Acupuncture & IVF preparation for conditions that may impact the outcome of IVF cycle

A lot of people during lockdown are feeling very frustrated. Things are starting to get moving now and clinics are starting to open again but for some people there is still quite a waiting list because they’ve just started up. A lot of people want to know what they can do at the moment to help things. I will go through some of the things that you can do for yourself while you’re waiting. It’s a bit of a checklist because sometimes when patients come in for treatment, they’ll say “I wish I’d come to see you sooner”. There’s a lot of information that we go through, advice that we give and patients would have liked to have done those things earlier. Some really simple things that you can do to help yourself when you’re preparing for IVF may seem common sense stuff but sometimes you just need a little bit of a kick to remind you that these are the important things to think about. First of all, eating – eat as well as you can. Go for natural foods where possible, stay away from processed foods, go for the best quality that you can get hold of. If you can afford organic food, then, ideally, buy organic. If you are working to the minimum, you can look at things like the Dirty Dozen that will tell you the worst foods that you can eat that aren’t organic and which ones are best for you to buy. Those are little simple tweaks you can make without having to go completely organic. Look at the quality of the produce you can get hold of, look at the quality of milk if you use dairy products. If you have got digestive issues or complex conditions, consider if working with a nutritionist would benefit you, if you need to go on that deeper level. Look at what supplements you’re taking. Often we see patients coming in who are taking too many supplements. They’re doubling up, they’re taking a preconception multivitamin but they’ve also read that maybe they should add this product in and don’t always realize that they’re doubling up. This is where a nutritionist could really come in because over-supplementation is just as negative as not having any supplements. Do your research on that side of things. Giving up smoking is a really obvious tip. If you’re struggling and you do smoke, seek help. There are different methods out there that you can use. There’s a fantastic book that a lot of people have found very useful and you can read that. There are lots of things out there but we know that smoking actually decreases your reproductive years and it can affect all the processes throughout reproduction development during your cycle. Trying to get rid of smoking where possible will really help. Alcohol – the research is mixed around alcohol. For men, as long as they’re having low to moderate amounts of alcohol this should be OK. It depends again, in certain circumstances. If you were seeing somebody like myself, they would look at your constitution and be able to tell you whether you can get away with having alcohol or if it is those tiny amounts that you might be having still having an impact. Keep it low because you don’t want to feel necessarily like you can’t have any fun and your life is on hold but just be conscious that you’re not overdoing it with alcohol. Definitely, when you come to start an IVF cycle, we would tell you to cut the alcohol out just for the cycle at least. With IVF there has been research that has shown reduced life birth rates when people have drunk excessive amounts. Be conscious of the amount you drink. Caffeine – it’s a little bit mixed. Sometimes we hear very negative things around caffeine and male fertility, other times, we’re not seeing that it’s substantiated. From a TCM (Traditional Chinese Medicine) point of view, caffeine is a diuretic and it’s going to decrease the fluids in your body and in certain cases we’ll see some issues in the semen being too thick or the women are having night sweats. We want to be conscious that the body has enough fluids so caffeine is going to have a negative impact on the body. If you’re a particularly anxious person, you struggle to sleep, caffeine isn’t going to be great. Reducing caffeine as much as possible, switching to decaf will really help you. Another thing to look at is medication. Depending on if you’ve already seen a consultant or not, or you may be waiting for IVF, things that you want to check is whether the medication that you’re on at the moment may have any impact on fertility. Sometimes your GP might not have picked up on that or you might not have got to the stage to speak to your GP. Doing that research to make sure you’re not taking anything that is going to impede your chances of conception because often there are alternatives that can be used. Exercise – you can’t go wrong with exercise, it gets your energy moving, it gets your blood circulation going, it helps with your mental health. On the other side, make sure you’re not overdoing it as well. Listen to your body, if you’re feeling tired, if you need a rest, then do rest. Make sure you get plenty of sleep. Particularly in lockdown, people have really struggled with keeping good sleeping habits. If you have got out of routine, try and work to get back into a good routine. Ideally, be in bed by 10:30 PM, this is where we would want you to be as a Chinese medicine practitioner. One of the reasons is that at night your liver helps detoxify the body, it helps regenerate for the next day and if you’re up late, you’re then giving your body other functions rather than being able to rest and repair. 11 o’clock is deliver time so get to bed at 10:30, you can still be watching a movie for a little while but at least if you’re resting, your body can then do its jobs and it would during the night. It’s also about getting a decent number of hours of sleep. Emotional health is also important. If you’ve had issues in the past, you might have had traumatic events happen to you, you may have had miscarriages, there may be lots of different things that you’ve experienced and that may be affecting you, now is a good time to address those before going into an IVF cycle if you’ve got the chance. If you’re a worrier trying to find ways to switch your mind off and stop that overthinking will really help you. Building a practice of mindfulness or meditation or some kind of activity that occupies your mind like knitting can help switch you out of those negative thoughts. Use those to help calm your mind. If you’ve got issues around grief or fear, perhaps working with a therapist if you can help address those. IVF is an emotional process as well and we want your emotional health to be as good as possible. Stress, worry, emotional stress – try and bring more love and joy into your life. Go for hobbies and things that are going to really excite you. We can get stuck in the mundane and almost forget how to have fun sometimes. Bring in things that will help make you feel happy, having fun, bring out that inner child if you can. Frustration – if you’ve got a lot of frustration and anger and feelings that you’re suppressing, try and get them out. Exercise is really good for this. Boxing if you’ve really got lots of aggression that you need to get out of you. Do what you can to work on your emotional health and also be creative because sometimes being creative and making things happen can really help get things moving on an emotional level. Also, look at your environment. I’ll talk a little bit more in detail about this later but what are you being exposed to, what are your living arrangements, how can you make those things as healthy as possible for you? Now is the time if you are preparing for an IVF cycle and you want to do acupuncture to start looking for an acupuncturist so you’re ready and you can start the ball rolling.

