Contents 1. Introduction 2. Acupuncture and Fertility Management 2.1 Fertility Management without assisted conception 2.1.1 Female benefits 2.1.2 Male Benefits 2.2 Assisted Reproductive Techniques 2.2.1 Effects when performed on day of embryo transfer 2.3 Psychological Impact on Patients undergoing ART 3. Gynecological Problems 3.1 Polycystic Ovary Syndrome (PCOS) 3.2 Endometriosis 4. Conclusion 1. Introduction
The use of acupuncture with respect to managing fertility (naturally or during assisted
reproductive techniques) or to treat gynaecological problems is gaining popularity but
remains controversial. There appears much confusion over the impact this traditional Chinese
medicine has on such health issues, and current studies are clearly conflicting. However,
many Western based fertility or IVF clinics now offer acupuncture as an adjunct to other
treatments and there is ongoing research into its effects and mechanism of action.
Despite its increasing use, currently there is a lack of published research. Western medicine
places a high importance on animal research and randomised controlled trials before
accepting a new medicine or technique into mainstream use. Acupuncture research has been
criticised for failing to adhere to these design protocols, and consequently there is confusion
and debate regarding its efficacy. However, in recent years there has been an increase in
randomised controlled trials, and several studies using model animals to elucidate the
mechanism of action. This report aims to summarise the current published works on
acupuncture and several aspects of fertility including management of fertility and several
PubMed was searched using several search terms to identify original publications relevant to
this report. Summaries are presented in Tables One to Five, references at the end of this
Table One: Acupuncture and fertility management in patients not receiving ART, supported
Table Two: Acupuncture and IVF outcomes when used at times other than embryo transfer
Table Three: Acupuncture and IVF outcome when used at embryo transfer
Table Four: Acupuncture and effect on PCOS
Table Five: Acupuncture and effect on endometriosis
2. Acupuncture and Fertility Management
Traditional Chinese Medicine (TCM) is still a primary source of preventative medicine and
treatment in many Asian Countries, and is comprised of acupuncture together with Chinese
Herbal Medicines. TCM has been used in such cultures to treat gynaecological concerns for
many years. As early as 1237 AD the first TCM book dedicated solely to gynaecology and
obstetrics was published; The Complete Book of Effective Prescriptions for Diseases of
Women. Since then TCM has been used for endometriosis, infertility, dysmenorrhea,
abnormal uterine bleeding, premenstrual syndrome, menopausal syndrome, uterine fibroids
and chronic pelvic inflammation, polycystic ovarian syndrome (PCOS), cervicitis and
vaginitis. For a good review see Zhou & Qu, 2009.
A recent questionnaire study set by the British Acupuncture Council reported that 80% of UK
acupuncture practitioners said the majority of their fertility-based work was related to assisted
conception. (Bovey, et al., 2010) This is clearly different from its wide-spread use in Asian
countries, and reflects how acupuncture is most commonly used as an adjunct to Western
medicine, and is unlikely to constitute a primary source of treatment in Western countries.
As acupuncture has become more common in Europe, scientific research has also increased,
albeit slowly. There is a bias towards research into acupuncture’s use during ART, although
there are a number of studies investigating its benefit and mechanism with regard to infertile
patients not undergoing ART. Interestingly, while it has been reported that the use of
acupuncture for males is uncommon (Bovey, et al., 2010) there appears to be a research bias
towards investigating male fertility parameters in patients not receiving concomitant ART.
2.1 Fertility Management without assisted conception 2.1.1 Female benefits
An early attempt to elucidate acupuncture’s effect on hormonal profiles was published in
1976 in The American Journal of Chinese Medicine (AJCM). (Aso, et al., 1976) Using fertile
patients at various stages in their menstrual cycle, the authors concluded that properly
performed electro-acupuncture stimulation might affect the female endocrine function. A
later study more specifically focusing on 45 infertile patients concluded that auricular
acupuncture would offer a valuable alternative therapy for female infertility due to hormone
disorders, restoring normal ovulation. (Gerhard and Postneek, 1992) The authors saw that
various disorders of the autonomic nervous system normalised during acupuncture, and only
matched-control patients receiving hormonal treatments suffered side-effects. Another study,
using points Ganshu (UB 18), Shenshu (UB 23), Guanyuan (Ren 4), Zhongji (Ren 3), and
Sanyinjiao (Sp 6) also concluded acupuncture could modulate the endocrine system to induce
ovulation. (Mo, et al., 1993) Lastly, in 1997 Chen et al published their experiences of both
human and animal studies into electro-acupuncture and ovulation, and concluded electro-
acupuncture could possibly regulate endocrine dysfunction by several mechanisms, including
influencing gene expression within the brain normalising secretion of GnRH, LH and
oestrogen to restore normal and functional ovulation. (Chen, 1997)
A study in 1996 also suggested acupuncture could modulate female fertility by virtue of the
sympathetic nervous system. Ten women known to have high pulsatility indexes (PI) in
uterine arteries were given acupuncture for one month, on top of gonadotrophin-releasing
hormone down-regulation to remove any endogenous causes for changes in their PI. Post-
acupuncture PI values were significantly reduced compared to their baseline values, and the
authors suggested this was due to the acupuncture having a central inhibitory effect on the
sympathetic nervous system. (Stener-Victorin, et al., 1996) A recent study found that manual
acupuncture at bilateral SP6 could elicit immediate reductions in uterine PI values. (Yu, et al.,
Since the mid 1990’s there have only been a few studies focusing on sub-fertile patients not
undergoing ART. However, they appear rather consistent in identifying benefits to
acupuncture, with results regarding ovulation either equivalent or better than Western
hormonal treatments, and similarly positive results regarding pregnancy rates. However, it
should be noted that full text versions of these studies are currently unavailable so a complete
critical analysis is not possible. The exact acupuncture timing and regime used is unknown,
as are patient ages. The mechanism by which acupuncture achieves the results is likely not
established by these studies. More research is needed to build on these preliminary results,
but the current studies appear to have positive outcomes and improve patients’ fertility
without resorting to IVF. Studies using patients with PCOS suggest acupuncture may have
some ability to restore normal ovulation.
