by Aina Zhang, L. Ac. MD
Fall 2006
In recent years acupuncture has been increasingly used as an alternative and complementary treatment to Assisted Reproductive Technology (ART). Although there are only a few clinical studies published outside China to support this ancient therapy in the treatment of female infertility, reports from patients who have tried it are very favourable.
Reported benefits from published clinical studies
According to recently published clinical studies, acupuncture can:
• increase the success rate of in vitro fertilization (IVF) by 42%, with pre & post transfer acupuncture
• relieve stress related to infertility and its treatment
• improve the production and quality of ova
• normalize the hypothalamic-pituitary-ovarian axis and menstrual cycle 3
• reduce the risk of miscarriage and ectopic pregnancy
• provide an alternative treatment for patients who are intolerant, ineligible, contraindicated or simply cannot afford conventional infertility treatment 3
Observed benefits from my clinical practice
There are many additional benefits that I have observed during my twenty years of practice:
• It is an effective treatment for unexplained infertility.
• It has many desirable effects, such as a regulated menstrual cycle, reduced premenstrual syndromes (PMS), relieved physical and emotional stresses associated with infertility and subsequent treatment, and improved overall health.
• It has no short-term or long-term side effects.
• It offers new hope for patients who are unable to conceive with the help of ART alone.
• It is relatively inexpensive and is often covered by private insurance.
Pathology of female infertility in traditional Chinese medicine
As you can imagine, the pathology of female infertility in Traditional Chinese Medicine (TCM) can be very complex. The terms used in TCM, such as Kidney, Liver and Blood, have different meanings from those of Western medicine, and are capitalized here to show that the meaning isn’t the same. They are widely used for lack of better translations. If you’d like to learn more about TCM and infertility, refer to the three books recommended at the end of this article.
According to a study published in the Journal of Traditional Chinese Medicine, liver Qi (vital energy) Stagnation and Kidney Deficiencies account for 51.7% and 22.4% of female infertility patients. This conclusion is hardly surprising when you consider current lifestyles and the demography of manyfemale infertility patients. Liver Qi Stagnation is often associated with stress, a sedentary lifestyle, and a greasy diet. Kidney (whether Yin, Yang or Essence) Deficiency on the other hand is often the result of a very demanding lifestyle and the natural process of aging.
These percentages confirm my own clinical observation which is that younger infertility patients tend to have Liver Qi Stagnation and older (over 40) patients tend to have Kidney Deficiency. However, it’s important to understand that this finding is just one piece of the puzzle as almost all fertility patients show more than one pattern.
According to TCM theory, the liver plays a vital role in the reproductive system. Liver Qi moves the Blood and stagnation of Liver Qi is likely to cause Blood Stasis. In time, Blood Stasis may cause endometriosis, uterine fibroids and ovarian cysts, dysmenorrhoea, irregular menstruation and scanty menstruation, which are all known contributors to female infertility.
The kidney is the most important organ in the reproductive system, and any aspect of kidney deficiency, whether Yin, Yang or Essence Deficiency often leads to amenorrhea, anovulation, a small uterus, thin endometrium, low ova quality and premature ovarian failure.
Treatment of female infertility by traditional Chinese medicine
Like western medicine, the first step to successful treatment with TCM is proper diagnosis. Once the syndromes (the nature of illness) are diagnosed, the TCM practitioner has already formed an opinion on the pathogenic factors, pathogenesis, location, and prognosis.
In my practice, I pay more attention to the syndromes than the disease itself. This means that if I find the same disease in a number of patients and determine that they have different syndromes, I treat each case differently. For example, two female patients each have polycystic ovarian syndromes (PCOS), but one patient’s PCOS is caused by Spleen and Kidney Deficiency, and the other by Liver Qi Stagnation. In treating each of these patients, I would use very different acupuncture points and herbs.
When the diseases presented in different patients are different, but the syndromes are the same, I treat the patients similarly. For example, if I have three infertility patients, one with PCOS, another with endometriosis and a third with premature ovarian failure (POF), and I find that they are all caused by Kidney Deficiency, then I would use very similar acupuncture points and herbs to treat these three patients.
Depending on the diagnosed syndromes, the patient’s personal constitution and diagnosis from the fertility clinic, I then outline a treatment objective. To achieve the treatment objective, I often use a combination of acupuncture and Chinese herbal medicine. Sometimes, nutritional supplements and dietary regulation are also used.
Acupuncture treatment protocols to complement ART
The protocols for using acupuncture and herbal medicine to support fertility treatment are clearly explained in a book titled Acupuncture & IVF by Lifang Liang. Treatments complementary to IVF involve three phases: Pre-IVF, During IVF and Post-IVF.
In the Pre-IVF phase, weekly acupuncture is recommended for at least three months to alleviate the side effects of medical treatments, increase the response to hormonal stimulation and improve the reproductive organs and overall health.
In the 2nd phase, for the duration of the IVF treatment, weekly acupuncture plus pre & post transfer acupuncture is recommended. This will increase blood flow to the uterus and ovaries, reduce the stress response caused by IVF and calm the uterus to facilitate implantation.
