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Fertility

This study by scientists at Adelaide University was commissioned by the Australian government and showed Chinese herbal medicine doubled pregnancy rates over a four month period.


this study has been updated in 2016: http://dx.doi.org/10.1016/j.ctim.2014.12.004


Acupuncture in fertility and obstetrics - Research Summaries
(this list courtesy Alberto d'Attillio - www.attiliodalberto.com/fertility_research.php)

Latest Fertility Research Using Acupuncture and Chinese Herbal Medicine
  1. Acupuncture     and Chinese herbs helps infertility: Acupuncture and Chinese herbs prevent infertility after emergency ectopic pregnancy surgery. Ectopic pregnancies occur when a fertilized egg does not implant in the uterus.     Qihai (CV5) and Tianshu (ST25) are depicted in this photograph. A common     form of ectopic pregnancy is a tubal pregnancy wherein the fertilized egg     remains in one of the fallopian tubes. The fertilized egg cannot survive.     It is a life-threatening condition that may require emergency surgery or     an injection of methotrexate to stop cell growth. Unfortunately, this may     lead to residual blockage of the fallopian tubes and subsequent     infertility. Li XR, Zhang GF, Zhang MW, Chang CF & Zhang D. (2014).     Clinical Observations on the Effect of Combined Treatment with Acupuncture     and Medicine on Tubal Patency after Ectopic Pregnancy Surgery. Shanghai     Journal of Acupuncture and Moxibustion. 33(9).
  2. Acupuncture     better than western medicine at improving sperm quality: A total of 12 studies     involving 2,177 patients were included, the quality of which was evaluated     as mediocre. For the treatment of male infertility, acupuncture is     reported to be equally effective as TMC and more effective than Western     medicine, and its effectiveness is enhanced when applied in combination     with either TCM or Western medicine. Acupuncture is distinctively     efficacious in improving sperm quality. Zhonghua Nan Ke Xue. 2015     Jul;21(7):637-45.
  3. Acupuncture     very safe in pregnancy: Although     the safety of acupuncture per se in pregnancy is reasonably well accepted,     there remains debate regarding needling at points historically considered     to be 'forbidden' during pregnancy. This article reviews the scientific     literature on this topic. These findings are reassuring and will help     individualised risk:benefit assessment before treating pregnant women.     Given the numerous evidence-based indications for obstetric acupuncture     and lack of evidence of harm, risk:benefit assessments will often fall in     favour of treatment. Acupunct Med. 2015 Oct;33(5):413-9. doi:     10.1136/acupmed-2015-010936. Epub 2015 Sep 11.
  4. Acupressure     ripens cervix: Cervical     ripening is one of the main stages of initiation labor. Acupressure in     Chinese medicine is considered as an invasive technique, which through     reliving oxytocin ripens the cervix. Acupoint Sanyinjiao (SP6) was     selected in this study because it is the acupoint selected in gynecology     and it is easy for women to locate and apply pressure without medical     assistance. There was a significant difference between mothers' educations     in the three groups. Most of the mothers (59.5%) in the     researcher-performed acupressure group had secondary education. Cervical     ripening was significantly different between the three groups after 48     hours (P = 0.05), yet there was no significant difference after 96 hours     and at the time of admission. Mean Bishop score was enhanced after 48     hours in the researcher-performed acupressure group (P = 0.021) and the     self-performed acupressure group (P = 0.007) in comparison to the control     group. The results showed that acupressure is a safe technique and leads     to cervical ripening. Thus, regarding the desired results that were     achieved when mothers applied acupressure themselves, it could be     suggested that it is beneficial for mothers to be trained to apply this     method at home. Iran Red Crescent Med J. 2015 Aug 24;17(8):e28691. doi:     10.5812/ircmj.28691. eCollection 2015.
  5. Acupuncture     reduces labour duration: Nowadays, acupuncture is     widely used to manage pain, and childbirth is a condition requiring     appropriate pain management interventions. In this study, we investigated     the effects of acupuncture on labor pain, serum cortisol level, and     duration of labor. We conducted a randomized, single-blind, controlled     trial that included 63 nulliparous women: 32 in the study group and 31 in     the control group. Acupuncture was performed at the SP-6 and the LI-4     points in the study group, and sham acupuncture was performed at the same     points in the control group. Our results show that acupuncture is     significantly associated with a decreased duration of labour. J Acupunct     Meridian Stud. 2015 Oct;8(5):249-54. doi: 10.1016/j.jams.2015.08.003. Epub     2015 Sep 11.
  6. Acupuncture     reduces FSH levels and increases antral follicle count, AMH levels and     pregnancy rates: The aim of this study was to investigate the     effect of transcutaneous electrical acupoint stimulation (TEAS) on ovarian     reserve in patients with diminished ovarian reserve undergoing in vitro     fertilization and embryo transfer. A total of 240 patients were randomly     divided into the Han's acupoint nerve stimulator TEAS treatment (TES),     comforting false Han's placebo (FHP), artificial endometrial cycle     treatment (AEC), and control (CON) groups. TEAS and AEC treatments could     improve basal endocrine levels in patients, and increase the number of     oocytes retrieved and high-quality embryos. TEAS treatment could improve the     clinical pregnancy rate in patients with decreased ovarian reserve during     in vitro fertilization and embryo transfer cycles. J Obstet Gynaecol Res.     2015 Oct 12. doi: 10.1111/jog.12810.
