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 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.
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.
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.
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.
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. That 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
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.
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.
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.
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 & 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.
In Chinese medicine, we don’t use a thing, we don’t say here take these mushrooms they’re going to help you get pregnant. In Chinese medicine, we create formulas and formula means two herbs up to as many herbs as possible, you can have 30 herbs in a formula. I’m not sure what mushrooms you’re referring to, but even if you did tell me what you were referring to, I would say really you don’t want to take mushrooms, you want to take the proper formula for your pathology. What does that mean? It means what is your pathology, it means what is your height and weight, how old are you, do you have more than one pathology, etc. Many patients have endometriosis and polycystic ovarian syndrome, so it’s a little more complicated than just saying which mushrooms, should I be taking.
I’m sorry, I can’t give you a better answer than that, but that’s pretty much what I have to say. If you want, I’m happy to work with you, and I can prescribe herbs, and you can get them sent to you from New York.
I couldn’t really ask for a better question, this question elucidates what I was saying previously about sperm DNA fragmentation, and this is the proof. This is a woman who used a donor egg, so you have to assume that the donor was young and probably though not definitely a proven donor, and so usually, donor egg cases work, not always, but in this case, you did get pregnant with the donor egg but the sperm had 29% DNA fragmentation, so what happened was the egg and the sperm became a bad embryo, and that’s why you got pregnant and miscarried. The key here is to fix your husband’s sperm than do another donor egg cycle when his DNA fragmentation is much reduced, and you’ll probably get pregnant and stay pregnant.
For those of you who don’t know what adenomyosis is, it’s a form of endometriosis, so what adenomyosis is, it’s the endometrium itself, it digs into the myometrium, which is the muscle layer of the uterus, and as a result of this, the uterus itself can become deformed, and as a result of that deviation from the normal shape, it is difficult to get pregnant.
I would have to say that this is probably, what I would consider, as it is an anatomical issue, I’m not sure that acupuncture and herbs are the right way to go for adenomyosis. Now, if it’s not severe adenomyosis and the uterine cavity has not been distorted anatomically. Then the lupron is a good thing to use, the lupron essentially will starve the body of estrogen, and estrogen is something that feeds endometriosis. Therefore, it will feed adenomyosis, and so I think lupron is a good way to go. I don’t think acupuncture and herbs are the right protocol for adenomyosis.
Incompetent cervix is where the placenta and the baby can actually drop, and I don’t think that acupuncture and herbs again would help. This is an anatomical issue, I think that you need to have what’s called uterine or cervical surcharge, which is where they stitch up the cervix after you become pregnant, to prevent this fetus or the uterus itself from dropping down, I wouldn’t even call it surgery, but it’s more or less a procedure, and I think that’s the right way to go with this.
It’s a mushroom that has some positive qualities, but you wouldn’t make a chicken soup just by throwing a chicken in a pot of water, you use chicken stock, and you put in some maybe celery, potatoes, carrots, and some seasoning. That’s kind of the same with herbs, cordyceps is analogous to the chicken, you wouldn’t just use cordyceps, you really want to get a customized herbal formula that is specific for your presentation. The cytokines, they are coming as a result of the NK cells. For those of you who don’t know, NK cells are natural killer cells, 70% of which reside in the uterus, 30% are in the circulation.
People are not sure what they’re doing in the circulation. NK cells in the uterus are anti-carcinogenic cells, they spray something called TNFα, which stands for tumor necrosis factor-alpha. So if the NK cells see what looks like a cancer cell, they’ll spray it with TNFα to try to kill cancer, that’s the function of NK cells. These NK cells should not be activated in a patient who doesn’t have cancer, of course, this doesn’t mean that you have cancer, please don’t get nervous, there are many women with activated NK cells, that don’t have cancer.
This is an autoimmune issue, and the way to treat this is with something called intralipid therapy, which was discovered by a woman whose name is Dr Carolyn Coulam, and you can google her, but in any event, intralipid therapy is the way to go with this. You may want to consider acupuncture and herbs, not for the NK cells but because you’re 43, and even if you didn’t have the NK cells, you still have a low ovarian reserve and probably poor egg quality, so I would say yes, use acupuncture and herbs and get a customized herbal formula but use intralipid therapy to eradicate the NK cells. By the way, it doesn’t completely kill the NK cells forever and ever, so the way you use intralipid therapy is right before the transfer and then several times after the transfer.
The answer is yes, and no. I’ll start with a no, so if it’s an anatomical defect, congenital bilateral absence of the vas deferens if it’s a genetic defect, microdeletion of the Y chromosome if a man had testicular cancer, and he had a radiation therapy – acupuncture and herbs are going to do nothing for that man. However, if you have men that have minor varicoceles, and it is where the blood vessels and the testicles expand blood pools there and stay there, and as a result of it staying there, it causes an inflammatory process, inflammation kills the sperm, so if you have a minor varicocele, acupuncture and herbs are very effective.
If you have idiopathic sperm problems, meaning that you have sperm problems, but there’s no anatomical nor a genetic defect, you just happen to have poor morphology or motility or a low sperm count, absolutely acupuncture can help. There are many studies, I provided such studies on one of my PowerPoint slides, which include studies on sperm anomalies and acupuncture and, of course, you can simply go to Google and type in studies on acupuncture and poor sperm quality, and you’ll probably come up with hundreds of different studies.
I’ll give you the percentages. If a man has sperm DNA fragmentation from 0 to 15%, there’s a good fertility outcome, sperm DNA fragmentation from between 15 to 29% is good to fair outcomes, and above 29% or above 30%, there are very few good outcomes. What do most embryologists and even reproductive endocrinologists think about sperm DNA fragmentation, they think, and I’m not saying this in a way, I’m smart, and they’re not, I know more than they do, I’m not, that’s not where I’m coming from, I’m simply saying we all have different experiences.
