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Hijama (wet cupping) for female infertility treatment: a pilot study

DOI:10.18203/2320-1770.ijrcog20163842

Authors:

prof Hassan Abduljabbar

King Abdulaziz University

Samiha A. Mourad

King Abdulaziz University

Ayman M Oraif

International Medical Center

Frequency of variables obtained from women undergoing Hijama prior to IVF.

…

Pregnancy rate after Hijama.

…

Therapy used by women prior to undergoing Hijama.

…

Available via license: CC BY-NC

Content may be subject to copyright.

November 2016 · Volume 5 · Issue 11 Page 3799

International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Abduljabbar H et al. Int J Reprod Contracept Obstet Gynecol. 2016 Nov;5(11):3799-3801

www.ijrcog.org

pISSN 2320-1770 | eISSN 2320-1789

Original Research Article

Hijama (wet cupping) for female infertility treatment: a pilot study

Hassan Abduljabbar*, Anhar Gazzaz, Samiha Mourad, Ayman Oraif

INTRODUCTION

Infertility is defined as failure to conceive after one year

of regular unprotected intercourse. It affects about 10-

15% of reproductive age couples.1

Hijama (wet cupping) or sometimes-called bloodletting is

used as a complementary treatment for many diseases,

but no studies were done for its use as treatment of

female infertility.2 Acupuncture which has been studied

more extensively than Hijama, includes different

techniques including bloodletting. Acupuncture works by

stimulating the hypothalamus and the pituitary gland,

resulting in a broad spectrum of therapeutic systemic

effects.3,4

Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah 21452, Kingdom

of Saudi Arabia

Received: 26 August 2016

Revised: 26 August 2016

Accepted: 26 September 2016

*Correspondence:

Dr. Hassan Abduljabbar,

E-mail: profaj17@yahoo.com

the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial

use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background:

To assess the effectiveness of wet cupping (Hijama) as a treatment of female factor infertility. The

primary outcome measured was pregnancy rates after Hijama. The secondary outcome measured was the effect on the

reproductive hormonal profile before and after Hijama.

Methods:

A pilot clinical study was conducted for the use of Hijama as treatment for female infertility at King

Abdulaziz University Hospital from September 2013 to May 2015. Inclusion criteria included: patients with female

factor infertility between 20-50 years of age. Exclusion criteria were women who were menopausal, male factor

infertility and pregnancy. Informed consent was obtained from all patients. Upon inclusion in the study, an interview

with the participant was done. Blood tests were done at the initial visit which included a complete blood count and

hormonal profile (FSH, LH, Estradiol, Progesterone, TSH) if not done already. Patients had repeated Hijama each

month if pregnancy did not occur.

Results:

Out of 59 women, 31 (52.5%) had primary infertility and 28 (47.5%) had secondary infertility. The duration

of infertility ranged from 1 to 22 years. In 40 women (67.8%), the partner had a normal semen analysis and 19

(32.2%) had oligospermia. 12 women had an abnormal hystosalpngiogram (20.3%) with two women with complete

bilateral tubal blockage. 36 women (61%) had a normal hormonal profile (FSH, LH, TSH, Prolactin). 12 patients

(20.3%) became pregnant after hijama; 7 patients had only one or two sessions of Hijama and one patient had 7

sessions. Factors that were found to affect pregnancy rate included: patient with no dysmenorrhea (p 0.034),

secondary infertility diagnosis (p 0.005) and history of OCP use (P 0.04). There were significant changes of the

hormonal profile before and after Hijama.

Conclusions:

Hijama might be beneficial in infertile women to achieve a pregnancy. Further studies are needed to

confirm the findings from this study.

Keywords: Acupuncture, Ancient health care, Complementary treatment, Hijama, Wet cupping

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20163842

Abduljabbar H et al. Int J Reprod Contracept Obstet Gynecol. 2016 Nov;5(11):3799-3801

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 5 · Issue 11 Page 3800

Acupuncture techniques can induce regular ovulation in

females with polycystic ovarian syndrome (PCOS).

Recent data showed that acupuncture increases the

pregnancy rates from 26.3 % to 42.5 % when performed

both pre- and post- IVF.5

This pilot study was conducted to assess the effectiveness

of the use Hijama as treatment for female factor

infertility. Primary Outcomes measured were pregnancy

rates after Hijama prior to undergoing in vitro

fertilization. Secondary outcomes were changes in

reproductive hormonal profile (Follicle stimulating

hormone, luteinizing hormone, Estradiol, Progesterone)

before and after Hijama.

