Complementary Therapies for Pregnancy | Melbourne IVF

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Complementary Therapies

What is complementary treatment and IVF?

Complementary or adjuvant therapy is additional treatment that can be considered during IVF treatment with the aim of trying to increase pregnancy success, particularly in women who have had multiple unsuccessful IVF cycles.

Complementary or alternative therapies are used by many people to improve their overall physical and emotional health. This could include medicines, such as herbal, vitamin, mineral, homoeopathic, nutritional and other supplements and therapies such as Chinese medicine, chiropractic, naturopathy, osteopathy, acupuncture, homoeopathy, reflexology and aromatherapy.

IVF is a highly successful treatment option for many forms of infertility, however sometimes it takes multiple attempts before success and this can be frustrating. The most important factor impacting the success of IVF is a woman's age and the genetic quality of her eggs. Other contributing factors include quality of sperm and the uterine 'environment.'

Why try complementary therapies?

Complementary therapies, including complementary medicines and hormones aim to try to improve the following outcomes:

  • The number and quality of eggs retrieved in a stimulation cycle
  • The quality of embryos created
  • Uterine environment
  • Sperm quality

At Melbourne IVF, our philosophy of individualised patient care means that a patient may, from time to time, decide with their fertility specialist, to try an adjuvant treatment. It is important to be fully informed about the risks and benefits of each therapy and understand that the use of adjuvant treatments is currently not proven and that safety may not be established. Please speak with your fertility specialist if you require further information or clarification on these treatments.

Summary of complementary therapies

This table outlines the potential role of various adjuvant therapies in IVF practice.  Adjuvant therapies have not been incorporated into established clinical practice to date because they have not yet been confirmed in large scientific studies to be safe and effective.

At Melbourne IVF we are constantly investing in clinical research to ensure we give our patients access to the most advanced science in fertility investigation and treatment to ensure the best possible outcome. 

Therapy or
Medication
Proposed Use in IVFSafety & Possible Side EffectsEfficacyEvidence
AcupunctureTo increase pregnancy rates when used during IVF cycleSafeLimited evidenceMeta-analysis shows possible benefit with pregnancy in IVF patients
Low Dose AspirinTo improve the implantation rate and decrease miscarriageNo/low risk/mild side effectsLimited evidenceInsufficient evidence of the benefit in pregnancy rates in IVF patients
HeparinTo improve the implantation rate and decrease miscarriageNo/low risk/mild side effectsLimited evidenceStudies show  inconsistent results

Overall, no benefit shown in the pregnancy rate of IVF patients
MelatoninTo improve egg and embryo qualityNo/low risk/mild side effectsNo evidenceAntioxidant effect on egg and embryo quality being evaluated at Melbourne IVF
TestosteroneTo increase egg numbers and quality in poor IVF respondersModerate risk/moderate side effectsNo/Limited evidenceCurrently being trialled at Melbourne IVF
DHEATo increase egg numbers and quality in poor IVF responderModerate risk/moderate side effectsNo/Limited evidenceLimited small trials with variable results
Growth HormoneTo increase egg numbers and the quality in poor IVF respondersModerate risk/moderate side effectsNo evidenceLimited small trials with variable results
CorticosteroidsTo improve the implantation  rate in patients experiencing repeated IVF failure due to underlying immune dysfunctionHigh risk/serious side effectsNo evidenceCurrently no evidence

Still under research
Endometrial InjuryTo improve embryo implantationNo/Low risk

Mild side effects
Limited evidenceTo date, studies have been too small to draw any conclusions

 

Acupuncture and fertility

Acupuncture has long been used in Eastern Medicine to treat fertility. Many women find acupuncture helpful in reducing stress levels. There are many studies currently being undertaken to determine where acupuncture assists fertility.

Benefits of acupuncture may include:

  • reducing stress during IVF treatment
  • stimulating blood flow to the uterus and ovaries which may influence the menstrual cycle and ovulation

Low dose aspirin

Potential benefit

Low dose aspirin (LDA) has been widely used as a supplementary treatment to IVF particularly in recurrent IVF failure or miscarriages.  LDA thins the blood and relaxes the blood vessels. Research has shown that LDA used in conjunction with heparin helps to improve pregnancy outcomes in women diagnosed with Anti-Phospholipid Syndrome (APS), however not in women who have Anti -phospholipid antibodies (APA)without the syndrome.

