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Acupuncture – can it increase chances of getting pregnant?

Mike Berkley, LAc, FABORM
Acupuncturist, Herbalist and Integrative Medicine Practitioner, The Berkley Center for Reproductive Wellness
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From this video you will find out:
  • How can acupuncture help with PCOS and how many sessions are needed to increase your chances?
  • What you should know about Chinese herbs and how beneficial are they?
  • Is acupuncture effective in the treatment of endometriosis?
  • Can acupuncture help follicles grow?
  • How can miscarriage be prevented with acupuncture and TCM?

Does acupuncture help with trying to conceive?

In this webinar, Mike Berkley, Founder & Director of The Berkley Center for Reproductive Wellness, New York City, USA, has discussed acupuncture, how it’s done, and its benefits when trying to conceive.

PCOS (Polycystic ovary syndrome)

Patients with polycystic ovarian syndrome (PCOS) have a difficult time ovulating. Sometimes they don’t ovulate at all. PCOS patients sometimes ovulate every month. There’s a whole spectrum from minor to severe pathology. It’s a disorder of anovulation. These PCOS patients have a difficult time ovulating, and their hormones are out of balance. They have high levels of insulin and high levels of testosterone. Frequently, patients are morbidly obese, which is dangerous for the heart and can cause gestational diabetes and hypertension during pregnancy.

50% of PCOS patients have normal body weight. PCOS patients are twice as likely to miscarry compared to the non-PCOS population because the egg quality is typically compromised due to having too much testosterone, which perhaps causes the estrogen not to function properly.

Acupuncture and herbal medicine have a regulatory effect. They delete or drain that which is in excess and support and give that which is deficient. In the PCOS patient, there’s too much testosterone. As you can see here, acupuncture has a regulatory effect. It often harmonizes and regulates the follicular state. This will attempt to balance the testosterone and estrogen, leading to better egg quality. This can reduce the possibility of miscarriage and increase the possibility of a full-term pregnancy and a live birth, of course. The best outcomes are found when combining complementary medicine with Western medicine.

Acupuncture vs Herbs

Acupuncture doesn’t give anything to the body; they are just stainless-steel needles. There’s nothing in the needles. It stimulates blood flow to the reproductive organs, so the FSH and LH from your brain get to the ovaries through the blood. When you eat, the nutrient products from the food get all over your body, from your eyebrow to your nose to your ovaries, through the blood. When you inhale oxygen, every cell and tissue in the body becomes oxygenated through the blood; it needs to be to survive.

Acupuncture enhances hemodynamics. It enhances, strengthens, and facilitates blood flow. When utilizing acupuncture for the patient facing a fertility challenge, we’re specifically trying to facilitate improved blood flow to either the ovaries, the endometrium lining of the uterus, or, in men, the testicles to improve the sperm. That’s why and how improved blood flow can elevate and enhance the chances of conception.

Herbal medicine is something that you drink, and it is very different from acupuncture. Herbal medicine serves to nourish different parts of the body. The herbs any acupuncturist would use to help facilitate conception, are going to influence the ovaries, the testes, or the lining.

Every patient gets treated twice per week. They take herbs twice per day, seven days per week. The acupuncture works from the outside in, and the herbal medicine works from the inside out. Combining acupuncture and herbal medicine is the best way to go.

One thing I would like to say that’s very important is that herbs come in many different formats. You can drink them from a bottle with an eye dropper that you put under your tongue, take pills, or take raw herbs. The raw herbs are the best way to go. They are fresh and can be customized specifically for each patient. You cannot do that with pills, and you cannot do that with a tincture that you put under your tongue.  I only prescribe customized raw herbs.

Endometriosis

Endometriosis is a disease where endometrial tissue, which normally lines the uterus, is found outside the uterus. This is completely abnormal because uterine tissue belongs only to the uterus. When this tissue is found elsewhere in the body, it reacts to hormones just like the tissue inside the uterus.

