When the body is in free flow, with no blockage, there can be no imbalance, disharmony, or pain. It is only when the flow of qi, blood and fluids is compromised that a pattern of disharmony results. Thus, the goal for all acupuncture treatment is to restore the body to the natural state of homeostasis.
To illustrate this fundamental acupuncture treatment principle, let us discuss the nature of pain in the body.
If you are experiencing tightness in your neck, it may be due to an accumulation of stress in your shoulders and back. As your muscles get tighter, the free flow through that area of your body is being compromised. You may not be aware of the effects of this stress immediately. The holding pattern of your body and the manifestation in postural changes may not register as a problem until you wake up one day and you can no longer turn your head. Now the body has your attention, you are in pain. Acupuncture will open the areas of blockage, releasing the neck and restoring the flow through the acupuncture points and meridian channels and, as a result, your neck is pain is ameliorated.
When treating pain a variety of acupuncture points are utilized: local treatment to the affected area, trigger point release in the muscles, and acupuncture points distal to the affected area are chosen to reduce inflammation and increase circulation and healing. Often the muscles themselves need to be relaxed and, for this, a combination of acupuncture with additional modalities such as cupping, the application of cups to the skin to draw out deep inflammation, and massage are indicated. Achieving free flow through the acupuncture points is the treatment principle for all conditions. Determining where to place the acupuncture needles is the art of acupuncture combined with the experience of the acupuncturist.
When the body is open and balanced, there is no discomfort. This is manifested in the seemingly boundless energy of healthy children. As the body ages, we accumulate holding patterns of stress and fatigue, and it becomes necessary to remind the channels what free flow feels like. Originally designed to connect and circulate energy from the internal organs to the surface of the body and then back again, the meridian channels perform a very important job. Acupuncture treatment is designed to open the channels, resulting in being whole and complete again.
When viewing the body in this way, it is more difficult to understand how acupuncture and Chinese medicine can help more complex internal symptoms, such as infertility, fatigue and depression. Fertility enhancement acupuncture often treats both female and male patterns. To help prepare the body for pregnancy, the acupuncturist guides qi, blood and fluids to the reproductive system increasing the likelihood of a successful pregnancy.
The result is better circulation, fresh new blood and surging qi through the reproductive organs. In addition, the acupuncture treatments are designed to reduce stress levels in the patient, to facilitate a deep sense of relaxation. As a result of this treatment, sleep, metabolism, and digestion often improve, a very welcome side effect of the acupuncture treatment.
In conditions affecting emotional health, Chinese medicine again teaches a simple principle, emotional balance is the ability to feel all emotions appropriately. Often when presented with heightened mental challenges, we get fixed in one emotional state. So often the patient suffering from fatigue and depression also feels unmotivated and lacking in self-esteem. It is by helping the emotions to move freely that the patient begins to feel less afraid and more motivated to take action.
A healthy emotional state can be observed in early childhood. A toddler will be happy one minute, screaming and frustrated the next, and then back to happy before the tears have time to dry. Unfortunately, as we age, our emotional responses become more and more predictable, rigid and neurotic. It becomes difficult to adjust our patterned responses and the free flow of emotions becomes blocked.
Fatigue is often a result of being set in one emotion. We yearn for change and freedom so we may feel better. Drug addition and drug dependency are often a result of a depressed view of oneself or one’s current situation. Acupuncture can help to treat these conditions by opening the channels and freeing the emotions so that they can return to a more centered and balanced state.
In conclusion, the acupuncturist’s main priority is to restore the natural free flow throughout the mind and body. Regardless of whether the patient needs stress and pain relief, support conceiving or holding a pregnancy, or emotional balancing, the guiding principle of acupuncture treatment remains the same; free flow promotes harmony and optimal health in the body.
Abbey Fromkin, M.S., L.Ac.
