After treating infertility cases for twenty-one years I've arrived at some conclusions which I'd like to share.

1. A reproductive endocrinologist cannot determine when an embryo is "good".  Embryo grading means nothing unless it's a bad embryo.  Yes, one can visualize a 'bad' embryo, but even with PGD, a 'good' embryo is undeterminable. How many times have you heard about an embryo (blast) which is 'normal' based upon PGD and the cycle fails?  Here's why: embryo grading is only as good as current diagnostic procedures. Perhaps in time, embryo testing will be viable. Yes, PGD can rule out various chromosomal anomalies but that is determining a 'bad' embryo. My point is - if an embryo looks bad, it probably is. If an embryo looks good, it may not be.  This why including acupuncture and herbal -medicine in your reproductive medicine protocol makes sense. Acupuncture and herbal medicine can improve egg quality and embryo quality. There are many studies on the web that are revealing.
2. Endometriosis can still contribute to infertility even after laparoscopy. Why? Because it may not be possible to eradicate all endometriosis due to several reasons.
a. Some endometriotic tissue looks exactly like normal tissue and therefore, the surgeon will not be able to observe this tissue as diseased tissue.
b. Some endometriotic tissue may be on structures which are difficult or dangerous to reach and the surgeon will opt not to try and excise this tissue.
Endometriosis does more than cause tubal pathology; it changes the uterine environment by causing an inflammatory state in the uterus. This is not amenable to facilitating an ongoing implantation. This is why acupuncture and herbal medicine should be included in the reproductive medicine protocol of those trying-to-conceive who have been diagnosed with endometriosis as acupuncture and herbal medicine can reduce inflammation and make the uterus more hospitable to an implanting embryo.
3. PCOS We all think of PCOS as a metabolic-endocrinological disorder whose main deterrent to conception is lack of ovulation. All of this is correct but myopic. Clomid or gonadotropins can cause one to develop mature eggs and other meds are used to actually facilitate ovulation - but that's not enough. Why do many PCOS patients not conceive after several IUI's or even IVF's? Because women with PCOS have excess androgen within the follicular fluid. Androgen is an anti-estrogen and as such causes or can contribute to poor egg quality. This is why PCOS patients have a difficult time conceiving or frequently miscarry. In fact, those with PCOS are twice as likely to miscarry as those in the non-pcos population. Acupuncture and herbal medicine should be included in your reproductive medicine protocol is you have PCOS since we know that these Chinese medicine protocols help clear the ovary and its contents of 'debris' and other pathological substances, i.e. androgen excess.

For more information on how acupuncture and herbal medicine may be of help to you visit our site: http://berkleycenter.com

What Prevents Egg Production?

Many women who have difficulty conceiving wonder “Why? What prevents me from producing eggs?” A number of factors affect your fertility:

Age – Your age has a large impact on fertility. Your fertility is greatest during your twenties through age 35.  After age 35 your body’s ability to become pregnant decreases significantly.

Early onset menopause – A key symptom is the absence of your menstrual period. Early menopause may be caused by environmental factors including immune disease, chemotherapy and smoking, but the cause of many cases of early menopause is unknown.

Stress – Extended periods of stress can affect hormone levels thereby reducing your ability to produce and mature eggs. Make sure you are taking steps to alleviate your stress levels.

Polycystic Ovary Syndrome (PCOS) – PCOS is an ovulatory disorder where your body is unable to produce eggs normally due to cysts in the ovaries.  Women who are diagnosed with PCOS may find the cause of their weight issues in addition to “What prevents me from producing eggs?” Women who have PCOS often have trouble metabolizing sugar which results in weight gain.

High prolactin levels – Prolactin is a naturally occurring hormone in a woman’s body that is responsible for the production of breast milk.  If a woman has high prolactin levels when she is not nursing or pregnant can have issues with ovulation.

Your weight – Good overall health is important to fertility. Being overweight or underweight can create problems with ovulation. Reaching your ideal weight may address "what prevents me from producing eggs."

Blocked or scarred tubes – In order for an embryo to implant after fertilization, it must move thorough the fallopian tubes.  The issue may not be with egg production.  Instead, it may be that blocked or damaged tubes are preventing the egg and sperm from joining. 

Article Repost from newhopefertility.com

Women with PCOS or anovulation demonstrate higher live birth rates than women with tubal infertility

Women with polycystic ovary syndrome appear to have more success across the reproductive lifespan than women with tubal infertility, new data suggest.

“Women with PCOS have an increased number of antral follicles in the ovary and higher anti-Mullerian hormone levels,” researchers at the University of Pennsylvania in Philadelphia wrote.

