After treating infertility cases for fourteen years I am now, in addition to my fertility practice, treating pelvic pain and menopausal symptoms.
Acupuncture and herbal medicine are very helpful in treating these issues.
Best wishes.
mike
Wednesday, November 28
Wednesday, October 17
Male Factor and Herbal Medicine
Male Factor and Herbal Medicine
This is an interesting revelation of how, after four months of treatment with herbal medicine, the semen analysis of this patient was significantly improved. I started treating this patient in June of 2012.
Mike Berkley, L.Ac.
DATE OF INITIAL EXAMINATION: 02/16/2012
SEMEN ANALYSIS
PARAMETERS RESULTS NORMAL VALUES
LIQUIFACTIONS <30 mins="mins">
VOLUME 2.6 mL >2.0 mL
VISCOSITY Normal -3 Normal / 1+
COLOR Gray/White Grey/ White
pH 7.6 7.2 – 8.0
SPERM COUNT 15 million/mL >20 mill/mL
TOTAL SPERM 39 Million >40 million
COUNT
MOTILITY 53% > 50%
PROGRESSION 2-3 3 – 4
AGGLUTINATION 0 % < 10 %
ROUND CELLS 0 % < 5
DATE OF EXAMINATION: 10-08-2012 (after 4 months of herbs)
SEMEN ANALYSIS
PARAMETERS RESULTS NORMAL VALUES
LIQUIFACTIONS <30 mins="mins">
VOLUME 1.5 mL >2.0 mL
VISCOSITY Normal -3 Normal / 1+
COLOR Gray/White Grey/ White
pH 7.6 7.2 – 8.0
SPERM COUNT 34 million/mL >20 mill/mL
TOTAL SPERM 51 Million >40 million
COUNT
MOTILITY 58% > 50%
PROGRESSION 3 3 – 4
AGGLUTINATION 0 % < 10 %
ROUND CELLS 0 % < 5
DNA fragmentation index (SCSA Labs)
34.9
After four months of treatment DFI: 18.2%
TCM Diagnosis: Stagnation of qi and stasis of blood in the liver channel
Treatment principle: Course the liver, rectify and regulate qi and resolve stagnation, quicken the blood and transform stasis, benefit the sperm and improve sperm parameters
Li zhi he, 9
Yu jin, 9
Chuan niu xi, 9
Wang bu liu xing, 4.5
Dang shen, 15
Bai zhu, 9
Fu ling, 15
Zhi gan cao, 4.5
Shu di, 15
Dang gui, 9
Bai shao, 15
Please don’t use these herbs for your case. Each patient must get an herbal medicine prescription which is customized for them.
This is an interesting revelation of how, after four months of treatment with herbal medicine, the semen analysis of this patient was significantly improved. I started treating this patient in June of 2012.
Mike Berkley, L.Ac.
DATE OF INITIAL EXAMINATION: 02/16/2012
SEMEN ANALYSIS
PARAMETERS RESULTS NORMAL VALUES
LIQUIFACTIONS <30 mins="mins">
VOLUME 2.6 mL >2.0 mL
VISCOSITY Normal -3 Normal / 1+
COLOR Gray/White Grey/ White
pH 7.6 7.2 – 8.0
SPERM COUNT 15 million/mL >20 mill/mL
TOTAL SPERM 39 Million >40 million
COUNT
MOTILITY 53% > 50%
PROGRESSION 2-3 3 – 4
AGGLUTINATION 0 % < 10 %
ROUND CELLS 0 % < 5
DATE OF EXAMINATION: 10-08-2012 (after 4 months of herbs)
SEMEN ANALYSIS
PARAMETERS RESULTS NORMAL VALUES
LIQUIFACTIONS <30 mins="mins">
VOLUME 1.5 mL >2.0 mL
VISCOSITY Normal -3 Normal / 1+
COLOR Gray/White Grey/ White
pH 7.6 7.2 – 8.0
SPERM COUNT 34 million/mL >20 mill/mL
TOTAL SPERM 51 Million >40 million
COUNT
MOTILITY 58% > 50%
PROGRESSION 3 3 – 4
AGGLUTINATION 0 % < 10 %
ROUND CELLS 0 % < 5
DNA fragmentation index (SCSA Labs)
34.9
After four months of treatment DFI: 18.2%
TCM Diagnosis: Stagnation of qi and stasis of blood in the liver channel
Treatment principle: Course the liver, rectify and regulate qi and resolve stagnation, quicken the blood and transform stasis, benefit the sperm and improve sperm parameters
Li zhi he, 9
Yu jin, 9
Chuan niu xi, 9
Wang bu liu xing, 4.5
Dang shen, 15
Bai zhu, 9
Fu ling, 15
Zhi gan cao, 4.5
Shu di, 15
Dang gui, 9
Bai shao, 15
Please don’t use these herbs for your case. Each patient must get an herbal medicine prescription which is customized for them.
Monday, August 13
Reproductive Health and Pelvic Organ Prolapse
When women are young, reproductive health is often at the forefront of their minds. The excitement of pregnancy and childbirth inspires women to lead healthy lives. However, once a woman is past her childbearing years, she may not give as much thought to her reproductive organs. However, post-childbirth and pre-menopause is a key time to focus on strengthening the core and pelvic floor muscles to prevent common menopausal conditions, such as Pelvic Organ Prolapse (POP).
By leading a healthy lifestyle women can avoid some of the negative side effects of menopause.
What is Pelvic Organ Prolapse?
Pelvic Organ Prolapse is usually diagnosed in women between the ages of 50 and 79. In fact, approximately 50 percent of all women will be diagnosed with POP in their lifetime. It occurs when the tissues and muscles surrounding the pelvic organs weaken. If they become weak enough, organs in the pelvic cavity can begin to shift and drop. In severe cases of POP, organs can begin to prolapse into the vaginal canal. The organs most affected by POP include the bladder, cervix, uterus and rectum.
Sometimes the symptoms of POP are so mild that a woman is unaware she has the condition. Her doctor will diagnose it during a routine pelvic exam. Other times, a woman can actually feel organs and tissues collapsing into her vagina. Symptoms of POP include:
• An inability to insert a tampon
• A bulging or tugging sensation in the pelvis, lower back or vagina
• Discomfort or pain during sexual intercourse
• Difficulty beginning to urinate or a weakened stream
• Constipation
• Light spotting or bleeding
Reproductive Health can Reverse or Prevent Pelvic Organ Prolapse
The symptoms of POP can be prevented, or at least minimized, by maintaining reproductive health. Some things that can be done proactively include:
Focus on Overall Health: Women's reproductive health is directly related to their overall health. There are other factors linked to POP, such as smoking and obesity. By maintaining a healthy weight, exercising, and eliminating unhealthy addictions, women can help to keep muscles and tissues healthy and strong.
Exercise the Core: There are exercises women can do to maintain strong core and pelvic floor muscles. These include daily Kegel exercises, Yoga and Pilates. The stronger the core and pelvic muscles are, the less likely they are to prolapse or detach from the pelvic wall.
Treatment for Pelvic Organ Prolapse
There are a variety of treatments that can treat POP. Women who are diagnosed with POP should discuss these options with their health care professional to thoroughly understand the risks and benefits to each. Some treatments, such as a vaginal pessary, are less invasive and can be used successfully to treat mild to moderate cases of POP.
Sometimes, surgical intervention is the most effective way to treat more moderate to severe cases. One method utilizes a medical device called transvaginal mesh. This device has been linked to a large number of health complications. Mesh erosion and organ perforation are some of these major complications of the surgical mesh. Many women who have been affected by these side effects have filed mesh lawsuits. If a woman is considering surgical intervention, she should discuss which method is best for her particular set of symptoms to find the safest treatment available.
Elizabeth Carrollton writes about defective medical devices and dangerous drugs for Drugwatch.
Read about mesh lawsuits
Read more about pelvic organ prolapse
Friday, August 3
Slower...
I am now fifty-six years-old. This is sobering as I still believe that I'm twenty-five. So what have I lost? Some physical flixibility, two wives to divorce, all of my black hair (replaced with cool gray - not the cueball!), some of my libido, some of my energy, some of my ability to focus and concentrate.
What I have gained is slowness. I walk slower so I can see more; I talk less quickly so I am more apt to be a better listner, i work out more slowly so I work out efficiently, i write slower so i need to edit less, i work slower so i get to transfer more qi to my patients, i dance slower so i get to spend more physical time being close to my woman feeling her heat and smelling her perfume, i read slower, so i acquire more info; i watch which is different form 'seeing'; seeing is passive, watching is active. i watch myself mostly to see that i am happy with my moves off and on the court, to be certain that i walk in all valleys and on all hills with integrity - sometimes i don't but then i can see it because i was watching and by watching i may do better next time. i have closer friends becasue as time is short i only spend time with those i love. i spend more time with male friends because those were the ones with whom i shared the least intimacy. my arms remain open longer and close more slowly so my heart is receiving more. i sit longer so therefore i am being more instead of doing more and by doing less i am more and therefore this is proof that indeed less is more.
So im thinking - youth does and age is - but one cannot be until one has done so youth and aging are all perfectly natural inhalations and exhalations of the dao. i am happy to have been able to do and to be able to do less and be more and therefore be more and thus be able to do more. Hah! Amazing.
Being...
What I have gained is slowness. I walk slower so I can see more; I talk less quickly so I am more apt to be a better listner, i work out more slowly so I work out efficiently, i write slower so i need to edit less, i work slower so i get to transfer more qi to my patients, i dance slower so i get to spend more physical time being close to my woman feeling her heat and smelling her perfume, i read slower, so i acquire more info; i watch which is different form 'seeing'; seeing is passive, watching is active. i watch myself mostly to see that i am happy with my moves off and on the court, to be certain that i walk in all valleys and on all hills with integrity - sometimes i don't but then i can see it because i was watching and by watching i may do better next time. i have closer friends becasue as time is short i only spend time with those i love. i spend more time with male friends because those were the ones with whom i shared the least intimacy. my arms remain open longer and close more slowly so my heart is receiving more. i sit longer so therefore i am being more instead of doing more and by doing less i am more and therefore this is proof that indeed less is more.
So im thinking - youth does and age is - but one cannot be until one has done so youth and aging are all perfectly natural inhalations and exhalations of the dao. i am happy to have been able to do and to be able to do less and be more and therefore be more and thus be able to do more. Hah! Amazing.
Being...
Wednesday, July 18
Infertility Increases Risk of Serious Psychiatric Illness
Infertility Increases Risk of Serious Psychiatric Illness
Published: July 16, 2012Multiple small studies have demonstrated a link between infertility and psychological distress, reporting high rates of anxiety and depressive symptoms among women with infertility. These studies have evaluated psychiatric symptoms or psychological distress; however, less is known about the prevalence of more significant psychiatric disorders in this population.
Data from the largest study to date of women with infertility was recently presented at the annual meeting of ESHRE (European Society of Human Reproduction and Embryology) by Dr. Birgitte Baldur-Felskov.
Danish investigators were able to examine the records of 98,737 Danish women evaluated for infertility between 1973 and 2008. They found that women who remained childless after their first investigation for infertility had more hospitalizations for psychiatric illness than women who had at least one child following their investigation. The most common discharge diagnoses were “anxiety, adjustment and obsessive compulsive disorders” followed by “affective disorders including depression.”
In another study (also from Denmark), investigators examine a cohort of 51,221 women with primary or secondary infertility who had been referred to hospitals or private fertility clinics in Denmark between 1973 and 1998. Each woman was followed from the date of her initial fertility evaluation until 2006.