  7. TCM to     increase IUI success rates: In the first study that     measures the effectiveness of both herbs and acupuncture in combination     with IUI infertility treatment, Dr. Shahar Lev-Ari and Keren Sela of TAU's     Sackler Faculty of Medicine and the Tel Aviv Medical Center say that the     results, which have been published in the Journal of Integrative Medicine,     show a significant increase in fertility when the therapies are     administered side-by-side. In terms of both conception and take-home baby     rates, the test group fared far better than the control group. Out of the     29 women in the test group, 65.5 percent conceived, and 41.4 percent     delivered healthy babies. In the control group, only 39.4 percent     conceived and 26.9 percent delivered. The vast difference in success rates     is even more surprising when the age of the average participant was taken     into account, Dr. Lev-Ari and Sela note. "The average age of the     women in the study group was 39.4, while that of the control group was     37.1. Normally, the older the mother, the lower the pregnancy and delivery     rates," they explain.
  8. Reduced     fertility stress: Acupuncture     may be a useful intervention to assist with the reduction of     infertility-related stress. At the end of the 8-week intervention, women     in the acupuncture group reported significant changes on two domains on     the Fertility Problem Inventory with less social concern (mean difference     [MD] -3.75, 95% confidence interval [CI] -7.58 to 0.84, p=0.05), and less     relationship concern (MD -3.66, 95% CI -6.80 to -0.052, p=0.02). There     were also trends toward a reduction of infertility stress on other     domains, and a trend toward improved self-efficacy (MD 11.9, 95% CI -2.20     to 26.0, p=0.09) and less anxiety (MD -2.54, 95% CI -5.95 to 0.86, p=0.08)     in the acupuncture group compared with the wait-list control. (Journal of     Alternative and Complementary Medicine, 2011 Oct;17(10):923-30. Epub 2011     Oct 6.
  9. Increase     embryo transfer rates in IVF: Increase of success rate for     women undergoing embryo transfer by transcutaneous electrical acupoint     stimulation. Group 3 had TEAS treatments: 24 hours before ET and 30     minutes after ET and had a clinical PR, embryos implantation rate, and     live birth rate of (50.0%, 25.9%, and 42.0%, respectively), which was     significantly higher than the control group. (Fertility and Sterility     Volume 96, Issue 4, Pages 912-916, October 2011).
  10. Regulating     fertility hormones: stress     and other factors can disrupt the function of the hypothalamic     pituitary-ovarian axis (HPOA), causing hormonal imbalances that can     negatively impact fertility. Acupuncture has been shown to affect hormone levels     by promoting the release of beta-endorphin in the brain, which affects the     release of gonadotrophin releasing hormone by the hypothalamus, follicle     stimulating hormone from the pituitary gland, and oestrogen and     progesterone levels from the ovary (Ng EH, So WS, Gao J, Wong YY, Ho PC.     The role of acupuncture in the management of subfertility. Fertil Steril.     2008 Jul;90(1):1-13., Huang ST, Chen AP. Traditional Chinese medicine and     infertility. Curr Opin Obstet Gynecol. 2008 Jun;20(3):211-5., Lim CE, Wong     WS. Current evidence of acupuncture on polycystic ovarian syndrome.     Gynecol Endocrinol. 2010 Mar 16. [Epub ahead of print], Stener-Victorin E,     Wu X. Effects and mechanisms of acupuncture in the reproductive system.     Auton Neurosci. 2010 Mar 27. [Epub ahead of print]).
  11. Increasing     blood flow to the reproductive organs: stress also stimulates the     sympathetic nervous system, which causes constriction of ovarian arteries.     Acupuncture inhibits this sympathetic activity, improving blood flow to     the ovaries (Stener-Victorin E, Humaidan P. Use of acupuncture in female     infertility and a summary of recent acupuncture studies related to embryo     transfer. Acupunct Med. 2006 Dec;24(4):157-63., Lim CE, Wong WS. Current     evidence of acupuncture on polycystic ovarian syndrome.Gynecol Endocrinol.     2010 Mar 16. [Epub ahead of print]), enhancing the environment in which     ovarian follicles develop. It also increases blood flow to the uterus     (Stener-Victorin E, Waldenström U, Andersson SA, Wikland M. Reduction of     blood flow impedance in the uterine arteries of infertile women with     electro-acupuncture. Hum Reprod. 1996 Jun;11(6):1314-7., Huang ST, Chen     AP. Traditional Chinese medicine and infertility. Curr Opin Obstet     Gynecol. 2008 Jun;20(3):211-5.), improving the thickness of the endometrial     lining and increasing the chances of embryo implantation.
  12. Counteracting     the effects of polycystic ovarian syndrome (PCOS): PCOS is one of the most common     causes of female infertility. By reducing sympathetic nerve activity and     balancing hormone levels, acupuncture has been shown to reduce the number     of ovarian cysts, stimulate ovulation, enhance blastocyst implantation and     regulate the menstrual cycle in women with PCOS (Stener-Victorin E,     Waldenström U, Tägnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of     electro-acupuncture on anovulation in women with polycystic ovary syndrome     Acta Obstet Gynecol Scand. 2000 Mar;79(3):180-8., Stener-Victorin E, Jedel     E, Mannerås L. Acupuncture in polycystic ovary syndrome: current     experimental and clinical evidence. J Neuroendocrinol. 2008     Mar;20(3):290-8., Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB.     Low-frequency electroacupuncture and physical exercise decrease high     muscle sympathetic nerve activity in polycystic ovary syndrome. Am J     Physiol Regul Integr Comp Physiol. 2009 Aug;297(2):R387-95., Zhang WY,     Huang GY, Liu J. [Influences of acupuncture on infertility of rats with     polycystic ovarian syndrome] [in Chinese] Zhongguo Zhong Xi Yi Jie He Za     Zhi. 2009 Nov;29(11):997-1000.). It may also help to control secondary     effects such as obesity and anorexia (Lim 2010).
