Paulus Protocol

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The Paulus Protocol and fertility acupuncture

Since 2002, the Paulus Protocol has played a significant role in shaping how acupuncture is used alongside IVF treatment. It is one of the earliest attempts to examine fertility acupuncture within a controlled clinical trial, and it provided a practical framework that many practitioners have since adopted or adapted.

The original study, conducted by Wolfgang Paulus, investigated whether acupuncture given around the time of embryo transfer (ET) could influence implantation rates in women undergoing IVF.

The original study

The trial involved 160 women undergoing IVF treatment, divided into two equal groups of 80.

• One group received two acupuncture treatments on the day of embryo transfer
  • one shortly before ET
  • one shortly after ET
• The second group acted as a control group and received no additional treatment on the day.

The acupuncture protocol used a fixed set of points, chosen with specific physiological aims in mind:
to encourage uterine blood flow, reduce areas of tension or stagnation, and promote overall systemic relaxation at a critical moment in the IVF process.

Results

The outcome measure was whether implantation occurred.

• In the control group, 21 out of 80 women experienced successful implantation — approximately 26%
• In the acupuncture group, 34 out of 80 women implanted successfully — approximately 43%

This difference was statistically significant and attracted considerable attention at the time, helping to bring fertility acupuncture into wider clinical discussion.

Developments since the original protocol

Since the original publication, the Paulus Protocol has been revisited, modified, and refined by many experienced practitioners.

Subsequent discussion and research have suggested that:

• The strict requirement to treat only on the day of embryo transfer is not always essential, particularly regarding the pre-transfer treatment
• Acupuncture given in the days leading up to ET may be equally important in preparing the uterine environment and regulating the nervous system

As understanding of timing and physiology has evolved, many practitioners now use the Paulus Protocol as a foundation, rather than as a rigid formula.

A Chinese Medicine perspective: refinement and depth

From a Chinese Medicine standpoint, later adaptations of the protocol have focused on enhancing the functional relationships between channels, rather than simply repeating the original point prescription.

In particular, leading practitioners have emphasised the role of the Extraordinary Vessels — channel systems that are deeply involved in regulation of reproduction, constitutional balance, and the uterus itself.

This approach aims not only to influence blood flow and relaxation, but also to:

• support the communication between Kidney, Uterus, and Heart
• stabilise the emotional and autonomic state
• create a calm, receptive internal environment

The modified Paulus protocol used in practice

For those familiar with Chinese Medicine terminology, a commonly used modified Paulus protocol includes:

Before embryo transfer

• DU-20
• PC-6
• SP-4
• ST-29
• SP-8

After embryo transfer

• LI-4
• SP-10
• ST-36
• SP-6
• LU-7
• KID-6

This combination is designed to be supportive yet calming, promoting circulation without overstimulation and helping the body settle after the procedure.

Individualised treatment

In my practice, acupuncture is never applied mechanically.

While the modified Paulus protocol provides a useful starting point, each treatment is shaped by:

• the individual’s presentation
• pulse and channel assessment
• constitutional tendencies
• emotional and nervous-system state

The protocol acts as a reference framework, not a fixed recipe. Point selection is adjusted to reflect the actual energetic balance present at the time of treatment, ensuring that care remains individualised, responsive, and clinically appropriate.

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