Preparation & support during IVF & other A.R.T.

In some instances ART cannot be successfully carried out, or cannot be carried out at all. Reasons for this may be:

1. Ovarian factors raised FSH, poor ovarian response, few follicles, reduced quality of eggs;
2. Sperm factors poor sperm counts, motility, morphology (with ICSI this factor is less relevant), poor quality of sperm;
3. Uterine factors poor receptivity of the endometrial lining (thus low implantation rate), thin uterine lining, slippery endometrium (fluid often from fallopian tubes);
4. Embryonic factors poor embryo quality (embryos who do not divide sufficiently or disintegrate early); embryo not viable leading to miscarriage.

The benefit of Chinese medicine on fertility is well documented, both in the classics of Chinese medicine and in research carried out world-wide.

• We now know that Chinese medicine can restore and increase ovarian function leading to reduced FSH & LH levels, better follicle production & ovulation as well as restoration of the biphasic basal body temperature with good progesterone secretion. 
• Improving ovarian function and normalising progesterone & oestrogen will automatically improve the thickness and nourishment of the uterine lining. New research also shows that acupuncture done just prior to embryo transfer increases the pregnancy rate significantly (see below), probably by regulating the autonomic nervous system — involved in the control of muscles and glands — and thus making the lining of the uterus more receptive.
• Numerous researches show the effectiveness of Chinese medicine on sperm count, mobility, morphology and liquefaction. Very exiting research was carried out in Israel that shows that males with no sperm at all (azoospermia) can expect a raise in sperm count with treatment of Chinese medicine. 
• Improved ovarian function & follicle production as well as improved sperm quality will lead to better quality eggs and sperm. This is the foundation for viable embryos and foetuses, seen in successful implantation and low miscarriage rate.
• Acupuncture is also very effective at reducing stress levels. Stress can interfere with a woman's ability to ovulate. Chronic stress also lowers progesterone levels and can interfere with the embryo implanting into the uterine lining.

Treatment with Chinese medicine in preparation and support for A.R.T.

To get the greatest benefit from Chinese medicine when combining it to IVF three stages of treatment should be carried out:

• The preparation phase: where emphasis is placed on improving ovarian function, egg quality, uterine thickness and sperm quality as well as regulating the menstrual cycle, and improving menstrual disorders and/ or fluid retention (see below);
• The support phase: where the body is supported through the actual process of the IVF treatment;
• The embryo transfer: where the endometrium is prepared for transfer.

The preparation phase

A diagnosis is made following the principles of Chinese medicine as well as incorporating results from the Basal Body Temperature (BBT) readings and other test results as well as the Western medical diagnosis. The observations taken from the BBT chart and sperm tests guide both diagnosis and treatment in TCM and can also be used to assess treatment progress. A treatment plan is then established with acupuncture and/ or Chinese herbal medicine.

The support phase 

This phase begins when the woman starts her hormone regime for IVF. Support is mainly given with acupuncture. Point selection varies according to the stage of treatment e.g. it changes with down-regulation or stimulation.

Acupuncture treatment aids down-regulation as well as prevents or helps with adverse effects arising from the medication (common adverse effects are headaches, hot flushes or mood swings).

Acupuncture treatment during stimulation and between egg retrieval and embryo transfer focuses on supporting the body and egg growth.

As one of the major risks for IVF is poor endometrial receptivity at the time of embryo transfer, treatment to increase the thickness and blood supply of the endometrial lining are included in all treatments. 

The embryo transfer 

A certain acupuncture protocol is carried out as near to the transfer time as possible to increase uterine receptivity. Research has shown how acupuncture applied just before and after embryo transfer increases the chances of a successful implantation. (see below) 

Note on hydrosalpinx (fluid-filled fallopian tubes) 

Some women are told they have excessive fluids on their fallopian tubes which leak into the uterus making the surface of the endometrium too slippery for implantation. Tubes are often tied or even removed to increase the effectiveness of any ART procedure.

Chinese medicine has a good understanding about the over-production of fluid in the reproductive system. It's advisable therefore to consider natural treatments when being faced with this problem before going on to more invasive procedures, particularly if the tubes are not structurally damaged and therefore potentially available for natural conception. The treatment with Chinese medicine may incorporate acupuncture treatment to relax and clear the fallopian tubes, and/or an herbal prescription to clear away any excessive fluid.

Research - Acupuncture for embryo transfer

Recent research in Germany has suggested that using acupuncture with IVF increased the pregnancy rate to nearly 50%. A 42% clinical pregnancy rate was achieved in the test group compared to 26% in the control group that did not receive acupuncture. The researchers concluded that acupuncture seems to be a useful tool for improving pregnancy rate after assisted reproductive techniques.

The treatment in this study involved giving acupuncture just before and just after embryo transfer.

Points were chosen that relax the uterus and improve blood flow according to traditional Chinese medicine. "Acupuncture may also affect the autonomic nervous system involved in the control of muscles and glands and thus may make the lining of the uterus more receptive to receiving an embryo" the researchers concluded.

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K (2000). Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy, Fertility and Sterility, Vol 77, No 4.