In the Post-IVF phase, weekly acupuncture for up to three months is recommended for pregnant patients to reduce their risk of miscarriage and ectopic pregnancy. It is essential for patients with a history of miscarriage and ectopic pregnancy to receive treatment during this phase.
In my clinical practice, the above protocol can easily be modified to accommodate just about any ART procedure.
Success rates of acupuncture treatment
I have been asked numerous times about the success rate of acupuncture to treat female infertility. Unfortunately, I can’t offer a straight and definitive answer to this question. Presently, there aren’t many sizable, randomized and controlled clinical studies available to prove the efficacy of acupuncture in the treatment of female infertility. The absence of such studies is probably due to a lack of funding.
Currently, the majority of infertility patients come for acupuncture treatment after they have exhausted all other options, and these are often the most difficult cases to treat. Until there are randomized, controlled studies to make a fair comparison between the efficacy of acupuncture and various ART techniques, simply comparing success rates is not viable.
In addition, successful treatments also largely depend on the knowledge and experience of the individual practitioner. In Quebec, the minimum requirement is a three-year CEGEP degree, which isonly offered at Rosemont College, but Chinese herbal medicine is not part of the curriculum.
However, as the feedback from patients who have tried acupuncture is overwhelmingly positive, there is a growing number of patients seeking acupuncture treatment early in the fertility treatment process rather than making it a solution of last resort.
From May to June 2006, I am pleased to report that there were eighteen pregnancies in my clinic. Eleven of these patients used acupuncture and herbal medicine exclusively and were treated from a few weeks to over a year. The other seven patients received ART treatment, mostly IVF, in addition to acupuncture and herbal medicine. Although these numbers are not statistically significant, they do show that acupuncture treatment certainly does not lack for success in the treatment of female infertility.
Safety issues, myths and controversies
The safe practice of acupuncture and herbal medicine has been meticulously recorded over two millennia in China. Today, well-developed acupuncture treatment protocols used to complement modern ART have been tested in clinical studies to ensure their efficacy and safety.
Despite its impeccable safety record and growing popularity, many people still have difficulty understanding the power of these tiny needles in the hands of an acupuncturist, because it is:
• based on a completely unfamiliar paradigm and philosophy.
• currently unexplainable by modern science.
• built on the existence of meridians, which don’t actually correspond to any recognized body system, such as the blood, lymphatic or nerve systems.
• not intuitively believable. How can a few thin needles, placed randomly on the skin, produce significant physiological changes?
• a practice that’s only a few decades old in North America, although it has been practiced for over two thousand years in China.
• insufficiently supported by randomized, controlled studies.
Chinese herbal medicine is also safe and even more versatile and potent than acupuncture. It is much less known and therefore much less used, even by many acupuncturists in North America.
Some patients and fertility doctors have unfounded fears of these herbs interfering with fertility procedures and drugs. If used expertly in conjunction with acupuncture, they are truly a powerful tool in the treatment of female infertility. Personally, I have been using herbal powders in my clinic since 1995 and have never found any adverse reactions.
Three case studies
To illustrate the healing potential of acupuncture and Chinese herbal medicine, here are the histories of three recent patients of mine.
Conclusion
In recent years, acupuncture has been gaining support from patients and some fertility specialists. Many fertility clinics have started recommending acupuncture to their patients, and some US clinics now have acupuncturists on staff.
Finding an experienced acupuncturist and faithfully following the requirements - whether it’s drinking bitter herbal teas, changing your lifestyle or receiving regular acupuncture treatments - are the keys to successful fertility treatment.
About the author
Aina Zhang, L. Ac. (Quebec), MD & Master’s Degree in Gynaecology (China), owns and operates Clinique SinoCare located in Montreal. In recent years, she has devoted most of her practice to the treatment of infertility. Her professionalism and expertise have earned her respect of numerous patients and fertility specialists in Montreal. She can be reached at 514-483-6669,ainazhang@sinocare.ca or at www.sinocare.ca .
Recommended reading
• The Infertility Cure: The Ancient Chinese Wellness Program for Getting Pregnant and Having Healthy Babies by Randine Lewis. Little, Brown and Company, 2004.
• Fulfilling The Essence: the Handbook of Traditional & Contemporary Chinese Treatments for Female Infertility by Bob Flaws. Blue Poppy Press, 1999.
• Acupuncture & IVF by Lifang Liang. Blue Poppy Press, 2003.
Footnotes
please go to www.sinocare.ca for a comprehensive list of relevant studies and articles
W. E. Paulus and M. Zhang, et al., “Influence of acupuncture on the pregnancy rate in patients who undergo ART,” Fertility and Sterility, vol. 77, no. 4 (Apr. 2002).
R. Chang, et al., “Role of acupuncture in the treatment of female infertility,” Fertility and Sterility, vol. 78, no. 6 (Dec. 2002).
X. Min, et al., “Kidney-reinforcing herbal therapy increases pregnancy rate in older infertility women,” Journal of Guangzhou University of Traditional Chinese Medicine(July 2004).
P. Magarelli, “Acupuncture in IVF linked to lower miscarriage and ectopic rates,” Ob/Gyn News (Jan. 2005).
Journal of Traditional Chinese Medicine, vol. 46, no. 3, March 2005, p. 216
Acupuncture & IVF by Lifang Liang. Blue Poppy Press, 2003
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