For example, if a woman has endometriosis in the intestines, she may experience rectal bleeding during menstruation. Similarly, if it’s in the nostrils, she may bleed from the nose during her period. Endometriosis is considered an autoimmune and inflammatory disorder. There are several reasons why endometriosis negatively impacts fertility. One reason is that it can cause tubal damage, leading to issues with conception. In cases where endometriosis has damaged or blocked the fallopian tubes, IVF (In Vitro Fertilization) may be necessary. However, IVF success rates can be lower in women with endometriosis due to the inflammatory environment within the uterus. Despite the disorder primarily affecting areas outside the uterus, pro-inflammatory cytokines can find their way into the uterine cavity, creating an unfavorable environment for embryo implantation and pregnancy.

Can acupuncture and herbal medicine help? First and foremost, if a patient is diagnosed with endometriosis, acupuncture and herbal medicine are not typically the initial treatment. The first step usually involves a laparoscopy to remove the endometriotic tissue. This surgical procedure aims to reduce the presence of inflammatory proteins in the uterus, thereby improving the chances of conception. However, even after a successful laparoscopy, some women may still struggle to conceive. This can be due to residual endometriosis that may not have been completely removed during surgery, especially if the tissue appeared normal. In such cases, further testing, such as the ReceptivaDX test (or its equivalent), may be performed to detect the presence of specific molecules like BCL6, which indicate ongoing endometriosis despite surgical intervention.
Once confirmed, acupuncture and herbal medicine can play a supportive role by helping to manage inflammation, which is often the underlying cause of infertility post-laparoscopy. These treatments aim to significantly reduce inflammation, thereby potentially improving fertility outcomes.

If you have endometriosis and have undergone a laparoscopy but are still experiencing difficulty getting pregnant, acupuncture and herbal medicine may be beneficial in reducing inflammation and improving your chances of conceiving.

Advanced maternal age

Advanced maternal age refers to any woman who is over 35 years old. You have to look at this arc: over here, you’re 13 years old, you start to menstruate; over here, you’re 52 years old, you’re in menopause. At the top of the arc, you’re 35 years old. Once you’re on the side of 35 years old, your fecundity, which means your ability to conceive in any given month, starts to decrease. Fortunately, it decreases slowly over time. Nonetheless, once you’re 35 and older if you’re having a problem getting pregnant, and you don’t have polycystic ovarian syndrome, you don’t have endometriosis, and there’s no male factor involvement, then why is it that you’re having a problem getting pregnant?

There are generally two reasons: low ovarian reserve and poor egg quality. Acupuncture and herbal medicine can do nothing to increase the quantity of eggs that any woman has. However, acupuncture and herbal medicine, as discussed previously, can serve to improve egg quality. I have many patients in their 40s, and though many cases fail, many cases succeed. Before they got the acupuncture and herbs, they did 6 IUIs and 5 IVFs and didn’t get pregnant.

Advanced maternal age is something that frequently, though not always, can be successfully treated with acupuncture and herbal medicine, often combined with IVF. But remember, IVF is a mechanical procedure: you remove the egg, fertilize it with the sperm, and now you have an embryo that you transfer. That’s it. If you have poor egg quality, poor lining quality, or poor sperm quality, the reproductive endocrinologist has no power to alter those issues. Acupuncture and herbal medicine do.

This is why the gold standard for reproductive medicine should be “East meets West.” Hopefully, one day it will be that way.

Chromosomally abnormal embryos

The two main reasons for infertility are low ovarian reserve and poor egg quality. In the context of poor egg quality, what one will find is that often the eggs or embryos are chromosomally abnormal. So, acupuncture and herbs can never make a chromosomally abnormal embryo normal. But let me briefly explain the trajectory, the passage, and the pathway of an egg.

An egg resides in a follicle. You have quiescent follicles, meaning they’re sleeping, quiet, dormant, and not doing anything. They’re tiny, measured in micrometers. Full-grown, mature follicles are measured in millimeters. A mature follicle is typically around 20 millimeters in size.
It takes three months from the primordial follicle, the sleeping follicle, to become a 20-millimeter mature follicle. So, when you provide acupuncture and herbal treatment to a patient for three months, what we’re aiming to affect are not the follicles that are 4 to 6, or 8 millimeters in size. We’re targeting the primordial follicles, which take 90 days to become a mature follicle. Therefore, the goal is to influence the primordial follicles so that by the time they mature, you will have a better-quality egg within those follicles.

