Can Alternative Medicine Complement IVF Treatment?

December 7, 2010Carole 4 Comments »

There is a huge amount of interest in using alternatives to traditional Western medicine to treat a variety of diseases and infertility is no exception.  Everyone wants to find something (for example, acupuncture, herbal medicines) that could be used to improve the  pregnancy rates from traditional medical treatments which are far from 100% effective. Recently, a reader asked me to comment about acupuncture and other alternative medicines as a complement to IVF treatment.

There are several things to keep in mind when considering alternative medicine.

First, is there any scientific evidence supporting claims? If so, was that evidence collected independently or only by scientific authors who also happen to sell that product? Was that evidence collected using a prospective randomized controlled trial?

Prospective means was that the study question was in place and defined before the experiment began, not after the results were in. Data mining of results from two groups of patients after the interventions occurred are retrospective trials and are more vulnerable to wishful interpretation because you are looking for evidence to support your viewpoint. This is much weaker scientific evidence.

Randomized means that patients were placed into the trial in random order, without any selection bias into either the treatment or control group. In health care, especially, there is a tendency to put patients into treatment groups if they are most likely to benefit from the treatment. While this is the best approach if treatment is the goal, it is the worst approach if you are trying to figure out if a treatment is actually effective. It biases the results and increases the probability you will find “treatment effects” that are actually due to non-random enrollment.

A controlled trial is one in which you have two groups of people, one group is receiving the treatment or intervention, the other is receiving a placebo. The control subject must be treated the the same in all respects except they do not receive the medicine or treatment that you are trying to test. So any treatment effects can be attributed to the test medicine and not other variables between the two groups. For instance, a placebo pill is an inert pill, made the same way as the treatment pill but without the medicine. Both control and experimental groups get a pill, so that both groups receive the same psychological effect that taking a pill may have and both are exposed to the same potential effects from the carrier ingredients.  If the experimental drug has real treatment effects, a stronger beneficial effect should be seen in the group receiving the real medication compared to the control group–if all other variables are taken into account or controlled. If the control subjects were to receive no pill at all, instead of a placebo, the control subjects may do worse simply because they know they did not get treatment, artificially inflating any perceived benefit received in the treatment group.

Second, there are many many reasons for infertility problems, does your problem lend itself to improvement from this product? For example, a product or treatment that claims to provide relaxation benefits can not help someone whose problem is scarred tubes, even if the product were effective, relaxation wouldn’t reverse tubal scarring. On the other hand, there does appear to be a link between excessive stress and hormonal function. Since egg production and ovulation are highly dependent on normal hormonal function, it is possible that relaxation techniques that help a person manage stress could be helpful in normalizing hormone function and supporting fertility. There are also may be some psychological benefits from feeling that you are doing absolutely everything you can do to help your situation.

The debate about complementary medicines to IVF can be understood by considering  a study reported in 2007 and the heated debate that followed. Dr. Jacky Boivin, a psychologist, wanted to study why women seeking fertility treatment sought out alternative medicine instead of conventional psychological therapy to deal with stress. She reviewed the psychosocial and medical profiles of 818 Danish women at both the start of their IVF treatment, and then looked to see which women decided to use  complementary therapy in the next 12 months. Not surprisingly, women who were more stressed and worried about treatment failure were more likely to seek out alternative medicine to augment the traditional medicine. A surprising result was that women who used complementary alternative medicine had a 20% lower pregnancy rate than those that relied on traditional medicine alone. This study is flawed because Boivin found a difference–other than alternative medicine use– in the women who chose alternative medicine compared to those that didn’t which could affect their results with IVF. Patients using alternative medicine had a longer history of infertility and failed attempts to conceive and reported more feelings of stress than the traditional medicine group. Both these factors would make the alternative medicine group less likely to conceive than the traditional medicine group regardless of whether they used alternative medicine or not. Another problem with this study is that it is preliminary. This report was presented at a medical conference, which unlike research published in a scientific journal, is not subjected to peer review in advance of presentation.

The rebuttal from alternative medicine proponents was swift and furious. Emma Farrant, a member of the Register of Chinese Herbal Medicine and the British Acupuncture Council, wrote this rebuttal to an article published in the Guardian about Boivin’s study. She points to two other studies which show a beneficial effect of alternative medicine on IVF pregnancy rates. According to Farrant, “Measuring the Effectiveness of Chinese Herbal Medicine in Improving Infertility (Wing & Sedlmeier), showed that Chinese herbal medicine, when prescribed correctly, actually increases fertility – 56% of the sample group were pregnant within six months of starting their final treatment. Another, The German Study on Acupuncture and ART (Paulus, Zhang, Strehler, El-Danasouri and Sterzik), demonstrated that acupuncture improved pregnancy rates during IVF – with 42% of the acupuncture group pregnant within six weeks, compared to 21% of the control group.”

