mix of evidence to help you make up your own mind. I've presented this in layman’s terms - because reading each of these studies in full is hard-going, it’s difficult to figure out what the studies are saying and tricky to understand the results. Doing the research made my brain ache, but also really excited me.

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I have chosen to only cite positive acupuncture studies when I personally have been able to read through the entire full paper version of the study including the methodology (what they actually did). Many research papers with positive results only share shortened summary versions of their findings - I have chosen not to include them on my web page because the quality of the evidence isn’t good enough for me.

 

 

Read through the whole discussion below or hop to a specific topic

 

What Does the BAcC Say About the Evidence of Acupuncture For Fertility?

 

Acupuncture in the IVF stimulation phase and the Mechanisms of How It Works

 

Acupuncture Pre and Post Transfer and the Mechanisms of How It Works

 

So why are there sometimes mixed results, or results that show that acupuncture doesn’t work?

 

Acupuncture for PCOS Poly Cystic Ovary Syndrome

 

 

 

What Does the BAcC Say About the Evidence of Acupuncture For Fertility?

 

British Acupuncture Council’s Factsheet about acupuncture for fertility

 

In the British Acupuncture Council’s fertility factsheet, they advise that acupuncture has positive effects on birth rates in IVF, and that acupuncture may be a useful treatment option for stress and anxiety whilst embarking on a fertility journey. Click the link to read their detailed fact sheet and commentary in full. 

 

 

 

Acupuncture in the IVF Stimulation Phase and the Mechanisms of How It Works

 

This study found that acupuncture improved blood flow to the ovaries and improved pregnancy rates when given before egg collection. We can speculate that acupuncture in a natural follicular phase may have the same positive effect for optimising blood flow to the ovaries when TTC naturally.

 

The effects of acupuncture on ovarian blood supply and pregnancy outcomes in patients receiving assisted reproduction. Xu ZZ et al, 2018.

 

This is a fantastic study to share with you. This study looked at women with fertility problems due to a range of issues; fallopian tube blockages, endometriosis, immune issues, ovulatory disorders and unexplained fertility problems. It compared three groups with around 55 people in each: a no acupuncture group, a true acupuncture group, and a sham acupuncture group. The same doctor gave the acupuncture treatments to the two acupuncture groups from shortly after their period finished, to just before egg collection.

 

The true acupuncture group received four lower tummy acupuncture points and two leg acupuncture points (ren 3, ren 4, zi gong, St 29, Sp 6 and Sp 10). The sham acupuncture group received two arm and two leg points that were real acupuncture points (TH 5, TH 9, GB 34, GB31) but not points you’d typically use to support fertility, but real points and properly inserted real acupuncture needles. Both groups received acupuncture every day from day 7 of their period starting to trigger injection, so I’m assuming this was around 4-6 days of acupuncture treatment.  

 

Results firstly assessed the blood flow around the ovaries. In the true acupuncture group, results showed that blood flowing to the ovaries was better. In the sham acupuncture and the no acupuncture group, blood flow was around equally less. One of the reasons this is a great study is that it’s demonstrating that acupuncture can’t therefore be deemed to be a placebo.

 

The study also looked at pregnancy rates (live birth rates were not provided). The clinical pregnancy rate of the true acupuncture group was significantly higher than the others at just over 50%, compared to just over 30% in both the sham acupuncture and the no acupuncture group.

 

How does acupuncture work?

 

It’s theorised that the increased blood flow to the ovaries is one of the reasons why acupuncture is good for fertility and improving pregnancy rates. The authors theorise that better blood flow and oxygenation to the ovaries made better quality eggs, and they also theorise that the acupuncture helped the hormonal communication system between the ovaries and the brain regulate (brain and ovaries ‘talking’ better to each other).

 

 

 

Acupuncture Pre and Post Transfer and the Mechanisms of How It Works

 

Now let’s talk about acupuncture AFTER egg collection in IVF. Both studies I discuss here show really positive effects, the first looks at acupuncture twice after transfer and the second study looks at acupuncture pre and post transfer. Both found that having acupuncture led to significantly higher pregnancy results. We can speculate that these findings could be applied to natural conception fertility journeys with acupuncture being useful around ovulation.

 

Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study, Dieterle et al, 2006.

 

In this German study, there were two groups of around 100 participants in each: one true acupuncture and one sham. In this study the ‘sham’ used real acupuncture points and real needles but using points not intended to support fertility (similar the the Xu study above).

