printThe use of acupuncture in reproductive medicine has not been well investigated to date. A review of the literature reveals only a few studies, most of which are flawed by poor design, and a lack of valid outcome measures and diagnostic criteria, which make it difficult to interpret the results. However, in recent years the effect of acupuncture on different conditions (pain and diseases) has been studied from a Western scientific perspective and the results show that acupuncture has both a physiological and a psychological impact. The aim of the studies presented below was to investigate whether acupuncture has a role in reproductive medicine.
Auricular acupuncture in the treatment of female infertility. Gynecological Endocrinology, 1992 Sep, 6(3):171-81. (UI: 93071204) (Requested library location(s) not linked. Try F PE .)
Abstract Following a complete gynecologic--endocrinologic workup, 45 infertile women suffering from oligoamenorrhea (n = 27) or luteal insufficiency (n = 18) were treated with auricular acupuncture. Results were compared to those of 45 women who received hormone treatment. Both groups were matched for age, duration of infertility, body mass index, previous pregnancies, menstrual cycle and tubal patency.
Women treated with acupuncture had 22 pregnancies, 11 after acupuncture, four spontaneously, and seven after appropriate medication. Women treated with hormones had 20 pregnancies, five spontaneously, and 15 in response to therapy. Four women of each group had abortions. Endometriosis (normal menstrual cycles) was seen in 35% (38) of the women of each group who failed to respond to therapy with pregnancy. Only 4 of the women who responded to acupuncture or hormone treatment with a pregnancy had endometriosis, and 7% had normal cycles. In addition, women who continued to be infertile after hormone therapy had higher body mass indices and testosterone values than the therapy responders from this group.
Women who became pregnant after acupuncture suffered more often from menstrual abnormalities and luteal insufficiency with lower estrogen, thyrotropin (TSH) and dehydroepiandrosterone sulfate (DHEAS) concentrations than the women who achieved pregnancy after hormone treatment. Although the pregnancy rate was similar for both groups, eumenorrheic women treated with acupuncture had adnexitis, endometriosis, out-of-phase endometria and reduced postcoital tests more often than those receiving hormones.
Twelve of the 27 women (44%) with menstrual irregularities remained infertile after therapy with acupuncture compared to 15 of the 27 (56%) controls treated with hormones, even though hormone disorders were more pronounced in the acupuncture group. Side-effects were observed only during hormone treatment. Various disorders of the autonomic nervous system normalized during acupuncture. Based on our data, auricular acupuncture seems to offer a valuable alternative therapy for female infertility due to hormone disorders.
Electroacupuncture effects on uterine artery blood flow impedance (1) Research on in-vitro fertilization (IVF) treatment has, among other things, focused on optimizing positive results with minimum complications. One line of research has been to modify different stimulation regimens, and another has been to investigate and improve the quality of the culture medium and the selection of the best embryos. Successful IVF and embryo transfer (ET) require optimal endometrial receptivity at the time of implantation. Blood flow impedance in the uterine arteries, measured as the pulsatility index (PI), is considered valuable in assessing endometrial receptivity in association with IVF and ET treatment. An optimal range of PI at the time of ET seems to be between 2.0 and 2.9. Steer et al. (1992) showed that a mean uterine arterial PI >3.0 at the time of ET predicted 35% of pregnancy failures (2). A third line of research, aimed at improving IVF outcome, is now conceivable.
The aim of the present study was to evaluate whether repeated electro-acupuncture (EA) treatments can reduce high blood flow impedance in the uterine arteries to an optimal PI level between 2.0 and 2.9.
Ten infertile women, aged between 25 - 40 years, with a mean PI >3.0 in the uterine arteries, attending the clinic for IVF and ET treatment were included. The mean PI of the uterine arteries (mean of three PI on each side) was measured on each patient with transvaginal ultrasonography and pulsed Doppler curves. The measurements were done twice before the first EA treatment, after the eight EA treatments and again 10-14 days after the EA period. EA was given eight times, twice a week for 4 weeks. There were no differences between the first two PI measurements, which were taken prior to the first EA. However, in comparison with the mean baseline PI taken before down regulation and before the first EA, the mean PI taken both after the last EA and 10 - 14 days later was significantly reduced.
The present study showed that repeated EA treatments reduce a high PI value in the uterine arteries to normal levels directly after and 10 - 14 days after the EA period. Whether the subsequent increase in blood flow influences endometrial receptivity, and therefore implantation and pregnancy rate, in women undergoing IVF and ET remains to be shown.
Electroacupuncture as anesthesia during oocyte aspiration (3) The anesthetic method used during oocyte aspiration should provide adequate analgesia during the procedure and rapid recovery afterwards. In Sweden the most frequently employed procedure is a paracervical block (PCB) in combination with i.v. opiates. Premedication with sedative drugs may be used. Intravenous opiates and different combinations of premedication can cause side-effects such as tiredness, nausea, and confusion.
The aim of the present study was to compare EA and PCB, EA group, with a fast-acting opiate (alfentanil) and PCB, alfentanil group, with regard to pain related to oocyte aspiration, discomfort, adequacy of anesthesia, abdominal pain, stress, nausea, and IVF outcome parameters.
One hundred and fifty infertile women, aged between 25 - 46 years, undergoing IVF and ET with vaginal ultrasound guided oocyte aspiration, were recruited. Seventy-five women received EA and a PCB, applied at the start of the oocyte aspiration procedure. Seventy-five women received alfentanil i.v. and had the PCB. The outcome variable was the Visual Analogue Scale (VAS). There were no significant differences between the EA group and the alfentanil group before oocyte aspiration and 2 hours after oocyte aspiration concerning abdominal pain and nausea. There were no significant differences between the EA group and the alfentanil group with respect to pain directly related to oocyte aspiration. Two hours after oocyte aspiration reported both the EA group and the alfentanil group that they had received adequate pain relief. Positive side-effects were that women who received EA as anesthesia were considerably more alert, less tired, and able to leave the clinic earlier than women who received alfentanil.
The present study shows that EA and PCB is as good an anesthetic method as alfentanil and PCB during oocyte aspiration without any observed negative side-effects and can be a valuable alternative to conventional anesthesia.
References
Stener Victorin E, Waldenstrom U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod 1996;11(6):1314-7.
Steer CV, Campbell S, Tan SL, Crayford T, Mills C, Mason BA, et al. The use of transvaginal colour flow imaging after in vitro fertilization to identify optimum uterine conditions before embryo transfer. Fertil. Steril. 1992;57:372-6.
Stener-Victorin E, Waldenström U, Nilsson L, Wikland M, Janson PO. A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 1999;14(10):2480-4.
FERTILITY AND STERILITY® VOL. 77, NO. 4, APRIL 2002
Copyright ©2002 American Society for Reproductive Medicine
Published by Elsevier Science Inc., Printed on acid-free paper in U.S.A.