Animal studies have also been used to help confirm the impact provided by acupuncture. A
paper published in 2003 using a rat model concluded electro-acupuncture possibly mediated
its action by increasing GnRH cell numbers in the brain, resulting in a similar increase in
blood oestrogen levels. They also stated corticotropin-releasing hormone (CRH) played an
important role in electro-acupunctures capability to restore normal function of the
hypothalamus-pituitary-ovarian axis. (Zhao, et al., 2003) Rat models also support a true
benefit for acupuncture on implantation, as electro-acupuncture after conception can allow
normal endometrium development, antagonising the effect of Mifepristone; a
used as anif given during the first two months of pregnancy.
(Liu, et al., 2007a) A further study by the same group concluded acupuncture may work by
modulating both hormones and their receptor expression levels. (Liu, et al., 2007b) Later they
concluded acupuncture’s effect was mediated by increasing the levels of connexin 43 mRNA
Other rat models have reported increased ovarian blood flow responses to electro-
acupuncture, mediated by a reflex response via ovarian sympathetic nerves (Stener-Victorin,
et al., 2003) although this was later shown to be frequency dependent, and dependent on the
stage of the oestrous cycle. (Stener-Victorin, et al., 2006) Others have reported acupuncture
can regulate the function of hypothalamus-pituitary-ovarian axis by modulating the activity
of numerous brain nuclei, measured by changes in C-fos expression. (Hu, et al., 1993) A
rabbit model has also reported effects on brain activity, stating GnRH levels (which are
pulsatile during ovulation) from the mediobasal hypothalamus (MBH) become amplified
Consequently, while further validation is necessary, it is becoming accepted that acupuncture
may improve fertility by modulating the sympathetic nervous system, affecting uterine and
ovarian blood flow, and more directly interacting with the hypothalamic-pituitary-ovarian
axis by affecting hormone (and receptor) expression level.
2.1.2 Male Benefits
While investigations into acupuncture’s ability to aid men whilst undergoing ART are very
limited, there have been a number of studies investigating its ability to modulate natural
fertility parameters in sub-fertile men. An early study reported significant improvements in
total sperm count, concentration, motility and hormonal profiles (compared to baseline) after
28 males received 10 treatments over three weeks. (Fischl, et al., 1984) Another study using
28 men reported increases in sperm concentration and motility but not in volume, nor the
men’s psychological outlook as assessed by a written test. (Riegler, et al., 1984) The exact
acupuncture protocol (timing, duration etc) is however unknown.
Since then, a number of original research studies have been published. Although they are also
conflicting with regard to what degree sub-fertility may be managed by acupuncture, they
have all reported some positive results. Routine and biochemical semen parameters, levels of
anti-sperm antibodies, testicular blood flow and scrotal temperature have all been suggested
The exact mechanism by which this occurs is not currently clear, and while the above studies
do have several shortcomings, collectively they highlight the need for ongoing research to
further validate the use of acupuncture in a male-fertility setting.
Acupuncture is likely to have a high psychological mechanism, as further discussed below.
Consequently is a surprising that there is little research into acupuncture and ejaculation
problems. A systematic review published last year identified just four suitable studies and
concluded ‘the evidence is insufficient to suggest that acupuncture is an effective intervention for treating erectile dysfunction (ED). Further research is required to investigate whether there are specific benefits of acupuncture for men with ED.’ (Lee, et al., 2009) Nonetheless, a
thorough study using a diabetic-induced rat for a model of physiological erectile dysfunction
noted that moxibustion at "Shenshu" (BL 23) and "Sanyinjiao" (SP 6) has a significant effect
on the erectile function in the rats, which was related to improved blood sugars and
promotion of the NO-cGMP pathway (a signalling transduction system) within the penis.
(Yang, et al., 2007) Further research into this area is warranted to determine whether
acupuncture can improve symptoms of erectile dysfunction, regardless of whether it develops
for physiological or psychological reasons.
2.2 Assisted Reproductive Techniques
Research into the benefits of acupuncture during IVF has gained some focus, with four
original research studies being published this year. (Andersen, et al., 2010; Madaschi, et al.,
2010; Moy, et al., 2010; So, et al., 2010) Collectively these studies have investigated
pregnancy rates when acupuncture was given during stimulation or in conjunction with
embryo transfer, and all have reported finding no significance differences when using
The use of acupuncture during IVF is currently surrounded with confusion, and
inconsistencies. While the majority of studies appear to satisfactorily match their control
groups to treatment groups, the patient samples are highly heterogeneous in terms of age,
fertility cause and previous number of ART cycles. Differing definitions of clinical
pregnancy, ongoing pregnancy etc confuse direct comparisons. Each country has different
laws regarding embryo selection and number of embryos routinely transferred, and this
means each paper has highly contrasting IVF protocols, adding further difficulty to drawing
Studies have predominantly focused on performing acupuncture during the stimulation phase
or pre- and post-embryo transfer in an attempt to improve pregnancy rates, although some
have performed acupuncture solely after embryo transfer. Tables two and three discuss these
original papers. While there have been a number of reviews, meta-analyses into acupuncture
duringIVF protocols are very limited, with some focusing solely on papers investigating
acupuncture around embryo transfer. El-Toukhy et al conducted a meta-analysis using 13
relevant trials, including a total of 2500 women randomised to either acupuncture or control
group. These patients received acupuncture either during oocyte retrieval or around the time
of embryo transfer. On analysis of the data it was concluded acupuncture had no significant
effect on clinical pregnancy rates or live birth rates, regardless of when the acupuncture was
performed. (El Toukhy, et al., 2008) A similar review published by the same author one year
later, now incorporating 14 trials including 2870 women came to the same conclusion (El-
While less researched than improvements in pregnancy rates, another suggested benefit of
acupuncture is to reduce the risk of ovarian hyper-stimulation syndrome (OHSS). A study in
1997 reported the results of ten patients who had taken human menopausal gonadotrophin
(HMG) and subsequently developed OHSS (to varying degrees). Each were given
acupuncture instead of human chorionic gonadotrophin (HCG) for ovulation induction in an
attempt to prevent exacerbation of the OHSS. Over 11 menstrual cycles (one patient had a
reoccurrence of OHSS), 9 experienced a substantial remittance or disappearance of
symptoms. Two pregnancies resulted when using acupuncture in the absence of HCG,
leading the authors to conclude acupuncture is effective in ovulation induction and allows
OHSS to be managed effectively. (Cai, 1997) No other paper appears to directly discuss
OHSS and acupuncture, although patients with PCOS are at high risk of OHSS and
acupuncture in these patients has gained some focus, and is discussed later.
