Frequently Asked Questions

• How does acupuncture work for infertility?

  • Functional infertility is very often related to stress. This may be the reason that infertility seems to be extremely common in women who work in stressful office environments or have stressful family lives. Acupuncture is very beneficial for decreasing excess tension in the body by balancing the autonomic nervous system. Hormonal imbalances and circulatory problems can also be addressed by acupuncture. 

• How exactly does acupuncture influence the female reproductive system?

  • Acupuncture promotes the circulation of blood in the pelvic cavity and improves ovarian function. Acupuncture treatment is also be beneficial in promoting follicle production and growth, enhancing uterine blood flow and improving uterine lining thickness. 

•  What do I need to do prior to my appointment?

  • Before your appointment it is recommended that you first see your specialist and that your husband and you complete the tests to determine the possible cause of infertility. It is helpful if you bring all the previous medical reports and test results with you for the first consultation.

  • Most infertility patients are asked to record their basal body temperature every morning. A properly recorded basal temperature chart can give us a clue whether you are ovulating or not and the     degree of hormonal imbalance. You will be asked to continuously record your basal temperature throughout the treatment process in order to evaluate your progress

• When during my cycle should I get acupuncture done? Should I come just before ovulation?

  • Acupuncture treatments should be done once or twice per week, depending on your age and health history. You can expect a limited effect by receiving acupuncture only around ovulation time. Compared to many of the fertility drugs which provide a powerful effect for a short duration, the immediate effect of acupuncture treatment is, in general, very subtle. The cumulative effect from regular acupuncture treatments, however, can produce significant long lasting benefits.

• Do you use different types of acupuncture treatments depending on the time of the cycle?

  • The treatments are often slightly modified in order to induce more specific effects depending on the time of the cycle. For example, a specific protocol may be used when applying acupuncture after ovulation, in order to maintain a low stress level in an attempt to support the implantation. The technique I prefer to use is Japanese style acupuncture, which is very gentle and painless and can be applied safely throughout the cycle.

• How does acupuncture assist in improving the likelihood of pregnancy?

  • Although we have mentioned several possible effects of acupuncture on the female reproductive system, one should not regard acupuncture as a cure for infertility. Our approach focuses on optimizing a patient's entire organic system and is intended to improve overall health. As a result, fertility may be greatly enhanced.

  • Within the modern medical approach to fertility, there still exists a fair amount of controversy and disagreement among the reproductive specialists. However, there are two factors that every specialist agrees upon. First, when the woman is younger the success rate is significantly higher. Second, when the woman is healthier, the success rate is also increased. Thus, acupuncture can be used to improve one's overall health status, thereby positively enhancing the chance for conception to occur.
     

• If aging negatively affects fertility, does acupuncture reverse the aging process?

  • There is a strong correlation between age and reproductive health. However, it is important to remember that there are two types of aging: chronological and biological. While everyone ages at the same speed chronologically, the biological aging process differs greatly among each individual. That is the reason why each woman goes into menopause at a different time of their lives. So while it is generally true that the quality of a woman's eggs declines as she ages, eggs of some women in their forties can be excellent quality due to slow biological aging.

  • It is not possible to stop chronological aging, however, we can definitely influence the progress of biological aging. Abusive lifestyle factors such as poor diet, smoking, stress, and insufficient sleep all accelerate the cell oxidation and the biological aging process. Practicing a healthy lifestyle in addition to regular acupuncture treatments will have a positive impact in slowing down the aging process.

  • I have reservation in using the statement that acupuncture can reverse the aging process. However, we have seen cases at our clinic in recent years in which women that have had high levels of FSH, which is a good indicator of the onset of menopause, began to have regular menstruation after receiving acupuncture on a regular basis.

• My FSH is too high. Does acupuncture correct hormonal imbalance?

  • An increasing number of women are visiting acupuncture clinics seeking help in correcting the hormone imbalances (FSH, LH, progesterone, prolactin etc.) they are suffering from.

  • Regular acupuncture treatments can be very helpful in regulating hormonal imbalances, although it should be noted that acupuncture does not directly alter the female hormones. Rather, acupuncture is considered to influence the hormonal regulation centers in the brain and autonomic nervous system (i.e., the hypothalamic-pituitary-ovarian axis) and as a result, improvement in hormonal status can occur over time.

As you receive a series of treatments, how do you and I know that acupuncture is working?

If you are not presently on hormones, we recommend that you record your basal body temperature (BBT) every morning. The BBT chart is not the best method available to detect the exact time of ovulation, however, it is an excellent method to get an idea about the female hormone fluctuation pattern and can be used as a one of the indexes to know your progress by observing changes in the BBT pattern from month to month.

