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!
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