In vitro fertilization adjunctive interventions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4]

## Overview

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## Adjunctive Interventions

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There are several variations or improvements of IVF, such as ICSI, ZIFT, GIFT and PGD. An increasing number of fertility specialists and centers offer acupuncture as a part of their IVF protocol, or maintain a list of acupuncturists specializing in infertility.

### ICSI

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Main article: Intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) is a more recent development associated with IVF which allows the sperm to be directly injected in to the egg using micromanipulation. This is used for sperm that have difficulty penetrating the egg and when sperm numbers are very low. ICSI results in success rates equal to IVF fertilisation.

### ZIFT

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Main article: Zygote intrafallopian transfer

In Zygote intrafallopian transfer (ZIFT) eggs are removed from the woman, fertilized and then placed in the woman's fallopian tubes rather than the uterus.

### GIFT

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Main article: Gamete intrafallopian transfer

In gamete intrafallopian transfer (GIFT) eggs are removed from the woman, and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilization to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilisation, and not an in vitro fertilisation.

### PGD

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Main article: Preimplantation genetic diagnosis

PGD can be performed on embryos prior to the embryo transfer. A similar, but more general test has been developed called Preimplantation Genetic Haplotyping (PGH).

### Acupuncture

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An increasing number of fertility specialists and centers recognize the benefits of acupuncture and offer acupuncture as a part of their IVF protocol. Limited but supportive[1] evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life[1] of patients undergoing IVF and that it is a safe[1] adjunct therapy.

#### Mechanism of acupuncture

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Scientific literature lists four[1] mechanisms of how acupuncture can improve IVF outcomes ; these include

* Neuroendicrinological modulations
* Increased blood flow to uterus and ovaries
* Modulation in cytokines
* Reducing stress, anxiety and depression

#### Studies

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Summarizing four acupuncture trials published in peer reviewed scientific journal Fertility and sterility, involving a total of just under 800 women, the results clearly showed a pregnancy was twice as likely to occur in the acupuncture group compared to the control group[5]. Many fertility specialists recognize the positive role of acupuncture, although there are some methodological issues to be taken into account when assessing non-pharmacological studies, furthermore there are issues when assessing effectiveness of acupuncture, as the treatment is performed in person and is very difficult to fake acupuncture. Even the fake needles used in acupuncture trials as a placebo are considered to be able to produce a therapeutic effect through acupressure, making the research even more difficult.

Following are examples of individual studies.

According to a report published in Fertility and Sterility, if done correctly, Acupuncture significantly improves IVF success rate[6].

Researchers in Adelaide has evaluated the effect of acupuncture on women undergoing IVF, and couldn't exclude a smaller treatment effect. However, there was no (statistically) significant difference compared to a control group of women not getting acupuncture[2]

A randomized, prospective study [7] showed that acupuncture significantly (p<0.01) increased IVF implantation rates and pregnancy rates. Positive trends were also observed in miscarriage rates although the results were not statistically significant. The study has been criticized by one scientist for lacking traditional scientific practices when interpreting the data [3], and by another scientist that positive impact of acupuncture on IVF success rates is not definitive. [4]. However, assessments of nonpharmacological treatments must take into consideration additional methodological issues. This criticism is possibly arising from lack of understanding of methodological differences in clinical trials evaluating nonpharmacological and pharmacological treatments[5] and in particular methodological issues in trials of acupuncture [6].

#### Electro-acupuncture in oocyte retrieval for IVF

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Electro-acupuncture has a proven analgesic effect in oocyte retrieval for IVF.

### Complementary medicines

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Infertility patients commonly use complementary medicines. Health-care practitioners and fertility specialists need to be proactive in acquiring and documenting the use of these practices. There is a need to provide further information to patients on the use of CMs and therapies. Further research examining the reasons for use of CMs and therapies is needed.[8]

### Hypnosis

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A study of hypnotherapy suggests a higher success rate when integrated with treatment [9]. However, this study is not without criticism. Experts say the study failed to take into account key differences between the groups compared in the study. These differences would have had a major influence on their chances of conceiving [7].

## References

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1. ↑ 1.0 1.1 1.2 1.3 [1] Anderson BJ, Haimovici F, Ginsburg ES, Schust DJ, Wayne PM. Pacific College of Oriental Medicine, New York, USA.
2. ↑ [2] Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Smith C, Coyle M, Norman RJ. School of Health Science, The University of South Australia, South Australia, Australia. caroline.smith@acnhw.com.au
3. ↑ [3] Collins J. Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada. collinsj@auracom.com
4. ↑ Domar AD. Domar Center for Complementary Healthcare, Boston IVF, Massachusetts, USA. Domar@domarcenter.com
5. ↑ Methodological Differences in Clinical Trials Evaluating Nonpharmacological and Pharmacological Treatments of Hip and Knee Osteoarthritis Isabelle Boutron, MD; Florence Tubach, MD; Bruno Giraudeau, PhD; Philippe Ravaud, MD, PhD JAMA. 2003;290:1062-1070
6. ↑ Methodological Issues in Trials of Acupuncture Kaptchuk et al. JAMA.2001; 285: 1015-1016.
7. ↑ BBC Hypnosis 'doubles IVF success'