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Introduction
What I want to do here is offer a bit of insight into the benefits
of the Western approach of evaluating what is effective in treating
infertility and what can have a cause/effect on fertility.
When I was in Korea, I studied with a renowned master in this field.
Dr. Kang Myuang Ja had a very high success rate in bringing forth
live births in her 20 years of study and work. She only used acupuncture
and herbs and supported a wholesome diet. Smoking was a major issue
in the 40% male infertility she treated at her 10 story hospital in
downtown Seoul.
Dr. Kang’s reputation was widespread and everyone understood
that this approach took time and no one questioned that. Eighty percent
of her patients would be pregnant within a year of working with her
then continue prenatal care until birth and post natal care after
birth to assure a quick and healthy recovery for the mother and prepare
her for future children.
Once I returned to California and was introduced to many patients
undergoing IUI/IVF’s I had a whole other arena to study and
get familiar with. I needed to understand how these drugs could be
categorized in Oriental medical paradigm; how would the herbs used
affect or interface with the drugs and so forth. In those days there
was no one to teach me all this, I just had to work it out for myself.
Over time and after working with 200 – 300 + new patients per
year, I discovered that those who were undergoing ART procedures needed
to have significant pre-conception care. It was apparent that this
was as important if not more so than those patients who chose the
natural pre-conception care approach. As you read further, you will
see why.
Success of IVF and IUI vs. Natural Preconception Care
Fertility and Sterility, The Official Journal of the American Society
for Reproductive Medicine, p.327
2001 - There were 65,363 transfers (3.1 average # of embryos transferred)
totaling 291,710 embryos of which there were 18,703 deliveries, which
resulted in 26,254 births (allowing for multiples). This calculates
to 33.4% of transfers that resulted in live births and 84.9% of the
embryos transferred that did not make it.
The stats are much worse with IUI’s. The couple begins with
a 90% FAIL rate and with each IUI after that, the fail rate increases.
All doctors are aware of this and more will offer this anyway before
sending a couple over to IVF. After reading the article on Clomid
and the side effects it has from a TCM perspective, you will see why
Wolfe and her associates do not recommend this approach at all. If
there might be an issue of ASA (anti-sperm-antibody) Wolfe will often
recommend a few cycles of natural IUI’s
At Wellness Within, as well as Dr. Miki Shima in Cortemadera, Dr.
Randine Lewis (author of The Infertility Cure), The Joycelyn Clinic
in Sydney Australia, Dr. Ray Rubio in L.A., Dr. Kang Myuang Ja in
Seoul… all these clinics are working with the preconception
care approach as well as ART couples, show much higher success rates
using the time honored natural preconception care approach. At Wellness
Within, we are showing a range of success between 40 – 85% depending
on the age and history of each couple.
The greatest deterrent for the greater success with the natural preconception
care approach we see at Wellness Within is impatience. Each couple
that comes to us has been trying for a long time to conceive and they
are worn down from it. Everyone wants a baby last year and who can
blame them.
Even so, after factoring in the time, the expense, the toll on the
body from the drugs, and then just comparing the percentages of success
and logic should rule over emotion. Sometimes it does, sometimes not.
Stats Using Pre-conception Care with ART Procedures
Many people come to us having read about the German study that used
two treatments of acupuncture with IVF. The only thing that this really
shows is that some acupuncture is better than none at all. One of
my great beefs with this study is how poorly designed it was and how
many of my colleagues use this as an appropriate gage of how to treat
IVF women with our very sophisticated paradigm of health care.
While it did show a 27% success over those who had no acupuncture,
we can do so much better than this when addressing each woman’s
constitutional deficiencies and preparing her for pregnancy by counseling
her how to lower stress in her lifestyle with proper exercise, meditation,
sleeping in, resting during the day; with proper nutrition and herbal
formulas, regular acupuncture treatments, etc.