2.2.1 Effects when performed on day of embryo transfer
In contrast to outcomes when used during stimulation, studies solely investigating the use of
acupuncture with embryo transfer appear more promising. The first randomised, controlled,
prospective study into the impact of acupuncture pre- and post-embryo transfer was
performed in 2002 by Paulus et al. A total of 160 healthy women undergoing either IVF or
ICSI due to a variety of reasons were recruited into the study, and randomised to receive
either no acupuncture (n = 80) or acupuncture in two 25 minute sessions, one pre- and one
post-embryo transfer (n = 80). The acupuncture points used were Cx6 (Neiguan), Sp8 (Diji),
Liv3 (Taichong), Gv20 (Baihui), and S29 (Guilai) before embryo transfer.
(Sanyinjiao), Sp10(Xuehai), and Li4 (Hegu). In conjunction, auricular acupuncture was
performed at ear point 55 (Shenmen), ear point 58 (Zhigong), ear point 22 (Neifenmi), and ear
point 34 (Naodian). Two needles were inserted in the right ear, the other two needles in the
left ear. The four needles remained in the ears for 25 minutes. The side of the auricular
acupuncture was changed after embryo transfer. These points were chosen as
‘’Taiying meridians (spleen) and Yangming meridians (stomach, colon) would result in
better blood perfusion and more energy in the uterus. Stimulation of the body points Cx6,
Liv3, and Gv20, as well as stimulation of the ear points 34 and 55, would sedate the patient.
Ear point 58 would influence the uterus, whereas ear point 22 would stabilize the endocrine
system.’’ (Paulus, et al., 2002) The measured outcome was clinical pregnancy rates at 6
weeks, and the rate of 42.5% in the acupuncture group was significantly higher than seen in
the control group (26.3%). However, it should be noted that all patients were selected as they
had good quality embryos, and the mean age in both groups was 32 years.
Since this preliminary study, a number of studies have attempted to replicate their findings.
Some studies have reported a non-significant impact on pregnancy rates, although many
report a trend to improving outcomes and they generally have a positive outlook on the use of
acupuncture, deeming it safe and useful to reduce stress and improve optimism. (Johnson,
2006; Smith, et al., 2006) (Domar, et al., 2009) (Andersen, et al., 2010; Madaschi, et al.,
2010). However, Paulus’ results have been successfully replicated by some (Westergaard, et
al., 2006) and Margerelli et al concluded that acupuncture improves pregnancy rates by
modulating the stress response, evidenced by significantly different cortisol and prolactin
levels in patients receiving acupuncture compared to controls. (Magarelli, et al., 2009). One
paper performing acupuncture only after embryo transfer (on the day, and again 3 days later)
also reported significant increases in pregnancy rates. (Dieterle, et al., 2006)
A meta-analysis specifically including only studies investigating acupuncture at the time of
embryo transfer has recently been published. (Manheimer, et al., 2008) Seven trials with
1366 women undergoing in vitro fertilisation were included, and all studies were randomised
controlled trials that compared needle acupuncture performed within one day of embryo
transfer with sham acupuncture or no treatment. They concluded that there was preliminary
evidence to suggest acupuncture given with embryo transfer improves rates of pregnancy and
live birth. (Manheimer, et al., 2008) Another meta-analysis, also published in 2008, also
agreed with this conclusion, stating if the aim of acupuncture is to improve pregnancy rates, it
should be given on the day of embryo transfer. Acupuncture with oocyte retrieval reduced
pain, but did not increase pregnancy rates. (Ng, et al., 2008)
It would appear that performing acupuncture around the time of embryo transfer may be more
beneficial than if performed at any other time during the ART cycle, although individual
papers are still conflicting and it is clear that more randomised controlled studies,
incorporating a large sample size are necessary in order to prove this. However, as now
discussed further, a number of studies have highlighted the important impact acupuncture
may have on psychological parameters, predominately stress. Acupuncture may also have
benefits for reducing pain during oocyte retrieval, and this may be particularly beneficial for
some women but is not discussed further here.
2.3 Psychological Impact on Patients undergoing ART
A search in PubMed using the term ‘acupuncture, stress’ returns 422 papers, indicating that
its use for stress reduction is well researched. Stress has been linked to reducing fertility and,
considering this association, the paucity of research specifically evaluating stress modulation
in response to acupuncture during ART is surprising.
There is seemingly only one paper that measures the effect acupuncture has on stress
hormones. Magarelli et al, found that acupuncture seemingly had a beneficial regulation of
cortisol and prolactin in 67 patients undergoing IVF (Magarelli, et al., 2009). Cortisol and
prolactin are indicative of stress, but clearly there is too little evidence to confirm
acupuncture can inducing physiological changes in stress markers. The authors themselves
made it clear they were unsure whether the increased pregnancy rates in the acupuncture
group were due to reduced stress but it will be an interesting avenue for future research.