METHODS

This pilot prospective study was conducted at the

prophetic medicine clinic in King Abdulaziz University

Hospital, Jeddah, Saudi Arabia from September 2013 to

August 2015. Patients were referred from infertility

clinics to the prophetic medicine clinic.

Inclusion criteria patients with female factor infertility

between 20-50 years of age. Exclusion criteria: women

who were menopausal, male factor infertility and

pregnancy. . Informed consent was obtained from all

patients and participation was voluntary. Upon inclusion

in the study, an interview with the participant was done.

Blood tests were done at the initial visit which included a

complete blood count with differential and hormonal

profile (FSH, LH, Estradiol, Progesterone,TSH) if not

done already. Women were offered Hijama while waiting

for their IVF cycle. If they achieved pregnancy after

Hijama, the IVF cycle was cancelled.

Patients had repeated Hijama each month (on the second

day of menses) if pregnancy did not occur.

Hijama

Hijama was done in 13 points as follows: 2 points at the

posterolateral aspect of the head (between the 2 ears,

points 1,55,11,49,120) 2 points bilaterally at the renal

angle, 2 points bilaterally between the tibia and fibula

inferolateral to the knee, 2 points bilaterally at the dorsum

of the feet above the big toe. Hijama was conducted on

the second day of menses and repeated monthly if

pregnancy did not occur.

Ethical approval was obtained.

The Statistical Package for the Social Sciences (PC SPSS

version 20) was used to analyze data using (chi-square

test). The frequencies of occurrence of different variables

were calculated. P Value less than 0.01 were considered

significant.

RESULTS

A total of 59 patients were recruited into the study. 31

patients (52.5%) had primary infertility and 28 patients

(47.5%) had secondary infertility. The duration of

infertility ranged from 1 to 22 years with a mean of 5.87

(SD 5.28).

Questionnaire data collected included; history of oral

contraceptive use (20/59, 39.9%) and normal semen

analysis (40/59, 67.8%). All women had a

hysterosalpingogram to assess tubal patency; 12 were

abnormal (20.3%), two had complete bilateral tubal

blockage, the remaining had unilateral tubal blockage. 36

women (61%) had a normal hormonal profile (Table 1).

Table 1: Frequency of variables obtained from women

undergoing Hijama prior to IVF.

Variable

Frequency

(N=59)

Percentage

(%)

History of oral

contraceptive use

Yes

33.9

66.1

Semen analysis

Normal

Oligospermia

67.8

32.2

Hystosalpngiogram

Normal

Abnormal

79.7

20.3

Hormonal profile *

Normal

Abnormal

61.0

*Hormonal profile (Basal Follicle stimulating hormone,

Luetinzing hormone, Estradiol)

Out of 59 women who had Hijama, 12 (20.3%) got

pregnant. Of those, 7 patients had only one or two

sessions of Hijama and one patient had 7 sessions (Table

2).

Table 2: Pregnancy rate after Hijama.

Pregnancy

Frequency

Percentage

Yes

20.3

79.7

Total

100

All patients were on the waiting list for either their first

or repeated cycle and had previous therapy (Table 3).

There were significant changes of measured hormones

before and after Hijama. There was a significant

reduction in the level of LH (p = <0.05) and significant

reduction in the level of FSH (p = <0.001). There was no

significant reduction in the level of TSH (p = 0.012) nor

prolactin (p = 0.545) (Table 4).

Abduljabbar H et al. Int J Reprod Contracept Obstet Gynecol. 2016 Nov;5(11):3799-3801

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 5 · Issue 11 Page 3801

Table 3: Therapy used by women prior to undergoing

Hijama.

Previous therapy

# of patient

(N=59)

Percentage

(%)

Ovulation Induction

76.3

Laparoscopy for

endometriosis

8.5

Intrauterine

insemination

32.2

In vitro fertilization

33.9

Table 4: Levels of measured hormones before and

after Hijama.

