Traditional Chinese Medicine in the Treatment of Infertility

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Photo of Chines Stones with words representing the therapy (calm, smooth, peace)Traditional Chinese Medicine in the Treatment of Infertility

by Mike Berkley, L.Ac., FABORM 
The Berkley Center 
    (Note: Register and Join us on April 8 at 7:30 ET. Mike will answer your questions about how to use acupuncture and herbs to enhance fertility.)

Although the goals of Complementary medicine and conventional Western medicine are the same, their ideas about what causes a disease, the nature of the disease itself, and the process used to regain health are very different. The physician learns that disease must be cured by prescribing medicine or by surgery. There is nothing inherently wrong with this approach. It often works. But why does Complementary medicine succeed where conventional Western medicine sometimes fails? What is it about acupuncture and herbal medicine that can result in relief of symptoms or even a cure that is often lacking in conventional Western medicine? 

Though the ultimate result of Complementary medicine care is to cure the patient, the doctor of Complementary medicine attempts to do this by treating the whole person, taking into account the various attributes of an individual that, when combined, account for an individual’s health status.  A person, according to the tenets of Complementary medicine, is more than their condition. To treat just the condition may yield results, but, however impressive, these results are usually temporary. 

People are not, according to Complementary medicine, represented solely by their illness, but by the accumulation of every human interaction engaged in from the moment of their birth and by the culture they are exposed to. The emotional experiences, eating habits, work habits, work and living environment, personal habits, and social network all contribute to their disease, and are factors that, when changed appropriately, may lead to regained health.  

The power and effectiveness of Chinese medicine is evidenced by its long history of continued success. More than a quarter of the world’s population currently uses Complementary medicine as part of their health-care regimen. Chinese medicine is the only form of classical medicine that is regularly and continuously used outside of its country of origin.

The experienced doctor must use his or her own interpretive skills and consider not only what the patient reports to them about their condition, but also what they reveal without meaning too and what they don’t express. This leads to a better understanding of who the patient is and what the deeper, underlying cause of their condition may be.

The practitioner of Chinese medicine is trained to observe one’s tone of voice, complexion, eyes (in Complementary medicine, the shen or sprit of an individual is said to be revealed through the eyes), facial expression, overall demeanor, and how one walks, sits, and stands, and to use these observations to arrive at a diagnosis. Before the patient says one word, the doctor already has some idea of who this person is, clinically, simply by observing them.

A great doctor is one who can process a mix of medical knowledge with a personal sensitivity based on experience.  The practitioner of Complementary medicine specializes not just in inserting needles or prescribing herbal remedies, but in being able to see ‘hidden’ or subtle conditions that may not been seen or understood by practitioners of other types of medicine. This ability to see these hidden elements is difficult to master, and is done without the benefit of modern technology.

The only diagnostic tools used by practitioners of Chinese medicine are the “Four Examinations”: Observing, Listening/Smelling, Questioning, and Palpating. This method of diagnosis dates back over 3,000 years, and although it may seem quite simple, it is far from simplistic. Each of the Four Examinations can take years to master, and the astute practitioner uses them to arrive at a differential diagnosis.  With the advent of technology—as amazing, necessary, and beneficial as it is—there seems to be a direct correlation between advances in technology and a decline in doctor sensitivity to the patient, and thus, misdiagnosis.  The ability to listen and observe clearly, yields gems that are clues to the cause of disease.  This is the stuff of Complementary medicine.

Proper treatment in Complementary medicine is more than the elimination of the disease.  In addition to attacking a factor that is contributing to the disease process, it is the responsibility of the practitioner of Complementary medicine to support the individual in his or her goal of achieving overall total health, which includes the physical, psychological, emotional, and spiritual aspects of the patient.  This multidimensional approach is crucial to the process of healing. Without it, practitioner are merely “chasing” the sickness and forgetting that the patient is much more than their disease. They are a whole person—the sum of a lifetime of experiences.

