Acupuncture – is it worth doing before and after the embryo transfer?

Nathan Billings
Holistic Fertility Acupuncture Specialist, UNICA Clinic – Prague

Lifestyle and Fertility

"Nathan Billings explores the potential benefits of acupuncture for implantation.
From this video you will find out:
  • Can Chinese Herbal Medicine boost your fertility?
  • In what ways can acupuncture affect your fertility?
  • What do studies say about combining acupuncture with IVF?
  • Is there any evidence that acupuncture can reduce stress?
  • What is the ideal number of acupuncture appointments, and when it is best to perform them?

How acupuncture can impact your IVF success?

In this event, Nathan Billings, Holistic Fertility Acupuncture Specialist at Unica Clinic, discussed how acupuncture can impact your final outcome before and after embryo transfer.

Acupuncture is one modality in the much larger system of Chinese medicine. Chinese medicine is a large complex system of healthcare that encompasses acupuncture, Chinese herbs, massage, cupping, diet and other modalities. Chinese herbs are always used in a formula, you need two or more herbs. There are hundreds of herbs, they’re combined and matched in different ways to create different formulas. Diet is a big part of Chinese medicine, they have very particular ideas on diets and how diet can affect different body types and different diseases.


Acupuncture is among the oldest healing practices in the world, dating back 2500 years, and has been refined and improved over that period. There are different styles of acupuncture, including Chinese, Korean, and Japanese. In Chinese medicine, there are 14 primary channels, sometimes called meridians, that span the body. There are three on the inside of the arm, three on the outside of the arm, and then three on the inside of the leg, and three on the outside of the leg, there’s also one that goes down the midline in the front and one that goes down the midline on the back. They’re all connected, it’s more useful to think about them as a grid that spans the whole body. Like in Western medicine, they healthily help the body function, but from a Chinese medicine perspective, some organs have functioned similarly to our scientific understanding of organs, but some are unique to Chinese medicine.

Each of the organs has a different relationship with each of the other organs, and these relationships are what keep the balance in the overall system. The goal of Chinese medicine is to find balance, so you can be healthy. Too much or too little of something can throw the system out of balance, and that’s when you’ll experience unhealthy symptoms. This imbalance leads to a blockage in the flow of Qi (chi) along the channels and meridians, and you can be unblocked according to Chinese medicine by using acupuncture at certain points along these channels.

The Yin and Yang can be sewn as a part of a continuum, a sort of spectrum that goes back and forth. The hot and cold is also a part of Yin and Yang, but we also look for signs of heat and cold in the body, which can help determine the course of treatment. Qi is another big subject related to the previous two, it’s the body’s energy, and we want the right amount of it to maintain good health.

An acupuncturist will try to diagnose your particular condition, they will ask about symptoms you’re experiencing, your overall health and your lifestyle, they will look at your tongue and feel the pulse on both arms, both the tongue and the pulse can give information about the organs and general health. Many acupuncturists will palpate the body along the channels to give them an idea of where to insert the needles, they are looking for patterns of symptoms which then give a diagnosis on which they can base a treatment. In Chinese medicine, it’s all about the pattern of a person. Then treating based on that pattern when the needles are inserted, they’re typically retained for 20 to 30 minutes, maybe more. The needles are thin pieces of metal, they’re solid, they are so thin that dozens of them could fit into a syringe or a hypodermic needle, they’re completely sterile, they are used only once, and then they’re disposed of. They are perfectly safe assuming you have a qualified acupuncturist using them. When a needle is inserted, you may feel pressure at the point, and you may feel a hot or cold sensation, if any of the needles are uncomfortable, you can tell your acupuncturist, and they can change it. It’s all about communication, sometimes you might feel uncomfortable for just a moment, but you can quickly adjust to it. It’s a very relaxing and pleasant process.

Acupuncture & fertility

Chinese medicine has been used for thousands of years for women’s health care and fertility. Depending on what the issue is, Chinese medicine can treat many of the causes of infertility, but not necessarily if there’s a physical blockage. In Chinese medicine, the first rule is that we try to regulate the cycle if it’s irregular if the cycle is too short or too long if the period is too heavy or too light if they’re spotting before the period or if ovulation if there are premenstrual symptoms, etc.

Acupuncture will have a particular treatment during the follicular phase, a different one in the ovulation phase and another during the luteal phase. Any underlying medical conditions that the patient has been diagnosed with, such as thyroid issues, uterine fibroids, endometriosis, and PCOS, although the last two can be a little more difficult with Chinese medicine, can be treated. If part of the issue with a couple’s fertility is with the man, then he should also seek out an acupuncturist who will treat him with the hopes of increasing sperm quality and motility. Stress is a factor in male infertility, the acupuncture affects endogenous opioids and neurotransmitters, serotonin and dopamine. Acupuncture treatments over time can help reduce stress levels by sort of igniting the opioids and the neurotransmitters. Male infertility and acupuncture have not been studied much, but some small studies show positive results, however much more is needed to confirm these results.

