Case Study: IUI Success After 7 Years. Diagnosis: Endometriosis and Low Progesterone

IUI and acupuncture success after 7 years of infertility!
IUI and acupuncture success after 7 years of infertility!

A 33 year old woman came to our office after experiencing infertility for 7 years. She had a history of endometriosis and low progesterone. Her husband had a history of low motility. She had never been pregnant and was feeling very frustrated.

Her previous fertility treatment included multiple medicated cycles using both clomid and letrozole and two previous IUI cycles. She had undergone two laparoscopies to treat endometriosis. She began fertility treatment in another state before moving to Tennessee, where she began seeing Dr. Doody in Knoxville.

She came to the Tennessee Center for Reproductive Acupuncture for her third IUI cycle. She took 150mg of clomid to stimulate follicle development in preparation for the IUI. You can read more about our general treatment recommendations here.

We saw her a total of three times during her IUI cycle.

The first treatment was done on cycle day 6 to support follicle growth and reduce the side effects from the clomid. Supporting the first phase of the cycle and making it as healthy as possible sets up the rest of the cycle for optimal fertility and can help treat luteal phase defect.

The second treatment of the cycle was done the morning of the IUI itself. This treatment helped to facilitate ovulation. Acupuncture has been shown to be an effective means of ovulation induction and we like to use it along with the trigger shot.

The points used for the first and second treatments followed a modified Stener-Victorin protocol. This protocol has been specifically shown to increase blood flow to the uterus and is used successfully to improve IVF cycle success and regulate hormones.

The third treatment of the cycle was done 6 days following the IUI to support implantation, reduce uterine contractions, ease stress and support healthy progesterone levels. The points used for this treatment followed a modified Paulus protocol. The Paulus protocol is commonly used before and after embryo transfer during an IVF cycle and has been shown to improve pregnancy rates.

She received a positive pregnancy test about a week later. Her HCG levels rose an appropriate amount between her tests. The pregnancy was confirmed by ultrasound, and has been going well for mom and baby.

We are very excited for her success and hope the rest of her pregnancy goes well!

If you’d like to add acupuncture to your upcoming IUI cycle, call or contact us and we will find a protocol that is best for your cycle! 865-315-3845

My Visit with Dr. Donesky and The Fertility Center: Knoxville, TN

Last week, I had the opportunity to share how fertility acupuncture can benefit those undergoing IUI and IVF with Dr. Donesky and the staff at the Fertility Center. The Fertility Center has offices in Knoxville and Chattanooga.

First off, Knoxville is so lucky to have Dr. Donesky and crew. They truly love their work, and it shows. Although, I have to say that all of the clinics, doctors, and staff in Knoxville that I have met with are really wonderful. We are a very fortunate community!

At my presentation, I explained how acupuncture can be utilized as a complement to any fertility cycle. We went over our IUI and IVF protocols and I presented some of the research that our protocols are based off of.

My main job as an acupuncturist to someone going through fertility treatment is to support the doctors’ efforts. When done in combination with IVF/IUI, acupuncture can improve pregnancy (and live birth rates), reduce miscarriages, reduce side effects of medications, and lessen the feelings of stress. The protocols are all based on each patient’s cycle timing and unique situation.

We talked about acupuncture’s safety during pregnancy and it’s usefulness during the first trimester for morning sickness and even, possibly, miscarriage prevention.

It was a really fun meeting and I am looking forward to working more closely with them and the other clinics here in town. I am grateful to them for having me!

It is my hope that more cycles will be done using acupuncture as a complementary therapy!

If you are struggling with infertility, please consider getting a work up from a reproductive endocrinologist. Having answers will help you make an educated decision on your best path towards parenthood.

Preventing Miscarriage with Acupuncture

Acupuncture can be helpful in preventing miscarriage from certain causes.
Acupuncture can be helpful in preventing miscarriage from certain causes.

Finally seeing those two lines on a pregnancy test is a long-awaited, and rightfully celebrated, moment for all of my patients! This joy can quickly become sadness if the pregnancy is not viable. Miscarriage is a very common occurrence with 10-25% of all pregnancies ending in miscarriage. The most common cause of miscarriage is genetic abnormalities that cause the embryo to be non-viable. Other causes of miscarriage can include:

  • Hormonal abnormalities: PCOS, low progesterone, diabetes, etc
  • Lifestyle issues: smoking, excessive alcohol use, excessive caffeine, drug use,exposure to toxic substances, etc
  • Maternal age: the prevalence of genetic abnormalities increase with age
  • Thin or low quality endometrial lining
  • Immune system issues
  • Trauma: generally only very severe trauma leads to miscarriage
  • Structural abnormalities in the uterus: adhesions, polyps, septum, etc
  • Blood clotting: anti-phospholipid syndrome

For less than 1% women, miscarriages can become recurrent. This is typically diagnosed after having 3 miscarriages. A thorough workup is done to try and find out the cause and determine what treatment is appropriate. Fortunately, many causes of recurrent miscarriage are treatable. Even in the case of genetic abnormalities, like chromosome translocation, preimplantation genetic diagnosis (PGD) can be utilized in combination with IVF to help decrease the chance of miscarriage.

 

What can I do to prevent miscarriage?

