Fertility Challenges and Some Answers
What are the benefits of using acupuncture when treating a patient with PCOS?
PCOS is both an endocrinologic as well as a metabolic disorder. The patient can present with polycystic ovaries, hyperandrogenism, hirsutism, and hyperinsulinemia. Furthermore, PCOS patients have a difficult time conceiving. One of the reasons is anovulation. Also, the egg quality is very often compromised as there is too much testosterone in the follicle. This acts as an anti-estrogen and therefore, the eggs lack proper nourishment. In fact, the PCOS population experiences miscarriage more than the non-PCOS population.
Acupuncture and herbal medicine are ‘regulators. They reduce that which is in excess and supplement that which is diminished. In the PCOS patient, we want to reduce the testosterone milieu, increase the follicular estrogen, regulate the menstrual cycle and help facilitate conception. Acupuncture and herbs often accomplish this goal.
Another goal of the practitioner of traditional Chinese medicine is to council patients about life-style. If a PCOS patient is morbidly obese, she may face gestational diabetes, preeclampsia or eclampsia. This can cause serious health issues for mom and baby. Through lifestyle counselling, it is often possible to help this type of patient lose weight.
Obesity will also elevate estrogen levels which can, over time, contribute to cancer as well as contribute to infertility. The hormones must be balanced. Too much estrogen is as detrimental as not enough. Via the regulatory effects of acupuncture and herbs, weight can be lost, hormones can be rebalanced, menses can regulate, and conception may occur. I am not suggesting that acupuncture and herbal medicine is the holy-grail. It can help some people, sometimes; just like IVF.
What are the benefits of using acupuncture when treating a patient with endometriosis?
Endometriosis is a pro-inflammatory cytokine disease. In other words, there are inflammatory factors causing havoc in the reproductive system.
Even though endometriosis is a disease which occurs outside of the uterus, the inflammatory processes make their way into the uterine cavity altering the lining and the environment. This in and of itself is the main biological factor of infertility. There are physical issues as well. For example, tubal adhesions can occur which makes conception via intercourse or IUI impossible.
IVF is a must in those cases. Many patients with endometriosis also have activated Nk cells. These cells are meant to attack cancer cells in the uterus. But in endometriosis patients, these Nk cells often mistake the embryo for a cancer cell and attack and kill it.
Even after laparoscopic surgery, the patient can STILL have endometriosis. Here’s why: endometriotic lesions have various colours; brown, red, purple, power-burn, etc. This tells the surgeon “this is endo – resect it”. The problem is, some endometriosis tissue looks exactly like normal tissue. So, the surgeon can’t even see this tissue, let alone remove it. In my mind, even after a laparoscopy, it should be assumed that the patient still may have endometriosis.
In endometriosis cases (after laparoscopy always!) our aim is to try and reduce the inflammatory processes that may still be manifesting in the uterus and to try and regulate immune function. One protein that is a marker for poor fertility outcomes and is often seen in endometriosis patients is BCL6. BCL6 in some medical circles is what is thought to cause infertility in the endometriosis patient. By regulation of immunological function and clearing inflammation, BCL6 may be down-regulated and the ability to conceive will be improved.
What are the benefits of using acupuncture when treating a patient with sperm anomalies?
A typical semen analysis looks at count, volume, concentration, morphology and motility and ph. They all come back normal and the wife is 100% normal and she’s 27 years old and they can’t conceive? Why not? One potential reason is a ‘hidden pathology’ that is often not tested for. The pathology is sperm DNA fragmentation.
The common consensus amongst reproductive endocrinologists is that the only barrier to fertilization caused by DNA fragmentation is that the sperm can’t penetrate the egg. The patient is treated via ICSI (the sperm is injected directly into the egg to engender fertilization.) Often these cases end up in non-pregnancy or miscarriage. It is, in my opinion, not advisable to force a poor-quality sperm into an egg and expect a good outcome. Interestingly, some of these cases do end up with live births. But many do not.
Acupuncture can strongly improve hemodynamics to the testes, delivery oxygen, hormones, nutrient and electrolytes. Acupuncture also helps facilitate to excretion of debris or dead cells from the testes. This can improve testicular function and significantly reduce sperm DNA fragmentation. Taking antioxidants is extremely important in these cases as well since there is a tendency in these men to have high levels of oxidative stress in the testicular environment which can significantly harm sperm.
What are the benefits of using acupuncture to relieve stress in couples experience fertility challenges?
Stress is an interesting and uncertain issue when it comes to infertility cases. Yes; all parties involved are stressed. They want a child and can’t conceive. But does stress actually contribute to infertility? I’m not sure. Here’s why: In any war zone, in any part of the world, in any time in history, the most horrible, stressful, unspeakable things occur. But children are born in these war zones daily. I know for sure that stress can negatively impact sperm count but I’m not certain about the effect on fertility in the female patient. Nonetheless, acupuncture is excellent at mitigating stress, which, at the very least, will make the couple feel better, stronger, healthier, and more capable of dealing with the difficult journey ahead.
What are the benefits of using acupuncture when treating a patient who has low ovarian reserve and poor egg quality?
Acupuncture is very effective at improving blood flow to anywhere in the body that the practitioner wants. For example, if a patient has ‘tennis elbow’ (lateral epicondylitis) and you insert needles near and at the elbow, it will signal healing immunological substances to the site to repair the damage. So is the case with ovaries. We can stimulate blood to the ovaries directly stimulating delivery of oxygen, nutrients, electrolytes and hormones while also removing dead cells from the ovaries. This will not, under any circumstances provide a woman with more eggs but can, frequently, improve egg quality. This is very important.
Remember, in the IVF setting an egg is retrieved, fertilized and the subsequent embryo is transferred into the uterus, but… the reproductive endocrinologist can only work with the materials presented to him or her. So, if the egg quality is poor but a blastocyst is formed, the transfer will occur, and pregnancy will not ensue. If through acupuncture and/or herbal medicine, egg quality is improved, there will be an obvious increase in the chances of a successful outcome.
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