  13. Reducing     miscarriage: A     randomised controlled trial comparing acupuncture (plus moxibustion) to     medication (oral clomiphene) in 120 women with infertility due to     ovulatory disturbance. After treatment for 3 menstrual cycles women in     both groups showed similar increases in ovulation rates. However, the     pregnancy rate in the acupuncture group was significantly higher than that     in the medication group (p<0.05), due to lower levels of miscarriage.     (Song FJ. Zheng SL. Ma DZ. [Clinical observation on acupuncture for     treatment of infertility of ovulatory disturbance]. [Chinese] Zhongguo     Zhenjiu. 28(1):21-3, 2008 Jan.)
  14. Regulating     endocrine system: A     randomised controlled trial with 240 women with endocrine dysfunctional     infertility, 160 receiving acupuncture and 80 clomiphene. The pregnancy     rate was 65% in the acupuncture group and 45% for the medication, a     statistically significant difference (p<0.5) (Yang JR, Ma YY, Liu YL,     Wang HL, Liu Z. [Controlled study on acupuncture for treatment of     endocrine dysfunctional infertility] [Chinese]. Zhongguo Zhenjiu.     2005;25(5):299-300)
  15. Regulating     ovulation: Prospective,     longitudinal non-randomized clinical study investigating the effect of     acupuncture on ovulation in 24 women with PCOS and oligo-/amenorrhea.     Found that electro-acupuncture induced regular ovulation in 38% of women.     In addition, acupuncture influenced neruoendocrine and endocrine     parameters indicative of PCOS, such as LH/FSH ratios, mean testosterone     concentrations, and beta-endorphin concentrations. (Stener-Victorin E,     Waldenström U, Tägnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of     electro-acupuncture on anovulation in women with polycystic ovary syndrome     Acta Obstet Gynecol Scand. 2000 Mar;79(3):180-8.)
  16. Acupuncture     during embryo transfer: A     systematic review that looked at the effectiveness of acupuncture in the     outcomes of assisted reproductive treatment (ART). A total of 13     randomised controlled trials were included of acupuncture for couples who     were undergoing ART comparing acupuncture treatment alone or acupuncture     with concurrent ART versus no treatment, placebo or sham acupuncture plus     ART for the treatment of primary and secondary infertility. These found     evidence of benefit when acupuncture is performed on the day of embryo     transfer on the live birth rate (OR 1.86, 95%CI 1.29 to 2.77), but not     when it is performed two to three days after embryo transfer (OR 1.79,     95%CI 0.93 to 3.44). There was no evidence of benefit on pregnancy     outcomes when acupuncture was performed around the time of oocyte     retrieval. The reviewers concluded that acupuncture performed on the day     of embryo transfer shows a beneficial effect on the live birth rate.     (Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted conception.     Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006920.     DOI: 10.1002/14651858.CD006920.pub2.)
  17. Acupuncture     during embryo transfer: A     systematic review that evaluated whether acupuncture improves rates of     pregnancy and live birth when used as an adjuvant treatment to embryo     transfer in women undergoing in vitro fertilisation. It included a total     of 7 randomised controlled trials with 1,366 women Trials with sham     acupuncture and no adjuvant treatment as controls were pooled for the     primary analysis. Complementing the embryo transfer process with     acupuncture was associated with significant and clinically relevant     improvements in clinical pregnancy (OR 1.65, 95%CI 1.27 to 2.14; number     needed to treat [NNT] 10, 95%CI 7 to 17), ongoing pregnancy (1.87, 1.40 to     2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 95%CI 1.39 to     2.64; NNT 9, 95%CI 6 to 17). The reviewers concluded that current     preliminary evidence suggests that acupuncture given with embryo transfer     improves rates of pregnancy and live birth among women undergoing in vitro     fertilisation. (Manheimer E et al. Effects of acupuncture on rates of     pregnancy and live birth among women undergoing in vitro fertilisation:     systematic review and meta-analysis. BMJ 2008;336(7643):545-9.)
  18. Acupuncture     during IVF: An     overview of the use of acupuncture as an adjunct therapy for in vitro     fertilization (IVF). There is limited but supportive evidence suggesting     that acupuncture may improve the success rate of IVF and the quality of     life of patients undergoing IVF and that it is a safe adjunct therapy.     Most studies reviewed had design limitations, and the acupuncture     interventions employed often were not consistent with traditional Chinese     medical principles. The reviewed literature suggested 4 possible     mechanisms by which acupuncture could improve the outcome of IVF:     modulating neuroendocrinological factors; increasing blood flow to the     uterus and ovaries; modulating cytokines; and reducing stress, anxiety,     and depression. They concluded that more high-quality randomized,     controlled trials were required. (Anderson et al. In vitro fertilization     and acupuncture: clinical efficacy and mechanistic basis. Altern. Ther.     Health Med. 2007;13(3):38-48)
  19. Acupuncture     during IVF: A randomised     controlled trial that compared three acupuncture methods to evaluate which     method is most effective for IVF. A total of 52 IVF patients were randomly     assigned to receive traditional Chinese acupuncture plus     electroacupuncture, acupuncture alone (control), or electroacupuncture     alone (second control). Comparisons of IVF effectiveness rates were made     for each method. All three acupuncture methods increased the success rate     for IVF, and there was a marked increase with the combination treatment     (81.8% success, which is twice the US average for IVF alone; p0.05). The     researchers concluded that their results suggest the combination of     acupuncture and electroacupuncture is a promising new technique for the     treatment of infertility with a higher IVF success rate than that of     either treatment alone. (Kong S, Hughes A. Acupuncture as an adjunct to in     vitro fertilization: A randomized trial. Medical Acupuncture     2009;21:179-82.)
