Can acupuncture be used to treat infertility?

Acupuncture, frequently combined with herbal medicine, has been used for centuries to treat
some but not all causes of infertility. For example, acupuncture and herbs will not work to
address tubal adhesions which can occur as a result of pelvic inflammatory disease or
endometriosis.

However, in this situation, an individual could still benefit from acupuncture and herbs
because of the potential effect of improved ovarian and follicular function. Additionally,
acupuncture can increase blood flow to the endometrium, helping to facilitate a thick, rich
lining.

When should acupuncture treatment begin?

Acupuncture is similar to physical therapy in that it is a process-oriented method of medical

intervention. It is better to do more than less. Patients are commonly treated for three to four
months before progressing to insemination, in vitro fertilization (IVF), or donor-egg transfer.
This pacing of treatment seems to have a therapeutic effect.

In a study by Stener-Victorin et al from the Departments of Obstetrics and Gynecology Fertility

Centre, Scandinavia and University of Gothenburg, women are encouraged to receive
acupuncture treatments pre and post embryo transfer.

Clinical observations from the Berkley Center for Reproductive Wellness suggest that the most
effective fertility treatments involve a combination of acupuncture, herbal medicine, and
traditional medicine. However, conception occasionally occurs when acupuncture and herbal
medicines are used without traditional medical interventions.

When should I stop?

Typically most miscarriages occur within the first 3 months of pregnancy. Consequently,
treatment of patients may often last through week twelve to help prevent miscarriage.

Are the acupuncture points different after an insemination, IVF, or donor-egg transfer than
before?

Acupuncturists should not place needles in the abdomino-pelvic area after insemination or
transfer. There are 6 contraindicated acupuncture points which should be avoided when the
patient is pregnant or pregnancy is suspected.

These include VB21, E12, IG 4, BP6, V60, V67 and any points on the lower abdomen.

What are the risks of using acupuncture with infertility?

There are minimal risks in using acupuncture for fertility treatment. The risk of miscarriage
may increase if incorrect acupuncture points are used during pregnancy. This is one reason
why those choosing to include acupuncture in their treatment regimen should only be treated
by an acupuncturist who specializes in treating fertility disorders. Acupuncture is generally safe
regardless of a person’s medical history.
Who make up typical patients?

Acupuncture can be used to treat any type of fertility disorder including spasmed tubes.
Spasmed tubes are often de-spasmed with acupuncture, though blocked tubes will not
respond to acupuncture. Acupuncture is often combined with herbal remedies to treat
elevated follicle stimulating hormone (FSH), repeated pregnancy loss, unexplained (idiopathic)
infertility, luteal phase defect, hyperprolactinemia (when not caused by a prolactinoma),
polycystic ovarian syndrome (PCOS) with annovulatory cycles and male factor including men
affected with sperm-DNA-fragmentation.

What is acupuncture?

Acupuncture is based on a system of Traditional Chinese Medicine (TCM) dating back 3,000
years. Fine needles are inserted at points around your body to correct imbalance in energy or
‘qi’, which is said to flow around your body in ‘channels’ or ‘meridians’.

Acupuncturists believe there are 500 different acupuncture points around the body and that
stimulating these with tiny needles can get your energy flowing. Acupuncture is used to treat a
wide range of conditions, from anxiety and acne, to back pain and nausea. And the needles are
so fine, it really shouldn’t hurt!

How can acupuncture help with fertility?

Acupuncturists aim to rebalance your energy flow and prime your body for fertility. The British
Acupuncture Council believes acupuncture may boost female fertility by doing three key
things:

 Regulating hormone function

 Increasing blood flow to the ovaries and uterus and helping to relax your muscles
which can improve the chance of an embryo implanting.
 Tackling the causes of polycystic ovary syndrome (PCOS) – a common cause of
infertility
 Generally helping to relieve stress and make you feel more relaxed

Is it recognised by the medical community?

The jury’s out. Many doctors are sceptical about acupuncture, saying there’s little scientific
evidence it can help with infertility. But others believe it can help by stimulating nerve and
muscle tissue, and by helping you relax and de-stress – which is key to boosting fertility.

