Acupuncture for IVF support

A bit of IVF history

IVF is a sort of miracle for couples who have found it difficult to conceive naturally.

In the very early days of IVF, clinics worked with a woman’s natural cycle, monitoring the ovaries for follicle development and ‘harvesting’ the single dominant egg. The chances of the technique working back then were less than 1%.

Whilst today it’s taken for granted, before the first IVF baby was born in 1978, if you couldn’t conceive naturally, there was no hope of ever having a family.

Gradually, as the methods improved and things like culture medium developed, the chances rose to something like 25% – which is more or less what nature can manage in any given month.

Since then, further advances mean that success rates for some clinics, for a woman under 35, have risen to an astonishing 55%. For women over 40, the odds are lower, only 10-15%, but still significantly higher than in a natural month.

The human factor

Adding a little acupuncture

Whilst these amazing new techniques allow the whole process to be finely manipulated, treatment has become increasingly technical and somehow less human – the thing that most women complain of.

Acupuncture can provide both an antidote to this technological wizardry and a physical and emotional support through the various stages of your treatment. Because classical Chinese medicine, considers the person as a whole, it’s always ‘you’ who’s undergoing the IVF and treatment factors in the effects of the drugs, the stress, the anxiety, on that ‘you-ness’.

As an acupuncturist, and having seen dozens of girls through IVF, I can honestly say that the thing they most value, apart from reducing any side effects from the meds, is having a calm place to retreat from the world for an hour and the emotional support and acknowledgement of the stress of the whole process.

IVF cycles – 2 protocols: 1 goal

All IVF treatment aims to help you to conceive. There are two paths to your ‘take home baby’, the Long Protocol and the Short Protocol. The Long Protocol is actually the same as the Short Protocol but with an extra module at the beginning.

In fact these days the majority of cycles use the short protocol, partly on the basis that it takes less time and partly because it exposes you to less medication. For some people, however, the long protocol is more appropriate. Your consultant will decide which one is right for you.

Whichever the protocol, your consultant needs to take control of your natural menstrual cycle, so that he can choose drugs to manipulate your hormones and prevent premature ovulation once the stimulation phase begins.

The fertility hormones, LH (leutinising hormone) and FSH (follicle stimulating hormone) are stored in your pituitary gland and released in response to another hormone, GnRH (gonadotropin releasing hormone) at various stages in your normal cycle.

In the Long IVF protocol, drugs called GnRH agonists overstimulate the pituitary and cause it to ‘dump’ its stores all at once. Continuing the drug for several days, prevents it from building or releasing new stores. This is what’s known as down-regulation

In the Short cycle, drugs known as GnRH antagonists attach to the GnRH receptors in the pituitary and block the release of the stored FSH and LH.

Choosing your protocol – why your consultant selects Long vs Short

Factor	Short (antagonist) protocol	Long (agonist) protocol
Primary approach	Standard first-line choice for the majority of patients today.	Tailored approach for specific clinical indications.
Ovarian reserve	Ideal for normal responders and high responders (e.g., PCOS).	Often preferred for poor responders or specific egg quality concerns.
OHSS risk	Significantly lower risk of Ovarian Hyperstimulation Syndrome.	Higher risk; requires extra monitoring if high ovarian reserve.
Specific conditions	Excellent for patients with PCOS or high antral follicle counts.	Commonly used for patients with severe endometriosis or adenomyosis (helps suppress inflammation).
Treatment duration	Shorter (around 2–3 weeks total). Fewer injections required.	Longer (around 4–5 weeks total due to the down-regulation phase).
Cycle flexibility	Highly effective, though less flexible for precise calendar scheduling.	Allows precise control over the exact timing of egg retrieval.

Navigating your protocol – medication and scans

Whichever protocol you’re put on, you’ll have to deal with the medication schedule. Each phase uses different drugs. Here’s a table that lays out which drugs are used, when and why and how you administer them.

