Acupuncture in IVF Linked to Lower Miscarriage and Ectopic Rates

PHILADELPHIA — Women who receive acupuncture during the stimulation phase of an in vitro fertilization cycle and again immediately after embryo transfer have a higher live-birth rate than do controls, according to the first acupuncture study with this end point.

“Other studies have looked at pregnancy rates, but what is really important is whether or not there is a baby,” said Paul C. Magarelli, M.D., who reported his findings at the annual meeting of the American Society for Reproductive Medicine.

The retrospective study included 131 women who were undergoing standard in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). All of these women were considered good prognosis candidates for IVF/ICSI and were given the choice of having acupuncture.

A total of 83 women declined (controls) and 48 accepted.

photo via todaysmama.com

There were no significant differences between the two groups in terms of infertility diagnoses, demographics, and treatment protocols, except that sperm morphology was slightly better in the partners of women receiving acupuncture (7.3% vs. 5.9 % normal forms with strict criteria evaluation), and the average uterine artery pulsatility index was lower in the acupuncture group (1.57 vs. 1.72), said Dr. Magarelli of the department of ob.gyn. at the University of New Mexico, Albuquerque.

The study found that pregnancy rates per embryo transfer were not significantly different between the two groups (50% in the acupuncture group and 45% in controls).

The miscarriage rate was almost halved in the acupuncture group (8% vs. 14%).

In addition, the rate of ectopic pregnancies was significantly lower in the acupuncture group—0 of 24 pregnancies (0%) vs. 2 of 37 pregnancies (9%), said Dr. Magarelli, who is also in private practice in Colorado Springs and Albuquerque.

Thus, the live-birth rate per IVF/ICSI cycle was significantly higher in the acupuncture group than in controls (21% vs. 16%).

“The live-birth rate per pregnancy is an even more telling number, since some cycles get cancelled. There was a 42% live-birth rate per pregnancy in the acupuncture group, compared to a 35% rate in the nonacupuncture group,” Dr. Magarelli said in an interview with this newspaper.

“We believe that what we are doing is improving the uterine environment such that implantation is improved,” he added.

The study used two acupuncture protocols.

The Stener-Victorin electrostimulation protocol—which has been shown to reduce high uterine artery blood flow impedence, or pulsatility index (Hum. Reprod. 1996;11:1314-7)—was used for eight treatments during ovarian stimulation.

The second acupuncture technique—the Paulus protocol, which has been associated with improved pregnancy rates (Fertil. Steril. 2002;77:721-4)—was used within 24 hours before the embryo transfer and 1 hour after.

“This protocol has demonstrated reductions in uterine contractility, so by relaxing the uterus before the embryo transfer and immediately after, we felt we were setting up a better environment for implantation,” Dr. Magarelli said.

For more information on IVF and acupuncture, visit www.berkleycenter.com

212-685-0985

Embryo Grading

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

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

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

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

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

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

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

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

Supplement could be key to pregnancy for older women

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

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



The answer may lie in a single vitamin.



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



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



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



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



Five years ago, it was 33.



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



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



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



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



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



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



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



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



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



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



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



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



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



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



Mitochondria need co-enzyme Q10 to make energy.



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



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



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



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



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



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



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



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



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



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



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



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



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



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



© Copyright (c) The Vancouver Sun



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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

I’m going to study herbs now.

A great embryo - or is it?

There is no way a doctor can determine that an embryo is of good quality with today's diagnostic capabilities. This is why when a doctor says "you have a beautiful embryo and a beautiful lining" these are merely words of encouragement with no substantive clinical value.

The reasoning behind my statement is based on my experience. Thousands of patients have perfect blastocysts transferred and get pregnant and miscarry or don't get pregnant.

Thousands of patients have 5 cell embryos with some percentage of fragmentation manifest and conceive and deilver a healthy child.

Why is this? Probably becuase there are many processes and hormones, chemicals and other biochemical components that need to be in perfect balance before conception will occur.

