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Infertility

The superior physician does not just treat disease but teaches society and helps form the intentions of humanity.
~Sun Si Miao

mother and baby

The Western View:

Definition: 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 entertained 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 whereas 10% have unexplained causes.

Unexplained Infertility:
While the causes are unknown, these couples are still encouraged to try treatment. 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 Infertility: Ovulation disorders, fallopian tube obstruction and scarring, uterine and cervical disorders, endometriosis, immunological factors, polycystic ovaries, (premature) ovarian failure.

Male Infertility: Low sperm count, abnormal sperm morphology, poor motility, varicocele, immunological factors, 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, and adoption. Acupuncture has been a recent addition to many ART clinic programs in Europe and the United States. 

How can I enhance my fertility?
Oriental Medicine (OM) has long been known to treat both female and male infertility. Infertility seems to be on the rise though it appears mostly to be related to the fact that today’s couples delay child-bearing. Infertility affects about one in six couples. Anovulation, amenorrhea, short luteal phase, or various hormonal imbalances may be the cause though there are many other reasons why infertility persists.

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 nutrition. In traditional cultures, couples typically prepared themselves six months prior to conception by eating specific nutrient-dense, fertility-enhancing foods. Eating these types of foods which are based on an Oriental medical diagnosis can positively influence a couple’s ability to conceive. Couples coming to Oriental Health Solutions will receive a detailed meal plan.

What can Oriental Medicine and Acupuncture do for my partner’s and my infertility problem?

infantOriental 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 may also support patients during in vitro fertilization, artificial insemination, and gonadotropin assisted cycles using your own eggs or those of a donor. Studies have shown that acupuncture increases the success rate of ART and helps to alleviate side-effects (Paulus et al, 2001). Acupuncture is a low-cost, noninvasive, safe treatment, and has virtually no side effects. It’s a great adjunct treatment to western medical procedures. A CBS News article in 2004 described the merits of using acupuncture for the treatment of infertility in which it described how couples are turning more frequently to acupuncture to enhance their fertility and in vitro fertilization outcomes and the importance of finding a qualified and experienced practitioner to treat underlying problems (CBS news 2004). A recent study published in Fertility & Sterility (December 2009) Diane Cridennda LAc and Paul Magarelli MD were able to show how acupuncture enhances IVF outcomes as well as explain methods of action. Please click on the photo above to listen to a Dawn Davenport’s radio interview on the subject.

How does Oriental Medicine and Acupuncture affect our fertility?

Researchers have examined 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 alters brain chemistry by changing the release of neurotransmitters and neuro-hormones in a beneficial way. Studies show promising data that acupuncture may affect the menstrual cycle by changing 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 balance between the hypothalamus, pituitary and reproductive organs which is why stress, among other factors, may contribute to irregular menstruation and/or premenstrual syndrome. A stressed woman is generally tense, and may, therefore, suffer more likely from spasms in the fallopian tubes and the uterus which may disrupt implantation. Stress also makes her susceptible to mood swings. Acupuncture releases endorphins thereby counters the negative effects of stress. Many patients experience acupuncture as a very relaxing experience that can be felt as 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)

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. Healthy blood supported by a healthy, nutrient-dense diet will provide the ovaries and uterus with more nourishment. 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 my high FSH levels?

Women who have elevated FSH levels may benefit from increased blood flow to the reproductive organs and thereby create balance within the endocrine system. FSH levels can fluctuate and unfortunately, having one FSH test result is only a window into what is going on at that specific time. Oriental medicine offers both acupuncture and Chinese herbal therapy to women who are in this situation and many times treatment is successful allowing her to conceive naturally or with the help for Assisted Reproductive Technology (ART). Specific herbs have been known for thousands of years to enhance the health of follicles.

How does acupuncture benefit conception?

Strengthening 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. 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 (meridians). There are many benefits to using acupuncture, herbal therapy, targeted diets, and nutritional supplements to effectively curb the inflammatory response.  (Gerhard 1992 ; Emmons et al, 2001)

I have had several miscarriages. How can Oriental Medicine help?