Acupuncturist: Berkley Center for Reproductive Wellness and Women’s Health
Wednesday, March 23
Wednesday, March 16
The Sperm Chromatin Structure Assay (SCSA) and DNA Fragmentation: What Is It and What Does It Mean?
This article from a Resolve 2006 newsletter written by Dr. Werthman
Until several years ago the belief among most reproductive specialists was that if a man had live sperm then they were suitable for use with IVF / ICSI and if the female partner didn’t get pregnant or a miscarriage ensued then it was probably an egg quality issue. Several studies had implied that the conventional sperm parameters (count, motility and morphology) as measured on a routine semen analysis had no bearing on success when ICSI was used. Many couples pursued egg donation after failed IVF attempts because the husband’s semen parameters were relatively normal and yet conception hadn’t occurred. Some of these same couples were still unable to conceive even with the “better quality” donor eggs leaving both the doctors and the couples frustrated and perplexed. Some couples then went on to use both egg donors and surrogates thinking it was both an egg quality and implantation issue, again without success. The only commonality was the husband’s sperm.
About a year and a half ago a relatively new concept was introduced to clinical practice; sperm quality was dependent on the amount of damage to the sperm DNA or DNA fragmentation. Simply put, DNA is arranged in a double helix or ladder configuration with side rails and rungs. If the rungs are broken, then the ladder is unsteady and won’t function properly. What has recently been shown in several studies is very interesting and in some ways unexpected. Sperm DNA fragmentation has little or nothing to do with the parameters that we measure on the routine semen analysis. It has little to do with the shape of the sperm or whether the sperm are moving. It is a completely independent variable. Men with otherwise normal semen analyses can have a high degree of DNA damage and men with what was called very poor sperm quality can have very little DNA damage. More importantly what has also been demonstrated is that the degree of DNA fragmentation correlates very highly with the inability of the sperm to initiate a birth regardless of the technology used to fertilize the egg such as insemination, IVF or ICSI. Sperm with high DNA fragmentation may fertilize an egg and embryo development stops before implantation or may even initiate a pregnancy but there is a significantly higher likelihood that it will result in miscarriage. By testing for sperm DNA fragmentation, many cases of formally “unexplained” infertility can now be explained. Many of those couples who have been previously unable to conceive with what would be considered extreme measures have been diagnosed with high sperm DNA fragmentation and treated. It is now very clear to see that having this information about the quality of the sperm can be tremendously helpful to couples and their physicians.
There are several ways to test for sperm DNA fragmentation; the most widely used and statistically robust test is called the Sperm Chromatin Structure Assay or SCSA. The patient semen samples are frozen and shipped in a liquid nitrogen container to the SCSA reference laboratory in South Dakota. The sperm are thawed out and a stress is applied (low pH). The sperm are then labeled with a special orange colored dye that only attaches to the ends of broken DNA within the sperm cell. If the DNA is intact then no dye will attach to the sperm. A machine called a flow cytometer is used to analyze ten thousand sperm from the sample. The sperm are passed single file by a beam of light that hits the dye inside the sperm cell and reflects light at a specific wavelength causing the sperm to appear either orange (damaged) or green (normal). A computer counts the percentage of green versus orange-labeled sperm and software allows for creation of a graphic plot of the percent of damaged sperm giving an index known as the DNA fragmentation Index (DFI).
The data from thousands of patients has been analyzed and correlated with the patient’s clinical outcomes and references ranges were compiled. A normal sample has less then 15% of the sperm with DNA damage. Men with poor fertility potential have greater then 30% of their sperm damaged. A DFI Between 16% and 29% is considered good to fair fertility potential but becomes poorer as it approaches 27%. These numbers are thresholds meaning that above 30% the outcome for most couples was failure to have a birth even though only 30+ percent of the sperm were damaged. Under 15% most couples achieved success. The logical questions that arose were: what about the rest of the undamaged sperm in the sample? Why don’t those sperm work? What causes sperm DNA fragmentation? Can the DNA fragmentation be reduced and the sperm improved? If so, How?
