This is without doubt an ambitious book, and its ambit is really much larger than the title suggests. It might be more appropriately labelled as a practical guide to the treatment of infertility with acupuncture. We are nearly halfway through the book before the fundamentals of ART are properly introduced, with the first third devoted to typical TCM gynaecology and fertility theory. Throughout the ART sections, the underlying pathology is extensively dissected. Although this makes much of the text fairly typical of other gynae/ fertility texts, it seems essential for this book to work, given that the theoretical basis of acupuncture treatment alongside ART is essentially inseparable from gynaecological work in general. The sections on frequency and timing of intercourse and the use of basal body temperature (BBT) charts (which seem somewhat redundant in the context of ART/IVF treatment) do little to restrict the book’s coverage, and the sheer scope of the book, with its multiple interlinking themes, means the structure becomes somewhat messy.
This book is extremely well researched and referenced. Its strong biomedical leanings will appeal to many, although its TCM content seems somewhat scant in comparison to other texts in the field. However, the inherent problem in writing a book with a strong biomedicine focus is that biomedicine itself has not reached a consensus on many of the principles, protocols, methods and medications used in assisted reproduction. In many cases, for each referenced article quoted by the authors to support their argument, several others might be cited that support a different opinion. Subjects such as the predictive value placed on FSH and AMH levels are presented as if they are agreed norms, yet there is actually considerable debate as to their accuracy and meaning. Despite the close attention and hard work that has obviously gone into this book, the authors struggle to hold on to the slippery beast that is modern biomedical fertility treatment. Due to the rapidity with which biomedicine shifts, develops and evolves its techniques and theories, this book may have a limited lifespan. In addition, reproductive immunology is given short attention, with the authors claiming this complex area lies outside the scope of their text; for an important and rapidly expanding area, this subject perhaps deserved more attention. The authors also do not address the significant differences in approach between ART clinics. There can be huge differences between the tests and treatments provided in a private central city clinic compared to a rural NHS unit. Presumably this book is reflective of the clinics attended by patients of the authors, but this means that some practitioners may feel that it does not reflect the ART treatment being used for their patients. For example, at our central London clinic we see patients taking medications on a daily basis that are given scant or no mention in the book, and other drugs being taken at dosages far in excess of the stated maximum. Understanding the approaches of particular ART clinics is important for acupuncture practitioners, and any practitioner who passes on to their patients the testing regimes recommended here (immunology, thrombophilia or genetic screening for instance), may find that their particular clinic simply does not offer them.
In a book so firmly rooted in references, it seems odd that authors veer off into conjecture when it suits them. For example, acupuncture on the day of embryo transfer is the singularly most researched aspect in this area, with multiple papers presenting positive results and several presenting negative or statistically non-significant results.
Almost all of the positive papers present timing as an integral aspect of success, with the most beneficial acupuncture treatment being performed shortly before and after embryo transfer. However, the authors state that such timescales should not be rigidly adhered to, and that in their experience acupuncture treatment 24 hours before and after transfer can be just as effective. Without evidence this advice appears to be based on the logistics of the acupuncture clinic rather than evidence-based best practice.
Where the book is most useful is in its clear acknowledgement that practitioners working in this area need skills far beyond acupuncture techniques in order to be successful. The sections on patient management are very good. Given that IVF units are frequently too busy to provide the necessary emotional or informational support to patients, managing expectations and the disappointment when treatment fails is an integral part of the fertility acupuncturist’s day-to-day life. The nutritional advice presented (including vitamin and mineral supplementation) is welcome, and although it would have little place in a classical TCM text, represents a commonplace aspect of good clinical practice. However, although male factor subfertility is considered to be involved in 50 per cent of infertility cases, the authors only dedicate a few pages to its treatment. While in private practice female patients often predominate, part of our role as practitioners is to educate patients as to the full extent of what might be achieved if both partners were treated appropriately.
For a book that attempts to deal with the practical reality of treating alongside ART, more difficult areas – such as getting second opinions, obtaining further testing and even practitioner disagreement with ART clinics – that are common in clinical practice tend to be skirted around. Similarly, although the relevant TCM patterns are perfectly well documented, they are all given a similar weighting, without pointing out, for example, that there is little that can be done about a pattern of Kidney jing deficiency if the patient turns up ten days before their egg collection. All in all there could be much more clinical guidance to inform practitioners what is or is not possible.
Overall, this is a difficult book to read. There is much information here, but the reader has to work hard to extract it. It is an interesting addition to the existing literature on this subject, and will likely appeal more to medical acupuncturists or those with a strong biomedical leaning, but we are still yet to have a defining text on this subject.
Daniel Elliott–The Journal of Chinese Medicine
For more on acupuncture and IVF
For Chinese Medicine and acupuncture in Louisville, KY, contact Jeffrey Russell at Abacus Chinese Medicine, 502 299-8900.