There is a lot you can do on your own to help prevent miscarriage. Much of this work involves managing chronic illness or hormonal imbalances and modifying complicating lifestyle factors. For example:

  • Quit smoking as soon as possible in your conception journey
  • Limit coffee and tea to 1-2 cups daily
  • Maintain a healthy BMI
  • Seek the help of your physician in managing diabetes, PCOS, or other health problems
  • Eat a healthy whole-foods diet high in fruits, veggies, and protein and low in sugar and processed foods
  • Limit exposure to toxic chemicals or environments
  • Avoid dangerous situations or activities where severe trauma may occur 

 

How Can Acupuncture Help?

Acupuncture can be a very useful for assisting in the prevention of miscarriage when not related to chromosomal abnormalities by treating many of the common causes of miscarriage. Acupuncture can be helpful in the following ways:

  • Increasing the thickness and quality of the endometrial lining
  • Helping regulate hormones
  • Helping to treat PCOS 
  • Reducing uterine contractions in early pregnancy
  • Improving uterine blood flow to help prevent blood clots
  • Regulating the immune system
  • Stress reduction

What does the research say?

Research on acupuncture and miscarriage is very promising. One recent study on acupuncture done along with IVF showed a 50% decrease in the miscarriage rate.

Another study suggests acupuncture may even be a potential supportive treatment for threatened or recurrent miscarriages due to its beneficial effects on serum cortisol and prolactin levels during IVF.

Acupuncture’s known effects on stress are also a possible mechanism by which miscarriage rates could be reduced. According this same study, it is possible that stress in very early pregnancy may cause overactivity of the hypothalamus-pituitary-ovarian axis leading to reduced progesterone levels. In reducing this stress, progesterone levels may stay higher.

 

When should I start acupuncture?

Acupuncture can be started at any point along your journey. Some basic recommendations are here:

  • If you are pregnant: We recommend acupuncture weekly through the first trimester to support blood flow to the uterus, reduce stress, and support progesterone levels before the placenta is fully developed.
  • If you are trying to conceive: Generally, it is recommended to begin acupuncture 3 months prior to conception for most causes of recurrent miscarriage. This allows the treatments to affect overall cycle health, hormone balance, and egg quality as it takes 90 days for an egg to prepare for ovulation. However, the effects of acupuncture are beneficial at any stage of your journey, and accumulate over time. We see many women while they are actively trying to conceive naturally or with fertility treatment. We have protocols for IVF, IUI, medicated cycles and couples trying naturally.

 

Please give our office a call to discuss your specific situation or to schedule an appointment. We are more than happy to answer any questions you may have. We wish you the best of luck!!

 

 

References:

http://www.huffingtonpost.co.uk/jacquelinehurst/acupuncture-to-support-fe_b_5958722.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342918/

http://americanpregnancy.org/pregnancy-complications/miscarriage/

http://www.acog.org/~/media/For%20Patients/faq100.pdf

http://natural-fertility-info.com/increase-egg-health

http://eastwindsacupuncture.com/acupuncture-in-ivf-linked-to-lower-miscarriage-and-ectopic-rates/

 

Pre-Birth Acupuncture: Helping Prepare Your Body for The Best Birth Possible

Here's a quick guide to Pre-Birth Acupuncture
Here’s a quick guide to Pre-Birth Acupuncture

If you’re nearing the end of your pregnancy, you’ve undoubtedly spent many hours day-dreaming about the upcoming birth of your baby. The last few weeks of pregnancy are a really exciting time! You may have even written a birth plan and discussed your wishes with your doctor or midwife. Many of you will desire to have a vaginal delivery or may even be trying to avoid using any medications during labor and trying to do everything you can to help ensure your birth goes according to plan.

In addition to keeping healthy and active during your pregnancy, there is one more thing you can do in the final weeks of your pregnancy to help encourage a healthy delivery. Pre-Birth acupuncture is helpful in preparing your body and mind for labor and delivery.

 

What is pre-birth acupuncture?

Pre-Birth Acupuncture is a series of 4-5 weekly treatments beginning at week 36 of your pregnancy that are designed to help your body go into labor on time and to labor to progress normally and without complication once it begins. It is not labor induction and will not bring on labor. The baby is in control of his or her arrival date.

Pre-birth acupuncture reduces the need for epidurals, emergency C-sections, and reduces the time you spend in active labor. Overall, vaginal birth rates increase in women who receive these treatments.

 

What does the research show:

  1. Reduces the time spent in the first stage labor (period of time between 3 cm dilated and full dilation) by an average of 2 hours
  2. Reduces the number of inductions in frist time moms by 43% and 35% in all others
  3. Reduces rate of epidural usage by 31%
  4. Reduces emergency C-section rate by 32%
  5. Increases vaginal birth rates by 9%

 

In addition to these benefits, this is a great time to address any stress or symptoms that you might be experiencing in the last few weeks. Acupuncture can be useful for swelling, back/hip pain, acid reflux, headaches, and many other common pregnancy symptoms. We can even use acupuncture to encourage breech babies to turn!

We recommend these treatments as a standard part of our prenatal acupuncture protocol, and many women choose to start prenatal acupuncture in these final weeks to help make their birth plans a reality.

Give us a call with questions or to set up your pre-birth treatments today!

 

References:

https://acupuncture.rhizome.net.nz/acupuncture/research/prebirth/

How We Treat Male Factor Infertility

Acupuncture treatment is helpful in treating many causes of male infertility.
Acupuncture treatment is helpful in treating many causes of male infertility.

Infertility is often seen as something only women have to be concerned about. The reality is that infertility is due to female factors 30% of the time, male factors 30% of the time, and both partners or unexplained infertility 30% of the time.

