By fertility experts from Spain.
Mike Berkley, Founder & Director of The Berkley Center for Reproductive Wellness, is answering patients’ questions about acupuncture and herbal medicine and their benefits for expecting women or IVF patients after embryo transfer.
The first thing I’m going to talk about is what acupuncture and herbal medicine are not good for. They are not good for issues that concern anatomical defects. So for example, if a patient has endometriosis and has scarring of the fallopian tubes, this is definitely a case for in vitro fertilization. Acupuncture and herbal medicine cannot unscar or unblock tubes, however, even in the case of endometriosis, with bilateral tubal adhesions, scarring or blockage, acupuncture, herbal medicine can still be used but it must be used in conjunction with in vitro fertilization and, of course, why would acupuncture/herbal medicine be used even in this patient with endometriosis, with tubal damage because this patient may in addition to having endometriosis be experiencing either chronic failures with IVF transfers or chronic miscarriages due to the fact that the egg quality is bad so even though there’s tubal damage we can still work with this patient to try and improve the egg quality or the lining quality or even with the husband if there’s an issue with the sperm quality.
Basically, any type or many types or most types of fertility challenges can be treated with acupuncture/herbal medicine. As I’ve described, we can treat the endometriosis patient but not to remove the endometriosis – that must be done with laparoscopic intervention. We can certainly treat polycystic ovarian syndrome patients. We can treat patients whose diagnosis is nothing more than advanced maternal age because women that are above 35 years old and older have fewer eggs than women that are 34 years old and younger and remember acupuncture and herbal medicine cannot give you more eggs but usually, when a woman has a low ovarian reserve there is always or typically the addition of compromised egg quality. Even in this patient with a little ovarian reserve, if we can get her one good egg and the sperm is good, the lining is good and the uterus is clear, she potentially has a great upside to improving her egg quality even if she’s 42 years old.
Many types of fertility cases can be treated with acupuncture & herbs. I’m a firm believer that in 99.9% of cases that the best-case scenario for any patient that’s experiencing fertility challenges is to be seen by a reproductive endocrinologist and to utilize acupuncture and herbal medicine – it’s almost like one plus one equals three because the acupuncture and the herbs combined with reproductive medicine will actually be more effective than using one of those modalities alone.
This is a very good question so depending upon what literature anyone reads malefactor fertility issues account for between 35% and 50% of infertility cases. Many times you have cases where there are both parties are involved. You have the female with the polycystic ovarian syndrome and you have the man with low sperm count or some kind of combination like this. It depends on what the situation is with the men but I’ll first tell you what we can do and then I’ll tell you what we can’t do.
Men that have low sperm count, poor morphology, poor motility and something else called sperm DNA fragmentation often can benefit from acupuncture and herbs. Acupuncture and herbal medicine very frequently can positively affect men by increasing sperm count, increasing morphology, increasing motility and decreasing sperm DNA fragmentation.
Now let’s talk about physical abnormalities or genetic abnormalities. There’s something called micro deletion of the Y chromosome which is where men aren’t producing sperm at all. This is a genetic dysfunction. This is a donor sperm case. Acupuncture/herbs can do nothing for the patient if the man has a severe varicocele that means a varicocele that requires surgery. Acupuncture herbal medicine probably won’t be efficacious in helping this patient.
If a man has a minor varicocele, acupuncture/herbs sometimes can help this patient. If a man has a physical and anatomical defect, congenital bilateral absence of the vas deferens means that sperm cannot come out in the ejaculate, acupuncture/herbal medicine cannot treat that. Basically, if it’s a count morphology, motility, a volume issue or sperm DNA fragmentation issue acupuncture/herbs can be and often are very effective.
Another great question. I touched upon this a little bit in my first answer. But it’s worth going into it a little bit more. It really depends on the case. If you have scarred tubes either because you had a pelvic inflammatory disease, perhaps chlamydia or perhaps endometriosis. Assuming that the pelvic inflammatory disease has been treated with antibiotics but you still have scarred tubes and you must do an IVF, if you’re 24 years old and you have this issue, there’s a presumption at least on my part until I know differently that the egg quality should be very good and therefore you should do in vitro fertilization and you’ll probably get pregnant on your own.
However, as I say if the tubes are scarred or blocked because of endometriosis, this is a case for acupuncture and herbs, again not to treat the endometriosis but to help the patient get pregnant because even after a laparoscopy the patient still has endometriosis. If there any doctors listening in, they may raise their eyebrows or raise their hands like that but I’m correct in what I’m stating and I’ll tell you why. Because some endometriotic adhesions which is to say endometriosis tissue that is outside of the uterus but in the pelvis or in other areas of the body look like normal tissue.
