ACUPUNCTURE FOR FERTILITY: DOCTORS SAY, ‘WHY NOT?’
By Elena Conis, Special to the LA Times
July 4 2005
With more patients asking for it, some clinics are offering the ancient technique.
Jackie Apuzzo is 16 weeks pregnant something she was beginning to think would never happen.
Following nine years of unsuccessful efforts to have a baby, including failed in vitro fertilization, a miscarriage and a diagnosis of endometriosis, the 37-year-old social worker finally visited an acupuncturist on the advice of a friend. After two months of acupuncture treatments and a regimen of Chinese herbs, she became pregnant.
“I was a little apprehensive about the needles at first,” said Apuzzo. But in April, Apuzzo’s acupuncturist in Santa Monica looked at her tongue, checked her pulse and declared the Long Beach resident pregnant. Apuzzo later confirmed the diagnosis with a blood test.
As more women than ever delay having children until their 30s and 40s, infertility is a growing challenge in the U.S. An estimated 3 million couples are unable to conceive after a year of trying, according to the American Society for Reproductive Medicine. Fertility clinics have done a brisk business in recent years, but now doctors say that a growing number of women who have been unable to get pregnant through conventional medical treatments are seeking out alternatives such as acupuncture. Demand for the traditional Chinese method is so great that an increasing number of fertility doctors now are collaborating with acupuncturists, with some physicians adding acupuncturists to their staff, according to doctors and experts in the field.
Although many acupuncturists and doctors of oriental medicine swear by the treatment ‹ and have relied on it as an infertility remedy for years ‹ the mainstream medical community remains divided on acupuncture’s efficacy. Some doctors say more research is needed to demonstrate acupuncture’s effectiveness, and others believe it’s irresponsible to recommend the treatment based on the existing scientific evidence.
Most fertility specialists trace the current popularity of acupuncture treatment to a German study published in 2002 in the journal Fertility and Sterility. The study, led by Dr. Wolfgang Paulus at the University of Ulm, found that 42% of women receiving acupuncture just before and after an assisted-reproductive therapy, such as IVF, became pregnant; that compared with 26% of patients who got pregnant with assisted-reproductive treatments but who received no acupuncture therapy.
Later that year, Dr. Raymond Chang and colleagues at Cornell University’s medical school in New York published a paper in the same journal, describing several ways acupuncture might actually improve a woman’s chances of conceiving: relaxation, regulating reproductive hormones and improving the lining of the uterus, where the embryo needs to be implanted before it can develop.
Because of the reports, published in a prestigious journal, “some doctors started to say, let’s try it out,” said Dr. Paul C. Magarelli, a fertility specialist in Colorado Springs, Colo.
Deming Huang, an acupuncturist at Stanford University’s Center for Integrative Medicine in Palo Alto, said patient interest began to rise about the same time. At the Stanford clinic, more women began asking their doctors for referrals to acupuncturists. And though it’s not easy to measure the effect of popular culture on medical trends, more than a few women may have been swayed to try acupuncture when the “Sex and the City” character Charlotte visited an acupuncturist in an effort to get pregnant during the show’s final season.
Alice Domar, director of the Mind/Body Center for Women’s Health at the Boston IVF fertility clinic, describes efforts by physicians to recommend acupuncture for fertility treatments as a “mini-scandal.” But even the clinic where she works is preparing to hire an acupuncturist to add to its current mix of relaxation and confidence-building techniques for fertility patients a decision Domar, a psychologist, says she struggles with as a scientist.
“With the data we have right now, one cannot say that acupuncture increases pregnancy rates,” Domar said.
Western studies on the topic have so far produced inconsistent results, making it impossible, she said, for experts to draw definitive conclusions.
Early studies on the subject suggested acupuncture might increase blood flow to the uterus which would improve the chances of a pregnancy taking hold but later research refuted this.
Studies led by Magarelli, the Colorado specialist, suggested acupuncture increased pregnancy rates in patients who doctors had determined had little hope of getting pregnant. He and colleague Diane Cridennda, a licensed Colorado Springs acupuncturist, also showed that women who received acupuncture had more “take-home babies.” That is, they were less likely to lose pregnancies to miscarriage or embryos that failed to take hold in the uterus.
But like the German study results, Magarelli’s findings have been faulted for failing to rule out psychological or psychosomatic effects of the treatment. Patients who received a fake treatment might have responded to the treatment as if it were truly effective simply because they believed it was ‹ a phenomenon known as the placebo effect.
Paulus addressed the problem in a 2003 study by comparing the effects of acupuncture with fake or sham acupuncture, placing needles against acupuncture points without penetrating the skin. The results showed no difference in pregnancy rates between patients who received true acupuncture and those who were given the sham.
Acupuncture needles, about the width of a hair, are just barely felt when inserted, making it difficult to come up with a good sham treatment to help rule out the placebo effect. As Domar put it, “If patients are getting pricked with a needle, they know it.”
It’s hard to study acupuncture for other reasons too. Treatment regimens have varied from one study to the next. A study performed by researchers at the Robert Wood Johnson Medical School in Camden, N.J., found no effects of acupuncture on pregnancy rates but their patients had just one acupuncture session, whereas other studies used two or more.
To rule out the effects of other aspects of the treatment, Western researchers often trim acupuncture down to its simplest element: needles. But acupuncturists don’t simply insert needles; most take a whole-body approach, asking broad questions about patient history, making recommendations about nutrition and stress management and prescribing herbal remedies.
