A farewell to Lefty, politics, & acupuncture

Thanks again for all your well-wishes. I just got the call from Dr. Y, and he told me that Lefty stopped growing. 😦 In the words of IVFfervescent gal, I hope he enjoyed his few days on earth.

We have our WTF appointment scheduled for Friday at 9am.

*****

The news of the end of Lefty’s fight was somewhat softened by this morning’s Supreme Court rulings. I don’t mean to get political on y’all, but as an infertile heterosexual Californian, I’m grateful that SCOTUS rejected the argument that the ability to procreate was a prerequisite to a valid marriage… (No really, that was “the essential thrust of” the defendants’ position!) 

*****

In other news, I did something very unscientific yesterday. I went to see an acupuncturist who specializes in infertility, let’s call her J. I learned about her on the forum of my local Resolve support group, where she has rave reviews. She is also conveniently located 7 minutes from my house, and had an evening appointment available for the next day.

C and I arrived at J’s office at 5:30 and went in. She read over my forms (9 pages of them!) and asked some questions about me and my future treatment plans. The stuff she said sounded reasonable. She didn’t promise to cure my diminished ovarian reserve or improve egg quality. She said that our goal would be to increase blood flow to my lady organs, and hopefully achieve subtle improvement in my antral follicle count. She expressed interest in hearing what Dr. Y says to us at our upcoming appointment so she can adjust our treatment plan accordingly. We also discussed coffee and alcohol and supplements (more on those in a future post). C asked her whether she could do anything for his rib and back pain from the accident. She said she would be glad to once she got me set up.

The mood of the office was very spa-like: dim lighting, relaxing New Age music, faint smell of incense and massage oil. J had me strip except for bra & underwear and lay on my back on the table (which resembled a massage table), covered by towels. She directed a heat lamp at my feet; put needles in my tummy, arms, hands and feet; and covered my eyes with an eye pillow. I didn’t feel much as the needles went in. Then she did moxibustion (burning a cigar-like stick of mugwort to warm the regions where the acupuncture needles were). Lastly, J started a CD of ‘Meditations for the Fertile Soul’ by Randine Lewis and placed a bell in my hand, in case I needed anything. Then she left and took C to another room.

I’m not a very good meditator. I tried, but my mind would wander after a few minutes each time. But I was pretty relaxed, and the heat lamp felt good.

J came back (30 minutes later? 45 minutes?), removed the needles, put a heat pad on my belly, and massaged my back, shoulders, and feet with a peppermint-scented massage oil. And that was it!

With the support group discount ($10 off), she charged me $115 for this visit, with future visits costing $75. She didn’t charge at all for C’s treatment, which included acupuncture and cupping therapy. (C is Vietnamese, and despite usually being pretty skeptical, he seems to have inherited a belief in the efficacy of Eastern medicine from his parents.)

Overall, we were both pleased and plan to go back once a week for the time being.

*****

So, why do I say acupuncture is unscientific?

Here’s what I learned about acupuncture from a few hours of PubMed searching and reading abstracts. (As I mentioned before, I am not an expert. Specifically, I have no idea whether certain journals or researchers are more or less credible, though I speculate below about their possible biases…)

First, I looked for PubMed articles about acupuncture and diminished ovarian reserve:

Well…There aren’t many. A PubMed search of “acupuncture diminished ovarian reserve” turned up no hits; modifying the search to “acupuncture ovarian reserve” returned a whopping three hits. “Acupuncture AMH” returns a single article about treating PCOS. “Acupuncture FSH” turned up more, but most were about PCOS or treating menopausal symptoms…

In conclusion, I don’t think a lot of people have studied the effect of acupuncture on egg quality or quantity, but here are promising quotes from the abstracts of a few of the articles I found:

  • “Electroacupuncture therapy has a good clinical effect for IVF patients with poor ovarian reserve, and can improve oocyte quality and pregnancy outcome.”
  • There was “no statistical difference in the number of retrieved oocytes and the fertilization rate…Acupuncture combined CM-MTSSG [Chinese materia medica for tonifying shen and soothing gan] could obviously alleviate unfavorable emotions as anxiety and depression in patients with IVF-ET, effectively improve the treatment outcomes. Its effects might be correlated with lowering the excitability of the sympathetic nervous system, elevating the quality of oocytes, and improving the endometrial receptivity.” [my emphasis]
  • “The results suggest that electroacupuncture could decrease serum FSH and LH levels and increase serum E2 level in women with primary ovarian insufficiency with little or no side effects; however, further randomized control trials are needed.”

Next, I tried to find PubMed articles about acupuncture and IVF:

A PubMed search of “acupuncture IVF” returned 63 hits. Most of these were about the effect of acupuncture on embryo transfer, some were about acupuncture analgesia during egg-retrieval, and others were about acupuncture and male factor infertility.

