Acupuncture needle

How Many People Have Some Difficulty Starting A Pregnancy?

For the UK alone, The National Collaborating Centre for Women’s and Children’s Health estimate one in seven couples (1) have problems with infertility at some point. Another estimate is 10 to 15%, with 9% of UK women aged between 15 and 45 yrs old requiring treatment at least once in their lifetime (2).  Internationally, one recent study estimated between 3.5 and 16.7% of couples in different populations reported subfertility issues.  Globally, 43 to 63% of those couples reportedly sought medical intervention (3).

Why Talk About Traditional Chinese Medicine Acupuncture And Infertility?

TCM has been practiced in the West from small beginnings in the 1970s growing to the extent where many European and American cities and even small towns have TCM clinics in many neighbourhoods. Whilst the practice may perhaps have been viewed in the 1970’s and 1908’s as more esoteric, or even as weird, wacky nonsense, it has gradually shaken off its negative press and replaced it with a more medical reputation.  Centuries old it may be, but in modern China it is practiced alongside modern medicine, in the same hospital, run by the state, with white coats and stethoscopes rather than perhaps the ‘smells and bells’ fondly imagined by romantically minded westerners in the 1970’s. One third of China’s outpatients appointments use TCM (that’s 1.3 billion treatments in 2008), offered often as well as modern conventional medicine by 49% of China’s doctors (4).

The famous Yin Yang symbol has particular meaning within TCM acupuncture

TCM has a long history of seeing patients with male and female infertility problems, indeed for much of China’s long history, it was the official healthcare system. Click on the links to explore how acupuncture is used with male and female subfertility patients and how acupuncture is used with IVF.

References

1. National Collaborating Centre for Women and Children’s Health. 2004. Fertility Treatment and Assessment for People with Fertility Problems. [online]. London: National Collaborating Centre for Women and Children’s Health. Available at:

http://www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBFertilityFull.pdf

2. Evers, J. L. H. 2002. Female Subfertility. The Lancet. 360, pp. 151-59.

3. Boivin, J et al. 2007. International Estimates of Infertility Prevalence and Treatment-Seeking: Potential Need and Demand for Infertility Medical Care. Human Reproduction. 22 (6), pp.1506-12.

4. Xu, J. & Yang, Y. 2009. Traditional Chinese Medicine in the Chinese Health Care System. Health Policy. 90, pp.133-39.

Yin Yang symbol photo credit: http://www.sxc.hu/profile/hisks

Men with fertility issues are also trying acupuncture these days

TCM practitioners seeing male patients with difficulty starting or adding to their family frequently offer acupuncture. Some practitioners are able to offer additionally Chinese herbal medicine alongside it.  It is impossible to adequately discuss the TCM medical theory in depth here, but broadly speaking a brief outline may be useful. TCM characterises health as the times when the body’s Qi flows smoothly, in the correct order, without any impediments or erratic movements. Qi which is imbalanced would be encouraged back into a more regulated state to encourage the body towards regaining health by healing itself.

Traditional Chinese Medicine acupuncture subdivides Qi into yin (female) and yang (male) vital energy

In the West less standard scientific format research appears readily available for the men than the women into acupuncture or Chinese herbal interventions, although many case studies exist, especially of course in China itself. A notable 2005 study by an international team in Germany and Italy included 40 men who had a 2 year history without the desired pregnancy with their partners. All men were diagnosed using modern medicine as experiencing “idiopathic infertility” due to oligospermia (low sperm density), asthenospermia (difficulties in sperm motility) or teratozoospermia (difficulties in sperm shape and structure). These conditions can be said to be very common among male patients seeking help to conceive. 28 received acupuncture twice a week for 5 weeks, compared to 12 who did not as a control group. The study found acupuncture resulted in a general improvement in sperm quality and suggested its use alone or alongside assisted reproduction technology (1). Future larger studies are planned to explore the mechanisms at work. It is worth remembering that some areas of conventional modern medicine are better studied and understood than others. Acupuncture often can’t attract the large budgets for research common for modern pharmaceutical drugs. This may be part of the explanation of why although it is widely used in the East, it is not as conventionally accepted in the West, as Western physicians may struggle to locate locally acceptable scientific resources on clinical uses. Any man considering TCM is best placed to consult a qualified practitioner, and not hesitate to enquire of their training, qualifications and professional memberships. Good practioners have no problem answering such questions. Patients should also always feel free to choose to use conventional medicine.