Most doctors don't want to do embryo transfers on women whose linings are less than 9 mm but there are many documented pregnancies which occur with 5mm linings.

The role of acupuncture and herbal medicine is, essentially, one of balancing, or harmonizing - facilitating a state as close to homeostasis as possible.  This is why when patients include acupuncture and herbal medicine into their IVF embryo transfer protocols success is often found where previous failures were ongoing.

I had a patient today who has had 4 failed IVF cycles. She has been getting acupuncture and I suggested that she take herbs. She informed me that her doctor didn't want her to take herbs; I asked her what her doctor has done for her so far.  She then decided to take herbs.

If IVF were the answer, the success rates would be higher than 25-35%.  If acupuncture and herbal medicine were the answer, there would be no need for IVF. But, when these two modalities are used together, the results are frequently better than that achieved when using one of them alone.

Many doctors don't want their patients to take herbs becasue there hasn't been enough scientific research done on herbal medicine and they don't have proof of it's efficacy.  Do you have proof that God exists? Yet you have faith that he(or she) does. And, interestingly, many doctors and scientists believe in God though there is absolutely no evidence to prove the existance of God. I would say this may represent a double standard in these individuals.

Am I asking too much of my patients to have faith in herbs? After all, there is greater evidence of their efficacy than there is of the existance of God. Herbs have been ingested and have helped heal millions of people for thousands of years. You can see, touch, taste, feel and smell herbs. And you can see their immediate effect. Can you state the same about God?

I think the proof is in the pudding. IVF is only as good as it's positive outcomes and that doesn't mean pregnancies it means take home babies. Until IVF can provide a 100% success rate, patients and doctors alike are foolish to shun herbs.

Want more proof? Just ask any of my success patients about how acupuncture and herbs changed their lives by helping to facilitate an ongoing pregnancy.

I believe in integrative medicine, not egocentric, segrated, fear-based medicine. Isn't interesting how the practice of Western medicine is a microcosm of the world in which we live. Full of in-fighting, and egos, and ignorance?

Chinese medicine is far more inclusive. For example, in China today, most hospitals use both Western and Chinese medicine to treat in-patient and out-patient cases.

In Germany, homeopathy is wide-spread and is used in conjunction with Western traditional medicine. In France, acupuncture has been used for 400 years.

What is wrong with the mind, heart and soul of the American medical instituion?

Did you know that a 10mm lining provides absolutely no assurance of its health nor its ability to recieve and nurture an implanted embryo?  Some 10mm linings are pathologic and some 5mm linings are perfectly physiologic. Did you know that by doing a transvaginal ultra-sound with a color doppler a doctor can determine if there is adequate blood flow to the lining? Did you know that if there is inadequate blood flow to the lining a pregnancy will not occur? Did you know that acupuncture and herbal medicine can greatly increase blood flow to the lining?

I'll leave you with these thoughts for now. Think carefully about what I have written.

Conception is a natural process – Or…don’t microwave your dinner!

Process

Conception, pregnancy and parturition are a process. One definition of process is “a series of actions, changes, or functions bringing about a result”. Any natural process is better in every way than an artificial one. A good example is cooking. There is the process of cooking which is a slow, mindful act and there is microwave cooking which is basically a non-participatory act without natural process. There is no relationship between the chef and the outcome of the meal. Which meal tastes better? And, which is healthier to eat?

The process of conception is quite complicated and requires the perfect balance and function of many components all working in a coordinated and harmonious fashion. Sperm must be attracted to egg, it must find the egg, and it must penetrate the egg. The egg has be high quality and so too must be the sperm. The lining must have qualitative integrity. The embryo must find the lining and must be able to penetrate it. The placenta must develop and nourish the developing fetus and rid the fetus of waste matter. The placenta must protect the fetus from immunological attack. The cytokines, proteins, immune function, blood flow, gycoproteins, hormones must all be in balance and not under or over functioning. There must be absence of pathological mitigators which can contribute to infertility or promote miscarriage. Each and every player in the orchestra of conception must be in tune. One sour note and pregnancy will not occur or miscarriage will ensue.

