Journal of the Association of Chartered Physiotherapists in Women’s Health, Autumn 2008, 103, 29–38

CLINICAL PAPER

The use of acupuncture with in vitro fertilization: is

there a point?
J. Longbottom
Private Practice, St Neots, Cambridgeshire, UK

Abstract
This paper presents a Western biomedical model of acupuncture and a traditional
Chinese medical (TCM) approach to the use of this technique within in vitro
fertilization (IVF) in one private practice. The author demonstrates the underlying
mechanisms of introducing an acupuncture protocol as a means of preparing
women for IVF, both physically and emotionally, by enhancing optimum
endometrium conditions, increasing uterine blood flow, and supporting the
embryo pre- and post-IVF intervention. Acupuncture can also support men in
terms of enhancing the quality, motility and viability of sperm, and providing
emotional support throughout the process.

Keywords: acupuncture, fertility, infertility, in vitro fertilization.

Introduction Infertility is not confined to the female, but

Infertility can be defined as the inability to regardless of whether it manifests in either or
conceive following one year of unprotected inter- both partners, it is associated with significant
course. This condition affects nearly 15% of all mental trauma, and imposes serious financial
couples who are trying to have a baby: Evers constraints on those undergoing assessment
(2002) reported that approximately one in every and treatment. This process is stressful, can be
six couples have trouble with conception. costly and imposes a physical strain upon the
Although the following list is by no means reproductive system, especially in the female.
exhaustive, the causes of infertility may be Reported statistics vary, but it would seem that
broadly categorized into eight major groups around 30% of men are sub-fertile and at least
(Strauss & Barbieri 2004): 2% are totally infertile; furthermore, there is
much scientific debate concerning the evidence
(1) abnormalities in oocyte production;
that male fertility is decreasing markedly as a
(2) anatomical abnormalities leading to the
result of modern lifestyles. It has been estimated
obstruction of sperm transportation, or the
that about 9% of the UK’s 28.5 million men
passage of the oocyte and/or embryo
might have difficulty impregnating their partners
through the reproductive tract (i.e. tubal,
(Cigno & Rosati 1996).
uterine, cervical and peritoneal factors);
In vitro fertilization (IVF) is the most success-
(3) abnormalities in the implantation process,
ful of the various forms of infertility treatment,
including early defects in embryo develop-
and for many, it may be the last hope of becom-
ment, embryo abnormalities and borderline
ing pregnant. Practitioners are advised to offer
hormonal imbalances;
no expectations of success because the failure
(4) unexplained infertility;
rates of IVF are high and patients bring enor-
(5) egg age;
mous expectations to the treatment. Some 35 261
(6) body weight, smoking, alcohol and caffeine
IVF cycles were performed in the UK in 2006,
intake;
but on average, the success rate of IVF per single
(7) emotional factors; and
initiated cycle (using a fresh, non-donor oocyte)
(8) immunological factors.
is only 33% (CDCP 2003) and the majority of
Correspondence: Jennie Longbottom, Parks Therapy Centre,
86 Cambridge Street, St Neots, Cambridgeshire PE19 1PJ, IVF cycles do not result in pregnancy (Rosenthal
UK (e-mail: [email protected]). & Anderson 2007). Because of the high financial
 2008 Association of Chartered Physiotherapists in Women’s Health 29
J. Longbottom

