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The Journal of Alternative and Complementary Medicine Vol. 24, No. 6 pp. 578-583

Evaluation of “Energy Resonance by Cutaneous Stimulation” Among Women Treated by In Vitro Fertilization

Camille Gay (1), Anne Cros (1), Julie Berbis (2), Florence Bretelle (1,3), Jeanne Perrin (1,4), and Blandine Courbiere (1,4)

1 Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception–Hôpital Nord, Marseille, France.
2 EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix Marseille University, Marseille, France.
3 Aix Marseille University, CNRS UMR 7278, Inserm U1095, Marseille, France.
4 Aix Marseille University, CNRS, IRD, Avignon University, IMBE UMR 7263, Marseille, France.

Abstract

Objectives:

Pregnancy rate in in vitro fertilization (IVF) depends on many factors, such as the characteristics of the couple and the clinicobiological parameters. Interest in alternative and complementary medicine (ACM) for IVF is discussed because of the lack of scientific evidence. Energy resonance by cutaneous stimulation (ERCS), an acupuncture-like technique, consists of skin stimulation to transmit vibratory messages. The aim of this study was to evaluate the effect of ERCS on live birth rates (LBRs) in IVF.

Design:

A prospective observation study was performed in the Unit of Assisted Reproductive Technologies of a University Teaching Hospital. Every woman who agreed to participate in this study and received a fresh embryo transfer (ET) after IVF or Intracytoplasmic Sperm Injection (ICSI) was included. Patients randomly underwent an ERCS session on the day of ET according to the schedule of the midwife performing this technique. The control group consisted of women undergoing ET under usual conditions. The main outcome measure was the LBR per transfer.

Results:

Three-hundred-eighteen women were included, 120 in the ERCS + ET group and 198 in the ET without ERCS group. None of the women dropped out. The clinical characteristics in both groups were comparable. There was a significant difference in the clinical pregnancy rates, 31.7% in the ERCS group versus 21.7% in the No ERCS group (p=0.037). The LBR in the ERCS group was nearly significantly higher, 29.2% versus 20.7% in the No ERCS group (p=0,059).

Conclusions:

Women undergoing ERCS on the day of ET had a significantly higher IVF pregnancy rate. However, this methodology made not possible to draw conclusions about the mechanisms that induced the increase of IVF LBRs: placebo effect, “cocooning,” or ERCS self-effect? Further well-conducted studies are strongly needed to assess ERCS efficacy.

https://www.liebertpub.com/doi/abs/10.1089/acm.2017.0155


Excerpts:

"Among alternative and complementary medicine (ACM), acupuncture has gained increased interest during pregnancy and is now recommended by the French Health Authority for treatment of nausea and vomiting during early pregnancy (grade A). Several studies have shown that acupuncture could facilitate inversion of a breech fetus.2,3 In ART, researchers have shown increased interest in combining ACM and ART techniques to increase pregnancy rate; these approaches include acupuncture,4,5 auricular acupressure,6 or other Traditional Chinese Medicines,7 hypnosis,8 and relaxation.9

"In a randomized study of 305 women, Qu et al. reported that the LBR was significantly higher in the group treated by auricular acupressure than in the group without acupressure or 'placebo acupressure.' In a case–control study of 184 couples, Levitas et al. reported a significant improvement in the implantation rate and clinical pregnancies in the group of women who underwent a hypnosis session during embryo transfer (ET).8 Poehl et al. observed increased pregnancy rate among patients who received psychologic support during IVF compared with those who refused support.10 However, the results of these studies on ACM are contradictory, and some studies found no improvement in pregnancy rate when comparing acupuncture with placebo.11,12 The most recent meta-analysis by Abou-Setta et al. did not find a benefit of ACM.13 Moreover, the mechanisms explaining the efficacy of these techniques have been debated at length.14–16

"Energy resonance by cutaneous stimulation (ERCS) (Résonance Energétique par Stimulation Cutanée, RESC, in French) is a recent ACM technique developed in France by a physiotherapist, Patrick Fouchier. It involves creating resonance between stimulation of cutaneous points with the fingertips to perceive and transmit vibratory and wave messages in tissues. Stimulation points, inherited from Traditional Chinese Medicine, are distributed on meridians (energy circulation pathways). Stimulation points are identical in acupuncture, acupressure, and ERCS, but are stimulated in different ways, including with needles in acupuncture, firm or smooth pressure for acupressure (to reduce muscular tension), and gentle touch and intent to withdraw in the case of ERCS (to create waves between the contact points). The hypothesis of the physiologic function of ERCS is based on the production of acoustic waves (resonance) by a cutaneous point brush and transmission of theses waves in the body (fluid environment).

"According to the developer (www.resc.fr), this technique would be able to sense turbulence induced by diseases and emotions to help patients calm down, whatever the disease, and should not be substituted for medical treatment. ERCS is used to treat pain based on its presumed analgesic and anxiolytic actions. There are no previous scientific publications on ERCS.

"Increasing number of French midwifes and nurses are receiving training to perform ERCS, especially for pain treatment. However, no prior scientific evaluation objectively evaluated its efficacy."

