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Acupuncture, one of the oldest and most commonly used medical procedures in the world, is designed to encourage the body to promote natural healing and improve functioning. Acupuncture originated in China more than 2000 years ago but gained prominence in the US when New York Times reporter James Reston described how Chinese doctors used needles to manage his post-operative pain. Medical acupuncture in the US incorporates traditions from China as well as Japan, Korea and other countries. The technique has become an increasingly popular form of complimentary / alternative medicine and is practiced by physicians, dentists and many other practitioners for a myriad of conditions. In a survey published in 2002 by the CDC an estimated 8.2 million Americans have used acupuncture and relatively few complications have been reported to the FDA.

As one of the key components of Traditional Chinese Medicine (TCM), acupuncture aims to keep the body in a balanced state. In Chinese texts the models of health, disease, and treatment are presented in terms of patients' harmony or disharmony within the larger order of nature, and involve their responses to external extremes of wind, heat, damp, dryness, and cold, as well as to internal extremes of anger, excitement, worry, sadness, and fear. TCM sees the body as a delicate balance of two opposing and inseparable forces: yin and yang. Yin represents the cold, slow or passive principle and yang the hot, excited or active principle. An internal imbalance of yin and yang (disease) leads to blockages in the flow of Qi, (pronounced “chee”), vital energy that flows along pathways or meridians.

Available at: http://consensus.nih.gov/1997/1997Acupuncture107html.htm

The body is comprised of 12 main meridians, 8 secondary meridians and more than 2,000 acupuncture points that connect with them. The principal energy pathways are named for organs whose realms of influence are expanded from their conventional biomedical physiology to include functional, energetic, and metaphorical qualities (eg, Kidney supervises bones, marrow, joints, hearing, head hair, will, and motivation; Spleen oversees digestion, blood production, blood-related functions such as menstruation, and nurturing and introspection).

According to the NIH the most scientifically studied technique involves piercing the skin with hair-thin, solid, metallic needles manipulated either by hand or by electrical stimulation. Most patients feel no or minimal pain as the needles are being inserted when done by a qualified practitioner. Since the 1970s, guidelines for education, practice, and regulation in acupuncture have been established and implemented.

The use of acupuncture as an adjunct treatment for infertility has also gained popularity in the last decade although its role is the subject of much discussion. It is hypothesized that acupuncture influences central stimulation of ß-endorphin secretion which impacts gonadotropin and steroid secretion as well as increasing blood flow to the uterus and ovaries and improving implantation.
The difficulty studying the effects of acupuncture involves the use of placebos. In pharmaceutical studies placebos are used in place of the medication being studied however, choosing a placebo in acupuncture research according to one critic is more difficult. Since 2001 retractable needles are available as placebo controls so the patient is unaware of whether or not they are receiving true treatment or sham acupuncture.

The first randomized, controlled, prospective trial of acupuncture for IVF was published by Paulus et al in 2002. In this study 80 women who received acupuncture 25 minutes before and after embryo transfer had a significantly higher pregnancy rate than 80 women who had no treatment. Critics of this study argued that there was no control for the placebo effect (that is, results were the due to psychological or psychosomatic causes) and when the same group presented a placebo-controlled study one year later no statistical difference was noted. Magarelli et al published two studies 2004 comparing pregnancy rates in poor and normal responders to IVF. In both they reported higher pregnancy rates in the patients who received acupuncture compared to those who did not and additionally reported lower miscarriage rates in the normal responders who received acupuncture compared to the control group.

In May 2006, Fertility and Sterility published three studies on the use of acupuncture in IVF. The Danish study compared pregnancy rates in a control group (87 patients) who had no treatment, another group (95 patients) who received acupuncture on the day of embryo transfer and a third group (91 patients) who received acupuncture on the day of embryo transfer and again 2 days later. They found a significant improvement in the outcomes for patients who received treatment compared to the control group but no advantage to receiving treatment twice. The second study by Dieterle et al compared 116 patients who received acupuncture treatment twice, 30 minutes after embryo transfer and again 3 days later to 109 patients who received placebo acupuncture and also found significant improvements in the pregnancy rates in the patients who received treatment. Finally, an Australian study compared the pregnancy rates of 110 women who received treatment to 118 who received placebo acupuncture and found no significant differences. An interesting observation was noted when subjects were asked about side effects of treatment. The most commonly reported side effects in order were relaxation, feeling calm and peaceful and feeling energized however, relaxation was more likely to be reported by those in the control group.

In conclusion, more research is needed using standardized methods and placebo needles to enhance the comparability of the results between studies on the use of acupuncture as an adjunct to infertility treatment. Infertility causes stress and at a minimum acupuncture can reduce stress and anxiety however whether or not it significantly improves pregnancy outcome will be debated until there is sufficient data to support the claims. Your health care provider is the best source of information on the risks or benefits of any therapy and can refer you to a qualified practitioner if acupuncture is recommended.

References:
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