 

Both groups had acupuncture just after embryo transfer in IVF, and again 3 days later. The same practitioner delivered all the treatments. The acupuncture group came up trumps.

 

I must point out that because this study is now 20 years old, IVF protocols have changed. For this study the embryos were transferred usually on day 3, so the acupuncture treatments would have been on day 3 of embryo age and day 6 of embryo age (with day 0 being day of fertilisation). Whereas now in modern IVF, day 5 blastocysts are transferred instead of day 3 embryos, so a post-transfer treatment will be on day 5 after transfer (or day 6 the following day).

 

The true acupuncture group had their first treatment using points: Ren 4 (lower tummy), Ren 6 (lower tummy), St 29 (lower tummy), Pc6 (arm), Sp10 (thigh), Sp8 (mid lower leg). They were also given ear seeds (acupressure plasters) to one ear on ear acupuncture points Shenmen, uterus, endocrine, pizhixia subcortex (which isn’t a common point name and I had trouble identifying that it means the subcortex point I believe) which they could press themselves at home twice a day for ten minutes for two days. In their second treatment three days later, the points used were: LI4 (hand), Sp6 (lower leg), St 36 (top of the lower leg), Kid 3 (inner ankle), Liv 3 (foot). The same ear seeds were used- again over further two days- to be pressed twice a day, but in the opposite ear.

 

The ‘sham’ acupuncture group had the exact same format of treatment intervals and instructions, but used the same acupuncture points for both their treatments. These points were: SJ/TH9 (forearm), SJ/TH12 (upper arm), GB 31 (thigh), GB32 (thigh), GB 34 (top of lower leg). The ear seed protocol was the same and used on: ear point 17 (Shangzhi), ear point 14 (Feng si), ear point 8 (Sisheng), and ear point 53 (Jian) (I’m personally not familiar with any of these ear acupuncture points!).

 

Results were brilliant, with the true acupuncture group benefiting by twice as many ongoing pregnancies.

 

What’s great about this study is that actual real acupuncture was used in both groups, same practitioner, same needles, same protocol- but very different results were achieved. This lets us know that acupuncture isn’t a placebo, and that different acupuncture points lead to different effects. It was also a well designed study, and the two groups were randomised properly, and the various ‘causes’ to the fertility were split well between the two groups.

 

So we know from these studies that in IVF, acupuncture is great in the stimulation phase and in the early post transfer phase. What we can speculate is that therefore in a natural cycle, acupuncture will be useful in both the follicular phase (the first half of a cycle before ovulation)  and the early luteal phase of a cycle  (shortly after ovulation). The following study gave acupuncture both pre and post transfer.

 

 

 

Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy, Paulus et al, 2002

A study by Paulus has led to a lot of the current recommendations of acupuncture points that acupuncturists use regularly pre and post transfer.  I think these acupuncture points are mentioned in all the learning I’ve personally done (although with caveats to remember that with Traditional Acupuncture you’ve got to still take into account the individuality of the patient and take their individual health imbalances into account and amend ‘protocols’ accordingly if required).

 

The results from the Paulus study showed that acupuncture before and after transfer gave significantly higher pregnancy results compared to having no acupuncture; 42.5% acupuncture group and 26.3% no acupuncture group.

 

This was a well designed study which used 190 people split into two groups, making sure the groups were equally split in various factors so that statistically there was no difference between the two groups. The acupuncture group received acupuncture 25 mins before and 25 mins after embryo transfer, at the same IVF clinic. The other group didn’t receive any acupuncture.

 

Before transfer points were Ren 6 (lower tummy), Sp 8 (leg), Liv 3 (foot), Du 20 (head) and St 29 (lower tummy) plus ear points; shenmen, uterus, endocrine point (neifenmi), and subcortex (naodian)- two on each ear.

 

After transfer points were St 36 (leg), Sp 6 (leg), Sp 10 (thigh), LI4 (hand) The ear points were then swapped over to the other ear.

 

The authors comment that the reason they chose these specific acupuncture points was due to TCM principles from acupuncturist Giovanni Maciocia: stimulation of Taiyin meridians (spleen) and Yangming meridians (stomach, large intestine) would result in better blood perfusion and more energy in the uterus. Stimulation of the body points Ren6, Liv3, and Du20, as well as stimulation of the ear points 34 (subcortex) and 55 (shenmen), would sedate the patient. Ear point 58 (uterus) would influence the uterus, whereas ear point 22 (endocrine) would stabilise the endocrine system. (NB I assume the authors mean ‘calm and relax’ when they say the word ‘sedate’).