  20. Acupuncture     for stress during embryo transfer in IVF: A randomised controlled trial     to assess the efficacy of acupuncture on pregnancy rates in 150 women     undergoing IVF. The women were allocated to acupuncture before and after     embryo transfer, while the control group lay quietly. All the women then     completed questionnaires on anxiety and optimism. There were no     significant differences in pregnancy rates between the two groups, but the     acupuncture patients reported significantly less anxiety post-transfer and     reported feeling more optimistic about their cycle and enjoyed their     sessions more than the control subjects. The researchers concluded that     the use of acupuncture in patients undergoing IVF was not associated with     an increase in pregnancy rates but did help women feel more relaxed and     more optimistic. (Domar AD et al. The impact of acupuncture on in vitro     fertilization outcome. Fertil Steril 2009;91:723-6.)
  21. Acupuncture     during embryo transfer in IVF: A randomised controlled trial     of 228 women receiving 3 sessions (one either side of embryo transfer and     one earlier in the process) of acupuncture or non-invasive sham needling.     The clinical pregnancy rates were 31% for acupuncture, 23% control.     Pregnancy rates at 18 weeks were 28% and 18% respectively. The differences     were not statistically significant but would be clinically significant. Authors     conclusions: there was no significant difference in the pregnancy rate     between groups; however, a smaller treatment effect cannot be excluded.     (Smith C et al. Influence of acupuncture stimulation on pregnancy rates     for women undergoing embryo transfer. Fertil Steril. 2006; 85(5):1352-8.)
  22. Acupuncture     for IVF and ICSI: A     randomised controlled trial that evaluated the effect of acupuncture on     reproductive outcome in 273 women undergoing IVF/intracytoplasmic sperm     injection (ICSI). One group of patients received acupuncture on the day of     embryo transfer, another group on embryo transfer day and again 2 days     later (i.e. closer to implantation day), and both groups were compared     with a control group that did not receive acupuncture. Clinical and     ongoing pregnancy rates were significantly higher in the first acupuncture     group compared with controls (39% vs. 26% and 36% vs. 22%, respectively).     The clinical and ongoing pregnancy rates in the second acupuncture group     (36% and 26%, respectively) were higher than in controls, but the     difference did not reach statistical difference. The researchers concluded     that acupuncture on the day of embryo transfer significantly improves the     reproductive outcome of IVF/ICSI, compared with no acupuncture, but     repeating acupuncture two days later provides no additional beneficial     effect. (Westergaard LG et al. Acupuncture on the day of embryo transfer     significantly improves the reproductive outcome in infertile women: a     prospective, randomized trial. Fertil Steril 2006;85:1341-6.)
  23. Regulation     of cortisol and prolactin during IVF: A study that looked at whether     changes in serum cortisol and prolactin are affected by acupuncture in IVF     patients. In all, 67 infertile women undergoing IVF were grouped as     controls (IVF with no acupuncture) and treated (IVF with acupuncture)     according to acupuncture protocols derived from randomized controlled     trials. Cortisol levels in the acupuncture group were significantly higher     on IVF medication days 7, 8, 9, 11, 12, and 13 compared with controls. Prolactin     levels in the acupuncture group were significantly higher on IVF     medication days 5, 6, 7, and 8 compared with controls. The researchers     concluded that there appears to be a beneficial regulation of cortisol and     prolactin with acupuncture during the medication phase of the IVF     treatment. (Magarelli PC et al. Changes in serum cortisol and prolactin     associated with acupuncture during controlled ovarian hyperstimulation in     women undergoing in vitro fertilization-embryo transfer treatment. Fertil     Steril 2008; 92(6):1870-9.)
  24. Reducing     labour pain: A     systematic review that critically evaluated the evidence on acupuncture     for labour pain management. Ten randomised controlled trials involving     2,038 women receiving acupuncture alone, or as an adjunct to conventional     analgesia, for pain relief in labour were included. Pain intensity on a     100-mm visual analogue scale and uptake of other analgesic methods were     used as primary outcomes. VAS for pain intensity data were available in     seven studies, and pooling of this data showed that acupuncture was not     superior to minimal acupuncture at 1 hour and at 2 hours. Patients     reported significantly reduced pain by 4% and 6% during electroacupuncture     (EA) treatment at 15 and 30 minutes compared with placebo EA. Compared     with no intervention, acupuncture reduced pain by 11% for the first 30     minutes. In trials where acupuncture was compared with conventional     analgesia, women receiving acupuncture required less meperidine and other     analgesic methods. No acupuncture-related adverse events were reported.     (Cho SH et al. Acupuncture for pain relief in labour: a systematic review     and meta-analysis. BJOG 2010;117(8):907-20.)
  25. Induction     of labour: A     systematic review of the existing scientific evidence on the potential     role of acupuncture for induction of labour during pregnancy. Ten studies     were identified. The duration of labour as a result of acupuncture     treatment ranged from 10 hours 20 minutes to 29.1 hours. All of the     studies demonstrated labour induction by acupuncture treatment. However,     because two (of the five) randomised controlled trials reported that there     was no statistically significant effect of acupuncture, these results are     more suggestive than definitive. The reviewers concluded that, although     the definitive role of acupuncture in inducing labour is still yet to be     established, the existing studies suggest that acupuncture may be     beneficial in labour induction. (Lim CE et al. Effect of acupuncture on     induction of labor. J Altern Complement Med 2009;15:1209-14.)
