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PHILADELPHIA — Women who receive acupuncture during the stimulation phase of an in vitro fertilization cycle and again immediately after embryo transfer have a higher live-birth rate than do controls, according to the first acupuncture study with this end point.

“Other studies have looked at pregnancy rates, but what is really important is whether or not there is a baby,” said Paul C. Magarelli, M.D., who reported his findings at the annual meeting of the American Society for Reproductive Medicine.

The retrospective study included 131 women who were undergoing standard in vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI). All of these women were considered good prognosis candidates for IVF/ICSI and were given the choice of having acupuncture.

A total of 83 women declined (controls) and 48 accepted.

There were no significant differences between the two groups in terms of infertility diagnoses, demographics, and treatment protocols, except that sperm morphology was slightly better in the partners of women receiving acupuncture (7.3% vs. 5.9 % normal forms with strict criteria evaluation), and the average uterine artery pulsatility index was lower in the acupuncture group (1.57 vs. 1.72), said Dr. Magarelli of the department of ob.gyn. at the University of New Mexico, Albuquerque.

The study found that pregnancy rates per embryo transfer were not significantly different between the two groups (50% in the acupuncture group and 45% in controls).

The miscarriage rate was almost halved in the acupuncture group (8% vs. 14%).

In addition, the rate of ectopic pregnancies was significantly lower in the acupuncture group—0 of 24 pregnancies (0%) vs. 2 of 37 pregnancies (9%), said Dr. Magarelli, who is also in private practice in Colorado Springs and Albuquerque.

Thus, the live-birth rate per IVF/ICSI cycle was significantly higher in the acupuncture group than in controls (21% vs. 16%).

“The live-birth rate per pregnancy is an even more telling number, since some cycles get cancelled. There was a 42% live-birth rate per pregnancy in the acupuncture group, compared to a 35% rate in the nonacupuncture group,” Dr. Magarelli said in an interview with this newspaper.

“We believe that what we are doing is improving the uterine environment such that implantation is improved,” he added.

The study used two acupuncture protocols.

The Stener-Victorin electrostimulation protocol—which has been shown to reduce high uterine artery blood flow impedance, or pulsatility index (Hum. Reprod. 1996;11:1314-7)—was used for eight treatments during ovarian stimulation.

The second acupuncture technique—the Paulus protocol, which has been associated with improved pregnancy rates (Fertil. Steril. 2002;77:721-4)—was used within 24 hours before the embryo transfer and 1 hour after.

“This protocol has demonstrated reductions in uterine contractility, so by relaxing the uterus before the embryo transfer and immediately after, we felt we were setting up a better environment for implantation,” Dr. Magarelli said.

Medical experts are finding potential in the use of acupuncture as adjunctive therapy for women undergoing infertility treatment. In a new study testing the feasibility of this alternative approach, doctors compared outcomes between two groups of patients: those who underwent acupuncture combined with IVF, and those who underwent IVF alone.(1)

A Medical Approach with a Long History

Acupuncture is one of the most ancient medical treatments in the world, dating back several millennia, originating in China, but finally becoming popular in more modern times in the United States in the early 1970s. The practice is used not just as an adjunctive infertility treatment, but also a wide variety of medical conditions.

It involves applying a range of procedures that stimulate anatomical points on the body. The technique that has been studied the most scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

Traditional Chinese medicine holds that there are more than 2,000 acupuncture points on the body, and that these connect with more than a dozen main and secondary pathways known as meridians. Chinese medicine practitioners believe these meridians conduct energy, or qi (chee), throughout the body. Essentially, acupuncture helps maintain the balance between qi and the opposing forces of yin and yang, which in turn regulates spiritual, emotional, mental and physical balance.(2)

"Western medicine takes a very different approach," explained lead study investigator Paul Magarelli, MD, PhD, a practicing reproductive endocrinologist and medical director of the Reproductive Medicine & Fertility Center in Colorado Springs. "We use medications. We override [biological] systems."

Yet while treatment for infertility, such as in-vitro fertilization (IVF), has taken major strides in the last two decades, odds are that couples won't achieve a pregnancy 60% of the time by solely using the Western approach, Magarelli explained. "A lot of the time, the patient gets one try at becoming pregnant, mainly because of the cost," he said.

Considering the Alternative

Thus, patients have begun looking at alternative options, mainly integrative medicine, in hopes of boosting those odds, Magarelli said.

