Acupuncture in reproductive medicine. Applications in human assisted reproduction and aspects of clinical and experimental neuroendocrinology

Abstract: The use of acupuncture in the area of reproductive medicine is relatively new, and it has been rather poorly investigated in the past. When muscle afferents are stimulated by acupuncture in somatic segments related to the innervation of the ovaries and the uterus, functional changes occur in the neural substrate that may influence reproductive function and result in peripheral, segmental and central effects. The aims and results of the present thesis were:· To determine whether electro-acupuncture (EA) can reduce high blood flow impedance in the uterine arteries of women during in-vitro fertilization (IVF) and embryo transfer (ET). Results: EA reduced the blood flow impedance (PI) in the uterine arteries to normal levels 10 - 14 days after the last EA treatment, which corresponds to the time for ET.· To determine whether EA as an anaesthetic method can be an alternative to pharmacological anaesthetic methods during oocyte aspiration in IVF.Results: EA was shown to be as effective as conventional anaesthetics during oocyte aspiration. EA may also have a positive effect on the IVF outcome.· To elucidate whether EA can modify the release of neuropeptides, gonadotropins, and gonadal steroids and induce ovulation in women with polycystic ovary syndrome (PCOS) and anovulation.Results: EA induced regular ovulation in 38% of the women with PCOS and anovulation. EA also exerted long-lasting effects on endocrinological and neuroendocrinological parameters shown by significantly decreased luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratios, and testosterone and b-endorphin concentrations and increased prolactin concentrations 3 months after the last EA treatment. It was possible to identify a distinct subgroup of women who responded well to EA. They were less androgenic and had a less pronounced metabolic disturbance compared with women who experienced no effect shown by low BMIs, WHRs, testosterone concentrations, testosterone/sex hormone-binding globulin (SHBG) ratios, and basal insulin concentrations and high SHBG concentrations.· To evaluate the effects of EA on neuroendocrinological parameters in rats with estradiol valerate (EV)-induced PCO by analysing nerve growth factor (NGF) and corticotropin-releasing factor (CRF) tissue concentrations in the brain, the adrenal glands, and the ovaries.Results: EA treatments decreased concentrations of NGF and CRF in the ovaries, possibly through inhibition of the sympathetic nervous system and a decrease in stress.In conclusion, the results show that EA merits consideration as an alternative or complement to traditional pharmacological treatments in reproductive medicine for improvement of uterine artery blood flow, for pain relief during oocyte aspiration, and for ovulation induction in women with PCOS characterized by a less pronounced metabolic disturbance. The effects can most likely be attributed to an inhibition of excessive sympathetic tone and to activation of antinociceptive systems.