Ovulatory dysfunctions are one of the most common causes of female infertility. A large percentage of those are PCOS. Acupuncture has a lot of different effects on the body, one of which is increasing blood circulation so if we can increase the blood circulation to the ovaries and the uterus with acupuncture, then we can have an effect on things like inflammation in the ovaries. Often, you’ll see that the ovaries are quite enlarged. Acupuncture can help reduce the size of the ovaries. If you’ve got a lot of ovarian cysts, this movement that acupuncture creates can help work on those cysts and help reduce them. With polycystic ovary patients, who often have insulin resistance syndrome, we know that acupuncture reduces the insulin in the body by decreasing the blood sugar. One of the things that we have to be conscious of as acupuncturists, if we’re treating people with type 1 diabetes, that their blood sugars don’t drop too much when we’re treating them (I’ve seen that happen), we know that it really does have a very effective response on this. Also, it works on the sympathetic nervous system, it works on the endocrine system and the neuroendocrine system. It helps regulate the hormones, it helps regulate your endorphins, your stress responses, all of the factors that will influence ovulation in the body. One of the things we try and do is regulate menstrual cycles. Depending on the severity of somebody’s ovulation issues it may actually be that we can get a regular cycle going that can even enable natural conception prior to an IVF cycle. If you’ve got the time giving that opportunity might get you the result that you want anyway. If it’s more severe, the aim is just to get your cycle as regular as possible because if we can get your cycle regular, your body is going to be in a much more balanced state and, therefore, will respond more favorably to the medication because it’s already halfway there. One of the things to point out is that acupuncture is dose-dependent so being conscious of your ability to go frequently is quite important. As acupuncturists, one of the things that makes us sad is when people get in touch and it’s just too late for us to help them. Sometimes it’s because we’re just booked up and we don’t have the ability to fit people in but also that we just don’t have enough time before they start a cycle to do the preparation work that we would really like to do. Being conscious of that, if you are thinking about doing something like acupuncture, get in touch as quick as you can because you don’t have to start treatment straight away but you can get those appointments booked in that are going to give you the right amount of time to give it its best chance. There’s been research that has shown that acupuncture significantly improves the birth rate of some fertile patients undergoing IVF and ICSI so I think that alone is a good motivator to go and give that preparatory time before you start an IVF cycle. There was another piece of research from China that also showed that the birth rate was 52% with acupuncture, where the sham group and the control group only got 30% so the statistics that we are starting to see from the research are quite significant.

Blocked tubes don’t affect IVF. The IVF will override a blocked tube. But if you’ve had an HSG, try and get as much information as possible because sometimes the tubes are blocked because there is a lot of scarring and damage to a tube but not always. If you find out that the tubes look blocked but they can’t see any significant scarring or if you find that there’s a minor blockage at what we call the proximal end (which is the end closest to your uterus), then it might be worth considering having a course of acupuncture before you do the IVF. It might also be worth considering things like abdominal massage. The reason being that about 60% of people who have HSG and find that they have blocked tubes later find that they’ve cleared. One of the reasons is that sometimes the tubes can just spasm and stress tension in the body can also create those spasms in the tubes. Also, they can just be blocked with excess mucus. When we look at patients and their constitution, sometimes we’ll see that that person is quite damp or has a lot of mucus in their body. Me, for example (it’s hay fever season). My sinuses will block up so I am prone to what we would call phlegm damping in the sinuses. From a fertility point of view, if we see a patient has a lot of phlegm damp in their body, we can use the acupuncture to help relax the body, get the liver energy moving so that those tubes relax. We can tonify the body and move that phlegm damp. It might be if things are pronounced that we even use herbs to do that. It may be that the opportunity is there to clear those tubes and also produce a natural pregnancy. If that doesn’t happen, it’s just putting you in a better state ready for IVF. I have had patients who have had blocked tubes and been told that they can’t conceive naturally, conceived naturally before an IVF cycle so I have seen it clinically as well.

