Research, Sources and Additional Information

Recommendations for Further Reading
  • It Starts with the Egg by Rebecca Fett
  • Making Babies by Jill Blakeway, LAc and Sami David, MD
  • Feed Your Fertility by Emily Bartlett and Laura Erlich
  • The Infertility Cure by Randine Lewis, PhD
  • Taking Charge of Your Fertility by Toni Weschler
Acupuncture and Chinese Herbal Medicine Fertility Research
  1. Blood Flow to the Uterus and Acupuncture Research
  2. Breech Research
  3. Chinese Herbal Medicine and Fertility Research
  4. Female Fertility Research
  5. IVF and Acupuncture Research
  6. Labor Preparation Research
  7. Lactation and Acupuncture Research
  8. Male Factor Infertility Research
  9. PCOS and Acupuncture Research
  10. Postpartum Depression and Acupuncture Research
  11. Pregnancy and Acupuncture Research

1. Blood Flow to the Uterus and Acupuncture Research

Stener-Victorin E, Waldenström U, Andersson SA, Wikland M. 1996. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupunctureHum Reprod. 11(6):1314-7.

CONCLUSION(S): Compared to the mean baseline PI (pulsatility index), the mean PI was significantly reduced both shortly after the eighth EA treatment (P < 0.0001) and 10-14 days after the EA period (P < 0.0001).

2. Breech Research

Cardini F, Weixin H. 1998. Moxibustion for correction of breech presentation: a randomized controlled trialJAMA. 280(18):1580-4.

CONCLUSION(S): Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.

Habek D, Cerkez Habek J, and Jagust M. 2003. Acupuncture conversion of fetal breech presentationFetal Diagn Ther. 18(6):418-21.

CONCLUSION(S): We believe that AP correction of fetal malpresentation is a relatively simple, efficacious and inexpensive method associated with a lower percentage of operatively completed deliveries, which definitely reflects in improved parameters of vital and perinatal statistics.

Neri I, Airola G, Contu G, Allais G, Facchinetti F, Benedetto C. 2004. Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled studyJ Matern Fetal Neonatal Med. 15(4):247-52.

CONCLUSION(S): Acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.

Vas J, Aranda-Regules JM, Modesto M, Ramos-Monserrat M, Barón M, Aguilar I, Benítez-Parejo N, Ramírez-Carmona C, Rivas-Ruiz F. 2013. Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trialAcupunct Med. 31(1):31-8.

CONCLUSION(S): Moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. We believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus.

3. Chinese Herbal Medicine and Fertility Research

Ried K, Stuart K. 2011. Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic reviewComplement Ther Med. 19(6):319-31.

CONCLUSION(S): Our review suggests that management of female infertility with Chinese Herbal Medicine can improve pregnancy rates two-fold within a four month period compared with Western Medical fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to TCM diagnosis, appears to be fundamental to successful treatment of female infertility.

See CJ, McCulloch M, Smikle C, Gao J. 2011. Chinese herbal medicine and clomiphene citrate for anovulation: a meta-analysis of randomized controlled trialsJ Altern Complement Med. 17(5):397-405.

CONCLUSION(S): Chinese herbal medicine may increase the effectiveness of CC therapy. However, the RCTs are of poor methodological quality and small sample size, and the results require confirmation with rigorously controlled studies.

4. Female Fertility Research

Gui J, Xiong F, Yang W, Li J, Huang G. 2012. Effects of acupuncture on LIF and IL-12 in rats of implantation failureAm J Reprod Immunol. 67(5):383-90.

CONCLUSION(S): Acupuncture could improve the poor receptive state of endometrium by promoting LIF and IL-12 secretion to improve blastocyst implantation.

Ried K, Stuart K. 2011. Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic reviewComplement Ther Med. 19(6):319-31.

CONCLUSION(S): Our review suggests that management of female infertility with Chinese Herbal Medicine can improve pregnancy rates two-fold within a four month period compared with Western Medical fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to TCM diagnosis, appears to be fundamental to successful treatment of female infertility.

