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Articles

• Not Just Skin Deep - Acupuncture for Facial Rejuvenation
• Acupuncture: A Cure for Intertility (on Fox News)
• Acupuncture 'more than a placebo'
• Health: Acupuncture & Pregnancy (on CBS 3)
• Acupuncture gets a face lift and much more (on USA Today)
• Acupuncture for fertility: Doctors say, 'Why Not?' (LA Times)

Acupuncture for fertility: Doctors say, 'Why not?'

By Elena Conis  July 04, 2005  Los Angeles Times

Jackie Apuzzo is 16 weeks pregnant -- something she was beginning to think would never happen. Following nine years of unsuccessful efforts to have a baby, including failed in vitro fertilization, a miscarriage and a diagnosis of endometriosis, the 37-year-old social worker finally visited an acupuncturist on the advice of a friend. After two months of acupuncture treatments and a regimen of Chinese herbs, she became pregnant.

"I was a little apprehensive about the needles at first," said Apuzzo. But in April, Apuzzo's acupuncturist in Santa Monica looked at her tongue, checked her pulse and declared the Long Beach resident pregnant. Apuzzo later confirmed the diagnosis with a blood test.

As more women than ever delay having children until their 30s and 40s, infertility is a growing challenge in the U.S. An estimated 3 million couples are unable to conceive after a year of trying, according to the American Society for Reproductive Medicine. Fertility clinics have done a brisk business in recent years, but now doctors say that a growing number of women who have been unable to get pregnant through conventional medical treatments are seeking out alternatives such as acupuncture. Demand for the traditional Chinese method is so great that an increasing number of fertility doctors now are collaborating with acupuncturists, with some physicians adding acupuncturists to their staff, according to doctors and experts in the field.

Although many acupuncturists and doctors of oriental medicine swear by the treatment -- and have relied on it as an infertility remedy for years -- the mainstream medical community remains divided on acupuncture's efficacy. Some doctors say more research is needed to demonstrate acupuncture's effectiveness, and others believe it's irresponsible to recommend the treatment based on the existing scientific evidence.

Most fertility specialists trace the current popularity of acupuncture treatment to a German study published in 2002 in the journal Fertility and Sterility. The study, led by Dr. Wolfgang Paulus at the University of Ulm, found that 42% of women receiving acupuncture just before and after an assisted-reproductive therapy, such as IVF, became pregnant; that compared with 26% of patients who got pregnant with assisted-reproductive treatments but who received no acupuncture therapy.

Later that year, Dr. Raymond Chang and colleagues at Cornell University's medical school in New York published a paper in the same journal, describing several ways acupuncture might actually improve a woman's chances of conceiving: relaxation, regulating reproductive hormones and improving the lining of the uterus, where the embryo needs to be implanted before it can develop.

Because of the reports, published in a prestigious journal, "some doctors started to say, let's try it out," said Dr. Paul C. Magarelli, a fertility specialist in Colorado Springs, Colo.

Deming Huang, an acupuncturist at Stanford University's Center for Integrative Medicine in Palo Alto, said patient interest began to rise about the same time. At the Stanford clinic, more women began asking their doctors for referrals to acupuncturists. And though it's not easy to measure the effect of popular culture on medical trends, more than a few women may have been swayed to try acupuncture when the "Sex and the City" character Charlotte visited an acupuncturist in an effort to get pregnant during the show's final season.

Alice Domar, director of the Mind/Body Center for Women's Health at the Boston IVF fertility clinic, describes efforts by physicians to recommend acupuncture for fertility treatments as a "mini-scandal." But even the clinic where she works is preparing to hire an acupuncturist to add to its current mix of relaxation and confidence-building techniques for fertility patients -- a decision Domar, a psychologist, says she struggles with as a scientist.

"With the data we have right now, one cannot say that acupuncture increases pregnancy rates," Domar said. Western studies on the topic have so far produced inconsistent results, making it impossible, she said, for experts to draw definitive conclusions.