and emotional cost of this procedure, many were significantly higher in the acupuncture
couples have turned to complementary and group (P<0.01). The acupuncture group main-
alternative medicine, and there is now a prolifer- tained serum levels of progesterone and pro-
ation of patient self-referrals for acupuncture as lactin, as well as the protein and messenger
well a world-wide increase in the number of ribonucleic acid expression levels of progester-
acupuncture clinics offering this therapy as one receptors and prolactin receptors (P<0.05),
an adjunct to IVF procedures (Rosenthal & suggesting that acupuncture may help to sustain
Anderson 2007). Within the present author’s progesterone levels regardless of hormonally
own practice, self-referrals have doubled in the adverse environmental factors, such as high
past 12 months. doses of oestrogen in water supplies (Warhurst
Acupuncture has been used extensively in 1995).
China to regulate the female reproductive system Margarelli & Cridennda (2004a) investigated
via the stimulation of qi and blood, and by prolactin and cortisol levels in patients receiving
regulating homeostasis (Maciocia 1997). Within acupuncture during an IVF cycle. Both prolactin
the Western model of acupuncture, the potential and cortisol levels increased; elevated hydro-
mechanisms of needling may mediate the release cortisone levels in follicular fluid have been
of neurotransmitters that can in turn stimulate shown to improve pregnancy rates. In a previous
secretion of gonadotropin-releasing hormone study, the above authors found a statistically
(GnRH), and therefore, assist ovulation, blood significant (42%) increase in ongoing preg-
flow and fertility (Mayer et al. 1977; Anderson nancies, as well as a statistically significant
et al. 2007). Several studies have examined the reduction in the number of miscarriages and
mechanisms of action. Richer & Ford (2001) ectopic pregnancies (Margarelli et al. 2004b).
demonstrated that endometrial thickness may be All the above studies reinforce the idea that
one factor in pregnancy outcomes. Yu et al. correct point selection according to the infertility
(2007) studied the effect of acupuncture on pattern diagnosis, correct timing and admin-
uterine lining when combined with sildenafil istration of acupuncture, and obtaining a sub-
(Viagra). Although this was only a pilot study, stantial de qi response consistently improve
all four subjects achieved an increase in endo- pregnancy outcomes. Because of the potential
metrial lining from <8 mm to >10 mm following for negative effects as a result of improper acu-
acupuncture and sildenafil, including one patient puncture administration, it is prudent to utilize
who had not responded to sildenafil alone. The acupuncturists who have demonstrated compe-
above authors hypothesized that effects on the tency and knowledge in reproductive medicine;
endometrium could be stimulated by a resulting indeed, the normal standards in the USA dictate
increase in the supply of nitric oxide synthase, that all acupuncture practitioners undertake
which contributes to transmission from one the American Society of Oriental Reproductive
neuron to another, to the immune system and to Medicine Board examinations.
dilating blood vessels. The IVF and acupuncture procedure involves
Liu et al. (2007a) investigated the effect of several phases, all of which require careful co-
acupuncture on implantation by studying at ordination, experience, and above all, working
three groups of rats: a control group; rats treated at all times with the IVF team. Those without
only with mifepristone, which is used as an knowledge of fertility, infertility and the physio-
abortifacient in the first 2 months of pregnancy; logical processes of acupuncture, or those with-
and a group treated with both mifepristone and out adequate liaison with fertility carers and the
acupuncture. The rats that received mifepristone team members should not consider it.
plus acupuncture had the same implantation The present paper is intended to introduce
rates as normal rats. The mifepristone-only physiotherapists to the use of acupuncture
group had significantly less pregnancies within the management of IVF. It is not meant
(P<0.01), providing further evidence of the abil- to offer a prescription for intervention, or
ity of acupuncture to reverse certain chemotoxic encouragement for physiotherapists to use this
agents that may be contributing to infertility technique without adequate training, knowledge
(Horn 2007). and insurance. This paper is presented in order
Liu et al. (2007b) followed the above study to demonstrate the present author’s experience
with another in which they measured a number of clinical practice, in which she uses a combined
of serum parameters; namely, pregnancy rates approach to acupuncture within IVF. The views
and the average number of blastocysts, which and protocols used in this example are not
30  2008 Association of Chartered Physiotherapists in Women’s Health
 Acupuncture and in vitro fertilization

