How acupuncture & Chinese medicine can be used to support IVF and how we can help during Covid-19

If we look at acupuncture on a very simple level, acupuncture is the insertion of very fine needles into specific points on the body which are located along energy pathways, called meridians. A lot of patients will ask me: How does acupuncture work? The first thing I usually say is if you think of it on a really basic level that the needle has been inserted into your body, and your body will react to that, in the same way, it would if you injured yourself. Your body will increase circulation to that area to try and send everything that your body needs to heal, and so it has a stimulating effect on the body. We are starting to see lots of more research come out around acupuncture, and the scientific world is starting to give us the real answers as to how acupuncture works. One of the things we now know is that acupuncture stimulates the release of beta-endorphins which are responsible for reducing stress in the body and achieving that kind of homeostasis, that balanced situation. They also are found within the hypothalamus, they’re found within the pituitary gland, and these are all really important organs within hormone production, and so in terms of fertility, if we know that acupuncture helps produce endorphins, helps to relax, and it works on the hypothalamus and the pituitary gland, we know that it’s going to have a benefit. You’ve got two axes that are talked about within medicine around fertility, so you’ve g the HPA axis which is the hypothalamic-pituitary-adrenal gland and the HPO axis which is the hypothalamic-pituitary-ovarian, and they all work together in their little biofeedback and interact and keep our hormones in balance. If you’re really stressed, and your cortisol levels rise, your adrenals are going to work harder, and that’s going to have an impact on how the hypothalamus and the pituitary gland function, and h your other hormones are produced. So acupuncture really just helps balance these out, helps to keep these axes working in a nice, clean way. Another function that we know acupuncture has from research, it’s been shown to improve what’s called the pulsatility index, and so that is a measurement of resistance of blood flow. It’s shown that it improves that, so if acupuncture improves blood circulation again, in terms of fertility, we know that it can help increase circulation to the ovaries, to the uterus and this again has many benefits. If your blood circulation is better, it’s going to increase nutrition to your ovaries, it’s going to get what your body needs, where it needs it. It’s also going to mean that your ovaries are potentially going to function better, so if you’re in an IVF cycle, it’s going to help increase the response potentially. It can also increase blood circulation at the uterine lining, so it can thicken better or when you’re having a period, and the lining is coming away, it’s going to come away more effectively, and hopefully you’re not going to have kind of clots or bits left behind. So when you have your next cycle you’re not going to have so much old blood, those kinds of things. Circulation is just key, in Chinese medicine, and it’s one of the very basis of everything we do. If we know the circulation is good, then we know the body is going to function better. Another thing that has been shown in research is that it also, modulates what’s called the cytokine levels and the cytokine response in the body, and cytokines are just proteins that the body releases in lots of different processes, but 2 that we look at quite a lot in terms of fertility are cytokine response in inflammation and immune response. So again if you’re thinking about kind of conditions like endometriosis, we know cytokines play a role in that, and also male infertility, we see high levels of cytokines in semen when there are fertility issues. So acupuncture can help modulate the cytokines and improve these situations.

About Chinese herbs, I really feel like they are the unsung hero of Chinese medicine, they get forgotten, and a lot of people don’t realize that a lot of work we do in terms of treating fertility and supporting patients in preparing them for artificial reproductive treatments involves Chinese herbs. There’s still a lot of fear around herbs, maybe from articles, people have read that herbs may be toxic, that they may affect the liver function, they may affect the kidney function. Chinese herbs come in lots of different forms, and in my practice, I prefer to use what we call a granulated form, it’s very much like instant coffee, so it’s very easy to use, but different practitioners will use different types, they might use dried herbs, they might make herbs up into capsules. First of all, they come in lots of different forms, they’ve been used for over 5000 years, and they really do have a very good history of safety and their side effects are pretty minimal, particularly if you compare them to pharmaceutical drugs and the side effects that they have. Chinese herbs are very good. Within the UK, we have a couple of governing bodies as well. We’ve got the Register of Chinese Herbal Medicine and The Association of Traditional Chinese Medicine, so when you’re looking for a herbalist or an acupuncturist who uses herbs as well, it’s important to make sure that they’re registered with somebody like that. Then you know that the herbs they’re using will not contain any banned herbs, so many of the herbs that you may have read about with toxic properties, we’re actually not allowed to use anyway in the UK. We don’t use any animal products in the UK, so you know if you have concerns about that, that’s not an issue. They’re mostly plants that are indigenous to China, but we use a lot of really common herbs, things like mint, ginger, liquorice,dates, they’re not all as weird as people may think. Chinese herbs are great for putting back what the body hasn’t got. If you’ve got long-term chronic conditions like endometriosis, PCOS or it could be that you have other health conditions aside from fertility issues that are having an impact on your health. If you’ve got digestive issues, herbs can be great for getting your digestive health back to form, so I want people to realize that herbs are not as scary as they might think and they’re not as unusual or weird as they might think. They might taste disgusting, that’s for sure, not all of them, but there is a big role for herbs in fertility treatment for sure. The other thing I often see, patients are concerned about herbs and their use around an IVF cycle or any fertility treatment they may be having. If you’re seeing an experienced practitioner, they generally will not use herbs around an IVF cycle or say f.e., if you’ve just started Clomid, what I would generally say is, let’s watch and see how you behave with the Clomid, we’re not going to add herbs into that equation until we know what’s going on. At a later date, herbs might be something that we would consider if the body isn’t responding in the way that we want it to do. A herbalist will always stop herbs before you start an IVF cycle of medication, we know how long we should be looking at, in terms of those things, so it’s not a big concern around fertility treatment. Also, you’ve got to spend time and just speak to your practitioner, they’ll explain things to you. One of the things to remember is that we all have the same goal, we all want our patients to have a child they long for, so we’re all just trying to do our best.