Women who suffer from repeated miscarriages either have an imbalanced immune system, or undernourished reproductive system. A thorough health history and analysis will determine how this issue should be addressed. Often, women benefit greatly from eating a nutrient-dense diet, supplemention with omega-3 fatty acids and taking herbs for a short time to nourish the reproductive organs. Additionally, acupuncture treatments may 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, abdomen, etc), and acne. An ultrasound reveals many unripe fluid-filled sacs around the ovaries. Many women suffer from anovulation and subsequent amenorrhea (no periods) and some 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 have insulin resistance and are prone to type-2 diabetes, high cholesterol, high blood pressure, patches of thickened skin and dark brown or black skin on the neck, arms, breasts, or thighs. The exact cause of PCOS is unclear, but it is hypothesized that PCOS is linked to insulin-resistance. 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 good quality eggs, sperm, and 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. ART has higher success rates if the the uterine terrain is abundant with nutrients, and the woman’s endocrine system is balanced. (Paulus et al, 2001; Chang et al, 2002; Westergaard et al, 2006; Smith et al, 2006)

What about the side-effects of ART?

Acupuncture may help to reduce the side effects some women experience from the medications and the stress of the IVF experience. With acupuncture’s calming and balance-enhancing effects, women tend to feel more relaxed and centered. Acupuncture helps treat abdominal bloating, mood swings, hot flashes and headaches that women may experience during the ART cycle.

Low-Cost, High-Quality Pregnancy & Ovulation Tests

Please check out for early pregnancy tests, and ovulation tests:
http://store.yahoo.com/cgi-bin/clink?early-pregnancy-tests+2bVFHV+index.html

Or basal thermometers:
http://www.early-pregnancy-tests.com/bbt-thermometers.html

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

In men, infertility may be due to a systemic issue or a life-style problem. 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 may 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)

How many treatments will I need?

Many couples experience a sense of urgency as their biological clock is ticking. It is, however, important to remember that conception is a process of “receiving”. Therefore, it is crucial that the couple stays as relaxed as possible. It is helpful to complete about three months of treatment using either acupuncture and/or Chinese herbs (depending on your specific circumstance) due to the time needed to balance your system. However, we have helped many patients to conceive during that time frame. Here at OHS, our practitioners have decades of experience, and are always happy to work with you and your doctor in order to best fit your needs.

Does every Acupuncturist have additional training for the Treatment of Infertility?

In 2006, the American Board of Oriental Reproductive Endocrinology (http://www.aborm.org) was founded. Its goal is to provide certification for Oriental medical practitioners to ensure qualified knowledge, experience, and the ability to effectively interact with reproductive endocrinologists, as the treatment of infertility is currently not part of a standard Oriental medical school curriculum.

Please view their website for a nationwide list of certified practitioners.

Assisted Reproductive Clinics Nationwide

http://www.sart.org/find_frm.html

Acupressure point location description and video to Induce Labor

http://acupuncture.rhizome.net.nz/acupressure/About.aspx

Post-partum Pain acupressure

http://acupuncture.rhizome.net.nz/Acupressure/afterpains.aspx

Acupressure for Breast Feeding

http://acupuncture.rhizome.net.nz/Acupressure/breastfeeding.aspx

Testimonials:

Happy New Year! I hope this card finds you well. I’ve meaning to mail this check for weeks now. I am sorry it’s so tardy. Our little boy is miraculously still in my belly. We’ve named him Tim for his strength and endurance. I hope you’re doing well and please know how much I appreciate all of your love and support throughout this pregnancy.
Love,
B. and F. B., Durham, NC

Thank you so much!!! Without you we wouldn’t have had our little girl. After five years of trying to conceive… She is so precious and strong. I sailed through the pregnancy and our daughter is vital and so very beautiful. Thank you for your helping hand to bring her here! And thank you for the work you do! I can’t believe she is here.
With gratitude,
M.E. Chapel Hill

It took four painful miscarriages until I came to see you. You patiently explained to me about specific foods, I drank those god-awful herb teas and in three months I was pregnant. I now hold my little girl in my arms and we still can’t believe it. After all these years of emotional roller coasters! Thank you so very much. God bless you!
C.V. Chapel Hill

I wanted to thank you again for all your wonderful support getting me prepared for pregnancy. I think it made a tremendous difference; I’ll never know for certain, but I’d guess it would have been very difficult for me to now have a child without your efforts.

If you are interested, here’s a link to some additional pictures of our son. (I have to laugh that I didn’t know that the picture of me below would also be destined to show up on the Kodak site’s advertising blitz; just what everyone wants—a mug with my belly on it!!)

Anyway, thanks for all you do for me and so many others.

