Monday, March 31

NYC Community Event for Endometriosis and Infertility

Community Presentation on Endometriosis

 Thursday, April 17, 2014
 The Berkley Center 
16 E 40th Street, 2nd Floor
New York, NY 10016

This is an open event to the community to join us for an intimiate Q&A with Director and Founder of the Berkley Center, Mike Berkley about the topic of Endometriosis.

March is Endometriosis Awareness Month


Acupuncture has been shown to help idiopathic couples, women with PCOS, endometriosis and poor egg quality due to advanced maternal age. 

Let's start with PCOS. These patients typically have double the miscarriage rate of patients in the non pcos population and are often infertile; the etiology of both of these dynamics occurs as a result of poor egg quality as a result of ovarian hyperandrogenism.

Acupuncture improves hemodynamics to the uterus and to the ovaries there by facilitating an improved excretion of androgen from the ovaries leaving the ovaries with a less challenged estrogenic milieu. This can, in some case, improve egg quality and therefore help to improve pregnancy outcomes while simultaneously reducing miscarriage due to aneuploides.

Furthermore, acupuncture, along with exercise and life-style counseling can often improve weight loss, which, in and of itself, lowers the androgen profile of these patients.

Acupuncture has also been shown to facilitate ovulation in some of these patients but I believe that an east meets west approach to care is best as clomiphine citrate (clomid) or injectables can almost guarantee ovulation - but not improved egg quality. The utilization of both modalities therefore potentiates the effect of both with a concomitant advantage to the patient.

On to endometriosis: this is an autoimmune, inflammatory disorder that is mostly (though not always) diagnosed via laparoscopic intervention. When laparoscopy is performed fertility quotients often improve even in cases where there is no tubal pathology. Why is this? It is because when endometriotic implants are resected, the origin of pro-inflammatory cytokines is eliminated and the uterine milieu is improved and perhaps (I don't know for sure) pinopode behavior and manifestation is improved.

It is a fact that even though endometriosis in inherently a disease that is not of the uterus, uterine linings in woman with endometriosis are often clinically or sub-clinically affected. So not only are there uterine inflammatory processes occurring but implantation failure may also be a contributing factor. None of this has anything to do with the tubes. When a laparoscopy is executed it is probable that not all of the endometriosis is resected because 1)some endometriosis has the same color as normal tissue and 2) some endometriosis is located in areas that are either unavailable to the surgeon or are hidden behind various pelvic structures. As a result, some pro inflammatory cytokine activity may sill be manifest even after laparoscopic intervention. Since acupuncture improves hemodynamics, once again the utilization of acupuncture may serve to help excrete these unwanted cytokines improving uterine receptivity and environment creating a more hospitable environment for an embryo.

Some woman status-post resection still have severe pelvic pain and remain infertile (and I am taking age and other confounding pathologies out of the equation). Why is this? Probably because there remain ectopic endometrium with concomitant pathology at the level of the uterus. Acupuncture often helps these patients for the reason(s) I stated above.

In the case of the idiopathic patient, the acupuncturist, through his or her diagnostic evaluation will often uncover factors that are not taken into consideration during the Western medical evaluation. These issues (clots in the menstruate, severe pelvic pain with menses, night sweats, cold pelvis, severe stress and more) lead the practitioner of traditional Chinese medicine to arrive at what is known as a 'pattern of disharmony' and that pattern is then treated. Often, pregnancy results. Though the language and paradigm of traditional Chinese medicine are different from this of Western medicine there must be some biological, metabolic, endocrinological, neurologic effect occurring in response to the acupuncture which often, though certainly not always results in pregnancy.
Stranger stories have been told. For example: take the patient who has undergone 6 IUI's and 6 IVF's (even with PGD or CGH) and have never conceived and the couple gives up. Four years later, she conceives with intercourse and has a live birth of a healthy baby.

The point is, as you can imagine, Western diagnostic capabilities are excellent but not complete nor all encompassing. Certainly fertility evaluations will be different 50 years from now. There are reasons for infertility that none of us are aware of and only a few that we are.

The use of acupuncture may be touching upon areas that Western medicine is not looking at or paying attention to. This is not a criticism but a scientific fact. We know what we know, we don't know what we don't know, but we must know that we don't know; in time, we will know more but never all.

I hope this helped to elucidate the use and mechanism-of-action of acupuncture in the setting of the infertile patient. 

Best wishes. 
Mike Berkley, L.Ac.

Friday, March 28

Acupuncture After IVF?

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.
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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.