DISCLAIMER: NO information here is intended to be taken as medical advice – or used as a substitute for professional medical advice. Any person with any health concerns is advised instead to consult their doctor. In the case of persons seeking therapy using Traditional Chinese Medicine, this information cannot be taken as medical advice and persons are advised instead to consult a suitably qualified professional practitioner.

References

1. Pei, J. et al. 2005. Quantitative evaluation of spermatatozoa ultrastructure after acupuncture treatment for idiopathic male infertility.  Fertility and Sterility. 84 (1), pp. 141-147.

Professional Bodies – Sources of More Information on Traditional Chinese Medicine:

The Association of Traditional Chinese Medicine (UK), London:

http://www.atcm.co.uk/

The British Acupuncture Council:

http://www.acupuncture.org.uk/

The Register of Chinese Herbal Medicine:

http://www.rchm.co.uk/

Modern scientific research has focused on combining acupuncture and IVF

Recently, the media has picked up on success stories and interest in combining In Vitro Fertilisation (IVF) reproductive medicine with Traditional Chinese Medicine (TCM) acupuncture. In considering this issue, some interesting, and sometimes confusing information comes to light.

In the West, recent scientific studies focused on the use of acupuncture during courses of IVF treatment.  However, acupuncture is only one method within TCM, which also uses cupping, moxibustion, herbal medicine, dietary therapy, ‘Tui Na’ style massage & Qi Gong style exercise.  Nonetheless, 3 clinical trials concluded acupuncture before/on the day of embryo transfer improved the number of pregnancies [^3,4,5]. They all cited research suggesting acupuncture improves uterine artery blood flow, which is associated with more successful IVF outcomes [⁶].  Systematic reviews of clinical trials by the British Medical Journal [⁷] and the Cochrane Collaboration (linked to the UK’s NHS National Library for Health) [⁸] were also positive news, finding statistically significant improvement in live birth rates.  Confusingly though, the Cochrane review appeared to suggest this was a placebo effect. Another clinical trial [⁹] found no significant effects, but suggested that their study may have been ‘under-powered’ (meaning not conducted on a large enough scale).

The ‘TCM community’ itself has long debated suitable ways of researching acupuncture. One drawback is randomised controlled double-blind trials (RCTs) employed within modern orthodox medicine often group patients together by its own diagnosis, then treat them in a standardised way regardless of the TCM diagnosis. Whereas in ‘authentic’ TCM, each patinet is given their own TCM diagnosis. In practice, this effectively means 2 patients with a modern conventional medical diagnosis for ‘Fallopian Tube Obstruction’ for example, could end up with 2 different distinct and different TCM diagnoses for the condition of ‘Qi’  and ‘Xue’ which explain the subfertility. The difficulty apears to be understandable, in a sense. As an entirely separate medical practice TCM is practiced according to the ‘laws’ of TCM, rather than working from the diagnosis of modern medicine and using the same acupuncture points for every case – according to TCM, this would not be ‘normal’ practice, in case the TCM diagnoses demanded different points be used. In modern use, many TCM practitioners do also interpret modern medical findings but within a TCM theoritical framework – again, being unlikely to use the same protocol for every case.

Whilst there appears to be a way to go before TCM can be evaluated to satisfy science in the West, the safest conclusion is probably this does not automatically mean the treatment never works. It is interesting to remember there are also practices within modern conventional medicine which are not fully understood. Any woman considering TCM acupuncture for this issue is best advised to visit a practitioner with adequate training, hygienic practice and a willingness to answer any question she may have. Professional associations representing TCM practitioners in the UK include The Association of Traditional Chinese Medicine (UK), the  British Acupuncture Council and the Register of Chinese Herbal Medicine. (A very few long established practitioners may also have no affiliation, but take reliable recommendation as key here).

Traditional theory, such as Yin-Yang, is a world away from modern medicine but that doesn't mean it all doesn't work

DISCLAIMER: NO information here is intended to be taken as medical advice – or used as a substitute for professional medical advice. Any person with any health concerns is advised instead to consult their doctor. In the case of persons seeking therapy using Traditional Chinese Medicine, this information cannot be taken as medical advice and persons are advised instead to consult a suitably qualified professional practitioner.

Yin-Yang symbol photo credit: http://www.sxc.hu/profile/hisks

References

1.Boivin, J et al. (2007). ‘International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care’. Human Reproduction. 22 (6), p.1506-1512.

2. Xu, J. & Yang, Y. (2009). ‘Traditional Chinese medicine in the Chinese health care system’. Health Policy. 90, p.133-139.

