Tuesday, May 12, 2009

Remembering failures

My school is running a big infertility seminar. Which you would think would please me, but sadly, no, it does not. First of all, various people have been going around smugly saying how much acupuncture helps with infertility. Which it DOES, don't get me wrong. But they are implying that it is the answer to everything for everyone, which it is not. And when I say meekly "but it doesn't help everyone" I am usually met with a blank stare, or some tale of how someone somewhere got pregnant after acupuncture treatment. Uh huh. Ye-es. But you don't know if that person would have gotten pregnant anyway, even without treatment, and how much of any gain was actually caused by the treatment.

And then the annoying guy in my class is of course friends with one of the RE's from the big local practice (where I went, and was a patient of the senior RE before he fired me for being too, well, infertile). So the annoying guy is being insufferable about how amazing his friend is and how open he is to acupuncture, and that they are making these huge gains, and blah blah blah.

Oh god, it is going to be tough over the next few weeks leading up to this thing. It's like the whole school is buzzing about infertility and it is reopening some old wounds. But none of the people who are spouting off as experts are really thinking things through. Since going to school, I have realized that one of the people I went to (who sells himself as an infertility "guru") basically just used every single acupuncture point that was ever related to infertility. Rii-ight. And I'm sure it worked for a lot of women, but then again, there are many reasons WHY women become infertile, and one should presumably treat those reasons differently. A more targeted treatment may have been better for the harder cases like me, rather than using a scattergun approach. It seems to me like most of the acupuncturists only remember their successes, and don't think hard enough about their failures. They don't continue trying to find out the reasons for infertility. They don't keep trying to change the treatment, they don't keep refining. They don't know WHY it doesn't work for everyone. They don't remember that the failures gradually drift away and try something else. When they should dagnabbit.

If they were being rigorous about wanting this stuff to work, they would be researching more. Asking WHY more. But many, sadly I think, have some successes and rest on their laurels. And THAT'S what's annoying me. It's like like anyone who remains barren after acupuncture must be somehow wilfully barren, or something. Not like perhaps the practitioners could be at fault.

6 comments:

Stephanie said...

I went to the "guru" guy, too. And, while he was excellent for draining off excess fluids from the medications, I didn't get pregnant. In fact, I had the worst count/quality after ER that I *ever* had.

I don't blame acupuncture for that, obviously. But, for some, it *isn't* the answer for the primary problem. It did relax me and it did help with the side effects and that was useful.

Personally, I am amused at the notion of the "wilfully barren". That made me giggle.

Sara said...

Oh Sarah, I can imagine how hard that must be.

That was exactly my reaction to acupuncture as treatment. Of course it works in some cases, but I got SOOOO frustrated by people telling me that it would work for me, when it didn't. My acupuncturist was negative to the point of near-hostility when I told her that I was going to the RE. I quit shortly after. Of course it's possible that if I had stuck with her I wouldn't have needed IVF, but I think that it's likely that if I had stuck with her, I wouldn't have my daughter now.

I'm glad that you're out there advocating for change.

paragon2pieces said...

It sounds like the situation is really tough right now.

But as I was reading your post, I was thinking that once you graduate you will likely have a number of infertile patients. They are going to be so lucky to work with someone as empathetic and understanding as you are to the challenges of IF.

Good luck getting through this difficult time.

Dora said...

Man, that sucks! When I was cycling with my crusty old eggs I had to set my acu straight about my goals for her treatment. I was under no illusion that acu was going to perform miracles with my old ovaries. I was looking for relief for the aches and pains and stress I was dealing with. Thankfully, she got it.

Anonymous said...

Acupuncture Therapy Does Not Increase Clinical Pregnancy Rates in IVF

April 27, 2009

Despite extensive research conducted on acupuncture as an adjunct to IVF, there are conflicting results regarding its effect in improving ART outcome. Now, a recent randomized prospective study published in Fertility and Sterility reports that acupuncture is not effective in improving the pregnancy rate during IVF, but may help patients feel more relaxed and optimistic during the procedure.

Alice D Domar, from Boston IVF, Waltham, Massachusetts, and colleagues conducted the single blinded study on 150 subjects who opted for embryo transfer, after randomly assigning them into acupuncture and control groups. Study cases were subjected to acupuncture treatment, as per the protocol first described by Paulus and colleagues, for 25 minutes prior to and after the embryo transfer procedure. The researchers further obtained the completed questionnaires on anxiety and optimism from all participants. The main outcome measures of the study included anxiety, optimism and clinical pregnancy rates.

Demographic characteristics, including psychological variables and age, were found to be similar in both groups before randomization. The study results revealed that, compared to control subjects, the patients who underwent the acupuncture treatment went through the IVF cycles better. Also, the acupuncture patients reported to be less anxious after the embryo transfer and more optimistic towards their IVF treatment outcome.

In another study, El-Toukhy, et al. (Current Opinion in Obstetrics and Gynecology, 2009) evaluated the effect of acupuncture as an adjuvant therapy on IVF treatment outcome. The researchers analyzed the data from 14 relevant clinical trials involving 2,870 female subjects. Five trials (n=877), examining the IVF outcome when acupuncture therapy was carried out during oocyte retrieval, did not show any significant difference in clinical pregnancy rate between the treatment group and the control. The other nine trials (n=1,993), which analyzed IVF outcome after acupuncture was performed during the time of embryo transfer, also reported no substantial difference in the clinical pregnancy rate. Based on the study findings, the researchers concluded that acupuncture should not be recommended as an adjuvant therapy to improve success rate of the IVF procedure.

In contrast, a systematic review and meta-analysis conducted by Eric Manheimer, et al. (British Medical Journal, 2008) reported the benefits of using acupuncture treatment at the time of embryo transfer in improving the rates of pregnancy and live birth in patients undergoing IVF. The meta-analyses, which included seven trials with 1,366 female subjects opting for IVF, did not report any clinical heterogeneity. The use of adjuvant acupuncture therapy in conjunction with embryo transfer showed a substantial increase in clinical pregnancy (odds ratio =1.65), ongoing pregnancy (OR=1.87) and live birth (OR=1.91). However, a pre-specified subgroup analysis involving three trials, suggested limited benefit of acupuncture (OR=1.24).

In view of the conflicting study results, more population-based cohort clinical trials may be required to substantiate the use of acupuncture as an adjuvant therapy with ART to improve the pregnancy rates. However, as of now the majority of the evidence suggests that its benefit is limited to relieving the psychological stress associated with the IVF treatment.

References

1. Domar AD, Meshay I, Kelliher J, Alper M, Powers RD. The impact of acupuncture on in vitro fertilization outcome. Fertil Steril. 2009 Mar;91(3):723-6.

2. El-Toukhy T, Khalaf Y. The impact of acupuncture on assisted reproductive technology outcome. Curr Opin Obstet Gynecol. 2009 Mar 5.

3. Manheimer E, Zhang G, Udoff L, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilization: systematic review and meta-analysis. BMJ 2008;0. Last Accessed on Apr 22, 2009.

calliope said...

While I enjoyed going to the acu during IVF I don't think it was magic at all. And it is annoying for people to assume that it is some fix all. Don't get me wrong I think it can help, but it is just one thing.
I can not imagine having to walk around your school with all of this stuff going on. sheesh.
xoxoxoxoxo

p.s. Stephanie- how are you doing???