  26. Moxibustion     for breech: A     systematic review including 6 randomised controlled trials and a total of     1,087 pregnant women that assessed moxibustion for breech presentation.     The rate of cephalic version among the moxibustion group was 72.5% versus     53.2% in the control group (relative risk, 1.36; 95% CI 1.17-1.58). In     terms of safety, no significant differences were found in the comparison     of moxibustion with other techniques. The reviewers concluded that     moxibustion at acupuncture point BL67 has been shown to produce a positive     effect, whether used alone or in combination with acupuncture or postural     measures, in comparison with observation or postural methods alone, for     the correction of breech presentation. (Vas J et al. Correction of     nonvertex presentation with moxibustion: a systematic review and     metaanalysis. Am J Obstet Gynecol 2009;201:241-59.)
  27. Breech: A systematic review that     evaluated the efficacy and safety of moxibustion to treat breech     presentation. Ten randomised controlled trials involving 2,090 women and 7     controlled clinical trials involving 1,409 women were included.     Meta-analysis of randomised controlled trials showed significant     differences between moxibustion and no treatment (RR 1.35, 95% CI 1.20 to     1.51; 3 RCTs), but not between moxibustion and knee-chest position.     Moxibustion plus other therapeutic methods showed significant beneficial     effects (RR 1.36, 95% CI 1.21 to 1.54; 2 RCTs). For nonrandomised     controlled trials, moxibustion was more effective than no treatment (RR     1.29, 95% CI 1.17 to 1.42; 2 CCTs) but not more effective than the     knee-chest position treatment. The reviewers concluded that moxibustion,     acupuncture and laser acupoint stimulation tend to be effective in the     correction of breech presentation. (Li X et al. Moxibustion and other acupuncture     point stimulation methods to treat breech presentation: a systematic     review of clinical trials. Chin Med 2009;4:4.)
  28. Breech: A systematic review of studies     that assessed the effectiveness of acupuncture-type interventions     (moxibustion, acupuncture, or electro-acupuncture) on acupuncture point BL     67 to correct breech presentation compared to expectant management. Six     randomised controlled trials and three cohort studies fulfilled the     inclusion criteria. In the former, the pooled proportion of breech presentations     was 34% following treatment versus 66% in the control group (OR 0.25, 95%     CI 0.11-0.58). The pooled proportion in the cohort studies was 15% versus     36% (OR 0.29, 95% CI 0.19-0.43). The reviewers concluded that their     results suggest that acupuncture-type interventions on BL 67 are effective     in correcting breech presentation compared to expectant management. (van     den Berg I et al. Effectiveness of acupuncture-type interventions versus     expectant management to correct breech presentation: a systematic review.     Complement Ther Med 2008;16:92-100.)
  29. Breech: A modelling study to estimate     the effectiveness and costs of breech version with acupuncture-type     interventions, including moxibustion, on BL67 compared to expectant     management for women with a foetal breech presentation at 33 weeks     gestation. The results suggested that such an intervention would reduce     the number of breech presentations at term, thus reducing the number of     caesarean sections, and so would be cost-effective compared to expectant     management, including external cephalic version. (van den Berg I e tal.     Cost-effectiveness of breech version by acupuncture-type interventions on     BL 67, including moxibustion, for women with a breech foetus at 33 weeks     gestation: a modelling approach. Complement Ther Med 2010;18:67-77.)
  30. Reducing     labour pain: A     systematic review that examined currently available evidence supporting     the use of alternative and complementary therapies for pain management in     labour. It included three trials of acupuncture involving 496 women. These     showed a decreased need for pain relief. The reviewers concluded that     acupuncture may be beneficial for the management of pain during labour,     but the small number of women studied was a limitation. (Smith CA et al.     Complementary and alternative therapies for pain management in labour.     Cochrane Database Syst Rev 2006 Oct 18;(4):CD003521.)
  31. Depression     during pregnancy: A     randomised controlled trial that assessed the efficacy of acupuncture for     depression during pregnancy in 150 pregnant women given acupuncture     specific for depression or one of two active controls: control acupuncture     or massage. Treatments lasted 8 weeks (12 sessions). The primary outcome     was the Hamilton Rating Scale for Depression, at baseline and after 4 and     8 weeks of treatment. Women who received acupuncture specific for     depression experienced a greater rate of decrease in symptom severity     (p<0.05) compared with the combined controls (Cohen's d=0.39, 95% CI     0.01-0.77) or control acupuncture alone (p<0.05; Cohen's d=0.46, 95% CI     0.01-0.92). They also had significantly greater response rate (63.0%) than     the combined controls (44.3%; and control acupuncture alone (37.5%;     p<0.05). Symptom reduction and response rates did not differ     significantly between controls. The researchers concluded that acupuncture     specific for depression reduces symptoms and increases response rate in     similar amounts to those observed with standard depression treatments and     could be a viable treatment option for depression during pregnancy.     (Manber R et al. Acupuncture for depression during pregnancy: a randomized     controlled trial. Obstet Gynecol 2010;115:511-20.)
