A randomised controlled trial (RCT) published in 2019 has drawn the conclusion that women who use acupuncture with Clomid (clomiphene citrate) may have improved pregnancy rates.
What is clomiphene citrate (also known as Clomid)?
Clomiphene citrate, commonly known in Australia as Clomid, is a medication which falls within a category of drugs called selective estrogen receptor modulators (SERM).
Most women who take Clomid do so because they have probably presented to a doctor having experienced anovulatory infertility (which means they can’t fall pregnant because they either don’t ovulate or don’t ovulate reliably or regularly).
As a fertility drug, Clomid is designed to initiate ovulation.
What is the acupuncture with Clomid relationship?
Historically, there has been no formal acupuncture with Clomid relationship.
However, there has certainly been women undergoing fertility treatment with Clomid who have also chosen to have a course of acupuncture with Clomid.
What hormones regulate the menstrual cycle?
There is a gland deep within the brain called the hypothalamus. The hypothalamus regulates the hormonal cascade women experience which initiates ovulation.
The hypothalamus produces a hormone called gonadtrophin releasing hormone (GnRH, for short).
Another gland, the anterior pituitary, has GnRH receptors on it (which means hypothalamic GnRH *binds* to the anterior pituitary).
When this binding happens, the anterior pituitary produces two hormones. One of these is called follicle stimulating hormone (FSH) and the other is luteinising hormone (LH).
FSH and LH travel via the blood stream, looking for receptors – which they find on the ovary.
The ovary responds to the FSH and produces follicles and eggs. The eggs produce another hormone called estrogen.
Estrogen travels through the blood stream and when it reaches the hypothalamus it *binds* to oestrogen receptors and turns down the hypothalamus’ production of GnRH.
How does Clomid work?
Clomid works by binding to the hypothalamic estrogen receptors and blocking them from assessing how much estrogen is circulating.
This prompts the hypothalamus to think there isn’t enough estrogen, so it produces GnRH to stimulate FSH in the pituitary which then stimulates the ovaries to produces more follicles to produce more estrogen.
For this reason, women taking Clomid are able to ovulate.
Does Clomid have any side effects?
The biggest side effect of Clomid is that it increases the prospect that a woman will ovulate and therefore, theoretically, be more fertile.
Clomid, in some women, may also stimulate the ovaries to produce multiple follicles, thereby putting her at risk of a multiple gestation pregnancy (TWINS!!!!).
Often, at least for the first time taking Clomid, a doctor will monitor the ovarian response to the medication either with scans or bloods or both.
Some women who take Clomid report experiencing hot flushes, changes in the mood (irritability and teariness), abdominal bloating and tenderness.
Clomid is a well studied drug which was invented in the 1950s and remains the world’s most widely used fertility drug.
Does acupuncture with Clomid present any risks?
This study which looked at acupuncture with Clomid as a stand alone therapy and adjuvant therapy, reported no increase in risk or other adverse events.
What did this acupuncture with Clomid study seek to examine?
Researchers looked at eight databases and studied nine randomised controlled trials (RCT).
An RCT is a piece of research which pools the results of multiple pieces of similar RCT research.
This RCT and meta-analysis involved nine trials and 1441 women – some of whom had only acupuncture; some of whom only had Clomid and some of whom had both.
What did we learn about acupuncture with Clomid?
The study demonstrated the following:
- ovulation rates and pregnancy rates were not improved when acupuncture was used as an adjuvant therapy with Clomid (adjuvant means the acupuncture was only administered while taking the Clomid)
- when used as an adjuvant therapy, acupuncture with Clomid did not appear to reduce pregnancy loss
- when acupuncture with clomid was used as a separate therapy (that is, with its own structured treatment plan across a wider timeframe) there was improved pregnancy rates. There was also evidence to suggest that women receiving acupuncture produced larger follicles (although not statistically significant)
What accounts for these differing acupuncture with Clomid results?
The authors of the study hypothesise two issues which might account for these results:
- standardised acupuncture (or predetermined acupuncture or formulaic acupuncture) protocols may not be as effective as acupuncture with Clomid which is individualised for the patient
- design flaws in the studies may have skewed the results
Is there anything else in this acupuncture with Clomid study I should know?
When using acupuncture with Clomid consider a course of acupuncture across a wider period of time than when you are just taking Clomid. This is consistent with general acupuncture practice.
Also, be mindful that research outcomes involving acupuncture with Clomid may not necessarily reproduce the same outcomes in a clinical environment.
The study also has no facility to track pregnancies to birth to determine whether the intervention also increased live birth rates which underscores the difference between a pregnancy and a birth.
Finally, the RCT – while robust and of a high standard – would benefit with review and more inclusion data to produce a larger sample (although the existing sample is adequate).
Where can I find out more about acupuncture with Clomid treatment?
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