Potential side effects

Side effects include indigestion and stomach ulcers. In a small proportion of people breathing difficulties due to an allergic reaction may be experienced.  It is not recommended in patients with asthma.

A small number of animal studies have suggested more recently that LDA may have subtle adverse effects on embryo development in the uterine lining.

Risk and benefit assessment

To date there is insufficient evidence to show that the use of LDA in IVF improves the pregnancy rate. 

There is also some question about the safety of LDA and no good evidence of efficacy.

Further Reading

  1. Dentali F, Ageno W, Rezoagli E, Rancan E, Squizzato A, Middeldorp S,  Margaglione M, and Grandone E. Low-dose aspirin for in vitro fertilization or intracytoplasmic sperm injection: a systematic review and a meta-analysis of the literature. J Thromb Haemost, 2012 vol. 10 (10) pp. 2075-2085
  2. Empson M et al. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. The Cochrane Database Systematic Reviews 2005 Art. No.:CD002859.
  3. Mak A, Cheung MW, Cheak AA, Ho RC. Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression.Rheumatology 2010;49:281-288.
  4. Siristatidis CS, Dodd SR, Drakeley AJ. Aspirin for in vitro fertilisation. Cochrane Database Syst Rev 2011; Art. No.: CD004832. DOI: 10.1002/14651858. CD004832.pub3

Heparin

Potential benefits

Hypercoagulation (thickening) of maternal blood due to the autoimmune disorder Antiphospholipid Syndrome (APS) is associated with recurrent miscarriage. Heparin thins the blood and improves pregnancy outcomes in women who have APS. Heparin is sometimes given to women who have experienced repeated IVF failure based the theory that potentially altered maternal blood coagulation status and micro clot formation could interfere with different stages of embryo implantation.

Possible side effects

Side effects of heparin include bruising at injection sites, bleeding, heparin-induced thrombocytopenia (HITs) and osteoporosis. Low dosages over short time duration are usually not associated with major complications.

Risks and benefit assessment

There are inconsistent results from research about the benefits of Heparin in IVF patients.  A large study performed at Melbourne IVF did not show any benefit of using Heparin in patients with IVF implantation failure who also tested positive for APA antibodies.

To date, the safety profile of Heparin is good however this is a lack of good evidence of its benefit.

Further Reading

  1. Bohlmann MK. Effects and effectiveness of heparin in assisted reproduction. Journal of Reproductive Immunology. 2011;90:82-90.
  2. Chamley L et al. Action of anticardiolipin and antibodies to β2-glycoprotein-I on trophoblast proliferation as a mechanism for fetal death. Lancet 1998;352:1037-8.
  3. Di Simone N et al. Antiphospholipid antibodies affect trophoblast gonadotropin secretion and invasiveness by binding directly and through adhered β2-glycprotein I. Arthritis and Rheumatism. 2000;43:140-50.
  4. Empson M et al. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. The Cochrane Database Systematic Reviews 2005 Art. No.:CD002859.
  5. Nardo LG et al. Medical adjuncts in IVF: evidence for clinical practice. Human Fertility 2009;12(1):1-13.
  6. Nelson R, Greer IA. The potential role of heparin in assisted conception. Human Reproduction Update. 2008;14:623-45.
  7. Pettila V et al. Thrombophylaxis with low-molecular weight heparin in pregnancy. Thrombosis Research 1999;96:275-82.
  8. Rey E et al. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet 2003;361:901-8.
  9. Stern C et al. A randomised, double-blind, placebo-controlled trial of heparin and aspirin for women with in vitro fertilization implantation failure and antiphospholipid or antinuclear antibodies. Fertility and Sterility. 2003;80:376-83.

