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41 questions

My daughter, aged 39, has had 4 failed attempts at IVF using embryos created from donor eggs and sperm. She was made infertile age 19 when she was diagnosed with cancer and had her ovaries removed. 3 weeks later I was told it wasn't cancer she had and that IVF would be made available to her. It has taken 20 years for the treatment to be offered. She still has a womb.  Her second cycle of IVF is due to start in the next month. It is heartbreaking to watch her disappointment when it doesn't work. Would acupuncture help  ?

We are very sorry to hear of your daughter's early experiences; that is quite some burden to be handed at such a young age.

We are always very cautious in answering questions about acupuncture and IVF. Treatment for fertility has become something of a growth industry over the last decade, and a great many clinics are now offering acupuncture as a part of the package. More disturbingly, from this expert's perspective at least, is the fact that the charges for sessions are running at a much higher level than for an ordinary acupuncture session. This is difficult to fathom; from a Chinese medicine perspective, there are only people, not conditions, and the essence of good treatment is to treat the patient and not the disease. This means, broadly speaking, that whatever disease label a patient has the treatment should be the same because it is the inherent imbalances in the system which express themselves as symptoms. With everything in the system being interconnected that means that a symptom could appear anywhere, and means that good practice tries to understand why this particular symptom arises in this person. Ultimately, however, even if this remains unclear, balancing the system as a whole should help to relieve the symptom.

Something of a long preamble, we're afraid, but the bottom line is that there are no specific points which a practitioner can use which by themselves for IVF make all the difference. There is one rather well-known protocol, called the Paulus Protocol, which received a great deal of publicity a few years ago, because it was shown to improve the success of implantation by treating the patient at the time the eggs were implanted, but the acupuncture was roundly criticised by many of our members for being formula treatment. However much better traditional treatment may have been, the bottom line is that there is some suggestion, backed up by properly conducted research, that acupuncture treatment at this stage can help. There are many studies, mostly Chinese, which tend to show positive outcomes too, such as this one

http://www.ncbi.nlm.nih.gov/pubmed/22243605

although, unlike this one, many are methodologically flawed.

As practitioners we would want to see first hand what else may be going on in your daughter's system which might be causing the embryos not to take. This can sometimes be very basic stuff, like the lower part of the abdomen being very cold and energetically unhelpful, right through to much more complex patterns involving some of the emotional disturbances which may be a part of the overall picture. The best advice that we can give is that your daughter visits a BAcC member local to her and seeks a brief face to face assessment of what may be going on.

An increasing number of members have undertaken postgraduate training in this area, and there are many websites, some belonging to our own members, which speak of acupuncture and fertility treatment as though it were a recognised sub-section of Chinese medicine. It isn't, but there is often some value to be had from seeing a practitioner who specialises in working with women having IVF treatment. Being able to talk to someone who knows exactly what happens is often helpful.

Q:  I am getting acupuncture for fertility reasons but I am a little worried.  My practitioner does not talk at all during the session which is probably normal. He begins with a very rough massage and then places needles in key areas. I am left to lie there for 20 mins until he returns to  the room and says you are finished now and that's it. I keep hearing how relaxing acupuncture is,  so I am now worried because my sessions seem so functional.  In saying that I am there to help me get pregnant so if it works I can live without the relaxation element. Please advise.

A: We are sorry to hear that your experience of treatment is not quite as you expected. Of course you are absolutely right - when you become pregnant the fact that the sessions were not as relaxing as you had hoped will fade into the background. As one of our old teachers once said, 'you're there to make people better, not to make friends'. That said, he was mainly warning about avoiding difficult treatments and hard questions, not about failing to make rapport -this was one of his great legacies, the need to establish a good rapport. While it is not an essential part of the treatment, many people do report going into states of deep relaxation when they are treated, and most practitioners will try to ensure that their patients find the experience enjoyable, whether because they drop into a restful and meditative state or talk about
their experiences and life in general.

Some practitioners, however, do not work in this way. It is not unknown for practitioners to work in the way you describe, and for some practitioners trained overseas this can often be the norm. Many Chinese practitioners, for example, are used to treating people in outpatient departments such as those where they initially trained, and this can involve working at great speed to move from patient to patient, with sometimes as many as 100 patients to see in a day. Working in the way you describe could simply be how they were trained.  This is not confined to Chinese practice; there are also a number of indigenous practitioners who prefer to let the needles do
the talking, and treat and leave. Indeed the majority of Chinese practitioner working in the West enjoy the greater amount of time available to build rapport and allow for relaxation.

Essentially, then, this is not abnormal, but not quite what you had hoped for. We suppose the choices are a little bit stark: carry on as is or drop this practitioner and go to another one. We would not be foolish enough to suggest you talk to the practitioner about changing the way he works. It might, though, he possible to address the fact that the massage is a little intense by asking for a more gentle version of the same; most responsible practitioners will be more than happy to adjust their treatments to suit the patient. This may help to make the treatment more relaxing.