Pathologies are guests (and we hope temporary ones!) in a home that serves as a gracious host—our physical, emotional, and spiritual selves.  Complementary medicine first is concerned with strengthening the immune function, which includes balancing the physical, emotional, and spiritual attributes of the patient, so as to be able to assist the patient in his or her endeavor to do battle and destroy the “enemy at the gates.” When people can’t sleep because they are anxious and depressed, they become chronically exhausted and chronically sick as a result of a compromised immune system.

The key to cure is to not view curing the disease itself as the be-all and end-all in treatment, but instead to treat the root of the disease—the anxiety and depression that causes the insomnia, which facilitates exhaustion, which lowers the immune function, which leads to chronic illnesses. So rather than prescribing antibiotics repeatedly, a practitioner of Complementary medicine might address the patient’s anxiety/depression syndrome or refer them to a psychotherapist for appropriate intervention while simultaneously providing Complementary forms of treatment.

Infertility and Complementary Medicine:  Mechanisms of Action

Historically, infertility—particularly “functional” infertility—was attributed to psychological problems of one or both partners. Preliminary works in the 1940s and 1950s considered “psychogenic infertility” as the major cause of failure to conceive in as many as 50% of cases. As recently as the late 1960s, it was commonly believed that reproductive failure was the result of psychological and emotional factors. Psychogenic infertility was supposed to occur because of unconscious anxiety about sexual feelings, ambivalence toward motherhood, unresolved Oedipal conflict, or conflicts of gender identity.

Fortunately, advances in reproductive endocrinology and medical technology, as well as in psychological research, have de-emphasized the significance of psychopathology as the basis of infertility. Stress does, however, play a part.

A study done at Harvard showed that stress reduces the hypothalamic-anterior-pituitary-ovarian axis function, and should thus be considered in the infertility workup. Acupuncture releases endorphins that mitigate one’s response to stressful stimuli, thus enhancing the possibility of conception. Biologically, since the hypothalamus regulates both stress responses as well as the sex hormones, it’s easy to see how stress may contribute to infertility in some women.

Excessive physical stress may even lead to complete suppression of the menstrual cycle, and this is often seen in female marathon runners, who develop “runner’s amenorrhea.” In less severe cases, it could cause anovulation or irregular menstrual cycles. When activated by emotional stress, the pituitary gland also produces increased amounts of prolactin, and elevated levels of prolactin can contribute to irregular ovulation. The female reproductive tract contains stress-hormone receptors; stress can affect fertility.

However, more complex mechanisms may be at play, and researchers still don’t completely understand how stress interacts with the reproductive system. This is a story that is still unfolding, and during the last 20 years, the new field of psychoneuroimmunology has emerged. This field focuses on how your mind can affect your body. Research has shown that the brain produces special molecules called neuropeptides in response to emotions, and that these peptides can interact with every cell of the body, including those of the immune system.  In this view, the mind and the body are not only connected, but inseparable, so that it is hardly surprising that stress can have a negative influence on fertility.

Stress can reduce sperm counts as well. Testicular biopsy specimens obtained from prisoners awaiting execution (who were obviously under extreme stress) revealed complete spermatogenetic arrest in all cases.

The stress factors that acupuncture addresses stems from both psychological and emotional factors as well as physical ones. For example, extremely painful premenstrual or mid-cycle pain can be debilitating. This type of physical stress no doubt produces emotional stress as a result of missed work, interference in activities, and the pain itself, which in turn can compromise the function of the reproductive system.

The insertion of acupuncture needles has been shown to effectively increase blood circulation. Enhanced blood flow to the reproductive environment clearly improves pregnancy outcomes.

A Diagnostic Window: East Meets West

It is becoming more and more prevalent that research conducted by Western scientists and physicians are highlighting the effectiveness of traditional Chinese medicine. In an article published in the December 2002 issue of the medical journal Fertility and Sterility, the authors reviewed existing evidence regarding the role of acupuncture in the treatment of infertility, and identified a number of studies indicating that acupuncture can increase the success rates of infertility treatments, including IVF.

