Frequently Asked Questions About Acupuncture and Infertility
Tim H. Tanaka, Ph.D., Director at The Pacific Wellness Institute, answers the most frequent inquiries regarding infertility acupuncture protocols, medical fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF) with acupuncture treatment.
Click any of the following links or scroll down to read all frequently asked questions about acupuncture and infertility:
INFERTILITY and ACUPUNCTURE
- How exactly does acupuncture influence the female reproductive system?
- How does acupuncture assist in improving the likelihood of pregnancy?
- If aging negatively affects fertility, does acupuncture reverse the aging process?
- My FSH is too high. Does acupuncture correct hormonal imbalance?
- As I receive a series of treatments, how do you and I know that acupuncture is working for me?
- Where are you going to place the needles?
- What else besides the acupuncture points determines the effect of the treatment?
- What is the science behind the SES acupuncture technique?
- What is moxibustion treatment?
- When during my cycle should I get acupuncture done? Should I come just before ovulation?
- What if I unknowingly become pregnant while I am receiving acupuncture?
ACUPUNCTURE and MEDICAL FERTILITY TREATMENTS
- Do you provide acupuncture treatments in conjunction with medical fertility treatments?
- During the IVF cycle, my hormone levels will be intentionally skewed by medications. How will acupuncture affect my hormone levels at this time?
- I will be undergoing IVF. When should I start acupuncture?
RESEARCH in ACUPUNCTURE and INFERTILITY
- I would like to get acupuncture according to the protocol used in a German study. What are your thoughts on this method?
- Are there any other research articles showing the efficacy of acupuncture for fertility?
- How strong is the evidence of efficacy of acupuncture for infertility?
- What is your success rate of acupuncture treatment for infertility?
- How many of your infertility patients successfully became pregnant?
- What about acupuncture and male factor infertility?
DIET and LIFESTYLE
- Do I need to modify my diet?
- Do you have any recommendations regarding supplements?
- What about taking herbs?
- What else is important in addition to receiving acupuncture?
ACUPUNCTURE TREATMENT at THE PACIFIC WELLNESS INSTITUTE
- What is unique about the acupuncture system at The Pacific Wellness Institute?
- I live very far away. Do you have any other location?
INFERTILITY and ACUPUNCTURE
How exactly does acupuncture influence the female reproductive system?
Acupuncture has been reported to promote the circulation of blood in the pelvic cavity and improve ovarian function.1Acupuncture treatment may be beneficial in promoting follicle production,2 enhancing uterine blood flow3 and improving uterine lining thickness.4, 5
How does acupuncture assist in improving the likelihood of pregnancy?
Although we have mentioned several possible effects of acupuncture on the female reproductive system, one should not regard acupuncture as a cure for infertility. Our approach focuses on optimizing a patient’s entire organic system and is intended to improve overall health. As a result, fertility may be greatly enhanced.
Within the modern medical approach to fertility, there still exists a fair amount of controversy and disagreement among the reproductive specialists. However, there are two factors that every specialist agrees upon. First, when the woman is younger, the in vitro fertilization (IVF) success rate is significantly higher. Second, when the woman is healthier, the success rate of IVF is also increased. Thus, acupuncture can be used to improve one’s overall health status, thereby positively enhancing the chance of pregnancy.
There is a strong correlation between age and reproductive health. However, it is important to remember that there are two types of aging: chronological and biological. While everyone ages at the same speed chronologically, the biological aging process differs greatly among each individual. That is the reason why each woman goes into menopause at a different time of their lives. So while it is generally true that the quality of a woman’s eggs declines as she ages, eggs of some women in their forties can be excellent quality due to slow biological aging.
It is not possible to stop chronological aging, however, we can definitely influence the progress of biological aging. Abusive lifestyle factors such as poor diet, smoking, stress, and insufficient sleep all accelerate the cell oxidation and the biological aging process. Practicing a healthy lifestyle in addition to regular acupuncture treatments will have a positive impact in slowing down the aging process.
