Acupuncture-assisted fertility
Is it for You?
Eric Serejski. L.AC, Dipl. AC & CH.
Distributor: Ebook: Amazon. © 2012
Table of Content
Introduction
1. Benefit of Interest
1.1 Observations
1.2 Mechanisms
1.3. Putative role in Unexplained Infertility
2. Marginal increment cost and Benefits of Interest
Conclusion
References
The incidence of infertility has continued to rise over the last ten years and it is estimated that it affects at least 11% of couples of reproductive age (over 10 million couples in the USA). About 30% of these couples are still diagnosed with unexplained infertility[1]. About 2 million couples seek infertility treatments each year with a spending of $3 to $5 billions and a success rate of about 33 to 36%.
Introduction
Approaches to infertility are complex and costly. They foster the development, application, risk analyses and fitting cost-effectiveness of novel strategies.[2-3] This article suggests the inclusion of acupuncture in assisted fertility protocols. The incremental cost of acupuncture treatment is marginal compared to the benefit of interest. In addition, the complementary diagnostic approach of acupuncture may be of significant benefit in the approach of unexplained infertility.
Infertility has been addressed by Traditional Chinese Medicine (TCM, also called Oriental Medicine), acupuncture and Chinese herbs (AC and CH), for the past 3,000 years.[4-5] However, in the context of modern reproductive endocrinology and infertility, AC is best used as an adjunctive and synergistic therapy complementing western treatments.
1. Benefit of Interest
1.1 Observations
Recent meta-analyses suggest that acupuncture given with embryo transfer improves rates of pregnancy among women undergoing in vitro fertilization (IVF) (for every ten women treated with acupuncture and IVF, one additional pregnancy may be achieved).]6] Notably, AC on the day of peri-embryo transfer (ET) appears to significantly improve the reproductive outcome of IVF/ICSI (Intracytoplasmic Sperm Injection)[7-8]
1.2 Mechanisms
AC influences the reproductive system in several ways: 1) promotion of ovulation[9] (Studies report comparable results between acupuncture and clomiphene finding pregnancy rates of 65% and 45%, respectively[10-11]), 2) promotion of ovarian and uterine blood flow, 3) regulation of the sympathetic nervous system, 4) regulation of the endocrine system, and 5) regulation of the neuroendocrine system.[12]
More specifically, studies on AC-Assisted Fertility in Polycystic Ovary Syndromes (PCOS) show the following: 1) endogenous regulation,[13-14] 2) induction of regular ovulation,[15] 3) reduction of blood flow impedance in uterine arteries,[16] 4) changes in serum FSH, LH and follicular sizes.[17-18]
In animal estradiol PCOS-induced, studies indicate the following effects of AC: 1) decrease in ovarian nerve growth factor (NGF)[19-20] and ovarian endothelin-1 (ET-1),[21] 2) increase of ovarian blood flow[22-23], 3) increase in hypothalamus beta-endorphin[24], 4) decrease of ovarian CRF[25], and 4) modulation of some functions of the hypothalamus-hypophysis-gonadal axis such as facilitating gonadotropin-releasing hormone (GnRH) from the medio-basal hypothalamus.[26-27]
Finally, biological evidence points to an immune-endocrine disequilibrium in response to stress and describes a hierarchy of biological mediators involved in a stress trigger to reproductive failure and epidemiological evidence presents positive correlations between various pregnancy failure outcomes with pre-conception negative life events and elevated daily urinary cortisol.[28] Such factors increasingly suggest the inclusion of stress reduction therapies during fertility treatments[29-30] and numerous studies document the significant improvement in emotional health and wellbeing of AC-treated patients, including women undergoing assisted reproduction.[31]
1.3. Putative role in unexplained infertility
TCM is classified by the NIH as a whole medical system.[32] As such, it is built upon a complete system of theory, diagnosis, and practice. In light of unexplained infertility, the inclusion of a complete medical system with marginal increment cost and 3,000 years of clinical history should not be negated. Specifically, in the cases of infertility and menstruation disorders, the TCM paradigm allows the inclusion of about ten differential diagnoses and treatment approaches.[33] It is to note that novel systems approaches integrating AC permit an even more powerful use of it within the context of the western paradigm.[34]
2. Marginal increment cost and Benefits of interest
While systemic review of cost analysis of AC-Assisted Fertility are lacking, positive cost effectiveness has been reported for other conditions.[35-36-37-38] In fertility treatments, the inclusion of AC therapy would be a marginal increment cost. A monthly acupuncture support per patient, consisting of an average of five treatments per month would be of approximately $600 per month (or per cycle). With an average cost for a complete IVF cycle in the US of about $12,000 plus medications, the AC increment cost is at the most 5%. The benefit is at least an optimization of the western procedures, and a decrease in IVF pricing plans ("shared risk" IVF pricing, IVF cost warranty program, IVF cost protection plan, IVF refund plan, etc.). Conjoint analysis also indicate that patients prefer good staff attitudes to a 6% increase in the probability of live birth[39]: An individualized AC support can only be an added element to services provided within fertility programs.
Conclusion
The inclusion of acupuncture in assisted fertility protocols has marginal incremental cost (about 5%) compared to the benefits of interest. These benefits range from increased success rates to added approaches to unexplained infertility, decreased patient's emotional distress, and increased personalization of the protocol. Finally, such marginal incremental cost with benefits of interests directly decreases IVF pricing plans.
References
[1] Collins J. Current best evidence for the advanced treatment of unexplained subfertility. Human Reproduction. 2003; 18(5): 907-912.
[2] Macklon NS, Stouffer RL, Giudice LC, Fauser B. The Science behind 25 Years of Ovarian Stimulation for in Vitro Fertilization. Endocrine Reviews. 2005 27 (2): 170-207.
