New patients to the Hewitt Fertility Centre receive an information pack containing various leaflets and booklets detailing all they may encounter whilst seeking to achieve their aim of parenthood. Amongst this paper trail of detail is one leaflet that, for me at least, stands out, it’s the leaflet entitled "Acupuncture, Supporting you & your IVF programme". How does a millennia old practice with its roots in traditional East Asian medicine fit with one of the pinnacles of modern medical science? I often wonder what patients make of the juxtaposition of two practices that, on the face of it, are so far apart.
It was with this in mind that I prepared my recent talk to the Patient Support Group at the Hewitt Fertility Centre’s Knutsford clinic.
Traditional Chinese Medicine (TCM) has much to say about both men and womens’ health as well as fertility in particular yet to appreciate what it recommends requires a level of understanding of the models of health it is based upon. For me, to interpret acupuncture from a modern, scientific basis has two difficulties; it ignores the cultural and historical context of the models plus it is attempting to apply an inappropriate system of understanding. It's a bit like trying to establish directions from location A to B when you only know the way from C to B. What does interest me is research into where acupuncture produces results and this is where supporting fertility with acupuncture has shown to be of value.
When treating more everyday conditions with acupuncture there is flexibility around frequency of treatment and applicability of lifestyle advice dependent upon the nature of the ailment. Acupuncture at the Hewitt Fertility Centre often presents a different situation; acupuncture is being presented at an advanced stage of treatment, often within the last month or two. What then do I, as an acupuncturist, seek to do? There are three main priorities:
1. To treat the effects of the medication
2. To support the patient emotionally
3. To continue to address any underlying TCM pathology
So when you look at the Treatment booklet for Patients and Carers it tells you that with the down regulation drugs you may experience headaches, hot flushes and mood swings; that the ovarian stimulation injections may lead to patients experiencing abdominal swelling and bloating. Whilst TCM doesn’t have a concept of down regulation or ovarian stimulation it has various interpretations of headaches, hot flushes, mood swings and bloating which can be used effectively in these circumstances, utilising the TCM interpretation of the patients underlying health. In this way we tailor the acupuncture treatment to the patient; it is rare that an acupuncturist follows a set protocol although there are one or two exceptions.
In 2002 a research paper was published on what has become known as the Paulus Protocol1, detailing a prospective randomised controlled trial seeking to determine whether acupuncture improves the clinical pregnancy rate after IVF or ICSI treatment. The acupuncture group received a set acupuncture treatment prior to and after the embryo treatment; the analysis shows that the pregnancy rate for the acupuncture group was considerably higher than the control group i.e. clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, compared to 26.3% (21 out of 80 patients) in the control group. At the Hewitt Fertility Centre, those patients requesting acupuncture at the time of embryo transfer receive the same protocol as that used in the study.
This type of research has the great advantage that pregnancy is a purely objective outcome leaving less room for distracting debate about placebo effects; an embryo transfer either leads to pregnancy or it doesn’t. A later systematic review and meta-analysis2 published in 2008 brought together a range of findings to conclude that "acupuncture increased the odds of clinical pregnancy by 65% compared to control groups” and that whilst this could be an overestimate, argued these were still "clinically relevant benefits". Many patients find this a compelling reason to have acupuncture during their treatment at the Hewitt.
The patients I see at the Hewitt's Knutsford Clinic choose to have acupuncture for a number of reasons: some are seeking relaxation, some support during their treatment; others have read about this type of research on the various forums available on the internet whilst others have benefitted from acupuncture before. Whatever your motivation to choose acupuncture rest assured the acupuncturists at both Knutsford and Liverpool are all members of the British Acupuncture Council and specialise in supporting fertility treatment programmes.
Mark Guggiari provides acupuncture at the Hewitt Fertility Centre, Knutsford and is a member of the British Acupuncture Council and Acupuncture Fertility Network. Patients at the Hewitt, Knutsford can contact him on 07887 551963.
Acupuncture is also available at the Hewitt in Liverpool Women’s Hospital; contact Norma Rodgers on 07739 693906.
1 Paulus,W., Zhang, M et all (2002). Influence of Acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and Sterility, 77(4). 721-724
2 Manheimer, E., Zhang, G., Udoff, L.,Haramati, A., Langenberg, P., et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis BMJ 2008; 336 :545