New York Fertility Acupuncture: What Can I do in 2012 to Have my Baby?

New York Fertility Acupuncture: What Can I do in 2012 to Have my Baby?: Congratulations to all of you that that were faced with fertility challenges in 2011 and had babies. As for the rest of you still TTC, all ...

What Can I do in 2012 to Have my Baby?

Congratulations to all of you that that were faced with fertility challenges in 2011 and had babies. As for the rest of you still TTC,  all is not lost;  you do have a chance to conceive in 2012.

The question you should be asking yourselves is "what can I do to help get pregnant that I haven't already done?"  This doesn't only refer to protocols such as IUI, IVF, donor-egg, acupuncture and herbal medicine, but choosing the right reproductive endocrinologist and acupuncturist to create a winning team.

Many couples will go to an RE (reproductive endocrinologist) because of a gynecologist's recommendation or the recommendation of a friend. This is not a bad policy and often yields excellent results. But after several failed attempts with an RE and the support of an acupuncturist perhaps it might be prudent to consider a new team.

I work closely with several reproductive endocrinologists and I think they are wonderful. They have a great bed-side manner; they listen, they answer questions, they don't rush, they respond quickly to your calls and emails and they are seasoned, high level doctors; they also support acupuncture and recommend it to their patients; in other words - they are well informed about other modalities of medical intervention other than their own which have been shown to be effective in increasing positive outcomes.  And they have high success rates not only in getting women pregnant, but more importantly  - in take home babies!

  These are the RE's that I recommend:
1. Joel Batzofin, M.D., of New York Fertility Services http://www.batzofinfertilityservices.com
2. Tanmoy Mukherjee, M.D., of RMA-NY http://www.rmany.com
3. Dan Stein, M.D., of St. Luke's-Roosevelt http://www.infertilityspecialistnewyork.com
4. Glenn Schattman, M.D., of New York Cornell http://www.ivf.org
5. Dan Levine, M.D., of  Hudson Valley Fertility http://www.hudsonvalleyfertility.com
6. Robert Kiltz, M.D., CNY Fertility  http://www.cnyfertility.com

A Little Data About Each of These Great Docs!

Dr. Batzofin is an expert on immunological causes of infertility and chronic repeated miscarriage. These causes are often overlooked and take many years typically to diagnose. And by that time you've lost precious time and more eggs. Dr. Batzofin does so after the first couple of visits!  He is a brilliant investigator, diagnostician, and reproductive specialist.  Dr. Batzofin always elicits a smile from his patients even in their darkest moments. He is a man of great humor, high integrity and excellence in medicine. I am proud to call him a friend.

Dr. Mukherjee is a great and seasoned reproductive endocrinologist who has the advantage of working with a seasoned team of seasoned pros including Drs. Ben Sandler, Lawrence Grunfeld and the medical director, Alan Copperman. Complicated cases get discussed and analyzed by the 'team' so a clearer picture of the case may be arrived at. So you as a patient have the advantage of having many doctors working on your case but enjoying the benefit having a wonderful relationship with just one- Dr. Mukherjee.

Dr. Stein is one of the few real competitors of Dr. Zhang of New Hope Fertility. He offers a similar but better protocol. What makes it better in my opinion is that Dr. Stein, after a single egg retrieval transfers a single 'fresh' embryo unlike Dr. Zhang who first freezes, then thaws, then transfers. Fresh transfers  statistically have better outcomes than frozen.  Dr. Stein is a truly compassionate man who works slowly, carefully and attentively with each and every patient - you are never rushed when you are with him. In fact when you sit across his desk you really feel like you're at his home, in his living room having an important dialogue - about you and your needs.

Dr. Schattman works under the aegis of medical director, Zev Rosenwaks, M.D., and has an excellent team of doctors, nurses and state-of-the-art facilities behind him to help ensure that your IVF procedure yields the result you want -  a baby. Dr. Schattman is also a brilliant surgeon and a great guy.

Dr. Dan Levine of Hudson Valley Fertility is one of the most caring, loving and compassionate doctors I have ever met. And he takes all comers. He treated a woman with an fsh of 100 and she got pregnant and delivered a healthy baby. His wife Debbie is an expert on natural foods for fertility enhancement. They are a great team, delivering big results from a small, warm, homey, and wonderful practice.

Dr. Kiltz is a story unto himself. He is a most unique gentleman. He is a brilliant diagnostician and amazing reproductive endocrinologist. He has offices in Albany and Syracuse. He cooks organic food, practices Tai Chi, meditates, takes beautiful photographs, hikes the wondrous mountains of upstate New York and creates babies. He writes poetry. He has been an inspiration to hundreds of patients and is certainly an inspiration to me. I have met his parents and brothers - he comes from a tight knit, loving family - all of whom have open arms for friends and patients alike - these two distinct entities are usually indistinguishable.  Dr. Kiltz is responsible for helping thousands of couple have babies. He is the 'guru' of reproductive medicine.

Regarding acupuncturists: most of them treat various pathologies from insomnia to infertility. You wouldn't go to an RE that treats infertility and asthma would you? You'd want to be cared for by a specialist -  a doctor who knows a lot about a little - not a little about a lot.

One of the reasons to consider having a consultation with me is because I am the first acupuncturist in the United States to completely devote a complementary wellness practice to the care and treatment of those faced with fertility challenges. I am licensed and board certified in acupuncture and I am board certified in herbal medicine.

I have been treating infertility for fourteen years and nothing but infertility.  Of course I highly recommend that you also consult with several acupuncturists so you can get a good 'gut' feeling about the one you choose to work with.  If you'd like to find out more about me and The Berkley Center for Reproductive Wellness please visit our site http://www.berkleycenter.com.  Other highly qualified acupuncturists who specialize in treating those with fertility challenges may be found at http://www.aborm.org.

Remember, at The Berkley Center for Reproductive Wellness we offer a 100% money back guarantee and free mini consultations. We want to be 100% certain that you have had every opportunity to have your questions answered and to feel totally comfortable with the team at The Berkley Center before your become a patient.   Make sure that the acupuncturists you visit are willing to give you your money back if you are not satisfied and be certain to ask them if they will see you - free - for a brief consultation -  we do and we always will.  Be sure to call us at 212-685-0985 to learn about our money back guarantee and to schedule your free mini consultation.

Merry Christmas, Happy Chanuka, Happy Kwanza, Happy Life, and best wishes on your journey to family.

Love and Blessings...

Mike Berkley, L.Ac., FABORM
212-685-0985

About Dawn Harris – Fertility Advocate

I am a Certified Doula who has over 10 years practical experience with integrative medicine, coaching, consulting and fertility exposure.

My six years plus journey with infertility is what has inspired me to bring this to other individuals.

I have always been drawn to women’s health…having my own health challenges and seeking different alternative directions for optimal benefits.

My background includes over 18 years of legal services work, ballet, creation of proprietary organic nutraceutically-enhanced products/bakery and spiritual counseling.

I avidly practice creative visualization and Kundalini yoga.

The skill I am most known for is inspiring other’s Bliss.

Let me help you manifest your miracle and Heart’s Desire.

CONTACT INFO:




Dawn Harris

email: info@myfertilityadvocate.com

Phone: 917-334-3407 www.myfertilityadvocate.com

Why a Fertility Advocate?