definitive, and no attempt has been made to a reduction in egg quality and quantity; poor
critically appraise all research cited, present the endocrine readings, caused by high levels of
methodology for each infertility protocol or give follicle-stimulating hormone; reduced blood flow
preference to one protocol over another. and cervical mucous secretions; and low oestro-
gen levels and less-frequent monthly ovulations
(Jansen 2003).
The phases of in vitro fertilization
The IVF process involves several phases that
must be carefully coordinated and precisely Western evidence for clinical reasoning
timed. The phases involve several protocols, Neurophysiological research has provided evi-
which may include the use of oral contracep- dence that acupuncture treatment regulates
tives, GnRH agonists and uterine blood flow neurotransmitters and increases the secretion of
impedance measurements. These protocols vary GnRH, as well as increasing blood flow by
and are constantly being refined by collabora- inhibiting uterine central sympathetic nerve
tions between women, clinics and physicians activity (Stener-Victorin et al. 1996), and stimu-
(Rosenthal & Anderson 2007). The debate con- lating the production of endogenous opioids by
cerning acupuncture point selection varies inhibiting the central nervous system outflow
according to experience, training and TCM pat- and biological stress responses (Cho et al. 1998).
tern diagnosis. What is intriguing is that, unlike most other
The main phases are outlined for guidance disease processes within gynaecology, where
only; constant liaison with the consultant and either inflammation or degeneration are the
the IVF team is essential for an integrated major presentations, we are now faced with
approach. changes within the patient’s normal bodily hor-
monal balances, which calls for a greater degree
of clinical reasoning within our acupuncture
Phase I: Hormonal down-regulation approach. Within Western evidence-based medi-
Most commonly, an oral contraceptive is used, cine, we rely on the function of the hypothala-
followed by GnRH (Lupron) to inhibit ovula- mus, anterior pituitary and ovaries in the
tion. In theory, the ovaries are rested in prep- production of oestrogen and progesterone to
aration for maximum stimulation. effect endometrial changes. Within TCM philos-
ophy, the yin and yang phases of the normal
menstrual cycle have a profound effect on point
Acupuncture intervention
selection and pattern identification, and should
Within the present author’s practice, acupunc-
not be ignored.
ture is not only offered pre- and post-embryo
transfer (ET), but also for the preparation of the
female and, if necessary, the male. The latter is Traditional Chinese medicine clinical
regarded as essential before IVF dates are agreed reasoning
with the multidisciplinary team. The diagnoses Within TCM, the diagnosis relies on the balance
of infertility are extensive; the following list between blood and qi in the uterine cavity, the
details common presentations at the present supply of Kidney (KI) qi to the uterus itself,
author’s practice: and the smooth action of blood in Spleen
(SP) and Liver (LV) meridians supplying the
+ anovulation;
fallopian tubes, ovaries and endometrium. Bal-
+ a small uterus;
ance, harmony and homeostasis are required to
+ poor follicle development;
offer the best possible opportunity for IVF and
+ poor egg quality;
successful implantation. Therefore, treatment
+ poor blood flow within the uterus and
will be directed towards improving qi and
endometrium; and
blood flow to the relevant meridians [i.e.
+ the ageing female.
Stomach (ST), LV, KI and SP] via He-sea
Advancing female age is an important factor points. These points have a particular action on
in low pregnancy outcomes (Gindoff 2008). meridians by means of increasing the flow of qi
Problems affecting women attempting pregnancy and blood to their named meridian, rather like
at the age of 40 years and above include: a the opening of a lock gate. The present author is
decrease in fertility rates of approximately 50%; presently engaged in research using Doppler
a two- to threefold increased risk of miscarriage; ultrasound to investigate the action of He-sea
 2008 Association of Chartered Physiotherapists in Women’s Health 31
J. Longbottom
Table 1. He-sea acupuncture points to supply the pelvis: (L) lumbar segment; and (S) sacral segment

Meridian Point and nerve supply Action

Stomach (ST) ST36 Nourishes pelvic blood and qi

L4, L5

Spleen (SP) SP9 Lower abdominal stagnation of qi;

S1, S2, S3 leucorrhoea

Liver (LV) LV8 Increases pelvic and genital blood and qi;
L5, S1, S2 nourishes the smooth action of blood

