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Fertility

The Western View

After one year of unprotected intercourse without having achieved pregnancy a couple is considered infertile. If a medical cause for infertility is discovered, various treatment options can be considered, including Oriental medicine. 10% of American couples suffer from infertility. Among infertile couples, about 40% are due to female infertility, 40% are due to male infertility, 10% have both female and male factor involvement, and about 10% have unexplained causes.

While the causes are unknown, these couples are still encouraged to try treatment. Western medicine offers them tools with assisted reproductive technology (ART). Couples with unexplained infertility often find acupuncture and Oriental medicine to be a non-invasive, inexpensive way to offer a new perspective on their fertility process.

Female factors include ovulation disorders, fallopian tube obstruction and scarring, uterine and cervical disorders, endometriosis, immunological factors, polycystic ovaries, (premature) ovarian failure, and poor egg quality.

Male factors include low sperm count, abnormal sperm morphology, poor motility, varicocele, immunological factors, sperm fragmentation, and ejaculation disorders.

Western Medical Treatment Options

Ovulation induction through gonadotropin injections, artificial insemination (IUI) with or without the use of gonadotropins, In-Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), Zygote Intrafallopian Transfer (ZIFT), Intracytoplasmic Sperm Injection (ICSI), Epididymal and testicular sperm extraction, freezing of sperm and embryos, donor eggs, sperm or embryos, surrogate parenting, embryo adoption. Acupuncture has been a recent addition to many ART clinic programs in Europe and the United States. 

How can Oriental Medicine enhance fertility for me and my partner?


Oriental Medicine (OM) has long been known to treat both female and male infertility. Infertility seems to be on the rise in women and men of all ages, although it is exacerbated by the fact that many of today’s couples delay child-bearing. Infertility affects about one in six couples.

OM teaches that fertility is a woman’s natural state between the onset of her menstruation and menopause. Problems with fertility in both men and women result from imbalances within the organ systems, hormones, and energy networks or acupuncture meridians.

The premise for Oriental medicine in the treatment of infertility is to create a hospitable environment in a woman’s womb. This can be achieved using herbs, acupuncture, and appropriate diet. In traditional cultures, couples typically prepared themselves for six months to a year prior to conception, by eating specific nutrient-dense, fertility-enhancing foods. Eating these “fertility foods” can positively influence a couple’s ability to conceive. Couples coming to Oriental Health Solutions will receive a detailed meal plan that is custom-tailored to fit their individual constitutions and needs. It is our goal to not just assist couples to have a child, but to have an extremely healthy child.

healthy smilesTo learn more about this, you can review our Blueprint for a Healthy Baby which is based on the work of Weston A. Price, DDS.

How can Oriental Medicine and Acupuncture address my partner’s and my infertility problems?

Oriental medicine offers a natural, non-invasive approach to treating infertility by focusing on enhancing the quality of eggs, sperm, endometrial lining and cervical fluid. Sometimes this approach is sufficient for couples to conceive on their own and it offers a valuable adjunct for couples who are about to undergo the expense and physical demands of IVF. Acupuncture can also support patients during in vitro fertilization using your own eggs or those of a donor, artificial insemination, and gonadotropin assisted cycles. Studies have shown that acupuncture increases the success rate of ART and helps to alleviate side-effects (Paulus et al, 2001, Magarelli et al, 2009). The largest meta-analysis on acupuncture and IVF to date, involving 24 randomized clinical trials (RCTs) and 5,547 completed embryo transfers, found that acupuncture significantly improves both clinical pregnancy rates and live birth rates (Zheng et al, 2012). Acupuncture is a low-cost, noninvasive, safe treatment, and has virtually no side effects. Many fertility clinics recommend that patients have acupuncture in order to enhance their Western medical procedures. 

healthy baby video

How does the science interpret Oriental Medicine’s effects on fertility?

Many scientific studies have examined how acupuncture affects the body. Researchers have found evidence that acupuncture points are conductors of electromagnetic impulses. Stimulating these points along their pathways via acupuncture enables the release of endorphins and stimulates immune system cells to specific sites. It activates opioids within the central nervous system, which is associated with pain reduction. Acupuncture has been shown to alter brain activity, body sensations and autonomic nervous system functions. Acupuncture impacts autonomic nervous system functions such as immune reactions, blood pressure, blood flow, and body temperature regulation. It regulates brain chemistry by changing the release of neurotransmitters and neuro-hormones in a beneficial way. Studies show promising data that acupuncture affects the menstrual cycle by altering neuroendocrine effects on the body. This means that different combinations of acupuncture points may play a role in the release of the hormones responsible for regulating a woman’s menstrual cycle and enhancing a couple’s fertility. (Pomeranz et al, 2001)

How does stress affect fertility?