Mean (range)

LH (mIU/L)

Before Hijama

After Hijama

8.468 (2.0-24.8)

5.962 (1.7-11.9)

0.001*

FSH (mIU/L)

Before Hijama

After Hijama

7.609 (2.1-24.0)

6.571 (2.7-14.0)

0.05*

TSH (mIU/L)

Before Hijama

After hijama

2.875 (0.01-8.93)

2.595 (0.01-5.21)

0.012

Prolactin (mIU/L)

Before Hijama

After Hijama

305.94 (5.0-897.0)

211.94 (128.0-

379.0)

0.545

LH = Luteinizing hormone

FSH = Follicle stimulating hormone

TSH = Thyroid stimulating hormone

mIU/L= milli-international unit per litre

DISCUSSION

Acupuncture techniques can induce regular ovulation in

females with PCOS. Recent Data found that acupuncture

increased pregnancy rates from 26.3% to 42.5% when

performed both pre- and post- IVF transfer.6

Acupuncture may have an effect through different

mechanisms: central effect on the hypothalamic-pituitary-

ovarian axis (beta-endorphin levels which affect GnRH

secretion, and gonadotropin levels), and a Peripheral

effect on the uterus itself.

Acupuncture was used as a substitute for HCG to trigger

ovulation in one study. There was an improvement in

ovulation in women with PCOS from 15% to 66% up to 3

months after treatment.7

A few studies showed that the use of acupuncture in IVF

cycles on the same day of embryo transfer improves

pregnancy rates in infertile women significantly.8

There is evidence for the beneficial effects of

acupuncture as well as other complementary and

alternative medicine (CAM) modalities when used

ininfertile patients.3

Acupuncture was considered a safe practice for women

undergoing IVF.4

CONCLUSION

Hijama might be beneficial in infertile women to achieve

a pregnancy. Further studies are needed to confirm the

findings from this study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the

Institutional Ethics Committee

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Cite this article as: Abduljabbar H, Gazzaz A,

Mourad S, Oraif A. Hijama (wet cupping) for female

infertility treatment: a pilot study. Int J Reprod

Contracept Obstet Gynecol 2016;5:3799-3801.

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Article

Mar 2012

To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes. Systematic review and meta-analysis. Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects of acupuncture on IVF outcomes. Not applicable. The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture. The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis. Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation. Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects from using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

Randomized controlled trial: Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization

Article

Feb 2011

To evaluate the influence of "true" versus "sham" acupuncture on pregnancy rates (PRs) in women undergoing IVF. Randomized controlled trial, double-blinded with independent observer. Academic infertility clinic. One hundred sixty patients <38 years old undergoing IVF with or without intracytoplasmic sperm injection. Subjects were randomly allocated to the true or sham group and underwent acupuncture 25 minutes before and after ET. Subjects completed a McGill Pain Questionnaire regarding their clinical symptoms during ET. Clinical PR and clinical symptoms during ET. While the overall clinical PR was 51.25%, there was no significant difference between the arms of the study (true = 45.3% vs. sham = 52.7%); 33.1% of the patients had ultrasound-documented singleton pregnancy, and 15% of patients had twin gestations, while one patient in the true arm had a triplet gestation. There were significant differences in the subjective, affective, and total pain experience between both arms. The subjects in the true arm described their acupuncture session as being more "tiring" and "fearful" and experienced more "achiness" compared with their sham counterparts. There was no statistically significant difference in the clinical or chemical PRs between both groups. Patients undergoing true acupuncture had differing sensory experiences compared with patients in the sham arm. There were no significant adverse effects observed during the study, suggesting that acupuncture is safe for women undergoing ET.

The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: A pilot study

Article

Aug 2010

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center. 57 infertile patients undergoing IVF or IVF/ICSI. Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care. Perceive Stress Scale scores, pregnancy rates. women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased their perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status. The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: A prospective, randomized trial

Article

Jun 2006

To evaluate the effect of acupuncture on reproductive outcome in patients treated with IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on the day of ET, another group on ET day and again 2 days later (i.e., closer to implantation day), and both groups were compared with a control group that did not receive acupuncture. Prospective, randomized trial. Private fertility center. During the study period all patients receiving IVF or ICSI treatment were offered participation in the study. On the day of oocyte retrieval, patients were randomly allocated (with sealed envelopes) to receive acupuncture on the day of ET (ACU 1 group, n = 95), on that day and again 2 days later (ACU 2 group, n = 91), or no acupuncture (control group, n = 87). Acupuncture was performed immediately before and after ET (ACU 1 and 2 groups), with each session lasting 25 minutes; and one 25-minute session was performed 2 days later in the ACU 2 group. Clinical pregnancy and ongoing pregnancy rates in the three groups. Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the ACU 2 group (36% and 26%) were higher than in controls, but the difference did not reach statistical difference. Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2 provided no additional beneficial effect.