Acupuncture and chinese herbal treatment for women undergoing intrauterine insemination

Available online at Acupuncture and Chinese herbal treatment for women undergoing Keren Sela , Ofer Lehavi , Amnon Buchan , Karin Kedar-Shalem , a Unit of Complementary Medicine, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., Tel Aviv 64239, Israel b Fertility Research Institute, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Received 19 September 2010; received in revised form 10 April 2011; accepted 11 April 2011 Abstract
Aim: To assess the effect of traditional Chinese medicine (TCM, acupuncture and medicinal herbs) as a therapeutic adjuvant to ovulation inductionwith intrauterine insemination (IUI) procedures and evaluate its contribution to pregnancy and “take-home baby” rates.
Materials and methods: A comparative retrospective study was carried out in a university – affiliated municipal hospital. All women undergoingartificial insemination by donor spermatozoa (AID) and concomitantly treated with TCM were invited to participate. The enrolled women underwentweekly TCM in parallel with medical therapy. The treatment lasted between 2 and 36 cycles (equivalent to a time period ranging from one monthto one year). The control group was comprised of women who underwent AID without TCM and whose data were retrospectively retrieved fromhospital files. Pregnancy was assessed by human chorionic gonadotropin findings in blood 12–14 days after IUI. The birth rate was calculatedduring follow-up.
Results: A total of 29 women aged 30–45 years were enrolled in the study. The historical control group included 94 women aged 28–46 years.
Women who combined TCM with the procedures for undergoing IUI had significantly higher pregnancy (OR = 4.403, 95% CI 1.51–12.835,p = 0.007) and birth rates (OR = 3.905, 95% CI 1.321–11.549, p = 0.014) than the control group.
Conclusions: TCM appears to be beneficial as an adjunctive treatment in IUI procedures. Randomized controlled trials are needed to further assessthe role of acupuncture and herbs in this setting.
2011 Elsevier GmbH. All rights reserved.
Keywords: Traditional Chinese medicine; Infertility; IUI; Integrative medicine Introduction
120,000 treatment cycles were performed in clinics in the UnitedStates alone The term “infertility” is generally defined as the failure of a Two critical factors in establishing the prognosis, time course couple to conceive after 12 months of regular unprotected inter- for evaluation and treatment are the age of the female partner course. Around 10–15% of couples have difficulty conceiving at and the duration of infertility. In general, there is a decrease in some point in their reproductive lives and seek specialist fertil- fertility with age. Studies show a decrease in monthly fecun- ity treatment n 2000, about 200,000 babies were conceived dity beyond age 30 with a more significant decline after age 35 through in vitro fertilization (IVF) worldwide, and in 2003, over The causes of this age-related decrease in conception haveto do with chromosomal abnormalities, spontaneous abortions,aging of oocytes and luteal phase defects that are characteris-tic findings among older women. In terms of the duration of ∗ Corresponding author at: Laboratory of Herbal Medicine and Cancer infertility, women who have not conceived after 2–3 years have Research, Research, Complementary and Integrative Medicine Unit, Israel.
a poor prognosis, although the advances in assisted reproduc- Tel.: +972 3 6947506; fax: +972 3 6974789.
tion therapies (ART) have greatly enhanced the likelihood for E-mail address: (S. Lev-ari).
1876-3820/$ – see front matter 2011 Elsevier GmbH. All rights reserved.
Please cite this article in press as: Sela K, et al. Acupuncture and Chinese herbal treatment for women undergoing intrauterine insemination.
Eur J Integr Med (2011), doi: ARTICLE IN PRESS
K. Sela et al. / European Journal of Integrative Medicine xxx (2011) xxx–xxx Originating 2500 years ago in China, acupuncture is one of and Ligusticum Chuanxiong Both acupuncture and Chi- the most widespread forms of complementary and alternative nese herbal medicine have been widely used for thousands of medicine (CAM) in the USA and Europe The general years in Eastern societies and are gaining rapid popularity in the theory of acupuncture is based on the premise that disruptions of natural balanced energy flow (Qi) are responsible for diseasepathogenesis. The use of acupuncture is aimed at correcting Aim of the study
these imbalances and restoring health by the stimulation ofanatomical points on the skin with thin metallic needles that are To date, no studies have been done to assess effect of acupunc- usually manipulated by the practitioner’s hands or by electrical ture in combination with Chinese herbs on patients undergoing stimulation. The National Institutes of Health (NIH) Consensus Panel on Acupuncture (1997) concluded that acupuncture may The present study employs a retrospective study, the first in be useful as an adjunct treatment or an acceptable alternative in our knowledge, to investigate the effect of both acupuncture and a comprehensive management program for avoiding the use or Chinese herbs as an adjunct to women undergoing AID.
reducing the dose of conventional medication ge clinicaltrials have shown that acupuncture is an effective treatment fora variety of conditions Materials and methods
The topic of infertility and traditional Chinese medicine (TCM) has sparked much curiosity over the past few years.
