Thursday, March 31


Endometriosis and pain

Pain in the endometriosis patient is caused by several factors which may function individually or concurrently.

1. Inflammation

2. Increased prostaglandins (pain substance)

3. Adhesions which cause distortion of the pelvic organs

4. Endometriotic adhesions on nerves (the woman with endometriosis who suffers with sciatica for example, as a result of endometriotic adhesions on the sciatic nerve)

Acupuncture and herbal medicine often facilitate the following effects.

1. A reduction of inflammation

2. An interruption of the prostaglandin cascade

3. Increase blood flow to areas with adhesions delivering appropriate biochemical products which increase healing; macrohphages for example, which serve to ‘eat’ foreign objects in the body of which an adhesion is but one. Acupuncture nor herbs can eradicate adhesions or endometriotic implants but may, as a result of increased delivery of mitigating biochemical substances, help reduce pain.

If you have pain pre and during menses, pain with deep penetration during intercourse, pain with ovulation, pain at mid cycle, and bowel changes with menses this is suggestive of endometriosis.

Before you get your laparoscopy (for example, if there is a 3 month waiting period because of your surgeons busy schedule), then use acupuncture and herbs to help reduce the pain.

In many cases pain is completely ameliorated after laparoscopy. There are occasions however, when pain persists. It is at this juncture that the use of acupuncture and herbs are very appropriate. Your ONLY alternatives are strong pain medication or medication which will prevent you from menstruating such as aromatase inhibitors or Lupron.

Though these medications will reduce pain, and prevent endometriosis re-growth you will not be able to get pregnant while on them. Even though these drugs can help reduce pain, they will also reduce your estrogen levels which, over time, can negatively affect your heart, brain function, and bone density. Acupuncture and herbs do not have these side-effects and permit pregnancy to occur.

The Berkley Center for Reproductive Wellness is pleased to announce that we are now treating endometriosis patients in addition to treating those couples who are trying to start or grow their families.

Endometriosis and infertility

Endometriosis causes infertility for several reasons.

1. Tubal damage which prevent egg fertilization.

2. Inflammatory proteins in the uterine cavity which prevent implantation

3. Implantation deficit as a result of endometrial pathology associated with endometriosis

4. Possible additional contributing autoimmune disorders which can contribute to infertility; activated natural killer cells, for example.

For the individual wishing to achieve pregnancy who has tubal damage, in-vitro-fertilization after laparoscopic excision surgery is the quickest means to a successful outcome in general. However, the endometrial lining itself is often pathologic and even after a laparoscopy, implantation failure is common. Even the best laparascopic surgeon cannot always excise all endometrial implants.

If, after a laparoscopy, if any endometriosis is still manifest, so too will be the inflammatory proteins associated with endometriosis which contribute to a hostile uterine environment preventing embryo implantation. One may think of this state as having a fever in the uterus. In essence, the uterus is sick. Acupuncture and specifically customized herbal medicine can, in some cases, as mentioned above, reduce these proteins, improve the uterine environment, and help increase pregnancy and live birth rates.

Wednesday, March 23

How does Acupuncture work?

For the Chinese and other like-minded individuals, it’s simple. Acupuncture works because it moves the Qi and blood within the body. One of the most important precepts of Chinese Medical theory states, “Where there is a free flow of Qi and Blood, there is no pain or dysfunction. Where there is no free flow of Qi and Blood, there is pain and dysfunction.”

If that’s the case, how do Qi and Blood become disordered?

Qi is the functional force that moves blood and “gets things done” within the Chinese body. It may become negatively affected in some of the following common ways:

*Repetitive strain disorder


*Climactic factors/wind, cold, damp, dryness, heat

*Nutritional insults/poor diet, drugs, alcohol, caffeine, etc..

*Disordered & imbalanced emotional states/anger and depression in particular

*Personal habits/overwork, overeating, too much sex (for men it’s a problem )

I’ve heard about Tai Qi and Qi Gong. What do these do for people?

They are “core level” practices within Chinese medicine related to the warming,

stretching and healing of the body. They help move the Qi and blood along their

meridian pathways, thus promoting a healthy body, mind and spirit. When practiced

along with acupuncture they enhance acupuncture’s beneficial effects thus helping

regulate normal body functions.

