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.
