Acupuncture and Fertility - A Research Overview

Acupuncture, in the last few decades, has become the focus of extensive scientific research and innumerable clinical trials with regards to its effects on improving fertility, both naturally and in conjunction with IVF. The majority of evidence demonstrates that acupuncture and Traditional Chinese Medicine (TCM) can significantly improve a couple's chances of conceiving as well as sustaining a healthy viable pregnancy to full term. But the million dollar question is – how?

Traditional explanations refer to acupuncture and Chinese medicine's ability to restore balance and improve vitality in the men and women seeking treatment. They emphasise that TCM is a holistic system of medicine that treats each person individually to address their unique health concerns, and that it is by nurturing their optimal state of health that conception can more easily occur.

As beautifully poetic as this sounds, most Western patients would like their explanation with a bit more 'science'. So, in the rest of this article, I will summarise some of the main areas of research regarding acupuncture and fertility, from a scientific perspective.

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Egg quality

One question that is of great concern, especially to women attempting to conceive later in their lives, is what can be done to improve the quality of their eggs. Unfortunately, neither Western medicine or Chinese medicine can do anything to increase the number of eggs in the ovary. However, TCM can influence a range of factors that affect the quality of the eggs that are there, when they are in their final stages of maturation, four months prior to ovulation. The final maturation stage just prior to ovulation is highly critical, as this is when most chromosomal errors occur, during a process called meiosis. Optimising the environment within which egg maturation takes place, with acupuncture as well as with diet and lifestyle changes, leads to higher fertilisation rates, more viable embryos, and a greater chance of successful implantation & healthy pregnancy (1).
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Just like every organ, tissue and cell in the body, the ovaries and follicles (which contain the eggs) require a good blood supply containing the right nutrients and the right hormone signals to function optimally. In older ovaries, the blood flow to the follicles is reduced at the later stages of their development, which can compromise their viability. Acupuncture has been shown to promote the growth of new blood vessels in the ovaries, as well as increase the flow of blood, and thus the delivery of optimal nutrition and oxygen to the developing eggs (2, 3). Research has shown that eggs released from follicles with optimal oxygen content and blood supply have greater fertilisation rates and development potential (4).

​Ovulation and Menstrual Health

A topic that receives considerably less attention in our culture, and even often in discussions about fertility, is that of menstrual health. Menstrual health is intimately related to female health and fertility, and is considered incredibly important from a TCM perspective. Symptoms such as short, long or irregular cycles; painful periods; excessive or scanty menstrual flow; and delayed ovulation, are all considered diagnostic signs that can inform the correct treatment for improved reproductive health and fertility.

A recent systematic overview of acupuncture and women's health found that acupuncture's effects are multimodal, incorporating endocrine, physiological and neurological pathways to initiate changes in the body, including changes to women's reproductive functioning. Data suggests that acupuncture may improve menstrual health, may be used to induce ovulation, and that women experiencing delays in becoming pregnant have greater capacity to cope (5). Women experiencing anovulatory cycles due to polycystic ovarian syndrome (PCOS) receiving acupuncture have been shown to have a higher ovulation frequency than the control group in a randomised clinical trial (6).

Stress 

We all know that too much stress isn't good for us – but did you know that stress can directly impact your fertility? Stress activates our “fight, flight or freeze” state, a once adaptive biochemical response to life-threatening stressors, that in our modern day age of continual low grade stress has become maladaptive. When our body is in this state, fertility is naturally compromised, as our energy is directed away from reproductive capacities in preference of energy for potentially life-saving activities. ​

​Two recent studies looking at the specific connection between stress and fertility took measurements of participants salivary stress biomarkers (e.g. salivary cortisol) and how long it took them to become pregnant. They concluded that stress significantly reduced the likelihood of conception during each fertile window, meaning that the women who were more stressed took longer to fall pregnant (7,8).

