What Does Clinical Research Say About Acupuncture & IVF?

Chokniti Khongchum

The following is a review of some of the clinical evidence that shows that acupuncture is very effective in increasing the clinical pregnancy rates among clients undergoing IVF. It was compiled by the team at Rocky Coast Acupuncture in Portland, Maine. To find out more about Rocky Coast and our fertility program, please click here.

Introduction

Clinical research has repeatedly shown that acupuncture can increase your chances of a successful IVF transfer. This has led to a general acceptance in the broader medical community that acupuncture is a useful adjunct to in vitro fertilization (IVF). However, most reproductive endocrinologists do not have acupuncturists on staff and do not know how to answer questions about acupuncture.  If you are undergoing IVF, or are seriously considering it, this paper will help you determine if you should also make appointments for acupuncture to maximize your chance of a successful pregnancy.

This paper reviews some of the key clinical test trials and their conclusions to get a better picture of why acupuncture has become so popular so quickly. We will cover acupuncture’s demonstrated ability to increase your chances of a successful IVF cycle, and review what those results might mean for you.

Our statements are backed up by research, so any time you see a last name followed by a year in parenthesis you can skip to the end of this paper and see the reference listed in alphabetical order by that last name. For example, if you read a comment that has (Smith, 2021) afterward, you know that in the references section of this post there is an academic paper by someone named Smith that was published in 2021. There will be a live link to the paper so you can check it out for yourself.

That said, we know most people reading this are not clinical researchers, so we did our best to keep the language clear and summarize what these studies say so that you do not have to go through the original research on your own.

In a Nutshell

If you have been trying to conceive and are considering IVF, you know that this type of assisted reproductive technology offers the possibility of a miracle. You also probably know that, like all medical treatments, IVF is not guaranteed to work. This is why, as a general rule, most clients are told to expect between 4 and 6 cycles to achieve a successful pregnancy.

However, there is no hard and fast rule about when you personally will become pregnant. It could be 1 cycle, it could be 6, and it could be anywhere in between. When you consider that the average IVF cycle costs between $10,000 - $15,000 without factoring medication or pre-screenings (Penn Medicine, 2018), it really makes sense to do everything you safely can to maximize your chance of success so as to undergo as few cycles as possible before getting pregnant.

Thankfully, acupuncture has clinically demonstrated the ability to increase the chance of clinical pregnancy (CP) when done in conjunction with IVF. It is a time-tested, safe and most importantly, restorative way to improve your chances of pregnancy.

Let’s look at those numbers a little more closely

When trying to establish the rate of pregnancy from IVF over multiple age groups, scientists typically use what is called a prospective study. This allows the researchers to follow a large group of people over a long period of time.

To that end, a 2015 British prospective study (Smith, 2015) looked at 156,947 people who had been trying to conceive for an average of four years before treatment. The people studied ranged in age from 18-55, with a median age of 35. That means half the people studied were 35 or older, and half were 35 or younger.  The participating people received a total of 257,398 IVF ovarian stimulation cycles over a period of 7 years.

This study found that the average live birth rate (LBR) for a single IVF cycle in a woman 40 or younger is just over 32%. In other words, about a third of all study participants under 40 got pregnant on their first cycle. The average LBR goes up considerably with multiple cycles of IVF. After 6 cycles, the LBR for women under 40 more than doubles to 68%.

Between the ages of 40 and 42, an individual IVF cycle has a success rate closer to 12%. In other words 1 in 10 women between 40 and 42 years old got pregnant on their first IVF transfer. After 6 cycles the LBR for this population basically triples to 31.5%.

After 42 years old, this study found that the LBR falls to under 5% for an individual cycle. Unfortunately, the study did not find that multiple cycles improved the chances of live birth in this population.  That said, it is important to note that the individual person’s body is the most important variable. In other words, the physical health and ovarian reserve of women in this age group swings wildly due to lifestyle, diet and genetics. Those factors will determine the outcome far more than the number of years you have been alive.

As seen below, this highlights how important auxiliary therapies like acupuncture can be to this process.

