Explanations and answers
Explanations and answers
You’ve decided to try…
In the past decade, the number of first-time births after the age of 40 has risen by 40%. This isn’t surprising, since happily, in the modern world women benefit from equal opportunity. These social changes have created a reality in which women start trying to fall pregnant at a later age compared to previous decades. This is all well and good, but age should not be taken for granted – it is a significant factor in the chances of getting pregnant, but it is equally important not to stress, since today there are treatments that increase the chances of pregnancy at a later age.
It’s important to know the facts:
Fertility decreases with age. Up to the age of 35, the chances of getting pregnant each month are around 25%-30%, whereas after 40, chances drop to around 5% a month, depending on your ovarian reserve, which can be measured in a blood tests for FSH and AMH. Nonetheless, there are women who fall pregnant easily even in this age range, and anyway, as we said – don’t stress! It doesn’t help and may even do harm. Medicine offers a diverse variety of solutions that will be personally tailored to your condition, and acupuncture is effective in supporting your fertility. If you are 35+, I will suggest that you have your hormonal profile tested (blood test), and from there we will proceed according to the results. For women in this age range, I will design a special diet that includes foods that contain phytoestrogens, such as soy products, and other foods with estrogen receptor affinity.
DHA is an omega-3 fatty acid. Studies have shown that it contributes to ovulation based on the assumption that DHA fatty acids lead to an increase in progesterone secretion, which in turn contributes to endometrial thickness, an essential condition for embryo implantation. Significant research on the subject is still lacking, and consequently there is no clear recommendation by the Ministry of Health as to DHA supplementation. Incidentally, DHA has been found to be important to male fertility due to its effect on sperm quality. When I treat patients in the 35+ age group I generally recommend food supplements known to have positive effects on fertility, such as myo-inositol, melatonin and CoQ10.
Polycystic ovaries are usually enlarged, and although they contain a large number of follicles, the follicles are small. This prevents regular monthly ovulation and can cause fertility problems, but the condition can be resolved with medication. Polycystic ovaries can be diagnosed with ultrasound, but an image of a polycystic ovary is not necessarily indicative of polycystic ovary syndrome (PCOS), which is a hormonal disorder that indeed affects fertility due to anovulation (lack of ovulation). Research has shown that losing excess weight, making lifestyle changes, the right nutrition and treatment with medication to restore hormone balance have a favorable effect on PCOS and thus, will help with related infertility issues.
An irregularly shaped uterus is not a disease. There are mechanical problems that can be expressed in a change in cervical structure as a result of damage (following surgery) or an infection, and there are mechanical problems related to the structure of the uterus such as a uterine septum, where the uterus has a wedge of extra tissue (septum) hanging from the top that can extend all the way down to the cervix, functionally dividing the uterus into two cavities, or a polyp inside the uterus, both of which can prevent implantation. Another mechanical problem could be associated with the fallopian tubes: if one of them is blocked, the sperm cannot reach the egg. All of these issues can only be diagnosed using imaging (such as ultrasound or a hysterosalpingogram (HSG), a test that uses X-rays and a special dye to detect scar tissue, polyps and other growths that may be blocking your tubes or preventing a fertilized egg from implanting properly), and there are medical procedures that resolve or bypass these issues to enable you to fall pregnant.
Fertility tests are not intended to determine that you have a fertility problem but for exploratory purposes! and then to suggest the most suitable solution. I will immediately describe the initial tests, but please note that this is a partial, general list, and I will be happy to refer you to a fertility specialist, who will decide which tests you need to have.
To determine your hormonal profile. The test is generally done between the second and fifth day of your menstrual cycle, in most cases between the second and third day. You may also be asked to have general blood tests and thrombophilia (clotting) screening.
A scan of your ovaries to check follicle development is generally done close to your ovulation date. In the scan, endometrial thickness will also be assessed to make sure that it will support implantation, and your fallopian tubes scanned to make sure that they will allow for the successful passage of the fertilized egg to the uterus.
A thin, lighted tube is inserted into the vagina to examine the cervix and the inside of the uterus, as well as the endometrium and fallopian tubes. The test is not done during your period to allow for good visibility and can be performed under general anesthesia, which is recommended in cases where a surgical procedure is required, such as an endometrial biopsy or septum removal.