When a laparoscopic surgeon removes or excises endometriosis from the body inevitably the surgeon will leave some endometriosis behind. You can have endometriosis and not get pregnant even if your tubes are good. Why is that? The tubes are fine, everything is fine but there’s some endometriosis in there. Because endometriosis is an inflammatory disease and even though endometriosis is a disease that takes place outside of the uterus, these inflammatory proteins called cytokines find their way inside of the uterus and elevate the temperature of the uterus and, therefore, there is a hostile environment in the uterus in patients with endometriosis. You can utilize acupuncture and herbal medicine to try to reduce or significantly reduce or eliminate the inflammatory environment in the uterus. This will help to improve and increase the pregnancy outcome. Even if your tubes are scarred or blocked, if you and have any history of infertility after IVF, I would say that acupuncture herbs could be useful for you.
hat’s a very good question. I would say the same thing that constitutes a qualified acupuncturist/herbalist is the same thing that constitutes a reproductive-endocrinologist meaning that the acupuncturist/herbalist has gone through school, has sat and passed the state boards, has maintained their board certification in acupuncture and herbal medicine and, certainly, I would say that there are a couple of important things here – many acupuncturists treat many things.
The typical acupuncturist will treat your back pain, your foot pain, your elbow pain, your headaches and your infertility case. I would never go to that acupuncturist unless that’s the only option that you have. After all, you wouldn’t go to a podiatrist, the foot doctor, to help you get pregnant, you wouldn’t go to a neurologist to help you get pregnant.
Why would you go to an acupuncturist who treats many things to help you get pregnant? You must go to an acupuncturist that specifically is involved in the care and treatment of individuals or couples faced with fertility challenges. I think, in addition, to getting board-certified and maintaining that certification and good standing I think devotion to the pathology or the challenge of infertility and experience. For example, if you’re going to have a choice between an acupuncturist/herbalist who’s been specializing in infertility for one year and you have an option to see somebody who’s been in practice for five years, I think that you should go to the practitioner who’s been in practice for five years. I think that’s uh that’s my response to that.
I was going to give a one-word answer and my answer was going to be “no” and that was going to be my entire answer. But I’m going to qualify that. There are no side effects from acupuncture outside of the fact that bruising can occur because one is sticking needles in the body and so blood vessels can be broken, capillaries can be broken and cause a bruise. My response to that is so what, who cares? When you’re injecting gonadotropins to do IVF, you get bruise – so what, who cares? It’s only a bruise; the bruise will go away. Beyond that, there are no harmful side effects to acupuncture.
Regarding herbal medicine, that’s a whole different topic. Herbs or internal medicine, you drink them, they have various effects on the body and I would only say this: you must only get herbs that would be prescribed herbs by a board-certified herbalist. This means somebody who has gone to school for 2-4 years or whatever the program they’re in to study herbs and then they have to sit for a board exam nomination to pass the board examination to be a board-certified herbalist. Herbs can be dangerous. You have to think of herbal medicine the same thing as Western medicine you wouldn’t take Western medicine from your next-door neighbour.
You would go to your physician and get prescribed Western medicine because the physician knows the dose to give you. The physician knows that you shouldn’t take this medicine because you have a heart condition or you shouldn’t take that medicine because you have hypotension. There are various reasons not to give patients herbs and the practitioner must be very astute and qualified and knowledgeable to make sure to get the patient the right herbs.
Under the care of a board-certified herbalist, it is my contention that you’re totally safe. I wouldn’t just go into a store and buy herbs and I certainly wouldn’t take herbs from somebody who’s not board-certified. You won’t get killed with herbs but you can have severe constipation, severe diarrhoea, severe nausea. This is if somebody doesn’t know what they’re doing when they’re prescribing herbs.
I do not, however, I don’t know this person personally but I know of a fairly famous acupuncturist in London who specializes in reproductive challenges and she is very tied into the good and respected reproductive endocrinologists in London. I’ll give you her name you can google her and then you can connect with her and she can lead you to the reproductive doctor. Her name is Zita West. Just google her in London and she’ll help you.
This is a terrific question. I got an email today from a woman, she’s not my patient but she just had a question for me. She said that she’d done two IVFs and had acupuncture right before the transfer and both IVFs failed. What you don’t want to do is just do acupuncture pre-transfer or pre- and post-embryo transfer? Acupuncture is a process-oriented modality. How many of you that are listening go to the gym? If any of you go to the gym, I would put to you for your consideration that you don’t go to the gym once a week. You probably go to the gym 2-5 times a week. It could be two times, it could be three times. More is better when you go to the gym.
What if, God forbid, you’re in a car accident and you bust up your shoulder. You get surgery on your shoulder, you can’t move your shoulder, you have to go to physical therapy. You’re not going to go to physical therapy once a week, of that I can assure you. You’re going to go to physical therapy five times a week and then four times a week and three times a week for several months to have a full range of motion and a reduction in pain. More is better.