In this study, they discovered that women who did not have a child after initial fertility evaluation had a greater than twofold risk of suicide (HR: 2.43; 95% CI: 1.38-3.71) than women who had at least one child after evaluation. Women with secondary infertility, i.e. women who had a child before a fertility evaluation but did not succeed in having another child after evaluation, also had an increased risk for suicide (HR: 1.68; 95% CI, 0.82-3.41), although this finding was not statistically significant.
These two reports extend our understanding of the impact of infertility and its treatment on risk for serious psychiatric illness. While future studies will help to determine which women are the most vulnerable to illness in this setting, these two large studies highlight the need for adequate screening for psychiatric illness and appropriate interventions in women who are evaluated for infertility.
[Mike Berkley writes: Acupuncture and herbal medicine have been shown to effective treatment modalitites for anxiety and depression.]
Ruta Nonacs, MD PhD
Kjaer TK, Jensen A, Dalton SO, et al. Suicide in Danish women evaluated for fertility problems. Hum Reprod. 2011;26(9):2401-7.
Read more: Childless Women With Fertility Problems at Higher Risk of Hospitalization for Psychiatric Disorders (Science Daily)
Published: July 16, 2012Multiple small studies have demonstrated a link between infertility and psychological distress, reporting high rates of anxiety and depressive symptoms among women with infertility. These studies have evaluated psychiatric symptoms or psychological distress; however, less is known about the prevalence of more significant psychiatric disorders in this population.
Data from the largest study to date of women with infertility was recently presented at the annual meeting of ESHRE (European Society of Human Reproduction and Embryology) by Dr. Birgitte Baldur-Felskov.
Danish investigators were able to examine the records of 98,737 Danish women evaluated for infertility between 1973 and 2008. They found that women who remained childless after their first investigation for infertility had more hospitalizations for psychiatric illness than women who had at least one child following their investigation. The most common discharge diagnoses were “anxiety, adjustment and obsessive compulsive disorders” followed by “affective disorders including depression.”
In another study (also from Denmark), investigators examine a cohort of 51,221 women with primary or secondary infertility who had been referred to hospitals or private fertility clinics in Denmark between 1973 and 1998. Each woman was followed from the date of her initial fertility evaluation until 2006.
In this study, they discovered that women who did not have a child after initial fertility evaluation had a greater than twofold risk of suicide (HR: 2.43; 95% CI: 1.38-3.71) than women who had at least one child after evaluation. Women with secondary infertility, i.e. women who had a child before a fertility evaluation but did not succeed in having another child after evaluation, also had an increased risk for suicide (HR: 1.68; 95% CI, 0.82-3.41), although this finding was not statistically significant.
These two reports extend our understanding of the impact of infertility and its treatment on risk for serious psychiatric illness. While future studies will help to determine which women are the most vulnerable to illness in this setting, these two large studies highlight the need for adequate screening for psychiatric illness and appropriate interventions in women who are evaluated for infertility.
[Mike Berkley writes: Acupuncture and herbal medicine have been shown to effective treatment modalitites for anxiety and depression.]
Ruta Nonacs, MD PhD
Kjaer TK, Jensen A, Dalton SO, et al. Suicide in Danish women evaluated for fertility problems. Hum Reprod. 2011;26(9):2401-7.
Read more: Childless Women With Fertility Problems at Higher Risk of Hospitalization for Psychiatric Disorders (Science Daily)
Thursday, May 24
Wednesday, April 18
My Fertility Journey: A Journey into the Green Revolution!
Apr 14
Written by Diana Palmentiero
Many women think of their infertility issues as a struggle. Having lived through the “struggle” twice and survived, I have come to realize that I was on an incredible journey. I just didn’t realize it at the time.
My journey began in the spring of 2004 when I was 37, married for 6 months and trying to conceive for the first time in my life. The first month we tried, I became pregnant. Wow, that was easy! Then at 5 weeks pregnant, I began bleeding. I was shocked, confused, disappointed and every other emotion you can be when you miscarry, especially the first time you are pregnant.
After the first miscarriage my husband and I tried again for several months but we were once again disappointed when I miscarried the second time I became pregnant. Now my feelings included “what did I do to cause this to happen?” I was a healthy woman with no medical issues and now I had had 2 miscarriages in less than a year each time I had been pregnant. Somehow this must be my fault. Miscarriage is not a topic that many people discuss so I had no one to talk to about it. I was becoming increasingly despondent. If I wanted to feel better, I knew that I needed to take action.
Being 38, I realized that my eggs were not getting any younger so my husband and I decided to visit our local fertility doctor. The next thing I knew he was telling me that I had a little problem called high FSH and that I had a less than 1% chance of having a “take home baby.” I was going to need his help and quickly. So we started fertility treatments. I was put on the highest dosage of fertility drugs that anyone could possibly take and then felt like I had PMS for 24 hrs. a day, 7 days a week.
Between the high dosage of fertility drugs and the emotional roller coaster that I was on, I became depressed. If someone looked at me the wrong way, I would start to cry. Holidays didn’t help either. The worst was having to go to the hospital to wait for someone else to give birth. I spent most of the time in the bathroom crying until the baby was wheeled up to the nursery glass window.
After 6 months of roller coaster emotions and only being able to go through 2 IUIs, we did not get pregnant. Although I desperately wanted to have a child, I hated all the medications that I was on so I began to explore other options.
And where do you turn to when you need alternate solutions? The Internet, of course! That’s where I started to read about acupuncture and traditional Chinese medicine. The idea behind it is that “infertility” happens when a woman’s body is not in balance. I never realized that so many things in our bodies need to happen perfectly for conception to occur. When a woman’s body is not in balance and it’s trying to have a baby, then either (a) conception won’t happen, or (b) as in my case, it will happen, but a woman won’t stay pregnant. I then discovered a book called “The Infertility Cure.” What a great title! Who wouldn’t want a “cure” for their infertility, as if it is a disease? I quickly ordered one. Here’s a link to find out more about her at The Fertile Soul. Dr. Lewis also holds retreats so I found out where her next retreat was being held and headed out to Austin, Texas. By this time it was January 2006.
What a life altering experience the retreat was. It lasted for 5 days. Along with Dr. Lewis, there were dynamic speakers, classes, spa treatments, and group healings. Dr. Lewis herself claimed in her literature that I “would enter a lifestyle path that [I] won’t ever want to leave.” One of my favorite sessions of the retreat was on nutrition. She stressed the importance of eating whole, natural and organic foods and especially not eating foods that are processed. She also stressed eating gluten-free and dairy-free. Before I knew it, I had lost 7 lbs.
When I came home from the retreat, I felt like a changed person. Although I had a back-up plan to start IVF a few months later, I believed that I was going to get pregnant without medical intervention. Dr. Lewis referred me to an acupuncturist, Dr. Michael Berkley of The Berkley Center, who performed acupuncture and prescribed herbal teas from a pharmacy in Chinatown called Kamwo. And sure enough, one month after I came home from the retreat, I was pregnant! As I continued on my pregnancy journey, I realized that Dr. Lewis was right and that I wanted to continue on the path that had helped me to have a child. I made some changes in my life that I had learned at the retreat which would also be beneficial for my unborn child. My husband and I continued to eat more natural and organic foods.
When my daughter April was born in 2006, we decided that she would be breast-feed for 1 year and eat organic baby foods when she began to eat solids. Later, as I was cleaning the house and April started to crawl around, I realized that I did not want her to breathe in the fumes from the cleaning products that I was using. This made me change my cleaning products to more eco-friendly ones. My fertility issues and experience at the retreat made me aware how important it is to know exactly what is going into your body, no matter how it goes in.
When we tried to have a sibling for April, we again went through the same struggles. April was nine months old when I had my third miscarriage after 5 weeks. We again decided to try acupuncture and herbal teas. Dr. Berkley referred me to Dr. Yaron Seidman of Hunyuan Fertility. He made some further, individualized dietary suggestions such as eating more liver. (That wasn’t much fun.)
The next time we had a miscarriage, I had not been using acupuncture long enough. That’s when I knew it was time to give my body a rest. We took three months off from acupuncture and trying to conceive. When we began again, I started going to acupuncture and brewing and drinking herbal teas. This time it worked and my son Cody was born in July of 2009.
And now, almost 6 years and 2 kids later, I am doing things that I never thought I would do. For the past 2 years, I have joined Sport Hill Farm’s Cash Crop program, so that my family can enjoy farm fresh vegetables. We now eat mostly organic foods from meats to breads to cookies and jellies. We recycle as much as we can and use healthier cleaning solutions. My fertility struggles led me on a journey to where I eventually became a part of the “green revolution.” Who knew that would happen but I think it is incredible!
Written by Diana Palmentiero
Many women think of their infertility issues as a struggle. Having lived through the “struggle” twice and survived, I have come to realize that I was on an incredible journey. I just didn’t realize it at the time.
My journey began in the spring of 2004 when I was 37, married for 6 months and trying to conceive for the first time in my life. The first month we tried, I became pregnant. Wow, that was easy! Then at 5 weeks pregnant, I began bleeding. I was shocked, confused, disappointed and every other emotion you can be when you miscarry, especially the first time you are pregnant.
After the first miscarriage my husband and I tried again for several months but we were once again disappointed when I miscarried the second time I became pregnant. Now my feelings included “what did I do to cause this to happen?” I was a healthy woman with no medical issues and now I had had 2 miscarriages in less than a year each time I had been pregnant. Somehow this must be my fault. Miscarriage is not a topic that many people discuss so I had no one to talk to about it. I was becoming increasingly despondent. If I wanted to feel better, I knew that I needed to take action.
Being 38, I realized that my eggs were not getting any younger so my husband and I decided to visit our local fertility doctor. The next thing I knew he was telling me that I had a little problem called high FSH and that I had a less than 1% chance of having a “take home baby.” I was going to need his help and quickly. So we started fertility treatments. I was put on the highest dosage of fertility drugs that anyone could possibly take and then felt like I had PMS for 24 hrs. a day, 7 days a week.
Between the high dosage of fertility drugs and the emotional roller coaster that I was on, I became depressed. If someone looked at me the wrong way, I would start to cry. Holidays didn’t help either. The worst was having to go to the hospital to wait for someone else to give birth. I spent most of the time in the bathroom crying until the baby was wheeled up to the nursery glass window.
After 6 months of roller coaster emotions and only being able to go through 2 IUIs, we did not get pregnant. Although I desperately wanted to have a child, I hated all the medications that I was on so I began to explore other options.
And where do you turn to when you need alternate solutions? The Internet, of course! That’s where I started to read about acupuncture and traditional Chinese medicine. The idea behind it is that “infertility” happens when a woman’s body is not in balance. I never realized that so many things in our bodies need to happen perfectly for conception to occur. When a woman’s body is not in balance and it’s trying to have a baby, then either (a) conception won’t happen, or (b) as in my case, it will happen, but a woman won’t stay pregnant. I then discovered a book called “The Infertility Cure.” What a great title! Who wouldn’t want a “cure” for their infertility, as if it is a disease? I quickly ordered one. Here’s a link to find out more about her at The Fertile Soul. Dr. Lewis also holds retreats so I found out where her next retreat was being held and headed out to Austin, Texas. By this time it was January 2006.
What a life altering experience the retreat was. It lasted for 5 days. Along with Dr. Lewis, there were dynamic speakers, classes, spa treatments, and group healings. Dr. Lewis herself claimed in her literature that I “would enter a lifestyle path that [I] won’t ever want to leave.” One of my favorite sessions of the retreat was on nutrition. She stressed the importance of eating whole, natural and organic foods and especially not eating foods that are processed. She also stressed eating gluten-free and dairy-free. Before I knew it, I had lost 7 lbs.