Melatonin

Potential benefits

Melatonin is a naturally occurring hormone involved in the regulation of circadian rhythm (sleep pattern).  It is a powerful antioxidant that decreases oxidative stress.  Oxidative stress contributes to the depletion of the ovarian egg reserve.   Melatonin is thought to be involved in different ovarian processes and this is supported by observations that disruptions in circadian rhythmicity, as observed in female shift workers for example, are associated with menstrual dysfunction.  Melatonin can also induce a resurgence of regular ovulation in perimenopausal women.

Melatonin is also thought to be involved in egg maturation and there is some evidence to suggest its role in the protection of nuclear and mitochondrial DNA. 

There is an association between higher melatonin levels in the follicular fluid surrounding the oocyte (egg) collected during IVF and apparent less oxidative stress damage to the egg.  A 2008 study demonstrated that the administration of melatonin to IVF patients improved their fertilisation rates and increased the number of good quality embryos. 

Possible side effects

The ideal dosage and duration of treatment is unknown but melatonin is generally well tolerated with few side effects.   Common side effects include daytime sleepiness, dizziness, headaches, nausea and vivid dreams.  Other less commonly observed effects are abdominal discomfort, mild anxiety, irritability, confusion and short-lasting feelings of depression.  It is important to note that melatonin can interact with various medications including anticoagulants, immunosuppressants, medications for diabetes, antihypertensives and sedatives. 

Risk and benefit assessment

There are presently no large conclusive studies showing benefits of melatonin in the IVF population.  The 2008 study showing an increased fertilization rate only involved a small number of patients.  Limited conclusions can be drawn from small studies and more studies are required for the assessment of any potential long term beneficial or harmful effects. 

The safety profile of Melatonin is reasonable however there are various side effects.  To date, evidence of its benefit has not been proven.

Further Reading

  1. Agarwal A, Gupta S, Sekhon L, Shah R. Redox considerations in female reproductive function and assisted reproduction: from molecular mechanisms to health implications. Antioxid Redox Signal. Aug 2008;10(8):1375-1403.
  2. Bellipanni G, Bianchi P, Pierpaoli W, Bulian D, Ilyia E. Effects of melatonin in premenopausal and menopausal women: a randomized and placebo controlled study. Experimental Gerontology. 2001;36(2):297-310.
  3. Labyak S, Lava S, Turek F, Zee P. Effects of shiftwork on sleep and menstrual function in nurses. Health care for women international. 2002;23(6-7):703-714.
  4. McGee EA, Hsu S-Y, Kaipia A, J.W. Hsueh A. Cell death and survival during ovarian follicle development. Molecular and Cellular Endocrinology. 1998;140(1-2):15-18.
  5. Reiter RJ, Acuña-Castroviejo D, Tan DX, Burkhardt S (June 2001). "Free radical-mediated molecular damage. Mechanisms for the protective actions of melatonin in the central nervous system". Annals of the New York Academy of Sciences 939: 200–15
  6. Tamura H, Takasaki A, Miwa I, et al. Oxidative stress impairs oocyte quality and melatonin protects oocytes from free radical damage and improves fertilization rate. Journal of pineal research. 2008;44(3):280-287.
  7. Tamura H, Takasaki A, Miwa I, et al. Oxidative stress impairs oocyte quality and melatonin protects oocytes from free radical damage and improves fertilization rate. Journal of pineal research. 2008;44(3):280-287.
  8. Tamura et al.: The role of melatonin as an antioxidant in the follicle.  Journal of Ovarian Research 2012 5:5.

Testosterone

Potential Benefits

Testosterone is an androgen (male sex steroid hormone) that is primarily secreted by the ovaries of females and the testes of males. Testosterone is essential for health and well-being and is required for oestrogen synthesis. The proposed mechanism of action is similar to DHEAS in preventing smaller ovarian follicles from degeneration and promoting growth of larger follicles.

Previous studies have suggested that testosterone plays a critical role in early follicular development and granulosa cell proliferation in the ovary. It stimulates early stages of follicular growth and increases the number of pre-antral and antral follicles. Increased intra-ovarian concentration of testosterone may enhance the responsiveness of ovaries to Follicle Stimulating Hormone (FSH).

