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The science behind acupuncture for fertility and pregnancy

The science behind acupuncture for fertility and pregnancy

12 min read

This article was updated on June 15, 2021. Our clinical research team is currently evaluating additional research shared with us by acupuncturists, and we plan to update this article once that review is complete.

Acupuncture is considered a form of integrated medicine. It's most commonly used to treat pain, but there are a wide range of conditions that acupuncture can address — including reproductive health and fertility-related conditions. Here, we're diving into the science behind acupuncture for fertility and pregnancy outcomes.

Before we get started, it's important to understand that the science behind acupuncture is unfortunately not clear-cut: integrated health practices like acupuncture, yoga, and herbal medicine are studied less than other practices, though they deserve equal attention. While fertility science is evolving, there are still really big gaps in the research.

But even if an aspect of treatment isn't validated by large-scale, randomized trials (one of the things we look for when evaluating the science behind different practices), it can still have great benefits for you as an individual. Ultimately, personal experience can be just as valuable as scientific evidence.

Main takeaways

  • Acupuncture is a popular form of traditional Chinese medicine, which aims to fix problems with energy flow that may be affecting your health. Specific acupuncture points are meant to have specific functions. There are designated points for reproductive health and function.
  • While new data emerges every year, there's still nowhere near enough research on fertility-specific acupuncture’s effect on fertility and reproductive health-related conditions. Some studies suggest that acupuncture of any kind (not just fertility-specific acupuncture) may increase live birth rates in patients doing IVF treatment. Others demonstrate that it helps ease fertility-related stress and anxiety. There are no significant short- or long-term negative effects of acupuncture.
  • Here's what the American Society for Reproductive Medicine has to say: "Acupuncture proponents have recommended it for a variety of medical conditions that affect fertility. These include polycystic ovary syndrome (PCOS), fibroids, endometriosis, and issues with ovarian reserve and sperm quality. It may also help relieve some of the side effects associated with fertility drugs (such as bloating and nausea). Acupuncture has been shown to promote relaxation. While some medical studies have shown acupuncture to be helpful in treating these fertility problems, other studies have not."

Modern Fertility medical advisor Dr. Temeka Zore, MD, FACOG, a reproductive endocrinologist who specializes in infertility (REI), says she discusses acupuncture with patients who've had lots of stress or anxiety while trying to conceive — as well as those who've had unsuccessful past in-vitro fertilization (IVF) attempts. "The pros of acupuncture are that the individual may feel more relaxed and have a reduction in anxiety and stress levels," she explains. But the "direct benefits will vary on the individual."

OB-GYN Dr. Jenn Conti, MD, MS, MSc, Modern Fertility medical advisor and adjunct clinical assistant professor at Stanford University School of Medicine, takes this approach to acupuncture: "Anything non-harmful that also aids in stress reduction during what can often be a very stressful process is fine by me."

Acupuncture 101

The first mention of acupuncture was in China about 2,000 years ago, though it’s believed people have been using acupuncture techniques as early as about 4,000 years ago. There are several different forms of acupuncture seen across the world today, but here we’ll focus on the type that’s most commonly used in the US: traditional Chinese acupuncture.

According to traditional Chinese medicine (TCM), we all have an internal energy (called “qi”) that flows throughout our bodies, keeping everything healthy and functioning as normal. Health issues may arise if our internal energy gets blocked and isn’t able to flow properly. This is where acupuncture comes in: Acupuncture needles are placed at specific points in the body, depending on what health issue you’re experiencing, to help unblock that energy and send your body back to its normal healthy state.

Licensed acupuncturist Amanda Moler, LAc, ABORM sees clients for fertility-specific treatment at her San Francisco-based clinic, Anchor Acupuncture & Wellness — where she says 80% of their clients are there for fertility. "Where the practice of Chinese medicine truly shines is in its unique ability to reach beyond these metrics behold our patients as part of nature: Beautiful complex ecosystems of body, mind, and spirit, worthy of reverence," Moler explains. "When I meet my patients from this inclusive, holistic perspective, all kinds of healing can happen — on the way to pregnancy or perhaps even paving the way for new life to take root."