Another way to gauge whether or not you are responding to treatment is to be mindful of your symptoms from month to month.  Are your pre-menstrual symptoms less severe, are you having less cramping, less irritability, less blood clots etc…  How are you feeling in general?  Are you sleeping better?  Do you have more stamina throughout the day? Has your digestion improved?  

As mentioned earlier, the focus of our acupuncture approach is to help improve overall health. Therefore, as patients receive a series of acupuncture treatments, many of them experience enhanced feelings of well-being such as more restful sleep, better digestion, decreased anxiety, increase of energy, etc. These physical and emotional shifts can only positively influence the chance of conceiving regardless of whether one is trying naturally or undergoing medical reproductive treatment.


Where are the needles going to be placed the needles?

The location of acupuncture points will vary from patient to patient and from treatment to treatment. Some of the most well-known acupuncture points, traditionally used to influence the function of the female reproductive organs, are located on the lower back, lower abdomen, and legs. The points on the lumbar, sacrum, and low abdominal regions are particularly important in consideration of female anatomy and the related nerve interventions. The points on head, neck, upper back and arms are used in order to stimulate autonomic nervous system and further induce the relaxation response.


What else besides the acupuncture points determines the effect of the treatment?

The needling technique which is used is very important.  In our system, we use very fine needles and very subtle painless insertion.  Studies have shown that this method produces the most beneficial effect on the autonomic nervous system.  We also use direct moxabustion treatment.

 

The timing of the acupuncture treatments is also important. Generally speaking one or two visits per week are recommended throughout the menstrual cycle.  During the ovulation period we may require an additional visit.


 

What is moxibustion treatment?

Moxibustion is a form of heat treatment that stimulates specific acupuncture points of the body. Moxibustion is used in tandem with acupuncture to treat a variety of diseases. We use moxabustion to help warm the uterus and ovaries.  Many of the women who we see having difficulty conceiving have symptoms of cold hands and feet even in the summer time and sufficient blood flow to their reproductive organs is often compromised. The heat stimulation applied on selected acupuncture points helps to increase blood circulation to the uterus and pelvic area. The gentle soothing heat provided by moxa also induces deep relaxation response which aids fertility as well.


What about taking herbs?

Taking herbs is an essential part of the treatment process.  As with acupuncture, each person receives an individualized cyclical administration of herbal formulas, depending on the time of the month.  For example, during the follicular phase an herbal formula may be given that will strengthen blood and promote follicular developement.  During the ovulation, an herbal formula may be given to warm the uterus, especially in women who tend to be cold, to enhance the release of the ovum.  These herbal formulas are of the highest quality available.  There is extensive research available regarding there efficacy (Tanaka et al. 2003; Takahashi 1994; Tanaka 2003).

What is the success rate of acupuncture treatment for infertility?


Infertility is caused by a variety of factors and it is well known that fertility rates vary significantly depending on various factors such as age and co-existing medical conditions. It is important to consider those variables when calculating statistics. Also, it is necessary that separate statistics are produced for patients who conceived naturally with acupuncture and for patients who underwent assisted reproductive technologies (ART) or any other medical fertility treatment in conjunction with acupuncture. Furthermore, statistics derived from an insufficient number of cases in each group contain a large margin of error  These are just a few examples of difficulties regarding success rate statistics. Lastly, statistics can be easily manipulated and success rate can vary greatly depending on the criteria and rules used when calculating the statistics.


  

Are acupuncture treatments provided in conjunction with medical fertility treatments?

Yes, we are seeing more and more patients who are using acupuncture as a method to enhance their ART success. We will work with your reproductive endocrinlogist to ensure that you are giving yourself the best possible chance of becoming pregnant. We also have patients who have been going through cycle monitoring at there gynecologists office with or without fertility drugs.


During the IVF cycle, hormone levels will be intentionally skewed by medications. How will acupuncture affect hormone levels at this time?

Acupuncture has some effect in balancing hormonal systems, likely by influencing the hormonal regulation center of the brain, thus it only influences them within a homeostatic range. Hormonal medications on the other hand have a much more powerful and direct effect and can skew the hormone status outside of the normal homeostatic range. In circumstances such as this, acupuncture only influences the body to respond better within the pharmaceutical intervention. Regulating the hormones during the IVF cycle is the sole responsibility of the fertility specialist - to monitor the blood on a consistent basis along with all the dosages and the medication protocols.


I am undergoing IVF treatment and I am considering receiving acupuncture treatments as well. Are there any negative effects on my fertility treatment?

