I was recently interviewed for Fran Meadosw wonderful blog. Here is the interview:
Do you have a personal experience that you would like to share with infertility?
When my wife and I were trying to conceive, we were not able to do so. I was not an acupuncturist at the time; I was a computer salesman. My wife went to Elaine Stern, a fantastic acupuncturist and herbalist for treatment. After three months of acupuncture and herbs, my wife became pregnant and subsequently gave birth to a healthy, beautiful baby boy. He’s still my baby even though he’s now eighteen years old!
Why did you choose the field of acupuncture and herbal medicine for reproductive disorders?
When I started out in acupuncture I treated pain. I had a woman come to my office for care. She wanted assistance in getting pregnant. I didn’t know what FSH or IUI or IVF meant. All I wanted to do was to treat her neck and back pain. I explained to this patient that I knew nothing about infertility or how to treat it. She had four IUI’s and two or three IVF’s; all resulting in negative outcomes. I promised her that I would do the research on how to treat infertility issues with acupuncture and herbs. Her issue was advanced maternal age. After two or three months of care with me, this patient became pregnant at forty-years of age and gave birth to a healthy, baby boy. I knew then that I was going to give up pain management and devote the rest of my professional life to learning Western and Chinese reproductive medicine so I could help couples start or grow their families.
Share with us how acupuncture and herbal medicine can help boost male fertility? Give us an example of treatments for a new male patient.
There are five key points to determining sperm health. The four most common parameters are volume which refers to the amount of sperm ejaculated, count, which refers to the amount of sperm in the ejaculate, morphology, which refers to the shape of the sperm and motility which refers to the ability of sperm to swim in a straight line. Other issues which are germane to sperm physiology are the amount of white blood cells in a given sample of sperm which may represent an infection, and sperm dna fragmentation which is the separation or breaking of DNA strands into pieces. A study showed a significant increase in miscarriage in patients with high DNA damage compared with those with low DNA damage.
Any deviation from the normal standards in these parameters can either lead to sub-fertility, infertility, or chronic miscarriage. Acupuncture and herbal medicine can often help to normalize sperms pathologies. Where there are genetic defects, for example a micro-deletion of the y chromosome which causes either reduced sperm (oligospermia) or no sperm (aspermia), acupuncture and herbal medicine cannot help. When there are structural abnormalities such as a congenital absence of the vas deferens acupuncture and herbs cannot help. Congenital bilateral absence of the vas deferens occurs in males when the tubes that carry sperm out of the testes (the vas deferens) fail to develop properly. Although the testes usually develop and function normally, sperm cannot be transported through the vas deferens to become part of semen. As a result, men with this condition are unable to father children (infertile) unless they use donor sperm. However, in the pathological states of low sperm count, poor motility, poor morphology, low volume and sperm dna fragmentation, with the cause being genetic or anatomical, acupuncture and herbs often help to remedy these pathological states.
The key effect of acupuncture and herbs on the health of sperm comes from their ability to increase blood flow to the testes and to increase the excretion of dead cellular debris from the testes. Blood carries nutrients, hormones, electrolytes and oxygen to the testes. This improves testicular function and health and often results in improved sperm parameters including count, volume, morphology, motility, and sperm dna fragmentation.
Sperm dna fragmentation is represented by percentages which look like this: 0-15% represent good fertility outcomes; 15-29% represents fair outcomes, and >29% represents infertility and/or chronic recurrent miscarriage. There are men who present with dna fragmentation levels above 50. Acupuncture and herbal medicine can often reduce sperm dna fragmentation levels to the normal range.
Do you work with both patients who are undergoing IUI or IVF as well as patients looking to go the more natural route?