Kidney (KI) KI10 Benefits kidney organ qi

S1, S2

points on blood flow to the pelvic viscera (Table

1). The ST, SP, LV and KI meridians all flow
through the pelvic basin, and are essential to the
stimulation of qi and blood flow to the pelvis
(Fig. 1).
Associated points are used to calm the patient,
help sleep and nourish the meridians that supply
the pelvis in an effort to restore homeostasis,
reduce stress and facilitate ease of implanta-
tion during this phase (Table 2). Patients are
treated twice a week until their stress levels are
more manageable and relaxation techniques
are being practised regularly with good effect.
The use of hypnotherapy and cognitive behav-
ioural therapy referrals is recommended if acu-
puncture intervention is not offering sufficient
stress reduction.
Patients are encouraged to acupressure the
He-sea points and stimulate blood flow via the
Figure 1. Pelvic meridians. femoral artery with gentle arterial massage.
Table 2. Suggested ‘calming’ acupuncture points to aid relaxation and sleep: (L) lumbar segment; and (S) sacral segment
Meridian Point and nerve supply Action

Large Intestine (LI) LI4 Nourishes liver

Liver (LV) LV3 Blood;

‘Four gates’ for regulates the pelvis;
neurohumeral effects nourishes the uterus;
calms the patient

Extra points Yintang Calms the mind;

Stimulation of melatonin induces sleep;
for sleep and cicadium reduces agitation and restlessness
rhythm

Spleen (SP) SP6 Activates the Kidney, Spleen and Liver channels;
S1, S2 calms the spirit
SP12
L1, L2, L3

Conception Vessel (CV) CV4 Used with heat to invigorate circulation, qi and blood to the uterus
L1
CV6
L1

32  2008 Association of Chartered Physiotherapists in Women’s Health

 Acupuncture and in vitro fertilization
Table 3. Normal values for semen analysis (Clavey 2003)

Value
Factor Good Poor

Sperm count (/cc) 20–100 000 000 <20 000 000

Motility Grade III and IV More than 40% abnormal
Morphology Morphology More than 40% abnormal
Liquefaction Easily poured Poor viscosity (remains gelled)
Volume (cc) 2–5 <2

Table 4. Suggested acupuncture points for blood and qi stimulation of sperm production: (L) lumbar
segment
Meridian Point Action

Bladder (BL) BL23 Stimulation of kidney qi;

