When to Have Acupuncture During IVF
Welcome! I am glad you are here. I know it can be both exciting and overwhelming to be starting or currently going through in vitro fertilization (IVF). If you are looking for information about when to have acupuncture during IVF this blog post is for you.
For some women and couples IVF is the answer to their dream of having a child. It is amazing technology and I am so glad it exists. That said, it can also be expensive and very stressful so why not integrate acupuncture to help with stress and increase your chance of a successful outcome.
I am going to cover acupuncture prior to starting IVF and acupuncture during IVF.
Acupuncture for 3 months prior to starting IVF: Preconception Care
Ideally, we would start working together 3 months prior to starting IVF. The most important time to optimize your fertility (and that of your male partner if you have one) is the 3 months prior to starting IVF. During these 3 months we will address the root cause of infertility while improving both egg and sperm quality and uterine receptivity.
Why three months? Eggs mature in 90-day cycles (maturation cycle for sperm is 70-90 days). During this 90-day window acupuncture works to improve blood flow to the ovaries. This improved ovarian blood flow allows for better nourishment and thus potentially improved egg quality and fertilization. Acupuncture also regulates the endocrine system to create a better hormonal environment for the growth and development of healthy ovarian follicles. The ovaries are amazing little powerhouses full of mitochondria (about as many as the muscles in the heart!). To be at their peak potential they need good blood flow and an ideal hormonal environment.
Since a key component of IVF is the stimulation of the ovaries to produce and retrieve as many eggs as possible then acupuncture’s role in supporting ovarian health and egg quality is an important complement to IVF.
In addition to ovarian health and egg quality is the ability of your ovaries to adequately respond to the stimulation medications. The stimulation meds used in IVF are simply bigger doses of the hormones your body already produces. One key IVF medication is Follicle Stimulating Hormone (FSH). FSH is a hormone produced by the pituitary gland that plays a key role in stimulating the ovaries to produce eggs. In a person with a good ovarian reserve (a healthy number of eggs), the body usually requires lower amounts of FSH to stimulate the ovaries. However, when a person’s ovarian reserve starts to decline (typically with age), the ovaries become less responsive to FSH. As a result, the body compensates by producing higher levels of FSH. High FSH levels are often associated with a lower number of eggs available for fertilization, which can lead to a poorer response to IVF. Sounds bad but acupuncture and herbal medicine can reduce levels of FSH to help improve your response to IVF medications. However, you need to address this prior to starting IVF or if you have had failed IVF cycles and want to take a break to work on improving your hormone profile.
Let’s not leave out the sperm! It takes two to tango. Sperm quality is solely responsible in about 20% of infertility cases and is a contributing factor in another 30% to 40% of all infertility cases. Acupuncture and herbal medicine can improve issues like low sperm count, poor motility and poor morphology but, similar to ovarian health, you want to start addressing this before beginning IVF. With technological advances like Intracytoplasmic Sperm Injection (ICSI) – where the embryologist selects one sperm to fertilize an egg – IVF has opened up the door to parenthood for more people. So yes, you could rely on technology to select a sperm but why not do everything you can to improve all your sperm parameters beforehand? Healthy egg + healthy sperm = healthy embryo.
The final piece of the puzzle is the uterine environment. Expanding on the above equation we want to see healthy egg + healthy sperm + healthy uterine environment = healthy pregnancy. Acupuncture can address issues like a thin uterine lining (you need a nice thick lining for the embryo to implant and grow) as well as support optimal endometrial receptivity. A recent study found that acupuncture along with IVF medications called Gonadotropin-releasing hormone (GnRH) agonists improved the endometrial receptivity of patients with recurrent implantation failure in IVF thereby increasing clinical pregnancy rates and improving pregnancy outcomes (Yang et al., 2024).
Another reason for starting acupuncture 3 months prior to beginning IVF is to address any underlying causes of infertility. Beyond thinking about egg and sperm quality and uterine receptivity there are a host of issues that can impact optimal fertility. By addressing the root cause of these issues before starting IVF you may see improved IVF outcomes and, as has been the case for several of my patients, you could get pregnant naturally and not even need IVF!
Common conditions I treat that impact fertility and, potentially, IVF outcomes include:
Diminished ovarian reserve
Premature ovarian failure
Low AMH
Unexplained infertility
Secondary infertility
Ovulatory disorders
Thin endometrial lining
Recurrent miscarriage and pregnancy loss.
Acupuncture has successfully been used alongside IVF since the first research studies in the late 1990s. Early studies found that acupuncture on or around embryo transfer significantly improved IVF pregnancy rates. These studies found that acupuncture increases blood flow to the reproductive organs which may increase the quality and quantity of eggs as well as uterine thickness and receptivity.
When to have acupuncture during IVF
These days, IVF generally has two distinct phases: stimulation phase and embryo transfer.
Acupuncture during the stimulation phase of IVF
During the stimulation phase, medications are used to cause multiple follicles to grow in a synchronized manner until maturation (without stimulation medication there will be one or maybe two dominate mature follicle). Once there are multiple mature follicles a medication is given to trigger ovulation (e.g. the trigger shot) and eggs are surgically aspirated just prior to actual ovulation. The eggs are fertilized with washed sperm (or injected with one sperm via ICSI) and left to grow. Fertilized eggs that mature to the blastocyst stage (5-7 days) can be genetically tested and all embryos are frozen.
While not common these days, in some situations a Reproductive Endocrinologist may advise doing a “fresh transfer” where a mature embryo is transferred to your uterus rather than being frozen.
