Acupuncture boosts clinical pregnancy rates and balances biochemistry in infertility patients with a thin endometrium. First Affiliated Hospital of Xinjiang Medical University researchers combined acupuncture with standard drug therapy. They determined that acupuncture plus estradiol valerate drug therapy produced superior patient outcomes compared with patients using only estradiol valerate.

Estradiol valerate is a form of estrogen used to treat hormone imbalances. The estradiol valerate tablet control group obtained a 20.0% clinical pregnancy rate. The combined protocol treatment group had a 33.3% clinical pregnancy rate. The addition of acupuncture to the treatment protocol increased the pregnancy rate by 13.3% (p<0.05). [1]

Biochemical measures for the study included endometrium thickness, endometrial morphology, resistance index (RI), and pulsatility index (PI). RI and PI are two parameters used in ultrasound to calculate endometrial blood flow. High scores of either RI or PI are indicative endometrial conditions. After treatment, the endometrial thickness improved to various degrees in the two groups (p<0.05). In the treatment group, the number of type A endometriums increased after treatment (p<0.01), and was significantly different from that in the control group (p<0.05). In independent research, Xu et al. notes that “The endometrium morphology can be divided into three types, of which type A is characterized by a three-line endometrium in ultrasound, which has good receptivity and can lead to high embryo implantation rates.” [2] After treatment, both PI and RI in the treatment group were significantly lower than those in the control group (p<0.05).

Two Groups Compared
Researchers (Wang et al.) used the following study design. A total of 60 patients were treated and evaluated in this study. The patients were diagnosed with infertility due to thin endometriums between April 2017 and January 2018. They were randomly assigned to the acupuncture group or control group, with 30 patients in each group. The age range of the acupuncture group was 25–40 years (mean age 34 years), with a disease duration of 1–15 years (mean duration 4.9 years). The age range of the control group was 24–40 years (mean age 35 years), with a disease duration of 1–14 years (mean duration 4.5 years). There were no statistically significant differences in terms of their age and duration of disease between the two groups (p>0.05).

All patients included in the study suffered from thin endometriums due to kidney yang deficiency. A thin endometrium is defined as an endometrial thickness of <8 mm on ultrasound. [3] In Traditional Chinese Medicine (TCM), a thin endometrium is categorized into several differential diagnostic patterns. The pattern investigated in this study (kidney yang deficiency) is characterized by infertility, scanty menstruation, aching lumbar region and knees, dizziness or tinnitus, urinary frequency at night, clear and excessive urine, dark menses, clots, and menstrual pain. The tongue is light, dark, or has stasis speckles, with a white coating. The pulse is deep and fine, or deep, fine, and thready. Patients with the following conditions were excluded from the study:

• Severe and comorbid liver and kidney dysfunction
• Uterine submucosal fibroids, endometrial polyps, and genital malformations
• Endocrine dysfunction
• Ovulation disorders
• Known or suspected pregnancy
• Mental disorders

Acupuncture
Both groups of patients started by consuming 2 mg of estradiol valerate tablets on the third day of a menstrual cycle, 2 times daily. The drug treatment stopped on the day of the luteinizing hormone (LH) peak. Meanwhile, participants assigned to the acupuncture group received treatment using the following primary acupoints:

• CV12 (Zhongwan)
• ST25 (Tianshu)
• GB26 (Daimai)
• CV6 (Qihai)
• CV4 (Guanyuan)
• EX CA1 (Zigong)
• SP10 (Xuehai)
• ST36 (Zusanli)
• SP6 (Sanyinjiao)
• LV3 (Taichong)
• BL23 (Shenshu)
• GV4 (Mingmen)

After insertion of a standard-size acupuncture needle, mild reinforcing and reducing techniques (ping bu ping xie) were applied to each acupoint for obtaining deqi. Once a deqi sensation was obtained, the needles were retained for 30 minutes. For bilateral Zigong, Guanyuan, Zusanli, and Shenshu, moxibustion was also applied. Moxa cigar cuttings, each 2 cm long, were attached to each needle handle and ignited. Moxa was left in place to self-extinguish. A total of 3 cuttings were used for each point. Treatment was administered for each menstrual cycle and continued for a total of 3 cycles.

Summary
Research indicates that acupuncture is an effective means of improving clinical pregnancy rates. The combination therapy of estradiol valerate plus acupuncture demonstrates clinically superior patient outcomes to patients receiving only estradiol valerate. Based on the evidence, patients are best served with an integrated treatment protocol of acupuncture and hormone therapy.

References:
[1] Wang XM, Yuan HL, Liu H, Zhou W, Tian LJ, Zhou Y. Effect of Warm Needling on Endometrial Receptivity in Kidney-yang Deficiency Patients with Thin Endometrium [J]. Shanghai Journal of Acupuncture and Moxibustion, 2019,38(07):758-761.
[2] Xu J, Tang HY, Tang LS, et al. Effects of Wenjingyu Formula on endometrial morphology and pregnancy of infertility patients with endometrial lesions in IVF-ET cycle[J]. Shandong Medical Journal, 2015,55(5):19-21.
[3] Yue Jie. Science of Gynecology[M], the 7th Edition, Beijing: People’s Medical Publishing House, 2008:415.