Question: I’m a heavy coffee drinker, consuming five cups per day. I’m concerned that my addiction to caffeine will hurt my chances of getting pregnant. How much caffeine is acceptable?

Answer: Moderate caffeine intake for women trying to conceive is acceptable. As a general guideline, women trying to conceive should limit intake to 3 cups of coffee (or 300 mg of caffeine) per day (Organization of Teratology Information Services (OTIS) 2001). Results from large published studies have not demonstrated that moderate caffeine intake adversely affects fertility (International Food Information Council (IFIC) August 2002). Furthermore, caffeine consumption has not shown to have an impact on fertility or birth defects for the male partner or sperm donor (OTIS 2001).

For women who are pregnant, there have been several studies analyzing the affect of caffeine and pregnancy with the conclusions of those individual studies being mixed (IFIC August 2002). Keep in mind that if you are pregnant or breastfeeding, the caffeine you consume may transfer to the infant. As such, guidelines for caffeine intake of pregnant or breastfeeding women are a little more rigid. The recommendation by OTIS and Motherisk is that consuming less than 1½ cups of coffee (or 150 mg of caffeine) per day is not likely to increase the chances of miscarriage or a low birth weight baby. The American Academy of Pediatrics states that: “no harm is likely to occur in a nursing child whose mother drinks one cup of coffee a day.”

For more information on the affect of caffeine on fertility, visit the National Toxicology Program-Department of Health and Human Services website. The website provides a more detailed look at some of the clinical studies referenced above. Additionally it provides a chart showing the levels of caffeine in certain food and drinks. This information is available at: http://cerhr.niehs.nih.gov/common/caffeine.html.

– Eldon Schriock, MD

PFC patients often inquire about the use of acupuncture as a part of their infertility treatment, and, as such, PFC brings you insight from Bethany Richardson M.S., L.Ac and Leslie Oldershaw, L. Ac., two Bay Area acupuncturists who integrate fertility treatment into their practices. As background, Bethany Richardson was originally a massage therapist who took a Chinese diagnosis course while working on her Shiatsu certification. That course sparked her interest in pursuing a degree in acupuncture and led her to discover her love for science and the integration of eastern and western medicine. Leslie Oldershaw entered the field of acupuncture after spending her college years dedicated to pre-med courses. She became aware of Chinese medicine as a system of treatment while in college, and it fit perfectly with her passion for eastern philosophy and culture. She had always been interested in women’s health and found that fertility treatment in Chinese medicine truly encompasses all aspects of a woman’s health. Recently, PFC interviewed Leslie and Bethany about their approach to infertility, integrative medicine, and the strengths and weaknesses of acupuncture as a fertility treatment.

PFC: When a patient first comes to you and cites infertility as the reason for their visit, what sort of initial work-up do you do?

Leslie Oldershaw: I do a very comprehensive intake that involves an interview that takes a full medical history. Depending on their history, they may have had labwork done, or I may be ordering tests. From a fertility standpoint I like to see the basic hormone panels, including a cycle day 3 FSH, TSH, Estradiol, and also a mid-luteal progesterone test. If they have done a Clomid Challenge test, I love to see those results. If they have had a HSG or an ultrasound, I like to see that as well. From a general wellness perspective, I need to see a CBC and lipid panel and a comprehensive metabolic panel. When it comes to age, if a patient is younger we can be less aggressive. If a patient is older, we will be more aggressive. If they are 30, I will do this basic work-up, but I will be more inclined to just look at how they do over the next 6 months. If someone who is 40 comes to me, I will recommend that they consult a reproductive endocrinologist. They may want to have more of an accelerated timeline in terms of their treatment options. One of the challenges that I have is that I get patients who don’t want to do the western tests. They don’t want a workup, or the partner doesn’t want to do a semen analysis. I spend a lot of time educating patients to make an informed decision rather than shooting in the dark. I will be more persuasive with my arguments as the patient gets older!

Bethany Richardson: Normally, by the time a patient sees me they have already been to a fertility expert. I ask them to bring in their most current blood work. If they have had an antral follicle count, I want to know what that is. The basal temperature chart gives me a wealth of information. I look at it more in terms of a Chinese diagnosis, not necessarily are they ovulating or when they are ovulating, which is important, but are they running too hot or too cold. It gives me a lot of subtle information from a Traditional Chinese Medicine (TCM) standpoint. If I am looking at a woman who is younger, maybe 31 or 32 years old, then I look at her history of antibiotic use and if they have a history of digestive problems. I look at her menstrual cycle, her PMS, and if she is able to detoxify her hormones correctly. If I am looking at an older woman, I look and see if she is too hot or too cold. Does she have an excess of hormones? I see people mainly when they are desperate. They come to me after two cycles of IVF and want to do everything they possibly can for the next cycle. And unfortunately, I would be more effective if I saw them earlier on, but I do what I can when patients come to me.

PFC: If a patient comes to you and she already knows she must do IVF or IUI to get pregnant, what type of protocols do you offer in conjunction with her fertility treatment?

Leslie Oldershaw: When I work with a patient leading up to the treatment cycle, there are a couple of different protocols we can utilize. The more comprehensive protocol requires 2-4 months and allows you to incorporate nutrition, acupuncture and herbal modalities. We can do a tremendous amount to build a patient up, particularly if they are coming out of a miscarriage. We also work with patients on a shorter timeline, where they might be coming in to work with us a few weeks before an IVF cycle, and then we are primarily relying mostly on acupuncture to promote good blood flow and circulation. We will talk to the patient about nutritional support, including a pre-natal vitamin and omega-3 essential fatty acids. There is not enough research at this point to use fertility medications in conjunction with herbs. If things don’t go as expected the doctor needs to be able to troubleshoot what went wrong. My feeling is that acupuncture is of benefit to everyone. The people for whom acupuncture does not work are the patients who are very needle phobic. And I have to say, my IVF patients are champs. They look at my very small needles and they scoff!