An HSG will be performed immediately after your period has ended. A contrast medium is injected into the uterine cavity so that X-ray images of the uterine cavity and the passage between the fallopian tubes and the uterus can be taken.
It’s also important for your partner to have a sperm morphology test and an examination to rule out undescended testes (cryptorchidism), etc.
The post-coital test examines sperm survival in cervical mucus. PCT is performed during your ovulation. You will be asked to have sex 4-12 hours before the test, and a sample of your cervical mucus will be taken to determine whether your partner’s sperm are migrating into your reproductive system
The assumption that “the body needs to detox” before a planned pregnancy is mistaken! There is no need to detox, because the active ingredient in the pill is eliminated by the body a few hours after the pill was taken and no longer has any effect, regardless of the length of time you have been on the pill. But it’s important to be aware that your menstrual cycle may take time – weeks or even months – to reestablish itself in terms of regularity. Acupuncture can help balance the hormonal system and restore a regular menstrual cycle.
Incidentally, if you became pregnant while on the pill, this doesn’t appear to increase the risk of birth defects and there is no need for an abortion.
I want to start trying to get pregnant – when is the best time of the month to try for a baby?
How can I tell when I’m ovulating?
Menstrual cycle refers to the number of days from Day 1 of bleeding to Day 1 of bleeding in your next period.
Period is the number of continuous days of bleeding within each of your menstrual cycles.
Ovulation is the time when you are fertile and it is the only time in the menstrual cycle when you can fall pregnant, typically lasting just 48-72 hours.
Most women know when they will be getting their next period, if their periods are regular. Ovulation occurs when the ripe egg is released from the ovary into the fallopian tube, where it waits, ready to fertilized. Generally, ovulation occurs around 14 days before your next period. Meaning, if you have a regular cycle of 28-35 days, the calculation is simple: calculate the length of your average menstrual cycle in the past three months and deduct 14 days. For example, if your cycle is 28 days you probably ovulate at around Day 14, and if your cycle is 35 days, you ovulate on Day 21. Today, ovulation home tests are available, or you can have your follicles monitored. Most research recommends having sex 4 days before ovulating, 2 days before ovulating, on the day you ovulate and 2 days after ovulating – just to be on the safe side! Sperm is patient: it waits 48-72 hours for the egg to arrive, and that’s your window of opportunity to get pregnant. Some women actually feel themselves ovulating, as they experience a dull pain on the side of the abdomen where the ovary is releasing an egg. Sometimes the pain is accompanied by transparent vaginal discharge, similar to egg white.
One way or another, as you plan your pregnancy, it’s a good idea to make an appointment with your gynecologist to go over your medical history and have preliminary tests – a gynecological examination, blood tests, genetic tests, vaccines, a pap smear and others.
Checking your basal body temperature (BBT) may detect ovulation, but since the temperature rises after you have already ovulated, when your chances of conceiving are lower, I recommend that you look for the days that precede ovulation.
How to do it: Every morning, from the first day of your menstrual cycle, take your temperature first thing when you wake up – after ovulating, the body temperature usually rises 0.5⁰C to 1⁰C due to the effect of progesterone.
The main advantage of checking your BBT is to help women with irregular periods to work out when they will have their period in the following months. I believe that this method is inefficient in determining when you will ovulate and I tend to recommend it less.
Folic acid is a B vitamin that significantly lowers the risk of the unborn baby having a neural tube defect. Taking folic acid is recommended throughout your reproductive years and particularly in the three months before conceiving as well as during your pregnancy. The recommended dose is 400 micrograms (mcg) daily.
Other vitamins recommended by the Ministry of Health during a normal pregnancy are iodine (150-250 mcg/day), vitamin D – 5-10 mcg/day, and there are dietary supplements that contain all of the above, such as Prenatal, a multivitamin for pregnant women, and others.
Health organizations recommend genetic testing for all couples planning a pregnancy. Exactly which tests are recommended is determined according to each parent’s origin. Expanded genetic testing to rule out rare genetic diseases is available privately. Pre-pregnancy genetic counseling will be recommended if there are genetic disorders that run in the family, which might be hereditary.
