A successful IVF procedure involves not only the transfer of a viable embryo, but also an optimal uterine environment. While much emphasis is placed on improving the sperm and the egg; receptivity of the womb is an often forgotten concept to pregnancy success.
Pulsatility Index and Blood Flow to the Uterus
For any woman undergoing IVF, poorly controlled diabetes, poor circulation, or lack of physical activity may be cause for concern of impaired blood flow to the pelvic region. However, a rarely discussed, but much more precise technique exists for predicting both uterine blood flow and the success of an embryo transfer.
Transvaginal ultrasound can be used to measure the pulsatility index in the uterine arteries, which is an assessment of blood flow to the area. A higher index indicates greater restriction of blood flow to the uterus. The pulsatility index has been a tool used in multiple studies to assess endometrial receptivity (1, 3, 4, 5, 6, 7) or even predict IVF success (3). In numerous studies, a higher index has been associated with a decreased pregnancy rate following embryo transfer (2, 3, 4, 5, 7). In fact, Steer et al. demonstrated that a pulsatility index of 3.0 or more at the time of embryo transfer could actually predict 35% of failed pregnancies (3) .
Can Electroacupuncture Increase IVF Success?
Luckily, the pulsatility index can be modified. Electroacupuncture, which involves gentle electrical stimulation of acupuncture points over the lower back and legs, was shown to reduce blood flow impedance to the uterine arteries (8). In this study, a group of women undergoing IVF received a series of 8 acupuncture sessions over the course of 4 weeks. In these women, a statistically significant drop in the pulsatility index was measured by the end of the 8th sessions, and this benefit was maintained even 10-14 days after the treatment period had ended. Following the series of acupuncture treatments, the pulsatility index fell within the desired range for optimal uterine receptivity of 2.0 – 2.99, for the majority of the women in this study (8).
Optimal endometrial receptivity at the time of implantation is a requirement for successful pregnancy. Studies have repeatedly noted that measuring blood flow impedance in the uterine arteries, can be a useful assessment for endometrial receptivity and even IVF success. The findings of the current study suggest that a series of 8 electroacupuncture treatments can increase uterine artery blood flow and promote endometrial receptivity in women undergoing IVF (8).
- Goswamy, R.K. and Steptoe, P.C. Doppler ultrasound studies of the uterine artery in spontaneous ovarian cycles. Hum. Reprod. 1988; 3, 721-726.
- Goswamy, R.K., Williams, G. and Steptoe, P.C. Decreased uterine perfusion – cause of infertility. Hum. Reprod. 1988; 3, 955-959.
- Steer, C.V., Campbell, S., Tan, S.L. et al. The use of transvaginal colour flow imaging after in vitro fertilization to identify optimum uterine conditions before embryo transfer. Fertil. Steril. 1992; 57, 372-376.
- Steer, C.V., Tan, S.L., Mason, B.A. and Campbell, S. Vaginal color Doppler assessment of uterine artery impedance correlates with immunohistochemical markers of endometrial receptivity required for the implantation of an embryo. Fertil., Steril. 1995; 61, 101-108.
- Sterzik, K., Hütter, W., Grab, D. et al. Doppler sonographic findings and their correlation with implantation in an in vitro fertilizalion program. Fertil. Steril. 1989; 52, 825-828.
- Tekay, A., Martikainen, H. and Jouppila, P. Blood flow changes in uterine and ovarian vasculature, and predictive value of transvaginal pulsed colour Doppler ultrasonography in an in- vitro fertilization programme. Hum. Reprod. 1995; 10, 688-693.
- Coulam, C.B., Stem. I.J., Soenksen D.M., Britten, S. and Bustillo, M. Comparison of pulsatility indices on the day of oocyte retrieval and embryo transfer. Hum. Reprod. 1995; 10, 82-84.
- Stener-Victorin, E., Waldenström, U., Andersson, S.A. and Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro- acupuncture. Hum Reprod. 1996;11, 1314-1317.