3.  Dieterle, S, Gao, Y,  Hartzmann, W., Neuer, A. (2006). ‘Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomised, prospective, controlled clinical study’. Fertility and Sterility. 85 (5), p. 1347-1351.

4. Paulus, , W.E, Zhang, M., Strehler, E., El-Danasouri, I & Sterzik, K. (2002). ‘Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy’.  Fertility and Sterility. 77 (4), p. 721-724.

5. Westergaard, L.G. et al. (2006). ‘ Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomised trial’. Fertility and Sterility. 85(5), p. 1341-1346.

6. Steiner-Victorin, E.,  Waldenstrom, Andersson  S.A. & Wilkland, M. (1996). Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture’. Human Reproduction. 11, p.1314-1317.

7. Manheimer, E., Zhang, G., Udoff, L., Haramati, A., Langenberg, P., Berman, B. & Boulter, L.M. (2008). ‘Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis’. BMJ. 336 (7643), p. 545-549.

8. Cheong, YC., Hung Yu Ng E & Ledger, WL.  (2008). ‘Acupuncture and assisted conception (Review)’. The Cochrane Library. 4, p.97-108.

9. Smith, C., Coyle, M. & Norman, R.J. (2006). ‘Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer’. Fertility and Sterility. 85 (5), p. 1352-1358.

Professional Bodies – Sources of More Information on Traditional Chinese Medicine – please note, these associations do not have any relationship with this site and these are provided purely for reference:

The Association of Traditional Chinese Medicine (UK), London:

http://www.atcm.co.uk/

The British Acupuncture Council:

http://www.acupuncture.org.uk/

The Register of Chinese Herbal Medicine:

http://www.rchm.co.uk/

Female acupuncture model showing channels and acupuncture points

Perhaps the best known acupuncture style in the UK used by people with problems starting or adding to a family is Traditional Chinese Medicine (TCM). Practitioners generally take a full TCM style health consultation and make a diagnosis according to TCM theory. TCM looks at the symptoms the patient describes, the signs of the body and emotions, the diet and lifestyle to help illuminate the condition.

TCM theory is necessarily complex, as you would expect in any major medical system. Very basic starting points are the concept of the body having smooth, ordered flowing of Qi (vital energy) in health. Treatment is aimed at influencing any imbalances in the flow of Qi to encourage the body back to the smoothest flow possible. Qi is believed to flow along energy pathways in the body, the jing luo, translated as channels (or meridians) and collaterals (collateral channels or meridians. This gives TCM a different anatomical basis to modern conventional medicine, which is also reflected in the different functions ascribed to the vital organs. Whilst some TCM concepts have been sometimes dismissed as ‘unscientific’, or ‘unworkable’, one observation may be the rise in popularity of TCM as a therapy is not yet matched by science’s ability to understand how it works.

On the basis of the TCM diagnosis, generally points are specifically chosen, meaning that different points may be used each time the patient has a fresh appointment. The needles are inserted and are sometimes stimulated to achieve ‘de qi’ – in very simple terms, sensations which are felt to indicate the Qi is active at the acupuncture point area (1). The needles are kept in place for some time; an average might be 20-30 minutes. Once the needles are in place, modern science suggests that endorphins are released, natural chemical messangers which assist in promoting relaxation. Generally speaking, patients are encouraged to gently relax and enjoy the sensations. Practitioners sometimes also use moxibustion, where mugwort is either burned in a tight roll, looking a bit like a cigar, and gently wafter over the skin, or by placing a little tight pinch of it on the end of some of the needles. This feels warm and often soothing, and will never burn the skin with a well-trained practitioner in charge.

Moxibustion - the gentle burning of herbs for their theraputic vapours- may be used alongside acupuncture

Practitioners also sometimes use cupping – these are round glass  spheres, looking a little like old style fisher-men’s net weights (remember those greenish orbs by the seaside boats?). These spheres are usually clear heavy glass, and the practitioner uses a piece of burning cotton wool soaked in alcohol solution to make a flame with which they create a vacuum. The burning material is quickly placed inside the cup, then removed, then the cup placed rapidly onto the skin. The heat makes a vacuum, so the cup sucks a little skin into the cup, creating a dome shape. This can be done either on top of the needles, or sepeartely. another technique is sliding cupping, where oil is applied to the body and the cups are moved around – this can feel like a very very deep massage. Again, with a good practitioner the patient should come to no harm! Another way to use cups is the modern suction method, which uses a pump instead of the more theatrical looking flaming techniques.

