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Dongyun Liang
Abstract: Acupuncture has proven effective in treating infertility. The author has found common characteristics of acupuncture treatments for infertility after utilizing it in many cases. These include: regulating menstruation, accurately selecting acupoints, and adjusting the treatment plan to the stage of the menstrual cycle. While strengthening the kidney and the spleen, and regulating Chong and Ren were typical, the treatment was also focused on calming the mind, soothing nerves, and harmonizing the heart and the liver. Also, treating both husband and wife simultaneously. This strategy of an infertility treatment regimen is based on a foundation of Traditional Chinese Medicine (TCM) and the author’s clinical experience, which will contribute to the patients and their families.
Key words: infertility, acupuncture, regulating menstruation, calm the mind.
Traditionally Chinese medicine has said: “first acupuncture, second moxibustion, and then third herbal medicines”. Because acupuncture appears to be fast, convenient, cost-effective, and to have few side effects, most practitioners who practice acupuncture outside of China follow this principle in clinical work. Outside of China, generally, acupuncturists and herbalists don’t have permission to prescribe western medications. This environment obliges acupuncturists to study the mechanisms of TCM and learn techniques of acupuncture, so that the potential of acupuncture is further developed. Treatment models of acupuncture with herbal medicine are popular in the most TCM clinics. The vitality of Traditional Chinese Medicine relies on its clinical approaches! The clinical outcomes are the important goals that practitioners pursue. This is why TCM and acupuncture can develoe rapidly and be welcomed overseas. Acupuncture is a key component of Traditional Chinese Medicine. The theoretical basis of acupuncture is the channel system. The channel system of the human body is like a huge network that connects different parts of the body, forming a comprehensive and complex three dimensional circuit diagram, which goes round and round in an infinite loop. The channel pertains to the organ, and connects externally to the limbs”, which communicates between the inside and outside, running from above to below, forming an organic framework, transmitting information, circulating qi and blood, and nourishing the human body. The most important channels which have a bearing on women’s physiology and pathology are the Chong, Ren, Du, and Dai Mai of the eight extraordinary vessels, especially the Chong and Ren Mai. Both perform their own functions and coordinate to regulate women’s menstruation, pregnancy, childbirth, and breastfeeding. In the Huang Di Nei Jing Su Wen, Chapter One: On Art of Health Cultivation in Ancient Times there was a conversation between Huang Di and Qi Bo about “When a woman is fourteen years old, the “Tiankui” [reproductive essence] arrives, the Ren channel is open, the Chong channel is also exuberant, menstruation begins, therefore pulse is strong, therefore conception is possible”.
First regulating menstruation and managing menstrual diseases in infertility clinics
The treatment of infertility lies first in regulation of menstruation, and the basic treatment method is “Identification of Patterns and Treatment”. The kidney is the foundation of innate constitution in human bodies. The onset of menstruation and the regularity of cycles are most closely related to the kidney. Normally, periodic ovulation and menstruation are prerequisites for a woman’s ability to conceive. Dr. Zhu Zhenheng, one of the four great masters of the Jin-Yuan era wrote: “Pregnancy relies on regulating menstruation.” Regulating menstruation can maximize the potential of fertility, because disorders of menstruation directly affect the success of conception.
Women who have chronic menorrhagia, hypomenorrhea, irregular menstruation, amenorrhea or other menstrual diseases can develop dysfunction of various organs, disharmony of the qi and blood, and, consequently, they damage and create dysfunction of the Chong and Ren Mai and imbalances of the reproductive axis of the Kidney, Tiankui, Chong, Ren, and uterine system. Over time, if the Tiankui is scarce, or there is emptiness of the Chong and Ren’s “sea of blood” it will lead to an inability to be fertilized and conceived.
“Women utilize the liver for their innate constitution”. The liver governs dispersion and the free flow of qi, which is directly related to women’s ovulation and menstrual cycles. The ovulation is easily impacted and closely related to menstruation. Therefore, the author believes that acupuncture treatment during menstruation is very important. The author proposed that it is necessary to break the traditional prohibition of acupuncture during menstruation, and to create a new pathway, treating patients during menstruation.
The menstrual cycle is usually divided into the follicular, ovulation and luteal phases, while the follicular phase can be subdivided into the stages of menstruation, post-menstruation and ovulation [1]. The reason for understanding the stages of menstruation is to select points accurately and maximize the therapeutic effects from acupuncture. The goal of acupuncture during menstruation is to regulate qi and blood, promote blood circulation and eliminate blood stasis, which ensures the smooth exfoliation of endometrium. It is the process that removes blood stasis to promote tissue regeneration. The late menstrual period is the most important time in the cycle, because the follicles are maturing and the endometrium is gradually repaired during the time. Meanwhile, the Chong Mai also needs to be filled with yin-blood during the late menstrual period. If the cycle is prolonged, it indicates that the yin-blood in the channels is insufficient. It will take longer for the follicles to undergo development and maturation, which is one of the main reasons for the delayed ovulation. Therefore, acupuncture in the later stage of menstruation should focus on nourishing yin and blood, and regulating Chong and Ren channels. In addition, according to the principle of “leading the yin from the yang” in the Nei Jing, the back-shu points on the bladder meridian should be selected in the treatment plan, because the back-shu points on the lower back can improve the blood supply of the uterus. During ovulation, the yin essence is abundant, and the qi and blood in the Chong and Ren Mai are full. Under the warmth of yang qi in the kidney, the yin essence transforms into yang qi. At this time, acupuncture treatments focus on soothing the liver and regulating qi, nourishing the channels, activating collaterals, supplementing the kidney yang, and dilating the fallopian tubes, so that the transformation of yin and yang is smooth, and the eggs can be released quickly. The luteal phase is when yang qi is sufficient in the spleen and kidney, and the qi, blood, and yin and yang are in harmony. At this time, although yin essence and yang qi are both abundant, yang qi is generally dominant. The sea of blood is filled. Now it is well prepared for menstruation and pregnancy. The treatment principles during the luteal phase are to strengthen the spleen and kidney, replenish qi and build up yang, and also warm the uterus to facilitate the implantation of the embryo. If there are any problems presenting during this time (like a decline in luteal function), they are usually related to the kidney yang. But without yin, there is no growth of the yang, and vice versa. Yin and yang are mutually rooted and interdependent. Therefore, tonifying kidney yang can be carried out by means of nourishing kidney yin, essence and blood. Acupuncture during the luteal phase should nourish yin and blood, strengthen the spleen and kidney, supplement the qi and yang, and harmonize Chong and Ren. If treated properly, it can ensure the safety of the embryo and prevent the occurrence of a miscarriage.