Research has shown that acupuncture treatments reduce stress, a common occurrence for couples dealing with infertility. Stress alters the subtle but important balance between the hypothalamus, pituitary and reproductive organs. This is why stress, among other factors, may cause irregular menstruation and/or premenstrual syndrome. A stressed woman is generally tense, and as a result may suffer more from spasms in the fallopian tubes and the uterus, which may disrupt implantation. Stress is also associated with more anxiety and depression, which would negatively affect fertility. Acupuncture releases endorphins, thereby counteracting the negative effects of stress. Many patients find their acupuncture sessions to be a very relaxing experience that induces an almost trance-like state, which is most likely due to the release of endorphins. Many patients even fall asleep during treatments (Chang et al, 2002).

Low-Cost, High-Quality Pregnancy & Ovulation Tests

mother and baby Good quality early pregnancy tests and ovulation tests can be found at http://www.early-pregnancy-tests.com/.

http://store.yahoo.com/cgi-bin/clink?early-pregnancy-tests+2bVFHV+index.html

Basal body temperature thermometers are also available.

Can Acupuncture, diet and Chinese herbs help build a woman’s endometrial lining?

Acupuncture has been shown to increase blood flow to the reproductive organs. A nutrient-dense diet that builds good quality blood and optimal hormonal balance provides the ovaries and uterus with the best raw materials to grow a healthy baby. The Chinese pharmacopeia offers many blood tonics that enrich the endometrial lining. Increased blood flow improves follicle and egg health and promotes the lining of the uterus to create a hospitable environment for an embryo to implant and grow. This holds true whether the woman is undergoing gonadotropin therapy or is attempting to conceive naturally (Stener-Victorin, 1998).

How does Oriental Medicine address high FSH levels?

Women who have elevated FSH levels will benefit from regulating their cycles through acupuncture and Chinese herbal therapy, which increase blood flow to the reproductive organs and balance within the endocrine system. FSH levels can fluctuate; having one FSH test result is only a snapshot of that hormone during a very narrow window of time, but it does give some information on general ovarian responsiveness. Acupuncture and Chinese herbal therapy—two tools that have been used for over a thousand years to enhance fertility—can be helpful for women who have had a high FSH reading and want to improve the state of their eggs and ovaries. Treatment is often successful, and allows the woman to conceive naturally or with the help of Assisted Reproductive Technology (ART). 

How does acupuncture benefit conception?


baby FangStrengthening the immune system plays a very important role in conception. Acupuncture helps to adjust the amount of white blood cells, T-cells and antibodies in the body thereby regulating the body’s immune system. This is relevant when there are immunological reasons for infertility, failed implantation problems, or repeated miscarriages. Inflammation, so common in the general population, can also have an effect on the reproductive system; this is particular seen in those women who may have food sensitivities (Soni 2010). Women with endometriosis typically present with some type of systemic inflammation as well as circulatory problems. Acupuncture also fosters receptivity by opening the energy pathways, or meridians. There are many benefits to using acupuncture, herbal therapy, targeted diets, and nutritional supplements to effectively curb the inflammatory response, and enhance implantation (Gerhard 1992; Emmons et al, 2001).
Photo © Fang Cai

How can Oriental Medicine help with recurrent miscarriages?

Women who suffer from recurrent miscarriages either have an imbalanced immune system, or undernourished reproductive system. Soni et al, for example, looked at celiac disease and its potential of altering fertility due to its immunological impact (Soni et al, 2010). A thorough health history and analysis will determine how this issue should be addressed. Often, women benefit greatly from eating a nutrient-dense diet, supplementing with omega-3 fatty acids and taking Chinese herbs for a short time to nourish the reproductive organs. Additionally, acupuncture treatments can assist pregnant women in preventing a miscarriage.

I was diagnosed with PCOS. What can you offer?

An estimated 10% of childbearing women have Polycystic Ovarian Disease (PCOS).  PCOS is a disorder that typically presents with obesity, hirsutism (unusual hair growth in the face, chest, back, etc), and acne. An ultrasound may reveal many unripe fluid-filled sacs around the ovaries. Many women suffer from anovulation and subsequent amenorrhea (no periods); and others have regular or irregular cycles. Many women have high levels of male hormones, also known as androgens. In women with PCOS, the ovaries do not produce all the hormones they need for follicles to fully mature. The follicles start to grow, but merely become cysts rather than fully-developed eggs. Because mature eggs secrete progesterone, progesterone is not produced in PCOS patients. Instead, the cysts may produce male hormones, which in turn prevent ovulation. Some of these women are prone to type-II diabetes, high cholesterol, high blood pressure, patches of thickened skin and dark brown or black skin on the neck, arms, breasts, or thighs (acanthosis nigricans).