Indeed, at our clinics at Wellness Within, we are pushing 50- 65%
success (depending on age and dietary compliancy) for the couples
that use a minimum of four months preconception care BEFORE IVF. Like
the German study, for those who come in a week to a few weeks before
the ART procedure, the success drops accordingly. Why? It takes time
for the body to adjust, to restore homeostasis. Just like loosing
weight. As much as I’d like to loose 40 #’s in a month,
that’s just not going to happen and last.
IVF and IUI and the Effects of the Yang Stimulating Drugs used
in ART
There’s plenty written on the points to use before and after
transfer with IVF and these can also be applied to those undergoing
IUI. I think that far more important than cook-booking these points
is stepping back and looking at what we know works traditionally.
And that is, it takes TIME for the body to make corrections and prepare
for conception. At our clinics we say there is pre natal care, which
everyone is familiar with, but there is also Pre-Conception Care that
deserves equal attention.
This Pre-Conception care is what TCM (traditional Chinese medicine)
is all about. Because of the amount of time that it takes for sperm
and egg cells to mature to the point that they can be available at
any given cycle, when we have patients who come in for natural fertility
treatments, they know it’s for a minimum of three cycles. After
that, I expect them to get pregnant within 2 – 6 months.
This clinical outcome coincides with numerous case studies from China,
the Jocelyn clinic in Sydney Australia, Dr. Kang’s 10-story
hospital in Seoul as well as our clinics in PA and SJ.
Now having said that, let’s look at what and how TCM can interface
with those who have chosen this modality (ART) for conception.
How to Treat when Clomid is being used:
Originally, Clomid was intended as a form of BC because it prevents
the pituitary from perceiving circulating estrogen levels. It is indicated
for the treatment of ovulatory dysfunction in patients with PCOS and
various forms of amenorrhea. Clomid, from a TCM view, is perceived
as having Yang-invigorating effects. However, by over invigorating
the Yang, Clomid disturbs the Qi and depletes the Yin. It can:
- Cause cysts formation
- Thin the endometrium
- Thin cervical fluid
These are all barriers to conception.
If a person already has damaged Yin, she is more at risk for experiencing
the side effects associated with Ki and Li Yin deficiency and there
is a much greater chance of failure during the Clomid-stimulated
cycle.
Using Clomind begins with a 90% FAIL rate and worse, Clomid actually
can deplete a woman’s fertility. Who then should receive Clomid?
From this perspective, on patients who would respond favorably to
Clomid are women who have a Ki Yang Deficiency, Sp Qi deficiency or
cold and dampness in the Uterus. In these patterns the Yang stimulating
effects of Clomid can help restore a woman’s ovulatory response.
(See Suggested Reading, The Infertility Cure, Randine Lewis)
Blood Tests vs. Salvia/Hair Testing - Using a Different Measuring
Device To Explain the “non-Specific Etiology” of Infertility
There is another article on this site that explains the difference
in these tests. It’s important that you read this and understand
the difference and why the Salvia and Hair Lab tests can explain
the unexplainable for many couples who come in with an etiology
of “Non-Specific” etiology for their infertility. All
the Western lab tests show everything is “fine”. Well,
obviously everything is NOT fine or there would not be so many couples
coming in with this diagnosis.
Our bodies are programmed to reproduce. Indeed, we’re practically
compelled to do so as with all other species. So if we are using
a measuring device that says everything is “just fine”,
perhaps we need to use a different measuring device.
Here’s a few of the problems I see with blood tests to determine
hormone levels:
• First, in indicating what the FSH or Progesterone levels are
is no relationship to each other and this is important. Everything,
in order to be understood, must be in relationship to something else.
For example, what is tall? Who knows? Unless we can relate it to something,
it has no meaning. Knowing what the estrogens/progesterone levels
are in both the follicular and luteal phase are equally important.
• Secondly, since the FSH should surge about 24 hours before
ovulation, I’ve never understood why the FSH is measured on
day three.