Everybody can benefit from acupuncture, that’s for sure. If we’re talking about endorphins and how it can regulate that stress response and relax, I’m pretty sure most people will benefit from a good chill out session. When we’re looking at it in terms of fertility, the majority of patients we see are female, and often we’ll see a female come for consultation, and then they’ll tell us that the problem is with my partner, he’s got sperm issues, so don’t forget that we can help the men and they can come along and get treatment. Acupuncture and Chinese herbs can help you at all stages and in all manner, in different types of artificial reproductive techniques. We tailor the treatment to what you need and where you’re at in your cycle or your fertility journey. You’ve just got to kind of plan ahead and think where am I and what do I need to do, and that’s where we are, we’re there to help you plan your treatment and prepare you for anything you might be looking to undergo as well.

Ideally, you should find somebody to help you, at least 3 months before you start ART treatment. The reason we would like to see patients 3 to 6 months before they start treatment is that we want to help make a plan for you, and one of the things we find quite a lot is people will get in touch sadly late, our diaries do fill up very quickly so being able to accommodate people for the appointments they need is sometimes difficult if they get in touch too late. Also, we look at things like the life cycle of a follicle, so a dormant follicle in the ovary through the time to when it is recruited to become active follicles it’s roughly about 3-4 months, and it’s the same with sperm. It’s about 90 days, so for us to influence what is being used or what is going to kind of respond to medication, we need that little time scale, so things can start working in the body. It gives you time to implement in the lifestyle techniques that we might discuss, start supplements etc. make those changes and for them to have an impact on you and your life, your body. It’s no good starting some supplements 3 days before you start your IVF cycle because they’re not going to have that impact. We see patients quite a lot who we come and we can help them conceive naturally. So if there is the potential that we can help you do that, it’s nice if we’ve got that time and if that doesn’t happen at least we’ve got your body in a much better position for an IVF cycle. If somebody had PCOS, I have such patient once where she walked into the clinic with a sheepish look on her face, and when I asked what happened, she just said I’ve had a period, and she’s had her first period at 26. We were able to do that through diet and lifestyle, and acupuncture and herbs. We can have a big impact on Patients and if we can help you get where you need to be, we’d much rather see you do those things if we can, but at least you know if she went on to do IVF it is going to respond a lot better because her cycle is going to be more regular, it’s going to be closer to the norm, so those are the kinds of things we’ll try and achieve with patients. If we’ve got plenty of time with them before they’re starting any reproductive treatment. We’ll take into consideration patients journeys, let’s say a patient comes along, and they’ve already done 6 rounds of Clomid, they’ve already done IUI, they might have done several rounds of IVF, and these things take a huge toll on the body. What we like to do if we’ve got enough time before somebody gets back into treatment, is to build their body back up, nourish their body because particularly if you’ve done several rounds of IVF, you’ll recognize that it’s very exhausting. It has an emotional impact on the body and sometimes some things are left behind from the medication, so people may still be experiencing things like night sweats, they might feel their hormones are fluctuating, and they can feel that in their mood and other kinds of hormonal symptoms that are coming to the surface. These are the things that we try and improve before a patient starts treatment again.

