Journey to Pregnancy
Fertility Treatment
Introduction to Fertility
It is estimated that 30-40% of women and men have difficulty in conceiving. The definition of infertility is the inability to conceive after a year of unprotected intercourse in women under 35, or after six months in women 35 or over, or the inability to carry a pregnancy to term. Also included are diagnosed problems of anovulation, tubal blockage, low sperm count, low morphology, etc.A diagnosis of infertility is not a diagnosis of sterility. While about 15% of all couples are infertile, only 1% is sterile (meaning that conception is physically ruled out). Of the couples that seek help, more than half can eventually conceive a child.
If you fall under any of the following you may want to seek specialized reproductive assistance:
- Regular unprotected intercourse with no pregnancy for a year
- Trying to conceive for at least 6 months when 35 years of age or older
- Irregular or difficult menstrual cycles
- A history of pelvic pain, infections, uterine fibroids, cysts, endometriosis
- Abdominal or reproductive surgery
- Two or more miscarriages
Male problems that may alert you to a problem may include:
- Low sperm count, motility, morphology
- Prostatitis, urinary infections
- Reproductive surgery
Methods of Impregnation: The following is a list, from preferred to less preferred, of methods of impregnation:
- Sexual intercourse
- Artificial insemination
- Fresh sperm preferred over frozen.
Acupuncture for Fertility
Acupuncture and traditional Chinese herbal medicine have had many years of success in assisting fertility. As stand alone modalities, acupuncture and Chinese herbal formulas have had great success in treating difficult conception. Current studies in the US and Europe are yielding very promising results for both males and females. Acupuncture Has Fertility Boosting Benefits, Acupuncture Improves Fertility in Men, Too, Effect or Acupuncture on Sperm Parameters.Acupuncture and Chinese herbal medicine incorporate thousands of years of clinical study, observation, and treatment of difficult conception. In the last 40 years with the introduction of Traditional Chinese Medicine into Europe and North America, we have seen an exponential increase in interest and studies pointing to the efficacy of this medicine in treating a variety of imbalances/illnesses ranging from depression to chronic and acute pain to infertility.Acupuncture and herbal medicine can assist conception in the following ways:
- Improve the function of the ovaries to produce higher quality eggs;
- Regulate the hormones to produce a larger number of follicles;
- Increase blood flow to the uterus and increase the uterine lining;
- Improve sperm volume, count, motility and morphology;
- Strengthen the immune system;
- Decrease stress;
- Increase the chance of conceiving;
- Decrease the chance of a miscarriage
IVF Support
Preparation for IVF cycle with acupuncture
Couples planning for a future IVF cycle should ideally begin preparatory acupuncture treatment 3 months prior to beginning their medicated cycle. Because ovarian follicles go through a 90-120 day follicular development period before they mature for ovulation, and sperm require a period of at least 90 days for maturation, we generally recommend a minimum of 3 months of treatment prior to IVF stimulation in order to best maximize egg and sperm quality.
Chinese medicine can greatly help to prepare the body in these areas, where western medicine offers few treatment options. Improving the quality of the parents' eggs and sperm prior to IVF is our main focus to help achieve a successful pregnancy and decrease the risk for early miscarriage.
For women, treatment is directed towards improving egg quality, hormonal balance and preparing an ideal uterine environment for implantation. We accomplish this through improving ovarian functioning, regulating reproductive hormones, increasing blood circulation to the ovaries and uterus, and by improving the quality of the follicular fluids that nourish the developing eggs. Pre-existing menstrual irregularities and other factors affecting fertility can be treated during this time to maximize natural reproductive health. The better prepared the body and mind are for the procedure ahead, the greater the chance in achieving a healthy pregnancy through IVF.
For many couples choosing to undergo an IVF cycle, male fertility factors also play a role. In the 3 months prior to IVF, Chinese medicine can be utilized to improve upon the quality of the sperm. Treatment is aimed at improving sperm count, morphology and motility. As with the woman’s eggs, healthier sperm contribute to healthier, more viable embryos.