DNA fragmentation can be thought of as a marker for other types of damage to the sperm. It is a kin to seeing the tip of the iceberg. Apparently, in semen samples with greater then 30% DNA fragmentation, other abnormalities are occurring with the non-fragmented sperm that the SCSA doesn’t measure and that is why samples used with DFIs above this level do not usually result in births.
The causes of high DNA fragmentation are those same causes of male factor infertility that we have known about for years such as chemical/toxin exposure, heat exposure, varicocele, infection, age, smoking, testicular cancer, radiation, and anything that increases the free radical levels in the semen among a list of many other things. It is very important to understand that sperm DNA fragmentation can change with time and it can be improved in many cases. The goal of a male factor evaluation is to seek out the causes of poor sperm quality and try to correct them so conception can occur naturally or to improve the sperm quality for IVF and maximize the chances of success. In situations where DFI can’t be improved there is evidence to suggest that removing the sperm directly from the testicle via biopsy and using it with ICSI may lead to better outcomes then using poor quality ejaculated sperm. Other options include counseling patients regarding the use of donor sperm either by insemination or fertilizing a portion of the eggs harvested for ICSI with donor sperm and a portion with the patient’s sperm, once again to maximize odds.
The clinical utility of the SCSA is readily apparent. All men with an abnormal semen analysis are candidates for this test as well as men with normal semen analyses who have failed IVF for unexplained reasons. Those couples using egg donors or surrogates may also benefit from screening prior to going thru the procedures because the effort and costs are so great. Men with poor DFI should have a male factor evaluation including a physical examination by a male reproductive specialist. These new concepts have a significant implication on how we practice and what we recommend to couples but we must bear in mind that this test does not have a predictive values of 100% as healthy babies have been born from men with high DFI but this is fairly uncommon.
There are herbal medicine formulas which are exceedingly high in antioxidant properties. At The Berkley Center for Reproductive Wellness we have had great success in treating this disorder.
Until several years ago the belief among most reproductive specialists was that if a man had live sperm then they were suitable for use with IVF / ICSI and if the female partner didn’t get pregnant or a miscarriage ensued then it was probably an egg quality issue. Several studies had implied that the conventional sperm parameters (count, motility and morphology) as measured on a routine semen analysis had no bearing on success when ICSI was used. Many couples pursued egg donation after failed IVF attempts because the husband’s semen parameters were relatively normal and yet conception hadn’t occurred. Some of these same couples were still unable to conceive even with the “better quality” donor eggs leaving both the doctors and the couples frustrated and perplexed. Some couples then went on to use both egg donors and surrogates thinking it was both an egg quality and implantation issue, again without success. The only commonality was the husband’s sperm.
About a year and a half ago a relatively new concept was introduced to clinical practice; sperm quality was dependent on the amount of damage to the sperm DNA or DNA fragmentation. Simply put, DNA is arranged in a double helix or ladder configuration with side rails and rungs. If the rungs are broken, then the ladder is unsteady and won’t function properly. What has recently been shown in several studies is very interesting and in some ways unexpected. Sperm DNA fragmentation has little or nothing to do with the parameters that we measure on the routine semen analysis. It has little to do with the shape of the sperm or whether the sperm are moving. It is a completely independent variable. Men with otherwise normal semen analyses can have a high degree of DNA damage and men with what was called very poor sperm quality can have very little DNA damage. More importantly what has also been demonstrated is that the degree of DNA fragmentation correlates very highly with the inability of the sperm to initiate a birth regardless of the technology used to fertilize the egg such as insemination, IVF or ICSI. Sperm with high DNA fragmentation may fertilize an egg and embryo development stops before implantation or may even initiate a pregnancy but there is a significantly higher likelihood that it will result in miscarriage. By testing for sperm DNA fragmentation, many cases of formally “unexplained” infertility can now be explained. Many of those couples who have been previously unable to conceive with what would be considered extreme measures have been diagnosed with high sperm DNA fragmentation and treated. It is now very clear to see that having this information about the quality of the sperm can be tremendously helpful to couples and their physicians.