We have reservation in using the statement that acupuncture can reverse the aging process. However, we have had a few cases at our clinic in recent years in which women over 50 who were postmenopausal began to have regular menstruation after receiving acupuncture on a regular basis for general health.
An increasing number of women are visiting acupuncture clinics seeking help in correcting the hormone imbalances (FSH, LH, E2, progesterone, prolactin etc.) they are suffering from.
Regular acupuncture treatments can be very helpful in regulating hormonal imbalances, although it should be noted that acupuncture does not directly alter the female hormones. Rather, acupuncture is considered to influence the hormonal regulation centers in the brain and autonomic nervous system (i.e., the hypothalamic-pituitary-ovarian axis) and as a result, improvement in hormonal status can occur over time.
If you are not presently on hormones, we recommend that you record your basal body temperature (BBT) every morning. The BBT chart is not the best method available to detect the exact time of ovulation, however, it is an excellent method to get an idea about the female hormone fluctuation pattern and can be used as one of the indexes to know your progress by observing changes in the BBT pattern from month to month.
In addition, at The Pacific Wellness Institute, we frequently monitor the patient’s heart rate variability (HRV) by attaching a small sensor onto a fingertip during the acupuncture session. HRV is a well established non-invasive and comprehensive method6 for evaluation of the autonomic nervous system (the nervous system that controls internal organ functions including heart, lungs, and reproductive organs) and can be used as a general indicator of overall health status.
As mentioned earlier, the focus of our acupuncture approach is to help improve overall health. Therefore, as patients receive a series of acupuncture treatments, many of them experience enhanced feelings of well-being such as more restful sleep, better digestion, decreased anxiety, increase of energy, etc. These physical and emotional shifts can only positively influence the chance of conceiving regardless of whether one is trying naturally or undergoing medical reproductive treatment.
Our specialized Fertility Enhancement Protocol involves acupuncture stimulation on both the front and back of the body.
The exact location of acupuncture points will vary from patient to patient and from treatment to treatment. Some of the most well-known acupuncture points, traditionally used to influence the function of the female reproductive organs, are located on the lower back, lower abdomen, and legs. The points on the lumbar, sacrum, and low abdominal regions are particularly important in consideration of female anatomy and the related nerve segmental innervations. The points on head, neck, upper back and arms are used in order to stimulate the autonomic nervous system and further induce the relaxation response.
In North America most students learn to treat a patient by matching the condition with prescribed acupuncture points in a textbook. Thus, there are many practitioners who tend to only focus on selection of acupuncture points, and not pay enough attention to other equally (if not more) important variables in providing effective acupuncture. Consistent efficacy cannot be expected by simply inserting needles at specific points in the body. Research experiments7-9 clearly demonstrate that even when the same acupuncture point is stimulated, the physiological response varies greatly (sometimes even in opposite directions) depending on how (the depth of the needle, the intensity, etc.) and when the point is stimulated.
The SES acupuncture technique has been studied extensively in Japanese and Canadian research facilities.7-9 At The Pacific Wellness Institute, we usually administer SES technique at the end of each session in order to further balance and enhance the activity of the autonomic nervous system which governs our internal organs and influences hormone functions. The depth of the needle (no more than 5mm. in depth) and the respiratory phase during stimulation are the important keys to induce a favorable physiological response. According to Dr. K. Nishijo (Prof. Emeritus, Tsukuba College of Technology) who first elucidated this technique, virtually any points can induce the desirable effect as long as the stimulation method mentioned is properly followed.
Moxibustion is a form of fire heat treatment that stimulates specific acupuncture points of the body. Moxibustion has been used in tandem with acupuncture to treat a variety of diseases throughout Asia for thousands of years. Most women who have difficulty conceiving have symptoms of cold hands and feet even in the summertime and sufficient blood flow to their reproductive organs is often compromised. The heat stimulation applied on selected acupuncture points helps to increase blood circulation to the uterus and pelvic area. The gentle soothing heat provided by moxa also induces a deep relaxation response which aids fertility as well.
