Resumo

CUNHA, Mariana et al. Impact ff acupuncture on female infertility: considerations apropos of a case and review of the state of the art. Arq Med [online]. 2013, vol.27, n.2, pp.49-57. ISSN 2183-2447.

In vitro fertilization (IVF) is an expensive treatment, invasive and of limited accessibility. The psychological effect of acupuncture (Ac), a technique with origin in Traditional Chinese Medicine (TCM) in infertility has been the object of intensive research in particular as applied during IVF treatments. We describe the case of a woman aged 34 years old, with severe infertility (decreased ovarian/reserve diminished, poor embryo development and repeated implantation failures), which was submitted to several unsuccessful IVF treatments. The conventional stimulation protocol was then optimized and an additional manual Ac session was performed, 25 min before and after embryo transfer (ET), according to published protocols. From this combined therapeutic approach during the 4th treatment cycle, a successful pregnancy was established with birth of a healthy child, although we can not conclude about the particular effect of Ac in this success. From this clinical case-report we performed a non-systematic revision of the literature about Ac in female infertility. The main mechanisms of Ac action seem to be related to: (a) modelling of neuro-humoral factors, (b) increase in blood flow to the reproductive tract, (c) and decrease in anxiety and depression. The actual research suggests that Ac may have a beneficial effect in female infertility only as an adjuvant therapy. However, there are conflicting results on the success of the clinical pregnancy rates (CP). In several studies, Ac significantly increased CP rates, either using electro-acupuncture (EAc) during oocyte retrieval and using conventional analgesia as controls (46-59% vs 28-34%), or during ET (39-43% vs 24-26%). On the contrary, other studies revealed non-significant increased CP rates either with EAc (31.1% vs 34.4%), or during ET, using as controls non-Ac, sham-Ac (Ac in different acupoints) or in the same acupoints with a non-penetrating needle (Ac-placebo) (31-45% vs 23-53%). At present, under evidence-based -medicine it is not possible to recommend to routinely incorporate Ac in the guidelines of IVF conventional treatments. Evidently, more studies are needed to clarify the clinical efficacy of Ac and its biological mechanism in female infertility.

Palavras-chave : Acupuncture; reproductive medicine; infertility.

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