Friday, May 15, 2009

Does acupuncture really help infertility?

OK, so I didn't ask for any opinions on the effectiveness of acupuncture for infertility, but seeing as I got them, I thought I'd give my views. And yes, Anonymous, I know you snuck a comment in there, but seeing as it was just a study that most of us know about anyway, I let it stand.

Now, bear in mind, that these thoughts have been formed after much infertility, but not much acupuncture school (yet). I will probably revise my thoughts as I learn more.

Right, that's that out of the way.

I do think acupuncture can be very helpful. But I don't think that acupuncture performs well in the context of the studies that have been undertaken, and when used short-term as the studies tend to do. I also wonder some times whether Randine Lewis' The Infertility Cure didn't do some harm as well as good - for example, she talks about flooding the ovaries with energy during the follicular phase. Which is all well and good if your body has energy to spare in the first place. However, if your issue is that you don't have enough energy, where is this extra going to come from? It's like we've got into this Western medicine mindset that a quick fix can be achieved. I mean, yes, she stresses a lot that it's not short term, but we all tend to take segments out of books and focus on those component parts without really taking in the whole teaching.

To my mind, infertility is caused at the end of a long chain of events (ignoring blocked tubes caused by an infection, say). We don't eat well, or we don't exercise enough, or we weigh too much or too little, or we are under stress, or we are getting older. Or, let's put it another way, we are just living in this stressful, difficult time on earth. Our bodies will fight hard to keep the important functions performing well - our hearts will beat, our lungs will work, our stomachs will digest food. But if something is a little off, it'll draw on some resources from systems that are not essential to survival - maybe our skin starts to look a little tired. Maybe our hair starts to go grey. Maybe our thyroid starts to have trouble. Maybe we start getting digestive issues. Maybe we find ourselves not sleeping well, stressing. Maybe our ovaries start to run out of steam. Reproduction is an energy-intensive business, and especially the female system is extremely delicately balanced. But let's face it, it's not that important in our bodies' orders of priority, so it may go into decline before the rest of us.

So, can we fix things by shooting some drugs in? Sure, some of the time we can. Sometimes it doesn't work quite so well, though. Can we fix things by doing some acupuncture for the 2-week period before an egg retrieval? Well, maybe sometimes, but most of the time, it is not enough time, and it's not specific enough. If my problem is that my digestion is off because I haven't eaten enough protein and have had too much sugar and not enough exercise for the last 20 years, and this means I am lacking in energy, will 2 weeks worth of acu fix it? No. Similarly, if your problem is that you are a stockbroker/lawyer/tax accountant who is also marathon runner and arguing with your husband and you are so stressed out that you are not ovulating at all any more, can you be fixed with 2 weeks worth of acu? And, more importantly, will using the same acupuncture points on both of us work equally well for both of us? No, and no.

The studies use particular points in particular combinations for particular periods of time. That's like using one cholesterol medication for a short period of time to see if it is effective on every cardiovascular problem - when some of the problems may be due to high blood pressure, or high blood sugar, and not high cholesterol. The cholesterol medication may work for some people, but perhaps others needed a different drug, or needed to be on it for a longer period of time. Or maybe they just needed to go on vacation and de-stress. Likewise with acupuncture. While there are a fairly large number of points that are useful for "infertility," each point can have a slightly different effect. If it is on the spleen channel, maybe it helps with infertility that is related to poor digestion/diet (because in Chinese medicine, the spleen is related to digestion). If it is on the liver channel, maybe it helps with infertility that is related to stress. One size does not fit all.

It seems that infertility acupuncture has got away from its basics. Acupuncture is very good for chronic health problems, and pain. Infertility is mostly a chronic health problem, and needs to be treated using a very individualized approach on a long term basis, to build up the patient's energy reserves or whatever they need. And if that means not using points for infertility, or ignoring the infertility aspect for a while to just bring the patient's health into balance while letting the body deal with the ovaries in its own way, then that's what should be done. So that when the patient gets to an IVF cycle, their own body is more prepared to do what it needs to do to respond to the medications.

And, the patient needs to be involved - they need to be given clear help with food intake, exercise and stress management. Because I think these are key with infertility. We patients don't like to admit it, but it's our own lifestyles that are big contributors. But it's no good to just throw suggestions out there in a random fashion - people need to be sat down and really taken through all this. And, importantly, acupuncturists need to be flexible and keep looking for answers and ways to help the patient. My first acupuncturist told me to eat meat. I said no. We reached an impasse and got no further. Actually, there are plenty of vegetarian foods he could have suggested that would have helped me - not as quickly as me tucking into a steak, admittedly. But I would have slowly got somewhere if I had known how important it was for me to limit sugar and fat, and increase protein, and pay attention to whether foods are "warming" or "cooling" and the like. Likewise, telling someone to give up coffee when that is what they love and what gets them through the morning isn't going to go down well - perhaps the acupuncturist can work with the patient and say, OK, it's either give up coffee, OR cut down on the coffee but also give up ice cream and chocolate and do some meditation in the evening - in other words, work with them to find out what they really don't want to change and offer alternatives. It's got to be something that the patient can actually do. Books like The Infertility Cure offer plenty of diet suggestions, but they are so confusing, especially when it's not clear what your problem really is, and you are trying to incorporate two or three different patterns like spleen qi deficiency and liver blood deficiency - if one list of foods says "eat black beans" and the other says "don't eat black beans" what is a patient to do?