Other explanations about acupuncture’s effects come from biologists and neuroscientists. Once your muscles sense the needles being inserted, they send signals to the spinal cord and brain, which then receive these signals and may respond by changing the production and release of certain chemical compounds. For example, muscles may send signals to the brain and spinal cord in response to acupuncture that lead to an increase in endorphin production, which contributes to the pain-relieving effect of acupuncture that many people report.

Why the research is behind

Integrated health practices (think things like acupuncture, yoga, and herbal remedies) are not studied in the scientific realm as much as products of other areas of medicine (think things that are produced by pharmaceutical companies).

According to Dr. Conti, "One central issue is that we don't have the right methods to evaluate its efficacy in Western medicine because, as an Eastern medicine tool, it is designed to be personalized to the individual, which precludes it from the type of rigorous population-based studies that are the standard in Western medicine."

This means we have way more studies on the effect of ovulation-inducing meds like clomiphene citrate (Clomid) or letrozole (Femara) than we do studies of acupuncture on ovulation, for example. That being said, there is an active and growing body of work on how acupuncture might affect conditions and hormones linked to fertility and reproductive health.

Our team is excited to keep tabs on this research as it evolves, and we'll always update our content as more clinical info emerges.

Overview of studies on acupuncture and fertility

"Generally speaking, we know that acupuncture decreases inflammation and improves circulation," Moler says. However, she adds, "Focusing more specifically on what the research tells us about fertility, we need to be cautious in terms of drawing conclusions as much more research is needed."

We dug into existing research to understand the demonstrated efficacy of fertility-specific acupuncture for a variety of fertility-related issues and conditions. Below, you'll find our biggest takeaways broken down by topic.

Acupuncture can help with fertility stress

Fertility and conception can be stressful, whether it’s alone or with a partner, or with or without using medical interventions. A few studies have looked at the impact on acupuncture and stress around the time of ART procedures, generally finding that it can lower stress levels (as compared to no intervention at all).

Similarly, acupuncture (compared to nothing) may also lower levels of fertility-related stress in people diagnosed with infertility. Though there isn’t clear evidence that these reductions in stress directly translate to improved reproductive outcomes, taking care of your mental health is always a good thing.

At Moler's clinic, she sees this benefit firsthand: "In this process, perceptions of stress diminish, anxieties transform into confidence, sleep improves — and fertility naturally is optimized," she explains.

Acupuncture and fertility outcomes

Outcomes in assisted reproductive technology (ART): When it comes to acupuncture and fertility, perhaps the *most* research has been done in the sub-realm of ART outcomes specifically. First, some historical perspective: In the early 2000s, a few studies came out (like this and this) asserting that fertility-specific acupuncture done before and after embryo transfer increased pregnancies and live birth rates. Based on these early studies, many clinics rushed to offer acupuncture to their patients.

Fast forward a decade later, and the positive effect of acupuncture on ART outcomes is a bit more complicated. We now have large controlled clinical trials (like this one) and several systematic reviews and meta-analyses which seem to converge on similar conclusions — but more research is still needed. All that aside, here's what the research found: While acupuncture doesn’t improve live birth rates, implantation rates, clinical pregnancy rates, or any other metric of ART "success" as compared to "sham" acupuncture (i.e., placebo acupuncture, where needles are placed in points that are not known to be acupuncture points), acupuncture does seem to improve live birth rates as compared to no treatment of any kind.

Since the research referenced above didn't have the strongest methodology, the jury is still out (for now) on the beneficial effects of acupuncture on ART outcomes. What we can say more confidently is that there’s no evidence of acupuncture having negative effects.

Outcomes in non-assisted reproduction (aka "natural" conception): There aren’t any published studies on whether acupuncture is beneficial for people attempting to conceive without using medical intervention. Because of this, we can’t say whether time to pregnancy, pregnancy rates, implantation rates, ovulation frequency, live births, or miscarriage rates are affected by acupuncture use in this group.

