We live and die by the sword called science (and Media)

I find it hard to believe that acupuncture on transfer day can reduce pregnancy rates. I also was surprised that one or two treatments could dramatically improve pregnancy rates with IVF. I have never thought of my medicine as one disease-one treatment - 100 %cure. I believe we help with fertility issues when we get the cause of the imbalance and correct the imbalance by treating the underlying pattern. This treatment can last from 3 months to a year. Lets put aside for a moment that there are still more studies supporting the acupuncture treatment on transfer day than there are against acupuncture. It is still are responsibility to do no harm and do what is in the best interest of the patient. For me that is looking at the study, discussing the study with both RE's and acupuncture colleagues. Which I have started. Hopefully they will join in this discussion and share their views.

Some of the points that they have highlighted are:
* There are few that support the negative effect and many more that shoe acupuncture benefits IVF when done on transfer day
* Sticking to research protocols is poor Chinese medicine practice.
* The points in the Paulus study are by far not the best point combination.
* Acupuncture and Chinese medicine has a great positive impact when used during the preconception phase (3-6 months) an IVF transfer.
* Those who adopted the western medical approach at the expense of Chinese medicine principles will now suffer the plight of selling out.
* The more you try to practice based on scientific studies the more you move away form what you know (The Dao) and the less effective your treatments become. Also, it is harder to serve your patients and connect to their soul when you are caught up in science and protocols.

I have heard Randine warn those of us who specialize in treating infertility that we are playing a dangerous game by trying to please the RE's at the expense of how our medicine is meant to practiced. Randine, I hope you can add to what you think the impact of these negative studies have on our practice. More importantly, to remind us of the strength and effectiveness our medicine and why it has survived for thousands of years without the assistance of western science.

Lorne
www.acubalance.ca
www.prodseminars.com

First, I wonder if the news has it right. They rarely do.

Regardless, Has western med been honest about how the IVF affects the health of the babies they are producing? What about the mothers who take all those high dosages of hormones, how are they affected? You would think if long tern HRT was dangerous then extremely high dosages of HRT over a short term can also be harmful.

It is good they are looking at what works and what does not work. But I think they need have a good long look at how they practice before they "police" us. Check out the video

I know I know, the damn Paulus study changed clinical medicine more drastically than any other study...blah blah blah...this wasn't acupuncture at all anyway! The only reason we claimed it to be 'acupuncture' was because the results were so good. I really think it is time we start teaching our western medical counterparts about the true essence of TCM, and that it is necessary to use different methods to determine its validity. After all, we are all doctors, we should be able to figure this out, right?!?

I Do not think western medicine basj=king i sthe answer. Althogh the video is enlightening and concerning I agree with tcmloren that it is not about "us against them"

If you really think about, most western drugs and interventions are not proven scientifivally to work. And for those that do work we do not know why just like science is not sure how acupuncture works.

tcmloren, what do you suggest is an effective means of educating?

Lorne and Randine are spot on about the limitations of western research. RCTs were primarily developed to establish efficacy and safety of pharmaceuticals. Forgive me for stating the obvious, but acupuncture is not a pharmaceutical. It is important for us not to allow the baby to be thrown out with the bathwater so to speak, just because one study observed an undesirable outcome. One adverse study in the field of reproductive endocrinology does not disprove its entire practice. Accordingly, this single study does not disprove acupuncture in the field of reproductive medicine as a whole.

This particular IVF study is interesting, and from my perspective, there is something to gain from it. In the interest of full disclosure, I was one of the acupuncturists who worked on it. I am not, however, concerned about the outcome or regret being a part of it. If I could go back and do it again, I would advocate for onsite acupuncture versus off site. Even so, I doubt we would see the same results in the original Paulus study even with this change. Let us not overlook the outcome measure in the Paulus study was the appearance of a gestational sac, not a take home baby – not even the observation of a heartbeat. How many of us have had a patient with this outcome and no take home baby? I’m guessing more than a few.

Regardless, this study is not a signal that acupuncture does not work – quite the opposite. In my mind, it provides an opportunity to discuss with patient and western doctor alike why acupuncture research is self-limiting as it is done currently. I think it provides some evidence that day of ET acupuncture is not as effective as the original Paulus study suggests. Something many of us already suspected in our practices and in discussions with colleagues. (I also think it provides some insight as to just how stressful that day of transfer can really be on our patients.)

From my perspective, we can continue to bemoan western research. Or, we can choose to do something about how we are represented in it. Consider Cridennda and Magarelli’s work. While several of their projects still apply a slightly modified Paulus protocol, some also incorporate (albeit standardized) what could be generalized as pre-conception care. Their outcomes thus far appear to be quite successful. Is this the way we all should practice? Absolutely not. But this research does provide a catalyst for dialogue with western physicians.

My intention is for the couples I work with to conceive and hold open that possibility for them. I encourage them to do the same. However, I am not attached to this outcome. Some will conceive, some will not, but that is for another post. The beauty of TCM is that we evaluate and treat the individual, not a research subject who only receives a standardized protocol. Our intention is to address mind, body and spirit.

Research can be used as a way of educating the public and western medical community alike. If acupuncture is to be studied within this paradigm, we as practitioners must begin to take an interest in designing it so that it reflects the way we practice in the field, or with ecological validity. We must begin designing studies that as a minimum take into consideration our differential diagnosis. This is not easily measured or standardized by a randomized control trial, but it is possible. We can be the influence that widens that camera angle from the “veins of the leaf of the tree” to the existence of a tree among many.

Warmly,
lee.

Lee Hullender, LAc
www.abundantspring.com