Acupuncture for IVF and IUI Optimization

Although acupuncture and Traditional Chinese Medicine (TCM) for the treatment of infertility has been practiced for thousands of years, the combination of acupuncture with in vitro fertilization (IVF) and intrauterine insemination (IUI) has emerged in recent years as an effective method for improving pregnancy and live birth rates.

I see amazing results when TCM is applied to women who both TTC (try to conceive) naturally, as well as those who plan to receive interventions with assisted reproductive technology (ART). The success of either IVF or IUI still depends on the balanced state of both you and your partner’s individual bodies, and that is what acupuncture and herbal medicine do best.

Acupuncture helps to mitigate issues of circulation, inflammation, and other blockages (such elevated stress hormones) that may be preventing you from conceiving and carrying to term. Acupuncture and Chinese herbal medicine can also help alleviate the side effects that come along with of some of the IVF drugs/medications. Acupuncture and TCM are relatively safe, very effective, and holistically supportive treatments for women undergoing ART, making the entire process more comfortable, less stressful, and increasing odds for success. I have seen improved responses to stimulation drugs, improved hormone levels, better fertilization rates, higher pregnancy rates, and lower miscarriage rates in patients who receive acupuncture regularly before, during, and after a cycle. Some studies show more than double the chances of conception for couples utilizing acupuncture alongside IVF. Preparation with acupuncture should be scheduled carefully to have the best chance of success.

Using the methods of TCM, a licensed acupuncturist will diagnose and treat each patient individually, so recommendations may vary depending on your health and medical history. For IVF/IUI optimization, beginning acupuncture treatments before, early on in a cycle, or even on a break is preferable. Ideally, we would like to start acupuncture treatments three to six months before the planned IUI/IVF cycle, as well. However, if this is not possible, we should still see good results with treatment while you are in the cycle, and we will often increase frequency of visits.

Before an IVF Cycle

Ideally, I would meet with both partners one to two times a week for at least three months prior to their IVF/IUI cycle, as this is a full egg and sperm development cycle. For couples with complex or especially challenging health situations, six months would be even better. Remember that there is a lot we can do to help improve both sperm and egg quality, but important changes take time. During this time, we will focus on general health and wellbeing, increasing both partners’ reserves, and fine-tuning blood circulation. Starting treatment prior to fertility medications also opens up the possibility of utilizing herbal medicine alongside acupuncture, which can be crucial for some people.

Priming Phase

During the priming phase, I recommend to continue weekly acupuncture. For most cycles, women take medications to temporarily suppress the ovaries in preparation for stimulation. This phase is typically around a month long. We may decide to continue with herbs during this phase, depending on the your specific condition and the medications you’re taking.

Stimulation Phase

Stimulating medications are used to enhance the growth of eggs in the ovaries, and during this time we will continue with weekly or twice weekly acupuncture. This phase can vary in length from cycle to cycle and will be monitored closely by your doctor.

1-2 days Prior to Retrieval

Once ovarian follicles are at the correct stage and size, you will be given a trigger to complete egg maturation in preparation for retrieval. Research shows that acupuncture at this time is very important to help with your eggs’ final maturation and should be done within the day or two prior to retrieval.

After Retrieval

After your eggs have been retrieved, you may feel some cramping, bloating, and discomfort from the procedure. The retrieval is an invasive procedure and acupuncture will be very useful to stimulate the healing process and prepare your uterus for implantation. At this time, acupuncture points will be used to relax the uterus, repair micro-trauma by increasing blood circulation and decreasing inflammation, and prepare your body for embryo transfer.

Before Transfer

I recommend for you to schedule acupuncture treatments at least 24-48 hours before and after IUI/embryo transfer. I also offer the “Paulus protocol” done on-site at your fertility center, which includes not one—but two—acupuncture sessions immediately before and after the procedure. Read more about this evidence-based protocol here. My focus with acupuncture is to help create a calm and optimal environment for the embryo.

After Transfer

As IUI/embryo transfer procedures are typically scheduled for the early morning, I highly recommend scheduling acupuncture later the same day or the following day (unless you choose acupuncture immediately after on-site), with a second session 3-4 days later. At the very least, I encourage following up with 2-3 acupuncture treatments within the 5-7 days following embryo transfer, in order to further assist implantation and embryo development. Studies have shown that acupuncture just before or after an embryo transfer will increase the odds of a successful pregnancy.

