In vitro fertilization (IVF), as a choice for more than1,000,000 infertile couples each year, give rise to the birth of over 3,000,000 babies worldwide1. In Europe, over 300,000 treatment cycles of IVF or intracytoplasmic sperm injection (ICSI) are performed each year2; in the United States, babies conceived through IVF or ICSI comprise 2%-3% of total births3. As a series of traditional medical practices originating in China, Traditional Chinese Medicine (TCM) is widely used by women to improve their health, from preventing miscarriage at the early phase of pregnancy to alleviating menopausal symptoms In recent years, many infertile couples have chosen TCM as an adjunct when they undergo IVF4,5. However, conclusions from clinical trials were inconsistent. Thus, clinicians and infertile couples feel it hard to decide whether they should choose TCM to improve IVF outcomes6.
To standardize clinical trials. The effects of TCM on IVF outcomes depend on many factors, such as TCM diagnosis of patient’s conditions, the timing of TCM treatment, selection of herbs/acupoints, expertise and qualification of the practitioners, types of acupuncture (traditional needling acupuncture, electro-acupuncture, laser acupuncture or auricular acupuncture, etc), processing of herbs and the formulation. To standardize clinical trials, the following items may be useful for the design of further research aiming to evaluate the effects of TCM on IVF outcomes:
(1) selection of herbs and/or acupoints should be based on the correct TCM diagnosis;
(2) standardized acupuncture methods or the standard processing or formulations of herbs should be applied to enhance comparability among different studies;
(3) live birth should be the primary outcome;
(4) data on hormones and psychological index during the treatment should be collected;
(5) inter-country differences in infertile patients’ experience, expectations and knowledge of TCM may lead to variable IVF outcomes, thus international cooperation is urgently needed to better understanding of the effects of TCM treatment on IVF outcomes;
(6) to solve the confusions caused by different protocols for TCM treatment of IVF and ICSI in various centers, an international multicenter study group to evaluate the effects of acupuncture on IVF and ICSI outcomes should be established7;
(7) different confounders, which have been shown to influence IVF outcomes, should be taken into account, including life style factors (maternal and paternal age, weight, vitamin and iodine in-take, alcohol and caffeine consumption, smoking, substance misuse, stress, environmental pollutants, oxidative stress, etc), gynecological factors (duration and cause of infertility, presence and characteristics of uterine fibroids etc), number of previous IVF or ICSI cycles, presence of male factor, race and ethnicity 8-11;
(8) for the trials using acupuncture, standards for reporting interventions in clinical trials of acupuncture (STRICTA) criteria should be applied to make protocols reproducible12;
(9) detailed, fixed protocols based on the correct diagnosis of the patient’s syndrome according to TCM theories and expert opinion should be established; and
(10) a sufficient dose of treatment over the most appropriate time period should be provided.
To find the best timing of TCM intervention before, during or after IVF. As shown in Figure 1, different timing in the provision of TCM intervention during IVF may account for variations in outcome and a “standardized” research is needed to define the appropriate time to provide TCM to maximize its effects. For example, in some of the studies, acupuncture was applied around the time of trans- vaginal oocyte retrieval (TVOR) to assess the pain-relieving effects, however, in other trials, acupuncture was applied around the time of embryonic transfer (ET). Before TVOR, TCM, including functional food extracted from Chinese herbal medicine, aims to strengthen natural menstrual cycle, improve development of follicle, increase reactivity of ovary to drugs and improve uterine endometrial receptivity. Non-pharmaceutical treatment is often used around TVOR and ET to relieve anxiety levels, which improves IVF outcomes13. However, after the confirmation of pregnancy, non-pharmaceutical treatment, especially acupuncture, should not be conducted. If used appropriately, TCM can be expected to facilitate in vitro fertilization in cases of unexplained infertility, early ovarian failure, polycystic ovary syndrome (PCOS) and amenorrhoea, or a prolonged menstrual cycle caused by an ovarian problem and where the patient wants to conceive quickly, such as with age over 35, or for other personal reasons, although better evidence is still needed for each of these indications.
Xiao Jian Zhong Tang (Minor Construct the Middle Decoction): A Formula to Warm the Centre or Supplement Yin?
Yan Shi-Lin & Tao Yi; Translated by Paola Campanel…; 2014
Acupuncture compares with Western medicine for climacteric depression
Quan Xiao Hong et al.; 2016