Fertility is a woman’s sacred right.

Conception and fertility treatments are often roads sometimes fraught with obstacles.

A daunting process at best.

A mystery…a maze…a road with no map.

We all need an advocate in our lives…I am that person and I will show you that the REAL advocate is YOU.

I can, and will, guide and teach you ALL the tools you need to advocate for yourself.

I have personally dealt with the challenges of getting and staying pregnant…the countless doctor’s appointments, endless energy and the emotional roller coaster!

I have gathered the tools and resources necessary for you to successfully navigate yourself through this process.

After six and a half years of this journey, I am now blessed with twin boys…and I want to give the benefit of all the information I have gathered back to you. I can actually help you save on your resources…time, energy or finances.

My goal is to empower and inspire you…to have the best understanding of fertility…from conception to pregnancy.





This may involve:

• Education about fertility from evaluation through treatments including integrative options of Eastern and Western modalities. Get a fertility checklist!

• Choosing the right doctor, clinic…to know when or if it’s time to see a fertility specialist or change the plan, doctor etc.

• Support with IVF, surrogacy, donor egg or sperm

• Male factor infertility

• Identification of other contributing factors-emotional imbalances (stress management techniques)

• Understanding you have choices and options; how to articulate your needs to your doctor

• Support on dealing with family member’s and friends through this time

• Supporting you to set up a birth plan (home or water birth, birthing center, minimal obstetrics) and pregnancy you envision. I can support you from pre-conception through mid-pregnancy and assist with choice of birth provider/options(midwife, birth doula, obstetrician)



This is a time when you need to have someone who’s there for you. Whether it’s your 1st or your 4th child, you’re in your 20’s or your 40’s, I am that person.

Let me help you unlock the mystery of fertility and reach your most successful outcome.



If you wish to schedule a 15 minute complimentary consultation, please send an e-mail to info@myfertilityadvocate.com or call 917-334-3407. Skype calls available as well. My rates are on a sliding scale so that I may accommodate all. Package rates available for further discounts.
CONTACT INFO:




Dawn Harris

email: info@myfertilityadvocate.com

Phone: 917-334-3407 www.myfertilityadvocate.com

Herbs and Blood Clotting Disorders Contributing to Recurrent Miscarriage

Both anticoagulants and antiplatelet mitigators are medicines that reduce blood clotting in an artery, a vein or the heart.

Heparin and Lovenox are anticoagulants and aspirin is an antiplatelet.

Antiplatelets such as aspirin decreases platelet aggregation and thrombus formation. They are mostly used in problems with arterial circulation where anticoagulants have little effect.

Anticoagulant medications make the blood 'thinner' and prevent the formation of blood clots and hence could prevent stroke.

Both anticoagulants and antiplatelet medications have been used to treat chronic recurrent miscarriage due to thrombophilic disease.

There are several herbal medicines which possess antiplatelet and anticoagulant properties.

Jiang Huang and Yu Jin are herbs that possess antiplatelet properties. Chuan xiong has both anticoagulant and antiplatelet properties.

I am not recommending that a patient with a thrombophilic presentation use herbs instead of Western medicine which possess the required qualities necessary to prevent miscarriage via anticoagulant or antiplatelet activity. Sometimes however, a drug does not possess the same qualities of an herb. An herbal formula, for example, has a multitiered effect. The correct formula might for example, be used to reduce inflammation, reduce platelet aggregation and/or reduce coagulopathies as well as reduce stress, strengthen the immune function and help facilitate weight loss in an obese patient. All of these things would be required in a patient of this type to increase the odds of a successful on-going pregnancy; not just Heparin or Lovenox or Aspirin. This is important to consider in case you miscarry even when taking these types of meds.

In other words, you may need more intervention than these meds are capable of providing.

I would recommend that you follow the instructions of your reproductive endocrinologist and hope for the best. But in the face of failure with traditional Western medical approaches, trying herbs may help contribute to a full term pregnancy. In my practice I have seen this occur many times.

Many patients faced with the difficult challenge of trying to conceive or who recurrently miscarry are instructed by their reproductive endocrinologists to not take herbs. This is because your doctor is trying to protect you because his or her training is in Western medicine and not in Chinese medicine and they do not feel comfortable mixing Western medicine with herbs.

Though their hearts are in the right place, their experience is not. I have, on multiple occasions prescribed herbs to patients who were taking gonadotropins or Clomid or Lupron, etc., and have never seen any problems. The combination either helped the patient or did not.

The herbs will not reduce the effectiveness of the meds nor, in most cases will they increase the potency of the meds. The only exception to this would occur if I prescribed herbs with anticoagulant/antiplateleet properties to a patient who was taking Lovenox or Heparin. Then there would be a potentiating and possibly dangerous effect.

Acupuncture can increase metabolic function and stimulate the flow of blood throughout the body. Increasing hemodynamics is not, however the same as actually reducing platelet aggregation or reducing hypercoagulation. The benefit of using acupuncture with herbs is that the acupuncture will help ensure the distribution of the herbs throughout the body.

Typically when getting treated for infertility or recurrent pregnancy loss the most effective approach in the absence of success with Western medicine alone is to combine acupuncture, herbs and Western medicine.

Herbs and Blood Clotting Disorders Contributing to Recurrent Miscarriage
Both anticoagulants and antiplatelet mitigators are medicines that reduce blood clotting in an artery, a vein or the heart.

Heparin and Lovenox are anticoagulants and aspirin is an antiplatelet.

Antiplatelets such as aspirin decreases platelet aggregation and thrombus formation. They are mostly used in problems with arterial circulation where anticoagulants have little effect.

Anticoagulant medications make the blood 'thinner' and prevent the formation of blood clots and hence could prevent stroke.

Both anticoagulants and antiplatelet medications have been used to treat chronic recurrent miscarriage due to thrombophilic disease.

There are several herbal medicines which possess antiplatelet and anticoagulant properties.

Jiang Huang and Yu Jin are herbs that possess antiplatelet properties. Chuan xiong has both anticoagulant and antiplatelet properties.

I am not recommending that a patient with a thrombophilic presentation use herbs instead of Western medicine which possess the required qualities necessary to prevent miscarriage via anticoagulant or antiplatelet activity. Sometimes however, a drug does not possess the same qualities of an herb. An herbal formula, for example, has a multitiered effect. The correct formula might for example, be used to reduce inflammation, reduce platelet aggregation and/or reduce coagulopathies as well as reduce stress, strengthen the immune function and help facilitate weight loss in an obese patient. All of these things would be required in a patient of this type to increase the odds of a successful on-going pregnancy; not just Heparin or Lovenox or Aspirin. This is important to consider in case you miscarry even when taking these types of meds.

In other words, you may need more intervention than these meds are capable of providing.

I would recommend that you follow the instructions of your reproductive endocrinologist and hope for the best. But in the face of failure with traditional Western medical approaches, trying herbs may help contribute to a full term pregnancy. In my practice I have seen this occur many times.

Many patients faced with the difficult challenge of trying to conceive or who recurrently miscarry are instructed by their reproductive endocrinologists to not take herbs. This is because your doctor is trying to protect you because his or her training is in Western medicine and not in Chinese medicine and they do not feel comfortable mixing Western medicine with herbs.

