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.
Showing posts with label egg quality. Show all posts
Showing posts with label egg quality. Show all posts
Thursday, February 23
Saturday, May 14
Supplementation of mitochondrial nutrients may improve the availability of energy production for the maturing oocyte and the developing embryo and thus reduce aneuploidy and assist in clinical pregnancies and live birth rates.
5/14/2011
Supplementation of mitochondrial nutrients may improve the availability of energy production for the maturing oocyte and the developing embryo and thus reduce aneuploidy and assist in clinical pregnancies and live birth rates.
Ovulation leads to resumption of meiosis in the oocyte. This means that there is an alignment and separation of chromosomes by the nuclear spindle. The mature oocyte then contains 23 chromosomes. 23 chromosomes are isolated outside of the zona- pellucida in the first polar body. When penetrated by a euploidic sperm a second polar body is extruded and the zygote then has a normal diploid complement of 46 chromosomes. The process of extruding chromosomes outside of the oocyte as well as expulsion of the second polar body requires energy.
The energy required for metabolic function of the oocyte is provided by mitochondria and ATP. The egg has more mitochondrial cells than any other tissue in the body. During recruitment of follicles mitochondrial DNA increases from 6000 copies to about 200,000.
Mitochondrial DNA is very vulnerable to mutations and deletions. The inheritance of mitochondrial DNA is strictly maternal. We can see from a TCM perspective that this is a clear depiction of yang within yin since the absence of the female’s yang qi would mean a complete lack of mitochondria/ATP. Mitochondria is where the power cells, ATP are stored. As a woman ages her mitochondrial function (yang qi) declines and, as a result there are mutations and deletions in the nucleotides which is where mitochondrial DNA is stored.
Oxidative phosphorylation is a metabolic pathway that uses energy released by the oxidation of nutrients to produce adenosine triphosphate (ATP). Although oxidative phosphorylation is a vital part of metabolism, it produces reactive oxygen species such as superoxide and hydrogen peroxide, which lead to propagation of free radicals, damaging cells and contributing to disease and, possibly, aging (senescence). Free radicals are harmful to egg and sperm quality.
One of the more frequent nucleotide deletions is the “common” deletion of 4977 base pairs, almost a third of the whole mitochondrial DNA genome. This deletion was shown to have a high prevalence in unfertilized oocytes and oocytes from older patients. As women and eggs age, mitochondrial energy production diminishes. Many processes of oocyte maturation especially nuclear spindle activity and chromosomal segregation become impaired.
It appears that free radicals along with reduced ATP and mitochondrial anomalies cause follicular damage and aneuploidy in the older woman.
Supplementation of mitochondrial nutrients may improve the availability of energy production for the maturing oocyte and the developing embryo and thus reduce aneuploidy and assist in clinical pregnancies and live birth rates. There are two ways to supplement these nutrients; exogenously and endogenously. For example, exogenous supplementation with Coenzyme Q10 helps to create ATP. It is also a major antioxidant. Natural systemic CoQ10 decreases with age.
An endogenous means of supplementation has less to do with directly affecting the function of the ovaries than improving systemic function so that ovarian function will improve naturally.
In order for a family to function in a healthy fashion all members of the family must be healthy. Let’s look at this statement from a different perspective: if one family member is sick, it will affect the others members of the family, either physically, emotionally or both. So the family dynamic must be treated; not just the sick individual. This is a more organic and holistic approach to treating the root and not the branch or the etiology as opposed to the symptoms. This is the goal of endogenous supplementation with, for example, herbal medicine.
An herbal formula that may be used to treat poor egg quality endogenously, due to yin-essence vacuity with depletion of yang might be composed of:
Xiang fu, dang gui, bai shao, shu di, rou cong rong, rou gui, shan yao, dang shen, mai dong and lu rong.
Of course, a formula must be created based upon a differential diagnosis and must strictly follow a treatment principle but this formula elucidates the pathology being treated: yin-essence vacuity with yang qi depletion.
There are two herbs, dang gui and xiang fu which will help ‘move’ the other herbs so stagnation will not occur but dissemination will. There also two herbs to help benefit the kidneys through supplementation of the spleen qi; shan yao and dang shen. Mai dong is used to benefit metal so as to promote water. Rou cong rong, rou gui and lu rong warm the kidneys, promote yang and benefit essence.
These methods of treatment involving benefitting the kidneys through supplementation of the spleen qi and benefitting metal to promote water; are referred to as treating ‘one step removed’. In other words we don’t just treat the organ or channel involved but we also treat organs that have a direct effect on other organs. It’s similar to using lung acupuncture points as part of a protocol to positively affect the large intestine.