Male fertility is really important. First of all, we have to find out are there any structural abnormalities that are causing male fertility issues. If there is a structural abnormality that is maybe congenital, like the vas deferens have never formed properly, then we can’t help that. But there are a lot of cases where sperm parameters come back abnormal, but they can’t find a cause. Also, you can have non-obstructive azoospermia which means that there isn’t anything blocking the root out for the sperm, there’s nothing in the way that is visibly impeding that sperm production and in those cases, it’s worth considering things like acupuncture and herbs as well. From a lifestyle point of view, all the things I spoke about earlier in terms of keeping the alcohol consumption as low as possible, looking at your work environment, whether you are being exposed to any chemicals during your work, whether you work in a very hot environment. I see a lot of engineers who work in the engine rooms of ships where it’s very hot. Changing your situation can improve your fertility. Do you exercise enough?  In terms of thinking about insulin resistance. A lot of fertility medicine is very much focused on the female but a lot of the things we see in female fertility also happen with men. Has your thyroid been checked? How stressed are you? Dealing with that emotional side of finding out that there is something going on with your sperm is just as important. We know that actually high stress can impact all factors of male fertility. Looking at mindfulness, anything you can do to relax, building that into your lifestyle is very important. Another key thing is varicoceles. I see often in practice that the testicles are not getting checked and this is really important. Currently, the NICE (The National Institute for Health and Care Excellence) guidelines in the UK do not encourage varicocele treatment but there are some fantastic urologists out there who are working towards changing that. It’s important for men to know that varicocele are very common so they’re found in about 15% of men in the population. They are a bit like varicose veins but in the testes. If you have fertility issues and you haven’t had your testicles checked, then I would say please do go get them checked by your GP. If you visit your GP and they find a varicocele that is obvious, then try and get referred. Most GPs that I’ve worked with do follow through with treatment where it’s appropriate. The reason I’m really passionate about this is because the research really does show that treating a varicocele helps on all levels. Even if you have good sperm parameters but your partner experienced recurrent miscarriages or is just not getting pregnant and you’ve been trying for such a long time or you’ve done IVF cycles and everything looks good on your sperm but then when they come to fertilize, either you have less than the expected average of embryos fertilizing or you end up with very little left. It’s really worth investigating this. What the research shows is that when a varicocele is treated, everything improves, even in patients whose sperm parameters have been normal, they’ve seen improvements when there has been treatment. There was a piece of research that said in men who had their varicoceles treated they saw 12% higher fertilization rates, 15% higher life birth rates and 9% fewer miscarriages. For me to see data like that is enough alone to confirm my opinions around getting varicoceles treated. Acupuncture can also help with these things on a circulatory basis but I do always encourage my patients to have those investigations done. Also herbal medicine can help because if there is poor blood flow, we have really good herbs that can work on that. Sadly the research is really lagging behind in male fertility. But I really hope in the future that more research will be done and we can start to show the benefits of what we do around these treatments. Acupuncture also is going to help boost circulation in the testicles, it’s going to help boost your general health, it’s going to help relax you with any stress or emotional problems around male fertility, it’s going to reduce insulin resistance if you’re having problems with that. It’s also good for any erectile issues, ejaculatory issues and these have all been proven through research and it helps boost testosterone. It also reduces cytokine levels which can also affect sperm quality and if there’s immune factors going on in either side, then acupuncture can also help with that and various herbs that we use. In preparation for ICSI, address as many lifestyle factors as possible, find out if you’ve been checked for varicocele if you’ve got the opportunity. It’s worth looking at that, particularly, if you’ve had recurrent problems or recurrent failed cycles where it indicates there may be something going on there and then try and get some acupuncture.

