Watch the webinar with Mike Berkley, Licensed and Board Certified in Acupuncture, The Founder and Director of the Berkeley Center for Reproductive Wellness, located in New York City. Mike is a life acupuncturist and has been specialized in the treatment of infertility for 23 years. Mike discussed acupuncture and its impact on successful IVF outcomes.
Acupuncture & herbal medicine
Acupuncture and herbal medicine have been used to treat fertility challenges for 2500 years. In China, it was important to have a baby, but it was even more important to have a male baby. The Chinese spent a lot of time medically trying to figure out ways to improve fertility outcomes.
Nowadays, about three-quarters of the world’s population uses acupuncture, herbs not necessarily for fertility reasons. Acupuncture and herbal medicine work best when treating a patient faced with fertility challenges who don’t have an anatomical defect or defects. For example, a septate uterus is a uterus where there’s a piece of tissue running down the middle of the uterus, separating it into two different cavities, that’s something that can be fixed with surgical procedure, acupuncture, herbs can do nothing in such situation.
If a man has a congenital bilateral absence of the vas deferens, this is an anatomical defect in the testicles, acupuncture and herbs cannot help this patient as well.
Acupuncture & herbs – how does it work?
There are tons of supporting evidence and research attesting to the efficacy of acupuncture in the context of fertility improvement.
First, they
increase blood flow to the testes lining and follicles. Blood is a messenger, which carries hormones, nutrients, electrolytes and oxygen to every cell in your body, including egg sperm and lining, for example, your FSH and your LH come from your brain, from the pituitary gland. They travel from the pituitary to your ovaries through the blood, so if we can improve the haemodynamics of blood, if we can improve the delivery of blood to the ovaries or the testes, we’re improving the delivery of the good stuff, and we’re improving the excretion of dead cells. As a result, you’ll often find an outcome of better egg quality, better lining quality and, or better sperm quality.
Additionally,
acupuncture and herbs have a calming and stress-reducing effect on the individual patient. Acupuncturists cannot perform IVF, however, reproductive endocrinologists cannot improve egg or sperm or lining quality. They don’t have any medicine for it, they don’t have any techniques for it, they cannot do what an acupuncturist do, and an acupuncturist cannot do what they can. Therefore,
the best-case scenario is a Western with Chinese medicine approach. You’ll be treated by a highly qualified reproductive endocrinologist and a highly qualified acupuncturist and herbalist specializing in treating fertility cases.
PCOS & acupuncture, herbs
People with Polycystic ovarian syndrome (PCOS) either don’t get pregnant or miscarry quite frequently.
The fact is the miscarriage rate in the IVF patient is twice that of the non-IVF population. Mike explained that the reason for that is that PCOS patients have too much androgen in the follicles. Androgen acts as an anti-estrogen, essentially, this is causing poor egg quality and poor follicular quality, and as a result, PCOS patient has poor egg quality. One of the reasons for such a patient not getting pregnant is because such a patient doesn’t ovulate regularly. That’s all addressable with Western medicine through the use of drugs like Clomid or Letrozole or even injectable gonadotropins, but even when you can get a PCOS patient to ovulate, even if you do IVF with that patient and you do ICSI where you inject the sperm into the egg, there’s a good chance she won’t get pregnant. There’s a good chance that if she does, she will miscarry. That is not to say that PCOS patients don’t get pregnant with IUI or IVF or even naturally, they certainly do, but they have a harder time doing so and staying pregnant.
The
PCOS patient is a good patient for acupuncture, herbs, not really to make that patient ovulate, but to improve the egg quality and the lining quality.
Endometriosis & acupuncture
There are four different stages of endometriosis. Some patients have endometriosis and do not have tubal damage, but they still can’t get pregnant because endometriosis is an inflammatory disorder, it’s an autoimmune disorder, it’s a very complicated disorder. Essentially in the absence of tubal damage, the patient typically has inflammatory proteins in the uterus, inflammatory cytokines. It means that the uterus is inflamed, it’s overheated, and as a result, it’s not going to be very amenable to receiving or having an embryo implant.
Usually, it is advised to do a laparoscopy, a procedure used to eradicate endometriosis. The doctor will get rid of all the endometriosis, the patient has to do an IVF. She’s been treated laparoscopically, and yet she still can’t get pregnant. Why? It is because endometriosis has its discoloured tissue still, it can be purplish, black and grey, it can be reddish, so the surgeon is going to eradicate or cut out tissue that has the different colours because that’s endometriosis, so the laparoscopic surgeon does so. The patient waits a month or two to try to conceive, she still can’t conceive, and by the way, she’s only 30 years old, so it’s not an advanced maternal age case. Well, some endometriosis tissue that is not in the uterus, it’s outside the uterus, it’s still endometriosis. It looks exactly like normal tissue, so the doctor is not going to resect that tissue because the doctor can’t even see that. The tissue is discoloured, so they’re not going to remove it. This patient cannot conceive because she still does have some amount of endometriosis in the pelvic region, even if there are no sperm problems or other problems, even if there are no sperm problems or other problems. As a result, these inflammatory cytokines are finding their way into the uterine cavity, causing a hostile environment for the embryo. Therefore, pregnancy does not take place, and the answer to that is to use acupuncture and herbs.
