Acupuncture for Infertility in Women
This summary is intended to illustrate Acupuncture for Infertility in Women, as an example of a method of treatment that has become more established in Western medicine over the last decade. Discussed are the scientific documentation, the physiological basis for the use of acupuncture and evidence for the use of acupuncture in this area. There are unfortunately few well-designed papers on the effectiveness of acupuncture in the field of infertility. The underlying mechanisms of acupuncture are often described in the language of Traditional Chinese Medicine (TCM), and surprisingly few penetrating discussions have dealt with the physiological background of acupuncture.
What is it that make us think that acupuncture can have an effect on different conditions in reproductive medicine? In acupuncture both physiological and psychological mechanisms may be involved . Much simplified it could be explained as follows.
Both acupuncture and electro-acupuncture (EA) stimuli excite mechanoreceptors with low and high thresholds in muscles and other tissues. By stimulation of muscle afferents in somatic segments according to the innervation of the ovaries and the uterus, it is thought that inhibitoring systems in the spinal cord are activated, resulting in segmental inhibition of sympathetic outflow and pain pathways as predicted by the gate control theory.
At the same time, interneurons connected to higher control systems are excited. This results in the release of ß-endorphin via two different systems. One system includes the hypothalamus and neuronal network that projects to the midbrain and brainstem nuclei which in turn activate two pain-alleviating, descending neuronal pathways: the serotoninergic (5-HT) and the (NA) systems. There is also evidence that the hypothalmic ß-endorphin system has a central role in changes seen in autonomic functions after acupuncture. This is probably due to an inhibition of the vasomotor centre (VMC) resulting in a sustained decrease of general sympathetic tone.
In the other system is ß-endorphin released into the blood from hypothalamus via the anterior pituitary. This release is regulated by corticotropin-releasing factor (CRF). CRF promotes the release of ß-endorphin, adrenocorticotrophic hormone (ACTH) and melanocyte-stimulating hormone (MSH) in equimolar amounts through stimulation of the synthesis of their precrusor pro-opiomelanocortin (POMC). These hormones exert their effects in different target organs via the bloodstream. Stress increases the activity of the hypothalamo-pituitary-adrenal (HPA) axis and decreases reproductive functions.
In addition, acupuncture is probably one of the most effective non-pharmacological methods in terms of activating placebo effects. Indeed, acupuncture works by stimulating endogenous opioids and so, it appears, does the placebo effect.
The described findings with regard to the central ß-endorphinergic release and the decreased sympathetic tone support the idea that EA may be effective in reproductive medicine.
Is there evidence for the use of acupuncture for infertility in women?
Many childless couples hoping for pregnancy try acupuncture, but what evidence do we have today that tell us if acupuncture affects the pregnancy rate? There are a large number of studies when search on MEDLINE – most of them is in Chinese or Russian and have only English abstracts. Below you find a review of some relevant article in the area.
Gerhard et al. 1992: Infertility – auricular acupuncture
90 infertile women with recognised hormonal disorders; 45 women received auricular acupuncture over 12 sessions and were compared with 45 matched women, which received conventional hormonal therapy. Pregnancy rates – no difference between the groups. Additionally, side-effects were fewer and tendency to misscarry was lower in the acupuncture group.
Xiaoming et al. 1993: Undefined anovulation
Thirty-four women with undefined ovulatory dysfunction were treated on average 30 times with manual acupuncture according to TCM theory. Twelve get bipahsic basal body temperature curve BBT in more than 2 cycles and/or pregnancy. In addition, a regulatory effect on plasma concentrations of gondatropins and estogen, indicates an influence on the HPG axis.
Chen et al 1991: Anovulation – polycystic ovary syndrome (PCOS)
Eleven women with anovulation (9 with PCOS) and five healty controls were given 4-5 Hz EA for ovulation induction, 3 days per cycle in 3 cycles. Ovulation induction was shown in 6 of 13 cycles, in the anovulatory women. The plasma ß-endorphin concentrations decreased and the hand skin temperature increased significantly after EA treatment. The EA effect was attributed to an inhibition of high activity in the sympathetic nervous system.
Stener-Victorin et al 2000: EA – Anovulation – PCOS
Twenty-four women with well defined PCOS (typical ultrasonographic appearance, no more than 4 bleeding per year) were given 2 Hz EA twice a week for 2 weeks and then once a week, altogether 10–14 treatments. Interestingly, the LH/FSH ratio, the testosterone concentrations and the ß-endorphin concentrations decreased significantly following EA when all the participants were analysed together and blood samples before the EA period were compared with the samples taken 3 months after the last EA treatment.
This results is also supported by experimental data.
In conclusion, it appears that acupuncture may have a beneficial effect on women with PCOS and anovulation, and might serve as a complement to first line therapy in ovulation induction supported by both clinical and experimental evidence. Acupuncture has not been shown to improve the pregnancy rate. However, there is a need for more RCTs in well-defined diagnoses.