The ultimate goal of IVF is to increase take-home baby rates, and this seems to have resulted
in the belief that all aspects of IVF should be contributing to this achievement. However, IVF
itself is an extremely stressful period: daily injections, blood tests, ultrasounds, surgical
procedures (oocyte retrieval, embryo transfer) and the ongoing possibility of failure place an
enormous strain on already stressed patients. Heightened anxiety also places a burden on
familial and working relationships. A poor support network and an inability to cope can lead
to many women being unable to repeat the process after a failed cycle. Consequently, any
method to relieve this aspect of treatment is highly desirable, and acupuncture may be able to
offer important benefits for stress reduction. Even if acupuncture is shown not to directly
increase pregnancy rates, if it can reduce anxiety and increase calmness and optimism
patients may feel more in control and able to cope with IVF and multiple cycles, if necessary.
A few studies investigating acupuncture on physiological variables have also asked patients
to report their feelings regarding the protocol. Interestingly, there are also conflicting results
with regard to psychological parameters. A recent study has reported that acupuncture
resulted in more negative feelings (pain etc) than the control group (Moy, et al., 2010),
another stating that while anxiety was reduced it was not to a significant level. (So, et al.,
2009) However, this is not a consistent finding; a recent paper stated increased feelings of
calmness and optimism. (Domar, et al., 2009)
Despite a clear increase in acupuncture use, there is to date only two papers specifically
designed to investigate patients’ perceptions of acupuncture. A preliminary pilot study using
semi-structured questionnaires evaluated the experiences of 8 patients who had used
acupuncture during IVF. All women felt they had heard a lot of information about
acupuncture and its potential benefits, perceived acupuncture to be more similar to
mainstream treatments than other complementary/alternative therapies (and felt re-assured by
this) and to be safe. Importantly, while all women perceived the potential for acupuncture to
help to be high, they also felt that even if acupuncture provided no benefits it would not
interfere with their body or other Western drugs etc, and could do no harm. The two patients
who became pregnant felt acupuncture had helped them, while those remaining childless
stated acupuncture helped them cope. (de Lacey Sheryl, 2009)
Another small pilot study also found that acupuncture was associated with less stress both
before and after embryo transfer, and that such patients had improved pregnancy rates. This
study suggests that a reduction in stress may significantly impact on pregnancy rates, and that
for some people this may be achieved by acupuncture. (Balk, et al., 2009)
Similar studies should follow, investigating a wide range of patients from different countries.
Replication of the results may help further establish acupuncture as an appropriate adjunct
therapy for use during IVF, or even during attempts to improve natural fertility by reducing
3. Gynecological Problems 3.1 Polycystic Ovary Syndrome (PCOS)
PCOS is one of the most common endocrine disorders in women, and is a leading cause of
infertility despite its aetiology not being fully elucidated. Pharmaceutical interventions are
not adequate for all patients, and may have adverse side-effects. Consequently, acupuncture
has been used in an attempt to reduce the symptoms, and increase the fertility status of
Rat models of PCOS have been created either by a single injection of oestradiol valerate or
by continuous release of DHT. Neither model fully replicates the symptoms seen in human
patients, but they do exhibit some of the morphological, endocrine and metabolomic
alterations of PCOS. Such models have been used to implicate the sympathetic nervous
system (in response to altered nerve growth factor (NGF)) and immune abnormalities in the
development and maintenance of PCOS, as such rats show abnormalities in these variables
compared to controls. Acupuncture interventions are generally very successful, reversing
most of the symptoms seen in model rats. This has been achieved in some groups by
decreasing elevated NGF levels therefore limiting the hyperactivity of the sympathetic
nervous system. However, exercise also has similar effects, and is possibly even more
effective in causing weight loss, which is of particular importance to women wishing to
become pregnant. Other groups report acupuncture can modulate corticotropin-releasing
hormone (CRH), endothelin-1 (ET-1), β-endorphins and various serum hormonal levels,
therefore improving PCOS-like symptoms. Yet, these results are not seen by all groups and
since rat models are not fully representative of human PCOS, extrapolating evidence to
Although there are some human studies investigating acupuncture’s effect on certain
symptoms of PCOS (insulin resistance, obesity etc) there are less that explicitly investigate
women with diagnosed PCOS. Such studies do however report improvements in most
symptoms and signs of PCOS such as leptin, fat and insulin abnormalities and reproductive
hormone abnormalities. Menstrual and ovulation are restored in many cases, and some even
report acupuncture’s ability to aid weight loss. As for murine models though, exercise also
has a similar effect, so acupuncture is perhaps best applied to patients who are also counseled
appropriately on diet and exercise choices to improve their symptoms. However, one paper
found that after 6 cycles the symptoms returned to patients receiving domiphen and chorionic
gonadotrophin, but not to those receiving acupuncture, which suggests that acupuncture may
have better long term effects on some patients than pharmaceutical interventions. (Chen, et
Ongoing studies into acupuncture and PCOS relief are needed, but it appears that acupuncture
may be a beneficial adjunct to patients receiving treatment, especially when patients make
lifestyle changes to reduce their symptoms.
Acupuncture’s effect on endometriosis is less well researched than for PCOS, and most
studies focus on an ability to reduce dysmenorrhea. While the analgesic effect of acupuncture
is supported in these patients, as in others with chronic pain conditions, it should be
remembered that a reduction in pain does not necessarily reflect a concomitant improvement
in fertility status. No clear effect on improving fertility in patients with endometriosis is seen
by the current literature due to a lack of specific investigations. However, there is some
promise offered by a murine model that concludes that acupuncture may be capable of curing
endometriosis by acting on matrix metalloproteinase-2 levels to inhibit endometrial tissue
invasion. This is a bold claim, and much more research is needed in order to validate it.
(Chen, et al., 2008) There is however one recent paper that found that acupuncture, in
conjunction with ‘medicine’ can significantly improve oocyte retrieval, implantation and
pregnancy rates in endometriosis patients undergoing IVF. While the medicine referred to is
unclear in the abstract, this is an interesting finding and should be further investigated.
