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ACUPUNCTURE AND BLOOD FLOW: Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization–embryo transfer treatment



Magarelli, PC, D Cridennda, M Cohen. Fertil Steril. 2009 Dec;92(6):1870-9 Fertility and Sterility
A number of women going through IVF were given acupuncture to increase blood flow through the uterine arteries in the immediate weeks before egg collection. The researchers found that the women who had acupuncture showed beneficial changes in serum levels of stress hormones compared to the control group of women who did not have acupuncture. The acupuncture treatments appear to normalize levels of cortisol and prolactin which have been artificially depressed by the IVF drugs. This may have implications for both egg quality and implantation. In addition the pregnancy and live birth rate was significantly higher in the acupuncture group.



Objective: To determine whether changes in serum cortisol (CORT) and PRL are affected by acupuncture (Ac) in Ac-treated IVF patients.
Design: Prospective cohort clinical study.
Setting: Private practice reproductive endocrinology and infertility clinic and private practice acupuncture consortium.
Patient(s): Sixty-seven reproductive-age infertile women undergoing IVF.
Intervention(s): Blood samples were obtained from all consenting new infertility patients and serum CORT and serum PRL were obtained prospectively. Patients were grouped as controls (IVF with no Ac) and treated (IVF with Ac) according to acupuncture protocols derived from randomized controlled trials.
Main Outcome Measure(s): Serum levels of CORT and PRL were measured and synchronized with medication stimulation days of the IVF cycle (e.g., day 2 of stimulation, day 3, etc.). Reproductive outcomes were collected according to Society for Assisted Reproductive Technology protocols, and results were compared between controls and those patients treated with Ac.
Result(s): CORT levels in Ac group were significantly higher on IVF medication days 7, 8, 9, 11, 12, and 13 compared with controls. PRL levels in the Ac group were significantly higher on IVF medication days 5, 6, 7, and 8 compared with controls.
Conclusion(s): In this study, there appears to be a beneficial regulation of CORT and PRL in the Ac group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics. (Fertil Steril� 2008;-:-–-. �2008 by American Society for Reproductive Medicine.)




ACUPUNCTURE, STRESS AND FERTILITY; Auricular Acupressure Reduces Anxiety Levels and Improves Outcomes of in Vitro Fertilization


Fan Qu et al, Sci Rep Nature, (2014), 4, Article number: 5028
Scientific Reports, Nature Publishing
300 women who were doing IVF due to blocked tubes, were randomised into groups that received stimulation to auricular acupuncture points (small seeds were taped onto 3 points related to nervous system or ovary and uterus function) or to sham points or no treatment. The women in the active treatment group had a markedly higher pregnancy rate than did those in the sham or control groups. Additionally they reported less stress and anxiety.




The study was to explore whether auricular acupressure (AA) can relieve anxiety during the period from trans-vaginal oocyte retrieval to the embryo transfer in IVF treatment and whether AA can improve the outcomes of IVF. 305 infertile patients with tubal blockage who were referred for IVF were included. The women were randomized into a control group with 102 cases, a Sham-AA group with 102 cases and an AA group with 101 cases. The anxiety levels were rated with Spielberger’s State Trait Anxiety Inventory and the Amsterdam Preoperative Anxiety and Information Scale. Data of clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) were obtained. The levels of neuropeptide Y (NPY) and transforming growth factor alpha (TGF-alpha) in the follicular fluids were detected with ELISA. After treatment, in AA group, the levels of state anxiety, preoperative anxiety and need-for-information were significantly lower, whereas CPR, IR, LBR and NPY levels in the follicular fluids were markedly higher than Sham-AA group and control group. We concluded that AA could help to reduce anxiety levels associated with IVF and improves the outcomes of IVF partly through increasing the levels of NPY in the follicular fluids.



Stress reduces conception probabilities across the fertile window: evidence in support of relaxation.