[3] Collins J. An international survey of the health economics of IVF and ICSI. Human Reproduction Update. 2002; 8(3): 265-277.
[4] See Serejski E. The Chinese Kama Sutra - Health, Healing and Sexuality for a translation of the earliest Chinese documents on the topic.
[5] Johnson D. Acupuncture prior to and at embryo transfer in an assisted conception unita case series. Acupunct Med. 2006; 24: 23-28.
[6] Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008; 336: 545-549.
[7] Westergaard LG, et al. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril. 2006; 85: 1341-1346.
[8] Paulus WE, et al. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril. 2002; 77: 721-724.
[9] Song F, Zheng S, Ma D. [Clinical observation on acupuncture for treatment of infertility of ovulatory disturbance] Zhongguo Zhen Jiu, 2008, 28, 21-23.
[10] Yang J, et al. [Controlled study on acupuncture for treatment of endocrine dysfunctional infertility] Zhongguo Zhen Jiu. 2005; 25: 299-300.
[11] Song F, Zheng S, Ma D. [Clinical observation on acupuncture for treatment of infertility of ovulatory disturbance] Zhongguo Zhen Jiu. 2008; 28: 21-23.
[12] Serejski E. Acupuncture and Cerebral Circulation. AcupunctureToday. 2004 Jan. Available from Acupuncturetoday.com.
[13] Stener-Victorin E, Jedel E, Manner's L. Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence. J Neuroendocrinol. 2008; 20: 290-298.
[14] Stener-Victorin E, Humaidan P. Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med. 2006; 24: 157-163.
[15] Stener-Victorin E, et al. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2000; 79: 180-188.
[16] Stener-Victorin E, et al. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod. 1996; 11: 1314-1317.
[17] Chen D, et al. [Clinical study on needle-pricking therapy for treatment of polycystic ovarial syndrome] Zhongguo Zhen Jiu. 2007; 27: 99-102.
[18] Yu J, Zheng HM, Ping SM. [Changes in serum FSH, LH and ovarian follicular growth during electroacupuncture for induction of ovulation] Zhong Xi Yi Jie He Za Zhi. 1989; 9: 199-202, 195.
[19] Bai YH, et al. Electro-acupuncture reverses nerve growth factor abundance in experimental polycystic ovaries in the rat. Gynecol Obstet Invest. 2004; 57: 80-85.
[20] Stener-Victorin E, et al. Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol Reprod. 2000; 63: 1497-1503.
[21] Stener-Victorin E, et al. Steroid-induced polycystic ovaries in rats: effect of electro-acupuncture on concentrations of endothelin-1 and nerve growth factor (NGF), and expression of NGF mRNA in the ovaries, the adrenal glands, and the central nervous system. Reprod Biol Endocrinol. 2003; 1: 33.
[22] Stener-Victorin E, et al. Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries. Reprod Biol Endocrinol. 2004; 2: 16.
[23] Stener-Victorin, E.; et al. Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries. Reprod Biol Endocrinol. 2004; 2: 16.
[24] Stener-Victorin E, Lindholm C. Immunity and beta-endorphin concentrations in hypothalamus and plasma in rats with steroid-induced polycystic ovaries: effect of low-frequency electroacupuncture. Biol Reprod. 2004; 70: 329-333.
[25] Stener-Victorin E, et al. Effects of electro-acupuncture on corticotropin-releasing factor in rats with experimentally-induced polycystic ovaries. Neuropeptides. 2001; 35: 227-231.
[26] Yang SP, Yu J, He L. Release of gonadotropin-releasing hormone (GnRH) from the medio-basal hypothalamus induced by electroacupuncture in conscious female rabbits. Acupunct Electrother Res. 1994; 19: 19-27.
[27] Wang S, Zhu B. [Regulative effect of electroacupuncture on hypothalamus-hypophysis-gonad axis in different stages of estrous cycles in rats] Zhen Ci Yan Jiu. 2007; 32: 119-124.
[28] Nakamura K, Sheps S, Arck, PC. Stress and reproductive failure: past notions, present insights and future directions. J Assist Reprod Genet. 2008; 25, 47-62.
[29] Campagne DM. Should fertilization treatment start with reducing stress? Hum Reprod. 2006; 21: 1651-1658.
[30] Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007; 21: 293-308.
[31] Coyle M, Smith C. A survey comparing TCM diagnosis, health status and medical diagnosis in women undergoing assisted reproduction. Acupunct Med. 2005; 23: 62-69
[32] What Is Complementary and Alternative Medicine? (N.I.H.)
[33] See for example Maciocia G. Obstetrics and Gynecology in Chinese Medicine. New York: Churchill Livingstone: 1998. pp. 159-276, 691-740.
[34] Serejski E. Advanced lectures to professionals, Lectures 350-P - Gynecology and 355-P - Sexual Dysfunctions and infertility. 2006-present.
[35] Berkovitz S, et al. High volume acupuncture clinic (HVAC) for chronic knee pain - audit of a possible model for delivery of acupuncture in the National Health Service. Acupunct Med. 2008; 26: 46-50.
[36] Ballegaard S, et al. Long-term effects of integrated rehabilitation in patients with advanced angina pectoris: a nonrandomized comparative study. J Altern Complement Med. 2004; 10: 777-783.
[37] Bonafede M, et al. The effect of acupuncture utilization on healthcare utilization. Med Care. 2008; 46: 41-48.
[38] Witt CM, et al. Cost-effectiveness of acupuncture treatment in patients with headache. Cephalalgia. 2008; 28: 334-345.
[39] Collins J. An international survey of the health economics of IVF and ICSI. Human Reproduction Update. 2002; 8(3): 265-277.