Paulus et al. evaluated the effect of acupuncture on the pregnancyrate in ART (IVF) by comparing a group of patients who under- The Chinese Medicine Department is part of the Fertility went acupuncture treatment shortly before and after embryo Research Institute in the Tel Aviv Sourasky Medical Center transfer with a control group that did not have acupuncture (TASMC). It is an outpatient clinic that caters to both women Those authors’ conclusions were that acupuncture seemed to be and men undergoing fertility treatments. In order to form our a useful tool for improving pregnancy rates after IVF. More study group, we included all the patients who underwent IUI recent randomized controlled studies evaluated the effect of by donor spermatozoa between the years 2002 and 2007. From acupuncture on reproductive outcome in patients treated with 110 female patients treated in our clinic, 45 underwent artifi- IVF/intracytoplasmic sperm injection (ICSI) Again, cial insemination by donor spermatozoa (AID). Excluding those both studies showed that acupuncture on the day of embryo who underwent IVF (n = 16), the remaining 29 women who transfer significantly improved the reproductive outcome of underwent IUI treatments comprised our study group.
IVF/ICSI compared with no acupuncture. A recently publishedsystematic review and meta-analysis of randomized controlled trials suggested that acupuncture given concomitantly withembryo transfer improves the rates of pregnancy and of live A team of two accredited acupuncture practitioners selected births among women undergoing IVF A research team acupuncture points and herbal formulae based on the TCM from Hong Kong further validated this claim In addition, method of pattern discrimination. This method aims at har- acupuncture may be effective in restoring ovulation in patients monizing different organ systems based on symptoms (menses with polycystic ovarian syndrome contributing a posi- history, number of eggs in failed treatment protocols, basal body tive effect on subfertility. In contrast, several other studies failed temperature, endometrial thickness and more) and signs (anal- to show any beneficial role of acupuncture in this field ysis of tongue and radial pulse, abdomen and body palpation).
One such example showed that placebo acupuncture was more Once a pattern of disharmony has been determined, the treatment effective than real acupuncture, drugs or other procedures in seeks to balance the body by acupuncture and herbal treatment.
enhancing pregnancy rates during IVF treatments Tonification of the kidney system and of the spleen qi, tonifi- Three main mechanisms have been suggested to explain cation of the liver blood and heart blood, and harmonization the effect of acupuncture on subfertility: by regulating the of the liver are common treatment principles in many cases of hypothalamic–pituitary–ovarian axis thus affecting ovulation infertility. They roughly correspond to anovulation patterns, thin and the menstrual cycle by affecting blood flow to the endometrial lining and poor ovarian quality due to age.
uterus by affecting endorphin production and secre- The standard acupuncture intervention in our institution tion, thus inhibiting the central nervous system and reducing entails the insertion of disposable sterile 0.16-mm thick nee- dles manufactured by “Seirin” company, Japan, and imported by Herbal medicine is the other large branch of TCM. Simi- “Medicin Bom” Co., with Israeli Health Department approval.
larly to acupuncture, herbal treatment aims at restoring balance Acupuncture is performed after alcohol wipe of the skin at and health by administering medicinal properties from plants, the specific point. Needles are left in place and manipulated animals and minerals. The Chinese pharmacopoeia includes manually. Treatments generally last for 20–25 min and are thousands of such herbal products, and their use in the field administered weekly, with special attention given during the fol- of gynecology and obstetrics both in China and in the west is licular phase. Treatment was sometimes given post-ovulation as widespread Some examples of these substances are Peo- well, such as in cases of luteal phase defect or frequent miscar- Please cite this article in press as: Sela K, et al. Acupuncture and Chinese herbal treatment for women undergoing intrauterine insemination.
Eur J Integr Med (2011), ARTICLE IN PRESS
K. Sela et al. / European Journal of Integrative Medicine xxx (2011) xxx–xxx Comparison of baseline data on women who underwent concomitant artificial Multi-variant analysis for primary outcomes (A) pregnancy (B) birth rates insemination by donor spermatozoa (AID) and traditional Chinese medicine comparison between the intervention and control groups, while controlling for treatment (TCM, study Group) and women who underwent AID alone (controls).
independent variables taken at baseline. All outcome measures were analyzedseparately, with a p-value <0.05 indicating statistical significance.