• Then there is the problem with measuring progesterone (without
it’s relationship to estrogen) on day 21. Again, there is this
leap of faith that assumes that if it’s high on day 21, then
there is enough for the remainder of the cycle. Not so, according
to the hormone panel we do with the saliva testing. In almost every
case of infertility, we find that the progesterone drops after day
21. Remember, the hormones we are measuring with this soft
tissue testing are actually the free, unbound hormones in use at
the time of measurement. Whereas in the blood test, you are measuring
the protein bound hormones that are potential hormones that can
become available. The free hormones are calculated from this measurement
and that can be a skewed measurement if there are sufficient xeno-hormones
in the body affecting the calculation.
Advantages of the Hair Analysis Tests
The information we get from this test is extremely important in
understanding where the deficiencies are in the endocrine system
and especially that Hypothalamus/Adrenal/Pituitary axis so crucial
to fertility. Here we get some of the answers to all those cases
of “non-specific infertility”. With this information,
then we know exactly how to prescribe for the individual’s
specific nutritional needs.
The Hair Analysis Test had been denigrated on the Western Front,
by those who did not understand how the tests were done and that
different labs use different methods of analysis to determine different
data.
For example, an article was written in JAMA that “proved”
that hair analysis was inaccurate. Let’s look at how this outcome
was determined. The notorious “quack buster:, Stephen_Barret,
who lost the case against the chiropractic profession at the Supreme
Court level, was hired to investigate the efficacy of hair analysis
lab testing. He took a population of TWO, his daughter and
her girlfriend, cut their hair, mixed it up and sent samples of
this to various labs in the country that does hair testing.
Now let’s look at how ridiculous Barret‘s protocol of
investigation was.
• Some labs wash the hair samples when they get it, others
don’t. This can make a huge difference depending on what the
lab is looking for.
• For some labs, like the one we use at Wellness Within, hair
must be washed with clarifying shampoo in water that has neither
sodium or potassium water softeners in it.
• Dandruff shampoos are high in selenium and the water softener
will affect the potassium and sodium results.
• The hair must be cut with stainless steel scissors, so that
other metals won’t affect the mineral results.
• Hair Must Be Cut using only the first 1 ½”
of hair from the scalp, so we review what is happening in the body
for the last 3 months.
Pretty complicated, right? Because no one reviewing the results
of Barrett‘s “research” understood this kind of
complexity and that different labs review different data, this ineptitude
called research was printed in a very prestigious medical journal
as valid. Most Western docs buy what is printed in JAMA, so this
unfortunately shuts the door on a very valid and important source
in evaluating a person’s endocrine system.
Let’s review how Dr. Eck’s (the founder of Analytical
Research Labs) life long work with hair analysis came about. He
took 10,000 young, healthy athletes and then another 10,000 hair
analysis on very sick people and ran the data to compare what minerals
and ratios affected the endocrine system. Unlike other hair analysis
labs Dr. Eck’s specialty is just this. This is not to say
that other hair analysis labs are flawed, just different analysis.
This test is remarkable on several levels. First, because it is
a cellular level test, it shows us the direction that the body is
moving toward. For example, the ratio of Ca/Mg will indicate if
the person is moving toward insulin resistance. The body will do
everything it possibly can to keep the blood at homeostasis, so
mineral deficiencies that we find at the cellular level most likely
would not show up at the blood level. This is a good thing, ‘cause
by then, it’s really late in the game to restore homeostasis.
Advantage of the Salvia Test for Male and Female Hormones
I’ve gone over this in a separate article on this site and
mentioned it above on the section of the problems I see with using
a Blood Test to evaluate hormonal levels in both men and women.
With this test, we are reviewing male and female hormones in their
free, unbound state. To do this with a blood test would be cost
prohibitive for most people.
With this test we can see the relationship between estrogen and
progesterone in both the follicular and luteal stage. We can see
if there is possibly an exogenous source of progesterone and we
can see if the woman is in estrogen dominance. If so, she cannot
get pregnant – another cause and effect of “non-specific”
infertility. Exogenous source of progesterone is very common in
both men and women and this is addressed in another article.
