Reproductive stimulation, acupuncture helps troubled mares conceive and carry full term

Acupuncture treatment in mares and stallions seems to provide benefit as a therapy to treat reproductive disorders dependent on the condition and the duration of treatment. In addition to study and use in horses, there is considerable use and study in several species, including its use in women, especially as an analgesic for obstetric and gynecological procedures (see story). For those animals that do not respond well to conventional medicine, traditional Chinese medicine affords a viable alternative that has shown results for horses during the past several millennia.

Dr. Shen Xie administers acupuncture to Moly, an 18-year-old Thoroughbred mare, who had a normal foal after three sessions of acupuncture. She had suffered from infertility for four years before the treatment.

William H. McCormick, VMD, Middleburg, Va., asks: "What is different about this ancient medical approach that is not provided by our spectacularly successful Western medicine? Does traditional Chinese medicine, the style of modern Chinese medicine that is taught at the official medical universities in China today, have some advantages over our conventional Western veterinary procedures?"

The ancient art is especially helpful for reproductive stimulation in animals that otherwise are unresponsive to Western medicine, according to Rhonda Rathgeber, DVM, Hagyard-Davidson-McGee.

"Reproductive disorders in both stallions and mares respond well to acupuncture therapy, which will improve the overall health of the horse and thereby improve reproductive function," Rathgeber says.

Acupuncture regimens exist for reproductive problems, including those for irregular estrus cycles, anestrus, excessive behavioral estrus, retained corpus luteum, urine pooling, uterine infection and/or uterine fluid, uterine inertia including lack of uterine tone or contractions, endometritis, vaginitis, prevention of abortion, dystocia, pyometra, retained placenta, uterine and post-partum hemorrhage, prolapsed uterus and insufficient lactation. Acupuncture analgesia combined with lower amounts of conventional anesthesia compounds can be beneficially used for cesarean section in debilitated mares, she says. Acupuncture can be used in colts and stallions for cryptorchidism (abdominal or undescended testis); orchitis (inflammation of the testis); paraphimosis (penile paralysis or inability to retract the penis in the sheath); libido problems; sore backs; and behavioral problems.

In China and the United States, many successful outcomes have been documented using acupuncture and Chinese herbal medications in tandem to benefit the reproductive process of both mares and stallions. Aquapuncture — the hypodermic injection of points with small amounts of sterile liquids, such as vitamin B12 or hormones, for a more prolonged stimulation — also has been shown to be effective to treat infertility in mares. Prostaglandin injected into the Bai Wei point (located at the lumbosacral junction on the dorsal midline) has been used to stimulate luteolysis or disruption of the corpus luteum, triggering the mare to come back in heat. Hormones injected into acupoints have also been shown to stimulate mares to cycle more regularly.

Case in point

Acupuncture was shown to reduce the amount of uterine fluid in Thoroughbred mares 24 hours post treatment, measured by rectal ultrasonography, Rathgeber reports. Treated before and after breeding, these mares subsequently had a conception rate of 86 percent. Previously, these mares needed to be bred repeatedly, and most were barren due to infertility an average of 2.8 years prior to acupuncture treatment. In addition to the acupuncture treatment, all mares were treated with oxytocin, intrauterine antibiotics and occasionally systemic antibiotics. The mares in the study were kept on Western therapies because they had been treated with those therapies for all the previous matings. The only difference was the acupuncture.

"Since then, I have treated thousands of mares, and I feel comfortable with the viscerosomatic response that it achieves," Rathgeber says. "The veterinarian that palpates the mares will notice a difference in uterine tone the day after the acupuncture is done. That is the best selling point that I have."

Bob Hillman, DVM, Cornell University, says though he uses Western medicine fairly exclusively, he will try acupuncture if the patient doesn't respond.

"I've had good results with some endo-metritis cases. Mares that had been bred numerous times without getting pregnant were accumulating fluid following breeding. In spite of having been treated by Western medicine — lavaging the uterus, treated with antibiotics, prostaglandin and oxytocin — they still were not getting pregnant," Hillman says. "When we added acupuncture to those cases, several of them did become pregnant. It doesn't work 100 percent, though nothing does. I've had good luck with a few of them doing that."

Dr. Shen Xie, DVM, PhD, MS, of the University of Florida Veterinary College, discusses the use of acupuncture and herbal medicines to treat infertility and endometritis (Xie and Liu, 1997; Liu and Xie, 1999). The various infertility conditions treated are pathological ovary and uterine disorders, including anestrus due to ovary quiescence and persistent corpus luteum, irregular estrus, anovulatory follicles and silent estrus. Xie also commonly treats cases of endometritis with Chinese herbal medicine.

Though acupuncture can be used to treat reproductive problems in mares and stallions, the most-common patient is the older mare, either barren or pregnant with painful severe arthritis, according to Chris Cahill, DVM in Lexington, Ky.

"If they don't feel good, they're expending energy to fight pain as opposed to focusing in their reproductive system," Cahill says.

He works on these mares in layers, first to alleviate pain, then to deal with reproductive deficiencies. Many of them will be sore in the lower back, hips and hocks. With these older mares the purpose of the acupuncture is to increase the energy to the lower back, the hip and waist area using the geriatric acupoints.