Early studies on the subject suggested acupuncture might increase blood flow to the uterus -- which would improve the chances of a pregnancy taking hold -- but later research refuted this.

Studies led by Magarelli, the Colorado specialist, suggested acupuncture increased pregnancy rates in patients who doctors had determined had little hope of getting pregnant. He and colleague Diane Cridennda, a licensed Colorado Springs acupuncturist, also showed that women who received acupuncture had more "take-home babies." That is, they were less likely to lose pregnancies to miscarriage or embryos that failed to take hold in the uterus.

But like the German study results, Magarelli's findings have been faulted for failing to rule out psychological or psychosomatic effects of the treatment. Patients who received a fake treatment might have responded to the treatment as if it were truly effective simply because they believed it was -- a phenomenon known as the placebo effect.

Paulus addressed the problem in a 2003 study by comparing the effects of acupuncture with fake or sham acupuncture, placing needles against acupuncture points without penetrating the skin. The results showed no difference in pregnancy rates between patients who received true acupuncture and those who were given the sham.

Acupuncture needles, about the width of a hair, are just barely felt when inserted, making it difficult to come up with a good sham treatment to help rule out the placebo effect. As Domar put it, "If patients are getting pricked with a needle, they know it."

It's hard to study acupuncture for other reasons too. Treatment regimens have varied from one study to the next. A study performed by researchers at the Robert Wood Johnson Medical School in Camden, N.J., found no effects of acupuncture on pregnancy rates -- but their patients had just one acupuncture session, whereas other studies used two or more.

To rule out the effects of other aspects of the treatment, Western researchers often trim acupuncture down to its simplest element: needles. But acupuncturists don't simply insert needles; most take a whole-body approach, asking broad questions about patient history, making recommendations about nutrition and stress management and prescribing herbal remedies.

"Our goal is not just to get the patient pregnant," said Dr. Daoshing Ni, co-founder of the Tao of Wellness center in Santa Monica, which sees hundreds of infertility patients each week. "Getting pregnant is just one step in our overall goal" of improving a patient's health, he explained.

Researchers here and in Europe hope to eventually shed light on whether acupuncture is truly beneficial for women trying to get pregnant. For now, however, doctors face a conundrum: Should they recommend an unproven treatment, discourage such treatment or take no stance at all, said Dr. James Dillard, of the Rosenthal Center for Complementary and Alternative Medicine at Columbia University.

Because acupuncture is considered relatively safe, Dillard said, more fertility doctors are deciding that it's OK to add it to the mix. "It's a big black-and-white outcome; you're either pregnant or you're not," he said. "If it turns out it's just the placebo effect, who cares?"

Many also say evidence that acupuncture relaxes patients is sufficient to recommend it, given the stress of dealing with infertility. In fact, women undergoing infertility treatments face stress levels on par with those of women coping with chronic illnesses such as heart disease and cancer, according to the American Society for Reproductive Medicine.

But skeptics like Domar feel it may still be too soon to recommend the treatment. "Patients are not going for acupuncture to feel good; they're going for acupuncture to get pregnant. And they're spending thousands of dollars for it. It's a dilemma."

Now pregnant, Jackie Apuzzo is still undergoing acupuncture treatment, although her therapy has changed: no more herbs and fewer needles in different locations. Her baby is due in December. Reflecting on the trials of the last several years, Apuzzo said the best thing about acupuncture was that it saved her from a second stressful IVF cycle, which she had planned for this month. "I'm glad we don't have to go through that again," Apuzzo said. "I just wish that I had considered the alternatives before jumping into the big guns."

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Forget the knife and syringe. The tool of choice for a growing number of wrinkle-phobes is a needle — scores of them.

Cosmetic acupuncture practitioners and patients swear by the results: Foreheads are smoothed, tummies tucked, breasts lifted and double chins become single once again. And as tales of botched Botox injections spread — the lawsuit filed by a sickened Beverly Hills socialite; at least four Botox recipients now seriously ill with botulism — acupuncturists say their non-toxic technique is proving ever more alluring.