That was one motivation for this study. But Magarelli says he didn't always believe in the potential of complementary approaches like acupuncture. "I just did not feel that the data existed that supported acupuncture," he recalled. Over time, studying the medical literature about the topic intrigued him enough to launch a study of his own.

In a previous analysis, Magarelli recruited patients with the poorest prognoses (over age 35, several male factor, elevated FSH level, or those who failed IVF in the past) in his clinic, who were given acupuncture in combination with IVF, and compared them with the same types of patients who received IVF alone. Two years later, he and his colleagues retrospectively evaluated the data.

"Those patients who were treated with the acupuncture [and] who were poor prognosis had equivalent pregnancies to those [considered] good prognosis patients," Magarelli explained, an outcome he found "amazing".

This led to the latest study involving "good prognosis" patients. Specifically, the researchers wanted to determine the efficacy of electro stimulation or traditional acupuncture combined with auricular (or ear) acupuncture. Electro stimulation acupuncture is the term used to describe the approach that involves electrical stimulation. These approaches are used to either improve uterine bloodflow or help relax the uterus prior to embryo transfer in IVF.

One hundred fourteen patients undergoing in-vitro fertilization after controlled ovarian hyperstimulation were included in the study. Only those women described as having a good response to ovarian hyperstimulation and whose partners' sperm morphology (quality) was also good were analyzed for the research.

Each patient underwent ovarian hyperstimulation using a standard protocol, including the use of gonadotropins and a gonadotropin releasing-hormone (GnRH) agonist or antagonist. Each woman who then responded well to ovulation induction underwent either electro stimulation acupuncture or traditional combined with auricular acupuncture in conjunction with IVF. For this study, 53 underwent acupuncture combined with IVF, and 61 underwent IVF alone.

The investigators then analyzed successful pregnancies in the group of women, as well as the miscarriage rate.

Acupuncture Patients Had Improved Outcomes

Of those in the acupuncture group, 51 percent achieved a successful pregnancy, the research team noted. That compares to 36 percent of those who underwent IVF alone. Comparatively, the miscarriage rate was 8% and 20% in the acupuncture versus non-acupuncture group, respectively.

There were no ectopic (Tubal) pregnancies in the group of women who underwent acupuncture, but 9% of those in the group without acupuncture had a Tubal pregnancy. The investigators also reported 23% more births per pregnancy among those who had acupuncture as part of their infertility treatment.

"In previously published data, acupuncture was reserved for poorer prognosis patients, and enhanced outcomes were observed," wrote Magarelli and his colleagues. "In this study, we demonstrated that good prognosis patients would also benefit from inclusion of published acupuncture protocols."

They say this is the first published study to include birth-related IVF outcome in patients also treated with acupuncture.

Why does acupuncture theoretically work for infertility? Medical experts hypothesize that the ancient approach positively impacts opioid production in the central nervous system, which in turn, positively influences gonadotropin secretion.(3) These naturally-produced opioids, like endorphins, are similar to the actions of opiate drugs. Gonadotropins are the hormones that help promote normal reproductive function in the body. They include follicle-stimulating hormone (FSH), which helps promote follicle maturity prior to the release of an egg in women, and sperm production in men.(4) Experts also suggest acupuncture has a positive effect on uterine bloodflow.

For the Future

The study will likely be expanded early next year, Magarelli study. In the next phase, data will be collected on all patients, regardless of prognosis. "I would suspect that … we're going to see that, across the board, we can improve anywhere between 5 percent and 15 percent the number of babies successfully created through the process of IVF and acupuncture," he said.

"What blows me away, personally, is how I have absolutely seen things that I didn't think were possible by placing a needle somewhere."

1. Magarelli PC, Cridennda DK, Cohen M. Acupuncture and good prognosis IVF patients: Synergy. 60th Annual Meeting of the American Society for Reproductive Medicine. 2004 Oct 16-20. Philadelphia, PA.
2. National Center for Complementary and Alternative Medicine (NCCAM). National Institutes of Health (NIH).
3. Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril 2002 Dec;78(6):1149-53.-+
4. Department of Obstetrics and Gynecology. Geneva University Hospital. Sexual Hormones. Available at: http://www.gfmer.ch/Endo/Lectures_08/sexual_hormones.htm. Accessed November 2, 2004.

The sunrise in the east affirms the balance and harmony within the universe. As the golden glow of the western sky sets, it shimmers with the promise of hope for tomorrow. The endless facets of nature complement one another; light and dark, cold and warmth, life and death. Having a baby is no different; the integration of mind and body, male and female, must work together to achieve the balance needed. For many couples facing infertility, maintaining this equilibrium seems elusive and out of reach.

