Download PDF
Semin Reprod Med 2016; 34(02): 067-073
DOI: 10.1055/s-0035-1571194
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Complementary Therapies and Medicines and Reproductive Medicine

Caroline A. Smith
1   National Institute of Complementary Medicine, Western Sydney University, Penrith, Australia
,
Mike Armour
1   National Institute of Complementary Medicine, Western Sydney University, Penrith, Australia
,
Carolyn Ee
2   Department of General Practice, University of Melbourne, Victoria, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
11 February 2016 (online)

    Permissions and Reprints

Abstract

Complementary therapies and medicines are a broad and diverse range of treatments, and are frequently used by women and their partners during the preconception period to assist with infertility, and to address pregnancy-related conditions. Despite frequent use, the evidence examining the efficacy, effectiveness, and safety for many modalities is lacking, with variable study quality. In this article, we provide an overview of research evidence with the aim of examining the evidence to inform clinical practice. During the preconception period, there is mixed evidence for acupuncture to improve ovulation, or increase pregnancy rates. Acupuncture may improve sperm quality, but there is insufficient evidence to determine whether this results in improved pregnancy and live birth rates. Acupuncture can be described as a low-risk intervention. Chinese and Western herbal medicines may increase pregnancy rates; however, study quality is low. The evaluation of efficacy, effectiveness, and safety during the first trimester of pregnancy has most commonly reported on herbs, supplements, and practices such as acupuncture. There is high-quality evidence reporting the benefits of herbal medicines and acupuncture to treat nausea in pregnancy. The benefit from ginger to manage symptoms of nausea in early pregnancy is incorporated in national clinical guidelines, and vitamin B6 is recommended as a first-line treatment for nausea and vomiting in pregnancy. The safety of ginger and vitamin B6 is considered to be well established, and is based on epidemiological studies. Acupuncture has been shown to reduce back pain and improve function for women in early pregnancy. There is little evidence to support the use of cranberries in pregnancy for prevention of urinary tract infections, and chiropractic treatment for back pain. Overall the numbers of studies are small and of low quality, although the modalities appear to be low risk of harm.