Phase/purpose	Common brand names	How it’s taken	What it does
Down regulation Pre stim phase	Synarel, Buserelin, Prostap	Nasal spray or Subcutaneous injection	Puts your ovaries to sleep. Temporarily pauses your natural cycle so the clinic has complete control over your timeline.
Stimulation (Stims) Days 2-12	Gonal-F, Menopur, Bemfola, Ovaleap	Subcutaneous injection	Grows the follicles. Mimics your natural Follicle Stimulating Hormone (FSH) to encourage multiple eggs to grow at once instead of just one.
Suppression Added mid Stims	Fyremadel, Cetrotide, Orgalutran	Subcutaneous injection	Prevents premature ovulation. Stops your body from releasing those growing eggs before the doctor can collect them.
The Trigger Exactly 36 hours before EC	Ovitrelle, Gonasi, Zivafert	Subcutaneous injection	The final countdown. Mimics the natural LH surge to kickstart the final maturation of the eggs so they are ready for retrieval.
Luteal support Post retrieval to transfer	Cyclogest, Lubion, Progynova	Vaginal pessary, injection, or oral tablet	Prepares the nest. Progesterone and estrogen thicken and support the uterine lining, making it receptive to the embryo.

Scans – checking what’s happening

Throughout your cycle you’ll have a number of scans: a baseline scan to make sure your system is ‘in neutral’; several scans to keep an eye on follicle development and the uterine lining during stims; a scan to make sure the follicles are of the right size before the trigger shot; a scan to guide the needle at egg collection; an abdominal scan to guide the catheter at embryo transfer; and finally a scan to confirm pregnancy. With the exception of the ET scan all the other scans are transvaginal.

The following table lists the whys and the whens of scans in a normal IVF schedule

Scan phase	Timing/when	Primary purpose/what’s being measured
Baseline scan	Day 2–4 of menstrual cycle (before starting stims)	Checks for ovarian cysts, measures uterine lining thickness, and assesses baseline Antral Follicle Count (AFC) to confirm it is safe to start stimulation.
Follicle monitoring scans (usually 2-3 visits)	Days 5–10 of stimulation (every 2–3 days)	Tracks follicle growth rates, monitors endometrial lining thickness & pattern (aiming for a trilaminar look), and informs medication dosage adjustments.
Pre-trigger scan	Days 10–12 of stimulation	Confirms leading follicles have reached mature size (18–20 mm) to determine the exact timing for the trigger shot and egg retrieval.
Embryo transfer scan (abdominal)	Day 3 or Day 5 post-retrieval (Transfer Day)	Guides the catheter visually through the cervix to ensure precise placement of the embryo within the upper uterine cavity.
Viability/early pregnancy scan	6–7 weeks gestation (~2–3 weeks post-BFP)	Confirms an intrauterine pregnancy, checks for a fetal heartbeat, confirms gestational sac location, and rules out ectopic or multiple pregnancies.

The Stages of IVF – what happens

🌿IVF Phase 1 – Down regs (Long protocol only)

Down regulation starts at the end of your last cycle c. day 21, and is the stage in the Long Protocol when your natural hormone cycle is put into neutral so your consultant can take control and establish a medication regime that will prepare your body for the stimulatory (Stims) phase when your ovaries are coaxed into producing multiple follicles.

It’s hardly a secret that all drugs come with side effects; at least in an IVF cycle, they are mostly contained within the cycle itself, and the effects are transitory. In the first 7 days of this phase, your body is encouraged to dump its stores of Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) all at one go. This un-natural spike in hormone levels in turn causes the ovaries to produce extra estrogen.

As these hormone levels spike, they can cause a variety of symptoms, such as

• Pelvic fullness or mild bloating
• Breast tenderness
• Mild cramping or spotting
• Headaches or mood swings

If you have endometriosis or fibroids, you might experience a brief increase in pain.

After c 7-14 days, the pituitary gland gives up the fight and completely stops releasing FSH and LH. As a result, the ovaries also go into neutral and estrogen levels fall to practically zero. This is a sort of temporary menopausal state.