2.Select acupuncture meridians and points based on the menstrual cycle
In order to obtain the best therapeutic effect, it is also very important to choose the optimal channels and points for treatment. The acupuncture points and channels on the Liver, Spleen, kidney, Chong, Ren, Du, Dai and Bladder channels are the key points for treating infertility. From an anatomical perspective, these points are located on the inner side of the legs, lower abdomen, and lower back. They are directly connected to the pelvic reproductive organs, including the points of Zi Gong [extra point on lower abdomen], Gui Lai [ST 29], Qi Hai [CV 6], Guan Yuan [CV 4], Zhong Ji [CV 3], Yin Ling Quan [SP 9], San Yin Jiao [SP 6], Ming Men [GV 4], and Ba Liao [the eight sacral liao points]. According to the physiological characteristics of reproduction, acupuncture points are selected based on the pattern and disease differentiation. The author’s clinical experience is that, in the follicular phase, the points of the yin channels are most important; during the luteal phase, points on the yang meridians are the most important. Electrical stimulation is used during ovulation.
In Li Shizhen’s Examination of the Eight Extraordinary Vessels, the twelve channels are the main channel system, all running vertically up and down, but the Dai originates from the sides of the lower abdomen below the 12th rib, encircling the body and passing around the waist. It is like a belt. The two channels of Chong and Ren follow the abdomen, lateral to the umbilicus, and pass through the Qi Chong [ST 30]. They have collaterals which connect them to the Du Mai. The Chong, Ren and Du Mai have the same origin, but each follows its own pathway. They connect to each other by the network channels. The twelve channels and the eight extraordinary vessels all pass through the abdomen. The abdomen is the center of the channels of the human body, where the channels meet. Therefore, the principal treatments for infertility use abdominal points, including Guan Yuan [CV 4], Qi Hai [CV 6], Zhong Ji [CV 3], Gui Lai [ST 29], Tian Shu [ST 25] and extra points like Zi Gong, or the “four orthogonal positions” points of the umbilical acupuncture microsystem[2][these are four points surrounding the navel, above, below and to the two sides]. All the points have the effect of treating gynecological diseases, irregular menstruation, and infertility.
With the principle of “where the channels pass, and where the main treatments are”, the channels of the Chong, Ren, liver, spleen, and kidney are involved in the pathogenesis of gynecological diseases as well as their treatments. Zi Gong is an extra point which lies 4 cun below and 3 cun lateral the navel. It is the body surface projection of the ovary, an organ important for the process of conception and the regulation of menstrual blood. The point Gui Lai [ST 29] belongs to the stomach foot yangming channel, located in the lower abdomen, 4 cun below and 2 cun lateral to the navel. It goes to the root, which promotes circulation, removes stasis, regulates menstruation, relieves pain, regulates the blood chamber, and warms the lower Jiao. The points of Zhong Ji [CV 3], Guan Yuan [CV 4], and Qi Hai [CV 6] all belong to Ren channel. The Nan Jing says: “The Ren channel originates from the middle pole, goes above the margin of the pubic hair, runs along the abdomen, going up to Guan Yuan [CV 4], and reaches the throat.” This yin channel is called “the sea of yin vessels”. The Ren Mai has the function of nourishing and regulating yin channels and qi. We regard qi as yang and blood as yin. Yin and blood are most closely related to diseases of pregnancy, childbirth, and menstruation. Zhong Ji [CV 3] strengthens the kidney and essence, helps to transform qi, and clears heat and dampness. Qi Hai [CV 6] is the original source point of the “huang” [membranes], the sea of qi, and the qi meeting point of the lower Jiao. It is used to treat the deficiency of the yuan qi and diseases of qi vacuity. Because of the relationship between qi and blood, which includes their interdependence and mutual consumption, disorders of qi stagnation, blood stasis and qi vacuity should be managed by this acupuncture point. As The Song of Sheng Yu states: “to treat all kinds of qi diseases, acupuncture and moxibustion at Qi Hai are appropriate.” Tian Shu [ST 25] point is located 2 cun lateral from the navel. Tian Shu comes from the Ling Shu Gu Du [“the extent of the bones”] chapter, and it is on the stomach channel. It is the Mu point of the large intestine, and the pivot of the upper, middle and lower burners. Because the Yangming is rich in qi and blood, Tian Shu replenishes the resources of the human body. Older patients with infertility often suffer from vacuity of essence and blood in the lower burner. The Tian Shu point can transfer resources from the upper and middle burners to the lower burner, cultivating “soil” and replenishing energy, and often increase the chance of conception for patients with intractable infertility. It can also treat irregular menstruation, dysmenorrhea, endometritis, dysfunctional uterine bleeding and other gynecological diseases. The “four orthogonal position” points from umbilical acupuncture are usually used in the luteal phase, which takes advantage of their strong nourishing function, including nourishing the qi and blood, helping yang qi, harmonizing the heart and kidney, and coordinating the liver and lungs. Tian Shu is also very good for patients with decreased luteal phase function and recurrent miscarriage.
San Yin Jiao [SP 6] is on the spleen channel. It is the point where the liver, spleen and kidney channels meet. The kidney stores essence, the liver stores blood, and the spleen controls blood. San Yin Jiao is an important acupuncture point that ensures the normal function of Chong and Ren’s storage of the blood. Qi Men [LV 14] is the Mu point of the liver, and also an intersection of the foot Jueyin, foot Taiyin, and Yin Wei Mai channels. This point has the effects of invigorating the spleen, soothing the liver, regulating qi, promoting blood circulation, and protecting the liver. It can not only regulate the functions of viscera and bowels, and treat liver diseases, but also manage diseases that happen to the associated channels. The liver channel follows the thigh, crosses the genitals, reaches the lower abdomen, continues bilateral to the stomach, runs through the diaphragm, and distributes through the area of the ribs. When combined with Tai Chong [LV 3], Qi Men is applied specifically to treat discomfort and menstrual disorders due to liver qi issues, especially for the infertile patients with delayed ovulation and long menstrual cycles.
The Du Mai is located on the midline of the back, and it is the governor of the yang channels. The six yang channels intersect with the Du Mai at Da Zhui [GV 14], which has the function of regulating the Qi and blood of the Yang Meridian. Therefore, it is called the “Governor of Yang Channels” and the “Sea of Yang Channels”, in charge of regulating reproductive function. Bai Hui [GV 20] is the intersection of hundreds of channels which run through the entire body. The head is the gathering place of all yang, the ancestor of all the channels. The Bai Hui acupoint is the place where the qi of the channels converge. Bai Hui is located on the point of the head where all the yang channels meet, and also contains yin within the yang. Bai Hui is closely connected with the brain. It is an important point used to regulate the function of the brain (hypothalamus and pituitary gland). Bai Hui is important in the management of infertility. Ming Men [GV 4] is the fundamental source of energy for life processes in the body. It strengthens the kidney yang. The Yao Shu [GV 2] is the second point on the Du Mai. It is located at the sacral hiatus, the origin of Yang qi. This acupoint was once used as an effective anesthesia point for gynecological surgery used to remove the uterus and ovaries. The eight sacral Liao points are effective areas for treating all manner of gynecological and andrological diseases, which can supplement vitality, warm the Chong and Ren Mai, reduce inflammation, relieve pain, promote blood circulation, eliminate blood stasis, raise the yang and lift what has sunk downwards.
Among Master Tung’s acupuncture Points, the Fu Ke Xue [Gynecology Point 11.24] and Huan Chao [Return to the Nest/Ovaries 11.06] [3] are the system’s two main points whose main function is treating gynecological diseases. Both points can treat irregular menstruation, dysmenorrhea, infertility, and they are called “The Child-Giving-Guanyin Bodhisattva” .
