IVF and IUI Support

Understanding IVF and IUI

IVF and IUI are medical treatments for infertility, which is usually defined as not achieving pregnancy after 12 months of regular unprotected intercourse.^[1] About 1 in 8 women of reproductive age in the US receives infertility services each year.^[1] Both treatments are planned and carried out by a physician, and this page describes only the supportive care we can offer around them.

Common symptoms

Infertility itself is not a symptom-based illness, since the main sign is the lack of pregnancy over time. Some of the causes do produce symptoms, such as irregular or absent periods when ovulation is disrupted.^[1]

The treatment process often brings its own strain. In one survey of 97 women during the ovarian stimulation phase of IVF, 43 percent had anxiety, 30 percent had depression and about 43 percent had poor sleep quality.^[2]

Causes and risk factors

The most common causes of infertility are ovulation problems, male factor infertility and tubal disease, and in about 15 percent of couples no cause is found.^[1] Female age, smoking and obesity affect fertility.^[1]

The male partner contributes substantially to about half of infertility cases, which is why both partners should be evaluated.^[3]

How it is diagnosed and treated conventionally

A fertility evaluation looks for ovulation problems, male factor and tubal disease, and treatment is matched to the cause and to the woman's age.^[1] Ovulation-inducing medicines such as clomiphene or letrozole, or injectable gonadotropins, may be tried first. Adverse effects of gonadotropins include multiple pregnancy and ovarian hyperstimulation syndrome.^[1]

IUI is often used for unexplained infertility or mild male factor infertility, and IVF is considered if those approaches do not work, or sooner for older women or for severe male factor or tubal disease.^[1] A Cochrane review of 15 trials found that, for unexplained infertility, the evidence on whether IUI improves live birth was uncertain and mostly of low quality. It did find IUI with ovarian stimulation probably helps when the chance of natural conception is low.^[4]

Why IVF and IUI calls for a whole-person approach

Success with IVF or IUI depends mainly on medical factors such as age and the cause of infertility, and your fertility team manages those. Other parts of life still matter for how you cope with months of treatment, injections, waiting and uncertain outcomes.

Our supportive care is aimed at the person going through treatment, not at changing the biology of the cycle.

Emotional strain

Fertility treatment is emotionally demanding. A survey of women having IVF found high rates of anxiety and depression.^[2] A study of 450 women found that anxiety, depression and stress symptoms before a first cycle were not linked to the chance of clinical pregnancy.^[5] Stress is therefore a reason for support in its own right, but it should not be blamed for a failed cycle.

Sleep

In the survey of women in IVF stimulation, higher anxiety scores were linked to worse sleep quality.^[2] Poor sleep is a common and treatable burden during cycles, and it is one of the things we may address.

Age, weight and smoking

Female age is the strongest factor in fertility, and smoking and obesity can also reduce it.^[1] These are discussed with your physician. We do not offer weight-loss or smoking programs as treatment for infertility.

Both partners

Male factors contribute to about half of cases, so fertility care involves both partners.^[3]

Acupuncture as supportive care in IVF and IUI

What the research shows

Acupuncture has not been shown to raise live birth rates in IVF when tested against a convincing sham. The largest trial enrolled 848 women at 16 centers in Australia and New Zealand. Live births occurred in 18.3 percent of the real acupuncture group and 17.8 percent of the sham group, and the authors concluded the findings do not support acupuncture to improve live births.^[6]

A 2021 meta-analysis of 8 placebo-controlled trials with 3,607 women reached the same result for acupuncture around embryo transfer. Clinical pregnancy, ongoing pregnancy, miscarriage and live birth rates did not differ from placebo acupuncture, and the placebo was not different from usual care.^[7] A 2010 review of 14 trials also found no evidence of benefit.^[8]

Other meta-analyses are more favorable but have weaknesses. One pooling 25 trials found higher clinical pregnancy and live birth rates with acupuncture, and another of 58 trials found higher rates but rated the certainty of evidence as extremely low to low, with no high-quality evidence.^{[9, 10]} Two others found a higher clinical pregnancy rate but no significant difference in live births, with results depending on the type of control used.^{[11, 12]} One of these suggested a benefit in women with earlier unsuccessful IVF cycles, but the authors cited poor reporting and flaws in the studies.^[11]

We found no acupuncture trials for IUI cycles. Acupuncture has also been studied for anxiety around IVF. In one trial, ear acupressure reduced anxiety compared with a sham and with no treatment, but this is a single study of a different technique.^[13]

