Diminished Ovarian Reserve and regulation of the Hypothalamic-Pituitary-Ovarian axis
A review of the literature on Acupuncture and Fertility
Diminished ovarian reserve (DOR) affects women between the ages of 16-40 and refers to the decreased production of oocytes (ovarian cells) and decreased fertility.
In the Traditional Chinese Medicine model, DOR is classified as a symptom of delayed menorrhea, oligomenorrhea, amenorrhea, irregular menstrual cycle and infertility.4 In other words, the hormone feedback mechanism is out of sync, leading to unregulated cycles and unpredictable ovulation.
The effects of acupuncture on fertility suggest the regulation of the Hypothalamic Pituitary Ovarian axis, the hormonal feedback mechanism that controls the female sex hormones as they fluctuate according to the menstrual cycle.
Many factors can disrupt the menstrual cycle including stress, changes in environment, coming off birth control and fluctuations in weight. The good news is that Acupuncture can help you get back on track, allowing your body to normalize it’s hormones and regulate the cycle.
Reproductive endocrinologists determine female reproductive potential by assessing ovarian reserve in measuring Follicle Stimulating hormone (FSH) and its relative ratio to estradiol (E2). Together these values are combined with Antral Follicle Count (AFC) and anti-Mullerian hormone (AMH). Based on previous studies, acupuncture both improves AFC and AMH which is a predictor for ovarian reserve.1
Furthermore, acupuncture intervention is a benefit to improving the regulatory function of the hypothalamic-pituitary-ovarian axis by modulating endogenous opioids like beta endorphins, thereby affecting the release of gonadotropin-releasing hormone (GnRH). This hormone triggers the release of FSH and LH, the primary hormones stimulating follicular growth and ovulation.
More recent studies have shown that electro-acupuncture can improve uterine and ovarian blood flow of infertile women while having a more regulatory effect on the follicular hormones. Regulating the follicular hormones is essential to egg quality and quantity thereby improving ovulation and pregnancy outcomes.
Chinese medicine has been used to treat female infertility in China for more than 2000 years and the growing body of published research suggest that acupuncture improves assisted reproductive outcomes and natural conception.
Treatment strategies vary, yet four distinct treatment protocols have been identified to support the four distinct phases of the menstrual cycle.1
- Menses phase (day 1-4)
- Blood is discharged
- Treatment supports Qi, blood and Kidney tonification.
- Follicular phase (day 5-11)
- Yin and Blood are most abundant in the follicular phase
- Treatment goals are to support the follicle maturation and nourish Yin and Blood
- Ovulation phase (day 12-17)
- Yin transforms into Yang through the Qi mechanism
- Treatment goals are to circulate Qi and Blood, promote ovulation
- Luteal Phase (day 18-onset of menses)
- Yang becomes most abundant
- Treatment goals are to benefit the Kidney Yang by circulating Liver Qi and calming the Shen
Weekly treatments are recommended and herbal therapy and acupuncture points are based on the cycle phases. A minimum of 2 treatments a week for three months is clinically seen to improve reproductive outcomes.1
The Kidneys are the governor of reproduction and is the key to healthy fertility. Several studies have confirmed the effectiveness of Kidney-tonifying medicine in improving reproductive function and pregnancy outcomes. Acupuncture and herbal medicine is in a unique position to fill the gap in women’s healthcare, providing safe, effective and natural medicine.
Today acupuncture is utilized in combination with In-vitro fertilization and assisted reproductive techniques due to is safety and measurable outcomes in improving ovarian reserves. By regulating the four phases of the cycle (Menses, Follicular, Ovulation and Luteal), acupuncture therapy can generate healthy cycles and improve fertility outcomes. 2
- Hullender Rubin L, Marx BL. Diminished Ovarian Reserve, Clomid, and Traditional Chinese Medicine: A Case Study. Med Acupunct. 2012 Dec;24(4):273-280. doi: 10.1089/acu.2012.0912. PMID: 24761166; PMCID: PMC3579201.
- Jang S, Kim KH, Jun JH, You S. Acupuncture for in vitro fertilization in women with poor ovarian response: a systematic review. Integr Med Res. 2020 Jun;9(2):100395. doi: 10.1016/j.imr.2020.02.003. Epub 2020 Feb 27. PMID: 32322482; PMCID: PMC7160570.
- Wei W, Liu LY, Chen L, Su MH, Hong XJ. Acupuncture for “poor ovarian response” of women to controlled ovarian hyperstimulation: A protocol for meta-analysis and systematic review. Medicine (Baltimore). 2020 Oct 30;99(44):e22868. doi: 10.1097/MD.0000000000022868. PMID: 33126333; PMCID: PMC7598851.
- Zhang, C., & Zhang, C. (2016). Advancement in the treatment of diminished ovarian reserve by traditional Chinese and Western medicine (Review). Experimental and Therapeutic Medicine, 11, 1173-1176. https://doi.org/10.3892/etm.2016.3025