Distal acupoints that can be selected are: Zu San Li [ST 36], which strengthens the spleen, nourishes blood and supplements qi. Tai Chong [LV 3], the auricular points Shen Men, Liver, and Tai Yang calm the spirit, settle the mind, soothe the liver and regulate qi. For a treatment abdominal frontal points and the dorsal points are applied in alternate treatments. These acupoints are used in the combinations including points from the upper and lower body, as well as distal and proximal to the problem area. All of these achieve dredging of the qi of Chong, Ren, and Du Mai and three yin channels of the leg. This ensures that the essence and blood are sufficient, the qi and blood are vigorous, and the eggs are strong.
Studies have shown that acupuncture can effectively promote blood circulation, regulate the gonadal hormone axis, improve ovarian function, and increase egg discharge. Acupuncture can also improve endometrial receptivity, increase the chance of pregnancy, and, when combined with herbal treatment, can supplement the delayed action of herbs alone.
3. Acupuncture technique
Acupuncture techniques for treating infertility are different in China versus other countries. The needles used in the United States (U.S.) have tubes, and the needles are disposable. Acupuncture is a relatively new therapy in the category of alternative medicine. It has been accept- ed by people in the U.S. and most of them get good therapeutic effects. The author has practiced Traditional Chinese Medicine (TCM) and acupuncture abroad for many years and found that populations of Caucasian and African American descent are more sensitive to acupuncture than Asians, which is called the “De Qi” reaction. This may be related to their eating habits and physical fitness. It may also be due to that Caucasians and African Americans having thicker muscles, channels, and richer qi in their meridians. They are relatively sensitive to Acupuncture[4].
According to the foundational theory of acupuncture, in order to achieve effects with treatment, patients must have the sensation of “de- qi”. In China, acupuncture has been performed with thick needles, heavy stimulation, and heavy manipulation. Most patients in countries outside China don’t tolerate the manipulation of vigorous lifting and thrusting, insertion, and twisting. The strong de-qi related sensations of soreness, numbness, fullness, and heaviness make them afraid of acupuncture. Therefore, when practicing TCM and acupuncture in these countries, researching how to increase the efficacy of acupuncture without strong manipulation and improving compliance from patients have become important topics. Yongming Li proposed that “soft acupuncture” therapy is more suitable for American patients[5]. Shaobai Wang named it “Pleasant Acupuncture”[6], also known as “Sugar Needle”[7].
Regarding the phenomenon of a channel conduction, patients will have different sensations, for example feeling warm under the needle, having increased bowel sounds, or even feeling heaviness of head and going to sleep. Some patients seem to see colors. Some patients describe the feeling of a stream flowing and rippling in the body after falling asleep. These phenomena should be the manifestation of de-qi, which are positive responses to the treatment. We call the de-qi phenomena a thera-peutic-level acupuncture sensation. Because de-qi is a sign of a patient’s disease rapidly being managed, de-qi is a high level and the best acupuncture sensation, which set the premise as patient’s comfort. As the Nei Jing described, “The key of insertion is to obtain the qi (de qi), and therefore be effective. Only when the qi arrives will acupuncture be effective. The effect, it is said, is as if the wind blows away clouds and there is a clear azure sky. These are all the Dao of acupuncture.”
Acupuncture for older infertile women is mainly based on gentle and shallow needling. However, it is appropriate to perform deep needling on abdominal points. After 5-10 minutes, approximately 90% of patients fall asleep peacefully. After the treatments, patients usually give feedback to the practitioners, including a deep sleepy feeling, joy, comfort, and feeling refreshed.
For patients with no ovulation or delayed ovulation, the method of needling around the Zi Gong point can be used during the ovulatory portion of the period[8]. Taking Zi Gong as the center, four needles are inserted towards the center from 1 cun above, below, left, and right. The purpose is to increase the blood supply to the ovary, which can be enhanced further by 30 minutes of electrical acupuncture stimulation. Maturation of follicles and ovulation can be triggered quickly with an increase of the blood supply. For patients with no ovulation, amenorrhea,or PCOS with obesity, in addition to needling the uterine points, select the Feng Wei [“phoenix tail”] points (Chang Qiang [GV 1], Yao Shu [GV 2] and Hui Yang [BL 35]), using 2.5-3 cun needles. The insertion of acupoints Chang Qiang and Yao Shu at an angle of 15 degrees upward. When patient feels a qi sensation, twist forward, and then press down for about 30-60 seconds. The patients will feel that the lumbosacral region gradually gets warmer. The warm sensation will go up to the neck, head, and may even spread to the arms and hands. The Hui Yang point is needling at a 45-degree angle, inserting in the direction of the perineum. When the needle is on the left side of the perineum, the needle tip is inserted in the direction of the right side of the perineum and vice versa. The key technique of insertion is to slowly twist and enter deeper until the patient feels genital contractions or a radiating sensation, then to twist the needle forward, press down to generate warm sensation[9], and hold the needle for about 60 seconds. Patients usually feel warm in both ovaries or the lower abdomen. Some patients who are not sensitive, need a longer needling time. I named this acupuncture technique the “Fengwei Therapy” . The purpose of acupuncture at Fengwei points is to open up the Du Mai, promote local blood circulation, stimulate the internal gonads, and thereby regulate the uterus, ovaries and other organs in the abdomen. For older patients, who come with kidney yang deficiency, intolerance of cold, and extremely poor function of the corpus luteum, Dr. Wei Liu created a treatment plan of ‘4 Du Mai Needles’ . These are Yao Shu [GV 2], Yao YangGuan [GV 3], Ming Men [GV 4], and Zhi Yang [GV 9]. The key to insertion in this technique is to follow the course of the Du Mail. The needle needs to be inserted from bottom to top at an angle of about 30°. First, the needle should be held such that the handle is also bent towards the body, then it is swung from side to side 10-20 times. Then the needle should be bent upwards and downwards in 20-30 arcing movements. These make the needle’s body look like a fishing hook. It is important to focus your mind on your Lao Gong [PC 9] point as much as possible when manipulating the needle. When you feel your palm getting warm, the effect of the treatment has been achieved. Meanwhile, the patient will feel that their lower back is hot like a stove. Retain the needles for half an hour after having this de-qi sensation. The 4 Du Mai Needles can invigorate the yang energy of the body, warming and smoothing the Du Mai. When the body’s Yang energy gets supplemented, the yin will be available to nourish the body.
4. Critical factors for increasing circulation: Treatment frequency and low-frequency electro-acupuncture
Acupuncture treatments should be consistent, it is better when employed 2-3 times a week rather than once a week, especially during the menstrual period and around ovulation. Because acupuncture during menstrual period can help eliminate static blood and shed the endometrial lining from the uterus. It will support the establishment of a new endometrium by supplying blood and resources to the uterus, providing a good internal environment for implantation of the embryo. The treatment of infertility with acupuncture usually takes 3 months. The frequency of treatments varies from person to person. If there is adequate financial support, to ensure the optimal treatment outcome, it is recommended to be treated 2-3 times per week.
