A new perspective on infertility treatment

How many failed IUI's and IVF's have you had? Four? Five? Seven? Have you heard this "you are producing beautiful embryos, your lining looks great and your husbands sperm is off the charts"?  How many failed donor egg cycles have you had?

You may be a victim of poor diagnosis.  For example, how many of you have had a fluid ultra sound? If you have not, raise your hand.  Did you know...one polyp residing in the uterine cavity can prevent implantation? Did you know that frequently a transvaginal ultra sound cannot detect a polyp but a fluid ultra sound always can?

Let's look at a common scenario together. You are thirty-nine years old and you have an fsh of 17 and you have endometriosis. Your doctor thinks that you are not getting pregnant because you have an inflammatory disorder (endometriosis), and that you have poor egg quality, and low ovarian reserve indicated by your age and fsh levels respectively. But, if you have a regular period, the odds are that you still have some good eggs and may have a chance to conceive, else why would your doctor be willing to proceed with an IVF embryo transfer.

The fact that you have been diagnosed with endometriosis indicates that you have had it surgically addressed and so now its clinical relevance is diminished. Now its down to egg quality and ovarian reserve. If you still menstruate regularly, you still have some good eggs even if your fsh is 17. 

So why are you not conceiving? Perhaps because of a physical obstruction, i.e., a polyp or worse, multiple polyps. Polyps are easilly, painlessly and quickly removed via a hysteroscopy.  So, instead of continuing to have ivf after ivf and failure after failure why not rule out possible hidden causes of your problem with simple procedures?  I am not trying to insinuate that all infertility stems from improper diagnosis; sometimes woman can't conceive for reasons which are beyond the scope of current diagnostic tools. I am, however, suggesting that many cases of infertility can be successfully treated where heretofore, they have not.

Did you know that day 3 embryos with less than 6 cells and more than 10 cells are often indicative of poor sperm quality?  Yes I know: your husband had a normal semen analysis. But, has he had a sperm dna fragmentation assay? This test can reveal a  hidden sperm pathology that may be contributing to your inability to conceive?

If his sperm tests normal from the perspectives of volume, count, motility, and volume and you are producing day 3 embryos with less than 6 cells or more than 10 cells, he should have this test. Frequently this test is not performed because your doctor doesn't believe in this test and wouldn't know what to do with the results anyway.  Doctors will tell you that the only challenge that sperm with fragmented dna poses is their inability to penetrate an egg, so the answer is simple: do icsi. ICSI is a process whereupon the sperm is injected into the egg enabling forced fertilization. So your egg is being fertilized with a sperm that couldn't, on it's own, have done this. Essentially, by default, you are ending up with a less than optimal embryo which may yeild a pregnancy which may either result in miscarriage or produce a male child with the same problem as his dad with his future familiy planning requiring IVF with ICSI.

So, are we not, through these 'band-aid' procedures facilitating a nation of weakened children and actually contributing to a generation of infertile couples?

You're wondering what the solution is.  Well that begets a question. If you had type 2 diabetes and were very overweight and had insulin resistance you could do two things to get better: 1) take Metformin and possible other medications or you could change your diet, lose weight, exercise and cure your-self.

One approach is a 'band-aid' approach and one approach is to address the problem at its root.  The solution lies ahead.

Back to sperm dna fragmentation. Before we can hope to address a 'root' treatment we first need to know what causes the problem. Reactive oxidative species or 'ROS' causes fragmentation of the dna in the sperm. ROS is caused by environmental assault such as exposure to certain chemicals, toxins, etc., which can come from smoking marijuana or cigarettes, testicular injury or testicluar surgery allowing antibodies to enter the testicular environment and cause damage.

The severity of DNA fragmentation is determinied by the amount of sperm that is affected. 0 to 15% is indicative of good outcomes in IVF procedures; 15% to 29% means that chances are fair to good; numbers above 29% usually do not result in live births.

In the idiopathic (no known cause) infertile couple, a full diagnosis has not been rendered without a sperm dna fragmentation test. What is the cure? The eradication of free radicals which manifest as a result of ROS.

How? acupuncture ( stimulates blood to the testis helping to send more oxygen and nutrients and dispel dead cells), herbs which have anti oxidant properties, vitamins C and E which have strong anti oxidant properties and daily intake of wheatgrass juice. There is no traditional Western medical approach to the successful treatment of sperm dna fragmentation.

Is medical ego perhaps a contributing factor to the paucity of testing done for this significant pathology?  In other words: if the doctor doesn't 'believe' in the test then it won't be done.  Can you see air? Can you see microorganisms? Can you see God? Can you see energy? No, no, no and no. Do you believe in their existance?  Is your day to day behavior not based upon your belief in these entities even though you have never seen even one of them? 