Low ovarian reserve

Acupuncture and herbs cannot increase ovarian reserve, unfortunately. Women lose a thousand and one eggs every month— a thousand die, which is called atresia (cell death), and one is ovulated. So, unfortunately, neither acupuncture, herbal medicine, nor any Western medicine can give you more eggs.

If you have a regular period—whether it’s every 26 days or every 35 days—and you ovulate at least 12 days before day one of your cycle (day one of your menses), it means you have some good eggs.  The problem is, that you don’t have enough good eggs, so every time they do a retrieval, you’re getting a bad egg.

Therefore, the purpose of acupuncture, again, is to potentially give you more good eggs by working on the primordial follicles. We’re not going to give you more eggs, but maybe we can give you more good eggs.

Acupuncture will increase the delivery of oxygen electrolytes, nutrients, and hormones, and it will help excrete dead cells from the follicular environment leading to improved egg quality.

Male factor

The data shows that the male factor contributes from 35% to 50% of infertility. So often, you have cases of both male and female factors. For example, the wife is 39 years old with low ovarian reserve and poor egg quality, while the man has poor morphology and low sperm count. These are typical issues that affect males:

  • Low sperm count
  • Poor morphology (sperm shape)
  • Poor motility (ability to swim straight)
  • Sperm DNA fragmentation

A sperm DNA fragmentation assay is rarely done, though it should be. The problem with sperm DNA fragmentation is that the sperm may not penetrate the egg. The reproductive endocrinologist may suggest intracytoplasmic sperm injection (ICSI) despite this issue, which involves injecting sperm directly into the egg to create an embryo. However, this can lead to poor embryo quality because bad sperm are forced into the egg.

Whenever I have a male patient with poor sperm parameters (count, morphology, motility), I always recommend a sperm DNA fragmentation assay. Here’s some data on sperm DNA fragmentation:

  • 0-15% fragmentation: Good fertility outcomes
  • 15-29% fragmentation: Good to fair outcomes
  • Above 29% fragmentation: No pregnancies

In Western medicine, there’s no effective treatment for high sperm DNA fragmentation. Acupuncture and herbs, however, are very effective in reducing sperm DNA fragmentation. The goal isn’t necessarily to reach zero fragmentation but rather to reduce it to between 0% and 15%.

Acupuncture and herbs are also effective in treating low sperm count, poor morphology, and poor motility. However, there are certain conditions they cannot treat. For instance, anatomical defects in the testes (like varicocele) or genetic abnormalities (such as microdeletions of the Y chromosome) cannot be treated with acupuncture or herbs.

Many men have idiopathic pathologies (no known cause) like low sperm count without hormonal abnormalities. In such cases, acupuncture and herbs are not just an option but often the only effective treatment, as Western medicine offers no alternative solutions. There’s no Western medical response to Sperm DNA fragmentation. Acupuncture and herbs are very effective.

In vitro fertilization has produced more than 5 million live births. However, there were more transfers than there were live births. So, maybe there were 5 million live births and 18 to 20 million transfers. Why is that? It’s because of sperm DNA fragmentation or poor egg quality leading to poor embryo quality. Acupuncture can help change that, so we can increase the odds of getting you pregnant and keeping you pregnant.

Miscarriage

Why do women miscarry? There are many reasons:

  1. Aneuploidy: This means a chromosomally abnormal embryo.
  2. Subchorionic Hematoma: This is a blood clot that bleeds and grows. The Western medical response to this is bed rest. The subchorionic hematoma is physically adjacent to the implanted embryo. The embryo is growing and developing. At week 5, the placenta starts to form. This hematoma grows at the same time. If the hematoma outgrows the embryo, a miscarriage is guaranteed.
    The treatment is to use only herbs because herbs are much more powerful than acupuncture. This doesn’t mean acupuncture isn’t effective, but for these types of internal problems, herbs are the way to go. If you have a subchorionic hematoma, bed rest may be helpful. You have to lie in bed for a week or more; it may help, or it may not. If the subchorionic hematoma continues to grow, that’s not good. Get acupuncture and herbs, but herbs are the best option.
  3. Implantation Failure: Why does a woman experience implantation failure?  Sometimes, there’s not enough blood flow inside the uterus itself, inside the endometrium. The uterus can be 10 millimeters thick. The doctor will perform a transvaginal ultrasound and say you have a beautiful trilaminar 10-millimeter lining. It looks like it’s very good; in fact, it is 10 millimeters and trilaminar, but it’s not a good lining. This will not result in implantation.
  4. Overuse of Clomid (Clomiphene Citrate): This can cause the suppression of estrogen receptors in the lining. So, your lining will not respond to estrogen, it will not thicken, and you will not have embryo implantation.  If you’re doing intrauterine insemination (IUI) — it’s better to use Letrozole. It’s essentially a breast cancer drug, but it does the same thing as Clomid without causing the down-regulation of estrogen receptors in the lining.

