Short answer, yes. It is safe and effective to combine acupuncture with any type of fertility treatment including medicated cycles, IUI, IVF, FET, donor IVF, etc. We have worked closely with all of the Knoxville fertility doctors and clinics and even clinics from out of state and have the experience needed to support you throughout whatever cycle your doctor is recommending.
Long answer, there are quite a few reasons why you might consider combining acupuncture with any type of fertility treatment cycle.
1. Increase your chances of success: Acupuncture has been shown in many research studies to increase chances of ovulation, conception, clinical pregnancy, and live birth when combined with fertility treatment.
In IUI cycles, a study showed pregnancy rates for those using acupuncture with their treatment was 65.5% vs 39.9% for those doing just an IUI cycle.
Doing acupuncture only before and after embryo transfer leads to a 42.5% pregnancy rate vs 26.3% in women who did not use acupuncture.
In women doing clomid, femara, injectable or other medicated cycles, one study showed rates of ovulation of 67.8% vs 51.9% and a conception rate of 51.9% for the acupuncture and treatment group, vs 30.4% for the treatment only group.
2. Reduce overall cost of fertility treatment: While there is a cost to receiving acupuncture treatments, adding acupuncture to your fertility treatment plan can reduce the number of cycles needed to achieve pregnancy, thereby significantly reducing costs.
3. Decrease side effects of treatment: Acupuncture is often used symptomatically during a treatment cycle to decrease side effects such as:
Help increase cervical mucous production
Cramping or pain during cycle
4. Support throughout the cycle: We’ve been working with patients going through fertility treatments for a long time and know the how tough the emotional rollercoaster can be. We also know that it isn’t often a topic discussed with friends and family. So we strive to support you and help answer any questions along the way.
5. Acupuncture can be used to support your doctor’s treatment for conditions such as:
6. Decrease Side effects of treatment: Acupuncture is often used symptomatically during a treatment cycle to decrease side effects such as:
Help increase cervical mucous production
Cramping or pain during cycle
When should I begin treatment? In an ideal world, we would see our patients 3 months before the begin any fertility treatment. We refer to this treatment phase as “Preconception.” During these three months, we work to regulate the menstrual cycle, correct any hormone imbalances, and increase blood flow to help your body give the best chance for a good response to treatment.
However, we don’t always live in an ideal world. Often we see our patients at the beginning of their cycle. Of course, we can start treatment at any time throughout your cycle, so it is never too late to receive benefit from acupuncture.
We are always available for questions via phone or email and encourage you to reach out and discuss your situation so we can find an acupuncture treatment plan that is right for you!
As our patients struggling with infertility finally get pregnant, aside from the joy of finally seeing those two lines, there are many decisions that need to be made. What provider is right for my pregnancy? What type of birth do I want?
Many of our patients have never allowed themselves to consider any of these things for fear of ‘putting the cart before the horse,’ so to speak. So this process, while exciting and wonderful, can be overwhelming and stressful.
One thing we often discuss with our patients, as they get closer to delivery, is their birth plan. It is our desire for our patients to be informed about their choices and have a provider they trust and feel totally comfortable with. One thing that can really help during your pregnancy and birth is having a doula. As highly trained, non-medical birth experts, they can walk through your needs, fears, desires, etc and help you come up with a birth plan and guide you and your partner through labor.
I asked a trusted doula friend of mine to do a post for our blog about what role a doula can play and why you would consider working with one. So, without further adieu, here is Hillary Ebling with East Tennessee Doulas.
I am Hillary Ebling, and I am a birth doula and postpartum doula in Knoxville, TN . I work with fellow doula, Danielle Anthony, at East TN Doulas. Working as a doula, we work with expectant families so they may have the best chance of achieving their ideal birth. Our goal is that you feel confident, cared for, and respected during your childbearing year.