The articles fell into four major categories:

  1. Articles that said acupuncture is effective
  2. Articles that said acupuncture is ineffective
  3. Articles that said acupuncture is effective, but that its effectiveness can be attributed to the placebo effect
  4. Articles that said there is not enough evidence to say

The majority of articles in Category 1 appear in journals with titles like Acupuncture in Medicine, Journal of Alternative and Complementary Medicine, Complementary Therapies in Clinical Practice, Zhonguo Zhen Jiu [translation: Chinese Acupuncture & Moxibustion], Zhongguo Zhong Xi Yi Jie He Za Zhi [translation: Chinese Journal of Integrated Traditional and Western Medicine], Evidence-Based Complementary and Alternative Medicine, and Clinical Journal of Integrated Medicine.

Now, I don’t want to say that these journals are suspect, but I think it’s fair to say that their titles at least suggest a belief in the efficacy of acupuncture…

Some quotes from abstracts that supported acupuncture:

  •  “The results mainly indicate that acupuncture, especially around the time of the controlled ovarian hyperstimulation, improves pregnancy outcomes in women undergoing IVF.”
  • “Transcutaneous electrical acupoint stimulation, especially double transcutaneous electrical acupoint stimulation, significantly improved the clinical outcome of embryo transfer.” (I think it’s worth noting that this was an article in Fertility and Sterility.)
  • “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. 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.”
  • “In this study, there appears to be a beneficial regulation of cortisol and prolactin in the acupuncture group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics.” (Another article in Fertility and Sterility.)
  • “Limited but supportive 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. However, this conclusion should be interpreted with caution because most studies reviewed had design limitations, and the acupuncture interventions employed often were not consistent with traditional Chinese medical principles. 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.”
  • “Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.”

The majority of articles in Categories 2-4 appear in journals with names like Fertility and Sterility, Human Reproduction, BJOG – An International Journal of Obstetrics and Gynaecology, and Clinical and Experimental Obstetrics & Gynecology.

One might argue that these journals – which focus on Western medical interventions – might be biased against acupuncture and other alternative therapies.

Some quotes from abstracts that did not support acupuncture:

  • “When studies with and without placebo controls were analyzed separately, a placebo effect was suggested.”
  • “No significant benefits of acupuncture are found to improve the outcomes of IVF or ICSI.” (Perhaps also worth noting that this was an article in the Journal of Alternative and Complementary Medicine.)
  • “New emerging evidence from clinical trials demonstrates that acupuncture performed at the time of embryo transfer does not improve the pregnancy or live birth outcome after treatment.”
  • “There was no statistically significant difference in the clinical or chemical pregnancy rates between both groups [true acupuncture vs. sham acupuncture]… There were no significant adverse effects observed during the study, suggesting that acupuncture is safe for women undergoing ET.”
  • “Currently available literature does not provide sufficient evidence that adjuvant acupuncture improves IVF clinical pregnancy rate.”
  • “The use of acupuncture in patients undergoing IVF was not associated with an increase in pregnancy rates but they were more relaxed and more optimistic.”
  • “Acupuncture performed twice weekly during the follicular and luteal phase does not seem to improve pregnancy rates following IVF-ET.”

Particularly interesting were the articles that explored the possible placebo effect of acupuncture. Many of these studies used “sham” acupuncture needles that don’t actually penetrate the skin (in one case referred to as the Streitberger control). What they generally found is that patients who did sham acupuncture got the same benefit as (or in one case greater than) those receiving real acupuncture. Here are some quotes from abstracts that addressed the placebo effect of acupuncture:

  • “Placebo acupuncture was associated with a significantly higher overall pregnancy rate when compared with real acupuncture. Placebo acupuncture may not be inert.”
  •  “Acupuncture improves clinical pregnancy rate and live birth rate among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control.” (In Fertility and Sterility.)
  • “Even if adjuvant acupuncture were to increase IVF success rates only through a psychosomatic effect mechanism, such as by reducing stress, this stress-reduction effect would be integral to the working mechanism by which adjuvant acupuncture increases IVF pregnancy rates; therefore, it seems inappropriate to control for and separate out any such stress-reduction effect by using a sham control.” (In Reproductive Medicine Online.)

So why am I doing acupuncture?

Not one of the studies I saw in my search showed a negative impact of acupuncture on pregnancy rates. And very few said there was no improvement relative to no acupuncture. Rather, they said that there was no improvement relative to sham acupuncture. They also seemed to agree that patients enjoyed acupuncture, and that there was likely a psychological benefit. The fact also remains that the Chinese have been performing acupuncture for thousands of years, which in my mind affords it a level of credibility beyond that of other ‘unproven’ treatments.