Yes. Whether a patient is undergoing an IUI or IVF or trying to conceive naturally several things are required for pregnancy and live birth. They are: good eggs, good sperm, good endometrial quality and lack of a disease state that can mitigate fertility or contribute to miscarriage. No matter how many IUI’s or IVF’s are attempted, without high quality egg, sperm and lining and the absence of systemic pathology, either pregnancy will not occur or miscarriage will occur. The effect of acupuncture and herbal medicine for female factor infertility stemming from poor egg quality is the same as that for male factor which is to increase blood flow to the ovaries to facilitate the same effect as mentioned above. Acupuncture, via the release of beta-endorphins has a vasoldilatory effect and can frequently improve blood flow (hemodynamics) through the uterine artery which contributes to greater lining health. The uterine artery branches off and feeds the ovaries as well; this can often contribute to improved egg quality. Many diseases that can contribute to infertility and/or miscarriage should be treated with both Western and traditional Chinese medicine or, just Western medicine alone. Two examples are 1) hypothyroidism. Hypothyroidism can contribute to infertility. It is best treated by a Western reproductive endocrinologist with Synthroid. I see no place for acupuncture and herbs in this type of case. Another case where the patient may benefit from the intervention of both modalitities of care is endometriosis. For the purposes of this interview it is not possible to elucidate everything about endometriosis. Let’s just say that endometriosis is an inflammatory, autoimmune disease that affects fertility in many planes. The way endometriosis is addressed is typically via laparoscopic surgery. However, it is usually not possible to get all of the endometrial implants out during the surgery and the inclusion of herbal medicine can frequently reduce the remaining inflammatory state which can contribute to the facilitation of pregnancy and a live birth.
Regarding patients trying to conceive naturally, I won’t treat them unless they are seen and evaluated by a reproductive endocrinologist first. There is no way for me to determine if the patient has a uterine anomaly, blocked tubes, polycystic ovarian disease, endometriosis, autoimmune fertility dysregulators or male factor infertility. Therefore, treating a patient without them first having had an evaluation by a reproductive endocrinologist is irresponsible. Once the patient has had their evaluation, I can then determine if I think that they may benefit from acupuncture and herbs or, if they should have a surgery or if the reproductive endocrinologist, the patient and I should move forward in a team-oriented approach to care.
Tell us how most men that you treat react to starting a program of treatments for male factor?
Typically male patients are the most difficult to treat. As a result of the pressures on little boys to “take it like a man”, “be a man”, “be brave”, “don’t cry”, “don’t be a wimp”, etc, etc, men are less likely to seek care for any malady. Treatment flies in the face of their image of masculinity especially when it comes to treating sperm anomalies, as sperm, in many cases, for many men, represents their ‘manhood’. Another issue is that men complain that they “have no time for treatment” which, I suspect is a defense mechanism to avoid treatment due to the aforementioned reasons. It is too bad that many men have these insecurities. It is my view that these insecurities represent the damage that society has done to men based upon societies ill-informed definition of masculinity.
Have you experience men expressing themselves emotionally as most women do?
There is always a "great moment" - What is your moment when hearing of a pregnancy announcement and/or a successful birth under your care?
When my patient tells me that she is pregnant we often hug each other and cry together. This is a ‘great moment’!
Wednesday, January 30
Acupuncture should be continued after embryo transfer and confirmed pregnancy at the frequency of two times weekly for 13 weeks to help reduce the chances of 1st trimester miscarriage.
There are many causes of miscarriage. The most frequent cause is poor egg and/or sperm quality creating a chromosomally abnormal embryo. By order of natural selection and survival of the fittest, pregnancies that occur with these embryos frequently abort.
Another common cause of miscarriage is poor hemodynamics or blood flow. Strong blood flow is important throughout the entire pregnancy but poor blood flow at the beginning of a pregnancy often results in miscarriage as a result of initial lack of nutrient delivery to the implanted blastocyst and then, later on, lack of nutrient delivery to the placenta. Placentation typically occurs between weeks 5 and 9 during an on-going pregnancy.
The job of the placenta is two-fold: 1) to transport nourishment to the developing fetus; 2) to excrete waste matter from the developing fetus. If the placenta fails to maintain its functional integrity, a miscarriage will ensue. One of the reasons that placental demise occurs is because of poor blood-flow or inferior hemodynamics. Acupuncture improves blood-flow.
We know acupuncture improves blood-flow because when women have transvaginal ultrasound examinations with a color doppler before and after acupuncture treatment, there is frequently more blood available and visible at the level of the uterus after acupuncture intervention. A color doppler is a medical device which measures and visualizes blood flow.
The result of poor blood-flow to the placenta is intra-uterine-fetal-demise; the fetus stops developing and miscarriage manifests.
As 90 percent of miscarriages occur within the first trimester, I treat for 13 weeks or, one week past the first trimester to help ensure an on-going pregnancy. Of course there are 2nd and 3rd trimester miscarriages, but most miscarriages are first trimester events.
Based on the above data, it is, in my clinical estimation, important to continue to receive acupuncture after an embryo transfer and when pregnancy is confirmed to help reduce first trimester miscarriages.
@Mike Berkley, L.Ac.
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