Chinese Medicine, Reproductive Health, Pregnancy and IVF support.
Whether you are preparing to conceive, actively trying to conceive or embarking on IVF, Chinese medicine has a lot to offer you. Below are listed a number of different clinical programmes which have been designed to address the needs of couples facing the challenges of modern life while trying to maximise general and reproductive health.
There is much information and misinformation about what constitutes a good preconception diet. From a Chinese medicine point of view the middle road is usually the healthiest where moderation of some foods is recommended and a good balance of healthy and fresh fruits and vegetables with adequate protein is encouraged. A TCM practitioner takes into account the different constitution and situation of each individual before dietary advice is given.
A properly functioning digestive system is an important focus of treatment, so that nutrients are absorbed and utilised well. If there are any digestive issues such as bloating, bowel disorders, reflux, cravings or low appetite these can be addressed with acupuncture.
Schedule; Acupuncture once a week if there are digestive symptoms, until symptoms improve.
If you are overweight a little bit of weight loss goes a long way to improving fertility. Losing 5 kg is a manageable target for most and you can start now. Just moving your metabolism a little bit in the direction of burning off fat stores, can stimulate ovarian activity, improve egg and sperm quality and increase fertility.
Acupuncture has often been used, as part of a comprehensive programme, to help reduce appetite and improve metabolism to promote weight loss. An analysis of your constitution and the reasons for your weight gain by an experienced acupuncturist will lead to an individualised treatment plan designed to aid weight loss in a safe and stable manner. We use gentle electro acupuncture and Chinese herbal medicine to help reduce BMI. We have found it to be particularly helpful in reducing waist circumference in women with PCOS. Acupuncture appears to have an effect in reducing the level of specific hormones which affect appetite and metabolism.
Stimulation of ear acupuncture points is often used to help with weight loss. Certain ear points have been shown to stimulate the auricular branch of the vagal nerve and raise serotonin levels, both of which increase tone in the smooth muscle of the stomach, thus helping to suppress appetite.
Suggested Schedule; Acupuncture 1 – 3 times per week for 1 – 3 months before IVF, or until goal weight is achieved or until you conceive.
The environment that eggs occupy during their lengthy maturation process in the ovary has an impact on what shape they are in before meeting a sperm (with or without an IVF embryologist in attendance). They need a good blood supply, the right nutrients, the right hormone signals and the capacity to supply enough energy to the embryo.
This has important implications, particularly for eggs that are coming from slightly older ovaries (and possibly for eggs coming from women with PCOS or endometriosis). While no treatment can turn back the clock, or change the DNA, acupuncture and herbs can be used in an attempt to rejuvenate some oocyte characteristics by improving delivery of nutrition to the developing egg and enhancing its capacity to make energy (see below). While this is purely theoretical at this stage, there are some interesting findings which make it feasible (see below)
Suggested Schedule; Acupuncture once a week, Chinese herbs twice a day for 3 – 6 months
Many clinical trials in several countries have demonstrated a possible benefit of acupuncture treatment to some sperm parameters (references). A meta analysis of some of these trials indicated that motility and count may be improved by acupuncture but it has been suggested that larger trials be done before definitive conclusions can be reached.
In these trials mild electro-acupuncture is applied to the abdomen and the lower legs. This has been shown to increase blood flow through the small blood vessels of the testes, potentially improving delivery of nutrients to developing sperm and promoting optimal sperm vitality. Thus acupuncture can be considered as part of a pre-conception programme even where there is a normal semen analysis.
Schedule: Acupuncture 1 – 2 times per week for 5 – 10 weeks (10 – 15 treatments in total). Read More →
Being under weight affects ovary function, as much as being over weight does (although in a different way). Acupuncture can help to regulate the sympathetic nervous system (reducing adrenalin) and improve appetite. In conjunction with behavioural and dietary modifications this can help to put weight on.
One of the things mentioned a lot in a traditional Chinese medicine gynaecology textbook, including the chapter on fertility, is the term “Regulating the Cycle”. What this refers to is the ideal of a 28 day menstrual cycle (give or take a few days), and a regular ovulation occurring around the middle of that cycle. This is one of the first aims of much TCM treatment of gynaecological disorders. A regular menstrual cycle is an indication of good ovary function and good hormone balance.