So, I think that acupuncture might help – either by “correcting my flow of qi” and thereby increasing blood flow to my lady organs (as J tells me), or by simply forcing me to lie still and relax for an hour or so each week, or via the placebo effect. The scientist in me thinks the latter two mechanisms are more likely, even as the romantic in me (and the 20-year-old who studied abroad in the People’s Republic of China) would love to think that it might work via the former.

But frankly, I don’t really care why it might work; I’m just looking for it to work. Worst case scenario, I spend $75 per week for an hour of quiet relaxation.

 

p.s. If you want to read a different take on gay marriage and acupuncture, check out Stupid Stork’s latest post.

Advertisements
Previous Post
Leave a comment

35 Comments

  1. Sigh. I’m so sorry about Lefty. I have been refreshing like crazy hoping for good news. Much love.

    Reply
    • Thanks. I didn’t have much hope after Monday’s phone call, so it didn’t hit too hard today.

      Reply
  2. Sorry about Lefty. I tried acupuncture once, but couldn’t relax at all. I thought my needle-phobia was just injections, and I was fine with my eyes closed as they went in, but then all I could think about afterwards was all the little needles in my body. Probably better off I didn’t keep it up!

    Reply
    • Thanks. Yeah, I definitely wouldn’t continue to spend the money and time if I didn’t find it relaxing!

      Reply
  3. I am so, so sorry about Lefty. SO sorry. That sucks hardcore – you are in my thoughts.

    Weirdly enough I just wrote about acupuncture and gays – are we twins?

    Reply
    • Thank you. Just read your post and commented. Brilliant. And I totes wish we were twins! 😉

      Reply
  4. I’m very sorry about lefty. That just, plain, SUCKS! Hugs to you…

    I’m all for doing things that can’t hurt and might help. At the very least, you’ll get a little R&R out of the deal, so enjoy those acupuncture sessions for what they are.

    Reply
  5. Sorry about lefty. That sucks big time. I hope that you get all of your questions answered on Friday and will be able to plan for the next step. I love acupuncture and I do believe that it has helped me achieve more balance in my body. I used to feel very cold all the time and these days I feel that my body temperature is more regulated. So at least that helps. I hope that things will look up for you from this point on. 🙂

    Reply
    • Thank you. That’s good to know about body temperature. I have pretty crappy circulation, so if acupuncture just fixes that, it would totally be worth it in my mind. (As it is now, C often recoils when I try to touch him with my icy hands…)

      Reply
  6. Travel well, Lefty. You may not have stayed long, but you were thought of a lot while you were here. You didn’t become a baby, but hopefully you helped the medical team with vital information that will eventually lead to a baby for your proud parents. You played your part, dude.

    Reply
    • Thank you. I LOVE the way you anthropomorphized Lefty in all your comments! My mom got all teary-eyed the other day talking about how touching it was to have all these strangers from around the world rooting for my little embryo by name!

      Reply
  7. Oh and THANK YOU Infertile Chemist for your fantastic research on acupuncture. I am bookmarking it to read through more carefully later. I really appreciate your intelligence, and the way your cool-headed analytical approach is mixed with a sense of playfulness. I think the way you value western science but also recognise its limitations and are open to other approaches really mirrors my own feelings (except I don’t have the fantastic knowledge you have).

    Reply
  8. Im really sorry. I don’t know how scientific acupuncture is but I do find it very relaxing. And that is very good already. Sending you s big hug.

    Reply
  9. Thank you so much for such an awesome comprehensive review! As a fellow Californian, I’m also cheering today’s ruling and thanks to Elena Keegan for pointing out that there aren’t many children coming out of a marriage of 55 year olds!

    Reply
    • 🙂 The SoCal IF bloggers should have an IRL party to celebrate one of these days! I’d totally drive to LA for that…

      Reply
  10. First of all, I am sorry for Lefty. But IVFfervescent gal said it best. Second delighted that your SCOTUS has finally made a brilliant decision on the stupidity that was DOMA. Third, acupuncture. When I was in a car accident about 2 years ago I was seeing a physiotherapist. She was terrible. After a session I would be in bed for 2 days unable to walk further than the bathroom. She knew she was terrible and left to go back to school. My new therapist was brilliant, and introduced acupuncture into the last few minutes of a session. I could instantly walk again. The pain, which had persisted for months, started to subside. I got my life back. This is incredibly anecdotal… and as I scientist myself I was so skeptical that there was anything at all to acupuncture when she suggested it. But I was converted and would do it again for anything similar. I am hoping you will have a similar experience.