Compared to many of the fertility drugs which provide a powerful effect for a short duration, the immediate effect of acupuncture treatment is, in general, very subtle. The cumulative effect from regular acupuncture treatments, however, can produce significant long lasting benefits. Therefore, it is generally recommended that you receive acupuncture treatments on a regular basis, 1 to 2 times a week, throughout your cycle, especially during an initial treatment period (the first 2-3months). Following the initial period, certain patients may be advised to focus the treatment on a specific phase of their menstrual cycle. Our specialized Fertility Enhancement Protocol utilizes different acupuncture procedures depending on the phase of menstrual cycle (during menstruation, pre-ovulation, ovulation/pre-implantation and luteal phases), in order to further potentiate the therapeutic effect and safety of the treatment.
While the concern is totally understandable (certain acupuncture procedures are indeed contraindicated during pregnancy), asking a vague question like, Is it safe to do acupuncture after ovulation (or during pregnancy)? is basically the same as asking, Is it safe to take ‘medication’ after ovulation? or Is it safe to eat ‘food’ during pregnancy? As explained in other pages, there are many ways of doing acupuncture and potential risks and benefits vary greatly depending on who does the treatment and when and what kind of acupuncture methods are used. Please keep in mind this important issue when you read about acupuncture in any media or discuss your acupuncture treatment with your doctor. Unfortunately, many people (including health professionals and acupuncturists) frequently discuss acupuncture in generic terms.
As indicated, our acupuncture procedure is virtually non-invasive and it is not only absolutely safe but it is designed to be administered during any phase of the menstrual cycle in order to achieve the most optimal cumulative effect.
ACUPUNCTURE and MEDICAL FERTILITY TREATMENTS
A number of patients have been receiving acupuncture at The Pacific Wellness Institute while undergoing IVF or IUI treatments. We also have patients who have been going through cycle monitoring with or without fertility drugs.
Acupuncture has some effect in balancing hormonal systems, likely by influencing the hormonal regulation center of the brain, thus it only influences them within a homeostatic range. Hormonal medication on the other hand has a much more powerful and direct effect, thus it can skew the hormone status outside of the normal homeostatic range. In circumstances such as this, acupuncture only influences the body to respond better within the pharmaceutical intervention. Regulating the hormones during the IVF cycle is the sole responsibility of the fertility specialist – to monitor the blood on a consistent basis along with all the dosages and the medication protocols.
While some patients respond to acupuncture quickly, acupuncture certainly does not work overnight. Most patients require a series of ongoing treatments over a few months to a year. The recommended treatment schedule is based on consideration of a variety of factors in each individual case. In many cases, we recommend that you start acupuncture treatment at least 2 months prior to the commencement of the IVF cycle and that you continue for 1 to 2 times a week until the day of the transfer.
RESEARCH in ACUPUNCTURE and INFERTILITY
In April 2002, German researchers reported that they had increased the success rate by nearly 50% in women undergoing in vitro fertilization (IVF) using acupuncture.10 Their results are quite impressive especially when considering that they had administered only two short acupuncture treatments. We definitely have yet to see further replicated studies to confirm their findings and applicability under different settings. It is important to remember that the results obtained by the German group are only applicable to a very limited patient population under very restricted circumstances as in the research study.
In the German study, acupuncture was only applied immediately before and after the embryo transfer, which means that there was no influence of acupuncture on the patients’ eggs. Quality of eggs is a large factor to consider in fertility and the study only enrolled couples who had good quality embryos (Type I or II). Further, the mechanism of how the intervention worked according to this protocol is totally unknown as they have failed to demonstrate any meaningful changes in the uterine pulsatility index (indicator of blood flow in the uterus) before and after acupuncture versus the control. Just like other research studies, this German study was designed only to address one main research question. This study was not designed to determine when or how acupuncture would best be administered. It is very unlikely that most patients would obtain consistent clinical outcome by simply using the acupuncture points they listed in the study. Their conclusions should not be widely extrapolated.
