Archive for July, 2010
By East Coast Fertility
July 30th, 2010 at 8:52 am
On August 1st, at East Coast Fertility’s Brooklyn office, our psychologist, Dr. Kris Bevilacqua will present "Expectations for Treatment". When I asked Dr. Bevilacqua what she will be talking about at this special gathering, this is what she said:
"When couples marry and women try to conceive, they believe achieving a pregnancy will be easy and natural. They see other families around them with children and assume it will happen for them not long after they start trying. For younger couples not conceiving on schedule can be the first test of life not working out like they planned. For older couples it can be an unexpected challenge that requires medical interventions they never thought they would need. The idea that the intimate task of making a baby would need help from an expert can cause feelings of shame and inadequacy. What had started as an act of love can become a job with a monthly success indicator.
Sometimes, fear of failure, belief that the future of a relationship is connected to having children, and generally looking on the bright side, can cause expectations for success from treatment that may be wishful thinking. In a natural population of women age 20 to 24 years-old trying to conceive and having sexual relations on regularly, 85% of them will achieve a pregnancy within a year. Within 2 years, 92% will conceive. This leaves 8 out of every 100 young women not pregnant. Some will conceive in the future, some will require medical assistance, and a very few will not be able to conceive. As we age, it becomes harder to become pregnant, even when we don’t feel older. It can feel downright unfair when nature doesn’t cooperate with our plans to have a family. Luckily, we live at a time when there is help for many infertility problems.
Seeking medical treatment for help with what was supposed to be a natural process can feel like failure for some couples. Even for those who are ready to ‘fix’ the problem quickly, infertility treatment can feel like a loss: a loss of intimacy in the relationship, a loss of identity as a fertile individual, loss of control over one’s life plan, loss of belief about how life is supposed to be, loss of faith after having done everything ‘right.’ These feelings of loss can lead to depressive symptoms, fears, sadness, and anxiety which is why a psychologist is part of the medical team available to help patients get through treatment with emotional support".
So, August 1st, we will talk about all of this – about how it is when we finally decide to seek treatment, the simplest and least invasive treatments are not always the fastest paths to pregnancy. Sometimes these methods take patience, a good sense of what is possible with each method, and the ability to tolerate cycles that aren’t successful. We’ll talk about managing expectations, ways to deal with disappointment when a cycle doesn’t succeed, and how to feel emotionally connected to each other when everyone around you is having a baby.
Please join us!!!
When: Sunday August 1, at 12 noon.
Where: East Coast Fertility
1725 East 12th Street Suite 401
Brooklyn, NY 11229
RSVP: While this event is free – Please let us know that you are coming!
Tel (718) 375-6400
This event is open to all people struggling to build a family. You do not have to be a patient of East Coast Fertility to attend.
By Mike Berkley, L.ac.
July 29th, 2010 at 9:50 am
Infertility and TCM – Mechanisms of Action
It was shown in a study done at Harvard that stress reduces the hypothalamic-anterior pituitary-ovarian axis function, thus being a factor to be considered in the infertility work-up. Acupuncture releases endorphins which mitigate ones response to stressful stimuli thus enhancing the possibility for conception.
"Historically, infertility, particularly "functional" infertility, was attributed to abnormal psychological functioning on the part of one or both members of the couple. 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, and modern research shows that there is little evidence to support a role for personality factors or conflicts as a cause of infertility. This perspective unburdens the couple by relieving them of the additional guilt of thinking that it is their mental stress that may be responsible for their infertility.
Biologically, since the hypothalamus regulates both stress responses as well as the sex hormones, it’s easy to see how stress could cause infertility in some women. Excessive 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 stress, the pituitary gland also produces increased amounts of prolactin, and elevated levels of prolactin could cause irregular ovulation. Since the female reproductive tract contains catecholamine receptors catecholamines produced in response to stress may potentially affect fertility, for example, by interfering with the transport of gametes through the Fallopian tube or by altering uterine blood flow. 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, which is still unfolding, and during the last 20 years, the new field of psychoneuroimmunology has emerged, which 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 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 also inseparable, so that it is hardly surprising that stress can have a negative influence on fertility.
Stress can reduce sperm counts as well. Thus, testicular biopsies obtained from prisoners awaiting execution, who were obviously under extreme stress, revealed complete spermatogenetic arrest in all cases. Researchers have also showed significantly lower semen volume and sperm concentration in a group of chronically stressed marmoset monkey, and these changes were attributed to lower concentrations of LH and testosterone (which were reduced in the stressed group). However, how relevant these research findings are in clinical practice is still to be determined.(i) "
The stress factors that acupuncture addresses stems from both psycho-emotional factors as well as physical etiologies. For example, extremely painful pre-menstruum or mid cycle pain can be debilitating. This type of physical stress, no doubt produces emotional stress as a result of missed work, manifest pain and other life-style factors resulting from such extreme pain; all can mitigate the function of the reproductive system.
