L.A. Times story on acupuncture

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July 4, 2005 latimes.com : Health E-mail story Print Most

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Acupuncture for fertility: Doctors say, 'Why not?'

a.. With more patients asking for it, some clinics are offering the

ancient technique.

 

By Elena Conis, Special to The Times

 

 

Jackie Apuzzo is 16 weeks pregnant - something she was beginning to think

would never happen.

 

Following nine years of unsuccessful efforts to have a baby, including

failed in vitro fertilization, a miscarriage and a diagnosis of endometriosis,

the 37-year-old social worker finally visited an acupuncturist on the advice of

a friend. After two months of acupuncture treatments and a regimen of Chinese

herbs, she became pregnant.

 

 

 

 

 

 

 

 

" I was a little apprehensive about the needles at first, " said Apuzzo. But

in April, Apuzzo's acupuncturist in Santa Monica looked at her tongue, checked

her pulse and declared the Long Beach resident pregnant. Apuzzo later confirmed

the diagnosis with a blood test.

 

As more women than ever delay having children until their 30s and 40s,

infertility is a growing challenge in the U.S. An estimated 3 million couples

are unable to conceive after a year of trying, according to the American Society

for Reproductive Medicine. Fertility clinics have done a brisk business in

recent years, but now doctors say that a growing number of women who have been

unable to get pregnant through conventional medical treatments are seeking out

alternatives such as acupuncture. Demand for the traditional Chinese method is

so great that an increasing number of fertility doctors now are collaborating

with acupuncturists, with some physicians adding acupuncturists to their staff,

according to doctors and experts in the field.

 

Although many acupuncturists and doctors of oriental medicine swear by the

treatment - and have relied on it as an infertility remedy for years - the

mainstream medical community remains divided on acupuncture's efficacy. Some

doctors say more research is needed to demonstrate acupuncture's effectiveness,

and others believe it's irresponsible to recommend the treatment based on the

existing scientific evidence.

 

Most fertility specialists trace the current popularity of acupuncture

treatment to a German study published in 2002 in the journal Fertility and

Sterility. The study, led by Dr. Wolfgang Paulus at the University of Ulm, found

that 42% of women receiving acupuncture just before and after an

assisted-reproductive therapy, such as IVF, became pregnant; that compared with

26% of patients who got pregnant with assisted-reproductive treatments but who

received no acupuncture therapy.

 

Later that year, Dr. Raymond Chang and colleagues at Cornell University's

medical school in New York published a paper in the same journal, describing

several ways acupuncture might actually improve a woman's chances of conceiving:

relaxation, regulating reproductive hormones and improving the lining of the

uterus, where the embryo needs to be implanted before it can develop.

 

Because of the reports, published in a prestigious journal, " some doctors

started to say, let's try it out, " said Dr. Paul C. Magarelli, a fertility

specialist in Colorado Springs, Colo.

 

Deming Huang, an acupuncturist at Stanford University's Center for

Integrative Medicine in Palo Alto, said patient interest began to rise about the

same time. At the Stanford clinic, more women began asking their doctors for

referrals to acupuncturists. And though it's not easy to measure the effect of

popular culture on medical trends, more than a few women may have been swayed to

try acupuncture when the " Sex and the City " character Charlotte visited an

acupuncturist in an effort to get pregnant during the show's final season.

 

Alice Domar, director of the Mind/Body Center for Women's Health at the

Boston IVF fertility clinic, describes efforts by physicians to recommend

acupuncture for fertility treatments as a " mini-scandal. " But even the clinic

where she works is preparing to hire an acupuncturist to add to its current mix

of relaxation and confidence-building techniques for fertility patients - a

decision Domar, a psychologist, says she struggles with as a scientist.

 

" With the data we have right now, one cannot say that acupuncture

increases pregnancy rates, " Domar said. Western studies on the topic have so far

produced inconsistent results, making it impossible, she said, for experts to

draw definitive conclusions.

 

Early studies on the subject suggested acupuncture might increase blood

flow to the uterus - which would improve the chances of a pregnancy taking hold

- but later research refuted this.

 

Studies led by Magarelli, the Colorado specialist, suggested acupuncture

increased pregnancy rates in patients who doctors had determined had little hope

of getting pregnant. He and colleague Diane Cridennda, a licensed Colorado

Springs acupuncturist, also showed that women who received acupuncture had more

" take-home babies. " That is, they were less likely to lose pregnancies to

miscarriage or embryos that failed to take hold in the uterus.

 

But like the German study results, Magarelli's findings have been faulted

for failing to rule out psychological or psychosomatic effects of the treatment.

Patients who received a fake treatment might have responded to the treatment as

if it were truly effective simply because they believed it was - a phenomenon

known as the placebo effect.

 

Paulus addressed the problem in a 2003 study by comparing the effects of

acupuncture with fake or sham acupuncture, placing needles against acupuncture

points without penetrating the skin. The results showed no difference in

pregnancy rates between patients who received true acupuncture and those who

were given the sham.

 

Acupuncture needles, about the width of a hair, are just barely felt when

inserted, making it difficult to come up with a good sham treatment to help rule

out the placebo effect. As Domar put it, " If patients are getting pricked with a

needle, they know it. "

 

It's hard to study acupuncture for other reasons too. Treatment regimens

have varied from one study to the next. A study performed by researchers at the

Robert Wood Johnson Medical School in Camden, N.J., found no effects of

acupuncture on pregnancy rates - but their patients had just one acupuncture

session, whereas other studies used two or more.

 

To rule out the effects of other aspects of the treatment, Western

researchers often trim acupuncture down to its simplest element: needles. But

acupuncturists don't simply insert needles; most take a whole-body approach,

asking broad questions about patient history, making recommendations about

nutrition and stress management and prescribing herbal remedies.

 

" Our goal is not just to get the patient pregnant, " said Dr. Daoshing Ni,

co-founder of the Tao of Wellness center in Santa Monica, which sees hundreds of

infertility patients each week. " Getting pregnant is just one step in our

overall goal " of improving a patient's health, he explained.

 

Researchers here and in Europe hope to eventually shed light on whether

acupuncture is truly beneficial for women trying to get pregnant. For now,

however, doctors face a conundrum: Should they recommend an unproven treatment,

discourage such treatment or take no stance at all, said Dr. James Dillard, of

the Rosenthal Center for Complementary and Alternative Medicine at Columbia

University.

 

Because acupuncture is considered relatively safe, Dillard said, more

fertility doctors are deciding that it's OK to add it to the mix. " It's a big

black-and-white outcome; you're either pregnant or you're not, " he said. " If it

turns out it's just the placebo effect, who cares? "

 

Many also say evidence that acupuncture relaxes patients is sufficient to

recommend it, given the stress of dealing with infertility. In fact, women

undergoing infertility treatments face stress levels on par with those of women

coping with chronic illnesses such as heart disease and cancer, according to the

American Society for Reproductive Medicine.

 

But skeptics like Domar feel it may still be too soon to recommend the

treatment. " Patients are not going for acupuncture to feel good; they're going

for acupuncture to get pregnant. And they're spending thousands of dollars for

it. It's a dilemma. "

 

Now pregnant, Jackie Apuzzo is still undergoing acupuncture treatment,

although her therapy has changed: no more herbs and fewer needles in different

locations. Her baby is due in December.

 

Reflecting on the trials of the last several years, Apuzzo said the best

thing about acupuncture was that it saved her from a second stressful IVF cycle,

which she had planned for this month. " I'm glad we don't have to go through that

again, " Apuzzo said. " I just wish that I had considered the alternatives before

jumping into the big guns. "