Studies have shown that the ovaries of older women are more prone to lower oxygen levels than younger women, which may lead to a decrease in the quality of eggs[10]. It is important to treat patients by using low-frequency electro-acupuncture in the follicular phase, specifically at the stage of follicular recruitment. Low-frequency electro-acupuncture is performed at points on the inner side of the lower limbs (San Yin Jiao [SP 6] and Yin Ling Quan [SP 9]) and the abdomen. It can significantly increase the blood flow of the uterus and ovaries and provide enough resources to promote follicle development. During the ovulation period, the previously discussed needling around Zi Gong can be performed. Low-frequency electro-acupuncture can also expand the fallopian tubes, which allows mature eggs to move into the fallopian tube quickly, thereby avoiding the age-related degradation of the eggs. During the phase of preparation for assisted reproduction, it is important to increase blood flow in the ovaries and the uterus. It can be achieved by continuously using low-frequency electroacupuncture on the lower abdomen, medial lower extremities, alternating with the lower back points (especially the sacral Liao points) alternately.
Age of Acupuncture Treatment
The World Health Organization (WHO) stipulates that infertility refers to a normal sexual life without any contraceptive measures for one year, without successful pregnancy. There are two types of infertility, primary, where one has never been pregnant, and secondary, where there have been previous pregnancies. Generally speaking, the treatment of primary infertility takes a little longer when compared to secondary infertility. Women over 35 years of age who have presented with infertility as defined above are especially challenged. What needs to be emphasized in particular is that after 35 women have a limited irreversible reduction of fertility. Experts from the American Society of Reproductive Medicine have further restricted the age of infertility in recent years[11]. Those who are between 35 and 38 years old, who have been trying to conceive for half a year and are infertile; and those over 39 years who have been trying for 3 months and have not conceived women with the two conditions above will need to perform fertility evaluation and are recommended for an infertility diagnosis.
Therefore, women in the childbearing period should seize the opportunity after marriage and get pregnant as soon as possible. Because the younger they are, the better the quality of follicles, the better the chance of endometrial receptivity. Many patients do not know about this. It is very common for people to marry later in life, after the age of 35, or who are still busy studying and working. Because they do not understand the seriousness of the decline of the ovarian function, they lack a sense of urgency. When they think everything is ready and want to get pregnant, they find out it is too late, because most of them are beyond the period of fertility [12].
Western women start to take contraceptives medication at a young age. Some start to take medicine in junior high school. It is common for women to continuously use contraceptives for over 20 years. These medications can lead to a decline of ovarian function. After stopping the medication, the ovary can remain dormant for a long time, which leads to irregular menstruation, delayed ovulation, anovulation, and, at times, premature ovarian failure, possibly bringing on menopause. Therefore, once there is a diagnosis of infertility, getting early treatment is very important. Because acupuncture can stimulate a dormant ovary, which increases the reserve function of the ovary, improves the responsiveness of patients with low ovarian response, and adjusts the hypothalamic-pituitary-ovarian Axis. All of these will induce follicle development and maturation, improving oocyte and ovarian functions, therefore achieving pregnancy.
6. Acupuncture combined with IVF and IUI
Assisted reproductive technology (ART) has become more and more mature today. The first generation of in vitro fertilization (IVF) was developed in 1978. At present we are in the fourth generation of the technology, however, the success rate of IVF/ Intrauterine insemination (IUI) could still be improved. According to the Center for Disease Control and Prevention (CDC) the U.S. report for 2020, the success rate of IVF for women under the age of 35 is 47.2%; the success rate for women aged 35-37 is 34.6%; the success rate for women aged 38-40 is 22. 1%, and the success rate for women above the age 40 is only 7.2%”[13]. This is why most infertility centers are unwilling to accept patients over 40 years old. Because the high failure rate will affect the reputation of the fertility center. Improving the success rate of IVF/ IUI has been a subject of research for many years. A study from Dr. Wolfgang E. Paulus, a German reproductive expert, demonstrated that acupuncture can significantly improve the success rate of IVF conception. The increase rate can be as high as 15%. The study also indicated that the rate for patient carrying to term increased as much as 23%[14].
A treatment model of acupuncture combined with IVF/ IUI has been formed in the United States. Acupuncture is implemented before and after IVF/ IUI treatment. The U.S. and some other countries use acupuncture as an auxiliary intervention for IVF/ IUI. The main purpose of acupuncture is to improve the blood supply of the uterus and ovary, promote endometrial receptivity, calm the mind, stabilize the spirit, soothe the liver and relieve qi stagnation, and relieve the side effects of the hormone treatments employed. The points selected are mostly on the Chong and Ren Mai, and supplemented with points on the kidney, spleen, and bladder channels.
The author has observed through many years of clinical work that it is difficult to achieve the treatment goals for older infertile patients if acupuncture treatments are only applied before and after the embryo transfer. Because the ovarian function of these patients has declined and the egg quality has decreased, it takes about 3 months of acupuncture treatment to improve the ovarian function. Once IVF starts, patients will receive a large amount of chemical hormones. Most reproductive doctors will not let patients undergo both IVF treatment and take Chinese herbal medicine at the same time, because there is little experimental data on the interactions of herbal products and the hormones administered. It is not known whether the two have antagonistic effects. For the safety of patients, they should not be used together. Because of this, the author suggests that it is best to start treatment with acupuncture and herbal medicine about 2-3 months before the start of an IVF cycle. Once the IVF treatments start, the patient can use acupuncture without the herbal medicine. The frequency of acupuncture can be increased to 3 times a week in order to improve the effects. However, when patients take ovulation inhibitors orally or intramuscularly, it is best to avoid using acupuncture points that induce ovulation, such as the Zi Gong [extra point], Gui Lai [ST 29], Ba Liao [the sacral Liao points], He Gu [LI 4], Xue Hai [SP 10], etc, so as to avoid conflicting reactions with medications. Once the patient is confirmed to be pregnant, acupuncture is mainly aimed at calming the mind, nourishing the blood and preventing miscarriage. It is important to avoid work on acupoints around the waist and abdomen which may lead to miscarriage. “
It has been clinically proven that acupuncture combined with IVF treatment can avoid the side effects that come from western medical treatments, such as ovarian hyperstimulation syndrome, excessive abdominal distention, fluid retention, extreme anxiety, insomnia and headache, etc. The combination can also reduce the patient’s dependence on western medications.
Tranquilizing the mind and calming the spirit: Strategy of treating the heart and liver together throughout Infertility management
The Neijing says “The key to acupuncture is first of all to concentrate and focus”. In the Ling Shu: The Root of Spirit it mentions that “All of acupuncture’s laws first must be rooted in the spirit”. The Nei Jing believed that obtaining qi with a concentrated spirit is an exquisite acupuncture skill. It is also the key to achieve therapeutic outcomes. Before needling, the doctor calms down to observe the patient’s qi. When inserting the needle, the doctor concentrates on adjusting his own qi, and asks the patient to keep his mind focused on receiving the qi. When the doctor makes an adjustment of the acupuncture treatment, with the skills of tonification and dispersion, it can be found that the “spirit” runs through the whole process of acupuncture. “The root of the spirit” is the key to the therapeutic effect of acupuncture, and is the foundation and core of acupuncture! The Nei Jing pays great attention to regulation of qi and therefore, to the adjustment of the Spirit. It is said that: “The Spirit and the yin and yang are unified, and Spirit and qi are never separated”. Regulating qi is also regulating the spirit, and regulating the spirit is also regulating qi.
Emotional activities belong to the heart and liver. The heart governs the mind and the blood, while the Liver governs the ethereal soul and qi. The heart and liver are closely related. The
Ming Yi Za Zhe (The Collection of Experiences of Famous Physicians in the Ming Dynasty) said, “The liver qi flows smoothly and the heart qi is harmonious, and the liver qi is stagnant and the heart qi is exhausted”. The Nei Jing says: “The heart is the sovereign of all organs and represents the consciousness of one’s being. It is responsible for intelligence, wisdom, and spiritual transformation” . “The heart is the master of the Zang-Fu, internal organs. Sorrow causes the heart to be disturbed, and if the heart is disturbed it results in the shaking of the internal organs” . The liver stores blood and governs emotions. According to Zhang Jingyue’s Fu Ren Gui, Zi Si Lei “If not feeling joyful, the Chong and Ren channels will be not nourished and stabilized, consequently, one won’t be able to be pregnant.” The liver stores blood and is in charge of dredging. Blood is the foundation of women’s bodies. If the liver blood is full, the Chong channel is strong, which perfuses into the uterus. If the liver qi stagnates, and the dredging function is impaired, it results in menstrual disorders, the delay of ovulation, and difficult pregnancy. Older women, especially professional women who have high pressure jobs, late marriage, chronic stress, anxiety, and insomnia are at high risk to have endocrine disorders and infertility. Therefore, it is necessary to treat the heart and liver together, calm the mind, stabilize the emotions, and encourage appropriate psychological counseling. Acupuncture points are mostly selected from the heart, pericardium, and liver channels, as well as the acupoints of like Bai Hui [GV 20], Tai Yang [extra], Yin Tang [extra] and Shen Men [HT 7]. This concept of treatment runs throughout the whole process of infertility treatment rather than just during the luteal phase.
By treating husband and wife simultaneously, the double effects will achieve
The whole process of conception is completed by the husband and wife. For patients with infertility after many years of marriage, most of the husbands and wives have stagnation of qi in the heart and the liver. If the patient has the financial means, it is recommended that the couple receive acupuncture treatment at the same time, with or without electroacupuncture stimulation, in accordance with the patient’s conditions. If the husband’s sperm is normal, and there is not the financial means, the wife should be the one who receives the majority of the treatment. But the husband should also receive acupuncture treatment at the same time as his wife on the day of ovulation. Acupuncture can not only relax their spirits, coordinate the intimacy between the husband and wife, increase the husband’s sense of responsibility and participation, but also expand the fallopian tubes and vas deferens, improve the receptivity of the endometrium, and allow the energetic eggs and sperm to combine quickly. So that fertilized eggs are conducive to implantation, forming high-quality embryos, and improving the chances for pregnancy.
These are my clinical experiences and contributions to the community of infertile patients. I would like to share with my colleagues these experiences of acupuncture in infertility management. Acupuncture can regulate qi and the mind, invigorate the spleen and the kidney, and balance yin and yang. Therefore, acupuncture can improve ovarian reserve function, increase egg quality, promote endometrial receptivity, and achieve an increased rate of pregnancy!
淺談針灸治療不孕症的臨床體會
梁東雲
摘要：針灸有效治療不孕症已被臨床證實，作者通過大量的實踐，找出了不孕患者治療 的針灸共性，予以調理月經，分期治療，精準取穴。在補腎健脾，調理衝任的同時，注 重安神定志、心肝兼顧，男女同治的理念，此治療方法具有臨床普及意義，可為同行借鑒。
關鍵詞：不孕、針刺，調經，調神
中醫古訓常說 “一針二灸三用藥”。國外的中醫治療疾病時大都遵循這一原則。因為針 灸是見效最快，簡單易行，方便經濟，且無副作用。由於國外不允許使用西藥，特殊的 環境迫使大家學習鑽研，使針灸潛力得到了進一步開發，而且大部分診所形成了以針帶 藥的治療模式。中醫的生命在臨床, 療效是根本，這就是海外中醫針灸得以快速發展， 深受大家歡迎的根本所在。針灸是中醫的一大特色，而針灸的理論基礎又是經絡系統。人體經絡系統像一張巨大的網將身體不同部位聯繫起來，構成了一個全面而復雜的人體經絡立體線路圖，周而復始，如環無端。經絡“內屬於臟腑，外絡於肢節”，是溝通內外, 貫串上下，形成了一個有機整體，傳遞信息，運行氣血，營養全身。與婦女生理, 病理聯繫最為密切為奇經八脈中的衝，任，督，帶，尤以沖任二脈最為重要，衝為血海，任主胞胎，督為總督，帶主約束，它們各司其職，相互合作，共同調節婦女的經，孕，產，乳。《黃帝內經》素問. 上古天真論有云：“女子二七，天癸至，任脈通，太衝脈盛，月事以時下，故有子。
1.針灸治療不孕應以調理月經和月經期疾病為先
不孕症的治療首先在於調理月經, 基本的治療方法是“辨證論治”。腎為先天之本，女子月經的來潮及其周期的規律性與腎關係最為密切。正常的、週期性的排卵和月經是女子能否受孕的前提條件。金元四大家之一朱震亨曾寫到：“求子之道，莫如調經也”。因為任何月經不調的疾病都會直接影響到受孕的成功與否, 所以調經治療可以使生育的 潛能達到最大化。婦女長期的月經過多、月經過少、月經先後不定期、閉經等這些月經 病，均可致女子的髒腑功能失調，氣血不和而致衝任受損和腎-天癸-衝任-胞宮生殖軸的 失調，天癸匱乏，衝任血海空虛，久而久之則致女子不能攝精而受孕。“女子以肝為先天”，肝主疏泄，直接與婦女的排卵和月經週期息息相關。月經先期，後期及先後不定期都會影響到排卵的時間提前或延後, 所以作者認為經期針灸治療非常重要，需要打 破原來經期禁針的傳統觀念。
通常月經週期可分為卵泡期，排卵期及黃體期。而卵泡期又可細分為月經期、經後期 及排卵期[1] 。分期針灸治療的目的在於精準取穴，使其效果達到最大化。月經期針灸的主要目為調節氣血, 活血化瘀，從而保證子宮內膜順利的剝落，以達瘀血不去，新血不生目的。經後期是月經週期中最重要的時段，因為此期卵泡逐漸發育成熟,子宮內膜 逐漸修復，衝脈需要利用此期充盈陰血。如果月經週期延長則預示衝脈陰血的虧空或充 盈不夠, 卵泡需要更長時間才能發育成熟, 這就是造成排卵延遲的一個主要原因。所以經 後期針灸應該重在滋陰養血, 調理衝任二脈。此外,根據內經 “從陽引陰”的原則, 可 以適當選擇膀胱經背俞穴, 因為針刺下腰部背俞穴能夠提高子宮的血供。排卵期陰精充 沛, 衝任氣血充盛, 在腎中陽氣的溫煦下, 陰精化生陽氣，此時針灸重在疏肝理氣，通經 活絡兼補腎陽, 其目的旨在擴張輸卵管，使陰陽轉化順利，卵子得以迅速排出。黃體期 為脾腎陽氣充足，氣血陰陽和諧階段，此時 雖陰精與陽氣皆充盛, 但總體以陽氣佔優勢,血海充盈, 為行經或孕育作好準備。黃體期的治療的原則為健脾補腎，益氣壯陽，溫煦 子宮以利胚胎著床和妊娠。通常這個時期呈現的任何根源性問題都和腎陽有關，即黃體 功能下降。但陽無陰不生，陰無陽不長，陰陽互根，相互依存，所以補腎陽可以在滋腎陰、養精血的基礎上進行。故黃體期針灸要以滋陰養血，健脾補腎，益氣壯陽，和諧衝任, 如果治療得當，即可保證胚胎的安全，預防流產的發生。
2. 根據月經週期不同階段的特點選擇相應的針灸經絡及穴位
為了獲得最佳的治療效果, 針灸選擇最佳的經絡、穴位也很重要。通常肝經、脾經、腎 經、衝脈、任脈、督脈、帶脈和膀胱經的穴位多為治療不孕症的重點穴位, 其助孕效果 顯著。從解剖上看, 這些穴位位於腿部的內側、下腹部及下腰部, 直接和盆腔生殖器官 有聯繫。譬如子宮，歸來，氣海，關元，中極、陰陵泉，三陰交，命門，八廖等穴。根 據月經週期不同時段的生殖生理特點，在辨病的基礎上，辨證取穴。我的臨床經驗是， 通常卵泡期多以陰經穴位為主，黃體期多以陽經穴位為主，排卵期加用電刺激。
李時珍《奇經八脈考.帶脈》：“十二經脈是經絡系統的主體，皆上下縱向而行，惟帶脈起少腹之側，季肋之下，環身一周，絡腰而過，如束帶之狀。而衝任二脈，循腹脅，夾臍旁，傳流於氣沖，屬於帶脈，絡於督脈。衝、任、督三脈，同起而異行，一源而三岐，皆絡帶脈。”由此可知，十二經脈與奇經八脈循行皆經腹部，腹部是人體經絡中樞，經脈交會之處。所以在治療高齡不孕的臨床中，本著“經脈所過，主治所及”的腧穴治療特點，兼顧婦科疾病病機所涉及的衝任、肝、脾、腎三臟，治療時主要選用腹部的關元，氣海，中極，歸來，天樞以及經外奇穴子宮穴，臍針“四正位”[2] 等穴，所用穴位均有治療婦科疾病，月經不調，帶下不孕等功效。子宮穴為經外奇穴，為於臍下4寸，旁開3寸。為卵巢的體表投影處，是女性孕育胎兒、化生經血的重要臟器。歸來穴屬於足陽明胃經，位於下腹部，臍下4寸，旁開2寸，有返本歸根、理復還納之功，此穴可以傳輸胃經下行經水，散化衝脈外傳之熱，有活血化淤、調經止痛，調血室，溫下焦的作用。中極、關元、氣海均歸屬任脈。