Chinese medicine which consists mainly of acupuncture and herbal medicine does not work by adding to that which is deficient or reducing that which is in excess; Western medicine is good at that. For example, a common practice in treating a deficiency syndrome, i.e., hypothyroidism is to ADD synthroid. Or a common method at reducing excess insulin is by prescribing Metformin. These medicines which add or suppress or reduce have changed the face of civilization. Without the intervention of Western medicine and surgery our life-span would probably not exceed 40 years of age and three million babies would not have been born as a result of IVF. How many couples however, have remained childless even though they have undergone multiple IVFs? I am guessing more than three million.

Here is why: Just as a microwave oven can cook a meal, IVF can create a baby. But, as the microwave does not supplant the relationship between the chef and the food and the process of creating a meal, IVF cannot, in all its glory, in all cases, replace the natural process which is necessary to occur for conception and a take-home-baby to ensue.


The alternative

Acupuncture and herbal medicine are essentially used to create a state as close to homeostasis as possible. Homeostasis is when everything in the body and mind work perfectly. Obviously, this is not attainable. But, acupuncture and herbs attempt this and by attempting it a greater state of systemic and psycho-emotional health is frequently achieved. This is why, in many cases, acupuncture and herbs work to help one achieve pregnancy when IVF fails.

Because the greater one’s physical and psycho-emotional health is, the more likely they will be to conceive and deliver.

Based upon fourteen years of clinical experience in the field of infertility it is my professional opinion that the best case scenario for the infertile patient is to utilize Western medicine in conjunction with acupuncture and herbal medicine. The reason for this is quite simple. When the reproductive endocrinologist retrieves eggs and fertilizes them with sperm the resulting embryo is as good as its constituent components, egg and sperm. Most IVFs that fail do so because of poor egg quality and/or poor sperm quality. The reproductive endocrinologist cannot improve egg or sperm quality; acupuncture and herbs frequently can.

Blood

I saw a thirty four year old patient today. She has conceived three times with intercourse only to miscarry each time. She did get pregnant and delivered a baby as a result of insemination. She had one subsequent failed IVF. Now her doctor recommends donor egg with IVF. The patient has cold hands and feet, a pale complexion, low energy and gets dizzy. Obviously she has poor hemodynamics.

Blood is what carries FSH and LH from the brain to the ovaries; blood nourishes the endometrial lining; blood carries oxygen, electrolytes and nutrition to the entire reproductive system and removes waste matter from the reproductive environment. When cells die which they constantly do, they are ‘eaten’ up by macrophages. If the immune function is not functioning normally and debris is not removed, the outer layer of the dead cells breach and the internal toxic substance circulates within the ovarian milieu causing degradation in ovarian/egg quality. Acupuncture and herbal medicine increase blood flow; as a result this- can in many instances improve the health and function of the target tissue: ovaries and endometrial lining.

Why are you not using acupuncture and herbs?

It is difficult for me to understand why all infertile patients don’t include acupuncture and herbal medicine in their protocols. Why would they not? There has been so much research elucidating the efficacy of acupuncture in the treatment of infertility that acupuncture is no longer referred to as ‘alternative’ medicine but rather ‘complementary’ medicine. Herbs have a three-thousand year history of positive clinical outcomes.

Herb safety

Regarding the safety profile of herbs I have this to say: there are at least one million hospitalizations per year in America alone which occur as a result of adverse reactions to Western medicine. Many of these hospitalizations result in death. This does not happen with herbal medicine.

It is ironic therefore, that many (but no longer all!) doctors don’t want their patients on herbs because “they don’t know what’s in them”. Do you know what’s in Lupron? Or Gonal F? Did you know that ovarian hyper stimulation even from clomid can be fatal?

