How Fertility Acupuncture works for each IVF Stage

In this article we are going to look at the main stages of IVF, the common medications, side effects and the Chinese Medicine translations of these and how acupuncture supports you for each specific stage, including IUI and frozen transfers.

Stages of drug treatment during the IVF cycle:  

1.      Down regulation to turn off hormones

2.      Stimulation to produce the eggs.

3.      Trigger injection to mature eggs

4.      Egg collection

5. Embryo Transfer

1.      Down Regulation

These drugs work at the level of the pituitary to shut down normal hormone production and stop ovulation. They down regulate the natural hormones for a more controlled treatment cycle.

They are usually administered by injection or nasal spray. They are called GnRH (gonadotrophin releasing hormone) analogues or pituitary agonists/antagonists. They can cause menopause type side effects and some patients have called them the ‘Devil’s Drug’ due to this. Don’t worry as the effects are short term and acupuncture can counter-act them.  

Side Effects:

·       Hot flushes

·       Headaches

·       Mood changes

·       Waking at night

Chinese Medicine:

In Chinese Medicine we call this Yin deficiency and Liver Qi Stagnation. We use points to nourish your Yin (feminine energy). We do this by supporting your Heart and Kidney channels with acupuncture points. We also move the Liver channel to release the emotional blockages.

Names of Medications:

The agonists can be part of a short protocol to give your body a hormone flare before shutting down hormone production. The most common ones that Creation Acupuncture patients encounter are BUSERELIN and PROSTAP. The antagonists also have a role in stage 3, which we will discuss further on…

Agonists:

·       Prostap

·       Buserelin

·       Supercar, suprefact

·       Nafarelin, synarel

·       Leuprolide, Lupron

Antagonists:

·       Cetrorelix, cetrotide, orgalutran

Oral Contraceptive Pill:

If your clinic has put you on a long protocol, you may also have the oral contraceptive pill such as norethisterone. The pill allows your ovaries to rest and resets the cycle so that it can be controlled.

Acupuncture for Down Regulation:

The pill causes stagnation so a fertility acupuncturist will use needles to move the Qi and Blood. When we move Blood, we make sure that the oestrogen levels are lowered for the beginning of the cycle. We also support the Spleen and use a lot of calming points during the long protocol.

2.      Stimulation

The second stage introduces follicle stimulating drugs which mirror natural hormones and have an FSH like effect as well as raising E2 (oestrogen) levels. They can cause PMT type side effects. They are administered by injection. With IUI, this stage could use the IVF stimulation drug or a milder version of ovulation induction such as clomid or letrozole.

Names of medications:

·       Menopur

·       Gonal-F

·       FollistimAQ

·       Merional

·       Menogon

·       Puregon

Acupuncture for Stimulation:

During the stimulation phase, the medications hit the Qi hard and your energy is depleted. So a fertility acupuncturist will support your Spleen and Kidney to nourish follicular growth and egg quality. We also include calming points for the spirit. In the case of PMT symptoms, we move the Liver Qi and clear Heat.

·       If the lining of the Uterus is thin, there are specific points that we can use to increase the lining.

·       If follicles are slow to grow we include points on the abdomen to increase Qi and Blood flow to the ovaries and follicles, usually incorporating electro-acupuncture.

·       With PCOS or a large number of follicles present, in this stage, we clear Damp and Heat, in order to reduce the risk of overstimulation.

·       With patients with endometriosis or immune system issues, there are also a set protocol of acupuncture points to move the Qi and Blood and support the immune system.

3.      Maturation of Eggs

During the third stage, GnRH medication such as cetrotide or ganorelix prevent ovulation so the follicles are grown to optimum size. They block the LH surge in response to rising oestrogen. Side effects such as headaches and mood swings could occur. When the follicles have reached around 18-20mm the HCG (human chorionic gonadotrophin) trigger injection matures the eggs so they are ready for collection. This is given 36 hours before egg collection and timed precisely.

Names of medications:

·       GnRh – cetrotide, ganorelix

·       HCG – pregnyl, gonasi, ovitrelle

Acupuncture After Trigger Shot:

In acupuncture, we aim to treat patients on the day after the trigger injection has been administered which is the day before egg collection or IUI. We nourish the Spleen, Liver, Kidneys and ovaries to support the maturation of the eggs.

4.      Egg Collection

During trans-vaginal oocyte removal (TVOR) more commonly known as egg collection, each follicle is cut in order to retrieve as many eggs as is possible. The body thinks it has had an operation. Oestrogen rich fluid flows into the peritoneal cavity and there is an element of recovery necessary, especially if multiple follicles have been produced and cut into.

Names of medications:

Sedative medication such as benzodiazepines will be administered intra-venously by an anaesthetist. The dose may vary according to patients and tolerance to sedation has a correlation with alcohol tolerance so how you feel afterwards varies from patient to patient.

Acupuncture post egg collection:

In acupuncture, we aim to treat patients after egg collection if there is PCOS or multiple follicles as we need to clear damp, move blood and support the spleen to aid recovery. Acupuncture post egg collection in a PCOS woman, or someone with high hormone levels, can help to prevent OHSS (over-stimulation) in order to maximise the chances of a successful fresh transfer.

What Happens in a Frozen Cycle?

Usually two weeks of agonist medication is given to suppress the pituitary and prevent natural ovulation.

Then oestrogen (Ostrodial) is introduced via patches, creams or tablets. This thickens the lining of the uterus.

When the lining is thick enough, progesterone is added to mature the lining and make the endometrium receptive to implantation.

The stage of the uterus matches with the stage of embryo development.

5. Embryo Transfer

In order to place the embryo into the uterus, the cervix is dilated and the embryo or embryos are transferred via a catheter. The embryologist then checks the catheter via microscopic equipment to ensure that all the embryos have been inserted.

There is usually no need for sedation and the procedure is quick and straightforward. There is no evidence that sitting or lying after transfer have any effect on the outcome. However, there is research suggesting that laughing after transfer, for example, watching a comedy show, does have a positive effect on pregnancy outcomes.

Acupuncture for Embryo Transfer:

There is a set acupuncture treatment named the Paulus Protocol that is associated with higher rates of pregnancy after embryo transfer when a set protocol of acupuncture points are performed before and after transfer. These points include auricular (ear) acupuncture and earseeds which should be manipulated during transfer. The treatment principles are to relax the uterus, nourish the blood and increase blood flow to the uterus, calm the emotions and boost the Qi. There are also points on the top of the head that help to hold the embryo in place.

Implantation Acupuncture

For a day 3 embryo, implantation would begin 5 days post transfer.

For a day 5 blastocyst, implantation would begin 3 days post transfer.

All the acupuncture treatment we give at this point is designed to nourish embryo growth and maintain implantation. We use points to keep hormone levels raised and the lining thick, prevent unnecessary uterine contractions and calm the emotions.

As a fertility support trained acupuncturist, we believe that implantation is a key time for acupuncture.

I would aim to treat patients twice in the week of transfer with a choice between pre, post and implantation acupuncture.

Good luck to all of you going through assisted reproduction!

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