In the Southwest, the symmetry of East and West are working in concert to bring options and hope to couples experiencing infertility. In March of 2004, Reproductive Medicine & Fertility Center (RMFC) joined with the University of New Mexico, Department of Obstetrics & Gynecology to form RMFC@UNM™, whose private practice specialization is in vitro fertilization (IVF) treatments. Medical director Paul Magarelli, M.D., Ph.D., a board certified reproductive endocrinologist and infertility specialist, says RMFC@UNM™ seeks to provide New Mexico’s infertile couples with compassionate, exceptional, ad-vanced IVF services.

Nationwide, the Centers for Disease Control and Prevention reports 99,629 procedures were performed in 2000 by in vitro fertilization (IVF) — fertility treatments in which the egg and sperm are handled in the laboratory — resulting in 25,228 live births and 35,025 infants. In New Mexico limited access to fertility specialists has resulted in declining IVF procedures. With the opening of RMFC@UNM™, Magarelli estimates that within two years, 150 to 200 procedures will be performed annually in Albuquerque.

In 2002, in an effort to enhance reproductive services in New Mexico, Magarelli conducted a seminar in Santa Fe. Three people attended. At a subsequent seminar, a few months later, the room was filled. “We have the capability and people want this information. New Mexico as a whole is interested in integrative care.”

RMFC@UNM™ is an outgrowth of Dr. Magarelli’s fertility practice in Colorado Springs and a response to genuine desire for expanded services in New Mexico. Working with local professionals in Albuquerque and Colorado Springs, Magarelli offers comprehensive services to his patients at both centers. He hopes the new center in Albuquerque and his affiliation with the University of New Mexico will enhance the one other program operating in New Mexico.

The Problem
When couples face infertility, they want answers. A desire to understand exactly why they cannot get pregnant is of the utmost importance. Dr. Magarelli has created a simple chart outlining four critical questions all patients should ask their doctors. The answers will determine the appropriate treatment for each couple.

Ask your doctor to check the following: Are there sperm? A semen analysis at an Andrology Lab; Are there eggs? Day 2, 3, or 4 after your menstrual cycle starts have your doctor check your blood for Estradiol, FSH, and LH hormones; Can the sperm and egg meet? Have your MD order an HSG or X-ray dye test on Day 10 of your cycle — this will tell him if your fallopian tubes are open or not; Does the baby have a safe place to grow? The same HSG above will also tell your MD that you can safely carry a child.

A Partnership
For a specific and challenging segment of Magarelli’s practice, “high tech” Western medicine seemed to provide few answers. He looked to a respected colleague and an ancient medical tradition for alternatives.

Diane Cridennda is a doctor of oriental medicine (D.O.M.) practicing in Colorado Springs. Magarelli began referring some of his more challenging patients, those with a limited chance of getting pregnant, to Cridennda for acupuncture treatments.

Two articles have appeared in the scientific literature that thrust acupuncture into the spotlight as a viable complementary modality for the treatment of infertility. The protocols outlined in the articles are widely accepted and used successfully in conjunction with IVF to treat infertility.

Cridennda has been following the protocol for 10 years. “Participating in the acupuncture treatment gives women a sense of control; it’s empowering to be able to contribute and actively participate in their care,” she says. Cridennda adds, “The rewards are heartwarming.”

The protocol includes:

• Eight treatments before egg retrieval, two times per week for four weeks
• One treatment the day before or morning of egg retrieval
• One treatment after the egg transfer.

The acupuncture treatments before and after egg transfer are to bolster the heart energy and connect the heart with the head. The other treatments promote increased blood flow to the uterine arteries, preparing to accept the embryo. The final treatment facilitates closure and enables the woman to hold the embryo and bring the baby to term.

Dr. Cridennda treats prospective fathers as well as mothers. The process for men is a little different. It takes three months of treatments to affect the sperm. The treatments consist of vitamins, antioxidants, and specific herbs.

Because of their collaboration, Doctors Magarelli and Cridennda have given birth to a three-year retrospective study, assessing the efficacy of combining IVF and acupuncture to treat infertility. Their results have not been duplicated.

The Bottom Line
Not only are 16 percent more women getting pregnant, but also more women are having babies. “It’s so neat,” Magarelli beams, “to tie together two areas that are really helping women.” The soon-to-be published study is the first to examine birth rates. “We’ve changed the focus to the baby, not just getting pregnant. We want babies, not just pregnancies.”