The recommended tests are for fragile X syndrome (FXS) (an inherited genetic disease causing mental disability); testing and screening to detect autosomal recessive disorders: Tay-Sachs, cystic fibrosis (mostly among Ashkenazi Jews); Gaucher and Canavan diseases (among Ashkenazi Jews); Bloom syndrome (mainly among Ashkenazis); Fanconi anemia, familial dysautonomia (among Ashkenazi Jews only if both parents are carriers; in this case the unborn is at risk of disease); screening for muscular dystrophy, spinal muscular atrophy (SMA), thalassemia, Costeff syndrome (for couples of Iraqi descent), summary metachromatic leukodystrophy (MLD) (for couples of Yemenite descent), mucolipidosis type IV (ML4) (for couples of Ashkenazi descent), ataxia telangiectasia (for couples of North African/Moroccan descent); Niemann-Pick (Ashkenazis); glycogen storage disease type 1 (Ashkenazi Jews); and testing for Usher syndrome.
It’s a good idea to check your vaccination status before you are pregnant, since there are infectious diseases that can be harmful to the fetus. It’s important to make sure you have been vaccinated against measles, mumps, rubella (German measles) and chickenpox – these vaccines are live attenuated vaccines and are not given during pregnancy! Consequently, it is recommended to have the MMR (measles, mumps, rubella) vaccine and the varicella (chickenpox) vaccine before getting pregnant. You can have inactivated vaccines (killed vaccines), such as against whooping cough or ‘flu, while you are pregnant – they pose no danger to the fetus and you should have them before or while you are pregnant.
If you’re overweight, it can cause problems in conceiving and affect your health during your pregnancy, and even compromise your unborn baby’s health. I recommend consulting a dietitian for professional help in losing weight before you get pregnant – now you have a good reason and lots of motivation, for you and your baby!
Recent research has shown that there is a connection between obesity and polycystic ovary syndrome, which is liable to cause irregular periods, increased levels of male hormones and infertility. Women with abdominal obesity were found to suffer from a mutation in the IL-6 gene, which is also involved in the pathophysiological characteristics associated with polycystic ovary syndrome. Being overweight or underweight increases the risk of complications during pregnancy; if you’re overweight, this could lead to gestational diabetes and high blood pressure. Obesity can lead to reduced fertility; a BMI of more than 25 is considered overweight, and a BMI of 30 and above is considered obese. Controlled weight loss is likely to dramatically improve the quality of your ovulation and help regulate your period.
There are acupuncture points that are known to be associated with the female reproductive system and to affect the hormonal system. By needling acupoints in the ovary area, we will induce blood flow to encourage ovarian stimulation and influence your ovulation and egg quality. There are acupuncture points that have been proved in clinical trials to stimulate the flow of blood to the uterus and can be used to affect the endometrium – a thick endometrium is critical for embryo implantation.
Since the hormonal system is also connected to the nervous system and both systems affect each other, I will always include acupoints that directly affect the parasympathetic nervous system and cause the brain to release “feel-good” brain chemicals such as endorphins. Your emotional condition has a big effect on your fertility. Stress has been measured and has been proven a major cause of fertility issues, and acupuncture has been found to be highly effective in treating stress. Acupuncture uses very thin needles, in most cases is painless and sometimes, isn’t even felt at all.
You’re having difficulty…
In the past decade, the number of first-time births after the age of 40 has risen by 40%. This isn’t surprising, since happily, in the modern world women benefit from equal opportunity. These social changes have created a reality in which women start trying to fall pregnant at a later age compared to previous decades. This is all well and good, but age should not be taken for granted – it is a significant factor in the chances of getting pregnant, but it is equally important not to stress, since today there are treatments that increase the chances of pregnancy at a later age.
It’s important to know the facts:
Fertility decreases with age. Up to the age of 35, the chances of getting pregnant each month are around 25%-30%, whereas after 40, chances drop to around 5% a month, depending on your ovarian reserve, which can be measured in a blood tests for FSH and AMH. Nonetheless, there are women who fall pregnant easily even in this age range, and anyway, as we said – don’t stress! It doesn’t help and may even do harm. Medicine offers a diverse variety of solutions that will be personally tailored to your condition, and acupuncture is effective in supporting your fertility. If you are 35+, I will suggest that you have your hormonal profile tested (blood test), and from there we will proceed according to the results. For women in this age range, I will design a special diet that includes foods that contain phytoestrogens, such as soy products, and other foods with estrogen receptor affinity.