The first reason one should use acupuncture and herbs, in this case, is because particular
acupuncture points and certain herbs will significantly reduce inflammation, causing a more amenable environment for implantation to occur and for a full-term pregnancy to manifest.
Male factor & acupuncture
Typically, semen analysis consists of count, morphology, motility, volume, sometimes they look at things called agglutination, they very rarely test for sperm DNA fragmentation. According to Mike, semen analyses do not portray the complete information on a man’s sperm because they do not include the sperm DNA fragmentation assay in the test.
The percentages of sperm DNA fragmentation 0 to 15% is good fertility outcomes, 15 to 29% is fair to good outcomes, and above 30%, very few if any pregnancies manifest. Poor quality sperm DNA can reduce a couple’s chance of getting pregnant by up to 10-fold.
There’s a part of the sperm called the chromatin. The chromatin is where the DNA of the sperm is held. DNA fragmentation occurs when there is a physical break in one or both of the DNA strands.
In men that have sperm DNA fragmentation above 30, it can’t penetrate the egg. In this situation, at the IVF clinic, they perform Intracytoplasmic Sperm Injection (ICSI), where they inject the egg with the sperm, thinking that this is the way to overcome this pathology. However, when one part of the body is significantly damaged, it affects the whole part of the body, and so it’s the same thing with DNA fragmentation. If you force-feed a sperm with a higher level of DNA fragmentation, either the patient won’t get pregnant, or she will get pregnant, and she’ll miscarry. T
hat is why it is so important to have the male do a test for sperm DNA fragmentation in the infertile couple and make sure you get that information, and then when you do get that information, you’ll know what to do with it.
The man should take things like CoQ10, zinc, selenium, pycnogenol, l-carnitine, l-arginine. Also, acupuncture and herbal medicine are very efficacious in reducing sperm DNA fragmentation levels.
Sperm DNA fragmentation – causes
- oxidative stress, the testicles house the most amount of oxidative stress in the body, it can also become an inflammatory issue; the testicles also house the highest level of antioxidants in the body, which are the things that fight free radicals which come from oxidative stress
- cigarette smoking, drug use, environmental toxins, advanced paternal age, varicocele, elevated testicular, etc.
Acupuncture & Implantation failure – poor uterine lining
On the graphic shown, the endometrial lining is above 8 millimetres, and on the right side, it’s below 7 millimetres. Typically, we want to see an endometrial lining of 10 millimetres, especially around cycle day 21. There are documented pregnancies with 6-millimetre linings, there are very few documented pregnancies with 5-millimetre linings and probably 0 pregnancies with 4-millimetre linings.
There are several causes of thin endometrium. One is an estrogen deficiency. Secondarily, you can have estrogen receptor site downregulation, which means that when a hormone goes to an area, it just doesn’t plop down in the area. Those are called receptor sites, and then the estrogen goes into the receptor site, it acts on the uterus or any other part of the body. The uterus will get thick and healthy, and ready for implantation. However, if the receptor sites are blocked, you can have a normal estrogen level but a thin endometrial lining.
That’s not a great case for acupuncture and herbs, but it is something that you could try because there’s nothing else to do other than using a surrogate. However, as Mike mentioned, he had patients who have had a thin endometrial lining of 5 millimetres, and he’s been able to get it to 6 millimetres, so that doesn’t sound like such a big deal, but it is because you have a much better chance of conceiving with a 6-millimetre lining than you do with a 5-millimetre lining. If you have a 4-millimetre lining, you’re just not going to get pregnant, but if you can get to 6-millimetres, you have a great chance of getting pregnant. Acupuncture is very good at stimulating blood flow to the uterine lining to help permeability of the blood through the lining.
There’s a quote that Mike shared:
Endometrial morphology is not analogous to intra-endometrial vascularization.
Endometrial morphology, the shape or the thickness of the lining is not analogous, it’s not equal to endometrial vascularization, the patency of the blood vessels in the lining. In other words, you can also have a beautiful 10-millimetre lining and not be getting pregnant because the lining is not healthy. It might look healthy, but in fact, it’s not healthy. There is a test called the
Receptiva test, which can check if the lining is healthy and that the lining is receptive at the time the embryo is introduced into the uterus. The uterus and the embryo communicate with each other. If the uterus and the lining are not in sync, pregnancy won’t occur. Typically on a 28-day cycle, a woman will have implantation on cycle day 21, but if it implants in cycle day 23, then she’s not going to get pregnant. Therefore, it is crucial to check and make sure your lining is healthy. If it’s thin, acupuncture herbs may be the answer.