Early evidence suggests that transdermal testosterone pre-treatment may increase clinical pregnancy and live birth rates in poor responders undergoing ovarian stimulation for IVF. A meta-analysis from 2012 on androgen use in IVF showed that transdermal testosterone was the only androgen observed to have a benefit.

Possible side effects

Excessive hair growth and acne are the major adverse reactions that have been reported and are quite common. Both of them are dose and duration related and generally reversible. With excessive use of any androgens there may rarely be deepening of the voice which may be irreversible. No adverse effects or any congenital malformations were identified in any of the relevant studies when testosterone was given by skin patch route of administration in low dose. 

Risk and benefit assessment

Although the latest evidence suggests there is potential benefit in using testosterone in poor responders, the evidence is still limited. Only two randomized studies with a total of 163 patients were involved. Although no adverse effects or congenital malformations were reported in these patients, the safety of the medication is yet to be established.

To date, the safety profile of Testosterone has not been established and there is no proof it has any benefit.

Further Reading

  1. Braunstein GD. Safety of testosterone treatment in post-menopausal women. Fertil Steril. 2007;88(1):1.
  2. Bosdou JK et al. The use of androgens or androgen-modulating agents in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis. Human Reproduction Update. 2012;18(2):127-145.
  3. Harlow CR et al. Androgen modulatin of follicle-stimulating hormone-induced granulosa cell steroidogenesis in the primate ovary. Endocrinology 1986;3:1403-1405.
  4. Hillier  SG and De Zwart FA. Evidence that granulosa cell aromatase induction/activation by follicle-stimulating hormone is an androgen receptor-regulated process in-vitro. Endocrinology 1981;4:1303-1305.
  5. Hillier  SG et al. Location and developmental regulation of androgen receptor in primate ovary. Human Reprod 1997;1:107-111.
  6. Vendola KA et al. Androgens stimulate early stages of follicular growth in the primate ovary. J Clin Invest 1998;12:2622-2629.
  7. Weil et al. Androgen receptor gene expression in the primate ovary: cellular localization, regulation, and functional correlations. J Clin Endocrinol Metab 1998;7:2479-2485.

DHEA - Dehydroepiandrosterone

Proposed benefits

Dehydroepiandrosterone (DHEA) is a weak androgen (male sex hormone) that is converted to testosterone in the body. Dehydroepiandrosterone sulphate (DHEAS) is the sulphate version of DHEA and is found predominantly in the blood.  Both work as precursors for the intracellular production of oestrogen and androgens. Androgens may have specific roles in the smaller follicles protecting them from degeneration and promoting them to grow.

Some controlled studies have demonstrated that DHEA may have a role in follicle development but no evidence to date suggests that this helps produce more follicles or results in better quality eggs.

Since 2000, there have been several small studies suggesting a possible improvement in ovarian response and pregnancy rates in IVF.  Two randomised controlled studies demonstrated positive effects but they have to be interpreted with caution due to the methodology used.  Another recent study suggested that DHEAS administration may improve the genetic quality of embryos and decrease miscarriage rates. It is important to note that these studies do not currently provide sufficient evidence for safety or efficacy.

Potential side effects  

Side effects may include oily skin, acne and hair loss. Some patients have noticed improved energy levels and an increased libido while on DHEA. There has been a single report of a post traumatic seizure one month after DHEA supplementation. Prolonged use of DHEA can worsen cardiac arrhythmias and hormone sensitive tumours. There may be an increased risk of bowel cancer and diabetes with prolonged use.

Risk and benefit assessment

There is currently a lack of robust evidence showing a benefit from supplementing DHEA in IVF. The ideal dosage and duration of supplementation is unknown and the safety of administration has not been proven.

Due to the lack of evidence and possible adverse side-effects, DHEAS is not recommended for use in patients undergoing fertility treatment unless patients are enrolled in a clinical trial or after extensive discussion with their fertility specialist. 

To date, the safety of DHEA has not been established and there is a lack of evidence of its benefit.