Stener-Victorin E, Wu X. 2010. Effects and mechanisms of acupuncture in the reproductive systemAuton Neurosci. 157(1-2):46-51.

ABSTRACT: The use of acupuncture to treat reproductive dysfunction has not been well investigated. Only a few clinical studies have been reported, most of which are flawed by poor design and a lack of valid outcome measures and diagnostic criteria, making the results difficult to interpret. Experimental studies, however, show that acupuncture has substantial effects on reproductive function. Here we review the possible mechanisms of action of acupuncture on the reproductive system and its effects on reproductive dysfunction, focusing in particular on polycystic ovary syndrome, the most common endocrine and metabolic disorder in women. Clinical and experimental evidence demonstrates that acupuncture is a suitable alternative or complement to pharmacological induction of ovulation, without adverse side effects. Clearly, acupuncture modulates endogenous regulatory systems, including the sympathetic nervous system, the endocrine system, and the neuroendocrine system. Randomized clinical trials are warranted to further evaluate the clinical effects of acupuncture in reproductive disorders.

5. IVF and Acupuncture Research

di Villahermosa DI, Santos LG, Nogueira MB, Vilarino FL, Barbosa CP. 2013. Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trialAcupunct Med. 31(2):157-61.

RESULTS: The clinical pregnancy rate in the acupuncture group was significantly higher than that in the control and sham groups (35.7% vs 7.1% vs 10.7%; p=0.0169).

CONCLUSION(S): In this study, acupuncture and moxibustion increased pregnancy rates when used as an adjuvant treatment in women undergoing IVF, when embryo implantation had failed.

Hullender Rubin LE, Opsahl MS, Wiemer KE, Mist SD, Caughey AB. 2015. Impact of whole systems traditional Chinese medicine on in vitro fertilization outcomes. Reprod Biomed Online. 30(6):602-12.

RESULTS: Live birth rates were 48.2% IVF alone vs. 50.8% acupuncture only vs. 61.3% whole systems TCM.

ABSTRACT: Patients undergoing IVF may receive either acupuncture or whole-systems traditional Chinese medicine (WS-TCM) as an adjuvant IVF treatment. WS-TCM is a complex intervention that can include acupuncture, Chinese herbal medicine, dietary, lifestyle recommendations. In this retrospective cohort study, 1231 IVF patient records were reviewed to assess the effect of adjuvant WS-TCM on IVF outcomes compared among three groups: IVF with no additional treatment; IVF and elective acupuncture on day of embryo transfer; or IVF and elective WS-TCM. Overall, IVF with adjuvant WS-TCM was associated with greater odds of live birth in donor and non-donor cycles (48.2% IVF alone vs. 50.8% acupuncture only vs. 61.3% whole systems TCM).

Magarelli PC, Cridennda DK, Cohen M. 2009. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization-embryo transfer treatment. Fertil Steril. 92(6):1870-9.

CONCLUSION(S): In this study, there appears to be a beneficial regulation of CORT and PRL in the Ac group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics.

Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM. 2008. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysisBMJ. 336(7643):545-9.

CONCLUSION(S): Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. 2002. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapyFertil Steril. 77(4):721-4.

CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after ART.

Stener-Victorin E, Humaidan P. 2006. Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transferAcupunct Med. 24(4):157-63.

ABSTRACT: During the last five years, the use of acupuncture in female infertility as an adjuvant to conventional treatment in assisted reproductive technology (ART) has increased in popularity. The present paper briefly discusses clinical and experimental data on the effect of acupuncture on uterine and ovarian blood flow, as an analgesic method during ART, and on endocrine and metabolic disturbances such as polycystic ovary syndrome (PCOS). Further it gives a summary of recent studies evaluating the effect of acupuncture before and after embryo transfer on pregnancy outcome. Of the four published RCTs, three reveal significantly higher pregnancy rates in the acupuncture groups compared with the control groups. But the use of different study protocols makes it difficult to draw definitive conclusions. It seems, however, that acupuncture has a positive effect and no adverse effects on pregnancy outcome.

Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. 2006. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trialFertil Steril. 85(5):1341-6.

CONCLUSION(S): Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2 provided no additional beneficial effect.

