The AFA Blog

East meets west and ivf success rates benefit

by Corey Whelan

For many men and women who are struggling to conceive a child, Traditional Chinese Medicine (TCM), including the practice of acupuncture, has proven to be a successful enhancement to western reproductive protocols.  Over the past decade, the number of  infertility specialists who have begun to acknowledge the potential benefits of acupuncture for patient care has grown considerably.

A wide host of studies demonstrate that acupuncture improves reproductive outcomes for most patients undergoing assisted reproductive technology; these include fewer ectopic pregnancies, lower miscarriage rates, and less multiple births.  However, the American Society for Reproductive Medicine (ASRM) does not agree.  Published highlights from the 62nd annual meeting of ASRM included excerpts from research conducted by Lehl and co-investigators as well as contradictory research conducted by lead investigator Paul Magarelli. Magarelli's findings indicate that "the modulation of reproductive and stress hormone levels with acupuncture is a possible explanation of infertility modifying effect."  However, the ASRM's position continues to be that "although acupuncture might improve IVF outcome, convincing evidence is not yet available".  Later findings also reported upon at ASRM's 2009 meeting,  and presented by Drs. James Smith and Arate Aelon indicated that CAM (complementary alternative medicine) did not increase pregnancy rates among IVF patients.

Despite competing studies, many within the field of assisted reproductive technology have embraced this 3,000 year old practice and the trend of East Meets West IVF clinics is becoming popular nationwide.

So how does acupuncture support traditional methods?  TCM has been shown to  help women with PCOS (polycystic ovarian syndrome) ovulate without the support of drugs such as clomid.  For the endometriosis patient, acupuncture, in conjunction with herbal medicine, can often reduce the inflammatory environment, and thus the pain that earmarks this disorder.

Traditional Chinese Medicine is a holistic approach to health, meaning that the whole person, not just the reproductive organs, are taken into account.  This includes psychological issues such as depression, and also the individual's lifestyle.  A single woman who has recently been laid off from work for example, might receive different treatment than a woman in a solid, financially secure situation..

TCM is intrinsically different from reproductive technology, and points to  the kidney as the internal organ responsible for the reproductive cycle, including growth, and also the aging process.  If kidney energy becomes depleted by poor diet or stress, one of the possible outcomes, according to the principles of TCM, is infertility.  

So will it work for you?  The concept of acupuncture will not appeal to every patient.  Given the number of infertility medications that are given via injection, you may feel that there are already enough needles in your life.  But if  you are currently considering adding acupuncture to your treatment protocol, discuss the concept with a physician that you trust, weigh the pros and cons, and make the decision that feels most approprate for you.  

Sources:

Lehl K, Pitzer L, Schoolcraft WB, Stevens JM. Elective acupuncture treatment pre and post embryo transfer: comparison of clinical pregnancy and implantation rates within age groups and in recipients of donor oocytes. Program and abstracts of the American Society for Reproductive Medicine 62nd Annual Conference; October 21-25, 2006; New Orleans, Louisiana. Session P-556.

Magarelli PC, Cohen M, Cridennda DK. Proposed mechanism of action of acupuncture on IVF outcomes. Program and abstracts of the American Society for Reproductive Medicine 62nd Annual Conference; October 21-25, 2006; New Orleans, Louisiana. Session P-118.

Adapted with permission from an earlier article published at www.examiner.com

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Thyroid Health and Infertility

by Stacey Roberts, PT, MH, Ph.D-C

Today we are going to discuss a very common issue that is often over looked and can for some mean the difference between having a child and not. 

 As I go through a patient's history I am always surprised at the tests that haven't been done or the issues that have been pushed off as normal and not addressed.  One of these such issues is thyroid health. Thyroid health is imperative in becoming pregnant and in holding the pregnancy so when a fertility issue persists, in my opinion, more detailed screening of the thyroid should be done, even if the standard tests have come up normal.  This is not only a woman's issue, i.e.  any time there is an issue with the sperm count and quality, it could be related to the thyroid.

So many times we see patients who have classic thyroid symptoms but have never had their thyroid screened beyond just doing the standard TSH testing.  Most times if their TSH has come in within "normal" limits, they are told their thyroid is "normal" and there is nothing wrong.  Then they begin doing their temperature charts for me and the temperatures indicate that the thyroid is not working optimally so I come back to them and request that they have their thyroid screened.  Some people look at me like I am crazy and others just scratch their heads.  

The confusion with the thyroid starts in the standard tests.  Normally a physician will test TSH which is the hormone that is supposed to be reflective of how the thyroid is working. The pituitary makes  more TSH if  thyroid hormone  is not enough or slows down in production if the thyroid is making too much.  The pituitary which secretes TSH is continually monitoring the blood to see how much thyroid hormone is present so in theory this should be an accurate indicator of thyroid function, but it doesn't always seem to work that way.  A scientist and MD Dr. George Gillson from Canada once stated in an International Hormone conference that TSH really only tells us what the brain needs for thyroid hormone, not what the rest of the body needs.

Therefore TSH can be normal but the thyroid hormone out put may not be optimal for you.  Another excellent reference for this http://thyroid.about.com

The range of "normal" for thyroid hormone varies quite significantly from lab to lab.  One lab may say that .4 to 4.0 is normal where another lab may say .3 to 6.0 is normal.  Our normal reference range, based onwhat we see in the clinic is 1.5 to 2.0 (with .3 to 3.0 being the full range we use), anything over 2.0 or below 1.5  gets our attention and we support the thyroid.   However even men and women who have TSH within this optimal range can show low thyroid out put on further inspection.  I know, its confusing.

If you have been dealing with fertility issues for awhile though its a good idea to have a more thorough screening.  For example, I would suggest that you ask your doctor to test FT4 and FT3, which are the actual hormones produced by the thyroid.  Your physician may be resistant to testing these if there is no apparent thyroid history or if TSH is normal so be ready to take responsibility for your own health and give him/her good reasons to test these. 

The other tests that should be considered if you have been dealing with fertility issues for a while and/or if you have had recurrent miscarriages or difficulty getting pregnant after a miscarriage or stillbirth, is thyroid antibodies.  These are tested even less frequently than the thyroid hormones and its a shame as it has been shown that a woman with elevated thyroid antibodies (which can be elevated even if TSH is "normal") are 3 times more likely to experience post natal depression and more likley to experience miscarriage. Most physicians do not test this if TSH is normal however thyroid antibodies can be elevated even with normal TSH.  Though traditionally physicians not familiar with its signficance regarding miscarriage will not treat elevated thyroid antibodies, but instead will often tell you to wait until the thyroid fails (or TSH rises above its "normal" range, before they will treat this.  Based on research reviewed in the New York Times, medical treatment for this is typically Thyroxine.  This treatment apparently decreases the incidence of miscarriage by half. 

Natural remedies for optimising thyroid function are also available from herbs and nutritional supplements.  An Ayurvedic herb called Withania Somnifera and Chinese herb Bacopa Monneri are a few herbs that have been shown to effect thyroid hormone levels.  And nutrients such as selenium, zinc, iodine and chromium are significantly important as well.  Keep in mind that the thyroid hormone T3 helps make progesterone and the nutrients mentioned are imperative in this process.

Clearly this is important information for any woman who wants to become pregnant or who is already pregnant.   French researchers stated in a recent abstract, "Thyroid autoimmunity is associated with hypofertility, particularly with spontaneous abortion.

Stacey Roberts is a leading herbalist and internationally recognized expert on complimentary medicines.