Acupuncture-Pregnancy-2381Buck Louis GM et al, Fertil Steril. 2011, 95, 7, pg 2184 – 2189 Fertility and Sterility

While this study did not involve IVF patients its conclusions nevertheless have relevance to women trying to fall pregnant with IVF. The study showed a clear relationship with higher stress levels and reduced conception rates. This may be one of the ways that acupuncture, which reduces stress hormones, can improve fertility.




Objective: To assess salivary stress biomarkers (cortisol and alpha-amylase) and female fecundity.
Design: Prospective cohort design.
Setting: United Kingdom.
Patient(s): 274 women aged 18 to 40 years who were attempting pregnancy.
Intervention(s): Observation for six cycles or until pregnancy: women collected basal saliva samples on day 6 of each cycle, and used fertility monitors to identify ovulation and pregnancy test kits for pregnancy detection.
Main Outcome Measure(s): Salivary cortisol (mug/dL) and alpha-amylase (U/mL) concentration measurements; fecundity measured by time-to-pregnancy and the probability of pregnancy during the fertile window as estimated from discrete-time survival and Bayesian modeling techniques, respectively.
Result(s): Alpha-amylase but not cortisol concentrations were negatively associated with fecundity in the first cycle (fecundity odds ratio = 0.85; 95% confidence interval 0.67, 1.09) after adjusting for the couples’ ages, intercourse frequency, and alcohol consumption. Statistically significant reductions in the probability of conception across the fertile window during the first cycle attempting pregnancy were observed for women whose salivary concentrations of alpha-amylase were in the upper quartiles in comparison with women in the lower quartiles (highest posterior density: -0.284; 95% interval -0.540, -0.029).
Conclusion(s): Stress significantly reduced the probability of conception each day during the fertile window, possibly exerting its effect through the sympathetic medullar pathway.



 ACUPUNCTURE, HERBS AND ENDOMETRIOSIS: Complementary and Alternative Medicine for Endometriosis: A Review of Utilization and Mechanism


Kong S et al, Volume (2014), Article ID 146383, 16 pages Evidence-Based Comp and Altern Med Evidence-Based Complementary and Alternative Medicine
This very thorough review compares results of treatment of endometriosis with acupuncture or herbal therapies and pharmaceutical or surgical approaches. A number of therapies, including using Chinese herbs per rectum, obtained great relief for patients, but without the side effects caused by drugs or surgery.




Endometriosis (EM) is one of the common gynecological conditions causing menstrual and pelvic pain and affects 10%–15% of women of reproductive age. In recent years, the complementary and alternative medical (CAM) treatment for EM has become popular due to the few adverse reactions reported. The CAM therapy for EM includes several different treatments such as herbs (herbal prescription, extract, and patent), acupuncture, microwave physiotherapy, and Chinese herb medicine enema (CHM enema). These CAM therapies are effective at relieving dysmenorrhoea, shrinking adnexal masses, and promoting pregnancy, with less unpleasant side effects when compared to hormonal and surgical treatments. In this review, we focus on the status quo of CAM on EM and try to identify therapeutic efficacy and mechanisms based on some clinical and experimental studies. We hope to provide some instructive suggestions for clinical treatment and experimental research in the future.



Acupuncture for ovulation induction in polycystic ovary syndrome: A randomized controlled trial.


Johansson J et al, Am J Physiol Endocrinol Metab. 2013 May 1;304(9):E934-43
American Journal of Physiology – Endocrinology and Metabolism

This trial showed that repeated acupuncture treatments increased ovulation frequency in PCOS patients and abnormally high ovarian and adrenal hormone levels were reduced.




Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome (PCOS). Our aim was to investigate whether acupuncture affects ovulation frequency and to understand the underlying mechanisms of any such effect by analyzing luteinizing hormone (LH) and sex steroid secretion in women with PCOS. This prospective, randomized, controlled clinical trial was conducted between June 2009 and September 2010. Thirty-two women with PCOS were randomized to receive either acupuncture in combination with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10-13 weeks. Main outcome measures were changes in LH secretion patterns from baseline to after 10-13 weeks of treatment and ovulation frequency during the treatment period. Secondary outcomes were changes in the secretion of sex steroids, anti-Müllerian hormone, inhibin B, and serum cortisol. Ovulation frequency during treatment was higher in the acupuncture group compared with the control group. After 10-13 weeks of intervention, circulating levels of estrone, estrone sulfate, estradiol, dehydroepiandrosterone, dehydroepiandrosterone-sulfate, androstenedione, testosterone, free-testosterone, dihydrotestosterone, androsterone glucuronide, androstane-3α, 17β-diol-3glucuronide, and androstane-3α, 17β-diol-17glucuronide decreased within the acupuncture group and were significantly lower than in the control group for all of these except androstenedione. We conclude that repeated acupuncture treatments resulted in higher ovulation frequency in lean/overweight women with PCOS and were more effective than just meeting with the therapist. Ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion.



Electroacupuncture for cervical ripening prior to labor induction: a randomized clinical trial


Gribel G et al, Arch Gynecol Obstet (2011) 283:1233–1238 Archives Gynecology and Obstetrics
Two groups of women had their labours induced with either electroacupuncture or with prostaglandins. In both groups labour was successfully induced however the electroacupuncture group experienced significantly fewer obstetric complications including caesarian sections.





Purpose: The present study was aimed to compare the effects of the use of electroacupuncture and misoprostol in inducing labor in patients with Bishop score7 and to observe the characteristics of labor in both methods.
Methods: As much as 67 pregnant women with Bishop score7, single cephalic presentation with gestational age confirmed by first-trimester ultrasound, reactive cardiotocography, and amniotic fluid volume and estimated fetal weight within the respective normal ranges for gestational age were selected. They were randomized into 2 groups: electroacupuncture (AC) or misoprostol (M).
Results: There were no significant differences regarding age, gestational age, fetal weight, parity, Bishop score, or indication for induction. Labor was the main outcome, which was obtained in both groups without significant difference regarding frequency (p = 0.07) and time of induction (p = 0.29). Absence of obstetric complication, higher duration of labor (p = 0.036), and tendency to a higher satisfaction of the patients (p = 0.046) were observed among patients of group AC. Higher frequency of cesarean sections (p = 0.014) and obstetric complications (9.3%) were observed among patients of group M.
Conclusions: Our results showed that electroacupuncture can be used to obtain cervical ripening, with similar results as compared with misoprostol, with a significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications.



Moxibustion for breech presentation: significant new evidence


Smith C, Acupunct Med 2013;31:5-6 Acupuncture in Medicine

In this editorial Caroline Smith from University of Western Sydney, discusses recent findings and analysis (Cochrane Review) of treatment for breech presentation.


In this review moxibustion was not found to reduce the number of non-cephalic presentations at birth compared with no treatment (p=0.45) however it resulted in decreased use of oxytocin before or during labour for women who had vaginal deliveries compared with no treatment (risk ratio (RR) 0.28, 95% CI 0.13 to 0.60) and was found to result in fewer non-cephalic presentations at birth compared with acupuncture (RR 0.25, 95% CI 0.09 to 0.72).
When combined with acupuncture, moxibustion resulted in fewer non-cephalic presentations at birth (RR 0.73, 95% CI 0.57 to 0.94), and fewer births by caesarean section (RR 0.79, 95% CI 0.64 to 0.98) compared with no treatment.
When combined with a postural technique, it was found to result in fewer non-cephalic presentations at birth compared with the postural technique alone (RR 0.26, 95% CI 0.12 to 0.56).



Acupuncture for pelvic and back pain in pregnancy: a systematic review.

Ee CC et al, 2008 Am J Obstet Gynecol Mar;198(3):254-9. American Jnl Obstetrics and Gynecology
This review of 3 trials examining treatment of back and pelvic pain in pregnancy concludes that acupuncture, as an adjunct to standard treatment, is superior to standard treatment alone and physiotherapy.




