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What is IVF

Fertility declines with advancing age and the number of couples seeking infertility treatment at an older age is constantly increasing. A top quality embryo is believed to have the highest potential for implantation and development into a child. A better understanding of the relative importance of patient and treatment characteristics and of embryo quality could help to optimise the existing therapeutic schemes and the safety of in IVF(In vitro fertilization). Alternative medicine such as Traditional Chinese Medicine(TCM) has been supporting IVF treatments in recent years to boost success rate.

IVF is a technique of reproductive medicine. Following controlled ovarian stimulation (COS), eggs are retrieved from the ovaries. After these eggs are cultivated and fertilized and have developed into embryos of a certain size, they are transferred to the uterus for implantation and growth.

IVF was first successful in the United States in 1981. Since then, it has become a widely accepted method of treatment for infertile couples.

How can TCM help?

1. Improve IVF outcomes (clinical pregnancy rates and live birth rates)
A review found that women undergoing IVF together with more acupuncture sessions were twice as likely to have a baby compared to women who did IVF alone, and 60% more likely when compared with women who just had two acupuncture treatments on the day of embryo transfer. 
Another study found that acupuncture performed in 80 patients 25 minutes before and after embryo transfer vs control group without acupuncture. Clinical pregnancies in 34 of 80 patients (42.5%) in the acupuncture group, compared to 26.3% (21 out of 80 patients) in the control group.
 
2. Improve egg quality
A good egg equality is essential for a successful embryo growth to blastocyst. A study found that acupuncture can enhance oocyte maturation and fertilization rate, and reduce the granulosa-cell apoptosis index in an IVF program. 
 
3. Stress reduction

Several studies have shown that the uterus has contractions and that these contractions could cause expulsion of the transferred IVF embryos. If the contractions were reduced by acupuncture then that could be a mechanism for an improvement in IVF pregnancy rate. Results of a study indicate that acupuncture can reduce anxiety symptoms observed by the reduction of psychological parameters of women undergoing IVF. This can reduce the chances of decreased implantation rates in stressful women.

EMW TCM - IVF Approach

Stage 1: Preparatory Phase (2-3 months before IVF cycle)

Hormonal imbalances in the body due to stressful lifestyle or after a failed IVF/ET treatment can affect the interplay of the body’s own hormones and disrupt the maturation of the ovum and the construction of the endometrium and development of the embryo. Some patients suffer from depression or nervous agitation, which gives rise to or aggravates additional symptoms like exhaustion, insomnia, or changes in appetite and weight. In this case, it is recommended to regulate the imbalances in the body for 2–3 months with TCM and to allow the body to recuperate before the start of another IVF treatment.

These deviations from the ideal state provide the explanation for a continued lack of pregnancy in spite of the fact that the biomedical preconditions, for example, an endometrial thickness of 10 mm, good embryo morphology, and an optimal hormonal state,are fulfilled. TCM always treats the whole person. A healthy appetite and sleep, balanced emotional state, and regular digestion are good and important signs for the patient.

Stage 2: Down-regulation Phase

In this phase, the patient receives high doses of GnRH-a (gonadotropin-releasing hormone agonist), often known as a “long protocol”, to inhibit the activityof the reproductive axis and the body’s own hormones. This is called down-regulation and often begins in the luteal phase of the previous cycle. Patients with endometriosis and adenomyosis are treated for 2–3 months to control the endometriosis lesions. Patients with an irregular cycle or FSH (follicle-stimulating hormone) levels of more than 15 U/L are often given the “pill,” for example Marvelon, for 1–3 months prior to the start of IVF/ET treatment. This protocol is increasingly ditched in favour of the ‘short protocol’, and is usually done for patients with low follicles extraction.