OK. I don’t necessarily believe that the movement of “Qi and Blood” are the reason acupuncture works. What is the western biomedical explanation for how acupuncture produces its effects?

*It inhibits the secretion of the neurotransmitter “Substance P” along ascending pain

sensory pathways to the brain, effectively “gating out” painful stimuli at the level of

the dorsal root ganglion in the spinal cord where the cell bodies of sensory neurons

are located. (The Melzak and Walls, MDs hypothesis)

*It facilitates the release of serotonin, dopamine, GABA and other inhibitory central

nervous system neuropeptides which translates into a happier, pain free affect.

*It affects the hypothalamic-pituitary-endocrine axis thus affecting hormonal and

metabolic functions within the body.

*It exerts its visceral effects on the tissues of the body via the glial cell – neuroendocrine

pathway hypothesis of Richard Gerber, MD.

*It stimulates the activity of certain immune system cells and supportive cells (fibroblasts

and fibrocytes) within connective tissue matrix.

*It produces muscle fasciculation which ultimately relaxes hypertonic muscle and connective tissue.

What is Chinese herbal medicine? And is it safe?

Chinese herbal medicine is a nearly five thousand year old practice of imbibing

special naturally derived medicinal substances as contained within the Chinese

Materia Medica, that when taken in combination with each other – most Chinese

herbal formulas contain at least four different medicinal agents – accentuate the

positive effects of each, while diminishing any unwanted side effects. When properly employed, it is the oldest, safest system of internal medicinals in the world. Western allopathic medicine cannot make that claim.

What is Chinese nutritional therapy?

Chinese nutrition therapy involves the inclusion or omission of certain food

items which are known to affect the state of Qi and Blood within the body,

down to the specificity of which internal organ(s) may be positively affected.

It is often used in conjunction with Chinese herbal formulas for the resolution

of internal disorders, as well as promoting overall maintenance of good health.

Does acupuncture hurt? Let’s get real here…

When an acupuncture needle pierces the surface of the skin, it typically inserts to

a moderate depth within the connective tissue. Most often, the patient experiences

an initial pricking sensation which gives way to a feeling of pressure and warmth.

The ancient Chinese texts called this “De Qi,” or “The arrival of Qi” to the point. Most

patients do not find this sensation painful or uncomfortable. The needles are made of surgical grade stainless steel, very thin in diameter, solid – thus not ripping of tissue like a hypodermic needle, presterilized and disposable. Counter-intuitively, a quicker,

faster, deeper insertion produces less of a “De Qi” sensation than one more superficially


What is moxibustion? How does it feel?

Moxibustion is the smoldering of a medicinal herb – artemesia vulgaris – on the handle of a needle, or on the protected skin of a patient to induce an even greater movement of Qi than would be produced by an acupuncture needle alone. It is often used for internal conditions and to tonify the overall Qi of the body. It warms the point and feels quite comfortable. Many patients report loving the feeling of moxibustion.

What is cupping? Why did Gwenyth Paltrow look like that?

Perhaps it was a publicity stunt? Cupping involves the application of

hollow glass spheres onto the protected skin of the patient, each cup creating a vacuum

which pulls skin, connective tissue and muscle up into the cup. The cup is then moved

around the skin, resulting in a greater flow of Qi and Blood to the local area, thus relieving pain and loosening up the tissues. It is often applied to muscular adhesions as well as areas of chronic stress and “stagnation,” within Oriental medical theory.

What is Gua Sha? Why on earth would I want to look like that?

When Qi and Blood get “stuck” in chronically tight muscle and connective tissue,

“Sha” results. Cupping is one way to relieve the “Sha”. Another method is to

“Gua” it away. A base of protective liniment is applied to the skin, and the practitioner

brushes the area with a porcelain soup spoon, or other suitable device. In western medical terms, the capillary beds are broken underneath the skin resulting in varying

degrees of ecchymosis or bruising. New blood and the Qi that carries it will slowly

repair the local tissues producing a healthier metabolic state than previously found, and relieve tightness and pain. It looks unusual, but feels great, especially starting a few days after its application.

What is a typical course of treatment like?