Don’t misunderstand, I am 100% pro IUI, IVF and donor egg-IVF protocols. But to not partake of a modality with proven results which may change the course from a negative outcome to a positive one especially in the patient who has had multiple IUI/IVF failures is a clinical error.


Mike Berkley, L.Ac., FABORM

Founder and Director, The Berkley Center for Reproductive Medicine

Mike Berkley, L.Ac. is in the News!

Many within the field of assisted reproductive technology have embraced this 3,000 year old practice and the trend of East Meets West IVF clinics is becoming popular nationwide. One such integrated practice is Batzofin Fertility Services in New York City. According to Joel Batzofin, M.D. "There is a myriad of ways to travel the road to fertility success, and everyone's situation is unique". The location of Batzofin's practice is adjacent to The Berkley Center for Reproductive Wellness, where TCM and acupuncture are administered to infertility patients.

IVF & Acupuncture -repsonse to new challenge to efficacy

It's a Meta Analysis of already published RCT's on Acupuncture/IVF. I'm sure that it includes the "usual suspects", i.e. the same RCT's or at lest most of the ones, that have been looked at in the previous Meta Analysis, i.e. Mannheimer, etc. What's curious of course, is how different PI's can look at the same RCT's for Meta Analysis, and come out of the number crunching with vastly different conclusions.

This has to do with the fact that the strength of any given Meta Analysis relates to the homogeneity of the RCT's looked at within it. Because the published RCT's in Acupuncture and IVF are not very homogeneous in terms of their inclusion criteria, exclusion criteria, controls, STRICTA guidelines, etc., it is very difficult to say for sure whether or not their is a positive, negative, or no effect from Acupuncture in IVF patients. Even Professor Adam Balen (co-author of one of the ABORM Reference Texts (Balen and Jacobs) noted, " patients needed to be aware of the lack of evidence on acupuncture and herbs before signing up to a course of treatment.There was a a great deal of discrepancy, he added, in the way in which the trials were designed and the type of acupuncture used".

Dr. Balen goes on to say, "Any future randomised controlled trials in this area need to ensure that they use a standardised acupuncture method, have a large sample size and include adequate controls to account for any placebo effects".

Therein lies the "rub". Acupuncture is notoriously difficult to control or blind for, and both placebo acupuncture (fake acupuncture needles in real acupoints), and sham acupuncture (real acupuncture needles in "sham" off-channel points) are undoubtedly not inert controls, and therefore the outcomes are muddy.

Perhaps the greatest insight - and one that might point a motivation for this Meta Analysis - was the quote, "But this sometimes comes at a cost which could buy a couple a further cycle of IVF"

Let's face it, there is increasing competition among REI's for patients as the field has increased in number, so any non-conventional therapy or treatment that might compete with that revenue source is going to put under the microscope.

Ray Rubio, DAOM, L. Ac. (FABORM)
President/ABORM
Reproductive Medicine Department Chair/Yo San University DAOM Program

Westlake Complementary Medicine
910 Hampshire Road, Suite A
Westlake Village, CA 91361
Phone: (805) 497-1335
FAX: (805) 497-1336
email: rtoo@earthlink.net

If you can't get pregnant, IVF is usually the next port of call - but there are alternatives, as Paula Goodyer discovers.

It was 2005, and after nine months of IVF treatment and a positive pregnancy test, 36-year-old Jill King was having a routine ultrasound to check that all was well. But when she turned to the screen, expecting to see a heartbeat, there was just an empty embryonic sac. In a cruel biological hoax, the sac minus its embryo - called a blighted ovum - was causing positive signs of pregnancy. There were more disappointments to come. By the time she discontinued IVF two years later, King had produced 50 embryos, but no babies, at a cost of about $50,000.

"People talk about the grief of miscarriage, and I've experienced that, but to me each embryo was also a potential baby lost," she recalls. "Whenever I had an embryo transfer [where the embryo is passed through the cervix into the uterus], I'd be calculating when its birthday might be."

