What is IVF?
In vitro fertilization (IVF) is a type of assisted reproductive technology (ART) where sperm and an egg are fertilized outside of the human body. IVF is a complex process that involves retrieving eggs from ovaries and manually combining them with sperm in a lab for fertilization. Several days after fertilization, the fertilized egg (now called an embryo) is placed inside a uterus. Pregnancy occurs when this embryo implants itself into the uterine wall.
Why is IVF performed?
People choose IVF for many reasons, including infertility issues or when one partner has an existing health condition. Some people will try IVF after other fertility methods have failed or if they’re at an advanced maternal age. IVF is also a reproductive option for same-sex couples or people who wish to have a baby without a partner.
IVF is an option if you or your partner has:
- Blocked or damaged fallopian tubes.
- Endometriosis.
- Low sperm count or other sperm impairments.
- Polycystic ovary syndrome (PCOS) or other ovarian conditions.
- Uterine fibroids.
- Problems with your uterus.
- Risk of passing on a genetic disease or disorder.
- Unexplained infertility.
- Are using an egg donor or a gestational surrogate.
How long is the IVF process from beginning to end?
IVF is a complicated process with many steps. On average, you can expect the process to last four to six weeks. This includes the time before egg retrieval, when a person takes fertility medication until they’re tested for pregnancy.
The IVF Procedure
IVF (In vitro fertilization) involves a series of steps to help individuals or couples with fertility issues achieve pregnancy. Here are the key steps involved:
- Birth Control Pills or Estrogen: Before starting IVF, medications like birth control pills or estrogen are used to regulate the menstrual cycle and prevent ovarian cysts, which helps control the timing of treatment and improves egg retrieval outcomes.
- Ovarian Stimulation: Hormonal injections stimulate the ovaries to produce multiple eggs in one cycle, as opposed to the single egg produced naturally. The medication type, dose, and frequency are tailored to the individual’s needs. Monitoring through ultrasounds and blood tests tracks the ovaries’ response.
- Trigger Shot: When eggs are ready for retrieval, a trigger shot is administered 36 hours before the procedure to finalize egg maturation.
- Egg Retrieval: Under sedation, a needle is inserted through the vagina into the ovaries, guided by ultrasound, to collect eggs. These eggs are placed in an incubator.
- Fertilization: Fertilization is typically achieved through intracytoplasmic sperm injection (ICSI), where sperm is injected into mature eggs. Eggs that are immature are placed in a dish with sperm, though they rarely mature after this process.
- Embryo Development: Over the next 5-6 days, fertilized eggs develop into embryos. Only about 50% of embryos reach the blastocyst stage, which is ideal for transfer. Suitable embryos are frozen for future use.
- Embryo Transfer: Two types of transfers are possible: fresh or frozen. Fresh embryos are transferred within a few days after retrieval, while frozen embryos are thawed and transferred at a later time. Hormonal treatment is used to prepare the uterus for the embryo.
- Pregnancy: A blood test is performed 9-14 days after transfer to check for pregnancy. The embryo must implant in the uterus for pregnancy to occur.
Throughout this process, factors like age, medical history, and hormone levels are considered to tailor the IVF treatment to the individual. Consulting with a healthcare provider is crucial to understand the process and determine the best approach.
Acupuncture and IVF
In modern medicine, IVF has helped millions of couples in achieving their parenting dreams, however pregnancy success rate remains low, about 35 percent for women ages 35 to 40, and about 20 percent for those ages 40 and older. Thus, more and more patients are turning to alternative medicine for help, and the management of infertility using acupuncture has become an expanding area of practice in the medical world.
Acupuncture is the most commonly used complementary treatment alongside IVF treatment and has become integrated into many of the best fertility clinics across the world.
A study in 1992 found that conception rates with acupuncture rose to 42.5% compared to a non acupuncture control group that achieved a success rate of only 26.5%.¹ The interest generated by this research led to similar trials, which produced similar results. More recently the British Medical Journal analysed all the available research that stood up to rigorous scrutiny.² This large study involving 1366 patients also found that acupuncture significantly increases the success of IVF treatment.
In practical terms they concluded acupuncture creates one additional pregnancy for every 10 cycles of IVF performed.
How does acupuncture improve IVF success rates?
A successful IVF pregnancy depends on a variety of factors, including the age of the couple, sperm and egg quality, endometrial lining etc. Recent research had found acupuncture a useful technique in combination with other western medical treatment in improving fertility rate. In women, acupuncture works to stimulate egg production. Acupoints are selected to relax the body and improve the blood perfusion to her reproductive organs, which will improve follicle development and enhance egg quality. Good perfusion of blood to the endometrial lining also helps with implantation of the egg. In men, acupoints are selected to restore and improve the kidney function, which is linked closely with the male reproductive system. Restoring kidney function improves blood flow, and improves sperm quality and sperm count.
Acupuncture for IVF sessions done before and after embryo transfer had shown an increase in pregnancy success rate. However individual cases of acupuncture treatment during IVF need to be managed differently. IVF is not just about implantation – during the IVF process, both the embryo quality and implantation process carry the same weight in IVF success rate. For certain patients, especially those with low ovarian reserve or advanced age, acupuncture for IVF treatment should start as early as possible, i.e. preparing the body to be in its optimal state for IVF is important.
