In 2006, Westergaard and colleagues conducted a study evaluating the effect of acupuncture in patients undergoing IVF/ICSI. One group receive acupuncture on the day of ET (group ‘Acu1’); another group on the day of ET and also 2 days later (group ‘Acu2’). Both groups were compared with a control group that did not receive any acupuncture treatment.
Like many others, Westergaard chose to follow the acupuncture points mentioned in Paulus et al (2002). Acupuncture was performed immediately before and after ET for both groups, with each session lasting 25 minutes. For group Acu2, another 25 minutes session was performed 2 days later using a completely different set of acupoints. These points were chosen to reduce sympathetic activation, and also to improve of uterine blood perfusion, so as to enhance endometrial receptivity for implantation.
Overall, clinical pregnancy and live birth rates were higher in group Acu1 than the two other groups. This study showed how acupuncture during the day of ET helps improve the reproductive outcomes of IVF/ICSI. That said, it is worth noting that repeating acupuncture 2 days later had no additional benefit. In fact, the group that received acupuncture 2 days after ET had a miscarriage rate of 33%. This is higher than the 21% miscarriage rate in the group that had acupuncture only on the day of ET, or the 15% in the control group. Statistical analysis showed that these results might still have occurred by random chance.
1. Timing of Implantation
Westergaard wanted acupuncture exactly 2 days later because implantation of the embryos into the uterine lining does not occur for two to five days after ET depending on when the embryos were transferred. It is unknown whether the effect of acupuncture performed on the day of ET would last until the day of embryo implantation or longer. The timing of implantation is different for different women — as acupuncture has been shown to cause contraction in the uterus, any stimulation two days after ET might be disruptive for some women. Furthermore, building up a thick healthy endometrium for implantation does not occur within a day but is more likely the outcome of routine and consistent acupuncture done weeks before the start of the IVF cycle.
2. Choice of Points
Also, the acupoints mentioned might not have been suitable for post-ET treatment. We do notice that the lower abdomen was clearly avoided but points LI4 and SP6 are a point-pair that is contraindicated during pregnancy. These points are often used to stimulate labor and can cause uterine contraction. Historical wisdom should not be neglected and this pair may not be suitable during the implantation window.
3. Training and Consistency in Needling
Lastly, the nurses conducting the acupuncture sessions were briefly trained just for the purpose of this study, each performing between 2 to 24 acupuncture sessions. Westergaard did mention that the needles were stimulated to maintain deqi sensation for every session. This could be a partial contributing factor for the discrepancy in the outcomes as well.
Our understanding is that this study leans towards using a Paulus-type protocol only on the day of embryo transfer, and using a separate “implantation” protocol 2 days post-transfer. Same day post-ET treatment is often not so convenient, and if not implementable, we suggest that you rest after the procedure and come back for an “implantation” protocol about 4-7 days after ET.