Finally, she approached Jane Lyttleton, a traditional Chinese medicine (TCM) practitioner in Sydney who specialises in treating infertility. After three months of using Chinese herbs and acupuncture, King conceived naturally and gave birth to a daughter last year. "My message to other couples is be open-minded about alternative treatments," says King. "I know that for many people, IVF is the answer - but when both partners have been tested for all the typical causes and your infertility is still classed as 'unexplained', then Western medicine may not be the best approach. How can it successfully treat a problem it can't diagnose?"

Lyttleton is the first to admit that TCM is no cure-all for infertility, but it can help to normalise hormone levels, thus making ovulation more regular. It also improves the lining of the uterus and helps to prevent endometriosis and polycystic ovary syndrome (common causes of fertility problems in women). Sluggish or abnormally shaped sperm can benefit from Chinese medicine, too. "But it can't help with blocked Fallopian tubes - even if tubes are scarred rather than fully blocked," cautions Lyttleton. "I'd encourage a woman to try IVF in those circumstances."

Some cases of unexplained fertility may have a cause that is overlooked if IVF is used as a first, rather than a last, resort, says Dr Anne Clark, medical director of Fertility First, a clinic in Sydney's Hurstville.

Being overweight, smoking or drinking too much - even a lack of vitamin D or iodine - can sabotage conception or increase the risk of miscarriage, points out Clark. While the clinic offers IVF treatment, 25 to 30 per cent of couples conceive without it after correcting certain lifestyle factors.

"Women are hammered for being overweight or for smoking, but we know that with men, nine kilograms of extra weight can lower fertility by altering hormone levels," she says. "We also know that fragmentation of DNA in male sperm is a common cause of miscarriage, and that factors such as smoking, alcohol and possibly caffeine may be contributing."

Her study in 2008 of 800 men who were attending Fertility First found 58 per cent had sperm damage, but that lifestyle changes and vitamin supplements could help prevent this. "Unlike eggs, which are as old as the woman herself, sperm is freshly made every three months," says Clark. "Because of this, you can often reverse the problem quickly."

This was the case for Matthew Lake, a 34-year-old landscaper whose partner, Amanda, had had three miscarriages by the time she was 29. Test results showed she had no obvious problem, but Matthew had fragmented DNA in 33 per cent of his sperm.

At Clark's suggestion, he reduced his weekly beer consumption from 24 to seven, stopped drinking Coke and took a daily multivitamin. He also took supplements of coenzyme Q10 and vitamins E and C, antioxidants that, according to some research, help reduce sperm damage.
"After six months, the number of fragmented sperm had dropped to nine per cent - a month later I was pregnant," says Amanda. "I don't think people realise the problem can often be with the male partner, and that the solution can be simple."
In Clark's experience, men are often only asked to provide a sperm sample, and if that is problematic, the couple are directed to IVF rather than addressing a man's underlying health problems. The pressure of ageing impels couples towards IVF, too, she says.

Francesca Naish, from the Jocelyn Centre for Natural Fertility Management in Sydney, agrees. "People are in a hurry to conceive, but they need to take about three months to clean up first."
The "cleaning up" regimen recommended by the centre, which employs medical practitioners, naturopaths and an acupuncturist, entails both partners eating whole food - preferably organic - taking herbs and vitamin and mineral supplements, and reducing exposure to environmental toxins.

"Take the example of a hairdresser or a motor mechanic," says Naish. "She's exposed to bleaches and solvents, and he's working with solvents, heavy metals and paints. This doesn't mean hairdressers and mechanics can't make babies together, but if their fertility is already compromised, these exposures can make conception - especially of a healthy baby - harder." Other workers who come into contact with pesticides, such as farmers, may experience problems, too, explains Naish, as can people who spend a lot of time flying (sperm and eggs can be affected by radiation at high altitude). Some studies have linked heavy mobile phone use to reduced sperm count and sperm health. In isolation, these factors may mean nothing, but an accumulation of them, plus increasing age, can make a difference.