DHA is an omega-3 fatty acid. Studies have shown that it contributes to ovulation based on the assumption that DHA fatty acids lead to an increase in progesterone secretion, which in turn contributes to endometrial thickness, an essential condition for embryo implantation. Significant research on the subject is still lacking, and consequently there is no clear recommendation by the Ministry of Health as to DHA supplementation. Incidentally, DHA has been found to be important to male fertility due to its effect on sperm quality. When I treat patients in the 35+ age group I generally recommend food supplements known to have positive effects on fertility, such as myo-inositol, melatonin and CoQ10.
“Fertility problem” is a very broad definition and will only be treated as such after you have had regular unprotected sex for at least a year trying to fall pregnant and haven’t. The best approach is to look at the big picture, and after I have asked you about all the factors that could affect your fertility, such as your menstrual cycle, your lifestyle in terms of nutrition, sleep and work habits, I may possibly refer you to a fertility specialist for tests to complete the picture and build a treatment plan that is tailored to your condition. In many cases, no clear medical cause is found, and there are cases in which I discover impatience rather than inability to conceive!
The good news is that in most cases, there is a solution – if a particular fertility issue has been found, a treatment plan will be tailored for you, and acupuncture is able to support the chosen treatment and increase the chances of its success.
If no medical problem has been diagnosed as an underlying cause of your inability to conceive, which is known in the professional jargon as unexplained infertility, your treatment will most likely consist of nutritional counseling and acupuncture, which will integrate treating both your hormonal and nervous systems.
Polycystic ovaries are usually enlarged, and although they contain a large number of follicles, the follicles are small. This prevents regular monthly ovulation and can cause fertility problems, but the condition can be resolved with medication. Polycystic ovaries can be diagnosed with ultrasound, but an image of a polycystic ovary is not necessarily indicative of polycystic ovary syndrome (PCOS), which is a hormonal disorder that indeed affects fertility due to anovulation (lack of ovulation). Research has shown that losing excess weight, making lifestyle changes, the right nutrition and treatment with medication to restore hormone balance have a favorable effect on PCOS and thus, will help with related infertility issues.
An irregularly shaped uterus is not a disease. There are mechanical problems that can be expressed in a change in cervical structure as a result of damage (following surgery) or an infection, and there are mechanical problems related to the structure of the uterus such as a uterine septum, where the uterus has a wedge of extra tissue (septum) hanging from the top that can extend all the way down to the cervix, functionally dividing the uterus into two cavities, or a polyp inside the uterus, both of which can prevent implantation. Another mechanical problem could be associated with the fallopian tubes: if one of them is blocked, the sperm cannot reach the egg. All of these issues can only be diagnosed using imaging (such as ultrasound or a hysterosalpingogram (HSG), a test that uses X-rays and a special dye to detect scar tissue, polyps and other growths that may be blocking your tubes or preventing a fertilized egg from implanting properly), and there are medical procedures that resolve or bypass these issues to enable you to fall pregnant.
Fertility tests are not intended to determine that you have a fertility problem but for exploratory purposes! and then to suggest the most suitable solution. I will immediately describe the initial tests, but please note that this is a partial, general list, and I will be happy to refer you to a fertility specialist, who will decide which tests you need to have.
Blood tests: To determine your hormonal profile. The test is generally done between the second and fifth day of your menstrual cycle, in most cases between the second and third day. You may also be asked to have general blood tests and thrombophilia (clotting) screening.
Ultrasound (US): A scan of your ovaries to check follicle development is generally done close to your ovulation date. In the scan, endometrial thickness will also be assessed to make sure that it will support implantation, and your fallopian tubes scanned to make sure that they will allow for the successful passage of the fertilized egg to the uterus.
Hysteroscopy: A thin, lighted tube is inserted into the vagina to examine the cervix and the inside of the uterus, as well as the endometrium and fallopian tubes. The test is not done during your period to allow for good visibility and can be performed under general anesthesia, which is recommended in cases where a surgical procedure is required, such as an endometrial biopsy or septum removal.
HSG: An HSG will be performed immediately after your period has ended. A contrast medium is injected into the uterine cavity so that X-ray images of the uterine cavity and the passage between the fallopian tubes and the uterus can be taken.
It’s also important for your partner to have a sperm morphology test and an examination to rule out undescended testes (cryptorchidism), etc.
PCT: The post-coital test examines sperm survival in cervical mucus. PCT is performed during your ovulation. You will be asked to have sex 4-12 hours before the test, and a sample of your cervical mucus will be taken to determine whether your partner’s sperm are migrating into your reproductive system.
