Tim H. Tanaka, Ph.D. April 20, 2013
Note: Acupuncture protocols used in clinical studies are generally simplified, short, and standardized procedures, because the protocols are developed not only with consideration of its potential efficacy but also by considering its experimental design, budgets, time constraint, and other methodological factors.
They are compromised acupuncture protocols, and often far from those commonly used in clinical practice.
Study by Paulus, WE et al.
One hundred sixty patients who were undergoing IVF and who had good quality embryos were randomly divided into the following two groups: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80). Each patient in the experimental group received an acupuncture treatment 25 minutes before and after embryo transfer.
The needles were left in position for 25 minutes and then removed. Before embryo transfer, the following Acupoints were used: PC6 (Neiguan), SP8 (Diji), LR3 (Taichong), GV20 (Baihui), and ST29 (Guilai). After embryo transfer, the following Acupoints were used: ST36 (Zusanli), SP6 (Sanyinjiao), SP10 (Xuehai), and LI4 (Hegu).
Additional AcuPoints: Additional AcuPoints: Auricular acupuncture at the following points, without rotation: ear point 55 (Shenmen), ear point 58 (Zhigong), ear point 22 (Neifenmi), and ear point 34 (Naodian). Two needles were inserted in the right ear, the other two needles in the left ear. The four needles remained in the ears for 25 minutes. The side of the auricular acupuncture was changed after embryo transfer.
The locations of acupuncture points used in this study are shown in Figures 1 and 2.
Figure 1: German Acupuncture Protocol Points before Embryo Transfer
Paulus WE, et al. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and sterility 2002; 77(4): 721-4.
Figure 2: German Acupuncture Protocol Points after Embryo Transfer
Their results showed that clinical pregnancies were documented in 34 out 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. Since this preliminary study, a number of studies e.g. 2-7 have attempted to replicate their findings using the same or similar acupuncture around embryo transfer protocols (German Acupuncture Protocol), however, the results were equivocal.
A systematic review published in 2008,8 reported a non-significant impact of German acupuncture protocol, based on the meta-analysis of 8 trials on acupuncture during IVF. An updated meta-analysis of 9 trials by the same research group further confirmed their original finding.9 (about Systematic Review and Meta-Analysis)
Despite the less than impressive follow-up data since the highly publicized initial study by Paulus, et al.,1 the German protocol has been widely used among acupuncturists. In fact, it quickly became a “gold standard” acupuncture protocol during IVF cycle.
In my view however, the German acupuncture protocol is a typical example of the standardized, compromised acupuncture used in many acupuncture trials, which does not reflect the practice of classical acupuncture and traditional Chinese medicine.