Big hug and lots of admiration~
K.B., Durham, NC

This was an email communication from a patient to her western medical physician:

I thought you might like to see a picture of my daughter born recently. It is really too long of a story for email—but my healing journey started with my appointments with you and your suggestions of seeing several other people. Over the past 2 years, I’ve received acupuncture off and on to build up my immune system and get rid of my chronic sinusitis and sore throat that I had for a year and a half. Even though I had another miscarriage in the fall of 04 the physical healing from that was much easier and I was able to recover from that physically and even emotionally better. But I would say if you asked me last January if I would have a baby this January, I would have been rather doubtful that it would happen. But then by some miracle I think we conceived on my husband’s 40th birthday. This time I had my pregnancy monitored by the reproductive endocrinology group, got acupuncture and herbs for a few weeks early in the pregnancy for miscarriage prevention and had a healthy pregnancy. I also did the acupuncture program during the last 4 weeks of pregnancy to prepare my body for a smooth labor and had my pelvis aligned by my chiropractor and I prayed. A Lot! The practitioner at OHS is very good and I thank you for telling me about the clinic! My delivery on New Year’s Eve couldn’t have gone better—I worked with a doula and had another totally natural childbirth (my third) after having a C-section in ‘97 with my first child. But this was the smoothest labor by far. This labor went fast—I only had about 1 hr of tough contractions and then my daughter basically jumped out of me—she popped her head and shoulders out before my doctor was even there. Her birth has brought so much healing to me and to my whole family and I feel incredibly grateful.

Best wishes to you for the New Year!
B. F., Chapel Hill, NC

Here finally is a picture of our son. He is so strong and happy. Thank you for all your hard work and commitment to bring him here. I had no idea this would be possible with all those years of anovulation. It is a miracle! He is a miracle!
God bless you!”
H.V., Durham, NC

mother and babyI just wanted to let you know how much I appreciate all of your assistance. Your kind manner and open ears really helped me to get my body in balance and accomplish my goals. I am now 13 weeks pregnant and feeling great. I had some problems with bleeding but after my most recent ultrasound my baby is fine. Thanks again for everything and I wish the best for you and all of your patients. I‘m sure I’ll see you in the future. God Bless, J. S., Roxboro, NC
PS: I’ll keep you posted. I am due Christmas day!

I hope all is well with you. I think about you often and I am so thankful for everything you did for my husband and I. Being a mother is so much more than I ever imagined. Our daughter is such a blessing. We are so fortunate to have her in our lives. She is doing very well. Growing, playing, laughing and making every moment so precious. She is growing so fast and looks like a little girl. My husband mentioned he stopped by to see you a few months ago when I was interviewing at Duke. I am so glad you were able to see our cutie. I did get the job and my work schedule is much more conducive to having a family than my previous job.

Since I switched jobs, I have to switch doctors. I am so upset about having to leave my original doctor in Chapel Hill. They were absolutely wonderful throughout my whole pregnancy. Do you have a recommendation for a new OB/GYN that you work with that accepts my new insurance? I know not all doctors believe in alternative medicine and I want to make sure my new doctor does because I am confident that what you did for us resulted in our beautiful daughter. Thank you!
M. E., Mebane, NC

I hope your week is going well. I just wanted to touch base with you with some rather surprising development.  When I saw you last week, I told you I was premenstrual.  Well, those symptoms went away and this morning was my 18th day since ovulation with my temperature remaining very high.  So I took a pregnancy test and it was positive!  You can imagine my surprise after 3 ½ years of trying and 3 failed IVF cycles!  My husband says you must have quite the magic touch!!!  We’re obviously excited and rather stunned but we’re trying not to get carried away until we see what happens.  I was just wondering whether you suggest I continue taking the herbs you gave me or should I stop?  Thanks!

L.B., Cary, NC

Greetings from a former patient:
You may recall that I came to see you for multiple (5) miscarriages and you successfully helped me get pregnant with twins, then carry them to term. My family moved out of state shortly after the twins were born. We were SHOCKED about a year later to find ourselves pregnant with our fourth child—even more surprised that the pregnancy worked. You broke the miscarriage pattern, indeed! I still can’t believe I went from unexplained infertility to mom of four. I hope you’re doing well, and I continue to have very fond memories of you and your work helping to create our wonderful family.
Best,
A.F., Portland, ME

References

1. CBS News, New York, July 24, 2004.
    http://www.cbsnews.com/stories/2004/07/23/earlyshow/saturday/main631441.shtml

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

3. 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.

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

5. 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.

6. 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.

7. 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.

8. 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.

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

12. 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.

13. 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.

14. 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.

15. 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 http://www.orientalhealthsolutions.com/resources

16. Lao L. et al. Is Acupuncture Safe? A Systematic Review of Case Reports. Altern Ther Health   Med 2003;9(1):72-83