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How many sessions of fertility acupuncture do you need for IVF?

By Irina Szmelskyj, DipAc, MSc, MBAcC, MBAA, BAFMOR, FRSPH
Fertility Acupuncturist, Author, Speaker, Lecturer, Examiner

About the author: Irina Szmelskyj is an award-winning fertility and IVF acupuncturist, a co-author of a best-selling textbook ‘Acupuncture for IVF and Assisted Reproduction: An Integrated Approach to Treatment and Management’. Irina is also a lecturer on the subject of acupuncture for infertility and IVF and is an award-winning acupuncturist specialising in reproductive medicine practicing at True Health Clinics in Huntingdon, Cambridgeshire and CAM Therapies in Cambridge, UK.

In a hurry? Key takeaway points from this article

The number of acupuncture sessions needed during IVF treatment depends on factors such as female age, ovarian reserve, previous response to IVF medication and reasons for needing IVF. In one study, it was found that women who received nine acupuncture treatments had a significantly higher IVF success rate compared to those who had fewer sessions. 

Up to 5 months before IVF

Preparation phase: 0-12 treatments

The biggest cause of IVF failure is poor genetic quality of eggs. The latest research shows that egg quality is strongly affected by follicular and ovarian environments. If the environment is good, eggs are genetically healthier.

Follicles that contain eggs take over a year to develop from their dormant stage. During the last 5 months of their development ovarian follicles grow tiny blood vessels and from this point on nutrients and hormones in the blood supply can affect follicular development. Treatment during this phase aims to improve blood vessels micro-development, balance reproductive hormones and ensure optimal nutrition in order to positively influence the ovarian and follicular environments.

Younger women who have good ovarian reserve don’t need as much treatment as their eggs are usually genetically stronger. In fact, in some cases no pre-treatment is required. For example, if a couple is having IVF because of male-factor infertility and the female partner is young, healthy and has good ovarian reserve.

Women who have poor ovarian reserve or suffer from certain conditions known to affect egg quality need more treatment during this phase.

Your acupuncturist will be able to advise you when you should begin your acupuncture treatment and approximately how many sessions you are likely to need. 

Day 1 of stimulation to egg collection day

Stimulation phase: 3-4 treatments

Regular acupuncture, every three to four days, may be needed during this time to increase response to stimulation medication by improving ovarian and uterine blood flow, manage stress levels and continue to address health issues identified during the preparation phase.

Ideally, the first treatment should be administered within the first three to four days of stimulation. The last treatment should be administered within 48 hours of the egg retrieval procedure. This is because adequate blood flow is especially important during this phase, particularly in older patients, as research shows that follicles that have poor blood supply during this stage produce more genetically damaged eggs

Egg collection to embryo transfer

Egg retrieval recovery phase: 0-2 treatments

Most patients do not need any treatment during this time. However, some women who experience complications during or after the egg retrieval procedure, for example, pain or symptoms of mild to moderate OHSS, may benefit from additional acupuncture treatment during this time. Please note, severe OHSS requires immediate hospitalisation. If in doubt, call your IVF clinic’s emergency number or go to A&E.

Day 2, 3, 5 or 6 after egg collection

Embryo transfer day: 0-2 treatments

Research shows that two acupuncture treatments administered on the day of embryo transfer (one session before and one after the transfer) can significantly increase IVF success rates. In fact, some studies show that acupuncture during this stage can almost double IVF success rates. Researchers are still trying to understand exactly how acupuncture does this. The working hypotheses are that acupuncture helps to reduce uterine contractions that may be triggered by the transfer procedure (these uterine contractions are associated with poor IVF results) and helps to regulate stress levels.

More research is needed to establish exactly what is the most optimal acupuncture treatment protocol, but, typically, two acupuncture treatments are administered on the day of embryo transfer, one before and one after the transfer. If it is logistically difficult to do two treatments on the same day,  the first treatment can be done on the day before embryo transfer. 

In some patients, embryo transfer acupuncture treatment may not be needed. For example, if enough acupuncture treatment has been administered in the run up to embryo transfer, then the beneficial effects of acupuncture should be already established. 

Days 6-10 after egg collection

Implantation phase: 1 treatments

Implantation is the final stage before a pregnancy test and most IVF cycles that are not successful fail at this point. The implantation process is still not fully understood. The main reasons for implantation failure are thought to include genetically unstable embryos, compromised uterine receptivity, strong uterine contractions, high stress levels, and an abnormally functioning immune system that ‘attacks’ and destroys the embryo.

Acupuncture treatment during the implantation phase aims to ‘calm’ the uterus, regulate the immune system, reduce stress levels and help improve blood circulation. 

Positive pregnancy test onwards 

Pregnancy support: as required

Most pregnancies progress without complications. However, IVF pregnancies are at a slightly higher risk of failure. The risk of miscarriages is higher in couples where either one or both partners are older and in patients who have certain medical conditions that predispose them to miscarriages. Unfortunately, some of these predisposing conditions may be hidden and we only find out about them once the pregnancy loss has occurred.

So, we recommend that all patients continue with acupuncture during the first trimester. Patients whose pregnancies are considered to be low risk are usually discharged at 12 weeks gestation. Patients who have high-risk pregnancies are advised to carry on with acupuncture treatments on a less frequent basis. Every 4-6 weeks is sufficient in most cases.

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