    Reply
    • Great to know that it worked even on a skeptic! I’m definitely planning to keep going for the time being…

      Reply
  11. I am so sorry…I have only heard positive things about acupuncture so why not try it…it can only help your AMH level

    Reply
  12. I’m sorry to hear that Lefty didn’t stick around. I know this wasn’t a surprise, but if you’re anything like me, there is still a bit of hope lingering around until it’s officially over.

    Very timely and comprehensive acupuncture discussion! I’m considering starting acupuncture treatments now to support upcoming IVF, but the scientist in me has been hesitant. I keep thinking that my thrice weekly yoga sessions should be filling this particular role. But I guess I’d rather engage in unnecessary relaxation and pampering once a week than question whether or not it would have helped later on.

    Reply
    • Thanks. Yeah, based on the thin evidence, I’d be hesitant to “recommend” acupuncture to somebody, but I definitely wouldn’t discourage anyone either. You could always try it out and see what you think?

      I unfortunately don’t enjoy yoga in the slightest. I’m the opposite of flexible, and end up spending the whole time feeling inadequate and self-conscious. Not exactly relaxing…

      Reply
  13. Oh news about lefty made me sad 😦 I’m sorry. I hope Friday goes ok.

    I’m glad you found an awesome acupuncturist. I used to love moxibustion. Acupuncture has helped me with lower back pain (which the chiropractor didn’t fix), cystitis (I can battle it without antibiotics) and destressing (it lowered my prolactin levels last year). I’m also pretty sure it’s helped with ovulation. I do think it can help overall wellbeing and that’s got to have a domino effect on fertility.

    What did she say about alcohol and coffee?

    Reply
    • Thanks. She said there was ‘an oil’ in coffee that raises cortisol levels for several hours, and recommended I replace it with tea (even caffeinated tea) or hot water with lemon (but that an occasional cup was probably okay). She said small amounts of alcohol a few times per week are fine. In particular, she said there are health benefits to red wine. I didn’t ask about hoppy beers or margaritas…because I wasn’t willing to stop drinking them even if she said I should! 😉

      Reply
      • Ha! That makes sense to me about cortisol (but I’ll wait for your scientific post) but gah! I’m running out of herbal alternatives – I get bored easily. I did well on Nettle tea for a year. Now it tastes vile.

        Btw .. one day I hope you turn your blog into a book because you explain and research things so much better than half the fertility books I’ve read. Thank you!

      • Aw shucks! You sound like my mom. 😉

      • I’ll take that as a compliment 😀

  14. I’m very sorry about Lefty 😦
    I’m all for placebo treatments if they work. I don’t care if it’s a real or imagined benefit, the influence of the mind is a powerful thing.

    Reply
  15. Oh, RIP Lefty… he gave it his all, which is all that counts. (or she, I guess).

    I also tried acupuncture but was made to come every other day leading up to ovulation, then they didn’t touch me during the 2WW. But that was still about four sessions at $80 each, which really adds up. It definitely doesn’t do any harm, and I’m sure it does increase blood flow to the uterus, but I’m not sure how I feel about paying $80 to relax. Eventually I stopped going, did IVF and it all worked out… but then I know other women who SWEAR by acupuncture. I don’t know, it seems to have very different effects on every individual, so you gotta just go with what feels right!

    Reply
  16. I’ve been doing acupuncture since my first failed IVF. I might be proof that it doesn’t work (sorry, lame attempt at infertility humour). As I was reading your post I realized that my first IVF resulted in my smallest egg retrieval and it was the only one that I didn’t do acupuncture during.

    I’m not a scientist, but I do recall reading something about a Swedish study that suggested acupuncture was helpful. I don’t recall the particulars.

    I really enjoy my acupuncture sessions. My girl stays in the room and we have some wonderful conversations. She used to be a social worker and knows how to listen to people. The relaxation and conversation is wonderful and I look forward to it. Also, one of my first treatments relieved my menstrual cramps for 4 hours which was quite amazing considering I was a skeptic and so don’t believe it was the placebo effect.

    Reply
  17. Your friend IRL : )

     /  June 29, 2013

    Hi.

    Me: Lefty didn’t make it.
    Q: (Big sigh). Dang it, dang it, dang it.
    Man of few words.
    We were hopeful that lil’ stinker would surprise us all. We have our pom poms ready for next time. : )
    Although it wasn’t related to fertility, I did go to a handful of acupuncture appointments for an old bootcamp injury years ago. The pain I was experiencing for weeks was better just a few hours after each appointment until eventually, it was completely gone. Like you, I probably wouldn’t recommend it to anyone, but I certainly don’t think it can hurt. It will be the next stop on the quest to end my back pain if PT doesn’t do the trick.

    Reply
  1. Supplements, Part I: DHEA | the infertile chemist

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: