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!