Keywords

complementary therapies and medicines - pregnancy - preconception - health
 

  • References

  • 1 Berman B. Cochrane Complementary Medicine Field. About the Cochrane Collaboration 1 2006;
    PubMedGoogle Scholar
  • 2 de Lacey S, Smith CA, Paterson C. Building resilience: a preliminary exploration of women's perceptions of the use of acupuncture as an adjunct to in vitro fertilisation. BMC Complement Altern Med 2009; 9: 50
    CrossrefPubMedGoogle Scholar
  • 3 Rayner JA, Willis K, Burgess R. Women's use of complementary and alternative medicine for fertility enhancement: a review of the literature. J Altern Complement Med 2011; 17 (8) 685-690
    CrossrefPubMedGoogle Scholar
  • 4 Boivin J, Schmidt L. Use of complementary and alternative medicines associated with a 30% lower ongoing pregnancy/live birth rate during 12 months of fertility treatment. Hum Reprod 2009; 24 (7) 1626-1631
    CrossrefPubMedGoogle Scholar
  • 5 Hall HG, Griffiths DL, McKenna LG. The use of complementary and alternative medicine by pregnant women: a literature review. Midwifery 2011; 27 (6) 817-824
    CrossrefPubMedGoogle Scholar
  • 6 Bishop JL, Northstone K, Green JR, Thompson EA. The use of complementary and alternative medicine in pregnancy: data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Complement Ther Med 2011; 19 (6) 303-310
    CrossrefPubMedGoogle Scholar
  • 7 Adams J, Lui CW, Sibbritt D , et al. Women's use of complementary and alternative medicine during pregnancy: a critical review of the literature. Birth 2009; 36 (3) 237-245
    CrossrefPubMedGoogle Scholar
  • 8 Pastore LM, Williams CD, Jenkins J, Patrie JT. True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2011; 96 (10) 3143-3150
    CrossrefPubMedGoogle Scholar
  • 9 Stener-Victorin E, Waldenström U, Tägnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2000; 79 (3) 180-188
    CrossrefPubMedGoogle Scholar
  • 10 Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol 1992; 6 (3) 171-181
    CrossrefPubMedGoogle Scholar
  • 11 Johansson J, Stener-Victorin E. Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction. Evid Based Complement Altern Med 2013; 2013: 762615
    PubMedGoogle Scholar
  • 12 Dohle GR, Colpi GM, Hargreave TB, Papp GK, Jungwirth A, Weidner W ; EAU Working Group on Male Infertility. EAU guidelines on male infertility. Eur Urol 2005; 48 (5) 703-711
    CrossrefPubMedGoogle Scholar
  • 13 Sharlip ID, Jarow JP, Belker AM , et al. Best practice policies for male infertility. Fertil Steril 2002; 77 (5) 873-882
    CrossrefPubMedGoogle Scholar
  • 14 Jerng UM, Jo JY, Lee S, Lee JM, Kwon O. The effectiveness and safety of acupuncture for poor semen quality in infertile males: a systematic review and meta-analysis. Asian J Androl 2014; 16 (6) 884-891
    CrossrefPubMedGoogle Scholar
  • 15 Dieterle S, Li C, Greb R, Bartzsch F, Hatzmann W, Huang D. A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. Fertil Steril 2009; 92 (4) 1340-1343
    CrossrefPubMedGoogle Scholar
  • 16 Pei J, Strehler E, Noss U , et al. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertil Steril 2005; 84 (1) 141-147
    CrossrefPubMedGoogle Scholar
  • 17 Huang DM, Huang GY, Lu FE, Stefan D, Andreas N, Robert G. Acupuncture for infertility: is it an effective therapy?. Chin J Integr Med 2011; 17 (5) 386-395
    CrossrefPubMedGoogle Scholar
  • 18 Ried K. Chinese herbal medicine for female infertility: an updated meta-analysis. Complement Ther Med 2015; 23 (1) 116-128
    CrossrefPubMedGoogle Scholar
  • 19 Ushiroyama T, Hosotani T, Yamashita Y, Yamashita H, Ueki M. Effects of Unkei-to on FSH, LH and estradiol in anovulatory young women with hyper- or hypo-functioning conditions. Am J Chin Med 2003; 31 (5) 763-771
    CrossrefPubMedGoogle Scholar
  • 20 Gerhard I, Patek A, Monga B, Blank A, Gorkow C. Mastodynon(R) bei weiblicher Sterilität. Forsch Komplementarmed 1998; 5 (6) 272-278
    CrossrefPubMedGoogle Scholar
  • 21 Westphal LM, Polan ML, Trant AS. Double-blind, placebo-controlled study of Fertilityblend: a nutritional supplement for improving fertility in women. Clin Exp Obstet Gynecol 2006; 33 (4) 205-208
    PubMedGoogle Scholar