Male infertility can even go undiagnosed by some practitioners not experienced in treating fertility. A semen analysis should be part of your initial workup with your reproductive endocrinologist. It is a non-invasive, low cost test that can really have an impact on your best course of action.

 

Common causes of male factor infertility include:

  • Varicocele
  • Infection
  • Hormonal Problems
  • Oxidative Stress
  • Blockage of sperm flow
  • DNA Fragmentation
  • Previous vasectomy

 

Many times, varicoceles or blockages can be corrected with surgery. Follow up semen analysis will ensure that fertility has been restored. Other causes can be treated with medication or lifestyle changes. Sperm can sometimes even be removed from the testical directly to be used in an IVF cycle in a minor surgical procedure if needed.

 

Optimizing male fertility is an often overlooked part of a couple’s journey and, yet, there is so much you can do. Various lifestyle changes, complementary medicine, and supplements can have a big impact on male fertility.

 

ACUPUNCTURE AND MALE FACTOR INFERTILITY

Acupuncture has been used successfully to help treat male infertility. Research studies showed both an increase in the total number of sperm present and an increase in the number of sperm present without structural abnormalities. Acupuncture can also be used to help regulate hormonal imbalances.

At the Tennessee Center for Reproductive Acupuncture, we would like to treat both the male and female partners to help them optimize their fertility. Our recommendations for male factor fertility depend on the timing of the cycle. Sperm go through a 3 month growth and maturation process before they are ready to fertilize and egg. Because of this we like to see men 3 months before their fertility cycle, if possible. However, benefit has been seen from much shorter treatment windows and you can start treatment at any time during your journey. Feel free to call us for a recommendation on your situation.

 

SUPPLEMENTS TO TREAT MALE FACTOR INFERTILITY

We carry Conception XR supplements for male fertility. There are two versions of this supplement, detailed below. Their primary ingredients are antioxidants and other nutrients shown to increase pregnancy and birth rates and improve sperm motility.

  • Reproductive Health Formula: This formula is designed to support normal male fertility and is recommended for any man trying to conceive. You can think of it as a prenatal vitamin for men! It is also recommended for IVF cycles, when motility support is not necessary.

XR3_300w_300h_sb

  • Motility Support: This formula has an added ingredient, L-carnitine, that is specifically helpful with sperm motility. It is recommended for low motility or when trying to conceive naturally or through IUI or medicated cycles.

XM1_300w_300h_sb

LIFESTYLE CHANGES TO SUPPORT MALE FERTILITY

  1. Smoking has been shown to be very detrimental to sperm health. Please see your doctor about quitting.
  2. Alcohol: Limit to 1 drink per day.
  3. Keep your testicles cool: Avoid hot tubs, laptops on your lap, high temperature work areas, or prolonged baths.
  4. Diet: Increase your fruit and veggie intake and stay hydrated.
  5. Exercise: Aim for 30 minutes of moderate exercise per day.
  6. Harmful supplements: Some supplements containing DHEA or other ingredients, often used for muscle building, can impair sperm development.
  7. Environmental Hazards: Avoid working with radiation, pesticides, solvents, or other fumes when possible.

 

Sources:

http://www.theralogix.com/sp/theralogix-conceptionxr-motility-support/

http://www.theralogix.com/sp/theralogix-conceptionxr-reproductive-health/

http://www.webmd.com/infertility-and-reproduction/news/20050803/acupuncture-may-improve-sperm-quality

http://www.resolve.org/about-infertility/optimizing-fertility/enhancing-male-fertility.html

Treating PCOS with Acupuncture, Inositol, and Diet

Polycystic Ovarian Syndrome (PCOS) is a common diagnosis that affects approximately 7 million women, although it is thought that less than half of all cases are properly diagnosed. Many women with PCOS will experience some degree of difficulty in getting pregnant and many will use fertility treatments to conceive.

 

Symptoms associated with PCOS are:

  • Irregular periods or having very long cycles
  • Weight gain (or having a hard time losing weight)
  • Unusual hair loss
  • Hair growth on face or body (hirsutism)
  • Acne
  • Dark Patches of Skin
  • Anovulation (not ovulating)

 

PCOS is a complex diagnosis and women will not necessarily have all of the above symptoms. Insulin resistance is a common factor in the disease and can lead to the development of type-2 diabetes. Other factors include the presence of multiple ovarian cysts, high testosterone levels, high blood pressure, high cholesterol and high triglycerides. A combination of these factors leads to reduced egg quality, irregular cycles, and infertility.

As you can see, the early detection and treatment of PCOS is extremely important! Luckily, PCOS is generally a treatable condition and responds well to many different types of treatment including fertility treatments. Many, many women with PCOS will go on to have healthy babies.

 

TREATING PCOS:

ACUPUNCTURE: Treatment with acupuncture has been shown to promote ovulation and, over time, regulate FSH/LH levels back to normal. In one study, a single acupuncture treatment was shown to work as well as an injection of HCG in inducing ovulation. Studies on longer courses of acupuncture treatment have shown a normalization of hormone levels, cycle length, and ovulation. These results could still be seen 3 months after finishing acupuncture treatment. In our clinic, we have seen great results in treating PCOS both for women trying naturally or using some form of fertility treatment.