In a study conducted by Dr. Wolfgang Paulus (Christian-Lauritzen-Institut, Ulm, Germany) and colleagues, half of a group of 160 women who were about to undergo IVF were randomly assigned to receive acupuncture therapy before and after embryo transfer. In the women who received acupuncture, the needles were placed at points believed to influence reproductive factors (for example, by improving blood flow to the uterus).

The acupuncture group had a higher rate of pregnancy compared with those not given acupuncture (43% versus 26%), suggesting that acupuncture can be used to improve pregnancy rates during IVF.

One alternative medicine diagnosis that exists which may be help to explain male or female infertility is called Liver qi stagnation. Key identifiers of an individual with this condition are anger, rage, frustration, depression, and anxiety.

Dr. Secondo Fassino (University School of Medicine, Turin, Italy) and colleagues recorded the personal characteristics of 156 infertile and 80 fertile couples, and measured their degree of psychopathology. When the researchers divided the couples according to the nature of the infertility—organic, functional, or undetermined—they found that anxiety, depression, and a tendency toward anger suppression could predict the diagnosis of organic or functional infertility in women with 97% accuracy. For infertile men, anxiety was also an important independent predictor of functional infertility, increasing the likelihood of having this form of infertility five-fold, while depression was more predictive of organic infertility. However, unlike in women, anger did not appear to influence infertility in men. These results suggest that, beyond the distress that accompanies the failure of repeated attempts to conceive a baby, psychological problems may contribute to functional infertility.

Herbal Medicine

The exact mechanisms of action of herbal medicine intervention are not, at this time, completely understood. However, herbal medicine has been used successfully to treat infertility for thousands of years.               

Practitioners of Chinese herbal medicine rarely use a single herb in treatment. Chinese herbs are formula based; many herbs are mixed together to create the perfect ‘decoction’ specifically designed for the individual patient.

Some formulas contain two herbs and some thirty or more herbs. Each herb has many functions. Each herb has its own flavor, nature, temperature and trophism.  Prescribing the correct herbal medicinals requires extensive training and clinical experience. 

Self-medicating with herbal medicine presents a dual dilemma. At best the herbs will be useless, as the key to correct formula prescription is an accurate differential diagnosis that can only be rendered by a licensed, Board-Certified, experienced practitioner. In the worst case, self-prescribing of herbal medicine may prove harmful.  

One should take herbs only when they’re prescribed by a Board-Certified herbalist. Not only is herbal medicine safe, it is highly effective and free of harmful side effects that often accompany pharmaceutical drugs. There are more than one million hospitalizations per year as a result of drug-induced side effects; not so with herbal medicine.

I have prescribed herbal formulas for 14 years to improve egg and endometrial quality. This is often effective, but, as in all fields of medicine, there is no guaranty of success.  Herbal medicine is also very often used successfully in treating certain sperm anomalies.

The Berkley Center: Treating Fertility Challenges

Clearly, further research is needed to fully understand the mechanisms of action of acupuncture and herbal medicine in treating the infertile patient. Nevertheless, it is my opinion, based on fourteen years of clinical care that the best-case scenario for patient faced with fertility challenges is to offer them every reasonable option which may serve to address their underlying condition. The integration of acupuncture and herbal medicine into the treatment protocol of the infertile patient, from a clinical perspective, based on current scientific and empirical data makes sense.

STUDIES

  1. BMJ  2008;336:545-549 (8 March), doi:10.1136/bmj.39471.430451.BE (published 7 February 2008)

Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis

Eric Manheimer, research associate1, Grant Zhang, assistant professor1, Laurence Udoff, assistant professor2, Aviad Haramati, professor3, Patricia Langenberg, professor and vice-chair4, Brian M Berman, professor1, Lex M Bouter, professor and vice chancellor (rector magnificus)5

1 Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207, USA, 2 Department of Obstetrics, Gynecology and Reproductive Services, University of Maryland School of Medicine, 3 Department of Physiology and Biophysics and Medicine, Georgetown University School of Medicine, Washington, DC, 4 Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 5 VU University Amsterdam De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands

Correspondence to: E Manheimer emanheimer@compmed.umm.edu

Objective To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation.