Acupuncture is a process-oriented modality. Under the care of myself, for example, my job is to improve the egg quality, the lining quality or the sperm quality and that takes time. The best-case scenario is to be treated three months in advance of a retrieval. It doesn’t often work that way when a patient will call me and say listen I’m doing a transfer next week and I want to start acupuncture. My response to the patient is that’s fine, don’t worry, come in tomorrow and start and you’re going to have your transfer next week. I’m going to treat you today, twice this week, pre- and post-embryo transfer and then I’m going to treat you after the transfer. If you’re pregnant after the transfer, wonderful, I’m going to treat you twice a week for 13 weeks to help prevent miscarriage because 90% of miscarriages occur within the first 12 weeks.
If God forbids, the cycle fails, that’s awful, but, remember, we’ve already started the acupuncture even way before a week before your transfer. We’ve already started to stimulate blood flow to the ovaries to help improve the egg quality, the lining quality and the uterus. Now your cycle has failed, we’re going to continue to treat you twice a week until the next transfer, then you’ll get pregnant, possibly, hopefully, God willing, then I treat you twice a week for thirteen weeks, then I say goodbye, good luck, send me a photograph of the baby or better yet bring the kid in so I can give him or her a kiss. So I hope that I was able to give you some answers in a convoluted way.
This is a question that’s unanswerable but I will explain why it’s unanswerable. E-mail a reproductive endocrinologist who you’ve never seen and never met and say “dear doctor, hi, my name is Nancy Jones and I want to know what medicine and what protocol do you suggest?” The reproductive endocrinologist is going to say I can’t tell you that, you’ve got to come in, we’ve got to do an ultrasound, we’ve got to test your blood, we’ve got to do an intake and evaluation, examination and then we can determine what the best protocol is. In order to prescribe herbal medicine formula, a full intake and evaluation have to be done. We have to find out what we are treating, how old is the patient, what’s her weight, what’s her health, determine if her tubes are good, so we know if the cervix is open enough, does she have polycystic ovarian syndrome or endometriosis, or perhaps she has a septate uterus and needs surgery. It’s impossible to suggest any herbs without doing an intake and evaluation first.
This is a tough question. Premature ovarian reserve decline. I’m going to eliminate the word decline and I’m going to say this. Forget the age, if your FSH is over 40 and you haven’t had a period in three months in a row, unfortunately, in my humble opinion, this is a case for a donor egg, and not a case for acupuncture and herbal medicine. If you’re 40 years old or over 40 and you have ovarian decline but you still have a regular menstrual cycle, what that simply means is that you have low ovarian reserve but you still have a regular period so that does mean, in fact, that you have eggs that are probably qualitatively not good. I would take a journey with that patient but as I said if the FSH is over 40 and you’ve not had a period for three months, I’m sorry to say that it’s a donor egg case. I shouldn’t say I’m sorry to say that because doing donor egg is not a death sentence, in fact, it’s a life sentence – you’re going to have a baby with a donor egg. I shouldn’t say it in a negative term but acupuncture herbs are not appropriate in that case.
Zita West is an acupuncturist. She’s not a reproductive endocrinologist but she’s an acupuncturist like myself who specializes in treating fertility issues and she has connections with many reproductive endocrinologists in London. If you contact Zita West, she can connect you with a good reproductive endocrinologist.
This is another interesting question. My answer is no and I’ll qualify that a little bit. Original acupuncture comes out of China but shortly after that, it moved to Japan and then shortly after that it went to Korea and then the first European country to ever have acupuncture was England. They’ve had acupuncture in England for four hundred years. In the United States, we’ve had acupuncture here only since 1975. Whether you find a Korean acupuncturist or a Japanese acupuncturist, let me restate – whether you find an acupuncturist that does Japanese style, Korean style or Chinese style acupuncture, none of it matters because they are all legitimate, effective and of value as long as the practitioner is qualified and knows what they’re doing.
This is a difficult question as well. I can’t fully see the question because my picture is obscuring it but I’m understanding that the corpus luteum has some yellow fluid in it. The corpus luteum in Latin actually means yellow body so the corpus luteum is supposed to be yellow. I’m not sure that this egg donor has pathology. That’s the first thing I want to say. I’m not sure that this pathology there. If there is pathology and this has happened only one time, and it’s a young proven donor, I wouldn’t be too concerned about it.
However, yes, it is good for that patient, I suppose it’s good to that patient, it won’t hurt the patient, it’s like prenatal vitamins, they are good for the donor. Flaxseed oil is good, definitely vitamin D is good, folic acid as part of the prenatal of vitamins. If she has some yellow fluid, it doesn’t necessarily mean this pathology and if she’s a proven donor, I wouldn’t worry about it. But to answer your question, any of these nutriceuticals or vitamins that you mentioned is good. I’m not sure about the probiotics, that’s for a stomach issue, so I don’t think it has much to do with fertility but I hope I’ve answered you adequately.