 

SUPPLEMENTS: Supplementation with inositol has been shown to promote menstrual regularity and normal ovarian function in women. Additionally, it will reduce insulin resistance, and improve hormone levels. Inositol is a nutrient found in fruits, beans, grains, and nuts. It is also produced by the body. There are a couple of different types of inositol commonly available: D-chiro inositol and myo-inositol. Recent research has shown the greatest benefit from supplements containing a 40:1 of myo to D-chiro inositol. We recommend a supplement with this ratio called Ovasitol by Theralogix for our PCOS patients. It is recommended to take this for at least three consecutive months to see an improvement in hormone levels and menstrual cycles. And continued use will ensure these results continue.

Ovasitol can help improve fertility in women with PCOS.
Ovasitol can help improve fertility in women with PCOS.

LIFESTYLE/DIET: For many women, diet and lifestyle changes are enough to promote regular cycles. Regular exercise combined with a low-glycemic index diet can help to reduce insulin resistance and regulate the menstrual cycle. Working to maintain a healthy BMI is also helpful with studies showing an improvement of insulin and testosterone levels with just a 5% reduction in body weight. Some women can eliminate any signs of PCOS by working to improve their diet and lifestyle.

A quick guide to low glycemic index diets
A quick guide to low glycemic index diets

So, as you can see, PCOS, while a very frustrating diagnosis, is usually very treatable with very good outcomes using integrative care. Most of our PCOS patients go on to have healthy, pregnancies and healthy babies.

 

Please call us with any questions. We are very happy to help!

Sources:

http://www.acam.org/blogpost/1092863/185770/Acupuncture-for-Ovulation-Disorders-and-PCOS

http://www.advancedfertility.com/pcos.htm

http://www.theralogix.com/sp/theralogix-ovasitol/

TCM Style Acupuncture Performed Before and After Embryo Transfer Improves Pregnancy Rates: A Retrospective Study

 

Acupuncture done before and after embryo transfer increases pregnancy rates up to 57%.
Acupuncture done before and after embryo transfer increases pregnancy rates up to 57%.

 

Below you will find a research study written by our acupuncturist, Sarah Prater (under her maiden name, Fredrickson) for the journal American Acupuncturist. This was published in the Winter 2014 edition.

 

By Sarah .J. Fredrickson, MSOM, Dipl OM (NCCAOM), LAc; David B. Youran, Dipl Ac (NCCAOM), LAc; Glen K. Adaniya, PhD; Bradford L. Bopp, MD; Robert M. Colver, MD; Laura M. Reuter, MD

Abstract

Background
Conflicting evidence exists on whether acupuncture is beneficial for patients undergoing in vitro fertilization (IVF) cycles. This retrospective cohort study was undertaken to determine whether a unique protocol of a combined Chinese and Japanese style on-site acupuncture, performed both before and after embryo transfer, affects clinical outcomes.

Design and Setting
Forty-nine patients received a previously untested acupuncture protocol on-site before and after embryo transfer at Midwest Fertility Specialists, Indianapolis, Indiana, in 2007. The acupuncture treatment was performed 45 minutes before and 15 minutes after embryo transfer. The control group consisted of 212 patients who did not receive acupuncture and who underwent IVF cycles in the same time period. All cycles were fresh, non-donor successful embryo transfers. The clinical pregnancy rate (CPR) was defined as the presence of fetal cardiac activity. Data were analyzed using the unpaired t-test and Fisher’s exact test, with significance defined as P < 0.05.

Results and Conclusion

It was found that patients with a positive hCG were slightly higher in the acupuncture group than in the control group (57.1% vs.45.8%, p = 0.16). The acupuncture group also had a higher CPR (55.1% vs. 34.4%, p = 0.01). The miscarriage rate was lower for the acupuncture group compared to the control group (3.6% vs. 22.7%, p= 0.02). These results support the use of acupuncture in conjunction with IVF.

Keywords: TCM, acupuncture, infertility, IVF, embryo transfer
Introduction

Infertility affects roughly 1.5 million women in the United States..1 Many of these women will seek out various fertility treatments, and, of these, in-vitro fertilization is becoming more and more common, with 154,412 IVF “cycles” performed in 2011 versus 112,988 in 2003.2 IVF involves the retrieval and subsequent fertilization of a woman’s eggs,  produced by stimulating the ovaries with medications. The resulting embryos are grown in a laboratory setting and then transferred back into the uterus; this whole process takes approximately two weeks.3 Because of the significant cost, time commitment, and emotional impacts required for each cycle, there is great incentive to improve pregnancy and live birth rates. These rates have improved greatly from 14% of all IVF cycles resulting in a live birth in 1989 to 35% in 2008.4 Despite these profound advances, clinics are still searching for ways to improve this live birth rate.

The use of acupuncture has been regarded as a possible treatment to benefit IVF success rates. It has had obstetric and gynecological usage in China for many centuries. Following the 2002 Paulus study that reported increased pregnancy rates in patients receiving acupuncture before and after embryo transfer,5 many groups examined the impact of varied styles of acupuncture on pregnancy rates before and after embryo transfer. Modern research on this topic has shown mixed results. Some researchers found that groups that had sham or placebo acupuncture had higher pregnancy rates than the true acupuncture groups, although the difference between the two groups was not statistically significant.6,7,8

Complications in varied treatment styles and the effective sham and placebo treatments in acupuncture infertility discussed literature studies are visible in recent searches. This research questions the necessity of using sham or placebo acupuncture when examining the role acupuncture can play in pregnancy rates following IVF. This is due to the objective nature of a pregnancy test and the possibility of an acupuncture-induced stress reduction as the mechanism by which pregnancy rates are increased and thus considered as a therapeutic effect.9 Other research and meta-analysis shows inconclusive results that, during an IVF cycle, acupuncture can improve pregnancy rates. At this time there is not enough evidence to recommend it clinically for all patients.12,13,14

