Integrative Fertility Enhancement

1. Integrative Fertility Enhancement Cathryn Hu, Ph.D., O.M.D., L.Ac.

2. Conflict of Interest and Financial Disclosure Integrative Fertility Enhancement Cathryn Hu, Ph.D., O.M.D., L.Ac. President of Advanced Acupuncture, Inc. Professor of Advanced Acupuncture Institute None

3. Celebrating A New Life The miracle baby

4. Human Reproductive System Human Sexuality: Conception from www.abuhmed.org

5. Hormones involves in the Menstrual Cycle

6. Basal Temperature Record

7. Eggs maturation and travel process

8. Ovulation Process www. newscientist.com

9. Fertility Enhancement Program-an integrative approach Two phases of treatment in our integrative program: • 1.Preparation phase: Treating the causation of infertility, nourishing the reproductive organs and their functions. • 2. Trial phase: Promoting the ovarian functions of follicle maturation and increasing the lining of the uterus.

10. The objectives of Preparation Phase • Stress relief • Causation of infertility • PMS treatment • Endometriosis • Hormone balancing • Increasing mucus secretion • Sperm quality & quantity improvement

11. The objectives of Trial Phase • Stimulating follicles maturation • Promoting the ovulation • Balancing FSH, Estrogen, LH and Progesterone • Integrative with IVF procedures • Integrative with IUI procedures

12. The Hormonal Imbalanced Conditions • High FSH level • Polycystic Ovarian Syndromes (PCOS) • Luteal phase defect • Endometriosis • Assistant Reproductive Technology (ART)

13. Other Causations of Infertility • Stress- -Flight-or-fight response -Glucocorticoids can raise its level and weaken the reproductive system, potentially making infertility condition worse. (Prolactin) • Age- Conception rate: 30’yrs, 40’yrs, decline 5-10 % each year Developing chromosomal abnormalities: < 35yrs -the rate of is 1:2000 compare to >35yrs,1: 400 Miscarriage: <30 yrs = 15 %, >40yrs =40 %

14. The Causations of Infertility in Traditional Chinese Medicine • Male- • Kidney yin deficiency • Kidney yang deficiency • Liver qi stagnation • Spleen qi deficiency • Blood stagnation • Female- • Kidney deficiency • Cold uterus • Blood deficiency • Liver depression • Stagnant heat • Phlegm dampness

15. Kidney Yin deficiency signs & symptoms • Scanty, dark discharge at the end of the period or amenorrhea • Severe lumbago, dizziness, tinnitus • Cold sensation in the lower abdomen, loose stools, copious, clear urine • Dark facial complexion • Tongue is pale with thin white coating • Pulse is deep, thread and weak

16. Cold Uterus • Prolonged menstrual discharge but scanty in volume and mixed with dark clots • Cold lower abdominal pain relieved by warmth • The tongue coating is thin and white • The pulse is deep and slow

17. Blood deficiency signs & symptoms • Withered, sallow complexion • Scanty menstrual discharge during the last days of the period but light in color, dizziness, blurred vision, dry skin, constipation • Insidious pain after menstruation. • Tongue is pale • Pulse is thready and weak

18. Liver depression signs & symptoms • Early or late menstruation, scanty in volume and dark in color • Abdominal distention • Premenstrual breast distention • Mental depression, eructation and sighing • Tongue is red with a thin coating • Pulse is wiry and rapid

19. Stagnant Heat signs & symptoms • Scanty menstrual volume, red purplish in color and mixed with clots. • Distention and pain in the lower abdomen, especially along the sides, which refuses palpation. • History of lumbar soreness • Distension & pain of the chest and hypochondrias • Tongue is red with a thin coating • Pulse is wiry and rapid

20. Phlegm dampness signs & symptoms • An obese constitution • History of excessive phlegm • Pallor or puffiness • Delayed menstruation or amenorrhea and excessive leucorrhea • Tongue has a thin, white coating • Pulse is wiry and slippery