"A lot of women are just afraid," says Martha Lucas, who says the number seeking treatment has quadrupled since she opened her Denver practice three years ago. (Lucas guesses that the number going under the needle nationally constitutes a "small fraction" of the more than 128,000 Americans who, according to the American Society of Plastic Surgeons, had face lifts in 2003.) "They don't want to take the chance they're going to come out not only with an ice bag on but with some potentially more serious side effect."

And there's the argument that cosmetic acupuncture, like traditional acupuncture, takes a holistic approach to treatment, so not only do eyebrows unfurrow, but "you feel better overall," says Christine Kleinschmidt, who practices in St. Louis. "You're sleeping better, you've got more energy and better digestion. ... It's not just skin-deep."

Physicians find the fountain-of-youth claims far-fetched. "To be fair, most people look better after a good night's sleep, after a vacation or after being outside in fresh air, so I'm not saying there can't be some benefit," says ASPS president Scott Spear. But "I personally have not seen any evidence that cosmetic acupuncture has any significant or long-term benefits."

Lucas' protocol of 10 treatments over five weeks goes for $1,200, less than one-quarter of the cost of the average face lift, although the results, which Lucas says last three to five years, are far from permanent. Each session takes 45 to 60 minutes and involves 60 to 70 needles. Kleinschmidt charges $1,800 for a typical course of 12 treatments, not including monthly or bimonthly maintenance sessions.

MaryAgnes Klock calls Lucas a "miracle worker." The Dallas resident says her jowls are gone, her eyelids aren't drooping, and she has dropped 35 pounds. Klock, who works in sales, won't divulge her age, but she will say that the other day someone guessed she was 40.

Acupuncturists say that while business is busy for weddings and holidays, the future lies in preventive procedures.

"I wish I'd known," Klock says. "I would have had it done in my 30s."

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Health: Acupuncture & Pregnancy

Reporting Stephanie Stahl Feb 8, 2008 6:00 pm US/Eastern PHILADELPHIA (CBS 3)

• In 2005, 11.5 million surgical and non-surgical procedures were performed. 
• This is a 444% increase since 1997-119% in surgical procedures and 796% in non-surgical procedures
• Botox injections were the most common non-surgical procedure done in 2005,at nearly 3.3 million procedures - 2 million of those for women.
• The most common surgical procedure performed in 2005 was liposuction (455,489)
• Total expenditures came to US$8.2 billion for surgical and US$4.2 billion for non-surgical procedures.

•      Firmer skin and jaw line
•      Reduced and softened wrinkles
•      Vibrant and more even skin tone
•      Reduced or eliminated acne and rosacea
•      Increased energy and sense of well being
•      Reduced or eliminated hot flashes
•      Improved digestion
•      Reduction or elimination of insomnia

• What are your long-term goals?
• Are you prepared for the upkeep and the change in your tissue structure?
• How might this surgery or introduction of a foreign substance affect your health?

Acupuncture: A Cure for Infertility?

Tuesday , April 26, 2005 By Catherine Donaldson-Evans / NEW YORK /

Yet after enduring five painful years of trying to have their own baby, Appert and her husband Edward finally saw their dream come true last month when their son Henry was born — premature, but healthy.

For all the fertility treatments, technologies and prenatal care available to women today, Appert credits the success of her pregnancy to an ancient Chinese secret.

"I recommend acupuncture (search) to everyone," Appert said. "It does work. I did everything possible for years to have a baby. I almost lost hope."

The millennias-old Asian medical practice — in which the acupuncturist places tiny needles in various pressure points, or "Qi" (Chee), in the body to improve circulation and reduce stress — has been around in the United States for years as an "alternative" treatment for numerous ailments.

But recently, acupuncture has been picking up steam as a possible remedy for female infertility, with a handful of American and European studies showing that it enhances the success rate of in vitro fertilization (IVF) (search).