As you begin researching how to have a happy, healthy childbirth, you may run across the words “birth doula” and see that this is a person who supports a family during pregnancy and birth. That sounds awesome… but you already spent money on a medical provider, birth location, and higher price tag baby items like a car seat and a crib. You may think a doula is a luxury you should go without. Before your accept this, however, check out these compelling reasons to spend the money on a birth doula.
First, what is the role of a doula?
“Doula” is a Greek word meaning a woman who serves. I’m using a more formal definition of birth doula to refer to a specially trained birth companion (not a friend or loved one) who provides labor support. This labor support includes comfort measures and emotional support. “Comfort measures” means using massage, position changes, water, hot/cold packs, mindfulness, and breathing to help deal with the intensity of labor. “Emotional support” means using reflective listening, positive presence, and reassurance to help increase your confidence and satisfaction of your birth experience.
It is important to notice that doulas play a completely “non-medical” role. Doulas do not diagnose or treat in any modality, nor do we take blood pressure or temperature, fetal heart tone checks, vaginal examinations or postpartum clinical care. What this means as a client, is that you also need a medical provider, whether that is a midwife or a doctor, to attend your birth. In short, your medical providers keep you and your baby safe, provide all medications, deliver the baby, and take care of the mother postpartum, whereas the doula keeps the mother encouraged, comfortable, and confident.
Now that we have clarified the role, what are the benefits of having a doula for my clients?
First, a doula is the only team member entirely focused on the laboring parent’s physical comfort and emotional well-being.
Your medical providers attention is inherently split between two different people – exactly as it should be! We all want a happy, healthy mother and baby at the end of a birth. Their training is scientific and this is where their focus should be. Medical providers are often expected to care for multiple patients at a time and usually work shifts of time in the hospital or on-call period.
A doula’s training, on the other hand, focuses on the “art of labor support,” that is, the emotional needs of people in labor, and non-medical physical and emotional comfort measures (as mentioned in the examples above). Our sole focus is on the needs of the mother, not the baby. Unlike medical providers, doulas work with one client at a time. We will join you when asked, either in early labor or later in active labor. We will stay with you throughout, often with only very brief breaks.
Second, having a doula can help you have shorter, more satisfying birth with less interventions.
Although the exact reasons for this are unclear, there have been numerous studies showing that doulas help families. The largest systematic review of continuous labor support, reported the combined findings from 20+ randomized controlled trials, including over 15,000 women. These trials focused on the benefits of continuous support (having a support person constantly present throughout labor, not coming and going as family and medical providers often must). Women with continuous labor support are
28% less likely to have a cesarean section
31% less likely to use synthetic oxytocin to speed up labor
9% less likely to use any pain medication
34% less likely to rate their childbirth experience negatively
Why can’t a family member or partner fill the same role for free?
Outcomes were most improved and intervention rates were most dramatically lowered in the group with doulas as their support person, not a nurse, friend, or family member.
But do you need one if your partner is really supportive?
In a perfect world, your doula and your partner work together to give you the best birth possible. We cannot possibly replace the loving, intimate relationship of your partner. We don’t stand in the way of your partner being great labor support – we help him or her achieve it!
Our birth culture puts a lot of pressure on partners. A pregnant parent often expects her partner to be knowledgeable – and good – at a host of new things. You may expect your partner to help you emotionally (by providing reassurance, encouragement, and confidence in you) or physically (by encouraging coping mechanisms like breathing and relaxation and providing comfort measures like massage). Lastly, you might expect your partner to fulfill other roles, like updating family and friends of your labor progress. That’s a lot of expectations for one person to handle! For many partners, this may be the first time he or she has ever set foot in a delivery room or seen labor! Add the love your partner feels for you and your discomfort to the equation, and it can be completely overwhelming!
With a birth team of both a partner and a doula, though, we share the weight of these expectations. You will have twice the emotional support and reassurance. We can alternate providing physical support so your partner is less fatigued by the labor. We stay with you if your partner needs a break for food or to update your family. This way, you are never unsupported and your partner can have peace of mind while handling these tasks. We have seen many labors and can use our experience to provide helpful suggestions for new things to try for both you and your partner.