There’s also evidence to suggest that conception rates improved during IVF when acupuncture
was performed, but this was only true when the acupuncture was performed the same day the
embryos were being implanted in the uterus.

Acupuncture during fertility treatment

Acupuncture is such a popular treatment for infertility, some IVF clinics have acupuncturists
working in their clinics, or they’re keen to refer you to a local trusted practitioner. As the
research swings both ways, and the treatment itself is harmless, it’s generally accepted that
acupuncture for fertility could be worth trying if you’re looking to increase your chances of
success.

How might acupuncture help my partner’s fertility?

The British Acupuncture Council claims there’s evidence to show acupuncture increases sperm
motility (how fast the sperm swim), as well as increasing levels of the male sex hormone
testosterone and lowering the temperature of the scrotum (where sperm are stored), creating
a better environment for keeping them healthy.

What happens during a consultation?

Acupuncturists usually take a full medical history, including details of your menstrual cycle and
the results of fertility tests you’ve had. As well as the needle treatment, appointments usually
include advice on diet and lifestyle changes that can boost fertility.

How much does it cost?

Acupuncture for fertility problems isn’t available on the NHS, but it’s not too pricey. Privately
you can expect to pay between £25 and £40 per hour.

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).

The addition of acupuncture to clomiphene therapy increased pregnancy rates, lowered the
resistance and pulsatility indices of the uterine arteries, and reduced the adverse effects
caused by clomiphene. The increase in positive patient outcomes combined with reductions of
adverse effects supports the research team’s (Taian Maternal and Child Health Care Hospital)
conclusion, “TCM [Traditional Chinese Medicine] can be either applied alone or combined with
Western medicine to up pregnancy rates and treat infertility. With the help of TCM [i.e.,
acupuncture], treatment for infertility can be more effective while producing much less
adverse effects.” [1]

Clomiphene triggers the pituitary gland to produce hormones that stimulate ovulation. The
upside of this medication is that it stimulates the release of eggs from the ovaries. The
downside is that it may produce adverse effects and it is contraindicated for patients with
endometriosis and uterine fibroids. Notably, it may increase the incidence of having twins or
triplets. The researchers conclude that the addition of acupuncture to the clomiphene
treatment regimen mitigates the drug’s adverse effects and ups the pregnancy rate. Moreover,
the acupuncture protocol outperforms the clomiphene plus estradiol cypionate and
dydrogesterone protocol. Estradiol cypionate is an estrogen hormone and is often used for the
treatment of low estrogen levels. Estradiol cypionate may increase the rate of developing
blood clots, melasma (dark skin patches on the face), and may cause other adverse effects.
Dydrogesterone is a steroidal progestin used in many countries for the treatment of infertility
and threatened miscarriages.

The clinical study was conducted with a semi-protocolized approach to acupuncture point
selection. Identical primary acupuncture points were assigned to all patients and secondary
acupuncture points were prescribed based upon differential diagnostics. As a variable control,
secondary acupuncture point prescriptions were limited to one of three acupuncture point
groupings: liver qi stagnation, phlegm-dampness, blood stasis. Patients were not divided into
treatment and control groups based upon the diagnostic groups. Instead, they were randomly
divided into three groups and then diagnostic decisions were made for the addition of
secondary acupuncture points for the TCM treatment group.
A total of 43 patients were randomly distributed into three groups. Group 1 received only
clomiphene. Group 2 received clomiphene plus estradiol cypionate and dydrogesterone. Group
3 received clomiphene plus acupuncture and moxibustion. The number of patients in each
group was 15, 14, and 14 respectively. Patients ranged from ages 21–39. The preexisting
duration of anovulatory infertility ranged from 1–8 years.