The point here is that in all cases there is a chance that you will get pregnant on the first cycle, but it is a relatively small chance. For people under 42, the chances improve with each cycle until the 6th when it seems to level out. There are other large scale studies on this topic, and they found similar outcomes. If you are interested in seeing the expected success rate of your specific IVF, with your specific conditions, this calculator from the CDC is a great resource.

So what does this all mean for you?

Ultimately, it means that IVF holds the promise of a successful pregnancy and that is what matters the most. Once you make the decision to move forward with IVF, you will want to do everything you can to increase your chances, as each successive cycle is expensive, uncomfortable, and inconvenient.

Unfortunately, you can not control what the final outcome of any given cycle will be. However, there are some things that you can control. Eating well for fertility is one of them. Acupuncture is another.

William Fortunato

What do the studies say about acupuncture and IVF?

To answer this question we looked at an academic research paper that was published in the peer reviewed academic journal Reproductive Biomedicine in 2019. It is entitled, “Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis” (Smith, 2018). As it says in the title this is a meta analysis, which means that Smith and her team went through databases of existing randomized clinical trials (RCTs) and collected the data together to give a bigger picture of whether or not acupuncture works to increase the success rate of IVF.

Ultimately, her team found 20 randomized clinical test trials (RCTs), testing over 6,000 people, that met their criteria for being included in the meta analysis. Among the findings discussed:

Paulus et al (2002) found that clinical pregnancy rates for clients using IVF and acupuncture were 42.5% (34 out of 80 clients got pregnant). This is about 15% higher than the group that did IVF without acupuncture. This led the researchers to conclude, “Acupuncture seems to be a useful tool for improving pregnancy rate after ART” (Paulus, 2002).

Dieterle (2006) studied 225 IVF clients. 116 of them were given acupuncture alongside the treatment while the rest were given placebo. The acupuncture group had a clinical pregnancy rate almost double that of the control group. 33.6% of the client in the acupuncture group got pregnant from one IVF cycle, while only 15.6% for the control group that received IVF alone got pregnant in one cycle. If that number sounds low, remember that they didn’t filter the client by age, that’s a number across all age groups.

Westergaard (2006) found that 39% of women (across all ages) who received acupuncture with IVF got pregnant on one cycle, as opposed to 26% of those who received IVF alone. This led the team to conclude, “Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group as compared with controls.” For point of reference, that 13% improvement means months of pain and injecting yourself with hormones - not to mention tens of thousands of dollars - were saved by getting acupuncture before and after the transfer.

Smith (2006) found that for those subjects receiving acupuncture, the odds of achieving a pregnancy were 1.5 higher than for the control group. They tested over 200 women that were randomly assigned to either the acupuncture group or the placebo group. The acupuncture group had a pregnancy rate of 31%, whereas the placebo group had a clinical pregnancy rate of 23%. To put that in context, 8% more people got pregnant when using acupuncture. That may not sound like a lot, but on 200 subjects that is 16 more people who got pregnant from just one IVF cycle instead of multiple. There is no reason one of those 16 people can’t be you.

Across all studies collectively, the researchers found that women receiving acupuncture the day before embryo transfer saw a 30% increase in successful pregnancy over those who received no acupuncture.

None of the studies included in the meta analysis found that acupuncture posed a danger to either the mother or the embryo during transfer.

How might acupuncture work to improve outcomes?

There are a number of different theories here. The fact is that clinical science has not totally caught up yet with acupuncture’s mechanism of action. However, here are some of the main ideas floated by the research teams looking into this phenomenon:

Domar (2009), Taguchi (2019) and Smith (2018) found that acupuncture reduces stress in clients undergoing IVF. It is possible that the reduction in stress leads to a relaxation of the muscles, allowing the smoother transport of the embryo.

Sator-Katzenschlager (2006) found that acupuncture reduced pain intensity and analgesic consumption in women undergoing IVF. Pain causes constriction, so the idea here is similar that the acupuncture may be physically relaxing the body, allowing it to receive the transfer more readily. No matter what the mechanism, less pain is a real benefit.

Djaali (2019) found that acupuncture before and after egg transfer was able to modulate neuroendocrine factors and immune factors, increase blood flow to the uterus and ovaries. By monitoring these factors before, during, and after the acupuncture treatment, this research team was able to see that these changes occurred. More research is needed to explain exactly how this works. This is a promising new area of acupuncture research.