There are several ways to test for sperm DNA fragmentation; the most widely used and statistically robust test is called the Sperm Chromatin Structure Assay or SCSA. The patient semen samples are frozen and shipped in a liquid nitrogen container to the SCSA reference laboratory in South Dakota. The sperm are thawed out and a stress is applied (low pH). The sperm are then labeled with a special orange colored dye that only attaches to the ends of broken DNA within the sperm cell. If the DNA is intact then no dye will attach to the sperm. A machine called a flow cytometer is used to analyze ten thousand sperm from the sample. The sperm are passed single file by a beam of light that hits the dye inside the sperm cell and reflects light at a specific wavelength causing the sperm to appear either orange (damaged) or green (normal). A computer counts the percentage of green versus orange-labeled sperm and software allows for creation of a graphic plot of the percent of damaged sperm giving an index known as the DNA fragmentation Index (DFI).
The data from thousands of patients has been analyzed and correlated with the patient’s clinical outcomes and references ranges were compiled. A normal sample has less then 15% of the sperm with DNA damage. Men with poor fertility potential have greater then 30% of their sperm damaged. A DFI Between 16% and 29% is considered good to fair fertility potential but becomes poorer as it approaches 27%. These numbers are thresholds meaning that above 30% the outcome for most couples was failure to have a birth even though only 30+ percent of the sperm were damaged. Under 15% most couples achieved success. The logical questions that arose were: what about the rest of the undamaged sperm in the sample? Why don’t those sperm work? What causes sperm DNA fragmentation? Can the DNA fragmentation be reduced and the sperm improved? If so, How?
DNA fragmentation can be thought of as a marker for other types of damage to the sperm. It is a kin to seeing the tip of the iceberg. Apparently, in semen samples with greater then 30% DNA fragmentation, other abnormalities are occurring with the non-fragmented sperm that the SCSA doesn’t measure and that is why samples used with DFIs above this level do not usually result in births.
The causes of high DNA fragmentation are those same causes of male factor infertility that we have known about for years such as chemical/toxin exposure, heat exposure, varicocele, infection, age, smoking, testicular cancer, radiation, and anything that increases the free radical levels in the semen among a list of many other things. It is very important to understand that sperm DNA fragmentation can change with time and it can be improved in many cases. The goal of a male factor evaluation is to seek out the causes of poor sperm quality and try to correct them so conception can occur naturally or to improve the sperm quality for IVF and maximize the chances of success. In situations where DFI can’t be improved there is evidence to suggest that removing the sperm directly from the testicle via biopsy and using it with ICSI may lead to better outcomes then using poor quality ejaculated sperm. Other options include counseling patients regarding the use of donor sperm either by insemination or fertilizing a portion of the eggs harvested for ICSI with donor sperm and a portion with the patient’s sperm, once again to maximize odds.
The clinical utility of the SCSA is readily apparent. All men with an abnormal semen analysis are candidates for this test as well as men with normal semen analyses who have failed IVF for unexplained reasons. Those couples using egg donors or surrogates may also benefit from screening prior to going thru the procedures because the effort and costs are so great. Men with poor DFI should have a male factor evaluation including a physical examination by a male reproductive specialist. These new concepts have a significant implication on how we practice and what we recommend to couples but we must bear in mind that this test does not have a predictive values of 100% as healthy babies have been born from men with high DFI but this is fairly uncommon.
There are herbal medicine formulas which are exceedingly high in antioxidant properties. At The Berkley Center for Reproductive Wellness we have had great success in treating this disorder.
Wednesday, March 9
higher live-birth rates
PHILADELPHIA — Women who receive acupuncture during the stimulation phase of an in vitro fertilization cycle and again immediately after embryo transfer have a higher live-birth rate than do controls, according to the first acupuncture study with this end point.