Last but certainly not least, doulas provide informational support to the family.
By “informational support”, I mean explanation and discussion of practices and procedures, and assistance in acquiring any knowledge necessary to make informed decisions about your care. We help you find reputable, evidence-based information that will help you make informed decisions about your birth and your new baby’s care.
In essence, a doula doesn’t tell you how you should give birth. Instead, we share information with you so you can make informed decisions and then support you, whatever your choices.
Ok, so you definitely want a doula, but aren’t doulas expensive?
Often, yes – we are trying both to answer a calling and make a living. Although not usually covered by your insurance, some insurance companies will pay a portion or allow you to pay for your doula out of a health or flexible savings account. Contact your health insurance provider for more information about your specific situation.
DONA International’s Vision is “A doula for every woman who wants one”. With this in mind, many doulas offer some way to cut costs. I offer gift certificates so friends and family can donate to help financially (consider asking for this for baby shower presents!!). We do offer some packages of our services to save a little bit of money when bundling services. I am of course happy to answer any questions you have about my current options email us or give us a call at (865)315-8548.
Bottom Line: With all this information in mind, I urge you to consider carefully the benefits and options to offset the cost before you write off having a doula off as a luxury you can’t afford!
Many of our patients have been told they have poor egg quality or diminished ovarian reserve, or even poor embryo quality and this is the reason why they are having trouble conceiving or carrying a pregnancy to term. While it is true that your egg health diminishes over time, it is not true that there is nothing that can be done to help support your egg health.
Even if you don’t have any specific ovarian or egg quality issues, helping support good egg health will help increase the chances your cycle will be a success!
The total time it takes for one egg to fully mature is about 90 days. It is during this window of time that we are able to have the biggest impact on egg health. So, we recommend that all of our patients looking to plan a treatment cycle take advantage of this time to prepare and consider acupuncture, supplements, diet, and lifestyle changes to help support their egg health.
Some of the main factors affecting egg health are:
Diet and Nutrition
Blood flow to the uterus and ovaries
Oxygenation of your blood
Our three favorite ways to improve all of these factors affecting egg health are acupuncture (of course!), diet and exercise, and specific supplements.
Each of our treatment protocols (IUI, IVF, and medicated cycles) begins with the recommendation of preconception acupuncture. Preconception acupuncture is treatments given weekly in the 1-3 months prior to any fertility cycle specifically designed to support egg health and hormone balance.
By now, you probably know that acupuncture done alongside a fertility cycle can improve the chances of pregnancy for that cycle. What you may not know, is that acupuncture’s effect is cumulative, much like exercise. Each treatment and treatment cycle builds on the previous. Research done on fertility acupuncture supports this idea. Generally, the more acupuncture one receives, the better the pregnancy rates.
The reasons why acupuncture done in the months prior to a fertility cycle can have an impact on your egg health and the overall success of your cycle are:
Dramatically improved blood flow to the uterus and ovaries: This increases the delivery of oxygen and nutrients, and facilities waste product removal, improving overall egg health.
Hormone regulation: Many women notice changes in their cycles during preconception acupuncture: less pain, more regular ovulation, and normalization of menstrual flow.
Reduced stress: Help your body and mind get ready for the upcoming cycle.
2. Diet, Exercise and Lifestyle:
Diet: A healthy diet can dramatically affect one’s fertility (and overall health!). Taking the preconception time period to focus on eating a clean, whole-food, plant-based diet can help improve egg health. Our favorite general fertility diet comes from a Harvard Medical School research study, but many diagnoses related to infertility, such as endometriosis or PCOS, call for some specialized nutrition.
Overall, the basics of a healthy fertility diet include:
Low amounts of saturated fat: Choose plant based fats such as nuts, seeds, avocados, and healthy fats like those found in salmon and other fish.