Miscarriage in the early stages of pregnancy is common among women of all ages. It is a very sad experience, and the sense of loss is even worse if it has happened more than once. In most cases, women miscarry before the pregnancy has been clinically diagnosed, or after the eighth or ninth week. The most common cause of losing a pregnancy is a chromosomal abnormality (a genetic disorder of the fetus).
When is recurrent pregnancy loss defined as such? This varies between countries in terms of the number of miscarriages defined as “recurrent pregnancy loss”; generally, the number is around 3. In 50% of cases the cause cannot be identified, and in the rest, the following will be investigated: if the mother has preexisting medical conditions, uterine disorders (congenital, or the uterus is scarred following surgery or D&C), endocrine (thyroid) disorders, lack of progesterone, which plays an important part in supporting pregnancy in its initial stages, etc. Cervical insufficiency, or an incompetent cervix, may cause recurrent pregnancy loss, usually in the second trimester; in these cases, miscarriage can be prevented through a procedure called a cerclage, in which your doctor will sew a stitch around the weakened cervix to make it stronger, a procedure that is usually performed at 13 to 15 weeks of pregnancy.
So when should this be looked into? After how many miscarriages? If you are young and have no specific fertility issues, the recommendation is to see a specialist after three miscarriages, since there is a good chance of more than 75% that your next pregnancy will be healthy and successful. If you are older or have an existing fertility problem, you should see a specialist after two miscarriages. Acupuncture has been found to be effective among women who have suffered a number of recurrent pregnancy losses, and is even recommended as preventive treatment. Using acupuncture, we will stimulate blood flow to the uterus to thicken the endometrium, and to the fetus to support it and ensure that it continues to develop. Acupuncture will also address the mother’s emotional and mental state by supporting the nervous system and releasing tensions. We will make sure that you are in the best condition possible for the embryo to implant and to protect your pregnancy.
Checking your basal body temperature (BBT) may detect ovulation, but since the temperature rises after you have already ovulated, when your chances of conceiving are lower, I recommend that you look for the days that precede ovulation.
How to do it: Every morning, from the first day of your menstrual cycle, take your temperature first thing when you wake up – after ovulating, the body temperature usually rises 0.5⁰C to 1⁰C due to the effect of progesterone.
The main advantage of checking your BBT is to help women with irregular periods to work out when they will have their period in the following months. I believe that this method is inefficient in determining when you will ovulate and I tend to recommend it less.
If you’re overweight, it can cause problems in conceiving and affect your health during your pregnancy, and even compromise your unborn baby’s health. I recommend consulting a dietitian for professional help in losing weight before you get pregnant – now you have a good reason and lots of motivation, for you and your baby!
Recent research has shown that there is a connection between obesity and polycystic ovary syndrome, which is liable to cause irregular periods, increased levels of male hormones and infertility. Women with abdominal obesity were found to suffer from a mutation in the IL-6 gene, which is also involved in the pathophysiological characteristics associated with polycystic ovary syndrome. Being overweight or underweight increases the risk of complications during pregnancy; if you’re overweight, this could lead to gestational diabetes and high blood pressure. Obesity can lead to reduced fertility; a BMI of more than 25 is considered overweight, and a BMI of 30 and above is considered obese. Controlled weight loss is likely to dramatically improve the quality of your ovulation and help regulate your period.
There are acupuncture points that are known to be associated with the female reproductive system and to affect the hormonal system. By needling acupoints in the ovary area, we will induce blood flow to encourage ovarian stimulation and influence your ovulation and egg quality. There are acupuncture points that have been proved in clinical trials to stimulate the flow of blood to the uterus and can be used to affect the endometrium – a thick endometrium is critical for embryo implantation.
Since the hormonal system is also connected to the nervous system and both systems affect each other, I will always include acupoints that directly affect the parasympathetic nervous system and cause the brain to release “feel-good” brain chemicals such as endorphins. Your emotional condition has a big effect on your fertility. Stress has been measured and has been proven a major cause of fertility issues, and acupuncture has been found to be highly effective in treating stress. Acupuncture uses very thin needles, in most cases is painless and sometimes, isn’t even felt at all.
Thinking about IVF?
