We are all headed towards a state of ignorance which comes from the pursuit of knowledge.

For a long time now I have been privy to brilliant and articulate writings and research on the efficacy or lack thereof of traditional Chinese medicine.  You can find all the research you want on the Internet.   Some research shows efficacy in treating certain pathomechanisms of infertility and some research denies efficacy.

In Western medical approaches to the treatment of infertility there is much research that points to the efficacy of PGD and much research that denies its value. Many doctors promulgate intercourse the night before IVF, many don’t. Many doctors give patients antibiotics before a transfer, many don’t. Many doctors believe in IVIG or intralipid therapy, many don’t. There is lots of research on the deleterious effect of autoimmune mitigators of infertility including natural killer cells but there are many doctors who think this is all hogwash.

Many doctors believe in going straight to IVF after two failed IUI’s, though many believe that one should do four to five IUI’s before engaging in the first IVF.

Many IVF doctors believe in this protocol and many believe in that protocol. Many doctors believe that obesity interferes with fertility outcomes (there is research attesting to this!) and many doctors will do an IVF on a three hundred pound woman.

There was a time when I was very interested in research, which would prove the value of acupuncture in the treatment of the infertile patient. 

There is a parable that tells the story of a Zen master talking to his student and pointing at the moon. The student looked at the master’s finger and was summarily dismissed by the master.  Have we, as practitioners become too focused on the finger?

It is my contention that we are all headed towards a state of ignorance which comes from the pursuit of knowledge; an incorrect type of knowledge.  Knowledge or lack thereof of regarding why something works does not confer or negate efficacy.  I remember when I was a student at Pacific College of Oriental Medicine in Dr. Yan Wu’s class when a student asked Dr. Wu a question as to why, when a needle was inserted at a particular point, did it have the intended effect. Dr. Wu’s reply was “who cares – it just does”.  Dr. Wu is a master physician with more than 30 years of clinical TCM experience under his belt.  It is in the West that we care about cause and effect, but in TCM the effect is what counts.

I am now less inclined to be interested in research regarding TCM and it’s efficacy.  I am interested more in learning TCM and its theories and applications.  Those of you who are spending years and years doing research on how TCM mitigates a pro-inflammatory state may be fooled into thinking that you are learning something of value.  This is debatable.  True value is measured by our success rates. The way to higher success rates is attained through learning the medicine that we practice. Most of you, and certainly I, know very little about TCM just as reproductive endocrinologists know very little about why women conceive and why they do not.

 

If you want to help patients to conceive then learn your medicine.

Want facts? Here’s one:  I can look any patient or doctor in the eyes and state that acupuncture and herbal medicine have been used continuously for the past three thousand years to treat infertility; sometimes successfully.   It was used in China before the advent of Western medicine and is now used in China in conjunction with Western medicine to treat infertility.

I think that many of us (including me when I was a mere tadpole) felt that we needed the nod from Western medical practitioners and researchers to validate TCM.  Now that I am a frog, I realize that my own legs are strong enough to propel me forward.

Study Chinese medicine and study Western medicine and then integrate the two in a way that works for you. 

Be able to defend your ideas and treatment protocols; be sure that your ideas have integrity.

 Treat as many patients as you can so you may positively impact many lives.

I am through with sitting on the edge of my seat waiting for an REI to say, “Acupuncture seems to offer some value to those trying to conceive” and jump up and down shouting yea!  I don’t mean to seem trite or competitive, I assure you, this is not my intention, but here goes: we were successfully treating any and every pathology which existed long before Hippocrates was a twinkle in his momma’s eye.

I believe in the value of IVF – but not for all its research. Indeed with all its research it still has far more failed cases than successful ones. But it does have some successful cases, and that demands respect – as do acupuncture and herbs. So don’t show me research – show me take home babies.

Knowledge is doing.  You can study martial arts for years and analyze the dynamics of kicks, punches, thrusts and parries, and take - downs, and joints locks – but that does not mean that you can fight.  If you can’t fight, then you do not know martial arts – you research them only. Outcomes are all that matter. 

I have not renewed my memberships with AFA and Resolve. When they honor an acupuncturist for his or her work in the field of reproductive medicine I’ll re-join.  In the mean time, they will, one again, undoubtedly honor Zev Rosenwaks.  Dr. Rosenwaks, what is your success rate for the thirty-nine year-old women with ovarian resistance? Is it any better than mine? I don’t think so. 

I’m going to study herbs now.

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

What is the Berkley Method?

The Berkley Method represents an integrative approach to the diagnosis and treatment of the infertile patient.

This is unique within the community of most acupuncturists treating infertility.

Most acupuncturists in the U.S. diagnose and treat strictly from the perspective of traditional Chinese medicine. While this method of treatment is rather romantic it does not represent an East meets West approach to care which is the standard currently used in China.