Now, I know that many acupuncturists don't want to offer diet and lifestyle suggestions until the patient is an established patient and trusts the acupuncturist. You don't want to scare someone off at their first visit by telling them to do and change too much. But I also think that there's scope with some of the more chronic problems (and infertility is just one of them) to sit with the patient at the first visit, and spell out that it'll take a number of sessions to help, and that it's going to be a partnership, both the patient and the acupuncturist working together and making changes to the body. And to say, if it's not working (or not working fast enough), let's keep talking and making adjustments until we get it right. I think I would have appreciated that - after all, to know that there is a plan in place and to know that it might take a few weeks to see changes are both helpful, and help you to keep hope alive that things will improve.


Sara said...

I think most of the comments (other than anonymous, and a big whatever to her/him) were agreeing with you about the one-size-fits-all approach. Acting like one kind of treatment will solve all fertility problems is right up there with "just relax." Unhelpful and insulting. And that goes for acupuncture as much as anything else.

I know that you know that. I'm just agreeing with you here.

Billy said...

Very enlighting. thanks.

Anonymous said...


It sounds like you're still looking to place blame for your infertility. From what I've read of your blog, you're just one of those unlucky ones whose eggs get old very quickly. None of that is your fault. You've done nothing wrong. It's not that you didn't work hard enough.

There are lots of fat women in their late 30's and 40's who are stressed, who eat and sleep terribly that do get pregnant. Lucky for them! They're probably stuggling with something else that's unfixable in their lives, like their height or their complexion or that their family has ALS in their genes.


Anonymous said...

It's really tough to know if acupuncture has any affect. All I know is that crack addicts and prostitutes get pregnant all the time. Talk about high stress and unhealthy lifestyles.

Ultimately, I think western medicine has it right - it's mostly about age and the viability of the egg!

SS said...

Hi- usually a lurker here but thought I'd comment. I suffered with unexplained infertility beginning at age 31, eventually conceiving my first through IVF at 33. I started doing acupuncture about 2 months before my first IVF (5 months before my second and last IVF). I ate healthy, exercised moderately (after having exercised more rigorously previosuly), cut out caffeine, alcohol, and processed foods, focused all my energy on trying to conceive. We got pregnant with number 2 unassisted, at a period where I was heavier than before, exercised much less, was somewhat sleep deprived, was more stressed than ever about job/financial situation, ate more processed food, drank diet coke like it was going out of style (about 4 cans a day), and drank alcohol during the first 3 weeks of the cycle (stopped about a week after ovulation with the drinking). I feel like whatever was wrong with me for #1 was not anything that could have been fixed by acupuncture or lifestyle. TO elaborate on my less than ideal behavior while TTC #2, I didn't want to put myself through the pressure of trying to be perfect while trying for #2 because I was convinced that I was going to end up back at the RE. I also have a son less than 1 y.o. so exercising, eating right, and getting enough sleep are a challenge for me while also working full time.

annacyclopedia said...

Wow. This post is excellent - I clicked over from the LFCA and I'm so glad I did. I completely agree that acupuncture or for that matter any treatment, holistic or allopathic, absolutely must be individualized and responsive to the person being treated. My experience with naturopathic medicine and acupuncture has really helped me understand this - that it's about what is happening in my body at the moment and that I am responsible for participating in my own healing. But you're right - the practitioner definitely needs to show flexibility and patience with the person receiving treatment, just like the person being treated needs to accept that it's not about a quick fix that can be achieved by just being passive and waiting for results.

One of the hardest things to come to terms with for me was that while I am RESPONSIBLE for my health, I am not to BLAME when something goes differently from what I wish. It's a subtle distinction but a really important one, I think. But it really takes a huge shift in mindset to get out of the expectations we have coming from a Western medicine perspective.

Thanks for writing this - I'm so glad I got to read it. Best wishes for successful studies and the next steps along your journey, whatever they may be.

Jendeis said...

Here from LFCA. Just wanted to thank you for an extremely well-written post.

I think that I'm agreeing with you with the following: the importance of acupuncture to fertility treatments is not just the benefit that the treatment itself may provide, but acupuncture's focus on treatment of the whole person as opposed to a symptom.

I don't believe that acupuncture will get me pregnant. It's not the "magic pill". There is no magic pill. I do believe that acupuncture has helped me through this journey to deal with stress, stress-related ailments and depression (of long-standing, that is, it did not start with IF; IF just added to it).