PUTTING IT ALL TOGETHER
How Integrative fertility treatment can help you start your family
By Katherine Alexander Anderson, MBA, DACM, L.Ac., FABORM
Nearly 7 million women in the United States alone, suffer from the inability to conceive (CDC, 2010). With that many women afflicted, it’s no wonder most people tend to assume that fertility issues are just a woman’s problem. But infertility doesn’t just affect a woman. One-third of the time all infertility is due to female factors, another one-third due to male factors and the remaining one-third due to some combination of the two.  In the Western medical system, couples are generally advised to seek medical help if they are unable to achieve pregnancy after one year of unprotected intercourse if the woman is under 35 years of age, or after six months if she is over 35. This often leaves a woman feeling hopeless, frustrated and alone, in a process that can unfortunately become a journey in which she travels through the healthcare system and all the emotional ups and downs of navigating the unknown in search of this innate desire to start a family. While more and more couples are turning to alternative methods to help them conceive, many are still unaware of these options, especially about preconception care outside of the usual prenatal vitamins and folic acid. Preparing your body in advance of conception is critical - healthy mamas make for healthy babies – and so often patients and doctors alike neglect this aspect of reproductive care. This is where the ancient solutions of Chinese medicine can shine. This approach is useful when preparing your body for future conception, while actively trying to conceive naturally or in conjunction with assisted reproductive techniques such as intrauterine insemination (IUI) or in-vitro fertilization (IVF).

