Infertility is the inability of a couple to get pregnant despite having regular unprotected sex. A couple is regarded as infertile if, after regular sexual intercourse, they have not conceived in two years. It is estimated that one in seven UK couples has difficulty conceiving (HFEA, 2006). Identifiable causes of infertility include: ovulatory disorders in 27% of couples; tubal damage in 14% of couples; low sperm count or low sperm quality in 19% of couples. In 30% of couples the cause of infertility remains unexplained (NCCWCH, 2004). Female fertility declines with age, but the effect of age on male fertility is less clear (NICE, 2004). The difficulties couples encounter when facing fertility problems can lead to stress, which may further decrease chances of conception (Eugster & Vingerhoets, 1999). Acupuncture is a popular treatment choice for infertility (Smith 2010). How acupuncture can help Randomised trials in China have demonstrated significantly better pregnancy rates for acupuncture than medication (Yang 2005, Chen 2007, Song 2008), but these studies may not be of a high quality. In the West, clinical trials on acupuncture for natural fertility (i.e. not as an adjunct to assisted conception) are almost non-existent, though there is a small amount of positive evidence (Gerhard 1992, Stener-Victorin 2000, 2008, 2010). Research has established plausible mechanisms to explain how acupuncture may benefit fertility:
regulating fertility hormones – stress and other factors can disrupt the function of the hypothalamic pituitary-ovarian axis (HPOA), causing hormonal imbalances that can negatively impact fertility. Acupuncture has been shown to affect hormone levels by promoting the release of beta-endorphin in the brain, which affects the release of gonadotrophin releasing hormone by the hypothalamus, follicle stimulating hormone from the pituitary gland, and oestrogen and progesterone levels from the ovary (Ng 2008, Huang 2008, Lim 2010, Stener-Victorin 2010). Further details of these processes are emerging, for example mRNA expression of hormones, growth factors and other neuropeptides (He 2009)
increasing blood flow to the reproductive organs – stress also stimulates the sympathetic nervous system, which causes constriction of ovarian arteries. Acupuncture inhibits this sympathetic activity, improving blood flow to the ovaries (Stener-Victorin 2006, Lim 2010), enhancing the environment in which ovarian follicles develop. It also increases blood flow to the uterus (Stener-Victorin 1996, Huang 2008), improving the thickness of the endometrial lining and increasing the chances of embryo implantation.
counteracting the effects of polycystic ovarian syndrome (PCOS) – PCOS is one of the most common causes of female infertility. By reducing sympathetic nerve activity and balancing hormone levels, acupuncture has been shown to reduce the number of ovarian cysts, stimulate ovulation, enhance blastocyst implantation and regulate the menstrual cycle in women with PCOS (Stener-Victorin 2000, 2008, 2009, Zhang 2009). It may also help to control secondary effects such as obesity and anorexia (Lim 2010).
References Eugster A, Vingerhoets AJ. Psychological aspects of in vitro fertilization: a review. Soc Sci Med. 1999 Mar;48(5):575-89. Human Fertilisation and Embryology Authority (HFEA) Facts and figures for researchers and the media. (2006) www.hfea.gov.uk National Collaborating Centre for Women’s and Children’s Health Fertility (NCCWCH) Fertility: assessment and treatment for people with fertility problems (full NICE guideline). Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk National Institute for Health and Clinical Excellence (NICE) Fertility: assessment and treatment for people with fertility problems (NICE guideline). Clinical guideline 11. (2004) www.nice.org.uk Smith JF, Eisenberg ML, Millstein SG, Nachtigall RD et al. The use of complementary and alternative fertility treatment in couples seeking fertility care: data from a prospective cohort in the United States. Fertil Steril. 2010;93(7):2169-74.