Acupuncture is extremely gentle using a superficial Japanese acupuncture technique. The procedure is virtually non-invasive and its main effect is to aid relaxation through the Autonomic Nervous System.   Hence, there should be absolutely no negative impact with this type of treatment.


I will be undergoing IVF. When should I start acupuncture?

While some patients respond to acupuncture quickly, acupuncture certainly does not work overnight. Most patients require a series of ongoing treatments over a few months to a year. The recommended treatment schedule is based on consideration of a variety of factors in each individual case. In many cases, we recommend that you start acupuncture treatment at least 3 months prior to the commencement of the IVF cycle and that you continue for 1 to 2 times a week until the day of the transfer.




 

Research in Acupuncture and Infertility

I would like to get acupuncture according to the protocol used in a German study. What are your thoughts on this method?

In April 2002, German researchers reported that they had increased the success rate by nearly 50% in women undergoing in vitro fertilization (IVF) using acupuncture (Paulus et al. 2002). Their results are quite impressive especially when considering that they had administered only two short acupuncture treatments. We definitely have yet to see further replicated studies to confirm their findings and applicability under different settings. It is important to remember that the results obtained by the German group are only applicable to a very limited patient population under very restricted circumstances as in the research study.

In the German study, acupuncture was only applied immediately before and after the embryo transfer, which means that there was no influence of the acupuncture on the patients' eggs. Quality of eggs is a large factor to consider in fertility and the study only enrolled couples who had good quality embryos. Further, the mechanism of how the intervention worked according to this protocol is totally unknown as they have failed to demonstrate any meaningful changes in the uterine pulsatility index (indicator of blood flow in the uterus) before and after acupuncture versus the control. Just like other research studies, this German study was designed only to address one main research question. This study was not designed to determine when or how acupuncture would best be administered. It is very unlikely that most patients would obtain consistent clinical outcome by simply using the acupuncture points they listed in the study. Their conclusions should not be widely extrapolated.


 

Are there any other research articles showing the efficacy of acupuncture for fertility?

Besides the German study mentioned, there are other studies suggesting the positive influence of acupuncture on the female reproductive system(Gerhard et al. 1992; Stener-Victorin et al. 1996; Stener-Victorin et al. 2000) and using acupuncture treatment in conjunction with ART on difficult infertility cases(Kobayashi et al. 2003; Suzuki et al. 2002; Takahashi et al. 2002). However, the acupuncture treatment methods used, such as the acupuncture points, type of stimulation and duration and frequency of acupuncture treatment, varied greatly among each study.

Although any useful and applicable information from the research will be reflected in the design of your treatment protocol, currently there is too little data existing to develop any standardized acupuncture protocol for the treatment of infertility. At present, any acupuncture protocol and treatment schedule should be individually designed based on each patient's medical history and constitution. After all, individualized care is the main tenet of acupuncture as practiced for many years in the Orient.


How strong is the evidence of efficacy of acupuncture for infertility?

At present, evidence of the efficacy of acupuncture for infertility is for the most part anecdotal and there are only several pieces of scientific data available as cited above. In addition, all of the previous studies suffer from some methodological shortcomings such as small sample size or missing control (comparison) group, etc. It should be noted that although they have used completely different acupuncture protocols, authors of different previous research studies in acupuncture and infertility suggested the alteration of autonomic nervous system (ANS) as the possible mechanism of why acupuncture worked on fertility problems in their studies.

As indicated, while there is not enough 'direct' evidence linking acupuncture and fertility, sufficient data does exist indicating the relationship between stress and infertility or unsuccessful IVF.  It is well known that ongoing emotional stress creates imbalance in the ANS (sympathetic dominant state). Relaxation on the other hand, activates the parasympathetic branch of the ANS which is important for maintenance of proper regulation of our internal function including reproductive organs. As I have mentioned before, au number of previous studies have demonstrated that acupuncture does influence the activity of ANS

FAQ about Diet and Lifestyle Issues

Do I need to modify my diet?

I do not recommend any strict diet or drastic modification for women who are scheduled to undergo any fertility treatments such as IVF within the next few months. Many toxic substances will be released as one's body goes through a detoxification process, which will place the internal organs under a tremendous amount of physiological stress and cause one's system to become temporarily out of balance.

A healthy balanced diet is always important however, and you may be asked to fill out an additional questionnaire to give us an idea about your dietary and nutritional status. Most women who have difficulty conceiving are categorized as having a 'cold constitution' according to eastern medical diagnosis. Generally speaking, many young women consume a large amount of food and drink that cool down their internal organs, thus slowing down the functions of the reproductive system.


