Research Studies - Total Wellness Centre
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GENERAL FEMALE FERTILITY STUDIES

• A study conducted by the National Institutes of Health and the University of Oxford shows evidence that stress affects fertility. Researchers charted the ovulation cycles of 274 English women aged 18-40 years who were trying to conceive, and who participated in the Oxford Conception Study led by Cecilia Pyper, MB.BS. On the sixth day of her cycle, each woman collected a sample of her saliva, which was subsequently tested for alpha-amylase, an indicator of the body’s response to physical or psychological stress. The women’s saliva samples were also analyzed for cortisol, another hormone produced by the adrenal glands in response to stress. Each woman took part in the study until she became pregnant, or at the end of six menstrual cycles. Stress significantly reduced the probability of conception each day during the fertile window, possibly exerting its effect through the sympathetic medullar pathway. CONCLUSION: The researchers found that, all other factors being equal, women with high alpha-amylase levels were less likely to conceive than were women with low levels, during the fertile window– the six days when conception is most likely to occur. Researchers did not find a correlation between cortisol levels and the chances of conception.

The study results suggest that finding safe ways to alleviate stress may play a role in helping couples become pregnant,” said Alan E. Guttmacher, M.D., director of the NICHD. “Women trying to get pregnant should identify the stressors in their lives and work to alleviate them through yoga, acupuncture or relaxation therapy”, suggests Dr. William Hurd, division chief of the Reproductive Endocrinology and Infertility Center at University Hospitals Case Medical Center.1

 

• This is a study which attempts to understand the correlation between women’s stress levels and fecundity and infertility. Data suggest that stress and reproduction are interrelated; however, the directionality of that association is unclear, ie does infertility cause stress or does stress cause infertility? In 2005–2009, reserachers enrolled 501 couples in a prospective cohort study with preconception enrollment at two research sites (Michigan and Texas, USA). Couples were followed for up to 12 months as they tried to conceive and through pregnancy if it occurred. A total of 401 (80%) couples completed the study protocol and 373 (93%) had complete data available for this analysis. Enrolled women collected saliva the morning following enrollment and then the morning following their first observed study menses for the measurement of cortisol and alpha-amylase, which are biomarkers of stress. TTP was measured in cycles. Covariate data were captured on both a baseline questionnaire and daily journals. After adjustment for female age, race, income, and use of alcohol, caffeine and cigarettes while trying to conceive, women in the highest tertile of alpha-amylase exhibited a 29% reduction in fecundity (longer TTP) compared with women in the lowest tertile [fecundability odds ratios (FORs) = 0.71; 95% confidence interval (CI) = (0.51, 1.00); P < 0.05]. This reduction in fecundity translated into a >2-fold increased risk of infertility among these women [relative risk (RR) = 2.07; 95% CI = (1.04, 4.11)]. In contrast, we found no association between salivary cortisol and fecundability. Conclusion: The researchers were unable to determine directionality, but it was clear from the study there exists a strong correlation between stress and infertility.60

 

• Researchers in this study attempted to evaluate, retrospectively by clinic records, the effect of the Craig protocol in both donor and nondonor IVF cycles on four outcomes: (1) live births; (2) biochemical pregnancies; (3) adverse outcomes; and (4) live births in nondonor cycles across age groups established by the Society for Assisted Reproductive Technology. The Craig protocol included the following points before ET: GV-20, CV-6, ST-29, SP-8, PC-6, LV-3; Shenmen and Brain on the left ear; and Uterus and Endocrine on the right ear. After transfer the points were LI-4, SP-10, ST-36, SP-6, KI-3; Uterus and Endocrine on the left ear; and Shenmen and Brain on the right ear. In donor cycles, live birht rates were higher in the acupuncture group (relative risk=1.31, 95% CI 1.02-1.71). Conclusion: The Craig protocol was not found to lower IVF live birht rates. In fact, the Craig protocol was associated with higher live birth rates in donor cycles. These findings should be considered cautiously because more adequately powered, randomized research is needed.61

 

• This study aimed to assess the effect of Traditional Chinese Herbal Medicine (CHM) in the management of female infertility and on pregnancy rates compared with Western Medical (WM) treatment. The study suggests that management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4 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.37

 

• This was a study on the effect of acupuncture treatments on the psychosocial outcomes of women experiencing infertility. Thirty-two women aged 20-45 years received six sessions of acupuncture over 8 weeks. Women were observed for the outcomes on infertility self-efficacy, anxiety and infertility-related stress. At the end of the intervention, those women in the acupuncture group reported significant changes on two domains on the Fertility Problem Inventory. Conclusion: Acupuncture may be a useful intervention to assist with the reduction of infertility-related stress.40

 

• This study aimed to evaluate whether acupuncture improves the rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation. Eligible studies where randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth were compared. Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation by up to 65%.3SeeFULL TEXT.

 

• Swedish researchers looked at the role that acupuncture can play in the treatment of infertility and in particular its effect on uterine blood flow.4The pool of women used as test subjects had infertility problems and were diagnosed with decreased blood flow into the uterus which affects endometrial receptivity. When there is a decreased flow of blood into the uterus, treatment options are few and conception is difficult. Using specific points which correspond to the innervation of the uterus, researchers measured the amount of blood flow in women undergoing in vitro fertilization (IVF) treatment. The results showed that there was a significant increase in the blood flow into the uterus with the acupuncture treatment. Researchers attributed the effect of acupuncture to its influence on increased uterine arterial blood flow into the uterus which in turn would increase the chance for oocyte implantation.

 

• Researchers in Germany looked at the traditional methods of acupuncture to determine its efficacy with the use of traditional points based on Traditional Chinese Medicine combined with assisted reproductive techniques with embryo transfer (in vitro fertilization or IVF).5The acupoints chosen were used to relax the uterus. The main purpose of the study was to evaluate whether acupuncture accompanying embryo transfer increases clinical pregnancy rates.

A total of 160 patients participated in the study, 80 patients receiving acupuncture and assisted reproductive techniques and 80 patients undergoing assisted reproductive techniques without acupuncture. Treatment consisted of an acupuncture treatment before and after IVF. The results showed that the pregnancy rate for the acupuncture group was considerably higher than the control (42.5% acupuncture group versus 26.3% control group). Acupuncture is a useful tool for improving the pregnancy rate after ART.

 

• The purpose of this study was to provide an overview of the use of acupuncture as an adjunct therapy for in vitro fertilization (IVF), including an evidence-based evaluation of its efficacy and safety and an examination of possible mechanisms of action. Evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life of patients undergoing IVF and that it is a safe adjunct therapy. The reviewed literature suggests 4 possible mechanisms by which acupuncture could improve the outcome of IVF: modulating neuroendocrinological factors; increasing blood flow to the uterus and ovaries; modulating cytokines; and reducing stress, anxiety, and depression.6

 

• Some centres across North America now use assisted reproductive techniques combined with acupuncture. A fertility centre in Colorado Springs, Colorado utilizes both techniques.7The protocol used combines both techniques reported on in the Swedish and German research papers. Initially, the patient undergoes two treatments a week for four weeks of treatment before the IVF transfer which prepares the uterus’ endometrium for implantation by increasing arterial blood flow using acupoints based on the Swedish study. Pre- and post-embryo transfer, the patient is given acupuncture to relax the uterus as outlined in the German study.

There, results show that 16% more women get pregnant and 23% are having births. This combined technique of acupuncture with IVF is superior to IVF alone.

 

• Researchers attempted to evaluate the effectiveness of acupuncture on the reproductive outcome in patients treated with IVF or intracytoplasmic sperm injection (ICSI). Clinical and ongoing pregnancy rates were significantly higher in the group that received acupuncture as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). Researchers concluded that acupuncture significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture.8

 

• Acupuncture and Poor IVF Responders; A further study in April 2004 confirmed a significant increase in the number of pregnancies in patients who demonstrated elevated peak FSH and a longer history of infertility. This study had an IVF pregnancy rate of 53% in the acupuncture group compared to 38% in the non-acupuncture control group.9

 

• Acupuncture Reduces Pain After IVF. In this study, 286 women were randomly assigned to receive either electroacupuncture plus para-cervical block or alfentanil (a powerful analgesic) plus paracervical block during oocyte aspiration (egg retrieval). Both interventions induced adequate analgesia, however the electroacupuncture group reported significantly less abdominal pain, other pain, nausea and stress than the medication group, and required significantly less additional analgesic medication.10

 

• This study was designed to determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI). The clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher in the group that received acupuncture than in the control group (15.6% and 13.8%). The study concluded that luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.13

 

• Over a period of three years, acupuncture was offered to patients entering assisted reproduction therapy. Acupuncture sessions were given at varying, but usually weekly, intervals during the in vitro fertilisation (IVF) cycle, and immediately before and after embryo transfer. Twenty two patients (average age 36.2 years) were treated over a total of 26 IVF cycles and 15 pregnancies were achieved, as determined by presence of foetal heartbeat on ultrasound at four weeks post embryo transfer. There was a success rate of 57.7% in the acupuncture group compared with 45.3% for patients in the IVF unit not treated with acupuncture (P > 0.05). Relaxing effects were noted following acupuncture and it is speculated that this may have contributed to the increase in pregnancy rate for the acupuncture group.14

 