“Other studies have looked at pregnancy rates, but what is really important is whether or not there is a baby,” said Paul C. Magarelli, M.D., who reported his findings at the annual meeting of the American Society for Reproductive Medicine.
The retrospective study included 131 women who were undergoing standard in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). All of these women were considered good prognosis candidates for IVF/ICSI and were given the choice of having acupuncture.
A total of 83 women declined (controls) and 48 accepted.
There were no significant differences between the two groups in terms of infertility diagnoses, demographics, and treatment protocols, except that sperm morphology was slightly better in the partners of women receiving acupuncture (7.3% vs. 5.9 % normal forms with strict criteria evaluation), and the average uterine artery pulsatility index was lower in the acupuncture group (1.57 vs. 1.72), said Dr. Magarelli of the department of ob.gyn. at the University of New Mexico, Albuquerque.
The study found that pregnancy rates per embryo transfer were not significantly different between the two groups (50% in the acupuncture group and 45% in controls).
The miscarriage rate was almost halved in the acupuncture group (8% vs. 14%).
In addition, the rate of ectopic pregnancies was significantly lower in the acupuncture group—0 of 24 pregnancies (0%) vs. 2 of 37 pregnancies (9%), said Dr. Magarelli, who is also in private practice in Colorado Springs and Albuquerque.
Thus, the live-birth rate per IVF/ICSI cycle was significantly higher in the acupuncture group than in controls (21% vs. 16%).
“The live-birth rate per pregnancy is an even more telling number, since some cycles get cancelled. There was a 42% live-birth rate per pregnancy in the acupuncture group, compared to a 35% rate in the nonacupuncture group,” Dr. Magarelli said in an interview with this newspaper.
“We believe that what we are doing is improving the uterine environment such that implantation is improved,” he added.
The study used two acupuncture protocols.
The Stener-Victorin electrostimulation protocol—which has been shown to reduce high uterine artery blood flow impedence, or pulsatility index (Hum. Reprod. 1996;11:1314-7)—was used for eight treatments during ovarian stimulation.
The second acupuncture technique—the Paulus protocol, which has been associated with improved pregnancy rates (Fertil. Steril. 2002;77:721-4)—was used within 24 hours before the embryo transfer and 1 hour after.
“This protocol has demonstrated reductions in uterine contractility, so by relaxing the uterus before the embryo transfer and immediately after, we felt we were setting up a better environment for implantation,” Dr. Magarelli said.
“Other studies have looked at pregnancy rates, but what is really important is whether or not there is a baby,” said Paul C. Magarelli, M.D., who reported his findings at the annual meeting of the American Society for Reproductive Medicine.
The retrospective study included 131 women who were undergoing standard in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). All of these women were considered good prognosis candidates for IVF/ICSI and were given the choice of having acupuncture.
A total of 83 women declined (controls) and 48 accepted.
There were no significant differences between the two groups in terms of infertility diagnoses, demographics, and treatment protocols, except that sperm morphology was slightly better in the partners of women receiving acupuncture (7.3% vs. 5.9 % normal forms with strict criteria evaluation), and the average uterine artery pulsatility index was lower in the acupuncture group (1.57 vs. 1.72), said Dr. Magarelli of the department of ob.gyn. at the University of New Mexico, Albuquerque.
The study found that pregnancy rates per embryo transfer were not significantly different between the two groups (50% in the acupuncture group and 45% in controls).
The miscarriage rate was almost halved in the acupuncture group (8% vs. 14%).
In addition, the rate of ectopic pregnancies was significantly lower in the acupuncture group—0 of 24 pregnancies (0%) vs. 2 of 37 pregnancies (9%), said Dr. Magarelli, who is also in private practice in Colorado Springs and Albuquerque.