6. Labor Preparation Research

Gribel GP, Coca-Velarde LG, Moreira de Sá RA. 2011. Electroacupuncture for cervical ripening prior to labor induction: a randomized clinical trialArch Gynecol Obstet. 283(6):1233-8.

CONCLUSION(S): Our results showed that electroacupuncture can be used to obtain cervical ripening, with similar results as compared with misoprostol, with a significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications.

Harper TC, Coeytaux RR, Chen W, Campbell K, Kaufman JS, Moise KJ, Thorp JM. 2006. A randomized controlled trial of acupuncture for initiation of labor in nulliparous womenJ Matern Fetal Neonatal Med. 19(8):465-70.

OBJECTIVE: To evaluate the utility of outpatient acupuncture for labor stimulation.

RESULTS: Fifty-six women were randomized and completed the study procedures. Race, age, gestational age, and cervical Bishop score were similar in both groups. 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 labor spontaneously (70% vs. 50%, p = 0.12) and less likely to deliver by cesarean 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 enrollment (p = 0.05).

CONCLUSION(S): Acupuncture is well tolerated among term nulliparous women and holds promise in reducing interventions that occur in post-term pregnancies.

Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P. 2001. Acupuncture for cervical ripening and induction of labor at term–a randomized controlled trialWien Klin Wochenschr. 113(23-24):942-6.

CONCLUSION(S): Acupuncture at points LI4 and SP 6 supports cervical ripening at term and can shorten the time interval between the EDC and the actual time of delivery.

Zeisler H, Tempfer C, Mayerhofer K, Barrada M, Husslein P. 1998. Influence of acupuncture on duration of laborGynecol Obstet Invest. 46(1):22-5.

CONCLUSION(S): This study suggests that AP treatment is a recommendable form of childbirth preparation due to its positive effect on the duration of labor, namely by shortening the first stage of labor.

7. Lactation and Acupuncture Research

Kvist LJ, Hall-Lord ML, Rydhstroem H, Larsson BW. 2007. A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactationMidwifery. 23(2):184-95.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: If acupuncture treatment is acceptable to the mother, this, together with care interventions such as correction of breast feeding position and babies’ attachment to the breast, might be a more expedient and less invasive choice of treatment than the use of oxytocin nasal spray. Midwives, nurses or medical practitioners with specialist competence in breast feeding should be the primary care providers for mothers with inflammatory symptoms of the breast during lactation. The use of antibiotics for inflammatory symptoms of the breast should be closely monitored in order to help the global community reduce resistance development among bacterial pathogens.

Neri I, Allais G, Vaccaro V, Minniti S, Airola G, Schiapparelli P, Benedetto C, Facchinetti F. 2011. Acupuncture treatment as breastfeeding support: preliminary dataJ Altern Complement Med. 17(2):133-7.

CONCLUSION(S): Such preliminary data suggest that 3 weeks of acupuncture treatment were more effective than observation alone in maintaining breastfeeding until the third month of the newborns’ lives.

Wei L, Wang H, Han Y, Li C. 2008. Clinical observation on the effects of electroacupuncture at Shaoze (SI 1) in 46 cases of postpartum insufficient lactationJ Tradit Chin Med. 28(3):168-72.

CONCLUSION(S): Electroacupuncture at Shaoze (SI 1) was obviously effective for postpartum insufficient lactation.

8. Male Factor Infertility Research

Dieterle S, Li C, Greb R, Bartzsch F, Hatzmann W, Huang D. 2009. A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermiaFertil Steril. 92(4):1340–3.

CONCLUSION(S): This recent small clinical trial randomized 57 patients who had extremely low sperm counts, to acupuncture and placebo acupuncture groups. After receiving acupuncture twice weekly for 6 weeks, motility of sperm (but not overall count) was found to increase significantly. The authors conclude that the results of the present study support the significance of acupuncture in male patients with severe oligoasthenozoospermia. More evidence with larger trials needs to be accumulated before the efficacy and effectiveness of acupuncture in male infertility can be evaluated.