The cause for PCOS seems to point to insulin-resistance in which estradiol is converted into testosterone, causing the follicles to not fully mature during the usually estrogen-rich follicular phase. Therefore, maintaining a healthy diet that is devoid of sugar, starches and simple carbohydrates may be very important. Both acupuncture and herbal medicine can help to regulate insulin levels and balance the endocrine system (Stener-Victorin 2000).

Can Acupuncture enhance the outcome of Assisted Reproductive Therapy? (ART) 

Couples who have healthy sperm, eggs, and good quality endometrial lining typically have better outcomes when using ART. Many traditional cultures encouraged couples who were ready to conceive to eat sacred, nutrient-dense diets for about six months prior to trying to conceive. Oriental medicine also advocates the use of special fertility diets for couples who are attempting natural conception or use ART. Acupuncture improves ART success rates by improving egg quality, nourishing the uterine environment, and balancing the woman’s endocrine system, thereby increasing clinical pregnancy rates and live birth rates (Paulus et al, 2001; Chang et al, 2002; Westergaard et al, 2006; Smith et al, 2006; Magarelli et al, 2009, Zheng et al, 2012).

What about the side-effects of ART?

Acupuncture helps reduce the side effects some women experience from the medications and the stress of the IVF experience. Treatments help women to feel less anxious, more relaxed, and empowered. Acupunctures helps treat abdominal bloating, mood swings, hot flashes, insomnia, and headaches that women may experience during the ART cycle.

How can Oriental Medicine help sperm count, morphology and motility?

herbsIn men, infertility may be due to physiological or life-style problems. Male sperm counts in the U.S. have diminished by 50% since 1945 (Sinclair 2000). This may be due to dietary changes, xeno-estrogens (estrogen-like components in pesticides and herbicides in the environment), heavy metals and other environmental factors. An estimated 10% of men are infertile, and the male partner is a factor in up to 50% of infertile couples. In many cases, the exact cause of male infertility is unknown. Several studies indicate that acupuncture treatments significantly improve total functional sperm, the percentage of sperm viability, and the total motile spermatozoa per ejaculate. These results were obtained by taking sperm samples from the men before and after one to three months of acupuncture treatment (Siterman et al, 2000; Fischl et al, 1984).

Pei et al, found that acupuncture improved sperm production and motility (a measure of forward movement of sperm). Sperm samples were analyzed at the beginning and end of the study and showed significant improvements in sperm quality in the acupuncture group compared with the other group. Acupuncture treatment showed fewer structural defects in the sperm and an increase in the number of normal sperm in ejaculate. But other sperm abnormalities, such as immature sperm or sperm death, remained unchanged by acupuncture. The researchers state that acupuncture treatment is a simple, noninvasive method that can improve sperm quality (Pei et al, 2005).

What happens during a session?

During the initial visit we discuss your medical history, fertility related issues, menstrual history, and perform a physical examination. The physical examination consists of checking your pulse on your wrists, looking at the tongue and performing diagnostic palpations, which involves the pressing of specific reflex zones both on the abdomen, neck, hands, and feet. The palpation will offer further insights into the exact nature of the condition. The resulting treatment plan may consist of treatments at individual intervals using acupuncture, custom tailored herbal medicine, daily basal body temperature charting according to the Fertility Awareness Method (Ehling/Singer, 2001), dietary assessment and custom-tailored meal plans, and stress reduction techniques.

How many sessions are usually necessary?

Although it is not a requirement, it is ideal to begin therapy at least three months prior to ART, or have treatment for a minimum of three months if trying to conceive naturally. Sperm development takes approximately 90 days from start to finish; dormant egg cells take a comparable amount of time to mature. Also, it may take a few months for a woman to build up sufficient endometrial nutrients and balance her hormones. Therefore, it is best to carry out any necessary treatments, and make necessary dietary and lifestyle adjustments during this crucial three month window.

During this time, you and your partner may receive acupuncture treatments, make dietary adjustments, take fertility-enhancing Chinese herbs and nutritional supplements, or do a combination of these therapies. We recommend giving yourself a minimum of three moths to have the therapies take their desired effect, although we have helped many patients conceive during that time frame.

The practitioners at OHS have decades of experience and some are certified by the American Board of Oriental Reproductive Endocrinology - ABORM (www.aborm.org). We are always happy to work with you and your doctor in a way that best fits your needs.