• The aim of this study was to summarise the evidence from systematic reviews (SRs) and meta-analyses assessing the efficacy of acupuncture in treating common gynaecologic conditions. Six electronic databases, including two major English-language databases (PubMed and the Cochrane Library) and four Korean databases, were systematically searched for SRs and meta-analyses concerned with acupuncture and common gynaecologic diseases. The quality of the included studies was assessed using the Overview Quality Assessment Questionnaire. Of the 55 potentially relevant studies that were found, 16 SRs were included in this report. The study concluded that acupuncture was clearly beneficial in the management of chemotherapy-induced nausea and vomiting. In addition, current evidence suggests that acupuncture administered close to embryo transfer during in vitro fertilisation treatment improves the rates of pregnancy and live birth.17

 

• The purpose of this study was to determine the impact of hypnosis during embryo transfer on the outcome of in vitro fertilitization. Ninety-eight patients undergoing IVF and embryo transfer (ET) cycles were selected at random. Fifety-two clinical pregnancies were obtained. The implantation rate was 28% among those patients undergoing hypnotherapy veresus an implantation rate of 14.4% for the control group. CONCLUSION: This study suggests that the use of hypnosis during ET may significantly improve the IVF/ET cycle outcome in terms of increased implantation and clinical pregnancy rates. Furthermore, it seems that the patients’ attitude to the treatment was more favorable.39

 

• The purpose of this study was to determine whether 25OH-D (vitamin D) levels in the follicular fluid (FF) of infertile women undergoing IVF demonstrate a relationship with IVF cycle parameters and outcome, hypothesizing that levels of 25OH-D in body fluids are reflective of vitamin repletion status. Eighty-four infertile women undergoing IVF were studied. Serum and FF levels of 25OH-D were highly correlated (r = 0.94). Multivariable logistic regression analysis confirmed FF 25OH-D levels as an independent predictor to success of an IVF cycle; adjusting for age, body mass index, ethnicity, and number of embryos transferred, each ng/mL increase in FF 25OH-D increased the likelihood for achieving clinical pregnancy by 6%. CONCLUSION: Our findings that women with higher vitamin D level in their serum and FF are significantly more likely to achieve clinica pregnancy following IVF-embryo transfer are novel. A potential for benefit of vitamin D supplementation on treatment success in infertile patients undergoing IVF is suggested and merits further investigation.38

 

• The aim of this study was to examine the effect of acupuncture on self-efficacy for women receiving acupuncture for fertility support. Pretest and posttest measurement of infertility self-efficacy was conducted in this prospective observational study. Subjects were recruited from three acupuncture practices in South Eastern Australia. Women aged 18 to 45 years presenting for acupuncture treatment for natural conception or as an adjunct to assisted reproductive technology participated in this study. Consecutive new patients were invited to take part if they were planning a minimum of four acupuncture treatments as part of a current episode of care. The study found a significant increase in total infertility self-efficacy scale (ISE) scores from baseline and after four acupuncture treatments (N = 13; t [12] = 3.15, P = .008). Four women showed clinically significant improvement on ISE total scores using the significant change index. CONCLUSIONS: The data suggests that acupuncture improves self-efficacy and psychological coping for women experiencing delays with falling pregnant.19

 

• This study shows that despite differences between acupuncturists’ point selection and generally a highly variable practice between international acupuncture experts, a high degree of consensus exists amongst expert acupuncturists supporting treatment protocol for women undergoing Assisted Reproductive Technology (ART) treatment.READ MORE

 

• The aim of this study was to assess modalities of acupuncture treatments in fertility centers and compare them with investigated acupuncture treatments in randomized controlled trials (RCTs) related to ART. One in 5 couples is affected by infertility. To increase the effectiveness of assisted reproductive technology (ART) adjuvant acupuncture treatments are frequently administered. 180 fertility centers in Switzerland, Germany and Austria were invited to participate in an online survey assessing the provision of acupuncture in ART. Acupuncture was offered by 33 (38.4%) of all responding fertility centers (n = 86; responder rate = 47.8%). In 39.4% the selection of acupuncture points is standardized or semi-standardized (24.2%) and in 27.3% based on individual TCM-diagnosis. Body acupuncture using needle stimulation was mentioned most frequently (84.8%). Some clinics reported additional use of auricular acupuncture (24.2%) and moxibustion (21.2%). Treatment providers were mainly physician-acupuncturists (84.8%). Compared to the RCTs, these researchers found strong differences in point selection, mode of stimulation, and professional background of treatment providers. From this study it is clear that the selection of an acupuncturist is crucial to the success of the treatment. 45

 

• Infertility affects about 15% of couples in Western-societies with most progressing to fertility clinics for treatment. Despite being common, infertility is often experienced as a lonely road for affected couples. In this paper the researchers expand on their previously published findings of women’s experiences with infertility or difficulty of viable pregnancy who had sought Traditional Chinese Medicine (TCM) therapy in Australia, and focus on women’s quality of life, coping strategies, and support needs. Women reported through both questionnaires and interviews compromised quality of life due to the high level of distress, guilt, grief, and frustration caused by infertility. Reserachers noted that in infertility, ongoing emotional and instrumental support is pivotal to the wellbeing and quality of life of the affected. Traditional Chinese Medicine addresses some support needs in infertility not routinely available in the Western model of care. More peer-led and professional-led support groups are greatly needed for women experiencing infertility to help break isolation and raise awareness of integrative approaches to fertility management.49

 

• Assisted reproductive technologies (ART) are increasingly utilised for resolving difficulties conceiving. These technologies are expensive to both the public purse and the individual consumers. Acupuncture is widely used as an adjunct to ART with indications that it may assist reducing the time to conception and increasing live birth rates. Heterogeneity is high between treatment protocols. The aim of this study was to examine what fertility acupuncturists consider key components of best practice acupuncture during an ART cycle, and to establish an acupuncture protocol by consensus. Conclusion: Despite a lack of homogeneity in the research and clinical literature on ART and acupuncture, a consensus amongst experts on key components of a best practice treatment protocol was possible. Such consensus offers guidance for further research.41

 

• The purpose of this study was to determine whether changes in serum cortisol (CORT) and PRL are affected by acupuncture (Ac) in Ac-treated IVF patients. Blood samples were obtained from all consenting new infertility patients and serum CORT and serum PRL were obtained prospectively. Patients were grouped as controls (IVF with no Ac) and treated (IVF with Ac) according to acupuncture protocols derived from randomized controlled trials. Conclusion: There appears to be a beneficial regulation of CORT and PRL in the acupuncture group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics.52

 

• Acupuncture has been used to treat infertility extensively, including ovulatory dysfunction, in vitro fertilization and embryo transfer (IVF-ET), and male infertility. Researchers attempted to review recent studies in the field of fertility acupuncture. Conclusion: Most of the existing studies suggest a positive effect of acupuncture in infertility treatment. Firstly, acupuncture may improve ovulation by modulating the central and peripheral nervous systems, the neuroendocrine and endocrine systems, the ovarian blood flow, and metabolism. Secondly, acupuncture can improve the outcome of IVF-ET, and the mechanisms may be related to the increased uterine blood flow, inhibited uterine motility, and the anesis of depression, anxiety and stress. Its effect on modulating immune function also suggests helpfulness in improving the outcome of IVF-ET. Finally, the studies suggest that acupuncture plays a positive role in male infertility, the mechanism of which is not yet clear. Even though a positive effect of acupuncture in infertility has been found, well-designed multi-center, prospective randomized controlled studies are still needed to provide more reliable and valid scientific evidence. Furthermore, it is urgent and necessary to clarify the mechanism of acupuncture for infertility.53

 

• Infertility patients are increasingly using complementary and alternative medicine (CAM) to supplement or replace conventional fertility treatments. Researchers in Canada had the objective of determining the roles of CAM practitioners in the support and treatment of infertility. Semi-structured interviews were conducted in Ottawa, Canada in 2011 with CAM practitioners who specialized in naturopathy, acupuncture, traditional Chinese medicine, hypnotherapy and integrated medicine. Researchers concluded integrated infertility patient care through both collaboration with CAM practitioners and incorporation of CAM’s holistic, individualized and interdisciplinary approaches would greatly benefit infertility patients.62

 

• Researchers in this study wished to observe the effect of electro-acupuncture (EA) on the clinic outcomes and the occurrences of ovarian hyper-stimulation syndrome (OHSS) in in vitro fertilization and embryo transplantation. 109 patients who routinely received in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) at Reproductive Center were assigned to the control group (56 cases) and the EA group (53 cases). Patients in the control group received controlled ovarian hyper-stimulation (COH) referring to GnRH-a long protocol. On the basis of COH, those in the EA group received EA from the day of Gn injection to the day of embryo transfer. Estradiol (E2), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), and angiotensin (AT) II were measured in all patients on the day of hCG injection, the day of ovum pick up (OPU), and the day of embryo transfer (ET), respectively. The oocyte retrieval rate, good quality embryo rate, clinical pregnancy rate, the abortion rate, and the occurrence of OHSS were compared between the two groups. Researchers concluded EA, as an adjunctive therapy, could reduce the occurrence of OHSS in IVF. Besides, it did not decrease good embryo rates and pregnancy rates in IVF-ET, which might be associated with lowering local vascular permeability of ovaries.63

 

• Patients often ask us at Total Wellness, how far in advance of their IVF cycle they should receive acupuncture treatments? This study appears to be one of the first studies to attempt to answer that question.