Groups 1 and 2 received 50–100 mg of clomiphene, once per day. Group 2 also received 1 mg
of estradiol cypionate and 10 mg of dydrogesterone. Group 3 received clomiphene plus
acupuncture and moxibustion. The administration of care for all groups started on the 5th day
of menstruation and lasted for 5 consecutive days. One treatment course consisted of three
menstrual cycles. In total, 1–2 courses of treatment were applied. The TCM acupuncture
treatment protocol was as follows. Patients rested in a supine position. Upon disinfection, a
0.30 mm x 40 mm filiform needle was inserted into the following acupoints:

CV4 (Guanyuan) CV3 (Zhongji) Zigong ST29 (Guilai) SP6 (Sanyinjiao) ST36 (Zusanli)

CV4, CV3, Zigong, and ST29 were inserted transverse-obliquely (15° angle) to a depth of 1–1.2
cm. SP6 and ST36 were needled perpendicularly and manipulated with the Ping Bu Ping Xie
(tonify and sedate) technique. Additional acupoints were administered based on differential
diagnostic patterns.

For liver qi stagnation, the following acupoint was added: BL18 (Ganshu)

For phlegm and dampness, the following acupoint was added: ST40 (Fenglong)

For blood stasis, the following acupoints were added: SP10 (Xuehai) LV2 (Xingjian)

Moxibustion sessions lasted 30 minutes and were applied at a heat intensity level until the skin
became flushed. Sessions were conducted once per day. Moxibustion was not applied until 10
days passed after ovulation.

Moxibustion was applied at the following acupoints:

Zigong CV3 (Zhongji) CV4 (Guanyuan) ST29 (Guilai)

Additional research confirms that acupuncture combined with moxibustion is effective for the
treatment of infertility. Researchers conclude that acupuncture acts on the hypothalamus,
pituitary gland, and ovaries and regulates hormone levels in the body. [2, 3] Yu et al. conclude
that electroacupuncture can increase gonadotropin releasing hormone (GnRH) levels and
increases sensitivity of the ovaries to gonadotropin. The study documents that
electroacupuncture is effective for the treatment of infertility in anovulatory cases with low
levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH).
In a related study, Xu et.al conclude that acupuncture combined with moxibustion increases
ovulation rates. [5] The treatment protocol was as follows. First, acupuncture was applied to
the following acupoints: Zigong CV3 (Zhongji) CV4 (Guanyuan) ST36 (Zusanli) SP6 (Sanyinjiao)
LV3 (Taichong)

Additional acupoints were added based upon diagnostic patterns. For liver qi stagnation, BL18
was added; for phlegm and dampness, ST40 was added; for blood stasis, SP10 and LV2 were
added. Next, moxibustion was applied to Zigong, CV3, CV4, and ST36. Subsequently, an
electroacupuncture device was connected to the acupoints. The treatment was applied daily
for 3–7 consecutive days. The results of B-scan ultrasonography conducted during the study
documents that ovulation rates increase when acupuncture combined with moxibustion is
applied.

In another study, acupuncture has been found effective for increasing infertility rates for
women receiving IVF (in vitro fertilization) treatments. This highlights the role of acupuncture
in an integrative medicine environment. University of Maryland School of Medicine
researchers conclude that acupuncture increases pregnancy rates for women receiving IVF. In
a study of 16 high quality clinical trials consisting of 4,021 subjects, acupuncture significantly
raised pregnancy rates for women receiving IVF where otherwise pregnancy rates would have
been low.

Strong evidence indicates that acupuncture increases pregnancy rates for women with
anovulatory infertility and other forms of infertility. Acupuncture has been proven an effective
complementary therapy to drug therapy and IVF protocols. Research indicates that
acupuncture provides an additional benefit; it reduces the adverse effect rates of infertility
medications. Based on the findings of modern research, the use of acupuncture is an
appropriate, safe, and effective complementary therapy for the treatment of infertility.

Best Acupuncture Protocols for Infertility IVF and IUI 22 July 2012

New research demonstrates a consensus amongst acupuncture experts on best practice

treatment protocols for acupuncture enhancement of assisted reproductive technology (ART)
fertility treatments. ART includes all fertility treatments in which both the eggs and sperm are
handled. ART includes in vitro fertilization (IVF) and intrauterine insemination (IUI). In this
study, researchers set out to determine if a consensus exists on high priority acupuncture
points for the enhancement of ART.