The Ovarian Assessment Report (OAR)

The Ovarian Assessment Report by ReproSource, Inc provides women with an accurate assessment of ovulatory egg supply via testing of a single blood sample. The report provides women with their Egg Retrieval Score (ERS), which is a unique index score that gives a good estimate of the ovulatory egg supply by combining age with multiple ovary-related hormones. This test measures Anti-Müllerian hormone (AMH), Inhibin B, FSH, LH and estradiol. The ERS is a better predictor of IVF response than any of the FSH or AMH tests alone.

The test is ordered and interpreted by Paul Magarelli M.D., a Board Certified Reproductive Endocrinologist and Infertility specialist; he will provide OHS with the results for you.

References

1. Pomeranz B. Acupuncture Analgesia-Basic Research, Stux G, Hammershlag R (eds), Clinical Acupuncture: Scientific Basis, Berlin:Springer-Verlag, 2001. pp. 1-29

2. Stener-Victorin E. Reduction of blood flow impedance in the uterine arteries of infertility women with electro-acupuncture. Human Reproduction, Vol.11, No.6, 1996.—This study looked at women who had previously been diagnosed with a thin endometrial lining as a possible cause of fertility. The treatment group was given acupuncture for one month leading up to their IVF cycle and the uterine artery blood flow increased significantly within this time frame. This led to thicker endometrial lining in the treatment group versus the non-treatment group.

3. Gerhard I. Gynecol Endocrinol. 1992;6(3):171-181. Infertility: Similar results to hormonal treatment but with fewer side effects.

4. Emmons SL, Patton P. Acupuncture Treatment for infertile women undergoing intracytoplasmic sperm injection. Medical Acupuncture, A Journal for Physicians by Physicians, 2001 Vol. 12, No.2. – This study describes the use of acupuncture to stimulate follicle development in women undergoing in vitro fertilization. The case series included 6 women receiving intracytoplasmic sperm injection and acupuncture along with agents for ovarian stimulation.  The results revealed no pregnancies occurred in the non-acupuncture cycles. Three women produced more follicles with acupuncture treatment (mean, 11.3 vs 3.9 prior to acupuncture; P=.005). All 3 women conceived, but only 1 pregnancy lasted past the 1st trimester. Acupuncture may be a useful adjunct to gonadotropin therapy to produce follicles in women undergoing in vitro fertilization. This study examined whether acupuncture stimulated follicle development in women undergoing IVF. The patients in the study had previously exhibited poor follicle development despite the use of gonadotropins. Acupuncture was used twice a week for 4 weeks leading up to egg retrieval the results showed that the non-treatment group had an average amount of 3.7 follicles whereas the acupuncture treatment group had an average of 8.4 follicles.

5. Stener-Victorin E. Acta Obstet Gynecol Scand. 2000;79(3):180-8. Anovulation in PCOS: Electro-acupuncture appears to be useful to help stimulate ovulation in women with PCOS.

6. Chang R, et al. Role of acupuncture in the treatment of female infertility. Fertility and Sterility, Dec 2002;78(6):—Literature review of existing scientific rationale and clinical data for acupuncture for female infertility. Findings included positive effects on the central nervous system, influences on gonatropin secretion, and effects on uterine blood flow which affects endometrial thickness and morphology all of which are relevant for implantation. Acupuncture showed also significant improvements on stress related to infertility.

7. Paulus W, et al. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and Sterility, April 2002;77(4):721-4.—This study found that in a group of 160 women 80 who were treated with acupuncture before and after the embryo transfer phase of IVF had a 42.5% pregnancy rate vs. a 26.3% pregnancy rate in the non-treatment group.

8. Zheng CH et al. Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis. Fertility and Sterility, 2012 [Epub] – This is a meta-analysis of 24 randomized clinical trials for acupuncture and IVF, involving 5,807 participants. Clinical pregnancy rates and live birth rates were significantly higher in acupuncture groups as compared to sham or control groups. 

9. Westergaard LG, Mao Q, Krogslun M, Sandrini S, Lenz S, Grinsted J. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril, 2006 May;85(5):1341-6. – This study was a repeat of the Paulus study above showing 39% higher rates of pregnancy in the acupuncture treatment group.

10. Smith C, Coyle M, Norman RJ. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril, 2006 May;85(5):1352-8. —In this single-blinded, randomized controlled trial using an acupuncture treatment group and a sham acupuncture group, the pregnancy rate was 31% in the acupuncture group vs. 23% in the control group. The ongoing pregnancy rate was higher in the treatment group: 28% vs. 18%. 