In recent years, acupuncture has become more and more popular in the management of subfertility. Researchers in this study evaluated the impact of acupuncture during in vitro fertilization (IVF) treatment on the outcomes of clinical pregnancy in published randomized studies. This study was a systematic review and meta-analysis. This study showed that acupuncture did not significantly improve the IVF clinical pregnancy rate when performed only at the time of embryo transfer (ET), while researchers found pooled (cumulative) benefit of acupuncture for IVF when performed at follicle phase and 25 min before and after ET, as well as 30 min after ET and implantation phase. This finding is significant, as it speaks to both the timing of acupuncture and the cumulative effects of acupuncture.64

 

• This is one of the first studies that attempts to distinguish the effects of acupuncture alone as compared to acupuncture plus the full complement of traditional Chinese medicine. Patients undergoing IVF received 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, and lifestyle recommendations. In this retrospective cohort study, 1231 IVF patient records were reviewed to assess the effect of adjuvant WS-TCM on IVF outcomes. The primary outcome was live birth. The researchers concluded overall, IVF with adjuvant WS-TCM was associated with greater odds of live birth in donor and non-donor cycles.65

 

• The objective of this study was to observe the impacts on endometrial and pregnancy outcomes treated with acupuncture and moxibustion in the patients of in vitro fertilization-embryo transfer (IVF-ET) and explore the application value, of acupuncture and moxibustion in IVF-ET treatment. One hundred and fourteen patients of IVF-ET treated with standard long-term program at luteal phase were randomized into an observation group and a control group, 57 cases in each one. In the observation group, at the beginning of ovulatory induction, moxibustion was applied to Shenque (CV 8) and acupuncture was to Zhongji (CV 3), Guanyuan (CV 4), Qihai (CV 6), Zigong (EX-CA 1), Xuebai (SP 10), etc. till the transfer time for one session of treatment. Totally, 3 sessions were required. In the control group, no intervention of acupuncture and moxibustion was applied. The endometrial morphology, subendometrial blood flow index, the levels of serum estradiol (E2), progesterone (P) and luteinizing hormone (LH) on the day of injection of human chorionic gonadotropin (hCG), the dosage and time of gonadotropin (Gn), oocyte count, high-quality embryo number, embryo cultivation rate and clinical pregnant rate were observed in the two groups. At the conclusion of the study, researches found in IVF-ET treatment, acupuncture and moxibustion affect estrogen level on hCG day, improve high-quality embryo rate, endometrial blood flow state and morphology so that the endometrial receptivity is increased and the method is expected to be the assistant therapeutic approach for the improvement of IVF-ET outcome.72

ENDOMETRIOSIS

• Auricle acupuncture significantly reduces pain in cases of severe dysmenorrhea. In this Australian review, 24 studies were reviewed to determine the effectiveness and safety of acupuncture for pain in endometriosis. While it was found that more studies are warranted, the review concluded that acupuncture ‘cured’, was ‘significantly effective’ or ‘effective’ 91.9% of the time, for the treatment of pain associated with endometriosis. Chinese herbal medicine had a success rate of 60% of the time. To note, there was insignificant difference in the effectiveness between acupuncture and Chinese herbal medicine for the treatment of mild to moderate dysmenorrhoea, whereas auricular acupuncture did significantly reduce pain in cases of severe dysmenorrhoea. 31

 

• Acupuncture appears to be an effective pain treatment for endometriosis. The aim of this study was to examine whether acupuncture is an effective additional pain treatment for endometriosis. One hundred and one women aged 20-40 years participated and were randomised into two groups, each receiving two units of 10 acupuncture treatments, twice a week over a period of five weeks. Group 1 (n = 47) received verum-acupuncture during the first series, and group 2 (n = 54) received non-specific acupuncture. Group 1 showed a significant reduction of pain intensity after the first 10 treatments.32

 

• The aim of this study was to review the effectiveness and safety of Chinese Herbal Medicine (CHM) in alleviating endometriosis-related pain and infertility. In China, treatment of endometriosis using Chinese herbal medicine (CHM) is routine and considerable research into the role of CHM in alleviating pain, promoting fertility, and preventing relapse has taken place. Randomised controlled trials (RCTs) involving CHM and 158 women were included in this review. The researchers concluded that post-surgical administration of CHM may have comparable benefits to gestrinone but with fewer side effects. Oral CHM may have a better overall treatment effect than danazol; it may be more effective in relieving dysmenorrhoea and shrinking adnexal masses when used in conjunction with a CHM enema.47

 

• Reserachers in this study compared the difference in the clinical efficacy on endometriosis (EM) between electroacupuncture (EA) and western medication. EM patients were divided into an EA group and a western medication group. The EA was given once every two days. In the western medication group, mifepristone tablets were prescribed for oral administration, 12. 5 mg per treatment, once a day, for 6 months. The pain degree was observed before and after treatment and the clinical efficacy and recurrence rate were evaluated in the two groups. EA achieved a significant clinical efficacy, and the reoccurrence rate in 1 year in the EA group was clearly lower than that of the western medication group. Acupuncture therapy may be promoted as a potential treatment for EM in clinical practice. 80

POLYCYSTIC OVARY SYNDROME (PCOS)

• This study, conducted by neuroscientists in Stochholm, Sweden, aimed to determine whether low-frequency electro-acupuncture (EA) would benefit Polycystic ovary syndrome (PCOS) by decreasing hyperandrogenism and improve oligo/amenorrhea more effectively than physical exercise or no intervention. Scientists randomized 84 women with PCOS, aged 18-37 yr, to 16 wk of low-frequency EA, physical exercise, or no intervention. The primary outcome measure changes in the concentration of total testosterone (T) at week 16. Secondary outcome measures were changes in menstrual frequency; concentrations of androgens, estrogens, androgen precursors, and glucuronidated androgen metabolites; and acne and hirsutism. Both acupuncture and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-wk follow-up compared with no intervention. Low-frequency electro-acupuncture and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Conclusion: Low-frequency electro-acupuncture was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea.2

 

• A clinical and experimental study of integrated traditional Chinese and western medicine in the past 45 years. The study included observations on the induction of ovulation with acupuncture, and the treatment of polycystic ovary syndrome (PCOS) using acupuncture and herbal remedies. Acupuncture and herbs successfully promoted ovulation, affected serum FSH, and resolved the PCOS, resulting in ovulation.11

 

• This study was designed to evaluate if electro-acupuncture (EA) could affect oligo-/anovulation and related endocrine and neuroendocrine parameters in women with polycystic ovary syndrome (PCOS). Repeated EA treatments induced regular ovulations in more than one third of the women with PCOS. Electro-acupuncture offers an alternative to pharmacological ovulation induction.12

 

• The researchers in this study looked at one group of women with polycystic ovary syndrome who received a specific type of acupuncture called “electro-acupuncture” for four months. A second group of women were provided with heart rate monitors and instructed to exercise at least three times a week. A third group received no intervention. The study showed that activity in the sympathetic nervous system was lower in the women who received acupuncture and in those who took regular exercise than it was in the control group. The acupuncture treatment brought further benefits. Those who received acupuncture found that their menstruation became more “normal”. In addition, those that received acupuncture had their levels of testosterone reduced significantly. This is important because elevated testosterone levels are closely connected with the increased activity in the sympathetic nervous system of women. The researchers concluded that acupuncture and exercise can bring relief to women with polycystic ovary syndrome (PCOS).16

 

• The aim of this study was to review studies on acupuncture in reproductive medicine, in experimental and clinical settings. Studies suggest that acupuncture effects are mediated by changes in activity of the autonomic nervous system and stimulation of neuropeptides/neurotransmitters which may be involved in the pathogenesis of infertility. This study found there is evidence of benefit mainly when acupuncture is performed on the day of embryo transfer (ET) in the live birth rate. There was also found to be benefit when acupuncture is performed for female infertility due to polycystic ovary syndrome (PCOS). There is evidence of sperm quality improvement when acupuncture is performed on males affected by idiopathic infertility. Conclusions: Acupuncture seems to have beneficial effects on live birth rate when performed on the day of ET, and to be useful also in PCOS as well as in male idiopathic infertility, with very low incidence of side effects.18

 

• This study aimed to provide a literature review on evaluating the efficacy of acupuncture therapy in the treatment of polycystic ovarian syndrome (PCOS) and also to determine the possible mechanism of acupuncture treatment in PCOS. Four studies were recruited. Several studies showed that acupuncture significantly increases beta-endorphin levels for periods up to 24 h and may have regulatory effect on FSH, LH and androgen. beta-endorphin increased levels secondary to acupuncture affects the hyperthalamic-pituitary-adrenal (HPA) axis through promoting the release of ACTH through stimulation of its precursor pro-opiomelanocortin synthesis. Conclusion: 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.44

 

• Some evidence suggests there are beneficial effects of acupuncture on in vitro fertilisation (IVF) success rate. However, recent clinical trials could not duplicate these effects, especially in patients who are infertile with polycystic ovarian syndrome (PCOS) who are undergoing IVF. The aim of this study is to determine if acupuncture has an effect on IVF success rates in women with PCOS.