Although acupuncture has been used for centuries in some countries, its use in Western areas
is more recent, and growing. This increase in use means acupuncture is expected to be
exposed to the rigorous testing applied to all Western medicines. While more studies are
being done, it is fair to say that many do not adhere to the strict guidelines of randomised,
controlled studies; the ‘gold standard’ of Western medicine. Blinding is a particular problem
in many papers, and is seen by some to invalidate the results. A direct comparison of many of
the papers is also difficult. Different studies use different acupuncture protocols, timings and
durations. The causes of infertility and sub-fertility are numerous even within a single study.
The disparity between papers does make drawing a clear and logical conclusion complicated,
and this may be reflected in the lack of meta-analyses.
However, it may not be fair to even subject acupuncture to such research designs; it is not
after all a Western medicine. It is likely to always be seen as an adjunct to other
interventions, most evidently when used alongside IVF. Although the benefits of acupuncture
may not be clear, there are little if no reports of harm arising from acupuncture. It is
interesting that critics often state that any benefits from acupuncture are arising from a
placebo effect. Yet if something modulates an outcome positively, it should not matter if this
is from a physiological or psychological mechanism. More studies into patients’ perceptions
are needed in order to help strengthen acupuncture’s place as an adjunct to Western medicine.
If a patient believes a treatment will work, and feels supported in this belief by practitioners,
this may have a beneficial impact on the course of their treatment. This is particularly
important in a fertility setting, where psychological improvements such as stress reduction or
pain relief will have far reaching effects, and may well have a biological impact on
Alieva, E. A., Fanchenko, N. D., Parshutin, N. P., Gasparov, A. S. and Pshenichnikova, T. I.
(1993). The effect of a decrease in body weight in patients with the polycystic ovary syndrome. Akusherstvo i ginekologiia, 33.
Andersen, D., L ssl, K., Andersen, A. N., Fürbringer, J., Bach, H., Simonsen, J. and Larsen,
E. C. (2010). Acupuncture on the day of embryo transfer: a randomized controlled trial of 635 patients. Reproductive BioMedicine Online.
Aso, T., Motohashi, T., Murata, M., Nishimura, T., Kakizaki, K. and Kimura, S. (1976). The
influence of acupuncture stimulation on plasma levels of LH, FSH, progesterone and estradiol in normally ovulating women. Am J Chin Med4, 391-401.
Bai, Y. H., Lim, S. C., Song, C. H., Bae, C. S., Jin, C. S., Choi, B. C., Jang, C. H., Lee, S. H.
and Pak, S. C. (2004). Electro-acupuncture reverses nerve growth factor abundance in experimental polycystic ovaries in the rat. Gynecologic and obstetric investigation57, 80-85.
Balk, J., Catov, J., Horn, B., Gecsi, K. and Wakim, A. (2009). The relationship between
perceived stress, acupuncture, and pregnancy rates among IVF patients: A pilot study. Complementary Therapies in Clinical Practice16, 154-157.
Bovey, M., Lorenc, A. and Robinson, N. (2010). Extent of acupuncture practice for infertility
in the United Kingdom: experiences and perceptions of the practitioners. Fertility and Sterility.
Cai, X. (1997). Substitution of acupuncture for HCG in ovulation induction. Journal of Traditional Chinese Medicine17, 119-121.
Cakmak, Y. O., Akpinar, N., Ekinci, G. and Bekiroglu, N. (2008). Point-and frequency-
specific response of the testicular artery to abdominal electroacupuncture in humans. Fertility and Sterility90, 1732-1738.
Chen, B. Y. (1997). Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian
axis. Acupuncture and Electro Therapeutics Research-the International Journal22, 97-108.
Chen, D., Chen, S. R., Shi, X. L., Guo, F. L., Zhu, Y. K., Li, S., Cai, M. X., Deng, L. H. and
Xu, H. (2007). Clinical study on needle-pricking therapy for treatment of polycystic ovarial syndrome. Zhongguo zhen jiu= Chinese acupuncture & moxibustion27, 99.
Chen, J., Liu, L. L., Cui, W. and Sun, W. (2009). Effects of electroacupuncture on in vitro
fertilization-embryo transfer (IVF-ET) of patients with poor ovarian response. Zhongguo zhen jiu= Chinese acupuncture & moxibustion29, 775.
Chen, M., Zhang, H., Li, J. and Dong, G. R. (2010). Clinical observation on acupuncture
combined with acupoint sticking therapy for treatment of dysmenorrhea caused by endometriosis. Zhongguo zhen jiu= Chinese acupuncture & moxibustion30, 725.
Chen, Y. F., Zhang, C. Y., Zhang, X. Y., Sun, M. P., Zhang, Y., Huang, L., Jiang, W. Y.,
Yang, W. J. and Kong, W. G. (2008). Effects of acupuncture combined with medicine on expression of matrix metalloproteinase-2 in the rat of endometriosis. Zhongguo zhen jiu= Chinese acupuncture & moxibustion28, 675.
Craig, L. B., Criniti, A. R., Hansen, K. R., Marshall, L. A. and Soules, M. R. (2007).
Acupuncture lowers pregnancy rates when performed before and after embryo transfer. Fertility and Sterility88, 40.
de Lacey Sheryl, S. C. (2009). Building resilience: A preliminary exploration of women's
perceptions of the use of acupuncture as an adjunct to In Vitro Fertilisation. BMC Complementary and Alternative Medicine9.
Dieterle, S., Chunfang, L. I., Greb, R., Bartzsch, F., Hatzmann, W. and Dongmei, H. (2009).
A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. Fertility and Sterility92, 1340- 1343.
Dieterle, S., Ying, G., Hatzmann, W. and Neuer, A. (2006). Effect of acupuncture on the
outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertility and Sterility85, 1347-1351.
Domar, A. D., Meshay, I., Kelliher, J., Alper, M. and Powers, R. D. (2009). The impact of
acupuncture on in vitro fertilization outcome. Fertility and Sterility91, 723-726.
Dong, C., Chen, S. R., Jiang, J., Xiao, Y. H., Cai, M. X., Zhang, Y. J., Xu, H., Deng, L. H.
and Li, S. (2006). Clinical observation and study of mechanisms of needle-picking therapy for primary infertility of abnormal sperm. Zhongguo zhen jiu= Chinese acupuncture & moxibustion26, 389.