After a woman ovulates, first of all, what happens is the first thing the woman has is called the follicle. The follicle houses the egg and once the egg is extruded it or comes out of the follicle, the follicle under the influence of something called LH which is in the brain, it’s luteinizing hormone, this becomes the corpus luteum. The corpus luteum is manifested during the luteal phase.
Let’s just say a woman has a 28-day cycle, hypothetically, she ovulates on day 14 so then she has a corpus luteum and that corpus luteum’s job is to secrete a little bit of estrogen and a lot of progesterone to get the endometrial lining ready to receive an embryo, ready to have an embryo implant and ready to facilitate pregnancy. That’s what the corpus luteum does. If pregnancy is not manifested by cycle day 21 or cycle day 22, the estrogen and the progesterone sinks. The corpus luteum now becomes something called the corpus albicans which means the white body and the woman menstruates.
I’m not a hundred percent clear on the case. I understand your question completely. I think really what I’m saying is I don’t think I can offer you anymore. I would certainly speak to your reproductive endocrinologist and if she had a corpus luteum right after her period, perhaps the corpus luteum hadn’t become a corpus albicans yet and now it is and perhaps it is a little late and transferring from a corpus luteum to a corpus albicans. I would recommend speaking to the reproductive doctor.
Again I want to tell everybody that’s participating that these are fantastic, intelligent, well-thought-out and really good questions so congratulations and kudos to all of you. Yes, absolutely, acupuncture should be done during the two-week wait. This is what I explained to my patients. After the transfer, you must continue to get treated twice a week and we’re going to treat you twice a week after the transfer to help prevent miscarriage.
Now that may sound odd “help prevent miscarriage” – she just had the transfer. How do you even know she’s pregnant? In fact, she can’t even be pregnant right because it takes 5-6 days for implantation to occur. We must treat the patient and pretend that she’s pregnant.
Why pretend that she’s pregnant? Because we’re not going to know if she’s pregnant until she has enough HCG that can be detected through the blood to determine that she’s pregnant but obviously she’s going to be pregnant before that HCG is elevated enough in the serum in the blood to be detected. So we have to act as if, using the acupuncture to stimulate blood flow to this developing embryo and even the developing placenta, that comes from starting at week five. Yes, we must continue to retreat right after the transfer non-stop.
There is one important thing to say: that there are certain contraindicated acupuncture points in a pregnant patient, so let’s say that a patient had an IVF with a blastocyst, a day 5 embryo, so this may take one or two days to implant. Even if she had a transfer of a 5-day embryo today and the next time she came to visit me was Wednesday two days from now, I would change my acupuncture protocol I would make sure to use the acupuncture points that are meant to mitigate – to reduce the chances of miscarriage but also to not use any contraindicated points that possibly can facilitate a miscarriage.
You want to get acupuncture, if you can, 3-4 months before you even start using the injectables. But assuming that you’re going to do a transfer next week and your best friend said listen you should try acupuncture or your doctor said that, you don’t have three months so start now. Certainly, on the day of transfer, you should get acupuncture pre- and post-embryo transfer on the same day. You have to be at the doctor for the transfer at 3 o’clock this afternoon, you must get acupuncture at 1:30 or 2:00 o’clock in the afternoon and then go back to the acupuncture at 5 o’clock this afternoon and after your transfer and then go home and rest. The question continues, for example, which day is the stimulation and which days before and after that and so on. I’ve answered most of the questions and then during the two-week wait period, as I mentioned previously, you should continue to get acupuncture.
If you get a transfer on a Monday, come back, make them believe you’re in New York City, you will see me today 2 times pre- and post-embryo transfer, then you will be back this Wednesday for treatment and this Friday for treatment and next week you will come back twice for treatment – I’m going to treat you as if you’re pregnant until I found out that you’re not. When you’re not, I’m going to continue to give you acupuncture. Then when you do the transfer, I’m going to treat pre- and post- and you’ll be pregnant and then we’re going to continue to treat you twice a week right after the transfer, right after we find out that you’re pregnant, we’re going to treat you twice a week for 13 weeks to help reduce the possibility of miscarriage.
If the surrogate is getting acupuncture and herbal medicine by a board-certified acupuncturist and a board-certified herbalist, that’s totally fine. Perhaps she wants some help with her uterine lining. I’m not exactly sure why the surrogate would need acupuncture and herbs, let’s just play with this idea. You have a 28-year-old surrogate, you’re going to transfer this embryo into her and she has she’s perfectly healthy she’s 28-31, her uterus is good, everything is normal, everything is fine, why does she even need acupuncture and herbs? If she does, then perhaps she’s not the right surrogate? Unless you’re using a family member which sometimes happens right. Sometimes somebody will use their sister or something like that. There’s an emotional reason to do it. The surrogates you can only get acupuncture herbs if the surrogate needs acupuncture herbs and if she needs acupuncture herbs then it’s safe for her to take it as I said as long as she’s under certified specialists care.