With endometriosis, looking at your diet, lifestyle and similar to PCOS, endometriosis is very estrogen dominant so looking at environmental factors, trying to reduce any chemicals that you’re exposed to (also in your diet). When I speak about things like finding good-quality milk that hasn’t got as many hormones in. In the shops, there is average milk, organic milk, milk classed as A1 and A2 milk and better quality milk that is the one that comes from grass-fed cows or goats. Going dairy-free is the next option. We’ve got a lot of really good dairy-free options available now. I would explore that to reduce the hormones that you’re being exposed to and again the meat quality that you’re eating that could potentially have hormones in it. If your condition is particularly serious and you’re not sure where to go with diet, then looking at a nutritionist is a really good idea. Also looking at the products, the chemicals that you’re using in your home and on yourself. One of the mild anxieties I have at the moment is all the disinfectants we are using amid Covid-19 and there’s not a lot we can do about that, other than maybe explore the options that are going to reduce the number of side effects and side products that come from these disinfectants. Some of the byproducts can have negative impact on our body and these chemicals become what’s known as endocrine disruptors so they disrupt how your body is responding to hormones. That’s exactly what we don’t want when we’ve got a situation of hormone dominance in the body. Looking at natural cleaning products, natural cosmetics, getting everything as natural as possible and reducing your chemical exposure will really help on that side of things. Also gut health, in general for everybody, is really beneficial but particularly if you have an estrogen dominance. So making sure that you’re having good quality regular daily bowel movements. You can address that either through a nutritionist or looking at what diet changes you can make to improve your condition. Are there maybe foods that you’re eating that can be inflammatory? We hear a lot of things these days about people being gluten intolerant. I’d say that not everybody necessarily has a medical issue around foods like gluten but they are difficult to digest and just because it creates some difficulty in the digestive system, doesn’t make it OK, if you haven’t got celiac disease, if you’re eating foods and your digestion is bad, you’re having bloating, taking away the foods that are difficult to digest will really help. Reducing things like gluten, taking away dairy where possible can really help calm the digestive system down. Then looking at things like probiotics, prebiotics, digestive enzymes. This is where working with a nutritionist can really come in. Addressing as much as possible to get your digestion as healthy as it can be so that you’re going to excrete any excess hormones in your body. If you’re not having a daily bowel movement and your body is producing lots of estrogen, there’s nowhere for it to get out. As a result, as your body produces more estrogen, it just adds to the estrogen that’s already there and it becomes a vicious cycle. To sum up, gut health is really important in fertility in terms of balancing hormones. Other things to look at is pain management with endometriosis and controlling how that is affecting you and how it’s affecting your menstrual flow. Looking at things like abdominal massage. You can teach yourself self-abdominal massage or, hopefully, when things calm down with Covid-19, you can look at integrating things like this massage into your life and they’ll really help. Anything that’s going to get the circulation going in your body is beneficial. Also, if you’ve got a lot of scarring inside from the endometriosis, it can change the structure of everything inside. What we really need is for things to be as aligned as possible so that your blood flow can move properly. Sometimes that scarring and the pain that is created from the endometriosis can really affect how things are aligned. If your muscles in your body are really tense and you’ve got pain on one side, you’re going to change your position, you’re going to develop compensatory patterns within your body. So anything that can help release that tension is beneficial. The same way if you had an injury, you injured your back, you might then start to walk funny and you end up having to need a massage or physio to help get your alignment back. Think about that on a monthly basis when you’re having very severe periods, anything that’s going to reduce your pain and relax those muscles is helpful. Looking at things like castor oil packs. There’s loads of information out there on castor oil and how you can use it. It can be quite beneficial for the pain of menstrual periods and so that would be something worth investigating as well. There are also supplements that can help with inflammation, e.g. turmeric. Incorporating foods and supplements into your diet that are going to help reduce any inflammation can be beneficial. We also know that women with endometriosis often have an excess of what we call peritoneal fluid and that tells us that there is potentially an environment that isn’t healthy. There could be infection there, there can be immune reactions going on. All of these things that get things moving will help clear that and that again is where acupuncture comes in by boosting the circulation. It’s also really good for pain relief. The research is very clear on acupuncture for period pain, dysmenorrhea, so using acupuncture or herbs to manage conditions like endometriosis. I would bring fibroids under this umbrella as well in terms of how they impact the body. Sometimes it depends on the severity of these conditions as to how much we can do but we can generally manage the severity of them and prevent them getting worse, help control the pain, help balance the hormones out so they are being less stimulated and in that way maintaining the condition in a better state. Also, there are things out there which you might have read about there are medicinal mushrooms that can be used. I would really recommend, if you’re interested in these things, reading about them and then finding a well-trained herbalist who can prescribe these for you. They can be very specific in their actions and not all of them suit every situation. It may be beneficial to have particular blood tests to decide which ones are the most appropriate ones to use.

This is an interesting one because a lot of people focus on the transfer day. Yes, it’s important in terms of this is the big crescendo, this is what we’ve worked towards to get these embryos in your body. But the most important stage is the preparation stage and the stimulation stage of an IVF cycle. Getting enough treatment before you get to embryo transfer is really important. I would say without a doubt the stimulatory phase if you’re having a full IVF cycle is really the more important stage. Before the embryo transfer, we do a lot of work on relaxing you, calming your mind, preparing you for going to the clinic to have the treatment because obviously it’s a big deal. It’s a very stressful day. We also use points that help relax the uterus so it makes that transfer easier. We’re using points that are going to help boost the circulation, ready to kind of nourish that uterus and accept an embryo. After embryo transfer, depending on the day of your transfer, the actions of the acupuncture change. It’s about keeping you relaxed, it’s about getting the circulation going to help give sufficient blood supply to the fine lining to help implantation, to help that embryo bed into you. Regulating the hormones so that your body’s response is appropriate to that embryo that’s been implanted and then just relaxing you, ready for the two-week wait which is the really big rollercoaster ride.

With fibroids, it’s a similar way to what I’ve described with endometriosis. With fibroids, we’ve got an accumulation within the body of what we would describe as blood stasis. Often fibroid patients have very heavy, painful periods so we would address those with treatment, trying to get the period flow to a more manageable level. If you have very heavy periods, then it’s going to affect your body’s resources and can lead to things like anemia. You want to counteract those factors. It’s also the pain side, the pain management making your life more comfortable. The hormonal balance – because again fibroids are generally responsive to estrogen so we want to make sure that your hormones are as balanced as possible to try and discourage those fibroids to grow and making that environment as healthy as possible ready for conception.

