Infertility and Acupuncture in Atlanta

Introduction

Oriental Medicine (OM) has been used to successfully treat infertility for centuries. The practice of acupuncture and Chinese Herbal Medicine has grown tremendously in the United States over the past forty years, and has been effectively integrated into Western Medicine in many European countries for the past century or two. It is a medicine that is rich in tradition, yet flexible and adaptable enough to integrate into the highly technological and advanced field of modern reproductive endocrinology. More and more couples are seeking acupuncture and Chinese Herbal Medicine in order to enhance the effectiveness of Assisted Reproductive Technologies (ART) or as a stand-alone therapy to enhance fertility.

In order to understand how Oriental Medicine works, we must first examine the paradigm on which it is based, compared with Western Medicine. In the West, modern medicine is based on the Cartesian model of man as machine. René Descartes was a 17th century French mathematician and philosopher who likened man to a well-made clock, composed of many parts. When the parts break down or become diseased, they are removed or replaced. In the Eastern model, man is likened to a garden that is tended and nurtured. Each part of the garden affects the entire landscape and is intertwined with the whole. Utilizing a combined approach to infertility offers the best of both worlds and may increase the odds of a successful pregnancy.

Research on acupuncture effectiveness in treating infertility

Numerous small studies have demonstrated the effectiveness of acupuncture and electroacupuncture in treating infertility, both in the patient undergoing ART and in the patient not utilizing ART. Animal and human studies have shown an increased response to pituitary hormones and to stimulation medicines (gonadotropins), with an increased number of follicles. Estrogen levels are increased. Reproducible studies demonstrate a positive effect on uterine blood flow and uterine contraction and relaxation. In the journal Fertility and Sterility in April, 2002, researchers compared 80 women undergoing IVF along with acupuncture to an age and diagnosis-matched population of women undergoing IVF alone. Pregnancy rates were dramatically and significantly increased in the IVF-acupuncture group, from 26% to 43%. A few studies have demonstrated a measurable effect on male subfertility. More research is underway in Europe, China, and the U.S. to better quantify the effect of acupuncture on infertility.

What is Acupuncture? What are Meridians and Qi?
The language of Chinese Medicine is rich with metaphor. Qi, which is loosely translated as energy or vitality, courses through meridians, or channels, in the body in order to bring nourishment and life to all parts of the body. There are twelve principal internal organs that are also nourished by qi and blood. Acupuncture is the placement of very thin, solid needles in order to ensure the smooth flow of qi through the meridians. Acupuncture is also helpful in maintaining balance in the organs so that the body functions harmoniously and well. In Chinese Medicine it is vital to tend to the body when it is well. According to the Chinese classics, to wait until the body is sick to seek help is like waiting until one is thirsty to dig a well, or waiting until one is engaged in war to forge weapons. Chinese Medicine is preventive medicine, yet also effectively treats imbalances that present as disease.

Jing, translated as essence, is composed of two parts-prenatal jing and postnatal jing. Prenatal jing is inherited from the parents and is passed on to offspring, while postnatal jing is cultivated as a result of lifestyle and dietary choices. Both are essential for effective reproduction. Jing is correlated with the Western concept of chromosomal energy.

Chinese Medicine and Reproduction
Compared to Western medicine, the organs considered in Oriental Medicine have wider spheres of influence that include both their physiological functions and energetic aspects. Of the twelve organ systems identified by Oriental Medicine, three principal ones are involved in fertility according to Chinese classics. These are the Kidney, Liver, and Spleen. The Kidney system governs the basal reproductive energy through its storage of jing. In women, the jing is responsible for egg quality; in men, it is responsible for sperm quality. The Liver system stores the blood and has control over the facilitation of ovulation. The Spleen system makes the blood and qi and carries an energetic quality of holding. Through Spleen energy, the uterine lining can become thick and well-nourished to hold and support the developing embryo. From the perspective of Oriental Medicine, a diagnosis can be made regardless of whether the cause of a woman’s infertility has been identified in Western terms. The diagnosis, based on factors that include consideration of a woman’s symptoms, lifestyle and tendencies, dictates the treatment strategy. The following examples illustrate this idea:

Case Reports
Patient A is a 38 year old woman with a Western diagnosis of Polycystic Ovarian Syndrome (PCOS). She is 5’4” and weighs 206 lbs. Her day 3 level of Follicle Stimulating Hormone (FSH) was 16 within the past month. She mentions a sore back and knees, a ‘popping’ sensation in her ears at night, a sensation of feeling cold most of the time, and regular but long menstrual cycles (35-40 days). OM Diagnosis and Treatment Strategy: Patient A’s history points to a predominant Kidney qi deficiency. The elevated FSH reading indicates a depletion of the jing that is associated with diminished egg quality and reserve. Delayed menses, soreness in the back and knees, the popping sensation in the ears, and delayed menses are also signs of Kidney deficiency. Strengthening the Kidney system would be a reasonable approach with acupuncture.

Patient B is a 35 year old woman complaining of Pre Menstrual Syndrome (PMS) manifesting as irritability and cramps during both ovulation and menses. She tends to run a little warm and can become constipated easily. She sometimes gets an uncomfortable pain under her rib cage as her period starts. Periods are regular, occurring every 29 days. Her menstrual blood contains dark clots that cause pain when passing. She has never been pregnant, and her Western diagnosis is unexplained infertility. OM Diagnosis and Treatment Strategy: Patient B has Liver qi and blood stagnation. The cramps, irritability, rib pain, constipation, and menstrual clots all suggest that the Liver qi is not consistently regulating the flow of blood. Promoting the smooth flow of Liver qi and blood would be the goal of acupuncture treatment in this case.