About the acupuncture for IVF treatment process
Acupuncture treatment, acupuncture does not merely involve the use of needles. Electrotherapy, heat therapy, moxibustion in combination with acupuncture would always give a better result. Electro-acupuncture is a form of acupuncture where a small electric current is passed between pairs of needles. The electric current ensures that stimulation will be consistent and stronger, and when the frequency and intensity of the impulse being delivered is increased, it’s especially helpful in cases of stagnant “Qi”. Heat therapy such as heating lamp or moxibustion are also commonly used in conjunction with acupuncture to warm the regions and meridian points. These will improve the local or general blood circulation which will induce a smoother flow of “Qi” and blood, and warm the meridians. This form of therapy is especially effective for a “cold” or “yang deficiency” body constitution.
The Stages of Acupuncture during IVF
The following stages give an idea of the ideal timings of acupuncture treatment when used alongside IVF treatment and the purpose of treatment at each stage. You will see that emphasis is placed on enhancing the function of the uterine environment throughout in order to improve the likelyhood of successful implantation. The healthy function of the uterine environment is, in Chinese medicine, reflected through the nature of the menstrual flow, which ideally should be bright red, free flowing and without pain or clotting.
Stage 1 – Acupuncture prior to IVF
Many clients choose to start their acupuncture in the months running up to an IVF cycle. Often IVF occurs after months or years of trying to conceive naturally, or with other assisted methods such as Clomid or IUI. Although the research shows that acupuncture on the day of the embryo transfer significantly increases the success of IVF, it is the experience of most acupuncturists and their patients that a period of preparatory treatment before an IVF cycle can increase the success rate even further. Acupuncturists at this stage will work to regulate the menstrual cycle, support efficient and regular ovulation and optimise hormone levels. Your acupuncturist will assess each stage of your menstrual cycle and look to ensure the release of the best possible egg and the development of the best possible implantation environment. IVF units increasingly use FSH levels as an acceptance criteria for patients looking to start IVF. Acupuncture can be useful in lowering this level if it is too high to allow treatment to start.
Stage 2 – Acupuncture during down-regulation (long protocol) or before the period (short protocol)
During down-regulation, the medication is used to stop the stimulation of the ovaries by the pituitary gland. This effectively puts your menstrual cycle on pause, so that the ovaries can be controlled with stimulation drugs. However such regulation can cause the period to be delayed, to be lighter or to not come at all. At this point acupuncture treatment is focused on ensuring an efficient elimination of the womb lining. Producing a full clear-out of the old endometrium allows the best opportunity to develop a fresh, healthy and thick lining with good blood flow.
Treatment may also be used at this stage to reduce the potential side effects of down-regulation such as headaches or hot flushes.
If you are on the short protocol (and are not taking down-regulation medication), the principle is exactly the same – to try to achieve the best possible clear out of the old lining to make way for the new.
Stage 3 – During the stimulation phase
During the stimulation phase follicles start to develop in the ovaries and the womb lining starts to build up again. The medications are targeting the ovaries to produce multiple mature follicles. IVF stimulation enables the ovaries to provide more mature eggs to be collected than on a normal natural cycle. As such the acupuncture does not significantly add to number of follicles produced, but rather concentrates on optimising the quality and function of the womb lining, helping it both thicken and have a good blood supply. Typically patients are seen twice during this phase and if there is any specific issues such as thin endomtretrium, blood-clotting disorders, or very dark clotted menstrual flow, an additional treatment may be given during this phase
Stage 4 – Acupuncture at embryo transfer
This is the time that many patients have heard of and that much of the research focuses on. Acupuncture is performed both before and after the embryo transfer.
The purpose of the treatment is to increase blood flow to the womb lining in order to increase receptivity, and to reduce any uterine contractions or spasms that may occur due to the transfer procedure itself.
In some IVF units this treatment can be performed on site. In most situations it cannot and means a trip to the acupuncturist before travelling to the IVF unit, and then straight back to the acupuncture clinic after the embryo transfer.
Research strongly suggests that these treatments are time-dependent which means it should be done as soon as possible before and after. Although this can be logistically difficult for many acupuncturists, research shows that settling for treatment a day before and a day after provides no significant benefit.
At this point treatment also works to regulate stress hormones which affect implantation, reduce anxiety and calm the mind.
Please note we cannot see clients for embryo transfer treatments in isolation and do not see anyone as an initial session for this treatment. Pre and post embryo transfer treatments will be done whenever reasonably possible.
Stage 5 – Acupuncture in the two week wait and beyond
There appears to be little evidence that having acupuncture during the “two week wait” after embryo transfer increases implantation rates.
However, this is a very stressful period for many couples, and if anxiety levels are high, acupuncture may be used to help relax during this time.
Ideally, once a positive result has been achieved, treatment until week 12 of the pregnancy is recommended in order to maintain balance and ensure the pregnancy progresses smoothly.
As a complementary form of fertility treatment, acupuncture is better accepted than confinement herbs as there are no known contraindications with modern Western medicine. Moreover, acupuncture acts as a “stabiliser” during the IVF process, restoring internal balance, helping patients to improve their physical and emotional wellness. Acupuncture treatments, therefore, enable patients to go through the IVF journey with greater confidence, leading to higher pregnancy success rates.