IUI, intrauterine insemination, is recommended in cases where there is a mild fertility problem, usually unexplained, or, alternatively, for donor insemination. The semen undergoes a process of sperm “washing”, which enables a concentrated amount of healthy sperm to be collected, and then directly injected into your uterine cavity to increase the chances of pregnancy by “saving” the time and distance the sperm has to travel and enabling a larger amount of strong sperm to get closer to the fertilization location, making it easier to fertilize your egg. IUI is the treatment of choice in cases of poor egg quality or problems with sperm delivery (in these cases, the sperm can also be enhanced), in cases of unexplained infertility and cervical stenosis or abnormalities.
IUI can be done “naturally” by synchronizing the insemination with ovulation, or supported by hormone therapy (to increase the number of mature follicles). On the insemination day, semen is collected from the father and undergoes preparation – sperm washing and separation of the sperm cells from the seminal fluid – rendering a concentrated amount of healthy sperm, which is injected into the uterus. IUI does not require anesthesia.
Acupuncture is highly recommended in IUI procedures. Before insemination, we will stimulate blood flow to the ovaries to induce effective ovulation – mature follicles and healthy eggs, and we’ll also use acupuncture to help the patient to be calm and relaxed to prevent uterine cramping. Immediately after insemination, we’ll use acupuncture to increase blood flow to the uterus to thicken the endometrium, which is crucial for implantation, and we’ll continue to maintain blood flow to the uterus to support the embryo’s development.
IVF is the treatment of choice for women who are unable to conceive naturally, and when hormone therapy or artificial insemination have been unsuccessful.
What happens in IVF?
The woman’s egg is fertilized by the man’s sperm outside the uterus, in laboratory conditions.
The fertilized egg – the embryo – is returned to the uterus, and the mother is given hormones to sustain the development of her pregnancy.
Who is IVF suitable for?
IVF is recommended when a woman’s fallopian tubes are blocked or otherwise damaged, when adhesions have formed around the ovaries, when there are male fertility problems and for gestational surrogacy.
What happens in the process?
The woman will be treated with hormones to stimulate her ovaries to produce a large number of follicles, which will develop into mature eggs that will be harvested from the woman’s body at a precisely determined time using gentle suction (the procedure is guided by ultrasound). At the same time, the man will provide sperm in a special, sterilized test tube. The sperm will be screened and enhanced, and now the magic begins: the eggs and sperm are placed in a petri dish for fertilization. The eggs will divide into a certain number of cells (6-12), and the fertilized egg/s (embryo/s) will be transferred to the woman’s uterus, which is treated with hormones to create optimal conditions for embryo implantation. If a number of eggs are fertilized and several embryos have developed, the practice is to freeze some of them for future use.
So yes, the IVF procedure isn’t simple, but once you understand the various stages it all looks different and much less daunting.
Step 1: The ovaries are stimulated to induce ovulation.
Step 2: The eggs are harvested.
Step 3: The sperm is prepared and washed.
Step 4: Fertilization in the lab.
Step 5 (the final stage): Embryo transfer.
There are two traditional protocols – long (agonist) and short (antagonist). The Long Protocol aims to control ovulation and prevent early ovulation. To achieve this, the woman will have hormonal treatment: she will take medications that affect the action of the pituitary gland by suppressing its secretions, or in other words – prevent spontaneous ovulation. Only after the woman has had her first period following this suppression will ovarian stimulation begin.
In the Short Protocol, drugs are used to immediately suppress the pituitary gland and prevent spontaneous ovulation, allowing ovarian stimulation to begin much sooner.
Research has proved that acupuncture has a definite, important effect on IVF success rates
For three years, I led a clinical trial at the Homerton Fertility Centre at Homerton University Hospital in London. The goal was to examine and compare two random groups of women undergoing IVF. One group underwent IVF only, whereas the other was treated with acupuncture according to a certain protocol in addition to conservative IVF. Pregnancy and live birth rates were examined, and the group that was treated with acupuncture in addition to the IVF protocol delivered significantly higher pregnancy and live birth rates – meaning that acupuncture significantly increased IVF success rates. The study also examined and compared quality of life and possible IVF side effects between the two groups, and here again, we found an advantage for the group that had also been treated with acupuncture – they reported fewer side effects (such as hyperhidrosis (excessive sweating), mood swings, abdominal swelling and pain, constipation, edema, sleep disturbances, etc.) and overall, felt better – physically and emotionally – than the women in the control group.