Aging is a natural process and in the present culture health-care providers are often faced with the challenge of trying to reverse the reproductive clock with assisted reproductive interventions. These techniques such as IUI and IVF are often successful but more often they are not.
The main reason that ART fails more than it succeeds is because ART is primarily a mechanical process which cannot improve the components required to facilitate a clinical pregnancy and a live birth – egg and sperm.
Though CoQ10 has shown promising results, it still is not a full system approach. In other words it works on egg and sperm but not lining and other presentations which can alter the perfect balance, integration and function of the entire body to allow for pregnancy.
Acupuncture and herbal medicine are less involved per se in improving one area of function but more to the point, they improve all systems and functionality of the human organism –psycho-emotionally and physically.
Let’s use an analogy. If you lived in a rickety old house which was literally falling apart and it had very drafty windows you could spend $20,000.00 replacing the windows with state-of-the art windows and the drafts would be gone. But the house would fall apart anyway in a short time. In order for the house to be healthy the entire house must be addressed, not just the windows. IUI and IVF are really just dealing with the windows. TCM rebuilds the house.
The lungs, spleen and kidneys are the primary organs which, according to the theory of TCM, contribute to the creation and dissemination of energy or qi in the human being. As a person grows older their aerobic capacity decreases, their digestion worsens, their lower back and knees weaken, and their sexual and urinary functions worsen. That’s because these named organs are becoming deficient in qi which is a natural part of aging. If these organs could be nurtured, supplemented, and regulated their functionability may improve.
Improvement would be witnessed as improvement in the functions associated with each organ that I mentioned above. However, these three organs have far greater responsibility than that which is associated with the organs themselves. Egg quality, sperm quality, lining quality and the emotional state can all be improved with their respective improvement.
Then, when an IVF ET is performed the products (egg, sperm and endometrium) that the REI are mechanically manipulating will be superior in health and have a higher possibility of manifesting in a live birth.
The best outcomes for pregnancy and live births will come not from improved IVF techniques or more powerful drugs to facilitate greater folliculogenesis but through the improvement of the quality of the necessary components to achieve pregnancy: sperm, egg, and lining along with the down-regulation of pathogenic factors that can mitigate fertility such as immunological factors, blood clotting factors and inflammatory processes (endometriosis without pelvic distortion for example).
Acupuncture and herbal medicine has been effective in treating many cases of infertility for more than two thousand years.
When East meets West in the clinic, then patients will have the best chance of turning their dreams of having a family into a reality.
Mike Berkley, L.Ac., FABORM
Supplementation of mitochondrial nutrients may improve the availability of energy production for the maturing oocyte and the developing embryo and thus reduce aneuploidy and assist in clinical pregnancies and live birth rates.
Ovulation leads to resumption of meiosis in the oocyte. This means that there is an alignment and separation of chromosomes by the nuclear spindle. The mature oocyte then contains 23 chromosomes. 23 chromosomes are isolated outside of the zona- pellucida in the first polar body. When penetrated by a euploidic sperm a second polar body is extruded and the zygote then has a normal diploid complement of 46 chromosomes. The process of extruding chromosomes outside of the oocyte as well as expulsion of the second polar body requires energy.
The energy required for metabolic function of the oocyte is provided by mitochondria and ATP. The egg has more mitochondrial cells than any other tissue in the body. During recruitment of follicles mitochondrial DNA increases from 6000 copies to about 200,000.
Mitochondrial DNA is very vulnerable to mutations and deletions. The inheritance of mitochondrial DNA is strictly maternal. We can see from a TCM perspective that this is a clear depiction of yang within yin since the absence of the female’s yang qi would mean a complete lack of mitochondria/ATP. Mitochondria is where the power cells, ATP are stored. As a woman ages her mitochondrial function (yang qi) declines and, as a result there are mutations and deletions in the nucleotides which is where mitochondrial DNA is stored.
Oxidative phosphorylation is a metabolic pathway that uses energy released by the oxidation of nutrients to produce adenosine triphosphate (ATP). Although oxidative phosphorylation is a vital part of metabolism, it produces reactive oxygen species such as superoxide and hydrogen peroxide, which lead to propagation of free radicals, damaging cells and contributing to disease and, possibly, aging (senescence). Free radicals are harmful to egg and sperm quality.
One of the more frequent nucleotide deletions is the “common” deletion of 4977 base pairs, almost a third of the whole mitochondrial DNA genome. This deletion was shown to have a high prevalence in unfertilized oocytes and oocytes from older patients. As women and eggs age, mitochondrial energy production diminishes. Many processes of oocyte maturation especially nuclear spindle activity and chromosomal segregation become impaired.