Many simple neuromuscular complaints of healthy individuals may resolve

within two to four visits, especially when combined with other proactive modalities

like Pilates, Yoga, Stretching, Qi Gong & Tai Qi. Internal disorders typically take

longer periods of time to shift into healthier patterns of organ functioning and thus usually require longer periods of treatment, along with Chinese herbal medicine, to successfully resolve.

Does insurance pay for treatment?

It may. Check with your health insurance carrier to determine if acupuncture is a covered benefit under your specific health plan. Some employers provide flex accounts that reimburse employees for out of pocket health care costs. As an independent self-employed practitioner, I am not a participating provider under any insurance plan and thus operate on a fee for service basis, with payment made at the time of treatment. I do offer “Superbill receipts” and gladly offer any other paperwork that may help patients obtain reimbursement for their expenses.

Why should I come to see you as opposed to another practitioner?

Because I’m good, with far more western biomedical knowledge than many other acupuncturists/herbalists. I truly care for you, taking the time to listen and treat, if desired, the totality of your complaints. When I don’t think I can help sufficiently, I refer out to a host of western medical specialists including many other complementary providers. That being said, the dynamics of the patient-practitioner relationship are
individual to every person I see. I strive to meet and exceed patients’ expectations of my care for them.

How would acupuncture support my goals for which I do Pilates, Feldenkrais, Alexander technique and Gyrotonic?

Great question! Whether on the “Reformer,” “Allegro” or simply doing mechanically unassisted Pilates work, the goals are typically to tone muscles, improve posture, repair and prevent injuries while engaging in a low impact, full body workout that also reduces mental and physical stress. In Pilates, the “tree can only bend as well as the trunk supports the whole tree”. In Chinese medicine the “trunk” of the body is not only its core structural center (abdominals and axial skeleton) but the energetic “Tan Dien” a point a thumb and a half width’s inferior to the umbilicus, or belly button. Furthermore, the energetic flow of Qi and Blood is found deepest and most significantly in the “Jing” level of the body – the Chinese “core” – with its extraordinary meridian pathways from which the regular organs in turn get their Qi and Blood. (i.e. Chong mo, Ren mo, Yin Wei mo, Dai mo support the Kidney, Liver and Spleen meridians that nourish the uterus, ovaries and vagina for women.) The “Ying level” of the Chinese body relates to the twelve organs found within, i.e. Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Urinary Bladder, Kidney, Pericardium, San Jiao, Gall Bladder and Liver. The “Wei Level” of the Chinese body relates to the muscles, tendons and surface energetics that prevent external pernicious influences from penetrating the body and causing illness and disease. Fasciculation type needling releases hypertonic muscle, providing healthier tone, flexibility and range-of-motion. Acupuncture needles, especially auricular (ear) needles, also release endorphins, enkephalins, and appear to raise serotonin levels in the central nervous system, resulting in a happier, more stress free affect. Acupuncture also acts as an analgesic at the source myofascial pain, simultaneously reducing inflammation and speeding up the repair of soft tissue that has been injured. Pilates’ emphasis on breathing, along with therapeutic movement, also reduces stress and helps injured soft tissue heal faster.

Acupuncture - Optimizing your physical and mental health through free flow of qi

When the body is in free flow, with no blockage, there can be no imbalance, disharmony, or pain. It is only when the flow of qi, blood and fluids is compromised that a pattern of disharmony results. Thus, the goal for all acupuncture treatment is to restore the body to the natural state of homeostasis.

To illustrate this fundamental acupuncture treatment principle, let us discuss the nature of pain in the body.

If you are experiencing tightness in your neck, it may be due to an accumulation of stress in your shoulders and back. As your muscles get tighter, the free flow through that area of your body is being compromised. You may not be aware of the effects of this stress immediately. The holding pattern of your body and the manifestation in postural changes may not register as a problem until you wake up one day and you can no longer turn your head. Now the body has your attention, you are in pain. Acupuncture will open the areas of blockage, releasing the neck and restoring the flow through the acupuncture points and meridian channels and, as a result, your neck is pain is ameliorated.