This will vary, depending on the treatment protocol that you are receiving, whether it will be a long protocol cycle, a frozen cycle, a donor cycle etc. Based on a long protocol cycle f.e. , most of the time patients will be seen around once a week through the down-regulation stage, or if you’re on the contraceptive pill, we would still continue to see you about once a week. During the stimulation phase, we’ll continue that once a week pattern, but we’ll also edit it based on your history, so if you’re a poor responder, if you’ve got low ovarian reserve then we might increase the frequency of treatment to match that. As you have scans that give us a bit more diagnostics information, we may increase treatment so if your first scan we’re not quite seeing the follicles at the size they need to be, or you haven’t got quite as many as we would have expected, then we will up the treatment to try and increase the circulation, increase the response. Every practitioner have their own kind of style and protocol, and everything is always tailored to you, as the individual, but in general, there may be a treatment around egg collection. For me personally, logistically it’s often difficult to do a treatment after egg collection. One of the things I’m always thinking about is how can I reduce the stress levels of my patients. One key thing to think about is if a treatment is going to increase your stress, is it really worth going for it. It’s not always the end of the world if you miss a treatment if that treatment was going to cause a lot of stress to you. The post egg collection treatment is not one that I use as much as others., But, again if I see a patient who’s had a history of a difficult egg collection or maybe has cervical stenosis or something like that, and we know it is going to create a difficulty, then Ii will focus more around egg collection. The next key point for treatment will be transferred if you’re having a frozen cycle, we know for sure what day transfer is, but sometimes it’s not so known, and it’s a little bit last minute, so you might not have the ability to have a treatment before and after transfer. That’s not a major worry, most of the time we would expect you to come after your transfer, usually on the same day, at least within the 24 hours, then we’ll look at the two-week wait situation, so we can do treatment around the point when implantation would usually occur. We can also do treatment throughout the two-week –wait just to support you at that time because we definitely see that’s probably the hardest point for most patients. You’ve been so busy going in for scans and here and there for appointments then it’s just so quiet, and you’re left alone with your thoughts, and you’re waiting for that test day. Acupuncturists offer a lot of support emotionally, in that sense and we can help you to relax and get you through those two-week waits. If you do have a positive, we’re there to support you through early pregnancy. We know that there are increased chances of miscarriage with IVF, in the early stages and there’s quite a lot we can do to support early pregnancy, even just from an emotional point. Research has shown that women with a recurrent miscarriage history treatment by having someone to see regularly, to discuss their anxieties, it reduced the miscarriage rate quite significantly. There are things that we can do with acupuncture and herbs, I use herbs quite a lot in pregnancy to support my miscarriage patients. That’s something that a lot of people wouldn’t think about, would probably be quite anxious about, but what I find is that my patients, they know me so well by the time that they are pregnant, they have a deep level of trust already, and so they’re very comfortable with what we do. It doesn’t matter what kind of artificial treatment, you’re having, we can tailor it to that treatment, but once a week roughly in a long protocol cycle, you’re probably looking at around 6 treatments. Don’t forget the men, if there are male infertility issues, we can do the preparation work, and we can do some treatments on the run-up to when they have to give their sample.

We know that because there are pieces of research that have shown that. If you want to learn more about it, you can Google it, just looking at the effects of acupuncture and if you put in acupuncture endorphins research, that will definitely come up. One of the things you can do, it depends on where you are, in which country you’re in and how freely available testing is. Where I am based testing isn’t very freely available, the NHS hasn’t got a lot of Money, so testing is also tight on that side of things, but in theory, if you had high cortisol levels you could have a blood test that has shown that your cortisol is consistently high, you can have some acupuncture and work with your acupuncturist, in theory, you could after some amount of treatment retest your cortisol levels to show that it had reduced.