When I came home from the retreat, I felt like a changed person. Although I had a back-up plan to start IVF a few months later, I believed that I was going to get pregnant without medical intervention. Dr. Lewis referred me to an acupuncturist, Dr. Michael Berkley of The Berkley Center, who performed acupuncture and prescribed herbal teas from a pharmacy in Chinatown called Kamwo. And sure enough, one month after I came home from the retreat, I was pregnant! As I continued on my pregnancy journey, I realized that Dr. Lewis was right and that I wanted to continue on the path that had helped me to have a child. I made some changes in my life that I had learned at the retreat which would also be beneficial for my unborn child. My husband and I continued to eat more natural and organic foods.
When my daughter April was born in 2006, we decided that she would be breast-feed for 1 year and eat organic baby foods when she began to eat solids. Later, as I was cleaning the house and April started to crawl around, I realized that I did not want her to breathe in the fumes from the cleaning products that I was using. This made me change my cleaning products to more eco-friendly ones. My fertility issues and experience at the retreat made me aware how important it is to know exactly what is going into your body, no matter how it goes in.
When we tried to have a sibling for April, we again went through the same struggles. April was nine months old when I had my third miscarriage after 5 weeks. We again decided to try acupuncture and herbal teas. Dr. Berkley referred me to Dr. Yaron Seidman of Hunyuan Fertility. He made some further, individualized dietary suggestions such as eating more liver. (That wasn’t much fun.)
The next time we had a miscarriage, I had not been using acupuncture long enough. That’s when I knew it was time to give my body a rest. We took three months off from acupuncture and trying to conceive. When we began again, I started going to acupuncture and brewing and drinking herbal teas. This time it worked and my son Cody was born in July of 2009.
And now, almost 6 years and 2 kids later, I am doing things that I never thought I would do. For the past 2 years, I have joined Sport Hill Farm’s Cash Crop program, so that my family can enjoy farm fresh vegetables. We now eat mostly organic foods from meats to breads to cookies and jellies. We recycle as much as we can and use healthier cleaning solutions. My fertility struggles led me on a journey to where I eventually became a part of the “green revolution.” Who knew that would happen but I think it is incredible!
Wednesday, April 11
Recognize that because you are not familiar with something and that it has not been rigorously tested by Western scientific standards does not negate its efficaciousness.
Dear Esteemed Colleagues:
Many of you have recommended that your patients do not take herbal medicine when TTC.
Recognize that because you are not familiar with something and that it has not been rigorously tested by Western scientific standards does not negate its efficaciousness.
I implore you to maintain an open mind and to realize that Western medicine and Western reproductive medicine is not the ‘only’ medicine that works.
Science per se, is about seeking the truth. The truth is that Chinese herbs have been used safely to treat fertility cases for thousands of years without iatrogenic effect, unlike many pharma products.
I beg you to be more flexible in your standards (not lower them!), which may be based on dogma as opposed to rejection after investigation; not very scientific indeed. Why not study the effects of herbs on infertile patients instead of outright rejection – that indeed seems like a more rigorous approach than outright denial of efficacy and the bold statement that ‘herbs can be harmful’.
I would be happy of course, to participate in the study. Let’s move forward in medicine - not Western medicine – but medicine. Medicine is something that positively affects a patient’s outcome - this is true whether the medicine comes from Ferring, Organon, or the mountains of China. It’s about time that minds start to open instead of remaining hermetically sealed.
Let me know if you are brave enough, or inquisitive enough to seek the truth about herbs in the milieu of the infertile patient. Let’s break new ground together; let’s think out of the box together; let’s be pioneers together!
Respectfully,
Mike Berkley, Licensed Acupuncturist/Board Certified Herbalist; FABORM
http://www.berkleycenter.com
Many of you have recommended that your patients do not take herbal medicine when TTC.
Recognize that because you are not familiar with something and that it has not been rigorously tested by Western scientific standards does not negate its efficaciousness.
I implore you to maintain an open mind and to realize that Western medicine and Western reproductive medicine is not the ‘only’ medicine that works.
Science per se, is about seeking the truth. The truth is that Chinese herbs have been used safely to treat fertility cases for thousands of years without iatrogenic effect, unlike many pharma products.
I beg you to be more flexible in your standards (not lower them!), which may be based on dogma as opposed to rejection after investigation; not very scientific indeed. Why not study the effects of herbs on infertile patients instead of outright rejection – that indeed seems like a more rigorous approach than outright denial of efficacy and the bold statement that ‘herbs can be harmful’.
I would be happy of course, to participate in the study. Let’s move forward in medicine - not Western medicine – but medicine. Medicine is something that positively affects a patient’s outcome - this is true whether the medicine comes from Ferring, Organon, or the mountains of China. It’s about time that minds start to open instead of remaining hermetically sealed.
Let me know if you are brave enough, or inquisitive enough to seek the truth about herbs in the milieu of the infertile patient. Let’s break new ground together; let’s think out of the box together; let’s be pioneers together!
Respectfully,
Mike Berkley, Licensed Acupuncturist/Board Certified Herbalist; FABORM
http://www.berkleycenter.com
Monday, March 19
Endometriosis – or is it? And...a diagnostic dilemma
Endometriosis can present with mild adhesions or deep infiltrative lesions whereupon the endometriosis has penetrated deep into organs and adnexa.
There is no medical cure for endometriosis. Surgery is the gold standard for amelioration. Ablative therapy cauterizes the endometriosis on the surface and can penetrate deeper and deeper but without precision and therefore can be dangerous to underlying tissue and surrounding structures. Excision is precise and safer.
There are four stages of endometriosis of endometriosis from stage one to stage four with stage four being the most severe.
This staging is in fact, inadequate, as there are cases of endometriosis that are far more severe than that which is shown in the above photo. There should probably be six stages to facilitate greater accuracy in determining and tracking disease.
Endometriosis is an autoimmune disease with a genetic predisposition.
There are several theories as to the etiology of endometriosis including Sampson's theory which postulates that retrograde menstruation carries blood through the fallopian tubes out and onto surrounding organs and tissue depositing epithelial remnants that attach and proliferate and act in response to hormones in the same way that eutopic endometrium does.; displaced coelimic epithelium; the lymphatic route; and surgery whereupon there is deposition of endometrial epithelial cells in other parts of the body (C-section).
Stem cells may also play a role in endometriosis. This is evident from the fact that total hysterectomy is not a cure for endometriosis and endometriosis can form in the absence of the uterus and ovaries. As stem cells are totipotent, they may, especially with dysregulation of the KRAS gene (Molecular Human Reproduction Vol.12, No.11 pp. 671–676, 2006) contribute to the development of endometriosis.
The gold standard for detection of endometriosis is via laparoscopic exploration, followed by therapeutic excision if endometriosis is found.
If a patient has an endometrioma it can typically be seen via TVU. But the absence of an endometrioma should in way be construed as an absence of endometriosis.
A woman with endometriosis may present with these symptoms – and she may be asymptommatic
1. Doubling over in pain
2. Missing school or work due to menstrual pain
3. Pain with defecation
4. Requirements of narcotics to reduce menstrual pain
5. The use of birth control pills or GnRH agonisits for pain reduction - which are not effective
6. Pelvic pain during adolescence
7. Infertility
8. A family history of severe menstrual pain
9. Endometriosis at stage 4 can be asymptomatic
10. Endometriosis at stage 1 can present with severe pain
When is laparoscopy appropriate?
I would certainly recommend laparoscopic review in an infertile patient who is under thirty-four years old and has a diagnosis of idiopathic infertility where there is also an absence of male factor, where there are at least three of the above sypmtoms manifest. Of course one problem with this algorhythmic approach is that endometriosis can be prevalent in the absence of symptomatology.
Even with negative hysterosalpingographic findings and negative TVU findings, endometriosis many be extant.
Infertility
Endometriosis is causative of infertility via several pathways including tubal damage, endometrial abnormality, inflammation in the uterine cavity, and low libido as a result of painful intercourse.
The endometrium is dysregulated in the patient with endometriosis: this can cause implantation failure. There is extra macrophage proliferation emitting proinflammatory cytokines within the uterine cavity: this may cause an inflammatory uterine environment that can be destructive to the embryo. There is also an inappropriate presence of MMP’s in the endometrium of the endometriosis patient during the window of implantation causing inappropriate and excessive tissue destruction and possibly preventing implantation (Ann N Y Acad Sci. 2002 Mar; 955:37-47; discussion 86-8, 396-406.)
Pregnancy
Some patients get pregnant even though they have endometriosis some do not. Some conceive after a laparoscopy and some do not. These variances exist perhaps because of varying degrees of disease; this of course, presupposes an absence of other pathologic states that may be contributory factors to inability to conceive. Another possibility is that not all of the endometriosis was excised and therefore there is still a hostile uterine environment as a result of continued prevalence of an inflammatory environment.
Chronic pelvic pain
Interstitial cystitis can mimic some symptoms of endometriosis.
IC is a chronic inflammation of the bladder wall.
Symptoms
1. Painful intercourse
2. Pelvic pain
3. Painful urination
4. Frequent urination (up to 60 times a day in severe cases)
5. Urgency to urinate
Treatment is symptomatic
Diagnosis is made by ruling out other causes. Tests include:
1. Bladder biopsy
2. Cystoscopy (endoscopy of bladder)
3. Urine analysis
4. Urine culture
5. Urine cytology
6. Video urodynamics (shows how much urine must be in the bladder before you feel the need to urinate)
Data about IC was obtained from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001508/
Traditional Chinese medicine
The dilemma of differential diagnosis
When a patient reports to the clinic for care and presents with chronic pelvic pain and dyspareunia one may immediately think of endometriosis.
If the pain is dull and aching one will undoubtedly state that stagnation of liver qi is the diagnostic foundation. If the pain is sharp and stabbing one will conclude that stasis of blood is the culprit. Of course in the chronic presentation both qi and blood will be stuck.
Typically the diagnosis which is commonly arrived at in the patient who reports a history of endometriosis is stagnation of liver qi and stasis of liver blood.
But we know that endometriosis is an inflammatory disorder and we also know that endometriosis is only manifest where there is ectopic endometrial epithelial cells.
This then renders the diagnosis of qi stagnation and stasis of blood incorrect. If there is ectopic deposition of cells and tissue – those cells could only have arrived in ectopic locations via rebellion. So rebellious qi and blood must be part of the differential diagnosis. If endometriosis is an inflammatory disease where inflammatory cytokines end up in the uterine cavity then we must include heat as part of the diagnosis. So, rather than qi stagnation and stasis of blood, I would diagnose this patient as being afflicted with rebellious qi and blood with heat trapped in the uterus. Frequently the endometriosis patient will not present with heat signs and then I diagnose the case as rebellious qi and blood with hidden heat trapped in the uterus.
Then there is another diagnostic dilemma: when the patients reports to you status post laparoscopy and complains of still having chronic pelvic pain, do we consider that her diagnosis of endometriosis is of value in helping us to formulate a TCM differential diagnosis? No – because the endometriotic implants have been excised and therefore the endometriosis, at least for the time being is no longer extant.
Then we can safely state that the diagnosis is stagnation of liver qi and stasis of liver blood based strictly on the patients symptoms. So: what once was – no longer is – and therefore, the diagnosis must change.
If the patient presents in clinic with a chief complaint of chronic pelvic pain and a Western medical diagnosis of IC, the TCM diagnosis is damp-heat in the bladder. This is a very different diagnosis than that of the endometriosis patient – with or without active endometriosis.