El-Toukhy, T. and Khalaf, Y. (2009). The impact of acupuncture on assisted reproductive
technology outcome. Current Opinion in Obstetrics and Gynecology21, 240.
El Toukhy, T., Sunkara, S. K., Khairy, M., Dyer, R., Khalaf, Y. and Coomarasamy, A.
(2008). A systematic review and meta analysis of acupuncture in in vitro fertilisation. BJOG: An International Journal of Obstetrics & Gynaecology115, 1203-1213.
Feng, Y., Johansson, J., Shao, R., Mannerås, L., Fernandez-Rodriguez, J., Billig, H. and
Stener-Victorin, E. (2009). Hypothalamic neuroendocrine functions in rats with dihydrotestosterone-induced polycystic ovary syndrome: effects of low-frequency electro-acupuncture. PLoS One4, e6638.
Fischl, F., Riegler, R., Bieglmayer, C., Nasr, F. and Neumark, J. (1984). Modification of
semen quality by acupuncture in subfertile males. Geburtshilfe und Frauenheilkunde 44, 510.
Fu, B., Lun, X. and Gong, Y. (2005). Effects of the combined therapy of acupuncture with
herbal drugs on male immune infertility--a clinical report of 50 cases. Journal of traditional Chinese medicine= Chung i tsa chih ying wen pan/sponsored by All-China Association of Traditional Chinese Medicine, Academy of Traditional Chinese Medicine25, 186.
Gerhard, I. and Postneek, F. (1992). Auricular acupuncture in the treatment of female
infertility. Gynecological endocrinology: the official journal of the International Society of Gynecological Endocrinology6, 171.
Gurfinkel, E., Cedenho, A. P., Yamamura, Y. and Srougi, M. (2003). Effects of acupuncture
and moxa treatment in patients with semen abnormalities. Asian journal of andrology 5, 345-348.
Ho, M., Huang, L. C., Chang, Y. Y., Chen, H. Y., Chang, W. C., Yang, T. C. and Tsai, H. D.
(2009). Electroacupuncture Reduces Uterine Artery Blood Flow Impedance in Infertile Women. Taiwanese Journal of Obstetrics and Gynecology48, 148-151.
Hu, Z., Chen, B., Tong, J., Huang, D. and Lu, S. (1993). The change of C-fos expression in
immunohistochemistry study. Acupuncture & electro-therapeutics research18, 117.
Huang, G. Y., Zheng, C. H., Wu, Y. X. and Wang, W. (2010). Involvement of connexin 43 in
the acupuncture effect of improving rat blastocyst implantation. Fertility and Sterility 93, 1715-1717.
Jedel, E., Labrie, F., Odén, A., Holm, G., Nilsson, L., Janson, P. O., Lind, A. K., Ohlsson, C.
and Stener-Victorin, E. (2010). Impact of electroacupuncture and exercise on hyperandrogenism and oligo/amenorrhoea in women with polycystic ovary syndrome: A randomized controlled trial. American Journal of Physiology-Endocrinology And Metabolism.
Jiang, D. S. and Ding, D. (2009). Clinical observation on acupuncture combined with
medication for treatment of continuing unovulation infertility. Zhongguo zhen jiu= Chinese acupuncture & moxibustion29, 21.
Jin, Y. B., Sun, Z. L. and Jin, H. F. (2009). Randomized controlled study on ear-
electroacupuncture treatment of endometriosis-induced dysmenorrhea in patients. Zhen ci yan jiu= Acupuncture research/[Zhongguo yi xue ke xue yuan Yi xue qing bao yan jiu suo bian ji]34, 188.
Johansson, J., Feng, Y., Shao, R., Lonn, M., Billig, H. and Stener-Victorin, E. (2010). Intense
electroacupuncture normalizes insulin sensitivity, increases muscle GLUT4 content, and improves lipid profile in a rat model of polycystic ovary syndrome. American Journal of Physiology- Endocrinology And Metabolism299, E551.
Johnson, D. (2006). Acupuncture prior to and at embryo transfer in an assisted conception
unit–. Acupuncture in Medicine24, 23-28.
Lai, M. H., Ma, H. X., Yao, H., Liu, H., Song, X. H., Huang, W. Y. and Wu, X. K. (2010).
Effect of abdominal acupuncture therapy on the endocrine and metabolism in obesity- type polycystic ovarian syndrome patients]. Zhen ci yan jiu= Acupuncture research/[Zhongguo yi xue ke xue yuan Yi xue qing bao yan jiu suo bian ji]35, 298.
Lee, M. S., Shin, B. C. and Ernst, E. (2009). Acupuncture for treating erectile dysfunction: a
systematic review. BJU international104, 366-370.
Liu, X. Y., Huang, G. Y. and Zhang, M. M. (2007a). Effects of acupuncture promoting
embryo implantation and development in the rat with dysfunctional embryo implantation. Zhongguo zhen jiu= Chinese acupuncture & moxibustion27, 439.
Liu, X. Y., Huang, G. Y. and Zhang, M. M. (2007b). Preliminary study on the mechanisms of
acupuncture in promoting embryo implantation in rats. Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi= Chinese journal of integrated traditional and Western medicine/Zhongguo Zhong xi yi jie he xue hui, Zhongguo Zhong yi yan jiu yuan zhu ban27, 633.
Madaschi, C., Braga, D., Figueira, R. C. S., Iaconelli, A. and Borges, E. (2010). Effect of
acupuncture on assisted reproduction treatment outcomes. Acupuncture in Medicine 28, 180 - 184.
Magarelli, P. C., Cridennda, D. K. and Cohen, M. (2009). Changes in serum cortisol and
prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization-embryo transfer treatment. Fertility and Sterility92, 1870-1879.
Manheimer, E., Zhang, G., Udoff, L., Haramati, A., Langenberg, P., Berman, B. M. and
Bouter, L. M. (2008). Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. British Medical Journal336, 545.
