1 in 7 couples struggle to conceive and require assistance to be able to become pregnant or have a baby. I always recommend checking out the NICE guidelines fertility problems and assessment for knowing what to ask your GP for if you and your partner have been having difficulties conceiving at any stage.
The success rate of IVF on the NHS in 2019 was:
- 32% for women under 35
- 25% for women aged 35-37
- 19% for women aged 38-39
- 11% for women aged 40-42
- 5% for women aged 43-44
- 4% over the age of 44
Can complementary therapies help us to conceive?
Possibly, possibly not. Research is largely funded by pharmaceutical companies, and complementary therapies don’t sell medications or medical techniques sadly (which is why complementary therapies for any condition tend to have less research available in general).
However, there is some evidence that complementary therapies could impact and improve the success rates of either spontaneously conceiving a baby OR in aiding the success rates of assisted conception such as IVF or ICSI.
How could complementary therapies help conception?
Trying to conceive can be incredibly stressful, and telling people wanting a baby to relax is quite frankly pointless, annoying and creates more stress. Essentially, couples have one chance a month every 21-35 days on average to be able to time the conception right IF regular periods and fertility are optimum. With each month that passes, every day you’re left wondering, ‘Will it be this month where I have a positive pregnancy test? Will this month be the successful implantation?’
Ovulation and cycle tracking, mucous tracking, researching and reading is all anxiety inducing. Trying to conceive is something many couples just imagine will be natural and happen spontaneously, but sadly for some it does not. In addition, modern contraception, dietary intake, lifestyle choices, medical conditions, time of year, exposure to chemicals and previous medical and surgical history can all impact on fertility.
But stress does impact on ovulation, and possibly implantation too. From a biological perspective, humans are not designed to conceive babies when we are in high stress situations – we are meant to either run away or fight the threat which is causing stress, so blood is diverted away from our reproductive organs (hence why our sex drives can decreases in high periods of stress too) and diverts it instead to our heart, lungs, and digestive system where the oxygenated blood flow is required the most.
It also can impact on our hormonal control which again can impact on egg release, but also in terms of maintaining a pregnancy. It is also where, as a Midwife, I have had many couples in my care unexpectedly become pregnant sometimes years down the line when they have suddenly stopped trying, or stopped the IVF attempts. The number of stories I could tell of women who were in the process of adoptions, of huge lifestyle changes, of those deciding to up sticks and travel, of moving house, buying houses or businesses to invest their time elsewhere after such an incredibly long journey is unreal. It is these stories which makes my heart burst and give me hope that for some couples they will eventually reach their end goal of having a baby: sometimes long after the hope had gone.
So what complementary therapies aim to do is two fold: Firstly promote relaxation in a number of ways, but also restore balance and improve circulation and blood flow depending on the complementary therapy of choice.
What is the research on complementary therapies?
I have only explored two complementary therapies within this article: Massage and acupuncture (as these have the largest bodies of evidence available), however, there is some evidence on reflexology and even acupressure too.
Massage
Massage stimulates blood flow round the body, promotes endorphin and oxytocin release and reduces stress. In addition, there is a theory that massage therapy prior to blastocyst transfer in a cryo-cycle improves embryo implantation, most likely due to a reduction in stress, a reduction in uterine contractions and enhancement of blood flow to the uterus. In a study of 267 patients undergoing IVF, massage therapy during implantation was compared to no massage therapy in a randomised trial. In the massage group:
- There were significantly higher pregnancy rates (58.9 vs 41.7%)
- Higher ongoing pregnancy rates (53.6% vs 33.2%)
- Higher live birth rates (32% vs 20.3%)
There were no differences between groups in terms of demographics, ages, hormonal substitution, endometrium structures or build ups, quality of transferred embryos or quality of transfers. There were no adverse effects reported in the massage group (Ockhowart et al. 2015)
In an observational study of 1392 women undergoing IVF with a range of reasons for IVF need, all participants received a whole body massage therapy. Rice et al (2015) reported a clearing of blocked fallopian tubes in 60.85% of patients, with a 56.64% rate of pregnancy in these patients with blocked fallopian tubes.
