Researchers find acupuncture combined with clomiphene more effective than clomiphene plus supplementary hormonal pharmaceuticals for the treatment of infertility. The combination of acupuncture plus clomiphene produces significantly higher pregnancy rates for women with anovulatory infertility than clomiphene plus estradiol cypionate and dydrogesterone. The data was published in the report entitled Effects of Acupuncture on the Endometrium in Anovulatory Cases Treated by Clomiphene: A Clinical Observation.

The addition of acupuncture to clomiphene therapy increased pregnancy rates, lowered the resistance and pulsatility indices of the uterine arteries, and reduced the adverse effects caused by clomiphene. The increase in positive patient outcomes combined with reductions of adverse effects supports the research team’s (Taian Maternal and Child Health Care Hospital) conclusion, “TCM [Traditional Chinese Medicine] can be either applied alone or combined with Western medicine to up pregnancy rates and treat infertility. With the help of TCM [i.e., acupuncture], treatment for infertility can be more effective while producing much less adverse effects.” [1]

Clomiphene triggers the pituitary gland to produce hormones that stimulate ovulation. The upside of this medication is that it stimulates the release of eggs from the ovaries. The downside is that it may produce adverse effects and it is contraindicated for patients with endometriosis and uterine fibroids. Notably, it may increase the incidence of having twins or triplets. The researchers conclude that the addition of acupuncture to the clomiphene treatment regimen mitigates the drug’s adverse effects and ups the pregnancy rate. Moreover, the acupuncture protocol outperforms the clomiphene plus estradiol cypionate and dydrogesterone protocol. Estradiol cypionate is an estrogen hormone and is often used for the treatment of low estrogen levels. Estradiol cypionate may increase the rate of developing blood clots, melasma (dark skin patches on the face), and may cause other adverse effects. Dydrogesterone is a steroidal progestin used in many countries for the treatment of infertility and threatened miscarriages.

The clinical study was conducted with a semi-protocolized approach to acupuncture point selection. Identical primary acupuncture points were assigned to all patients and secondary acupuncture points were prescribed based upon differential diagnostics. As a variable control, secondary acupuncture point prescriptions were limited to one of three acupuncture point groupings: liver qi stagnation, phlegm-dampness, blood stasis. Patients were not divided into treatment and control groups based upon the diagnostic groups. Instead, they were randomly divided into three groups and then diagnostic decisions were made for the addition of secondary acupuncture points for the TCM treatment group.

A total of 43 patients were randomly distributed into three groups. Group 1 received only clomiphene. Group 2 received clomiphene plus estradiol cypionate and dydrogesterone. Group 3 received clomiphene plus acupuncture and moxibustion. The number of patients in each group was 15, 14, and 14 respectively. Patients ranged from ages 21–39. The preexisting duration of anovulatory infertility ranged from 1–8 years.

Groups 1 and 2 received 50–100 mg of clomiphene, once per day. Group 2 also received 1 mg of estradiol cypionate and 10 mg of dydrogesterone. Group 3 received clomiphene plus acupuncture and moxibustion. The administration of care for all groups started on the 5th day of menstruation and lasted for 5 consecutive days. One treatment course consisted of three menstrual cycles. In total, 1–2 courses of treatment were applied. The TCM acupuncture treatment protocol was as follows. Patients rested in a supine position. Upon disinfection, a 0.30 mm x 40 mm filiform needle was inserted into the following acupoints:

• CV4 (Guanyuan)
• CV3 (Zhongji)
• Zigong
• ST29 (Guilai)
• SP6 (Sanyinjiao)
• ST36 (Zusanli)

CV4, CV3, Zigong, and ST29 were inserted transverse-obliquely (15° angle) to a depth of 1–1.2 cm. SP6 and ST36 were needled perpendicularly and manipulated with the Ping Bu Ping Xie (tonify and sedate) technique. Additional acupoints were administered based on differential diagnostic patterns. For liver qi stagnation, the following acupoint was added:

