Acupuncture and exercise restore adipose tissue expression of sympathetic markers and improve ovarian morphology in rats with dihydrotestosterone-induced PCOS. Mannerås, et al. Am J Physiol Regul Integr Comp Physiol. 2009 Apr;296(4):R1124-31.

• In this study they showed that acupuncture in combination with exercise significantly improves ovarian quality, including antral follicle count and the morphology of the follicles. It also showed that acupuncture can significantly improve PCOS outcomes. While this particular study was done on rats, it has been our clinical observation that exercise can make a very significant impact in fertility and overall health. Several of our practitioners created a fertility yoga DVD that is specifically targeted to improving fertility outcomes. It is available on Amazon.com and is entitled "Restoring Fertility".

• This was an interesting study that examined the question of whether acupuncture improves pregnancy rates through stress reduction. The answer was that acupuncture significantly improves pregnancy rates, but not by reducing stress levels (as measured by cortisol and prolactin). Of particular interest in this study, however, was the fact that this particular acupuncture protocol doubled a woman's chances of maintaining her pregnancy (p<.05). In this protocol they combined a modified version of the Paulus protocol with the Stenner-Victorin protocol for a total of 11 acupuncture treatments during an IVF cycle. This study suggests that the addition of the Stener-Victorin protocol may be very useful to reduce the chances of miscarriage.

A randomized double blind comparison of real and placebo acupuncture in IVF treatment. Hum Reprod. 2009 Feb;24(2):341-8. Epub 2008 Oct 21.

• This study demonstrates what Dr. Brandon Horn and Dr. Judith Balk have been lecturing on for several years now. Most of the studies that make conclusions about acupuncture are misleading. There are many reasons for this, but one important reason is that there are infinite combinations of acupuncture points, each one having different physiological effects. So how could one acupuncture protocol possibly represent all of acupuncture? The answer is it's not possible. In this study, they showed that what people are using as so-called "placebo controls" may actually be active treatments and be giving false results. This was discussed in depth by Dr. Balk and Dr. Horn in the June 2008 issue of the Journal of Chinese Medicine and in their lectures around the country.
  

Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis: Manheimer E, et.al. British Medical Journal, 2008 Feb 7; [Epub ahead of print]

• This was a meta-analysis looking at all the available, high quality acupuncture research. When taking all factors into account the investigators found that "acupuncture increased the odds of a live birth 91% compared with the control groups." What the authors did not mention was that the analysis was biased AGAINST acupuncture (see the June 2008 issue of the Journal of Chinese Medicine for a publication written by Judith Balk, MD, MPH and Brandon Horn, PhD, JD, LAc for details). Therefore, the true effects of acupuncture are even higher than this.

Acupuncture and assisted conception. Cheong et al. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006920.

• The Cochrane Database is considered by Western physicians to be the "official" position of evidence based medicine, so it is a big deal in the medical world that they concluded that acupuncture improves live birth rates. Of course there is no serious analysis as to why there are differences in the studies. The Journal of Chinese Medicine article by Drs. Horn and Balk discussed above provide an excellent analysis.

A systematic review and meta-analysis of acupuncture in in vitro fertilisation BJOG. 2008 Sep;115(10):1203-13. Epub 2008 Jul 23.

• This was a fairly rediculous meta-analysis where they included studies that had unfavorable outcomes (even though some of these studies had been excluded from other meta-analyses due to methodological problems). At the same time, they excluded studies that had favorable outcomes, including the study with one of the largest number of subjects. That's like me saying that ice cream doesn't taste good because I can find 100 people who don't like it and I'm going to exclude 1,000 people who do like it. This is data manipulation and it's done all the time to varying degrees. You can basically get any result you want if you just massage your inclusion and exclusion criteria.
  

• This is another review of the use of acupuncture for IVF. The author discusses a summary of the evidence and concludes that "the order of magnitude of improved outcomes [with acupuncture] is higher than more conventional adjunct maneuvers".

A Pilot Study Evaluating the Combination of Acupuncture with Sildenafil on Endometrial Thickness: Yu et.al. Presented at the Pacific Coast Reproductive Society Meeting 2007 Apr 20.

• This was an interesting study utilizing a dynamic acupuncture protocol that changed according to the patients' individual needs. Participants in the study all had poor uterine linings in prior cycles (less than 8 mm). Although it was only a pilot study, all subjects achieved lining thickness of 10 mm or greater. Lining thicknesses of 8mm or less have been shown to have substantially lower pregnancy rates than those over 9mm so this is a very significant finding and may be another mechanism by which acupuncture is improving pregnancy rates.

• This is an excellent article :-) that analyses the current acupuncture literature related to IVF. It points out a number of fallacies that have been perpetuated by commentators that are not familiar with acupuncture. When filtering out studies that had improper study design or improper use of acupuncture (such as the use of acupuncture points that are contraindicated during pregnancy), this article certainly reinforces others that properly conducted acupuncture can greatly improve IVF outcomes.

ACUPUNCTURE PERFORMED BEFORE AND AFTER EMBRYO TRANSFER IMPROVES PREGNANCY RATES. D. B. Youran. Fertility and Sterility. September 2008 (Vol. 90, Pages S240-S241)

• This study used a different acupuncture protocol timed immediately before and immediately after the embryo transfers. They found a statistically significant increase in pregnancies. (55% clinical pregnancies in the acupuncture group versus 34% in the control group). There were also significantly less pregnancy losses (only 4% in the acupuncture group versus 23% loss in the control group).
  

Clinical observation on acupuncture for treatment of infertility of ovulatory disturbance. Song et al. Zhongguo Zhen Jiu. 2008 Jan;28(1):21-3.