“Do I believe in it? Absolutely,” said Dr. Paul C. Magarelli, an infertility doctor at the Reproductive Medicine & Fertility Center in Colorado Springs, Colo., and co-author of an ongoing study into the use of acupuncture with IVF with Dr. Diane K. Cridennda. Cridennda is a licensed acupuncturist with a master's degree in Oriental medicine from the International Institute of Chinese Medicine (search) who owns East Winds Acupuncture, also in Colorado Springs.

Magarelli said he joined the study at the urging of Cridennda, who had approached him about using acupuncture with IVF based on her knowledge of its history as an Eastern fertility treatment. A skeptic at first, Magarelli said he dismissed the idea for a while before signing on.

"I thought, this is rubbish — it can't be true," Magarelli said. "But no matter how I look at this data, I see an improvement. ... I'm pretty much a convert."

In general, studies seem to indicate that doing acupuncture about 30 minutes before and after in vitro fertilization can increase the chance that the embryo will be implanted successfully and reduce the chance of miscarriage.

There are also indications that the effectiveness of the IVF drugs and procedure may improve if acupuncture is done about once a week in the month or two leading up to the start of IVF and then continued regularly — once or twice a week — during the whole cycle.

And, as in Appert's case, there is anecdotal evidence that acupuncture can help with other fertility and pregnancy problems. Appert didn't need IVF to conceive, but she was told she probably couldn't carry a healthy baby to term because of her liver disorder.

But some doctors caution that there is no "magic pill" for fertility, pregnancy and IVF troubles — whether it's acupuncture or something else.

"The jury is still out on that," said Dr. Eric Surrey, president of the Society for Assisted Reproductive Technology (SART) (search), who has a practice at the Colorado Center for Reproductive Medicine. "I don't think we have good data to show that acupuncture before and after the embryo transfer is truly beneficial."

And they warn against making too much of claims that acupuncture can help with having babies.

"It's impossible to say at this point," said Dr. Robert Schenken, president of the American Society for Reproductive Medicine (ASRM) (search), who has a practice at the University of Texas Health Science Center. "In the absence of any controlled data, I don't think we can come to a firm conclusion."

Promising Research

Acupuncture seems to help some women because it improves circulation to the ovaries (search) — which makes for healthier eggs — and to the uterus (search), which increases the chances that the lining will be strong enough to hold those eggs to full-term.

"Acupuncture provides better circulation and better blood flow to the womb," said Dr. Raymond Chang, director of New York's Meridian Medical Group, who has been incorporating acupuncture into fertility treatments for the past decade. "It will give a better chance for the eggs to be nourished and therefore carried."

There's also the fact that acupuncture can be a stress-reliever during an emotional time.

"Trying to get pregnant is incredibly stressful," said Victoria Koos, the acupuncturist who treated Appert at Yin and Tonic Acupuncture in New York. "They're crossing their fingers. The longer they're trying to get pregnant, the worse it gets ... Part of [acupuncture's success] is simply relaxation. When the body is relaxed, all systems function better."

The Colorado study Magarelli and Cridennda presented at a conference this fall is one of a series the pair have done with acupuncture and in vitro.

That one looked at 114 patients who had a good chance of IVF being effective, some who did acupuncture and some who didn’t. It found, among other things, that there were fewer miscarriages, more pregnancies and a 7 percent higher birth rate among those who got acupuncture treatment over those who didn’t, according to Magarelli.

It piggybacked off other research the team did on 147 “poor responders” to IVF, which found that the pregnancy rate was 40 percent, with 11 percent more babies born, among those who did acupuncture with in vitro fertilization compared to those who didn’t.

In March, Magarelli and Cridennda released findings in Italy involving patients with an average prognosis for IVF success. Those yielded clear numbers that the pregnancy rate increased with acupuncture by 24 percent, according to Magarelli.