This is question is definitely coming from a doctor. For those of you who don’t understand this question, TH1 is a T helper cell 1 which is a protein that produces inflammation and TH2 is an anti-inflammatory protein or an anti-inflammatory cytokine. This is very complicated stuff so most people including myself think that inflammation is the root of all pathology and, of course, pathology causes inflammation.
However, inflammation in many cases now is our friend and in a normal typical uterine environment it always starts out in a TH1 environment, in other words there’s always inflammation in the uterus but you have to understand. Lighting a match to light your cigarette is no problem but setting your house on fire is a problem but they’re both flames, they’re both fire, it’s just the level of fire and how long is the fire going to last. If you light the match, it’ll stay lit for a minute and go out. If you light your house on fire, it could be burning for four days. You want to have TH1 present in the uterine cavity because inflammation serves to degrade the uterine lining. I’ll repeat that. it serves to degrade the uterine lining. You want degradation of the uterine lining because degradation of the uterine lining helps facilitate embryo implantation.
After a certain point, perhaps once the embryo is implanting or has implanted, there is a transference of TH1 to TH2 so the uterus no longer is being affected by an inflammatory environment, it’s being affected by an anti-inflammatory environment which is the correct environment for the ongoing health and development of the implanted embryo. Now to the next part of this question is the TNF alpha is high? It’s a little bit out of my scope of knowledge when we talk about TH1, TH2 and TNF alpha. I’m not sure I understand the relationship between those two but I will speak about TNF alpha anyway within a different context. Women that have elevated activated natural killer cells will have inappropriate excretion of TNF alpha and what TNF alpha is tumor necrosis factor. TNF alpha resides in the uterus. 70% of TNF alpha resides in the uterus. 30% of it is in the bloodstream. Nobody knows what it’s doing in the bloodstream but we certainly know what it’s doing in the uterus. It’s there to fight uterine cancer and ovarian cancer but the only time TNF alpha or active or activated natural killer cells which spray TNF alpha on the tumor cell, the only time the natural killer cells should be activated is if there’s a tumor. If you have activated natural killer cells that are manifesting and you don’t have cancer, this is an autoimmune disorder and these natural killer cells are spraying TNF alpha not on a tumor cell but on your embryo and killing them. The way to treat this is not with acupuncture and herbs but with intra lipid therapy or IVIG which is intravenous immunoglobulin therapy which is quite expensive. Most doctors have shifted to intro lipid therapy which does the same thing. It will suppress the natural killer cells and you’ll go ahead and get pregnant and everything will be fine.
This is a rather advanced and complicated question. We never talked about acupuncture – how acupuncture reduces inflammation. I would say if a person has activated natural killer cells, acupuncture/herbal medicine are not the right modality. Intra lipid therapy is the right modality and if you have TH1 environment in the uterus that’s ongoing, that is also probably not the best case for an acupuncturist and herbalist. We have to find out why there’s a TH1predominance in the uterus. Is it because this patient has endometriosis or endometritis or some other inflammatory disorder in the uterus? This has to be parsed out by a reproductive endocrinologist. I think I’ll end my answer there.
I just want to say I am so impressed with these questions. It almost sounds like my best friend acupuncturist is asking me these questions. These are just great questions. Here’s the answer: the answer is absolutely 100%, yes, herbal medicine can be taken with supplements and IVF medications. However, I will go back to something old and then talk about something new.
The old is make sure that your acupuncturist and herbalist is licensed and board certified, has at least 5 years’ experience in reproductive dysfunction, has devoted the practice to it and knows what they’re doing – that’s my first answer, that’s repeating what I said before. The new answer is or in addition to that answer most reproductive endocrinologists, 99% of them, will not want their patients taking herbs while you are taking what’s called gonadotropins, reproductive medicine.
It’s not because the reproductive endocrinologist is a bad guy or a bad gal or they don’t know any better. They don’t want you to be taking herbs because they don’t know herbs, they know Western medicine and they are making an assumption, justifiably so, based on their educational background that the herbal medicine may either attenuate, may increase or decrease the effect of the reproductive medicine. They want reproductive medicine, the gonadotropins, to go into your body and not to be mitigated by other things. From my 23 years of experience, I have given many patients herbal medicine while they were on gonadotropins and they’ve either gotten pregnant or they haven’t but I’m quite comfortable in saying that they haven’t gotten pregnant because they were taking herbal medicine, because I’ve given patients herbal medicine while they were on gonadotropins and they did get pregnant. I don’t think there’s any downside to taking herbs while you’re taking gonadotropins.