In patients with endometriosis, there was a 42.81% pregnancy success rate with full body massage therapy. The massage therapy also lowered follicle stimulating hormone (FSH) in 49.18% of patients, with a 39.34% success rate of pregnancy in this particular group. In patients with PCOS, 53.57% of women achieved a pregnancy with massage therapy. Overall, the total success rate of IVF with whole massage body therapy regardless of reason was 56.16% with massage therapy. Whilst this isn’t a randomised trial, and purely observational data, compared to the success rates of IVF on the NHS, it appears massage therapy during IVF implantation *may* improve the chances of successful implantation and pregnancy.
Acupuncture
Acupuncture can aid with menstrual cycle (and body) regulation and help to restore any imbalances that exist within the body. A randomised trial of 56 women comparing lifestyle advice and acupuncture for spontaneous conceptions (with no previous fertility concerns) found no difference between pregnancy rates during the study time amongst the group, HOWEVER:
- Those receiving acupuncture and dietary advice conceived in 5.5 weeks of the intervention on average
- Those who did not have acupuncture or dietary advice conceived in 10.67 weeks on average
- There was a higher percentage of live births in the acupuncture and lifestyle advice group with 80% of pregnancies having a live birth; compared to 60% of pregnancies having a live birth in the non acupuncture and lifestyle advice group.
In the follow up study, of those who did not conceive during the study, there was a higher number of women who spontaneously conceived in the acupuncture and lifestyle advice group with 10 women having successful pregnancies, compared to only 5 in the non acupuncture and lifestyle advice group (Cochrane, 2018)
In a meta analysis of 27 studies with 6116 participants, there were higher numbers of pregnancies in the IVF groups with acupuncture compared to no acupuncture or sham acupuncture. There were no statistical differences in the live birth rates of either group (Xie et al, 2019).
In the Cochrane review of PCOS and acupuncture by Lim et al (2019), the conclusion was that there was not enough evidence to make recommendations in using acupuncture in this particular group of women, however when they compared true acupuncture to sham (placebo) acupuncture there were clinically relevant differences in live birth rates for the women who received the therapeutic acupuncture compared to sham acupuncture. The studies were too small to draw conclusions, but there were differences noted.
From a risk benefit perspective, another Cochrane review concluded that there is no evidence of acupuncture having any impact on miscarriage rates or side effects, and that whilst there is not enough evidence to be able to recommend acupuncture alongside IVF, there is also no known harms and essentially, it is choice as to whether couples trying to conceive choose to use acupuncture.
Overall
Overall it is choice. There may be some benefits of using complementary therapies, and the only real risk is the financial cost of these complementary therapies. Without the funding allocated the same way it is to medical treatment, there may never be enough conclusive evidence to recommend complementary therapies alongside IVF or aiding spontaneous conception completely. But as seen in the studies above, there may be many benefits and when undergoing the process of trying to conceive or assisted conception, anything which improves the success rate, reduces stress levels and helps couples in any way is worth a shot.
If you are choosing any complementary therapist, check out their credentials and ensure they undertake a full assessment before beginning treatment, including your intention of trying to conceive.
References
Cochrane, Suzanne et al. “Corrigendum to “Prior to Conception: The Role of an Acupuncture Protocol in Improving Women’s Reproductive Functioning Assessed by a Pilot Pragmatic Randomised Controlled Trial”.” Evidence-based complementary and alternative medicine : eCAM vol. 2018 2343604. 2 May. 2018, doi:10.1155/2018/2343604
NICE (2017) Fertility problems assessment and treatment available from: https://www.nice.org.uk/guidance/cg156
Okhowat J, Murtinger M, Schuff M, Wogatzky J, Spitzer D, Vanderzwalmen P, Wirleitner B, Zech NH. Massage therapy improves in vitro fertilization outcome in patients undergoing blastocyst transfer in a cryo-cycle. Altern Ther Health Med. 2015 Mar-Apr;21(2):16-22. PMID: 25830275.
Rice et al. (2015) Ten-year Retrospective Study on the Efficacy of a Manual Physical Therapy to Treat Female Infertility. Alternative therapies in health and medicine.
Stener-Victorin, E. , Humaidan, P. Use of acupuncture in female infertility and a summary of recent acupuncture studies relates to embryo transfer. Acupunct Med 2006; 2: 157–63.
Xie et al. BMC Complementary and Alternative Medicine (2019) 19:131
https://doi.org/10.1186/s12906-019-2523-7
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