Manneras, L., Cajander, S., Lonn, M. and Stener-Victorin, E. (2009). Acupuncture and
exercise restore adipose tissue expression of sympathetic markers and improve ovarian morphology in rats with dihydrotestosterone-induced PCOS. American Journal of Physiology- Regulatory, Integrative and Comparative Physiology296, R1124.
Manneras, L., Jonsdottir, I. H., Holmang, A., Lonn, M. and Stener-Victorin, E. (2008). Low-
frequency electro-acupuncture and physical exercise improve metabolic disturbances and modulate gene expression in adipose tissue in rats with dihydrotestosterone- induced polycystic ovary syndrome. Endocrinology149, 3559.
Manni, L., Lundeberg, T., Holmang, A., Aloe, L. and Stener-Victorin, E. (2005). Effect of
electro-acupuncture on ovarian expression of alpha (1)-and beta (2)-adrenoceptors,
and p75 neurotrophin receptors in rats with steroid-induced polycystic ovaries. Reprod Biol Endocrinol3, 21.
Mo, X., Li, D., Pu, Y., Xi, G., Le, X. and Fu, Z. (1993). Clinical studies on the mechanism
for acupuncture stimulation of ovulation. JOURNAL OF TRADITIONAL CHINESE MEDICINE-ENGLISH EDITION-13, 115-115.
Moy, I., Milad, M. P., Barnes, R., Confino, E., Kazer, R. R. and Zhang, X. (2010).
Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization. Fertility and Sterility.
Ng, E. H. Y., So, W. S., Gao, J., Wong, Y. Y. and Ho, P. C. (2008). The role of acupuncture
in the management of subfertility. Fertility and Sterility90, 1-13.
Paulus, W. E., Zhang, M., Strehler, E., El-Danasouri, I. and Sterzik, K. (2002). Influence of
acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and Sterility77, 721-724.
Pei, J., Strehler, E., Noss, U., Abt, M., Piomboni, P., Baccetti, B. and Sterzik, K. (2005).
Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. therapy84, 141-7.
Riegler, R., Fischl, F., Bunzel, B. and Neumark, J. (1984). Correlation of psychological
changes and spermiogram improvements following acupuncture. Der Urologe. Ausg. A23, 329.
Rubi-Klein, K., Kucera-Sliutz, E., Nissel, H., Bijak, M., Stockenhuber, D., Fink, M. and
Wolkenstein, E. (2010). Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis? A randomised controlled cross-over trial Eur J Obstet Gynecol Reprod Biol. 153, 90-93.
Sherman, S., Eltes, F., Wolfson, V., Zabludovsky, N. and Bartoov, B. (1997). Effect of
acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Systems Biology in Reproductive Medicine39, 155-161.
Shu-ping, L. I., Chen, L. I. U., Qian, X. U. E. and Guo-min, H. U. O. (2008). Effect of
Acupuncture Therapy on Immune Function of Rats Endometriosis. Liaoning Journal of Traditional Chinese Medicine.
Siterman, S., Eltes, F., Schechter, L., Maimon, Y., Lederman, H. and Bartoov, B. (2009).
Success of acupuncture treatment in patients with initially low sperm output is associated with a decrease in scrotal skin temperature. Asian journal of andrology11, 200-208.
Siterman, S., Eltes, F., Wolfson, V., Lederman, H. and Bartoov, B. (2000). Does acupuncture
treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia32, 31-39.
Smith, C., Coyle, M. and Norman, R. J. (2006). Influence of acupuncture stimulation on
pregnancy rates for women undergoing embryo transfer. Fertility and Sterility85, 1352-1358.
So, E. W. S., Ng, E. H. Y., Wong, Y. Y., Lau, E. Y. L., Yeung, W. S. B. and Ho, P. C.
(2009). A randomized double blind comparison of real and placebo acupuncture in IVF treatment. Human Reproduction24, 341.
So, E. W. S., Ng, E. H. Y., Wong, Y. Y., Yeung, W. S. B. and Ho, P. C. (2010). Acupuncture
for frozen-thawed embryo transfer cycles: a double-blind randomized controlled trial. Reproductive BioMedicine Online20, 814-821.
Song, F. J., Zheng, S. L. and Ma, D. Z. (2008). Clinical observation on acupuncture for
treatment of infertility of ovulatory disturbance. Zhongguo zhen jiu= Chinese acupuncture & moxibustion28, 21.
Stener-Victorin, E., Fujisawa, S. and Kurosawa, M. (2006). Ovarian blood flow responses to
electroacupuncture stimulation depend on estrous cycle and on site and frequency of stimulation in anesthetized rats. Journal of Applied Physiology101, 84.
Stener-Victorin, E., Jedel, E., Janson, P. O. and Sverrisdottir, Y. B. (2009). Low-frequency
electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. American Journal of Physiology- Regulatory, Integrative and Comparative Physiology297, R387.
Stener-Victorin, E., Kobayashi, R. and Kurosawa, M. (2003a). Ovarian blood flow responses
to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats. Autonomic Neuroscience108, 50-56.
Stener-Victorin, E., Kobayashi, R., Watanabe, O., Lundeberg, T. and Kurosawa, M. (2004a).
Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries. Reprod Biol Endocrinol2, 16.
Stener-Victorin, E. and Lindholm, C. (2004b). Immunity and -endorphin concentrations in
hypothalamus and plasma in rats with steroid-induced polycystic ovaries: effect of low-frequency electroacupuncture. Biology of reproduction70, 329.
Stener-Victorin, E., Lundeberg, T., Cajander, S., Aloe, L., Manni, L., Waldenstrom, U. and
Janson, P. O. (2003b). Steroid-induced polycystic ovaries in rats: effect of electro- acupuncture on concentrations of endothelin-1 and nerve growth factor (NGF), and expression of NGF mRNA in the ovaries, the adrenal glands, and the central nervous system. Reprod Biol Endocrinol1, 33.
Stener-Victorin, E., Lundeberg, T., Waldenström, U., Bileviciute-Ljungar, I. and Janson, P.