Vitamin D is a pretty unanimous one. These days, it’s recommended in terms of fertility for both male and female. I’m not a nutritionist so to talk about supplements on a deep level is really beyond my expertise. That’s why I often refer to a nutritionist. The key things to look at are your dosages, making sure that you’re not excessively dosing. Everything you’ve listed is what you would find in a good conception multivitamin so they should be fine. What are the dosages that you’re taking? Are they within safe levels? If you’re unsure, exploring that with a nutritionist would be a good idea.

I don’t know. This is the big nutrition field. It’s not going to do you any harm to have things like pomegranate and grapefruit juice. Grapefruit juice – you have to watch if you are on any kind of blood thinning and heart medications. Simply checking that you haven’t got anything that’s going to interact with things you’re taking is very important. There are really good websites out there where you can check interactions. You’re going to get lots of vitamins from these. Foods like pomegranate that are that darker, red color are rich in antioxidants and they are very good for fertility health, for reducing cytokines, boosting the body. It’s not going to do any harm. Has anybody really never get pregnant because they didn’t eat an avocado? I think we get a little bit too hung up on the nutrition sometimes. When I first started on all the forums they would always talk about peas and that you shouldn’t eat them. If peas were really why people weren’t getting pregnant, I think we’d have a much bigger issue than we do have. I think just eating really healthily, eating good whole foods, good quality foods and then if you want to take it to a deeper level, exploring it with a professional. What they will do is they will do tests and they’ll see what your actual nutrient levels are or they’ll see where your hormones are at and they know what foods will balance those out. It is much better for you. I think it’s really important that we don’t let the food consume us. A lot of patients become almost caught in this trap of really wanting to do the best they can to help themselves. Food is a great way to do that because you can channel the energy of wanting to do something into cooking and making nice food but it’s not going to the extreme of worrying at every little thing. “Is this right? Should I eat that? Shouldn’t eat that?” because then that becomes an extra stressor and that’s really not helpful. I have patients who worry that they’ve eaten a bit of cake. Your IVF isn’t going to fail because you’ve just had a bit of cake. Don’t worry too much, do the best you can. There isn’t a lot of evidence or research around these things to conclude to eat certain things or not. Do your best and don’t worry too much.

Some research says that caffeine is OK, some will say it’s not too bad. The question is how many things are you going to cut out of your life? How comfortable are you with that? A lot of people get to a point where they feel like their life is on hold because everything is focused on getting pregnant. I don’t think a couple of cups of decaf tea is really going to be the thing that you need to worry about. If you think about something and it does make you question it, so maybe if you do drink decaf tea are you going to stress about the fact that you had decaf tea? Then you may be better off going for a herbal tea or looking for an alternative. It’s finding what’s the right balance for you. On the other side, if you cut out decaf tea and you can no longer have tea in any form and tea is something you really enjoy, then you’re probably better just having a couple of cups of decaf tea. I think we do get really focused on all of the things that we can do to make ourselves as healthy as possible. But then we forget about the stress that those things can cause. It’s really about trying to find that balance as much as you can.

My question would be why were you on the pill in the first place. You’re not normally kept on the pill for too long. It depends on where you’re having treatment. Most clinics will only have you on the pill for a few weeks before starting an IVF cycle. Were there any underlying issues that resulted in you going on the pill in the first place? Secondly, the pill has an impact on the body of affecting ovulation, it stops ovulation so when you come off the pill, your body has to rebalance and that can sometimes take a little while. First of all, try not to stress because it’s not been too long yet. How long are your cycles normally? Some patients come and they have just stopped birth control and you’ll see that all women respond differently to birth control pills. Some people can go on the pill and come off and straight away their periods return. Periods of other women struggle to return. It does have varying impacts on different people. Give it a bit of time. The things that are going to get your energy moving and they’re going to boost circulation and help with ovulation, exercise, reducing your stress, acupuncture, self-abdominal massage can help. If it does get to the point where it’s dragging on, then get some blood tests. Definitely, acupuncture and Chinese medicine can help you in these situations. It’s just difficult without full information to give you complete advice. I would also try and get in contact with your clinic, relay the stress that this has caused and see what they can potentially suggest for you. They might be able to refer you to blood tests. It’s really hard with Covid-19 and knowing how people are working at the moment. Definitely seek help if you can. See an acupuncturist these are things that we work with on a regular basis. Hopefully, you can get your IVF soon.

It’s a difficult one because without knowing somebody’s full history, you can’t say what you would ideally do in a situation. If you’ve planned to do 4 weeks, then that’s what you have available and you’re doing the best you can. In a frozen embryo transfer, most of the work’s already been done in terms of getting that embryo ready. So there’s less work to do so. I think you’ve made a good plan. Depending on somebody’s history, if they had a more complex history, if they haven’t had treatment before, we would try and see people for 3-4 months before they do any kind of IVF treatment. However, we do know, in reality, that isn’t always possible. What you’ve done sounds pretty good.

