Was she infertile?
The patient in question was a 33-year-old family practice doctor who believed she was infertile. By definition, infertility is failure to conceive after a year of regular intercourse without contraception. She didn’t meet that definition. She only tried for 6 months before seeing a doctor, and then for 2 more months (with some kind of unspecified medicine) and then she consulted a reproductive endocrinologist who apparently told her she was infertile because of a high FSH level. Then she “did her own research” and supposedly found that acupuncture was a key part of infertility treatment. So she sought infertility treatment from an acupuncturist.
What do FSH levels mean?
High FSH can indicate menopause or poor ovarian responsiveness. In the treatment of infertility with in vitro fertilization (IVF), FSH level measured on day 3 of the menstrual cycle is predictive of fertility within that IVF cycle. But for diagnosing infertility, one measurement is not enough to base predictions on. Lab values vary, and FSH levels are known to fluctuate with factors like stress and illness.
It sounds like she was told she was infertile based on one FSH test; if so, that was an unwarranted diagnosis. Then, during acupuncture treatment, the FSH levels dropped. Did they drop because of the acupuncture? Did they drop for other reasons like a reduction in stress? Would they have dropped anyway without any treatment at all? We don’t know. She attributes it to the acupuncture, but she may be committing the post hoc ergo propter hoc fallacy (“correlation is not causation”).
After six months of acupuncture, she became pregnant and subsequently gave birth to a healthy baby. The treatments consisted of needle insertions and supplements (not identified) from an acupuncturist who claims to “treat the whole person” and restore the woman’s normal healthy reproductive cycle “as best as can be naturally done.” He admits:
I’m not a doctor, I don’t pretend to be a doctor, and I don’t have the diagnostic tools of a doctor.
One literature review found that acupuncture “may have a role” in the treatment of polycystic ovarian syndrome (PCOS) (which this patient did not have), but a controlled study showed no difference between true and sham acupuncture for PCOS. A study with a sham acupuncture control claimed to show an improvement in menopausal symptoms with acupuncture, but no difference in FSH levels was detected. A study from China showed an increase in FSH in aging men with partial androgen deficiency when they were treated with acupuncture and medication, but not with acupuncture alone.
A search of PubMed didn’t turn up any credible evidence for the effectiveness of acupuncture for treating infertility per se. One systematic review found no evidence of effectiveness for infertility except in one specific area of embryo transfer. There were a number of articles about IVF. A Cochrane review looked at embryo transfer in assisted conception and concluded that acupuncture:
shows a beneficial effect on the live birth rate; however, with the present evidence this could be attributed to placebo effect and the small number of women included in the trials. Acupuncture should not be offered during the luteal phase in routine clinical practice until further evidence is available from sufficiently powered RCTs.
One study showed an improvement in measures of stress in infertility patients. I wrote about a study of acupuncture for IVF that showed it didn’t work: the researchers tried to blame the patients for not having good quality embryos. When that didn’t turn out to be true, they still recommended using acupuncture. The Skeptic’s Dictionary has a good overview of the published evidence on acupuncture for infertility. Steven Novella has written about a study that showed that using CAM (several modalities included) resulted in lower pregnancy rates.
In short, I don’t know where she did her research, but I couldn’t find any credible evidence to support using acupuncture either for infertility or for raising FSH levels. And there is no plausible physiologic mechanism by which it could be expected to help other than perhaps by assisting relaxation and reducing worry, anxiety, and stress.
The news story was credulous, didn’t adequately explain the facts, and didn’t present any conflicting data or opinions. It provided two links for readers to get more information: both are extremely biased and contain misinformation. One link is to another credulous example of poor reporting from the popular media, and the other is a link to the website of the Acupuncture Center of Ann Arbor, which offers a number of questionable treatments including DHEA and bioidentical hormones.
There was nothing from skeptics or from patients who had acupuncture and did not get pregnant. There wasn’t even the usual token effort to present “both sides” of a controversial story. This is not good science journalism. It isn’t even science journalism. It amounts to irresponsible sensationalism and free advertising for the Acupuncture Center of Ann Arbor.
This woman did not meet the criteria for a diagnosis of infertility when she started seeking treatment. There’s every reason to think she got pregnant just in the natural course of things, and no reason to think acupuncture had any effect. The news report and article are a travesty. Detroit deserves better.Acupuncture, Infertility, and Horrible Reporting Harriet Hall