Most of my patients prefer to be informed, so I have provided a solid collection of research reports that provide summaries of the research undertaken and the results.
When you visit an acupuncturist, you don’t get study treatment, you get individualised care, your acupuncturist gets to know you, lifestyle, diet and environment advice is provided and is taken into account in the treatment. Assistance from other fields might be incorporated into the plan with the aim of getting you results. For example, fatigued clients can see their GP to have thyroid levels checked, iron levels, they may see a psychologist to help with emotional issues or start at the gym to get pent-up energy moving.
Yes this can be heavy reading for those who don’t have a background in medicine, but I would be happy to answer any questions in regards to the research during my consultations.
But first, a note of caution. Before clicking through to read the research below please take into consideration researching acupuncture is challenging.
- It’s expensive and funds aren’t readily available
- It’s very difficult to blind (term for making the participant or treatment giver unaware if the care is the active acupuncture or nonactive control). The devices used now as an assumed non-active control are actually showing to have an effect on the body, so controversy abounds as to their usefulness.
- Statistical analysis prefers large samples, this means running bigger studies which brings with it difficulties of finding experienced acupuncturists able to leave their own clinic and devote the time required for a large study.
- Trials prefer standardised treatment, this is the same points or groups of points for each participant, this runs completely against the concept of Chinese medicine, where the individual’s diagnosis governs point selection. This lack of individualisation means we often are testing a prescribed point selection being given to a random group, some of whom it will suit some it won’t, and comparing that to a group given random needling of true or nonacupuncture points. (ie not all nausea suffers have the same Chinese diagnosis, it may be a stagnation issue, heat issue or deficiency- so different points are needed).
- Recruiting for studies can be difficult if there is a ‘standard care’ allocation, rather than risk ending up in a group that get no treatment clients may choose not to enter the trial, or they enter and then withdraw because they have no incentive to continue.
Doing systematic reviews adds more challenges, because of the heterogeneity- that is variation between studies, ie different points are used, length of sessions, timing of sessions, different inclusion and exclusion criteria, different manner of measuring outcomes, ie 1 study may rate nausea symptoms on a scale of 1 to 10, another may have used a different scale or look at how much ‘quality’ sleep clients got or how daily life was affected.
So often the study states low level of evidence, insufficient evidence, or no ability to conclude- this is not the same as saying acupuncture doesn’t work! It means that study or review was not able to draw a conclusion, or because of methodology issues not results the evidence was down graded.
Listed below are examples of research currently available, treatment for mentioned conditions may not be available at this clinic,or may vary from the protocol mentioned in the studies. Please call or text to discuss your individual situation.
Acupuncture and IVF
A review on the Role of Acupuncture in IVF
Acupuncture and IVF research: current and future directions
Acupuncture just on or around transfer day did not improve results but did reduce stress. The review did find collating studies difficult due to the great variation in methods. They found evidence that several sessions of acupuncture improved endometrial thickness, reduced stress, and improved client satisfaction. Observational studies found importantly an increase in clinical pregnancies and live births
Studies done in the early 2000’s showed limited acupuncture sessions done on and around the day of transfer could increase IVF success rates. Current research is less supportive of limited sessions and indicates receiving more sessions of acupuncture is beneficial to improve live births. Acupuncture done just on the day of transfer, and possibly once before or after cannot result in higher LIVE BIRTHS because a short course of acupuncture cannot correct issues for the whole time of egg production, implantation, early placentation and the rest of pregnancy. Although sessions just at transfer may well reduce stress and anxiety around transfer and IVF (Shen et al 2014).
Clients in the early acupuncture IVF studies were far more likely to have conception difficulties around egg and sperm meeting (conditions such as sperm factor and tubal factors) (Paulus et al 2002, Smith et al 2006, Dieterle et al 2006). Recent study participants were diagnosed with more underlying factors such as endometriosis, PCOS, premature ovarian failure, and “unexplained infertility”, probably reflecting a change in the clientele now looking to IVF to assist fertility. These underlying issues need to be addressed.
Systematic reviews in 2013(Manheimer et al) showed minimal effect when treatment was only concentrated on transfer day, whereas increased sessions of acupuncture showed pooled benefit 2014 (Shen et al), and in 2017(Qian et al).