Besides the German study mentioned, there are other studies suggesting a positive influence of acupuncture on the female reproductive system3, 11, 12 and using acupuncture treatment in conjunction with ART on difficult infertility cases.4, 5, 13
The May 2006 issue of the journal, Fertility and Sterility, featured series of acupuncture related articles (three original research papers and additional commentary articles).14-19 Two of the original articles reported higher pregnancy rates among patients who received acupuncture in conjunction with their IVF cycles versus patients who received “placebo acupuncture” or no treatment. One study found no significant difference in pregnancy rates between the acupuncture group and control (placebo) group. While it is encouraging to see the additional data supporting the efficacy and safety of acupuncture use in conjunction with IVF, some experts have raised a number of issues and questions regarding the somewhat contradictory evidence on acupuncture. They are urging for more rigorous studies.
It should be noted that a simplified acupuncture protocol used in one previous study is not likely the best possible approach for everyone. Acupuncture works by very complex mechanisms and responses are influenced by numerous factors. It would take years to clarify the exact underlying mechanism of acupuncture and to create standardized treatment protocols according to each condition. Although there is a plethora of anecdotal evidence on the efficacy of acupuncture on fertility, more scientific studies are needed. In the meantime, sensible experienced acupuncturists develop individualized treatment plans based on scientific and traditional empirical knowledge combined with the latest research information available.
At present, evidence of the efficacy of acupuncture for infertility is for the most part anecdotal and there are only several pieces of scientific data available as cited above. In addition, all of the previous studies suffer from some methodological shortcomings such as small sample size or missing control (comparison) group, etc. It should be noted that although they have used completely different acupuncture protocols, authors of different previous research studies in acupuncture and infertility suggested the alteration of autonomic nervous system (ANS) as the possible mechanism of why acupuncture worked on fertility problems in their studies.
As indicated, while there is not enough ‘direct’ evidence linking acupuncture and fertility, sufficient data does exist indicating the relationship between stress and infertility or unsuccessful IVF.20-24 It is well known that ongoing emotional stress creates imbalance in the ANS (sympathetic dominant state). Relaxation on the other hand, activates the parasympathetic branch of the ANS which is important for maintenance of proper regulation of our internal function including reproductive organs. A number of previous studies have demonstrated that acupuncture does influence the activity of the ANS.7, 8, 25, 26
|A paper published in Social Science and Medicine21 stated that psychosocial factors, like ineffective coping strategies, anxiety, and/or depression are associated with a lower pregnancy rate following IVF-procedures. In addition, support has been found suggesting that stress reduction through relaxation training or behavioral treatment improves conception rates.
At The Pacific Wellness Institute we are not producing success rate statistics. We are also unaware of any acupuncture clinics providing their success rate (please keep in mind that “claims” and “statistics” are totally different animals). There are a number of methodological difficulties regarding success rate statistics and no standardized guideline exists to calculate the success rate of acupuncture for infertility cases. Statistics can be easily manipulated and success rate can vary greatly depending on the criteria and rules used when calculating the statistics.
Infertility is caused by a variety of factors and it is well known that fertility rates vary significantly depending on various factors such as age and co-existing medical conditions. It is important to consider those variables when calculating statistics. Also, it is necessary that separate statistics be produced for patients who conceived naturally with acupuncture and for patients who underwent assisted reproductive technologies (ART) or any other medical fertility treatment in conjunction with acupuncture. Furthermore, statistics derived from an insufficient number of cases in each group contain a large margin of error. These are just a few examples of methodological difficulties regarding success rate statistics.
At The Pacific Wellness Instituteãï¿½ï¿½we have been following up on the outcome of our infertility patients, periodically summarizing data.
Our most recent outcome review (Feb. 2007) indicated that we confirmed 76 pregnancies among patients who received acupuncture specifically for ongoing fertility concerns during the two year period from Jan 1, 2004 to Dec 31, 2005.
*We have not been able to follow up with every single patient. Cases when pregnancy occurred more than one cycle away from the last acupuncture session were not included in the data.
