Acupuncture and reflexology are the first complementary therapies to be used alongside conventional fertility treatments in Ireland, writes Sylvia Thompson in the third and final part of her series on integrated medicine.
An increasing number of couples who find it difficult to conceive are trying to improve their lifestyles by reducing their stress levels, getting fit and eating more nutritious foods.
There is also an international group of pre-conceptual healthcare practitioners who, through the organisation Foresight, promote natural fertility management methods. And, the latest development in the US is fertility retreats in which couples approach their infertility problems in a holistic way using a variety of therapies and treatments.
Despite these international trends, the integration of specific complementary therapies into conventional approaches to infertility is growing at a slower rate.
In Ireland, the most noteworthy developments have been in the use of acupuncture and reflexology by women before, during and after assisted reproductive technology (ART) treatment.
Celine Leonard is an acupuncturist and Chinese medicine practitioner who works as part of the team at the Merrion Fertility Clinic at the National Maternity Hospital, Dublin: "There is a growing body of evidence that acupuncture and Chinese herbal medicine can help build up the resources of the woman, reduce stress, assist implantation and support the pregnancy following ART," she says.
Dr Mary Wingfield, clinical director of the Merrion Fertility Clinic, says there have been a few studies which suggest acupuncture may be of benefit during in vitro fertilisation.
"The initial studies are encouraging but it needs further study. Overall, there is very little data in the medical literature to suggest that Chinese medicine or other complementary therapies make a difference but some people seem to become pregnant while having these therapies," she says.
"At the Merrion Clinic, we are very happy to continue acupuncture and we have seen how it works very well for pain in conditions such as endometriosis where western medicines would interfere with the treatment.
"It is also useful for chronic conditions such as irritable bowel syndrome or premenstrual syndrome, both of which can be aggravated by the stress of IVF. Fertility treatments are very stressful and anything that can reduce the stress levels is valuable."
Dr Edgar Mocanu, consultant at the Human Assisted Reproduction Institute (HARI), Rotunda Hospital, Dublin, says two randomised controlled trials were published last month in the Fertility and Sterility Journal which reported improved reproductive outcomes when acupuncture was given compared with no acupuncture.
However, he cautions against the small number of patients in each trial (about 100 in each group). "There is a very high chance of variability in results of small trials, and larger scale trials need to be carried out before acupuncture could be implemented in routine clinical practice," he says.
While awaiting larger trials, anecdotal evidence of the value of acupuncture continues to fuel people's desire to use complementary therapies alongside conventional fertility treatments.
Mother of three-month-old twins Audrey (39) explains how she availed of acupuncture during her second attempt to become pregnant with IVF treatment.
"I had done one frozen cycle and not become pregnant.
"For the second treatment, the consultant recommended I do acupuncture alongside the treatment," she says.
"I found it a great support. It is a hugely intense and stressful time of your life and the acupuncture took the fear out of it for me. I saw the acupuncturist in the lead-up to treatment, during treatment, the day I had the embryo transfer and right through the first six months of the pregnancy.
"It made a huge difference. It helped my sleep patterns, calmed me in such a way that I always thought the pregnancy would work out," she says.
Celine Leonard says Chinese medicine can also support women following the implantation of the embryo to prevent miscarriage - an area in which western medicine can't intervene.
Currently, fertility clinics in Ireland are opposed to the use of Chinese herbs during ART treatment although Leonard is adamant that Chinese herbs prescribed by a registered, accredited Chinese medicine practitioner will not interfere with western medicines.
Reflexology is another complementary therapy that is being used alongside conventional treatments for infertility. Although not yet integrated into the conventional approaches to infertility, it has become a popular therapy selected by women themselves.
Luah McIlraith is a trained medical nurse and reflexologist who has worked with women having difficulty conceiving, those on IVF treatment and those who have post-IVF treatment who haven't conceived.
"If there is a known mechanical medical reason for their infertility, no amount of reflexology can change that. But, reducing stress and relaxing couples is crucial to conception," she says.
"I try to get each of them into as calm a state as possible. Reflexology works on every system of the body and helps them to work in harmony with each other. That can be effective in itself."
McIlraith also teaches couples how to give each other a foot massage.
"There is great togetherness in this which also means not all the emphasis is placed on the woman," she says.
Overall, as more and more women delay having their families until their 30s and sometimes their early 40s, infertility will continue to be a complex and highly stressful problem for many couples.
Complementary therapists believe many of their approaches have a lot to offer but conventional medical practitioners are holding out for the scientific evidence before wholeheartedly integrating such therapies into orthodox practices.