Thus, the live-birth rate per IVF/ICSI cycle was significantly higher in the acupuncture group than in controls (21% vs. 16%).
“The live-birth rate per pregnancy is an even more telling number, since some cycles get cancelled. There was a 42% live-birth rate per pregnancy in the acupuncture group, compared to a 35% rate in the nonacupuncture group,” Dr. Magarelli said in an interview with this newspaper.
“We believe that what we are doing is improving the uterine environment such that implantation is improved,” he added.
The study used two acupuncture protocols.
The Stener-Victorin electrostimulation protocol—which has been shown to reduce high uterine artery blood flow impedence, or pulsatility index (Hum. Reprod. 1996;11:1314-7)—was used for eight treatments during ovarian stimulation.
The second acupuncture technique—the Paulus protocol, which has been associated with improved pregnancy rates (Fertil. Steril. 2002;77:721-4)—was used within 24 hours before the embryo transfer and 1 hour after.
“This protocol has demonstrated reductions in uterine contractility, so by relaxing the uterus before the embryo transfer and immediately after, we felt we were setting up a better environment for implantation,” Dr. Magarelli said.
Study Shows Acupuncture Treatment May Help Male Infertility Problems
Acupuncture may help some men overcome infertility problems by improving the quality of their sperm, according to a new study.
Researchers found that acupuncture treatment reduced the number of structural abnormalities in sperm and increased the overall number of normal sperm in a group of men with infertility problems.
They say the results suggest that acupuncture may complement traditional infertility treatments and help men reach their full reproductive potential.
Acupuncture May Ease Male Infertility
The male partner is a factor in up to 50% of infertile couples, write the researchers. In many cases, the cause of male infertility is unknown.
Previous studies of acupuncture and male infertility have suggested that acupuncture can improve sperm production and motility and count.
In this study, researchers looked at the effects of acupuncture on the structural health of sperm in men with infertility of unknown cause. The findings appear in the July issue of Fertility and Sterility.
Twenty-eight infertile men received acupuncture treatments twice a week for five weeks, and 12 received no treatment and served as a comparison group.
Researchers analyzed sperm samples at the beginning and end of the study and found significant improvements in sperm quality in the acupuncture group compared with the other group.
Acupuncture treatment was associated with fewer structural defects in the sperm and an increase in the number of normal sperm in ejaculate.
But other sperm abnormalities, such as immature sperm or sperm death, were unaffected by acupuncture.
The researchers write that acupuncture treatment is a simple, noninvasive method that can improve sperm quality.
SOURCE: Pei, J. Fertility and Sterility, July 2005; vol 84: pp 141-147.
Researchers found that acupuncture treatment reduced the number of structural abnormalities in sperm and increased the overall number of normal sperm in a group of men with infertility problems.
They say the results suggest that acupuncture may complement traditional infertility treatments and help men reach their full reproductive potential.
Acupuncture May Ease Male Infertility
The male partner is a factor in up to 50% of infertile couples, write the researchers. In many cases, the cause of male infertility is unknown.
Previous studies of acupuncture and male infertility have suggested that acupuncture can improve sperm production and motility and count.
In this study, researchers looked at the effects of acupuncture on the structural health of sperm in men with infertility of unknown cause. The findings appear in the July issue of Fertility and Sterility.
Twenty-eight infertile men received acupuncture treatments twice a week for five weeks, and 12 received no treatment and served as a comparison group.
Researchers analyzed sperm samples at the beginning and end of the study and found significant improvements in sperm quality in the acupuncture group compared with the other group.
Acupuncture treatment was associated with fewer structural defects in the sperm and an increase in the number of normal sperm in ejaculate.
But other sperm abnormalities, such as immature sperm or sperm death, were unaffected by acupuncture.
The researchers write that acupuncture treatment is a simple, noninvasive method that can improve sperm quality.
SOURCE: Pei, J. Fertility and Sterility, July 2005; vol 84: pp 141-147.
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