Clomiphene citrate, or Clomid, is a medication commonly used to treat anovulatory infertility. It works by binding to estrogen receptors, which tricks your body into thinking that estrogen levels are low, which then causes the brain to produce increased levels of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). It’s very effective in stimulating follicular growth and ovulation, but pregnancy rates do not align and have a higher rate of miscarriage.
An interesting systematic review and meta-analysis was just published in Acupuncture in Medicine. Much of our current acupuncture research compares fertility outcomes in groups where acupuncture is added to standard pharmacological treatments. This study is unique because it examines the separate effects of acupuncture versus clomiphene citrate. Researchers systematically reviewed journals for studies that involved acupuncture and clomiphene citrate. They identified nine separate randomized controlled trials that met robust inclusion criteria, yielding a total sample size of 1,441 women. The participants in these studies were unable to conceive after trying for more than a year and were diagnosed with anovulatory infertility. A meta-analysis of the data compared clinical outcomes of acupuncture versus clomiphene citrate and showed that the rates of ovulation were the same between groups. Furthermore, the groups receiving acupuncture alone had significantly greater follicular diameters, higher rates of pregnancy, and lower rates of subsequent miscarriage.
Clomiphene citrate has a remarkable ability to produce follicles in anovulatory conditions, but this study suggests that the follicles produced via acupuncture alone are superior in quality. Traditional Chinese medicine holds a concept of Jing, considered the congenital ‘essence’ passed on from our parents. While certain lifestyles and diets can preserve one’s Jing, its reserves are considered to be finite. In modern terms, we often equate this essence to genetics and reproductive function, such as ovarian reserve. Follicles that are stimulated using clomiphene citrate may lack the Jing vital to their overall success. Rather than revving up a tired system, acupuncture gently stokes the fire to recruit follicles using your body’s own resources. This may explain why the study found acupuncture-induced follicles to be of better quality and result in higher rates of a successful pregnancy. From a modern perspective, acupuncture has been shown to affect the hypothalamic-pituitary-adrenal axis and other neuroendocrine mechanisms, which supports overall systemic hormonal balance.
Many of our patients use clomiphene and other fertility medications at the same time they receive acupuncture. This study is not suggesting that acupuncture is futile in these cases – Chinese medicine can improve systemic balance in any phase of the fertility process – but these findings do open an interesting discussion in fertility medicine. Acupuncture can also reduce common side effects of pharmacological treatments, such as night sweating, hot flashes, headaches, and bloating. The authors of this study also note that individualized acupuncture treatments may have more significant effects than a standardized ‘fertility protocol.’ We find this to be the case when treating any condition with acupuncture, which is why we take time to learn about your unique constitution and create an individualized treatment plan that considers your body as a whole.