Acupuncture Treatment during IVF cycle
Acupuncture treatment during the IVF cycle helps to increase a woman’s appropriate response to hormonal stimulation. Treatment varies dependent on the phase of IVF: down-regulation, ovarian stimulation, egg retrieval, uterine preparation, and embryo transfer.
A study published in "Fertility and Sterility" in 2009, by Dr. Paul Magarelli and Diane Cridennda, examined the effect that acupuncture had on women during IVF stimulation. Women who used acupuncture as part of their protocols had lower levels of stress hormones than women who did not use acupuncture. The acupuncture appeared to help normalize the levels of cortisol and prolactin that are normally negatively affected by IVF drugs. This may have positive implications for both egg quality and implantation. Both the pregnancy rates and live birth rates were significantly higher in the group of women who received acupuncture.
We preform acupuncture treatments designed to support the different phases of IVF while decreasing the side-effects often experienced from IVF medications. Specifically, work on the following treatment goals:
• Improve blood flow to the uterus and ovaries to improve ovarian response to hormonal stimulation during IVF
• Thicken uterine lining to encourage implantation at time of transfer and into early pregnancy
• Decrease uterine cramping to encourage implantation and reduce miscarriage of the transferred embryo/embryos
• Decrease cortisol and reduce stress levels to improve LH and progesterone production to develop fertile cycle dynamics
On-site Acupuncture Pre & Post Embryo Transfer
We recommend following the same guidelines set forth in clinical research for the timing of acupuncture surrounding embryo transfer. Research demonstrates a significant increase in conception rates in women who receive acupuncture before and after embryo transfer.
We understand that there is always uncertainty about the exact scheduling of the embryo transfer until after egg retrieval, and sometimes even later. We do our very best to accommodate our patients' treatment schedules to allow for acupuncture to be used within the recommended time frames. This means we will schedule weekends and off-days and hours for as needed pre and post transfer treatments. This service is performed at on-site in affiliation with Ottawa Fertility Centre.
The "Journal of Fertility and Sterility" published a 2006 study by Dr. Lars Westergaard examining the effectiveness of acupuncture treatment pre and post embryo transfer on the outcome of IVF cycles. Dr. Westergaard found that acupuncture pre and post embryo transfer resulted in increases in ongoing pregnancy rates from IVf of over 60%.
The goals of pre/post-embryo transfer acupuncture treatment are:
• Relaxation (less stress produces higher pregnancy rates)
• Improved blood flow to the uterus to promote higher implantation rates
• Decreased uterine spasms and cramping to improve implantation rates
• Decreased incidence of miscarriage.
Continuing Acupuncture after IVF
Treatment with Chinese medicine should be continued throughout the first trimester to protect early pregnancy and prevent miscarriage. Chinese medicine has a long history of treating underlying factors that can lead to miscarriage. We continue to see women once per week through the 14th week of pregnancy.
Unexplained Infertility
The diagnosis of unexplained infertility can be the most frustrating one. It often leaves women and men feeling confused and frustrated, wishing they could have a reason to focus on and pursue specific treatment for.
We see a large number of couples each year for assistance in the treatment of unexplained infertility. While conventional western medicine may not be able to provide answers to what the underlying obstacles are to a couple’s unexplained infertility, Chinese medicine examines in depth the signs and symptoms of the menstrual cycle, the couple’s lifestyle, overall wellness, and stress, to diagnosis and treat the underlying imbalances that are preventing pregnancy.
The first step in treatment for unexplained infertility is to determine what imbalances are evident in the menstrual cycle, and then work to correct them. At the same time, we work on developing a more fertile lifestyle through general wellness, nutrition, exercise and stress reduction. Treatment may involve both the hopeful mother and father, depending on what is appropriate to each couple’s situation.