Further Reading

  1. Barad D, Brill H, Gleicher N: Update on the use of dehydroepiandrosterone supplementation among women with diminished ovarianfunction. J Assist Reprod Genet 2007, 24:629–634.
  2. Casson PR, Santoro N, Elkind-Hirsch K, Carson SA, Hornsby PJ, Abraham G, Buster JE: Postmenopausal  increases free insulin-like growth factor-I and decreases high-density lipoprotein: a six-month trial. Fertil Steril 1998, 70:107-110.
  3. Gleicher et al.: Dehydroepiandrosterone (DHEA) reduces embryo aneuploidy: direct evidence from preimplantation genetic screening(PGS). Reproductive Biology and Endocrinology 2010 8:140.
  4. Hodges CA, Ilagan A, Jenninger D, Keri R, Nilson J, Hunt PA: Experimental evidence that changes in oocyte growth influence meioticchromosome segregation. Hum Reprod 2002, 17:1171-1180.
  5. Karp G, Bentov Y, Masalha R, Ifergane G: Onset of posttraumatic seizure after dehydroepiandrosterone treatment. Fertil Steril 2009,91:e1-2, 931.
  6. Kayhan Yakin and Bulent Urman. DHEA as a miracle drug in the treatment of poor responders; hype or hope? Hum. Reprod. (2011) 26(8):1941-1944
  7. Moawad A, Shaeer M. Long term androgen priming by use of DHEA improves IVF outcomes in poor responders: A randomized control study. Middle East Fertil Soc J. 2012;17:268–74.
  8. Narkwichean et al.: Efficacy of dehydroepiandrosterone to improve ovarian response in women with diminished ovarian reserve: a meta-analysis. Reproductive Biology and Endocrinology 2013 11:44.
  9. Sen A, Hammes SR. Granulosa cell-specific androgen receptors are critical regulators of ovarian development and function. MolEndocrinol 2010;24:1393 – 1403.
  10. Sahelian R, Borken S. Dehydroepiandrosterone and cardiac arrhythmia. Ann Intern Med 1998; 129(7): 588.
  11. Weil SJ, Vendola K, Zhou J, Adesanya OO, Wang J, Okafor J, Bondy CA. Androgen receptor gene expression in the primate ovary: cellularlocalization, regulation, and functional correlations. J Clin Endocrinol Metab 1998;83:2479–2485.
  12. Wiser A, Gonen O, Ghetler Y, Shavit T, Berkovitz A, Shulman A. Addition of dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod 2010; 25:2496 – 2500.

Growth hormone

Potential benefits

Growth hormone (GH) has the potential to increase the effects of gonadotropins (the hormones which stimulate follicle and egg development) in the ovary by increasing a chemical called IGF -1. IGF-1 plays an important part in ovarian function by helping the activity of different enzymes including aromatase and 7 beta oestradiol.  It also affects progesterone production and LH receptor formation. IGF-1 has also been found to stimulate follicular development, oestrogen production and oocyte (egg) maturation.

Some studies of women who previously had a poor response to IVF treatment suggested there may be some beneficial effect on egg numbers at oocyte retrieval. However, there is currently no evidence that GH supplementation has any impact on pregnancy rates or the chance of giving birth to a healthy baby.

Possible side effects

Common adverse reactions may include injection site rashes and headaches. More rarely, patients can experience joint swelling and pain, carpal tunnel syndrome and an increased risk of diabetes.

Excessive use of GH may lead to acromegaly (a syndrome of body overgrowth) with swelling of the extremities and internal organs, particularly the heart and kidneys. GH has occasionally been associated with Hodgkin's lymphoma.

Risk and benefit assessment

A meta-analysis study looking at combined data from ten studies of 440 couples has shown that GH was not helpful in increasing pregnancy and birth rates when used routinely as an adjunct to IVF. This study however did not examine the use of GH in patients who had already failed to conceive in previous IVF cycles.

Currently there is a controlled clinical trial is being carried out across Australian IVF centres to investigate the use of GH during a stimulation cycle for poor responders of IVF. Melbourne IVF is contributing the largest number of patients to this study. The results will hopefully shed more light on whether there is any benefit to the use of GH for patients who respond poorly to conventional IVF treatment.