There are some people that do not believe in the existance of God or microorganisms. Does their lack of belief indicate the lack of existance of these things? It is the wise person who, though belief may not be held, understands that there is a  possibility of existance nonetheless.

Did you know that endometriosis is an autoimmune disease than can cause infertility even in the absence of damaged fallopian tubes? Another interesting thing that you should be aware of is that when one has an automimmune disease such as endometriosis there are often other autoimmune factors which can contribute to infertility which have not been diagnosed; but they should have been. I always recommend a full autoimmune evaluation when one of my patients presents with a known automimune disease to rule out the posibility of other, asymptomatic autoimmune disorders which can cause infertility.

The reason for the paucity of testing for autoimmune disorders which are known to contribute to infertility is that many doctors don't believe that autoimmune disorders can contribute to infertility. The terms yin and yang according to traditional Chinese medicine, means, among other things balance. Balance, according to the traditions of Chinese medicine is required for health, and imbalance is what leads to sickness. Would you agree that an immune system which acts innapropriately against it's host represents an imbalance? And, does it make clinical sense to try to rebalance the behavior of organ/endocrine systems to re-institute health?

Let me tell you an interesting story: when the surgeon general first advised the nation  that there was a direct link between lung cancer and other cancers with cigarette smoking, most doctors who smoked (many, many did) continued to do so becasue they didn't believe what the surgeon general said. Now, years later, most physicians don't smoke because they became convinced of the validity of the surgeon general's report. So, perhaps, years from now, many reproductive endocrinologists will finally understand the clinical significance of certain autoimmune disorders in so far as their role in infertility is concerned.

An example of an autoimmune disorder which can cause infertility is activated natural killer cells. These cells are meant to kill cancer in the uterus. They do so by spraying something called TNF-alpha or tumor necrosis factor on tumors, killing them, and in the best case scenario, saving the patient from endometrial cancer. 

However, in one with an autoimmune mitigated hyperactivity of activated NK cells, these cells spray TNF-alpha on the embryos, instantly killing them causing infertility.  This again is a hidden pathology as it presents with no signs or symptoms. 

The appropriate treatment is intralipid therapy or intravenous immunoglobulin therapy, both of which have been shown to positiviely effect pregnancy outcomes in patients presenting with highly activated NK cells. 

Again, this is the band-aid approach and, in many cases a band-aid approach is not a bad thing; if it works, it works and at the end of the day that's all we want.

To include a modality of medicine which can regulate immune function so that the body can behave normally again also makes sense. Acupuncture and herbal medicine can frequently manifest in this regulation of the immune system.  This is how acupuncture and herbal medicine helps patients who are HIV+ or in full blown AIDS to feel better and stronger - by immune function regulation to whatever extent possible.

Infertility treatment is still in its infancy stage. There have been more than three million babies born as a result of IVF. But this is similar to the concept that many people with cancer have been saved by medical intervention. Both are true, yet the fact remains many more people die from cancer than who are saved and many  more IVF's have been done without the production of a baby.

As time goes on, more and more research will yield better treatment approaches and perhaps one day  infertility will not exist.  In the mean time however it is my contention that all testing, even testing that may present a greater insight into the cause of a couples infertility should be rendered and, the root cause of the problem should simultaneously be treated with natural medicine such as acupuncture and herbs.

Western medicine is superior to Chinese medicine in treating the manifestation of an underlying disregulation or lack of harmony in the functioning of the body but traditional Chinese medicine is, in my opinion (based on clinical experience and three thousand years of data) superior in treating the human body and spirit at the deepest levels.  Therefore, the best approach to treatment of the infertile couple is to employ both modalitities of intervention.  This is the solution!

My Belly Will Rise

Another disappointment another failed cycle

Another thousand tears, my heart an icicle

A sled ride rapidly down the slope

To the land of depression and dashed hope

I sit at my window and watch the last days of winter, the sun burns the frost, the birds begin to sing, leaves turn green; flowers kiss each other and elope; yin transforms into yang

I am but a microcosm of the world I know-my heart must be tame – for soon I’ll be reading the ‘Book of Baby Names’

Remember this: It is only when the night is darkest that the sun will start to rise…

as will my belly.

mike berkley

Poetry

I am inviting anyone who wants to submit their writings, musings, poetry about their journey to family to submit your creative output to me for posting on my website. Your identitiy will not be disclosed but your hope will be; your pain will be; your love, sorrow, disappointment and joy will be; your soul will be.

Please submit your writing to mikeberkley@berkleycenter.com for publication on my site -  http://www.berkleycenter.com/. 

Your identitiy will not be revealed.

Share of your self and give to others and reap from others the positive energy that you will derive from their writings. 

Please help me to help you by facilitating the growth of this fertility creative project.
Thanks.
Love, peace and blessings...
mike

My son called me this morning...Sunday October 17th...