    In any event, if a patient has the down-regulation of estrogen receptors in the lining, acupuncture, and herbs are very good because they stimulate blood flow to the lining. This is going to increase blood flow in the endometrium, making the lining much healthier and helping improve and increase implantation rates.

  5. Infection: Sometimes, a patient can get an ascending infection in the urethra that goes up into the reproductive tract and can affect the tubes. Pelvic inflammatory disease, and chlamydia, these types of infections can occur. Acupuncture and herbs are not the way to go with this; this should be treated with antibiotics.
  6. Autoimmune issues: Again, this should be treated with Western medicine. If you have a history in your family of type 1 diabetes, rheumatoid arthritis, lupus, MS, vitiligo, or any type of autoimmune disease like Hashimoto’s thyroiditis, you must get a test done called a reproductive immunophenotype panel. This will determine if you have any other hidden autoimmune issues, and they can be easily treated with Western medicine. This will significantly improve your chances of conception. By the way, these things not only prevent conception, but if you’re lucky enough to get pregnant, they also contribute to miscarriage. So, you want to get that treated.
  7. Thin endometrium (less than 6 millimeters): Doctors used to say they wanted to see a 10-millimeter lining, but people could get pregnant with a 6-millimeter lining. If you have a 2-millimeter lining, you’re not going to get pregnant. If you don’t have a 10-millimeter lining, if you have a 6-millimeter, 7-millimeter, or 8-millimeter lining, you’re going to be fine.

Infection and autoimmune issues

Another test that doctors don’t typically do, which is an utter failure of the system of medicine, is testing every single woman for ureaplasma. Urea plasma is an infection that can be obtained through sexual intercourse without protection. So, if you or your husband have idiopathic infertility and you don’t know what’s going on, and you get this urea plasma test, only the woman gets tested. If it’s positive, you won’t get pregnant because this urea plasma is hostile to embryos. It’s easy to treat. You and your husband take antibiotics. In the States, Doxycycline is used. You take antibiotics for 10 days, and you’re cured, and then you get pregnant. When you go to your reproductive endocrinologist, you must respectfully insist that you get tested for ureaplasma. This is a hidden pathology. Patients can go for years and not get pregnant, and there’s nothing wrong with them except they have urea plasma that was never diagnosed.

A common type of autoimmune pathology is activated natural killer cells. All women have natural killer cells in the uterus. These cells are there to fight cancer, but sometimes these natural killer cells are turned on when they shouldn’t be. They should only be turned on if there’s uterine or ovarian cancer. Sometimes they are inappropriately turned on and they view the embryo as cancer. They spray the embryo with something called TNF alpha, which means tumor necrosis factor. Necrosis means death, so the natural killer cell will then activate the spraying of the TNF alpha onto the embryo, killing the embryo, thinking that the embryo is cancer. This is very easily treatable. One, two, three, no problem with Western medicine. This is not an ordinary test that every patient trying to conceive should get, as opposed to urea plasma, which every woman should get tested for.

 

 

- Questions and Answers

Can acupuncture be of help with Egg donation and how can it help?

I’m not sure that acupuncture is necessary or useful for donor eggs unless there’s an implantation issue. And sometimes, if there is, perhaps let’s say, a very thin lining, just the use of estrogen can thicken the lining and make it more receptive. So, I don’t think donor egg is the best-case scenario for the utilization of acupuncture and herbal medicine.

Do you think both acupuncture and lowered stress are the most successful? 