The patient with IC may not present with signs of damp-heat. Her only symptoms may be dyspareunia and CPP. Therefore, without the Western diagnosis available to us we may in fact miss a diagnostic pearl.
Based on the above it is my contention that having knowledge of the Western medical diagnosis can be very helpful in leading us to a more precise TCM differential diagnosis.
The fact is, in China today, most hospitals that have a Western wing and a TCM wing share data on cases and work together; so, the TCM doctor typically does know the Western medical diagnosis before he or she starts treating the patient.
We are not living in ancient China and we must remember that all knowledge which can help us to help our patients should be actively sought after, obtained and used. To not do this indicates a romantic belief that TCM is all our patients need and that the four examinations are all we need. This is ignorant and dangerous thinking based on dogma. This does not bode well for optimal patient care.
There is no medical cure for endometriosis. Surgery is the gold standard for amelioration. Ablative therapy cauterizes the endometriosis on the surface and can penetrate deeper and deeper but without precision and therefore can be dangerous to underlying tissue and surrounding structures. Excision is precise and safer.
There are four stages of endometriosis of endometriosis from stage one to stage four with stage four being the most severe.
This staging is in fact, inadequate, as there are cases of endometriosis that are far more severe than that which is shown in the above photo. There should probably be six stages to facilitate greater accuracy in determining and tracking disease.
Endometriosis is an autoimmune disease with a genetic predisposition.
There are several theories as to the etiology of endometriosis including Sampson's theory which postulates that retrograde menstruation carries blood through the fallopian tubes out and onto surrounding organs and tissue depositing epithelial remnants that attach and proliferate and act in response to hormones in the same way that eutopic endometrium does.; displaced coelimic epithelium; the lymphatic route; and surgery whereupon there is deposition of endometrial epithelial cells in other parts of the body (C-section).
Stem cells may also play a role in endometriosis. This is evident from the fact that total hysterectomy is not a cure for endometriosis and endometriosis can form in the absence of the uterus and ovaries. As stem cells are totipotent, they may, especially with dysregulation of the KRAS gene (Molecular Human Reproduction Vol.12, No.11 pp. 671–676, 2006) contribute to the development of endometriosis.
The gold standard for detection of endometriosis is via laparoscopic exploration, followed by therapeutic excision if endometriosis is found.
If a patient has an endometrioma it can typically be seen via TVU. But the absence of an endometrioma should in way be construed as an absence of endometriosis.
A woman with endometriosis may present with these symptoms – and she may be asymptommatic
1. Doubling over in pain
2. Missing school or work due to menstrual pain
3. Pain with defecation
4. Requirements of narcotics to reduce menstrual pain
5. The use of birth control pills or GnRH agonisits for pain reduction - which are not effective
6. Pelvic pain during adolescence
7. Infertility
8. A family history of severe menstrual pain
9. Endometriosis at stage 4 can be asymptomatic
10. Endometriosis at stage 1 can present with severe pain
When is laparoscopy appropriate?
I would certainly recommend laparoscopic review in an infertile patient who is under thirty-four years old and has a diagnosis of idiopathic infertility where there is also an absence of male factor, where there are at least three of the above sypmtoms manifest. Of course one problem with this algorhythmic approach is that endometriosis can be prevalent in the absence of symptomatology.
Even with negative hysterosalpingographic findings and negative TVU findings, endometriosis many be extant.
Infertility
Endometriosis is causative of infertility via several pathways including tubal damage, endometrial abnormality, inflammation in the uterine cavity, and low libido as a result of painful intercourse.
The endometrium is dysregulated in the patient with endometriosis: this can cause implantation failure. There is extra macrophage proliferation emitting proinflammatory cytokines within the uterine cavity: this may cause an inflammatory uterine environment that can be destructive to the embryo. There is also an inappropriate presence of MMP’s in the endometrium of the endometriosis patient during the window of implantation causing inappropriate and excessive tissue destruction and possibly preventing implantation (Ann N Y Acad Sci. 2002 Mar; 955:37-47; discussion 86-8, 396-406.)
Pregnancy
Some patients get pregnant even though they have endometriosis some do not. Some conceive after a laparoscopy and some do not. These variances exist perhaps because of varying degrees of disease; this of course, presupposes an absence of other pathologic states that may be contributory factors to inability to conceive. Another possibility is that not all of the endometriosis was excised and therefore there is still a hostile uterine environment as a result of continued prevalence of an inflammatory environment.
Chronic pelvic pain
Interstitial cystitis can mimic some symptoms of endometriosis.
IC is a chronic inflammation of the bladder wall.
Symptoms
1. Painful intercourse
2. Pelvic pain
3. Painful urination
4. Frequent urination (up to 60 times a day in severe cases)
5. Urgency to urinate
Treatment is symptomatic
Diagnosis is made by ruling out other causes. Tests include:
1. Bladder biopsy
2. Cystoscopy (endoscopy of bladder)
3. Urine analysis
4. Urine culture
5. Urine cytology
6. Video urodynamics (shows how much urine must be in the bladder before you feel the need to urinate)
Data about IC was obtained from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001508/
Traditional Chinese medicine
The dilemma of differential diagnosis
When a patient reports to the clinic for care and presents with chronic pelvic pain and dyspareunia one may immediately think of endometriosis.
If the pain is dull and aching one will undoubtedly state that stagnation of liver qi is the diagnostic foundation. If the pain is sharp and stabbing one will conclude that stasis of blood is the culprit. Of course in the chronic presentation both qi and blood will be stuck.
Typically the diagnosis which is commonly arrived at in the patient who reports a history of endometriosis is stagnation of liver qi and stasis of liver blood.
But we know that endometriosis is an inflammatory disorder and we also know that endometriosis is only manifest where there is ectopic endometrial epithelial cells.
This then renders the diagnosis of qi stagnation and stasis of blood incorrect. If there is ectopic deposition of cells and tissue – those cells could only have arrived in ectopic locations via rebellion. So rebellious qi and blood must be part of the differential diagnosis. If endometriosis is an inflammatory disease where inflammatory cytokines end up in the uterine cavity then we must include heat as part of the diagnosis. So, rather than qi stagnation and stasis of blood, I would diagnose this patient as being afflicted with rebellious qi and blood with heat trapped in the uterus. Frequently the endometriosis patient will not present with heat signs and then I diagnose the case as rebellious qi and blood with hidden heat trapped in the uterus.
Then there is another diagnostic dilemma: when the patients reports to you status post laparoscopy and complains of still having chronic pelvic pain, do we consider that her diagnosis of endometriosis is of value in helping us to formulate a TCM differential diagnosis? No – because the endometriotic implants have been excised and therefore the endometriosis, at least for the time being is no longer extant.
Then we can safely state that the diagnosis is stagnation of liver qi and stasis of liver blood based strictly on the patients symptoms. So: what once was – no longer is – and therefore, the diagnosis must change.
If the patient presents in clinic with a chief complaint of chronic pelvic pain and a Western medical diagnosis of IC, the TCM diagnosis is damp-heat in the bladder. This is a very different diagnosis than that of the endometriosis patient – with or without active endometriosis.
The patient with IC may not present with signs of damp-heat. Her only symptoms may be dyspareunia and CPP. Therefore, without the Western diagnosis available to us we may in fact miss a diagnostic pearl.
Based on the above it is my contention that having knowledge of the Western medical diagnosis can be very helpful in leading us to a more precise TCM differential diagnosis.
The fact is, in China today, most hospitals that have a Western wing and a TCM wing share data on cases and work together; so, the TCM doctor typically does know the Western medical diagnosis before he or she starts treating the patient.
We are not living in ancient China and we must remember that all knowledge which can help us to help our patients should be actively sought after, obtained and used. To not do this indicates a romantic belief that TCM is all our patients need and that the four examinations are all we need. This is ignorant and dangerous thinking based on dogma. This does not bode well for optimal patient care.
Friday, March 2
Acupuncturists - What Would You Do?
If a 38 year old female patient had 4 donor egg cycles where there were no pregnancies during the first two and one pregnancy each in each subsequent cycle ending in miscarriage at the third week?
There is no male factor and no pelvic distortion in the reproductive organs. The patient has elevated fsh and diminishes AMH – hence – donor egg.
She is symptomatic for endometriosis, has hypothyroidism as too does her mother and maternal grandmother. There is h/o infertility or miscarriage in the family.
Patient is normomorphic.
Her reproductive endocrinologist recommends another donor-egg cycle. I advised her against this.
What would you advise this patient to do from a Western medical perspective?
There is no male factor and no pelvic distortion in the reproductive organs. The patient has elevated fsh and diminishes AMH – hence – donor egg.
She is symptomatic for endometriosis, has hypothyroidism as too does her mother and maternal grandmother. There is h/o infertility or miscarriage in the family.
Patient is normomorphic.
Her reproductive endocrinologist recommends another donor-egg cycle. I advised her against this.
What would you advise this patient to do from a Western medical perspective?
Thursday, February 23
Meanderings on Oocyte Quality and Qi
Several reproductive hormones are related to ovarian reserve and follicle depletion. Ovarian reserve is assessed by measuring FSH, inhibin b and AMH as well as visualizing antral follicle count (afc) via transvaginal ultrasound examination. AMH suppresses FSH.
Qi has six functions. They are: transforming, transporting, containing or holding, raising, protecting and warming.
Inhibin b is analogous to the holding aspect of qi. FSH is analogous to the transforming aspect of qi as FSH transforms germ cells into follicles and primordial follicles into pre antral follicles and pre antral follicles into antral follicles and antral follicles into a graafian follicle.
One may consider that yang qi is associated with action and/or metabolic function and thus I might equate LH as a surge of yang qi facilitating the action of ovulation.
Ovulation also reflects the raising function of qi in that if qi is sinking or deficient, ovulation will not occur. The raising aspect helps the egg to burst through the follicle. So we can see the symbiotic relationship between spleen qi and kidney yang in the action of ovulation.
As the follicular pool diminishes either as a natural occurrence of aging or due to genetic defect, FSH increases due to a diminishment of inhibin b. Inhibin b is produced in the granulose cells of the follicle.
Oocytes are one type of physical manifestation of congenital kidney essence. Congenital essence is nurtured and supported by acquired essence which is derived from gu qi. Gu qi is essence qi derived from the transportation and transformation of food which is accomplished via the joint action of the stomach and spleen.
Typically with depletion of the follicular pool comes reduction in oocyte quality with greater opportunities for chromosomal anomalies, i.e. trisomies, monosomies, etc. It is my contention that acupuncture and herbs cannot increase the follicular pool anymore than he shou wu can turn the hair black. As in any ancient system (martial arts for example) theory, speculation and myth must be separated from clinical reality. But, I do know from clinical experience that oocyte quality can be improved. This evidence is obtained from clinical pregnancies as a result of the utilization of acupuncture and herbs where pregnancy did not occur prior to intervention. This occurs within a cohort of patients without other mitigating factors, i.e., tubal damage, male factor, POF, etc.
Since oocytes are a physical manifestation of kidney essence and congenital essence is nurtured and nourished by acquired essence, it is always important to tonify spleen qi when trying to fortify the kidneys and benefit essence. To tonify essence alone using herbs such as ze he che, rou cong rong, shu di, lu rong, etc. is a mistake. Theses herbs must be a part of a formula that utilizes spleen qi tonics as well. This is known as treating ‘one step removed’. It’s similar to benefitting metal to augment water as opposed to treating ‘water’ directly. An interesting analogy is the concept of treating local, distal and adjacent points when treating with acupuncture; not just putting a needle in LI11 to treat elbow pain or stiffness. So, in a way, we must think about using local, adjacent and distal herbs conceptually. This makes for a more sophisticated, more balanced and more efficacious formula.