A batch of cups used in Traditional Chinese Medicine acupuncture

The needles are then removed and placed into a sharps bin for safe disposal. In the UK today, the trend is definitely for standard use of disposable needles which are sterile until opened, only used once, and then disposed of, never to be used again. In other countries such as China, hospitals may autoclave to sterilise and then re-use needles, rather like surgical instruments are re-used, although patients can request disposables are used instead.

Auricular (ear) acupuncture work may involve an extra element: the practitioner may also offer ‘ear seeds’ or ‘ear magnets’ for use between appointments. These are generally a Chinese herbal seed, wang xing bu ling (Semen vaccariae) or special tiny magnetic ‘beads’ mounted on skin-friendly adhesive tape which is then stuck onto the ear skin like a tiny plaster. These are generally kept in place for a few days and are felt to encourage a beneficial flow of Qi.

References

1. Bovey, M. (2006). Deqi. Journal of Chinese Medicine. 81 (6), pp. 18-29.

DISCLAIMER: NO information here is intended to be taken as medical advice – or used as a substitute for professional medical advice. Any person with any health concerns is advised instead to consult their doctor. In the case of persons seeking therapy using Traditional Chinese Medicine, this information cannot be taken as medical advice and persons are advised instead to consult a suitably qualified professional practitioner.  Styles do vary between practitioners so this introduction should not be taken as a definitive guide to any practitioners practice standards. Many thanks.

Most practitioners offer acupuncture and some also may offer Chinese Herbal Medicine alongside it. The theory of TCM gynaecology is highly advanced, having been honed over the centuries.

Modern women may have children later and many try acupuncture to help them concieve

A Little Theory Overview

The following is of course a very condensed view, as TCM theory is complex and has become highly developed over the centuries. TCM maintains that Qi (vital energy) circulates throughout the body in an orderly fashion in the healthy individual. TCM practice always aims to correct imbalances in flow, impediments to flow or unusual Qi movement to help restore the body towards harmony. Qi flows in twelve regular channels (meridians) and eight extraordinary channels, which traverse the body in the same ‘map’ for every person. Acupuncture points exist along these pathways where the Qi is said to gather, therefore the channel Qi is held to be influenced by needling these points.

Acupuncture model with female points

A (Very) Little TCM Acupuncture Gynaecology Theory

The Chinese term bao gong is often translated as ‘uterus’, however it refers to all the internal female reproductive organs. The actual uterus is termed ‘zi gong’. It is supplied with all the ‘necessary materials’ for menstruation, conception, pregnancy and delivery by the organs, via the  extraordinary channels Ren, Chong, Dai and Du. Those connect to the twelve regular channels  and the organs.

Modern authors suggest perhaps the circuit of the Ren and Du channels via the Brain, Heart and Kidneys can relate to the modern equivalent, the hypothalamic-pituitary-ovarian (HPO) axis controlling gynaecological functions (1).

Studies in the West have tended to focus on combining acupuncture with in vitro fertilisation technique (IVF). However, TCM traditionally had to be used for patients without the benefit of any modern technology. Today, recent media reports state the Chinese trend for trying TCM first has not diminished (2), although in the West, it may be they choose modern conventional medicine first and a small number then complement it with TCM. Should any patient choose to try acupuncture, with or without other treatments, finding a properly qualified acupuncture practitioner is essential.  In many larger cities, patients can also choose to save money by taking acupuncture at the local acupuncture teaching school, often staffed by highly experienced senior staff and final year training practitioners. Patients should always be free to choose conventional medicine if they wish to, good practitioners are not averse to patients’ rights to choose.

DISCLAIMER: NO information here is intended to be taken as medical advice – or used as a substitute for professional medical advice. Any person with any health concerns is advised instead to consult their doctor. In the case of persons seeking therapy using Traditional Chinese Medicine, this information cannot be taken as medical advice and persons are advised instead to consult a suitably qualified professional practitioner.  TCM theory is fascinating but can only really be interpreted in any meaningful way by a qualified practitioner – please do not attempt to use this information in any other way than as an interesting introduction to some topics. Many thanks.

Silhouette photo credit http://www.sxc.hu/profile/katagaci

References

1. Maciocia, G. (1998). Obstetrics and gynaecology in Chinese medicine. London: Churchill Livingstone.

2. Chang, E. (2009) Breaking the silence on Chinas infertility treatments. [online]. CNN News, Available at:  http://edition.cnn.com/2009/WORLD/asiapcf/08/11/china.fertility/index.html