Acupuncture also regulates uterine and ovarian blood flow, which leads to a thicker uterine wall, so fertility is improved through embryo implantation being more successful. It can also impact beta-endorphin levels and thus hypothalamic function, which affects the gonadotropin-releasing hormone secretion in the menstrual cycle. It can affect neurotransmitters, serotonin and dopamine, which also lead to analgesia sedation and to the recovery of motor function, which can also help with menstrual pain.

Acupuncture has been shown to decrease blood sugar levels and decrease insulin resistance, which can be particularly useful in PCOS, so overall, with acupuncture, it’s possible to regulate the hormones, increase uterine and ovarian blood flow, decrease stress and treat other underlying conditions that may affect fertility.

Acupuncture & IVF

There have been very positive studies and meta-studies that show increases in success for patients that do a before and after treatment on the day of embryo transfer, particularly women with a lower chance of success, women that have not previously succeeded with IVF and women over the age of 36. There are a handful of studies that say it doesn’t help, or they say, it doesn’t, but it says that the results aren’t distinguishable from sham acupuncture. However, keep in mind that, first of all, different studies use different acupuncture points, so that could be an issue. Second, in different studies, various methodologies are used and sometimes, in studies, non-acupuncturists are used to insert the needles.

We know that acupuncture does reduce stress, IVF can be a very stressful process, the process as a whole can be stressful for couples, and then if you’re travelling abroad for the treatment, it can become even more stressful. There’s one great study that was just looking at stress and acupuncture and IVF, and that very clearly showed that women were much less stressed out and had a more positive outlook during the process when they were undergoing acupuncture.

What is the ideal amount of acupuncture sessions? There’s no consensus on the optimal treatments needed. It’s different for different people. The majority of women doing acupuncture with IVF will only have the acupuncture on the day of embryo transfer. However, there is good evidence to show this increases success. There’s one great study that showed improved odds of successful treatments starting 3 months before suppression, so that would be 12 or more treatments before 3 months, this is probably ideal. These things need to be studied more, we don’t have the exact number of treatments, but it’s best to go for those 12 treatments to give yourself the best chance of success.

- Questions and Answers

Does acupuncture hurt?

Almost everyone finds it not just painful, but very enjoyable. It’s been very well established that you get this endorphin effect from acupuncture, sometimes we call it sort of ‘acu-high’, you feel kind of very pleasantly out of it. There are veins and tendons and things like that you have to watch out for in the body, if anyone’s uncomfortable, you just change the position of the middle needle very quickly, and it’s all very fine. It’s a very relaxing, pleasurable process. Some people are more needle sensitive, so you might not needle them as deeply as other people, others just need to get used to the process.

Is having acupuncture by a naturopathic doctor just as beneficial as by an acupuncturist?

The term naturopathic doctor kind of varies from country to country. The training in the US might be different from the training in the UK or Continental Europe. I know some naturopaths in the US are highly trained in acupuncture, but some people will just get a weekend course, for example, a chiropractor will take a weekend course. A lot of times if you hear something in the news and it’s a problem with acupuncture, it wasn’t an acupuncturist doing it, that was someone with needles that were not an acupuncturist. The short answer is, a naturopathic doctor may be able to very effectively put needles in, assuming they have the proper training.

How many times and how long should one have acupuncture before fertility treatment?

The majority of women are just doing acupuncture before and after the transfer, on the day of transfer. There are good studies to show that it’s beneficial and that it increases your odds. I suspect more is better, and if you were to do it for 3 months before suppression, that would probably be ideal for 12 or more sessions.

Is there anybody who shouldn’t have acupuncture and can you have it once you get pregnant?

Some people might be just too jumpy or too needle-sensitive, so perhaps for such people, it might not be the best idea. However, most people find it extremely relaxing, but for some others, the idea of sitting calmly at a table for half an hour with needles in them would give them too much anxiety. It’s very possible that some people just respond better than others, and maybe some people don’t respond at all. Specific acupuncture points are contraindicated, we do not use them when someone’s pregnant, particularly in the first trimester, but it’s completely safe throughout pregnancy. Assuming you have someone qualified to do the acupuncture and they know which points not to do and the points to support you.