Qi tonifying herbs that go to the spleen and lungs are best to use as the lung is the mother of the kidney and the spleen tonifies the lungs and the spleen as mentioned previously creates acquired essence. Use herbs like shan yao, ren shen, dang shen, huang qi, etc.
Of course every case must be treated according to differential diagnosis and treatment principle. The above thoughts and ideas and merely those – thoughts and ideas on how the treatment of the kidney and spleen may in a sense, be appropriate in every case of advanced maternal age infertility where egg quality is suspect, regardless of the differential diagnosis. Another way to state this concept is: no matter what the differential diagnosis, treatment of the spleen and kidney should be included to improve oocyte quality.
Qi has six functions. They are: transforming, transporting, containing or holding, raising, protecting and warming.
Inhibin b is analogous to the holding aspect of qi. FSH is analogous to the transforming aspect of qi as FSH transforms germ cells into follicles and primordial follicles into pre antral follicles and pre antral follicles into antral follicles and antral follicles into a graafian follicle.
One may consider that yang qi is associated with action and/or metabolic function and thus I might equate LH as a surge of yang qi facilitating the action of ovulation.
Ovulation also reflects the raising function of qi in that if qi is sinking or deficient, ovulation will not occur. The raising aspect helps the egg to burst through the follicle. So we can see the symbiotic relationship between spleen qi and kidney yang in the action of ovulation.
As the follicular pool diminishes either as a natural occurrence of aging or due to genetic defect, FSH increases due to a diminishment of inhibin b. Inhibin b is produced in the granulose cells of the follicle.
Oocytes are one type of physical manifestation of congenital kidney essence. Congenital essence is nurtured and supported by acquired essence which is derived from gu qi. Gu qi is essence qi derived from the transportation and transformation of food which is accomplished via the joint action of the stomach and spleen.
Typically with depletion of the follicular pool comes reduction in oocyte quality with greater opportunities for chromosomal anomalies, i.e. trisomies, monosomies, etc. It is my contention that acupuncture and herbs cannot increase the follicular pool anymore than he shou wu can turn the hair black. As in any ancient system (martial arts for example) theory, speculation and myth must be separated from clinical reality. But, I do know from clinical experience that oocyte quality can be improved. This evidence is obtained from clinical pregnancies as a result of the utilization of acupuncture and herbs where pregnancy did not occur prior to intervention. This occurs within a cohort of patients without other mitigating factors, i.e., tubal damage, male factor, POF, etc.
Since oocytes are a physical manifestation of kidney essence and congenital essence is nurtured and nourished by acquired essence, it is always important to tonify spleen qi when trying to fortify the kidneys and benefit essence. To tonify essence alone using herbs such as ze he che, rou cong rong, shu di, lu rong, etc. is a mistake. Theses herbs must be a part of a formula that utilizes spleen qi tonics as well. This is known as treating ‘one step removed’. It’s similar to benefitting metal to augment water as opposed to treating ‘water’ directly. An interesting analogy is the concept of treating local, distal and adjacent points when treating with acupuncture; not just putting a needle in LI11 to treat elbow pain or stiffness. So, in a way, we must think about using local, adjacent and distal herbs conceptually. This makes for a more sophisticated, more balanced and more efficacious formula.
Qi tonifying herbs that go to the spleen and lungs are best to use as the lung is the mother of the kidney and the spleen tonifies the lungs and the spleen as mentioned previously creates acquired essence. Use herbs like shan yao, ren shen, dang shen, huang qi, etc.
Of course every case must be treated according to differential diagnosis and treatment principle. The above thoughts and ideas and merely those – thoughts and ideas on how the treatment of the kidney and spleen may in a sense, be appropriate in every case of advanced maternal age infertility where egg quality is suspect, regardless of the differential diagnosis. Another way to state this concept is: no matter what the differential diagnosis, treatment of the spleen and kidney should be included to improve oocyte quality.
Monday, January 16
Like countless other couples around the world my husband and I left trying to get pregnant until I was 39...
Like countless other couples around the world my husband and I left trying to get pregnant until I was 39, with little realisation what a journey we had in store for us. We were both fit and healthy so it never occurred to us that there would be any difficulty.
After 3 years and several failed attempts with IUI and IVF we were told that our best chance of success would be through egg donation. We were given all the statistics but felt that we weren’t ready to give up and make that decision.
By now we were becoming exhausted with what seemed to be a hopeless pursuit which was draining on so many levels, emotionally, physically and financially. It was at this time that we met Mike. The Berkley Center was recommended to us for pre and post transfer acupuncture. Mike made us feel welcome and his kindness and support was encouraging a refreshing change from the statistically orientated RE’s that we had previously dealt with. For the first time someone was giving us support and encouragement that we weren’t on a hopeless journey. Despite the fact that we lived overseas Mike conducted a telephone consult and prescribed a course of Chinese Herbs to be taken before the next IVF he also took the time to speak with my acupuncturist and advise him what protocol to use.
That IVF didn’t work but four months later we became pregnant naturally. Amazing considering all the failures along the way and believe me I was doing all sorts, meditation, yoga, a variety of supplements I even changed my job to reduce the amount of stress in my life but the one thing I had done differently was the herbs prescribed by Mike. I am happy to report that our precious baby boy was born April 2011 and was definatly worth the wait.
Mike is a true professional whose philosophy embraces the East meets West approach to infertility. I wish that we had known about the Berkley Center when we started our journey but it is where we are heading with help to conceive number two.
After 3 years and several failed attempts with IUI and IVF we were told that our best chance of success would be through egg donation. We were given all the statistics but felt that we weren’t ready to give up and make that decision.
By now we were becoming exhausted with what seemed to be a hopeless pursuit which was draining on so many levels, emotionally, physically and financially. It was at this time that we met Mike. The Berkley Center was recommended to us for pre and post transfer acupuncture. Mike made us feel welcome and his kindness and support was encouraging a refreshing change from the statistically orientated RE’s that we had previously dealt with. For the first time someone was giving us support and encouragement that we weren’t on a hopeless journey. Despite the fact that we lived overseas Mike conducted a telephone consult and prescribed a course of Chinese Herbs to be taken before the next IVF he also took the time to speak with my acupuncturist and advise him what protocol to use.
That IVF didn’t work but four months later we became pregnant naturally. Amazing considering all the failures along the way and believe me I was doing all sorts, meditation, yoga, a variety of supplements I even changed my job to reduce the amount of stress in my life but the one thing I had done differently was the herbs prescribed by Mike. I am happy to report that our precious baby boy was born April 2011 and was definatly worth the wait.
Mike is a true professional whose philosophy embraces the East meets West approach to infertility. I wish that we had known about the Berkley Center when we started our journey but it is where we are heading with help to conceive number two.
Thursday, January 5
Traditional Chinese Medicine in the Treatment of Infertility
Although the goals of Complementary medicine and conventional Western medicine are the same, their ideas about what causes a disease, the nature of the disease itself, and the process used to regain health are very different. The physician learns that disease must be cured by prescribing medicine or by surgery. There is nothing inherently wrong with this approach. It often works. But why does Complementary medicine succeed where conventional Western medicine sometimes fails? What is it about acupuncture and herbal medicine that can result in relief of symptoms or even a cure that is often lacking in conventional Western medicine?
Though the ultimate result of Complementary medicine care is to cure the patient, the doctor of Complementary medicine attempts to do this by treating the whole person, taking into account the various attributes of an individual that, when combined, account for an individual’s health status. A person, according to the tenets of Complementary medicine, is more than their condition. To treat just the condition may yield results, but, however impressive, these results are usually temporary.
People are not, according to Complementary medicine, represented solely by their illness, but by the accumulation of every human interaction engaged in from the moment of their birth and by the culture they are exposed to. The emotional experiences, eating habits, work habits, work and living environment, personal habits, and social network all contribute to their disease, and are factors that, when changed appropriately, may lead to regained health.
The power and effectiveness of Chinese medicine is evidenced by its long history of continued success. More than a quarter of the world’s population currently uses Complementary medicine as part of their health-care regimen. Chinese medicine is the only form of classical medicine that is regularly and continuously used outside of its country of origin.
The experienced doctor must use his or her own interpretive skills and consider not only what the patient reports to them about their condition, but also what they reveal without meaning too and what they don’t express. This leads to a better understanding of who the patient is and what the deeper, underlying cause of their condition may be.
The practitioner of Chinese medicine is trained to observe one’s tone of voice, complexion, eyes (in Complementary medicine, the shen or sprit of an individual is said to be revealed through the eyes), facial expression, overall demeanor, and how one walks, sits, and stands, and to use these observations to arrive at a diagnosis. Before the patient says one word, the doctor already has some idea of who this person is, clinically, simply by observing them.
A great doctor is one who can process a mix of medical knowledge with a personal sensitivity based on experience. The practitioner of Complementary medicine specializes not just in inserting needles or prescribing herbal remedies, but in being able to see ‘hidden’ or subtle conditions that may not been seen or understood by practitioners of other types of medicine. This ability to see these hidden elements is difficult to master, and is done without the benefit of modern technology.
The only diagnostic tools used by practitioners of Chinese medicine are the “Four Examinations”: Observing, Listening/Smelling, Questioning, and Palpating. This method of diagnosis dates back over 3,000 years, and although it may seem quite simple, it is far from simplistic. Each of the Four Examinations can take years to master, and the astute practitioner uses them to arrive at a differential diagnosis. With the advent of technology—as amazing, necessary, and beneficial as it is—there seems to be a direct correlation between advances in technology and a decline in doctor sensitivity to the patient, and thus, misdiagnosis. The ability to listen and observe clearly, yields gems that are clues to the cause of disease. This is the stuff of Complementary medicine.
Proper treatment in Complementary medicine is more than the elimination of the disease. In addition to attacking a factor that is contributing to the disease process, it is the responsibility of the practitioner of Complementary medicine to support the individual in his or her goal of achieving overall total health, which includes the physical, psychological, emotional, and spiritual aspects of the patient. This multidimensional approach is crucial to the process of healing. Without it, practitioner are merely “chasing” the sickness and forgetting that the patient is much more than their disease. They are a whole person—the sum of a lifetime of experiences.
Pathologies are guests (and we hope temporary ones!) in a home that serves as a gracious host—our physical, emotional, and spiritual selves. Complementary medicine first is concerned with strengthening the immune function, which includes balancing the physical, emotional, and spiritual attributes of the patient, so as to be able to assist the patient in his or her endeavor to do battle and destroy the “enemy at the gates.” When people can’t sleep because they are anxious and depressed, they become chronically exhausted and chronically sick as a result of a compromised immune system.
The key to cure is to not view curing the disease itself as the be-all and end-all in treatment, but instead to treat the root of the disease—the anxiety and depression that causes the insomnia, which facilitates exhaustion, which lowers the immune function, which leads to chronic illnesses. So rather than prescribing antibiotics repeatedly, a practitioner of Complementary medicine might address the patient’s anxiety/depression syndrome or refer them to a psychotherapist for appropriate intervention while simultaneously providing Complementary forms of treatment.
Infertility and Complementary Medicine: Mechanisms of Action
Historically, infertility—particularly “functional” infertility—was attributed to psychological problems of one or both partners. Preliminary works in the 1940s and 1950s considered “psychogenic infertility” as the major cause of failure to conceive in as many as 50% of cases. As recently as the late 1960s, it was commonly believed that reproductive failure was the result of psychological and emotional factors. Psychogenic infertility was supposed to occur because of unconscious anxiety about sexual feelings, ambivalence toward motherhood, unresolved Oedipal conflict, or conflicts of gender identity.