Rebutting the rebuttal, round 2. If you read on to the comments below Emma Farrant’s rebuttal, you will find a criticism of both the German and Chinese medicine studies as non-scientific. The Chinese study was published in the Journal of Chinese Medicine , but unfortunately the link to the study is no longer active. Also, the Journal of Chinese Medicine is pretty clear in its author’s guidelines that this journal solicits opinion pieces and summaries of existing claims, unlike a peer-reviewed journal which accepts original research articles and has a panel of scientists that reviews and approves or rejects an article based on scientific merit. So anything published in this Chinese journal, while interesting, has no real scientific standing. The German study was similarly criticized as not having followed accepted standards of scientific design and evaluation of results.

Other studies have described benefits of acupuncture on IVF outcome as reported in the Times on-line article, “Course of acupuncture may raise success of IVF treatment by 65%“. Even the author, Dr Eric Manheimer of the University of Maryland School of Medicine, was quick to dampen this hyperbolic headline. They looked at 108 trials of the effect of acupuncture on IVF outcomes and rejected all but 7 trials based on poor scientific design. Women received a 25-30 minute acupuncture treatment just before or  after their embryo transfer. The study authors contend that a modest effect was found when you look at the number of women that needed treatment with acupuncture to realize one additional pregnancy over control- that number was ten. Some of the effect may be attributed to a “placebo effect” of acupuncture, due to actual or perceived benefits from increased relaxation. Placebo effects can be real.

What about herbs and supplements? Here you run a greater risk of real effects that may not be helpful. Herbal medicines like St. John’s Wort are strong medicines used for depression and anxiety. Some evidence exists that St. John’s Wort may have a spermicidal effect on sperm. This review describes the scientific evidence for interactions between many popular herbal medicines and supplements  (for example, ginkgo, St. John’s Wort, ginseng, garlic, echinacea, saw palmetto and kava) and prescribed drugs which may have detrimental effects. It is very important to tell your doctor about any herbals supplements that you take so she can evaluate any potential interactions with the medications they are prescribing. Some supplements have been shown to interfere with estrogen function, making oral contraceptives less effective. Similar concerns have been raised that St. John’s Wort may make ovarian stimulation medications less effective.

There is a large misconception in the public that herbal is automatically healthier. Most prescribed medications have their origins in some plant or animal molecule that is found in nature that may be modified by the pharmaceutical industry to make it more effective or safer. That is why there is so much interest in preserving the biodiversity in the rain forests. Many of our future drugs may be found there. Although there is currently a pervasive climate of distrust against the pharmaceutical industry in general, it is an undeniable fact that pharmaceutical companies are required by federal law to provide scientific evidence that their drug is safe and effective before they can legally sell it. You might argue about whether compliance with federal law is adequate but at least the expectation exists and non-compliance has significant financial and even criminal penalties. In contrast, herbal medicines are not subject to federal regulation. NONE. Even if a herbal medicine was 100% effective and 100% safe, you have no assurance that the bottle you buy actually contains the medicine or if it does, that the effective dose is the same from bottle to bottle.

So what is a patient to do? Be skeptical and be informed. Acupuncture, if done hygienically, probably won’t hurt you and if you find it helpful to to manage the stress from treatment, it may help with some kinds of infertility (eg. hormonally based). Herbal medicines and supplements are more problematic. The safest course of action is to discuss any herbal medications you are taking with your doctor. Be skeptical of claims made by companies that sell products, especially if you can’t find any evidence that independent researchers showed similar results.  I think beneficial herbal medicines and alternative medicine treatments probably do exist, but good scientific studies proving safety and effectiveness are few and far between.

© 2010, Carole. All rights reserved.

4 Responses to this entry

  • Can Alternative Medicine Complement IVF Treatment? | Fertility Lab … | Fertility Acupuncture Says:

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  • Flowerchica Says:

    This is a very interesting article. I actually did an IVF cycle (no acupuncture) and then a Frozen Egg Transfer (with acupuncture). My frozen cycle was successful, my IVF was not. I know a sample size of 2 has no statistical significance, but I can say that the acupuncture really made me feel better. My doctor referred me to an acupuncturist that they use with their IVF patients. My doctor did not allow the acupuncturist to give me any herbs. I thought I’d be nervous, but the acupuncture literally took all of my stress away. I did 6 acupuncture sessions as well as one immediately before and after my transfer. After the transfer, I did acupuncture for stress and helping the embryo stick for 2 weeks.

    My acupuncturist has 2 protocols that my doctor allows him to do on their IVF patients. The 6-session one has a 80 % success rate and the 8-session one has a 100% success rate. And that’s just for getting a positive pregnancy test afterwards. Those numbers are specific to my acupuncturist and my doctor. I don’t know if the acupuncture helped, or if it just took care of my stress and left me in a happy state to receive my embryo, but I don’t see the harm in doing it.

    I agree, Eastern Medicine doesn’t feel very scientific at all. Even being diagnosed by an acupuncturist seems flaky. They look at your finger nails and tongue and can decide what needle points you need. I don’t buy into it all, but I do feel that it was a positive experience, and I continue to go because I do feel less stressed when I do acupuncture.

  • Carole Says:

    Thanks for your interesting comment about your acupuncture experience. I am so happy that you were able to become pregnant. Best Wishes for continued health and happiness for you and yours!

  • Buddy-Britten- the answers hub Says:

    Heat cannot be separated from fire, or beauty from The Eternal….

    Immodest words admit of no defense, for want of decency is want of sense.’);…

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