Though their hearts are in the right place, their experience is not. I have, on multiple occasions prescribed herbs to patients who were taking gonadotropins or Clomid or Lupron, etc., and have never seen any problems. The combination either helped the patient or did not.

The herbs will not reduce the effectiveness of the meds nor, in most cases will they increase the potency of the meds. The only exception to this would occur if I prescribed herbs with anticoagulant/antiplateleet properties to a patient who was taking Lovenox or Heparin. Then there would be a potentiating and possibly dangerous effect.

Acupuncture can increase metabolic function and stimulate the flow of blood throughout the body. Increasing hemodynamics is not, however the same as actually reducing platelet aggregation or reducing hypercoagulation. The benefit of using acupuncture with herbs is that the acupuncture will help ensure the distribution of the herbs throughout the body.
Typically when getting treated for infertility or recurrent pregnancy loss the most effective approach in the absence of success with Western medicine alone is to combine acupuncture, herbs and Western medicine.
When you are prescribed herbs be certain that a board certified herbalist is doing so.

Thanksgiving

You haven't had a child yet? Give thanks. You have a dream that will be realized. People who are starving in the world dream of food but they die of starvation. Do you love someone? Give thanks. Just imagine how empty your life would be without the ability to love. Are you loved? Give thanks. Lonliness kills. Learn to love yourself; give thanks as that relationship is precious. Learn to be alone and give thanks as being with self is truly being. Can you see? Hear? Smell? Taste? Feel? Can you orgasm? Do you appreciate good food and wine? Do you enjoy music and art? Did you wake up this morning? Then give thanks.

My love goes out to my friends, family and patients. I give thanks that you are all in my life.

In your Forties and Trying-to-Conceive?

Many women are trying-to-conceive while in their forties. Chances for success are limited and even if conception is achieved, the rate of miscarriage is high. The reason it is difficult to conceive is because the woman in her forties has (generally speaking) diminished ovarian reserve and a reduction in egg quality.

After several failed IVF cycles the usual next step is donor egg. Donor egg has between a 60 and 70 percent success rate.

Rate limiting factors may include but are not limited to poor uterine lining, poor sperm quality, and disease (autoimmune attack of the embryo – or poor patency of blood flow not nourishing the embryo or placenta).

Acupuncture and herbal medicine cannot increase ovarian reserve, but it can improve egg, lining and sperm quality in many instances. The mechanism-of-action is improved blood flow- to the ovaries and testes. A “perfect” 10 millimeter lining is not necessarily “perfect”. Many 10 millimeter linings do not have proper blood flow within the lining and this compromises the ability of the lining to maintain an implantation. The eggs of a woman in her forties can always stand to be improved. The sperm in a man in his mid to late forties is often sub-par and may often be improved with acupuncture and herbs.

I don’t, for example, believe that acupuncture and herbal medicine can get one pregnant

The desired and often obtained end result of the inclusion of acupuncture and herbal medicine when trying-to-conceive is an improvement in egg, lining and sperm quality. An IVF-embryo transfer is a ‘mechanical’ procedure: eggs are retrieved, mixed with sperm, embryos develop, and are placed in the uterus and the rest is pure luck.

IVF or IUI has no bearing on improving the chances of conception and an ongoing pregnancy via the mechanism of improving the constituent components of an embryo – egg and sperm. Acupuncture and herbs often fill in this gap. If egg and sperm and lining quality can be improved even a little bit, this may significantly enhance pregnancy outcomes.

Our expectations are not unrealistic. I don’t, for example, believe that acupuncture and herbal medicine can get one pregnant any more than an IVF can get one pregnant, even though pregnancies do occur as a result of both interventions occasionally. Pregnancy occurs as a result of the relative health of the woman who is housing the embryo in addition to the quality of the embryo and uterine lining. Many things can go wrong resulting in failed cycles. So, at the end of the day IUI, IVF, acupuncture and herbal medicine can help a woman conceive but cannot guarantee success. The key is this: you have the power to use additive means which today, more than ever, are at your disposal to help increase the odds of a healthy, ongoing pregnancy. Acupuncture and herbs are just but two. Psychotherapy, diet, exercise, biofeedback, yoga, taichi, and meditation can also be helpful.

Did you know that pregnant women who are highly stressed are more likely to give birth prematurely? This is a fact. Acupuncture, besides it action on the testes and ovaries and lining is also known to help reduce stress.

Repeated Donor Egg Failure

Why is it that some women with “good” lining and access to “good” sperm do not conceive with donor egg transfers? There are several reasons: 1) chromosomally abnormal eggs; 2) undiagnosed poor lining quality; 3) disease (as mentioned above). Most of these cases are considered ‘idiopathic’ meaning that your doctor does not understand why you are not getting pregnant. Idiopathic means ‘no known cause’. That the cause is ‘unknown’ does not mean that there is no cause.

Acupuncture and herbs are probably not necessary for the donor of the egg unless she is older than 35 years old, but realize that even 16 year old girls have some amount of chromosomally abnormal eggs. So if your cycle fails because of a chromosomally abnormal egg it is undoubtedly bad luck and should not typically re-occur.

However, if you have repeated failed donor egg cycles it is probably not a matter of egg quality, but more likely, sperm quality, lining quality or disease. Acupuncture and herbs can help improve lining quality and sperm quality and in some cases even reduce the effect of autoimmune issues or blood clotting issues which may contribute to repeated pregnancy loss. I do firmly believe, however, that the best and most effective way to treat autoimmune disorders or blood clotting disorders which may cause miscarriage is with Western medicine.

Stress and reactive-oxidative-species negatively affect sperm quality. Herbs and acupuncture can successfully reduce both as well as stimulate greater blood flow to the testes improving delivery of hormones, oxygen, electrolytes and nutrients thereat and enhancing the excretion of dead cells. This is the same mechanism-of-action whereby egg quality is improved in the ovary. Acupuncture cannot positively affect a man with no sperm. This is called aspermia. Nor can acupuncture improve sperm count due to genetic abnormalities (micro deletion of the y chromosome) or anatomical abnormalities of the testes (vericocele).



East meets West in Reproductive Medicine – The New Gold Standard

The most intelligent approach for the couple faced with difficulty conceiving and/or staying pregnant is to combine Eastern and Western medicine. These two modalities, though decidedly different, are, nonetheless, complementary and work synergistically. This means that by combining IUI or IVF or donor egg with acupuncture and herbs you should expect better results than when using one of these modalities alone.

In the world, most things manifest in pairs – marriage, night and day, summer and winter, exercise and rest, work and vacation, food and wine, joy and sorrow, etc. This is the yin and yang of life.

The ‘pair’ or yin and yang of reproductive medicine is embraced by recognizing the benefit of pairing Eastern and Western medicine.

What You Need Most when You’re in Your Forties and Trying to Conceive

1. Improved egg quality – acupuncture and herbs often facilitate this.

2. Improved lining quality - acupuncture and herbs often facilitate this.

3. Possibly improved sperm parameters - acupuncture and herbs often facilitate this.

4. Reduced stress - acupuncture and herbs often facilitate this.

5. Hope and Commitment – The Berkley Center for Reproductive Wellness always facilitates this.

Women in their forties are welcome here!