Fortunately, advances in reproductive endocrinology and medical technology, as well as in psychological research, have de-emphasized the significance of psychopathology as the basis of infertility. Stress does, however, play a part.
A study done at Harvard showed that stress reduces the hypothalamic-anterior-pituitary-ovarian axis function, and should thus be considered in the infertility workup. Acupuncture releases endorphins that mitigate one’s response to stressful stimuli, thus enhancing the possibility of conception. Biologically, since the hypothalamus regulates both stress responses as well as the sex hormones, it’s easy to see how stress may contribute to infertility in some women.
Excessive physical stress may even lead to complete suppression of the menstrual cycle, and this is often seen in female marathon runners, who develop “runner’s amenorrhea.” In less severe cases, it could cause anovulation or irregular menstrual cycles. When activated by emotional stress, the pituitary gland also produces increased amounts of prolactin, and elevated levels of prolactin can contribute to irregular ovulation. The female reproductive tract contains stress-hormone receptors; stress can affect fertility.
However, more complex mechanisms may be at play, and researchers still don’t completely understand how stress interacts with the reproductive system. This is a story that is still unfolding, and during the last 20 years, the new field of psychoneuroimmunology has emerged. This field focuses on how your mind can affect your body. Research has shown that the brain produces special molecules called neuropeptides in response to emotions, and that these peptides can interact with every cell of the body, including those of the immune system. In this view, the mind and the body are not only connected, but inseparable, so that it is hardly surprising that stress can have a negative influence on fertility.
Stress can reduce sperm counts as well. Testicular biopsy specimens obtained from prisoners awaiting execution (who were obviously under extreme stress) revealed complete spermatogenetic arrest in all cases.
The stress factors that acupuncture addresses stems from both psychological and emotional factors as well as physical ones. For example, extremely painful premenstrual or mid-cycle pain can be debilitating. This type of physical stress no doubt produces emotional stress as a result of missed work, interference in activities, and the pain itself, which in turn can compromise the function of the reproductive system.
The insertion of acupuncture needles has been shown to effectively increase blood circulation. Enhanced blood flow to the reproductive environment clearly improves pregnancy outcomes.
A Diagnostic Window: East Meets West
It is becoming more and more prevalent that research conducted by Western scientists and physicians are highlighting the effectiveness of traditional Chinese medicine. In an article published in the December 2002 issue of the medical journal Fertility and Sterility, the authors reviewed existing evidence regarding the role of acupuncture in the treatment of infertility, and identified a number of studies indicating that acupuncture can increase the success rates of infertility treatments, including IVF.
In a study conducted by Dr. Wolfgang Paulus (Christian-Lauritzen-Institut, Ulm, Germany) and colleagues, half of a group of 160 women who were about to undergo IVF were randomly assigned to receive acupuncture therapy before and after embryo transfer. In the women who received acupuncture, the needles were placed at points believed to influence reproductive factors (for example, by improving blood flow to the uterus).
The acupuncture group had a higher rate of pregnancy compared with those not given acupuncture (43% versus 26%), suggesting that acupuncture can be used to improve pregnancy rates during IVF.
One alternative medicine diagnosis that exists which may be help to explain male or female infertility is called Liver qi stagnation. Key identifiers of an individual with this condition are anger, rage, frustration, depression, and anxiety.
Dr. Secondo Fassino (University School of Medicine, Turin, Italy) and colleagues recorded the personal characteristics of 156 infertile and 80 fertile couples, and measured their degree of psychopathology. When the researchers divided the couples according to the nature of the infertility—organic, functional, or undetermined—they found that anxiety, depression, and a tendency toward anger suppression could predict the diagnosis of organic or functional infertility in women with 97% accuracy. For infertile men, anxiety was also an important independent predictor of functional infertility, increasing the likelihood of having this form of infertility five-fold, while depression was more predictive of organic infertility. However, unlike in women, anger did not appear to influence infertility in men. These results suggest that, beyond the distress that accompanies the failure of repeated attempts to conceive a baby, psychological problems may contribute to functional infertility.
Herbal Medicine
The exact mechanisms of action of herbal medicine intervention are not, at this time, completely understood. However, herbal medicine has been used successfully to treat infertility for thousands of years.
Practitioners of Chinese herbal medicine rarely use a single herb in treatment. Chinese herbs are formula based; many herbs are mixed together to create the perfect ‘decoction’ specifically designed for the individual patient.
Some formulas contain two herbs and some thirty or more herbs. Each herb has many functions. Each herb has its own flavor, nature, temperature and trophism. Prescribing the correct herbal medicinals requires extensive training and clinical experience.
Self-medicating with herbal medicine presents a dual dilemma. At best the herbs will be useless, as the key to correct formula prescription is an accurate differential diagnosis that can only be rendered by a licensed, Board-Certified, experienced practitioner. In the worst case, self-prescribing of herbal medicine may prove harmful.
One should take herbs only when they’re prescribed by a Board-Certified herbalist. Not only is herbal medicine safe, it is highly effective and free of harmful side effects that often accompany pharmaceutical drugs. There are more than one million hospitalizations per year as a result of drug-induced side effects; not so with herbal medicine.
I have prescribed herbal formulas for 14 years to improve egg and endometrial quality. This is often effective, but, as in all fields of medicine, there is no guaranty of success. Herbal medicine is also very often used successfully in treating certain sperm anomalies.
Clearly, further research is needed to fully understand the mechanisms of action of acupuncture and herbal medicine in treating the infertile patient. Nevertheless, it is my opinion, based on fourtenn years of clinical care that the best-case scenario for patient faced with fertility challenges is to offer them every reasonable option which may serve to address their underlying condition. The integration of acupuncture and herbal medicine into the treatment protocol of the infertile patient, from a clinical perspective, based on current scientific and empirical data makes sense.
http://www.berkleycenter.com
STUDIES
1. BMJ 2008;336:545-549 (8 March), doi:10.1136/bmj.39471.430451.BE (published 7 February 2008)
Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis
Eric Manheimer, research associate1, Grant Zhang, assistant professor1, Laurence Udoff, assistant professor2, Aviad Haramati, professor3, Patricia Langenberg, professor and vice-chair4, Brian M Berman, professor1, Lex M Bouter, professor and vice chancellor (rector magnificus)5
1 Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207, USA, 2 Department of Obstetrics, Gynecology and Reproductive Services, University of Maryland School of Medicine, 3 Department of Physiology and Biophysics and Medicine, Georgetown University School of Medicine, Washington, DC, 4 Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 5 VU University Amsterdam De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
Correspondence to: E Manheimer emanheimer@compmed.umm.edu
Objective To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation.
Design Systematic review and meta-analysis.
Data sources Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.
Review methods Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.
Data synthesis Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth. The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).
Conclusions Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.
2. Acupuncture and IVF Study Shows Early Promise for Increased Take Home Baby Rates
Posted on: Tuesday, 12 August 2008, 15:00 CDT
Dr. Paul C. Magarelli, a nationally noted specialist in the field of reproductive endocrinology and infertility, and Dr. Diane K. Cridennda, a recognized authority on acupuncture and Traditional Chinese Medicine, have announced early results of an ongoing study linking acupuncture to positive in-vitro fertilization (IVF) outcomes. The study, which includes the largest-ever participant pool for a study of its kind, explores the increase in take home baby rates associated with combined Eastern and Western medicine treatments.
Drs. Magarelli and Cridennda's ongoing research shows an astonishing 15 percent increase in pregnancies, with a 23 percent climb in actual births in IVF patients treated with acupuncture. In addition, of the 578 patients Magarelli has co-treated at the Reproductive Medicine & Fertility Centers and East Winds Acupuncture from 2003 to 2008, 26 percent more patients became pregnant with acupuncture treatments added to IVF, saving them the costs and heartache of having to repeat an IVF cycle. This savings would decrease the national IVF fertility costs by more than $150,000,000 per year in the United States alone.
"Infertility is a condition that affects more than 7.3 million people nationwide, and many of those couples are unaware of the potential that acupuncture holds for them," said Dr. Magarelli. "Our study demonstrates that acupuncture increases uterine blood flow, reduces stress and has an overall positive impact on our IVF patients. And the results really speak for themselves: one of every four of our patients who have used acupuncture in conjunction with IVF has not had to repeat an IVF cycle to create their families."
A three-part exploration of Drs. Magarelli and Cridennda's ongoing breakthrough acupuncture and IVF study will be published in Fertility Today magazine later this year. ABOUT DR. PAUL C. MAGARELLI
Dr. Paul Magarelli, MD., Ph.D., a member of the GENESIS Network for Reproductive Health (www.genesisivf.com), recently won the Practicing Physicians Award from the Pacific Coast Reproductive Society for his groundbreaking research on the impact of acupuncture on IVF pregnancies. Not only is he known for his instrumental work in creating new pricing structures to provide cost-effective, competent IVF care for the average wage earner, but he is best known to his patients for applying high-tech procedures with a personal touch. In addition to co-founding the Corona Institute for Reproductive Medicine & Fertility, he is the medical director of the Reproductive Medicine and Fertility Centers in Colorado and New Mexico, where he specializes in infertility and all aspects of hormonal pathology in women. Dr. Magarelli has been interviewed as an expert source for MSNBC, Fertility & Sterility and PregnancyandBaby.com. To learn more, visit www.ColoradoSpringsIVF.com and www.CoronaFertility.com.
ABOUT DR. DIANE K. CRIDENNDA
Diane K. Cridennda, L.Ac., (FABORM) is Board Certified in the field of Reproductive Oriental Medicine. She graduated from the International Institute of Chinese Medicine in l995 with her Masters of Oriental Medicine degree. She trained in Beijing, China to explore the root of this ancient healing art. She is NCCA certified, licensed in Colorado and is a member of Resolve, a national infertility support group. She has also had extensive training in Traditional Chinese Herbal Medicine. For more than seven years, Diane has been working with Reproductive Endocrinologists using a combination of Eastern and Western medicine therapies for the treatment of infertility. To learn more, visit http://www.eastwindsacupuncture.com./
3. Fertility & Sterility Journal Volume 85, Issue 5, Pages 1347-1351 (May 2006)
Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study
Stefan Dieterle, M.D.a , Gao Ying, M.D.ab, Wolfgang Hatzmann, M.D.a, Andreas Neuer, M.D.
4. Can acupuncture boost my fertility?
Skrivet för BabyCentre UK
The BabyCentre Editorial Team svarar:
Research suggests that acupuncture may be helpful to couples undergoing in-vitro fertilisation (IVF), but the verdict is still out on whether it can improve fertility in general. Although smaller studies show promising results, more research is needed before we can say for sure that this age-old therapy can help you get pregnant.
Acupuncture is based on the theory that vital energy (or "qi," pronounced "chee") flows through the body along certain pathways. Acupuncturists try to balance this energy and restore health by stimulating specific points along the pathways with thin needles. Although it has been a staple of Chinese medicine for some 5,000 years, acupuncture has only gained acceptance in the Western medical community in the past few decades.
In 2002, a team of German researchers discovered that acupuncture significantly increased the odds of pregnancy among a group of 160 women who were undergoing IVF treatment. Forty-two per cent of the women who received acupuncture got pregnant, compared to 26 per cent of those who didn't receive the treatment.
Since then, more research has given support to the benefits of acupuncture for women undergoing IVF. One study, also in Germany, reported that conception and ongoing pregnancy rates were higher for women who had acupuncture treatment in the the second part of their menstrual cycle (the luteal phase) following IVF or ICSI. While a Danish study found that conception rates were best improved by having an acupuncture treatment on the day the embryos were transferred into the uterus. Their findings showed that having an additional acupuncture treatment two days later did not improve the chances of conception or ongoing pregnancy.