The insertion of acupuncture needles has been shown to effectively increase blood circulation. Acupuncture is very effective in treating, for example, Reynaud’s Syndrome. Enhanced microcirculatory patency to the uterine lining does, undoubtedly contribute to a healthier and more growth oriented endometrium, especially when utilizing electrical stimulation on inserted acupuncture needles on points known as zigongxue which reside superior to the ovaries. The points zigongxue are located 3 inches inferior to the umbilicus and three inches bilateral to the anterior midline.
"They reviewed existing evidence regarding the role of acupuncture in the treatment of infertility, and identified a number of studies indicating that acupuncture can be beneficial as an adjunct to other infertility treatments, including IVF. Only one randomized controlled study examined the independent effect of acupuncture on IVF outcomes, but this indicated a positive effect.
The reviewed authors also highlight evidence that shows the effects of acupuncture may be mediated through neuropeptides that influence gonadotropin secretion, which could in turn affect the menstrual cycle. The technique can also reduce stress, which is known to adversely affect fertility, and has been implicated in the regulation of uterine blood flow." (ii)
"Using acupuncture during assisted reproduction may improve pregnancy rates, say researchers. However, they acknowledge that the mechanism behind this effect is unclear, and the team plans to carry out further studies to confirm, and further investigate, their findings.
Noting that acupuncture has been shown to affect the autonomic nervous system, Dr. Wolfgang Paulus (Christian-Lauritzen-Institut, Ulm, Germany) and colleagues postulated that the therapy could increase endometrial receptivity via control of related muscles and glands.
The researchers randomly assigned 160 women receiving assisted reproductive therapy to undergo IVF with or without acupuncture, before and after embryo transfer. In acupuncture subjects, the needles were placed at points believed to influence reproductive factors, for example by improving blood flow to the uterus.
Paulus et al report that the acupuncture group had a higher rate of pregnancy compared with those not given acupuncture (43 percent versus 26 percent). They conclude, therefore, that acupuncture could be "a useful tool" for improving pregnancy rates during certain infertility treatments." (iii)
A Diagnostic Window – East Meets West
One TCM diagnosis which exists and which may be etiologic for male or female infertility is called Liver qi stagnation. One of the key identifiers of an individual with the pattern differentiation of Liver qi stagnation is anger, rage, frustration, depression and anxiety.
"Symptoms of depression, anxiety, and anger may help in determining the nature of infertility experienced by some couples, and identify those who would benefit most from psychological counseling, suggest researchers.
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 the triad of anxiety, depression, and a tendency toward anger suppression successfully predicted the diagnosis of organic or functional infertility in women, with 97 percent 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, with men – unlike women – anger did not appear to influence infertility in men.
The results suggest the possibility of identifying a subgroup of infertile subjects where, beyond the distress that is consequent to the failure of repeated attempts to conceive a baby, there is also a poorly adaptive psychological functioning, which is likely to play an important role in the onset and course of functional infertility," the team concludes."(iv)
It is becoming more and more prevalent that research conducted by Western scientists and physicians are highlighting the veracity and effectiveness of Traditional Chinese Medicine.
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 that the best-case scenario for most patients is to offer them every reasonable option which may serve to successfully address their presentation. Based upon the empirical evidence of my practice in which I specialize in the treatment of the infertility, the integration of acupuncture and herbal medicine into the treatment protocol from a clinical perspective makes sense.
i Domar, Alice (back)
ii Fertility and Sterility 2002: 78: 1149-53 (back)
iii Fertility and Sterility 2002: 77: 721-724 (back)
iv Human Reproduction 2002; 17: 2986-94 (back)
v Adverse reactions to drugs are very common in everyday medical practice. A French study of 2067 adults aged 20-67 years attending a health centre for a check up reported that 14.7% gave reliable histories of systemic adverse reactions to one or more drugs. In a Swiss study of 5568 hospital inpatients, 17% had adverse reactions to drugs. Fatal drug reactions occur in 0.1% medical inpatients and 0.01% of surgical inpatients. The main drugs implicated are antibiotics and non-steroidal anti-inflammatory drugs. Adverse reactions to drugs occurring during anesthesia (muscle relaxants, general anesthetics, and opiates), although less common (1 in 6000 patients receiving anesthesia), are life threatening, with a mortality of about 6%.
BMJ 1998;316:1511-1514 ( 16 May )(back)