“What got us was that now we were seeing a firm trend toward getting more people pregnant,” he said.

The Colorado research seems to support some findings of two earlier studies, one in Germany by lead researcher Dr. Wolfgang E. Paulus — published in ASRM's “Fertility and Sterility” (search) in April 2002 — and one in Sweden by lead researcher Elisabet Stener-Victorin in the 1990s.

Of course, even those who believe in acupuncture concede that while the existing studies have yielded good information, there still isn't sufficient evidence, or a broad enough sample of patients tested, to call acupuncture a proven remedy.

"We are convinced, but scientifically you need proof — or so-called proof," Chang said. "There is a whole set of proof from lab experiments and animal studies to human studies, but it's very difficult to do human studies."

Schenken noted that even though there might be one set of data showing positive results, "it really needs to be corroborated, preferably with several different studies and different patient populations." For example, there can be bias when the entire study sample comes from the same clinic, or when patients know they're doing something different from usual.

Schenken said he doesn't get asked about acupuncture often, but when patients do, "we don't recommend it, but we do not discourage it."

Surrey takes a similar approach. In his opinion, the data "is not bad" on the theory that acupuncture can help when administered before IVF, but as far as acupuncture generally improving fertility or helping after the embryo transfer in IVF, "there really isn't a whole lot of data on that."

But at the very least, "there is absolutely nothing to show that it's harmful if it's done with a trained and appropriately skilled acupuncturist," he said. It's a notion that nearly everyone in the medical field — whether they believe in needles and Qi or not — seems to agree upon.

Some Eastern medicine-Western medicine rivalry may come into play with how to treat reproductive problems, but Chang said he sees more resistance with the use of Chinese herbs — which are ingested — than he does with acupuncture. Often, it's the in vitro specialists themselves who refer their patients to him for acupuncture after a couple of failed IVF attempts.

As for the couples trying to bring a child into the world — particularly through a complicated, invasive procedure like IVF— anything that helps the process along is welcome.

“IVF is so technical that patients feel like they’re being pushed and pulled … with acupuncture, they’re in a sense taking some control,” Magarelli said. "Acupuncture isn't a needle, it's an environment."

Added Koos: "They're on these incredibly strong drugs that make the poor women crazy. They're running around like Catwoman. This is to help them stay sane while they're going through the process."

The emotional cost of infertility comes with a hefty financial price tag as well — in vitro fertilization can cost anywhere from $10,000 to $20,000 a cycle and generally isn't covered by insurance; acupuncture ranges from about $30 to over $200 per treatment — Koos and Chang charge about $90 a pop — and certain health plans do cover at least a portion of it.

Meanwhile, researchers and experts in the field are excited at what they're seeing in the studies. Chang said he's currently working with NYU Medical Center on a trial that looks at IVF with and without acupuncture.

Appert, for her part, was at the end of her rope and felt she had nothing to lose. She started acupuncture with Koos about two months before she began trying to conceive — with needles in her toes and a couple of liver points — and continued with the treatments throughout the pregnancy.

"The first time I went, I was completely terrified. My husband went with me and held my hand," she said. "I could feel the muscles in my liver jump and an electric current going through my body. It was very strange but also felt right."

She said being monitored by both her obstetrician and Koos helped reassure her about what was going on during her high-risk pregnancy.

"She would tell me things about how I was doing physically and then I would go to the doctor and he would tell me the same thing," remembers Appert, who works as a professor.

When she got sick late in the pregnancy, both Koos and Appert's OB/GYN were able to detect when her liver went dangerously haywire and get her to the hospital for delivery six weeks early, before the problem harmed the fetus and caused another stillbirth.

Regardless of the skeptics, Appert said she's relieved that she was finally able to have a nearly full-term baby of her own. At 4 pounds, 6 ounces, Henry has been in intensive care but otherwise is doing "fine."

"It really was a miracle," the new mom gushed. "It's one of these weird things that Western medicine can't explain."

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