"Prospective participants were informed of the schedule for an ERCS session, which lasted for a total of 30 min before and after ET and did not require invasive procedures (no needles) or clothing removal. The patient was lying down, in silence or listening relaxing music. First, the midwife asked for few questions about medical history, pains, and anxiety about IVF treatment. Then, she touched points on a meridian to feel vibratory messages. The stimulation was gentle, with fingertips, and continued until the practician can feel resonance and wave circulation between the points. The points were chosen by the midwife according to the energetic diagnosis, so as for an acupuncture procedure, in an individualized combination. The basis of the ERCS protocol included three steps: stimulation of the feet, abdomen, then head and shoulders.

"On the day of ET, women were allocated to one of two groups, those who underwent an ERCS session and those who underwent ET under the usual conditions."

"After controlling for confounding factors related to pregnancy rate, it was observed that women who underwent ERCS on the day of ET had higher pregnancy rates and LBRs than women who did not undergo this technique. However, only the 8-week pregnancy rate was significantly different, whereas the LBR was not, although it trended toward significance. There was no significant difference for spontaneous early miscarriages and ectopic pregnancies. The observation that only the 8-week pregnancy rate was significantly different may be due to the lack of strength of this study."

"This was a prospective case–control study and not a randomized controlled study. The allocation of women in each group was random, but not randomized, because the study depended on whether the midwife was available to perform ERCS sessions."

"This was not a blinded study because women knew whether they underwent an ERCS session and physicians knew on the day of transfer whether the midwife was available to perform ERCS sessions. However, a double blinded randomized study for ERCS evaluation is difficult to establish because the caregiver knows always what technique he is doing...No previous international study has published data on ERCS, and there are no prior studies concerning the potential mechanism of the efficiency of ERCS. In this study, the mechanisms leading to higher pregnancy rates could be ERCS self-effect, placebo effect, or cocooning (increased therapeutic attention and caring, in a comfortable environment).

"Data on acupuncture are more widespread. Several studies have shown an interest in ACM in supporting ART, but meta-analyses are contradictory. Shen et al.5 did not find a significant difference in clinical pregnancy rate between groups with acupuncture versus without acupuncture during ET. They only found significant differences when acupuncture was performed 30?min before transfer, during the implantation period, and 25 min before and after ET. Several sessions of acupuncture or sessions at specific moments during the attempt could be necessary to improve pregnancy rates. In their meta-analysis, Manheimer et al. concluded that there was not a significant improvement of the IVF pregnancy rates after one to three acupuncture sessions,18,19 except in a subgroup of studies with low pregnancy rates (<32%, close to the European mean results20), which had significantly higher pregnancy rate. After excluding articles using sham acupuncture (called the Streiberger technique), Zheng et al.21 found a significant improvement in the clinical pregnancy rate and LBR whenever the session was performed. Sham needling technique uses blunt needles covered by plaster, which gives the impression that the needle is inserted into the skin. The authors suggest that this control technique, to protect patient blindness in the study, could help with this type of study. The needle tip, when touching the skin, stimulates acupuncture points and is thus not inert. Furthermore, analysis of only a subgroup of studies using the Streitberger technique as a control showed a decrease in LBR in the acupuncture group. These results may appear to be unbelievable considering that no secondary effect of acupuncture on pregnancy has ever been demonstrated."

"Regarding the explanation of the biological function or physiology of acupuncture, studies suggest that acupuncture could reduce stress during ET and improve pregnancy rate.26 Acupuncture would be able to improve blood flow and decrease uterine artery impedance.27,28 Some studies suggested that acupuncture is able to regulate growth factor rates in follicular fluid and blood as well as improve oocyte quality.29 Likewise, there is no consensus on this subject."

"Manheimer et al. reported that the use of 'sham acupuncture' as a control group is not justified because, even if acupuncture increases the LBR only because of a psychosomatic effect (like stress reduction), this effect could be a part of the function of acupuncture and cannot be compared with another stress reduction method.31"

"Despite biases which are difficult to avoid in studies on ACM, it was shown that women undergoing ERCS on the day of ET had significantly higher pregnancy rate and a trend to higher LBR. ACM must be studied with a thorough methodology to differentiate the effect of the own ACM technique and the placebo effect (due to cocooning). A blinded, randomized study, on a larger population comparing ERCS with therapeutic abstention and with a group receiving 'sham ERCS' (relaxation session with fingertips on fictive points, with a caregiver untrained in ERCS) is needed. This would be the only methodology that could help to distinguish the effect of ERCS from the 'cocooning' effect. In this case, the study would be single blinded, with the patient not knowing whether she is receiving true or sham ERCS. However, even if ERCS had a placebo effect or cocooning effect, the improvement in the pregnancy rate would be a sufficient argument to encourage supporting ACM as a complement to ART."



Comments:

The authors acknowledge that their results could be placebo effects and the need for further study.  However, they do not discuss the fact that their proposed mechanism ("It involves creating resonance between stimulation of cutaneous points with the fingertips to perceive and transmit vibratory and wave messages in tissues....The hypothesis of the physiologic function of ERCS is based on the production of acoustic waves (resonance) by a cutaneous point brush and transmission of theses waves in the body (fluid environment).") is inconsistent with scientific knowledge.

They also put in considerable discussion of effects of acupuncture and acupressure, even though these are quite distinct techniques.