Do you have any recommendations regarding supplements?

Many experts recommend a good vitamin/mineral supplementation program during the entire pregnancy and nursing periods. However, an excellent nutritional supplementation program (especially supplementing with folic acid) should be started as soon as you plan to become pregnant. Most commercially available prenatal vitamins are designed to meet a unique nutritional demand during pregnancy and nursing periods, therefore, they are high in calcium, magnesium, with a very high amount of iron, folic acid and other essential nutrients. Most patients who are having difficulty conceiving, however have different nutritional demands and a more specific supplementation program may be required. For example, it is known that the quality of eggs declines with age as a result of oxidative stress. A more bio-available multivitamin with a high antioxidant potential may be recommended. One study also suggests an association between oxidative stress and early miscarriage (Jenkins et al. 2000).

What else is important in addition to receiving acupuncture?


Regular Quality Sleep

Insomnia and poor quality sleep often result from the disruption of the circadian rhythms, the approximately 24 hour cyclic rhythm of our 'biological clock'. The 'biological clock' is a complex internal mechanism and is controlled by the suprachiasmatic nucleus (SCN), a tiny cluster of nerve cells in an area of the brain known as the hypothalamus. This 'biological clock' helps regulate breathing and heart rate, body temperature, blood pressure, hormone production, menstruation and other vital bodily functions. An irregular lifestyle can disrupt the normal circadian rhythmic pattern. Having regular quality sleep is extremely important for fertility as studies show low fertility rates and early pregnancy losses among shift workers.  Regular, quality sleep is particularly important if a woman is suffering from an irregular menstrual cycle, anovulation, amenorrhea, or PCOS, all of which can be considered to be part of a biological rhythm (infradian) disorder. Regular acupuncture treatment combined with our specific breathing exercise technique creates a specific coherent heart rhythm and greatly influences hypothalamic activity, helping restore normal biological rhythm.

 

Stress and Relaxation

Despite the well-known link between stress and infertility, the importance of stress management and relaxation is often underestimated. I believe stress contributes, at least to a certain degree, in almost all cases of primary infertility, unexplained failed IVF and unexplained miscarriages. Prolonged stress over the years can lead to the conditions that cause infertility. Stress hormones such as catecholamines (adrenalin, noradrenalin, and dopamine) and the hypothalamic-pituitary-adrenal axis interact with hormones which are responsible for normal ovulatory cycles (ie., GnRH, prolactin, LH and FSH).  Furthermore, some hormones that are released during times of stress can cause the uterus to contract and/or negatively interact with immune cells, both of which will interfere with proper implantation.

Regular practice of stress management and relaxation exercises is very important. However, in this day and age, everyone is exposed to all kinds of stress and realistically it is impossible to avoid stress. In fact, the medical tests and treatments for infertility are some of the major sources of stress for many infertile women.




 

Infertility Treatment at the Fertility Wellness Center

What is unique about our acupuncture system at The Fertility Wellness Center?

Our approach focuses on overall health and stress management while attempting to optimize female reproductive health:

1.   Japanese acupuncture treatment techniques used here at The Huntington Wellness Center are distinctively gentle and painless. The needles are inserted typically to no more than one or two millimeter in depth. This painless and gentle needling technique is crucial for the relaxation response to occur. Furthermore, because the procedure is virtually non-invasive, the treatment can be applied safely and effectively anytime during the menstrual cycle. This is important since consistent and regular treatments are required in order to achieve meaningful cumulative effect.

2.   Our acupuncture system is based on the autonomic nervous system. Proper balance of both branches of the ANS (sympathetic and parasympathetic) is crucial for optimal functioning of reproductive organs, blood flow circulation, hormone balance, immune system, and regulation of menstrual cycle. Much of the research activities over the last ten years have been exploring the most effective acupuncture methods to alter the ANS. The acupuncture we use in particular has been shown to shift the ANS to a favorable direction, based on studies conducted at a Japanese University Wakayama Medical University (Nishijo et al. 1995; Tanaka 1996; Tanaka et al. 1997).

3.   Most patients are treated with our approach, which involves Japanese acupuncture and moxibustion in combination with a specific breathing exercise. Studies have been indicating that this type of breathing has a profound effect on harmonizing the autonomic nervous system. It has also been considered that it influences the activities of the hypothalamus and pituitary glands. This particular breathing exercise is utilized during acupuncture sessions to further enhance the effect of acupuncture. In addition, patients are asked to practice this between the treatments to maintain the treatment benefits.

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