• BL18 (Ganshu)
  For phlegm and dampness, the following acupoint was added:
• ST40 (Fenglong)
  For blood stasis, the following acupoints were added:
• SP10 (Xuehai)
  LV2 (Xingjian)

Moxibustion sessions lasted 30 minutes and were applied at a heat intensity level until the skin became flushed. Sessions were conducted once per day. Moxibustion was not applied until 10 days passed after ovulation. Moxibustion was applied at the following acupoints:

• Zigong
• CV3 (Zhongji)
• CV4 (Guanyuan)
• ST29 (Guilai)

Additional research confirms that acupuncture combined with moxibustion is effective for the treatment of infertility. Researchers conclude that acupuncture acts on the hypothalamus, pituitary gland, and ovaries and regulates hormone levels in the body. [2, 3] Yu et al. conclude that electroacupuncture can increase gonadotropin releasing hormone (GnRH) levels and increases sensitivity of the ovaries to gonadotropin. The study documents that electroacupuncture is effective for the treatment of infertility in anovulatory cases with low levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH).

In a related study, Xu et.al conclude that acupuncture combined with moxibustion increases ovulation rates. [5] The treatment protocol was as follows. First, acupuncture was applied to the following acupoints:

• Zigong
• CV3 (Zhongji)
• CV4 (Guanyuan)
• ST36 (Zusanli)
• SP6 (Sanyinjiao)
• LV3 (Taichong)

Additional acupoints were added based upon diagnostic patterns. For liver qi stagnation, BL18 was added; for phlegm and dampness, ST40 was added; for blood stasis, SP10 and LV2 were added. Next, moxibustion was applied to Zigong, CV3, CV4, and ST36. Subsequently, an electroacupuncture device was connected to the acupoints. The treatment was applied daily for 3–7 consecutive days. The results of B-scan ultrasonography conducted during the study documents that ovulation rates increase when acupuncture combined with moxibustion is applied.

In another study, acupuncture has been found effective for increasing infertility rates for women receiving IVF (in vitro fertilization) treatments. This highlights the role of acupuncture in an integrative medicine environment. University of Maryland School of Medicine researchers conclude that acupuncture increases pregnancy rates for women receiving IVF. In a study of 16 high quality clinical trials consisting of 4,021 subjects, acupuncture significantly raised pregnancy rates for women receiving IVF where otherwise pregnancy rates would have been low.

Strong evidence indicates that acupuncture increases pregnancy rates for women with anovulatory infertility and other forms of infertility. Acupuncture has been proven an effective complementary therapy to drug therapy and IVF protocols. Research indicates that acupuncture provides an additional benefit; it reduces the adverse effect rates of infertility medications. Based on the findings of modern research, the use of acupuncture is an appropriate, safe, and effective complementary therapy for the treatment of infertility.

References
1. Effects of Acupuncture on the Endometrium in Anovulatory Cases Treated by Clomiphene: A Clinical Observation. Journal of Taishan Medical College. 2016, 37(9):1029-1031.
2. Yu J, Zheng HM, Bing SM. Changes in sSrum FSH, LH and Ovarian Follicular Growth During Electroacupuncture for Induction of Ovulation [J]. Chinese Journal of Integrated Traditional and Western Medicine. 1989, 9(4):199-202.
3. Sha GE, Huang WC, Ma RH. Acupuncture for Infertility: A Clinical Observation Based on 84 cases [J]. Journal of Clinical Acupuncture and Moxibustion. 1998, 14(1):16-18.
5. Xu XF, Gu Y, Gu Ling, Zhu YP. Investigating Advantages of TCM Intervention for Inducting Ovulation in Infertile Women [J]. Chinese Archives of Traditional Chinese Medicine. 2012, 30(3):467-468.
6. Cao ZY. Obstetrics and Gynecology [M]. Beijing: People’s Military Medical Publisher. 1999: 2474.
7. Manheimer, Eric, Daniëlle van der Windt, Ke Cheng, Kristen Stafford, Jianping Liu, Jayne Tierney, Lixing Lao, Brian M. Berman, Patricia Langenberg, and Lex M. Bouter. “The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis.” Human reproduction update (2013). University of Maryland.