Supplementation of mitochondrial nutrients may improve the availability of energy production for the maturing oocyte and the developing embryo and thus reduce aneuploidy and assist in clinical pregnancies and live birth rates.

5/14/2011

Supplementation of mitochondrial nutrients may improve the availability of energy production for the maturing oocyte and the developing embryo and thus reduce aneuploidy and assist in clinical pregnancies and live birth rates.

Ovulation leads to resumption of meiosis in the oocyte. This means that there is an alignment and separation of chromosomes by the nuclear spindle. The mature oocyte then contains 23 chromosomes. 23 chromosomes are isolated outside of the zona- pellucida in the first polar body. When penetrated by a euploidic sperm a second polar body is extruded and the zygote then has a normal diploid complement of 46 chromosomes. The process of extruding chromosomes outside of the oocyte as well as expulsion of the second polar body requires energy.

The energy required for metabolic function of the oocyte is provided by mitochondria and ATP. The egg has more mitochondrial cells than any other tissue in the body. During recruitment of follicles mitochondrial DNA increases from 6000 copies to about 200,000.

Mitochondrial DNA is very vulnerable to mutations and deletions. The inheritance of mitochondrial DNA is strictly maternal. We can see from a TCM perspective that this is a clear depiction of yang within yin since the absence of the female’s yang qi would mean a complete lack of mitochondria/ATP. Mitochondria is where the power cells, ATP are stored. As a woman ages her mitochondrial function (yang qi) declines and, as a result there are mutations and deletions in the nucleotides which is where mitochondrial DNA is stored.

Oxidative phosphorylation is a metabolic pathway that uses energy released by the oxidation of nutrients to produce adenosine triphosphate (ATP). Although oxidative phosphorylation is a vital part of metabolism, it produces reactive oxygen species such as superoxide and hydrogen peroxide, which lead to propagation of free radicals, damaging cells and contributing to disease and, possibly, aging (senescence). Free radicals are harmful to egg and sperm quality.

One of the more frequent nucleotide deletions is the “common” deletion of 4977 base pairs, almost a third of the whole mitochondrial DNA genome. This deletion was shown to have a high prevalence in unfertilized oocytes and oocytes from older patients. As women and eggs age, mitochondrial energy production diminishes. Many processes of oocyte maturation especially nuclear spindle activity and chromosomal segregation become impaired.

It appears that free radicals along with reduced ATP and mitochondrial anomalies cause follicular damage and aneuploidy in the older woman.

Supplementation of mitochondrial nutrients may improve the availability of energy production for the maturing oocyte and the developing embryo and thus reduce aneuploidy and assist in clinical pregnancies and live birth rates. There are two ways to supplement these nutrients; exogenously and endogenously. For example, exogenous supplementation with Coenzyme Q10 helps to create ATP. It is also a major antioxidant. Natural systemic CoQ10 decreases with age.

An endogenous means of supplementation has less to do with directly affecting the function of the ovaries than improving systemic function so that ovarian function will improve naturally.

In order for a family to function in a healthy fashion all members of the family must be healthy. Let’s look at this statement from a different perspective: if one family member is sick, it will affect the others members of the family, either physically, emotionally or both. So the family dynamic must be treated; not just the sick individual. This is a more organic and holistic approach to treating the root and not the branch or the etiology as opposed to the symptoms. This is the goal of endogenous supplementation with, for example, herbal medicine.

An herbal formula that may be used to treat poor egg quality endogenously, due to yin-essence vacuity with depletion of yang might be composed of:

Xiang fu, dang gui, bai shao, shu di, rou cong rong, rou gui, shan yao, dang shen, mai dong and lu rong.

Of course, a formula must be created based upon a differential diagnosis and must strictly follow a treatment principle but this formula elucidates the pathology being treated: yin-essence vacuity with yang qi depletion.

There are two herbs, dang gui and xiang fu which will help ‘move’ the other herbs so stagnation will not occur but dissemination will. There also two herbs to help benefit the kidneys through supplementation of the spleen qi; shan yao and dang shen. Mai dong is used to benefit metal so as to promote water. Rou cong rong, rou gui and lu rong warm the kidneys, promote yang and benefit essence.