Endometriosis and Herbs

I do use herbs to clear heat in endometriosis patients because endometriosis is an inflammatory disease. So even in the absence of heat signs/symptoms the patient still has ‘heat’. My most frequent dx in endo cases is derangement of qi and blood, qi and blood stagnation and stasis and hidden heat trapped in the interior. I don’t have a cookie-cutter formula for said cases as each case is different. But heat clearing is always part of my treatment principle and clinical goal in endometriosis patients. Also, IVIG/intralipid is not typically used to prevent miscarriage due to endometriosis or remnants of,  but rather to suppress activated natural killer cells which are often, though not always evident in the endo pt.  A pt w/ endo should be screened for activated nk cells, ata, apa, lac, and have a reproductive immunophenotype panel done to rule out other potential autoimmune etiologies of chronic recurrent miscarriage. It is often these OTHER causes that are the culprit rather than the endo itself which, is generally no longer extant as the dx of endo is done via lap and ablation is done at the time of discovery.  This may seem contradictory in that earlier I said I always use heat clearing herbs in the endo pt. and here I am saying that after a lap the endo is no longer extant. The reason I use heat clearing herbs even after a lap is because it is virtually impossible to ablate or resect ALL endo lesions. Some lesions are the SAME COLOR as normal tissue. So even after a lap, there is STILL ENDO though much less.

Infertility specialists believe they might have an answer for women prone to having miscarriages - natural killer cells.

With no scientific evidence to back up their suspicions, they are willing - but extremely cautious - to treat women like a 31-year-old Johannesburg businesswoman who has been trying to have a baby for four and a half years, but has too many NK cells.

The woman, who wants to be known only as Chantal, said: "I've done pregnancy tests each month, but to see the stick with the one line on it, instead of two, can crush you," she said.

Dr Merwyn Jacobson, medical director of Vitalab centre for assisted conception in Johannesburg, said: "We're trying to find explanations for things we don't understand. We may be way out and have to eat humble pie, but that's our thinking as of now."

During early pregnancy there is a dramatic increase in the number of NK cells, which search for and destroy harmful cells in the body.
Based on research by controversial British infertility specialist Dr George Ndukwe, Jacobson and his colleagues Dr Lawrence Gobetz and Dr Stephen Volschenk think over-reactive NK cells in the uterus attach to the growing embryo and destroy it because the killer cells view it as an "invader".

My notes: I have been espousing this pathomechanism for years. Herbs help to mitigate activate natural killer cells in addition to IVIG or intralipid therapy. mike berkley, L.AC., FABORM

Preserving Your Fertility - You're Invited

START SPREADING THE NEWS!


New York Fertility Services

Presents a free event

Stop The Clock

Preserving Your Fertility

Tuesday, November 15th, 2011

6:30pm – 8:00pm

16 E. 40th Street, 2nd Floor

New York, NY 10016



If you are single, in a relationship, or newly married and are wondering how long you can wait to start your family, this event is for you! Please join us for an evening of information about Age and Fertility. Dr. Joel Batzofin will address these topics:

 Infertility and Age – Where are you? How does one affect the other?

 Egg Freezing and Fertility Preservation – Can we “stop the clock”?

 Success Rates – What exactly do they mean?

 Egg Freezing Cycle Costs – Can I afford to do this? Can I afford NOT to?

Hors d’oeuvres will be served so bring your friends along to this informative event. We will have a drawing for a free Egg Freezing Cycle* to one lucky person who attends this event – you must be present to win. We will also offer a special “End of the Year” Egg Freezing Cycle Incentive for all who attend to help you preserve your fertility now so you can concentrate on living your life!









Reservations are a must.

RSVP to Teresa attrandolph@nyfsb.com or call 212-679-2289.

ivf and cancer

Ovarian Malignancy Risk Seen Doubled 15 Years After IVF By: JENNIE SMITH, Family Practice News Digital Network.

Women who have undergone in vitro fertilization appear to have a twofold risk of ovarian malignancies later in life, compared with women with fertility problems who never used IVF.

However, the risk of invasive ovarian cancer was not significantly increased in IVF-treated women until 15 years after IVF treatment, the results of the study found.

Results from a large Dutch cohort study of 25,152 women using linked medical records to identify women who had been seen for infertility and/or treated with IVF from 1983 to 1995 showed that borderline ovarian tumors accounted for most of the increase in risk after a median 15 years of follow-up. Most of the women were in their late 40s at the study end point.

The investigators of the study, which was published Oct. 26 in Human Reproduction, compared the 19,146 IVF-treated women in the cohort with a control group of 6,006 women who had been seen for fertility problems but had not undergone IVF (although they may have received other forms of treatment, including drugs). The investigators also looked at rates of ovarian malignancies in the general population (Hum. Reprod. 2011 [doi:10.1093/humrep/der322]).

Having subfertile controls was important, the investigators said, because women with infertility have a different risk profile for ovarian malignancies than do women in the population at large. Causes of infertility in the study included fallopian tube disorders, subfertility of a male partner, cervical factor, and endometriosis.

The investigators, led by Flora E. van Leeuwen, Ph.D., of the Netherlands Cancer Institute in Amsterdam, noted that the findings of a risk increase for ovarian malignancies confirmed older findings from smaller cohort studies. Borderline tumors are considered to have a low malignancy potential, and not much is known about which will become invasive, but these tumors do require treatment.

Nearly half of the 61 malignancies detected in the IVF-treated women were borderline tumors, while in the general population of women under age 50 years, these normally account for 15%-30% of malignancies, Dr. van Leeuwen and her colleagues found. A high proportion – 63% – of the borderline tumors seen in the IVF-treated group were serous, while mucinous tumors are more frequent in the general population.

After the researchers adjusted for such potential confounding factors as age, parity, and causes of infertility, IVF-treated women saw a significantly elevated risk for borderline ovarian tumors, compared with subfertile controls (hazard ratio 4.23) and for all ovarian malignancies combined, compared with controls (HR 2.14).

Risk of invasive ovarian cancer was not seen as significantly increased in the IVF-treated women, compared with controls (HR 1.51). However, compared with the general population, the IVF-treated women’s risk of developing invasive ovarian cancer was higher 15 years after IVF treatment, with a standard incidence ratio of 3.54. No increased risk was reported for non-IVF controls, compared with the general population.

Dr. van Leeuwen and her colleagues noted that they did not find evidence that repeated cycles of IVF increased the risk of malignancies, as might be expected. However, they wrote, the powers of their analyses were reduced by missing data and small numbers of women in the subgroups. In the IVF group, 40% of women had one to two stimulated IVF cycles, 39% had three to four cycles, and 21% received five or more cycles.

The type of infertility treatments were as follows: clomiphene/hMG (human menopausal gonadotropins) or FSH (follicle stimulating hormone)/hMG stimulation protocols were used until 1988-1989, whereas stimulation with GnRH (gonadotropin-releasing hormone) agonists became common after 1990 (from 20% in 1986 to about 90% after 1990), the investigators said.

Dr. van Leeuwen and her colleagues cited the large cohort size and long follow-up period as strengths of their study, as well as linkages to population-based cancer and pathology registries, which enabled the investigators to also evaluate the occurrence of borderline ovarian tumors.