The purpose of TCM during the “down-regulation phase” serves to replenish and supplement blood and essence without stimulating the reproductive function, which would run counter to the downregulation by GnRH-a. Our purpose of giving TCM is NOT to replace the function of GnRH. In addition, the use of IVF medications, such as Lupron, often results in Yin deficiency with Heat symptoms, which can be usually managed by acupuncture.

Stage 3: Ovulation Induction Phase

This phase corresponds to the length of time that the patient is taking gonadotropin-FSH or hMG (human menopausal gonadotropin) to stimulate the maturation of the oocyte. 

In addition to improving blood circulation to the pelvis, the treatment also helps to regulate the body’s response to the medications, so that any over-stimulation or under-stimulation is rectified. Usually, 3-5 acupuncture sessions are recommended during this phase before embryo retrival.

Stage 4: Egg Retrieval

This phase begins at the point in time when the follicles are almost fully matured and lasts until 1 day before the embryo transfer (ET). During this time span, patients undergo a variety of tests (blood tests, ultrasound, etc.) and surgeries; they are therefore often very tense. Acupuncture plays a big role in calming the patient in this phase.

Stage 5: Embryo Transfer

Research has shown that it is beneficial to perform acupuncture 25 minutes before and after embryo transfer to boost IVF success rate. in EMW Physiotherapy & TCM, we recommend patients to do acupuncture 1 hr before and after their embryo transfer.

What to expect on your first visit?

During your first visit, we will assess and identify the issues affecting your fertility. We strongly encourage patients to come for TCM treatment ideally 3 months before the start of your IVF cycle. We will develop a customised TCM treatment approach for you and a combination of TCM treatment modalities will be used. Basal Body Temperature(BBT) charting may be required as well. In order to successfully carry out an IVF/ET or ICSI/ ET treatment, it is important to treat any imbalances in the patient’s body by means of TCM and treatment takes time.

If you have booked an IVF treatment date with your doctor, and would like to book a consultation with us, please bring the following on your first visit if you have them:

  1. Ultrasound scan report
  2. Laparoscopy report(if any)
  3. Current medications
  4. Hormonal Profile (LH, FSH, Progesterone, Testosterone, Thyroid Hormones, AMH and Prolactin, if any)
  5. Semen Analysis

Your treatment plan will usually involve:

  1. TCM herbal prescriptions 
  2. Acupuncture (if you are willing)
  3. Adherence to a diet that will nourish your body and support IVF

Book an appointment to find out how we can help support you on your IVF journey.

Our TCM Physician

Acupuncture for Fertility in Singapore

Edmund graduated with a First Class Hons in Biomedical Sciences and Traditional Chinese Medicine from Nanyang Technological University, before taking a Masters in Gynaecology(TCM) in Liaoning, China. 

He has successfully treated patients with unexplained infertility, polycystic ovarian syndrome(PCOS) and endometriosis and helped them conceive naturally with Traditional Chinese Medicine.

References

Kusuma, A. C., Oktari, N., Mihardja, H., Srilestari, A., Simadibrata, C. L., Hestiantoro, A., … Muna, N. (2019).   Medical Acupuncture, 31(5), 289–297. doi:10.1089/acu.2019.1368

Wolfgang E Paulus, Mingmin Zhang, M.D.b, Erwin Strehler, M.D.a, Imam El-Danasouri, Ph.D.a, Karl Sterzik, M.D.a. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and Sterility April 2002 Volume 77, Issue 4, Pages 721–724

Rubin, L. E., Opsahl, M. S., Wiemer, K. E., Mist, S. D., & Caughey, A. B. (2015). Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes. Reproductive BioMedicine Online, 30(6), 602-612. doi:10.1016/j.rbmo.2015.02.005

Isoyama , Cordts EB, de Souza van Niewegen AM. Effect of acupuncture on symptoms of anxiety in women undergoing in vitro fertilisation: a prospective randomised controlled study Acupunct Med. 2012 Jun;30(2):85-8. doi: 10.1136/acupmed-2011-010064. Epub 2012 Apr 12.