I’m going to talk about stress. So, we know for a fact, without question, that stress reduces sperm count. But there is no data whatsoever, that I’m aware of, that indicates that stress has a direct effect on female fertility. And to prove my point to you, I will tell you this: wars are going on right now all over the world. There always have been, and much to my dismay, I assume there always will be. In these war zones, one cannot be in a more stressful situation—I don’t care what your situation is—you can’t be in a more stressful situation than having bombs dropping all around you and seeing dead people all over the street. In those scenarios, women get pregnant, give birth, and have babies. So, I’m not sure that stress is such an issue. It may be for some; it may not be for others. I honestly don’t know. I know it affects men; I’m not sure if it affects women.

What about sperm DNA Fragmentation rates?

Acupuncture and herbal medicine are very effective in reducing sperm DNA fragmentation in men who have sperm DNA fragmentation. So, you don’t typically see DNA fragmentation in an embryo; you will see it in a sperm. So, as far as a male factor is concerned, you know, not only do we use acupuncture to improve count, motility, and morphology, but we use it to reduce sperm DNA fragmentation as well.

Can any of the herbal teas (chamomile, thyme, etc.) benefit when trying to get pregnant? Or do they just help with sleep, and nerves? 

My expertise is in Chinese herbal medicine so chamomile and thyme I know nothing about I know that chamomile is tea thyme is a herb, but it’s not a medicinal herb and chamomile I don’t think is a medicinal herb I think chamomile I don’t know anything about thyme except that it tastes good the only thing I can tell you about chamomile is that it is it makes you calmer and relaxed, and it may help you go to sleep I really don’t think uh let me put it this way I have no experience as to the benefits of chamomile or time in the context of fertility improvement

I am 39, and we have 1 normal blastocyst (we did a Pre-implantation Genetic Screening), plan to transfer in October. Also, I had endometritis and I did a laparoscopy in January, how many acupuncture sessions should I do before implantation and what do you recommend avoiding?

I’m assuming that you were given antibiotics and that the endometritis has been eradicated. Of course, you’ll know this because your reproductive endocrinologist or gynaecologist will let you know. And you said you did a laparoscopy. I’m not sure if you did a laparoscopy for endometritis. Maybe this patient had endometriosis. You don’t typically get a laparoscopy for endometritis; you typically take antibiotics. I’m going to assume that you had endometriosis and had a laparoscopy. And you say, “How many acupuncture sessions should I do before the transfer?” This is a very good question and a difficult one. You already have an embryo, a normal embryo. I wouldn’t worry about it. If you’ve had a laparoscopy, and you’ve waited a month, and you’re healed and everything is good, and the uterus is in good shape, I would do the transfer right away and don’t worry about any acupuncture. I mean, yes, do acupuncture because if this transfer fails, at least the acupuncture that you’ve started now will start to work on those primordial follicles. So, when you do the next retrieval, you’ll hopefully continue to get good eggs, normal eggs after pre-implantation genetic diagnosis. As far as this embryo that you have, you can go ahead and transfer it now. In other words, there’s no acupuncture that you need right now because you have a normal blastocyst, so transfer it. The only reason to do acupuncture is if you know, in your mind, that if this cycle doesn’t work, you’re going to do another retrieval. Then start the acupuncture now, so you’re working on the primordial follicles for the subsequent retrieval and transfer.

Is it common to experience days of spotting/irregular bleeding in between menstrual bleeding, as well as experiencing an ovulatory cycle, after a month of acupuncture sessions? I have PCOS and have a history of irregular cycles. Despite dietary and lifestyle changes during the last two months, I’m not now experiencing an ovulatory cycle and spotting.