To date, the safety of GH is has not been well established.

Further Reading

  1. Duffy JMN, Ahmad G, Mohiyiddeen L, Nardo LG, Watson A. Growth hormone for in vitro fertilization. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD000099. DOI: 10.1002/14651858.CD000099.pub3.
  2. Erickson GF, Gabriel VG, Magoffin DA. Insulin-like factor- I regulates aromatase activity in human granulosa and granulosa luteal cells. Journal of Clinical Endocrinological Metabolism 1989;69:716Ð24.
  3. Homburg R, Eshel A, Abdulla HI, Jacobs HS. Growth hormone facilitates ovulation induction by gonadotropins. Clinical Endocrinology 1988;29:113Ð8.
  4. Hsu DJ, Hammond JM. Concomitant effects of growth hormone on secretion of insulin-like growth factor I and progesterone by cultured porcine granulosa cells. Endocrinology 1987;121(4):1343Ð8.
  5. Mason HD, Martikainen H, Beard RW, Anyaoku V, Franks S. Direct gonadotrophic effect of growth hormone on oestradiol production by human granulosa cell in vitro. Journal of Endocrinology 1990;126:R1ÐR2.
  6. Tesarik J, Hazout A, Mendoza C. Improvement of delivery and live birth rates after ICSI in women aged>40 years by ovarian co-stimulation with growth hormone. Human Reproduction 2005;20(9): 2536Ð2541.
  7. Yoshimura Y, Ando M, Nagamatsu S, Iwashita M, Adachi T, Sueoka K. Effects of insulin-like growth factor-I on follicle growth, oocyte maturation, and ovarian steroidogenesis and plasminogen activator activity in the rabbit. Biology of Reproduction 1996;55(1):152Ð60.

Corticosteroids

Potential benefit

Glucocorticoids are steroid hormones with potent anti-inflammatory and immunosuppressive properties. It has been suggested that the use of glucocorticoids may improve the intra-uterine environment and embryo implantation in some patients. This has been linked to the immune cells in the uterus called Natural Killer (NK) cells.

Elevated NK cells in the uterus or the blood of some patients are thought to be associated with recurrent implantation failure.  There is currently no evidence to support this. However, there is a theory for patients with IVF implantation failure that by suppressing the immune system with steroids the numbers of Natural Killer cells may be reduced.

Potential side effects

Common side effects of steroid use include thinning and discolouration of the skin, weight gain, sleep disturbance and mood changes. Steroids have also been shown to increase pregnancy complications such as gestational diabetes and maternal hypertension. There is a slightly increased risk of congenital heart defects and cleft lip/palate in babies born to women who have taken steroids during pregnancy, particularly in the first trimester.

Prolonged steroid use increases the risk of infection and delays wound healing. There is a risk of a rare but serious complication called ‘avascular necrosis of the head of the femur’ in which the top of the hip bone becomes eroded and is permanently damaged.

Importantly, stopping steroids suddenly can be associated with serious complications and this type of medication needs to be withdrawn slowly under medical supervision.

Risk and benefit assessment

The potential risk of serious complications and side effects along with the current lack of scientific evidence means that steroids are currently not routinely recommended during IVF treatment. 

To date, there are significant concerns with the safety of cortico steroids as well as no evidence of its benefit

Further Reading

  1. Boomsma CM, Keay SD, Macklon NS. Pre-implantation glucocorticoid administration for assisted reproductive technology cycles. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD005996. DOI: 10.1002/14651858.CD005996.pub3.
  2. Ledee-Bataille N et al. Role of endometrial tripod interleukin-18, -15, and -12 in inadequate uterine receptivity in patients with a history of repeated in vitro fertilization-embryo transfer failure. Fertility and Sterility 2005;83(3):598-605.
  3. Quenby S et al. Prednisolone reduces preconceptual endometrial natural killer cells in women with recurrent miscarriage. Fertility and Sterility. 2005;84:980-4.

