Acupuncture and Infertility

A reader asks, “What are your thoughts on acupuncture and infertility treatment?”

Short answer: Go get a massage instead.

Long answer: Let's start at Wikipedia (one of my favorite Web sites): “Acupuncture is a practice in which needles are inserted into various traditionally determined points of the body (“acupuncture points”) and then manipulated … Acupuncture is based on tradition and authority, not on the scientific method, and is not based in, and does not relate to, other interrelated fields of science such as human anatomy, human physiology, cellular biology, neuroscience, biochemistry, or physics.”

Here is my basic philosophy of treating patients: I don't recommend treatments that are not based on a scientific rationale and supported by at least some reasonable medical/scientific evidence. If you abandon this philosophy and say “let's try treatment X; after all, it can't hurt”, you enter the Neverland of medicine, with no rules, boundaries, or logic. And as to the concept “it can't hurt”, sometimes it does hurt. Ephedra, an herbal preparation used in traditional Chinese medicine for thousands of years, was pulled off the US market in 2004 after about 100 people died from taking it. And this problem isn't restricted to herbal medicines; there are many cases where well-meaning physicians tried a treatment based on very limited data that turned out to hurt, not help (DES is a classic example).

The problem with my philosophy is that medical evidence is not absolute, it can ebb and flow, and what is “some reasonable evidence” to one person may be insufficient to another. You can find one study in the medical literature that proves just about anything (my favorite example is a paper that claimed preeclampsia was caused by worms. It was published in a fairly respectable obstetric journal!). And although I am pretty conservative about what treatments to recommend, there are physicians more conservative than me on some things.

OK, back to acupuncture. There were a few small studies published that claimed acupuncture improved IVF success. Most of these studies compared acupuncture to nothing. More recently, larger studies which compared Chinese acupuncture to “sham” acupuncture, in which a needle was poked into the patient randomly, showed no influence on IVF outcomes. One study (So EW et al., Hum Reprod. 2009 Feb;24(2):341-8; the study was done in Hong Kong, where they should know something about acupuncture) showed the sham acupuncture group to have a slightly higher success rate (it was just a fluke, but the authors claimed sham acupuncture might have some benefit – arrgh!). Several other large, well-designed clinical trials also have shown no benefit to IVF patients getting acupuncture. Here is what the authors of a recent compilation of acupuncture studies concluded: “New emerging evidence from clinical trials demonstrates that acupuncture performed at the time of embryo transfer does not improve the pregnancy or live birth outcome after treatment. This evidence raises questions regarding the futility of conducting further research in this area and the quality of evidence needed before any specific intervention is incorporated into routine clinical practice, particularly when a scientific rationale is lacking.” (El-Toukhy T, Khalaf Y. Reprod Biomed Online. 2010 Sep;21(3):278-9)).

I hope you enjoy your massage.