Acupunture and IVF by Brian Acacio, M.D.
Acupuncture and IVF
Brian Acacio, M.D.
An old Chinese proverb states, “A flower cannot blossom without sunshine.” The same holds true with fertility. Chinese medicine emphasizes the proper conditions for a successful and healthy pregnancy. This is where Traditional Chinese Medicine (TCM) can play a very important role in improving IVF outcomes.
TCM has been practiced for hundreds of years. While Western medicine has been slow to embrace the benefits of TCM, we are beginning to see the benefits of the combined efforts. There are many studies that reveal TCM, and specifically acupuncture, can improve blood flow, enhance the immune system, and increase pain tolerance. While there are many other wild claims of the benefits of TCM, we believe that these therapies are best served when used in combination with Advanced Reproductive Technologies (ART), such as IVF.
In our acupuncture clinic, the first thing we do with a new patient is an extensive intake and physical examination. Using a specialized system of pulse taking and palpation, we can evaluate the overall status of the systems of the body that affect fertility. While some conditions can be treated fairly quickly, others may take months to address and may involve a combination of modalities. For example, if a patient wants to improve ovarian quality, it generally takes a minimum of three to six months of treatment using acupuncture, herbs and nutrition, whereas a simple case of thin uterine lining may only take one month on average for improvement.
Therefore, in preparation for an IVF cycle, the number of treatments can vary substantially. It is best to consult with an acupuncturist as far in advance of your IVF cycle as possible to determine your individual needs.
During the actual IVF cycle we use several base protocols. These protocols are then modified depending on a patient’s particular needs. Typically, a patient will receive four to ten treatments. Modifications are done if the patient has a history of poor response to a prior cycle, thin uterine lining, elevated FSH, etc. Modifications may be recommended if progress is not as expected. For example, if the endometrial thickness is below a certain level at various times during stimulation, another set of acupuncture treatments is added to help increase the lining to optimal thickness.
Most treatments are done in our office except on the day of the embryo transfer or in certain circumstances during retrieval. On the day of the embryo transfer, we administer two treatments. These are usually done at the IVF clinic: one immediately before and one immediately after the embryo transfer. Studies have shown differences in ongoing pregnancy rates with acupuncture. One factor impacting the pregnancy rate may be the timing of the embryo transfer protocol. In one acupuncture study the protocol was applied immediately before and immediately after embryo transfer, pregnancy rates increased by more than 60%. In another study, the protocol was applied on the day of the transfer, but not immediately before and after. They had a 40% increase in ongoing pregnancy rates.
It is also important to consider not only what protocols are being used, but how they are being applied. If improperly administered, acupuncture can potentially hinder a cycle. In fact, one study demonstrated that the improper administration of a protocol could reduce blood flow to the reproductive system. However, when done correctly, studies have shown that acupuncture can increase implantation rates, improve uterine and ovarian blood flow, increase live birth rates, increase sperm counts, morphology and motility and reduce miscarriages and ectopic pregnancies.
While acupuncture can do many things to improve IVF outcomes, there are also things it cannot do. Acupuncture can increase blood flow, but it cannot give you the nutrients that your body needs to prepare for and support a healthy pregnancy. Because of this, proper nutrition is indispensable; not just for getting pregnant, but to have a healthy and lasting pregnancy.
Nutritional issues are one of the most important and often neglected contributory factors to infertility. Almost everyone takes a prenatal vitamin without concern for their actual nutritional requirements. This can result in too much of one nutrient and too little of another. So, just as nutrient deficiencies may cause problems, too much of many nutrients can bio-accumulate and become toxic. For example, too little iron can cause infertility, but so can too much.
Also, taking a certain amount of a nutrient doesn’t mean your body is absorbing it. For example, most people know how important folic acid is for proper neural tube development. However, it will not work unless you are absorbing it. Symptoms like heartburn, bloating, bad breath and belching could indicate a reduced ability to absorb folic acid. Also, there can be genetic problems with metabolizing folic acid that require much higher doses to be taken. If you take too much folic acid, it can mask a vitamin B12 deficiency which could result in permanent neurological problems both for the mother and the fetus. So it is a very good idea to find out what your individual body needs and how much.
Finally, Herbal Medicine is another very useful adjunct to IVF. However, while herbs can be very useful to improve ovarian quality and quantity, endometrial thickness, progesterone levels, estrogen levels and many other aspects of a woman’s cycle, they can also be detrimental if taken at the wrong time during a cycle. This is especially so during an IVF cycle, where certain herbs or combinations thereof can block the IVF medications and potentially cause problems.
A final consideration is to work with a reproductive endocrinologist who not only is open to acupuncture, but who is proactive in their treatments. For example, in our clinic, Dr. Mory Nouriani and I encourage acupuncture for our patients as a general policy. Management of our patients includes referring them for proper TCM (herbal and acupuncture) evaluation before or even during a cycle.
Incorporating Traditional Chinese Medicine into your IVF cycle can not only substantially increase your chances of a successful IVF pregnancy, but a healthier IVF pregnancy. If you are contemplating IVF and would like to incorporate Traditional Chinese Medicine, we recommend you find a practitioner who is well versed in IVF acupuncture (and herbal medicine) and a reproductive endocrinologist who is open to incorporating Eastern therapies while allowing acupuncture on-site during an embryo transfer.
Brian Acacio, M.D., Medical Director of SIRM-Los Angeles, is actively involved in teaching and consulting at the University of Southern California (USC) and the University of California – Los Angeles (UCLA) and is a Clinical Assistant Professor at Loma Linda University. Dr. Acacio has additional teaching positions at the Glendale Adventist Hospital, Kern Medical Center, and Bakersfied. Dr. Acacio is the Vice-Chairman of the OB/GYN Dept. at Glendale Adventist Hospital and is Director of the Endocrinology and Infertility Dept. at White Memorial Medical Center.
Contact information:
Sher Institute of Reproductive Medicine – Los Angeles
1520 Chevy Chase Dr. Suite 101
Glendale, CA 91206
Phone: 818-291-1985
Fax: 818-291-1986
Email: briana@Inovamgmt.com
Website: http://www.haveababy.com