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A Pilot Study Evaluating the Combination of Acupuncture with Sildenafil on Endometrial Thickness
Wendy Yu, L.Ac., Brandon Horn, J.D., L.Ac., Brian Acacio, M.D., Daoshing Ni, D.O.M, L.Ac., Ph.D., Rudy Quintero, M.D., Mory Nouriani, M.D.
Sher Institutes for Reproductive Medicine, Glendale, CA and Eastern Center for Complementary Medicine, Los Angeles, CA Introduction
used depending on the location of the acupoints. The 34 gauge needles were used on points located on the trunk of the body and the 38 gauge Literature cited
Endometrial thickness has been shown to be an important prognostic factor needles used on the extremities. A far infrared lamp (TDP, China) was Hou, L.Q., Xiong, K.R. 2006. Effect of different needle-retained time of of successful embryo implantation. If the endometrial thickness is less than utilized for 20 minutes on the lower abdomen, approximately 12-18 inches electroacupuncture on expression of nitric oxide synthase in the 9 mm there is a significant reduction in live birth rates. Though there is from the skin’s surface. The base protocol included the following septum of the rat. Zhongguo Zhen Jiu 26:879-882.
conflicting data, preliminary evidence suggests that the administration of Kim, J., Shin, K.H., and Na, C.S. 2000. Effect of acupuncture treatment on vaginal Sildenafil can markedly improve endometrial thickness and result uterine motility and cyclooxygenase-2 expression in pregnant rats. in increased live IVF births. Our clinical observations are consistent with Conception Vessel 4
Gynecological and Obstetrics Investigation 50:225-230.
this. However, other clinics report inconsistent results. Therefore, we Conception Vessel 6
Spleen 10
Matsumoto, K. and Euler, D. 2002. Kiiko Matsumoto’s Clinical Strategies: Endometrial 
hypothesized that the difference in response between clinics may involve Large Intestine 10
Stomach 36
Thickness (mm)
In the Spirit of Master Nagano, Vol. 1. Kiiko Matsumoto International, other factors. When we looked into this, we found that many of our patients were simultaneously receiving acupuncture treatments. Paulus, W.E., Zhang, M., Strehler, E., El-Danasouri, I., and Sterzik, K. Studies on acupuncture have demonstrated positive effects on Microcurrent stimulation (Electrostimulator 8c.Pro, Pantheon Research, 2002. Influence of acupuncture on the pregnancy rate in patients who implantation rates, ongoing pregnancy rates and the number of live births. CA) was applied using standard leads in biphasic mode using 10 Hz from undergo assisted reproduction therapy. Fertility and Sterility 77:721- Acupuncture has also been shown, via measurements of pulsatility index, (L) Kidney 3 to Conception Vessel 4 and from (R) Kidney 3 to Conception to significantly increase blood flow to the uterus. Decreases in pulsatility Vessel 6. Needle-moxa was then applied to Conception Vessel 4 and Quintero, R. et al. 2004. A randomized, double-blind, controlled cross- index have been shown to significantly improve pregnancy rates. Conception Vessel 6 in the form of Japanese kyutoshin.
over study evaluating acupuncture as an adjunct to in-vitro Subjects
Researchers have also found that acupuncture has direct effects on the In accordance with Japanese meridian therapy, acupoint modifications fertilization. Fertility and Sterility 81:S3.
endometrium. Some of these include increases in progesterone receptor were then made if any of the following areas were uncomfortable to the Sher, G., and Fisch, J.D. 2002. Effect of vaginal sildenafil on the outcome concentration, a reduction in COX-2, and an increase in the activity of of in vitro fertilization (IVF) after multiple IVF failures attributed to nitric oxide synthase. Therefore, the purpose of our investigation was to poor endometrial development. Fertility and Sterility 78:1256-1257. evaluate the effects of combining acupuncture and Sildenafil suppositories Location of palpation response
Protocol Addition
Stener-Victorin, E., Waldenstrom, U., Andersson, S.A., and Wikland, M. 1996. Reduction of blood flow impedance in the uterine arteries of Lining Max Prior Cycle (mm)
Lining S+Acu (mm)
infertile women with electro-acupuncture. Human Reproduction Patient 1
Patient 2
Tian, D., Xie, X., and Wang, B. 1998. Study on the relationship between Patient 3
ovulation inducing effect of drug-acupuncture and endometrial Treatments were administered according to the following schedule: Patient 4
contents of estradiol receptor and progesterone receptor. ZhongguoZhong Xi Yi Jie He Za Zhi 18:225-226. Treatment Timing
Patient 5*
Materials and methods
Subjects were initially five females, ages 35 - 45, with prior IVF or IUI failures. However, one subject was later disqualified due to the discovery Uterine lining was measured during patients’ routine monitoring via Acknowledgments
of an undisclosed prior lining of 9 mm. All subjects had a Day 3 FSH < 9 fluid ultrasounds which were provided starting from cycle day 3 and mlU/ml and normal uterine cavity by fluid ultrasound or hysteroscopy. Conclusions
We’d like to thank the late Dr. Mory Nouriani for coordinating and repeated throughout stimulation phase.
Patients were excluded if they had known allergies to any fertility bringing this study to fruition. The loss of Dr. Nouriani has created a medications, a history of estrogen dependent neoplasms, abnormal uterine significant void in the field of reproductive medicine and he will be greatly This pilot study is consistent with previous reports that acupuncture cavity, history of DES exposure or Asherman’s syndrome.
missed by his patients, the practitioners and staff of both the Sher Institutes improves uterine lining measurements over previous cycles. Following IRB approval, consent, routine tests, FSH and estradiol for Reproductive Medicine and the Eastern Center for Complementary levels were obtained for each patient and either a fluid ultrasound or HSG Medicine. Our thoughts are with his wife, Dr. Kerri Parks and his 4 young This preliminary data supports the potential for a synergistic action was performed less than 6 months prior to initiation of treatment. Protocols children, Olivia, Nicholas, William and Mora. We would also like to thank between acupuncture and Sildenafil. We hypothesize these effects may be were designed for each patient using the fertility clinic’s standard Ferring Pharmaceuticals Inc. for providing the funds to make this study
All four subjects achieved endometrial lining thickness of greater than or due to acupuncture’s ability to upregulate nitric oxide synthase. However, techniques for evaluating the necessary dosage of gonadotropins. Patients equal to 10 mm following the administration of the combination of we cannot rule out other mechanisms of action since acupuncture has also received a Lupron long protocol using 300 to 450 units of gonadotropin acupuncture and Sildenafil: including one patient whose lining did not been shown to affect many other parameters. depending on age, prior IVF history and day 3 FSH value. exceed 5 mm in a previous cycle. Another patient, who had not responded Each patient was given 25 mg Sildenafil suppositories on CD9 and to Sildenafil alone in a prior IVF cycle, responded to the combination of a series of five acupuncture treatments provided by two acupuncturists The results of this preliminary data may also suggest a role for a similar Sildenafil and acupuncture. We also noted that endometrial thickness in who are certified by the National Certification Commission for combination in treating erectile dysfunction. Further testing and data is most patients continued to increase post-hCG administration.
For further information
Acupuncture and Oriental Medicine and the State of California. Thirty- Please contact [email protected]. More information on this and four gauge 1.5 inch and 38 gauge 1 inch needles (Millenia, China) were other acupuncture studies that relate to reproductive medicine can be found at For an online, PDF-version of this poster presentation, this can be obtained at


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