If you are already working with a medical doctor and undergoing fertility treatments, your acupuncture treatments will be tailored to help your body respond better to the planned fertility treatments, while helping to correct the underlying imbalances that are preventing conception. This is important in order to be better prepared for the next cycle, if the current fertility treatment is not successful.
We encourage couples with unexplained infertility to follow a holistic treatment plan that works to enhance fertility for a preconception period of at least three months. We do see some couples who become pregnant in the first few cycles of treatment, but to establish correct hormonal balance and improve the health of both the eggs and sperm, the anticipated period of increased fertility begins several months into treatment. With couples that continue though this plan, we have seen many healthy pregnancies occur.
High FSH, Low Ovarian Reserve, Poor Egg Quality
Being told you have “bad” eggs or very few viable eggs can be a devastating blow. There are many tests today that attempt to determine ovarian reserve, egg quality and reproductive age, including FSH, AMH, clomid challenge, day 3 estradiol, and antral follicle counts. Abnormal results found through these tests generally result in the diagnosis of diminished ovarian reserve and poor egg quality. This news can seem overwhelming, and the possibilities for pregnancy bleak and hopeless.
There is hope. We have seen many, many women who have been told that they would only conceive using donor eggs, women who have had IVF cycles canceled due to poor response, and women who have had multiple failed IVF cycles go on to have biological babies both naturally and through a combination of holistic medicine with ART.
Clinical research confirms that Acupuncture and Chinese Medicine can successfully increase blood flow to the entire pelvic region, including the reproductive organs. When the ovaries age, and when we are stressed, the available blood flow to the ovaries, and developing eggs, decreases. By enhancing blood flow to the ovaries with acupuncture, egg quality may improve, and the ovaries can become more responsive to circulating hormones and FSH.
It is important to understand there are three types of ovarian egg-producing follicles: primordial, antral, and mature. Antral follicles are small follicles that are ready to grow through hormonal stimulation for ovulation. Antral follicles can be measured and counted using vaginal ultrasound early in the menstrual cycle. Many reproductive specialists consider a woman’s antral follicle count to be the best predictor of ovarian reserve and an important factor in a woman’s chances for success with IVF.
Primordial follicles are the microscopic follicles that are in a state of deep sleep; they are not yet growing in preparation for ovulation. Primordial follicles are dormant and cannot be seen, but each contains an immature egg that will develop and mature for future cycles over 90-120 days. Our goal with acupuncture is to stimulate blood flow to these follicles to improve their health, quality, ability to grow and mature, and to help the ovaries recruit larger numbers of primordial follicles to become antral follicles.
During the 90 day pre-conception period during which these primordial follicles transition to antral follicles, we will incorporate a variety of strategies to facilitate normal, healthy egg development. Acupuncture plays a crucial role in our treatment plans for cases of Elevated FSH, Diminished Ovarian Reserve and Poor Egg Quality. We also employ other techniques to improve blood flow and to address the metabolic needs of the developing ovarian follicles and residing eggs.
Your personalized plan may include a combination of acupuncture, healthy dietary changes, nutritional supplements, herbal formulae, environmental detoxification, stress reducing techniques, and exercise. Your treatment plan will be tailored specifically to you to best address the unique factors affecting your fertility to give you the best chance for a healthy pregnancy.
Many women that have consistently followed our treatment plans have seen their FSH levels decrease, their antral follicle counts increase, and, if undergoing a subsequent IVF cycle, better response to stimulation, more mature eggs upon retrieval, healthier embryos and successful pregnancies.
PCOS
Polycystic ovarian syndrome, also known as polycystic ovarian disease (PCOD) affects 5 to 10 percent of women in North America, and is the leading cause of ovulatory based infertility.
Women with PCOS have high levels of male hormones (androgens), which interfere with the normal production of female hormones like estrogen. This results in the ovaries filling with cysts, and creates immature follicles that are unable to generate healthy eggs.
