Acupuncture & IVF - What this study doesn’t tell us

Does Acupuncture improve pregnancy and live birth rates alongside IVF cycles? If you read this article heading or the actual paper and the ultra-short (deceptive?) conclusion, you’d be forgiven for thinking not.

Acupuncture has been used for 2000+ years to improve health and fertility and thousands of women worldwide have chosen to use it alongside IVF for decades. So why did this study show otherwise? Or did it? Let’s break it down.

This study had 824 women divided into either acupuncture or sham acupuncture (fake acupuncture) groups, all receiving acupuncture on day 9 of their IVF cycle and twice on the day of embryo transfer, before and after. This study assessed the numbers of live births (not just pregnancies) and didn’t compare it to IVF only care.

In this study, undergoing IVF with either a maximum of 3 acupuncture or 3 fake acupuncture treatments, the birth rate was 18.3% with acupuncture or 17.8% with fake acupuncture.

Important to note; the study acknowledges “A recent meta-analysis examining placebo devices as effective control methods in acupuncture clinical trials found that these devices are not necessarily inert control interventions” and also “acknowledges the stage of embryo transfer was not balanced between groups, with a significantly higher number of women undergoing blastocyst transfer in the control group.” More, advanced-staged embryos were in the fake acupuncture group. Embryo stage greatly affects the success rates of pregnancy.

I digress…

Again this study is not comparing to IVF alone. Some reasons for the less than 20% success rate may be:

• Only 65% of women received all three treatments

• 71% of the women were experiencing infertility for more than 2 years. Reasons for infertility are many and varied, this study doesn’t attempt to explain reasons why and if their fertility is improving and/or the reasons for their infertility were being addressed

• This study doesn’t include data on sperm health which has a huge impact on fertility. It didn’t exclude cycles using ICSI which is typically used when there is low sperm count/qualityThis doesn’t give us general IVF only success rates, just compares real and fake acupuncture

Given almost three-quarters of the women in this study have experienced infertility for undescribed reasons for more than 2 years, was it likely that just 3 Acupuncture sessions was going to radically change this?

No, not really.

The power of Chinese Medicine when working with fertility is that it sees fertility and hormonal health as completely part of overall health (not separate to!) and that it is tailored to suit the needs of the individual, not a standard approach.

While each person is individually assessed and treatment plans are individualised, working to improve the menstrual cycles and overall health of a woman with a series of approximately 12x once weekly treatments is what we recommend for having you in the best shape for either natural or IVF conception.

Also, it takes two to tango! If the sperm quality is sub-optimal, then working to improve the health and fertility of a man over a similar time frame is also recommended.

Evidence of treating the individual over a longer period of time with Chinese Medicine to improve birth rates is shown in this 2015 study. “Acupuncture and herbal treatment was based on TCM pattern diagnosis and phase of menstrual cycle. According to Chinese medicine, regulating the menstrual cycle is considered a central treatment approach to female reproduction”
Individualised Whole System Chinese Medicine resulted in higher birth rates with IVF than IVF alone or just ‘day of embryo transfer’ acupuncture.

But back to the study at hand..

Some things to keep in mind with this study that may have affected acupuncture vs fake acupuncture results:

• In order to make comparisons in a study, you need to standardise most or all of the points used. See here on why that’s tricky for individualised patient treatments (the whole point of Chinese Medicine!)

• Needles used were thicker and longer than we use for most points in our clinic. This alters the effect and comfort of a point

• Some amazing acupuncture points used regularly in our clinic wouldn’t of been able to be used in this study as they are done on an angle, which, when you’re using the same needle tubes as the fake acupuncture, rules out points done on an angle

• We actually wouldn’t use some of the points used in this study

• If you have had acupuncture before, its usually pretty easy to tell if a needle has punctured the skin and de qineedle sensation felt, or if the needle folds up on itself and doesn’t pierce the skin. This could cloud the blinding and placebo effect of the trial

• Doing sham acupuncture away from known ‘fertility points’ doesn’t necessarily exclude an effect. Again, the study acknowledges “that these (sham acupuncture) devices are not necessarily inert control interventions”.

Does this mean this study is completely inaccurate?
Absolutely not! (Though some of the media headlines are misleading)
The authors of this study have done well. Chinese Medicine is difficult to standardise, its difficult to rule out placebo effect (fake acupuncture isn’t perfect but its also important to be aware of placebo effects in taking any pill or seeing any practitioner) and fertility has so many variants that it is very difficult to conduct a large-scale trial that attempts to rule out these variables and get a definitive result. Their efforts are applauded but more research is needed.

Does this mean acupuncture cant improve IVF outcomes at all?
No. This study has shown that doing a maximum of 3 treatments isn’t statistically significant in improving birth rates. We agree! More work on an individual’s health to improve fertility is whats needed.