To all of you who are going through this, don’t lose hope. Patients who have a hard time getting pregnant very frequently get pregnant, so don’t lose hope. First, you’ve had PCOS your entire life. You may be 21 years old; you may be 41 years old, but you’ve had PCOS probably when you were in the uterus, in your mother’s uterus. You probably had PCOS. Yes, it is common to experience days of spotting and irregular bleeding in between menstrual cycles. This can happen in the PCOS patient. You can have an ovulatory cycle—that’s one of the main factors of PCOS. But you say after a month of acupuncture sessions. Acupuncture, nor herbs, will worsen PCOS. So, if you got acupuncture, and then you have an ovulatory cycle, remember you’ve had an ovulatory cycle undoubtedly in the past because that’s what polycystic ovarian syndrome is. And then you say, despite dietary and lifestyle changes, you’re still experiencing an ovulatory cycle and spotting. So, what I want to say is that this is not at all uncommon for the PCOS patient. Number two, acupuncture is a process-oriented modality. It’s like exercising, like if you’re going to run in the marathon—you don’t run two miles once and expect to go on the marathon. You have to train and keep training and keep training. Acupuncture is process-oriented. How much acupuncture did you do? After a month of acupuncture, and maybe you’re going once a week—even if you’re going two times a week, you’ve got eight sessions. It’s not enough to make any changes, nor is it enough to hurt you. But that’s not even a good statement because acupuncture cannot hurt you. Acupuncture—this is a very important thing to note—acupuncture will not hurt you. It will either help you or it won’t, but it won’t hurt you. So just keep working, keep trying. And I think Western medicine would be good for you. I think taking Letrozole and doing some IUIs would be good because that kind of medicine will make you ovulate. Do acupuncture to improve the egg quality. This is a perfect case for Eastern and Western medicine.

I was told to stop using the progesterone because after 3 months they could not hear a heartbeat; then I miscarried; what could have helped the IUGR/fetal dismiss tests; what herbs and how long should I have acupuncture to have a healthy pregnancy?

Well, first of all, you had intrauterine growth retardation. I cannot tell you what herbs to take, and I’ll explain why. Look, this is how I work: I have a new patient, and I sit with the patient for an hour and do an entire intake. Everything is considered: How old is the patient? How much does she weigh? Does she have a heart condition? How many times has she miscarried? Has she never miscarried? Has she ever been pregnant? Does she have children? Does she not have children? Does she menstruate regularly? There are a million questions to determine who this patient is, you know, physiologically speaking. These questions enable me, or someone who does what I do, to arrive at a differential diagnosis in traditional Chinese medicine and then write a customized herbal formula specifically for that patient. So, I can’t tell you what herbs to use. As for how long you should utilize acupuncture, the way I work is I treat patients twice per week until they’re pregnant, and then twice per week for 13 weeks. That’s not answering your question directly, I know, but I’ll get to it. The answer is, that I’ve treated patients for three months, and I’ve treated patients for a year. I don’t typically treat patients for a year; I don’t want to treat patients for a year. I want to treat patients for three to four months and have them get pregnant. But it can take three months to a year to help a patient get pregnant, so I will stay with the patient until either they’re pregnant or they fire me. So, I can’t say how many treatments you should get. Let me give you a good analogy: You go to the reproductive endocrinologist, and you ask, “Doctor, how many intrauterine inseminations am I going to have to get before I get pregnant?” or “Doctor, how many IVF embryo transfers am I going to need before I get pregnant?” The doctor’s going to say, “I don’t know.” So, just keep getting treated until you’re pregnant, and then once you’re pregnant, keep getting acupuncture. I recommend to everybody that you get treated twice a week. You go to the gym—anybody here goes to the gym; you’re usually not going to the gym once a week. Sometimes you will, but people usually go to the gym three times a week at least because it’s a process-oriented modality. So is acupuncture.

Can you use herbs with SSRIs – selective serotonin reuptake inhibitors?

Absolutely 100%. For those of you who don’t know, this is about selective serotonin reuptake inhibitors (SSRIs), which are antidepressants. Yes, you can combine acupuncture with them. They operate through completely different pathways, so there’s no contraindication at all. You can use herbs while taking gonadotropins. Your reproductive endocrinologist may not want you to do so, and I’m not going to delve into that now because I have a patient, and you guys must go. But it’s safe to use acupuncture with gonadotropins. It will not interfere with the gonadotropins; it will not do anything negative. And it’s safe to do. So, yes, of course, without a doubt, you can use acupuncture with SSRIs.
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Authors
Picture of Mike Berkley, LAc, FABORM

Mike Berkley, LAc, FABORM

Mike Berkley is the founder and director of The Berkley Center for Reproductive Wellness. He is licensed and Board Certified in Acupuncture in New York State and certified in Chinese herbology by the National Certification Commission for Acupuncture and Oriental Medicine. Mike graduated from The Pacific College of Oriental Medicine in New York in 1996, and he has been treating reproductive disorders since then. Mike is the first acupuncturist/herbalist in the United States to work exclusively in the field of reproductive medicine.
Event Moderator
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Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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