《難經》曰： “任脈起於中極之下，以上毛際，循腹裡，上關元，至咽喉”，其運行於頸、喉、胸腹的正中線，能夠總任一身的陰經，稱為“陰脈之海”。任脈具有妊養和總調陰經脈氣的功能，人身以氣為陽，血為陰。婦女的胎、產、經、帶諸病，與陰血關係最為密切。中極培元助氣化，清熱利濕；氣海為肓之原穴，為諸氣之海，是下焦的氣會穴，為“元氣之聚，生氣之源”之處，主治元氣不足及下焦氣機失暢所致病證。根據氣血相互依存，相互為用的關係，凡氣滯而血行瘀阻、氣虛不攝血的婦女病證和穴位所在處的氣滯血瘀病證，都屬於本穴的治療範圍，如《勝玉歌》所言：“諸般氣症從何治，氣海針之灸亦宜”。天樞穴位於人體中腹部，肚臍旁開2寸處。天樞穴出自《靈樞. 骨度》，屬足陽明胃經，大腸之募穴，是上、中、下三焦的樞紐，本穴氣血強盛，為人體後天之氣的補充之元，因氣血物質與大腸經相符，向外傳輸是輸入大腸經所在的天部層次。高齡不孕患者多有下焦虧虛，精血匱乏，而天樞穴可以將上、中焦之營養輸入下焦，培土補元，對於頑固性不孕患者往往會增加受孕機率。臨床上可以治療月經不調，痛經，子宮內膜炎，功能性子宮出血等婦科疾患。臍針四正位通常用於黃體期，取其十全大補之意，可以起到補氣血，助陽氣，心腎同調，肝肺共理，對於黃體功能下降、習慣性流產的患者效果極佳。
三陰交歸屬足太陰脾經，為肝、脾、腎三經的交會穴，一穴通三經，可滋補肝腎、補養
精血、健脾利濕。腎藏精，肝藏血，脾統血，故三陰交又是保證衝任蓄藏功能正常的重要穴位。期門穴是肝之募穴，又是足厥陰，足太陰，陰維脈的交會穴。此穴具有健脾疏肝，理氣活血，護肝排毒之功效，不僅能調節臟腑功能，治療肝病，而且還能治療所交會經脈的病症。足厥陰肝經“循股際，入毛中，過陰器，抵小腹，挾胃，屬肝絡膽上貫膈，布協肋”，與太衝同用，專治肝氣不舒，月經失調。特別是高齡不孕排卵延遲，月經週期過長的患者。
督脈位於背部正中線，總督一身之陽經，六條陽經都與督脈交會於大椎，有調節陽經氣 血的作用，故有“總督諸陽”和“陽脈之海”之稱，主管生殖功能。百會為百脈之會，貫達全身。頭為諸陽之會，百脈之宗，百會穴則為各經脈氣匯聚之處，穴性屬陽，又於陽中寓陰，故能通達陰陽脈絡，連貫周身經穴。不孕症治療取百會，是因為百會與腦密切相連，是調節大腦(下丘腦，垂體) 功能的要穴。命門穴可以培元固本，補腎壯陽。腰俞穴是督脈的第二個穴位，位於骶管裂孔處，正是陽氣生髮的起始處，此穴曾是婦科摘除子宮卵巢手術的針麻有效穴。八髎穴則是通治一切婦科和男科疾病的神奇區域，可補助元氣，溫養衝任，消炎止痛，活血化瘀，昇陽舉陷。
董氏奇穴記載的“婦科穴，還巢穴”[3]是治療婦科疾病的兩個要穴，2穴均有治療月經不調，痛經，不孕等方面，效果奇特，故有“送子觀音”之稱。
遠端取穴足三里健脾養血，資助後天；太衝穴，耳神門，耳肝點，太陽等安神定志，疏 肝理氣。腹背穴位前後交替使用，上下取穴，遠近互補，共同達到疏通衝，任，督及三陰經經氣，使精血充足，氣血旺盛，卵子 強壯。多項研究表明，針灸能加強局部的血 液循環，有效的調節性腺軸，改善卵巢功能，提高卵子質量，促發卵子排出，針灸還能提高子宮內膜容受性，增加妊娠機會，可以彌補單用中藥治療效應延遲的不足。
3. 針刺的手法
在海外針灸治療不孕症，採用的針刺手法與中國國內不同。美國針灸所採用的針具都是一針一管，一次性使用。針灸對他們而言，屬於替代醫學中的一種新的自然療法，極易被他們接受且大都能得到很好的治療效果，筆者在國外行醫多年，發現白人，黑人 針灸效果比黃種人要敏感，譬如“氣化”反應，黃種人相對而言比較遲鈍。究其原因可能與他們的飲食習慣和身體素質有關，也可以理解為白種人，黑種人肌肉粗壯，經絡相對粗大，經絡裡面的氣相對充盈飽滿，所以針灸對他們而言，相對敏感而有效[4] 。
按照傳統的針灸理論，針刺時患者一定”得氣”，才能有效。中國國內針灸多采用粗針，重刺激，重手法，而國外大部分患者則不接受大幅度的提插捻轉，酸、痛、脹、麻會讓他們懼怕針灸。所以在海外行醫，面對不同的人種，如何增加針灸療效，提高依從性成為海外中醫人的一個重要課題。李永明 提出“軟針灸” 療法更適合美國病人[5] 。王少白命名 “輕針無感或微感舒適化針灸”[6] (Pleasant Acupuncture)，也被稱之 為“糖針”[7] 。
關於經絡傳導現象，有的患者感覺針下溫熱，有的出現腸鳴音增強，有的感覺頭重欲睡，有的眼前出現紅、黃、藍、綠、紫等不同的色彩，有的則描述入睡後感覺體內有小溪流水，輕輕流淌等等，這些現像都應是“得氣“的表現，是一種好的現象，我們將這些氣化現象稱之為高級針感。因為良好的得氣是患者快速消除疾病的標誌，而得氣是最佳的針感，高級針感則為患者舒適為前提，是得氣的最佳體現。正如《內經》說： “刺之要，氣至而有效，效之信，若風之吹雲，明乎若見蒼天，刺之道畢矣。”
高齡不孕的針法多以輕針淺刺為主，腹部穴位適當深刺，手法多以“糖針”為主，重視的是病人感覺舒適愉悅和放鬆享受感，約有90%的患者針後5- 10分鐘即安然入睡，更有的患者在 施針沒有結束時就已入睡。治療結束後病人通常會反 饋給醫者，譬如深層睡眠，愉悅舒適，精神煥然一新 等等。
對於不排卵或排卵延遲的患者，排卵期可採用子宮穴圍刺法[8] ，以子宮穴為中心，上下左右1公分處各扎一針，向子宮穴斜刺並施於電刺激30分鐘，其目的就是增加卵巢的血供，使成熟的卵子迅速排出，促發排卵。對於不排卵或閉經，特別是患有PCOS的肥胖患者，除了圍刺子宮穴外，加用鳳尾穴(長強、腰俞、會陽穴)，取2.5-3寸針，分別在長強、腰俞穴以15度角斜刺向上，當患者得氣後向前捻轉至滯針，然後下壓約30-60秒，患者會感到腰骶部漸漸發熱，熱感會上行至頸部、頭部，甚至會波及雙側胳臂及雙手。會陽穴則以45度角，針右側會陽時針尖方向左側會陰部方向刺入，針左側會陽時針尖方向右側會陰部方向刺入。針刺的要點在於慢慢撚轉透入深部至患者有陰部發緊或放射感時，向前捻轉滯針，下壓制熱[9] ，侯針約60秒，敏感患者會有雙側卵巢發熱或小腹發熱的感覺，不敏感的患者侯針時間略長，我把此針刺手法命名“鳳尾療法“。針刺鳳尾穴目的就是打通督脈， 促進局部的血液循環，刺激內在的性腺，從而反射到腹部內在的子宮，卵巢等器官。對於腎陽虧虛，喜熱 怕冷，黃體功能極差的高齡患者，可以加用劉偉醫生創立的督4針，腰俞，腰陽關，命門，至陽。針刺手法的要點，按照督脈的走行，進針需從下向上，約30°角斜刺，先行滯針，然後將針呈弓狀，左右搖擺10-20次後再上下呈拋物線運針20-30次，將針體呈釣魚狀，切記行針時盡量做到意守勞宮，自感手心發熱時即可取效，通常患者會感到下背部發熱似火爐，得氣後可留針半小時。督4針可以振奮人身之陽氣，溫通督脈，體陽而用陰。
4. 針灸治療的次數和低頻率電刺激是增加血流量的一個關鍵因素
針灸治療要有連貫性，每週2-3次比每週一次效果要好，特別在月經期和排卵期尤為重要，因為月經期針灸可以幫助子宮內舊的瘀血排出，讓脫落的子宮粘膜完全徹底清除，有利於子宮建立新的，帶有營養和血供的內膜，為將來的胚胎著床提供一個良好的內環境。針灸治療不孕症通常以3個月為一療程。 針灸的頻率也要因人而異，經濟條件好的建議每週2-3次；經濟條件差的每週一次，至少保證經期和排卵期的2次治療，否則難以達到預期的效果。