Generally, women come to me one to three months before beginning IVF to prepare the ground, prepare their bodies (and minds) for the procedure, balance their hormones, be treated to relax their nervous system so they start the process feeling calm and without any extra stress, and to regulate an irregular menstrual cycle by freeing blocks and increasing blood flow to the uterus. I’ll explain to you exactly what you will be going through, step by step, and which tools you will need to cope and go through the process in the best way possible. At this point, it’s important to prepare the body for pregnancy. I’ll explain about the right diet, based on foods that contain folic acid and fatty acids and supplements that are known to be beneficial for fertility, such as iodine and vitamin D, and about hot foods that warm the area of the uterus so that it is ready to accommodate an embryo.
In all stages of your fertility treatment, I will treat you on the basis of a research-based treatment protocol that changes according to the different stages of the fertilization process. In the ovarian stimulation phase, the goal of acupuncture is to stimulate blood flow to the ovaries, and then again before your eggs are harvested. We will also use acupuncture to treat the nervous system so that you are relaxed during the retrieval process and do not experience uterine cramps. Before the embryo transfer, treatment with acupuncture is very important to increase blood flow to the uterus and make sure that the endometrium is thick enough, which is crucial for implantation. And on the transfer day, acupuncture before and after the transfer is very important too.
Acupuncture has been found to be effective in reducing and preventing side effects associated with IVF!
The side effects that sometimes accompany fertility treatments are usually the result of hormonal treatments and can be expressed in the form of abdominal swelling, fluid retention, constipation, abdominal pain and nausea. Many women report mood swings, trouble sleeping and sometimes, the challenging process also causes anxiety and stress.
So how can acupuncture help? By building a treatment plan that will balance your hormonal system, and by choosing acupuncture points that have a direct, proven effect on the parasympathetic nervous system, the result is a patient whose hormones are balanced, a patient who is more relaxed and far less tense and anxious. Patients report that while they were being treated with acupuncture, they already felt themselves relax as their stress level decreased. Acupuncture will also be used to support your digestive system to prevent constipation and bloating, and I will recommend a diet that prevents water retention and promotes efficient digestion.
I’ll be with you at this stage and throughout the whole process to calm you, listen to you, to explain the physiological processes you are undergoing, and to treat any side effects you may be experiencing so that they are relieved, and even prevented! Many patients who had IVF in the past and then had acupuncture in the present round say that it’s a completely different experience with acupuncture, that this time, they didn’t have the side effects they had experienced in the earlier rounds.
What drugs are used in IVF?
Four kinds of medications are used in the IVF process:
Hormonal treatment to prevent early ovulation: Of the agonist group, such as Synarel and Buserelin, or of the GnRH antagonist group, such as Cetrotide or Orgalutron.
Hormonal treatment to stimulate growth of ovarian follicles: Treatment includes follicle stimulating hormone (FSH) given as an injection (usually by the patient herself). Examples are Gonal-F, Puregon, Menogon and Menopur.
Hormonal treatment to induce ovulation: Contains the hormone beta-hCG so that the egg will fully mature. Examples are Chorigon and Pregnyl.
Hormonal treatment to increase endometrial thickness: Medications containing progesterone/estrogen to thicken the endometrium for implantation, such as Endometrin, Crinone, Progynova and Estrofem.
There are acupuncture points that are known to be associated with the female reproductive system and to affect the hormonal system. By needling acupoints in the ovary area, we will induce blood flow to encourage ovarian stimulation and influence your ovulation and egg quality. There are acupuncture points that have been proved in clinical trials to stimulate the flow of blood to the uterus and can be used to affect the endometrium – a thick endometrium is critical for embryo implantation.
Since the hormonal system is also connected to the nervous system and both systems affect each other, I will always include acupoints that directly affect the parasympathetic nervous system and cause the brain to release “feel-good” brain chemicals such as endorphins. Your emotional condition has a big effect on your fertility. Stress has been measured and has been proven a major cause of fertility issues, and acupuncture has been found to be highly effective in treating stress. Acupuncture uses very thin needles, in most cases is painless and sometimes, isn’t even felt at all.
You’re already pregnant!
You can have acupuncture at any stage of your pregnancy, even during the very early or final stages, and even while giving birth!