With egg quality, this is a really difficult one because it’s something that’s very hard to research. In fertility medicine, we’re still learning a lot about what we can do around helping egg quality. We’ve got lots of information out there of things we can try but there isn’t necessarily a huge bank of information about what definitely works. We do know though that acupuncture helps improve the blood circulation to the ovaries, it helps balance the hormones so the impact that acupuncture has can improve how those eggs go through the follicular process, how they respond to the medication, how they’re released throughout your IVF cycle and how they are collected and developed into embryos. Just the acupuncture alone, the way it works with the blood circulation, hormonal regulation, endorphins, those kinds of things are really going to help. In an ideal world, it’s having that preparation time for all the ladies. It’s really difficult because there’s that ticking clock and it’s the question of how long are you prepared to wait before you do IVF? It’s down to individual situations because some consultants are saying to start things now but then some patients may be in the older bracket but actually their blood test results, their scans, the number of follicles they’re producing are really not that severe. If you’re only producing 1-2 follicles and you’re only getting 1-2 eggs, then time is more of the essence. I’d say as a rule of thumb, 3-4 months because that’s the length of time that it takes for follicles to be generated. It is always the ideal and the same with sperm. It’s a 90-day process for spermatogenesis. Wherever possible we’re going to try and get at least 3-4 months before you start an IVF cycle. However, we’ll always work with what we’ve got and then having good regular acupuncture throughout an IVF cycle is the ideal.

I generally don’t prescribe herbs during IVF. Purely because we need to see how the body’s responding to medication and herbs are very good during IVF if needed but as a last resort and do the work before you have the medication. In my practice I’ve found that I rarely need to use the herbs during an IVF cycle because usually, we’ve managed to get the things done that we want before you have the medication. Also clinics in the UK really don’t like patients to be on Chinese herbs. I think there is a lot of fear around Chinese herbal medicine. There’s just isn’t that education out there for the medical professionals to know more about it. There are always risks to some extent with things that you take the main risks being that if the herbs are just not the right combination. We do very complex diagnosis in Chinese medicine and the real skill is getting that diagnosis spot on, to pick the correct ingredients that we put into the formulas that we make. There’s the dynamic of herbs with IVF drugs that you know could be the wrong balance. It’s about having a practitioner that you really trust and someone who’s really experienced with herbs before having herbs during IVF. Herbs in general are very safe as long as they’re prescribed correctly and used within the correct dosage ranges and then the patient takes them correctly.

Yes, you can. What a practitioner would do is review all of the supplements that you’re on, they would then plan the herbal medicine that they wanted to prescribe and check that there are no interactions. There are certain herbs and supplements that we wouldn’t combine. We do use Vitex in Chinese medicine as well so if you were taking Vitex, you might be asked to stop it because it might be already something that practitioner is going to incorporate into your formula and you don’t want to double up. There are certain herbs, for example, that interact with things like B6 so we would always check what you’re taking before prescribing and alter things as need be.

I have to admit this is way out of my expertise range. I honestly don’t know what I would recommend in this situation. I’m sure that there are people in my network who would have the answers for you.

DHEA is a funny supplement. It’s not something that I would ever recommend a patient to take because that is outside of my expertise. It’s also something that it needs to be monitored so if you want to take DHEA, I would have that conversation with a consultant. Some clinics are very pro-DHEA and they will monitor their patients, while they take it. Others don’t recommend it. It can have side effects. I have seen both sides of the coin in my patients. I’ve seen patients who’ve responded beautifully on DHEA and it’s had a really good response when they’ve taken it. I’ve seen other patients in whom the effects on the androgens and the testosterone have been too negative. They’ve had dramatic skin changes, hair changes. It affected their mood dramatically and in some ways had much more negative effects. Some of the information that I give out to my patients comes from other IVF clinics, their experience and what they’ve seen around those supplements. I would say speak to the consultants you’re working with and get as much information as possible on using DHEA before you make that decision.

It really depends on why they have sperm issues and if it’s a congenital issue. Is it a factor that can be changed or not? Is it unknown? If it’s non-obstructive or we don’t know the reason for why those issues are there? Then I would say it’s worth trying for sure. I use herbs mainly when I see sperm issues and because they tend to, in my experience, get the best results. One of the things that is important to note with sperm is that where some men have normal sperm parameters, it may be that there’s DNA fragmentation that we don’t know about. Also, varicocele treatment can help with that. It’s the same with herbs. I’ve seen clinically men who have issues with their sperm and on paper, the changes don’t occur so it may be that their count hasn’t changed. Particularly with morphology maybe their percentage hasn’t risen but we see a pregnancy occur. I think sometimes there are things on a much deeper level that we’re not aware of, that we can’t necessarily measure that does have an impact. There are things that we can try and do.

It really depends on the history of the male partner, whether there are any known factors involved the history in general, whether you have had signs of conception previously that hasn’t progressed, if you’ve had a history of miscarriages. We would delve into that and that would really give us a clue as to whether there are some hidden underlying issues and how much work we may need to do on the body. As a rule of thumb, it’s that 3-month mark that we ideally go for because then we’ve got enough time to influence the sperm that is going to be produced for the IVF cycle. Three months is always the magic number. If we get any longer, then we’re jumping for joy because, potentially, we can help patients conceive naturally given the right circumstances. It’s whether people have got the time, whether they’re willing to wait long enough to give us that chance.

I’m not in London. I’m in the northeast but I know a lot of very good acupuncturists in London so just get in touch and we will send you the details.