 

Interestingly, there is much debate to be had amongst acupuncturists about why these specific points were chosen as arguably there are better/ alternate points to select according to Giavanni Maciocia’s advice! Perhaps it’s because Paulus- who led the study- was a German medical doctor and gynaecology and obstetrics specialist, not an acupuncturist. Regardless, these points got great results!

 

How Does Acupuncture Work?

 

With regards to the why and how did it work? Results found that blood flow to the uterus didn’t change with the two groups (whereas you’ll have read above in the Xu et al 2018 when they gave acupuncture twice in the follicle growth phase, it did increase blood flow). So here in this stage of a cycle they found that a reason for acupuncture’s success for pre and post transfer wasn’t due to better blood flow, but they speculate that it could be due to endorphins being released by acupuncture which calm the sympathetic nervous system (acupuncture helps move you from fight and flight into rest and digest calm-mode), and they speculate that acupuncture could help the brain:ovary communication pathway.

 

The authors also cite a study by Kim et al, 2000 (Effect of Acupuncture Treatment on Uterine Motility and Cyclooxygenase-2 Expression in Pregnant Rats) – which found that acupuncture in acupuncture point LI4 calmed the uterus from contracting in both pregnant and non-pregnant rats. They found that acupuncture on LI4 (on a rat- I’m not sure how on earth they needled this hand point on a rat?!) reduced COX-2 enzyme. COX-2 enzyme is a protein in the body that helps produce prostaglandins which act on the uterus – these chemicals cause inflammation and contractions in the uterus. Because acupuncture lowered this enzyme, acupuncture calmed the uterus - and it’s speculated that calming the uterus after IVF is one of the reasons that acupuncture may help. I’ve seen this study mentioned a few times during my research reading, but as it’s a rat study and therefore not high-quality human study, I haven’t wanted to discuss it in detail here. However it’s interesting to hear another speculation about how acupuncture might work.

 

 

 

So why are there sometimes mixed results, or results that show that acupuncture doesn’t work?

 

In the world of research, studies are generally either a randomised control trial (a single trial), or, things called systematic reviews or meta-analysis studies (where they pool tons of randomised control trial results together look at the overall findings and do clever maths and statistical stuff to make results comparable). This is where we do see mixed findings. Some showing clear better live birth rates with acupuncture for IVF, and some show no effect. And it is important that I point this out to you so that you can make your own informed decision.

 

I think it’s smart to question, how the heck can results be so different?  And you really do have to look into the different individual studies within the systematic reviews and pick them apart.

 

To present this example to you - which you’ll no doubt come across if you do some research - is a study by Craig et al which found acupuncture had a negative effect, it made things worse. This study drags down the overall results of many compiled findings in larger analyses. However- let me explain the Craig study to you so that you don’t take it at face value, and, you can see that it’s a not a good quality piece research (in my eyes at least).

 

Acupuncture lowers pregnancy rates when performed before and after embryo transfer, Craig et al 2007.  Let’s go through it…

 

All the other studies I’ve mentioned in this web page to you have been ‘good’ pieces of research- using sound methods where you can read exactly what’s been done, what acupuncture have been used, how the groups were randomised including the ages of the participants and the different fertility problems they have, even often reported how many previous tries at IVF they’ve had. You can read how these diversities are spread equally amongst the different groups as it’s published within the methodology of the study. I only include a piece of research discussed here on my website if I can read through it properly and cast my own critical eye on it.

 

Whereas this study was only published as an abstract for a conference- you can’t find the full paper to read, just the brief summary. This short version doesn’t go into any nitty gritty details- no transparency and no detailed protocol, no detailed methods section, no info about how many embryos were transferred, no details about when the pre and post transfer treatments were. What we do know is that they used acupuncture points based on a modified version of the Paulus points (no lists of points given) with 25 mins of acupuncture before and after and there were two practitioners, and that the control group didn’t receive acupuncture.  Whilst I wouldn’t discuss a similarly written ‘positive’ acupuncture study with you here on this web page (because it wouldn’t be a good piece of research), this study is picked up by others because the acupuncture-haters love to refer to it, and the larger studies scoop this in within their results.