Patient C is a 32 year old woman with a history of amenorrhea. She runs competitively. She reports dry skin and hair and difficulty falling asleep even when fatigued. Dull headaches, worse when she hasn’t eaten, bother her about once per week. Her work is stressful, and she tends to worry. She has a poor appetite that she admits may be a result of her trying to maintain strict control over her weight. She got pregnant a year ago but had a miscarriage at six weeks. She feels that she still hasn’t recovered the level of energy she had before the miscarriage. OM Diagnosis and Treatment: Patient C has Spleen qi and blood deficiency. Her lifestyle requires a great expenditure of qi without providing proper replenishment. Too low reserves of Spleen qi and blood may have contributed to the loss of her pregnancy a year ago. Strengthening her Spleen with acupuncture to produce quality qi and blood and suggesting lifestyle changes would be in order for this patient.

Each individual woman is affected by a variety of factors that have a role in her physiology. Diagnosis and treatment in Oriental Medicine takes as many of these factors into account as possible.

An Integrative Approach for Enhancing Fertility

Principles guiding treatment of infertility in Oriental Medicine have at their core a focus on promoting proper circulation in the meridians and organ systems related to reproduction. In addition, fostering a calm mind to promote the smooth flow of qi and blood is a primary goal of treatment. These principles work beneficially in concert with ART, which may or may not include in vitro fertilization (IVF) or intrauterine insemination (IUI) procedures. For patients using fertility drugs in timed intercourse cycles assisted with clomiphene, IVF, or IUI cycles, it is most common not to use Chinese herbs in conjunction with acupuncture. During an IVF cycle, patients are seen twice per week for six weeks preceding the egg retrieval and once within three to five days following the embryo transfer. In a similar manner, for an IUI cycle, patients follow the same schedule for acupuncture as for IVF until date of the HCG shot and once within three to five days following the insemination procedure. Depending on the Western diagnosis, it may be helpful for the male partner to receive acupuncture. Couples are advised to discuss any concerns about the intersection of Western treatment and acupuncture with their reproductive endocrinologist. When women are not undergoing ART, they are seen for acupuncture once a week for three to six months in preparation for pregnancy. The focus of treatment is the same as for ART but there is more flexibility to use Chinese herbs as an adjunct to treatment.

Other Therapies
In order to encourage fertility by incorporating several aspects of a woman’s life, other therapies that she can do at home are often proposed. These may include dietary suggestions and relaxation techniques. A varied diet containing fresh fruits and vegetables, whole grains, and healthy sources of protein. Spices may be helpful in moderation, but too much spicy food may have a dispersive effect that does not foster the smooth flow of qi and blood. In Oriental Medicine, a Law of Similars is observed when considering foods that may be useful in certain conditions. For example, the raspberry is likened to the shape and color of the uterus, so it is considered useful to consume raspberries for uterine health. Kidney beans and sesame seeds are both shaped like Kidneys, so they are incorporated into diets in which the Kidney system needs tonification. Wheat shafts grow upwards, so wheat is believed to raise the qi; root vegetables like carrots, potatoes and beets are believed to have a grounding effect on the qi. A diet of predominately cooked foods is advocated for the ease of digestion and the warming properties believed to result from their consumption; a diet consisting mostly of raw salads would be considered too cold to promote circulation in the meridians and organs related to reproduction. Patients are advised to limit their intake of dairy, stimulants, alcohol, and fatty and processed foods. Likewise, many patients have found relaxation techniques such as tai qi, qigong, yoga, meditation, and prayer to be useful. Lifestyle choices including getting enough rest, not working too much, and taking time for oneself are also important when attempting to enhance fertility.

About Metro Acupuncture
Metro Acupuncture is a centrally-located clinic in the Sandy Springs suburb of Atlanta, GA, specializing in infertility and women's health since 1997. Anna Kelly, MD is the medical director and founding acupuncturist. She is board certified in both anesthesiology and acupuncture. Dr. Kelly practices with three licensed acupuncturists (L.Ac), and the clinic offers several popular styles of acupuncture. Kerri Winston, Ph.D., L.Ac. has a Master of Science degree in Traditional Oriental Medicine from Pacific College of Oriental Medicine. She also received the Ph.D. in Chemical Engineering from the University of Washington in 1998 and enjoys research. She is nationally certified in Acupuncture and Chinese Herbology and is state licensed in Georgia and California. Mark Lewinter, L.Ac is a diplomate in Acupuncture and Chinese Herbology after receiving his Masters in Oriental Medicine from Southwest Acupuncture College. He is presently a student in philosophy and will receive his Masters in that field in 2006. David Jones, MPH, L.Ac. has a Master of Science degree in Traditional Chinese Medicine from Yo San University of Traditional Chinese Medicine in Los Angeles, California. He also earned a Master of Science in Public Health with an emphasis in Health Behavior through the University of Alabama School of Public Health. He has a special interest in mind/body medicine, wellness, and disease prevention.

Natural infertility treatment - Acupuncture