Acupuncture & Pre-, post- embryo transfer
Typically on the day of transfer,
acupuncture is done pre and post embryo transfer. If you’re getting an embryo transfer the next day at noon, you’ll get treated at 10:30 or 11 a.m. with acupuncture. You’ll go to have an embryo transfer, then you’ll come back to the acupuncturist and get acupuncture again.
It’s the only time that in the course of one’s IVF procedure that you will get acupuncture twice in 1 day. Why should you do acupuncture pre and post embryo transfer?
When you do acupuncture pre-transfer, you’re facilitating a great amount of blood flow to the lining to help enhance and make the lining healthier and more receptive to implantation. What is perhaps more important or equally important is the acupuncture that you get after the transfer. The uterine cavity is like two pieces of paper just lying on top of each other, the uterus only expands when there’s something in it, like a growing fetus otherwise, it’s just flat. There’s a top and a bottom and sides, but the top and the bottom are touching each other. When the reproductive endocrinologist does an embryo transfer in an IVF cycle, the doctor puts in this long tube through the vagina, through the cervix into the uterus to deposit the embryo or embryos, when that catheter touches the top or bottom of the uterus, it causes intense uterine spasming. As a result of the spasming, it can cause retrograde flow of the embryo, meaning the embryo can go upwards, towards the head, and as a result, you can get an ectopic pregnancy.
In fact, in the IVF population, ectopic pregnancies level far outweigh the number of ectopics in the non-IVF population.
When you utilize acupuncture post-embryo transfer, it stops the uterus from spasming, as a result, you are less likely to have an ectopic pregnancy. Therefore you are more likely to have endometrial implantation.
Acupuncture & Miscarriages – causes
- implantation failure – acupuncture & herbs
- aneuploid embryos – acupuncture & herbs
- endometriosis – surgery & possibly acupuncture
- endometritis – antibiotics
- infection – antibiotics
- IUGR (Intrauterine Growth Restriction) & IUFD (Intrauterine fetal demise) – acupuncture & herbs
- autoimmune issues – Western medicine
This is just a partial list of causes of miscarriage, you can see when to use acupuncture and herbal medicine and when to use Western medicine only.
Acupuncture & protocol
Mike presented his protocol and emphasized that his protocol might be different from other acupuncturist protocols.
Mike treats all patients twice per week until pregnant and then twice a week for 13 weeks to help prevent miscarriage. This is because 90% of miscarriages occur within the first 12 weeks, so if the patient can get to 13 weeks, inevitably, she’s going to have a baby. If the patient has a history of second or third trimester or even stillbirths, this patient will be treated until a week before the due date.
Acupuncture & case review
- A patient of 35 years old, diagnosed with PCOS, obese, has infertility with chronic recurrent miscarriage. She had 3 failed IUIs, 2 failed IVFs. She started acupuncture & herbs, after 6 months she was pregnant, and she delivered a sweet baby boy.
- Another case was a couple, both 33 years old, they’re both healthy, infertility due to unknown reasons which was under-diagnosed by their doctor. Typical semen analysis was done revealing a slightly low sperm count. The couple could have gotten pregnant with the amount of sperm that the husband had. They were trying since they were 29 years old. Mike recommended a sperm DNA fragmentation assay which revealed a sperm DNA fragmentation index of 40%. His semen analysis showed that his sperm was fine, but in fact, it was far from fine. The partner was treated for 4 months with acupuncture & herbs, he repeated the sperm DNA fragmentation test, and his DNA fragmentation dropped to 23%. They conceived within two cycles, they delivered a beautiful baby boy.
- Another case was about a patient with endometriosis. The patient was 36 years old, tried for five years with no success. Mike suspected that she had endometriosis based on some questions he asked. Mike advised her to go for laparoscopy, and it was confirmed that she had stage 4 endometriosis. The laparoscopy was performed, the patient’s tubes were in good condition. Endometriosis was removed, but she still wasn’t able to conceive. Mike treated her with acupuncture & herbs that had anti-inflammatory effects, she conceived within 6 months of treatment.
Acupuncture & herbs do not always work, they are not the holy grail, however, IVF doesn’t always work either. The take-home message is that
you’ll have a greater chance of conceiving, staying pregnant, delivering if you combine Western medicine with Chinese medicine. In Mike’s opinion, East meets Western reproductive medicine is the new gold standard.