  • 22 Bergmann J, Luft B, Boehmann S, Runnebaum B, Gerhard I. [The efficacy of the complex medication Phyto-Hypophyson L in female, hormone-related sterility. A randomized, placebo-controlled clinical double-blind study]. Forsch Komplementarmed Klass Naturheilkd 2000; 7 (4) 190-199
    CrossrefPubMedGoogle Scholar
  • 23 Arentz S, Abbott JA, Smith CA, Bensoussan A. Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings. BMC Complement Altern Med 2014; 14 (1) 511
    CrossrefPubMedGoogle Scholar
  • 24 Ahmad MK, Mahdi AA, Shukla KK , et al. Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fertil Steril 2010; 94 (3) 989-996
    CrossrefPubMedGoogle Scholar
  • 25 Shukla KK, Mahdi AA, Mishra V , et al. Withania somnifera improves semen quality by combating oxidative stress and cell death and improving essential metal concentrations. Reprod Biomed Online 2011; 22 (5) 421-427
    CrossrefPubMedGoogle Scholar
  • 26 Ambiye VR, Langade D, Dongre S, Aptikar P, Kulkarni M, Dongre A. Clinical evaluation of the spermatogenic activity of the root extract of ashwagandha (Withania somnifera) in oligospermic males: a pilot study. Evid Based Complement Alternat Med 2013; 2013: 571420
    PubMedGoogle Scholar
  • 27 Furuya Y, Akashi T, Fuse H. Effect of Bu-zhong-yi-qi-tang on seminal plasma cytokine levels in patients with idiopathic male infertility. Arch Androl 2004; 50 (1) 11-14
    CrossrefPubMedGoogle Scholar
  • 28 Wurn BF, Wurn LJ, King CR , et al. Treating female infertility and improving IVF pregnancy rates with a manual physical therapy technique. MedGenMed 2004; 6 (2) 51
    PubMedGoogle Scholar
  • 29 Holt J, Lord J, Acharya U , et al. The effectiveness of foot reflexology in inducing ovulation: a sham-controlled randomized trial. Fertil Steril 2009; 91 (6) 2514-2519
    CrossrefPubMedGoogle Scholar
  • 30 Tiran D. Ginger to reduce nausea and vomiting during pregnancy: evidence of effectiveness is not the same as proof of safety. Complement Ther Clin Pract 2012; 18 (1) 22-25
    CrossrefPubMedGoogle Scholar
  • 31 Nordeng H, Bayne K, Havnen GC, Paulsen BS. Use of herbal drugs during pregnancy among 600 Norwegian women in relation to concurrent use of conventional drugs and pregnancy outcome. Complement Ther Clin Pract 2011; 17 (3) 147-151
    CrossrefPubMedGoogle Scholar
  • 32 The National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies. 2014 ; Guideline 62
    PubMedGoogle Scholar
  • 33 Matthews A, Haas DM, O'Mathúna DP, Dowswell T. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2015; 9: CD007575
    PubMedGoogle Scholar
  • 34 Viljoen E, Visser J, Koen N, Musekiwa A. A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutr J 2014; 13: 20
    CrossrefPubMedGoogle Scholar
  • 35 Heitmann K, Nordeng H, Holst L. Safety of ginger use in pregnancy: results from a large population-based cohort study. Eur J Clin Pharmacol 2013; 69 (2) 269-277
    CrossrefPubMedGoogle Scholar
  • 36 Ding M, Leach M, Bradley H. The effectiveness and safety of ginger for pregnancy-induced nausea and vomiting: a systematic review. Women Birth 2013; 26 (1) e26-e30
    CrossrefPubMedGoogle Scholar
  • 37 Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001; 97 (4) 577-582
    CrossrefPubMedGoogle Scholar
  • 38 Willetts KE, Ekangaki A, Eden JA. Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled trial. Aust N Z J Obstet Gynaecol 2003; 43 (2) 139-144
    CrossrefPubMedGoogle Scholar
  • 39 Choi JS, Han JY, Ahn HK , et al. Assessment of fetal and neonatal outcomes in the offspring of women who had been treated with dried ginger (Zingiberis rhizoma siccus) for a variety of illnesses during pregnancy. J Obstet Gynaecol 2015; 35 (2) 125-130
    CrossrefPubMedGoogle Scholar
  • 40 American College of Obstetricians and Gynecologists. Practice Bulletin No. 153: Nausea and vomiting of pregnancy. Obstet Gynecol 2015; 126 (3) e12-e24
    CrossrefPubMedGoogle Scholar
  • 41 Koren G, Clark S, Hankins GD , et al. Effectiveness of delayed-release doxylamine and pyridoxine for nausea and vomiting of pregnancy: a randomised placebo controlled trial. Am J Obstet Gynecol 2010; 203 (6) 571.e1-7
    CrossrefPubMedGoogle Scholar
  • 42 McKeigue PM, Lamm SH, Linn S, Kutcher JS. Bendectin and birth defects: I. A meta-analysis of the epidemiologic studies. Teratology 1994; 50 (1) 27-37
    CrossrefPubMedGoogle Scholar
