Implantation of the embryo in the uterus is a vital and pivotal event which determines the success of an ongoing pregnancy after conception, or after transfer of an embryo in an IVF cycle.
The crucial role that the immune system plays in the process of implantation and the development of the placenta is gradually being elucidated though there is much we still don’t know. A positive finding of immune factors like anti-cardiolipin antibodies, anti- thyroid antibodies, anti-nuclear antibodies or an excess of some types of NK cells can indicate that there may be subtle imbalances in the immune environment of the uterus which are not conducive to establishing a healthy pregnancy.
Most women diagnosed with immune factors affecting fertility will be prescribed drugs to dampen the immune system and/or to reduce blood clotting. Although we are awaiting research to elucidate mechanisms, some patients will choose to have acupuncture as an adjunct therapy. We know that acupuncture is effective at increasing endorphins and other neurotransmitters, and it is thought that acupuncture may modulate immune function through this action. While we don’t yet know the mechanism, the increase in implantation rates in some of the acupuncture studies on IVF patients has been suggested to possibly be related to a regulation of intra-uterine immune factors.
Schedule; acupuncture once a week, twice a week at time of ovulation, or on the day of embryo transfer.
It is estimated that up to 50% of chromosomally normal embryos do not implant successfully. (1, 2)
Increasingly we believe that the immune system plays a crucial role in both successful and unsuccessful implantation. (3, 4) Autoimmune disease, or subtle imbalances in the immune regulation of the uterine environment can have a large impact on the success of a conception. For example elevated levels of certain immune cells called natural killer (NK) cells have been shown to impede successful implantation or establishment of pregnancy, as have activated T lymphocytes. (4) On the other hand the actions of some T cells and NK cells are necessary to promote a favourable environment for implantation. (5) It is largely through the secretion of signaling agents called cytokines released by these immune cells, that the intricate processes of implantation and creating a placenta can be enhanced or stymied.
Evidence suggests that acupuncture influences not only the nervous system but also the the immune system. Research examining the influence of acupuncture on the immune system is revealing interesting effects – the exact mechanisms are not yet clear and may turn out to be as intricate and involved as the immune system itself.
One of the areas we are particularly interested in, in reproductive medicine, is the anti-inflammatory or immuno-suppressive actions of acupuncture. Many disorders involving an auto immune reaction in the body show an imbalance between T helper 1 cell-derived and T helper 2 cell-derived pro-inflammatory and anti-inflammatory cytokines. The modulation of this Th1/Th2 balance has been a key strategy in the treatment of various immune disorders. Some research has indicated that this ratio may be reset by acupuncture by increasing levels of the cytokine TNF-alfa and decreasing levels of Interleukin 4 (6) Herbal formulas used in clinics in China, that have been shown to be helpful in reducing the risk of miscarriage, have also been shown to influence the Th1/Th2 imbalance. (12)
Some reviews on the effect of acupuncture on the immune system have concluded that appropriate and frequently applied acupuncture treatment may provoke sustained anti-inflammatory activity, without stimulation of pro-inflammatory cells. (7, 8)
We know that stress affects the immune system, elevating levels of activated T cells which can reduce implantation rates of embryos. We also know that high resting levels of cortisol are linked with elevated markers of inflammatory processes in the body which may affect implantation of the embryo. (9)
It is thought that acupuncture may exert a modulatory effect on such immune imbalances caused by anxiety and stress. In one study the maximum effect on the immune system of women suffering heightened anxiety was measured 72 hours after they received acupuncture and the effects of a course of acupuncture were still evident a month after it was completed. (10)
Some investigators think that the immuno-modulatory effect of acupuncture results from the increase in levels of endogenous opioids, -endorphin, met-encephalin, leu-encephalin, serotonin all of which increase with acupuncture treatment. These neurotransmitters create a sense of relaxation and have regulating effects on the immune system. (11)
- Coulam C et al, 1996, Am J Reprod Immunol, 35 330 – 337.
- Munne et al 1995 Fertil Steril 64, 382 – 391.
- Clark DA et al, Hum Reprod, 1994, 9, 2270 – 2277
- Coulam C, Roussev R, Am Jnl Reprod Immunol. 2003, 50, 340 – 345
- Eva Miko et al Reproductive BioMedicine Online 2010, 21, 750 – 756
- Song C et al Pharmacopsychiatry 2009; 42(5): 182-188
- Zijlstra F et al Mediators of Inflammation, 2003, 12, 59 – 69
- Sun K K, Hyunsu B Autonomic Neuroscience: Basic and Clinical 2010, 157, 38-41
- Gallinelli A et al Fertil Steril.2001, 76, 1, 85-91
- Arranz L et al Am J Chin Med. 2007, 35, 35-51.
- Cabioglu MT and B. Eren Cetin Am J Chin Med, 2008, 36, 25-36
- Liu F, Luo SP. Chin J Integr Med. 2009 Oct;15(5):353-8.