This study showed that acupuncture did not significantly improve the IVF clinical pregnancy rate when performed only at the time of ET, while they found pooled benefit of acupuncture for IVF when performed at follicle phase and 25 min before and after ET, as well as 30 min after ET and implantation phase.
A systematic review on the effects of acupuncture on rates of clinical pregnancy among women undergoing IVF
This systematic review included ONLY studies of acupuncture on or close to transfer day. It found no pooled benefit, although in studies with lower baseline rates, there was benefit shown, which could not be explained.
A review on the therapeutic effect of acupuncture on the outcomes of IVF
Part of the previous systematic review (above), this review found acupuncture improved clinical pregnancy rates, particularly when electro acupuncture was used.
IVF and Stress: A Comparison of Stress Levels in Women Undergoing Single versus Multiple Acupuncture Session Prior to Embryo Transfer
This study highlighted the added benefit of seeing a clinic well versed in the process of IVF and the stress it creates. Their conclusion said “stress remains significantly elevated for women undergoing only one session of acupuncture on the ET day. However, when undergoing multiple acupuncture sessions, stress scores were significantly lower. As demonstrated by a dose-dependent effect, acupuncture appears to be a promising stress-lowering tool for women undergoing IVF. Further research will require a comparison of IVF outcomes with and without acupuncture.”
Impact of whole systems traditional Chinese medicine on IVF outcomes
This study compared Chinese medicine treatment that allowed the clinician to treat using acupuncture, herbs, and advice on lifestyle. Etc. This is how this would happen if you saw an acupuncturist not bound by study design.
As compared to IVF alone, and IVF with only transfer day treatment. Acupuncture preformed as it would be in a clinic was found to give greater chance of a live birth, although it is noted a more rigorous study is required.
Polycystic Ovarian Syndrome (PCOS)
Infertility in Polycystic Ovary Syndrome treated with acupuncture and clomiphene
This Chinese study found with up to 3 cycles of treatment combining Acupuncture, Clomid and Chinese herbs gave better results than medication alone or TCM alone. Results were based on pregnancy rates, miscarriage rates, cervical mucus, and the thickness and maturation of the uterine lining.
Low Ovarian Reserve / Poor Responder
Electroacupuncture for reproductive hormone levels in patients with diminished ovarian reserve
This study treated women with diminished ovarian reserve. Acupuncture reduced elevated FSH, increased oestrogen levels, and improved the FSH/LH balance. Objectively 30% of women saw improved menstrual flows, and irritability was reduced.
Influence of acupuncture on the outcomes of IVF when embryo implantation has failed
This study looked at women with two failed IVF attempts. It used acupuncture and moxibustion and found a significantly higher number of women receiving acupuncture were successful.
Effects of “menstrual cycle-based acupuncture therapy” on IVF-ET in patients with decline in ovarian reserve
This study showed acupuncture given to women with diagnosed diminished ovarian reserve increased antral follicle counts, oestrogen levels, number of retrieved eggs, number of quality embryos, fertilisation rate and clinical pregnancy rate.
Cochrane Review, Chinese herbal medicine and unexplained recurrent miscarriage
This review found limited evidence (this is the usual difficulty of small studies for treating recurrent miscarriage with Chinese herbs) However they did find from the limited data that combining Chinese herbs and pharmaceuticals may be more effective than western treatment alone.
Premature Menopause / Ovarian Failure
A pilot study on the effect of acupuncture on Premature Ovarian Failure
This study investigated acupuncture for premature ovarian failure, results indicated acupuncture may reduce FSH and LH levels, raise oestrogen, relieve anxiety, reduce mental stress and improve menopausal symptoms. Although it was not fertility directed the changes seen are helpful to women attempting conception, particularly women with a FSH level too high for IVF.
Effectiveness of Acupuncture for Primary Ovarian Insufficiency
This systematic review was unable to make firm conclusions due to a lack of studies and poor design, they did however find acupuncture did significantly restore menstruation as well as improve hormone levels
Chinese Herbal Medicine and Premature Ovarian Failure
Chinese Herbal Medicine for premature ovarian failure
This systematic review found Chinese herbal medicine may relieve symptoms of premature ovarian failure partly through decreasing serum FSH levels
Pelvic Inflammatory Disease
Effect of acupuncture on inflammatory cytokines in patients with acute Pelvic Inflammatory Disease
This study found Acupuncture can regulate the levels of inflammatory markers in patients with acute pelvic inflammatory disease, and improve clinical symptoms. Inflammation is known to reduce implantation success.
