With one in eight U.S. couples suffering from infertility, it is likely you know or have worked with someone struggling to have a baby. Some may need to undergo assisted reproductive treatments like in vitro fertilization (IVF) and experience more psychological distress than fertile folks.
One study found that of people seeking fertility treatment, three-quarters of women and two-thirds of men were clinically anxious, and one-third of men and more than one-half of women were clinically depressed.1 Highly prevalent, the emotional burden of infertility compounds an already fraught process.
The psychological burden can become so great that up to 50 percent of fertility patients may abandon treatment before they become pregnant, even if they are still eligible for treatment or their cost of care is covered. The most common reason is the emotional cost.
Understanding IVF
IVF is a process whereby a patient undergoes ovarian stimulation by injecting hormones so that a cohort of follicles, hopefully containing eggs, are pushed to develop together. Once mature, the fertility specialist surgically suctions each follicle with the hope of collecting an egg.
After egg retrieval, viable eggs are fertilized to create embryos. If embryos are created, they can be genetically tested before freezing. Embryos are cryopreserved and stored until needed.
When the intended parent is ready to become pregnant, they go through a frozen embryo transfer (FET), whereby the embryo is thawed and placed inside the womb at the optimal time to ensure it can burrow into the uterine lining during the implantation window. Hopefully, pregnancy will result.
A fertility patient can undergo one or many ovarian stimulation cycles, depending on age and the ovarian stimulation cycle outcome. They will need to repeat it if there were no eggs from retrieval; or if in the lab, no eggs fertilize, no embryos are created, or no embryos are genetically normal.
Patients can also endure one or many FET cycles before achieving their intended goal of having a child. They will need to try again if implantation fails, or if a pregnancy is not viable or lost.
Why Is IVF So Hard?
IVF is both physically and emotionally demanding. The medications can have side effects, and procedures can be intrusive and sometimes painful. There may already be emotional suffering with the inability to become pregnant, and personal relationships can become strained as treatments drag on and there's still no pregnancy.
As noted above, the risk of failure at any time point is omnipresent, as well as a risk of pregnancy loss. There may be personal conflicts based on religious, moral or ethical challenges with IVF. Sometimes, it can be difficult to engage with clinical staff, creating a problematic dynamic whereby patients have little patience or do not feel supported by clinical staff.
Conversely, staff cannot cope with patient needs and demands, leading them to burn out quickly. For some, insurance covers the cost of IVF, but for others, the financial burden also contributes to distress.
Still, I don't mean to paint an entirely bleak picture. IVF is not impossible and, with support, can be tolerated. Hundreds of thousands of people have been successful. In fact, since the first successful cycle in 1978, an estimated 8 million babies born globally have been conceived with IVF.
How Can Acupuncture Benefit IVF Patients?
There is a long historical record describing infertility treatment with acupuncture and East Asian medicine (EAM) within the classical texts. Within the past three decades, we have translated acupuncture and EAM for infertility to integrate with IVF therapies. The intention all along is to improve patient health and birth outcomes.
Acupuncturists have used acupuncture alongside conventional therapies like chemotherapy, standard pain management and surgical interventions. It makes logical sense that we might add this drug-free therapy alongside IVF.
In large, high-quality meta-analyses, acupuncture improved IVF live births by about 30 percent compared to no treatment, but we don't see an improvement when acupuncture is compared with sham controls.2-3
Acupuncture may also benefit patients suffering from IVF-related anxiety. I recently published a meta-analysis investigating acupuncture as an intervention to reduce IVF-related anxiety.4 We found eight studies involving 1,785 participants that met our inclusion criteria and assessed anxiety as an outcome. Our analysis found acupuncture provided small, but significant improvements for IVF-related anxiety when compared with any control.
The evidence, unfortunately, was considered very low certainty, a grade that tells us how likely these results could change as more trials are done. The current acupuncture research was limited by the total number of included studies (<10) and the average number of participants (<200) in each study; the differences in control arms across the studies; and the different methods used to assess anxiety.
In the case of acupuncture addressing IVF-related anxiety, these results will undoubtedly change as more research emerges.
Editor's Note: Part 2 of this article (May issue) discusses the limitations with the research and proposes future directions of patient care.
References
- Pasch LA, Holley SR, Bleil ME, et al. Addressing the needs of fertility treatment patients and their partners: are they informed of and do they receive mental health services? Fertil Steril, 2016;106(1):209-215.e202.
- Smith CA, Armour M, Shewamene Z, et al. Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis. Reprod Biomed Online, 2019;38(3):364-379.
- Xie ZY, Peng ZH, Yao B, et al. The effects of acupuncture on pregnancy outcomes of in vitro fertilization: a systematic review and meta-analysis. BMC Complement Altern Med, 2019;19(1):131.
- Hullender Rubin L, Smith C, Schnyer R, et al. Effect of acupuncture on IVF-related anxiety: a systematic review and meta-analysis. Reprod Biomed Online, July 2022;45(1):69-80.
Dr. Lee Hullender Rubin is an internationally recognized, award-winning doctor of acupuncture, clinical researcher, and a leader in the field of integrative reproductive medicine. She practices in Portland, Ore., and provides continuing education at Rosefinch Academy.