When treating pain a variety of acupuncture points are utilized: local treatment to the affected area, trigger point release in the muscles, and acupuncture points distal to the affected area are chosen to reduce inflammation and increase circulation and healing. Often the muscles themselves need to be relaxed and, for this, a combination of acupuncture with additional modalities such as cupping, the application of cups to the skin to draw out deep inflammation, and massage are indicated. Achieving free flow through the acupuncture points is the treatment principle for all conditions. Determining where to place the acupuncture needles is the art of acupuncture combined with the experience of the acupuncturist.

When the body is open and balanced, there is no discomfort. This is manifested in the seemingly boundless energy of healthy children. As the body ages, we accumulate holding patterns of stress and fatigue, and it becomes necessary to remind the channels what free flow feels like. Originally designed to connect and circulate energy from the internal organs to the surface of the body and then back again, the meridian channels perform a very important job. Acupuncture treatment is designed to open the channels, resulting in being whole and complete again.

When viewing the body in this way, it is more difficult to understand how acupuncture and Chinese medicine can help more complex internal symptoms, such as infertility, fatigue and depression. Fertility enhancement acupuncture often treats both female and male patterns. To help prepare the body for pregnancy, the acupuncturist guides qi, blood and fluids to the reproductive system increasing the likelihood of a successful pregnancy.

The result is better circulation, fresh new blood and surging qi through the reproductive organs. In addition, the acupuncture treatments are designed to reduce stress levels in the patient, to facilitate a deep sense of relaxation. As a result of this treatment, sleep, metabolism, and digestion often improve, a very welcome side effect of the acupuncture treatment.

In conditions affecting emotional health, Chinese medicine again teaches a simple principle, emotional balance is the ability to feel all emotions appropriately. Often when presented with heightened mental challenges, we get fixed in one emotional state. So often the patient suffering from fatigue and depression also feels unmotivated and lacking in self-esteem. It is by helping the emotions to move freely that the patient begins to feel less afraid and more motivated to take action.

A healthy emotional state can be observed in early childhood. A toddler will be happy one minute, screaming and frustrated the next, and then back to happy before the tears have time to dry. Unfortunately, as we age, our emotional responses become more and more predictable, rigid and neurotic. It becomes difficult to adjust our patterned responses and the free flow of emotions becomes blocked.

Fatigue is often a result of being set in one emotion. We yearn for change and freedom so we may feel better. Drug addition and drug dependency are often a result of a depressed view of oneself or one’s current situation. Acupuncture can help to treat these conditions by opening the channels and freeing the emotions so that they can return to a more centered and balanced state.

In conclusion, the acupuncturist’s main priority is to restore the natural free flow throughout the mind and body. Regardless of whether the patient needs stress and pain relief, support conceiving or holding a pregnancy, or emotional balancing, the guiding principle of acupuncture treatment remains the same; free flow promotes harmony and optimal health in the body.

Abbey Fromkin, M.S., L.Ac.

Acupuncturist: Berkley Center for Reproductive Wellness and Women’s Health

Wednesday, March 16

The Sperm Chromatin Structure Assay (SCSA) and DNA Fragmentation: What Is It and What Does It Mean?

This article from a Resolve 2006 newsletter written by Dr. Werthman

Until several years ago the belief among most reproductive specialists was that if a man had live sperm then they were suitable for use with IVF / ICSI and if the female partner didn’t get pregnant or a miscarriage ensued then it was probably an egg quality issue. Several studies had implied that the conventional sperm parameters (count, motility and morphology) as measured on a routine semen analysis had no bearing on success when ICSI was used. Many couples pursued egg donation after failed IVF attempts because the husband’s semen parameters were relatively normal and yet conception hadn’t occurred. Some of these same couples were still unable to conceive even with the “better quality” donor eggs leaving both the doctors and the couples frustrated and perplexed. Some couples then went on to use both egg donors and surrogates thinking it was both an egg quality and implantation issue, again without success. The only commonality was the husband’s sperm.