We also see the levels of DHEA, a hormone precursor indicating the
stress on the adrenals, which can be confirmed with the Hair Analysis
testing. If the testosterone is elevated then we consider the possibility
of PCOS. We’re also given the range for FSH and LH surges,
how the corpus luteum responds and a second ratio that will determine
estrogen dominance.
All in all, it’s a remarkable test and now that I use it,
I don’t know how I’ve ever done without it. I now can
tell exactly, how to address each person. Our success rates in pregnancies
have increased substantially since using these test, prescribing
precisely and of course, let’s not diminish the importance
of the person’s compliance with a whole foods diet and lifestyle
issues.
Pottinger’s Cat Study and Infertility Being Nutritionally
Related
This study is reviewed briefly on my web site under articles, but
because of the importance of it in relationship to infertility,
I encourage each person reading this to buy the book, The Untold
Story of Milk, where Dr. Schmid reviews it in depth. The book itself
is a pager turner and well worth the few minutes it takes to go
to http://www.amazon.com/ and order it.
This 15-year research done by one of the great researching, clinical
MD’s of the 20th century proves that a whole foods diet is directly
related to not only degenerative diseases, but fertility.
Please, order it and read it.
Equating TCM Theory with Western Conventional View
The basis of all traditional Chinese medicine is energy.
There is an interesting theory about the development of the embryo
and the meridians.
1. As the embryo continues to develop, certain cells start to coalesce
along what look like fold lines. These fold lines mark the separation
of one group of cells from another and they also mark the connection
between groups of related cells.
2. As cells continue to differentiate along fold lines, they become
the organs and organ systems.
3. Modern researchers in Chinese medicine believe that the embryonic
folds become energy meridians.
4. These embryonic folds serve as ‘channels of connection’
between apparently separate parts of the body.
5. Think of the folds like an electrified fence. The folds keep
what’s on one side of the fence separated from what’s
on the other side. At the same time, if you were to put a jot of
electricity into one end of the fence, the energy would travel very
quickly and efficiently from point A to point B, even if they are
a long way from each other. This explains why points in the feet
or along the arms can affect the function of the kidneys or lungs
or ovaries.
How does Acupuncture Work?
Bear with me here, I think this is such a good analogy to help understand
acupuncture’s role in restoring homeostasis. An acupuncture
point is an area on the skin where the electromagnetic current that
runs throughout the body comes close to the surface, so it makes sense
that those spots would be sensitive to electrical energy from outside
the body. To continue with the electrified fence analogy,
to transmit energy through the fence, you’d want to find a
way of enhancing the flow of energy from one end of the fence to
the other by decreasing resistance.
What’s the best conductor of electrical energy? Yeah, you
know, metal!
So if you put a metal needle (which is an excellent conductor of
electricity) into an acupuncture point (where the meridian runs
close to the surface of the body), you are decreasing resistance
to the smooth flow of current while promoting the flow of energy
along that meridian.
The improved flow doesn’t just put more energy into a specific
organ; instead, it normalizes the flow of energy throughout the
system. If there’s too much energy, it allows the excess to
drain; if there’s too little energy, it allows more to flow
into that particular area or organ.
How Acupuncture Can Help Improve Fertility
The effects of acupuncture on the body’s electromagnetic field
have been studied extensively over the past few decades in both the
East and the West. Certain studies on acupuncture’s ability
to relieve pain also demonstrate how acupuncture can help improve
fertility.
These studies indicate that pressure exerted by a needle triggers
the release of prostaglandins, which stimulate production of chemicals
in the nerve endings, which in turn transmit a message to the hypothalamus.
This is of particular interest to us working with fertility because
it also controls the discharge of gonadotropin-releasing hormones
(GnRH), which govern ovulation, menstruation and pregnancy.
The Eastern explanation of the effects of acupuncture on the body
is far simpler: acupuncture balances the whole body system. Think
of a large field that gets its water from a network of canals. If
one of the canals were blocked at any point, the blockage would not
only keep the water from flowing to certain parts of the field but
also cause other parts to get too much water as things back up.