Nevertheless, experts in acupuncture and infertility continue to support more studies on the use of acupuncture before and after embryo transfer to improve pregnancy rates.10 Possible mechanisms of action might be the increased blood flow to the uterus, stimulation of the release of endogenous opioids, and the mediation of neurotransmitter release affecting gonadatropin-releasing hormone and its effect on the menstrual cycle10 or the regulation of cortisol and prolactin during the medication phase of the IVF treatment.11

The purpose of this review of individual cases was to examine the influence of acupuncture before and after embryo transfer on pregnancy rates in patients undergoing IVF. The objective was to determine if acupuncture treatment given before and after embryo transfer (ET) would improve pregnancy rates.

Methods

A retrospective review of charts was done at an Indianapolis fertility clinic on 261 patients who received IVF in 2007. Charts were chosen based on the successful completion of a fresh, non-donor embryo transfer in 2007 with or without acupuncture. No exclusions were made in the acupuncture group, but some statistical outliers within the control group were eliminated to ensure the groups were statistically similar in oocytes per patient, embryo cell count, and embryo fragmentation score. No exclusions were made specifically regarding diagnosis, age, or other factors.

Forty-nine patients received acupuncture by a single board certified licensed acupuncturist on-site before and after embryo transfer. The treatments were given in the same location as the ET to reduce traveling induced stress, which seems to improve results in other studies.12 The 212 patients who did not receive acupuncture served as the control group for this analysis. The charts in both the acupuncture and no acupuncture groups were reviewed retrospectively for beta pregnancy and clinical pregnancy by D.Y and G.A.

Controlled ovarian hyperstimulation was achieved by use of a standard gonadotropin releasing hormone agonist and recombinant follicle stimulating hormone (rFSH) protocol with the dosage varying for each patient. Antral follicle count and E2 levels were not collected for this study. Following human chorionic gonadotropin administration and oocyte retrieval after 36 hours; oocytes were inseminated 2 to 4 hours later by either standard insemination or by intracytoplasmic sperm injection (ICSI). Embryos were scored using standard morphological criteria on the morning of the Day 3 embryo transfer (ET). Embryos were assigned a fragmentation score of 4 if there was no fragmentation, a 3 if less than 10% of the embryo exhibited fragmentation, a 2 if between 10% and 50% of the embryo was fragmented, and a 1 if the embryo had greater than 50% fragmentation.

Acupuncture points were selected according to a combination of traditional Chinese and Japanese acupuncture for the treatment of infertility and through consensus of 4 experts in the field. The points were chosen to harmonize the Kidney and Spleen qi according to Japanese and Chinese theories. Acupuncture treatment was performed 45 minutes before embryo transfer and 15 minutes after embryo transfer. Acupuncture points used before the embryo transfer were Qihai CV-6, Guanyuan CV-4, Sanyinjiao SP-6, Taixi KI-3, Zhongfeng LR-4, Zusanli ST-36 and Yanglingquan GB-34. Acupuncture points used after the embryo transfer were Yinlingquan SP-9, Taichong LR-3, Taixi KI-3, Zusanli ST-36, and Yanglingquan GB-34. All points were needled bilaterally without the elicitation of the de qi sensation and the needle depth varied form 0.25 cun to 0.50 cun.. Needles were retained for 35 minutes. Seirin 0.20 x 30 mm acupuncture needles were used.
The beta pregnancy rate was the percentage of patients who had an initial hCG level, drawn 12 days after the embryo transfer, of 10 mIU/ml or greater. The clinical pregnancy rate (CPR) was defined as the percentage of patients with fetal cardiac activity. The miscarriage rate was the percentage of patients that had a positive hCG level but that failed to develop a fetal heart rate. Data was analyzed using the unpaired t-test and Fisher’s exact test, with significance defined as P < 0.05. The results are expressed as mean standard deviation or percentages as appropriate.

Results

The number of oocytes, cell number, fragmentation score, number of embryos frozen and number of embryos transferred in both groups was equivalent. Positive hCG was slightly higher in the acupuncture group versus the control group (57.1% vs. 45.8%). The clinical pregnancy rate for the patients receiving acupuncture was significantly higher than the control group (55.1% vs. 34.4%). In addition, the loss rate was significantly lower in the acupuncture group (3.6% vs. 22.7%). ( Insert Table 1/ and Graph)

All fresh, non-donor IVF cycles that ended in successful embryo transfer were included in the study. No exclusions were made in the acupuncture group, but some statistical outliers within the control group were eliminated to ensure the groups were statistically similar in oocytes per patient, embryo cell count, and embryo fragmentation score. No exclusions were made specifically regarding diagnosis, age, or other factors.
There were no adverse events related to the acupuncture treatment reported.
Discussion

Although other studies regarding acupuncture and IVF are inconclusive, perhaps the positive results in this study relate to several important factors .12,13,14 Acupuncture attempts to stimulate the body’s own reproductive potential, which may help to explain the positive results of this study. In addition, the treatments were performed on-site, eliminating the stress of traveling to another site before and after the embryo transfer.