Herbal formulae aimed at restoring balance and well-being are also tailored to specific needs. These formulae are frequently changed according to the menstrual cycle and medical interven- tions. Some examples of Chinese herbs that are used includePeonia Albae, Angelica Sinensis, Rehmannia and LigusticumChuanxiong. Herbal formulas are administered in powder or raw cycles. We used the t-test to assess for differences in independent (dried) form and imported by “Zen Herbs”, with Israeli Health variables at baseline between intervention and control groups.
The Fisher exact test was used to compare pregnancy and birthrates between the groups. We performed multiple regression to test for primary outcomes (pregnancy and birth rates) betweenthe intervention and control groups, while controlling for inde- Our primary outcome measure was a positive human chori- pendent variables (age, number of IUI cycles). All outcome onic gonadotropin (HCG) blood test carried out 12–14 days measures were analyzed separately, with a p-value <0.05 indicat- post-ovulation. We also measured the birth rates of the study ing statistical significance. Statistical analyses were performed and control groups during follow-up.
The study group consisted of 29 women who underwent Nineteen of the twenty-nine women in the study group con- AID concomitantly with TCM. Primary infertility accounted for ceived (65.5%), of whom twelve delivered and six miscarried.
58.6% of these cases. Their average age was 39.43 years (ranged Thirty-seven of the ninety-four women in the control group con- 30–45), and they had previously undergone an average of nine ceived (39.4%), of whom twenty-five delivered (26.6%) and AID cycles before seeking Chinese medical intervention. They continued the course of TCM for an average of five more cycles A multi-variant analysis for differences between the inter- vention and control groups, for primary dependent variables ofpregnancy and birth rates while controlling for possible con- founders (age, number of IUI treatments) has demonstrated thatacupuncture group resulted in higher rates of both pregnancies The control group for this study was retrieved from a large (OR = 4.403, 95% CI 1.51–12.835, p = 0.007) and birth rates pool of women who underwent AID in our Fertility Research (OR = 3.905, 95% CI 1.321–11.549, p = 0.014). Institute. We randomly retrieved patients’ files between 2002 marizes the comparison of pregnancy and birth rates of the 29 and 2007 and selected the women who were between 30 and 45 patients who underwent concomitant TCM and AID and those years of age at the beginning of AID treatments. Excluded were women diagnosed as having cancer or clotting irregularities as Six women (20.7%) in the acupuncture intervention group well as those who had undergone AID treatments for more than and twelve (12.8%) of the control comparison group had mis- two consecutive years. A total of 94 women fulfilled these crite- carriages. This had no statistical significance (p = 0.367).
ria. Their average age was 37.12 years and they had undergone There were no adverse effects caused by either the acupunc- an average of six AID treatments. Ten of these women (11%) had ture needles or herbal formulae in the TCM patients.
conceived in the past. All women in study and control groupshad a hormonal profile that supported ovulation.
the baseline characteristics of patients in The results of this comparative study demonstrated that TCM may be effective in enhancing fertility of women undergoing AID. The study group showed a significantly higher (p = 0.019)cumulative pregnancy rate (65.5%) over an average 4.5-month The patients’ records were retrospectively reviewed for treatment period compared to the control group (39.4%). In com- demographic information, such as age and number of previous parison, a retrospective analysis of 6139 AID cycles conducted Please cite this article in press as: Sela K, et al. Acupuncture and Chinese herbal treatment for women undergoing intrauterine insemination.
Eur J Integr Med (2011), doi: ARTICLE IN PRESS
K. Sela et al. / European Journal of Integrative Medicine xxx (2011) xxx–xxx in our facility between 1980 and 1997 showed a cumulative Conflict of interest
pregnancy rate of 36%, 53%, and 75% for 3, 6 and 12 months,respectively t should be noted that the average age of the women who underwent combined TCM and AID was 39 years,which is two years older than the average age of the controlgroup. As shown in this age difference has statisticalrelevance and makes the results more meaningful, given that References
The birth rate of the study group was also higher than the [1] Evers JL. Female subfertility. Lancet 2002;360:151–9.
[2] Centers for Disease Control and Prevention. Assisted reproductive tech- control group (41.4% vs. 26.9%, respectively, p = 0.014).
nology success rates: national summary and fertility clinic reports 2003.