These methods of treatment involving benefitting the kidneys through supplementation of the spleen qi and benefitting metal to promote water; are referred to as treating ‘one step removed’. In other words we don’t just treat the organ or channel involved but we also treat organs that have a direct effect on other organs. It’s similar to using lung acupuncture points as part of a protocol to positively affect the large intestine.

Aging is a natural process and in the present culture health-care providers are often faced with the challenge of trying to reverse the reproductive clock with assisted reproductive interventions. These techniques such as IUI and IVF are often successful but more often they are not.

The main reason that ART fails more than it succeeds is because ART is primarily a mechanical process which cannot improve the components required to facilitate a clinical pregnancy and a live birth – egg and sperm.

Though CoQ10 has shown promising results, it still is not a full system approach. In other words it works on egg and sperm but not lining and other presentations which can alter the perfect balance, integration and function of the entire body to allow for pregnancy.

Acupuncture and herbal medicine are less involved per se in improving one area of function but more to the point, they improve all systems and functionality of the human organism –psycho-emotionally and physically.

Let’s use an analogy. If you lived in a rickety old house which was literally falling apart and it had very drafty windows you could spend $20,000.00 replacing the windows with state-of-the art windows and the drafts would be gone. But the house would fall apart anyway in a short time. In order for the house to be healthy the entire house must be addressed, not just the windows. IUI and IVF are really just dealing with the windows. TCM rebuilds the house.

The lungs, spleen and kidneys are the primary organs which, according to the theory of TCM, contribute to the creation and dissemination of energy or qi in the human being. As a person grows older their aerobic capacity decreases, their digestion worsens, their lower back and knees weaken, and their sexual and urinary functions worsen. That’s because these named organs are becoming deficient in qi which is a natural part of aging. If these organs could be nurtured, supplemented, and regulated their functionability may improve.

Improvement would be witnessed as improvement in the functions associated with each organ that I mentioned above. However, these three organs have far greater responsibility than that which is associated with the organs themselves. Egg quality, sperm quality, lining quality and the emotional state can all be improved with their respective improvement.

Then, when an IVF ET is performed the products (egg, sperm and endometrium) that the REI are mechanically manipulating will be superior in health and have a higher possibility of manifesting in a live birth.

The best outcomes for pregnancy and live births will come not from improved IVF techniques or more powerful drugs to facilitate greater folliculogenesis but through the improvement of the quality of the necessary components to achieve pregnancy: sperm, egg, and lining along with the down-regulation of pathogenic factors that can mitigate fertility such as immunological factors, blood clotting factors and inflammatory processes (endometriosis without pelvic distortion for example).

Acupuncture and herbal medicine has been effective in treating many cases of infertility for more than two thousand years.

When East meets West in the clinic, then patients will have the best chance of turning their dreams of having a family into a reality.

Mike Berkley, L.Ac., FABORM

Conception is a natural process – Or…don’t microwave your dinner!

Process

Conception, pregnancy and parturition are a process. One definition of process is “a series of actions, changes, or functions bringing about a result”. Any natural process is better in every way than an artificial one. A good example is cooking. There is the process of cooking which is a slow, mindful act and there is microwave cooking which is basically a non-participatory act without natural process. There is no relationship between the chef and the outcome of the meal. Which meal tastes better? And, which is healthier to eat?

The process of conception is quite complicated and requires the perfect balance and function of many components all working in a coordinated and harmonious fashion. Sperm must be attracted to egg, it must find the egg, and it must penetrate the egg. The egg has be high quality and so too must be the sperm. The lining must have qualitative integrity. The embryo must find the lining and must be able to penetrate it. The placenta must develop and nourish the developing fetus and rid the fetus of waste matter. The placenta must protect the fetus from immunological attack. The cytokines, proteins, immune function, blood flow, gycoproteins, hormones must all be in balance and not under or over functioning. There must be absence of pathological mitigators which can contribute to infertility or promote miscarriage. Each and every player in the orchestra of conception must be in tune. One sour note and pregnancy will not occur or miscarriage will ensue.