Despite the focus on babies, cost is an enormous factor. In the past, IVF treatments were “up front, pay as you go” procedures. In New Mexico and Colorado, things have changed, thanks to an innovative funding program called Shared Risk, implemented by Dr. Magarelli.

Using in vitro, it takes approximately 2.2 attempts to get pregnant. Multiple attempts are costly and may not result in pregnancy. Through the Shared Risk program, patients receive four complete cycles of in vitro for the price of one. By making a deposit and affordable monthly payments, patients and doctors share the financial and fertility risk. This lowers the cost to families, increases the chances for pregnancy, and broadens access to these specialized services. Magarelli maintains, “We want to provide New Mexico women with options.”

For couples facing infertility, having a baby can be an arduous journey. The time and energy spent identifying resources and agonizing over how to pay for it all, coupled with the spiritual and emotional toll, can be daunting. Through it all, couples wrap themselves in hope and persevere.

East and West have converged in the high desert plains of the Southwest with a message of hope, anchored in traditional Chinese medicine and the promise of innovation that characterizes Western medicine. This balanced approach emanates from the very core of human existence and will move into the future helping couples, one baby at a time.Jahaan Martin is a freelance writer living in Albuquerque.

The newest technology has been joined by an ancient form of Chinese medicine at the Reproductive Medicine & Fertility Center in Colorado Springs.

Combining in vitro fertilization, or IVF, with acupuncture, a 5,000-yearold practice, appears to pay off for couples yearning to have a child, says Dr. Paul Magarelli, a reproductive endocrinologist and medical director of the center.

Magarelli and Diane Cridennda, owner of East Winds Acupuncture, conducted a study involving 203 of his patients who underwent IVF; 105 had IVF alone and 98 also had a specified series of acupuncture treatments. The acupuncture group’s pregnancy rate was 24 percent greater.

Magarelli presented his research last month before the World Congress on Human Reproduction in Venice, Italy. Previous studies, including research in Germany and China, also have pointed to the benefits of adding acupuncture to assisted-reproduction technologies.

Despite being deathly afraid of needles, Jo Ann Davis is among Magarelli’s in vitro patients who underwent acupuncture.

“I do believe it had an impact,” she says. As evidence, she points to her twins, a boy and a girl, who celebrated their first birthday recently.

In vitro fertilization involves harvesting eggs from a woman’s ovaries and fertilizing them in a laboratory dish with a man’s sperm. The resulting embryo is then transferred to the uterus.

According to the protocol followed by Magarelli and Cridennda, acupuncture sessions were twice a week for four weeks before retrieval of the eggs, and then just before and after the embryo transfer. Electro-stim acupuncture, involving a mild electrical current, was used.

Women generally find the sessions relaxing, Cridennda says. “Most of the girls say, when they start to get to the last of their pretransfer treatments, ‘Man, I’m going to miss my needle nap.’”

With Davis’ needle phobia, it wasn’t all that relaxing. But it wasn’t painful, either. She felt a vibration or tingling with the first sessions and a deep “stirring” with the final two.

“I could feel that right at my core, so that was pretty amazing.”

Magarelli was dubious when Cridennda, a doctor of Oriental medicine who trained in Beijing, approached him five years ago about using acupuncture for his patients.

But after Cridennda showed him data from some small studies — and after he became convinced it would at least cause no harm — Magarelli began sending her his patients who were having the most trouble becoming pregnant.

“What he noticed was, gee, they were getting pregnant,” Cridennda says.

In addition to an increased pregnancy rate in the acupuncture group, the rate of ectopic pregnancies “was almost nonexistent,” Magarelli says — 1.5 percent vs. 4.7 percent. In vitro fertilization is associated with an increased risk of ectopic pregnancies, in which the fertilized egg attaches someplace other than inside the uterus.

Acupuncture involves the insertion of hairthin needles at precise points to correct the flow of qi, or life energy.

How it may help reproduction isn’t clear, but it has been shown to increase blood flow into the uterus. It also may help by reducing stress.

Magarelli wants further research with more patients and is encouraging larger centers to conduct studies.

His objectivity, he says, may be compromised. Once skeptical of acupuncture, he’s now a believer.

He decided to experience acupuncture for himself after Cridennda approached him.

“I said I wouldn’t recommend anything without trying it. That first time, I walked in and there are fountains and tinkling noises and the mood music, and I’m like, ‘Oh, what am I doing here?’”

But he found it relaxing and now goes to Cridennda regularly for acupuncture.