Because the patients in this study received acupuncture immediately before and after ET, this could also explain the positive results. Studies showing treatment immediately before and after treatment at the same site had higher pregnancy rates in the acupuncture group compared with studies that did not specify time of acupuncture.12,13 The higher clinical pregnancy rate and lower miscarriage rate in the acupuncture group may be due to increased blood flow to the uterus.10

The unique combination of the Chinese and Japanese styles of the acupuncture treatment protocol in this study suggests there is still more research needed on the best protocols to treat infertility issues with acupuncture. This study was limited by its chart review nature and would benefit from having been a randomized controlled trial. The small number of patients in the acupuncture group as compared to the control group reflects that.

Also, considering that patients themselves elected to join either the acupuncture or control group, it is possible that the acupuncture patients had a healthier lifestyle, or some other confounding factor, which could have impacted results. There was no way to account for these factors during the chart analysis as charts were chosen only based upon the patients’ completion of a fresh, non-donor IVF cycle in 2007. Additionally, there was no way to determine if anyone in the control group received acupuncture from another practitioner on the day of ET, which may have affected the results. Due to these limitations, this analysis suggests there is still more research to be done on how best to treat infertility issues with acupuncture.

Conclusion

The results of this study point to the possibility that acupuncture is safe and may increase both clinical pregnancy rates and beta pregnancy rates in women undergoing IVF ET. In addition, this study showed a decrease in the loss rate among women in the acupuncture group. In comparison with the inconclusive results found in the literature, this study had a few key differences, including acupuncture performed on-site, acupuncture being performed immediately before and after ET, and the usage of a unique Chinese- and Japanese-derived type protocol.

A blinded, randomized study containing a larger number of  patients is necessary to determine if these results are clinically useful. Additionally, more research should be done to identify the key factor (or factors) within the methods of this study that led to the positive results.

References

1. Centers for Disease Control and Prevention [Internet]. Atlanta: CDC; c2013 [cited 2013 June] FastStats. Available from: http://www.cdc.gov/nchs/fastats/fertile.htm

2. Society for Assisted Reproductive Technology [Internet]. Birmingham (AL): SART; c1996-2013 [cited 2013 June] Available from: https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0

3. Society for Assisted Reproductive Technology [Internet]. Birmingham (AL): SART; c1996-2013 [cited 2013 June] Available from: http://www.sart.org/detail.aspx?id=1903

4. Society for Assisted Reproductive Technology [Internet]. Birmingham (AL): SART; c1996-2013 [cited 2013 June] Available from: http://www.sart.org/SART_Success_Rates/

http://www.sart.org/SART_Success_Rates/

5. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility &  Sterility. 2002 Apr; 77(4): 721-4.

6. Moy I, Milad MP, Barnes R, Confino E, Kazer RR, Zhang X. Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization. Fertility & Sterility. 2011 Feb; 95(2): 583-7.

7. Andersen D, Lossl K, Nyboe Andersen A, Furbringer J, Bach H, Simonsen J, Larsen EC. Acupuncture on the day of embryo transfer: A randomized controlled trial of 635 patients. Reproductive Biomedicine Online. 2010 Sep; 21(3): 366-72.

8. So EW. Ng EH, Wong YY, Lau EY, Yeung WS, Ho PC. A randomized double blind comparison of real and placebo acupuncture in IVF treatment. Human Reproduction. 2009 Feb; 24(2): 341-8.
9. Manheimer E. Selecting a control for in vitro fertilization and acupuncture randomized controlled trials (RCTs): How sham controls may unnecessarily complicate the RCT evidence base. Fertility & Sterility. 2011 Jun 30; 95(8): 2456-61.

 

10. Stener-Victorin E, Humaidan P. Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med. 2006 Dec; 24(4):157-63.
11. Magarelli PC, Cridennda DK. Cohen M. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization-embryo transfer treatment. Fertility & Sterility. 2009 Dec; 92(6):1870-9.
12. Manheimer E, Zhang G, Udoff L, Haramati A, Langerberg P, Berman BM, Bouter LM. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilization: systemic review and meta-analysis. BMJ. 2008;336:545.

13. El-Toukhy T, Sunkara S, Khairy M, Dyer R, Khalaf Y, Coomarasamy A. A systematic review and meta-analysis of acupuncture in in vitro fertilisation. BJOG: An International Journal of Obstetrics & Gynaecology. 115: 1203–1213. doi: 10.1111/j.1471-0528.2008.01838.x 2008.

14. Cheong Y, Nardo LG, Rutherford T, Ledger W. Acupuncture and herbal medicine in in vitro fertilization: a review of the evidence for clinical practice. Human Fertility. 2010 March; 13(1): 3-12.

Bios

Sarah J. Fredrickson, MSOM, Dipl OM (NCCAOM), LAc, completed a BS in biology at Indiana University in 2005 and completed her Master’s Degree in Acupuncture at Southwest Acupuncture College in Santa Fe, New Mexico, in 2008. She is currently in practice at Indiana Reproductive Acupuncture. Her clinical interests include infertility, prenatal care, and other women’s health issues.

David B. Youran, Dipl AC (NCCAOM), LAc, is the director and founder of Indiana Reproductive Acupuncture. He studied acupuncture and Oriental medicine during a four year apprenticeship program taught by Dr. Thomas Duckworth at the Inochi Institute in St. Louis, Missouri. He is the first acupuncturist in Indiana to specialize solely in treating infertility and pregnancy wellness issues.

