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.

 

Prenatal Acupuncture: A Happy and Healthy 9 Months

Acupuncture is a safe and effective treatment for many common pregnancy symptoms.
Acupuncture is a safe and effective treatment for many common pregnancy symptoms.

First off, congrats!!! Being pregnant can be one the most exciting times of a woman’s life! It is a time filled with so many emotions, many of which you probably felt within the first few days of finding out about the little one growing inside of you! When you look ahead at the next 9 months, you know you’ll be visiting your OB’s office frequently making sure everything is on track, and you and baby are healthy. You probably also know about the myriad of symptoms that are commonly experienced throughout pregnancy: morning sickness, heartburn, fatigue, swelling… the list goes on.

 

Some of these symptoms, while not necessarily a sign that anything is wrong, can be very bothersome. It’s not like you can just put your life down while you are pregnant! We, at the Tennessee Center for Reproductive Acupuncture, use acupuncture treatment throughout pregnancy to treat and prevent these symptoms as well as help support the health of mom and baby.

 

Acupuncture works with the body to treat common pregnancy symptoms in a way that is safe for you and your developing baby. Additionally, acupuncture works without the use of medications, so you can feel better without worrying about exposing your little one to anything dangerous. As you know, the list of over-the-counter remedies that are off-limits during pregnancy is quite extensive!

 

In addition to managing symptoms, we also see patients for general wellness and stress reduction. There is evidence that chronic stress during pregnancy can lead to lower birth weight, earlier delivery, and may even affect brain development. Many women come in throughout their pregnancies to keep symptoms at bay and help control stress. We generally recommend the following treatment timeline shown below for general pregnancy wellness and to help treat and prevent common symptoms. Of course, adjustments to this protocol are made as symptoms come and go, and we see many women on an as-needed basis.

 

First Trimester: One treatment every 1-2 weeks.

For many, the first trimester is the hardest part of pregnancy. For this reason, we recommend regular, frequent treatments to keep mom feeling her best.  Morning sickness, fatigue, and a general ‘sick’ feeling that many women have are the most common symptoms we see during this time. The first trimester is also the time when the majority of miscarriages occur. Evidence suggests that acupuncture can be used to help treat some causes of miscarriage. We use points at each treatment that can help minimize risk and help support a healthy pregnancy.

 

Second Trimester: One treatment every 4-6 weeks.

Ahh, the second trimester. Most women will agree that this is their favorite part of pregnancy! Around week 10-13, morning sickness and fatigue begin to fade and you feel like yourself again. Your body will start making some big changes, your belly grows to accommodate your growing baby, and your center of gravity begins to shift. The treatments during this time are focused on helping to manage symptoms such as back pain, ligament pain, heartburn, etc. that come with your rapidly changing body.

 

Third Trimester: Treatments every 2-3 weeks from week 30-36

Treatments every 1 week from 36 weeks to delivery

You’ve finally entered the homestretch! While you’re busy preparing the nursery, your baby continues to grow and you’re probably feeling it! Heartburn, ligament pain, back pain, and feet and ankle swelling are some of the most common symptoms we see during this time. In addition to helping you feel more comfortable, we begin working to prepare your body for labor and delivery. We can help to encourage baby to turn head down if they are in a breech presentation. This is best done around weeks 32-34 as baby still has plenty of room to move, though we can still help many babies turn during the later weeks. At week 36 we begin a series of pre-birth acupuncture treatments. These treatments are specifically designed to help your body prepare for labor and delivery. They can reduce time spent in labor, the need for an epidural, and help reduce your chances of an emergency C-section.

Here’s a nice little info-graphic explaining a bit more about pre-birth acupuncture:

PreBirth Acupuncture Info DOuble

Fourth Trimester: as needed

They say that your first 12 weeks with your new baby should really be called the “fourth trimester.” Your baby is busy getting used to the world outside of your body and your body is busy returning to it’s pre-pregnancy state. You’re both getting used to breastfeeding (if you choose to breastfeed) and there can be some hiccups along the way. Acupuncture treatment can be helpful for many common fourth trimester symptoms such as post-natal depression, clogged milk ducts, night sweats, and stress reduction. Generally we see women on an as-needed basis during this time.

 

As you can see, prenatal acupuncture can be a wonderful way to encourage a healthy pregnancy! If you have any questions about your pregnancy and/or acupuncture please call or contact the clinic. We are more than happy to help! I hope you enjoy your pregnancy!