Implantation of the embryo in the uterus is a vital and pivotal event which determines the success of an ongoing pregnancy after conception, or after transfer of an embryo in an IVF cycle.
The crucial role that the immune system plays in the process of implantation and the development of the placenta is gradually being elucidated though there is much we still don’t know. A positive finding of immune factors like anti-cardiolipin antibodies, anti- thyroid antibodies, anti-nuclear antibodies or an excess of some types of NK cells can indicate that there may be subtle imbalances in the immune environment of the uterus which are not conducive to establishing a healthy pregnancy.
Most women diagnosed with immune factors affecting fertility will be prescribed drugs to dampen the immune system and/or to reduce blood clotting. Although we are awaiting research to elucidate mechanisms, some patients will choose to have acupuncture as an adjunct therapy. We know that acupuncture is effective at increasing endorphins and other neurotransmitters, and it is thought that acupuncture may modulate immune function through this action. While we don’t yet know the mechanism, the increase in implantation rates in some of the acupuncture studies on IVF patients has been suggested to possibly be related to a regulation of intra-uterine immune factors.
Schedule; acupuncture once a week, twice a week at time of ovulation, or on the day of embryo transfer. Read More →
Women with PCOS, particularly those with irregular or infrequent periods, have their own particular challenges when it comes to conceiving. We don’t yet fully understand the causes of PCOS however we do know that certain acupuncture protocols can reduce some of the factors that operate to prevent polycystic ovaries working properly. For example some studies show that acupuncture reduces testosterone and LH (luteinising hormone) levels promoting the conditions for more frequent ovulation and better quality eggs. (references)
Patients with PCOS who are trying to conceive naturally or planning to do IVF, may benefit from doing a course of acupuncture over 3 to 4 months to improve ovary function. For those PCOS patients who do IVF, certain acupuncture protocols during the stimulation phase and after embryo transfer have been shown to reduce the risk of hyperstimulation.
Low intensity gentle electro-acupuncture is applied to points on the abdomen and the legs.
Suggested Schedule: Acupuncture 1 – 3 times a week until regular ovulation is re-established, until you conceive or for 3 months to prepare for IVF.
Endometriosis can damage ovary function (AMH is reduced in endometriosis patients) and can negatively impact the immune milieu (inflammatory cytokines are raised) and affects the lining of the uterus and its implantation sites. We use acupuncture to manage the symptoms of endometriosis like pain and menstrual disturbance. Chinese herbs are sometimes used in China to improve response to IVF drugs and pregnancy rates in endometriosis patients.
Acupuncture is best performed at specific times of the menstrual cycle. These will be decided in conjunction with your practitioner and will depend on your symptom picture and whether or not you are actively trying to conceive.
Suggested Schedule: Acupuncture once a week or fortnight. Chinese herbs daily (when not taking IVF drugs)
Obstructions to implantation, such as polyps or fibroids, are usually removed surgically. In the case that surgery is not desired, and fibroids are not large, then Chinese herbal medicine has a long history of being used to shrink them. Some of the symptoms caused by ovarian cysts (such as pain or cycle irregularity) may also be amenable to treatment with Chinese herbs and acupuncture.
Suggested Schedule: Acupuncture once per week for 2 – 3 cycles, herbs daily.
Stress, for most of us living and working in modern cities, is part of life. However it can get a lot worse when you are not conceiving as easily as you thought you would. And in a cruel vicious cycle, stress can have a negative impact on fertility. Women who are more stressed have reduced fertility, and during IVF cycles have lower embryo implantation rates. Stress has also been shown to affect semen quality.
For all these reasons acupuncture can be useful at specific times of the menstrual or the IVF cycle.
Acupuncture is well known for its ability to relax the patient and this has been demonstrated in an IVF setting. Its action in raising endorphin levels and reducing adrenalin and cortisol levels allows the body and mind to relax immediately and learn a different way of being. Our patients frequently comment on how relaxed they feel after their treatments.
Suggested Schedule; acupuncture once or twice a week or as required.
The connection between sleep and fertility is not always self evident, although getting to bed early with your partner may for some couples have obvious benefits.
You may not realise that the quality and quantity of your sleep influences sex hormones, sperm production, ovulation, immune factors, weight gain, mood, stress levels and longevity as well as the more obvious stamina.
Getting enough good quality sleep is an essential part of preparing for conception for all these reasons. Acupuncture has a proven track record (reviewed in several medical journals) of assisting to establish sound sleep patterns.