To his surprise, it even gave him relief from a repetitive-motion injury in his hand.

“He couldn’t believe it,” Cridennda said. “He would laugh, ‘Oh my gosh, the pain is gone.’”

CONTACT THE WRITER: 636-0272 or comics@gazette.com

NEW YORK — At 36, Lucy Appert has suffered through two miscarriages, a stillbirth at 8 1/2 months and, because of a rare pregnancy-related liver dysfunction, intensive illness and surgery.

Yet after enduring five painful years of trying to have their own baby, Appert and her husband Edward finally saw their dream come true last month when their son Henry was born — premature, but healthy.

For all the fertility treatments, technologies and prenatal care available to women today, Appert credits the success of her pregnancy to an ancient Chinese secret.

"I recommend acupuncture to everyone," Appert said. "It does work. I did everything possible for years to have a baby. I almost lost hope."

The millennias-old Asian medical practice — in which the acupuncturist places tiny needles in various pressure points, or "Qi" (Chee), in the body to improve circulation and reduce stress — has been around in the United States for years as an "alternative" treatment for numerous ailments.

But recently, acupuncture has been picking up steam as a possible remedy for female infertility, with a handful of American and European studies showing that it enhances the success rate of in vitro fertilization (IVF).

“Do I believe in it? Absolutely,” said Dr. Paul C. Magarelli, an infertility doctor at the Reproductive Medicine & Fertility Center in Colorado Springs, Colo., and co-author of an ongoing study into the use of acupuncture with IVF with Dr. Diane K. Cridennda. Cridennda is a licensed acupuncturist with a master's degree in Oriental medicine from the International Institute of Chinese Medicine who owns East Winds Acupuncture, also in Colorado Springs.

Magarelli said he joined the study at the urging of Cridennda, who had approached him about using acupuncture with IVF based on her knowledge of its history as an Eastern fertility treatment. A skeptic at first, Magarelli said he dismissed the idea for a while before signing on.

"I thought, this is rubbish — it can't be true," Magarelli said. "But no matter how I look at this data, I see an improvement. ... I'm pretty much a convert."

In general, studies seem to indicate that doing acupuncture about 30 minutes before and after in vitro fertilization can increase the chance that the embryo will be implanted successfully and reduce the chance of miscarriage.

There are also indications that the effectiveness of the IVF drugs and procedure may improve if acupuncture is done about once a week in the month or two leading up to the start of IVF and then continued regularly — once or twice a week — during the whole cycle.

And, as in Appert's case, there is anecdotal evidence that acupuncture can help with other fertility and pregnancy problems. Appert didn't need IVF to conceive, but she was told she probably couldn't carry a healthy baby to term because of her liver disorder.

But some doctors caution that there is no "magic pill" for fertility, pregnancy and IVF troubles — whether it's acupuncture or something else.

"The jury is still out on that," said Dr. Eric Surrey, president of the Society for Assisted Reproductive Technology (SART), who has a practice at the Colorado Center for Reproductive Medicine. "I don't think we have good data to show that acupuncture before and after the embryo transfer is truly beneficial."

And they warn against making too much of claims that acupuncture can help with having babies.

"It's impossible to say at this point," said Dr. Robert Schenken, president of the American Society for Reproductive Medicine (ASRM), who has a practice at the University of Texas Health Science Center. "In the absence of any controlled data, I don't think we can come to a firm conclusion."

Promising Research

Acupuncture seems to help some women because it improves circulation to the ovaries — which makes for healthier eggs — and to the uterus, which increases the chances that the lining will be strong enough to hold those eggs to full-term.

"Acupuncture provides better circulation and better blood flow to the womb," said Dr. Raymond Chang, director of New York's Meridian Medical Group, who has been incorporating acupuncture into fertility treatments for the past decade. "It will give a better chance for the eggs to be nourished and therefore carried."

There's also the fact that acupuncture can be a stress-reliever during an emotional time.

"Trying to get pregnant is incredibly stressful," said Victoria Koos, the acupuncturist who treated Appert at Yin and Tonic Acupuncture in New York. "They're crossing their fingers. The longer they're trying to get pregnant, the worse it gets ... Part of [acupuncture's success] is simply relaxation. When the body is relaxed, all systems function better."

The Colorado study Magarelli and Cridennda presented at a conference this fall is one of a series the pair have done with acupuncture and in vitro.

