In a randomized controlled trial comparing usual care to usual care plus 25 minutes of a standard acupuncture treatment pre-and postembryo transfer, the pregnancy rates were 43% in the intervention arm as opposed to 26% in the control arm (59). In a meta-analysis including seven trials and 1,366 women, the authors concluded that the evidence suggests that embryo transfer done with acupuncture improved pregnancy rates and live births among women undergoing IVF (60). At the same time, a meta-analysis including 13 trials and 2,500 women concluded there was not sufficient evidence to conclude that acupuncture improves IVF clinical pregnancy rates (61). The acupuncture protocols are typically designed to promote sedation, uterine relaxation, and increased uterine blood ﬂow. The basis for the effect of acupuncture is hypothesized to be potentially related to modulating neuroendocrinological factors, increases in uterine and ovarian blood ﬂow, modulating cytokines, and reducing stress, anxiety or depression. Blood ﬂow impedance in uterine arteries, measured as the pulsatility index, was considered useful in assessing endometrial receptivity to embryo transfer. A study was performed assessing the effect of electroacupuncture on the pulsatility index of infertile women. After treatment twice a week for 4 weeks, the mean pulsatility index was significantly reduced both shortly after the last treatment and also 10 to 14 days after the treatments. The skin temperature of the forehead was increased significantly, suggesting a central inhibition of sympathetic activity (62). In a study of women undergoing IVF, the women who received acupuncture had increased cortisol levels and increased prolactin levels when compared to the controls, trending toward more normal cycle dynamics (63). More studies are needed both in the efficacy of acupuncture and infertility and in the mechanisms of action. Clinically speaking, there is provocative evidence that acupuncture appears safe in early pregnancy and is reasonable to support if patients are interested.
Menopause Before the release of the results of the Women’s Health Initiative, 80% of women in the United States were using “nonprescriptive therapies” to help manage their menopausal symptoms, and many of these therapies were CAM approaches. In a study examining the use of CAM during menopause, a group of 3,302 women were followed across 6 years, and 80% of them used some form of CAM (64). In a study examining women’s treatment choices after discontinuing hormone therapy (HT), 76% of women reported using nonhormonal alternative therapies, and of these 68% found them helpful (65). In a study exploring women’s beliefs about “natural hormones,” women using compounding pharmacies believed that compared with standard hormones, natural hormones are safer, cause fewer side effects, and are equally or more effective for symptom relief. Many women believed natural hormone therapy was equally or more effective for long-term protection of bones and lipid levels (66). It is reasonable to assume that women are exploring and choosing such therapies in ever increasing numbers, often without being accurately or fully informed. This expanded market generates more products and promotion of alternatives. It is imperative that physicians be informed about these options so they can help patients make medically sound choices.
The list of botanicals promoted and used for the treatment of menopausal symptoms is extensive. Following is a review of the products most commonly used and recommended based on research evidence.