Monday, March 31

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.

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