Bethany Richardson: The type of treatment depends where on the continuum they are. I look at whether or not they have done IVF before, and what the results were. Were they a poor responder? How old are they? Sometimes they come to me and they tell me their IVF cycle is in three weeks. I can’t do anything with herbs in three weeks, but I can do some acupuncture. If it is six weeks or eight weeks, then we will have a real protocol. From my perspective the hormones you inject are a very warm tonic, which can burn out your cooling system. Depending on how they react to the injectables, I might try to work with them to take some time off from IVF and load them up with cooling tonics. What I see then is that cervical mucus increases, sleeping patterns regulate and stress levels go down. It’s hard for me to prove that it works, but I honestly believe that it does. Stress management, diet, acupuncture and IVF combined can add up to a much greater level of success.

PFC: What are the strengths and weaknesses of using acupuncture to treat infertility?

Bethany Richardson: It regulates the hormones, helps detoxify the body so you don’t have systemic inflammation, reduces PMS and pain. I think its only downfall is that it takes time. And a lot of the time—women aren’t willing to wait. And that’s where I come in again and say, it’s not a sprint, it’s a marathon. Acupuncture isn’t a golden pill. If you continue to eat poorly and not give your body good nutrients and antioxidants, then I can’t do as much.

PFC: Is there anything you want to add about treating infertility with acupuncture?

Leslie Oldershaw: I have always been keen on integrative approaches. There is a tremendous amount that western medicine can do to help people achieve a pregnancy. But what makes a critical difference for me is the integrative approach. What I am doing with my patients is different than what a Reproductive Endocrinologist does, but together we can work synergistically to create the best outcome.

Bethany Richardson: I am very excited about the future. I am hoping that eventually there will be research money that is earmarked for this arena. Often times acupuncture is seen as competitive with western medicine, and I don’t think it has to be. If we join forces we can be more effective together.

Photos provided by 3DbabyVu

A first glimpse of a baby in the womb, especially for women who have faced an arduous route to pregnancy, is perhaps as euphoric a moment as the “You’re Pregnant!” announcement. It is only natural for parents to want a visual connection with the infant as early as possible.

Seizing on this yearning, a new crop of commercial ultrasound studios has mushroomed all over the country, offering parents a chance to have a first look via an elaborate 3D and even 4D video ultrasound. At least three such businesses are in the Bay Area. Yet new parents contemplating a nonmedical 3D ultrasound simply for novelty or posterity should be fully aware of this technology in a rapidly evolving marketplace.

The safety of common medical ultrasounds is undisputed. For over 35 years, ob-gyns have used 2D ultrasound technology as standard practice to medically diagnose the health of a weeks-old fetus, enjoying an early glimpse of its emerging shape, major organ development, tissue and blood flow and when desired, the gender. The ultrasound repertoire is so common; over 80 million procedures are now performed in the US each year, reports one clinic.

Nevertheless, the Food and Drug Administration (FDA) and the primary medical association that oversees ultrasonography – the American Institute of Ultrasound Medicine (AIUM), have thus far refused to endorse 3D and 4D ultrasounds offered by commercial studios. The concern is less about the technology itself, and more about how it is applied. While the sound wave levels used for a 2D and a 3D/4D are reportedly of the same frequency, (it’s the computer diagnosis that creates the image differentiation), there is more built-in oversight in the medical community performing diagnostic ultrasounds.

For instance, is the person performing the commercial fetal portrait properly trained? Right now, it is up to the 3D studio to make sure that the person controlling the knobs and holding the transducer has undergone the same training standards required for ultrasonography at an ob-gyn office. Professional (non-physician) ultrasound practitioners undergo nearly three years of training, including 12-18 months for didactic and 12-18 months of clinical practice in order to gain the key certification from the American Registry of Diagnostic Medical Sonographers (ARDMS).

Moreover, there is concern that a commercial portrait ultrasound will reveal a developmental problem with the fetus that should be observed and discussed only through a physician/patient relationship. Another concern is that enthusiastic parents will forego a routine medical ultrasound after obtaining an elaborate portraiture one. In response, many commercial ultrasound studios are requiring patients to bring proof of a prior medical diagnostic ultrasound.

Finally, knowing a bit about the technology helps parents make an informed decision. In the medical community, the standard is to expose the fetus to the lowest possible exposure level for the shortest amount of time, usually 10 minutes or so. Because frequent ultrasonography at higher levels can produce a heating effect in bone and tissue, the aim is to minimize exposure. Yet some commercial fetal portrait studios offer deluxe packages involving a 45 minute video ultrasound.

A spokesperson from 3DBabyVu insists that the potential for physical damage to the fetus via a wrong decimal level setting is literally and virtually not possible, at least with the standard GE Voluson machines, which provide a cap to the frequency level. Yet he admitted that the same machines have two other settings for cardiac mode and vascular mode to examine more robust adult tissue. If patients choose to purchase a dynamic 3D or 4D image package offered by one of these enterprising studios, we strongly recommend that you learn as much as possible and even consult with your ob-gyn if you are at all confused. Also, it is best to confirm that the sonographer at the commercial studio is ARDM certified. Because the practice of fetal portraiture imaging is self-regulated, it is the patient’s responsibility to be aware of current research and be as informed as possible prior to using this new technology.