研究表明高齡女性的卵巢較年輕女性更容易處於低氧水平,這可能導致高齡女性的卵細胞質量下降[10] 。在卵泡募集的特定階段(卵泡期)使用低頻電針很重要, 於下肢內側(三陰交和陰陵泉)和小腹部的穴位實施低頻電針刺激，能夠顯著增加子宮和卵巢的血流量, 為卵細胞提供足夠的營養, 促使卵泡發育，有利於卵泡募集。排卵期可以於子宮穴(卵巢區域) 行圍刺療法加用低頻電針可以擴張輸卵管，讓成熟的卵子迅速排出，從而避免卵子老化。在準備人工輔助生殖的調節階段持續在下腹部和下肢內側以及下背部穴位(八廖穴)交替使用低頻電針有助於增加子宮和卵巢的血流。
5. 針灸治療的年齡
世界衛生組織(WTO)規定不孕症是指正常性生活一年未採取任何避孕措施，而沒有成功懷孕。有原發性和繼發性不孕2種情況，相對而言原發性不孕較繼發性不孕治療起來時間略長，取效略慢。高齡不孕指35 歲女性有正常性生活未有避孕而不孕者。特別需要強調的是35歲是女性生育力不可逆降低的界限。美國生殖醫學學會專家近年來對不孕的年齡做了進一步的限制[11]，年齡在35-38歲之間，試孕半年而不孕；39歲以上3個月同居未孕者，以上2種情況均應提前進行生育力評估並建議開始作為不孕症診治。
所以生育期的女性婚後要抓住時機，儘早懷孕。因為越年輕卵泡的質量就越好，子宮內膜的容受性也越佳。很多患者沒有這方面的常識，35以上結婚的人數很普遍，婚後還忙於學習，打拼事業，因為她們不了解卵巢功能下降所帶來的嚴重性，所以她們缺乏危機感。等到她們認為一切就緒，想準備懷孕時，才發現為時已晚, 因她們的年齡大都超過適孕期了[12] 。
西方女性很早就開始服用避孕藥，有的在初中即開始服藥，連續服藥超過20年的女性很普遍。正是這種情況導致了女性卵巢的功能下降，停藥後卵巢在相當長的時間內仍處於休眠狀態，從而導致月經不調，排卵延期或無排卵，有的還會出現卵巢早衰，提前進入更年期。所以一旦確定為不孕症，針灸的早期治療非常重要，因為針灸可以刺激休眠的卵巢，促其甦醒，改善卵巢的儲備功能，提高卵巢低反應患者的卵巢反應性，調整下丘腦-垂體-卵巢軸，促進卵泡發育成熟，提高卵母細胞質量，從而改善卵巢功能，提高妊娠率。
6. 針刺配合IVF、IUI
人工生殖技術發展到今天已經越來越成熟，試管嬰兒自1978年研發出了第一代至今已經到目前的的第三代、第四代，但是IVF/IUI的成功率仍有待提高。 據美國CDC (ART) 2020年報導， 35歲以下的女性 試管嬰兒的成功率在47.2%；35-37歲的女性成功率在34.6%；38-40歲的女性成功率在22. 1% ；40歲以上的女性成功率只有7.2%[13]。這也是為甚麽大部分不孕中心不願意接收40歲以上的患者，因為失敗率之高從而影響生殖中心的聲譽。如何提高IVF/IUI 的成功率，一直是生殖醫生多年來研究的課題。由德國的生殖專家Wolfgang E. Paulus 醫生主持的一項研究結果顯示，針灸治療可以顯著提高IVF受孕的成功率。增加的比例可高達15%以上，同時對提高不孕症患者成功產下健康胎兒的機率高達23%以上[14] 。
目前美國針灸配合IVF/IUI的治療模式已經形成，即在IVF/IUI治療前後實施針灸治療。海外利用針刺輔 助干預IVF/IUI，其主要目的為改善子宮、卵巢的血運，促進子宮內膜的容受性，安神定志，疏肝解鬱，緩解化學激素的副作用；而中國中醫學術界則強調穴位多以沖任脈為主，兼取腎經，脾經、膀胱經。
通過多年的臨床發現，對於高齡不孕患者，僅在胚胎移植的前後予以針刺，很難達到預定的目的，因為高齡患者的卵巢功能已經下降，卵子老化，而優質卵子則需要近3個月左右的時間才能逐步改善。
一旦IVF開始，患者就會接受大量的化學激素，大多數的生殖醫生會拒絕正在接受IVF治療的患者同時服用中藥，這是因為有關中藥與不孕症化學激素之間相互干擾的實驗數據太少，二者是否有拮抗作用不得而知，所以鑑於安全考慮，不宜聯合使用。根據上述原因，我認為最好在IVF開始前的2-3月就開始進行針藥的干預治療。一旦開始IVF，就只針不藥。針刺的頻率可以增加到每週3次。但是在患者口服或肌注排卵抑製劑時，針刺最好避免使用促發排卵的穴位，譬如子宮、歸來、八髎、合谷、血海等穴位，以免發生和化學藥物相衝突的反作用。一旦證實患者懷孕，針刺則以安神定志、養血安胎為主，避免使用腰腹部及一些刺激性較強的穴位，以免引發流產。
臨床證明，針刺配合IVF治療可以避免西藥治療的副作用，譬如卵巢過度刺激綜合徵，患者腹部過度脹氣，水液瀦留，極度焦慮，失眠頭痛等，同時也可以減少患者對西藥的依賴性。
7. 安神定志，心肝同治是貫穿在整個不孕過程中的重要思路
內經曰： “凡刺之真，必先治神”。《靈樞. 本神》 篇講到“凡刺之法，必先本於神”。《黃帝內經》 認為，得氣與治神是上工所具備的針灸精技，亦是針灸取得療效的關鍵因素，針刺最終獲得療效的關鍵是氣調而神治。針刺前，醫者恬淡靜神以察患者之氣機；進針時，醫者凝神調節自身之氣機，並囑患者守神以候氣；進針後，醫者守神以察氣，施以補瀉，令精微之神氣至，以調患者之神氣。由此可見，“神”貫穿於針刺的全過程，“本於神”是針刺取得療效的關鍵，是針刺的基礎與核心。《內經》中非常注重調氣，所謂“神與陰陽相統一，神氣不二”，所以調氣亦是調神，調神亦是調氣。
情志活動歸屬心肝兩臟。心主神誌、主血脈；肝主 疏泄，喜調達。心肝二臟關係密切。《明醫雜著.醫論》曰：“肝氣通則心氣和，肝氣滯則心氣乏。” 《內經》：“心者，君主之官，神明出焉”，“心者，五臟六腑之主也，憂愁則心動，心動則五臟六腑皆搖”。肝藏血，主情志，惡抑鬱。張景岳《婦人歸.子嗣類》：“情懷不暢則衝任不固，衝任不充則胎孕不受”。肝藏血，司疏泄之職，女子以血為本，肝血充盈，太衝脈盛，下注於胞宮。若肝氣鬱結，疏泄不利，致月經紊亂，排卵延期，難以受孕。美國高齡女性特別是職場女性，工作壓力大，結婚晚，精神長期的處於高度緊張狀態，焦慮失眠，導致內分泌紊亂而不孕。所以在臨床治療時要心肝同治，安神調神加以心理疏導。針刺選穴多為心經、心包經、肝經，百會、太陽、印堂及耳神門等穴位。此治療思路需要貫穿於不孕患症治療的全過程而 非僅僅用於黃體期的提法。
8. 夫妻同治，效果倍增
孕育的整個過程是要靠夫妻二人共同完成的，對於婚後多年不孕的患者，夫妻二人大都有心肝氣鬱的情況，如果患者經濟條件允許，建議夫妻同時接受針灸治療，根據具體情況可施予電針刺激。在丈夫精子正常的情況下，如果經濟條件不允許，治療則以妻子為 主，僅排卵當日需要夫妻同時接受針刺治療。因為針灸不但使他們精神放鬆，協調夫妻二人之間的親密性，增加丈夫的責任感和參與感，而且可以擴張輸卵管和輸精管，改善子宮內膜的容受性，讓充滿活力的卵子、精子迅速結合，使受精卵利於著床，形成優質 胚胎，提高受孕率。
以上僅是個人多年來針灸治療不孕症的點滴體會，有一定的共性可以作為同行借鑒。針灸通過調神調氣，健脾補腎，平衡陰陽，從而達到改善卵巢儲備功能，提高卵子質量，增加子宮內膜容受性，使受孕率大大提高。
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