About a year and a half ago a relatively new concept was introduced to clinical practice; sperm quality was dependent on the amount of damage to the sperm DNA or DNA fragmentation. Simply put, DNA is arranged in a double helix or ladder configuration with side rails and rungs. If the rungs are broken, then the ladder is unsteady and won’t function properly. What has recently been shown in several studies is very interesting and in some ways unexpected. Sperm DNA fragmentation has little or nothing to do with the parameters that we measure on the routine semen analysis. It has little to do with the shape of the sperm or whether the sperm are moving. It is a completely independent variable. Men with otherwise normal semen analyses can have a high degree of DNA damage and men with what was called very poor sperm quality can have very little DNA damage. More importantly what has also been demonstrated is that the degree of DNA fragmentation correlates very highly with the inability of the sperm to initiate a birth regardless of the technology used to fertilize the egg such as insemination, IVF or ICSI. Sperm with high DNA fragmentation may fertilize an egg and embryo development stops before implantation or may even initiate a pregnancy but there is a significantly higher likelihood that it will result in miscarriage. By testing for sperm DNA fragmentation, many cases of formally “unexplained” infertility can now be explained. Many of those couples who have been previously unable to conceive with what would be considered extreme measures have been diagnosed with high sperm DNA fragmentation and treated. It is now very clear to see that having this information about the quality of the sperm can be tremendously helpful to couples and their physicians.

There are several ways to test for sperm DNA fragmentation; the most widely used and statistically robust test is called the Sperm Chromatin Structure Assay or SCSA. The patient semen samples are frozen and shipped in a liquid nitrogen container to the SCSA reference laboratory in South Dakota. The sperm are thawed out and a stress is applied (low pH). The sperm are then labeled with a special orange colored dye that only attaches to the ends of broken DNA within the sperm cell. If the DNA is intact then no dye will attach to the sperm. A machine called a flow cytometer is used to analyze ten thousand sperm from the sample. The sperm are passed single file by a beam of light that hits the dye inside the sperm cell and reflects light at a specific wavelength causing the sperm to appear either orange (damaged) or green (normal). A computer counts the percentage of green versus orange-labeled sperm and software allows for creation of a graphic plot of the percent of damaged sperm giving an index known as the DNA fragmentation Index (DFI).

The data from thousands of patients has been analyzed and correlated with the patient’s clinical outcomes and references ranges were compiled. A normal sample has less then 15% of the sperm with DNA damage. Men with poor fertility potential have greater then 30% of their sperm damaged. A DFI Between 16% and 29% is considered good to fair fertility potential but becomes poorer as it approaches 27%. These numbers are thresholds meaning that above 30% the outcome for most couples was failure to have a birth even though only 30+ percent of the sperm were damaged. Under 15% most couples achieved success. The logical questions that arose were: what about the rest of the undamaged sperm in the sample? Why don’t those sperm work? What causes sperm DNA fragmentation? Can the DNA fragmentation be reduced and the sperm improved? If so, How?

DNA fragmentation can be thought of as a marker for other types of damage to the sperm. It is a kin to seeing the tip of the iceberg. Apparently, in semen samples with greater then 30% DNA fragmentation, other abnormalities are occurring with the non-fragmented sperm that the SCSA doesn’t measure and that is why samples used with DFIs above this level do not usually result in births.

The causes of high DNA fragmentation are those same causes of male factor infertility that we have known about for years such as chemical/toxin exposure, heat exposure, varicocele, infection, age, smoking, testicular cancer, radiation, and anything that increases the free radical levels in the semen among a list of many other things. It is very important to understand that sperm DNA fragmentation can change with time and it can be improved in many cases. The goal of a male factor evaluation is to seek out the causes of poor sperm quality and try to correct them so conception can occur naturally or to improve the sperm quality for IVF and maximize the chances of success. In situations where DFI can’t be improved there is evidence to suggest that removing the sperm directly from the testicle via biopsy and using it with ICSI may lead to better outcomes then using poor quality ejaculated sperm. Other options include counseling patients regarding the use of donor sperm either by insemination or fertilizing a portion of the eggs harvested for ICSI with donor sperm and a portion with the patient’s sperm, once again to maximize odds.

The clinical utility of the SCSA is readily apparent. All men with an abnormal semen analysis are candidates for this test as well as men with normal semen analyses who have failed IVF for unexplained reasons. Those couples using egg donors or surrogates may also benefit from screening prior to going thru the procedures because the effort and costs are so great. Men with poor DFI should have a male factor evaluation including a physical examination by a male reproductive specialist. These new concepts have a significant implication on how we practice and what we recommend to couples but we must bear in mind that this test does not have a predictive values of 100% as healthy babies have been born from men with high DFI but this is fairly uncommon.