Acupuncture is like removing the blockage from an energetic ‘canal.’
When the right points gets stimulated, energy that has been blocked
will flow freely again. The parts of the body that have been starved
for energy will receive it.
As an example of what some of the points can do:
1.Prolactin levels – these can be elevated from nursing which
is why it’s more difficult to get pregnant while nursing, but
prolactin can also be elevated from stress. Yintang, LI4, Li 2, Li
3 and the prolactin point in the ear can help resolve excess prolactin
levels. Use ONLY before ovulation.
2.Pituitary levels after ovulation can be harmonized with Bl 2, Bl
62, and SI 3
3.Improve blood flow to the pelvic organs: Zigong, GB 26, St 30, Ren
3, 4, 6, Sp 6, Bl 23, Bl 52, Bl 32, 32, 33, 34. These last four points
are found in the holes of the sacrum and stimulating them regulates
menses, treats lower back and pelvic pain, and resolves impairment
to fertility.
Studies have shown that electric stim of Bl 32 or Bl 28 signals t
there is too much sympathetic activity at the level of the second
lumbar to the second sacral vertebra (level with the pelvis). The
brain then signals the nerves to reduce sympathetic outflow, thereby
allowing the blood vessels to dilate and improving blood flow to the
pelvic organs. That’s what that Swedish study was all about
in proving the increase of the PI prior to transfer.
Just a couple of sidebars on the points chosen here.
Zigong (Palace of the child) most closely represents the ovaries and
is indicated for uterine and menstrual problems, especially infertility.
Help resolve cases of cervical stenosis (a narrowing of the canal
between the uterus and the cervical opening)
Ren 3 (Central Pole of the Conception Meridian) – Its translation,
Central Pole, from the Chinese word for North Star, which is in the
center of the sky. It lies over the Uterus and the conception meridian
and regulates menses, fortifies Ki, benefits the Bl and removes stagnation
and dampness from the pelvis. Randine Lewis, Ph.D. uses this point
to ‘water the uterous’ or subdue toxic heat found in conditions
like endometriosis with implantation difficulty and NK cells in the
endometrium. Use only before ovulation.
Ren 4 (Origin of the Source of the Conception Meridian). Represents
the source of life, the Dan Tien and the site of the Uterus. It fortifies
the Original Qi, nourishes Ki Essence and assists conception... use
only before ovulation.
St 30 (Rushing Qi. This point represents the crossing point of the
Penetrating meridian with the ovaries, fallopian tubes and uterus.
It’s said to disperse cold and stagnation in the pelvis.
Summary
The treatment of fertility has been a major Chinese health issue for
millennium and they have been remarkably successful in cultivating
protocols that work well. Using this as my foundation, I look over
the hundreds of couples that have come to me over the last five years
and I see a major difference in the couples seeking the traditional
care for fertility over the last 3 millenniuim and those seeking answers
to their infertility now.
The main difference is two things:
• Stress
• Malnutrition – and this has come about in the last 60
years as more and more processed foods, sugars, pesticides, herbicides,
xeno-hormones, preservatives seep into our diets and touted as “healthy”
and “enriched”. We no longer know what a whole grain is,
much less how to cook it. We know longer know what a processed food
is, especially if it’s labeled “natural” or “organic”.
Then it must be good, right? Not necessarily.
My clinical experience indicates that using herbal formulas and
acupuncture without addressing the foundation of an organic whole
foods diet shows lower success than when the couple focus’
on this as an ongoing life style.
As you can see there is so much that acupuncture can do (if you
did nor read the entire section of acupuncture and fertility it’s
really worth a few minutes of time to educate yourself on the amazing
sophistication of acupuncture points). Even so, without the foundational
support of optimum nutritional support, even when there is success
with pregnancy, the lack of superior nutrition is not passed on
to the fetus or in early childhood.
Natural Pre-conception care has by far, greater efficacy in treating
infertility than any Western ART procedures to date. It costs less
and has no harmful side effects and contributes to overall health
of the couple as well as the precious offspring.
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