Wednesday, March 26

Treating Infertility with Herbal Medicine

Herbal medicine has been used to treat internal disorders including infertility for thousands of years.
Practitioners of Chinese herbal medicine rarely use a single herb in treatment. Chinese herbs are formula based; many herbs are mixed together to create the perfect ‘concoction’ specifically designed for the individual patient.

Some formulae contain two herbs and some thirty or more herbs. Each herb has many functions. Each herb has its own flavor, nature, temperature and trophism.  Prescribing the right and the safe herbal medicinals requires training and clinical experience.  Herbal medicine is an extremely complex form of medicine which requires many years of arduous study and clinical experience to master. 

Self medicating with herbal medicine presents a dual dilemma. At best the herbs will be useless, as the key to correct formula prescription is an accurate differential diagnosis which can only be made by a licensed, board certified, experienced practitioner. At the worst case, self prescribing of herbal medicine may prove harmful or fatal.

A good example of this is Ma Huang/Ephedra.  Ma Huang is an herb prescribed on a daily basis by hundreds of TCM practitioners to thousands of patients safely. 
That several people have died as a result of taking Ma Huang has very little to do with the dangerous properties of the herb inasmuch as it has to do with individuals self-medicating.  Aspirin can prove fatal if taken by a hemophiliac.  This is not an indication that Aspirin should be banned or that it is a dangerous drug.   It is totally safe if used appropriately.

Herbal medicine is totally safe if prescribed by a knowledgeable expert. Not only is herbal medicine safe, it is highly effective in treating many pathologies without the concomitant harmful side-effects which often accompany pharmaceutical drugs.   There are greater than one million hospitalizations per year as a result of drug induced side-effects; not so with herbal medicine.
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There are many causes of infertility which include but are not limited to elevated FSH levels, PCOS, endometriosis, luteal phase defect, hyperprolactinemia; pituitary adenoma, blocked tubes, uterine anomalies, sperm anomalies, stress, and, infertility which is diagnosed as idiopathic. 

Traditional Chinese Medicine has, for more than three thousand years, successfully treated infertility; and it still does so today.

Nancy is thirty-nine years old and she wants to compete as an Olympic triathalete; she is five feet in height and weighs three hundred and thirty pounds.  Can she compete?  Let’s see.  She asks her best friend, Alice, for a recommendation for a nutritionist. Alice raves about Teresa J., a fabulous nutritionist who “changed her life”. So Nancy makes an appointment with TJ and has a consultation. Nancy listens attentively to TJ, takes notes and leaves TJ’s office full of enthusiasm, commitment and motivation.
Starting the next day Nancy begins implementing the new dietary regimen which TJ has prescribed.  Next, Nancy joins a local health club, hires a personal trainer and works out three to four days per week.  Finally, Nancy joins a meditation group and meditates daily.
What happened?  In twelve months, Nancy lost one hundred and fifty pounds, put on solid muscle, developed a ‘six-pack’ abdomen and can run twenty-five miles per week. She is in the best condition of her life!  Can she now compete in the Olympics? Well, I’m afraid not. To be an Olympic athlete requires a life-time commitment of training and nutritional guidance.  Nancy has, however, become healthier, stronger and happier than ever before!   What if Nancy wanted to get her reproductive system in Olympic condition? 

The proper life-style counseling which includes nutritional changes and perhaps an exercise routine and acupuncture and herbal medicine can get a women’s reproductive system in the best possible condition that it can be in at the present moment.  Your TCM practitioner should be able not only to treat you with acupuncture and the appropriate herbal formula but should also give you guidance regarding diet, exercise and life-style changes which will positively impact your health.

Many women undergo three to five unsuccessful IVF procedures. Often these procedures are unsuccessful for the same reason that Nancy could not even begin to be athletic – overall poor health and specifically, poor reproductive health. 
Women who are over thirty years old need to get their reproductive system in the best condition possible to achieve pregnancy either naturally or via an A.R.T. procedure.

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As we grow older our circulation becomes less patent. In addition to the frequent complaint of cold hands and feet, another effect of inhibited blood flow is that the quantity of blood flow to the uterine lining, ovarian tubes and ovaries is less.  Acupuncture and herbal medicine have a stimulatory effect on the blood circulation.  An example of impeded blood circulation is blood clots in the menstruate. Though in and of itself, menstrual clotting may not be an issue, it does indicate a circulatory dysfunction which can be both a manifestation of an illness (circulatory inhibition) and the cause of an illness (blood stagnation [i.e., endometriosis], causing infertility).

Acupuncture and herbal medicine can be an important aspect of one’s healthcare routine, used to assist in achieving the goal of better health in general and better reproductive health in particular.