O. (2001). Effects of electro-acupuncture on corticotropin-releasing factor in rats with experimentally-induced polycystic ovaries. Neuropeptides35, 227-231.
Stener-Victorin, E., Lundeberg, T., Waldenström, U., Manni, L., Aloe, L., Gunnarsson, S.
and Janson, P. O. (2000a). Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biology of reproduction63, 1497.
Stener-Victorin, E., Waldenstrom, U., Andersson, S. A. and Wikland, M. (1996). Reduction
of blood flow impedance in the uterine arteries of infertile women with electro- acupuncture. Human Reproduction11, 1314.
Stener-Victorin, E., Waldenström, U., Tägnfors, U., Lundeberg, T., Lindstedt, G. and Janson,
P. O. (2000b). Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta obstetricia et gynecologica Scandinavica79, 180- 188.
Sun, Y. Z. and Chen, H. L. (2006). Controlled study on Shu-Mu point combination for
treatment of endometriosis. Zhongguo zhen jiu= Chinese acupuncture & moxibustion 26, 863.
Sunkara, S. K., Coomarasamy, A., Khalaf, Y. and El-Toukhy, T. (2009). Acupuncture and in
vitro fertilization: updated meta-analysis. Human Reproduction24, 2047.
Tsenov, D. (1996). The effect of acupuncture in dysmenorrhea. Akusherstvo i ginekologii a
Wang, W., Check, J. H., Liss, J. R. and Choe, J. K. (2007). A matched controlled study to
evaluate the efficacy of acupuncture for improving pregnancy rates following in vitro fertilization-embryo transfer. Clinical and experimental obstetrics & gynecology34, 137.
Wang, Z. Q., Huang, Y. Q. and Liang, B. (2008). Clinical observation on electroacupuncture
and Chinese drug for treatment of oligospermia and asthenospermia of the male infertility patient. Zhongguo zhen jiu= Chinese acupuncture & moxibustion28, 805.
Wayne, P. M., Kerr, C. E., Schnyer, R. N., Legedza, A. T. R., Savetsky-German, J., Shields,
M. H., Buring, J. E., Davis, R. B., Conboy, L. A. and Highfield, E. (2008). Japanese- style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. Journal of pediatric and adolescent gynecology21, 247-257.
Westergaard, L. G., Mao, Q., Krogslund, M., Sandrini, S., Lenz, S. and Grinsted, J. (2006).
Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertility and Sterility85, 1341-1346.
Xiao-li, Y. U., Jun, C. and Wei, S. U. N. (2010). Acupuncture Combined with Medicine
Effects on Outcomes of Patients with Endometriosis Who Accepted IVF-ET. Liaoning Journal of Traditional Chinese Medicine.
Xu, J., Qu, H. Q. and Fang, H. L. (2009). Effect of electroacupuncture combined with
auricular point tapping and pressing on serum insulin and testosterone in the patients of obese women with polycystic ovary syndrome. Zhongguo zhen jiu= Chinese acupuncture & moxibustion29, 441.
Yang, J. R., Ma, Y. Y., Liu, Y. L., Wang, H. L. and Liu, Z. (2005). Controlled study on
acupuncture for treatment of endocrine dysfunctional infertility. Zhongguo zhen jiu= Chinese acupuncture & moxibustion25, 299.
Yang, S. P., Yu, J. and He, L. (1994). Release of gonadotropin-releasing hormone (GnRH)
from the medio-basal hypothalamus induced by electroacupuncture in conscious female rabbits. Acupuncture & electro-therapeutics research19, 19.
Yang, Y. K., Rong, H. B., Chen, H. P. and Tang, Y. (2007). Effects of moxibustion on
erectile function and NO-cGMP pathway in diabetic rats with erectile dysfunction. Zhongguo zhen jiu= Chinese acupuncture & moxibustion27, 353.
Yu, Y. P., Ma, L. X., Ma, Y. X., Liu, Y. Q., Liu, C. Z., Xie, J. P., Gao, S. Z. and Zhu, J.
(2010). Immediate Effect of Acupuncture at Sanyinjiao (SP6) and Xuanzhong (GB39) on Uterine Arterial Blood Flow in Primary Dysmenorrhea. The Journal of Alternative and Complementary Medicine, 168-291.
Zhang, M., Huang, G., Lu, F., Paulus, W. E. and Sterzik, K. (2002). Influence of acupuncture
on idiopathic male infertility in assisted reproductive technology. Journal of Huazhong University of Science and Technology. Medical sciences= Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban= Huazhong keji daxue xuebao. Yixue Yingdewen ban22, 228.
Zhang, W. Y., Huang, G. Y. and Liu, J. (2009). Influences of acupuncture on infertility of
rats with polycystic ovadian syndrome. Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi= Chinese journal of integrated traditional and Western medicine/Zhongguo Zhong xi yi jie he xue hui, Zhongguo Zhong yi yan jiu yuan zhu ban29, 997.
Zhao, H., Tian, Z. Z. and Chen, B. Y. (2003). An important role of corticotropin-releasing
hormone in electroacupuncture normalizing the subnormal function of hypothalamus- pituitary-ovary axis in ovariectomized rats. Neuroscience letters349, 25-28.
Zhiyuan, Q. (1997). Clinical observation of 54 cases of male infertility treated by
acupuncture and moxibustion. J Chin Med52, 12-13.
Zhou, J. and Qu, F. (2009). Treating gynaecological disorders with traditional Chinese
medicine: a review. African Journal of Traditional, Complementary, and Alternative Medicines6, 494.
Estrategia Diagnóstica a Seguir en la Investigación de la Hipoacusia en la Infancia Este capitulo esta basado en 3 conjeturas: (1) la sordera es común, (2) la etiología básica varía alrededor de todo el mundo y (3) la estrategia diagnóstica debe ser secuencial tomando en cuenta la lateralidad y la severidad de la pérdida auditiva. 1) La sordera es frecuente La sordera es el défi