What to Expect During Your First Acupuncture Treatment

Never had acupuncture before? Relax! This article will help relieve your fears.

 

We understand there is a lot mystery surrounding our medicine and the questions or even fears you might have the first time you come into our office. Rest assured, we are here to make you feel safe, comfortable, and help you grow your family!

 

If is our hope that this will help you feel more at ease at your first appointment, but if you have any specific concerns, please feel free to ask!

 

Your initial treatment will last about 1-1/2 hours: At your initial visit we make sure to have plenty of time to discuss your fertility history, goals, general health, and ensure all of your questions are answered. We’ll go over the benefits of acupuncture, what you can expect, and your treatment plan. You will then receive a full treatment session. It’s a good idea to make sure you’ve had something to eat before your appointment. Sometimes a treatment can make you feel momentarily lightheaded and this is more common if you’re hungry.

 

The treatment itself is very relaxing: When we are ready to begin treatment, you will be asked to lay down on a massage table either face up or face down. If we need you to undress to reach points on your back, for example, you will be allowed to change and get under a soft, flannel sheet. We keep our tables heated so you will be nice and warm, but we can turn them down or off if you get too warm.

 

The needles: After you’ve goteen situated on the table, we will swab all the points were going to use with alcohol and begin inserting the needles. Don’t worry, we will tell you when we are about to begin so there are no surprises! The insertion of the needle can feel like a tiny pinch, but many people don’t feel anything at all. Once they are all inserted you shouldn’t feel anything uncomfortable. If you do, tell your practitioner so they can make adjustments for you. Soon you will find yourself in a deep state of relaxation.

 

Length of Treatment: Once all the needles are in, and you are comfortable, you will be left to rest. The needles are left in for about 20-30 minutes and you will be checked on to ensure you remain comfortable. Most people will find themselves in a state of deep relaxation or even fall asleep!

 

Once the treatment is finished, needles will be removed. After you change, we will go over your treatment plan and reschedule you, if needed.

After your treatment you will probably feel very relaxed. You might find that you sleep well that night. If you have any questions after your treatment please call or email the office.

Our IVF Acupuncture Protocol: Improving Pregnancy Rates up to 60%

In_vitro_fertilization
TNCRA’s protocols for combining acupuncture with IVF treatment can significantly increase your chances of pregnancy.

With the development of in-vitro fertilization, many families unable to conceive were suddenly given hope. Over the years, there has been great scientific interest in improving this procedure and success rates have increased greatly and currently hover right around 30% for women under 35.

While this is all great news, most will agree that a success rate of 30% in the youngest population of infertile women leaves a lot of room for improvement. Women going through or preparing for IVF treatment will wonder if there is anything else they can be doing to improve their chances. In addition to maintaining a healthy body weight and lifestyle, acupuncture remains one of the most commonly sought after complementary treatments for women going through IVF. With numerous research studies showing improved pregnancy rates, many doctors and fertility clinics are coming on board with combining their treatments with acupuncture.

In our clinic, over the last two years, we saw a pregnancy rate around 60% for all women who went through an IVF cycle. This number includes all ages and all types of transfers (frozen, fresh, and donor). These results are truly amazing and in line with what many other acupuncturists are seeing in their own clinics.

Just think, if all women going through IVF had acupuncture treatment we would have so many more success stories and the cost savings of not having to do repeated IVF cycles would be tremendous!

We use a protocol inspired by the work of Dr. Magarelli and Diane Cridennda, and other fertility acupuncture research, that involves a series of treatments specifically timed throughout your IVF cycle to help support each phase of your cycle. This protocol has been shown to not only increase your chances of getting pregnant, but improves live birth rates as well! After all, the ultimate goal is a take-home-baby! Additionally, they found a reduction in the number of miscarriages,rates of ectopic pregnancy, and even lower numbers of multiple pregnancies when using this protocol in combination with IVF. The protocol has even been shown to help keep certain hormones at levels consistent with women who get pregnant on their own.

We divided the protocol into 4 phases corresponding with your cycle. The protocol itself begins when you begin your cycle medications, but can be preceded by treatments designed to help prepare your body for your upcoming cycle. 