They noted as a weakness of their study the fact that their group of subfertile controls was relatively small and that 40% of controls had been prescribed clomiphene, meaning that they were not truly unexposed if the cause of the malignancies was drug related and not related to ovarian puncture. The study was based on IVF treatment protocols through 1995 only, they added.

Still, the researchers concluded that they had demonstrated sufficient risk for women and their physicians to consider when deciding whether to start or continue IVF treatment.

The study was funded by the Dutch Ministry of Health, the Health Research and Development Counsel, and the Netherlands Cancer Institute. J.L.H. Evers declared that he works in a department that has received unrestricted research grants from Merck and Ferring. Neither Dr. van Leeuwen nor any other of her colleagues declared any relevant financial disclosures.

Maybe acupuncture and herbal medicine should be tried first! (mike berkley's note)

Acupuncture: A Cure for Infertility?

Catherine Donaldson-Evans

At 36, Lucy Appert has suffered through two miscarriages, a stillbirth at 8 1/2 months and, because of a rare pregnancy-related liver dysfunction, intensive illness and surgery.

Yet after enduring five painful years of trying to have their own baby, Appert and her husband Edward finally saw their dream come true last month when their son Henry was born — premature, but healthy.

For all the fertility treatments, technologies and prenatal care available to women today, Appert credits the success of her pregnancy to an ancient Chinese secret.

"I recommend acupuncture (search) to everyone," Appert said. "It does work. I did everything possible for years to have a baby. I almost lost hope."

The millennias-old Asian medical practice — in which the acupuncturist places tiny needles in various pressure points, or "Qi" (Chee), in the body to improve circulation and reduce stress — has been around in the United States for years as an "alternative" treatment for numerous ailments.

But recently, acupuncture has been picking up steam as a possible remedy for female infertility, with a handful of American and European studies showing that it enhances the success rate of in vitro fertilization (IVF) (search).

“Do I believe in it? Absolutely,” said Dr. Paul C. Magarelli, an infertility doctor at the Reproductive Medicine & Fertility Center in Colorado Springs, Colo., and co-author of an ongoing study into the use of acupuncture with IVF with Dr. Diane K. Cridennda. Cridennda is a licensed acupuncturist with a master's degree in Oriental medicine from the International Institute of Chinese Medicine (search) who owns East Winds Acupuncture, also in Colorado Springs.

Magarelli said he joined the study at the urging of Cridennda, who had approached him about using acupuncture with IVF based on her knowledge of its history as an Eastern fertility treatment. A skeptic at first, Magarelli said he dismissed the idea for a while before signing on.

"I thought, this is rubbish — it can't be true," Magarelli said. "But no matter how I look at this data, I see an improvement. ... I'm pretty much a convert."

In general, studies seem to indicate that doing acupuncture about 30 minutes before and after in vitro fertilization can increase the chance that the embryo will be implanted successfully and reduce the chance of miscarriage.

There are also indications that the effectiveness of the IVF drugs and procedure may improve if acupuncture is done about once a week in the month or two leading up to the start of IVF and then continued regularly — once or twice a week — during the whole cycle.
And, as in Appert's case, there is anecdotal evidence that acupuncture can help with other fertility and pregnancy problems. Appert didn't need IVF to conceive, but she was told she probably couldn't carry a healthy baby to term because of her liver disorder.

But some doctors caution that there is no "magic pill" for fertility, pregnancy and IVF troubles — whether it's acupuncture or something else.

"The jury is still out on that," said Dr. Eric Surrey, president of the Society for Assisted Reproductive Technology (SART) (search), who has a practice at the Colorado Center for Reproductive Medicine. "I don't think we have good data to show that acupuncture before and after the embryo transfer is truly beneficial."
And they warn against making too much of claims that acupuncture can help with having babies.
"It's impossible to say at this point," said Dr. Robert Schenken, president of the American Society for Reproductive Medicine (ASRM) (search), who has a practice at the University of Texas Health Science Center. "In the absence of any controlled data, I don't think we can come to a firm conclusion."

Promising Research

Acupuncture seems to help some women because it improves circulation to the ovaries (search) — which makes for healthier eggs — and to the uterus (search), which increases the chances that the lining will be strong enough to hold those eggs to full-term.

"Acupuncture provides better circulation and better blood flow to the womb," said Dr. Raymond Chang, director of New York's Meridian Medical Group, who has been incorporating acupuncture into fertility treatments for the past decade. "It will give a better chance for the eggs to be nourished and therefore carried."

There's also the fact that acupuncture can be a stress-reliever during an emotional time.

"Trying to get pregnant is incredibly stressful," said Victoria Koos, the acupuncturist who treated Appert at Yin and Tonic Acupuncture in New York. "They're crossing their fingers. The longer they're trying to get pregnant, the worse it gets ... Part of [acupuncture's success] is simply relaxation. When the body is relaxed, all systems function better."

The Colorado study Magarelli and Cridennda presented at a conference this fall is one of a series the pair have done with acupuncture and in vitro.

That one looked at 114 patients who had a good chance of IVF being effective, some who did acupuncture and some who didn’t. It found, among other things, that there were fewer miscarriages, more pregnancies and a 7 percent higher birth rate among those who got acupuncture treatment over those who didn’t, according to Magarelli.

It piggybacked off other research the team did on 147 “poor responders” to IVF, which found that the pregnancy rate was 40 percent, with 11 percent more babies born, among those who did acupuncture with in vitro fertilization compared to those who didn’t.

In March, Magarelli and Cridennda released findings in Italy involving patients with an average prognosis for IVF success. Those yielded clear numbers that the pregnancy rate increased with acupuncture by 24 percent, according to Magarelli.

“What got us was that now we were seeing a firm trend toward getting more people pregnant,” he said.

The Colorado research seems to support some findings of two earlier studies, one in Germany by lead researcher Dr. Wolfgang E. Paulus — published in ASRM's “Fertility and Sterility” (search) in April 2002 — and one in Sweden by lead researcher Elisabet Stener-Victorin in the 1990s.

Of course, even those who believe in acupuncture concede that while the existing studies have yielded good information, there still isn't sufficient evidence, or a broad enough sample of patients tested, to call acupuncture a proven remedy.

"We are convinced, but scientifically you need proof — or so-called proof," Chang said. "There is a whole set of proof from lab experiments and animal studies to human studies, but it's very difficult to do human studies."

Schenken noted that even though there might be one set of data showing positive results, "it really needs to be corroborated, preferably with several different studies and different patient populations." For example, there can be bias when the entire study sample comes from the same clinic, or when patients know they're doing something different from usual.

Schenken said he doesn't get asked about acupuncture often, but when patients do, "we don't recommend it, but we do not discourage it."
Surrey takes a similar approach. In his opinion, the data "is not bad" on the theory that acupuncture can help when administered before IVF, but as far as acupuncture generally improving fertility or helping after the embryo transfer in IVF, "there really isn't a whole lot of data on that."

But at the very least, "there is absolutely nothing to show that it's harmful if it's done with a trained and appropriately skilled acupuncturist," he said. It's a notion that nearly everyone in the medical field — whether they believe in needles and Qi or not — seems to agree upon.