Acupuncture during the stimulation phase is designed to improve blood flow to the ovaries to maximize their response to the IVF stimulation meds. Research has demonstrated that eggs that come from follicles with optimal blood and oxygen supply have higher fertilization rates (Bhal et al., 2001). I recommend weekly acupuncture treatments during the priming phase and twice a week when you are doing the stimulation meds. Besides supporting your ovaries, we can address and medication side-effects and help reduce all the stress that comes with this process.
Acupuncture for embryo transfer
The earliest research looking at the integration of acupuncture with IVF focused on acupuncture immediately before and immediately after a fresh embryo transfer. This ground breaking study found that acupuncture improved clinical pregnancy rates (Paulus et al., 2002). Since that time acupuncture during IVF has continued to be studied and acupuncture before and after embryo transfer is frequently recommended by fertility clinics with many creating space for this to happen on site.
In 2019 a systematic review and meta-analysis took a broader look at the use of acupuncture around the time of embryo transfer and found a 50% increase in clinical pregnancy rate with over three treatments and that treatment the day after embryo transfer showed no benefit to clinical pregnancy rate. The study also showed that a greater number of acupuncture treatments increased clinical pregnancy rates and 12 sessions of Acupuncture had an improved outcome for live birth rates over embryo transfer without acupuncture and embryo transfer with day of acupuncture. The analysis also showed that acupuncture had a greater benefit for patients who previously had been deemed a poor responder to IVF rather than patients in their first IVF cycle.
So, what does that all mean for acupuncture during the embryo transfer phase of IVF? If I am not already working with someone throughout their IVF process, I recommend that they do acupuncture for at least 4 weeks prior to embryo transfer to prepare their uterus to become a nice juicy nest for the waiting embryo to thrive within. I will also do acupuncture the morning of embryo transfer in my office and 5-7 days post transfer to support the implantation process and help with stress during the “two week wait.”
So, the take home is to start early, if you can, and plan on getting regular treatment throughout the IVF process. A study by Hullender Rubin et al (2015) found that whole systems traditional Chinese medicine was associated with greater odds of live births than IVF alone or IVF with day of acupuncture. In this study, whole systems traditional Chinese medicine included individualized acupuncture once or twice a week throughout the IVF process, individualized diet and lifestyle suggestions, nutritional supplement recommendations, and individualized Chinese medicine herbal formulas. Exactly the way I practice so it is nice to see some research supporting improved outcomes!
What about IUI?
It is not uncommon for people to start with 3-5 rounds intrauterine insemination (IUI) before moving onto IVF. IUI involved the injection of sperm into the uterus timed with ovulation. IUI may be done with or without stimulation medications or an ovulation trigger shot. Generally speaking, IUI increased your odds of getting pregnant naturally (if you have a partner with sperm) by about fifteen percent. IUI is a really great option for LGBTQ people and women using donor sperm who do not have other factors that may impact fertility. The same information about supporting optimal fertility and addressing any underlying conditions that impact fertility apply to IUI.
Whoop! What happens once you get a positive pregnancy test?
I see my fertility patients weekly for at least the first 7-8 weeks but ideally throughout the first trimester. The goal of acupuncture is to support your body in maintaining an optimal environment for a healthy pregnancy to progress. The miscarriage rate drops once cardiac activity is seen and drops even more after the first trimester.
So, here is a very general cheat sheet for when to get acupuncture during IVF:
Weekly 3 months prior to starting IVF
Once a week during priming
Twice a week during stimulation
Once to twice a week for at least 4 weeks before embryo transfer
Pre and post embryo transfer
Weekly for the first 7 – 12 weeks of pregnancy.
Please note that some conditions may warrant more frequent treatment but we would discuss that at your intake.
Ready to integrate acupuncture into your fertility journey? Let’s optimize your fertility! Schedule your free consultation or initial appointment here.
References
Bhal, P. S., Pugh, N. D., Gregory, L., O'Brien, S., & Shaw, R. W. (2001). Perifollicular vascularity as a potential variable affecting outcome in stimulated intrauterine insemination treatment cycles: a study using transvaginal power Doppler. Human reproduction (Oxford, England), 16(8), 1682–1689. https://doi.org/10.1093/humrep/16.8.1682
Hullender Rubin, L. E., Opsahl, M. S., Wiemer, K. E., Mist, S. D., & Caughey, A. B. (2015). Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes. Reproductive biomedicine online, 30(6), 602–612. https://doi.org/10.1016/j.rbmo.2015.02.005
Paulus, W. E., Zhang, M., Strehler, E., El-Danasouri, I., & Sterzik, K. (2002). Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and Sterility, 77(4), 721–724. https://doi.org/10.1016/s0015-0282(01)03273-3
Smith CA, Armour M, Shewamene Z, Tan HY, Norman RJ, Johnson NP. Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis. Reprod Biomed Online. 2019 Mar;38(3):364-379.
Yang, J., Lu, Y., Zhang, Y., Zhou, C., Liang, Q., & Liang, T. (2024). Acupuncture combined with gonadotropin-releasing hormone agonists improves endometrial receptivity and pregnancy outcome in patients with recurrent implantation failure of in vitro fertilization-embryo transfer. Journal of assisted reproduction and genetics, 41(8), 2185–2192. https://doi.org/10.1007/s10815-024-03140-7
Next on your reading list:
Fertility Acupuncture: Everything You Need to Know
Acupuncture Improves Poor Ovarian Response in IVF: Recent Research