I do believe in full transparency, of course, one will do what one will do. In my humble opinion, it’s my belief that you should fill in your reproductive endocrinologist and tell him or her that you want to take herbs and have the discussion so everybody’s working as a team.
Yes, 100%. As I mentioned earlier, on every patient that I have once they get pregnant, I treat them twice per week for thirteen weeks and then I let them go. The reason for that is 90% of miscarriages happen within the first 12 weeks. I never treat past 13 weeks with a rare exception: if I have a patient who has miscarried twice in the second trimester, I may treat her for the entire pregnancy but I must confess, in all honesty, in my 23 years of practice, I’ve not had that case, ever. To be more specific to you, yes, you should continue to treat it twice a week for thirteen weeks after pregnancy is confirmed
Another great question. There are several methods of delivery of herbs. One is you can take pills, one is you can take granules which just looks like a powder and you take the powder with some spoon and you put a certain amount in the cup and you pour boiling water and you drink it. The other one is called a tincture which is a a liquid with an eyedropper and you take a certain amount out and you just put it in your mouth and drink it or you put it under your tongue. I’m not familiar with how to take it because I never use them. Then the fourth way is raw herbs, actually real herbs.
The strongest type of herbs are the raw herbs and the best type of herbs, in my opinion, of the raw herbs. Let’s start from the top and look at pills. A pill comes in a bottle and you’re going to give this bottle to 25 patients but the pills contain the same dosage and the same amount of herbs and the same type of herbs in the pill. You’re going to give these herbs to 25 patients so to 2,500 patients, there’s no ability to differentiate, to change the herbal formula.
The beauty of herbal medicine is that you can compose an herbal medicine that is specific and exactly created only for the individual patient in front of me or any other practitioner. I don’t enjoy nor respect the utilization of pills in the dissemination of herbal medicine. Powders, granules are can be very good. The reason that I’m not in love with powders is because again talking about raw herbs, one of the things about raw herbs is that when the pharmacy cooks the herbs for you (my pharmacy cooks the herbs for you; many patients have to cook their own herbs; the pharmacy that I work with cooks the herbs), sometimes I want to be prepared in a certain way. I want you to fry this herb with salt, I want you to fry this or with honey or I want you to mix this herb with another herb but the other herb gets thrown out and doesn’t get put in the formula because just using the other herb will change certain properties of this herb that I want to keep in the formula.
You can only do that with raw herbs again a reason that I like to use raw herbs. As far as the tinctures are concerned, the tinctures are also not necessarily a bad way to go. I think they’re fairly efficacious but again those herbs cannot be processed. In Chinese, if you Google Pao Zhi – it means the processing of herbs. Everybody listening can google it and you’ll see that there are different ways to process herbs. The only way that you can do that the highest level of refinement in herbal medicine is raw herbs.
Another very good question. I’ll use my hands to show you – the vagina looks like this but the vagina can open like this. You may know or you may not know but the uterus is exactly the same. The uterus is completely flat, it does not look like this. It is not like an open little bowl below your tummy. It is flat.
If you can see my fingertips, in front of my fingertips is the vagina and then north of the vagina is the cervix which is right around here and then in here is the uterus. When somebody is getting an embryo transfer, how is that done? The reproductive endocrinologist puts a tube through the uterus, through the cervix here into the uterus. Whenever the top of the uterus or the bottom of the uterus is touched by anything, it will go like this, that’s called spasming.
I’m going to stop for a second and just tell you something else. There are a higher number of ectopic pregnancies in IVF patients than in the non-IVF population. Why is that? Because when that tube containing the embryo is put into the uterus and the uterus is spasming, it can cause retrograde flow of the embryo, meaning it can take the embryo and make it go backwards and sit and reside in the fallopian tube and then you will have an ectopic pregnancy.
When you do acupuncture before transfer, you are stimulating a lot of blood flow to the uterine cavity to help nourish the uterus itself and get the uterus ready additionally, ready for the implantation. After that transfer is done, your uterus will be spasming so you go back to the acupuncturist they put needles. Remember, the first treatment was to drive blood to the uterus to help receive the embryo to help facilitate implantation but after the transfer, the acupuncture is done to take the uterus going like this that you can see this and to make it go like this and just to stop spasming which will greatly reduce the possibility of ectopic pregnancy and therefore greatly increase the percentage of an endometrial pregnancy, a uterine pregnancy.