Some Eastern medicine-Western medicine rivalry may come into play with how to treat reproductive problems, but Chang said he sees more resistance with the use of Chinese herbs — which are ingested — than he does with acupuncture. Often, it's the in vitro specialists themselves who refer their patients to him for acupuncture after a couple of failed IVF attempts.

As for the couples trying to bring a child into the world — particularly through a complicated, invasive procedure like IVF— anything that helps the process along is welcome.

“IVF is so technical that patients feel like they’re being pushed and pulled … with acupuncture, they’re in a sense taking some control,” Magarelli said. "Acupuncture isn't a needle, it's an environment."

Added Koos: "They're on these incredibly strong drugs that make the poor women crazy. They're running around like Catwoman. This is to help them stay sane while they're going through the process."

The emotional cost of infertility comes with a hefty financial price tag as well — in vitro fertilization can cost anywhere from $10,000 to $20,000 a cycle and generally isn't covered by insurance; acupuncture ranges from about $30 to over $200 per treatment — Koos and Chang charge about $90 a pop — and certain health plans do cover at least a portion of it.

Meanwhile, researchers and experts in the field are excited at what they're seeing in the studies. Chang said he's currently working with NYU Medical Center on a trial that looks at IVF with and without acupuncture.
Appert, for her part, was at the end of her rope and felt she had nothing to lose. She started acupuncture with Koos about two months before she began trying to conceive — with needles in her toes and a couple of liver points — and continued with the treatments throughout the pregnancy.
"The first time I went, I was completely terrified. My husband went with me and held my hand," she said. "I could feel the muscles in my liver jump and an electric current going through my body. It was very strange but also felt right."

She said being monitored by both her obstetrician and Koos helped reassure her about what was going on during her high-risk pregnancy.

"She would tell me things about how I was doing physically and then I would go to the doctor and he would tell me the same thing," remembers Appert, who works as a professor.

When she got sick late in the pregnancy, both Koos and Appert's OB/GYN were able to detect when her liver went dangerously haywire and get her to the hospital for delivery six weeks early, before the problem harmed the fetus and caused another stillbirth.

Regardless of the skeptics, Appert said she's relieved that she was finally able to have a nearly full-term baby of her own. At 4 pounds, 6 ounces, Henry has been in intensive care but otherwise is doing "fine."

"It really was a miracle," the new mom gushed. "It's one of these weird things that Western medicine can't explain."

Women with unexplained infertility are at heightened risk for having undiagnosed celiac disease

Women with unexplained infertility are at heightened risk for having undiagnosed celiac disease (CD), which may be a modifiable and treatable risk factor, research suggests.

To determine whether an increased prevalence of undiagnosed CD might exist among a population of infertile women, investigators conducted a prospective cohort study at a U.S. infertility clinic. Serologic screening uncovered CD in four of 188 subjects, translating to an overall prevalence in this population of 2.1%.

Although this rate was not significantly higher than the expected 1.3%, undiagnosed CD was significantly more prevalent in the subset of 51 women presenting with unexplained infertility: Three (5.9%) of these women had previously undiagnosed CD (J Reprod Med. 2011;56:199-203).

All four women found to have CD underwent nutrition counseling to help them change over to a gluten-free diet. All four became pregnant within a year of diagnosis.

"Diagnosing CD in an infertile woman would be particularly beneficial if the low-cost (and low-risk) therapy of pursuing a gluten-free diet could improve chances for conception," study researcher, Janet Choi, MD, said in a statement.
From the October 2011 Issue of Clinical Advisor

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.”

Acupuncture increased success rate of 37.3 percent

A randomized placebo-controlled study of 309 women concludes that electro-acupuncture “significantly improved the clinical outcome of ET (embryo transfer).”1 IVF (in vitro fertilization) live birth rates jumped from 21.2 percent for women who did not use acupuncture to a 42 percent success rate for women who received acupuncture twice. The women received acupuncture 24 hours before the IVF procedure and 30 minutes after IVF. In another control group, women who only received acupuncture once, 30 minutes after IVF, had an increased success rate of 37.3 percent.


IVF is a treatment for infertility. This involves controlling a woman’s ovulatory process with medications, removing the ova (eggs) from the body, fertilizing the ova with sperm outside of the human body and then implanting the fertilized ova (zygote) into the uterus. Acupuncture for the treatment of infertility has received a great deal of press because singers Mariah Carey and Celine Dion used acupuncture with success. Mariah Carey used acupuncture to balance her body after a miscarriage in 2008. Carey said she did not use IVF but used acupuncture for stress relief and hormone therapy to boost her fertility. Celine Dion used acupuncture to achieve success with her 6th attempt at IVF. Both singers gave birth to healthy twins.

References:


Fertility and Sterility. Volume 96, Issue 4, October 2011, Pages 912-916. Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study. Rong Zhang Ph.D., Xiao-Jun Feng B.S., Qun Guan B.S., Wei Cui M.S., Ying Zheng M.S., Wei Sun B.S., Ji-Sheng Han M.D.

Research Centers:

Neuroscience Research Institute and Department of Neurobiology, Peking University Health Science Center, Key Laboratory of Neuroscience, The Ministry of Education and the Ministry of Public Health, Beijing, People's Republic of China.

Reproductive medical center, The second hospital affiliated to Shandong University of traditional Chinese medicine, Jinan, People's Republic of China.

New Study Finds Sperm Quality Decreases as Males Age

Colorado Researchers Confirm Men, like Women, have a Ticking Biological Clock that Impacts Fertility



DENVER, Oct. 17, 2011 /PRNewswire via COMTEX/ -- A new study conducted by the Colorado Center for Reproductive Medicine (CCRM) in conjunction with the National Foundation for Fertility Research (NFFR) concludes that sperm from middle-aged and older male mice is less likely to lead to a successful pregnancy. The study, the first-of-its-kind, found that sperm quality began to decrease in males at mid-life, 12 months and older (equivalent to forty and older for human males).



"This is not a study observing male factor infertility. Rather, this is a study about once fertile males becoming infertile because of age," said Mandy Katz-Jaffe, PhD, Scientific Director of NFFR. "We were able to document when sperm from older males begins to suffer quality problems, and to understand the impact of older sperm on reproductive outcome."



This is the first longitudinal study following males over a lifetime to directly correlate sperm aging with reproductive success. Ten young male mice with proven fertility were mated every month during their lifetimes as they naturally aged with fertile young females. "This study is unique because we were able to remove infertility related to the female aging from the equation and focus solely on the male," said Katz-Jaffe. "This is something that is impossible to accomplish with human studies."



This study found that when proven fertile male mice reached mid-life (12 months = forties):



Eggs were less likely to be fertilized by aged sperm.



Embryos were less likely to develop in vitro.



Embryos were less likely to implant in the uterus.



Natural conceptions were far fewer. Only 50 percent achieved pregnancy naturally at 12 months (forties) and 10 percent naturally at 15 months (fifties).



Assisted reproductive technologies (ART) improved the chance of clinical pregnancy.



The few successful natural conceptions with aged sperm resulted in significantly smaller fetuses and placental weight.



"There is much focus in society on the 'maternal biological clock.' This study shows us that we also need to be concerned about the 'paternal clock,'" said William Schoolcraft, M.D., Founder and Medical Director of CCRM. "Men in their thirties should consider freezing sperm if they plan to wait to have children. Men in their forties and fifties should consult a reproductive endocrinologist if their partner is unable to conceive after six months of active trying."



