Prior to conception: The role of an acupuncture protocol in enhancing women's reproductive functioning

摘要

Background: Fertility has become a major presenting condition in both biomedical and Traditional Chinese Medicine (TCM) clinics. Estimates of the number of couples encountering fertility problems vary from one in six to one in ten. The biomedical response to female fertility problems is generally agreed to be invasive, stressful and expensive. Chinese medicine has also been treating female fertility problems using a range of methods throughout its history. Acupuncture is increasingly used as an adjunct to assisted reproductive technologies and more widely in the complementary health care system. This study sought to explore the potential contribution of an acupuncture protocol to enhancing female fertility.;The following three stage research questions were posed: 1. What are the parametres of contemporary acupuncture practice in relation to female fertility and can a consensus be achieved among specialist practitioners on what constitutes an adequate acupuncture intervention to enhance women's reproductive functioning? 2. Does an acupuncture protocol administered prior to conception assist with female fertility outcomes? 3. Can the experience of women using acupuncture to promote their health in the period prior to conception shed light on our understandings of this intervention and future research directions?;The research process used a mixed methodology through developing a protocol from the experiences of specialist practitioners, applying that protocol within a clinical trial to explore the use of acupuncture in the lead up to conception, and exploring the experiences of the women who received the acupuncture intervention.;Methods: The acupuncture protocol was developed by consensus from an online focus group of internationally-sourced acupuncturists specialising in fertility. The clinical trial was a pragmatic design: 56 women were randomised to two groups -- one receiving a lifestyle-only intervention and the other acupuncture-plus-lifestyle -- with the manualised acupuncture intervention responsive to participants' presentation at the time of treatment. Half of the acupuncture recipients were interviewed in depth after the intervention. A mixed methods research methodology offered a richer data set with which to examine the outcomes for the trial population and the individual experiences of an acupuncture intervention.;Results: The acupuncture protocol developed by consensus was applied in the clinical trial without any difficulties reported by the participating acupuncturists. The results of the trial for the acupuncture recipients included significant changes in fertility awareness (adj.p=.011), quality of life scores (adj.p=.042), and personal agency measures (adj.p=.047). For these women there were also positive menstrual changes and halved times to conception. Participant reports reinforced the importance of wellbeing for women with fertility problems and the contribution acupuncture treatments make to a sense of personal transformation. The interviews also gave detailed explanations of trends in the trial data, for example, the trend toward increased menstrual regularity specifically meant several anovulatory women with polycystic ovary syndrome menstruated naturally. The data from the interviews brought new perspectives that elaborated or challenged the quantitative data. The participants in describing their responses to the acupuncture intervention related a complex story of change and transformation.;Conclusions: Mixed methodology research emerged as a useful approach to understanding a complex intervention such as acupuncture. This study points to acupuncture as a safe and beneficial preparation for conception. It also provides additional guidance to practice in that it tested a particular acupuncture protocol that treated according to time in the menstrual cycle, TCM and biomedical diagnosis, and presenting symptoms. The study results also confirm the importance of understanding acupuncture as an intervention that assists women to transform themselves. This thesis faces the challenge of interpreting a Chinese medical approach to the common and profound medical and personal dilemma of failed fertility to a biomedical science reader through the perspectives of the women who undertook the intervention. It concludes that knowledge is produced from diverse sources and diverse methodologies are required to understand how change occurs.