Acupuncture for IVF

Acupuncture is the most commonly used complementary treatment alongside IVF treatment and has become integrated into many of the best fertility clinics across the world.

A study in 1992 found that conception rates with acupuncture for IVF rose to 42.5% compared to a non acupuncture control group that achieved a success rate of only 26.5%.¹ The interest generated by this research led to similar trials, which produced similar results. More recently the British Medical Journal analysed all the available research that stood up to rigorous scrutiny.² This large study involving 1366 patients also found that acupuncture significantly increases the success of IVF treatment.

In practical terms they concluded acupuncture creates one additional pregnancy for every 10 cycles of IVF performed.

How it can help you


It has been suggested that acupuncture may increase implantation rates through³: 

• regulating stress hormones that affect implantation
• modulating neuroendocrinological factors (regulating hormone levels)
• increasing blood flow to the uterine lining
• modulating cytokines and immune response​

The Stages of Acupuncture during IVF

The following stages give an idea of the ideal timings of acupuncture treatment when used alongside IVF treatment and the purpose of treatment at each stage. You will see that emphasis is placed on enhancing the function of the uterine environment throughout in order to improve the likelyhood of successful implantation. The healthy function of the uterine environment is, in Chinese medicine, reflected through the nature of the menstrual flow, which ideally should be bright red, free flowing and without pain or clotting. 

Stage 1 – Acupuncture prior to IVF

Many clients choose to start their acupuncture in the months running up to an IVF cycle.​ Often IVF occurs after months or years of trying to conceive naturally, or with other assisted methods such as Clomid or IUI. Although the research shows that acupuncture on the day of the embryo transfer significantly increases the success of IVF, it is the experience of most acupuncturists and their patients that a period of preparatory treatment before an IVF cycle can increase the success rate even further. Acupuncturists at this stage will work to regulate the menstrual cycle, support efficient and regular ovulation and optimise hormone levels. Your acupuncturist will assess each stage of your menstrual cycle and look to ensure the release of the best possible egg and the development of the best possible implantation environment. IVF units increasingly use FSH levels as an acceptance criteria for patients looking to start IVF. Acupuncture can be useful in lowering this level if it is too high to allow treatment to start.

Stage 2 – Acupuncture during down-regulation (long protocol) or before the period (short protocol)

During down-regulation, the medication is used to stop the stimulation of the ovaries by the pituitary gland. This effectively puts your menstrual cycle on pause, so that the ovaries can be controlled with stimulation drugs. However such regulation can cause the period to be delayed, to be lighter or to not come at all. At this point acupuncture treatment is focused on ensuring an efficient elimination of the womb lining. Producing a full clear-out of the old endometrium allows the best opportunity to develop a fresh, healthy and thick lining with good blood flow.

Treatment may also be used at this stage to reduce the potential side effects of down-regulation such as headaches or hot flushes. 

If you are on the short protocol (and are not taking down-regulation medication), the principle is exactly the same – to try to achieve the best possible clear out of the old lining to make way for the new. 

Stage 3 – During the stimulation phase

During the stimulation phase follicles start to develop in the ovaries and the womb lining starts to build up again. The medications are targeting the ovaries to produce multiple mature follicles. IVF stimulation enables the ovaries to provide more mature eggs to be collected than on a normal natural cycle. As such the acupuncture does not significantly add to number of follicles produced, but rather concentrates on optimising the quality and function of the womb lining, helping it both thicken and have a good blood supply. Typically patients are seen twice during this phase and if there is any specific issues such as thin endomtretrium, blood-clotting disorders, or very dark clotted menstrual flow, an additional ​treatment may be given during this phase

Stage 4 – Acupuncture at embryo transfer

This is the time that many patients have heard of and that much of the research focuses on. Acupuncture is performed both before and after the embryo transfer.

The purpose of the treatment is to increase blood flow to the womb lining in order to increase receptivity, and to reduce any uterine contractions or spasms that may occur due to the transfer procedure itself. 

In some IVF units this treatment can be performed on site. In most situations it cannot and means a trip to the acupuncturist before travelling to the IVF unit, and then straight back to the acupuncture clinic after the embryo transfer.

Research strongly suggests that these treatments are time-dependent which means it should be done as soon as possible before and after. Although this can be logistically difficult for many acupuncturists, research shows that settling for treatment a day before and a day after provides no significant benefit. 

At this point treatment also works to regulate stress hormones which affect implantation, reduce anxiety and calm the mind.

Please note we cannot see clients for embryo transfer treatments in isolation and do not see anyone as an initial session for this treatment. Pre and post embryo transfer treatments will be done whenever reasonably possible.

There appears to be little evidence that having acupuncture during the “two week wait” after embryo transfer increases implantation rates.

However, this is a very stressful period for many couples, and if anxiety levels are high, acupuncture may be used to help relax during this time.

Ideally, once a positive result has been achieved, treatment until week 12 of the pregnancy is recommended in order to maintain balance and ensure the pregnancy progresses smoothly.

Acupuncture given by a qualified, registered practitioner is generally considered safe during IVF and early pregnancy. Serious side effects are rare; minor bruising or tiredness after a session can happen. Our practitioners adapt the points they use to each stage of your cycle and to pregnancy. You can tell your IVF clinic you are having acupuncture.

Ideally start one to three months before your cycle, with weekly sessions. If that isn’t possible, starting during stimulation still allows us to plan sessions around egg collection and transfer.

Both. The studies that first drew attention to acupuncture and IVF gave treatment immediately before and immediately after transfer on the same day, so that is what we aim for.

As close to the transfer as reasonably possible on the day, typically within [an hour or two] either side. We will plan the timing with you once you know your transfer time. We keep rooms available for embryo transfers so we can accommodate clients at short notice.

The research has mostly looked at fresh IVF cycles, but the same approach can be used for a frozen transfer: sessions while your lining builds, then before and after transfer.

Yes. There is less evidence that it affects implantation at this stage, but many patients find it helps them manage the stress of waiting.

No. We don’t offer embryo transfer treatment on its own or as a first appointment, because it works best as part of a planned course. Please get in touch as early in your cycle as you can.

References

1) Paulus, et.al. Fertility and Sterility Vol: 77, No. 4, APRIL 2002
2) Manheimer E, Zhang G, Udoff L, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ 2008;336(7643):545-549.
3) Anderson BJ, Haimovici F, Ginsburg ES, Schust DJ, Wayne PM, In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern Ther Health Med. 2007 May-Jun;13(3):38-48