I would say two months is not a very long time, in terms of treatment. One of the things that we see, and I have a fantastic mentor, her name is Navaa Carman, and she is so on it, in terms of how her brain works and how she collates data, and for a very long time I had noticed that after about 4 months I saw a huge increase in my patients conceiving, and she actually collated the data and she got a bell curve that showed this same pattern. So it’s this same idea, we have around the 3-month life cycle of follicles and sperm. You haven’t quite reached that stage yet, where the sperm that have had that full impact of treatment are yet to be fully mature and released, the same with the follicles, so 4 months is a really good timeline to assess things. One of the other things that I do with my patients, is I use things like basal body temperature charting, and that gives us a lot of insight into what’s going on within a menstrual cycle, and you can see the changes month by month as the body is improving and changing. You might see, that somebody has a very long follicular phase and their luteal phase, is so short that they may not have time for implantation to occur, and then you’ll see that change over the months as treatment progress. It’s very good feedback, knowing that things are helping because obviously with fertility there aren’t any physical indicators for you to know necessarily that treatment is working. With your partner, it could be if you’ve got that ability to retest his sperm in a couple of months, then you could do that. If you’re on a timeline where you’re going to be doing IVF anyway, if you get to that stage and they collect the sample, you can ask and find out if there has been an improvement. We’ve also got to remember the for sperm, it’s not just how it looks under the microscope, there is an impact on sperm on a much deeper level, that isn’t always tested in clinics as standard. There are things like DNA fragmentation, quite recently the research that has come out said that DNA fragmentation is an important aspect that we need to consider. There’s a lot more going on under the surface that you can’t really see yet. Like you’ve said your periods have changed, so something is going on there and you should see little signs of things changes. One of the things I often see as well with male patients particularly, when we’re treating the sperm, and we’re using herbs, they feel a difference in themselves, they have more vitality, more energy. Have a chat with your practitioner but also just be patient because you’re both on the other end of the scale, so things are going to need a little bit more work, have faith, it’s still early days.

Yes, it is the riskiest period in terms of pregnancy, and it is when the organs start to form, but acupuncture is safe throughout pregnancy. There are points which are spoken about as having a potential negative impact on pregnancy, and acupuncturists don’t use those points unless they really need to. What we now know is that points that are generally contraindicated in pregnancy, they don’t have such a negative effect as what we used to think. One of the things, we’ve seen is that people who don’t understand the theories of acupuncture have produced research using these points with pregnant women and when we looked into it, there was actually no negative impact, and if the treatment warrants the use of a point, then it has more benefit than negative. There isn’t a concern with using acupuncture throughout pregnancy, there’s more benefit if anything. If you’ve got a good relationship with an acupuncturist and you’ve used them throughout your journey to conception, you should have a level of trust and comfort around what they do, and then there is your support person, they know what you’ve been through, they understand a lot of what has happened, so again you can use them as a sounding board throughout the early stages. What I tend to do with my patients, is I’ll evaluate with them, once they conceive and based on their history and my kind of instinct around their case, I’ll decide as to what I want to do through early pregnancy, and I’ll put the ball in their court a little bit. A lot of patients still want to come back once a month for just a check-in because they felt that benefit of how acupuncture makes you feel, how it increases your energy and they just want to keep that upon some small level. Up to week 13 is one of the more crucial stages that we like to see our patients, so we can just give them as much support as possible.

Before, if we can. If we’ve got that time and you’ve had that foresight to be organized, we would prefer it for you to come before you start. If we see you and your health is good, there aren’t a lot of issues in your history, or it’s more on your partner’s side, we may not need to see you again until you start, but at least we have the opportunity to check if you do come sooner. We want to see you throughout IVF, but ideally both.

As I’ve mentioned before, the fertility support practitioner group which is set up by a lady called Naava Carman. That is my main go-to group if you want somebody who’s got that extra level of experience. If you look for the fertility support company, you’ll find those details, there are other networks throughout the UK, and if you search for fertility support acupuncture specialists, it will come up. In terms of specific advice for women over 45, it would be no different to advise that I would give to any other patient in terms of pre and post-transfer. A lot of the advice we give is very bespoke, so it’s down to your individual health or situation. Very basic advice would just be to eat well, to rest, to keep warm, entertain yourself with light-hearted things, you don’t want any kind of horror movies or anything that’s going to stress you out during your two-week-wait but just look after yourself.

I would say going into a Chinese medicine shop in a shopping centre is probably not the ideal source of treatment. Particularly in a case like yours, you want to try and find somebody who’s got that more specialist training, and also someone who can communicate effectively with you. Some herbs can help increase the uterine lining, and again there’s a lot of research out there on herbs, on so many conditions. It depends now, on where you’re at if your clinic’s starting to open, whether you’ve got time to kind of implement herbs into your treatment plan before you start your medication. Potentially, you could use herbs throughout an IVF cycle, but your clinic has got to feel comfortable and confident with that. You’ve got to have somebody, who can talk to your clinic, and communicate with them on that.