Acupuncture and reproductive health conditions

Polycystic ovary syndrome (PCOS): Some small studies have found a positive effect of acupuncture on hormone levels and ovulation in people with PCOS. But, more recent reviews and analyses of all the available data are not as supportive. When comparing PCOS-specific acupuncture to "sham" acupuncture, there are no differences in live birth or clinical pregnancy rates, nor are there differences in the frequency of ovulation or miscarriages.

There are no studies that directly compare these metrics in people with PCOS who get acupuncture vs. those who get other known efficacious treatments (like clomiphene citrate or letrozole), meaning we can’t make comparisons between these two groups.

Uterine fibroids: There are no randomized controlled trials on the effect of acupuncture on uterine fibroids, so be skeptical of people who confidently assert such claims.

Endometriosis: There are no large, reliable studies on the effect of acupuncture on endometriosis. But there is some evidence that acupuncture can be helpful in treating endometriosis-related pain, which makes sense with the fact that acupuncture is used primarily for its pain-relieving purposes in the US. Still, most of the currently published studies in the acupuncture-and-endometriosis-pain space are methodologically weak.

Acupuncture and other fertility factors

Fertility hormones: Some acupuncturists advertise their services as a way to "balance" or "fix" hormones implicated in fertility — and, in general, we have reason to believe that acupuncture-induced signals make their way to the brain and affect areas like the hypothalamus (which is at the top of the control center for the production of many fertility hormones). Dialing up or down the activity of the hypothalamus can therefore affect levels of hormones like FSH and LH, which are crucial for ovulation (which is crucial for conception!).

That being said, direct evidence of acupuncture affecting reproductive hormones in people is scant. But studies of female rats do find that acupuncture affects almost all reproductive hormones. Specifically, one recent study found that acupuncture administered to female rats (we hope they dimmed the lights and played relaxing music for them, as we do for humans!) every three days for a total of 15 days altered almost all reproductive hormones they looked at. TBD on how applicable this is to humans, who are a different species and have different treatment regimens.  

Thyroid function: Hormones related to thyroid function may impact fertility outcomes, meaning thyroid function may be an important thing to keep in check for people who are trying to conceive. Some reviews have suggested a beneficial impact of acupuncture on thyroid function. However, most of the original articles cited are not in English (unsurprisingly, most articles on TCM are written in Chinese) or easily downloadable in the US — so we were unable to evaluate these articles at this time.

What's it like to get acupuncture?

If you decide you want to get acupuncture, you might have some questions about what the experience will feel like. Before getting started, an acupuncturist will usually ask you questions about your lifestyle, your reason for wanting to do acupuncture, and your health history. They might also take a look at your tongue for additional clues about your mental and physical state. Based on your concerns and their assessment of your physical state, the acupuncturist will insert needles that are about as thin as a strand of hair in specific areas (also known as “meridians”) believed to aid in the treatment of specific conditions.

Once they’ve put the needles in the right areas, the acupuncturist will typically dim the lights, put on some calming music, and leave the room, usually for about 20-30 minutes. Some people take this time to think and relax, while others fall asleep.

Your treatment plan — how often you have sessions, how long they last, where needles are placed, and how many sessions you have overall — will depend on your specific concerns and how you are changing over time. For example, while some people using acupuncture for back pain need just a few sessions to see improvement, others may need more.

Are there any side effects?

Generally, there shouldn’t be. Some people may report a bit of pinching or pain at the needle insertion sites; if this is something you experience, you should tell your acupuncturist, who will make accommodations to ease that discomfort. Some people also may get small bruises at the insertion sites. Before acupuncturists switched to single-use disposable needles, there was a risk of infection — if needles weren’t cleaned properly between clients, people could get infected with things that clients previous to them had — but this is no longer a significant concern.

You can reduce the likelihood of unwanted side effects by making sure the acupuncturist you choose is trained and licensed. The American Society for Reproductive Medicine (ASRM) recommends finding an acupuncturist that is certified by one of the two main organizations for acupuncturists in the US (this and this). For people who feel more comfortable having an acupuncturist with training in both Western medicine and acupuncture, you can check out this list.