Compared to female infertility, there are fewer research publications discussing the efficacy of acupuncture on sperm quality.
However, we have treated a number of cases concerning male fertility issues such as low sperm count, motility, morphology, or hi DNA fragmentation etc and observed cases of impressive sperm quality improvement on various parameters. Still, not every case is responsive to acupuncture, thus we usually recommend the treatment on a trial basis for a period of 3 to 6 months.
It is worth noting that studies (randomized control trial and clinical case series) published in Japanese reproduction journals have indicated a significant improvement in sperm concentration and motility following administrations of certain Kampo formulations.43
DIET and LIFESTYLE
A healthy balanced diet is always important. You may be asked to fill out an additional questionnaire to give us an idea about your dietary and nutritional status. Many women who have difficulty conceiving are categorized as having a ‘cold constitution’ according to eastern medical diagnosis (see Moxibustion for further explanation). Generally speaking, many young women consume a large amount of food and drink that cool down their internal organs, thus slowing down the function of the reproductive system.
Many experts recommend a good vitamin/mineral supplementation program during the entire pregnancy and nursing periods. However, an excellent nutritional supplementation program (especially supplementing with folic acid) should be started as soon as you plan to become pregnant. Most commercially available prenatal vitamins are designed to meet the unique nutritional demand during pregnancy and nursing periods, therefore, they are high in calcium, magnesium, with a very high amount of iron, folic acid and other essential nutrients. Most patients who are having difficulty conceiving, however have different nutritional demands and a more specific supplementation program may be required. For example, it is known that the quality of eggs declines with age as a result of oxidative stress. A more bioavailable multivitamin with a high antioxidant potential may be recommended. One study also suggests an association between oxidative stress and early miscarriage.27
A variety of herbs have been traditionally used to improve the health of the reproductive organs.28 In recent years, Japanese Kampo formulas in particular, have been studied for various reproductive and gynecological concerns. 44 Accordingly, a growing number of Japanese physicians and specialists have been prescribing Kampo formulations on a routine basis for their patients.
Clothes and Underwear
Research studies suggest that the continuous mechanical pressure on the body by tight-fitted underwear can negatively affect the physiological homeostatic balance (i.e. hormone, body temperature regulation)29, 30 and digestive motility.31, 32 This occurs through altering the autonomic nervous system, a coordinator of the internal environment in the human body. It is important not to wear tight-fitted underwear in order not to obstruct the efficient blood and energy flow of your reproductive organs.
Regular Quality Sleep
Insomnia and poor quality sleep often result from the disruption of the circadian rhythm, the approximately 24 hour cyclic rhythm of our ‘biological clock’. The ‘biological clock’ is a complex internal mechanism and is controlled by the suprachiasmatic nucleus (SCN), a tiny cluster of nerve cells in an area of the brain known as the hypothalamus. This ‘biological clock’ helps regulate breathing and heart rate, body temperature, blood pressure, hormone production, menstruation and other vital bodily functions. An irregular lifestyle can disrupt the normal circadian rhythmic pattern.33 Having regular quality sleep is extremely important for fertility as studies show low fertility rates and early pregnancy losses among shift workers.34-39 Regular, quality sleep is particularly important if a woman is suffering from an irregular menstrual cycle, anovulation, amenorrhea, or PCOS, all of which can be considered to be part of a biological rhythm (infradian) disorder. Regular acupuncture treatment combined with our specific breathing exercise technique creates a specific coherent heart rhythm and greatly influences hypothalamic activity, helping restore normal biological rhythm. In some cases, I also recommend the use of light therapy. It is known that the absorption of a specific light spectrum via the eyes can stimulate the SCN, and help reset the biological clock.
