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.

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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!) 

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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.

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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.

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