Gurfinkel E, Cedenho AP, Yamamura Y, Srougi M. 2003. Effects of acupuncture and moxa treatment in patients with semen abnormalitiesAsian J Androl. 5(4):345-8.

CONCLUSION(S): The Chinese Traditional Medicine acupuncture and moxa techniques significantly increase the percentage of normal-form sperm in patients with oligoastenoteratozoospermia without apparent cause.

Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, Sterzik K. 2005. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertilityFertil Steril. 84(1):141-7.

CONCLUSION(S): The treatment of idiopathic male infertility could benefit from employing acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture, although we did not identify specific sperm pathologies that could be particularly sensitive to this therapy.

Siterman S, Eltes F, Schechter L, Maimon Y, Lederman H, Bartoov B. 2009. Success of acupuncture treatment in patients with initially low sperm output is associated with a decrease in scrotal skin temperature. Asian J Androl. 11(2):200-8.

CONCLUSION(S): Low sperm count in patients with inflammation of the genital tract seems to be associated with scrotal hyperthermia, and, consequently, acupuncture treatment is recommended for these men.

Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. 2000. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot studyAndrologia. 32(1):31-9.

CONCLUSION(S): Acupuncture may be a useful, non-traumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation.

Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. 1997. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm qualityArch Androl. 39(2):155-61.

CONCLUSION(S): Patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment.

9. PCOS and Acupuncture Research

Jedel E, Labrie F, Odén A, Holm G, Nilsson L, Janson PO, Lind AK, Ohlsson C, Stener-Victorin E. 2011. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trialAm J Physiol Endocrinol Metab. 300(1):E37-45.

CONCLUSION(S): Low-frequency EA and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Low-frequency EA was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea.

Johansson J, Redman L, Veldhuis PP, Sazonova A, Labrie F, Holm G, Johannsson G, Stener-Victorin E. 2013. Acupuncture for ovulation induction in polycystic ovary syndrome: A randomized controlled trialAm J Physiol Endocrinol Metab. 304(9):E934-43.

CONCLUSION(S): We conclude that repeated acupuncture treatments resulted in higher ovulation frequency in lean/overweight women with PCOS and were more effective than just meeting with the therapist. Ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion.

Leonhardt H, Hellström M, Gull B, Lind AK, Nilsson L, Janson PO, Stener-Victorin E. 2015. Serum anti-Müllerian hormone and ovarian morphology assessed by magnetic resonance imaging in response to acupuncture and exercise in women with polycystic ovary syndrome: secondary analyses of a randomized controlled trialActa Obstet Gynecol Scand. 94(3):279-87.

CONCLUSION(S): This study is the first to demonstrate that acupuncture reduces serum AMH levels and ovarian volume. Physical exercise did not influence circulating AMH or ovarian volume. Despite a within-group decrease in AFC, exercise did not lead to a between-group difference.

Lim CE, Wong WS. 2010. Current evidence of acupuncture on polycystic ovarian syndromeGynecol Endocrinol. 26(6):473-8.

CONCLUSION(S): Acupuncture is a safe and effective treatment to PCOS as the adverse effects of pharmacologic interventions are not expected by women with PCOS. Acupuncture therapy may have a role in PCOS by: increasing of blood flow to the ovaries, reducing of ovarian volume and the number of ovarian cysts, controlling hyperglycaemia through increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia. However, well-designed, randomised controlled trials are needed to elucidate the true effect of acupuncture on PCOS.

Mannerås L, Jonsdottir IH, Holmäng A, Lönn M, Stener-Victorin E. 2008. Low-frequency electro-acupuncture and physical exercise improve metabolic disturbances and modulate gene expression in adipose tissue in rats with dihydrotestosterone-induced polycystic ovary syndromeEndocrinology. 149(7):3559-68.

CONCLUSION(S): EA and exercise ameliorate insulin resistance in rats with PCOS. This effect may involve regulation of adipose tissue metabolism and production because EA and exercise each partly restore divergent adipose tissue gene expression associated with insulin resistance, obesity, and inflammation. In contrast to exercise, EA improves insulin sensitivity and modulates adipose tissue gene expression without influencing adipose tissue mass and cellularity.

Stener-Victorin E. 2013. Hypothetical physiological and molecular basis for the effect of acupuncture in the treatment of polycystic ovary syndromeMol Cell Endocrinol. 373(1-2):83-90.

ABSTRACT: Clinical and experimental evidence indicates that acupuncture may be a safe alternative or complement in the treatment of endocrine and reproductive function in women with polycystic ovary syndrome (PCOS). This review describes potential etiological factors of PCOS with the aim to support potential mechanism of action of acupuncture to relieve PCOS related symptoms. The theory that increased sympathetic activity contributes to the development and maintenance of PCOS is presented, and that the effects of acupuncture are, at least in part, mediated by modulation of sympathetic outflow. While there are no relevant randomized controlled studies on the use of acupuncture to treat metabolic abnormalities in women with PCOS, a number of experimental studies indicate that acupuncture may improve metabolic dysfunction. For each aspect of PCOS, it is important to pursue new treatment strategies that have fewer negative side effects than drug treatments, as women with PCOS often require prolonged treatment.

10. Postpartum Depression and Acupuncture Research

Chung KF, Yeung WF, Zhang ZJ, Yung KP, Man SC, Lee CP, Lam SK, Leung TW, Leung KY, Ziea ET, Taam Wong V. 2012. Randomized non-invasive sham-controlled pilot trial of electroacupuncture for postpartum depressionJ Affect Disord. 142(1-3):115-21.

CONCLUSION(S): Both electroacupuncture and non-invasive sham acupuncture were effective for postpartum depression. Further studies utilizing larger sample size, better recruitment strategies, and home-based acupuncture treatment are warranted.

11. Pregnancy and Acupuncture Research

Ee CC, Manheimer E, Pirotta MV, White AR. 2008. Acupuncture for pelvic and back pain in pregnancy: a systematic reviewAm J Obstet Gynecol. 198(3):254-9.

ABSTRACT: The objective of our study was to review the effectiveness of needle acupuncture in treating the common and disabling problem of pelvic and back pain in pregnancy. Two small trials on mixed pelvic/back pain and 1 large high-quality trial on pelvic pain met the inclusion criteria. Acupuncture, as an adjunct to standard treatment, was superior to standard treatment alone and physiotherapy in relieving mixed pelvic/back pain. Women with well-defined pelvic pain had greater relief of pain with a combination of acupuncture and standard treatment, compared to standard treatment alone or stabilizing exercises and standard treatment. We used a narrative synthesis due to significant clinical heterogeneity between trials. Few and minor adverse events were reported. We conclude that limited evidence supports acupuncture use in treating pregnancy-related pelvic and back pain. Additional high-quality trials are needed to test the existing promising evidence for this relatively safe and popular complementary therapy.

Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H. 2005. Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trialBMJ. 330(7494):761.

CONCLUSION(S): Acupuncture and stabilising exercises constitute efficient complements to standard treatment for the management of pelvic girdle pain during pregnancy. Acupuncture was superior to stabilising exercises in this study.

Manber R, Schnyer RN, Lyell D, Chambers AS, Caughey AB, Druzin M, Carlyle E, Celio C, Gress JL, Huang MI, et al. 2010. Acupuncture for depression during pregnancy: a randomized controlled trialObstet Gynecol. 115(3):511-20.

CONCLUSION(S): The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments of similar length and could be a viable treatment option for depression during pregnancy.

Xu J, MacKenzie IZ. 2012. The current use of acupuncture during pregnancy and childbirthCurr Opin Obstet Gynecol. 24(2):65-71.

CONCLUSION(S): Acupuncture therapy may offer some advantage over conventional treatment in the management of hyperemesis gravidarum and postcaesarean section pain and these areas warrant further study. Rigorous randomized studies, particularly those using objective measures, have failed to identify any obvious benefits from acupuncture for many of the other conditions studied.

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Photo Credits

Most of the photos in this book, excluding the cover illustrations, photos of the authors, and logos, are from www.dreamstime.com. Cover illustrations by Juli Douglas. Author photos by Jason McRuer.