Infertility treatments are becoming increasingly more com- Atlanta, GA: US Department of Health and Human Services; 2005.
mon. Women who seek medical interventions are exposed to [3] Adamson GD, De Mouzon J, Lancaster P, Nygren KG, Sullivan E, Zegers- varying amounts of hormones, ultrasound examinations, blood Hochschild F. World collaborative report on in vitro fertilization, 2000.
tests and, in the case of IVF, general anesthesia. These treat- [4] Bongaarts J. Infertility after age 30: a false alarm. Fam Plann Perspect ments also occasionally give rise to unwanted side effects, such as hot flashes, thinning of the endometrial lining, ovarian hyper- [5] Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, stimulation, weight gain and mental disturbances et al. Trends in alternative medicine use in the United States, 1990–1997: were no adverse effects associated with the use of acupuncture results of a follow-up national survey. J Am Med Assoc 1998;280:1569–75.
needles or herbal formulae in any of our patients, in agreement [6] Ernst E. Prevalence of use of complementary/alternative medicine: a sys- tematic review. Bull World Health Organ 2000;78:252–7.
with the findings of large-scales studies in which side effects [7] Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report associated with acupuncture tended to be uncommon, mild and #12. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. December 10, 2008 NIH.
TCM treatments that are tailored for specific diagnoses try to [8] Consensus Development Panel of Acupuncture. JAMA 1998;280:1518–24.
restore balance to the body by changing acupuncture points and [9] Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC.
Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the herbal formulae as needed. This is also the main reason why it is knee: a randomized, controlled trial. Ann Intern Med 2004;141:901–10.
so difficult to execute a randomized double blind standardized [10] Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR.
study in which all patients undergo one unmodified treatment Acupuncture for tension-type headache. Cochrane Database Syst Rev protocol. One example of this difficulty is described in a recent work that allocated real or placebo acupuncture on the day of [11] Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted embryo transfer to 370 randomly selected patients. The results reproduction therapy. Fertil Steril 2002;77:721–4.
unexpectedly showed an overall pregnancy rate that was signif- [12] Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J.
icantly higher in the placebo acupuncture group than that in the Acupuncture on the day of embryo transfer significantly improves the repro- real acupuncture group e therefore believe that retrospec- ductive outcome in infertile women: a prospective randomized trail. Fertil tive studies such as these, based on TCM differential diagnosis, [13] Dieterle S, Ying G, Hatzmann W, Neuer A. Effect of acupuncture on will serve as base for double blind randomized controlled stud- the outcome of in vitro fertilization and intracytoplasmic sperm injec- ies on those set of acupoints that have shown positive results.
tion: a randomized, prospective, controlled clinical study. Fertil Steril Chinese herbal formulas based on accepted TCM differential diagnosis can be formulated as well. A generally accepted TCM [14] Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman diagnosis with a standard set of acupoints and herbal formulas BM, et al. Effects of acupuncture on rates of pregnancy and live birthamong women undergoing in vitro fertilisation: systematic review and will allow widespread use of these ancient techniques.
meta-analysis. Br Med J 2008;336:545–9.
Limitations of the study: First, the number of patients enrolled [15] Ng EH, So WS, Gao J, Wong YY, Ho PC. The role of acupuncture in the in this study is relatively small. Secondly, our department serves management of subfertility. Fertil Steril 2008;90:1–13.
as an out-patient clinic for women who have an hormonal profile [16] Stener-Victorin E, Waldenström U, Tägnfors U, Lundeberg T, Lindstedt G, that support their ovulation. Since many women undergo their Janson PO. Effects of electro-acupuncture on anovulation in women withPCOS. Acta Obstet Gynecol Scand 2000;79:180–8.
follow up at their HMO, we do not have access to the complete [17] Pinborg A, Loft A, Andersen AN. Acupuncture with in vitro fertilisation.
hormonal profile of the comparative control group. Finally, the methodology of the study is a comparative retrospective study, [18] El-Toukhy T, Khalaf Y. The impact of acupuncture on assisted reproductive which needs to be further validated by randomized controlled technology outcome. Curr Opin Obstet Gynecol 2009;21:240–6.
[19] So EW, Ng EH, Wong YY, Lau EY, Yeung WS, Ho PC. A randomized double blind comparison of real and placebo acupuncture in IVF treatment.
In conclusion, our study was the first to combine acupuncture treatment with Chinese herbal medicine and demonstrated that [20] Ferin M, Vande Wiele R. Endogenous opioid peptides and the control of this approach is safe and promising as an effective adjunctive the menstrual cycle. Eur J Obstet Gynecol Reprod Biol 1984;18:365–73.
therapy to conventional care for infertility patients. Randomized [21] Stener-Victorin E, Waldenström U, Andersson SA, Wikland M. Reduction controlled trials are needed to further assess the role of TCM of blood flow impedance in the uterine arteries of infertile women withelectro-acupuncture. Hum Reprod 1996;11:1314–7.
as part of treatment management for increasing the number of [22] Ku YH, Chang YZ. Beta-endorphin- and GABA-mediated depressor effect healthy pregnancies among women who undergo intrauterine of specific electroacupuncture surpasses pressor response of emotional circuit. Peptides 2001;22:1465–70.