Stress and Relaxation
Despite the well-known link between stress and infertility,20, 21, 23, 40 the importance of stress management and relaxation is often underestimated. I believe stress contributes, at least to a certain degree, in almost all cases of primary infertility, unexplained failed IVF,22, 24 and unexplained miscarriages. Prolonged stress over the years can lead to the conditions that cause infertility. Stress hormones such as catecholamines (adrenalin, noradrenalin, and dopamine) and the hypothalamic-pituitary-adrenal axis interact with hormones which are responsible for normal ovulatory cycles (ie., GnRH, prolactin, LH and FSH).41 Furthermore, some hormones that are released during times of stress can cause the uterus to contract and/or negatively interact with immune cells, both of which will interfere with proper implantation.22, 42
Regular practice of stress management and relaxation exercises is very important. However, in this day and age, everyone is exposed to all kinds of stress and realistically it is impossible to avoid stress. In fact, the medical tests and treatments for infertility are some of the major sources of stress for many infertile women.23, 40, 41
At The Pacific Wellness Institute, we utilize an innovative approach for stress management and physiological entrainment called “Acupuncture and Sound Assisted Autonomic Modulation Technique” using the CD that I have specifically created. Temporary relaxation is not the main purpose of this exercise. This technique (breathing at a specific rate) is rather designed to improve our homeostatic reflexes and train our body to efficiently recover from stress. It should be noted that short periods of stress reaction are rarely harmful, but prolonged ongoing stress can cause harm to our system. Our patients are reminded to practice the breathing exercise between appointments as prescribed. Their progress is regularly monitored using a heart rate variability biofeedback system.
ACUPUNCTURE TREATMENT at THE PACIFIC WELLNESS INSTITUTE
- Japanese acupuncture treatment techniques used here at The Pacific Wellness Institute are distinctively gentle and painless. The needles are inserted typically to no more than one or two millimeter in depth. This painless and gentle needling technique is crucial for the relaxation response to occur. Furthermore, because the procedure is virtually non-invasive, the treatment can be applied safely and effectively anytime during the menstrual cycle. This is important since consistent and regular treatments are required in order to achieve meaningful cumulative effect.
- Our acupuncture system is based on the autonomic nervous system. Proper balance of both branches of the ANS (sympathetic and parasympathetic) is crucial for optimal functioning of reproductive organs, blood flow circulation, hormone balance, immune system, and regulation of menstrual cycle. Much of my research activities over the last ten years have been exploring the most effective acupuncture methods to alter the ANS. The SES acupuncture we use in particular has been shown to shift the ANS to a favorable direction, based on studies conducted at a Japanese University and The Pacific Wellness Institute.7-9
- For assessing the condition and progress, we utilize a state of the art biofeedback monitoring system for more objective measurement, instead of solely relying on subjective assessments or observations. In most treatment sessions, patients’ heart rhythms are monitored continuously and HRV spectrum can provide valuable real-time information about the status of the ANS and how the patient is responding during treatment.
- Most patients are treated with our innovative approach called Acupuncture and Sound Assisted Autonomic Modulation Technique which involves Japanese acupuncture and moxibustion in combination with a specific HRV biofeedback breathing exercise. Studies have been indicating that this type of breathing has a profound effect on harmonizing the autonomic nervous system. It has also been considered that it influences the activities of the hypothalamus and pituitary glands. This particular breathing exercise is utilized during acupuncture sessions to further enhance the effect of acupuncture. In addition, patients are asked to practice between the treatments to maintain the treatment benefits.
- Our specialized Fertility Enhancement Protocol is developed based on 25 years of clinical experience and research.
Please click here for more information about Acupuncture Fertility Program at Our Clinic
Because of our reputation and the quality of acupuncture service we offer, many of our patients are not from our neighborhood, but in fact, come from very far. Whatever the reason, if it is difficult for you to come to our clinic in Toronto, you can try to find a practitioner in your local area. Here are some resources and tips to find an acupuncturist for fertility issues in your area.
(NOTE: Please visit acupuncturemoxibustion.com for the most updated Infertility and Acupuncture information)
1. Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril. Dec 2002;78(6):1149-1153.