21. Individualized Treatment Plan • Individualizedtreatment plan based on etiology • Acupuncture: EA for follicle phase MA for Luteal phase • Herbal formula: Individualized Raw herbs Granules Pills/tablets Decoctions • Moxibustion • Cupping

22. Frequencies & Lengths of Acupuncture Treatment • Cumulative effect of series • 10-12 sessions to begin cellular change. • Pre-cycle: 1-2/wk X 3-6 cycles • Trial phase: 2-3/wk X 6-9 cycles • Average: 6-12 cycles • Less frequency with herbal prescription • Speed of improvement proportional to the length of time of imbalance

23. Mechanisms of Acupuncture (1) a clinical observation in Shanghai, China • Highly increase of the egg production • Regulate the function of hormone levels • Influence in the gene expression in the brain, normalizing secretion of GnRH, LH, and E2.

24. Researches for acupuncture that benefits the fertility Sandra Emmons, M.D: -Oregon Health Science University • Acupuncture before the IVF, improve the success rate of pregnant woman. • Rate significantly higher in the patients combine the herbal treatment. Cornel University’s Weil Medical College: • Summed up acupuncture’s positive effect o infertility issues. • There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and treatment of female infertility.

25. Mechanisms of acupuncture (2)- a study in Harvard, • Endorphins releases Mitigate one’s response to stressful stimuli, enhance the possibility of conception • Minimize prolactin Elevated prolactin could cause irregular ovulation

26. Treatment Protocols (1)Stress-relieve • Objectives: • Reduces stress and minimizes prolactin • By release certain chemicals and neuron-transmitter, such as endorphin, ekenephilin and serotonin, specially benefits the ART patient go through their procedure smoothly • Tx Protocols: Acupuncture: Shenmen, P 6, Sp-6 Herbal formula: Suan Zao Ren Tang (Sour jujube decoction) • Frequency: Combine with other treatment

27. Integrative Acupuncture Tx • Reduces stress • Enhances hormone regulation • Regulates the menstrual cycle • Promotes the ovarian functions • Invigorate the sperm qualities • Treats PMS, Amenorrhea, Endometriosis and blocked fallopian tubes • Increases the effectiveness of IVF, GIFT, ZIFT, and ET. Procedures • Protects the fragile embryo • Strengthen the immune system

28. Acupuncture & IVF procedures -Research in Christian Lairize Institute in Germany • 160 women getting IVF • Acupuncture before & after the embryo transfer • 50% of the patients increased successful implantation. • IVF group= 26.3 % • IVF plus acupuncture = 42.5 % • AAI successful rate is 64.9 % of integrative IVF patients at December, 2007.

29. Acupuncture on the day of Embryo Transfer • Acu1= 95, on the day 36%/34% • Acu2 =91, on the day and 2 days after 36%/26% • Control=87, no acupuncture. 26%/22% • Conclusion: • Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ ICSI. Compare to no acupuncture. • 2. Repeating acupuncture on ET day and 2 days after provided no additional benefit • Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. • Fertility Clinic Tranglen, Hellerup, Denmark. • Fertil Steril. 2006 May;85(5):1341-6. Epub 2006 Apr 5.

30. Pain Relieve During Oocyte Retrieval • EA has proven analgesic effect • Frequency at 80/20/2 Hz • Study of 152 cases Conclude that No differences in EA Frequencies. Humaidan P. Brock KBungum L. Stener-Victorin E. The fertility clinic, Vyborg Hospital, Skive, DK7800 Skive, Denmark, Reprod Biomed. Online, 2006 Jul; 13, (1):120-S.

31. Acupuncture & Protection of Embryo • Acupuncture boost blood flow to women’s reproductive organs and providing better nourishment. • Improve the lining of the uterus, enhance the embryo becomes embedded after conception. • Improve implantation and prevent the risk of miscarriage.