 

• Different mechanisms have been described for the effects of acupuncture on fertility. Acupuncture may mediate neurotransmitter release, which results in the stimulation of gonadotrophin-releasing hormone secretion. The production of neurotransmitters such as endogenous opioids may also inhibit central nervous system outflow and biological stress response. Acupuncture may also stimulate blood flow to the uterus by inhibiting uterine central sympathetic nerve activity. The researchers results showed a statistically higher mean of good quality embryos in group I compared with group II (p=0.044). Conclusion: Acupuncture at an early stage of oocyte recruitment may have a beneficial effect on embryo quality. 46

 

• Researchers attempted to answer the question of which therapy is the best therapy for infertility caused by polycystic ovary syndrome (PCOS). One hundred and twenty patients were randomized into three groups, a clomi-phene group, an acupuncture-moxibustion + Chinese medicine group and a clomiphene + acupuncture-moxibustion+ Chinese medicine group. The endometrial thickness, endometrial type and cervical mucus score on human chorionic gon adotropin (HCG) day, and ovulatory cycle rate, clinical pregnancy rate and abortion rate after treatment were observed in the patients of the three groups. Conclusions: The combined therapy of acupuncture, herbal medicine and clomiphene improves the pregnancy rate and reduces early abortion rate by effectively improving HCG day cervical mucus, endometrial thickness and morphology. The efficacy is apparently superior to the simple medication with clomiphene and the combined application of acupuncture and herbal medicine.66

 

• The aim of this study was to observe the effect of electroacupuncture (EA) treatment on the quality of ovum, stem cell factor (SCF) and pregnancy outcome in patients with polycystic ovarian syndrome (PCOS), so as to explore its underlying mechanism, improving pregnancy rates. A total of 200 PCOS patients undergoing in vitro fertilization-embryo transplantation (IVF-ET) were randomly divided into control (medication) group (n = 98) and EA group (n = 102). Comparison between the two groups showed that the high quality embryo rate, and serum and follicular fluid SCF contents were significantly higher in the EA group than in the medication group (P 0.05, P 0.01). A positive correlation was found between the high quality embryo rate and the SCF level in both follicular fluid and serum (P < 0.01). Researchers concluded that EA can improve high quality embryo rates, which may be related to its effect in increasing serum and follicular fluid SCF levels.81

 

• The aim of this prospective, randomized, controlled clinical trial was to investigate whether acupuncture affects ovulation frequency and to understand the underlying mechanisms of any such effect by analyzing LH and sex steroid secretion in women with PCOS. Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome (PCOS). Thirty-two women with PCOS were randomized to receive either acupuncture with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10-13 wk. Main outcome measures were changes in LH secretion patterns from baseline to after 10-13 wk of treatment and ovulation frequency during the treatment period. Secondary outcomes were changes in the secretion of sex steroids, anti-Müllerian hormone, inhibin B, and serum cortisol. Ovulation frequency during treatment was higher in the acupuncture group than in the control group. Researchers concluded 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.83

FSH AND AMH

• Researchers wished to investigate whether electro-acupuncture or physical exercise influence serum anti-Müllerian hormone (AMH), antral follicle count (AFC) or ovarian volume in women with polycystic ovary syndrome (PCOS). Seventy-four women with PCOS recruited from the general population. Women with PCOS were randomized to 16 weeks of electro-acupuncture (14 treatments), exercise (at least three times/week), or no intervention. Researchers in this study were 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. 69

 

• The aim of this study was to investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on ovarian reserve in patients with diminished ovarian reserve undergoing in vitro fertilization and embryo transfer. A total of 240 patients were randomly divided into the Han’s acupoint nerve stimulator TEAS treatment (TES), comforting false Han’s placebo (FHP), artificial endometrial cycle treatment (AEC), and control (CON) groups. Researchers concluded TEAS and AEC treatments could improve basal endocrine levels in patients, and increase the number of oocytes retrieved and high-quality embryos. TEAS treatment could improve the clinical pregnancy rate in patients with decreased ovarian reserve during in vitro fertilization and embryo transfer cycles.82

 

• Others have studied acupuncture treatment for polycystic ovary syndrome (PCOS). Anti-müllerian hormone (AMH) is positively correlated with the ovarian follicle pool, thus making it a useful ovarian reserve measure. AMH is elevated in women with PCOS and has been suggested as a diagnostic tool. This study examined the impact of electroacupuncture on AMH concentration in women with PCOS. Seventy-one women with PCOS participated in a randomized, double-blind, sham-controlled clinical trial of acupuncture. Three longitudinal AMH samples over the 5-month protocol were compared with objective ovulation parameters primarily using nonparametric statistics. Results indicated that AMH levels in PCOS were higher than published norms in women without PCOS. In conclusion, AMH correlated with an increased likelihood of monthly ovulation, as expected from the literature on women without PCOS. The lack of difference by intervention in AMH was consistent with the underlying clinical trial. AMH may be clinically useful to predict which PCOS women are more likely to respond to an intervention. 59

 

• The purpose of this study was to explore the clinical efficacy and action mechanism of acupuncture for premature ovarian failure (POF). Acupuncture was applied to participants, three times per week and 3 months were considered as one session. Totally two sessions were performed. The menstruation condition, estradiol (E2), follicle-stimulating hormone (FSH) and scores of the clinical perimenopausal symptoms were taken as treatment outcomes. The researchers concluded that acupuncture has certain effect on improving menstruation and perimenopausal symptoms in POF patients, which is likely related to increasing the level of E2. 67

 

• Researchers investigated the effect of acupuncture on women with premature ovarian failure (POF). All patients were treated with acupuncture once every other day, three times a week for three months. Acupoints, GV 20, GV 24, GB 13, CV 3, CV 4, BL 23, BL 32, ST 25, ST 28, ST 29, ST 36, SP 6, KI 3, and LR 3, were selected. Serums FSH, E2, and LH level, Self-Rating Anxiety Scale (SAS), and Kupperman score were measured at baseline and at the end of treatment; the menstrual cycle was recorded during one-month follow-up. Compared with baseline, patients’ serums FSH and LH were decreased, E2 was increased, and SAS score and Kupperman score were decreased. Four patients resumed menstrual cycle after treatment and two resumed during follow-up. No serious adverse events were found in all patients. The results indicate that acupuncture may decrease serums FSH and LH level, raise serum E2 level, relieve anxiety, reduce mental stress, and improve the menopausal symptoms, with no adverse side effects. 68

ANOVULATION

• This study aimed to compare the therapeutic effects of acupuncture and Western medicine for promoting ovulation on endocrine dysfunctional infertility. Two hundred and forty cases of infertility were randomly divided into an acupuncture group (n = 160) and a Western medicine group (n = 80). They were treated with acupuncture and clomiphene respectively and their therapeutic effects were compared. The pregnancy rate was 65.0% in the acupuncture group and 45.0% in the Western medicine group with a significant difference between the two groups (P < 0.05).15

 

• This study was designed to evaluate if electro-acupuncture (EA) could affect oligo-/anovulation and related endocrine and neuroendocrine parameters in women with polycystic ovary syndrome (PCOS). Repeated EA treatments induced regular ovulations in more than one third of the women with PCOS. Electro-acupuncture offers an alternative to pharmacological ovulation induction.

RESEARCH ON ACUPUNCTURE DURING PREGNANCY

• Acupuncture treatment reduces pelvic and back pain in pregnancy. In this Swedish study, 72 pregnant women suffering from pelvic or low back pain were randomly assigned to an acupuncture group or a control group. Traditional acupuncture points were needled in individualised treatments, once or twice a week until the disappearance of symptoms or delivery in the acupuncture group. Treatment was given for at least three weeks, twice weekly for the first two weeks, then once a week. The control group received no treatment. During the study period the pain decreased in 60% of patients in the acupuncture group compared to 14% of the controls, dropping to 43% and 9% respectively at the end of the study.20

 

• Moxibustion aids in the correction of breech presentation. Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. 130 subjects were randomized to the intervention group received stimulation of acupoint BL 67 by moxa (Japanese term for Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech presentation. The 130 subjects randomized to the control group received routine care but no interventions for breech presentation. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks’ gestation and delivery. 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.21

 

• In many Western countries breech presentation is an indication for elective Cesarean section. In order to correct fetal presentation, the stimulation of the acupoint BL67 by moxibustion, acupuncture or both has been proposed. Since no studies had previously been carried out on Western populations, pregnant Italian women at 33–35 weeks gestational age carrying a fetus in breech presentation were enrolled in a randomized, controlled trial involving an active BL67 point stimulation and an observation group.A total of 240 women at 33–35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. The study concluded that 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.22

 

• The objective of this study was to review the effectiveness of needle acupuncture in treating the common and disabling problem of pelvic and back pain in pregnancy. 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. Evidence supports the proposition that acupuncture is useful in treating pregnancy-related pelvic and back pain.23

 

• This study compared ongoing pregnancy and live birth rates in spontaneous users and non-users of complementary and alternative medicines (CAMs) during a 12-month period of assisted reproduction technique (ART) treatment. 728 women about to have ART for the first time completed self-report assessments prior to treatment. The ongoing pregnancy and live birth rate was 31.3% lower in CAM users (42.2%) compared with non-users (61.4%). The researchers concluded ONLY that concurrent CAM use should be monitored during ART. A main limitation to this study was that the researchers could not ascertain which type of CAM was most associated with lower pregnancy rates. Acupuncture was not specifically studied. Total Wellness Centre insists that all patients undergoing concurrent Western fertility and traditional Chinese medical treatments inform both their medical doctor and TCM practitioner of all treatments they are undergoing.24