This estrogen withdrawal can cause a variety of symptoms

• Hot flushes and night sweats
• Hormonal headaches and migraines
• Joint aches and pains (arthralgia)
• Mood changes
• Fatigue and brain fog
• Vaginal dryness

Acupuncture support during down-regs

In the first of these stages – the so called ‘flare’ phase – acupuncture can help by

• Modulating pain pathways
• Downregulating inflammation
• Releiving stress and anxiety

In the second stage, it can help, perhaps alongside medical ‘add back’ therapy, to

• Reduce hot flushes and night sweats
• Provide relief for joint aches and pains – often caused by lack of estrogen
• Help with fractured sleep and mood swings

Reaching Baseline

In a Long Protocol cycle, once a blood test and a scan confirm that your estrogen levels are extremely low and your uterine lining is thin, you’ll move into the stimulatory phase.

In the Short Protocol, baseline is considered to be day 2 of your natural cycle; day 1 is the start of your period.

In either case, you’ll have a scan to ensure that your ovaries are completely quiet, with no dominant follicles or large cysts, and that the uterine lining is thin. You’ll also have a blood test for estrogen and progesterone levels.

If everything’s clear, you’ll move into the stimulatory phase.

🌿IVF Phase 2 – Ovarian stimulation

So, however you got here, you’re about to start the really important work of growing follicles!

In a natural cycle, only one follicle would be chosen for ovulation every month. You’re about to transition straight into active hormone therapy which over-rides your own hormones and encourages your ovaries to produce multiple follicles at the same time.

Injections

For the first 4-5 days of Stims, you will self inject your meds just under your skin (subcutaneously) – usually in your belly or thigh. You’ll be given an evening time slot of a few hours during which to do the injection.

🌿You have to stick rigidly to that time window throughout this phase, in order to keep the circulating medication levels up. This early stage is completely unsupervised.

Monitoring

After these 4-5 days you’ll be called into the clinic for your first monitoring appointment, when you’ll have:-

• A scan to check on follicle development
• A blood test to check your estrogen levels

Based on these readings, your consultant will decide how to manipulate your drug regime and decide when to introduce another drug ( a supressant) to prevent any follicles from ovulating prematurely.

You’ll have follow up scans every 2-3 days after that, to monitor follicle growth, until the leading follicles get to about 18-22 mm.

🌿Acupuncture support during ‘Stims’

During this important stage, the role of acupuncture is to support both you and the whole IVF process, without interfering with what your meds are doing. Some of its strengths include

• Supporting endometrial quality
• Mitigating medication side effects
• Calming anxiety and reducing stress
• Managing ovarian discomfort

It does this by improving blood flow in the uterine artery to support the development of a thick and tri-laminar endometrium. By ‘moving qi, blood and body fluids’ and preventing ‘stagnation’ it helps reduce any side effects produced by your meds, such as bloating and distention, fatigue, digestive sluggishness, headaches or mood fluctuations.

Your ovaries become really quite large during this phase and acupuncture treatment can help to reduce pelvic tension, heaviness and dull aches. But speaking as an acupuncturist, the thing that acupuncture does best of all, is to reduce anxiety and stress.

In western terms, it triggers the release of endorphins, activates the parasympathetic nervous system and reduces cortisol levels. In Chinese medicine terms, we move the qi, calm the shen and harmonize the system.

This key phase with al its jabs scans and schedules can create quite a lot of anxiety, and most women coming for treatment, in addiition to symptom relief, like the feeling of being outside the demands of their everyday life for an hour and to feel listened to and supported.

🌿IVF Phase 3 – Trigger shot and Egg Collection

The trigger shot

Once enough follicles have reached maturity, you’ll be given precise instructions about your trigger shot – when and how to inject it.

The trigger shot doesn’t cause ovulation, but prompts your follicles to enter the final stage of maturation.

🌿The timing is critical. Too early and the eggs may not be mature enough to be fertilized, too late and you could ovulate before your scheduled EC appointment.

The drug your consultant uses will depend on

• Your hormone levels
• Follicle count
• Risk of OHSS

You’ll do the sub-cutaneous or intramuscular injection late at night (depending on your scheduled EC).

Common side efffects from this jab include

• mild bloating
• pelvic cramps
• headaches
• Mood swings

More severe symptoms can be a sign that your ovaries are over-stimulated – see OHSS below.

Egg collection

Egg collection/retrieval takes place exactly 36 hours after the trigger shot.