• This study compared acupuncture to Clomid and found that both induced the same effects on ovulation, however, in the acupuncture group, the pregnancy rate was higher and the miscarriage rate was lower.
  

Impact of Acupuncture Before and After Embryo Transfer on the Outcome of In-Vitro Fertilization Cycles: A Prospective Single-Blind Randomized Study. M. R. Benson, et al. Fertility and Sterility. September 2006 (Vol. 86, Issue 3, Page S135)

• In this study they had a 10% increase in Clinical pregnancies in the acupuncture group. Not statistically significant but a trend toward increase in pregnancies.
  

Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study.: Dieterle S, et.al. Fertility and Sterility 2006 Apr 7; [Epub ahead of print]

• This study showed that acupuncture can more than double ongoing pregnancy rates when compared to control subjects. It is important to emphasize that getting pregnant is only part of the story. We want HEALTHY pregnancies. To have the best chances to achieve a healthy pregnancy requires a comprehensive approach to your health. We cannot emphasize how important addressing your health comprehensively is for giving your baby the best chance at having a healthy and happy life. One of our practitioners addresses these issues in more detail here.

• This study once again demonstrates that properly applied acupuncture results in IVF ongoing pregnancy increases of over 60%.

• This study examined 228 IVF patients. The group that received true acupuncture showed improvements in ongoing pregnancies of over 50% compared to subjects that received a sham acupuncture treatment. This is very clinically significant, though it did not rise to the level of statistical significance.

• This is a discussion of the use of acupuncture in IVF relative to the authors' most recent study. Though they are not exactly sure how it is working, the authors state: "The present data corroborate previous studies demonstrating a significant beneficial effect of acupuncture in IVF"

• This landmark study published in one of the most prestigious medical journals in reproductive medicine demonstrated that women undergoing acupuncture treatments had an increase in ongoing pregnancy rates of over 60%, compared to control subjects that did not receive acupuncture.

• This was a pilot study where researchers used a completely different acupuncture protocol than the Paulus protocol, but found that in addition to duplicating the 60% increase in ongoing pregnancies of the Paulus study, there was a 180% increase in implantation rates and a significant reduction in the amount of gonadotrophins used (for an average cost savings greater than the cost of acupuncture for the cycle).

• This was an interesting retrospective study that found a significant increase in IVF pregnancy rates with acupuncture (40% increase). Though these increases were not as high as in the Paulus and Quintero studies, this study did not have exclusion criteria. Of particular interest in this study was that poor responders that received acupuncture had the same pregnancy rates as normal prognosis patients. In this study, poor responders were defined as those with elevated Peak FSH, longer history of infertility or poor sperm morphology.

• This study further demonstrates the importance of proper acupoint selection and proper administration of acupuncture protocols. The point protocol in this study varied greatly from previous studies that demonstrated positive pregnancy outcomes. This particular acupoint selection did not produce any increases in pregnancy rates.

• This study demonstrated that acupuncture can significantly increase ovarian blood flow. It also demonstrated that, even using the same acupuncture protocol, by a small modification in manipulation, you get the exact opposite effects. That is, you can decrease the ovarian blood flow. This study, therefore, is very important to illustrate the importance of using acupuncturists that have very thorough training in both acupuncture and infertility. Unfortunately, most patients are unaware of this and many medical professions practice acupuncture with as little as a weekend course. You should look for an acupuncturist that has extensive training (in California, for example, Licensed Acupuncturists must complete a four year program of study). It is best to find an acupuncturist with specialized training in infertility (e.g., F.A.B.O.R.M. designation meaning they have minimum qualifications to be designated as an infertility specialist). If you are undergoing IVF, it is imperative that your acupuncturist have significant experience with the IVF process. IVF is a subspecialty and there are many issues that will not be apparent to those without significant experience with IVF.

• This study compared acupuncture to standard hormone therapy in the treatment of infertility. For women with menstrual irregularities (a subgroup of the patients in the study), acupuncture increased pregnancies by 28% over hormone therapy. There were no side effects in the acupuncture group but there were in the hormone group. Taking all women in the study into account, combined acupuncture and hormone therapy achieved the best results, producing 10% more pregnancies than hormone therapy alone.

• Successful in-vitro fertilization (IVF) and embryo transfer require optimal endometrial receptivity at the time of implantation. The amount of blood flow to the uterus is considered valuable in assessing endometrial receptivity. This study showed that acupuncture treatments performed twice per week for four weeks significantly increase blood flow to the uterus and may explain one mechanism for the substantial increases in pregnancies when acupuncture is incorporated.

• This study examined the effects of acupuncture on stimulating ovulation and regulating ovulatory problems. The researchers concluded that acupuncture seems to increase progesterone levels and regulate FSH, LH and E2 levels. This study involved 30 acupuncture treatments and had an 82.35% effective rate.

• This review demonstrated that acupuncture analgesic effects are equal to conventional analgesic medication for oocyte retrieval. This is an important alternative for patients who are allergic or sensitive to analgesic medications.

• A simple application of ear acupuncture was shown to be as effective as drug therapy in improving fertility.

• This article notes the excellent results achieved in improving reproductive outcomes with mammals and proposes that acupuncture influences the hypothalamic-pituitary-gonadal axis as well as steroidogenesis.

• In this study, acupuncture was compared to Clomid administration in the treatment of endocrine dysfunction infertility. The study found acupuncture to have significantly higher pregnancy rates than Clomid administration (65% versus 45%). The study concluded that acupuncture is an effective treatment for infertility secondary to endocrine dysfunction.