  32. Dyspepsia     in pregnancy: A     randomised controlled trial under real-life conditions that assessed the     effects of acupuncture on symptomatic dyspepsia during pregnancy and     compared this with a group of patients undergoing conventional treatment     alone. A total of 42 conventionally-treated pregnant women were treated,     or not, by acupuncture. They reported the severity of symptoms and the     disability these were causing in daily aspects of life such as sleeping     and eating, using a numerical rating scale. The study also observed the     use of medications. Significant improvements in symptoms were found in the     acupuncture group. This group also used less medication and had a greater     improvement in their disabilities when compared with the control group.     The researchers concluded that acupuncture may alleviate dyspepsia during     pregnancy. (da Silva JB et al. Acupuncture for dyspepsia in pregnancy: a     prospective, randomised, controlled study. Acupunct Med 2009;27:50-3.)
  33. Reducing     labour pain: A     randomised controlled trial to investigate the effect of moxibustion at     Spleen 6 (SP 6) for uterine contraction pain in labour, and evaluate its     safety. In all, 174 women with singleton pregnancies and cephalic     presentation were allocated to a moxibustion group, a placebo-treated     group and ‘blank’ group. Moxibustion was applied for 30 minutes when the     cervix was 3cm dilated. The uterine contraction pain was assessed using a     Visual Analogue Scale (VAS). The VAS scores in the treatment group were     obviously decreased after 15 and 30 minutes of moxibustion (both     p<0.05), but there were no obvious changes in VAS scores in placebo     treated group and the blank group. VAS scores decreased more with     moxibustion than the other two groups (all p<0.05). After 30 minutes of     moxibustion, the effective rate of labour analgesia was 69.5% in the     moxibustion group (vs. 45.6% in the placebo and 43.1% in the blank group,     p<0.05). Postpartum haemorrhage was less, and the Apgar score of     newborn was higher, in the moxibustion group than in the placebo group and     blank group (all p<0.05). The researchers concluded that moxibustion at     Spleen 6 can relieve uterine contraction pain, and is not associated with     side effects in either the mother or infant. (Ma SX et al. Effect of     moxibustion at Sanyinjiao (SP 6) for uterine contraction pain in labor: a     randomized controlled trial [Article in Chinese] Zhongguo Zhen Jiu     2010;30:623-6.)
  34. Oligoasthenozoospermia: A randomised single-blind     placebo-controlled trial including 57 infertile men with severe     oligoasthenozoospermia, which compared traditional Chinese medicine (TCM)     acupuncture with placebo acupuncture. The TCM acupuncture group had a     significantly higher percentage of motile sperm (World Health Organization     categories A-C) than the placebo acupuncture group. (Dieterle S et al. A     prospective randomized placebo-controlled study of the effect of     acupuncture in infertile patients with severe oligoasthenozoospermia. Fertility     and Sterility 2009; 92: 1340-3.)
  35. Low     sperm count: A     study that assessed the effects of acupuncture treatment on sperm output     in patients with low sperm density associated with a high scrotal     temperature. A total of 39 men were given acupuncture for a low sperm     output. Based on 18 men with normal fertility (the control group),     threshold scrotal skin temperature was set at 30.5oC, and temperatures     above this were considered to be high. Accordingly, 34 of the 39     participants in the experimental group initially had high scrotal skin     temperature; the other five had normal values. Scrotal skin temperature     and sperm concentration were measured before and after acupuncture     treatment. Following treatment, 17 of the 34 patients with hyperthermia,     all of whom had genital tract inflammation, had normal scrotal skin     temperature; in 15 of these 17 patients, sperm count increased. In the     remaining 17 men with scrotal hyperthermia, neither scrotal skin     temperature nor sperm concentration was affected by the treatment; however,     90% had high gonadotrophins or mixed aetiological factors. The five     patients with initially normal scrotal temperatures were not affected by     the acupuncture treatment. The researchers concluded that low sperm count     in patients with inflammation of the genital tract seems to be associated     with scrotal hyperthermia, which can be reversed with acupuncture     treatment. (Siterman S et al. Success of acupuncture treatment in patients     with initially low sperm output is associated with a decrease in scrotal skin     temperature. Asian Journal of Andrology 2009; 11: 200-8.)
  36. Unexplained     male infertility: A     randomised controlled trial that evaluated the ultramorphologic sperm     features of idiopathic infertile men after acupuncture therapy. A total of     40 men with idiopathic oligozoospermia, asthenozoospermia, or     teratozoospermia took part. Twenty eight of the patients received     acupuncture twice a week over a period of 5 weeks. The samples from the     treatment group were randomised with semen samples from the 12 men in the     untreated control group and evaluated by transmission electron microscopy.     The data showed a significant increase after acupuncture in the percentage     and number of sperm without ultrastructural defects. However, specific     sperm pathologies in the form of apoptosis, immaturity, and necrosis     showed no statistically significant changes between the control and     treatment groups before and after treatment. The researchers concluded     that idiopathic male infertility could benefit from acupuncture treatment,     and result in a general improvement of sperm quality, specifically in the     ultrastructural integrity of spermatozoa. (Pei J et al. Quantitative     evaluation of spermatozoa ultrastructure after acupuncture treatment for     idiopathic male infertility. Fertility and Sterility 2005; 84: 141-7.)
