The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: A pilot study

Abstract

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center.

Patient(s): 57 infertile patients undergoing IVF or IVF/ICSI.

Interventions(s): Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care.

Main outcome measure(s): Perceive Stress Scale scores, pregnancy rates.

Result(s): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased their perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status.

Conclusions(s): The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

Introduction

Acupuncture is a therapy of inserting, manipulating and retaining very fine needles in specific “acupoints”. It appears to be helpful in improving the success rate of assisted reproductive techniques, although not all studies are positive.1, 2, 3, 4, 5 A recent systematic review and meta-analysis concluded that preliminary evidence suggests a role for acupuncture in infertility.⁶ The mechanisms by which acupuncture affects pregnancy rates are not known.

Currently at our institution (Magee-Womens Hospital), women are given the option to undergo acupuncture at the time of embryo transfer and/or earlier during the IVF cycle, and patients either self-select acupuncture or they self-select to not have acupuncture. In this pilot study, we compare subjects undergoing embryo transfer without acupuncture to those who have embryo transfer in conjunction with acupuncture to evaluate whether acupuncture improves stress levels, and whether either acupuncture or stress levels are associated with improved pregnancy rates.

The Perceived Stress Scale, which is a 10-item questionnaire is a valid and reliable tool that measures the degree to which situations in one's life are appraised as stressful.⁷ The PSS is sensitive to both stress from expectations concerning future events and to chronic stress deriving from ongoing life circumstances, both of which are potentially relevant for the IVF population. We hypothesized that an increased perception of stress at the time of embryo transfer could lead to lower IVF success rates, potentially through a sympathetic activation pathway, although the mechanism was not specifically studied in this pilot study.

Stress and anxiety are very common in infertility patients, especially those undergoing IVF.⁸ Anxiety and depression are considered causes of early drop-out after the first IVF cycle and are related to lower pregnancy rates.9, 10, 11 Acute and chronic stress in patients undergoing assisted reproduction affects biologic end points (i.e. number of oocytes retrieved and fertilized), as well as pregnancy, live birth delivery, birth weight and multiple gestations.12, 13 Thus, reducing stress and anxiety can be helpful in IVF patients. True acupuncture decreases anxiety levels when compared to sham acupuncture,¹⁴ {Kober, 2003 #38}.

We aimed to determine if acupuncture affects the levels of perceived stress at the time of embryo transfer, and whether either acupuncture or changes in stress levels play a role in the success rate in IVF. We chose to measure stress levels at the time of embryo transfer for several reasons. We postulated that reducing stress at the time of embryo transfer could result in less vasoconstriction and improved uterine receptivity. Embryo transfer data collection was logistically feasible; in addition, because all participants were receiving the same embryo transfer procedure, the study groups were fairly homogenous, with one key difference between groups being whether or not acupuncture was performed. To keep the group receiving acupuncture homogenous, the protocol used for all acupuncture patients was the same, that described by Paulus, which involves acupuncture before and after embryo transfer, on the day of embryo transfer.¹ This same protocol was found to improve pregnancy rates in a later study by a different investigator.¹⁵ We chose this protocol because we have found, both within the University of Pittsburgh, and in the community, this is the common acupuncture approach used in conjunction with embryo transfer. Paulus notes that he chose the points based on “acupuncture points that relax the uterus according to the principles of TCM.”