To prepare you for the procedure you’ll be given a light sedative (not usually an anaesthetic) which will keep you sleepy throughout, but only takes about an hour to come round from after the eggs have been harvested.

The eggs are collected through the wall of your vagina through a very fine needle attached to a transvaginal ultrasound probe. The fluid from each individual follicle is carefully aspirated and travels down a clear tube into warmed waiting test tubes.

It’s crucial that the fluid/eggs remain at body temperature (37C) during this phase.

Behind the scenes – Preparing the eggs

Once all the follicles have been emptied, the fluid is passed straight over to the embryologist, through a warmed hatch to maintain the fluid temperature.

Eggs are absolutely microscopic, so the embryologist has to examine the follicular fluid through a stereoscopic microscope, and extract each egg through a pipette as he comes across them. The eggs are washed in a nutrient rich liquid before being placed in a dish containing culture medium. The dish is then placed in an incubator which maintains body temperature, oxygen and carbon dioxide levels.

The eggs are left quietly to recover for a few hours before a prepared sperm sample, helpfully provided by your partner, is added to the dish.

Embryo Development

In a ‘standard’ IVF cycle, the egg and sperm mix will stay undisturbed in the incubator for 16-18 hours before being checked. Hopefully during that time some of the eggs will be fertilised and start their journey to becoming embryos.

What’s happening in the lab

The embryologist will check the dish at several important stages. As this involves taking it out of the incubator, the checks take only 30-60 seconds to avoid any temperature changes that might affect the developing embryos.

As with so much in IVF, this can all be a bit of an emotional roller coaster as you wait for you daily updates

• Day 1 – the fertilisation report.
• Day 3 – the midway cleavage update
• Day 5 – the big blastocyst/transfer day call

Transfer or Freeze

After egg retrieval and fertilization, the focus shifts to how and when your embryo transfer will take place. Depending on how your embryos develop and how your body responds to stimulation, your clinical team will recommend either a fresh transfer in the same cycle or a frozen embryo transfer (FET) later on.

Blastocyst Stage & Freezing

Embryos are typically cultured in the lab for 5 to 6 days until they reach the blastocyst stage. Watching how embryos develop over these few days helps embryologists select the ones with the highest potential for a healthy pregnancy. Any suitable remaining blastocysts can be safely frozen for future use.

• If the blastocyst is ‘perky’ and ready to go on day 5 you could have a fresh cycle or freeze. Your choice.
• If the blastocyst forms on day 6, the strategy would lean mostly to freezing
• If the blastocyst forms on day 7, the strategy is always to freeze.

When Freezing Comes First: Safety & OHSS

In some cycles, your clinic may advise freezing all your embryos rather than doing a fresh transfer—a strategy known as a “Freeze-All” protocol.

This is most commonly done to protect your health if you are at risk of Ovarian Hyperstimulation Syndrome (OHSS), a relatively common response to the trigger shot, or to give your hormone levels time to return to a natural baseline.

OHSS generally falls into two categories depending on when it occurs

• Early Onset (3–9 days after the trigger shot): This is a fairly mild, very common reaction to the medication itself as the ovaries settle down after collection.
• Late Onset (10–17 days after the trigger shot): This is driven by rising hCG levels from an establishing pregnancy. It tends to be more severe and longer-lasting.

Your clinical team will always monitor you closely for any rapidly developing symptoms. While severe OHSS requires hospitalisation, mild-to-moderate cases are routinely managed as outpatient conditions with rest, hydration, and close observation.

If you’d like to read more about specific OHSS symptoms, the Royal College of Obs and Gyn website provides comprehensive information.

Specialized & Optional Pathways

Depending on your individual situation, your fertility team may discuss additional options with you:

• Genetic testing (PGT): If you decide on genetic screening to avoid the risk of miscarriage, single gene inherited diseases or chromosomal abnormalities, a few cells from the selected embryos will be sent to the genetics lab and the remainder will be frozen until the test results are in. You can learn more about these specialized techniques on the official HFEA guidance page.
• Elective freezing: For reasons of future family planning, whether medical or social, some couples or single women choose to freeze embryos rather than have an immediate transfer.