In the reproductive endocrinological clinic, they believe that a man that has sperm DNA fragmentation is no problem, we know that high DNA fragmentation presents in a way that the sperm cannot penetrate the egg, so what are we going to do about it – we’re going to do ICSI (intracytoplasmic sperm injection), we’re going to take a syringe, put sperm in it, take the egg and go pop and push the sperm into the egg and that’s the answer, but if you remember 4 or 5 questions ago, there was a woman who said that she did donor egg twice, her husband had a sperm DNA fragmentation index of 29%, she got pregnant twice and miscarried twice, so DNA fragmentation is a bad thing. There are times when a doctor will do ICSI, and guess what, the woman will get pregnant and have a baby, but many times as this previous patient, it fails. If a man has sperm DNA fragmentation even above 25%, I would get it treated, and certainly, above 29%, you must get it treated. Acupuncture and herbs are the way to go, there’s no western medicine intervention for this.
I can’t recommend any foods, I have no real nutritional experience. If a man or a woman is too thin or too fat, it’s not good outcomes for fertility because being too thin or being too heavy alters the hormonal milia in the body and in the brain. Getting to a normal weight is fine, but what I said earlier was that there are some good nutraceuticals for men to take. Things like Coq10, pycnogenol, l-arginine, l-carnitine, zinc, selenium – I’m pretty sure selenium is a good nutraceutical for male factor as well.
I think that these nutraceuticals can be helpful, I don’t think that they obviate the need for acupuncture and herbs, they’re not as strong as acupuncture and herbs. I would recommend doing the whole thing, doing this takes the nutraceuticals and do acupuncture and herbs.
I’m not sure what 30, 20 means, but maybe you mean, it was 30, and it went down to 20. If it went down to 20, I don’t think there’s a problem, but if you mean to say that your husband has a sperm DNA fragmentation index of 30%, that is not a good thing. If he has a DNA fragmentation of 30%, he should get acupuncture and herbs. I really can’t tell you what herbs, you have to realize there are thousands of herbs, the way herbs work are like food, so like if you were going to have a party and 4 people out of the 20 people that came to your party had hypertension, you would make sure not to use salt in the preparation of their food where the other guests can take salt because they don’t have hypertension.
When it comes to herbs, they are made specifically for that individual. Is your husband overweight, is he of normal weight, is he too thin, does he have a history of other illnesses, does he have illnesses now, or what’s his age, does he have any testicular injury, etc? Many things go into creating a herbal formula, it doesn’t work like this. The formulas are specific for each individual person.
What’s probably going on is the same old story, it’s advanced maternal age, meaning lower ovarian reserve and poor egg quality, so you got pregnant when you were 39 years old, I guess, and you conceived, and you have a 3-year-old, so what I want to say to you, is that’s awesome and wonderful and congratulations, and I love to hear that, but I also want to say that you were lucky. It doesn’t mean that at 42, having 2
failed IFVs, that you cannot conceive, unfortunately, this is a game that’s going to give you bruised knees.
It’s an arduous, difficult, tortuous, demanding journey, and so if you have the time and the money and the emotional fortitude, I would say, do some more IVF attempts and try to get acupuncture, which you said you’ve done, but also take herbs. Herbs are much stronger, and more efficacious than acupuncture, but it doesn’t mean you shouldn’t use acupuncture, it stimulates blood throughout the body, it’s very important, but herbs can do a lot more, they’re much more efficacious and so try to take herbs if you can.
What’s going on undoubtedly, is that this is an age-related issue. I can tell you that for two reasons. Number one because you’re 38, once you’re on this side of 35, it doesn’t mean that you won’t get pregnant, but you’re less fecund, fecundity means the ability to conceive in any given month, so you’re less fecund when you’re over 35, but remember many 45-year-old patients get pregnant naturally, so don’t fret, you’re going to be okay. Number two, when you wrote you were able to freeze one embryo, that’s also an indication of low ovarian reserve and poor egg quality, the only reason you were able to freeze one embryo and not more is either because you got a lot of eggs retrieved, which I doubt, but maybe you did, but they were all bad quality and they died, and you were just left with one embryo, or else you did a retrieval of your two or three eggs, and you got one good embryo.
I would again recommend acupuncture and herbs, I treat all of my patients, twice weekly and I definitely think that as long as you have a regular period, you have a chance of getting pregnant, and you should stay with it. I definitely think that in vitro fertilization is more efficacious than IUI, and I think that acupuncture and herbs may be of utility to you, and I wish you godspeed on your journey to family.
I use it intermittently, I typically prefer not to use it. Sometimes pre-embryo transfer, I’ll do electrical stimulation on the needles because I want to get very aggressive in stimulating blood flow to the uterus. Now, everybody on this chat might be thinking, well if that’s a more aggressive treatment, that sounds like a better treatment, why not always use electroacupuncture. So the answer is like anything else in life, once you do this all the time, your body becomes used to it, and then its effectiveness diminishes. I like to use it less rather than more, and if you use electroacupuncture once in a while, you’ll have a good effect. If you use it every single treatment, it becomes just like using regular acupuncture.
This is what I’d suggested doing. I’m stating the obvious, you’ve probably done this, but I have nothing else to offer, well maybe a little more to offer. Get on Google and type in: fertility acupuncture specialists in your city, in Spain, and see what comes up – if nothing comes up, then do a phone consult with me. I will design an acupuncture protocol specifically for you and either email it to you or email it to any acupuncturist, it doesn’t matter who you pick, you can pick an acupuncturist that just does back pain all day, it makes no difference because when I’ll send that acupuncturist the right protocol, as long as they know where the acupuncture points are, which I’ll assume that they do, they just follow my protocol and they’ll be doing the right thing for you.