Glen Adaniya, PhD, graduated from Northwestern University and earned his MS and PhD in Biomedical Engineering at the University of Illinois in Chicago.

Bradford Bopp, MD, graduated from The Ohio State University, attended medical school at the University of Southern California, completed his residency in obstetrics and gynecology and his fellowship in reproductive endocrinology at Harvard University.

Robert Colver, MD, graduated from Indiana University, obtained his medical degree from the Indiana University School of Medicine, completed his residency in obstetrics and gynecology at St. Vincent Hospital in Indianapolis, and served a fellowship in reproductive endocrinology and infertility at the Medical College of Georgia.

Laura Reuter, MD, graduated from Cornell University, earned her medical degree at the University of Illinois, completed her residency in obstetrics and gynecology at Wayne State University, and completed a fellowship in reproductive endocrinology at the University of Illinois.

Adding Acupuncture to an IUI Cycle: Our Integrative Approach

Acupuncture treatment during an IUI cycle can improve your chances of pregnancy!
Acupuncture treatment during an IUI cycle can improve your chances of pregnancy!

 

For families navigating the world of assisted reproduction, many will find themselves considering an IUI cycle to get pregnant. IUI, or intrauterine insemination, involves a combination of hormones to stimulate a woman’s ovaries and the insertion of prepared sperm directly into the uterus during ovulation to increase chances of conception.

 

The rates of success of this treatment vary, but hovers, on average, around 10-20% per cycle for most women. Most couples will do 2-4 IUI cycles before additional treatment or IVF is recommended, though there may be reasons to consider an increase or decrease in the number of cycles attempted based on your specific diagnosis or situation.

 

If you’re like most facing an IUI cycle, you want to know what you can do to help increase your chances of success. Acupuncture treatment during an IUI cycle can help to optimize your body for conception and increase chances of pregnancy. While most of the fertility-acupuncture research is done on IVF, similar principles will apply. Acupuncture works by improving blood flow to the uterus and ovaries, regulating hormones, and helping reduce stress. All of these things together help to increase your chances of a take-home-baby.

 

RESEARCH: There are only a few research studies examining IUI and acupuncture specifically. One notable study out of Israel showed that women who did a combination of acupuncture and herbs with their IUI cycle had a pregnancy rate of 65.5% vs 39.4% who did the IUI alone, and live birth rates were 41.1% in the acupuncture group vs 26.9% in the IUI alone group. This is incredible news!

 

TNCRA PROTOCOL: Our protocols are based off the latest research and timed according to your cycle. You can begin treatment at any point during the cycle, but we like to start treatment 1-3 months prior to the IUI when possible to help improve the quality of the eggs and help bring your body into balance to optimize conditions for conception. We also like to work with men 1-3 months prior to the cycle to help improve sperm quality. We typically do not recommend herbs while you are taking any hormones, as the effects in combination with medications are largely unknown, though they may be used in the months or weeks leading up to the cycle. 

 

We will see you about three times during the IUI cycle itself. Each treatment, and it’s timing, is detailed below. The timing of the treatments is important, so we will stay in close communication with you during your cycle to make any needed changes.

 

First Treatment: Around cycle day 5-9

-improve blood flow to uterus and ovaries

-reduce stress

-decrease side effects of medications -increase egg quality and quantity

 

Second Treatment: Within 24-36 hours of the IUI procedure

-decrease uterine contractions

-facilitate ovulation

-support progesterone levels

-reduce stress

-increase the thickness and quality of the uterine lining

-improve blood flow to the uterus

 

Third Treatment: 5-7 days after the IUI

-decrease uterine contractions

 -increase implantation rates

 -reduce stress

-support early pregnancy

 

Once you have a positive pregnancy test, (fingers crossed!) we strongly recommend acupuncture to help support early pregnancy and reduce any symptoms such as fatigue and morning sickness. You can read more about prenatal acupuncture here.

As always, we are available to answer your questions and we will work with you and your cycle to create a plan that works best for you. Please call or email, we look forward to working with you! And good luck!!

Pineapple and Implantation: Does it really work?

Can eating pineapple really help you get pregnant?
Can eating pineapple really help you get pregnant?

If you’ve been consulting with Dr. Google, reading fertility blogs, or participating in message boards you’ve undoubtedly heard of using pineapple to support embryo implantation. Maybe you’ve even tried it, after all, what could it hurt and pineapple is delicious!

 

While the research supporting pineapple’s use as an implantation aid is still out, there are a few possible mechanisms by which it might be helpful. It all starts with bromelain. Bromelain is the enzyme in pineapple that is thought to give pineapple its therapeutic effects. Specifically, bromelin:

 

Is an anti-inflammatory agent: Research suggests that bromelain encourages the immune system to move away from an inflammatory state. This could possibly help women with implantation issues caused by inflammation.

 

Acts as a blood-thinner and anti-coagulant: Blood thinners, like aspirin, are commonly recommended to women trying to conceive by their doctors to support blood flow to the uterus. The bromelain in pineapple can have a similar effect. The healthier the blood flow is to the uterus, the higher the chances of conception. Acupuncture treatment also improves blood flow to the uterus.

 

So, if you’d like to try using pineapple to support implantation there are a few guidelines:

  1. Don’t use canned pineapple: the canning process can destroy bromelain
  2. Make sure to eat the core: this is where the highest concentration of bromelain is located.
  3. Use only after ovulation! See guidelines for use below. Eating too much pineapple before ovulating might increase the acidity of your cervical mucus, making it inhospitable for sperm.
  4. Is is not recommended to use pineapple (with core) as a fertility aid while taking any other type of blood thinner (aspirin, lovenox, etc) without discussing with your doctor.
  5. Choose an organic pineapple whenever possible.
  6. Stop eating pineapple (with core) if you find out you are pregnant. Pineapple (without core) as a snack is ok.