It takes two and this stressful journey is traveled more easily when the two of you do it together, supporting each other. Whether it is unexplained infertility, male factor or ovarian issues, focusing on improving general health and the health of the gametes on both sides often provides the solution when nothing else is working. Many of the couples we have treated have voiced an appreciation of the emotional and psychological benefits they experience when they come for treatments together. Saturday tends to be our couples day in the clinic.
Many IVF clinics like to transfer embryos into a natural environment. Embryos that have been frozen and successfully thawed are transferred back into a uterus in its natural state at exactly the right time for implantation. Using electro-stimulation on acupuncture points on the abdomen in the months and weeks before the transfer, has been shown to improve the structure of the uterine lining, and significantly enhance the implantation and pregnancy rate.
Schedule; 1-2 treatments per week in the 2-3 cycles before frozen embryo transfer
This treatment schedule is based on protocols used in clinical trials which demonstrate increased blood supply to the uterus and a regulation of hormones which may be important to follicle development and implantation. Recent analyses of the benefit of IVF patients receiving acupuncture have shown that patients who have treatment before and during the stimulation and implantation phases benefit more than those that have acupuncture only on the day of embryo transfer (reference)
Suggested Schedule: 2 treatments per week for 4 weeks (optimal) plus treatment at time of embryo transfer.
These one or two treatments are based on protocols used in clinical trials some of which showed an increase in pregnancy rates in certain groups of women receiving acupuncture (most commonly those for whom the expected pregnancy rate was 30% or less). The most recent study has found that such a small “dose” of acupuncture showed no effect on live birth rate in a large population of women of all ages undergoing IVF, compared with sham acupuncture . Some researchers report better results with more frequent administration of acupuncture before and during the stimulation phase of the IVF cycle. (You can find the references for these trials here, and here)
In our clinic we find that IVF patients appreciate the calm and relaxation that acupuncture brings on this special day, and gives them space to honour the arrival of the precious embryo.
Schedule: a – before or after transfer …… one treatment
Acupuncture may be useful in managing any side effects experienced during an IVF cycle. Reduced fatigue, stress, moodiness, abdomen swelling and discomfort and other side effects are reported by many women using acupuncture during their IVF cycle. In addition women report greater relaxation and control of anxiety (reference), and overall greater resilience. The acupuncture treatment will be different for each patient and depends on symptoms.
Suggested Schedule: 1-2 treatments per week as needed.
Some IVF patients may benefit from having an acupuncture treatment the day or two after egg collection, to help reduce any discomfort from local tissue trauma or bleeding, and help prepare the environment for the arrival of an embryo.
Suggested Schedule: 1 treatment a day or two after the procedure.
Regular monitoring of the pulse (a TCM diagnostic technique) and regular treatment with acupuncture designed to reduce anxiety may offer you important and reassuring support during these first few weeks of pregnancy. Doctors in NZ showed that regular monitoring and reassurance reduces miscarriage rates in some of their patients. One study in China found that […]
You may have had a long journey with plenty of medical intervention to get this far. Now is the time to relax, let mother nature do her job and enjoy your swelling belly. However should any minor pregnancy disorders develop, you may find acupuncture helpful. Suggested Schedule: 1 treatment per week, or as needed.
Acupuncture treatment applied in the 4 weeks before the due date for delivery has been found by some midwifes to reduce the rates of medical induction and emergency caesarian. It also has been shown to encourage cervical ripening and may shorten active phase labour time. (All references). However larger trials are needed to confirm these […]
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Yuan An et al, J Assist Reprod Genet. 2013 Jan; 30(1): 35–41
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Xian Zhang et al, 2018, Eur Jnl Int Med, https://doi.org/10.1016/j.eujim.2018.09.001
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Mehmet Tuǧrul Cabıoǧlu and N Ergene
The American Journal…
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Ching Hsiu Hsieh, The American Journal of Chinese Medicine, Vol.…
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Caroline Smith et al, JAMA, 2018 DOI: 10.1001/jama.2018.5336
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Gaudernack LC1, Forbord S, Hole E , Acta Obstet Gynecol…
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Arnoldi M et al, Human Reproduction. 25(20100600)pg i257, ESHRE…
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Ui Min Jerng et al
Asian J Androl. 2014 Nov-Dec; 16(6): 884–891
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