Does insurance cover acupuncture?

The answer is a giant “it depends.” Some insurers only cover acupuncture for specific conditions, some only cover it after first-line treatments haven’t worked, some only cover it for up to a certain number of sessions, and some won’t cover it at all, for any reason. It’s likely we see these differences in coverage among insurers because for many cases, there just isn’t enough data to firmly support the use of acupuncture as an effective, first-line treatment. (Of course, that doesn’t mean acupuncture doesn’t work, but rather that if it does, we just need more evidence for it.)

However, according to Dr. Zore, "Most acupuncturists will work with your finances and schedule to try to make acupuncture accessible."

Here’s what our community members say

Since everyone's experience with fertility-specific acupuncture is unique, we talked to four Modern Community members to find out what it was like for them.

Kat, 30, tried fertility acupuncture in what she calls a "kitchen sink" approach to conceiving. "I find acupuncture very relaxing, and it was always a really nice opportunity to take time for myself and take care of my physical and emotional well-being," she explains. At first, the acupuncture didn't seem particularly effective for Kat — but she left the second appointment feeling like it was helping her physically and emotionally: "My uterine lining did thicken enough to transfer and sustain my current pregnancy and it really helped with relaxing in the lead up to my [frozen embryo] transfer." She's since stopped because the process felt a little uncomfortable while pregnant. That said, Kat would recommend it to "everyone who has something specific [to treat] in mind."

After not getting a period for five months, Ashley, 33, decided to try acupuncture based on a recommendation from a fellow community member. For Ashley, acupuncture caused anxiety around what it might do to her body, and it hurt a little: "Most people say the needles don't hurt, but for me, I do feel pain when the needles get to a certain depth," she explains. Ashley isn't sure the treatment is doing anything for her menstrual cycle. While she did get her period three days after the first appointment, it's now been 74 days since her last one. "I am currently about to freeze my eggs, and it has been very stressful trying to decide if I should continue to see if I get a natural cycle or just move forward with taking Provera to induce a bleed so that I can continue with the egg freezing process," Ashley says. Still, she recommends acupuncture — as long as there's an understanding that it may or may not work.

For Jenn, who's 40, acupuncture felt like a good option after trying to get pregnant for six months. She loves it: "I feel calmer, less stressed, less irritable, and have fewer PMS symptoms since starting — which was about a month ago," she says. "My digestion is better, aches, pains and inflammation are lessening, and I feel an overall boost in health. My period cycles are also improving, length and blood quality." Jenn "100% recommend[s]" acupuncture for anyone who's trying to conceive.

Ashlee, who's currently pregnant, is 27. She and her husband are both in the military and found that trying to conceive with limited time availability was stressful. A friend recommended acupuncture, which Ashlee already had experience with: "I had done acupuncture before to help with aches and pains, and it had also helped me relax. So I thought, if nothing else, it would help me relax and bring joy to the process of trying." Ashlee had a consultation before starting treatment, and the acupuncturist kept tabs on how she was feeling throughout. "I sent my Modern Fertility results in, and went over my health history, worries, concerns, and hopes," she says. In the end, Ashlee "felt that it was very effective with my nerves. It helped me relax and brought a little bit of me time back to the process." She would definitely recommend it to others.

The bottom line

Acupuncture (as well as other integrated medicine techniques) is increasingly being sought after in the US to treat a wide range of conditions, including conditions related to fertility.

Because there haven’t been enough rigorous studies of acupuncture’s effect on fertility-related outcomes and reproductive health, we can’t say with 100% certainty whether it helps.

What we can say is that there’s emerging data to show a lot of benefits, and there's no evidence that acupuncture has negative impacts – it may help with the stress and anxiety that can surround fertility! If you’re curious to try it out, you can use this or this directory to find a certified practitioner near you.

Did you like this article?

Talia Shirazi, PhD

Talia is a clinical product scientist at Modern Fertility. She's passionate about reproductive health + behavioral neuroendocrinology. Talia received her PhD in biological anthropology at Penn State.

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