I’ll talk about the itchy, first. The Itchy is nothing to worry about. It’s not uncommon, it’s histamine response, it’s simply something that acts up as an allergic reaction. I don’t want to say you’re having an allergic reaction to the acupuncture but it’s almost like it’s brother or sister of allergy that the body thinks something is weird that’s going on and it’s sending these histamines to the site. It’s completely irrelevant, completely meaningless. What it is, it’s annoying but it has no negative connotation whatsoever. As far as the sites being achy, in my opinion, they should not be achy. 99% of the time needle insertion should not be painful. Retrieving the needles should not be painful. You should absolutely feel no pain after the needles.
There are some people that are needle sensitive. I happen to be needle sensitive when somebody puts a needle in me, I hate it, I find it very painful, I know it’s ironic but I can’t lie, it’s true and so you may be needle sensitive. If you are needle sensitive, perhaps, you are, ask your acupuncturist if he or she can use thinner needles. There’s a type of needle, it’s a Japanese needle, it’s manufactured by Seirin. They’re extraordinarily thin, thinner than the typical needles and you should not feel anything with them, no pain certainly, you still may get the itching but you won’t have any discomfort.
That’s a great question. I never treated a patient for relaxation. If my patient is on the table and she is feeling stressed, anxious or depressed, I’ll certainly treat her to try to make her calm and relaxed but that is not why I wake up every morning and run to my job. The acupuncture is meant, in my hands, certainly, for three reasons only, which is to improve egg quality, lining quality and sperm quality. Certainly, wondering if you’re on the table, I’ll use needles to help you relax but if I got a call from a patient who says listen I want to come in and get acupuncture to relax, I’ll never treat that patient. I’ll be very nice to the patient on the phone but I’ll say listen it’s just not what I do. I really appreciate your call. Thank you so much. There’s a million acupuncture staff there. You can go to somebody else. You can just go and get a massage, that’s very relaxing as well or meditate, etc. That’s not what I do but I wish you the best, thank you. Acupuncture is a lot more than relaxation.
That’s an interesting and a good question. In that case, what I’ll say is, many women get ovarian cysts. There are many different types of cysts but certainly what’s often encountered is something called an LUF which stands for a luteinized unruptured follicle so the woman is about to ovulate the level of LH goes up which is what’s going to make this woman ovulate and her follicle is trying to burst open to release the egg but it doesn’t and it turns into a cyst. If that’s the kind of cysts that you’re talking about, this is not uncommon.
It is unfortunate because what happens is the IVF cycle is typically canceled until the cyst goes away. Usually, the cyst will go away on its own within a month. Sometimes a doctor will give a patient birth control pills to help the cyst away or if it’s a different kind of cyst a dermoid cyst or an endometrioma which is a cyst from endometriosis, then a surgery is required. If this is a luteinized unruptured follicle and it happens frequently, I would give acupuncture and herbs a try. I haven’t had this kind of case before, believe it or not, in 23 years.
I would say that it falls easily within the realm of acupuncture/herbal medicine treatment if in fact it is luteinized unruptured follicle; it’s that kind of cyst and not a dermoid cyst or endometrioma or another type of cyst.
What is infertility? Infertility means you can’t get pregnant. I can’t become the next world champion middleweight boxer. Why not? Because I’m too old and that’s why. I’m trying to come up with an analogy here. The reason that I couldn’t be the boxer is because I’m too old. So the question is we’re not treating infertility.
Now I know that sounds odd: we’re not treating infertility. We’re treating what is making you infertile. Is it that you have polycystic ovarian syndrome with too much androgen and the follicles and you don’t ovulate, you don’t menstruate? Is it that you have these pro-inflammatory cytokines in your uterus and even in the absence you might have some endometriosis? Yes, then we can treat that. Is it because you have unexplained infertility but you’re anatomically within normal limits? Yes, we can treat that. The needles are going to go in a patient in certain locations based on what the differential diagnosis of the acupuncturist is.
If you come in and you’re 250 pounds and you’re 25 years old with a polycystic ovarian syndrome, you’re going to be treated completely differently than if you’re 120 pounds and you’re 23 years old to the same age and she has a polycystic ovarian syndrome. It would be different acupuncture locations and different herbal medicine formulas for both patients. This is very difficult to respond to because your FSH at 10.3 is not so bad but if your estradiol is above 65 then your FSH is not really 10.3. Your FSH is probably 12, 13 or 14 or 15 because an elevated estrogen level will suppress your FSH. So FSH is not the best number to look at the better number to look at which will determine your ovarian reserve is AMH.
If your AMH is 2.85, it looks to me like a very good, positive, beautiful AMH. It looks completely terrific, healthy and normal and every patient would like to have that AMH. There is one thing I want to say about that, I’m assuming that you’re in Europe and I’m in the United States. In Europe and in the United States we use different units of measurement. 2.85 may be elevated within the context of the unit of measurement that’s used in the country in which you reside. But if you are in California, USA, that’s totally normal, fantastic and wonderful. That means you have a very decent of ovarian reserve.