stimulation of sperm production

Conception Vessel (CV) CV4 Segmental innovation at L1

Liver (LV) LV8 He-sea points stimulating liver, qi and blood

Spleen (SP) SP6 He-sea points stimulating spleen, qi and blood

Stomach (ST) ST36 He-sea points stimulating stomach qi and blood

The male factor Recent research has shown that Viagra trig-
Acupuncture and TCM offer a large propor- gers and accelerates the acrosome reaction in
tion of infertile men not only hope, but a sperm, stimulating the premature release of
clear improvement in sperm count, motility, ‘egg-penetrating’ enzymes – which are produced
morphology and liquefaction (Clavey 2003) in order to break down the outer layer of the
(Table 3). egg – and therefore, preventing adequate egg
Male infertility has been identified as a prob- penetration on arrival. This poses a problem
lem for over 50% of childless couples in the UK. when Viagra is used in fertility clinics (over half
Although the causes are too numerous to discuss of UK fertility clinics use Viagra to promote
within the scope of the present paper, the more semen production; New Scientist 2008).
common presentations within the author’s prac-
tice are: Hormonal down-regulation
+ sperm production deficiency; Once hormonal down-regulation is about to
+ blocking of the epididymis, vas deferens or begin, the treatment strategy must be tailored to
ejaculatory duct; the goals of the IVF team and the medications
+ sperm antibodies; that are prescribed. During this period, the
+ injury; ovaries are allowed to rest and Lupron is used to
+ hormonal imbalance; prevent ovulation; this may cause a deficiency of
+ poor testicular descent; and qi and some pain in the pelvis. Table 5 lists the
+ varicocele. points that Liang (2003) suggested should be
used to treat patients experiencing side effects
The appropriate treatment and selection of from down-regulation.
points will depend upon accurate diagnosis of
the presenting condition. For a general tonifica-
tion of blood and qi, the points listed in Table 4 Phase II: Ovulation induction
are recommended before sperm storage. Treat- Gonadotropin-releasing hormone drugs are used
ment is offered daily as soon as the female to stimulate multiple follicles depending on age
embarks upon the IVF regime. Once again, and ovarian function. Oestrogen and luteinizing
sperm specimen results are necessary to deter- hormone levels are measured, follicular develop-
mine appropriate point selection. ment is tracked by ultrasound and dosages
 2008 Association of Chartered Physiotherapists in Women’s Health 33
J. Longbottom
Table 5. Suggested acupuncture points for down-regulation patient provides the following results at each
side effects (Liang 2003) attendance in order to determine whether further
Meridian Point acupuncture treatment is desired or the protocol
changed:
Stomach (ST) ST36
Spleen (SP) SP6, SP10
(1) Endometrial thickness scans. These scans
Liver (LV) and Large Intestine (LI) LV3, LI4 determine whether further acupuncture is
Extra points Yingtang, Zigonxue required to move qi and blood. The
endometrium should be at least 7–8 mm
thick for implantation of the egg and is an
adjusted accordingly, and just before ovulation indicator of progesterone levels. Acupunc-
occurs, human chorionic gonadotrophin (hCG) ture point Tituo is identified as a strong qi
is injected 33–35 h before oocyte retrieval to movement point should the endometrial
ensure follicle maturation. development be slow.
(2) Follicle growth and number. If follicle
Acupuncture intervention growth is poor, then using the Zigong and
While hCG stimulates multiple follicle produc- Ear Ovary points may be beneficial should
tion, acupuncture can support blood flow in the endometrial thickness be slow to develop.
pelvis and improve response to medication (3) Oestrodial levels. If readings are above
(Rosenthal & Anderson 2007). The points men- 5000 pg/ml early in the cycle, daily acupunc-
tioned in Table 4 may be used again, but often ture is required to lower this level of oestro-
with the addition of Lung 7 and KI6 to open dial. Points such as ST40, LV2 and LV3, and
the Extra Vessel or Chong Mai, and SP4 and KI2 and KI3 are used (Carman 2007) for 3
Pericardium 6 to open the Extra meridian or days with constant monitoring.
Penetrating Vessel (Liang 2003). This treatment
often requires three to four sessions, twice a
Phase III: Pre-embryo transfer
week, before oocyte retrieval.
The suggested treatment interval for acupunc-
Ovarian hyperstimulation syndrome (OHSS)
ture prior to ET is 30–40 min (Stener-Victorin &
is a potentially serious side effect at this stage.
Humaidan 2006), and thus, practitioners and
Mild OHSS may result in ovarian enlargement,
patients are required to offer flexibility in ap-
and abdominal pain, nausea and vomiting; the
pointments and treatment availability (Table 6).
latter symptoms may be alleviated by acupunc-
ture. Severe OHSS requires immediate attention
and/or surgical intervention. The first clinical Phase IV: Oocyte retrieval
signs of OHSS are dry mouth with copious Retrieval is performed under local anaesthetic
thirst, and therefore, it is essential that the and the oocytes are transferred for laboratory

Table 6. Pre-embryo transfer points (Paulus et al. 2003)

Meridian Point Action

Conception Vessel (CV) CV6 Tonification of kidney;

regulates blood

Spleen (SP) SP8 Regulates blood flow

Liver (LV) LV3 Regulates pelvis;

nourishes uterus;
calms the patient

Governor Vessel (GV) GV20 Improves uterine qi and lifts the spirit

Stomach (ST) ST29 Stimulates flow of blood to uterus

Auricular points* Shen Men (55) —

Zhigong (58) —
Neifenmi (22) —
Naodian (34) —

*Right ear.