Yes, they do. I see lots of patients who have had long histories, I have patients who come to me, and they’re on the run-up to IVF, and through just sequence of events, it may be that they haven’t gone to their GP as quick as they could have because they’ve hoped that it would happen naturally. I see patients who’ve been trying -4-5 or 6 years, and they come, and within a couple of months, they’re pregnant. I have patients who are on their run-up to IVF, and they fall pregnant naturally. We’ve had patients who’ve conceived, and they’ve started their down-regulation, and then found out they’re pregnant. I’ve seen patients who’ve been told they can’t conceive naturally, who’ve got blocked tubes and they conceived naturally. Anything and everything can happen. There’s always that potential for those things to happen and one of the things I see quite a lot is that it becomes a little bit of a chicken and egg cycle, it’s so stressful when you want this so much, and you work hard and have a stressful job. There is a huge percentage of teachers visitors because their lives are just so stressful with their work, and again it’s that effect that acupuncture has on endorphins and being able to relax a patient and get into your sympathetic nervous system. A lot of us are running around in this fight all the time because we just got to do this, got to do that and we don’t have that moment to switch off. Also, a lot of people have forgotten how to relax, they’ll come, and they lie on the couch, and they’re staring at the ceiling, and so I say, close your eyes, relax, and I hear that they don’t know how to do that. We have to train you to do that, and acupuncture is great because it activates the parasympathetic nervous system, and it’s that relaxed feeling that you get if you’re at the end of a yoga session, or you’ve meditated, that can sometimes just be enough for somebody to switch off.

A cure is probably not a word that I would use because adenomyosis is a chronic and serious condition. It’s influenced by the hormones, it’s similar to endometriosis. It’s not something you’re ever going to get rid of unless you’re going to have surgery. If there’s something that a doctor can do, depending on the location. Adenomyosis can be controlled though, and in some cases, we have seen it reduce. We’ve had patients who’ve been able to have scans, have treatment, and the scans have been repeated at a later date, and we’ve seen positive changes there. We see a lot of patients with adenomyosis and we have very positive results with things like the pain, and the discomfort goes away.

You could use it if you were planning to collect eggs to freeze them, and because you’re still going to have the hormonal treatment that may have side effects on you. Acupuncture is really good for helping counteract the side effects of medications. If you’re going through the cycle, it can relax you. Acupuncturists know what’s going to happen at each stage, so when you’ve got doubt and questions, they’re there, they can answer, and they can support you. I’ve had comments from consultants to my patients where they’ve said, you’ve had acupuncture because they can see that their blood pressure is lower and they’re much more relaxed when they have their egg collection to when they’ve had it previously and they haven’t had acupuncture. There are so many benefits to having it.

Yes, I do electroacupuncture, and it has the same effects. What we do with electroacupuncture is we put these electrodes on the needles to increase the stimulation. So if you’ve had acupuncture before, depending on the style of acupuncture that your practitioner uses, you may have had them come in and rotate and manipulate needles to increase the response from the body on the needle. Electroacupuncture does that on a more consistent level. We attach the electrodes to the needles to give it some kind of continuous stimulation. F. e. we might put it on a setting where it kind of has a rhythmic stimulation to the needle, and what it’s doing is just increasing the response, increasing kind of the strength of the treatment that we’re giving. With fertility, we use electroacupuncture quite a lot, to stimulate the ovaries, we use it with PCOS patients, we use it for patients who are poor responders, have a lower ovarian reserve, and we know it’s going to be harder maybe to get the follicles we want out, so we’ll use that during the stimulation session as well.

Usually, if coming for an initial consultation, treatment will vary from practitioner to practitioner. Most practitioners will do about an hour and a half for your first session, the first hour of that is your consultation and the last half an hour is usually the treatment. An average treatment length is around 20 minutes where you’re lying on the couch, but that will vary depending on the person’s constitution and the treatment that’s involved. If somebody is very deficient if they had something like chronic fatigue, we may only do treatment for maybe 10 minutes because it can be too strong for their body. If they’re very very deficient, so it is tailored, but I would expect the first treatment to be around 90 minutes. Then follow-up sessions would be about an hour, and you should be on the couch for around about 20 minutes. When it comes to the number of needles, it will vary, depending on the style of the acupuncturist you’re seeing, and each acupuncturist. In traditional Chinese medicine style acupuncture, we tend to put needles across the body, you can have needles head to toe. It will range from about 5 to 20 needles in a treatment which might sound a lot, but it isn’t.