 

• Acupuncture aids in the treatment of depression during pregnancy. A total of 150 pregnant women who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for major depressive disorder were randomized to receive either acupuncture specific for depression or one of two active controls: control acupuncture or massage. Treatments lasted 8 weeks (12 sessions). Fifty-two women were randomized to acupuncture specific for depression, 49 to control acupuncture, and 49 to massage. Women who received acupuncture specific for depression experienced a greater rate of decrease in symptom severity compared with the combined controls or control acupuncture alone. They also had significantly greater response rate (63.0%) than the combined controls (44.3%) and control acupuncture alone (37.5%). Symptom reduction and response rates did not differ significantly between controls (control acupuncture, 37.5%; massage, 50.0%). CONCLUSION: The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments (pharmaceuticals) of similar length and could be a viable treatment option for depression during pregnancy, or for depression in the general population. The potential risk to the fetus associated with pharmaceuticals can be avoided using natural therapies such as acupuncture.25

 

• Many women experience low-back (LBP) or pelvic pain during pregnancy. Pain usually increases as pregnancy advances, interfering with work, daily activities, and sleep. The purpose of this study was to determine what therapies, including acupuncture, exercise, “usual care” and physiotherapy were most effective at reducing lower back pain, pelvic pain, and lumbo-pelvic pain during pregnancy. Moderate-quality evidence showed that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening pelvic or lumbo-pelvic pain. Acupuncture was significantly more effective than exercise for reducing evening pelvic pain. A 16- to 20-week training program was no more successful than usual care in preventing pelvic or LBP. Low-quality evidence suggested that exercise reduced pain and disability from LBP. Reported adverse effects were minor and transient. 51

 

• Researchers in this study wanted to study whether the addition of moxibustion at 33-35 weeks gestation corrects non-vertex presentation (NVP). Researchers were disappointed with past studies lack of control. 406 women in Spain were placed in one of three groups; The first group received moxibustion at BL67, the second group received sham moxibustion at an inert point, and the third group received no intervention. All other intervention such as postural management were controlled. The researchers concluded that moxibustion at BL67 was effective at correcting NVP after 33 weeks of gestation.70

 

• This study attempted to determine if using moxibustion was effective to correct non-vertex (breech) presentation. Researchers employed a randomised controlled trial of 406 low-risk women with a fetus in ultrasound breech presentation with a gestational age of 33-35 weeks. Participants were assigned to 1) true moxibustion at point BL67 plus usual care; (2) moxibustion at SP1, a non-specific acupuncture point (sham moxibustion) plus usual care; or (3) usual care alone. The primary outcome was cephalic presentation at birth. Researchers concluded moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. They believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus.71

 

• Researchers studied the efficacy comparison of Chinese medicine’s labour inducement methods to conventional methods and to the combination of both. This study included 80 women aged 22-40, who required labor inducement. The study group consisted of 50 women who received Chinese medicine’s inducement treatment (Shiatsu and/or Acupuncture) prior to and/or during hospitalization. The control group consisted of 30 women who received customary hospital labor inducement methods. Significant correlation was found between Chinese medicine inducement methods (Shiatsu/Acupuncture) and reduction of additional interventions throughout the birth process, when these were given during hospitalization (x2=47.29, d.f.=21, p=0.001). Correlation close to significant was found when inducement was given prior to hospitalization, especially when labor was induced by Shiatsu (x2=16.8, d.f.=9, p=0.052). An outstanding difference was found in shortening the birth process time (MS=0.45, F(6,72)=2.505, p=0.029) when combining Chinese medicine and conventional inducement methods (medicinal/mechanical). Study results show that Chinese medicine inducement methods, whether or not combined with conventional methods, are an important and effective tool in their ability to reduce the extent of intervention throughout the birth process and also in reducing delivery completion interventions.73

MENOPAUSE

• Researchers found seven weeks of acupuncture treatment reduced the severity of nighttime hot flashes by twenty-eight percent among menopausal women compared with a six percent decrease among women who had a sham (placebo) acupuncture treatment.

 

Researchers compared the effects of acupuncture and placebo acupuncture treatment on the severity and frequency of nighttime hot flashes. Twenty-nine menopausal women experiencing at least seven moderate to severe hot flashes per day took part in the study.

 

All of the women underwent nine treatments from trained acupuncturists in sessions over seven weeks. Twelve of the women received real acupuncture using points selected to target hot flashes and sleepiness. The rest of the women received a sham acupuncture treatment using non-penetrating needles at random acupuncture channel points.

 

Throughout the study, the women reported the number and severity of their hot flashes. The results showed that nighttime hot flash severity decreased significantly (28 percent) among the women who received acupuncture versus. a 6 percent drop among the women who got the sham treatment. However, they did not see a similar finding in the frequency of nighttime hot flashes between the two groups.

 

Researcher Mary Huang, M.S., of Stanford University, and colleagues write that the results suggest acupuncture deserves further study as an alternative treatment for menopausal hot flashes.

 

The findings are published in the September 2006 issue of Fertility and Sterility.33

 

• According to a study published by the School of Health Sciences at the Victoria University of Melbourne city, Australia, acupuncture, herbal medicine and Tai Ji (Tai chi) exercise can be applied to prevent and treat osteoporosis. These treatments can be effective, if they are applied correctly. The therapies may also be used in the treatment and prevention of osteoporosis, as well as the general maintenance of women’s health during menopause.34

 

• Researchers observed the effects of acupuncture plus acupoint sticking of Migudan on bone mass density (BMD) and pain in patients with primary osteoporosis. Changes in BMD and cumulative scores of pain after treatment were investigated. The researchers found that acupuncture plus acupoint sticking of Migudan has definite therapeutic effects on primary osteoporosis and pain management.35

 

• The purpose of this study was to observe the efficacy of acupuncture and moxibustion on female obesity complicated with climacteric syndrome and its impact factors. One hundred and fifty-one cases of female obesity complicated with climacteric syndrome were treated according to the basic TCM principle as “pattern/syndrome differentiation”. The obesity patients complicated with climacteric syndrome presented unusually high level of obesity index, Kupperman index and FSH levels and unusually low level of estradiol. After treatment, the obesity index, Kupperman index and FSH levels were all reduced significantly (all P < 0.01) while estradiol level was increased significantly (P < 0.05). Conclusion: Acupuncture and moxibustion achieve the significant efficacy on obesity complicated with climacteric syndrome.42

 

• Researchers in this study wished to compare the therapeutic effect of Chinese herbal medicine (CHM), acupuncture, and hormone therapy on menopause and the related symptoms of peri- and postmenopausal women. Fifty-seven women completed 2 months of treatment with either CHM (5 g twice daily, n = 22), acupuncture plus CHM (Kun Bao Wan) 5 g twice daily plus sessions of acupuncture, n = 20), or hormone therapy (n = 15). CHM, acupuncture plus CHM, and hormone therapy significantly decreased Kupperman score (P < .001 in each group) and number the of symptoms (P < .05). Conclusion: The application of the combination of Chinese herbal medicine and acupuncture proved as effective as hormone therapy in the treatment of menopause-related symptoms, and it achieved better outcomes than herbal medicine alone.43

 

• Researchers aimed to investigate whether acupuncture has an effect on menopausal symptoms and to explore whether this effect is related to changes in hormone levels. Acupuncture is commonly used to treat menopausal symptoms and other gynaecological conditions. A total of 53 postmenopausal women were alternately assigned into two treatment groups: acupuncture (n=27) and sham acupuncture (n=26). Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). The serum oestradiol, follicular stimulating hormone (FSH) and luteinising hormone (LH) levels were measured at baseline and again after the first and last sessions. After treatment, total MRS, and the somatic and psychological subscale scores were significantly lower in the acupuncture group than the sham group (all p=0.001). The severity of hot flushes was found to be significantly decreased after treatment in acupuncture group (p=0.001). In the acupuncture group LH levels were lower and oestradiol levels were significantly higher than sham group (p=0.046 and p=0.045, respectively) after treatment, but there was no difference in FSH levels. Conclusion: Acupuncture was effective in reducing menopausal complaints when compared to sham acupuncture and can be considered as an alternative therapy in the treatment of menopausal symptoms.35

 

• Acupuncture is commonly used to treat menopausal symptoms and other gynaecological conditions. In this study, the authors aimed to investigate whether acupuncture has an effect on menopausal symptoms and to explore whether this effect is related to changes in hormone levels. Conclusion: Acupuncture was effective in reducing menopausal complaints when compared to sham acupuncture and can be considered as an alternative therapy in the treatment of menopausal symptoms.36

 

• The following study does not strictly pertain to the treatment of menopause, but is relevant nevertheless. Vasomotor symptoms are common adverse effects of antiestrogen hormone treatment in conventional breast cancer care. Hormone replacement therapy is contraindicated in patients with breast cancer. Venlafaxine (Effexor), the therapy of choice for these symptoms, has numerous adverse effects. Recent studies suggest acupuncture may be effective in reducing vasomotor symptoms in menopausal women. This randomized controlled trial tested whether acupuncture reduces vasomotor symptoms and produces fewer adverse effects than venlafaxine. Those who underwent acupuncture therapy had significant decreases in hot flashes, depressive symptoms, and other quality-of-life symptoms, including significant improvements in mental health from pre- to post-treatment. Conclusion: Acupuncture appears to be equivalent in effectiveness to drug therapy for the patients in this study, without the adverse side effects caused by venlafaxine. It is a safe, effective and durable treatment for vasomotor symptoms secondary to long-term antiestrogen hormone use in patients with breast cancer.55

