1. Acupuncture & Fertility What is the research telling us? Vicki Ball M.BHSc (Acu)

2. Fertility and Acupuncture what can we do

3. Research ACUPUNCTURE & IVF

4. Acupuncture & IVF Reduce uterine artery resistance Modulate immune response Relaxation prior to surgical procedures

5. Acupuncture on Day of Transfer Choong, 2008 (Cochrane Review) –13 RCTs reviewed in meta-analysis

6. Acupuncture on Day of Transfer Choong, 2008 (Cochrane Review) –13 RCTs reviewed in meta-analysis AcupunctureControl Clinical pregnancy rate 1022 women 39% 201/518 30% 150/504 Ongoing pregnancy rate 769 women Live Birth Rate 542 women

7. Acupuncture on Day of Transfer Choong, 2008 (Cochrane Review) –13 RCTs reviewed in meta-analysis AcupunctureControl Clinical pregnancy rate 1022 women 39% 201/518 30% 150/504 Ongoing pregnancy rate 769 women 32% 126/384 21% 81/385 Live Birth Rate 542 women

8. Acupuncture on Day of Transfer Choong, 2008 (Cochrane Review) –13 RCTs reviewed in meta-analysis AcupunctureControl Clinical pregnancy rate 1022 women 39% 201/518 30% 150/504 Ongoing pregnancy rate 769 women 32% 126/384 21% 81/385 Live Birth Rate 542 women 35% 95/275 22% 59/267

9. Miscarriage rates- Acupuncture on day of transfer AcupunctureControl 409 women 4% 9/204 5% 10/205 No statistical difference

10. Acupuncture before & after transfer + 2 days 2 studies (Dieterle, 2006; Westergaard, 2006) AcupunctureControl Clinical pregnancy rate 403 women 35% 72/207 19% 38/196 Ongoing pregnancy rate 403 women 28% 57/207 16% 32/196 Live Birth Rate 403 women 28% 57/207 17% 34/196

11. Miscarriage rates- Acupuncture before & after transfer +2 days AcupunctureControl 403 women 14% 30/207 9% 18/196 No statistical difference

12. Acupuncture around time of oocyte retrieval Studies performed show no significant difference in quality or quantity of oocytes retrieved. Better live birth rates if electro- acupuncture used as anesthetic rather that alfentanil (28/75 acupuncture 19/74 alfentanil)

13. Acupuncture around time of oocyte retrieval Clinically – too late Beneficial to have acupuncture following day to help speed recovery after surgical procedure – swelling, pain, inflammation. Ensure integrity of endometrium to allow for viable implantation.

14. Hypothalamic-Pituitary-Adrenal- Ovarian Axis (HPAO) Stress and its role in unexplained infertility..?

15. .

16. How does acupuncture affect the HPA? affects plasma beta endorphin affect the HPA by altering the release of hypothalamic gonadotrophin releasing hormone (GnRH) & pituitary gonadotrophin secretion.

17. Women Ovulation induction Increase microcirculation to reproductive organs Regulate hypothalamic-pituitary- ovarian axis Increase up-regulation of body’s own hormones

18. Acupuncture modulates immune factors influences specific and nonspecific cellular and humoral immunities. activates cell proliferation, including blood, reticuloendothelial, and traumatised cells. activates leucocytosis, microbicidal activity, antibodies, globulin, complement, and interferon. modulates hypothalamic-pituitary control of the autonomic and neuroendocrine systems. Rogers, 1992 Acupuncture for Immune-Mediated Disorders

19. Immune/ Inflammatory related disorders causing fertility problems Immune Endometriosis Failure of embryo to implant & miscarriage Thyroid disorders eg.Hashimotos Inflammatory High TNF alpha associated with repeated implantation failure in IVF

20. Treatment – men vs. women www.flatrock.org.nz

21. Man Increase sperm quality & quantity – morphology - motility Increase semen quality Faster results combining Chinese Herbal medicine with acupuncture

22. Questions?.

23. Moxa heat radiating down Stomach channel Schlebusch, K. P., Maric-Oehler, W., & Popp, F. A. (2005). Biophotonics in the infrared spectral range reveal acupuncture meridian structure of the body. J Altern Complement Med, 11(1), 171-173.

24. Propagated sensations along channels (PSCs/PSMs) Reported PSCs during acupuncture correspond to EMG changes (Bensoussan, 1984) PSCs follow pathways which closely correspond to channels (Ji, 1981) PSCs travel at a slower rate than nerve conduction PSCs travel at 3.5 – 10 cm/sec (Bensoussan,1994) A  fibres conduct at 6.3 m/sec [630 cm/sec] C fibres conduct at 0.5 – 2 m/sec [50-200 cm/sec] PSCs have been observed in many races (Deng, 1993) PSCs are frequently associated with clinical efficacy of acupuncture (Deng, 1993) PSCs can be blocked by mechanical pressure of more than 500 -1,00gm/mm 2 (Ji, 1981)