Everything is okay. I’ve had patients who have come in and they say “my God, I was supposed to take the HCG shot last night at 8 o’clock but I took it at midnight” – the shot that is going to make them ready for egg retrieval for in an IUI case to make them ovulate. It’s not the end of the world. If you can’t do acupuncture pre- and post-embryo treatment transfer, let me say this, there have been about five billion women in the history of mankind that never got acupuncture and they got pregnant so acupuncture is not the be-all and end-all. The data and science attest to the fact that doing acupuncture pre- and post-embryo transfer is very helpful. If you can’t do it, you can’t do it. It’s not the end of the world. Do the best you can. That’s all that one can ask. Let’s keep our fingers crossed.
It’s another great question. Let me explain something about sperm DNA fragmentation. The DNA in the sperm should look like this and DNA fragmentation means this is what the DNA looks like in the sperm.
There are many issues it’s a very big deep topic which I’m not going to go into but I’m going to give you the a very important piece of this. A man that has sperm DNA fragmentation above a certain amount about 29% that sperm cannot penetrate an egg. Above 29% there are very few pregnancies and then doctors will say well, it doesn’t matter, we’ll do ICSI which is intracytoplasmic sperm injection where they inject the sperm into the egg.
Very often it doesn’t work because you’re injecting a bad sperm into an egg. But 90% of men with sperm DNA fragmentation, let me repeat 90% of men with sperm DNA fragmentation are men that have poor sperm parameters. However, 10% of men that have perfect sperm also have sperm DNA fragmentation. The man get a sperm DNA fragmentation assay. I’ll give you the stats right now very fast. If there’s DNA fragmentation of 0 to 15%, there’s a good to fair fertility outcome. 15% to 29% it’s, I think, fair to poor outcome and above 29%, there are very few documented pregnancies.
You’ll know this so when you get the paperwork back. I’m sure the doctor will interpret it for you. But I recommend the sperm DNA fragmentation assay. I also recommend something else: you must get a test called ureaplasma test. This is an undetectable sexually transmitted infection test. It doesn’t mean that you cheated on him or he cheated on you. It simply means that if either one of you were sexually active before you met each other, you could have gotten this bacterial infection. It’s completely asymptomatic but it attacks sperm and embryos and it can be treated. The man never gets tested. If the man has it, the woman automatically has it. Then you’re both put on antibiotics for 10 days. This is a very often overlooked pathology that must be tested. I recommend that to you. I recommend sperm DNA fragmentation. Urea plasma sperm DNA fragmentation.
You should also get a fluid ultrasound which is where they put saline solution in the uterus and look in the uterus to make sure you don’t have polyps. Polyps are benign, they’re not cancerous but they will prevent you from getting pregnant. You should have that done and, obviously,y you must have hysterosalpingography, which I’m assuming you’ve had, to make sure that your tubes are good.
The answer is no. Chinese herbs don’t work like this. I know that people go into the drugstore or the health food store and they buy these things, they take Vitex, Dong Quai, etc. This doesn’t work like that. Let me tell you what happens when you’re taking Dong Quai. I’m going to make an analogy for a chicken soup. I have this big pot, I put it on the stove, fill it with chicken stock, I put in a chicken, turn on the soup and cook it for three hours and there’s my chicken soup. It’s not going to be very good. Why not? Because there’s no salt and pepper in the soup, there’s no carrots, potatoes or celery in the soup and there’s nothing else in the soup that might want to put in the soup. Because the soup needs ingredients. It needs ingredients to make it delicious to make it more palatable. It is the same with herbs. You can’t take an herb and have an effect. Herbs are only given, at least in the context of Chinese herbs, in formulas. A formula is two or more herbs so that’s really the way it works. I will meet a patient, do my evaluation and sit down for an hour and literally think about what I want to give the patient, write down the herbs and review it five times, take out this herb, add this herb, let us cook this herb with this herb, let’s cook this herb with vinegar. I don’t want to use 15 grams, I’ve changed my mind, let’s use 12 grams instead of 15 grams. This is how you really do herbs so just taking Dong Quai or Black Cohosh is an utter waste of time.
Asthenozoospermia, basically, means poor motility and poor morphology. Motility means the ability of the sperm to swim in a straight direction and morphology means the shape of the sperm. If it is not as a result of undescended testes when the man was a child, if it is not as a result of a chronic exposure to radiation, certain chemicals or certain medications that the man had to take, if it is not as a result of some physical anatomical structural defect within the testicles, yes, acupuncture/herbal medicine would be very effective for asthenozoospermia.
It’s totally out of my scope of knowledge. I’m terribly sorry. I’d rather give you an answer of I don’t know than to answer it where I don’t know. The answer is I don’t know I’m so sorry.