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Acupuncture, one of the world's oldest and most established healing practices, is growing in popularity as a way to complement the modern procedures of ART - Assisted Reproductive Technologies. Although the scientific evidence behind acupuncture is scanty, belief in this technique is so strong, some patients having just undergone implantation after IVF will head straight to their TCM (Traditional Chinese Medicine) practitioner for an immediate acupuncture treatment.
Acupuncture is just one component of Traditional Chinese Medicine (TCM), which also involves herbs, pelvic massages and dietary adjustments to garner a "whole body" systems approach to health. Following a track record of over 4000 years, nearly one quarter of the world's population turns to TCM for their primary heath care. In Western societies, acupuncture is frequently cited as providing almost instantaneous relief to debilitating ailments such as bad backs and sports injuries.
Tiny sterilized needles are inserted into key points of the body and left there for 20-30 minutes. Barely felt, the needles reportedly open up Qi (pronounced Chee), which is vital energy defined by increased blood flow and the benefits of the body's systems working together to break down so-called blockages.
Only two scientific research studies have examined the benefits of acupuncture with IVF treatment. The most talked about was reported in the journal Fertility & Sterility, April 2002 (Vol. 77, No.4) involving 160 IVF patients in Germany. Half of them underwent acupuncture before and after embryo transfer and the other half served as the control group. 34 out of the 80 women who received acupuncture revealed clinical pregnancies (42.5 %), whereas, 21 out of 80 women in the control group became clinically pregnant (26.1%).
Although the physiological mechanisms are not fully understood, it is believed that acupuncture optimizes endometrial receptivity and enhances blood flow to the pelvic area. According to TCM principles, energy flows through the body along pathways, or meridians. Acupuncture is a means of enhancing this energy and coaxing the body's responses to induce a desired physiological effect. Ideally, according to TCM practitioners, women should undergo acupuncture treatment 3-4 months prior to an IVF cycle instead of as a last minute flurry.
We at PFC encourage our patients who inquire about acupuncture to pursue it, and we provide a list of Bay Area TCM practitioners who are certified by the National Acupuncture and Oriental Medicine Alliance and licensed by the state of California. However, under no circumstance do we condone the use of herbal supplements that are sometimes provided with acupuncture for women undergoing infertility treatment at PFC. Most TCM practitioners agree with this approach, and will communicate your treatment protocol with our physicians here at PFC. --- Eldon Schriock, MD
Eldon Schriock, MD
| Eldon Schriock, MD |
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Since the early 90's, Dr. Schriock has been interested in acupuncture and has written on its affect on fertility. He supports patients who are interested in using acupuncture as an adjunct to their fertility treatments.
The marketplace offers a dizzying selection of devices to help women predict ovulation to increase their odds of conceiving. Collectively, these products are called ovulation predictor kits (OPKs) or fertility monitoring devices.
They are broadly grouped into two main types: those that gauge a woman's Luteinizing hormone (LH) surge and those that monitor one's estrogen level. The LH surge is tracked with urine testing strips, which are then discarded. Estrogen can be tracked with longer-use fertility monitoring devices that check saliva or other bodily fluids.
When under-going artificial insemination (AI) and intrauterine insemination (IUI), women need a very precise measurement of ovulation. Single-use OPKs that require urine testing first thing in the morning or after 2-4 hours of "holding it" are ideal for this. They react when a woman's pituitary gland sends out an LH surge, directing the egg to leave the ovary in 24-36 hours, like clockwork. The egg then spends the next 6-12 hours sliding down the fallopian tube where it must be fertilized before implanting into the uterus. This critical window requires sperm to be on the spot, ready to fertilize.
For LH testing, PFC recommends ClearPlan/ClearBlue Easy and Ovu-Kit One-Step because, in our experience, they tend to give the most unambiguous results. The kits that are not as highly recommended are Answer, First Response and generics; they appear to be more prone to false negative results.