It depends on the individual. You’re having a donor egg but how’s your general health? We can still learn a lot of things from what somebody’s menstrual cycle is, what their energy levels, their sleep, their stress levels are. We’ll look at all of those kinds of factors to just make sure your body is in the best position possible. We want that endometrial lining to be as good as it can be to have the best circulation so that it helps with implantation, placenta development and those things will help go on and support an early pregnancy and potentially reduce the chances of miscarriage. Where you can, getting some preparation working is just as helpful.

Acupuncture has a cumulative effect so what that means is the more you have it the more the benefits build up. How many and how often you need it to be effective will again depend on the case. For example, I have a patient who has amenorrhea (absence of menstruation), I’m going to want to see them at least once a week so that I can give their body as much work as possible to get the wheels in motion, to get their menstrual cycles going again. They come in and we look at their general health, we look at their basal body temperature charts. Sometimes I see their luteal phase is a bit shorter than we’d like it or their ovulation is not quite as smooth as they’d want to see. I’m going to target the treatments around the points in their cycle that I want to have an impact. They can have it less frequently. The length of time will again depend on how complex the case is and what’s going on to start with. One of the things that we have seen is that there’s a huge peak in conception particularly with patients who are trying to conceive naturally around the 3-4 month mark. It just echoes what we know about the follicular genesis, spermatogenesis that it all takes three months. Having a 3-month time period can be a really good guide. Start with that in mind for three or four months. Your practitioner will give you a much more detailed explanation of their expectations and where they think you might need to go but it’s very much individualized.

I would recommend it. The two-week wait is a really difficult time for patients emotionally and acupuncturists are there to support you. They’re part of your support team. They have got a wealth of information that they can share with you during that time. We can take into account your previous history and use the treatments to help support you in that stage to encourage implantation, to encourage pregnancy to occur and to help support early pregnancy. There are certain things that we see in patients that will then tell us the potential issues that they may have as they move forward with the pregnancy. Sometimes it’s quite difficult because I might have a patient who is pretty fit and healthy, they’ve done an IVF cycle, we’ve got them pregnant. They get in touch to tell us the good news. We tell them that we are there for them if they need us. We don’t want to be seen as pushing for acupuncture on our patients. Patients are very confident, particularly when they’re younger, that things are going to be OK. It’s an awful situation to be in when you really want to help and support somebody in those really early stages just in case, then they don’t come and they do miscarry. Then you’ve got to help them through it again. I’d say if you’ve got a good relationship with a practitioner and you’re feeling really good benefits from your treatment, trust your practitioner and use them as much as you can through the two-week way and then if you are successful stay with them until a point in pregnancy when we know that things are good. Miscarriage is common. It is higher in cases like IVF so doing what we can to support you is our job and that’s what we enjoy.

I work a lot with patients who want to combine therapies. If you have therapists that you enjoy seeing and you want to add something like acupuncture in, then speak to your reflexologist and acupuncturist. Some practitioners have differing opinions and they don’t like their patients to combine therapies. What I tend to do is if patients are seeing therapists that I know well, we’ll get together and we’ll plan our treatment. For example, I work with a reflexologist and sometimes what patients will do is they’ll see their reflexologist one week and their acupuncturist the next week. There may be situations where we’ve had patients who go for reflexology session and then acupuncture session straight after. That’s really not a good idea. That’s too much. Let’s schedule it and we’ll plan it for our patients. I really want to see this patient at this point in their cycle. What are your thoughts and what are you trying to achieve? Then we’ll plan it together to give the best benefit for our patients.

I’m not majorly up on this but there’s loads of information and research out there on parabens etc. and there are lots of natural products that you can find quite easily in the supermarkets these days. I loathe mentioning names because some brands have been bought by huge corporations and people will kill me for saying things like Method but you can find things like Method products out there. Do the research. If it’s a standard cleaning product, it’s likely that it’s going to have chemicals in it that could potentially affect you. It is a bit of a rabbit hole that you could go down. Even bleach, ammonia can have an impact on the body. I can’t be more helpful I’m not good at remembering names of things like that.

Fermented foods can be great. I did some training with a guy who is really into this a couple of years ago. What I learned from that was that you have within your body your natural bacteria that sometimes get out of balance. Foods like kefir and kimchi are made up of bacteria cultures and are really good. When you eat them, they will activate and multiply the bacteria that naturally live in your gut. By eating cultured bacteria you’re helping encourage the healthy growth of your own gut bacteria. From my personal experience, you have to play around with things like this. This is where a good nutritionist can come in. They can even do stool sampling if you’re having a lot of issues to see what is out of balance within your gut. But not every kind of probiotic food will suit everybody and it’s about getting the balance and not having too much. I went through a big kombucha phase and I really overdid it on the kombucha. I actually had a negative impact of just knocking my gut out of balance even more because I’ve gone the other way too much. I think in all aspects of nutrition, health and diet it’s about everything in moderation. Don’t go kimchi crazy but have those fermented foods. They’re very good. If you need to avoid dairy, you can have water kefir and that’s a really simple one to grow at home. You don’t even have to make it very complex. You can use very small amounts of sugar to grow it or you can put things into flavor like lemons and apricots. It has almost like a lemonade taste. Water kefir is probably one of my favorites to use. There are other non-dairy options. You can even grow kefir with milk alternatives. You just have to rotate it every so often and let it culture in some dairy to kind of recoup. It’s about balance and again always just seek professional help if you’re not sure. If you notice symptoms changing or your body not necessarily responding particularly favorably to one fermented food, then maybe your culture in your gut doesn’t like that one. I’ve played around and water kefir is the one that tends to sit well with my digestive system. You’ve just got to listen to your body and play around with these things a little bit.