2. Emmons S, Patton P. Acupuncture treatment for infertile women undergoing intracytoplasmic sperm injection. Medical Acupuncture: A Journal for Physicians by Physicians. 2000;12(2).
3. Stener-Victorin E, Waldenstrom U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod. Jun 1996;11(6):1314-1317.
4. Kobayashi M, Takahashi J, Suzuki H. Nanchisei funinshou ni taisuru shinkyu chiryou no kentou 4 (Acupuncture treatment on intractable infertility 4th report: Summary of 57 cases of insufficient endometrium lining treated with ART and acupuncture – Follow- up). Journal of the Japan Society of Acupuncture and Moxibustion. 2003;53(3):380.
5. Suzuki H, Takahashi J, Kobayashi M, Ochi M. Nanchisei funinshou ni taisuru shinkyu chiryou no kentou 1 (Acupuncture treatment on intractable infertility – 1st report: Summary of 57 cases of insufficient endometrium lining treated with ART and acupuncture). Journal of the Japan Society of Acupuncture and Moxibustion. 2002;52(3):309.
6. TaskForce. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. Mar 1 1996;93(5):1043-1065.
7. Nishijo K, Mori H, Tsukayama H, Yamashita H. Scientific Approach for Acupuncture. Journal of the Japan Society of Acupuncture and Moxibustion. 1995;45(3):177-191.
8. Tanaka TH. The Possibilities for Optimizing Acupuncture Treatment Results through Synchronization with Somatic State: Examination of Autonomic Response to Superficial Needling During Exhalation. American Journal of Acupuncture. 1996;24(4):233-239.
9. Tanaka TH, Leisman G, Nishijo K. The physiological responses induced by superficial acupuncture: a comparative study of acupuncture stimulation during exhalation phase and continuous stimulation. Int J Neurosci. Jun 1997;90(1-2):45-58.
10. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril. Apr 2002;77(4):721-724.
11. Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol. Sep 1992;6(3):171-181.
12. Stener-Victorin E, Waldenstrom U, Tagnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand. Mar 2000;79(3):180-188.
13. Takahashi J, Kobayashi M, Suzuki H, Ochi M. Nanchisei funinshou ni taisuru shinkyu chiryou no kentou – 2 (Acupuncture treatment on intractable infertility – 2nd report: Summary of 24 cases of idiopathic infertility treated with ART and acupuncture). Journal of the Japan Society of Acupuncture and Moxibustion. 2002;52(3):310.
14. 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. Fertil Steril. May 2006;85(5):1341-1346.
15. Smith C, Coyle M, Norman RJ. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril. May 2006;85(5):1352-1358.
16. Myers ER. Acupuncture as adjunctive therapy in assisted reproduction: remaining uncertainties. Fertil Steril. May 2006;85(5):1362-1363; discussion 1368-1370.
17. Domar AD. Acupuncture and infertility: we need to stick to good science. Fertil Steril. May 2006;85(5):1359-1361; discussion 1368-1370.
18. 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. May 2006;85(5):1347-1351.
19. Collins J. The play of chance. Fertil Steril. May 2006;85(5):1364-1367; discussion 1368-1370.
20. Chrousos GP, Torpy DJ, Gold PW. Interactions between the hypothalamic-pituitary-adrenal axis and the female reproductive system: clinical implications. Ann Intern Med. Aug 1 1998;129(3):229-240.
21. Eugster A, Vingerhoets AJ. Psychological aspects of in vitro fertilization: a review. Soc Sci Med. Mar 1999;48(5):575-589.
22. Gallinelli A, Roncaglia R, Matteo ML, Ciaccio I, Volpe A, Facchinetti F. Immunological changes and stress are associated with different implantation rates in patients undergoing in vitro fertilization-embryo transfer. Fertil Steril. Jul 2001;76(1):85-91.
23. Matsubayashi H, Iwasaki K, Hosaka T, Sugiyama Y, Suzuki T, Izumi S, Makino T. Spontaneous conception in a 50-year old woman after giving up in-vitro-fertilization (IVF) treatments: involvement of the psychological relief in successful pregnancy. Tokai J Exp Clin Med. Apr 2003;28(1):9-15.
