Research and reviews
These pages provide for interested doctors a library or resource of publications relating to Chinese medicine and reproductive health that have appeared in peer reviewed academic journals and listed in PubMed. Some of them are systematic reviews or meta-analyses, some are randomised controlled trials, and some are pilot studies. Some of these studies point the direction to future research but do not form the basis of therapeutic recommendations. Some of the results show a benefit of using Traditional Chinese medicine techniques and some show no benefit.
Clinical trials examining the effect of Chinese medicine on female fertility are not so common, for several reasons mostly relating to logistics of recruitment of participants and funding. However IVF clinics provide a platform for easy recruitment of patients, and evaluation of outcomes, hence much of the research published in this area examines the effect of acupuncture (and sometimes herbs) on IVF patients.
Research on the effect of acupuncture on male factor fertility, endometriosis and polycystic ovarian syndrome is being carried out in various parts of the world.
Fertility and Sterility, (journal of the American Society for Reproductive Medicine) has published many studies on the effect of acupuncture at the time of embryo transfer. The majority of these papers report an improvement in outcomes. If any provisional conclusion is to be drawn, it is that acupuncture appears to benefit clinical trial groups who have an expected pregnancy rate of around only 30% or less.
The large majority of small randomised controlled trials that examined the effect of acupuncture on IVF outcomes when administered on the day of embryo transfer, found a positive effect. However some more recent large randomised controlled trials (published in other journals) have not replicated this result, concluding that acupuncture on the day of transfer does not increase live birth rates for IVF patients. The more recent reviews (1) of trials examining more extensive use of acupuncture before and during an IVF cycle indicate a benefit, compared to those where only 2-3 treatments were administered.
Several research studies are summarised below. For more information please contact us.
Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study
Zhang R et al, Fertil Steril 2011, 96, 4 Pg 912-916, Fertility and Sterility
Objective: To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on pregnancy rates (PR) in women undergoing ET.
Design: Prospective, randomized, single-blinded placebo-controlled clinical trial.
Setting: Research and laboratory facilities.
Patients: A total of 309 patients, less than 45 years old, undergoing cryopreservation embryos transplant or fresh cycle IVF with or without intracytoplasmic sperm injection (ICSI).
Interventions: The subjects were randomly allocated to three groups: mock TEAS treatment: 30 minutes after ET (group I, n = 99); single TEAS treatment: 30 minutes after ET (group II, n = 110); and double TEAS treatments: 24 hours before ET and 30 minutes after ET (group III, n = 100).
Main Outcome Measures: Clinical PR, embryos implantation rate, live birth rate.
Results: The clinical PR, embryos implantation rate, and live birth rate of group I (29.3%, 15.0%, and 21.2%, respectively) were significantly lower than those in group II (42.7%, 25.7%, and 37.3%, respectively) and group III (50.0%, 25.9%, and 42.0%, respectively).
Conclusions: Transcutaneous electrical acupoint stimulation, especially double TEAS, significantly improved the clinical outcome of ET.
Randomized Controlled Trial: Effects of Acupuncture on Pregnancy Rates in Women Undergoing In Vitro Fertilization
Moy I et al Fertil Steril 2011 Vol 95 pg 583-587, Fertility and Sterility
This trial randomised 160 IVF patients, younger than 38 years, to have acupuncture on acupuncture points or on sham points before and after embryo transfer. No significant difference in pregnancy rate was found between the groups. The authors say “The findings are not the final word on acupuncture and IVF. One possibility, they note, is that acupuncture needling, even performed at non-acupuncture sites, has some sort of effect on IVF pregnancy rates. If that’s the case, effects of the sham acupuncture used in this study might have masked any benefit of the traditional version.
The researchers say that future studies could compare true acupuncture with “placebo” needles that do not penetrate the skin.
Objective: To evaluate the influence of “true” versus “sham” acupuncture on pregnancy rates (PRs) in women undergoing IVF.
Design: Randomized controlled trial, double-blinded with independent observer.
Setting: Academic infertility clinic.
Patients: One hundred sixty patients <38 years old undergoing IVF with or without intracytoplasmic sperm injection.
Interventions: Subjects were randomly allocated to the true or sham group and underwent acupuncture 25 minutes before and after ET. Subjects completed a McGill Pain Questionnaire regarding their clinical symptoms during ET.
Main Outcome Measures: Clinical PR and clinical symptoms during ET.
Results: While the overall clinical PR was 51.25%, there was no significant difference between the arms of the study (true = 45.3% vs. sham = 52.7%); 33.1% of the patients had ultrasound-documented singleton pregnancy, and 15% of patients had twin gestations, while one patient in the true arm had a triplet gestation. There were significant differences in the subjective, affective, and total pain experience between both arms. The subjects in the true arm described their acupuncture session as being more “tiring” and “fearful” and experienced more “achiness” compared with their sham counterparts.
Conclusions: There was no statistically significant difference in the clinical or chemical PRs between both groups. Patients undergoing true acupuncture had differing sensory experiences compared with patients in the sham arm. There were no significant adverse effects observed during the study, suggesting that acupuncture is safe for women undergoing ET.