Please cite this article in press as: Sela K, et al. Acupuncture and Chinese herbal treatment for women undergoing intrauterine insemination.
Eur J Integr Med (2011), ARTICLE IN PRESS
K. Sela et al. / European Journal of Integrative Medicine xxx (2011) xxx–xxx [23] Kim JH, Nam D, Park MK, Lee ES, Kim SH. Randomized control trial chong (a traditional Chinese medicine). Am J Obstet Gynecol 1989;161: of hand acupuncture for female stress urinary incontinence. Acupunct [31] Botchan A, Hauser R, Gamzu R, Yogev L, Paz G, Yavetz H. Results of [24] Maciocia G. Obstetrics and gynecology in Chinese medicine. New York: 6139 artificial insemination cycles with donor spermatozoa. Hum Reprod [25] Hsu FL, Lai CW, Cheng JT. Antihyperglycemic effects of paeoniflorin and [32] Haritha S, Rajagopalan G. Follicular growth, endometrial thickness, and 8-debenzoylpaeoniflorin, glucosides from the root of Paeonia lactiflora.
serum estradiol levels in spontaneous and clomiphene citrate-induced cycles. Int J Gynaecol Obstet 2003;81:287–92.
[26] Takeuchi T, Nishii O, Okamura T, Yaginuma T. Effect of paeoniflorin, [33] Kahnberg A, Enskog A, Brännström M, Lundin K, Bergh C. Prediction of glycyrrhizin and glycyrrhetic acid on ovarian androgen production. Am J ovarian hyperstimulation syndrome in women undergoing in vitro fertil- ization. Acta Obstet Gynecol Scand 2009;88:1373–81.
[27] Lau CB, Ho TC, Chan TW, Kim SC. Use of dong quai (Angelica sinensis) [34] Huisman D, Raymakers X, Hoomans EH. Understanding the burden of to treat peri- or postmenopausal symptoms in women with breast cancer: ovarian stimulation: fertility expert and patient perceptions. Reprod Biomed is it appropriate? Menopause 2005;12:734–40.
[28] Guo LM, Zhang RX, Jia ZP, Li MX, Wang J, Yin Q. Effects of Rehmannia [35] White A, Hayhoe S, Hart A, Ernst E. BMAS and AACP. British Medical glutinosa oligosaccharides on proliferation of HepG2 and insulin resis- Acupuncture Society and Acupuncture Association of Chartered Phys- tance. Zhongguo Zhong Yao Za Zhi 2007;32:1328–32.
iotherapists. Survey of adverse events following acupuncture (SAFA): [29] Chao SL, Huang LW, Yen HR. Pregnancy in premature ovarian fail- a prospective study of 32,000 consultations. Acupunct Med 2001;19: ure after therapy using Chinese herbal medicine. Chang Gung Med J [36] Melchart D, Weidenhammer W, Streng A, Reitmayr S, Hoppe A, Ernst E, [30] Tuttle RS, Marmelstein L, Trad T, Reddy S, Radley T. In vitro uter- et al. Prospective investigation of adverse effects of acupuncture in 97,733 ine response to tetramethylpyrazine, the active constituent of chung patients. Arch Intern Med 2004;164:104–5.
Please cite this article in press as: Sela K, et al. Acupuncture and Chinese herbal treatment for women undergoing intrauterine insemination.
Eur J Integr Med (2011), doi:



Multidrug efflux pump overexpression inStaphylococcus aureus after single and multiplein vitro exposures to biocides and dyesAure´lie A. Huet,1,3 Jose L. Raygada,2 Kabir Mendiratta,1 Susan M. Seo2and Glenn W. Kaatz1,21John D. Dingell Department of Veterans Affairs Medical Center, Detroit, MI 48201, USA2Department of Medicine, Division of Infectious Diseases, Wayne State University School of3E

Significance of sutherlandia

TERRA TREATMENT - the treatment you can trust! The Significance of Sutherlandia - PRO Sutherlandia has application in the treatment of all conditions that are associated with impaired immune function, stress or general debility of the body. It strengthens the body's natural immune response, supports the healing system and accelerates the recovery process. The full botanical name of Suther

Copyright © 2010-2014 Internet pdf articles