Chinese medicine which consists mainly of acupuncture and herbal medicine does not work by adding to that which is deficient or reducing that which is in excess; Western medicine is good at that. For example, a common practice in treating a deficiency syndrome, i.e., hypothyroidism is to ADD synthroid. Or a common method at reducing excess insulin is by prescribing Metformin. These medicines which add or suppress or reduce have changed the face of civilization. Without the intervention of Western medicine and surgery our life-span would probably not exceed 40 years of age and three million babies would not have been born as a result of IVF. How many couples however, have remained childless even though they have undergone multiple IVFs? I am guessing more than three million.

Here is why: Just as a microwave oven can cook a meal, IVF can create a baby. But, as the microwave does not supplant the relationship between the chef and the food and the process of creating a meal, IVF cannot, in all its glory, in all cases, replace the natural process which is necessary to occur for conception and a take-home-baby to ensue.


The alternative

Acupuncture and herbal medicine are essentially used to create a state as close to homeostasis as possible. Homeostasis is when everything in the body and mind work perfectly. Obviously, this is not attainable. But, acupuncture and herbs attempt this and by attempting it a greater state of systemic and psycho-emotional health is frequently achieved. This is why, in many cases, acupuncture and herbs work to help one achieve pregnancy when IVF fails.

Because the greater one’s physical and psycho-emotional health is, the more likely they will be to conceive and deliver.

Based upon fourteen years of clinical experience in the field of infertility it is my professional opinion that the best case scenario for the infertile patient is to utilize Western medicine in conjunction with acupuncture and herbal medicine. The reason for this is quite simple. When the reproductive endocrinologist retrieves eggs and fertilizes them with sperm the resulting embryo is as good as its constituent components, egg and sperm. Most IVFs that fail do so because of poor egg quality and/or poor sperm quality. The reproductive endocrinologist cannot improve egg or sperm quality; acupuncture and herbs frequently can.

Blood

I saw a thirty four year old patient today. She has conceived three times with intercourse only to miscarry each time. She did get pregnant and delivered a baby as a result of insemination. She had one subsequent failed IVF. Now her doctor recommends donor egg with IVF. The patient has cold hands and feet, a pale complexion, low energy and gets dizzy. Obviously she has poor hemodynamics.

Blood is what carries FSH and LH from the brain to the ovaries; blood nourishes the endometrial lining; blood carries oxygen, electrolytes and nutrition to the entire reproductive system and removes waste matter from the reproductive environment. When cells die which they constantly do, they are ‘eaten’ up by macrophages. If the immune function is not functioning normally and debris is not removed, the outer layer of the dead cells breach and the internal toxic substance circulates within the ovarian milieu causing degradation in ovarian/egg quality. Acupuncture and herbal medicine increase blood flow; as a result this- can in many instances improve the health and function of the target tissue: ovaries and endometrial lining.

Why are you not using acupuncture and herbs?

It is difficult for me to understand why all infertile patients don’t include acupuncture and herbal medicine in their protocols. Why would they not? There has been so much research elucidating the efficacy of acupuncture in the treatment of infertility that acupuncture is no longer referred to as ‘alternative’ medicine but rather ‘complementary’ medicine. Herbs have a three-thousand year history of positive clinical outcomes.

Herb safety

Regarding the safety profile of herbs I have this to say: there are at least one million hospitalizations per year in America alone which occur as a result of adverse reactions to Western medicine. Many of these hospitalizations result in death. This does not happen with herbal medicine.

It is ironic therefore, that many (but no longer all!) doctors don’t want their patients on herbs because “they don’t know what’s in them”. Do you know what’s in Lupron? Or Gonal F? Did you know that ovarian hyper stimulation even from clomid can be fatal?

Don’t misunderstand, I am 100% pro IUI, IVF and donor egg-IVF protocols. But to not partake of a modality with proven results which may change the course from a negative outcome to a positive one especially in the patient who has had multiple IUI/IVF failures is a clinical error.


Mike Berkley, L.Ac., FABORM

Founder and Director, The Berkley Center for Reproductive Medicine