Some women with PCOS have no symptoms. More often, however, women will experience some or all of the following symptoms:
• Weight gain or obesity
• Lack of ovulation, or very late ovulation
• Irregular periods or complete absence of menstruation (amenorrhea)
• Acne on the face, neck, chest and back
• Excessive hair growth (hirsutism) or abnormal hair growth
• Enlarged ovaries covered with cysts
• Insulin resistance/hyperinsulinemia
• Increased androgens (male hormones)
If your medical doctor suspects that you have PCOS, he or she may recommend that you have a blood test to check for elevated LH (luteinizing hormone), serum testosterone levels, and insulin resistance, and an ultrasound of the ovaries to determine if cysts are present (about 20% of all women will have ovarian cysts visible on the ultrasound, so having cysts does not necessarily mean you have PCOS).
It is always important to look at the individual pattern that each PCOS patient presents with. As women with PCOS know, every woman is affected differently. Women with PCOS can have many different combinations of symptoms and patterns of menstruation and ovulation.
We take into account all the signs and symptoms that are unique to your PCOS presentation to design a treatment plan specially targeted to bring your body back into balance. Treatment plans may combine acupuncture, diet, nutritional supplements, herbal formula, exercise, weight loss, and stress reduction techniques.
Our approach is to treat the underlying condition that is causing the hormonal imbalance as well as to alleviate symptoms. Typically a personalized treatment plan to re-balance hormones and regulate the menstrual period takes several months.
Many woman are able to regain regular cycles, ovulate regularly and conceive naturally with the help of our treatments and advice. Some women will still need to incorporate prescription medications into their fertility plan; we discuss this on a case by case basis. For these cases, incorporating a holistic treatment plan in conjunction with western treatment can help women with PCOS respond with less resistance to fertility treatments, and to more effectively develop healthy, mature eggs than with fertility drugs alone.
Endometriosis
Endometriosis is the presence of endometrial cells which make up the inner lining of the uterus outside of the uterus in the pelvic cavity.
It is not entirely known why women with endometriosis often have difficulty conceiving.
THE FOLLOWING FACTORS HAVE BEEN IDENTIFIED AS POTENTIAL FERTILITY IMPEDIMENTS FOR WOMEN WITH ENDOMETRIOSIS:
• The fallopian tubes may function abnormally, due to adhesions or scarring.
• The ovaries may not be functioning properly, possibly resulting in poor egg quality.
• Endometriosis may release toxic substances which may harm embryos during implantation.
• There may be higher risks for early miscarriage and chemical pregnancy.
• Immunological factors involved in endometriosis play an important role in endometriosis associated infertility.
Some women with endometriosis do not experience physical symptoms other than difficulty conceiving. The most common symptoms are:
• Menstrual cramps (pain level is not a good indicator of the severity of the endometriosis)
• Ovulation pain
• Difficult or painful intercourse
• Bleeding between periods
• Heavy menstrual bleeding
• Lower back pain
• Irregular or painful bowel movements
• Nausea and vomiting
• Infertility or sub-fertility
We take a multi-faceted approach to the treatment of endometriosis. We focus on regulating the menstrual cycle to improve hormonal balance, which in turn produces healthier eggs and promotes successful ovulation. Endometriosis can adversely affect the uterine environment, so we include strategies to address blood flow and reduce the inflammatory immune response that may interfere with implantation. This encourages a more “friendly” uterine environment for both implantation and early pregnancy. Lastly, we work to address specific symptom discomforts such as menstrual cramping, heavy menstrual flow and digestive pain.
Many women notice an improvement in the symptoms of their endometriosis very early into treatment. Acupuncture is a great alternative to surgery for women without structural obstructions to fertility due to scarring or adhesions from endometriosis. Acupuncture, incorporated into a comprehensive plan of fertile-living strategies, can provide a great deal of help in reducing the negative impacts endometriosis has on fertility, and can allow for pregnancy to be possible.