It appears that free radicals along with reduced ATP and mitochondrial anomalies cause follicular damage and aneuploidy in the older woman.
Supplementation of mitochondrial nutrients may improve the availability of energy production for the maturing oocyte and the developing embryo and thus reduce aneuploidy and assist in clinical pregnancies and live birth rates. There are two ways to supplement these nutrients; exogenously and endogenously. For example, exogenous supplementation with Coenzyme Q10 helps to create ATP. It is also a major antioxidant. Natural systemic CoQ10 decreases with age.
An endogenous means of supplementation has less to do with directly affecting the function of the ovaries than improving systemic function so that ovarian function will improve naturally.
In order for a family to function in a healthy fashion all members of the family must be healthy. Let’s look at this statement from a different perspective: if one family member is sick, it will affect the others members of the family, either physically, emotionally or both. So the family dynamic must be treated; not just the sick individual. This is a more organic and holistic approach to treating the root and not the branch or the etiology as opposed to the symptoms. This is the goal of endogenous supplementation with, for example, herbal medicine.
An herbal formula that may be used to treat poor egg quality endogenously, due to yin-essence vacuity with depletion of yang might be composed of:
Xiang fu, dang gui, bai shao, shu di, rou cong rong, rou gui, shan yao, dang shen, mai dong and lu rong.
Of course, a formula must be created based upon a differential diagnosis and must strictly follow a treatment principle but this formula elucidates the pathology being treated: yin-essence vacuity with yang qi depletion.
There are two herbs, dang gui and xiang fu which will help ‘move’ the other herbs so stagnation will not occur but dissemination will. There also two herbs to help benefit the kidneys through supplementation of the spleen qi; shan yao and dang shen. Mai dong is used to benefit metal so as to promote water. Rou cong rong, rou gui and lu rong warm the kidneys, promote yang and benefit essence.
These methods of treatment involving benefitting the kidneys through supplementation of the spleen qi and benefitting metal to promote water; are referred to as treating ‘one step removed’. In other words we don’t just treat the organ or channel involved but we also treat organs that have a direct effect on other organs. It’s similar to using lung acupuncture points as part of a protocol to positively affect the large intestine.
Aging is a natural process and in the present culture health-care providers are often faced with the challenge of trying to reverse the reproductive clock with assisted reproductive interventions. These techniques such as IUI and IVF are often successful but more often they are not.
The main reason that ART fails more than it succeeds is because ART is primarily a mechanical process which cannot improve the components required to facilitate a clinical pregnancy and a live birth – egg and sperm.
Though CoQ10 has shown promising results, it still is not a full system approach. In other words it works on egg and sperm but not lining and other presentations which can alter the perfect balance, integration and function of the entire body to allow for pregnancy.
Acupuncture and herbal medicine are less involved per se in improving one area of function but more to the point, they improve all systems and functionality of the human organism –psycho-emotionally and physically.
Let’s use an analogy. If you lived in a rickety old house which was literally falling apart and it had very drafty windows you could spend $20,000.00 replacing the windows with state-of-the art windows and the drafts would be gone. But the house would fall apart anyway in a short time. In order for the house to be healthy the entire house must be addressed, not just the windows. IUI and IVF are really just dealing with the windows. TCM rebuilds the house.
The lungs, spleen and kidneys are the primary organs which, according to the theory of TCM, contribute to the creation and dissemination of energy or qi in the human being. As a person grows older their aerobic capacity decreases, their digestion worsens, their lower back and knees weaken, and their sexual and urinary functions worsen. That’s because these named organs are becoming deficient in qi which is a natural part of aging. If these organs could be nurtured, supplemented, and regulated their functionability may improve.
Improvement would be witnessed as improvement in the functions associated with each organ that I mentioned above. However, these three organs have far greater responsibility than that which is associated with the organs themselves. Egg quality, sperm quality, lining quality and the emotional state can all be improved with their respective improvement.
Then, when an IVF ET is performed the products (egg, sperm and endometrium) that the REI are mechanically manipulating will be superior in health and have a higher possibility of manifesting in a live birth.
The best outcomes for pregnancy and live births will come not from improved IVF techniques or more powerful drugs to facilitate greater folliculogenesis but through the improvement of the quality of the necessary components to achieve pregnancy: sperm, egg, and lining along with the down-regulation of pathogenic factors that can mitigate fertility such as immunological factors, blood clotting factors and inflammatory processes (endometriosis without pelvic distortion for example).
Acupuncture and herbal medicine has been effective in treating many cases of infertility for more than two thousand years.