🌿IVF Phase 4 Embryo Transfer (ET)

So. At this point you have a beautiful blastocyst, a lush and receptive endometrium (uterine lining) and you’re all ready for the big day.

Embryo transfer is a relatively straightforward procedure and doesn’t take very long, typically 15-30 minutes. It isn’t painful so there’s no sedation or anaesthetic, and once it’s over, you can go straight home – almost an anticlimax after everything you’ve been through!

If you’re having a frozen embryo transfer you have two routes; medicated or natural cycle. The medicated route takes 3-6 weeks and involves medication support for each phase of your cycle and to get your endometrim ready to receive the embryo. It gives your team more control over the day of transfer.

In the natural cycle you have to wait to for your next period so your team can calculate the natural window for implantation.

If you’re having a fresh embryo transfer the procedure is just an extension of the whole cycle.

Here’s what happens during ET

• A nurse will do a quick abdo scan to make sure your bladder is full
• Your identity and the ID number of your embryo are checked
• You’ll lie back on the couch, feet in stirrups
• The doctor will insert a speculum into your vagina and gently wipe the cervix to remove any mucus
• An abdominal ultrasound displays the uterus on a monitor
• The doctor inserts a fine tube – the outer catheter – through the cervix to the womb entry and calls to the embryologist that he’s ready
• The embryologist loads your embryo into a tiny drop of fluid in a super fine catheter with a syringe attached and takes it in to the doctor
• The doctor slides this inner catheter through the guide tube straight to the centre of your uterus
• Watching the monitor, the doctor gently presses the syringe to transfer the embryo – you’ll see a sudden flash on the screen as air and the fluid carrying the embryo leaves the catheter
• The doctor withdraws the inner catheter and the embryologist takes it back to the lab and examines it under the microscope to make sure the embryo didn’t stick to the plastic of the tube.
• The embryologist will shout an all clear to the doctor and it’s all over!

After the procedure has been completed and the embryo has been safely transferred, the doctor will remove the speculum and you’ll lie flat on the couch for 5-10 minutes: Now you can empty your bladder (oh bliss!) and go home.

🌿Acupuncture for ET

Back in 2002, a German researcher called Wolfgang Paulus devised an acupuncture protocol to support IVF. It’s known as the Paulus Protocol and is the best researched and widely used treatment at embryo transfer.

The protocol has two sections: before transfer and after transfer and aims to prepare the uterus and calm the nervous system. It does this by

• Increasing blood flow to the uterus by dilating the uterine arteries
• Reducing uterine micro spasm caused by the catheter by calming the uterine muscles
• Reducing stress by increasing endorphins and reducing cortisol

This is all techno speak of course. Acupuncture has its own language – aiming to calm the ‘shen’ (your ‘heart-mind’), ‘move the qi and blood’ and prevent ‘stagnation’. Whatever you call it, it’s certain that most women feel much calmer and less keyed up after treatment.

🌿IVF Phase 5 – the ‘dreaded’ 10 day wait

Implantation isn’t a single moment; it is a delicate dialogue between your embryo and the lining of your womb—a continuous call and response. Over the course of the first five days after transfer, the embryo hatches, attaches, and burrows deep into the endometrium, eventually embedding completely so the cells can begin producing hCG.

While you wait for your pregnancy test, acupuncture can be a wonderful gentle support during an otherwise anxious time. Beyond continuing to encourage nutrient-rich blood flow to the uterine lining and supporting healthy progesterone levels, acupuncture excels at “calming the Shen“—soothing your nervous system, settling uterine micro-contractions, and easing the mental stress of waiting.

For many women, having a quiet, peaceful space to retreat to and feel genuinely supported during these ten to fourteen days makes all the difference.

A final thought

Navigating IVF treatment can be quite daunting, full of dense clinical detail and endless decisions to make.

I wrote this guide to help clarify the medical steps and what the cycle actually entails. But technology and clinical protocols are only part of the equation – having gentle, grounded support for your body and mind can make a world of difference to your experience.

Through Fertile Ground, I provide acupuncture and traditional care to support you alongside your clinic’s protocol – offering a calm space and a knowledgeable hand to hold whenever you need it.

Whatever your next steps, I wish you every success on your journey