Local, grass fed, organic meats whenever possible
Fresh fruits and veggies: We suggest eating foods from every color of the rainbow and making sure at least half of your plate is filled with veggies as an easy way to maximize your fruit and vegetable intake
Vegetable protein sources: Try to replace one serving of meat per day with a vegetarian protein source like beans or tofu.
Lots of fresh water: Try to avoid water bottled in plastic and stick to filtered when possible.
Whole grains: brown rice, quinoa, whole wheat bread and pasta, etc instead of simple, white carbs,
Iron rich plants: spinach, pumpkins, beans, tomatoes, and beets.
Full fat dairy instead of low fat varieties.
Minimal (or no) sugar intake: be sure to watch added sugars and high fructose corn syrup as they can hide in many unsuspecting foods as well as sugary drinks and desserts.
For women who have endometriosis, we recommend following an anti-inflammatory diet. For those with PCOS, a low-glycemic index diet is best.
Exercise: Regular aerobic exercise improves the oxygenation of blood and increased blood flow throughout the body. It is also a great stress reliever and helps maintain a healthy BMI, which is associated with higher pregnancy rates. Yoga is also a great way to strengthen your core and help reduce stress.
The preconception time is perfect for implementing a consistent exercise routine as exercise is commonly limited by your doctor during a fertility treatment cycle.
Lifestyle: There are many lifestyle habits that can have an effect on egg health. Our top suggestions are the following:
Allow personal ‘down-time’ to meditate, read, or just relax.
Listen to fertility meditations via Circle Bloom to help de-stress and foster a healthy body/mind connection
Work to reduce stress and overwork as much as possible
Seek counseling or a support group if you feel it is necessary.
3.Supplements and herbs: In addition to a good quality prenatal vitamin, there are some supplements that you can take that will help support egg quality and overall fertility. One supplement that has some evidence showing it’s efficacy is CoQ-10.
CoQ-10 is a vitamin-like substance (meaning our bodies can make some on their own) that functions within the energy production centers, called mitochondria, present in each cell. As we age, the efficiency of the mitochondria declines. The idea is that by supplementing CoQ-10, we can help support this energy production, which is especially needed for high-energy processes like the cellular division involved in egg production and embryo development. There is some preliminary research showing an egg-health benefit in mice and we await further research. CoQ-10 is generally regarded as very safe to take while trying to conceive and most experience no side effects. It also shows some promise in helping support male fertility as well.
Other supplements that we typically recommend are:
Fish Oil: high in omega-3 fatty acids to help reduce inflammation in the body
Probiotics: to support good digestion and absorption of nutrients.
There are also specific supplements and herbs available for other fertility related conditions such as PCOS, endometriosis, luteal phase defect, male factor infertility, etc and will be recommended as needed.
Please call 865-315-3845 or contact us, we are more than happy to answer your questions or set you up for preconception acupuncture! Good luck with your cycle!
Are you currently trying to get pregnant or planning to try in the next few months? Have you considered adding fertility acupuncture to your IVF, IUI, or medicated cycle?
You’ve probably read or heard a little about acupuncture for fertility, but maybe don’t know much about how it can help you. Here are our top five reasons why you should book an acupuncture treatment with your next cycle!
Increases Chances of a Take Home Baby: Research shows that acupuncture not only improves pregnancy rates (up to 60%!), but can reduce miscarriages leading to an overall increase in the chances of a take home baby! After all, this is what everyone facing infertility really wants! This research is typically done on IVF cycles, but the same mechanisms of action can help improve an IUI, medicated, or natural cycle in much the same way.
Improves Blood Flow: Acupuncture has been shown to increase blood flow to the uterus. This improved blood flow is associated with a better chance of embryo implantation in IVF cycles. It can also facilitate better nutrient delivery and waste product removal to potentially increase the the quality of your follicles and endometrial lining.