 

Interestingly, the actual objective of this trial was to look at whether acupuncture was still effective pre and post transfer when people had to drive to a clinic to receive the acupuncture instead of having it on site- (in other studies the acupuncture was generally administered on-site).

 

We could therefore speculate, does this study instead demonstrate that stress of driving across town to get to an acupuncture treatment in time before and after a transfer causes stress which negatively effects rates? Maybe?

 

This type of method just isn’t typical of true practice- as acupuncturists we are so aware of making sure that stress isn’t a factor - we only want people to come when it isn’t going to cause stress- or instead to pop over the following day after having a leisurely lunch and lovely afternoon after transfer.

 

Also, when you see an acupuncturist who you’ve already been having treatment with, you step into their treatment room and instantly feel calm because you’re used to it and you have developed this amazing calming association with it. Quite a different experience I imagine from the science study methods where you’re meeting the acupuncturist for the first time and probably having acupuncture for the very first time (perhaps in a clinical setting)- so you’re likely to feel nervy. If you then add the pressure of driving to a research study appointment after transfer, you can see where there are other factors which may be at play - but who knows, because we can’t read the actual study to see what happened in the methods!

 

In true real-world acupuncture practise we always have compassion and often give special timing-leeway for our valued clients reaching the pinnacle of their IVF treatment!

 

Something else was odd with this study… the clinical pregnancy rates in IVF were unusually high. Rates in the non-acupuncture group were around double than typical at 70% success (usual rates of success were around 30%).  Rates were 44% in the acupuncture group. Again, without seeing full methods we have to be dubious about the presented results, as it is so unusual for IVF to work so well.  To read a discussion from researchers about this, here is a great article: Commentary on the Cochrane Review of Acupuncture and Assisted Conception, Stener-Victorin and Mansteiner, 2001.

 

Personally I feel that if this study gave results which were the other way around, it wouldn’t even be discussed by other researchers due to the poor quality write-up of this research - it would be dismissed.

 

 

 

Acupuncture for PCOS Poly Cystic Ovary Syndrome

 

This is a great study to cite, as it shows that electro-acupuncture improved the regularity of periods and brought down testosterone levels in people with PCOS poly cystic ovarian syndrome. PCOS is characterised with struggles in regularly ovulating (and thus irregular periods), higher testosterone levels than typical, and ovaries with many under developed follicles.

 

Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial, 2010, Jedel et al

 

In this study, the authors compared electro acupuncture versus a routine of gentle exercise versus no intervention. Acupuncture results demonstrated a whopping increase in period regularity of 146% after 16 weeks of treatment (it did come down a bit again after stopping treatment 30 weeks later- moral of the story- keep having the acupuncture!), and it brought down free testosterone levels by 30%. So we see here, that acupuncture has a great effect in balancing hormones to encourage good ovulation.

 

The design of the study began with 74 participants, and the drop-out rate led to 59 people remaining at the 16 week results, and 50 people remaining for results at 32 weeks. There were three groups: two fifths of people had acupuncture, two fifths had exercise, and one fifth had no intervention. The researchers measured loads of hormone readings at the start, after 16 weeks of treatment (when the acupuncture treatment ended), and then again at 32 weeks (16 weeks after the acupuncture treatment stopped).

 

People had 14 acupuncture treatments over 16 weeks, beginning with treatments twice a week, then every week, then every other week- which is a nice way to treat- come frequently to begin with, and then increase the intervals.

 

The researchers comment that they chose acupuncture points which stimulate nerves that go to the ovaries. They used electro acupuncture (which puts a little gentle fizzy sensation through the points by attaching little crocodile clips to the points from a machine a bit like a tens machine- I like using electro acupuncture!) on points Ren 3, Ren 6 and St 29 (all lower tummy) and lower leg points Sp 6 and Sp9. They also used points which don’t stimulate ovarian nerves alternating between either LI4 (hand) and PC6 (arm) with ordinary acupuncture. They used low electro acupuncture frequency of 2hz with a little muscle twitch without discomfort for 30 min sessions.

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This is great study as results found readable chemical changes in the hormones, and, in the reported menstrual (period) regularity changes in the participants. Menstrual frequency got better with the exercise group, but no where near as much as the acupuncture group, there was no change in the control group, and acupuncture was the only group which affected testosterone levels