MALE STUDIES

• The aim of this controlled study was to assess the effectiveness of acupuncture on the sperm quality of males suffering from subfertility related to sperm impairment. Semen samples of 16 acupuncture-treated subfertile patients were analyzed before and one month after treatment (twice a week for 5 weeks). In parallel, semen samples of 16 control untreated subfertile males were examined. Two specimens were taken from the control group at an interval of two-eight months. The fertility index increased significantly (p <.05) following improvement in total functional sperm fraction, percentage of viability, total motile spermatozoa per ejaculate, and integrity of the axonema (p <.05), which occurred upon treatment. The intactness of axonema and sperm motility were highly correlated (corr. = .50,p < .05). This study strongly suggests patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment.26

 

• Forty men with idiopathic oligospermia, asthenospermia, or teratozoospermia were studied.27Twenty eight of the patients received acupuncture twice a week over a period of 5 weeks. The samples from the treatment group were randomized with semen samples from the 12 men in the untreated control group. Statistical evaluation using transmission electron microscopy data showed a statistically significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects in the total ejaculates. A statistically significant improvement was detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. 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.

 

• Researchers searched for the best method for increasing the quality of abnormal sperm. One hundred and sixty-eight cases of infertility were randomly divided into a treatment group of 85 cases and a control group of 83 cases. The treatment group were treated with needle-picking (acupuncture) at specific bilateral points. Their therapeutic effects were observed in 3 hospitals. The study resulted in a total effectiveness rate of 83.5% and a pregnancy rate of the patient’s partner of 78.8% in the treatment group, and a corresponding rate of 54.2% and 43.4% in the control group, which represents a very significant difference between the two groups (P < 0.01). Reproductive hormones improved significantly after treatment (P < 0.01); after treatment, superoxide dismulase (SOD) activity and Zn content in semen were elevated and cadmium level decreased significantly in the treatment group (P < 0.05).

 

The research shows that needle-picking therapy (acupuncture) can significantly improve and regulate endocrine function, increase the quality of semen and elevate pregnancy rate of the patient’s partner for the patient of primary abnormal sperm.28

 

• Classic therapies are usually ineffective in the treatment of patients with very poor sperm density. This study aimed to determine the effect of acupuncture on these males. Semen samples of 20 patients with a history of azoospermia were examined by light microscope (LM) and scanning electron microscope (SEM), with which a microsearch for spermatozoa was carried out. These examinations were performed before and 1 month after acupuncture treatment. The control group was comprised of 20 untreated males who underwent two semen examinations within a period of 2–4 months. A definite increase in sperm count was detected in the ejaculates of 10 (67%) of the 15 azoospermic patients. Seven of these males exhibited post-treatment spermatozoa that were detected even by LM. The sperm production of these seven males increased significantly, from 0 to an average of 1.5±2.4×106 spermatozoa per ejaculate (Z=−2.8, P≤0.01). Males with genital tract inflammation exhibited the most remarkable improvement in sperm density (on average from 0.3±0.6×106 spermatozoa per ejaculate to 3.3±3.2×106 spermatozoa per ejaculate; Z=−2.4, P≤0.02). Two pregnancies were achieved by the IVF-ICSI procedure. It is concluded that acupuncture may be a useful, nontraumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation.29

 

• The purpose of this study was to assess the clinical effects of the combined therapy of acupuncture with herbal drugs on male immune infertility and on antisperm antibody (AsAb). 100 male cases of infertility with positive AsAb were divided randomly into two groups, each consisting of 50 cases. The results showed that the total effective rate in the acupuncture-drug group was 90%; while that of the control group was 64%, the comparison showing a statistically significant difference (P<0.05). The positive rate of blood serum and/or AsAb in both the two groups decreased in varying degrees, but the negative-turning rate of AsAb in the acupuncture-drug group was more obvious, the comparison showing also a significant difference (P<0.05). The combined therapy of acupuncture with herbal drugs has definite therapeutic effects on male immune infertility, which can regulate AsAb and raise the immunity of the patients.30

 

• The researchers in this study carried on a quantitative analysis of fluorescence polarization degree and fluorescent intensity on wheat germ agglutinin (WGA) receptor in sperm membrane surface and protein macromolecule 1-Anilinonaph thalene-8-suphonic acid salt (1,8-ANS) of sperm membranes of patients with infertility and those with normal fertility. The method of study used an ultraviolet microspectrofluorometer (SMP, type: 05, made in Germany). The results were as follows: the patient’s WGA receptor in sperm membrane surface was decreased (P less than 0.001), and the 1, 8-ANS of fluorescent intensity in hydrophobic area of protein macromolecule of sperm membrane was increased (P less than 0.05). After the treatment with Shenjing Zhongzitang, WGA receptor was significantly increased and 1, 8-ANS fluorescent intensity whad become nearly normal. Researchers demonstrated that those Chinese medicinal herbs mentioned above have definitive influences upon the constitution of WGA receptors and protein macromolecules of sperm membranes.48

 

• Between 30% to 80% of male subfertility cases are considered to be due to the damaging effects of oxidative stress on sperm. Researchers wanted to answer the question if oral supplementation with antioxidants may improve sperm quality by reducing oxidative stress. The study included randomised controlled trials comparing any type or dose of antioxidant supplement (single or combined) taken by the male partner of a couple seeking fertility assistance with placebo, no treatment or another antioxidant. The outcomes were live birth, pregnancy, miscarriage, stillbirth, sperm DNA damage, sperm motility, sperm concentration and adverse effects. Men taking oral antioxidants had an associated statistically significant increase in live birth rate and pregnancy rate compared to the control groups. There were NO NEGATIVE SIDE EFFECTS reported with the antioxidant therapy used. Conclusion: The evidence suggests that antioxidant supplementation in subfertile males may improve the outcomes of live birth and pregnancy rate for subfertile couples undergoing ART cycles. 50

 

• The reseachers in this study employed a prospective, randomized, single-blind, placebo-controlled methodology to study 57 infertile patients with severe oligoasthenozoospermia. 28 Patients received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. Researchers observed acupuncture caused a significantly higher percentage of motile sperm (World Health Organization categories A-C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.54

 

• Various studies indicate that acupuncture may be an effective treatment for chronic prostatitis. Patients with prostatitis know that current western medical treatments such as long term antibiotic therapy and anti-inflammatories are ineffective and can have strong side effects. Acupuncture has no side effects and has been shown to be very effective at reducing inflammation, pain, improve voiding, and other symptoms, as well as assisting to treat the underlying causes of prostatitis. Additionally, the Mayo Clinic routinely advises its patients that studies indicate acupuncture can help with the symptoms of prostatitis.56

 

• To date few if any comprehensive studies have been undertaken to study the effects of acupuncture and or Chinese herbs on sperm DNA fragmentation. Please READ an interesting thesis from TCM doctoral candidate Virginia Prior of Yo San University in Los Angeles, California who concludes that while acupuncture and TCM does improve many factors associated with DNA fragmentation (morphology, motility, concentration, volume, count, hormone levels, quality and quantity of immune markers, antioxidant levels), more specific studies in this area are required.57

 

• The objective of this study was to evaluate the effect of acupuncture treatments on sperm parameters and pregnancy rates in patients with primary infertility. 30 men with the primary infertility were randomised into two groups. Group 1 underwent subinguinal microscopic varicocelectomy, and Group 2 underwent acupuncture treatment twice a week for 2 months. Both groups were evaluated with semen analysis at 6 months after the treatment. Patients in both groups were evaluated to determine if their partners had become pregnant. The researchers concluded that acupuncture treatment in primary infertile varicocele patients with semen abnormalities seems to be effective and has comparable results with the varicocelectomy treatment. 78

 

• This review was designed to systematically evaluate acupuncture as a treatment for male infertility. A total of 12 studies involving 2,177 patients were included in this review. For the treatment of male infertility, acupuncture is reported to be equally effective as traditional Chinese medicine (Chinese herbs) and more effective than Western medicine alone, and its effectiveness is enhanced when applied in combination with either TCM or Western medicine. Acupuncture is distinctively efficacious in improving sperm quality.79

CHILDREN'S STUDIES

• Recently acupuncture has increasingly being integrated into pediatric health care with acupuncture being used on ~150,000 children (0.2%). Researchers aim to update the evidence for the efficacy and safety of acupuncture for children and evaluate the methodological qualities of these studies to improve future research in this area. Researchers included 24 systematic reviews, comprising 142 randomized controlled trials (RCTs) with 12,787 participants. The efficacy of acupuncture for five diseases (Cerebral Palsy (CP(, nocturnal enuresis, tic disorders, amblyopia, and pain reduction) is promising. Only six reviews reported minor adverse events (AEs) and no fatal side effects were reported. The efficacy of acupuncture for some diseases is promising with only few minor side effects.77

 