“Our goal is not just to get the patient pregnant,” said Dr. Daoshing Ni, co-founder of the Tao of Wellness center in Santa Monica, which sees hundreds of infertility patients each week. “Getting pregnant is just one step in our overall goal” of improving a patient’s health, he explained.
Researchers here and in Europe hope to eventually shed light on whether acupuncture is truly beneficial for women trying to get pregnant. For now, however, doctors face a conundrum: Should they recommend an unproven treatment, discourage such treatment or take no stance at all, said Dr. James Dillard, of the Rosenthal Center for Complementary and Alternative Medicine at Columbia University.
Because acupuncture is considered relatively safe, Dillard said, more fertility doctors are deciding that it’s OK to add it to the mix. “It’s a big black-and-white outcome; you’re either pregnant or you’re not,” he said. “If it turns out it’s just the placebo effect, who cares?”
Many also say evidence that acupuncture relaxes patients is sufficient to recommend it, given the stress of dealing with infertility. In fact, women undergoing infertility treatments face stress levels on par with those of women coping with chronic illnesses such as heart disease and cancer, according to the American Society for Reproductive Medicine.
But skeptics like Domar feel it may still be too soon to recommend the treatment. “Patients are not going for acupuncture to feel good; they’re going for acupuncture to get pregnant. And they’re spending thousands of dollars for it. It’s a dilemma.”
Now pregnant, Jackie Apuzzo is still undergoing acupuncture treatment, although her therapy has changed: no more herbs and fewer needles in different locations. Her baby is due in December.
Reflecting on the trials of the last several years, Apuzzo said the best thing about acupuncture was that it saved her from a second stressful IVF cycle, which she had planned for this month. “I’m glad we don’t have to go through that again,” Apuzzo said. “I just wish that I had considered the alternatives before jumping into the big guns.”
THE POINT OF GETTING PREGNANT; ACUPUNCTURE MAY HELP WITH IN VITRO PROCEDURE
The newest technology has been joined by an ancient form of Chinese medicine at the Reproductive Medicine & Fertility Center in Colorado Springs. Combining in vitro fertilization, or IVF, with acupuncture, a 5,000-year-old practice, appears to pay off for couples yearning to have a child, says Dr. Paul Magarelli, a reproductive endocrinologist and medical director of the center. Magarelli and Diane Cridennda, owner of East Winds Acupuncture, conducted a study involving 203 of his patients who underwent IVF; 105 had IVF alone and 98 also had a specified series of acupuncture treatments. The acupuncture group’s pregnancy rate was 24 percent greater. Magarelli presented his research last month before the World Congress on Human Reproduction in Venice, Italy. Previous studies, including research in Germany and China, also have pointed to the benefits of adding acupuncture to assisted-reproduction technologies.
Despite being deathly afraid of needles, Jo Ann Davis is among Magarelli’s in vitro patients who underwent acupuncture. “I do believe it had an impact,” she says. As evidence, she points to her twins, a boy and a girl, who celebrated their first birthday recently.
In vitro fertilization involves harvesting eggs from a woman’s ovaries and fertilizing them in a laboratory dish with a man’s sperm. The resulting embryo is then transferred to the uterus. According to the protocol followed by Magarelli and Cridennda, acupuncture sessions were twice a week for four weeks before retrieval of the eggs, and then just before and after the embryo transfer. Electro-stim acupuncture, involving a mild electrical current, was used.
Women generally find the sessions relaxing, Cridennda says. “Most of the girls say when they start to get to the last of their pretransfer treatments, ‘Man, I’m going to miss my needle nap.'”
With Davis’ needle phobia, it wasn’t all that relaxing. But it wasn’t painful, either. She felt a vibration or tingling with the first sessions and a deep “stirring” with the final two. “I could feel that right at my core, so that was pretty amazing.” Magarelli was dubious when Cridennda, a doctor of Oriental medicine who trained in Beijing, approached him five years ago about using acupuncture for his patients. But after Cridennda showed him data from some small studies — and after he became convinced it would at least cause no harm — Magarelli began sending her his patients who were having the most trouble becoming pregnant.
What he noticed was, “Gee, they were getting pregnant,” Cridennda says. In addition to an increased pregnancy rate in the acupuncture group, the rate of ectopic pregnancies “was almost nonexistent,” Magarelli says — 1.5 percent vs. 4.7 percent. In vitro fertilization is associated with an increased risk of ectopic pregnancies, in which the fertilized egg attaches someplace other than inside the uterus.
Acupuncture involves the insertion of hair-thin needles at precise points to correct the flow of qi, or life energy. How it may help reproduction isn’t clear, but it has been shown to increase blood flow into the uterus. It also may help by reducing stress.
Magarelli wants further research with more patients and is encouraging larger centers to conduct studies. His objectivity, he says, may be compromised. Once skeptical of acupuncture, he’s now a believer.
He decided to experience acupuncture for himself after Cridennda approached him. “I said I wouldn’t recommend anything without trying it. That first time, I walked in and there are fountains and tinkling noises and the mood music, and I’m like, ‘Oh, what am I doing here?'” But he found it relaxing and now goes to Cridennda regularly for acupuncture. To his surprise, it even gave him relief from a repetitive- motion injury in his hand. “He couldn’t believe it,” Cridennda said. “He would laugh, ‘Oh my gosh, the pain is gone.'”
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