And asked me to join him to see Jackass 3 in 3-D.  I couldn't have been more pleased.  To have my son reach out to me and embrace me in his life (he is 15 years old) is the most complementary experience I can ever have. I can't express the joy that I derive when he invites me out with him..

After all, his life at this point is about 'hanging out' with his friends and don't forgot the raging hormones directed at anything in a dress. So when the call comes I am flattered and honored.

The greatest thing I every accomplished in my entire life was contributing to the birth of my son. I honor my relationship with him and love him intensely.

This, I suppose, the driving force behind my work in the field of infertility. If I can help another couple experience that which I do,  I know that I am helping to bestow a great gift to a couple faced with the difficult challenge of infertility. My love, heart and soul and best wishes go out to all of you involved in the struggle.  My mission is to help you become parents.

Thank you God, or the Dao or Nature for these two magnificant gifts; my son and my devotion to you.
I love you Noah.

Why I Hug My Patients

Over the many centuries of human existence, many social customs have emerged out of both necessity and leisure. The handshake is one custom that encompasses both of those origins. The handshake may appear little more than a formality to some, but to others it is a complete view into the personality of the person on the other end of the handshake. The handshake has also created nations and bought homesteads. However, in all cases it still requires two people to be executed correctly, thus causing an interaction to take place, which gives me the right, as a student of sociology, to investigate the handshake from a sociological perspective.

The Origin of the Handshake

The actual beginning of the handshake is as difficult to specifically determine as most events that happened before written history. However, there are many accounts that provide both comedy and insight. One origin offered by Herbert Spencer, in his book THE PRINCIPLES OF SOCIOLOGY, is that of two Arabs meting in a desert. They each reach for the others hand to kiss it in greeting. However, it is an insult to have your hand kissed by another individual, so both men try to withdraw from the lips of the other man. The end result of this meeting is the acceptance by both men that they wouldnt kiss the others hand, and thus they ended up only clasping the hand of the other, and the handshake was born. The mutual acceptance by the two men that the hands wouldnt be kissed shows the equality between the two individuals; however, that aspect will be discussed a little further down the page.

Perhaps a more practical origin of the handshake comes from medieval Europe, where kings and knights would extend their hands to each other, and [grasp the] others hand as a demonstration that each did not possess concealed weapons and intended no harm to the other (Hall). I say this is a more practical origin of the handshake, because it more closely resembles our current use of the handshake as a way to introduce ourselves to a person and open ourselves up to them for the purpose of interacting. Interestingly enough, the ancient Greeks used it similarly. It was a welcoming sign of friendliness, hospitality, and trust (Schriffin).

Still, despite the various possible and plausible origins that the handshake sprung from, the handshake has taken many diverse and, at times, conflicting meanings. The question as to the meaning of the handshake is what the next section of this page will address.

The Various Meanings of the Handshake

Why is the handshake so important in the business world? Why are most meetings between diplomats ended with a handshake? Why do secret orders, fraternities, and sororities include handshakes among their secret rituals? I believe Hall and Hall put it best when they wrote, The handshake represents an expression of equality.

Take, for example, the meeting of diplomats to discuss a peace initiative for two warring countries. With the handshake giving a sense of equality to the meeting, the playing field is leveled and the proceedings can occur, unhindered by feelings of inequality. Admittedly, most diplomatic meetings occur in times when one side has a dramatic diplomatic advantage over the other, however, the handshake can often serve to equalize the two diplomats with each other, rather than equalize the parties they are representing.

Another example of political use of the handshake to imply equality is in the Presidential debates, where the candidates face off in a discussion of current events and personal policy beliefs. At the beginning of the debates, the candidates shake hands, much like in boxing matches when opponents touch gloves before the first bell rings, and then again at the end, which Hall and Hall describe as a handshake of reconciliation, in which participants reestablish a sense of solidarity. However, in politics, the meaning of the handshake has been cheapened by politicians preying on peoples beliefs on the meanings of the handshake to help further their own political interests.

Politics isnt the only place in which the importance of the handshake has been made lesser in value. Over the course of the past two centuries of American existence, the importance of the handshake in the business world has declined from a once binding contract that pledged both your wealth and your honor, to little more than a business formality and tactical action. At one point in the banking industry, a person could lend and borrow money based on the palm-to-palm contact called a handshake.

Looking through the eyes of a symbolic interactionist, you could argue that the handshake is a binding agreement because it allows for the tangibility of feeling the other persons hand in yours and that contact and interaction is symbolic of the trust and reliance the two people are exchanging with each other. Because people develop a sense of personal space around them, physical contact between two people requires that this invisible barrier be suspended for the duration of the contact. Because the lowering of such a barrier requires trust in the person with which the interaction is taking place, the symbolic interactionist would say that the act of the handshake incorporates all those feelings into that one action.