Design Systematic review and meta-analysis.

Data sources Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.

Review methods Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.

Data synthesis Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth. The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).

Conclusions Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

  1. Acupuncture and IVF Study Shows Early Promise for Increased Take Home Baby Rates

Posted on: Tuesday, 12 August 2008, 15:00 CDT

Dr. Paul C. Magarelli, a nationally noted specialist in the field of reproductive endocrinology and infertility, and Dr. Diane K. Cridennda, a recognized authority on acupuncture and Traditional Chinese Medicine, have announced early results of an ongoing study linking acupuncture to positive in-vitro fertilization (IVF) outcomes. The study, which includes the largest-ever participant pool for a study of its kind, explores the increase in take home baby rates associated with combined Eastern and Western medicine treatments.

Drs. Magarelli and Cridennda's ongoing research shows an astonishing 15 percent increase in pregnancies, with a 23 percent climb in actual births in IVF patients treated with acupuncture. In addition, of the 578 patients Magarelli has co-treated at the Reproductive Medicine & Fertility Centers and East Winds Acupuncture from 2003 to 2008, 26 percent more patients became pregnant with acupuncture treatments added to IVF, saving them the costs and heartache of having to repeat an IVF cycle. This savings would decrease the national IVF fertility costs by more than $150,000,000 per year in the United States alone.

"Infertility is a condition that affects more than 7.3 million people nationwide, and many of those couples are unaware of the potential that acupuncture holds for them," said Dr. Magarelli. "Our study demonstrates that acupuncture increases uterine blood flow, reduces stress and has an overall positive impact on our IVF patients. And the results really speak for themselves: one of every four of our patients who have used acupuncture in conjunction with IVF has not had to repeat an IVF cycle to create their families."

A three-part exploration of Drs. Magarelli and Cridennda's ongoing breakthrough acupuncture and IVF study will be published in Fertility Today magazine later this year. ABOUT DR. PAUL C. MAGARELLI

Dr. Paul Magarelli, MD., Ph.D., a member of the GENESIS Network for Reproductive Health (www.genesisivf.com), recently won the Practicing Physicians Award from the Pacific Coast Reproductive Society for his groundbreaking research on the impact of acupuncture on IVF pregnancies. Not only is he known for his instrumental work in creating new pricing structures to provide cost-effective, competent IVF care for the average wage earner, but he is best known to his patients for applying high-tech procedures with a personal touch. In addition to co-founding the Corona Institute for Reproductive Medicine & Fertility, he is the medical director of the Reproductive Medicine and Fertility Centers in Colorado and New Mexico, where he specializes in infertility and all aspects of hormonal pathology in women. Dr. Magarelli has been interviewed as an expert source for MSNBC, Fertility & Sterility and PregnancyandBaby.com. To learn more, visit www.ColoradoSpringsIVF.com and www.CoronaFertility.com.

ABOUT DR. DIANE K. CRIDENNDA

Diane K. Cridennda, L.Ac., (FABORM) is Board Certified in the field of Reproductive Oriental Medicine. She graduated from the International Institute of Chinese Medicine in l995 with her Masters of Oriental Medicine degree. She trained in Beijing, China to explore the root of this ancient healing art. She is NCCA certified, licensed in Colorado and is a member of Resolve, a national infertility support group. She has also had extensive training in Traditional Chinese Herbal Medicine. For more than seven years, Diane has been working with Reproductive Endocrinologists using a combination of Eastern and Western medicine therapies for the treatment of infertility. To learn more, visit www.EastWindsAcupuncture.com.

  1. Fertility & Sterility Journal Volume 85, Issue 5, Pages 1347-1351 (May 2006)

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Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study

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Stefan Dieterle, M.D.aCorresponding Author Informationemail address, Gao Ying, M.D.ab, Wolfgang Hatzmann, M.D.a, Andreas Neuer, M.D.a

4.      Can acupuncture boost my fertility?

Skrivet för BabyCentre UK

The BabyCentre Editorial Team svarar:

Research suggests that acupuncture may be helpful to couples undergoing in-vitro fertilisation (IVF), but the verdict is still out on whether it can improve fertility in general. Although smaller studies show promising results, more research is needed before we can say for sure that this age-old therapy can help you get pregnant.