  • 43 Smith C, Crowther C, Willson K, Hotham N, McMillian V. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol 2004; 103 (4) 639-645
    CrossrefPubMedGoogle Scholar
  • 44 Ensiyeh J, Sakineh MA. Comparing ginger and vitamin B6 for the treatment of nausea and vomiting in pregnancy: a randomised controlled trial. Midwifery 2009; 25 (6) 649-653
    CrossrefPubMedGoogle Scholar
  • 45 Chittumma P, Kaewkiattikun K, Wiriyasiriwach B. Comparison of the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial. J Med Assoc Thai 2007; 90 (1) 15-20
    PubMedGoogle Scholar
  • 46 Sripramote M, Lekhyananda N. A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy. J Med Assoc Thai 2003; 86 (9) 846-853
    PubMedGoogle Scholar
  • 47 Krapels IP, van Rooij IA, Ocké MC, van Cleef BA, Kuijpers-Jagtman AM, Steegers-Theunissen RP. Maternal dietary B vitamin intake, other than folate, and the association with orofacial cleft in the offspring. Eur J Nutr 2004; 43 (1) 7-14
    CrossrefPubMedGoogle Scholar
  • 48 Bailey HD, Miller M, Langridge A , et al. Maternal dietary intake of folate and vitamins B6 and B12 during pregnancy and the risk of childhood acute lymphoblastic leukemia. Nutr Cancer 2012; 64 (7) 1122-1130
    CrossrefPubMedGoogle Scholar
  • 49 Heitmann K, Nordeng H, Holst L. Pregnancy outcome after use of cranberry in pregnancy—the Norwegian Mother and Child Cohort Study. BMC Complement Altern Med 2013; 13: 345
    CrossrefPubMedGoogle Scholar
  • 50 Dugoua JJ, Seely D, Perri D, Mills E, Koren G. Safety and efficacy of cranberry (Vaccinium macrocarpon) during pregnancy and lactation. Can J Clin Pharmacol 2008; 15 (1) e80-e86
    PubMedGoogle Scholar
  • 51 Forster DA, Denning A, Wills G, Bolger M, McCarthy E. Herbal medicine use during pregnancy in a group of Australian women. BMC Pregnancy Childbirth 2006; 6: 21
    CrossrefPubMedGoogle Scholar
  • 52 Jepson RG, Williams G, Craig JC. Efficacy of cranberry juice for preventing urinary tract infections. Cochrane Database Syst Rev 2012; 10: CD001321
    PubMedGoogle Scholar
  • 53 Wing DA, Rumney PJ, Preslicka CW, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol 2008; 180 (4) 1367-1372
    CrossrefPubMedGoogle Scholar
  • 54 Hope-Allan N, Adams J, Sibbritt D, Tracy S. The use of acupuncture in maternity care: a pilot study evaluating the acupuncture service in an Australian hospital antenatal clinic. Complement Ther Nurs Midwifery 2004; 10 (4) 229-232
    CrossrefPubMedGoogle Scholar
  • 55 Park J, Sohn Y, White AR, Lee H. The safety of acupuncture during pregnancy: a systematic review. Acupunct Med 2014; 32 (3) 257-266
    CrossrefPubMedGoogle Scholar
  • 56 Clarkson CE, O'mahony D, Jones DE. Adverse event reporting in studies of penetrating acupuncture during pregnancy: a systematic review. Acta Obstet Gynecol Scand 2015; 94 (5) 453-464
    CrossrefPubMedGoogle Scholar
  • 57 Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine 2005; 30 (8) 983-991
    CrossrefPubMedGoogle Scholar
  • 58 Pennick VE, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev 2007; (2) CD001139
    PubMedGoogle Scholar
  • 59 Smith C, Crowther C, Beilby J. Pregnancy outcome following women's participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy. Complement Ther Med 2002; 10 (2) 78-83
    CrossrefPubMedGoogle Scholar
  • 60 Knight B, Mudge C, Openshaw S, White A, Hart A. Effect of acupuncture on nausea of pregnancy: a randomized, controlled trial. Obstet Gynecol 2001; 97 (2) 184-188
    CrossrefPubMedGoogle Scholar
  • 61 Frawley J, Adams J, Sibbritt D, Steel A, Broom A, Gallois C. Prevalence and determinants of complementary and alternative medicine use during pregnancy: results from a nationally representative sample of Australian pregnant women. Aust N Z J Obstet Gynaecol 2013; 53 (4) 347-352
    CrossrefPubMedGoogle Scholar
  • 62 Stuber KJ, Smith DL. Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. J Manipulative Physiol Ther 2008; 31 (6) 447-454
    CrossrefPubMedGoogle Scholar
  • 63 Stuber KJ, Wynd S, Weis CA. Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature. Chiropr Man Therap 2012; 20: 8
    CrossrefPubMedGoogle Scholar
  • 64 Khorsan R, Hawk C, Lisi AJ, Kizhakkeveettil A. Manipulative therapy for pregnancy and related conditions: a systematic review. Obstet Gynecol Surv 2009; 64 (6) 416-427
    CrossrefPubMedGoogle Scholar