  37. Semen     abnormalities: A     randomised controlled treatment that evaluated the effect of acupuncture     and moxa treatment on the semen quality in 19 men with semen     abnormalities, such as low concentration, abnormal morphology and/or progressive     reduced motility without apparent cause. Patients were either given     acupuncture and moxa or sham acupuncture for 10 weeks. Semen analyses were     performed before and after the treatment course. The patients given     acupuncture had a significant increase in the percentage of     normally-formed sperm compared to the sham group. (Gurfinkel E et al.     Effects of acupuncture and moxa treatment in patients with semen     abnormalities. Asian Journal of Andrology 2003; 5: 345-8.)
  38. Low     sperm count: Azoospermia.     Light microscope (LM) and scanning electron microscope (SEM) were used to     examine semen before and 1 month after acupuncture treatment. The study     group originally contained three severely oligoteratoasthenozoospermic,     two pseudoazoospermic and 15 azoospermic patients. The control group was     comprised of 20 untreated males who underwent two semen examinations     within a period of 2-4 months and had initial andrological profiles     similar to those of the experimental group. No changes in any of the     parameters examined were observed in the control group. A definite     increase in sperm count was detected in the ejaculates of 10 (67%) of the     15 azoospermic patients, 7 of whom exhibited post-treatment spermatozoa     that were detected even by LM. The sperm production of these seven males     increased significantly, from 0 to an average of 1.5 x 106 spermatozoa per     ejaculate (p=0.01). Males with genital tract inflammation exhibited the     most remarkable improvement in sperm density (on average from 0.3 x 106     spermatozoa per ejaculate to 3.3 x 106 spermatozoa per ejaculate; p=0.02).     The researchers concluded that acupuncture may be a useful, nontraumatic     treatment for males with very poor sperm density, especially those with a     history of genital tract inflammation. (Siterman S et al. Does acupuncture     treatment affect sperm density in males with very low sperm count? A pilot     study. Andrologia 200l 32: 31-9.)
  39. IVF: Clinical pregnancies were     documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas     pregnancy rate was only 26.3% (21 out of 80 patients) in the control     group. Acupuncture seems to be a useful tool for improving pregnancy rate     after ART. Wolfgang E. Paulus, M.D.,[a] Mingmin Zhang, M.D.,[b] Erwin     Strehler, M.D.,[a] mam El-Danasouri, Ph.D.,[a] and Karl Sterzik, M.D.[a] Christian-Lauritzen-Institut,     Ulm, Germany
  40. Miscarriage: Women who receive acupuncture     during the stimulation phase of an in vitro fertilization cycle and again     immediately after embryo transfer have a higher live-birth rate than do     controls, according to the first acupuncture study with this end point.     The miscarriage rate was almost halved in the acupuncture group (8% vs.     14%). (Magarelli, OB/Gyn News, 2005)
  41. TCM     for IUI: In the     first study that measures the effectiveness of both herbs and acupuncture     in combination with IUI infertility treatment, Dr. Shahar Lev-Ari and     Keren Sela of TAU's Sackler Faculty of Medicine and the Tel Aviv Medical     Center say that the results, which have been published in the Journal of     Integrative Medicine, show a significant increase in fertility when the     therapies are administered side-by-side. In terms of both conception and     take-home baby rates, the test group fared far better than the control     group. Out of the 29 women in the test group, 65.5 percent conceived, and     41.4 percent delivered healthy babies. In the control group, only 39.4     percent conceived and 26.9 percent delivered. The vast difference in     success rates is even more surprising when the age of the average     participant was taken into account, Dr. Lev-Ari and Sela note. "The     average age of the women in the study group was 39.4, while that of the     control group was 37.1. Normally, the older the mother, the lower the     pregnancy and delivery rates," they explain.
  42. Female     fertility: The     management of female infertility with Chinese Herbal Medicine can improve     pregnancy rates 2-fold within a 4 month period compared with Western     Medical fertility drug therapy or IVF. Assessment of the quality of the     menstrual cycle, integral to TCM diagnosis, appears to be fundamental to     successful treatment of female infertility. Meta-analysis of RCTs     suggested a 3.5 greater likelihood of achieving a pregnancy with CHM     therapy over a 4-month period compared with WM drug therapy alone.     Meta-analysis of selected cohort studies (n = 616 women) suggested a mean     clinical pregnancy rate of 50% using CHM compared with IVF (30%) (p <     0.0001). (Complementary Therapies in Medicine Volume 19, Issue 6 , Pages     319-331, December 2011).
  43. LH     defect: Sixty     cases of infertility due to luteal phase defect were treated with herbs to     tonify the kidney and regulate the menstrual cycle. After the treatment,     the hyperthermal phase score of basal body temperature (BBT) was markedly     increased (P less than 0.05), the hyperthermal phase 7-8 days after     ovulation improved (P less than 0.001), the transitional period of BBT     remarkably shortened, and the pregnancy rate in 32 uncomplicated cases of     luteal phase defect was 56%. The close relationship between luteal phase     defect and the kidney deficiency syndrome in TCM was discussed. The key     points of the treatment included coordination of yin and yang, regulation     of qi and blood, and combination of tonification with reduction. (J Tradit     Chin Med. 1991 Jun;11(2):115-20. Lian F. Nanjing College of Traditional     Chinese Medicine.)