For women who have experienced recurrent pregnancy losses, I recommend acupuncture treatments already in the first trimester to sustain the pregnancy by increasing blood flow to the uterus and fetus. Sometimes women who have had miscarriages are stressed and anxious, mainly in the first trimester, so acupuncture for anxiety and stress relief is important to enable optimal conditions for the patient as her pregnancy progresses.
Generally, women come for acupuncture treatments in the first trimester when they suffer from morning sickness. In this case, acupuncture has been found to be very effective, and sometimes a patient will be sent home with small needles or magnets with transparent tape on her ear or near her wrist – the locations of the acupoints that are known to be helpful in treating morning sickness. In the second trimester, women come for treatment to restore their bodies’ overall balance and to strengthen their immune system, and of course, each treatment is personally tailored on the basis of a diagnosis. Because the body is going through changes, backache and leg pain are possible, which can be treated with acupuncture and advice on how to maintain correct posture, and certain exercises are given (I had the good fortune to study with one of the greatest experts in the U.S., Claudia Citkovitz, from whom I learned how to support pregnant women throughout all stages of their pregnancy, through to the birth itself).
As the third trimester draws near, we will begin to prepare the body for the birth. At this stage, it’s important to build “energy reserves” in the body via the kidney meridian, which in Chinese medicine is considered the most important for the mother’s and fetus’s immune system. We will stimulate blood flow to the pelvic and pelvic girdle area, and, of course, we will stimulate blood flow to the uterus, to the fetus, since he or she is the star of the event and must be ready and prepared!
As the last part of the third trimester draws close, most babies are in a headfirst position in the mother’s uterus. Breech presentation refers to a situation where the baby is in a bottom-first or feet-first position. In the early stages of pregnancy this is common and poses no problem, but as the birth draws near the situation should be addressed, and acupuncture has been proven in research as effective. Generally, at 35 weeks we will start treating the mother with acupuncture daily so that the baby will turn, by inserting a needle into a specific point or warming the point using a special technique called moxibustion, which has been proved to be effective in numerous clinical trials.
Some women suffer from morning sickness and vomiting in the first trimester. In these cases, acupuncture has been found to be highly effective. In many cases, the patient will be sent home with small needles or magnets with transparent tape on her ear or near her wrist – the locations of the acupoints that are known to be helpful in treating morning sickness and vomiting. Patients will also be supported by needling acupoints that affect the digestive system and balance stomach acidity.
Acupuncture is effective in treating heartburn (acid reflux) during pregnancy, and there is one acupoint that is considered to “work like magic”, since its positive effect on heartburn is dramatic, and pressure can even be applied by the patient herself. In these cases, I will also usually recommend a specific diet which involves abstaining from foods that increase acidity, such as meat and citrus fruits, nightshade vegetables and dairy products, and on the other hand, includes foods that are recommended because they counteract acid reflux such as bananas, pears, orange vegetables, nuts and natural, peeled almonds (almond milk is also recommended), baking soda, fresh cucumber juice, apples or fresh applesauce and others.
I feel very privileged to accompany women during the heartwarming (and sometimes challenging) process called pregnancy, and even more so (every time feels like the first time all over again), to be there with them when they give birth! During birth, acupuncture helps mitigate pain and induce labor (in cases of “stalled labor”, i.e. when a woman is in active labor and her labor slows down or stops). In most cases, I use acupressure, which is now a method that is practiced in most delivery rooms around the world and is very helpful in easing labor pains at all phases of childbirth (some women cannot have an epidural, and in those cases acupressure is highly effective). I’ll be by your side as you give birth if you want me to, to calm and support you, and to make sure you don’t forget to breathe – and even smile!
There are acupuncture points that are known to be associated with the female reproductive system and to affect the hormonal system. By needling acupoints in the ovary area, we will induce blood flow to encourage ovarian stimulation and influence your ovulation and egg quality. There are acupuncture points that have been proved in clinical trials to stimulate the flow of blood to the uterus and can be used to affect the endometrium – a thick endometrium is critical for embryo implantation.
Since the hormonal system is also connected to the nervous system and both systems affect each other, I will always include acupoints that directly affect the parasympathetic nervous system and cause the brain to release “feel-good” brain chemicals such as endorphins. Your emotional condition has a big effect on your fertility. Stress has been measured and has been proven a major cause of fertility issues, and acupuncture has been found to be highly effective in treating stress. Acupuncture uses very thin needles, in most cases is painless and sometimes, isn’t even felt at all.