We generally recommend that prospective patients shop around if they are in any doubt about what they are about to take on, and we always take the view that while rapport is not essential it helps to make the experience an enjoyable one. The same applies for length of treatment; if a very friendly practitioner works in 20 minute sessions that might not be as valuable to a prospective patient as treatment from someone with slightly less good rapport but who allows longer in the treatment room. People are perfectly free to change practitioners, and there is no reason for a subsequent practitioner to contact the previous one if the patient says that they should not. If you did choose to move, there would be no problem as long as you cancelled any outstanding treatments in good time.

Above all, though, we hope that the treatment works.

Q:  What is the best time in the cycle to begin acupuncture to boost fertility?

A: The prevalence of practitioners offering to assist in fertility has created a rather unwelcome myth that there are good and bad times to have treatment. From a Chinese medicine perspective, someone's fertility is a part of a much wider pattern of health and balance within the whole system, and the diagnosis made from this perspective will be about the person, not the part of the body or the time of the month. In exceptional circumstances there can be specific problems like Cold in the Womb which can be tracked back to specific events, but this is quite rare. The problems with fertility are often part of a much wider pattern, and treatment will have to be aimed at restoring balance across the system as a whole, which may take weeks or even months.

However, we would not want to write off the experience of an increasing number of our members who have undertaken postgraduate training in this area and whose focus has been on treating fertility and pregnancy for many years. Although the Chinese medicine does not set them apart, because we all use the same systems of diagnosis and treatment, their working knowledge of the problems which women experience and their experience of treating many women with fertility issues mean that they can be a great resource and help to a patient. They have seen similar problems before, and may well even have useful perspectives on what is happening from a western medical point of view - occasionally women slip through the conventional system with a fairly straightforward problem which has not been picked up. If you visit someone who focuses their work in this area, you may well benefit from their years of experience.

There are, though, no 'special points' which can be applied at specific times to make conception more likely. That said, many of us try to work in such a way that we treat near the time of ovulation to give the system the biggest boost possible, but there is no research evidence suggesting that this is any more than a construct which we use to fuel our own intention! Such research as does exist, which as our factsheet shows is not that great

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/female-fertility.html

tends to the view that the greatest help can come from treatment aimed at regularising the menstrual cycle or reducing the impact of PCOS. These, though, are usually treated systemically, i.e. for ten women presenting with irregular periods there may be ten different diagnoses and treatments in Chinese medicine depending on what is happening within their systems as a whole. In Chinese medicine every patient is unique, as is their treatment, even where there named condition is the same.

We are not able to give referrals to specific individuals or groups, but there are a number of well-established networks within the BAcC treating fertility issues with acupuncture, and a good search under 'acupuncture' 'fertility' and your area will very quickly identify those members who have undertaken postgraduate training in this field. We believe, though, that any BAcC member will be able to give you useful advice, and most importantly from your point of view, establish in a brief face to face assessment whether acupuncture is the best treatment to try to help you become pregnant.

 

Q:  My partner and I tried acupuncture for infertility and we both had a 'bioenergy stress test' performed (you hold a rod in one had and a small amount of electric current passes through your body and is tested by a practitioner holding a pen-type device against the finger tip of your other hand.) We asked questions and they did not really tell us how it was supposed to work. We explained symptoms but nobody looked at our tongues or checked our pulses, which we thought would happen.  They did not recommend any diet / herbs / lifestyle changes either apart from accupuncture.
So my questions are 1. is a bioenergy stress test alone a good way to know which pressure points to use on an individual and 2. how should a practitioner decide how (and where) to treat a patient?

A: There has been considerable controversy about the use of these machines. They derive from the work of a German scientist called Voll, and the first were known as EAV machines - Electro-acupuncture According to Voll. The technique borrows heavily on the concepts of energy flow and meridians, and overlaps with some of the basic premises of traditional Chinese medicine. There is no doubt that they record something, and there are many people in the UK, including a small number of BAcC members, who believe implicitly in their efficacy. They find that their observations using traditional techniques like tongue and pulse are confirmed by what their machines tell them.

However, a training in traditional acupuncture is not an entry ticket to the wide world of alternative and complementary medicine. We have a scope of practice as acupuncturists which outlines very clearly what we expect members to do, what members of the public can expect, and the point at which it becomes incumbent on the practitioner to tell a patient that what they are doing is not within the scope of practice. If this latter is the case, we have rules which specify that someone has to be properly trained, has to hold proper insurance for the technique in the event that our own insurers will not extend cover, and has to have explained all of this to a patient before they can be assumed to have given consent to the use of the adjunct, whatever it may be.

Tongue and pulse are pretty much standard fare in the main acupuncture styles, but we have to say that there are a number of traditions, Japanese Meridian Therapy being one, where palpation of the channels is the primary information gathering technique, drawing on the fact that a large percentage (as many as 20%) of Japanese acupuncture practitioners are blind. This goes back to an exemption granted to blind practitioners when non-medical acupuncture was banned in the late 19th century in Japan, and the fact that most training in Japanese remains apprentice style. One might argue that using a piece of modern technology to establish the same information was legitimate, although it has to be said that conductivity alone would not even begin to replicate the subtlety and sophistication of a properly trained practitioner.