There are herbal medicine formulas which are exceedingly high in antioxidant properties. At The Berkley Center for Reproductive Wellness we have had great success in treating this disorder.

Wednesday, March 9

higher live-birth rates

PHILADELPHIA — Women who receive acupuncture during the stimulation phase of an in vitro fertilization cycle and again immediately after embryo transfer have a higher live-birth rate than do controls, according to the first acupuncture study with this end point.

“Other studies have looked at pregnancy rates, but what is really important is whether or not there is a baby,” said Paul C. Magarelli, M.D., who reported his findings at the annual meeting of the American Society for Reproductive Medicine.

The retrospective study included 131 women who were undergoing standard in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). All of these women were considered good prognosis candidates for IVF/ICSI and were given the choice of having acupuncture.

A total of 83 women declined (controls) and 48 accepted.

There were no significant differences between the two groups in terms of infertility diagnoses, demographics, and treatment protocols, except that sperm morphology was slightly better in the partners of women receiving acupuncture (7.3% vs. 5.9 % normal forms with strict criteria evaluation), and the average uterine artery pulsatility index was lower in the acupuncture group (1.57 vs. 1.72), said Dr. Magarelli of the department of ob.gyn. at the University of New Mexico, Albuquerque.

The study found that pregnancy rates per embryo transfer were not significantly different between the two groups (50% in the acupuncture group and 45% in controls).

The miscarriage rate was almost halved in the acupuncture group (8% vs. 14%).

In addition, the rate of ectopic pregnancies was significantly lower in the acupuncture group—0 of 24 pregnancies (0%) vs. 2 of 37 pregnancies (9%), said Dr. Magarelli, who is also in private practice in Colorado Springs and Albuquerque.

Thus, the live-birth rate per IVF/ICSI cycle was significantly higher in the acupuncture group than in controls (21% vs. 16%).

“The live-birth rate per pregnancy is an even more telling number, since some cycles get cancelled. There was a 42% live-birth rate per pregnancy in the acupuncture group, compared to a 35% rate in the nonacupuncture group,” Dr. Magarelli said in an interview with this newspaper.

“We believe that what we are doing is improving the uterine environment such that implantation is improved,” he added.

The study used two acupuncture protocols.

The Stener-Victorin electrostimulation protocol—which has been shown to reduce high uterine artery blood flow impedence, or pulsatility index (Hum. Reprod. 1996;11:1314-7)—was used for eight treatments during ovarian stimulation.

The second acupuncture technique—the Paulus protocol, which has been associated with improved pregnancy rates (Fertil. Steril. 2002;77:721-4)—was used within 24 hours before the embryo transfer and 1 hour after.

“This protocol has demonstrated reductions in uterine contractility, so by relaxing the uterus before the embryo transfer and immediately after, we felt we were setting up a better environment for implantation,” Dr. Magarelli said.

Study Shows Acupuncture Treatment May Help Male Infertility Problems

Acupuncture may help some men overcome infertility problems by improving the quality of their sperm, according to a new study.

Researchers found that acupuncture treatment reduced the number of structural abnormalities in sperm and increased the overall number of normal sperm in a group of men with infertility problems.

They say the results suggest that acupuncture may complement traditional infertility treatments and help men reach their full reproductive potential.

Acupuncture May Ease Male Infertility

The male partner is a factor in up to 50% of infertile couples, write the researchers. In many cases, the cause of male infertility is unknown.

Previous studies of acupuncture and male infertility have suggested that acupuncture can improve sperm production and motility and count.

In this study, researchers looked at the effects of acupuncture on the structural health of sperm in men with infertility of unknown cause. The findings appear in the July issue of Fertility and Sterility.

Twenty-eight infertile men received acupuncture treatments twice a week for five weeks, and 12 received no treatment and served as a comparison group.

Researchers analyzed sperm samples at the beginning and end of the study and found significant improvements in sperm quality in the acupuncture group compared with the other group.

Acupuncture treatment was associated with 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, were unaffected by acupuncture.

The researchers write that acupuncture treatment is a simple, noninvasive method that can improve sperm quality.

SOURCE: Pei, J. Fertility and Sterility, July 2005; vol 84: pp 141-147.