11. Magarelli PC, Cridennda DK, Cohen M. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization-embryo transfer treatment. Fertil Steril 2009 Dec;92(6):1870-9.

12. Sinclair S. Male Infertility: Nutritional and environmental considerations. Altern Med Rev. 2000 Feb;5(1):28-38.

13. Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does Acupuncture treatment affect sperm density in males with very low sperm counts? A pilot study. Andrologia. 2000, Jan;32(1):31-9. The treatment group showed a significant improvement in sperm counts when compared to the control group which did not receive treatment.

14. Fischl F, Riegler R, Bieglmayer C, Nasr F, Neumark J. Modification of semen quality by acupuncture in subfertile males. Geburtshilfe Frauenheilkunde, 1984 Aug;4498):510-2. – This study also looked at sperm counts and overall motility and morphology and found that the acupuncture treatment group showed significant higher counts when compared to the non-treatment group.

15. Pei J, Strehler E, Noss U, et al. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertility and Sterility July 2005;84(1):141-7.

16. Ehling D, Singer K. Gauging a Woman’s Health by her Fertility Signals: Integrating Western with Traditional Chinese Medical Observations. Altern Ther Health Med. 1999;5(6):70-83. An analysis of using Fertility Awareness Method in conjunction with Oriental Medicine. Full article on www.orientalhealthsolutions.com/resources

17. Soni S, Badawy SZ. Celiac disease and its effect on human reproduction: a Review: J Reprod Med. 2010 Jan-Feb;55(1-2):3-8

Other studies of interest:

Tanaka T; Mizuno K; Umesaki N; Ogita S.  A preliminary immunopharmacological study of an antiendometriotic herbal medicine, Keishi-bukuryo-gan.  Osaka City Med J, 44(1):117-24 1998 Jun

Jeng H; Wu CM; Su SJ; Chang WC.  A substance isolated from Cornus officinalis enhances the motility of human sperm.  Am J Chin Med 1997;25(3-4):301-6.

Mo X; Li D; Pu Y; Xi G; Fu Z.  Clinical studies on the mechanism for acupuncture stimulation of ovulation.

Zeisler H, Eppel W, Husslein P, Bernaschek G, Deutinger J.  Influence of acupuncture on Doppler ultrasound in pregnant women.  BJOG:  An International Journal of Obstetrics and Gynaecology 109:12, 1419-1419.

Yoshimoto, Yasuhiro, M.D., Miyake, Akira, M.D., Tasaka, Keliichi, M.D., Aono, Toshihiro, M.D.  Ovulation following combined therapy with wen-jing-tang and clomiphene citrate therapy in anovulatory women.  American Journal of Chinese Medicine, Vol XVII Nos. 3-4, pp. 243-244, 1989.

Ying, Chen Bo, M.D., Jin, Yu, M.D.  Relationship between blood radioimmunoreactive beta-endorphin and hand skin temp during the electro-acu induction of ovulation.  Acupuncture & Electro-Therapeutics Res., Vol. 16, pp. 1-5, 1991.

Xuefen, Cai.  Substitution of acupuncture for HCG in ovulation induction.  Journal of Traditional Chinese Medicine 17 (2):119-121, 1997.
Chen, Bo-Ying, M.D.  Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis.  Acupuncture & Electro-Therapeutics Res., Int. J., Vol. 22, pp. 97-108, 1997.

Male Factor:

Gurfinkel, Edson, Cedenho, Agnaldo P, Yamamura, Ysao, Srougi, Miguel.  Effects of acupuncture and moxa treatment in patients with semen abnormalities.  Asian J Androl 2003 Dec;5:345-348.

Ishikawa H; Ohashi M; Hayakawa K; Kaneko S; Hata M.  Effects of guizhi-fuling-wan on male infertility with varicocele.  Am J Chin Med, 24(3-4):327-31 1966.

Yue GP; Chen Q.  Male infertility treated by bushen shengjing pill in clinical observation and evaluation on its curative effect.  Chung Kuo Chung His I Chieh Ho Tsa Chih, 16(8):463-6 1996 Aug.

Lai AN; Song JF; Liu XJ.  An experimental study on inhibitory effect of Chinese medicine tai-bao on antisperm antibody.  Chung Kuo Chung His I Chieh Ho Tsa Chih, 17(6):360-2 1997 Jun.

Yamanaka M; Kitamura M; Kishikawa H; Tsuboniwa N; Koga M; Nishimura K; Tsujimura A; Takahara S; Matsumiya K; Okuyama A.  Direct effects of Chinese herbal medicine “hachuekkito” on sperm movement.  Nippon Hinyokika Gakkaie Zasshi, 89(7):641-6 1998 Jul.