How acupuncture may work

Researchers have proposed that acupuncture could improve blood flow to the uterine lining. In a small sham-controlled trial of 70 women, acupuncture between egg retrieval and embryo transfer improved some blood-flow measures on ultrasound, but pregnancy and live birth rates did not differ.^[14] Whether blood-flow changes matter for outcome is not established.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the body, usually left in place for about 20 to 40 minutes. We plan a course of several visits and reassess. The timing of any visits relative to your cycle should be agreed with your fertility team.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[15] In the IVF placebo trials, adverse events were discomfort and bruising of mild to moderate degree.^[7] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant or may be pregnant after a transfer, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in IVF and IUI

The Ayurvedic view

In Ayurveda, fertility is traditionally linked to the balance of the doshas and the health of the reproductive tissues, and treatment is individualized. These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care traditionally combines diet and daily routine suggestions, such as regular meals and consistent sleep hours, with relaxing oil massage and, in some cases, individually prescribed herbs. Herbs such as shatavari (Asparagus racemosus) and ashwagandha (Withania somnifera) are traditionally used in women's reproductive health.^[16]

Panchakarma is not appropriate during active fertility treatment, pregnancy, acute illness or frailty.

What the research shows

We found no clinical trials of Ayurvedic medicine in women having IVF or IUI. A review of Ayurvedic herbs in female reproductive health described the potential benefits of herbs including shatavari and ashwagandha, but stressed the need for more rigorous studies and a critical look at study quality.^[16] Evidence is therefore insufficient to say whether any Ayurvedic treatment affects fertility treatment outcomes.

Supportive care for stress and sleep can reasonably be offered, but we do not claim that it improves the chance of pregnancy.

Herbal medicine as supportive care in IVF and IUI

Herbs and formulas that have been studied

Most research on herbs in fertility concerns Chinese herbal formulas given to women with infertility, often with polycystic ovary syndrome (PCOS), rather than women in IVF or IUI cycles. The formulas varied between trials and are prescribed individually.^{[17, 18]}

What the research shows

The evidence is limited and not specific to IVF. A meta-analysis of 40 trials in 4,247 women with infertility reported higher pregnancy rates with Chinese herbal medicine than with Western fertility drugs alone, but the trials covered a mix of causes, including PCOS, endometriosis and tubal blockage, and were not specific to IVF. The abstract does not report the quality of the trials.^[17] A Cochrane review of 5 trials in 414 women with PCOS found insufficient evidence for Chinese herbal medicine, with very low quality evidence for most comparisons and no live birth data. It found low-quality evidence that adding herbs to clomiphene raised pregnancy rates.^[18]

Safety and herb-drug interactions

Herbs can interact with medicines and may not be suitable during stimulation cycles, around egg retrieval or embryo transfer, or in early pregnancy. Reported herb-drug interactions include increased bleeding when some herbs are combined with warfarin or aspirin.^[19] The effect of most herbs on fertility medicines has not been studied, so your fertility physician should know about every herb and supplement you take.

About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic in one study.^[20] Herbs should come from tested sources and be prescribed individually. We recommend that herbs be stopped or reviewed with your physician once a transfer or insemination is done and pregnancy is possible.

Translating traditional medicine into modern biological language

This section is interpretation, not equivalence. Chinese medicine describes fertility problems in terms such as stagnation of qi and blood or deficiency of kidney essence. Researchers studying acupuncture in IVF have looked at measurable ideas that loosely parallel the pictures, such as uterine blood flow and the stress response, but the results are mixed.^{[6, 14]}

Ayurveda's emphasis on regular routines, sleep and calm digestion corresponds loosely to the sleep and emotional strain that surveys document in women undergoing treatment.^[2] No study has shown that a dosha or a TCM pattern corresponds to a particular biological process in infertility.

How this care fits with your medical care

Our care is supportive and complementary. Your reproductive endocrinologist or gynecologist directs IVF and IUI, and you should keep every appointment, medicine and instruction. Do not stop, delay or change any fertility medicine or protocol because of anything we suggest. We do not diagnose infertility or decide on treatment.

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Please bring your diagnosis, your cycle calendar and medication list, and a list of any herbs or supplements. If you become pregnant, tell us right away.

When to seek urgent medical care

Some symptoms during fertility treatment need prompt medical assessment, and ovarian hyperstimulation syndrome is a known adverse effect of the injectable medicines used in stimulation.^[1]

• Rapid weight gain, a swollen or painful abdomen, or nausea and vomiting during or after stimulation
• Shortness of breath or markedly reduced urination
• Severe or one-sided pelvic pain, or heavy vaginal bleeding
• Fever with pelvic pain after egg retrieval
• Pain, swelling or redness in one leg, or chest pain
• Thoughts of harming yourself (call or text 988, the Suicide and Crisis Lifeline)

If any of these occur, call your fertility clinic urgently, and call 911 or go to the nearest emergency department for emergencies.