If you’re having period pain, you can come just before your periods. If you’re having ovulation issues, coming just before you ovulate would be fantastic. There is benefit throughout your cycle so if you’re trying to plan your initial consultation with a practitioner, just get in as soon as you can. Most of the time we’re generally pretty busy. A lot of us have waiting lists so I would say to people “let’s just get you in and then from there we can get things planned”. Your practitioner will target your treatments appropriately but there’s always a benefit no matter where it is in your cycle.

I don’t know what’s in this tea so I can’t advise you. I’m going make the assumption that it is some kind of herbs that have warming effects like cinnamon. If I was going to treat a patient who I saw had symptoms of a cold uterus then I would use herbs that would warm the womb, the uterus. There are caveats to what we do with everything in Chinese medicine so even things as simple as ginger or peppermint are case sensitive. We’re always very careful with referring to anything as a generic product. Actually, in the UK we’re very restricted on things like that. As a really simple example, if a woman has nausea, the classical thing to think about is ginger. For some women that is much too heating and will create reflux and sweating. Peppermint is a better alternative for those women. It’s the same with things like a womb warming tea. You could potentially buy a product like that and already have too much heat within your body. I’m making assumptions here based on what’s in the product. Then it’s going to create too much heat in you and increase everything. If you’re looking at products that have a particular function, I would try and contact the person who’s selling those products and just check that they’re right for you, if that is something that you really want to use or look at seeing somebody professionally who can make something specific to you as an individual.

This is a supplement that I do talk about with my patients. I never say to somebody to take it. I’ll say to them to read about it and make a decision in depth. It’s not something that is suitable for everybody. Myo-Inositol is something that is really good for potentially improving egg quality, it can be really good for regulating the insulin so it’s used a lot with PCOS patients. I would say it is a product that I’m aware of. I do think it has a place but again it’s down to the individual and again if I was unsure what I would normally do is I would refer my patients to a nutritionist who could check that this was really a product for them.

It depends on what we’re treating but, yes, there can be long-term benefits to acupuncture. A simple example: I have treated patients in the past with things like cluster migraines and they’ve had a course of treatment. Their migraines have resolved and I’ve not heard from them for 3-4 years. Then I had a phone call from the patient after she’d had one migraine and she wanted to come back for treatment so there’s definitely long-term benefits. From a fertility point of view, if we can balance everything in your body and there’s no reason why it should swing back out of balance again, then we can potentially maintain that homeostasis. I see that quite a lot with patients, for example, who don’t have periods and we managed to induce their menstrual cycle again. Often that menstrual cycle will just keep going so there are those long-term benefits there.

It’s a slightly complex situation at the moment because it’s down to practitioners governing bodies, it’s down to their insurance companies that they’re with. The government hasn’t made a very clear decision. We think that on the 4th of July (2020) that is when a definitive answer will be given. We are allowed to do emergency treatments at the moment and so, from the information I have seen, it does seem like fertility treatment does fall into that category. I read something from the health secretary that said that actually we do fall into a field where we are allowed to work. One of the acupuncture governing bodies had chased this up and established this clarification for us. I would say, at the moment, most practitioners are doing emergency treatments depending on their personal circumstances and looking towards starting full practice at the beginning of July.

I would say probably in an ideal world, acupuncturists might want to see you 2-3 times a week but the way acupuncture is structured in the UK it would be very difficult to accommodate a patient potentially that often in practice. Also, I don’t know it’s like a case on case thing, how complex is that patient’s history, etc. If, for example, it was somebody who had something really significant going on like PCOS. In an ideal world, I would love to see somebody 2-3 times a week. Every other day is rarely possible because in China acupuncture is available in a much different way, working hours and the way clinics are structured enable those frequent treatments to happen. But most of us in the UK either work on our own or in a small clinic so there’s not always even somebody there to give a treatment every other day. If you haven’t got a complex condition, I see patients, I do 1-2 treatments and they conceive. Or I see them for a couple of months and they conceive and that’s me seeing them once a week or once a fortnight. I think there are some situations where really once a week is sufficient; it’s just really about their case. If you were keen to do acupuncture more regularly then I would really discuss that with your practitioner and see what provisions they can make to accommodate you. Because it may be that they can do a half-hour session rather than an hour session. There may be things that they can do to accommodate that. Realistically, we’d love to see our patients frequently and a lot of the time more frequently than we do. Cost is a factor and we’ve tried to create a system that’s as cost-effective for us, our patients as possible.