To determine if this plays a role in reproduction, the researchers collected information on 44,286 women who underwent in vitro fertilization (IVF) and were listed in the 2004 to 2006 Society for Assisted Reproductive Technologies database. They then compared outcomes of women with PCOS with those of women with tubal infertility after completion of IVF.

Results revealed that women of all ages with PCOS had a considerably higher live birth rate than women with tubal infertility. An adjusted model also indicated that the RR for live birth in women with PCOS vs. those with tubal infertility after IVF was 1.12 at age 35 years, 1.22 at age 40 years and 1.34 at age 45 years (P<.001), the researchers said.

“Women with PCOS or anovulation demonstrate higher live birth rates than women with tubal infertility across the reproductive lifespan,” the researchers wrote. “This novel finding becomes more robust in later reproductive life and suggests a lengthening of the fertility window.”

Study of 5,800 IVF cycles shows a trend toward decreasing success rates with increasing BMIs.

Encourage Healthy BMI in Patients Before IVF

PHILADELPHIA — Patients considering in vitro fertilization should be encouraged to aim for a healthy body mass index before they start treatment, results of a large retrospective study suggest.

“There was a trend toward decreasing success rates with increasing BMIs,” reported lead investigator David Ryley, M.D., of Beth Israel Deaconess Medical Center, Boston, and Boston IVF, a private fertility clinic.

The study reviewed more than 5,800 fresh, non-donor in vitro fertilization (IVF) cycles at Boston IVF in which the patient's BMI had been recorded, he reported at the annual meeting of the American Society for Reproductive Medicine.

Patients were divided into five groups according to BMI: under 20 kg/m2, 20-24.9 kg/m2, 25-29.9 kg/m2, 30-34.9 kg/m2, and more than 35 kg/m2. Women with a BMI of more than 40 kg/m2 are not allowed to undergo IVF at the center, he said.

There was no difference between the groups with respect to the number of mature follicles, number of oocytes retrieved, number of mature oocytes, the number of cycles per patient, and the number of embryos transferred. Still, patients in the highest BMI category had a significantly lower implantation rate and clinical pregnancy rate, compared with the other BMI groups.

Although the clinical pregnancy rate ranged from about 27% to almost 33% in the lower BMI categories, it was not quite 22% in the highest BMI category.

Similarly, the implantation rate ranged from 18% to 20% in the lower BMI categories, but it was only 13% in the highest BMI category.

Unlike previous published studies on this topic, the current study did not find an association between extremely low BMI and poor IVF success rates, Dr. Ryley said.

“The best data in the literature suggest that severely low BMIs under 20, or under 18, affect the hypothalamic-pituitary axis, such that patients have irregular menstrual cycles and, therefore, have an impaired chance of fertility,” he told this newspaper. “But in our study the patients with the lowest BMIs actually had the highest pregnancy rates—although the difference was only significant when compared with the highest BMI category.”

The study's findings are consistent with other reports of how excess weight can impact hormonal balance and the quality of oocytes and embryos, he said. Weight loss can often correct problems such as hyperinsulinemia and polycystic ovarian syndrome, which can in turn increase fertility.

But physicians should also know how to manage an IVF cycle in an overweight patient who has not lost weight.

“We know that patients with high BMIs require higher doses of medications, particularly gonadotropins, to stimulate folliculogenesis, and they often require longer cycles,” Dr. Ryley said. “By increasing the doses of these medications, you can often get an adequate number of oocytes. However, in many of these patients, hormonal imbalances may have a deleterious effect on the quality of oocytes you get.”

Find out how you can lose weight. Visit...

http://www.berkleycenter.com/

PCOS-Case Report

Ovulation After Acupuncture In PCOS Patient

EXETER, ENGLAND — A course of acupuncture was followed by ovulation in a 32-year-old woman with oligomenorrhea and primary infertility of 6 years' duration, Dr. Jin Xu said at a health care symposium sponsored by the University of Exeter.

Before undergoing acupuncture, the patient had “very infrequent” menstrual periods, and transvaginal ultrasound revealed polycystic ovaries. The patient's luteinizing hormone to follicle-stimulating hormone ratio exceeded 3:1, as is typical in polycystic ovary syndrome, and her testosterone level was elevated at 3.7 nmol/L.

Five daily sessions of electroacupuncture were performed on acupoints Guanyuan (Ren 4), Zhongji (Ren 3), Zigong (Extra 16), and Sanyinjiao (Sp 6), said Dr. Xu of the University of Oxford (England). Each acupuncture session lasted 25 minutes.

After the course of acupuncture, endometrial thickness increased from 4.5 mm to 8 mm by day 16, and a menstrual bleed was induced, Dr. Xu said.

Treatment was repeated in the next menstrual cycle, and the patient subsequently began to have regular periods. Three months later, she conceived and delivered a healthy baby girl at term, Dr. Xu said.