Acupuncture is based on the theory that vital energy (or "qi," pronounced "chee") flows through the body along certain pathways. Acupuncturists try to balance this energy and restore health by stimulating specific points along the pathways with thin needles. Although it has been a staple of Chinese medicine for some 5,000 years, acupuncture has only gained acceptance in the Western medical community in the past few decades.

In 2002, a team of German researchers discovered that acupuncture significantly increased the odds of pregnancy among a group of 160 women who were undergoing IVF treatment. Forty-two per cent of the women who received acupuncture got pregnant, compared to 26 per cent of those who didn't receive the treatment.

Since then, more research has given support to the benefits of acupuncture for women undergoing IVF. One study, also in Germany, reported that conception and ongoing pregnancy rates were higher for women who had acupuncture treatment in the the second part of their menstrual cycle (the luteal phase) following IVF or ICSI. While a Danish study found that conception rates were best improved by having an acupuncture treatment on the day the embryos were transferred into the uterus. Their findings showed that having an additional acupuncture treatment two days later did not improve the chances of conception or ongoing pregnancy.

So how does it work? Nobody really knows, but researchers think that acupuncture may help increase blood flow to the uterus and relax the muscle tissue, giving the embryos a better chance of implanting.

Acupuncture may also help male infertility. Regular treatments have been shown to improve sperm counts and motility (the strength with which the sperm swim) for men with fertility problems but not always significantly. To improve the chances of pregnancy by natural means, acupuncture treatment would need to increase a man's sperm count over the threshold needed for conception. This means a minimum of 10 to 12 million moving sperm per ejaculate, and the men in these studies didn't get up to those levels.

However, for couples considering assisted conception, acupuncture can help by improving the quality of the sperm. In a study published in 2005, researchers analysed sperm samples from men with infertility of unknown cause before and after acupuncture treatments. They found that acupuncture was associated with fewer structural defects in sperm and an increase in the number of normal sperm.
 

Most experts believe that we need larger and better studies, ideally random and double blind trials, using fake needles for some patients and real ones for others, in order to really know whether acupuncture is effective. In some of the studies mentioned above, the patients and healthcare providers knew that acupuncture was performed, so the studies weren't "blind" and the success of the treatment might have been due to what's known as the placebo effect. Perhaps it was the patients' belief in acupuncture, rather than the acupuncture itself, that accounted for the treatment's success.

However, in the end it doesn't matter that much whether the success of acupuncture is a placebo effect or not. The bottom line is that acupuncture is relatively safe, and if it improves fertility, even if it's only because you think it does, it may be worthwhile.

The best first step to treating any fertility problem is to contact a specialist. If you do decide to try acupuncture, look for a registered acupuncturist, some of whom are also medical doctors. The British Acupuncture Council (www.acupuncture.org.uk) can help you find one near you.

Reviewed May 2007

Sources

Chang R, Chung PH, Rosenwaks Z. 2002. Role of acupuncture in the treatment of female infertility. Fertil Steril. 78(6):1149-53

Dieterle S, Ying G, Hatzmann W, Neuer A. 2006. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril. 85(5):1347-51.

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

Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, Sterzik K. 2005. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertil Steril, 84(1):141-7

Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. 2000. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia, 32(1):31-9

Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. 1997. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl, 39(2):155-61

Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. 2006. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril. 85(5):1341-6

Zhang M, Huang G, Lu F, Paulus WE, Sterzik K. 2002. Influence of acupuncture on idiopathic male infertility in assisted reproductive technology. J Huazhong Univ Sci Technolog Med Sci, 22(3):228-30

 

 

Photo of Chines Stones with words representing the therapy (calm, smooth, peace)

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