34  2008 Association of Chartered Physiotherapists in Women’s Health

 Acupuncture and in vitro fertilization
Table 7. Acupuncture protocol 2 days after embryo transfer (Paulus et al. 2003)

Meridian Point Action

Governor Vessel (GV) GV20 Tonification of kidney;

regulates blood

Conception Vessel (CV) CV3 Regulates blood flow

Stomach (ST) ST29 Regulates pelvis;

ST36 nourishes uterus

Spleen (SP) SP9 —

SP10

storage. Women often experience discomfort older women as younger ones when CHM was
similar to deep menstrual pain during oocyte used, especially in the maturity of dominant
retrieval; this is caused by the needle passing follicles, which increases the chances of contain-
through the vagina and the aspiration of ing a mature egg and producing a viable embryo.
oocytes. Electro-acupuncture (EA) has been Chinese herbal medicine can be used to maintain
used to induce fast-acting opiate stimulation for corpus luteum function by increasing the size
analgesia, and studies have reported that EA can and vascularity of oocytes. This is important in
bring about reductions in both pain and side preventing miscarriage in the first 10–12 weeks
effects at this stage (Stener-Victorin et al. 1996). of pregnancy, when all progesterone comes from
the ovaries and corpus luteum; the placenta only
Laboratory culture fully takes over this function at 3 months (Heese
Oocytes are graded for maturity and cultured for 2006).
3–6 h before exposure to sperm. Sperm are
graded and incubated overnight, and checked
for signs of fertilization. The embryos are Phase VI: Post-embryo transfer
allowed to grow to the six- to eight-cell stage of Patients are required to rest in the lying position
development (i.e. 3 days) before implantation. whilst acupuncture is applied post-ET in the
present author’s own practice. This protocol was
Phase V: Embryo transfer cited by Paulus et al. (2003), who studied 160
Embryos are once again graded and implanted patients who received either acupuncture 25 min
into the uterus (Table 7). before and after ET (n=80), or a standard
regime of only bed rest 25 min after ET (n=80).
Luteal phase monitoring Traditional and auricular acupuncture points
Progesterone is given to support the endo- were used in the treatment group (Table 8). The
metrium and a pregnancy test is conducted 14 clinical pregnancy rate of 42.5% in the acupunc-
days after implantation. If the pregnancy test is ture group versus 26.3% in the control group was
positive, it is advisable to reduce the intensity of significantly in favour of the former (P=0.03).
de qi stimulation and avoid such points as SP6 Paulus et al. (2003) further recommended a third
and Large Intestine (LI) 4. These are considered arm to future trials involving placebo needles
cautionary points (AACP 2007), although there to rule out the possibility of psychological or
is no clinical or scientific evidence to support this psychosomatic effects in the acupuncture group.
view (Roemer 2005). Indeed, a number of these The above study has since provided the
points have been used in IVF trials without impetus for further studies (Smith et al. 2006;
obvious adverse effects or changes in live birth Westergaard et al. 2006; Dieterle et al. 2008)
weight, but please note the discussion of these and a systematic review (Manheimer et al. 2008).
results below (Westergaard et al. 2006). The latter authors concluded that acupuncture
Immediately after conception and for the next given with ET improves rates of pregnancy
12–14 weeks, acupuncture may be used to sup- among women undergoing IVF, and included
port and improve corpus luteum function, outcome data on live births that was not avail-
although Chinese herbal medicine (CHM) may able at the time of the study by Paulus et al.
be more effective. Wing & Sedlmeier (2006) (2003). Although the current estimates of the
noted that fertility markers improved as much in effects of adjuvant acupuncture on IVF are both
 2008 Association of Chartered Physiotherapists in Women’s Health 35
J. Longbottom
Table 8. Post-embryo transfer points (Paulus et al. 2003)

Meridian Point Action

Stomach (ST) ST36 Tonification of kidney;

regulates blood

Spleen (SP) SP6 Regulates blood flow

SP10

Large Intestine (LI) LI4 Regulates pelvis;

nourishes uterus;
calms the patient

Auricular points* Shen Men (55) Calming point

Zhigong (58) Uterus point
Neifenmi (22) Endocrine point
Naodian (34) Brain point

*Left ear.