 

4 Phases of TNCRA’s IVF Acupuncture Protocol: 

  1. Pre-Conception: Optional treatments in the 3 months preceding the cycle to manage stress, regulate hormones, and help your body prepare for the cycle.
  2. Ovarian Stimulation: 2-4 treatments given along side your ovarian stimulation medications to help increase the quality and quantity of your eggs and reduce side effects.
  3. Transfer: A treatment given immediately before and/or after your embryo transfer to increase blood flow to the uterine lining, reduce uterine contractions, and manage stress.
  4. Post-Transfer: One treatment 3-7 days post embryo transfer to support implantation and reduce stress.
  5. Massage: At TNCRA, we recommend getting a massage the week before your pregnancy test to calm the nervous system and help you relax as you await the results of your cycle. Lisa, with Transformations Massage, does our fertility massage and is located right in same office space.

 

Throughout your treatment you can expect to feel more relaxed, get better sleep, and see a reduced number of medication side effects like bloating, mood swings, and cramping. Many of our patients report that the cycles they’ve done without acupuncture are harder than those done with acupuncture. And, hopefully, at the end of it all you will get those long-awaited two pink lines!

We are comfortable working alongside any of Knoxville’s fertility doctors and have even seen patients from doctors in neighboring areas and out-of-state. We work closely with your cycle and will check in frequently to make sure the timing of your treatments is the most beneficial for your cycle. We truly love our work and want nothing more than for you to have the family of your dreams.

Please feel free to contact us by email or phone at 865-315-3845 if you have questions about your own cycle or are interested in scheduling an appointment. Or we have online scheduling available. We are always happy to help….and best of luck with your cycle!!

5 Things Your Fertility Acupuncturist Wants You to Know

New to acupuncture? We really don't care if you haven't shaved your legs.
New to acupuncture? We really don’t care if you haven’t shaved your legs.

Since many of our patients have never had acupuncture before, we put together this somewhat playful list of things to know that might help you be a bit more comfortable at your acupuncture appointment. Enjoy!

 

  1. We don’t care if you’ve shaved your legs (or if you shave them at all): Trust me, the last thing we’re thinking about when we’re looking for a point is how prickly or smooth your legs are. If I had a dime for each apology I’ve received for unshaven legs, I’d be rich! We do palpate to find the location for the needles, and that is the real focus. We’re usually trying to feel for a landmark along a bone or muscle to help us find the correct location for the point.

 

  1. We don’t notice your imperfections: People come in all shapes and sizes. I know we are all self conscious about certain things (hips, thighs, feet, belly….), and for many women weight can be a big issue. It can become an even bigger issue if you experience bloating with fertility treatments, or if you’re pregnant and your body is changing in new and unfamiliar ways. We think you look amazing! We’re here to help you along your journey to motherhood and are not thinking about your size, shape or anything else. However, if your weight might be an issue related to your fertility, we will talk about helping you make changes to get down to a healthy weight.

 

  1. We want to know if you’re afraid of needles: While the needles are painless and the treatment is very relaxing, we like to know if there is an underlying fear. There is a lot we can do to help alleviate fears such as answering your questions, explaining any aspect of the treatment in more detail, helping you breathe through needle insertions, or not mentioning needles at all! Our main goal during the treatment is to help you feel comfortable, so speak up! Trust us, after the first needle is put in, that fear will melt away!

 

  1. Tell us if you are uncomfortable during the treatment: If you’re too hot or too cold, let us know! If a needle feels uncomfortable, let us know! If you’re not sure how you can lay your arm comfortably without bumping a needle, ask and we’ll help you! I’ve even scratched a few itchy noses after needles were put in. (Why do noses always start itching the minute you can’t easily scratch them?) Anyways, in addition to receiving your acupuncture treatment, we want you to relax and enjoy it.

 

  1. It’s ok to share: We understand that infertility and pregnancy are deeply personal and it may be uncomfortable, hard, or even painful to share some of the details of your story. It is ok if you laugh, cry, or just don’t want to talk about something. We listen with open hearts and always have a tissue ready. We ask to better understand your history and to better understand you as a person. We also know things come up during our conversations that are considered “TMI” to many people. There is no such thing as TMI with your acupuncturist, so don’t ever shy away from something you feel is important because of what we might think. More often than not, what you share is incredibly helpful in giving you the best care. We are very used to talking about all things fertility and pregnancy related and want to use that information to help!