However, acupuncture has been extensively researched in the field of stress reduction and consistently demonstrates that it can significantly reduce stress levels, including the stress levels of patients seeking treatment for fertility. A recent comprehensive review from Australia indicates that acupuncture can help to reduce the stress and anxiety experienced by patients undertaking IVF, which may result in better outcomes (9). Another study looking at auricular acupressure concluded that the treatment during an IVF cycle led to a higher pregnancy rate as well as reduced rates of stress and anxiety (10).   ​

​Male Infertility

Of course, it is not only women who require and seek a holistic approach to improving their fertility. Male infertility is the most common reason for couples attending an IVF clinic – so if your (or your partner's) semen analysis is less than perfect, you are not alone. There are many things that men can do to improve their semen parameters, including diet and lifestyle changes (some that may surprise you!), as well as acupuncture and Chinese herbal medicine.

Research has shown that acupuncture can improve sperm quality by significantly improving sperm count, motility, morphology and vitality (11, 12, 13). Various mechanisms have been investigated, including the improvement of blood flow to the testes as well as an increase in important semen enzymes. A systematic review concluded that “acupuncture is distinctively efficacious in improving sperm quality” (14). And as discussed above, acupuncture is also excellent at reducing stress, which can greatly benefit the overall health and wellbeing of any man looking to improving his fertility.

​What about Chinese herbs?

A recent meta-analysis of 40 randomised controlled trials (RCT's) involving over 4000 women suggested that treatment of infertility with Chinese herbal medicine can improve pregnancy rates 2-fold over a 3-6 month period, compared to treatment with Western fertility drugs. Chinese herbal medicine was also seen to improve factors like ovulation rates, endometrial thickening, cervical mucus scores and BBT charts, thus increasing the likelihood of a healthy, viable pregnancy (15).

Not only do Chinese herbs improve many aspects of physiologic reproductive functioning, and result in twice as many pregnancies as fertility drugs, they are much less likely to cause any unpleasant side effects. As indicated, these impressive results do require commitment to taking herbal medicine for several months, however it is clear that it is an investment of time worth making.

Summary

It is evident that acupuncture and TCM have a lot to offer the couple seeking assistance on their fertility journey. Research has shown that acupuncture may offer assistance in relation to many aspects of health pertaining to fertility, such as egg quality, menstrual health, ovulation, stress, and semen parameters, in addition to any other factors that may be relevant to your individual circumstances. Whilst every journey is different, it makes sense to explore the benefits that acupuncture may offer you to optimise your fertility.

Please contact me if you have any questions about how acupuncture can help you on your fertility journey. If you know someone who may benefit from this information, I would be grateful if you shared it with them - thank you.

References
1. Fett, R, It starts with the Egg, 2014
2. Du Y et al, Neurol Res. 2011 33(1):101-7.
3. Stener-Victorin E et al, Jnl App Phys 2006, 101: 84-91
4. Bhal PS et al, Hum Reprod 1999;14:939-945 and Hum Reprod 2001;16:1682-1689.
5. Cochrane S et al, March 2014 Volume 2014: 6 Pages 313—325 International Journal of Women's Health
6. Am J Physiol Endocrinol Metab. 2013 May 1;304(9):E934-43. doi:
7. Fertil Steril. 2011 Jun;95(7):2184-9. doi: 10.1016/j.fertnstert.2010.06.078. Epub 2010 Aug 5.
8. Hum Reprod. 2014 May;29(5):1067-75. doi: 10.1093/humrep/deu032. Epub 2014 Mar 23.
9. Grant LE, Cochrane S, AJACM 2014, vol 9 Issue 1, pg 5 Australian Journal of Acupuncture and Chinese medicine
10. Sci Rep. 2014; 4: 5028.
11. Chen A et al, Jnl Acup Tuina Sci 2011 Vol 9, Number 4, 219-222
Journal of Acupuncture and Tuina Science
12. Wang Z et al, Zhongguo Zhen Jiu. 2008 Nov;28(11):805-7. Zhongguo Zhen Jiu
13. Cakmak Y et al, Fertil Steril 2008;90:1732–8 Fertility and Sterility
14. Zhonghua Nan Ke Xue. 2015 Jul;21(7):637-45.
15. Complement Ther Med. 2015 Feb;23(1):116-28. doi: 10.1016/j.ctim.2014.12.004. Epub 2015 Jan 3.