I’ve been going to an acupuncturist for nearly 3 years now. He focuses on my whole body, not just fertility. Sometimes he gives me herbs during IVF to support my blood flow and gut movements. I have appointments every 2 weeks and then weekly, closer to the IVF cycle. I am worried to take herbs whilst doing the transfer. Is there anything you can say about the herbs?

Personally, I wouldn’t do herbs after the drugs have been administered, once the doctors have taken over, I would stick with the acupuncture, but that’s just me, that doesn’t mean it’s harmful or a problem necessarily. There might be an interaction between Western medicine and Chinese herbs, therefore, I would discontinue herbs when Western medicine has been introduced. Acupuncture and herbs can help with regulating the cycle beforehand and getting that more regular and healthy, but as I mentioned, personally once the suppression started, I wouldn’t continue with the herbs.

Is Moxibustion good for fertility, or is acupuncture better?

Moxibustions is the herb mugwort, and it’s used quite a bit in Chinese medicine. There are different forms of it sometimes, it’s kind of packed into like a cigar-type shape, and you can kind of warm the skin with it sometimes we’ll put it on the end of the needle and light it on fire, and it’ll stimulate along with the acupuncture needle, it will warm that point, there are other forms of it as well. Moxibustion is, under certain circumstances, great for fertility, it depends on the pattern. We put things into different patterns, and for certain patterns, Moxibustion can be used along with acupuncture. Typically, you would use Moxibustion with acupuncture.

Can acupuncture help women who’ve had previously failed embryo transfers?

I’m hoping the studies are correct, showing that women who have had trouble before would have increased odds of getting pregnant or having a successful pregnancy and live birth. It’s certainly safe for these women to do it, and I would encourage it. The studies aren’t a slam dunk, so I can’t say without certitude that it’s going to help.

What about the small needles that you keep for some days after the acupuncture session?

I suspect you’re talking about intradermal needles, they’re basically tiny little needles on a tiny little square sticker, and you put them in the skin, and they can stay there until the sticker loses the adhesion for 3–4 days, and so sometimes acupuncturist will put them on a particular point to go as it were. Those intradermal needles sometimes go into the body, and sometimes they go into the ears.

I am having PGT-A genetic testing done on the embryos, which can take up to 6 weeks. Would it be best to start the acupuncture before the egg retrieval or pre and post-transfer only?

I tend to think that doing it before retrieval and before suppression is good to try and get the cycle as regular as possible. Up to ovulation and then through the building of the endometrium and clear shedding, so like the whole every part of that is working nicely, so you can have a good endometrium for implantation. I would argue that it’s acupuncture is good for all parts of this.

Should you continue acupuncture during the 2-week wait?

It should be safe after a week you learn that you have a positive result, but I think two weeks is a very reasonable thing to do. However, during the 2-week wait, I would not do acupuncture just to be safe.

What treatment do you recommend for a donor egg transfer?

I would recommend acupuncture for a few months to try and get your cycle and sort of tip-top shape, and so that the endometrium is at max thickness and nutrition level.

What’s the difference between auricular and standard acupuncture?

It’s ear acupuncture, and it’s basically a part of the same system. Most acupuncturists, if they do normal acupuncture, they know about auricular acupuncture as well. There’s actually a part of the protocol that I use on the day of transfer, I always use auricular acupuncture, so I do 2 points on each ear, and I always incorporate that.

Based on the studies, what is the percentage of success for an embryo transfer comparing acupuncture before and after transfer?

Some of the studies have been significantly different, like 20% or even higher. There’s been a lot of studies done, and there have been several meta-studies which would be looking at the overall thrust of the studies, but I don’t have them at hand now.
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Nathan Billings

Nathan Billings

Nathan Billings is a holistic fertility acupuncture specialist at Unica clinic in Prague. He is from the United States, where he got his master's degree in acupuncture. Now he has been living in Prague for over three years and here he has practised working with fertility patients. The Unica team is happy to have an American acupuncturist in its team, given that the practice there has spread earlier than it did in Europe.
Event Moderator
Professor Alan Thornhill

Professor Alan Thornhill

Professor Alan Thornhill is a fertility expert with over 25 years of experience and more than 100 scientific publications in IVF. Specifically, he’s a clinical scientist (specialising in embryology and genetics). Uniquely, he’s worked in IVF and diagnostic laboratories, research, clinical and business management, and even with the UK’s fertility regulator. Working in US and UK-based IVF clinics and consulting globally, he’s been involved in the IVF journeys of thousands of couples (both professionally and personally). He’s helped and advised patients, friends and strangers with issues including low sperm count, sperm and egg donation, genetic testing, surrogacy, treatment overseas and more. He currently works in the biotech industry, and his personal mission is to provide his unique brand of fertility coaching to people in need of help.
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