Su (2019) found that acupuncture promotes the absorption of endometrial cavity fluid and improves the uterine environment and endometrial receptivity. Again, more research is needed to back this up and describe a mechanism of action. However, this is another promising avenue that researchers are currently exploring.

Conclusion

Regardless of the mechanism of action, multiple high quality, peer reviewed, clinical research trials have shown that acupuncture works to increase the clinical pregnancy rate when combined with IVF. Considering the level of commitment it takes to go through multiple IVF cycles, it is in your interest to pursue acupuncture in conjunction with your ART treatment. Acupuncture is safe, effective, and relaxing.

To book your initial fertility acupuncture consultation at Rocky Coast in Portland, Maine, please click here. In person and telemedicine appointments are available. To learn more about getting acupuncture at Rocky Coast, please click here. 

References

Dieterle, S., Ying, G., Hatzmann, W., & Neuer, A. (2006). Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertility and sterility, 85(5), 1347–1351. https://doi.org/10.1016/j.fertnstert.2005.09.062

Djaali, W., Abdurrohim, K., & Helianthi, D. R. (2019). Management of Acupuncture as Adjuvant Therapy for In Vitro Fertilization. Medical acupuncture, 31(6), 361–365. https://doi.org/10.1089/acu.2019.1394

Domar, A. D., Meshay, I., Kelliher, J., Alper, M., & Powers, R. D. (2009). The impact of acupuncture on in vitro fertilization outcome. Fertility and sterility, 91(3), 723–726. https://doi.org/10.1016/j.fertnstert.2008.01.018

Paulus W., Zhang M., Strehler E., El-Danasouri I., Sterzik K. (20020). Influence of acupuncture on the pregnancy rate in clients who undergo assisted reproduction therapy. Fertil. Steril.; 77: 721-724. https://doi.org/10.1016/S0015-0282(01)03273-3

Penn Medicine (2018). IVF By The Numbers. https://www.pennmedicine.org/updates/blogs/fertility-blog/2018/march/ivf-by-the-numbers

Sator-Katzenschlager, S. M., Wölfler, M. M., Kozek-Langenecker, S. A., Sator, K., Sator, P. G., Li, B., Heinze, G., & Sator, M. O. (2006). Auricular electro-acupuncture as an additional perioperative analgesic method during oocyte aspiration in IVF treatment. Human reproduction (Oxford, England), 21(8), 2114–2120. https://doi.org/10.1093/humrep/del110

Smith, A., Tilling, K., Nelson, S. M., & Lawlor, D. A. (2015). Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles. JAMA, 314(24), 2654–2662.  https://doi.org/10.1001/jama.2015.17296

Smith, C. A., de Lacey, S., Chapman, M., Ratcliffe, J., Norman, R. J., Johnson, N. P., Boothroyd, C., & Fahey, P. (2018). Effect of Acupuncture vs Sham Acupuncture on Live Births Among Women Undergoing In Vitro Fertilization: A Randomized Clinical Trial. JAMA, 319(19), 1990–1998. https://doi.org/10.1001/jama.2018.5336

Smith, C., Coyle, M., & Norman, R. J. (2006). Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertility and sterility, 85(5), 1352–1358. https://doi.org/10.1016/j.fertnstert.2005.12.015

Su, W. W., Gao, X. A., Gao, Z. Y., Pan, J. L., Deng, F., & He, W. T. (2019). Zhongguo zhen jiu = Chinese acupuncture & moxibustion, 39(9), 923–926. https://doi.org/10.13703/j.0255-2930.2019.09.003

Taguchi, R., Sato, K., Adomi, S., Tanaka, N., Tamura, H., & Tamura, T. (2019). Acupuncture and Laser Acupuncture as Treatments for Emotional Distress in Infertile Women in Japan. Medical acupuncture, 31(6), 372–378. https://doi.org/10.1089/acu.2019.1344

Westergaard, L. G., Mao, Q., Krogslund, M., Sandrini, S., Lenz, S., & Grinsted, J. (2006). Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertility and sterility, 85(5), 1341–1346. https://doi.org/10.1016/j.fertnstert.2005.08.070