Many women of all ages are told they have diminished ovarian reserve. Follicle-stimulating hormone (FSH) and Anti-Mullerian hormone (AMH) are different ways of measuring ovarian reserve. Intra-vaginal ultrasound is also useful to determine the antral follicle count and size of the ovaries. High FSH and low AMH are linked to poor egg quality and conception rates, both stand-alone or in an intra-uterine insemination (IUI) or an in-vitro fertilization (IVF) cycle. FSH is the hormone your pituitary gland produces to trigger your ovaries to develop follicles in preparation for ovulation. AMH is a substance secreted by your primordial follicles, or follicles in “deep sleep”. The more follicles you have, the higher your AMH level, and the better your chances of conception. AMH can be tested on any day of your menstrual cycle, whereas FSH must be tested on day 2 or day 3, and in conjunction with estradiol to get a true reading. AMH has become an increasingly popular test since it can be done on any day of the cycle.
As we get older, the ovaries are less inclined to ovulate and the pituitary pumps out more FSH in an effort to get them to do so. This tendency is due a decrease in blood flow to the ovaries as we age, and hormonal fluctuations between the brain and the reproductive organs. Some IVF clinics will not accept patients with an FSH level higher than 12.
Acupuncture is the only known way to increase circulation to the reproductive organs. Once the ovaries are receiving better blood flow, they require less FSH to ovulate. It is true that there are changes in the DNA with age, which cannot be remedied through acupuncture and herbal medicine. However, eggs that are maturing in a well-oxygenated, nutrient-rich environment are going to be healthier than eggs developing in a state of stress due to poor blood supply and fluctuating hormone levels.
In conclusion, acupuncture can help women who have diminished ovarian reserve, who are attempting pregnancy either naturally, or with IUI or IVF, by increasing blood flow and regulating hormonal communication between the pituitary gland, ovaries, and brain. This results in healthier eggs and often decreases FSH levels. Additionally, women undergoing hormonal stimulation may require fewer drugs because the ovaries will be more responsive to the drugs.
Polycystic Ovarian Syndrome (PCOS)
PCOS is the most common metabolic disorder in women of reproductive age. Approximately 5-10% of women of reproductive age have PCOS. Some PCOS symptoms are irregular menstrual cycles, obesity, excess facial or body hair, and infertility. Clinical symptoms are infrequent or no ovulation, high levels of male hormones, and insulin resistance and ovaries have small cysts, follicles that have begun maturing and then stopped, and enlarged ovaries.
Western medical treatment options for women with PCOS who are having difficulty conceiving include drug therapy (metformin, clomid) and a weight loss regimen. Metformin (Glucophage) is a diabetes medication used to control blood sugar levels. Clomid is an anti-estrogenic drug that stimulates the pituitary to produce more follicle-stimulating hormone to promote ovulation. Both of these drugs can be effective in promoting ovulation in women with PCOS, but since the eggs are developing in an unhealthy (androgenic) environment, they are often not the highest quality. Weight loss is also effective in normalizing ovulation, but it is often difficult for women with PCOS to lose weight. A 5-10% total body weight reduction can increase the frequency of ovulation.
Acupuncture has been shown to increase the frequency of ovulation in women with PCOS. It also affects blood endocrine levels such as testosterone, LH to FSH ratios, and beta-endorphin concentrations. Through its effect on the nervous system and hypothalamic-pituitary-ovarian axis, acupuncture can restore normal hormonal function. Chinese herbal medicine can also help regulate blood hormone levels.
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Endometriosis is described as the abnormal growth of endometrial tissue outside of the uterus. The diagnosis can only be confirmed by a surgical procedure known as a laparoscopy. Endometriosis occurs in 7-10% of women in the general population, and 20-50% of women diagnosed with infertility. It is one of the leading causes of infertility, though the exact way it affects fertility is unclear. Symptoms that mark endometriosis include very heavy bleeding, severe menstrual cramps and/or back pain, painful intercourse, and digestive problems. Western medical treatment includes pain medication, surgery, and hormonal treatments that starve the misplaced endometrial tissue of hormonal stimulation. With hormonal treatment, ovulations are also halted, so this is not a viable treatment option for women who are trying to conceive.
Chinese medicine can offer treatment for women with endometriosis, whether they are trying to conceive or not. Chinese medicine sees endometriosis as a combination of blood stagnation and reproductive weakness. The body is not discharging the blood correctly, so it collects in areas where it should not and causes pain. The immune system then targets this misplaced endometrial tissue and creates a response, which results in more inflammation, which is a possible link to infertility. Acupuncture offers a treatment for endometriosis without halting ovulation, can alleviate pain and inflammation, and mediate the immune response. It also helps circulation to the reproductive organs, thereby helping the body flush out the endometrial tissue.
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An unexplained infertility diagnosis is the most frustrating, since most people want a specific diagnosis so they can address the issue. But unexplained infertility can be treated! While the diagnosis itself is frustrating, what it really means is that Western medicine does not have the tools to identify the problem.
Luckily, in Traditional Chinese Medicine, there is no such thing as unexplained infertility. All patients with infertility present with various symptoms and are treated accordingly. Slight inconsistencies in hormone levels and their interplay can result in infertility, but lab tests cannot diagnose them. Many lifestyle issues can be involved such as stress, diet, sleep patterns, and exercise (too much or too little). All of these factors will be examined by an acupuncturist. Of course, treatment with acupuncture and herbs can be concurrent with Western medical treatment, which will often result in the best possible outcome.
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Half of all couples facing infertility have a male factor involved, which is often diagnosed only after the female has gone through numerous tests and screenings. This apparent avoidance of the male factor could be due to the fact that Western medical treatments for it are minimal and questionable in effectiveness. If a varicocele (an abnormal enlargement of the veins in the scrotum) is diagnosed, oftentimes the couple is referred to IVF because the recovery time from the corrective operation is at least six months. Couples with fertility challenges often do not have six months to spare. Sometimes men are prescribed Clomid, the drug given to women to help them ovulate, though there are no clinical trials that show it increases sperm production.
Luckily, Chinese medicine has been treating male factor infertility for thousands of years. There are herbal formulas that support sperm production. Additionally, acupuncture has been shown to increase sperm count, motility, and morphology issues. Diet and lifestyle often play a role, since sperm are very sensitive to environmental factors. Simple changes like avoiding lengthy bike rides or the hot tub and an anti-oxidant supplement can improve sperm production and motility. Sperm are very sensitive to oxidative stress, and a simple supplement is often helpful.
Acupuncture also improves genital micro-circulation, regulates blood hormone levels, calms down the nervous system, and inhibits the release of stress hormones. In a study published in the journal “Fertility and Sterility,” authors Pei, Strehler, and Noss, concluded “In conjunction with ART or even for reaching natural fertility potential, acupuncture is a simple, noninvasive method that can improve sperm quality.”
Pei, J., Strehler E., Noss U., Abt M., Piomboni P., Baccetti B., Sterzik K. (2005). Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertility and Sterility; 84:141-147. doi:10.1016/j.fertilnstert.2004.12.056
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