Currently, about 17% couples in industrialised countries seek medical advice for infertility (Cahill 2002). The definition of infertility is usually the failure to conceive after 1 year of unprotected intercourse (European Society 1996). Infertility can be primary, in women who have never conceived, or secondary, in women who have previously conceived. In the UK, about 10-20% of infertility cases are unexplained (Isaksson 2004). The rest are the result of ovulatory failure (27%), tubal damage (14%), endometriosis (5%), low sperm count or quality (19%), or other causes (5%) (Effective Health Care 1992).
In developed countries, 95% of couples attempting to conceive are successful after 2 years (Brosens 2004). However, the chances of becoming pregnant vary with the cause and duration of infertility, the woman's age, the woman's previous pregnancy history, and the availability of different treatment options (Templeton 1998, Collins 1995). For the first 2-3 years of unexplained infertility, cumulative conception rates are 27-46% but decrease with increasing age of the woman and duration of infertility (Collins 1995).
The aims of infertility treatment in conventional medicine are to achieve the delivery of one healthy baby, and to reduce the distress associated with infertility, with minimal adverse effects. Interventions include intrauterine insemination plus controlled ovarian stimulation, in vitro fertilisation, intracytoplasmic sperm injection, gonadotrophin releasing hormone agonists, clomifene and tamoxifen, laparoscopic ovarian drilling, tubal flushing and laparoscopic ablation of endometrial deposits, depending on the cause of the infertility (Al-Inany 2004).
Al-Inany H. Female infertility. BMJ Clinical Evidence. Search date April 2004.
Brosens I, Gordts S, Valkenburg M, et al. Investigation of the infertile couple: when is the appropriate time to explore female infertility? Hum Reprod 2004;19:1689 -92.
Cahill DJ, Wardle PG. Management of infertility. BMJ 2002;325:28-32.
Collins JA, Burrows EA, Willan AR. The prognosis for live birth among untreated infertile couples. Fertil Steril 1995;64:22-8.
Effective Health Care. The management of subfertility. Effective Health Care Bull 1992;3:13.
European Society for Human Reproduction and Embryology. Guidelines to the prevalence, diagnosis, treatment and management of infertility, 1996. Hum Reprod 1996;11:1775-807.
Isaksson R, Tiitinen A. Present concept of unexplained infertility. Gynecol Endocrinol 2004;18:278-90.
Templeton A, Morris JK. IVF - factors affecting outcome. In:Templeton A, Cooke ID, O'Brien PMS, eds. 35th RCOG study group evidence-based fertility treatment. London: RCOG Press, 1998:265-73.
How acupuncture can help
Most clinical trials to date suggest that acupuncture may be useful in the embryo transfer stage of in vitro fertilisation, and results in an increased pregnancy rate and a greater number of live births (Cheong 2008, Manheimer 2008, Kong 2009, Chen 2009, Smith 2006, Westergaard 2006), though there have been exceptions (Domar 2009) (see Table overleaf). In one recent large trial the pregnancy rate in the acupuncture group was lower than that of the control (So 2009), thus affecting the results of subsequent reviews (Cheong 2010). This trial used an inappropriately active control treatment, a sort of acupressure, thus casting doubt on the validity of the findings.
Acupuncture may help in the treatment of infertility by:
- regulating fertility hormones - stress and other factors can disrupt the function of the hypothalamic pituitary-ovarian axis (HPOA). Acupuncture promotes the release of beta-endorphin in the brain, which regulates gonadatrophin releasing hormone from the hypothalamus, follicle stimulating hormone from the pituitary gland, and oestrogen and progesterone levels from the ovary (Anderson 2007).
- increasing blood flow to the reproductive organs (Ho 2009, Anderson 2007), which can improve the thickness of the endometrial lining, so increasing the chances of embryo implantation.
- increasing egg production (Jin 2009) and improving oocyte quality (Chen 2009), which could increase the chance of fertilisation.
- enhancing luteal function (Huang 2009)
- regulating follicle stimulation hormone-receptor expression (Jin 2009).
- normalising cortisol and prolactin levels on IVF medication days (Magarelli 2008); reducing stress (Anderson 2007)
- promoting embryo implantation (Liu 2008).