The options when trying to conceive.
Acupuncture and Chinese Medicine has been used for thousands of years to enhance fertility. Traditional Chinese Medicine (TCM) is a viable and highly successful holistic approach to pregnancy. The foundation of all fertility in Chinese Medicine is based first and foremost on regulating the menstrual cycles. A normal cycle in TCM is one which comes every 28-31 days, involves bleeding for 3-5 days which is bright red and with minimal clotting, cramping and premenstrual syndrome (PMS). Though painful periods with heavy clotted blood and significant PMS signs are the norm in our society, they are certainly not considered normal in TCM. Only once these cycles are regulated does conception occur more easily. A recent study confirms what TCM has known for many years; cycles less than 27 days or longer than 31 days result in decreased fertility rates (Wise, et al 2011). Chinese medicine is excellent at regulating the menstrual cycle because it takes an individualized approach to each patient. In TCM, there can be many Chinese medical diagnoses for a western disease (endometriosis, unexplained infertility, advanced maternal age, etc.) and it becomes dangerous to convert a western diagnosis into a TCM pattern. The Chinese saying ‘One disease many patterns; many patterns, one disease’ means that each patient’s treatment protocol including acupuncture points and Chinese herbal formulas are all customized to the patient. It is this customization that allows the ability to hone in on unique reasons one may not be conceiving and to fine-tune the approach for increased pregnancy rates. Once patients conceive, using TCM throughout pregnancy and postpartum is an effective way to decrease stress, lower blood pressure, regulate glucose levels, combat postpartum depression and increase milk supply (Lee et al, 2009).
The most well-known fertility option is IVF. But when is this appropriate? First introduced in the early 1980’s in the U.S., IVF offers the most hope for couples when there are mechanical issues such as blocked or no fallopian tubes and/or severe sperm issues such as low sperm count, poor motility or morphology. In IVF, medications are used to stimulate a woman to produce multiple eggs. These eggs can be harvested and united with sperm in a petri-dish or in the case of severe sperm issues, the sperm will be injected into viable mature eggs through a process called ICSI (Intracytoplasmic sperm injection). Success rates of IVF vary by age and by clinic. For those under 35 the success rates are higher and depend on fresh or frozen embryos but can be 40% or higher. For those over 40, live birth rates drop significantly. Given that this is a very expensive procedure costing upwards of $15,000 per cycle with varying degrees of success, many can’t afford this option nor do many want to pursue an invasive procedure with strong medications that can be potentially harmful. A less expensive option is IUI (Intrauterine insemination) in which the sperm is placed inside the woman’s uterus in the hopes that it will get closer to the fallopian tubes for fertilization to take place. Though less expensive, the success rates of this approach are less than 8% per month (Reindollar, 2010). IUI may or may not be combined with Clomiphene Citrate (Clomid) or Letrozole (Femara), two medications designed to help a woman ovulate, though different in their mechanisms. These medications are also often suggested for women to use independent of an IUI but something I caution women to consider carefully. While it may be true that up to 80% of women taking these drugs will ovulate and 10-12% of them will conceive per cycle (Azim, 2015), these statistics are based on women that either do not ovulate or have difficulty ovulating. If we know that a woman is already ovulating, I don’t believe these to be a great solution as evidenced by the low success rates as well as the small percentage of my patients that have actually conceived this way in the past ten years. Though still low success rates, a combined approach of IUI with ovulation drugs, however (versus either alone) is the better approach for someone with unexplained infertility (up to 30% of couples trying to conceive are diagnosed as unexplained) (Schattman, 2016) and it offers slightly higher success rates of 10% per cycle (Reindollar, 2010).
An Integrative Approach.
Integrating TCM, western diagnostics and procedures and functional medicine, or using TCM alone often offers a successful approach to pregnancy. Acupuncture as well as the other modalities of TCM including Chinese herbal medicine, nutritional therapy and mind-body practices such as yoga, qigong and meditation, offer a holistic approach to infertility. Fertility acupuncture gained awareness in the U.S. with a landmark study in 2002 that demonstrated that women receiving acupuncture in conjunction with an IVF cycle had higher clinical pregnancy rates (42.5% vs 26.3%). Numerous studies since then have confirmed similar success rates although through different methods of treatment. For example, the well-known Paulus study used acupuncture, but only immediately before and immediately after the IVF transfer. What we have learned through research since then is that preparation with acupuncture alone or with the full use of TCM (acupuncture, herbal medicine, nutrition, lifestyle) prior to an IVF cycle offers the best chances of increasing pregnancy (Magarelli & Cridennda, 2009; Hullender-Rubin, 2012), and that a minimum of 9-12 treatments prior to, is ideal. Incorporating Basal Body Temperature charting (BBT) as well as analyzing western diagnostics such as blood work results from a functional medicine perspective allows for a more effective and informed integrative approach. Some doctors dismiss the use of BBTs stating they do not predict ovulation. This is true. They are not a magic wand. They are a diagnostic tool, one of many, that assist the patient in understanding her body, as well as assist a fertility detective like myself in understanding the big picture. On many occasions, I have referred patients to their medical doctor suspecting and confirming ovulatory dysfunction and hormone imbalances which were preventing pregnancy based on using a functional medicine assessment and their BBTs as a 5th vital sign. Taking an integrative approach and knowing when to refer patients to a reproductive endocrinologist or gynecologist is critical.

It is important for any skilled medical professional to recognize the different treatment approaches for those struggling with infertility. Sometimes it will involve the use of medications or assisted techniques and sometimes it is better or the choice of the patient to try natural approaches. For those with mechanical impediments, IVF and IUI may be the best options and when combined with acupuncture and TCM, can increase these success rates significantly. The use of TCM is ideal for preconception because it focuses on regulating the cycles and hormonal imbalances, naturally so that conception can occur either spontaneously or in preparation for assisted techniques. A skilled fertility acupuncturist/Chinese medical doctor will have advanced training and certification in reproductive medicine. If they are a fellow of the American Board of Oriental Reproductive Medicine (www.aborm.org), patients and western medical doctors can rest assured that these practitioners are trained in western and eastern reproductive medicine and highly qualified to ensure patients receive the highest level of infertility care.

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Katherine Alexander Anderson is a Doctor of Acupuncture and Chinese Medicine, international speaker and President of the American Board of Oriental Reproductive Medicine (ABORM). She owns clinics in Maine and New Hampshire specializing exclusively in fertility and women’s health, as well as consults with women all over the world.