Under the care of a licensed and board certified acupuncturist/herbalist who is experienced in treating the infertile person there are no negative or dangerous side-effects associated with acupuncture or herbal medicine; there is only upside potential.   Using acupuncture and herbal medicine as part of the regimen to achieve a healthy reproductive system is a fertile idea.

Monday, March 24

Traditional Chinese Medicine

Although the goals of  Traditional Chinese Medicine (TCM) and allopathic medicine are the same, their ideas of etiology of disease, disease itself and the process used to regain health  are decidedly different.   The allopathic physician learns that disease must be cured by prescribing medicine which kills bacteria or renders a virus ineffective; at times surgical intervention is a necessity.

There is nothing inherently wrong with this approach. It often works.  The question worth exploring is why TCM succeeds when allopathic medicine fails? What is the mechanism of action of acupuncture and herbal medicine which results in palliation or cure that is not manifest in biomedicine?  It is through this exploration that the unique nature of TCM avails itself.

Though the goal of TCM is to cure a patient, the doctor of TCM attempts to do this not by treating the disease but rather by treating the whole person which takes into account the various attributes of an individual which, when combined, account for an individual being sick or healthy.  A person, according to the tenets of TCM is more than their pathology. To treat just the pathology may yield impressive though temporary results. 

People are not, according to TCM, represented solely by their illness, but by the accumulation of every human interaction engaged in from the moment of birth including the values of and the culture from which the individual develops. The emotional experiences, eating habits, work habits, work and living environment, personal habits and the social milieu are considerations which are important to fully comprehend for the deleterious effects they may have on the individual.

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Though the Western methodology of research of Chinese medicine has not, to date, been arrived at by the Western scientific community, the veracity and efficaciousness of this medical modality is nonetheless proved by its long history of continued success. More than a quarter of the world’s population regularly uses TCM as part of their health care regimen. Chinese medicine is the only form of classical medicine which is regularly and continuously used outside of its country of origin.

TCM is part science, empirical as that may be and part art. It’s practice is, to a greater or lesser degree interpreted and performed by based not only on the facts but also on the experience of the treating doctor. 

The experienced doctor must utilize his or her own interpretive skills, taking into consideration not only what the patient tells and shows, but also what they reveal without meaning too and, what they don’t express during the intake process. The empty spaces can contain more important information than the filled ones.  The tone of the voice, the complexion, the condition of the eyes, the facial expression, the overall demeanor, how one walks, sits, and stands are all observed and utilized by the doctor of Chinese medicine as part of the information required to arrive at a differential diagnosis.  In other words, even before the first words are spoken by the patient, the doctor already has some idea of who this person is.

The doctor must be able to note and sense inconsistencies in an individual that are expressed by the patient even without the patient being cognizant of the chasms which exist between what they verbally express and what their spiritual presentation divulges.

A great doctor is one who can process a mix of factual knowledge of medicine with a personal sensitivity based on experience.  The doctor of TCM specializes not just in inserting needles or prescribing herbal formulae but in being able to divine ‘hidden’ or subtle pathology which may not been seen or understood by practitioners of other types of medicine. In fact, a patient’s main complaint may be only one of several pathologies which are present though the patient herself is only aware of the one which is most important to her at the time of examination.  This ability of divination though quite difficult to master is ascertained without the benefit of modern technology; we rely on the  ‘Four Examinations’.

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This method of diagnosis dates back over three thousand years.  Observing, Listening and Smelling, Questioning and Palpating make up the ‘Four Examinations’. Listening and Smelling are considered to be one of the Four Examinations.  This method of diagnosis, though seemingly quite simple, is far from simplistic. It allows the astute practitioner to arrive at a differential diagnosis.  With the advent of technology, as amazing, necessary and beneficial as it is in relation to medical intervention, there seems to be a direct correlation between advancement in technological wonders with an increasing decrease in doctor sensitivity to the patient.  It is important to always remember that a patient is a person first!

Proper treatment in TCM is more than the elimination of pathological processes. In addition to attacking the pathological factor(s), it is the responsibility of the TCM doctor to support the individual in his or her goal of achieving overall total health which includes the physical-psycho-emotional and spiritual aspects of health.  This paradigmatic approach is an inexorable part of the process of healing. Without it, we are merely chasing the sickness and forgetting about the patient who, though a patient they may be must also be recognized first as a whole person, not just an embodiment of illness.

Pathologies are guests (and we hope temporary ones!) in a home which serves as a gracious host – our physical, emotional and spiritual selves.  TCM first is concerned with strengthening the immune function which includes homeostasis of the physical, emotional and spiritual attributes of the patient, so as to be able to assist the patient in his or her endeavor to do battle and destroy the enemy at the gates (or inside them).