Effects of acupuncture for the treatment of endometriosis-related pain
This systematic review looked at the use of acupuncture for endometriosis related pain not fertility, but it showed effect at reducing pain and reducing CA125 levels. CA125 levels have been suggested as a means of monitoring treatment effect for endometriosis.
A review using complementary and alternative medicine for Endometriosis
This review found therapies such as acupuncture, Chinese herbs and microwave physiotherapy may effectively modulate the progress of endometriosis by shrinking the lesions, suppressing the symptoms, and decreasing the recurrence rate.
RESEARCH OF PREGNANCY AND ACUPUNCTURE
Safety in pregnancy
The safety of acupuncture during pregnancy: a systematic review
This review looked at the safety of acupuncture and concluded acupuncture is associated with few adverse reactions when correctly applied.
Induction of labour
Acupuncture or acupressure for induction of labour
Cochrane review of labour induction by acupressure or acupuncture, 2017 Smith et al was unable to conclude if these interventions successfully induced labour because none of the studies recorded labours not induced within 24 hours of the treatment. The review was made difficult by the great variance in the studies, acupuncture and acupressure, manual and electro acupuncture, inductions done preterm and post term, the number and length of session, comparisons with ‘usual medical care’ and “sham acupuncture” devices. The end conclusion was acupuncture and acupressure did not reduce the number of caesarean sections required but did improve the favourability of the cervix for labour. Being unable to conclude if labour was successfully induced is not the same as saying acupuncture was not able to induce. A change in the definition of induction to having to have taken effect with 24 hours meant all the studies were missing key information.
Looking at the 4 studies in this review that used electro acupuncture (the method employed in this clinic) vs usual medical care results showed the Mean time to delivery occurred 21 hours sooner in the acupuncture group, but this difference did not reach statistical significance (p = 0.36). Compared to controls, women in the acupuncture group tended to be more likely to labour spontaneously (70% vs. 50%, p = 0.12) and less likely to deliver by caesarean section (39% vs. 17%, p = 0.07). Of women who were not induced, those in the acupuncture group were more likely to be delivered than the controls at any point after enrolment (p = 0.05). (Harper et al 2008, Gaudet et al 2010, Gribel et al 2011, Anderson et al 2013)
Acupuncture for nausea and vomiting: An update of clinical and experimental studies
A 2015 Cochrane review of interventions for nausea and vomiting in early pregnancy (Mathews A et al) examined studies looking at acupressure to the P6 point on the wrist, acustimulation, acupuncture, ginger, chamomile, vitamin B6, lemon oil, mint oil, and several drugs that are used to reduce nausea or vomiting. They found a lack of high-quality evidence to support any particular intervention. This is not the same as saying that the interventions studied are ineffective, but that there is insufficient strong evidence for any one intervention.
A 2006 review (Streitberger K et al) Found for pregnancy-related nausea and vomiting, results were mixed, but there is good clinical evidence from more than 40 randomised controlled trials that acupuncture has some effect in preventing or attenuating nausea and vomiting.
This review found that although there is some effect for acupuncture at preventing or attenuating nausea and vomiting, the results in pregnancy are mixed.
Interventions for nausea and vomiting in early pregnancy
This review was updated in 2015, but still only included two acupuncture studies, both of which used sham acupuncture as a control. The review found no significant effect from acupuncture. The point selection used in these trials is very different to those used in my clinic.
Back Hip and Pelvic pain
Interventions for preventing and treating pelvic and back pain in pregnancy.
The Cochrane review found acupuncture to be effective for low back and pelvic pain and to be more effective than physiotherapy or exercise therapy.
Acupuncture for Carpal Tunnel Syndrome: A Systematic Review of Randomized Controlled Trials
This review found evidence for acupuncture was encouraging but not convincing, again citing a lack of studies, and methodology as low.