For couples timing pregnancy to the LH surge, natural intercourse is recommended both on the day that the kit changes, and the next day. If a couple is going through IUI with fresh sperm, the insemination will be timed the day after the kit shows ovulation. If frozen sperm is being used, many times two inseminations take place: one on the day of change and another the following day.
The longer-use ovulation monitors that use saliva to measure estrogen levels typically identify a 72 hour peak "zone" of fertility. Tracking estrogen levels can be a fascinating process, although patients may need additional time to train their eye to spot the critical pattern that appears in saliva with elevated estrogen. Curiously, the salt content in body fluids increases with a rise in estrogen. Once dried in a magnified setting, the saliva reveals a distinct crystallization, or "ferning" from the salt level (see illustration on left), similar to ice patterns on a frosty window.
Some name brands include Fertile Focus, the Donna and Lady-Q. These devices are useful if couples can have frequent intercourse during their 3-6 day zone of fertility.
A brand new product that also tracks ovulation via estrogen levels uses a wrist watch-like calculator that must be worn every night. This device makes direct contact with one's skin, and uses a sensor that contains a non-allergenic gel released to detect one's estrogen from the moisture released off the wrist.
Since PFC has not reviewed the estrogen-monitoring products and their efficacy, patients are strongly advised to do their own research. ---Carolyn Givens, M.D.
*Reproduced with permission: www.maybeit.com
Our ability to grow embryos well, among other laboratory functions, is closely related to our willingness to evolve with change. Fifteen years ago, embryos were kept in the laboratory for up to 48 hours, because we lacked the knowledge and technology for maintaining healthy embryos outside the body for longer periods of time. Today, embryos can be routinely maintained in the laboratory for 5 or 6 days, if necessary, with well-established standards of care.
Most of the activities inside the laboratory are intricately complex and can only be performed by highly trained individuals who specialize in embryology and andrology. PFC is fortunate to have a large and experienced laboratory staff dedicated to the care and well being of eggs, embryos and sperm.
Uniquely in PFC's laboratory, all of our staff is licensed at the laboratory supervisor level, which is above and beyond the level necessary for performing routine procedures. Further, Andrew Runge, an embryologist with over 15 years experience, is a certified laboratory director, and Jean Popwell PhD, will soon be undergoing her directorship examination. All told, PFC's team of embryologists is second to none in experience, qualifications and dedication.
The laboratory itself is equipped with an array of highly complex equipment. Since the laboratory is a clean-room with access restricted only to embryologists and physicians, maintenance and housekeeping activities are handled by the lab staff themselves, including keeping the equipment fine-tuned and in excellent working order. When it is necessary to have visitors in the laboratory, they are escorted by laboratory staff but only after putting on white "bunny" suits. Any outside objects that enter the lab are cleaned with alcohol.
Significant capital investment by PFC allows the laboratory to be equipped with the highest quality and state-of-the-art equipment. Recently, our frozen embryo storage tanks were upgraded to computer-controlled models, which require less maintenance and are easier and more efficient to use.
In the next year PFC will continue to upgrade equipment, beginning with the installation of new incubators. Our existing incubators have given many years of excellent service but the new ones will be computer-monitored and self-sterilizing. This will free up embryologist time while allowing closer monitoring of individual incubator environments.
Our vision is to link vital laboratory information to physician and patient. Eventually when patients sit in our physicians' offices, it will be possible to view, via real-time monitoring, pictures of your embryos growing in the laboratory.
For those of you coming in for treatment in the next few months, you may notice small changes. There will be less emphasis on paper reports and easier computer access to your laboratory records for your physician. But since the lab is functioning behind the scenes, the changes may not be obvious. Be assured however, that even though the laboratory staff is somewhat invisible to you, the embryologists are striving to offer the best treatment with the best technology available. ---Joe Conaghan, PhD, Lab Director
Several years ago I received a call that would change my life forever. My mother was diagnosed with Huntington's Disease, an inherited neuropsychiatric disease that affects mind and body - (imagine Parkinson's and Alzheimer's combined). The chances of passing on the disease are 50/50, and symptoms usually appear between ages 35 and 50. Because there is no cure, many "at risk" for the disease choose not to learn if they have inherited the HD gene.