“It is likely that the hypothalamus-pituitary-ovary axis is involved in acupuncture-driven ovulation induction, but the mechanisms involved remain unclear,” he said.

Limited research has been conducted in this area, and it is unclear whether an actual effect on ovulation exists, Dr. Xu cautioned, adding that a clear need exists for randomized, controlled trials.

For more information on infertility, acupuncture and herbal medicine, visit www.berkleycenter.com

The Berkley Method - Acupuncture

The Berkley Method of Reproductive Wellness(TM) merges Western and complementary medical data enabling the creation of a complete and well rounded treatment protocol. All Berkley Method Certified Practitioners engage in on-going specialized training in Western reproductive science and complementary medicine for the treatment of those faced with fertility challenges.

The Berkley Method, in addition to its philosophy, includes a clinical aspect too. For example, I have started to compile specific acupuncture point protocols for specific pathologies. These point-prescriptions are effective. I have used them to achieve pregnancies for many years.

So far, I have written down my protocols for high fsh, vericoceles, low sperm count, pcos and endometriosis. More will follow.

These acupuncture point combinations must be used as guidelines, changed when necessary to fit the needs of the specific patient in treatment.

Thanks for reading!

Dr. Mike Berkley
mikeberkley@berkleycenter.com

Acupuncture may help relieve PCOS

Exercise also improves symptoms and related risk factors, study finds
-- Kevin McKeever
FRIDAY, Sept. 4 (HealthDay News) -- Acupuncture and exercise may help women better handle the symptoms and risks that come with hormone imbalances caused by certain ovarian cysts, Swedish researchers report.
About one in 10 women of reproductive age have polycystic ovarian syndrome, a condition that can start in the teen years and cause irregular menstrual cycles and infertility. Small immature cysts on the ovaries disrupt hormone production, causing excessive secretion of testosterone, the male sex hormone. In addition to infertility, it can increase a woman's odds of becoming obese and developing type 2 diabetes or cardiovascular disease, the study authors explained.
While the syndrome's cause remains mysterious, researchers believe it is linked to a highly active sympathetic nervous system, part of the body's internal controls that regulate several functions one cannot willingly manage, such as how wide one's pupils dilate.
In the study, women with polycystic ovarian syndrome were separated into three groups: one group received regular electro-acupuncture, in which weak electric current is sent through the needles; another group was given heart-rate monitors and told to exercise three or more times per week; the last group was given no additional treatment or instructions. After a four-month period, women in the acupuncture and exercise groups ended up with lower sympathetic nervous system activity, though the acupuncture group received additional benefits, the researchers found.
"Those who received acupuncture found that their menstruation became more normal. We could also see that their levels of testosterone became significantly lower, and this is an important observation, since elevated testosterone levels are closely connected with the increased activity in the sympathetic nervous system of women," study author Elisabet Stener-Victorin, an associate professor who has led the research at the Sahlgrenska Academy at the University of Gothenburg in Sweden, said in a news release issued by the institution.
More information
The Polycystic Ovarian Syndrome Association has more about polycystic ovarian syndrome.
SOURCE: University of Gothenburg, news release, Aug. 27, 2009

Case Report - Ovulation after acupuncture in PCOS patient

EXETER, ENGLAND — A course of acupuncture was followed by ovulation in a 32-year-old woman with oligomenorrhea and primary infertility of 6 years' duration, Dr. Jin Xu said at a health care symposium sponsored by the University of Exeter.
Before undergoing acupuncture, the patient had “very infrequent” menstrual periods, and transvaginal ultrasound revealed polycystic ovaries. The patient's luteinizing hormone to follicle-stimulating hormone ratio exceeded 3:1, as is typical in polycystic ovary syndrome, and her testosterone level was elevated at 3.7 nmol/L.
Five daily sessions of electroacupuncture were performed on acupoints Guanyuan (Ren 4), Zhongji (Ren 3), Zigong (Extra 16), and Sanyinjiao (Sp 6), said Dr. Xu of the University of Oxford (England). Each acupuncture session lasted 25 minutes.
After the course of acupuncture, endometrial thickness increased from 4.5 mm to 8 mm by day 16, and a menstrual bleed was induced, Dr. Xu said.
Treatment was repeated in the next menstrual cycle, and the patient subsequently began to have regular periods. Three months later, she conceived and delivered a healthy baby girl at term, Dr. Xu said.
“It is likely that the hypothalamus-pituitary-ovary axis is involved in acupuncture-driven ovulation induction, but the mechanisms involved remain unclear,” he said.
Limited research has been conducted in this area, and it is unclear whether an actual effect on ovulation exists, Dr. Xu cautioned, adding that a clear need exists for randomized, controlled trials.
For more information on infertility, acupuncture and herbal medicine, visit www.berkleycenter.com