About the Colorado Center for Reproductive Medicine



Founded in 1987 by Dr. William Schoolcraft, the Colorado Center for Reproductive Medicine is one of the nation's leading infertility treatment centers, providing a wide spectrum of infertility treatments ranging from basic infertility care to advanced in vitro fertilization (IVF) technology. Today, joined by Drs. Eric Surrey, Debra Minjarez and Robert Gustofson, Dr. Schoolcraft and his staff achieve some of the highest pregnancy rates in the country. CCRM has been ranked "The #1 Fertility Center in the U.S., with the Greatest Chance of Success" by Child.com. For more information, visit www.ColoCRM.com .



About the National Foundation for Fertility Research



The National Foundation for Fertility Research is 501 (c) (3) non-profit collaborative of internationally known researchers dedicated to advancing the field of reproductive medicine. The mission of NFFR is to ensure that all who seek fertility treatment have that joyous moment when they hold their baby for the very first time. Under the direction of Dr. Mandy Katz-Jaffe and her team of senior scientists and embryologists, NFFR research studies will continue to bring hope and new opportunities to couples seeking fertility treatment. For more information, visit www.fertilityresearch.org .



SOURCE Colorado Center for Reproductive Medicine (CCRM)



Copyright (C) 2011 PR Newswire. All rights reserved

Embryo Grading

I never understood the presumed science behind embryo grading. In fact the 'science of embryo grading' may be an oxymoron. Embryo grading is theoretical but not scientific. It is my experience that embryo grading gives patients fall hopes and also lowers hopes of patients inappropriately.  There have been many 4 cell embryos transferred on day two back in the 1980's in the U.S., which resulted in live births. There are many 6 cell embryos with up to 25% fragmentation which yield live births. There are countless grade A blastocysts which do not yeild a pregnancy or do, but with resultant miscarriage.  Yes, if an embryo has > 45 or 50% fragmentation it can be safely assumed that won't result in a pregnancy or live birth. But without such an extreme presentation, it is really not possible to predict an outcome.

I would rather the 'line' that reproductive endocrinologists offer their patients be "we have transferred 3 embryos successfully into your uterus. In 2 weeks we will know if you are pregnant. Let's keep our fingers crossed and hope for the best."  This way the patient has no expectation other than the fact that she will or will not become pregnant.  This is an issue of 'patient management' and one, which in my opinion, should be adhered to.

It is possible to determine a poor embryo. For example a 3 cell embryo with 40% fragmentation probably won't yeild a pregnancy or a live birth. However, it is impossible to determine a good quality embryo if by good quality it means that a reasonable expectation of pregnancy can be expected.  The underpinnings of what makes a good embryo good have yet to be parsed out scientifically.  This is equivalent to an acupuncturist feeling a pulse and telling the patient that they are pregnant. The acuracy of this endeavor is rarely experienced. However, a very experience acupuncturist probably can tell by pulse palpation whether a patient is pregnant before a reproductive endocrinologist can prognosticate the outcome of an IFV ET based upon visual inspection of an embryo.

The take-home message is this: do not be excited when you have an IVF-ET and your doctor raves about the beauty of your embryos just transferred, nor be dismayed when you are told that they are a grade C. You must clear your mind of expectation and 'be' and wait. It is very difficult to go through the day without an expected outcome. Expected outcomes are derived from your output which typically yeilds a result. This is an example of 'control' which we all thrive on and feel so lost without.  In the case of IVF-ET your output nor that of your doctor has any prognostic value. You must 'be' and wait and have no expectation. You can hope; and that's it.

This is also the case of the endometrium. Your doctor will tell you that you have a "beautiful 10 millimeter lining." You are 30 years old and so is your husband. His sperm is healthy, you are hormonally within-normal-limts and both you and your husband are anatomically normal. You have tried to conceive for two years with intercourse, you have done 4 intrauterine inseminations and two invitro-fertilization-embryo-transfers and you have never gotten pregnant. There is a good possibility that your endometrium is defective and can only be properly diagnosed via an endometrial biopsy.  Remember the things needed for a successful pregnancy and a live-birth are good egg, good sperm, good lining, anatomic normalcy and absence of pathology which can mitigate conception. Pathology which can mitigate conception is often under-diagnosed.  A perfect example of this is endometriosis. The mean-time to diagnosis for endometriosis in 10.3 years. Imagine this: a couple is idiopathic meaning that there is no known casue for their inability to conceive. After multiple attemps via assisted-reproductive-technology-interventions the reproductive endocrinologist states "it's time for you to consider using a donor egg" You are devastated, but you MUST HAVE THAT BABY! So you proceed and the transfer is negative. Then, after six years of trying, a doctor recommends a diagnostic laparoscopy to rule out endometriosis and you are found to have stage four endometriosis which is why, all along, you have not been able to conceive. But now you're forty-years old. So even though the endometriosis has been resceted, you have 40 year old eggs and your chances of conceiving with your own eggs are about 8-10%.  You were robbed of your opportunity to conceive becasue of the ultra-conservitism, ignorance or ego of your doctor.  I am not suggesting that at the drop of a hat a diagnostic laparscopy should be scheduled. What I am suggesting is that many reproductive endocrinologists (just as is the case with acupuncturists and every other type of health-care-provider) are too conservative and think-out-of-the-box when it's too late.

I had a doctor tell me recently that mild endometriosis doesn't interfere with conception. This is not true; it does. "Endometriosis is likely the most the common cause of endometrial receptivity defects, especially in cases of minimal or mild disease for which mechanical reasons do not explain the loss of fertility." This is from the September, 2011 issue of Fertility & Sterility, Vol 96, No 3, page 524.  When I brought this to the attention of the doctor, he replied with "Fertility & Sterility is a lousy journal." It is not. In fact, most American reproductive endocrinologists read it and respect it.

It is very difficult to find a good doctor in any field.  I know most of them, especially in New York City. If you would like guidance in finding one with an open mind, an agressive outlook and that has you in mind rather than protecting his or her ego I wouuld be happy to offer it to you.

Mike Berkley, L.Ac., FABORM
http://www.berkleycenter.com/
212-685-0985

Acupuncture Fertility Clinics in New York City

Can anyone tell me if they are aware of any acupuncture clinics in New York City besides The Berkley Center for Reproductive Wellness that JUST TREATS INFERTILITY CASES?

Thanks.
Mike Berkley, L.Ac., FABORM

Mariah Carey and Celine Dion used acupuncture with success.

New Research – IVF Fertility Success with Electro-Acupuncture 28 September 2011




A randomized placebo-controlled study of 309 women concludes that electro-acupuncture “significantly improved the clinical outcome of ET (embryo transfer).”1 IVF (in vitro fertilization) live birth rates jumped from 21.2 percent for women who did not use acupuncture to a 42 percent success rate for women who received acupuncture twice. The women received acupuncture 24 hours before the IVF procedure and 30 minutes after IVF. In another control group, women who only received acupuncture once, 30 minutes after IVF, had an increased success rate of 37.3 percent.



