Acupuncture on Day of Embryo Transfer
by David D. Cherry, O.M.D., L.Ac.
Clinical Director, Acupuncture Fertility Specialists
In April of 2002, Fertility and Sterility, the journal of the American Society of Reproductive Medicine, published the study[G1] that has since become known as “Paulus, et. al.” The protocol initially used in the Paulus study, now know as the Paulus Protocol, has since become the standard of care for the day-of-embryo-transfer (DOET) treatment in most acupuncture fertility clinics, including ours here at Acupuncture Fertility Specialists. Paulus demonstrated that this point protocol administered immediately before embryo transfer and again immediately after embryo transfer increased the success rate of embryo transfer, as compared to the control group, by 16.1%.
In May 2006, another study[G2] , Westergaard, et. al. was Published in Fertility and Sterility. Westergaard again clearly demonstrated an increase in the success rate of embryo transfer when acupuncture was performed immediately before and again immediately after embryo transfer. In Westergaard, the increase was 13%. The point selection in Westergaard differed slightly from Paulus.
We at Acupuncture Fertility Specialists began doing DOET protocols immediately after Paulus was published in 2002 using the Paulus Protocol. While I don’t entirely agree with the point selection in Paulus, it is the protocol we perform at our clinics on DOET. My thought was, and continues to be, that if Paulus worked that well, I am not inclined to try to fix it, and I’m not willing to risk my patients’ embryos to experiment with other point combinations. Our clinical results, measured in pregnancy rates compared to published numbers from the IVF clinics, were at least consistent with Paulus, if not slightly better in every year since the publication of that study.
In October of 2007, at the Annual Meeting of the American Society for Reproductive Medicine, an oral presentation was given of an analysis performed by Craig, et. al., which surprisingly demonstrated a decrease, as compared to a control group, in pregnancy rates where a modified Paulus protocol was administered offsite rather than onsite in the fertility clinics. This sent somewhat of a shockwave through the reproductive acupuncture community initially, as well as causing some reaction from most reproductive endocrinologists who had been referring their patients to acupuncture. Various theories have been advanced as to why Craig, et. al. is so disparate from prior studies. Initially, it appeared that the difference was the onsite (in the fertility clinic) acupuncture as compared to the offsite (in the acupuncture clinic) treatment. No indication of the distances traveled between the acupuncture and fertility clinics is given in Craig, et. al. After the publication of Craig, et. al., some reproductive endocrinologists modified their recommendations to patients regarding acupuncture and DOET. In our clinics, we experienced a number of requests for modifications in the protocol from the reproductive endocrinologists who referred to us. But also, a substantial number of them concluded, based on the fact that Craig, et. al. was so dramatically different from prior studies, that it might simply be a flawed study. Obviously, further investigation is indicated.
While we appreciate the results of Craig, et. al., the question becomes that of travel. It is apparent in Craig, et. al. that the travel to and from the acupuncture clinic may have negatively impacted the outcomes of these patients. However, in virtually all cases that I am aware of, the patient has to travel from their home to and from the fertility clinic on the day of transfer. In many cases, the distance the patient travels to and from the fertility clinic from her home is often substantial. I frequently see patients who travel 50 or 60 miles to get to the fertility clinic for transfer, only to get in the car and do the return trip a couple of hours later. This is an item for further investigation at a later date, hopefully.
Whether or not Craig, et.al. was an accurate depiction of events on day of transfer, we do believe that the patient should remain as restful and quiet as possible on transfer day. We do our best to minimize travel. In some cases, where we have prior agreements with the fertility clinics, we are able to do onsite acupuncture DOET. Paulus, et. al. and Westergaard, et.al. clearly demonstrated that acupuncture improves IVF success rates done onsite. We arrange onsite DOET wherever possible. In other cases, onsite DOET is not possible, and we modify the arrangements accordingly.
We are very fortunate to share a great working relationship with Robert Greene, M.D., Medical Director at Sher Institute of Reproductive Medicine in Sacramento. At SIRM, we frequently treat Dr.Greene’s patients on their DOET utilizing the Paulus Protocol onsite. Dr. Greene has shown us, through his unwavering hospitality, that he is in favor of the day of transfer protocol that we use in particular, and of acupuncture in general. I believe his patients are clearly well served utilizing a combination of his assisted reproduction methods and our acupuncture complement.
Further information regarding acupuncture treatment to complement assisted reproductive therapy may be found at our website, www.acupuncture4fertility.com.