The objective of our study was to review the effectiveness of needle acupuncture in treating the common and disabling problem of pelvic and back pain in pregnancy. Two small trials on mixed pelvic/back pain and 1 large high-quality trial on pelvic pain met the inclusion criteria. Acupuncture, as an adjunct to standard treatment, was superior to standard treatment alone and physiotherapy in relieving mixed pelvic/back pain. Women with well-defined pelvic pain had greater relief of pain with a combination of acupuncture and standard treatment, compared to standard treatment alone or stabilizing exercises and standard treatment. We used a narrative synthesis due to significant clinical heterogeneity between trials. Few and minor adverse events were reported. We conclude that limited evidence supports acupuncture use in treating pregnancy-related pelvic and back pain. Additional high-quality trials are needed to test the existing promising evidence for this relatively safe and popular complementary therapy.



Acupuncture Alleviates Postpartum Depression

Acupuncture relieves postpartum depression. Researchers conclude that acupuncture combined with psychological intervention has a similar total efficacy rate for the treatment of postpartum depression as the drug fluoxetine hydrochloride (Prozac®). Acupuncture plus psychological intervention had a 90.7% total effective rate and fluoxetine hydrochloride had a 90.5% total effective rate. The researchers note that acupuncture did not cause any adverse reactions but fluoxetine hydrochloride caused nausea, dizziness, and loss of appetite.

Postpartum depression’s biomedical signs and symptoms occur after childbirth and include: mood swings, unhappiness, insomnia, hypersomnia, psychomotor retardation, suicidal tendencies, cognitive dysfunction, low libido, exhaustion, anger, irritability, lack of appetite, not bonding with the baby, low self-esteem. In Traditional Chinese Medicine (TCM), postpartum depression belongs to depression syndrome and may include: depression, low energy, stifling chest sensation, sighing, loss of appetite, insomnia or dream disturbed sleep, frustration, crying, anger, worry, sadness, melancholy.

Subjects in the acupuncture plus psychological intervention group received acupuncture once per day at a rate of five sessions per week for a total of six weeks. The acupuncture needles were 0.35 x 25 mm and were retained for 30 minutes during each acupuncture session. The acupuncture points used in the study were: Baihui (GV20), Sishencong (EX-HN1), Neiguan (PC6), Taichong (LR3), Sanyinjiao (SP6), Zusanli (ST36). Moderate needling techniques were applied to achieve deqi sensations and patient comfortability.

The researchers note, “By regulating the exciting and inhibiting process of the cerebral cortex via the nervous system and immune system, acupuncture is able to balance various neurotransmitters among the intracephalic neuronal synapses, reduce the brain’s reaction to stress, relax the stressful spirit, regulate and treat the physical symptoms and relieve the depressive and anxious state.” They mapped out the acupuncture point selection choices based on TCM theory and note, “Those acupoints in combination are used to correct deficiency and expel blood stasis for both causative factors and symptoms, in order to realize the effects to soothe the liver, regulate qi, wake up the brain and tranquilize the heart-mind.”

GV20 and Sishencong were chosen because, “The head is the gathering site of all yang and the house of the mind.” LI4 and LR3 is the classic Siguan point combination, often referred to as the four gates in English. The researchers note that both are yuan-primary points and together they regulate qi, blood, yin and yang. They also “soothe the liver and regulate qi, open the orifice and calm the mind.” PC6 was cited as a luo-connecting point that benefits heart qi and calms the mind. SP6 was chosen for its ability to access the three yin meridians of the foot and for its ability to regulate qi and blood. ST36 was chosen for its ability to benefit stomach qi, source qi and blood production.

The researchers contrasted integrative complementary medicine with a conventional drug therapy approach to care. Both approaches achieved similar positive patient outcomes. However, the acupuncture plus psychological intervention regime caused no adverse effects whereas the medication regime of care caused several adverse effects.