Beyond Transfer

After IUI/embryo transfer and through the end of the 1st trimester if there is a pregnancy, I recommend continuing with weekly acupuncture to support a healthy pregnancy. Acupuncture treatments twice weekly for at least 12 weeks is ideal if there is a history of miscarriage or in an otherwise high-risk pregnancy. If the IUI/embryo transfer is unsuccessful, I recommend scheduling a re-evaluation to discuss any changes about the plan going forward.

How Exactly Do Acupuncture and TCM Complement IVF or IUI Treatment?

Acupuncture performed before and during IVF/IUI increases blood flow to the uterus and ovaries. In addition, acupuncture and herbal medicine regulate fertility hormones, which contribute to follicle development and increased chances of successful implantation. Acupuncture treatments around the time of embryo transfer help to promote uterine blood flow, reduce cortisol levels (the stress hormone), promote relaxation and increase pregnancy success rates by assisting with implantation and embryo development. I have seen improved responses to stimulation drugs, improved hormone levels, better fertilization rates, higher pregnancy rates, and lower miscarriage rates in patients who receive acupuncture regularly before, during, and after a cycle. Some studies show more than double the chances of conception for couples utilizing acupuncture alongside IVF. Preparation with acupuncture should be scheduled carefully to have the best chance of success.

Recent clinical studies suggest that acupuncture and Chinese herbal treatments may:

• balance reproductive hormones

• improve sperm (count, morphology, & motility)

• improve blood flow to the ovaries & uterus

• increase implantation rates & pregnancy rates

• enhance egg quality

• increase ovarian response

• increase uterine lining thickness and enhance uterine receptivity

• reduce stress, anxiety, and depression associated with infertility

• prevent miscarriage and early pregnancy loss

• decrease western drug & medication side effects

Research on TCM & Acupuncture with IVF

1. Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes: https://www.rbmojournal.com/article/S1472-6483(15)00092-9/fulltext

2. Acupuncture performed before and after embryo transfer: a randomized controlled trial: https://europepmc.org/abstract/med/24937975

3. Effectiveness guidance document (EGD) for Chinese medicine trials: a consensus document: https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-15-169

4. Acupuncture and in vitro fertilization: a retrospective chart review: https://www.liebertpub.com/doi/abs/10.1089/acm.2011.0888

5. P02.15. Acupuncture improves in vitro fertilization live birth outcomes: a retrospective chart review: https://link.springer.com/article/10.1186/1472-6882-12-S1-P71

6. The effects of adjuvant whole-systems traditional chinese medicine on in vitro fertilization live births: A retrospective cohort study: https://www.liebertpub.com/doi/full/10.1089/acm.2014.5029.abstract

7. Recurrent pregnancy loss and traditional Chinese medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689170/

8. Diminished ovarian reserve, clomid, and traditional Chinese medicine: A case study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579201/

9. Acupuncture and in vitro fertilisation research: Current and future directions: https://journals.sagepub.com/doi/abs/10.1136/acupmed-2016-011352

10. P02.163. Acupuncture and donor egg in vitro fertilization cycles: a retrospective chart review comparing two acupuncture protocols: https://link.springer.com/article/10.1186/1472-6882-12-S1-P219

11. Adjunctive Role of Chinese Herbs and Acupuncture in an In Vitro Fertilization Cycle: https://web.b.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=15207714&AN=52109204&h=oUJ51NcJoTp1NRSAz4ZpmKo%2fCEUh4MLi2eLNmyoPMotfwxAAcMfU399DOUhnw7ZQz9mkU1%2bdoKqkbhNVuBtrBA%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d15207714%26AN%3d52109204

12. Vaginismus Successfully Treated with Chinese Medicine- A Case Study: https://web.a.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=15207714&AN=45526763&h=lsPL84Isi3EWoWGv2NiNIa4dPjAJQhoxPL82ZABbq9cK0ttocklfMrIu5w5StgYf%2fnKSaNacIcntoKf9%2fC4EKA%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d15207714%26AN%3d45526763

13. Acupuncture and in vitro fertilisation research: current and future directions: https://search.proquest.com/openview/7b21c50c2742f1330fb4ca6e46bf755c/1?pq-origsite=gscholar&cbl=38462