IVF is a treatment for infertility. This involves controlling a woman’s ovulatory process with medications, removing the ova (eggs) from the body, fertilizing the ova with sperm outside of the human body and then implanting the fertilized ova (zygote) into the uterus. Acupuncture for the treatment of infertility has received a great deal of press because singers Mariah Carey and Celine Dion used acupuncture with success. Mariah Carey used acupuncture to balance her body after a miscarriage in 2008. Carey said she did not use IVF but used acupuncture for stress relief and hormone therapy to boost her fertility. Celine Dion used acupuncture to achieve success with her 6th attempt at IVF. Both singers gave birth to healthy twins.

References:


Fertility and Sterility. Volume 96, Issue 4, October 2011, Pages 912-916. Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study. Rong Zhang Ph.D., Xiao-Jun Feng B.S., Qun Guan B.S., Wei Cui M.S., Ying Zheng M.S., Wei Sun B.S., Ji-Sheng Han M.D.

Research Centers:

Neuroscience Research Institute and Department of Neurobiology, Peking University Health Science Center, Key Laboratory of Neuroscience, The Ministry of Education and the Ministry of Public Health, Beijing, People's Republic of China.

Reproductive medical center, The second hospital affiliated to Shandong University of traditional Chinese medicine, Jinan, People's Republic of China.

New York Fertility Acupuncture: RMA of NY

New York Fertility Acupuncture: RMA of NY

RMA of NY

Have established working relationship with RMA of New York and have been seeing some of their patients. Wonderful doctors all. I highly recoomend Drs. Mukherjee, Copperman, Sandler and Grunfeld. All top-notch, leading-edge reproductive endocrinologists - that care!

Supplement could be key to pregnancy for older women

Co-enzyme Q10 results in healthier eggs, delays onset of menopause during experiments on mice

By Sharon Kirkey, Postmedia News September 22, 2011 Canadian scientists are working on a way to make older human eggs young again - and maybe even slow menopause - experiments that could make it easier for women in their 40s and perhaps beyond to have babies.



The answer may lie in a single vitamin.



Toronto fertility doctors say their experiments in mice show that co-enzyme Q10 makes older mice produce more and healthier eggs. The doctors are now preparing to test the supplement on women aged 35 and older undergoing fertility treatments.



The work comes as women are pushing back motherhood ever later in life.



Across Canada, pregnancies in women over 35 are increasing, and fertility clinics are seeing more women over 40.



"Our mean age for patients first coming to see us is now 37," said Dr. Robert Casper, medical director of the Toronto Centre for Advanced Reproductive Technology.



Five years ago, it was 33.



Not only do older women find it more difficult to get pregnant, they run an elevated risk of miscarrying or of conceiving embryos with chromosomal abnormalities that cause conditions such as Down syndrome.



A woman is born with all the eggs she will ever have, and by the time she reaches her late 30s, the quality of those eggs begins an irreversible slide. They have less chance of leading to a normal live birth.



Eggs have 46 chromosomes to begin with, but they undergo a change when a woman ovulates. Each egg discards 23 of its own chromosomes and, if it's fertilized, takes in 23 from the sperm cell to replace them. But this takes a lot of energy.



The energy in eggs, and essentially in all human cells, is produced by mitochondria, little power packs inside all our cells. But these weaken with age so that they don't produce as much energy, resulting in a steady decline in tissue and organ function.



"Somebody who is 20 will have eggs with 20-year-old mitochondria in them, and somebody who's 40 will have 40-year-old mitochondria that will produce less energy," said Casper, professor in the division of reproductive sciences at the University of Toronto and a senior scientist at the Samuel Lunenfeld Research Institute at Toronto's Mount Sinai Hospital.



If there isn't enough energy to separate the chromosomes properly, some get left behind.



"They don't get pulled out," Casper explains.



Extra chromosomes can lead to aneuploidy, an abnormal number of chromosomes, the stringlike structures that carry our genetic material.



"That's why Down syndrome increases with age - it's all an energy issue," Casper said.



"It's not that there is anything wrong with the eggs, it's just that the batteries have run down."



Casper's team has been studying mitochondria for years, trying to understand whether it's possible to boost energy production in human eggs.



Together with Dr. Andrea Jurisicova, an associate professor in the department of obstetrics and gynecology at the University of Toronto, the researchers originally tried injecting young mitochondria into old mouse eggs, using a preparation made from cordblood stem cells, which are fetal cells, so that the old eggs would have young, healthy mitochondria.



The technique worked - it improved the quality of the eggs and the embryos. The problem was, the embryos had two different mitochondrial DNA - essentially, two different mothers. When Canada's Assisted Human Reproduction Act outlawed mitochondrial gene replacement in 2004, Casper's team abandoned that avenue of research.



Now they're taking a different tack, using co-enzyme Q10.



Mitochondria need co-enzyme Q10 to make energy.



The vitamin is also a powerful anti-oxidant that may prevent mitochondrial DNA damage, Casper said. Co-enzyme Q10's production by the body also decreases as we get older, starting around age 25.



"One of the theories about why we get old and die in the first place is that our cells just run out of energy - the mitochondria stop working properly and there's just not enough energy for cellular function so organs start to fail," Casper said. "A simple explanation could be that there's not enough fuel from the co-Q10 around."



In a pilot study using 52-week-old mice - mid-life for a mouse, and the equivalent of 40 to 50 for a human - Casper's team gave half the group co-enzyme Q10, and the other half a placebo. Next they compared eggs retrieved from both groups of mice with eggs from 10-week-old mice.



"What we found was that just treating the mice with co-Q10 we got more eggs than when we gave them fertility drugs," Casper said. The nuclear spindles that pull the chromosomes apart were more like those in young eggs. The litter size was bigger, and the eggs from the vitamin-treated mice had improved mitochondrial function.



Even more surprising, when the researchers examined the mouse ovaries, there were significantly more egg follicles in the old mice treated with the co-Q10 - suggesting, Casper said, "that we actually were able to delay the onset of the equivalent of menopause in the mice."



The glitch is that the mice were pre-treated for 18 weeks - the equivalent of 10 years or so relative to a human lifespan.



"We might be able to delay menopause, but it might take a decade of pre-treatment," Casper said. The more immediate application might be in improving an older woman's fertility by improving her egg quality. When word got out about his early research on the Internet, women undergoing fertility treatments began taking co-enzyme Q10.



Casper is now trying to recruit women over 35 for a study testing whether taking 600 mg daily of the supplement can lead to a higher number of chromosomally normal eggs.



The rub is that, as soon as the researchers explain the mouse results, none of the women want to be randomized to the placebo group, "especially if they're 40."



The Toronto researchers need 50 women for their study; they're up to 25 so far, after a year-and-a-half of trying.



If the mice experiments hold up in the clinical trials, the implications would be significant, Casper said. "Women could get pregnant easier when they're older."



It also could buoy calls for more single-embryo transfers. For years, fertility clinics have been putting three, four or more embryos back into women over 40 in the hope that at least one would implant and a baby would result.



"If we could improve the percentage of normal eggs, you wouldn't have to put back so many embryos."



The other hope is that, "if we can increase the energy for chromosome separation, then we could eliminate Down syndrome and other chromosomal abnormalities," said Casper.



© Copyright (c) The Vancouver Sun



Read more: http://www.vancouversun.com/health/Supplement+could+pregnancy+older+women/5440917/story.html#ixzz1ZFGGXaek

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