Once balanced and feeling good, he focuses on the patient's specific reproductive disorder, most commonly, a urine pooler or chronically infected dirty mare. He uses acupuncture once they've been under lights for about six weeks, typically by the middle of January when they start having the autumn cycle. Once in heat, when they're most receptive, he begins to work on the reproductive points along with continued work with the geriatric points.

"In my hands, most horses can be treated by less than 10 needles, or as few as seven," Cahill says.

Points of consideration

He uses the same set of points whether he's treating the older mare or the mean filly on the racetrack that has hormonal upset. Although with the young filly, there is a different technique because, "They're on fire," Cahill says.

With these racetrack fillies, acupuncture is used to reduce the energy. Cahill puts a needle in one of the points on the Bladder Meridian point, which is associated with the kidney.

"In the mean filly, I'll use a 25-gauge needle, which will be grabbed and actually become hard to take out. Though this can be very painful to the horse, you just have to continue to treat it regardless of the fact that they don't like it. You have to get the energy away from there," he says. "For the older mare, putting the needle in is like putting it in a garbage can; it falls right over. There is no energy there."

For the older mare, he uses these same points for stimulation.

"You want to bring energy to the area," he says.

Dr. Martha Rodgers, VMD, a certified acupuncturist in Lexington, Ky., has treated mares with fluid retention, either those with a slightly atonic uterus, or chronically "dirty" mares, that commonly retained a lot of fluid. Rodgers treats such mares with acupuncture, usually with a course of two or three treatments, using either electro-acupuncture (EA), which adds small electrical impulses to the needles, or a combination of electro-acupuncture and moxibustion, a technique that involves the burning of mugwort above an acupoint to facilitate healing.

"About 80 to 85 percent of the time, we can make an appreciable difference in reducing the amount of fluid to the point that they don't have fluid any longer, with about a 70-percent chance of them subsequently being in-foal," Rodgers says. "Of the 85 percent of those with little or no fluid, about 10 to15 percent still won't conceive, and therefore, the fluid retention was probably not their main issue. I also have used acupuncture quite a bit for horses that were not cycling properly.

"They either are not proceeding normally through the follicular stage (a follicle not maturing), or are in an anovulatory phase, not developing any follicles at all," Rodgers continues. "As long as they have a follicle that is at least 20mm in size, we are able to bring one follicle through ovulation about 70 to 80 percent of the time. If they have tiny follicles, less than 10-15mm, without a primary follicle that is trying to establish itself, it is likely, only a 30 to 40-percent chance that you can get a successful ovulation with two to three treatments. Sometimes you'll have to do more treatments. Usually with that we use a combination of dry needles with GnRH (gonadotropin-releasing hormone) in more than one of the ovarian points (along the bladder meridian along the back) to try to stimulate them."

Rodgers has also done a couple of mares with atonic uterus post-foaling, or atonic bladder post-foaling. Those treatments usually incorporate EA, with greater electricity, using points through the sacrum. Acupuncture has been used for those mares that are incontinent post-foaling, or partially so, or if they've had a foaling where the mare didn't really push at all, where the uterus post-foaling was unusually large and "baggy", and didn't involute very well in a normal time frame.

"Where the use of normal traditional medications, such as oxytocin, didn't seem to work, we'd use EA and successfully regain tone, function to the uterus," Rodgers says. "I've done two or three mares with atonic bladder. Those have all improved. I've done two mares that seemed to have atony of the uterus. They seemed to respond well, though they took more treatments, about five to six to get some resolution."

There is a syndrome that Dr. Marvin Cain, DVM, Versailles, Ohio, describes as the endocrine or reproductive syndrome, where mares become tender or "ouchy" in the back.

Cain uses acupuncture to treat mean fillies with hormone imbalance on the racetrack, common especially in the Fall and Spring. These fillies have a bad attitude, can be aggressive, and perform poorly on the track. According to Cain, it's not only their behavior that is affected by their hormones, but also their muscles. Due to the involvement of the psoas muscles, and the Meridian path and the structures below the L1 vertebrae, they tend to have a restricted forward choppy stride. It causes them to move up under themselves behind, instead of striding out properly, extending, they'll "bunny hop", running with both hind legs together sometimes. This hormonal imbalance occurs especially in the spring when there are a lot of transitional follicles, and when horses are shipped from track to track in the fall. Once shipped, being in a new environment, the fillies start cycling again, and begin to have the same serious problems.

Acupuncture treatment balances their hormonal output, which modifies their behavior and their physical performance. As the fillies cycle, it creates a surge in hormones that produces the physiological and behavioral consequences. Once treated with acupuncture, they tend to feel better. Once they are balanced, they run better. Their focus once again is racing, and their muscles then are allowing for proper gait and stride, Cain reports. One of the sequels to this ovarian maladjustment is "tying-up", he says. The acupuncture treatment, along with Chinese herbal medicine, also alleviates this muscular disorder and allows them to run freely again. Besides these racetrack fillies, Cain also uses acupuncture for deliveries, to enhance uterine tone, and for mares that pool urine.