Male Infertility
Almost one in six couples experience fertility problems. Studies show that while 40% of the time infertility is the result of female factors, 40% of the time it's also the result of male factors and 20% of the time the result is of a combination of both women and men. If you are experiencing difficulties getting pregnant, it is important that the male partner get his sperm checked since men can contribute to a couple's infertility over 50% of the time. The good news is men are easier to treat than females since men are constantly making new sperm (approximately 1000 sperm per heart beat).
Unfortunately male factor infertility gets overlooked since conventional treatment defaults to Intracytoplasmic sperm injection (ICSI) which put the woman through a medicated procedure involving surgery to remove her eggs to be inseminated by sperm in the IVF lab. If the case involves just the man, then there is so many non invasive treatments he can do so his female partner does not have to undergo an ICSI cycle. It takes about 72 to 90 days for sperm to mature and we have devised a program at Acubalance that involves lifestyle changes, avoiding environmental toxins that damage sperm, supplements known to improve sperm count, motility, morphology and repair DNA fragmentation and acupuncture over a 3 to 6 month period to optimize a mens sperm quality and allow him to reach his peak fertility potential.
Sperm problems may involve the quantity and/or quality of the sperm. A simple semen analysis can assess basic fertility. This simply involves asking your family doctor for a test requisition and taking a sperm sample to a local lab for testing. Often men feel embarrassed or stressed about providing the sample. There is no need to as the sample can be collected at home and discretely dropped off at a laboratory near you.
The semen analysis looks at the sperm in three different ways:
1. Sperm Count: This is the most important part of the test and the more sperm there is, the better!
2. Sperm Motility: This measures the percentage of sperm that is moving in a forward direction -- sperm needs to be able to travel from the vagina to the fallopian tubes where they meet the egg).
3. Sperm Morphology: This measures the shape of the sperm.It is quite common for men to have lot of abnormally-shaped sperm. Don’t feel too worried if you get this result as no one really knows how much impact this has on your overall fertility.
The following issues are the most common causes of male factor infertility:
Structural Problems
Various structural problems, such as blockages, can obstruct the passage of sperm or impair the ability to produce healthy sperm. These can result in several conditions, such as:
- Scarring
- Undescended testes
- Varicocele
- Vasectomy
Hormonal Imbalances
Imbalances caused by a lack of communication between the hypothalamus, the pituitary gland, and the testes can affect a man’s ability to produce healthy sperm.
Infections & Diseases
Many health conditions or diseases, including diabetes, cystic fibrosis, mumps, and any extended period of high fever, can reduce sperm production. As men are continually producing sperm, the infection effects may be reversible if no scarring or blockage has occurred, which can result in sperm function being restored over time.
Age
New research is showing that men’s sperm quality begins to decline around the age of 45 and impacts the health outcome of their child. We suggest men be proactive and make lifestyle changes and consult with an Acubalance practitioner to learn how to optimize soerm quality which impacts the health blueprint of your child.
Environmental Factors
There has been a dramatic decrease in men’s sperm counts worldwide. While the reason for this decline isn’t confirmed, many scientists believe environmental factors to be the cause
Additionally, working at a job where you are exposed to a lot of toxins can adversely affect your sperm count.
Lifestyles
Lifestyle factors can have a negative effect on sperm counts. These factors include:
- Unhealthy diet
- Excessive alcohol
- Marijuana
- Cigarettes
- Hot tubs
- Overweight (BMI over 25)
Treatments:
Acupuncture:
Recent studies have shown that acupuncture can effectively:
- Increase sperm production
- Increase the percentage of healthy sperm
- Improve sperm movement (motility)
- Improve the levels of hormones responsible for fertility
- Increase the rate of pregnancy when used in conjunction with ART studies
Acupuncture needles are never inserted into the genitals. The needles are instead painlessly inserted into acupuncture points in various other parts of the body.
Herbal Therapy
Herbal therapy is another important aspect of Chinese Medicine, and provides an essential compliment to acupuncture. Studies have shown that herbal formulas may improve low sperm counts or poor motility in male factor infertility.