24. Smeenk JM, Verhaak CM, Vingerhoets AJ, Sweep CG, Merkus JM, Willemsen SJ, van Minnen A, Straatman H, Braat DD. Stress and outcome success in IVF: the role of self-reports and endocrine variables. Hum Reprod. Jan 21 2005.
25. Agelink MW, Sanner D, Eich H, Pach J, Bertling R, Lemmer W, Klieser E, Lehmann E. [Does acupuncture influence the cardiac autonomic nervous system in patients with minor depression or anxiety disorders?]. Fortschr Neurol Psychiatr. Mar 2003;71(3):141-149.
26. Middlekauff HR, Hui K, Yu JL, Hamilton MA, Fonarow GC, Moriguchi J, Maclellan WR, Hage A. Acupuncture inhibits sympathetic activation during mental stress in advanced heart failure patients. J Card Fail. Dec 2002;8(6):399-406.
27. Jenkins C, Wilson R, Roberts J, Miller H, McKillop JH, Walker JJ. Antioxidants: their role in pregnancy and miscarriage. Antioxid Redox Signal. Fall 2000;2(3):623-628.
28. Liang L. Acupuncture & IVF. First ed. Boulder, CO: Blue Poppy Press; 2003.
29. Lee YA, Hyun KJ, Tokura H. The effects of skin pressure by clothing on circadian rhythms of core temperature and salivary melatonin. Chronobiol Int. Nov 2000;17(6):783-793.
30. Miyatsuji A, Matsumoto T, Mitarai S, Kotabe T, Takeshima T, Watanuki S. Effects of clothing pressure caused by different types of brassieres on autonomic nervous system activity evaluated by heart rate variability power spectral analysis. J Physiol Anthropol Appl Human Sci. Jan 2002;21(1):67-74.
31. Lee YA, Kikufuji N, Tokura H. Field studies on inhibitory influence of skin pressure exerted by a body compensatory brassiere on the amount of feces. J Physiol Anthropol Appl Human Sci. Jul 2000;19(4):191-194.
32. Takasu N, Furuoka S, Inatsugi N, Rutkowska D, Tokura H. The effects of skin pressure by clothing on whole gut transit time and amount of feces. J Physiol Anthropol Appl Human Sci. May 2000;19(3):151-156.
33. Grajewski B, Nguyen MM, Whelan EA, Cole RJ, Hein MJ. Measuring and identifying large-study metrics for circadian rhythm disruption in female flight attendants. Scand J Work Environ Health. Oct 2003;29(5):337-346.
34. Ahlborg G, Jr., Axelsson G, Bodin L. Shift work, nitrous oxide exposure and subfertility among Swedish midwives. Int J Epidemiol. Aug 1996;25(4):783-790.
35. Bisanti L, Olsen J, Basso O, Thonneau P, Karmaus W. Shift work and subfecundity: a European multicenter study. European Study Group on Infertility and Subfecundity. J Occup Environ Med. Apr 1996;38(4):352-358.
36. Mozurkewich EL, Luke B, Avni M, Wolf FM. Working conditions and adverse pregnancy outcome: a meta-analysis. Obstet Gynecol. Apr 2000;95(4):623-635.
37. Nurminen T. Female noise exposure, shift work, and reproduction. J Occup Environ Med. Aug 1995;37(8):945-950.
38. Nurminen T. Shift work and reproductive health. Scand J Work Environ Health. 1998;24 Suppl 3:28-34.
39. Scott AJ. Shift work and health. Prim Care. Dec 2000;27(4):1057-1079.
40. Kupka MS, Dorn C, Richter O, Schmutzler A, van der Ven H, Kulczycki A. Stress relief after infertility treatment–spontaneous conception, adoption and psychological counselling. Eur J Obstet Gynecol Reprod Biol. Oct 10 2003;110(2):190-195.
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Infertility General Information [Click here].