Acupuncture CEUs OnlineAcupuncture IVF and IUIART has been used in the USA since 1981 to
help women become pregnant. Although acupuncture and Chinese medicine for the treatment
of infertility is a time honored practice, the combination of acupuncture with ART has emerged
in recent years as an effective approach for improving pregnancy and live birth rates. In this
study, researchers administered three rounds of questionnaires to fifteen international
acupuncture fertility experts to determine if a consensus exists on best practice protocols.
The investigation revealed that several key components are central to acupuncture in
combination with ART. The timing of an acupuncture treatment in relation to the menstrual
cycle is of great importance. An acupuncture treatment administered between day 6 and 8 of
the “stimulated ART cycle” is optimal. In addition, it is ideal to have two acupuncture
treatments “on the day of embryo transfer.” Pre-transfer acupuncture points of high priority
are SP8, SP10, Liv3, ST29 and CV4. Post-transfer points include GV20, K3, SP6, P6 and K3.
Auricular acupuncture points Shenmen and Zigong were also determined to be of high priority.

Acupuncture for Female Infertility - Acu Treatment Protocols

Below you will find some of the more common tcm diagnoses and acupuncture treatment
protocols for female fertility issues. There are many ways to treat this condition with Eastern
Medicine and our presentation is only one of many possible options.

Note:When treating infertility cases it is imperative that the male partner receive a sperm
analysis. Regardless, it may be beneficial for both partners to receive regular treatments.

Etiology & Pathology:

Etiology:

Constitutional Deficiency - women with congenital KD deficiencies which may have arisen
from being born prematurely or having had an unhealthy mother.

Excessive Sexual Activity - particularly around puberty, but also in women who have had
multiple child births a/or chronic deficiencies of Jing and Blood - can lead to malnourishment
of the Bao Mai and Uterus.

Cold a/or Damp - may arise from KD Yang Deficiency or chronic exposures to cold/damp
during menstruation - can disrupt the Uterus.

Stagnations of Qi a/or Blood, possibly with Phlegm/damp - can block the Uterus.

Differentiation:

SHI Valaskatagis Maciocia

Cold in Patient pale, delayed Tongue: CV 5 - TH Mu, warm CV 2 - warm

the menstruation w/dark dilute Pale the uterus the Uterus
Uterus flow, pain a/or coldness of Pulse: CV 2 - warm the CV 4 - tonify
the lower abdomen Deep, Uterus Qi
improves with heat, slow CV 4 - tonify Qi GV 4 - tonify
aversion to cold, cold limbs, GV 4 - tonify Yang Yang
 may also have weak KD 3 - tonify KD KD 7 - tonify
back/knees a/or profuse KD Yang
clear urination UB 23 - KD
Shu

Blood Patient is likely to be overweight, irregular menstruation Tongue:

Stagnation w/clotting, delayed most likely, chest a/or hypochondriac White greasy
w/Phlegm distention, irritability, palpitation, dizziness, profuse sticky coat
(blocked leukorrhea. w/purple
fallopian spots
tubes) Pulse: Deep,
wiry
Valaskatagis CV 3 - resolve damp in lower abdomen
ST 30 - regulate menstruation
KD 13 - important point for infertility, influence chong mai
ST 40 - resolve phlegm
SP 6 - tonify SP, move lower abdomen
If discharge - SP 9
If profuse leukorrhea - UB 32
If hesitant flow - SP 8
Chest/hypochondriac distention - LV 3 w/PC 6
Maciocia Damp in the Lower Heater
CV 3 - resolve damp in lower abdomen
Zigong Xue - infertility
ST 28 - exces damp in the lower warmer
SP 9 - resolve damp
SP 6 - tonify SP
CV 9 - move stagnant water
LU 7 w/KD 6 - yin qiao ren mai
ST 30 - regulate menstruation
KD 14 - influence chong mai
UB 32 - move excesses in the lower warmer
TH 5 w/GB 41 - yang wei dai mai
Treatment for Blocked Fallopian Tubes
Use electrical stimulation from positive CV 4 to negative UB 32

KD Yang Deficiency

Signs & Symptoms:

Irregular menstruation w/scanty pinkish Blood, weak back a/or knees, fatigue, dizziness.

Tongue: Thin white coat

 Pulse: Deep, thin, particularly weak in the KD position

Treatment Points:

Valaskatagis Point Selection:

This is a general treatment for KD Deficiency (i.e. not strongly Yin or Yang)

UB 23 - KD Shu

KD 13 - important point for infertility, influence the chong mai

KD 2 - fire point, usually used to disperse empty fire rising causing sore throat, here it is
used w/moxa to strengthen and warm the Uterus

KD 3 - tonify KD

CV 4 - tonify Qi, Blood and Yin

If dizziness a/or tinnitus - TH 17

If weak back a/or knees - KD 10

Maciocia Point Selection:

KD 13 - important point for infertility, influence the chong mai

KD 3 - tonify KD

UB 23 - KD Shu

UB 52 - tonify psycho-emotional aspects of the KD

KD 6 w/LU 7 - yin qiao ren mai

CV 8 - strongly tonify Yang

CV 4 - tonify Yang

GV 4 - tonify Yang

KD Yin Deficiency

Signs & Symptoms:

Irregular menstruation, sore back, constipation, mallor flush, night sweats, heat in the 5
palms, insomnia, dry throat, dizziness, vertigo

Tongue: Red w/no coat

Pulse: Floating, empty, rapid

Treatment Points:
 Maciocia Point Selection:

CV 4 - tonify Yin

CV 7 - influence chong mai

KD 3 - tonify KD

KD 13 - important point for infertility - influence chong mai

LU 7 w/KD 6 - yin qiao ren mai

SP 6 - tonify Yin

UB 52 - strengthen willpower

Blood Deficiency

Signs & Symptoms:

Delayed menstruation w/scanty, pinkish flow, emaciation, sallow complexion, fatigue,

dizziness, may also have palpitations a/or insomnia if HT Blood is deficient

Tongue: Pale, possibly swollen

Pulse: Deep, thin, weak

Treatment Points:

Valaskatagis Point Selection:

CV 4 - tonify Yin & Blood

KD 13 - important point for infertility, influence the chong mai

Zigong Xue - infertility

SP 6 - tonify SP

ST 36 - tonify ST/SP

UB 18 - LV Shu

UB 20 - SP Shu

If signs of hot Blood - SP 10

If insomnia/palpitations - HT 7

If dizziness - GV 20

Maciocia Point Selection:

Same Points as above plus the following

 UB 23 - KD Shu

UB 17 - hui meeting of the Blood, instead of UB 18 above

Common TCM diagnostic patterns and acupuncture points for infertility

Most patients manifest mixed patterns (combinations of 2 or 3, or more), the treatment,

including the selection of acupoints needs to be modified
accordingly

Infertility due to liver depression qi stagnation

SP6: Sanyinjiao

KI13: Qixue

KI14: Siman

GB34: Yanglingquan

LR3: Taichong

CV3: Zhongji
Infertility due to phlegm dampness blockage & stagnation

ST30: Qichong

ST40: Fenglong

SP6: Sanyinjiao

SP9: Yinlingquan

CV3: Zhongji
Infertility due to blood vacuity

ST36: Zusanli

SP6: Sanyinjiao

SP9: Yinlingquan

CV6: Qihai
Infertility due to kidney vacuity

BL23: Shenshu

BL52: Zhishi

KI2: Rangu

KI13: Qixue

CV4: Guanyuan

CV6: Qihai

Infertility due to blood stasis

ST29: Guilai

SP6: Sanyinjiao

KI13: Qixue

CV3: Zhongji

Infertility due to uterine cold

GV4: Mingmen

CV2: Qugu

CV6: Qihai

CV7: Yinjiao

Infertility is defined as the inability to become pregnant after having unprotected sex for one
year or more. At Roxborough Community Acupuncture we’ve helped many women become
pregnant with and without the additional support of medical infertility specialists. In fact,
we’ve done the highly successful “German Protocol”

The Web MD article is referring to the study commonly known as “The German Protocol”, in
which two different sets of acupuncture points are used before and after an IVF transfer. Read
more about the German Protocol here on Pub Med. The bottom line is that Acupuncture
before and after an IFV transfer has been shown to nearly double the chance of a successful
conception.

The Male Factor

According to the American Society of Reproductive Medicine, “In approximately 40% of

infertile couples, the male partner is either the sole or a contributing cause of infertility.”
Although men often are reluctant to seek help, acupuncture can be used to help with issues
such as low sperm count, sperm motility, and poor quality sperm, as well as anxiety, stress, low
energy, and even issues like low sex drive and erectile difficulties.

If you are struggling to conceive on your own, or if you are currently seeking help from a
fertility specialist, adding acupuncture treatment into the equation can help you feel much
more relaxed, help create the right conditions for conception to occur, and significantly
improve the chances of successful IVF/IUI treatment.
When Should Acupuncture Treatment Begin?

Acupuncture treatment can be started at any time during the process, but ideally would be
started a few months prior to trying to conceive either naturally or with medical assistance.
The reason for this is that acupuncture can help correct imbalances and lower stress levels that
may prevent a successful attempt at conception. This helps quicken the time frame, may help
avoid the need for more expensive and invasive procedures, and can dramatically ease the
stress and anxiety of months of unsuccessful pregnancy attempts.

Patients can also benefit, from receiving treatment during the first and third trimester for
support around the baby’s development in the womb, during the first trimester for issues like
morning sickness, nausea, back pain, etc. And again at the end of the pregnancy, many
women find acupuncture helpful to turn a breech baby, help start labor, calm Braxton-Hicks
contractions, and deal with swelling in the hands and feet.

Infertility And Acupuncture: When Should I Stop?

Many patients choose to stop treatments once they become pregnant, while others, especially
those with a history of miscarriage and associated anxiety chose to continue treatment
throughout the pregnancy. There are many benefits to continuing treatment because
acupuncture can help reduce stress and anxiety and promote well-being throughout the
pregnancy.

Are The Acupuncture Points Different After An Insemination, IVF, or Donor-Egg Transfer
Than Before?

Yes, we use these points from the German Protocol as follows:

Pre-transfer–PC6, SP8, LR 3, Du 20, ST29 ear–shen men, uterus, endocrine, brain

Post transfer–ST36, SP6, SP10, LI4, ear–shen men, uterus, endocrine, brain

The study describes the actions of the Spleen (SP) and Stomach (ST) points as creating “better
blood perfusion and more energy to the uterus”, which means increased blood flow to the
uterus.

LI4 is useful in “inhibiting the uterus motility” which helps relaxes a uterus that may be in
spasm after transfer procedure.

At RCA, we offer a Three Month Program for fertility patients where they are treated
constitutionally for 3 months prior to their embryo transfer. We then suggest they get these 2
treatments done on the day of their embryo transfer. We, of course, will work with any
patient who seeks help, but we highly recommend beginning 3 months before attempting IUI
or IVF treatments.
Are there any risks associated with using acupuncture during pregnancy?

Aside from the usual minimal risks that acupuncture poses (including bruising of the skin
and/or slight bleeding, weakness, fainting and rare, mild aggravation of symptoms existing
prior to acupuncture treatment) acupuncture is supremely safe. There is little to no risk of
infection when all needles are sterile. RCA uses only one-time use, sterile disposable needles.
We do not reuse needles, even at different areas of the body for the same person. We always
avoid the “Forbidden Points” during pregnancy, which are the same points we will use to help
stimulate labor if a woman is past her due date.

Garden Acupuncture Best Acupuncture Protocols for IVF & IUI

A consensus has been achieved amongst the acupuncture experts on the best treatment
protocols for acupuncture enhancement when patients undergo assisted reproductive
technology (ART) fertility treatments. ART includes all fertility treatments in which both the
eggs and sperm are handled (i.e. in vitro fertilization (IVF) and intrauterine insemination (IUI).

ART has been used in the United States since 1981 to help women become pregnant. Although
acupuncture and Chinese medicine for the treatment of infertility is a very common practice in
Asia, the combination of acupuncture with ART has only recently emerged in the past few
years as an effective approach for improving pregnancy and live birth rates.

In this study, researchers set out to determine if a consensus exists on high priority
acupuncture points for the enhancement of ART. To complete this, they administered three
rounds of questionnaires to fifteen international acupuncture fertility experts to determine if a
consensus exists on best practice protocols.

The study revealed that several key components are essential to the use of acupuncture and
ART combination.

The timing of the acupuncture treatment in relation to the menstrual cycle is of great
importance.

An acupuncture treatment completed between day 6 and 8 of the “stimulated ART cycle” is
optimal.

It is ideal to have two (2) acupuncture treatments on the “day of embryo transfer.”

Pre-transfer acupuncture points of high priority include: Spleen 8, 10, Liver 3, Stomach 29,
Conception Vessel 4.
 Post-transfer acupuncture points include: Kidney 3, Spleen 6, Pericardium 6, Governor
Vessel 20.

Auricular acupuncture points were also considered to be of high value including: Shenmen
and ZiGong.

IVF & Pregnancy Acupuncture Protocols

There are a number of treatment options available to support you during your IVF, ICSI, IUI or
FET cycle, to increase your chance of success and to improve how you feel. Options range from
just one or two acupuncture treatments on the day of embryo transfer to a full course of
complementary medicine treatments leading up to that day, and throughout pregnancy.

The following treatment plans are recommended for acupuncture support before, during, and
after your IVF cycle;

Acupuncture support leading up to, during, and after an IVF cycle (including day of embryo
transfer, on site at PCRM)

Acupuncture for Male Factor Infertility

Acupuncture to support the first trimester of pregnancy

Acupuncture before and during the medication phase of IVF

Clinical trials have shown that acupuncture treatment before and during IVF increases blood
flow to the uterus and ovaries. In addition, acupuncture appears to regulate fertility hormones
which may contribute to follicle development and increased implantation. See research page
for further information. These trials reported increased pregnancy rates based on this
protocol.

Treatment 1: Two treatments per week for six weeks before egg retrieval (optimal) plus

: Treatment at the time of embryo transfer

Acupuncture at any phase of the IVF / ICSI / IUI / FET

Acupuncture can be used to manage any side effects you might experience and reduce anxiety.
These treatment protocols are based on the clinical experience of many acupuncturists and
their patients. Reduced fatigue, moodiness, abdomen swelling and discomfort and other side
effects are reported by many women using acupuncture during their IVF cycle. In addition
women report greater relaxation and control of anxiety. The acupuncture treatment will be
different for each patient and depends on your symptoms.

Treatment 2: One-two treatments per week as needed until ready to start treatment 1( above)

Acupuncture three days after egg collection (before embryo transfer)

We recommend that you have an acupuncture treatment three days after egg collection to
help prepare a calm environment for the arrival of an embryo for day five transfers. This
treatment can be combined with the programs above.

Treatment 3: One treatment 2-3 days after the egg collection before embryo transfer

Acupuncture on the day of embryo transfer

When your doctor tells you that your follicles (eggs) are ready you will be given an injection of
HCG, ‘the trigger’. It is at this point that the dates of your embryo transfer are known. Two
calendar days after ‘the trigger’ you will go to the IVF clinic for your oocyte pick-up (OPU) or
egg retrieval. Three to five days after the oocyte pick-up (OPU) will be your transfer dates (this
depends on the labs opinion of how the embryos are progressing ‘in vitro’, they will keep you
posted along the way). However, it is only the day before your actual embryo transfer date
that you will be told the precise time your embryo transfer procedure will be.

Therefore, as far as the administration of acupuncture on embryo transfer day is concerned,

there are 2 important times to call or email your acupuncturist;

1. when you know the date of your HCG ‘trigger’ &/or oocyte pick-up (OPU) so that they can
schedule you for tentative day 3 or 5 transfer dates
2. when you get the phone call from the IVF clinic telling you the actual embryo transfer date
and precise time the procedure will be.

On the day of embryo transfer, you will meet your acupuncturist 1.25 hrs before your
scheduled procedure time (i.e. transfer time is 10am, acupuncture is at 8:45am). This is a 20-30
minute pre-procedure acupuncture treatment. Then, post-embryo transfer procedure, once
the nurses have discharged you, a second 20 minute acupuncture treatment is administered.
These treatments help calm the woman and optimize uterine receptivity.

Treatment 4: Two acupuncture treatments on the day of embryo transfer: One treatment
before the transfer and another treatment after the transfer.

Acupuncture for frozen embryo transfer (FET) including donor eggs

Acupuncture treatment before and during IVF increases blood flow to the uterus and ovaries.
And acupuncture appears to regulate fertility hormones which may help follicle development
and inprove implantation.

Treatment 5: Two treatments per week for four weeks before embryo transfer, plus treatment
on the day of transfer.

Acupuncture during the first trimester of pregnancy

Acupuncture in early pregnancy has immune-modulating effects which help establish

implantation and prevent rejection of the embryo. It also increases micro-circulation (blood
flow) to the uterus to help properly nourish the embryo which is of particular importance
when a woman shows a tendency towards clotting factors or recurrent miscarriage.Clinical
trials have shown that regular monitoring and reassurance reduces miscarriage rates.
Acupuncture also reduces nausea and high stress levels that are so often associated with the
first 12 weeks of pregnancy.

Treatment 6: One treatment per week until week 13 of pregnancy.

Acupuncture during the third trimester of pregnancy (breech presentation & labour prep)

Acupuncture and moxibustion have demonstrated the ability to turn breech presentation. It is
most effective when done between the weeks of 34-36. The Moxibustion technique will be
taught at the first visit and must be preformed at home for 10-14 days consecutively (or until
medical confirmation that baby has turned). Acupuncture treatment applied in the 4 weeks
before the due date for delivery has been shown to reduce medical induction and emergency
caesarian rates. It also has been shown to encourage cervical ripening and shorten labour
time. If a woman does pass her due date, special acupuncture induction treatments have
shown effect clinically.

Treatment 7: Breech presentation – One treatment per week during weeks 34-36, at which
time an ‘at home’ moxibustion technique will be taught.

: Labour prep – One treatment per week during weeks 37-40. *Induction treatments are also
offered if necessary.

Acupuncture for male factor infertility (sperm)

These treatments protocols are based on clinical trials which demonstrate an increase in
sperm count and motility, and a decrease in abnormal forms after a course of acupuncture.
The pressure to produce a sperm sample on the day of egg collection can be significant enough
to cause a problem. Acupuncture reduces anxiety and can increase blood flow to the genital
area.

Treatment 8: Two treatments per week in the one to six weeks (4-6weeks optimal) prior to IVF.

: One treatment the morning of sperm donation (egg retrieval).

Treatment of various conditions that cause infertility

PCOS, endometriosis, recurrent pregnancy loss, unexplained infertility, diminished ovarian

reserve, premature ovarian failure, thyroid conditions, and stress, all play major roles in
positive IVF or natural fertility outcomes. Whether it is losing weight, managing pain,
regulating inflammation and immune response, increasing micro-circulation (blood flow),
enriching reproductive essence, hormone balancing, or stress relief, traditional Chinese
medicine, acupuncture, and naturopathic medicine can offer solutions.

Treatment 9: treatment protocols are determined on an individual basis depending on

conditions presenting. A specialist experienced in fertility and its treatment with
complimentary and alternative medicine will make a detailed diagnosis and will formulate an
appropriate treatment plan.

Considering the individual TCM patterns:

Common patterns: a. Cold uterus; b. Liver Qi stagnation; c. Blood stasis; d. Accumulation of

damp phlegm; e. Kidney jing, yang, and/or yin deficiency; F. Qi and blood deficiency

3. Acupuncture protocol in the process of long IVF treatment protocol

Down regulation Nourish yin Yingtang, SP9, LI4, LR3, LI6, LU7, SP6 or BL18,
BL20, BL23, SP9, KI3 (1)

Cycle day 1-3 No acupuncture If painful menstruation or headache (2)

Cycle day 4-7 Tonify Qi and blood DU20, RN4, RN3, ST36, SP6

Follicle stimulation Continue to support DU 20, ST29, LI4, LR3, SP36, SP10, SP8, SP6 (4)
period Qi and Blood,
Cycle day 8 to regulate LR Qi, and
aspiration (3) suppress LR Yang

On the day of ET Standard Half hour before ET: DU20, ST29, PC6, SP8,
LR3,
plus ear points: Shenmen, Endocrine and
Uterus;

After ET: LI4, SP6, SP10, ST36 (5)