significant and clinically relevant, these remain native medicine rely on anecdotes, from which
somewhat preliminary (Manheimer et al. 2008). peer reviewed case reports can be derived for
publication. These are essential and should be
encouraged as a first step to robust research
Discussion (Longbottom 2007).
A number of studies have investigated the poten- In all the trials cited above, the acupuncture
tial of acupuncture to improve the outcome of protocol and selection of points were designed
IVF (Vayena et al. 2002; Paulus et al. 2003; for the sole purpose of improving pregnancy
Dieterle et al. 2006; Johnson 2006; Smith et al. rates, and the point selection appears to have
2006; Stener-Victorin & Humaidan 2006; been based upon the first published trial (Paulus
Westergaard et al. 2006), but these have only et al. 2003). Few studies have investigated the
emphasized the use of acupuncture pre- and prolonged effect of acupuncture on both male
post-ET. The relevant protocols are not analysed and female blood flow and stress management
in the present paper because these are outside its procedures pre-IVF, or the influence of He-sea
scope, and the reasons for variations in point points on pelvic blood flow, which could be
choice and clinical reasoning are complex. Each applied as acupressure or transcutaneous electri-
of the researchers mentioned above examined a cal nerve stimulation (TENS) by patients who
particular field of interest to determine the effects had been instructed in these techniques.
of acupuncture intervention; for example, If acupuncture does work by modulating the
Stener-Victorin & Humaidan (2006) investigated balance of endogenous opioids, then burst-
whether repeated acupuncture treatments given frequency TENS (2–4 Hz) applied by the patient
over a period of 4 weeks exerted a general to the given points could safely, cheaply and
inhibiting effect on uterine sympathetic tone, easily be offered, and is worth investigating
thereby reducing high blood flow impedance in further.
uterine arteries, and increasing uterine blood The majority of acupuncture protocols
flow and hypothetical endometrial receptability. employed in studies to date do not reflect clinical
Despite this, acupuncture is still considered to practice. The dosages employed in many trials
be suspect in many circles (Domar 2006; Myers were low (i.e. between one and nine sessions).
2006) and there have been claims that higher In clinical practice, acupuncture treatments
pregnancy rates in acupuncture groups may be a occur over periods of weeks and even months
result of placebo effects. Stener-Victorin & (Anderson et al. 2007). Traditional Chinese
Humaidan (2006) suggested that, when debating medicine diagnosis was only discussed in one
this and discussing how alternative treatments trial (Smith et al. 2006), and no protocols were
have been scientifically tested, ‘one should real- tailored to deal with deficiencies or imbalances
ize that many treatments in conventional medi- (Maciocia 1997). It appears that a similar proto-
cine also lack rigorous testing, a failing that the col was used in most trials cited in the present
scientific community generally acknowledges paper, and this is somewhat contrary to the
must be remedied’. Both conventional and alter- clinical reasoning model taught in TCM and
36  2008 Association of Chartered Physiotherapists in Women’s Health
 Acupuncture and in vitro fertilization

acupuncture within physiotherapy. A fixed pro- nerves (Lee et al. 2004) and LI4 is considered to
tocol produces a fixed protocol bias, reducing cause cervical dilation (Ying 1985); therefore,
the likelihood that the treatment will be appro- care, knowledge and clinical judgement must be
priate and effective for all subjects. employed whenever acupuncture is used to assist
The IVF process is highly stressful, not only fertility and pregnancy.
because of drug interaction and the financial
implications of the treatment, but also because it
may involve serious adverse effects in the form of References
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Paulus W., Zhang M., Strehler E., Seybold B. & Sterzik K. S23.
(2003) Placebo-controlled trial of acupuncture effects in
assisted reproduction therapy. Paper presented at the Jennie Longbottom is chair of the Acupuncture
19th Annual Meeting of the European Society for Association of Chartered Physiotherapists, a
Human Reproduction and Embryology, Madrid, 30 June member of the British Acupuncture Council and
2003.
runs a private practice. She lectures at under-
Richer S. C. & Ford W. C. L. (2001) A critical investigation
of NADPH oxidase activity in human spermatozoa.
graduate, postgraduate and MSc level. Her
Molecular Human Reproduction 7 (3), 237–244. special interest is chronic pain, with a particular
Roemer A. T. (2005) Medical Acupuncture in Pregnancy: A emphasis on chronic pelvic pain and complex pain
Textbook. Thieme Publishing, Stuttgart. syndromes.

38  2008 Association of Chartered Physiotherapists in Women’s Health