• Researchers wished to add commentary to a recently published research paper entitled “Looking for new treatments of Infantile Colic” by Savino et al.. Researchers stated that the positive effects of acupuncture have been demonstrated to release pain and agitation in enfants with colic, and that acupuncture appears to be a safe treatment when performed by trained acupuncturists. Researchers opined that Inconclusive results in the few published articles on the subject may be due to different acupuncture points, different insertion times, different needling methods, differences in the outcome variables, in how the crying was measured and insufficient sample sizes. Further research is warranted to properly understand the utility, safety, and effectiveness of acupuncture in infants with colic.74

 

• The purpose of this study was to investigat the effectiveness of acupuncture in improving the volume and quality of mother’s milk (lactation). Researchers were also interested in determining if they could increse the success rate of breastfeeding. Based on the routine hospital care, the patients in the observation group received auricular point stimulation with vaccaria seed (non-needle acupuncture) at Endocrine (CO18), Mammary Gland, etc. 1 hour after childbirth, which was pressed 3 times daily, for 1-2 min each time. In the control group, routine hospital care was given, which didn’t include auricular point stimulation. The lactation volume, starting time of lactation and serum prolactin (PRL) were observed after 5 days of treatment. Compared with the control group, lactation volume in the observation group was more superior (P less than 0.01). Rate I of lactation volume in the observation group was 51.9% (27/52), which was obviously higher than 27.3% (15/55) in the control group (P less than 0.01). The starting time of lactation in the observation group was obviously earlier than that in the control group (P less than 0.05). The content of PRL was apparently improved after one or two days of childbirth (both P less than 0.05), and significantly increased after 5 days (P less than 0.01). Conclusion: This method appeared to improve lacation in mothers, and may be beneficial to increasing the success rate of breastfeeding.75

 

• This article investigates the efficacy of acupuncture for the maintenance of breastfeeding during the first 3 months of a newborn’s life. Acupuncture sessions were performed twice weekly for 3 weeks (total six sessions). The control group made weekly visits to the clinic and the midwife observed their breastfeeding, giving routine care. In both groups, a semistructured clinical assessment of breastfeeding quality was carried out by the midwife at enrollment and after 3 weeks. Moreover, in both groups a telephone interview was conducted by the midwife at the third month of the infants’ lives, regarding the continuation of breastfeeding. No significant difference in the exclusive breastfeeding rate before treatment was observed between acupuncture and observation groups (51.2% versus 48.8%). However, at 3 weeks post-enrollment, exclusive breastfeeding was significantly lower in the observation group than in the acupuncture group (60% versus 100%; (p  less than 0.03). At the third month of the newborns’ lives, breastfeeding was reported in 35% of the acupuncture group, compared to 15% of the observation group (p 0.03). The data suggests that 3 weeks of acupuncture treatment were more effective than observation alone in maintaining breastfeeding until the third month of the newborns’ lives.76

References

Most of these studies may be found on either MedLine (Pubmed), a free database of medical journals, or PLOS One. This list is not exhaustive as studies are ongoing and are published frequently. For a list of present and planned studies, a good place to review is the Cochrane Library online.

 

