Assisted
Reproduction Therapy (IVF)
Erectile
dysfunction
Infertility Study
Low Sperm Quality
Male Sterility
Menopause
Sperm Density
BACK page
2 of 2
Assisted
Reproduction Therapy (IVF) - continued
Commentary
The popularity of treatment methods not generally established in Western medicine, such as acupuncture, is increasing in reproductive medicine. Acupuncture is an integral part of the more than 3000-year-old medical tradition known as Traditional Chinese Medicine
(TCM). In recent years, the effect of acupuncture on different conditions (pain and diseases) has been studied from a Western scientific perspective, and the results indicate that acupuncture has both a physiological and a psychological impact (1). The mode of action of acupuncture most likely involves the activation of muscle afferents that modulate spinal and segmental reflexes and higher control systems, thereby allowing a neural substrate to influence reproductive functions (1,2).
Many infertile women undergo acupuncture in the course of in-vitro fertilization
(IVF), hoping it will improve their chance of success. But what scientific evidence do we have to support this? To date, only three published studies have investigated the effect of acupuncture in women undergoing IVF treatment, and the present article is one of them. The earliest study investigated the effect of acupuncture on blood flow impedance in the uterine arteries, known as the pulsatility index (PI) (3). This uncontrolled study showed that repeated electro-acupuncture (EA) reduced a high PI value in the uterine arteries to normal levels. The clinical use of EA to improve blood flow impedance in the uterine arteries in connection with IVF and ET treatment can still only be speculative. Whether the subsequent increase in blood flow influences endometrial receptivity-and, therefore, implantation and pregnancy rates-in women undergoing IVF and embryo transfer (ET) remains to be demonstrated.
In the present study, acupuncture during ET in IVF cycles resulted in significantly higher pregnancy rates than no acupuncture (42.5 vs. 26.3%). The authors concluded that, since they could not observe any differences in covariants between the acupuncture group and the control group, the results demonstrate that acupuncture therapy improves pregnancy rate. This is an interesting observation. However, the statistics in the study can be criticized, since no power calculation was presented. Furthermore, a success rate of 26.3% in the group without acupuncture is low, when as many as 2-3 embryos are transferred at one time. One would expect a pregnancy rate between 35% and 40%. Thus, the result may be a type 2 error and must be interpreted with care.
However, these results are in line with an observation made in the second of the three studies mentioned above. This study compared EA with alfentanil as anaesthesia during oocyte aspiration, but the number of subjects was also too small for any conclusions concerning pregnancy rate to be drawn (4). The main finding of this study was that EA was as effective as conventional
anaesthetics, but without any negative side effects. We have recently competed a study with a larger number of subjects and the results will be published in the near future. In conclusion, whether acupuncture has a positive effect on the pregnancy rate when given as pre-treatment, before oocyte aspiration, during oocyte aspiration, during ET, or in any combination of these stages, remains to be proven. The clinical use of acupuncture as an anaesthetic method during oocyte aspiration in IVF treatment can be recommended. An important clinical issue is that no negative side effects have been observed in any of the studies.
References
- Elisabet
Stener-Victorin, PhD, RPT
- G–teborg University, G–teborg, Sweden
Andersson S, Lundeberg T. Acupuncture - from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses 1995; 45:271-81.
- Stener-Victorin E, Wikland M, Waldenstr–m U, Lundeberg T. Alternative treatments in reproductive medicine: much ado about nothing. Acupuncture-a method of treatment in reproductive medicine: lack of evidence of an effect does not equal evidence of the lack of an effect. Hum Reprod 2002; 17:1942-6.
- Stener-Victorin E, Waldenstr–m U, Andersson SA,
Wikland, M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture.
Hum Reprod 1996; 11:1314-7.
-
Stener-Victorin E, Waldenstr–m U, Nilsson L, et al. A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 1999; 14:2480-4.
BACK page
2 of 2