A Goffmanesque Approach to the Handshake

Although in my research I never found an instance in which Goffman addresses the handshake directly, I did manage to gather some clues as to how he would probably view the interaction associated with the handshake. This section is dedicated to an analysis of the handshake from the most likely view Goffman would take. Note that these are not his direct applications of the various theoretical elements, but it is definitely a possible and accurate use of the theories. With that having been said, here is my analysis of the handshake through the eyes of Erving Goffmans various theories.

The act of shaking hands requires what Goffman calls focused interaction. This is where a person interacts with another person directly and pays attention to the responses and social cues given by that person. Instances of focused interaction are called encounters. As Goffman also states, encounters require openers, in order to show that both parties recognize the encounter that is now taking place, as well as closers, to signify the end of the encounter. The handshake serves both the purposes with little modification. Specifically in the business world, handshakes are often used at the beginning and end of business meeting, interviews, and whenever else people want to show that they have entered into the interaction (encounter) and are ready to listen and respond to what the other person has to say.

Another one of Erving Goffmans major theoretical concepts was that of the Dramaturgical Approach to interaction. Applying this theory to the act of the handshake can provide some interesting insights into the importance of the handshake in the modern business world. For instance, in an interview, there is a very set pattern of events that is to occur in order for the interaction to be perceived as normal. The interview begins and ends with a handshake, displaying the equality of the two people. This is a very important line in the script that guides this reaction. A weak handshake can often be seen as a departure from the script because it can signify inattentiveness, weakness, insecurity, or rudeness. After the interview has been concluded, the handshake is once again needed as if it were the finale of the play. This time the handshake is not that of introduction, but that of closure.

Conclusion
Another theory, although not one of Goffmans, that applies to the handshake and too business in general is that of the compulsion of proximity. This theory is credited to Deirde Boden and Harvey Molotch. The compulsion of proximity refers to humans need for face-to-face interaction. I discovered this theory while browsing through the textbook and thought that it had relevance to the handshake because despite the massive amounts of cheap long-distance communications technologies (i.e. fax, video-conferencing), there are still a lot of business travelers filling our airports day-to-day. I attribute this to the compulsion of proximity and to the importance of the handshake in the business world. Obviously there is still a high value placed on the value of the personal focused interaction and encounters that are enclosed by handshakes everyday. Many business coaches and personal behavioral books attribute to the handshake the role of encompassing your personality into a single action. This interaction cannot occur except in person. So, the price of this interaction is obviously worth the time and money it takes for these people to complete the interaction.

As you have read, the handshake is a very important part of the business world. A person would be foolish to overlook the importance of the handshake. So, to all those business students, professors, and anyone else interested in the importance of the handshake, remember that you are being judged on your handshake whether consciously or subconsciously, so make it count. Since starting my research, I have paid a lot of attention to how people shake hands and there is a lot to be learned through paying a little more attention every time you shake hands. So, remember this the next time you shake a hand and pay attention, it means more than you think.

The above was written by Keith Andrew and was found by doing a search on the web for the History of the Handshake.

Why I hug my patients

No where in the above article did I find the word 'intimacy'.  Doctors typically shake hands with their patients; a decidedly unintimate gesture; more busines-like.

My patients are faced with the challenge of infertility. They are medicated, talked at, poked and prodded, blood drawn, speculums inserted, and frequently disappointed by failed IUI's, ivfs and donor egg transfers.

Is intimacy only supposed to take place between the patient and her or his partner? Why can't a doctor have an intimate relationship with his or her patient?

Some definitions of intimacy that I found on the web
familiarity: close or warm friendship
closeness: a feeling of being intimate and belonging together
intimate - marked by close acquaintance, association, or familiarity; "intimate friend"
intimate - familiar: having mutual interests or affections; of established friendship

There is no intimation of 'sexuality' here. Only a close bond.  Shouldn't a patient and his or her doctor or health-care provider have a close bond? Is not having a close bond clinically important?

I believe in intimacy; warmth, compassion and love for my friends, family members and my patients: that is why i hug my patients; men and women: it is an intimate, connecting, comforting gesture.
Love and blessings and hugs!

mike berkley, L.Ac.

New Plainview, Long Island Holistic Fertility Center Update!

I will be seeing patients in the NEW Plainview, Long Island Holistic Fertility Center starting Friday, 10/15/09. Call 516- 204-7149 to schedule your appointment.

This is the FIRST comprehensive East meets West fertility Center in Long Island. I will be working closely with Dr. David Kreiner, the Founder and Director of East Coast Fertility to bring to best of complementary medicine and cutting-edge high tech techniques to help those challenged with infertility to start or grow their families.

Our mission is to provide nurturing, caring and state-of-the-art medicine in a warm, inviting environment, providing a safe-haven for those who want a comprehensive approach to their fertility needs.

It is our goal to transform patients into parents.

We would be honored to accompany you on your journey to family.

Love and blessings.
mike berkley, L.Ac.

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