The bottom line, though, is that you expected to be treated using traditional techniques, and not only were these not used but instead you were tested with a machine for the mechanism of which no adequate explanation was given. If the practitioner belongs to the BAcC, we would be interested in taking the matter up with them. We cannot prescribe what individual members do, but we can insist that they ensure that what they do falls within scope and, if it doesn't, is also explained to a patient sufficiently well that they can be said to have given properly informed consent. If the practitioner is not a BAcC member but belongs to another association, then we are confident that they will also have mechanisms through which you can address your concerns.

This expert's particular concern is that issues around fertility are often highly emotionally charged, and there is too much evidence from the wider field of fertility treatment of people using acupuncture in a non-traditional way for which they are charging extravagant sums of money. From the traditional acupuncture perspective, there is only acupuncture, not fertility acupuncture. There are no special points which form a special subset of treatment, and the kinds of patterns which present in women (and men) with fertility problems are not a jot different from patterns which manifest in different symptoms in other people. Traditional acupuncture treats the person, not the condition, and the treatment, often drawing heavily on tongue and pulse diagnosis, aims at re-establishing proper flow and function in the system as a whole in the simple belief that a system in balance will do what it's supposed to.

In the end, though, the proof of the pudding is in the eating. Many of the points used in western medical acupuncture, for example, are in the same place as those used in traditional acupuncture and will generate the same results for what are perceived as entirely different reasons. It may well be that the results given by the EAV machine match very closely the sorts of point choices someone may have made using traditional means of diagnosis. Hopefully the practitioner will be able to explain this better and more fully when you next visit. If, however, you remain dissatisfied with the outcome, then all professional associations have clearly signposted procedures for making complaints, over and above simply voting with your feet and finding someone who works as you would prefer them to with the old tried and trusted methods.  

Q: have PCOS and recently had a miscarriage in August after nearly 4 years of trying. I am keen to conceive again.  I have fortnightly reflexology appointments and am interested in acupuncture as I have heard positive reviews. Would this be beneficial for me to try this along with reflexology? Would this be likely to increase my chances?

A:   We have been asked about PCOS on a number of occasions, and a typical answer we have given has been:

Q. i suffer from pcos on both ovaries, i also suffer from weight issues due to this but have been told by nhs that they cannot help until my bmi is below 30. I know that i need to help myself but can accupuncture help whilst trying to concieve. Have been trying for 5 years.

A. The evidence for the treatment of fertility problems with acupuncture is a little thin, as our factsheet  shows. 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/female-fertility.html

There are a number of studies which appear to indicate that acupuncture may help PCOS and the attendant fertility problems which it can cause, but not enough and not enough of consistently high quality for us to make any claims.

  However, traditional Chinese medicine has a very long history of treating exactly the same issues which trouble people today, and although its conceptual basis is entirely different from conventional western medicine, the symptoms which people have and the way in which they describe them haven't changed, and have been diagnosed and treated in Chinese medicine terms for centuries. There are a number of patterns or syndromes in Chinese medicine which reflect quite closely the sorts of problems which PCOS sufferers have and their problems with fertility, and a practitioner may be able to use these as the basis of a worthwhile strategy.

We have to be realistic, though, PCOS makes pregnancy difficult, whatever system of medicine you use to diagnose it. Our main concern is that you are not led into unnecessary time and expense for something which cannot help, and not diverted from conventional treatment which may ultimately be of benefit. Our members are responsible and safe practitioners, and if you visit one local to you, we hope that they are happy to see you for a short consultation, hopefully without charge, to determine whether the unique case which you represent in Chinese medicine terms is one for which they feel that treatment may offer some hope.

We think that this remains sound advice. Acupuncture treatment will certainly do no harm, and from a Chinese medicine perspective, where treatment is aimed at the person rather than the named condition from which a person suffers, there is a great deal to be said for maximising the body's function. The simple but profound belief underpinning a great deal of eastern medicine is that if everything is functioning as it should, then symptoms will disappear. However, one has to be realistic; where there has been longstanding pathological change it may be a much harder task to try to return basic functions to their normal state, and we are always very careful to make sure that we do not give patients false and unrealistic expectations of what might happen.

We also need to re-iterate what we have said in earlier answers, that something of an industry has built up around female fertility issues which, in this expert's view, have started to see practitioners charging more for their services than they would for 'ordinary' treatment. There is nothing, in my view, to justify this; acupuncture treats the person, not the condition, and there is very little additional expertise available in Chinese medicine to treat the problems with fertility which does not form a part of the basic training which all practitioners have. The only advantage of expert training in fertility problems is that it imparts greater knowledge of the western medicine involved and passes on the wisdom and experience of expert practitioners. This may warrant a small additional charge, but we have seen acupuncture being offered within some of the fertility clinics outside the traditional acupuncture 'circuit' at alarming fees.

We are confident that if you visit a BAcC member local to you for advice you will get a fair and realistic assessment of how and whether acupuncture treatment may be of benefit to you. 

 

 

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