Endometrial injury

Potential benefit

Mechanical injury to the endometrium (lining of uterus) can be induced by an endometrial biopsy (endometrial scratch). We do not currently understand how mechanical injury improves embryo implantation, however it has been proposed that it may improve uterine receptivity and embryo implantation by influencing endometrial cell development and stimulating an immune response.

Some clinical trials have shown that minor mechanical injury to the endometrium in the couple of months prior to embryo transfer may improve implantation and pregnancy rates in women undergoing IVF treatment.

Possible side effects

It is common to experience period-like cramps or pelvic pain during and after the procedure. These are usually short-lived side effects.  Rarer complications include uterine perforation and infection.  Sometimes the procedure is required to be performed under sedation or general anaesthetic.

Risk and benefit assessment

As the studies to date have been small it is too early to draw definitive conclusions.  There is currently no definitive evidence as to the benefit of endometrial disruption. It is only recommended for certain group of patients after consultation with their fertility specialist. No major risk although sometimes very painful and sometimes impossible to perform without an anaesthetic.  There is possible benefit but cannot be offered during treatment cycle or in cycle when trying spontaneously to get pregnant. 

To date, there is no safety risk with Endrometrial Injury and it may have a possible benefit.

Further Reading

  1. El-Toukhy T et al. Local endometrial injury and IVF outcome: a systematic review and meta-analysis. Reproductive BioMedicine Online 2012; 25: 345-354.
  2. Gnainsky Y et al. Local injury of the endometrium induces an inflammatory response that promotes successful implantation. Fertility and Sterility 2010; 94: 2030-2036.
  3. Li R, Hao G. Local injury to the endometrium: its effect on implantation. Current Opinion in Obstetrics and Gynaecology 2009; 21: 236-239.
  4. Nastri C et al. Endometrial injury in women undergoing assisted reproductive techniques. Cochrane Database of Systematic Reviews 2012; 7: Art. No.: CD009517.
  5. Potdar N et al. Endometrial injury to overcome recurrent embryo implantation failure: a systematic review and meta-analysis. Reproductive BioMedicine Online 2012; 25: 561-571.

Multivitamins and fertility

Many multivitamins are considered beneficial to overall well-being, including:

  • Antioxidants – may protect cells from damage by free radicals in environmental and other toxins.
  • Coenzyme Q10 – an important antioxidant and ‘energy nutrient’ within every cell.
  • Vitamin E – an antioxidant that may promote circulation to the reproductive system, including to the placenta,
  • Vitamin C – an antioxidant important within the ovary itself and egg maturation and ovulation.
  • Mixed carotenoids – vitamin A (retinoid) is involved in creating DNA. In small amounts it is essential for healthy fetal development, particularly for the immune system and eyes.
  • Manganese – involved in enzyme functions that have antioxidant effects and transfer genetic information.
  • Zinc – an important nutrient for a healthy reproductive system and involved in sexual development, ovulation and the menstrual cycle.
  • Selenium – an antioxidant that supports normal conception.
  • Omega-3 fatty acids – a woman’s fat tissue stores retain a reserve of these fatty acids for the developing fetus
  • B-vitamins – B12, B6 and folate are three B vitamins significant for the reproductive system.

If you would like to try complementary therapies while also seeking medical support for conception, it is important that you discuss this with your fertility specialist. Acupuncture and vitamin supplements are generally considered to be compatible with most fertility treatments, though some complementary medicines may interfere.

Additional resources

The Preconception Health Special Interest Group and the Fertility Coalition - A partnership between the Victorian Assisted Reproductive Treatment Authority (VARTA), Jean Hailes for Women’s Health, Robinson Institute and Andrology Australia, and Your Fertility – have produced the following fact sheets summarising current evidence relating to factors affecting fertility and Assisted Reproductive Technology outcomes.

If you are interested in any of the complementary therapies offered by Melbourne IVF fertility specialists, contact our Community Liaison Administrators on 1800 111 483.
Read more about the Melbourne IVF counselling team »
Find out about the Melbourne IVF A Mindful Approach to IVF program »
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