There are well over 10,000 clinical trials of acupuncture in print and much work on how it works.
it is only possible to show a tiny proportion of that here! This helps to answer the critics who continue to suggest that there is no proper research evidence to support professional acupuncture practice.

A recent and readable Evidence Based Overview of Acupuncture clinical trials
from Australia can be found here:

a much more detailed version is also available on their site.

A reliable and readable information source on acupuncture and Chinese medicine can also be found at: https://www.jcm.co.uk/

Pain
A Recent (2017) 300page NHS Review of Acupuncture for pain & Depression

"We aimed to provide high-quality evidence about the use of acupuncture for chronic pain from existing data and to develop fresh evidence on the use of acupuncture for depression. We used systematic processes to combine and interpret data from high-quality clinical trials of acupuncture involving approximately 18,000 patients. The types of pain investigated in these trials were neck and lower back pain, osteoarthritis of the knee, headache and migraine. We found acupuncture to be more than simply a placebo as it was more effective than sham acupuncture, with sham acupuncture consisting of needling that did not penetrate the skin or needling at the wrong points. Acupuncture was also found to be better than standard medical care for all of these chronic pain conditions. In another analysis, we compared acupuncture with other physical therapies for osteoarthritis of the knee and found acupuncture to be one of the more clinically effective therapies and, when based on high-quality trial evidence, also cost-effective.... We also conducted a large-scale clinical trial of acupuncture or counselling for depression in which we found both interventions to be clinically effective and acupuncture to be cost-effective."

Chronic Back Pain
A 2016 US Dept of Health evidence summary of treatments for chronic back pain puts acupuncture at or near the top

Migraine
many trials have found acupuncture valuable to treat migraines, here's a summary of the evidence from the Cochrane Library, the most respected source.

Acute Pain
Acupuncture is increasingly being used for pain control in hospital Accident and Emergency (ER) departments. This recent study found it to be better than morphine.
Acupuncture vs intravenous morphine in the management of acute pain in the ED
 
In an A & E department acupuncture was compared to morphine to treat 300 ED patients with acute moderate to severe pain. 92% of the acupuncture patients had sufficient pain relief compared to 78% in the morphine group. The response to acupuncture was also significantly faster and there were fewer side effects. The authors concluded that, “In patients with acute pain presenting to the ED, acupuncture was associated with more effective and faster analgesia with better tolerance.”
 
Grissa MH, et al. Am J Emerg Med. July 2016  http://www.ncbi.nlm.nih.gov/pubmed/27475042

Shoulder Pain


General pain
Here is a massive and high quality review of the research into acupuncture and pain summarised the results from 18,000 patients and concluded that it was effective.

Rheumatoid arthritis



Cancer Patient Support
There is research evidence to show that acupuncture has a role in cancer care, including pain control, countering the adverse effects of chemotherapy and radiotherapy, helping with fatigue, oedema and some other symptoms.
The US Government Health body (the NIH) has published a summary of this evidence which is available here:
 


 
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