In related research, a meta-analysis of 87 papers published between 2002 and 2012 finds acupuncture effective in the treatment of labor pain and for the treatment of postpartum complications. Acupuncture was also found effective in inducing uterine contractions and shortening the birthing process. The report calls for continued research on acupuncture, herbal medicine and other forms of complementary medicine for the treatment of human reproductive issues.

An important study on acupuncture for the treatment of depression was recently conducted by University of York researchers. In a randomized controlled trial, the researchers note that acupuncture causes a “significant reduction in symptoms of depression in the short to medium term, and are not associated with serious adverse events.” The researchers conclude that acupuncture is both safe and effective as an adjunct therapy to primary care for patients with depression.

A related laboratory investigation demonstrates that acupuncture benefits brain biochemistry and regulates gene expression related to depression. The researchers conclude that electroacupuncture treats “depression by modifying or regulating the expression of various genes.” Electroacupuncture was applied to acupuncture points Baihui (DU20) and Yintang on depression model laboratory rats.

The research shows that depression causes “abnormal gene expression” in “a large number of genes” and this affects “multiple brain functions” and nerve cells. Depression causes pathological biochemical changes and these changes cause more depression. The researchers note, this “vicious circle makes it difficult to cure conditions such as depression.” They add “that electroacupuncture at Baihui and Yintang modulates depression by regulating the expression of particular genes.”

A total of 21 genes imbalanced by depression were normalized by the application of electroacupuncture. The researchers note that all 21 genes “were closer to a normal level” after the application of electroacupuncture. Clinically, electroacupuncture restored normal behaviors in the laboratory rats including actions in sucrose consumption, the swim test and the open field test.

Genes were examined in the hippocampus. The genes Tmp32, Vgf:Tmp32 and Vgf are downregulated during depression and are normalized through upregulation with electroacupuncture. The genes regulate neuroactive steroid hormones important to the nervous system. They regulate the function of the synapses, inflammation, myelination, the central nervous system and the HPA axis. The gene Trim32 “was downregulated in depression and returned to normal after electroacupuncture.”

The same was found for Igf2, a gene that promotes nerve cell proliferation and increased neurotransmitter levels between synapses. In the same way, Loc500373 and other genes were normalized. Loc500373 is involved in ATP formation and energy metabolism. Electroacupuncture was shown to “promote ATP formation” and consequently improved cell function. Electroacupuncture normalized Rtn4 gene levels and restored normal brain protein biosynthesis. Electroacupuncture normalized levels of Hifla, an important gene that regulates cellular apoptosis.

Electroacupuncture successfully downregulated genes involved in oxidative stress and inflammation that had been pathologically upregulated by depression. The investigators note that normalization caused by electroacupuncture benefits the brain by “maintaining tissue structure” and “restoring cell function.” The researchers note this provides “evidence to the observed clinical effect of electroacupuncture on depression.” The study shows that acupuncture normalizes gene levels involved in transcription/translation, neurotransmission, signal transduction, immune system inflammatory responses, metabolism, enzymatic reactions and protein biosynthesis.

Huang, Han-ling, Li Peng, Su Zheng, and Lu-shan Wang. “Observation on therapeutic effects of acupuncture plus psychological intervention for postpartum depression.” Journal of Acupuncture and Tuina Science 12, no. 6 (2014): 358-361.

Wu, Xiaoke, E. H. Ng, Elisabet Stener-Victorin, and Richard S. Legro. “Effects and Mechanisms of Complementary and Alternative Medicine during the Reproductive Process.” Evidence-based complementary and alternative medicine: eCAM 2014 (2014).

MacPherson, H., S. Richmond, M. Bland, S. Brealey, and R. Gabe. “Acupuncture and Counselling for Depression in Primary Care: A Randomised.” (2013).

Duan, Dongmei, Xiuyan Yang, T. Ya, and Liping Chen. “Hippocampal gene expression in a rat model of depression after electroacupuncture at the Baihui and Yintang acupoints.” Neural Regeneration Research 9, no. 1 (2014): 76.