Although there's evidence that the miscarriage rate is higher with IVF, says Naish, "this isn't necessarily to do with IVF technology, which is fantastic. Miscarriages can occur because other problems aren't being sorted out first," she says. "IVF helps sperm and egg to meet and then gets the fertilised egg to the uterus, but it doesn't solve underlying problems that can impede a pregnancy."

Anne Clark acknowledges that with IVF offering a monthly pregnancy rate that is two to three times higher than nature, it will always appeal to couples in the stressed-out 21st century. When she recommends waiting until the lifestyle changes kick in, some couples feel pretty thrown to begin with. "But achieving a pregnancy can be a bit like painting a wall," she says. "It's all in the preparation."

East meets West

Acupuncture and IVF might come from opposite sides of the medical fence, but there's growing interest in combining them. Some studies show an improvement in pregnancy rates if acupuncture is used at embryo transfer, says Jane Lyttleton, a traditional Chinese medicine practitioner who works in partnership with IVF clinics. "We need more research to understand how it works," she says. "It may be that acupuncture increases blood flow to the lining of the uterus, creating a better environment for the embryo to grow. It may lower levels of stress hormones or, by having a calming effect on a woman's immune system, it may reduce the chances of her body rejecting the pregnancy."

Source: smh.com.au

Acupuncture Could Play A Useful Role In The Treatment Of Female Infertility

Doctors at the Center for Reproductive Medicine and Infertility at Cornell’s Weill Medical College have investigated the potential usefulness of acupuncture in enhancing female fertility.

Traditional Chinese medicine would attribute a disease state, such as infertility, to energy disturbances or imbalances, or organ deficiencies and excesses. Acupuncture is used in this system as a way to correct disruptions in the flow of Qi (energy) and bring the body back to good health. Doctors Chang, Chung, and Rosenwaks examined the current literature on acupuncture from the perspective of Western medicine seeking to determine its impact on the hypothalamic-pituitary-ovarian axis and the pelvic organs, and its potential for easing stress and anxiety.

Connections were found between acupuncture and the production of endorphins, which affect hormones playing a part in the menstrual cycle. In addition, studies were identified indicating that acupuncture can have an impact on ovulation.

Stress and anxiety, which too often accompany infertility, and possibly exacerbate the condition, can be relieved by acupuncture. Studies have been done, as well, on its use in relieving depression. As the impact of anxiolytic drugs and anti-depressants on infertility treatment is unknown, acupuncture presents an alternative for infertility patients.

Based on the preliminary clinical data showing acupuncture’s neuroendocrine effect on the hypothalamic-pituitary-ovarian axis and peripheral impact on improving uterine blood flow and endometrial thickness, the authors feel that clinical trials are warranted to investigate systematically the efficacy of acupuncture in treating various conditions related to female infertility. As the physiologic mechanisms underlying acupuncture are becoming better understood, the technique has been shown in trials to relieve pain, alleviate chemotherapy-induced nausea, and to treat for substance abuse. If trials show that it has a positive effect on the physiology affecting fertility, it could become a useful adjunct to established treatments.

IVF Florida - a great bunch of IVF Docs!

I recently returned from a wonderful trip with my associate, Robert Macdonald from Margate Florida where we visited with Drs. Ory, Maxson, Barrionuevo, Hoffman and their fantastic office manager, Clayton Lawrence. What a team!

First of all, these guys have an amazing facility, state-of-the-art is an understatement.

We know that more and more couples faced with the challenge of infertility are seeking complementary medicine to support their journey through IVF; IVF Florida recognizes their patients needs and supports their use of acupuncture. This in and of itself makes them ahead of state-of-the-art. Their 'integrative' approach to fertility enhancement represents the direction that many in-the-know IVF clinics are pursuing.

Kudos to all of you for your recognition of the fact that an East Meets West approach to fertility enhancement makes sense.

Dr. Mike Berkley