So how does it work? Nobody really knows, but researchers think that acupuncture may help increase blood flow to the uterus and relax the muscle tissue, giving the embryos a better chance of implanting.
Acupuncture may also help male infertility. Regular treatments have been shown to improve sperm counts and motility (the strength with which the sperm swim) for men with fertility problems but not always significantly. To improve the chances of pregnancy by natural means, acupuncture treatment would need to increase a man's sperm count over the threshold needed for conception. This means a minimum of 10 to 12 million moving sperm per ejaculate, and the men in these studies didn't get up to those levels.
However, for couples considering assisted conception, acupuncture can help by improving the quality of the sperm. In a study published in 2005, researchers analysed sperm samples from men with infertility of unknown cause before and after acupuncture treatments. They found that acupuncture was associated with fewer structural defects in sperm and an increase in the number of normal sperm.
Most experts believe that we need larger and better studies, ideally random and double blind trials, using fake needles for some patients and real ones for others, in order to really know whether acupuncture is effective. In some of the studies mentioned above, the patients and healthcare providers knew that acupuncture was performed, so the studies weren't "blind" and the success of the treatment might have been due to what's known as the placebo effect. Perhaps it was the patients' belief in acupuncture, rather than the acupuncture itself, that accounted for the treatment's success.
However, in the end it doesn't matter that much whether the success of acupuncture is a placebo effect or not. The bottom line is that acupuncture is relatively safe, and if it improves fertility, even if it's only because you think it does, it may be worthwhile.
The best first step to treating any fertility problem is to contact a specialist. If you do decide to try acupuncture, look for a registered acupuncturist, some of whom are also medical doctors. The British Acupuncture Council (www.acupuncture.org.uk) can help you find one near you.
Reviewed May 2007
Sources
Chang R, Chung PH, Rosenwaks Z. 2002. Role of acupuncture in the treatment of female infertility. Fertil Steril. 78(6):1149-53
Dieterle S, Ying G, Hatzmann W, Neuer A. 2006. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril. 85(5):1347-51.
Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. 2002. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril, 77(4):721-4
Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, Sterzik K. 2005. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertil Steril, 84(1):141-7
Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. 2000. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia, 32(1):31-9
Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. 1997. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl, 39(2):155-61
Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. 2006. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril. 85(5):1341-6
Zhang M, Huang G, Lu F, Paulus WE, Sterzik K. 2002. Influence of acupuncture on idiopathic male infertility in assisted reproductive technology. J Huazhong Univ Sci Technolog Med Sci, 22(3):228-30
Though the ultimate result of Complementary medicine care is to cure the patient, the doctor of Complementary medicine attempts to do this by treating the whole person, taking into account the various attributes of an individual that, when combined, account for an individual’s health status. A person, according to the tenets of Complementary medicine, is more than their condition. To treat just the condition may yield results, but, however impressive, these results are usually temporary.
People are not, according to Complementary medicine, represented solely by their illness, but by the accumulation of every human interaction engaged in from the moment of their birth and by the culture they are exposed to. The emotional experiences, eating habits, work habits, work and living environment, personal habits, and social network all contribute to their disease, and are factors that, when changed appropriately, may lead to regained health.
The power and effectiveness of Chinese medicine is evidenced by its long history of continued success. More than a quarter of the world’s population currently uses Complementary medicine as part of their health-care regimen. Chinese medicine is the only form of classical medicine that is regularly and continuously used outside of its country of origin.
The experienced doctor must use his or her own interpretive skills and consider not only what the patient reports to them about their condition, but also what they reveal without meaning too and what they don’t express. This leads to a better understanding of who the patient is and what the deeper, underlying cause of their condition may be.
The practitioner of Chinese medicine is trained to observe one’s tone of voice, complexion, eyes (in Complementary medicine, the shen or sprit of an individual is said to be revealed through the eyes), facial expression, overall demeanor, and how one walks, sits, and stands, and to use these observations to arrive at a diagnosis. Before the patient says one word, the doctor already has some idea of who this person is, clinically, simply by observing them.
A great doctor is one who can process a mix of medical knowledge with a personal sensitivity based on experience. The practitioner of Complementary medicine specializes not just in inserting needles or prescribing herbal remedies, but in being able to see ‘hidden’ or subtle conditions that may not been seen or understood by practitioners of other types of medicine. This ability to see these hidden elements is difficult to master, and is done without the benefit of modern technology.
The only diagnostic tools used by practitioners of Chinese medicine are the “Four Examinations”: Observing, Listening/Smelling, Questioning, and Palpating. This method of diagnosis dates back over 3,000 years, and although it may seem quite simple, it is far from simplistic. Each of the Four Examinations can take years to master, and the astute practitioner uses them to arrive at a differential diagnosis. With the advent of technology—as amazing, necessary, and beneficial as it is—there seems to be a direct correlation between advances in technology and a decline in doctor sensitivity to the patient, and thus, misdiagnosis. The ability to listen and observe clearly, yields gems that are clues to the cause of disease. This is the stuff of Complementary medicine.
Proper treatment in Complementary medicine is more than the elimination of the disease. In addition to attacking a factor that is contributing to the disease process, it is the responsibility of the practitioner of Complementary medicine to support the individual in his or her goal of achieving overall total health, which includes the physical, psychological, emotional, and spiritual aspects of the patient. This multidimensional approach is crucial to the process of healing. Without it, practitioner are merely “chasing” the sickness and forgetting that the patient is much more than their disease. They are a whole person—the sum of a lifetime of experiences.
Pathologies are guests (and we hope temporary ones!) in a home that serves as a gracious host—our physical, emotional, and spiritual selves. Complementary medicine first is concerned with strengthening the immune function, which includes balancing the physical, emotional, and spiritual attributes of the patient, so as to be able to assist the patient in his or her endeavor to do battle and destroy the “enemy at the gates.” When people can’t sleep because they are anxious and depressed, they become chronically exhausted and chronically sick as a result of a compromised immune system.
The key to cure is to not view curing the disease itself as the be-all and end-all in treatment, but instead to treat the root of the disease—the anxiety and depression that causes the insomnia, which facilitates exhaustion, which lowers the immune function, which leads to chronic illnesses. So rather than prescribing antibiotics repeatedly, a practitioner of Complementary medicine might address the patient’s anxiety/depression syndrome or refer them to a psychotherapist for appropriate intervention while simultaneously providing Complementary forms of treatment.
Infertility and Complementary Medicine: Mechanisms of Action
Historically, infertility—particularly “functional” infertility—was attributed to psychological problems of one or both partners. Preliminary works in the 1940s and 1950s considered “psychogenic infertility” as the major cause of failure to conceive in as many as 50% of cases. As recently as the late 1960s, it was commonly believed that reproductive failure was the result of psychological and emotional factors. Psychogenic infertility was supposed to occur because of unconscious anxiety about sexual feelings, ambivalence toward motherhood, unresolved Oedipal conflict, or conflicts of gender identity.
Fortunately, advances in reproductive endocrinology and medical technology, as well as in psychological research, have de-emphasized the significance of psychopathology as the basis of infertility. Stress does, however, play a part.
A study done at Harvard showed that stress reduces the hypothalamic-anterior-pituitary-ovarian axis function, and should thus be considered in the infertility workup. Acupuncture releases endorphins that mitigate one’s response to stressful stimuli, thus enhancing the possibility of conception. Biologically, since the hypothalamus regulates both stress responses as well as the sex hormones, it’s easy to see how stress may contribute to infertility in some women.
Excessive physical stress may even lead to complete suppression of the menstrual cycle, and this is often seen in female marathon runners, who develop “runner’s amenorrhea.” In less severe cases, it could cause anovulation or irregular menstrual cycles. When activated by emotional stress, the pituitary gland also produces increased amounts of prolactin, and elevated levels of prolactin can contribute to irregular ovulation. The female reproductive tract contains stress-hormone receptors; stress can affect fertility.
However, more complex mechanisms may be at play, and researchers still don’t completely understand how stress interacts with the reproductive system. This is a story that is still unfolding, and during the last 20 years, the new field of psychoneuroimmunology has emerged. This field focuses on how your mind can affect your body. Research has shown that the brain produces special molecules called neuropeptides in response to emotions, and that these peptides can interact with every cell of the body, including those of the immune system. In this view, the mind and the body are not only connected, but inseparable, so that it is hardly surprising that stress can have a negative influence on fertility.
Stress can reduce sperm counts as well. Testicular biopsy specimens obtained from prisoners awaiting execution (who were obviously under extreme stress) revealed complete spermatogenetic arrest in all cases.
The stress factors that acupuncture addresses stems from both psychological and emotional factors as well as physical ones. For example, extremely painful premenstrual or mid-cycle pain can be debilitating. This type of physical stress no doubt produces emotional stress as a result of missed work, interference in activities, and the pain itself, which in turn can compromise the function of the reproductive system.
The insertion of acupuncture needles has been shown to effectively increase blood circulation. Enhanced blood flow to the reproductive environment clearly improves pregnancy outcomes.
A Diagnostic Window: East Meets West
It is becoming more and more prevalent that research conducted by Western scientists and physicians are highlighting the effectiveness of traditional Chinese medicine. In an article published in the December 2002 issue of the medical journal Fertility and Sterility, the authors reviewed existing evidence regarding the role of acupuncture in the treatment of infertility, and identified a number of studies indicating that acupuncture can increase the success rates of infertility treatments, including IVF.
In a study conducted by Dr. Wolfgang Paulus (Christian-Lauritzen-Institut, Ulm, Germany) and colleagues, half of a group of 160 women who were about to undergo IVF were randomly assigned to receive acupuncture therapy before and after embryo transfer. In the women who received acupuncture, the needles were placed at points believed to influence reproductive factors (for example, by improving blood flow to the uterus).
The acupuncture group had a higher rate of pregnancy compared with those not given acupuncture (43% versus 26%), suggesting that acupuncture can be used to improve pregnancy rates during IVF.
One alternative medicine diagnosis that exists which may be help to explain male or female infertility is called Liver qi stagnation. Key identifiers of an individual with this condition are anger, rage, frustration, depression, and anxiety.
Dr. Secondo Fassino (University School of Medicine, Turin, Italy) and colleagues recorded the personal characteristics of 156 infertile and 80 fertile couples, and measured their degree of psychopathology. When the researchers divided the couples according to the nature of the infertility—organic, functional, or undetermined—they found that anxiety, depression, and a tendency toward anger suppression could predict the diagnosis of organic or functional infertility in women with 97% accuracy. For infertile men, anxiety was also an important independent predictor of functional infertility, increasing the likelihood of having this form of infertility five-fold, while depression was more predictive of organic infertility. However, unlike in women, anger did not appear to influence infertility in men. These results suggest that, beyond the distress that accompanies the failure of repeated attempts to conceive a baby, psychological problems may contribute to functional infertility.
Herbal Medicine
The exact mechanisms of action of herbal medicine intervention are not, at this time, completely understood. However, herbal medicine has been used successfully to treat infertility for thousands of years.
Practitioners of Chinese herbal medicine rarely use a single herb in treatment. Chinese herbs are formula based; many herbs are mixed together to create the perfect ‘decoction’ specifically designed for the individual patient.
Some formulas contain two herbs and some thirty or more herbs. Each herb has many functions. Each herb has its own flavor, nature, temperature and trophism. Prescribing the correct herbal medicinals requires extensive training and clinical experience.
Self-medicating with herbal medicine presents a dual dilemma. At best the herbs will be useless, as the key to correct formula prescription is an accurate differential diagnosis that can only be rendered by a licensed, Board-Certified, experienced practitioner. In the worst case, self-prescribing of herbal medicine may prove harmful.