The East meets West approach is the more scientific approach; one which combines traditional Chinese medical applications such as acupuncture and herbal medicine along with scientific and medical approaches to care. For example, we are one of the few acupuncture centers that knows how to utilize herbal medicine in conjunction with clomid or gonadotropins and other medications such as dexamethasone, Lupron, Antigon, Tamoxofin, Letrazole, Naltrexone, etc. We also have extensive knowledge in treating disorders of pregnancy with herbal medicine such as sub chorionic hematoma and placenta previa. Most practitioners are not comfortable treating pregnant patients with herbal medicine because of their lack of clinical experience with herbs. We have saved many impending miscarriages with the use of herbs.

Integrative means that we combine both Western medical findings and traditional Chinese medicine findings when performing a diagnostic evaluation and creating a treatment plan. For example, a patient with endometriosis will be treated very differently than a patient with PCOS. A patient with high FSH will get very different treatment than one with high LH. A patient with low estrogen levels will get treated very differently than a patient with low FSH. These distinctions are very important when diagnosing and treating patients. You’ll want to know if your acupuncturist can make these distinctions and treat based upon them.

We are one of the few if not the only acupuncture center in NY that treats in this manner. We request and review the semen analysis, day 3 blood work, and thryroid findings. We also request testing for immunological factors and blood clotting (thrombophilic disorders) when necessary. We also request testing in some cases which may reveal a ‘hidden’ pathology of sperm which the typical semen analysis does not do.

We are probably the only acupuncture center that knows when to request certain tests and importantly how to interpret the results of these tests.

We are also the only fertility acupuncture center in Manhattan that has a Board of Advisors composed of some of the finest reproductive endocrinologists in NY State ( see our website to view our Board of Advisors).

The Berkley Center for Reproductive Wellness is the first acupuncture fertility center in New York City to specialize in infertility treatment. As the leader in our field we feel that we have learned to successfully integrate ancient and modern medicine. This gives our patients the best environment for care with the greatest chance of pregnancy and live births. We strongly believe that the best outcome for successful pregnancy and live birth is to be treated by a reproductive endocrinologist as well as an acupuncturist/herbalist who truly specializes in this field.

We are pleased to offer free mini consultations so that your questions may be answered and your concerns addressed. Bring in your reproductive medical findings and be prepared to have an active, interesting and informative conversation about your case. Hopefully, at the end of this lively dialogue you will have a lot more information than you had before you came in. This consultation in no way obligates you to be under our care. We offer this free mini consultation to help you make an informed decision when choosing your acupuncturist. In fact, you should have at least three FREE consultations with three separate practitioners – this way you can really have an informed opinion as to which practitioner is most suited to meet your needs.

We maintain relationships with many fantastic reproductive endocrinologists such as Drs. Alan Copperman, Tanmoy Mukherjee, Dan Stein, Dan Levine, Joel Batzofin, Glen Schattman, Robert Kiltz, Owen Davis, Sami David, Jonathan Scher, and many others.

These relationships make it easier for us to coordinate care with your reproductive endocrinologist providing you with a well rounded and highly coordinated patient centric-approach to care.

You should also know that we are available 24/7/365 for pre and post embryo transfer acupuncture treatment.

We are the first and the most experienced acupuncture clinic specializing in the field of oriental reproductive medicine in the United States.

Call us for excellence in care. 212-685-0985

Infertility, Endometriosis, Pain Management

Changes in my Acupuncture Protocol


After 13 years of study and clinical experience in treating infertility I have refined my approach to treating patients with acupuncture.
Previously I had always treated patients lying on their backs facing upwards.

Now I treat with three successive protocols: 1)Patient is on back facing upwards; 2) Next visit the patient is on his/her side and I needle the front and back simultaneously; 3) 3rd visit, I treat the patient face down and use acupuncture points on the back only.

This multi-faceted approach allows me to access many important acupuncture points on the body and potentially improve efficacy.

For those of you who are acupuncturists, I am using front mu points, back shu points and points of the 8 extra meridians as well as points which are appropriate for the pattern of disharmony being addressed.

I am starting to see good results with this new appropach.

Endometriosis

Recently, I have added endometriosis as a disease which I am treating.

Treatment is geared towards ameliorating pain AFTER a laparoscopy is performed; potentially slowing down it's re-growth after a laparoscopy by potentially regulating and stabilizing the immune function of the endometrium (for REI's: reduction of MMP's and aromatase IN THE uterine cavity. This is obviously experimental, but if success is manifest then many will be helped - if not, then I will strictly deal with pain management).

So, endometriosis patients are welcome!

Meditation & Pain Management

Lastly, we just completed our second Joanne Verkuilen, Fertility Meditation and everyone loved it! Thanks Joanne for a great job! Joanne is the Co-Founder of Circle+Bloom an incredible organization.

Oh...one more thing, I have hired two excellent acupuncturists whose expertise is in pain management. So, if you, a friend, or a loved one suffers with headache, back-pain, neck-pain, arthritis, etc., have them call Abbey Fromkin, L.Ac. or Jeff Wolf at The Berkley Center they will receive excellent care.

Ciao for now!