Acupuncture performed before and after embryo transfer improves pregnancy rates.
Objective: Conflicting evidence exists on whether acupuncture is beneficial for patients undergoing In Vitro Fertilization (IVF) cycles. Therefore, this study was undertaken to determine whether on-site acupuncture, per-
formed both before and after embryo transfer, affects clinical outcomes.
Design: Retrospective data analysis.
Materials and Methods: The Acupuncture Group consisted of 49 patients who received acupuncture on-site before and after embryo transfer in 2007. The treatment did not follow the Paulus protocol. The Control Group were 212 patients with no acupuncture undergoing IVF cycles in the same time period. The data was subdivided by SART age classifications to determine if acupuncture differentially benefitted certain age groups. Clinical Pregnancy Rate (CPR) was defined as the presence of fetal cardiac activity. Loss Rate was the percentage of pregnancies that did not
proceed from a positive hCG to a clinical pregnancy. Data were analyzed using the unpaired t-test and Fisher’s exact test, with significance defined as P < 0.05.
Results: Patients with a positive hCG were significantly higher in the Acupuncture Group for women less than 35 years old (63.3% vs.43.2%, p 1⁄4 0.048). The Acupuncture Group also had a higher CPR in the under 35 category (60.0% vs. 34.6%, p 1⁄4 0.01). There were no differences in the other age groups. Combining all the age groups, the cycle parameters between the two Groups were equivalent, while the CPR was higher and the Loss Rate lower for the Acupuncture group (Table 1).
TABLE 1. Cycle Data for All Age Groups
Acupuncture No Acupuncture P Value
N 49 212
Age 32.6 +4.2 32.0 +3.8 0.33
No. Oocytes 13.7 + 6.6 13.2+6.9 0.65
Cell Number 6.8 + 2.0 7.0 +2.1 0.36
Fragmentation Score 2.5 + 0.6 2.5 +0.6 1.00
No. Embryos Frozen 2.5 + 3.2 2.7 +3.5 0.85
No. Embryos Transferred 2.3 + 0.6 2.2 + 0.6 0.29
Positive hCG (%) 57.1 (28/49) 45.8 (97/212) 0.16
Clinical Pregnancy (%) 55.1 (27/49) 34.4 (75/212) 0.01
Loss Rate (%) 3.6 (1/28) 22.7 (22/97) 0.02
Conclusions: Although other studies regarding acupuncture have been inconclusive, perhaps these positive results are related to two important factors. The treatments were performed on-site, eliminating the stress of traveling to another site before and after the embryo transfer. Also, the acupuncture treatment protocol did not follow the traditional Paulus protocol, thereby suggesting there is still more research to be done on how best to treat
infertility issues with acupuncture.
The impact of acupuncture on in vitro fertilization outcome.
Domar A et al Fertil Steril 2009 Vol 91 Issue 3 pg 723-6, Fertility and Sterility
This study showed no acupuncture effect and the researchers felt this was due to the fact that they included many women who didn’t have good quality embryos available for transfer. While acupuncture may help a woman become pregnant after the transfer of a healthy embryo, the researcher noted in an interview, it can’t repair an embryo with chromosomal defects or other abnormalities. She added, “Despite the results of my own study, I still recommend acupuncture to women going through IVF”
Objective: To replicate previous research on the efficacy of acupuncture in increasing pregnancy rates (PR) in patients undergoing IVF and to determine whether such an increase was due to a placebo effect.
Design: Prospective, randomized, controlled, single blind trial. Setting: Private, academically affiliated, infertility clinic.
Patients: One hundred fifty patients scheduled to undergo embryo transfer.
Intervention(s): Subjects were randomized to either the acupuncture or control group. Acupuncture patients received the protocol, as first described by Paulus and his colleagues, for 25 minutes before and after embryo transfer. Control subjects laid quietly. All subjects then completed questionnaires on anxiety and optimism. The IVF staff remained blind to subject assignment.
Main Outcome Measures: Clinical PRs, anxiety, optimism.
Results: Before randomization both groups had similar demographic characteristics including age and psychological variables. There were no significant differences in PRs between the two groups. Acupuncture patients reported significantly less anxiety post-transfer and reported feeling more optimistic about their cycle and enjoyed their sessions more than the control subjects.
Conclusions: The use of acupuncture in patients undergoing IVF was not associated with an increase in PRs but they were more relaxed and more optimistic
Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy
Paulus W et al, Fertil Steril 2002 Vol 77, pg 721-724, Fertility and Sterility
Objective: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture.
Design: Prospective randomized study.
Setting: Fertility center.
Patients: After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80).
Interventions: Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy.
Main Outcome Measures: Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer.
Results: Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.
Conclusions: Acupuncture seems to be a useful tool for improving pregnancy rate after ART.
Qian, Y., Xia, XR., Ochin, H. et al. Arch Gynecol Obstet (2017) 295: 543. https://doi.org/10.1007/s00404-016-4255-y