 


Using Pineapple to Support Implantation:

First, cut the green top off and remove the outer peel of the pineapple with a knife. Then slice into 6-8 equal wedges (remember to not remove the core!). Eat 1 slice per day for 6-8 days.

 

  • Trying Naturally: Begin eating your wedges the day after ovulation.
  • IUI: Begin eating wedges the day after the IUI procedure.
  • IVF: Begin eating wedges the day of your embryo transfer

 

Hopefully you will soon be one of the many women who swears by the “pineapple trick.” Good luck!

 

 

 

References:

http://www.blossomclinic.net/2013/05/30/pineapple-and-ivf-embryo-implantation-ivf-success/

http://www.ncbi.nlm.nih.gov/pubmed/12107749?dopt=Abstract

http://natural-fertility-info.com/bromelain-pineapple-for-implantation.html

 

The 8 Most Common Fertility Tests and What They Mean

Rodney_Rousseau_first_poz_blood_drawn._July_2013
Decoding the alphabet soup of fertility testing.

It’s no secret that I fully support my patients getting tested by a fertility specialist. There is quite a lot of misinformation regarding fertility specialists. Many think they will be immediately told IVF is the only option. That is just not true. Fertility specialists have a huge toolbox to help with all causes of infertility and usually IVF is not the treatment initially suggested. The first step is getting a diagnosis. Simply being armed with a diagnosis from a specialist can be immensely helpful in deciding how best to proceed. We often see one of the following possibilities:

 

  • Sometimes the results will reveal something like a structural issue that cannot be helped with acupuncture alone.

 

  • Sometimes they will show that ovarian reserve is good and you can relax and continue to try on your own if you’d like.

 

  • Sometimes they do show that starting aggressive fertility treatment is your best option.

 

No matter the results of your testing, information is a very powerful tool and can help give you confidence in your family’s decision on how to proceed.

That being said, the alphabet soup of tests, acronyms, numbers, and data can be overwhelming. We spend a lot of time helping patients understand their results. So here is a list of some of the most common tests performed in a fertility work-up and what they mean.

 

1. AMH: Anti-mullerian hormone is produced in by the cells surrounding the immature follicles in your ovaries. As a woman ages, the number of immature follicles decreases and this level decreases. This test will gives a snapshot of your ovarian reserve and give your doctor an idea of how well you are expected to respond to treatment. It might even help guide which medications are recommended to you or their dosages.

 

2. Day 3 FSH: Follicle Stimulating Hormone is produced by the brain at the beginning of a woman’s menstrual cycle and encourages the development and maturation of an egg. FSH is another way to measure ovarian reserve. FSH levels increase as ovarian reserve decreases. The results of this test are also used to determine appropriate treatment.

 

3. LH: Luteinizing hormone is also produced in the brain. It is responsible for ovulation and surges to a high level right before ovulation each month. High levels of this hormone can be an indicator of PCOS or other causes of infertility.  If you are using ovulation predictor kits, this is the hormone that leads to a positive reading.

 

4. Progesterone Testing: Progesterone is produced in the ovary following ovulation by the corpus luteum. Testing this hormone around cycle day 21 can tell a woman if she’s ovulated that month. It remains high until a menstrual cycle beings and will remain high if pregnancy occurs. Low progesterone levels can be a cause of miscarriage, so it is often tested during early pregnancy as well. Progesterone is often supplemented via oral, vaginal suppository, or injection after ovulation if levels are low or during certain types of fertility treatments.  

 

5. Thyroid Testing: An overactive or underactive thyroid can cause fertility issues. Thyroid issues are also associated with miscarriage and other pregnancy complications. This is a very common test in someone that has fertility issues or experiences recurrent miscarriages. Levels should be between 0.5 to 5 mU/ml. Some doctors will monitor borderline or slightly-abnormal levels and other will choose to treat these cases. If you are having trouble conceiving or carrying to term, you might speak with your doctor about checking thyroid levels.

 

6. Ultrasound: Ultrasound is used to check for any physical problems that might be impacting fertility like polyps, uterine septum, etc.  It can also be used during a cycle to check for maturing follicles and is the method of choice for confirming a healthy pregnancy.

 

7. HSG: HSG or hysterosalpingiogram is a test to check if your fallopian tubes are open. Healthy tubes allow the egg and sperm to meet for conception and travel down into the uterus for implantation. Occasionally, one or both tubes will be damaged by trauma, endometriosis adhesions, scar-tissue, from a previous ectopic pregnancy, or other causes. This test is done after your finished menstruating but before ovulation and is used to determine the best course of treatment.

 

8. Semen analysis: Last but not least: Getting your partner tested during a fertility workup is extremely important. Often this testing is overlooked and inappropriate treatments can be recommended. Make sure you ask for a semen analysis if your doctor doesn’t suggest one. Many issues discovered through this testing can be treated successfully and there are specialized fertility treatments available for male factor infertility. A semen analysis consists of providing a sample (can usually be done at home or in the office) and then having a series of tests run including: semen volume, sperm count, morphology, and motility. Other more extensive testing may be performed or a follow up analysis done to confirm the results.