Living at risk with HD has altered my life completely. Every choice I make is influenced by the possibility I have inherited the HD gene. And no choice is more affected than that of bringing a child into the world.
As I grappled with my mother's news, two facts became certain: I wanted children and I did not want to know if I would someday get HD. Given this, my husband and I sought advice on how to have a healthy baby. Our genetics counselor outlined two viable options: Once pregnant I could have a "non-disclosing" CVS that would indicate if the fetus had inherited the chromosome from either my mother or my father, thereby not revealing if I had HD. The second option was a cutting-edge process through IVF called pre-implantation genetic diagnosis (PGD). This involves testing each embryo for the HD gene at the cellular level when the blastocyst is only 5 days old. Only healthy embryos are implanted.
After having experienced a failed pregnancy, CVS had no appeal. That left IVF/PGD. Yet in order to maintain my status as a non-disclosing patient, I arranged NOT to be told any details throughout the IVF cycle. Even knowing how many eggs were harvested or how many embryos were implanted; I could surmise my status. (Imagine: if none of the embryos were healthy, my doctors would stage a fake embryo transfer so I wouldn't suspect anything.) As such, it was important for all PFC doctors and staff not to reveal any information to me. Doing this meant putting total trust in everyone.
Trying to get pregnant through IVF is a costly endeavor: emotionally, physically and financially. I believed it would be easy because I had gotten pregnant so quickly before. Consequently, I was devastated when our first two attempts failed. In retrospect, I am amazed at how my husband and I endured, despite days when I had almost given up all hope.
After an exhausting six months and three attempts, I was finally pregnant. While overjoyed, I was still hesitant to believe it would go to term. Furthermore, I was required to have an amnio to ensure no errors were made, although given my non-disclosing status, I would not learn the results of that testing. It was only after my fifth month into pregnancy, that I believed I would have a healthy baby.
Our son is a miracle and my husband and I cherish him beyond belief. We are eternally grateful to the people who supported our choice to conceive a healthy baby using PGD.
---Patient’s name withheld upon request
Q:
It's the New Year and my husband and I plan to get serious about exercising and shed 10
pounds. Since I am trying to get pregnant, is there anything we should know?
A:
Before you jump on that bicycle, be aware that there is considerable debate about the impact
of exercise on fertility. A sudden and extreme change in your diet or work out regimen can have hidden consequences. Too strenuous exercise can lower estrogen levels and suppress the hypothalamus and pituitary gland, leading to irregular ovulation. Some women who exercise vigorously cease menstruating and ovulating all together.
In fact, because the research on even moderate exercise has been inconclusive, some reproductive endocrinologists advise their female patients to avoid all exercise that brings the heart rate above 110 beats per minute. This pretty much rules out jogging, aerobics and biking but not necessarily yoga and weight lifting.
Both women and men need some body fat in order to reproduce. (Although overweight women experience more hormonal imbalances because excess weight can cause excessive production of estrogen.) Body Mass Index measures the ideal level. Women who have a BMI of between 20 and 25 are most fertile.
As far as the male factor, the most important thing to remember is that sperm are very sensitive to heat. Taking saunas and hot tubs are enjoyable side benefits at many exercise clubs, but these heated conditions can greatly diminish healthy sperm counts. Bicycling is the main sport that is best avoided by men who want to maintain optimal conditions for reproduction.
---Philip Chenette, MD
Sperm morphology refers to the size and shape of the sperm.
The amount of abnormal sperm is high in humans compared to other mammals, but most of the defects are subtle. Obvious flaws, such as 2 tails or 2 heads, account for only a small percentage of the defects. Most inadequate sperm appear as too small, or with kinks in the tail or abnormally shaped heads. We are satisfied if a semen sample has 14% sperm with perfect morphology. Individuals with overall low sperm count may not have enough normal sperm in the sample to achieve fertilization. Even though sperm morphology issues are almost impossible to correct, they can be overcome by using ICSI to insert the sperm into the egg.
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