Hormone Regulation: Over the course of 1-3 months, acupuncture can help to regulate your reproductive hormones. For example, women with PCOS often begin ovulating after treatment with acupuncture. Subtle cycle changes also occur as hormones become more balanced. Changes often noticed during the course of treatment include: increased fertile cervical mucous, a longer luteal phase, reduced PMS symptoms, and even changes in your basal body temperature chart.
Reduced Stress: We all know struggling with infertility is stressful. Acupuncture can help you cope with this stress so you can relax and feel normal while going through treatment cycles. It causes a release of ‘feel-good’ chemical called endorphins in your brain that will…. well, help you feel good! You may also notice that you sleep better or have better digestion after treatment as well.
Treatment of Side effects: Often when we are treating patients during their cycles, we use points to reduce headaches, nausea, bloating, irritability, insomnia, hot flashes, night sweats, constipation, anxiety…. you name it! Making you feel comfortable during treatment is a huge part of what we do. The way we see it is that, for many couples, success can be a matter of time. Time finding the right medication combination that works with your body and time waiting for the right follicle to develop. If we can make that wait easier, you’re more likely to try an additional cycle or two and increase your chances of success! Additionally, we all know you can’t push the pause button on life while you undergo fertility treatment, so we work to help keep you at your best so you can continue to be a wife, co-worker, student, mother, sister, friend, and/or superwoman!
As you can see, combining acupuncture to your fertility treatment plan is a great way to, not only, increase your chances of pregnancy, but to feel more comfortable, relaxed and get a more regulated cycle!
We work with both men and women to find a treatment protocol that works with the timing of their cycles to give you the maximum benefit of acupuncture. Please give us a call or contact us online and we’ll walk you through what is best for your situation. Or, if you’re ready, you can schedule an appointment online now!
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.
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:
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
Improving uterine blood flow to help prevent blood clots
Regulating the immune system
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 studysuggests 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!!
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:
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
Reduces the number of inductions in frist time moms by 43% and 35% in all others
Reduces rate of epidural usage by 31%
Reduces emergency C-section rate by 32%
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!
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)
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.
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.
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.
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!
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
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 Fisherâ€™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
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 â€œcyclesâ€ performed in 2011 versus 112,988 in 2003.2 IVF involves the retrieval and subsequent fertilization of a womanâ€™s eggs,Â 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.
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 Fisherâ€™s exact test, with significance defined as P < 0.05. The results are expressed as mean standard deviation or percentages as appropriate.
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.
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 bodyâ€™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.
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 ofÂ 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.
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/
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 & Â 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:Â 1203â€“1213. doi:Â 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.
Sarah J. Fredrickson, MSOM, Dipl OM (NCCAOM), LAc, completed a BS in biology at Indiana University in 2005 and completed her Masterâ€™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.
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 healthy lifestyle, acupuncture remains one of the most commonly sought after complementary treatments for couples 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 egg/embryo 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 astounding!
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! 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 to support a healthy, successful cycle. After all, the ultimate goal is a take-home-baby!
We divided the protocol into 4 phases corresponding with your cycle. The bulk of the protocol begins when you begin your cycle medications, but it is recommended to being treatment designed to help prepare your body for your upcoming cycle about three months before your expected cycle.
4 Phases of TNCRA’s IVF Acupuncture Protocol:
Pre-Conception: Treatments in the 3 months preceding the cycle to manage stress, regulate hormones, and help your body prepare for the cycle. For more information about our preconception program click here.
Ovarian Stimulation: Treatments are done twice weekly along side your ovarian stimulation medications to help increase the quality and quantity of your eggs and reduce side effects.
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. We are available 7 days a week for pre and post embryo transfer appointments.
Transfer Follow Up: One treatment 5-7 days post embryo transfer to support implantation, early pregnancy, and reduce stress.
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 with acupuncture are ‘easeir’ than those done without. 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. We also have online scheduling available.
Please feel free to reach out, we are always happy to help!