32. Herbal Treatment • Affects many parts of the reproductive cycle by triggering the bodies own natural processes. • Trigger the hypothalamus and pituitary to release hormones that stimulates the production of FSH and LH • Individualized herbal formula is most effective • Follow up monthly objective evaluation of hormone test. • Aware of the ART treatment and drug interactions.

33. Individualized Herbal Treatment • Mainly to nourish the reproductive organs, enhance ovarian function, promote follicles maturation and increase linings of the uterus. • Classic Herbal formula • Individualized herbal formula modification • Length of treatment various from 2 to 6 cycles • Safe for early pregnancy and prevent miscarriage.

34. Herbs that Benefits Fertility

35. Classic Herbal Formulas Benefits Fertility • 1. Yu Lin Zhu- kidney deficiency • 2. You Gui Wan- kidney deficiency • 3. Wu Zi Yan Zong Wan-kidney deficiency • 4. Ai Fu Nuan Gong Wan-cold uterus • 5. Ren Shen Yang Rong Tang-Blood deficiency • 6. Yang Jing Zhong Yu Tang-Blood deficiency • 7. Chai Hu Shu Gan San-liver depression • 8. Kai Yu Zhong Yu Tang-liver depression • 9. Qi Re Xiao Yu Tang- Stagnant heat • 10. Xiao Zhi Mo Dao Tan Tang-Phlegm dampness • 11. Qi Gong Wan-Stagnant heat

36. Herbal Treatment Prevents Miscarriage-a Study from Fudan University of Shanghai, 2001 • The process of conception and pregnancy involves a suppression of the T-help immune response • Herbal medicine could inhibit specific immune injury, reprogram the immune system to not react to self-tissue, allow the normal suppression involved in implantation to occur. • Individualized herbs: Du zhong • Classical Formulas: Dingxiang shi di tang (Clove and Persimmon Calyx decoction)

37. Objective Evaluations • Initial evaluation • Infertility -causation • Consider the etiology in TCM • Refer to fertility specialist • Evaluates partner’s health conditions • Release medical records for the history of illness • Follow up evaluation: • Monthly hormonal tests: • Day 2/3: FSH, Estrogen, prolactin • During ovulation: Basal temperature chart, mucus and ovulation kits • Day 21 or 7 days post ovulation: Progesterone • Ultrasound: • Day 2: # of follicles & size • Day12/13: sizes of follicles • Follow up with fertility physician’s plan closely and report any unexpected reactions.

38. Food Flavors Recommendation • Sweet-Tonifies and harmonizes and relaxes. • Pungent- Dispersing and invigorating, promote circulation, moves Qi, blood, & body fluid. • Sour Astringent-Absorbing, consolidating • Bitter- Dries damp, disperses, often clears, damp, edema and heat • Salty-softens and dissolves hard masses. Moistens and lubricates the intestines • Bland- diuretic, promotes urination and relieves edema

39. Foods that Invigorates Blood

40. Foods Nourishes Blood

41. Foods that Benefits the lining growth

42. Food for clear the heat

43. Food for drain dampness

44. Foods that detoxifies

45. Foods that Relieves Food Retention

46. Foods that benefits kidney deficiency

47. Food that Strengthen Digestion

48. Prenatal Vitamins-Woman • Folic Acid- 400mg/day- development of baby’s brain and spinal cord (fortified cereals, green leafy vegetables, citrus, grapefruit) • Calcium- bone develop • Iron-prevent anemia ( green leaf vegetable, red meat) • Fibers- 30-35g/day (unrefined grains, whole wheat, beans, fruits and vegetables

49. Part II: Male Factors

50. Infertility isn’t just the woman’s problem anymore • 40-50 % male infertility • Inadequate # of sperm • Inhibited ejaculation • Retrograde ejaculation • Failure of descend into the scrotum • Antibodies to the sperm