That one looked at 114 patients who had a good chance of IVF being effective, some who did acupuncture and some who didn’t. It found, among other things, that there were fewer miscarriages, more pregnancies and a 7 percent higher birth rate among those who got acupuncture treatment over those who didn’t, according to Magarelli.

It piggybacked off other research the team did on 147 “poor responders” to IVF, which found that the pregnancy rate was 40 percent, with 11 percent more babies born, among those who did acupuncture with in vitro fertilization compared to those who didn’t.

In March, Magarelli and Cridennda released findings in Italy involving patients with an average prognosis for IVF success. Those yielded clear numbers that the pregnancy rate increased with acupuncture by 24 percent, according to Magarelli.

“What got us was that now we were seeing a firm trend toward getting more people pregnant,” he said.

The Colorado research seems to support some findings of two earlier studies, one in Germany by lead researcher Dr. Wolfgang E. Paulus — published in ASRM's “Fertility and Sterility” in April 2002 — and one in Sweden by lead researcher Elisabet Stener-Victorin in the 1990s.

Of course, even those who believe in acupuncture concede that while the existing studies have yielded good information, there still isn't sufficient evidence, or a broad enough sample of patients tested, to call acupuncture a proven remedy.

"We are convinced, but scientifically you need proof — or so-called proof," Chang said. "There is a whole set of proof from lab experiments and animal studies to human studies, but it's very difficult to do human studies."

Schenken noted that even though there might be one set of data showing positive results, "it really needs to be corroborated, preferably with several different studies and different patient populations." For example, there can be bias when the entire study sample comes from the same clinic, or when patients know they're doing something different from usual.

Schenken said he doesn't get asked about acupuncture often, but when patients do, "we don't recommend it, but we do not discourage it."

Surrey takes a similar approach. In his opinion, the data "is not bad" on the theory that acupuncture can help when administered before IVF, but as far as acupuncture generally improving fertility or helping after the embryo transfer in IVF, "there really isn't a whole lot of data on that."

But at the very least, "there is absolutely nothing to show that it's harmful if it's done with a trained and appropriately skilled acupuncturist," he said. It's a notion that nearly everyone in the medical field — whether they believe in needles and Qi or not — seems to agree upon.

Some Eastern medicine-Western medicine rivalry may come into play with how to treat reproductive problems, but Chang said he sees more resistance with the use of Chinese herbs — which are ingested — than he does with acupuncture. Often, it's the in vitro specialists themselves who refer their patients to him for acupuncture after a couple of failed IVF attempts.

As for the couples trying to bring a child into the world — particularly through a complicated, invasive procedure like IVF— anything that helps the process along is welcome.

“IVF is so technical that patients feel like they’re being pushed and pulled … with acupuncture, they’re in a sense taking some control,” Magarelli said. "Acupuncture isn't a needle, it's an environment."

Added Koos: "They're on these incredibly strong drugs that make the poor women crazy. They're running around like Catwoman. This is to help them stay sane while they're going through the process."

The emotional cost of infertility comes with a hefty financial price tag as well — in vitro fertilization can cost anywhere from $10,000 to $20,000 a cycle and generally isn't covered by insurance; acupuncture ranges from about $30 to over $200 per treatment — Koos and Chang charge about $90 a pop — and certain health plans do cover at least a portion of it.

Meanwhile, researchers and experts in the field are excited at what they're seeing in the studies. Chang said he's currently working with NYU Medical Center on a trial that looks at IVF with and without acupuncture.

Appert, for her part, was at the end of her rope and felt she had nothing to lose. She started acupuncture with Koos about two months before she began trying to conceive — with needles in her toes and a couple of liver points — and continued with the treatments throughout the pregnancy.

"The first time I went, I was completely terrified. My husband went with me and held my hand," she said. "I could feel the muscles in my liver jump and an electric current going through my body. It was very strange but also felt right."

She said being monitored by both her obstetrician and Koos helped reassure her about what was going on during her high-risk pregnancy.

"She would tell me things about how I was doing physically and then I would go to the doctor and he would tell me the same thing," remembers Appert, who works as a professor.

When she got sick late in the pregnancy, both Koos and Appert's OB/GYN were able to detect when her liver went dangerously haywire and get her to the hospital for delivery six weeks early, before the problem harmed the fetus and caused another stillbirth.

Regardless of the skeptics, Appert said she's relieved that she was finally able to have a nearly full-term baby of her own. At 4 pounds, 6 ounces, Henry has been in intensive care but otherwise is doing "fine."

"It really was a miracle," the new mom gushed. "It's one of these weird things that Western medicine can't explain."