When East meets West in the clinic, then patients will have the best chance of turning their dreams of having a family into a reality.
Mike Berkley, L.Ac., FABORM
Monday, March 8
Cigarette Smoking Contributes to Infertility and Miscarriage
Cigarette Smoking linked to Infertility and Miscarriage
Reproductive cells are vulnerable to genetic damage from smoking, but can be repaired.
In ejaculated spermatozoa, repair capacity declines drastically. This means that that repair is necessary at the time sperm is growing and developing in the testicles.
Smoking leads to chromosome errors which affect reproductive outcomes.
Smoking is associated with reduced numbers of eggs leading to early menopause.
Smoking inhibits embryo fragmentation; inhibition may confer survival advantage to embryos genetically altered. This can lead to pregnancy with impending miscarriage, or children born with cancer or born with genetic defects.
Smoking is associated with low sperm quality. Cadmium (a heavy metal), nicotine (a toxic alkaloid), and its metabolite cotinine, are detectable in testicular and ovarian tissue tissues and fluids in association with smoking. Cotinine incorporates into ovarian granulosa–lutein cells, compromising the developmental potential of follicles. Benzo[a]pyrene is a carcinogenic polycyclic aromatic hydrocarbon resulting from cigarette combustion.
Smoking-related cellular products were detectable in ovarian granulosa–lutein cells, eggs, sperm and embryos. Transmission of altered DNA from smoking by sperm was demonstrated in embryos and in association with increased risk of childhood cancer.
We know that cigarette smoking stems in part from anxiety. The satisfaction derived from cigarette smoking is complicated and manifold but nonetheless stems from the need to reduce anxiety.
In 1999, clinical researchers reported that inserting acupuncture needles into specific body points triggers the production of endorphins. In another study, higher levels of endorphins were found in cerebrospinal fluid after patients underwent acupuncture. Endorphins have been shown to reduce anxiety.
Based upon my clinical experience, acupuncture can aid in the cessation of cigarette smoking and thereby serve two purposes: 1) improve the health of the individual and, 2) improve the quality of egg and/or sperm and increase pregnancy outcomes and reduce miscarriage rates as well as aid in the health of the newborn.
If you and your partner are trying to conceive, the cessation of cigarette smoking is of the utmost importance.
At the Berkley Center for Reproductive Wellness, a leading fertility center in New York City, we have devised a protocol which confers an approximate 50% cure to cigarette smoking without drugs, nicotine, or other chemicals.
Reproductive cells are vulnerable to genetic damage from smoking, but can be repaired.
In ejaculated spermatozoa, repair capacity declines drastically. This means that that repair is necessary at the time sperm is growing and developing in the testicles.
Smoking leads to chromosome errors which affect reproductive outcomes.
Smoking is associated with reduced numbers of eggs leading to early menopause.
Smoking inhibits embryo fragmentation; inhibition may confer survival advantage to embryos genetically altered. This can lead to pregnancy with impending miscarriage, or children born with cancer or born with genetic defects.
Smoking is associated with low sperm quality. Cadmium (a heavy metal), nicotine (a toxic alkaloid), and its metabolite cotinine, are detectable in testicular and ovarian tissue tissues and fluids in association with smoking. Cotinine incorporates into ovarian granulosa–lutein cells, compromising the developmental potential of follicles. Benzo[a]pyrene is a carcinogenic polycyclic aromatic hydrocarbon resulting from cigarette combustion.
Smoking-related cellular products were detectable in ovarian granulosa–lutein cells, eggs, sperm and embryos. Transmission of altered DNA from smoking by sperm was demonstrated in embryos and in association with increased risk of childhood cancer.
We know that cigarette smoking stems in part from anxiety. The satisfaction derived from cigarette smoking is complicated and manifold but nonetheless stems from the need to reduce anxiety.
In 1999, clinical researchers reported that inserting acupuncture needles into specific body points triggers the production of endorphins. In another study, higher levels of endorphins were found in cerebrospinal fluid after patients underwent acupuncture. Endorphins have been shown to reduce anxiety.
Based upon my clinical experience, acupuncture can aid in the cessation of cigarette smoking and thereby serve two purposes: 1) improve the health of the individual and, 2) improve the quality of egg and/or sperm and increase pregnancy outcomes and reduce miscarriage rates as well as aid in the health of the newborn.
If you and your partner are trying to conceive, the cessation of cigarette smoking is of the utmost importance.
At the Berkley Center for Reproductive Wellness, a leading fertility center in New York City, we have devised a protocol which confers an approximate 50% cure to cigarette smoking without drugs, nicotine, or other chemicals.
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