One should take herbs only when they’re prescribed by a Board-Certified herbalist. Not only is herbal medicine safe, it is highly effective and free of harmful side effects that often accompany pharmaceutical drugs. There are more than one million hospitalizations per year as a result of drug-induced side effects; not so with herbal medicine.
I have prescribed herbal formulas for 14 years to improve egg and endometrial quality. This is often effective, but, as in all fields of medicine, there is no guaranty of success. Herbal medicine is also very often used successfully in treating certain sperm anomalies.
Clearly, further research is needed to fully understand the mechanisms of action of acupuncture and herbal medicine in treating the infertile patient. Nevertheless, it is my opinion, based on fourtenn years of clinical care that the best-case scenario for patient faced with fertility challenges is to offer them every reasonable option which may serve to address their underlying condition. The integration of acupuncture and herbal medicine into the treatment protocol of the infertile patient, from a clinical perspective, based on current scientific and empirical data makes sense.
http://www.berkleycenter.com
STUDIES
1. BMJ 2008;336:545-549 (8 March), doi:10.1136/bmj.39471.430451.BE (published 7 February 2008)
Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis
Eric Manheimer, research associate1, Grant Zhang, assistant professor1, Laurence Udoff, assistant professor2, Aviad Haramati, professor3, Patricia Langenberg, professor and vice-chair4, Brian M Berman, professor1, Lex M Bouter, professor and vice chancellor (rector magnificus)5
1 Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207, USA, 2 Department of Obstetrics, Gynecology and Reproductive Services, University of Maryland School of Medicine, 3 Department of Physiology and Biophysics and Medicine, Georgetown University School of Medicine, Washington, DC, 4 Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 5 VU University Amsterdam De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
Correspondence to: E Manheimer emanheimer@compmed.umm.edu
Objective To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation.
Design Systematic review and meta-analysis.
Data sources Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.
Review methods Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.
Data synthesis Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth. The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).
Conclusions Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.
2. Acupuncture and IVF Study Shows Early Promise for Increased Take Home Baby Rates
Posted on: Tuesday, 12 August 2008, 15:00 CDT
Dr. Paul C. Magarelli, a nationally noted specialist in the field of reproductive endocrinology and infertility, and Dr. Diane K. Cridennda, a recognized authority on acupuncture and Traditional Chinese Medicine, have announced early results of an ongoing study linking acupuncture to positive in-vitro fertilization (IVF) outcomes. The study, which includes the largest-ever participant pool for a study of its kind, explores the increase in take home baby rates associated with combined Eastern and Western medicine treatments.
Drs. Magarelli and Cridennda's ongoing research shows an astonishing 15 percent increase in pregnancies, with a 23 percent climb in actual births in IVF patients treated with acupuncture. In addition, of the 578 patients Magarelli has co-treated at the Reproductive Medicine & Fertility Centers and East Winds Acupuncture from 2003 to 2008, 26 percent more patients became pregnant with acupuncture treatments added to IVF, saving them the costs and heartache of having to repeat an IVF cycle. This savings would decrease the national IVF fertility costs by more than $150,000,000 per year in the United States alone.
"Infertility is a condition that affects more than 7.3 million people nationwide, and many of those couples are unaware of the potential that acupuncture holds for them," said Dr. Magarelli. "Our study demonstrates that acupuncture increases uterine blood flow, reduces stress and has an overall positive impact on our IVF patients. And the results really speak for themselves: one of every four of our patients who have used acupuncture in conjunction with IVF has not had to repeat an IVF cycle to create their families."
A three-part exploration of Drs. Magarelli and Cridennda's ongoing breakthrough acupuncture and IVF study will be published in Fertility Today magazine later this year. ABOUT DR. PAUL C. MAGARELLI
Dr. Paul Magarelli, MD., Ph.D., a member of the GENESIS Network for Reproductive Health (www.genesisivf.com), recently won the Practicing Physicians Award from the Pacific Coast Reproductive Society for his groundbreaking research on the impact of acupuncture on IVF pregnancies. Not only is he known for his instrumental work in creating new pricing structures to provide cost-effective, competent IVF care for the average wage earner, but he is best known to his patients for applying high-tech procedures with a personal touch. In addition to co-founding the Corona Institute for Reproductive Medicine & Fertility, he is the medical director of the Reproductive Medicine and Fertility Centers in Colorado and New Mexico, where he specializes in infertility and all aspects of hormonal pathology in women. Dr. Magarelli has been interviewed as an expert source for MSNBC, Fertility & Sterility and PregnancyandBaby.com. To learn more, visit www.ColoradoSpringsIVF.com and www.CoronaFertility.com.
ABOUT DR. DIANE K. CRIDENNDA
Diane K. Cridennda, L.Ac., (FABORM) is Board Certified in the field of Reproductive Oriental Medicine. She graduated from the International Institute of Chinese Medicine in l995 with her Masters of Oriental Medicine degree. She trained in Beijing, China to explore the root of this ancient healing art. She is NCCA certified, licensed in Colorado and is a member of Resolve, a national infertility support group. She has also had extensive training in Traditional Chinese Herbal Medicine. For more than seven years, Diane has been working with Reproductive Endocrinologists using a combination of Eastern and Western medicine therapies for the treatment of infertility. To learn more, visit http://www.eastwindsacupuncture.com./
3. Fertility & Sterility Journal Volume 85, Issue 5, Pages 1347-1351 (May 2006)
Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study
Stefan Dieterle, M.D.a , Gao Ying, M.D.ab, Wolfgang Hatzmann, M.D.a, Andreas Neuer, M.D.
4. Can acupuncture boost my fertility?
Skrivet för BabyCentre UK
The BabyCentre Editorial Team svarar:
Research suggests that acupuncture may be helpful to couples undergoing in-vitro fertilisation (IVF), but the verdict is still out on whether it can improve fertility in general. Although smaller studies show promising results, more research is needed before we can say for sure that this age-old therapy can help you get pregnant.
Acupuncture is based on the theory that vital energy (or "qi," pronounced "chee") flows through the body along certain pathways. Acupuncturists try to balance this energy and restore health by stimulating specific points along the pathways with thin needles. Although it has been a staple of Chinese medicine for some 5,000 years, acupuncture has only gained acceptance in the Western medical community in the past few decades.
In 2002, a team of German researchers discovered that acupuncture significantly increased the odds of pregnancy among a group of 160 women who were undergoing IVF treatment. Forty-two per cent of the women who received acupuncture got pregnant, compared to 26 per cent of those who didn't receive the treatment.
Since then, more research has given support to the benefits of acupuncture for women undergoing IVF. One study, also in Germany, reported that conception and ongoing pregnancy rates were higher for women who had acupuncture treatment in the the second part of their menstrual cycle (the luteal phase) following IVF or ICSI. While a Danish study found that conception rates were best improved by having an acupuncture treatment on the day the embryos were transferred into the uterus. Their findings showed that having an additional acupuncture treatment two days later did not improve the chances of conception or ongoing pregnancy.
So how does it work? Nobody really knows, but researchers think that acupuncture may help increase blood flow to the uterus and relax the muscle tissue, giving the embryos a better chance of implanting.
Acupuncture may also help male infertility. Regular treatments have been shown to improve sperm counts and motility (the strength with which the sperm swim) for men with fertility problems but not always significantly. To improve the chances of pregnancy by natural means, acupuncture treatment would need to increase a man's sperm count over the threshold needed for conception. This means a minimum of 10 to 12 million moving sperm per ejaculate, and the men in these studies didn't get up to those levels.
However, for couples considering assisted conception, acupuncture can help by improving the quality of the sperm. In a study published in 2005, researchers analysed sperm samples from men with infertility of unknown cause before and after acupuncture treatments. They found that acupuncture was associated with fewer structural defects in sperm and an increase in the number of normal sperm.
Most experts believe that we need larger and better studies, ideally random and double blind trials, using fake needles for some patients and real ones for others, in order to really know whether acupuncture is effective. In some of the studies mentioned above, the patients and healthcare providers knew that acupuncture was performed, so the studies weren't "blind" and the success of the treatment might have been due to what's known as the placebo effect. Perhaps it was the patients' belief in acupuncture, rather than the acupuncture itself, that accounted for the treatment's success.
However, in the end it doesn't matter that much whether the success of acupuncture is a placebo effect or not. The bottom line is that acupuncture is relatively safe, and if it improves fertility, even if it's only because you think it does, it may be worthwhile.
The best first step to treating any fertility problem is to contact a specialist. If you do decide to try acupuncture, look for a registered acupuncturist, some of whom are also medical doctors. The British Acupuncture Council (www.acupuncture.org.uk) can help you find one near you.
Reviewed May 2007
Sources
Chang R, Chung PH, Rosenwaks Z. 2002. Role of acupuncture in the treatment of female infertility. Fertil Steril. 78(6):1149-53
Dieterle S, Ying G, Hatzmann W, Neuer A. 2006. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril. 85(5):1347-51.
Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. 2002. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril, 77(4):721-4
Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, Sterzik K. 2005. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertil Steril, 84(1):141-7
Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. 2000. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia, 32(1):31-9
Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. 1997. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl, 39(2):155-61
Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. 2006. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril. 85(5):1341-6
Zhang M, Huang G, Lu F, Paulus WE, Sterzik K. 2002. Influence of acupuncture on idiopathic male infertility in assisted reproductive technology. J Huazhong Univ Sci Technolog Med Sci, 22(3):228-30
Wednesday, January 4
Finally…something for nothing!
We offer a free full-consultation and free treatment for anyone being treated by an acupuncturist for fertility-care.
We simply require two things to enable you to take advantage of this free offer valued at $250.00.
1. You must be or have been in treatment with your acupuncturist for at least three months where the goal of treatment was pregnancy.
2. You must bring your acupuncture treatment notes from your acupuncturist showing 3 months of treatment. You are entitled to a copy of your treatment notes from any doctor and any acupuncturist.
Have your free full-consultation and free treatment with Mike Berkley, a licensed and board certified- acupuncturist and board-certified herbalist who has been treating those faced with fertility challenges for fourteen years - no strings attached.
At the end of your consultation you will be provided with a treatment plan and lots of useful information. All of your questions will be answered.
We think it’s really important that both you and your partner attend, though this is a suggestion, not a requirement.
This is being offered to you so that you may have an opportunity to get a different diagnostic opinion and a different treatment plan - there is absolutely no obligation.
Call 212-685-0985 to schedule your free consultation and free treatment.
We look forward to meeting you and your partner and to helping make your dream of starting or growing your family a reality!
Visit our website!
We simply require two things to enable you to take advantage of this free offer valued at $250.00.
1. You must be or have been in treatment with your acupuncturist for at least three months where the goal of treatment was pregnancy.
2. You must bring your acupuncture treatment notes from your acupuncturist showing 3 months of treatment. You are entitled to a copy of your treatment notes from any doctor and any acupuncturist.
Have your free full-consultation and free treatment with Mike Berkley, a licensed and board certified- acupuncturist and board-certified herbalist who has been treating those faced with fertility challenges for fourteen years - no strings attached.
At the end of your consultation you will be provided with a treatment plan and lots of useful information. All of your questions will be answered.
We think it’s really important that both you and your partner attend, though this is a suggestion, not a requirement.
This is being offered to you so that you may have an opportunity to get a different diagnostic opinion and a different treatment plan - there is absolutely no obligation.
Call 212-685-0985 to schedule your free consultation and free treatment.
We look forward to meeting you and your partner and to helping make your dream of starting or growing your family a reality!
Visit our website!
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