  1. Germaine M. Buck Louis, Ph.D.a, Kirsten J. Lum, M.S.a, Rajeshwari Sundaram, Ph.D.a, Zhen Chen, Ph.D.a, Sungduk Kim, Ph.D.a, Courtney D. Lynch, Ph.D.b, Enrique F. Schisterman, Ph.D.a, Cecilia Pyper, B.S., M.B.c, Stress reduces conception probabilities across the fertile window: evidence in support of relaxation. Fertil Steril. 2011 Jun;95(7):2184-9. doi: 10.1016/j.fertnstert.2010.06.078. Epub 2010 Aug 5.Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland 20852, USA.
  2. Jedel E, Labrie F, Odén A, Holm G, Nilsson L, Janson PO, Lind AK, Ohlsson C, Stener-Victorin E., Impact of electro-acupuncture and Physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab. 2011 Jan;300(1):E37-45. Epub 2010 Oct 13.
  3. Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM., Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis., BMJ. 2008 Mar 8;336(7643):545-9. Epub 2008 Feb 7, Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207, USA. Full Text.
  4. Stener-Victorin, E., Waldenstrom, U., Andersson, S. and Wikland, M. (1996) Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod Biol., 11:1314-7, Department of Obstetrics and Gynaecology, Fertility Centre Scandinavia, University of Gothenburg, S-413 45 Gothenburg, Sweden.
  5. Paulus, WE., Zhang, M., Strehler, E., El-Danasouri, I and Sterzik, K. (2002) Influence of acupuncture on pregnancy rates in patients who undergo assisted reproduction therapy. Fertil Steril. 2002 Apr;77(4):721-4, Department of Reproductive Medicine, Christian-Lauritzen-Institut, Ulm, Germany.
  6. Anderson BJ, Haimovici F, Ginsburg ES, Schust DJ, Wayne PM, In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern Ther Health Med. 2007 May-Jun;13(3):38-48, Pacific College of Oriental Medicine, New York, USA.
  7. DePow, J. (2004) “East meets West: Acupuncture and Reproductive Medicine.” New Mexico Woman.
  8. Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J., Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial., Fertility and Sterility. 2006 May;85(5):1341-6. Epub 2006 Apr 5, Fertility Clinic Trianglen, Hellerup, Denmark.
  9. .C. Magarelli, D.K. Cridennda, Acupuncture & IVF poor responders: a cure? Fertility and Sterility, Volume 81, April 2004 p. 20 Supplement 3.
  10. Stener-Victorin E, Waldenström U, Wikland M, Nilsson L, Hägglund L, Lundeberg T., Electro-acupuncture as a peroperative analgesic method and its effects on implantation rate and neuropeptide Y concentrations in follicular fluid., Hum Reprod. 2003 Jul;18(7):1454-60, Department of Obstetrics and Gynaecology, Göteborg University, Gothenburg, Sweden.
  11. Zhong Xi Yi Jie He Xue Bao, Integrated traditional Chinese and western medicine should make new contribution to the reproductive health of women, 2004 Mar;2(2):83-5, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China.
  12. Stener-Victorin E, Waldenström U, Tägnfors U, Lundeberg T, Lindstedt G, Janson PO., Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome, Acta Obstet Gynecol Scand, 2000 Mar;79(3):180-8, Department of Obstetrics and Gynecology, Göteborg University, Sweden.
  13. Dieterle S, Ying G, Hatzmann W, Neuer A, Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril. 2006 May;85(5):1347-51. Epub 2006 Apr 17, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Witten/Herdecke, Dortmund, Germany.
  14. Johnson D., Acupuncture prior to and at embryo transfer in an assisted conception unit–a case series, Acupunct Med. 2006 Mar;24(1):23-8, Chobham Acupuncture Clinic, Chobham, Surrey.
  15. Yang JR, Ma YY, Liu YL, Wang HL, Liu Z., Controlled study on acupuncture for treatment of endocrine dysfunctional infertility, Zhongguo Zhen Jiu 2005 May;25(5):299-300, Lanzhou City First People’s Hospital, Gansu 730050, China.
  16. Elisabet Stener-Victorin, Elizabeth Jedel, Per Olof Janson, and Yrsa Bergmann Sverrisdottir1, Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome, Am J Physiol Regul Integr Comp Physiol 297: R387-R395, 2009, Institute of Neuroscience and Physiology, Dept. of Physiology, Sahlgrenska Academy, Univ. of Gothenburg, Box 434, SE-405 30 Göteborg, Sweden.
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  18. Franconi G, Manni L, Aloe L, Mazzilli F, Giambalvo Dal Ben G, Lenzi A, Fabbri A, Acupuncture in clinical and experimental reproductive medicine: a review., J Endocrinol Invest. 2011 Apr;34(4):307-11. doi: 10.3275/7500. Epub 2011 Feb 4., PMID: 21297382, Endocrinology Unit, S. Eugenio and CTO Hospitals, Tor Vergata University, Rome, Italy.
  19. Kovárová P, Smith CA, Turnbull DA., An exploratory study of the effect of acupuncture on self-efficacy for women seeking fertility support, Explore (NY). 2010 Sep-Oct;6(5):330-4. doi: 10.1016/j.explore.2010.06.002. PMID: 20832766, School of Psychology, The University of Adelaide, Adelaide, South Australia.
  20. Kvorning N, Holmberg C, Grennert L, Aberg A, Akeson J., Acupuncture relieves pelvic and low-back pain in late pregnancy, Acta Obstet Gynecol Scand 2004; 83(3): 246-50, Department of Anesthesia and Intensive Care, Hospital of Helsingborg, Sweden.
  21. Cardini F, Weixin H., Moxibustion for correction of breech presentation: a randomized controlled trial, JAMA. 1998 Nov 11;280(18):1580-4.
  22. Neri I, Airola G, Contu G, Allais G, Facchinetti F, Benedetto C., Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study, The Journal of Maternal–Fetal and Neonatal Medicine 2004 Apr;15(4):247-52, Department of Obstetrics and Gynecology, University of Modena-Reggio Emilia, Modena, Italy.
  23. Ee CC, Manheimer E, Pirotta MV, White AR., Acupuncture for pelvic and back pain in pregnancy: a systematic review., Am J Obstet Gynecol. 2008 Mar;198(3):254-9. doi: 10.1016/j.ajog.2007.11.008, Department of General Practice, University of Melbourne, Melbourne, Australia.
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  27. J. Pei, E. Strehler, U. Noss, M. Abt, P. Piomboni, B. Baccetti, K. Sterzik, Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility., Fertility and Sterility, Volume 84, Issue 1, Pages 141-147, 2005 Jul;84(1):141-7, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China.
  28. Dong C, Chen SR, Jiang J, Xiao YH, Cai MX, Zhang YJ, Xu H, Deng LH, Li S., Clinical observation and study of mechanisms of needle-picking therapy for primary infertility of abnormal sperm, Zhongguo Zhen Jiu. 2006 Jun;26(6):389-91, First Affiliated Hospital, Jinan University, Guangzhou 510630, China.
  29. S Siterman, F Eltes, V Wolfson, H Lederman, B Bartoov (2000), Does acupuncture treatment affect sperm density in males with very low sperm count? Andrologia. 2000 Jan;32(1):31-9, Institute of Chinese Medicine, Tel Aviv, Israel.
  30. Fu B, Lun X, Gong Y., Effects of the combined therapy of acupuncture with herbal drugs on male immune infertility–a clinical report of 50 cases., J Tradit Chin Med. 2005 Sep;25(3):186-9, Department of Acupuncture, Second Guangdong Provincial Worker’s Hospital, Guangzhou 510720, China.
  31. Zhu X, Hamilton KD, McNicol ED., Acupuncture for pain in endometriosis., Cochrane Database Syst Rev. 2011 Sep 7;9:CD007864. doi: 10.1002/14651858.CD007864.pub2, Center for Complementary Medicine Research, School of Biomedical and Health Science, University of Western Sydney, Building 24, Campbelltown Campus, Locked Bag 1797, Penrith South DC, Sydney, New South Wales, Australia, 1797.
  32. Rubi-Klein K, Kucera-Sliutz E, Nissel H, Bijak M, Stockenhuber D, Fink M, Wolkenstein E., Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis? A randomised controlled cross-over trial., Eur J Obstet Gynecol Reprod Biol. 2010 Nov;153(1):90-3.doi: 10.1016/j.ejogrb.2010.06.023. Epub 2010 Aug 21, Johannes Bischko Institute of Acupuncture, Vienna, Austria.
  33. Huang MI, Nir Y, Chen B, Schnyer R, Manber R., A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality, Fertility and Sterility, September 2006; Vol. 86: pp. 700-710, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.
  34. Xu H, Lawson D, Kras A, Ryan D., The use of preventive strategies for bone loss., Am J Chin Med. 2005;33(2):299-306. School of Health Sciences, Victoria University Melbourne City, Vic 8001, Australia.
  35. Xu YL, Jin JJ, Xu DY, Zheng Y., Effects of acupuncture plus acupoint sticking on bone mass density and pain in the patient of primary osteoporosis, Zhongguo Zhen Jiu. 2006 Feb;26(2):87-90, Clinical Medical College, Gansu College of TCM, Lanzhou 730000, China.
  36. Sunay D, Ozdiken M, Arslan H, Seven A, Aral Y., The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial., Acupunct Med. 2011 Mar;29(1):27-31. doi: 10.1136/aim.2010.003285, Department of Family Medicine, Ministry of Health, Ankara Training and Research Hospital, Kız kulesi sokak 3/5 Gaziosmanpasa Çankaya, Ankara, Turkey.
  37. Ried K, Stuart K., Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: A systematic review,Complement Ther Med. 2011 Dec;19(6):319-31. doi: 10.1016/j.ctim.2011.09.003. Epub 2011 Oct 5, Discipline of General Practice, School of Population Health & Clinical Practice, The University of Adelaide, South Australia.
  38. Ozkan S, Jindal S, Greenseid K, Shu J, Zeitlian G, Hickmon C, Pal L., Replete vitamin D stores predict reproductive success following in vitro fertilization, Fertil Steril. 2010 Sep;94(4):1314-9. Epub 2009 Jul 8., Kocaeli University, School of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey.
  39. Levitas E, Parmet A, Lunenfeld E, Bentov Y, Burstein E, Friger M, Potashnik G., Impact of hypnosis during embryo transfer on the outcome of in vitro fertilization-embryo transfer: a case-control study, Fertil Steril. 2006 May;85(5):1404-8. Epub 2006 Mar 29., Fertility and IVF Unit, Soroka University Medical Center, Beer-Sheva, Israel.
  40. Smith CA, Ussher JM, Perz J, Carmady B, de Lacey S., The effect of acupuncture on psychosocial outcomes for women experiencing infertility: a pilot randomized controlled trial., J Altern Complement Med. 2011 Oct;17(10):923-30. doi: 10.1089/acm.2010.0380. Epub 2011 Oct 6, Centre for Complementary Medicine Research, The University of Western Sydney, Sydney, New South Wales, Australia.
  41. Smith CA, Grant S, Lyttleton J, Cochrane S., Using a Delphi consensus process to develop an acupuncture treatment protocol by consensus for women undergoing Assisted Reproductive Technology (ART) treatment., BMC Complement Altern Med. 2012 Jul 7;12:88. doi: 10.1186/1472-6882-12-88, Centre for Complementary Medicine Research, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW, 2751, Australia.
  42. Ren BB, Liu ZC, Xu B., Observation on the efficacy of female obesity complicated with climacteric syndrome treated by acupuncture and moxibustion, Zhongguo Zhen Jiu. 2012 Oct;32(10):871-6, Provincial-Ministerial Level Key Laboratory of Acupuncture and Medicine of the Ministry of Education, Nanjing University of CM, Nanjing 210029, Jiangsu Province, China.
  43. Azizi H, Feng Liu Y, Du L, Hua Wang C, Bahrami-Taghanaki H, Ollah Esmaily H, Azizi H, Ou Xue X., Menopause-related symptoms: traditional Chinese medicine vs hormone therapy, Altern Ther Health Med. 2011 Jul-Aug;17(4):48-53., School of Traditional and Complementary Medicine, Mashhad University of Medical Sciences, Iran.
  44. Lim CE, Wong WS., Current evidence of acupuncture on polycystic ovarian syndrome, Gynecol Endocrinol. 2010 Jun;26(6):473-8. doi: 10.3109/09513591003686304, Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
  45. Nedeljković M, Bouzas-Ammann G, Zimmermann L, Stute P, Ausfeld-Hafter B., Modalities of acupuncture treatments in assisted reproductive technology–a comparison of treatment practice in Swiss, German, and Austrian fertility centers with findings from randomized controlled trials, Forsch Komplementmed. 2013;20(2):112-8. doi: 10.1159/000350717. Epub 2013 Apr 12, PMID: 23636030, Universität Bern, Kollegiale Instanz für Komplementärmedizin KIKOM, Bern, Schweiz.
  46. Rashidi BH, Tehrani ES, Hamedani NA, Pirzadeh L., Effects of acupuncture on the outcome of in vitro fertilisation and intracytoplasmic sperm injection in women with polycystic ovarian syndrome, Acupunct Med. 2013 Jun;31(2):151-6. doi: 10.1136/acupmed-2012-010198. Epub 2013 Feb 1, Department of Obstetrics and Gynecology, Vali-e-Asr Reproductive Health Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
  47. Andrew Flower, Jian Ping Liu, George Lewith, Paul Little, Qing Li, Chinese herbal medicine for endometriosis, Cochrane Menstrual Disorders and Subfertility Group, Cochrane Database Syst Rev. 2012 May 16;5:CD006568. doi: 10.1002/14651858.CD006568.pub3, ComplementaryMedicine ResearchUnit, Dept PrimaryMedical Care, Southampton University, Ringmer, UK.
  48. Liu XD, Effect of Chinese medicinal herbs on sperm membrane of infertile male,Zhong Xi Yi Jie He Za Zhi. 1990 Sep;10(9):519-21, 515, Shandong Institute of Traditional Chinese Medicine and Materia Medica, Jinan.
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  55. Walker EM, Rodriguez AI, Kohn B, Ball RM, Pegg J, Pocock JR, Nunez R, Peterson E, Jakary S, Levine RA., Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial, J Clin Oncol. 2010 Feb 1;28(4):634-40. doi: 10.1200/JCO.2009.23.5150. Epub 2009 Dec 28, Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA.
  56. Pontari M, Giusto L., New developments in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome, Curr Opin Urol. 2013 Nov;23(6):565-9. doi: 10.1097/MOU.0b013e3283656a55, Temple University Hospital, Department of Urology, Philadelphia, Pennsylvania, USA..see also: Liu SM, Xi JB, Chen XJ, Zhang YY, Huang Z, Zhang KS., Clinical observation of acupoint sticking therapy with Xiongbai Qianlie powder in the treatment of type III prostatitis syndrome, Zhongguo Zhen Jiu. 2012 Mar;32(3):201-4., Department of Urinary Surgery, The Third Affiliated Hospital of Beijing University of CM, Beijing 100029, China.. see also: Blanchet KD., Acupuncture: gaining acceptance in urology: proves effective for a number of chronic conditions., BJU Int. 2012 Jan;109(2):ii-iv. doi: 10.1111/j.1464-410X.2011.10828.x., PMID: 22212293 [PubMed – indexed for MEDLINE]. see also: Prostatities, by Mayo Clinic Staff: http://www.mayoclinic.com/print/prostatitis/DS00341/DSECTION=all&METHOD=print
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