5 IVF and Acupuncture Add Ons for Fertility Success

Have you ever heard of the scratch or the Emma Alice test from your fertility clinic?

And in your acupuncture session, why do you have ear acupuncture or the electro machine?

Let’s rate the benefits of both IVF and Acupuncture add-ons for fertility outcomes.

IVF Add-Ons:

1. Assisted Hatching

2. Endometrial Scratch

3. Embryo Glue

4. ERA

5. EMMA ALICE

   
   

Acupuncture Adjunctive Therapies:

1. Moxa

2. Auricular Acupuncture and Ear Seeds

3. Electro Acupuncture

   
   

Assisted Hatching

This involves thinning the outer layer of the embryo or making a tiny hole in it, before replacing it in the uterus during an IVF cycle.

Useful for:

·       Patients with high FSH

·       Patients over 38 years of age

·       Poor quality embryos

·       Embryos with thickened shells

·       History of failed IVF cycles

HFEA Rating: Red. No evidence from high quality studies to support its use.

Price: Varies greatly between clinics, some offer it as free if it is included in a package. Usually £200-500

Endometrial Scratch

Endometrial scratching is carried out before IVF, usually in the cycle before treatment at around day 21 (for those with a regular cycle). During the procedure, the lining of the uterus is scratched with a small sterile plastic tube. This triggers the repairing process at the site of injury which release chemicals and hormones which aid in endometrial receptivity to implantation. In order to establish a successful pregnancy, the environment in the uterus must be ideal for implantation. There may be some side effects such as abdominal cramping, pain and bleeding.

Useful for:

·       Previous failed transfer

·       History of miscarriage

·       History of failed IVF cycles with good quality embryos

HFEA Rating: Amber. Some evidence to suggest a benefit for enhanced fertility outcomes.  

Price: Approximately £300-350

Embryo Glue

Embryo glue is a culture medium containing hyaluronic acid. This is naturally found in the uterine lining and is important for implantation. Using embryo glue is believed to improve the chances of the embryo adhering to the endometrium. Some research suggests increased pregnancy rates from the use of embryo glue.

Useful for:

Anyone

HFEA Rating: Amber – no known risk, overall effectiveness unclear.

Price: Estimated at £220, some clinics provide it as standard.

ERA

This is endometrial receptivity analysis.

Using a biopsy of the uterus and monitoring for certain genes, ERA enables a fertility clinic to work out the optimum implantation window for your body and therefore they are able to tailor embryo transfer to a more specific and personalised timeline. This increases the chance of an optimal environment for implantation. The uterus is only receptive to implantation for this short window. Usually this is 7-9 days after the LH surge or trigger injection but research suggests that the implantation window it can be shorter or longer for different women. Therefore ERA allows for a more personalised treatment.

The results take 2-4 weeks so it usually undertaken in a dummy cycle or natural cycle before IVF.

Useful for:

• Women under 37 with a previous failed transfer of a good quality embryo.

• Recurrent IVF failure caused by endometrial issues.

• Women using donor eggs as future cycles may not be guaranteed.

• When there is only one embryo to transfer

• Surrogacy

Price: £1000-1500. Some clinics offer the trio of ERA EMMA ALICE for £1500

HFEA rating: Red. Not enough evidence from randomised controlled trials. However the research does show that ERA significantly increases the chances of pregnancy for women with recurrent IVF failure from endometrial issues.

EMMA ALICE Testing:

EMMA and ALICE are screening tests that check for bacteria in the uterus that might cause inflammation which can lead to implantation failure. Endometrial health is very important for successful implantation. The tests involve a small biopsy of endometrial tissue. Side effects can be cramping and bleeding.

EMMA

This is a detailed screening for endometrial bacteria and microbiome and analysing heathy bacteria levels for optimal implantation. If it is out of balance, vaginal probiotics are often prescribed to increase implantation success.

ALICE

This test assesses 8 bacteria that cause infections of the uterine lining. This is called endometritis and can be harmful to embryo implantation. Treatment is often antibiotics.

Useful for:

ALICE - natural conception, recurrent miscarriage

EMMA - includes the Alice testing.

• Patients with endometriosis

• 3 IVF failures

• Patients using donor eggs or embryos

• Recurrent miscarriage especially after a D and C

• Unexplained infertility

  
  

Price: ALICE £700, both £1000, trio £1500

HFEA Rating: No classification. This treatment doesn’t yet have enough randomised controlled trials demonstrating effectiveness for live births.

Acupuncture Adjunctive Therapies:

Moxa

During moxabustion (moxa) the herb mugwort is burnt in the form of a cigar stick, in a similar way to incense. It warms the uterus and the feet, where the kidney channel (important for supporting and strengthening the uterus) starts.

Moxa is very effective for quickly warming the uterus in preparation for optimal implantation. It should be used in preparation for IVF or natural conception. In order to support and maintain implantation and pregnancy, the uterus should be warm and the abdomen should feel warm to touch. You can also use acu-warmers with moxa or ginger. These are heated packs that you can strap to the abdomen.

Useful for:

• Cold in the Uterus

• Kidney Yang Deficiency

• Short luteal phase

• Low progesterone

• IVF failures

Price: £6-20 for 10 moxa sticks from Amazon.

Side effects: the smell is quite strong! Don’t use if you feel hot and have a diagnosis of heat in the body.

Auricular Acupuncture

Auricular acupuncture or ear needling, involves placing needles in auricular points on the ear. Each point responds to a different organ or area of the body. The common points needled in fertility acupuncture are:

Shen men – to calm the spirit

Endocrine – to balance the hormones

Uterus – to activate the Uterus to receive an embryo

Kidney – to support the Kidney energy to strengthen the Uterus

Spleen – to strengthen the Spleen energy

Ear seeds are vaccaria seeds adhered to a very small plaster, which attaches to the ear at specific acupuncture points. These usually stay on the ear for up to 7 days and when manipulated, help to stimulate the parasympathetic nervous system to reduce anxiety. For embryo transfer we also place ear seeds at the brain, endocrine and uterus points on the ear to support endometrial receptivity to implantation.

Price: Free with acupuncture session

Useful for:

• Embryo transfer

• Reducing stress and anxiety

  
  

Electro Acupuncture

 Electro acupuncture involves attaching wires to needles to send a small and safe electrical current though them. This activates the points more intensely and is especially effective for clearing blockages. We use these when we want to clear Damp or Blood Stasis, for example with PCOS or endometriosis patients. We also use them to stimulate the ovaries in the follicular phase and during the stimulation stage of IVF. This promotes blood and Qi flow to the ovaries and encourages follicular growth.

Price: Free with acupuncture session

Useful for:

• PCOS

• Endometriosis

• Fibroids

• Stimulation stage of IVF - follicle growth

• Increasing the lining of the uterus