News Letter,© Copyright
Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
Rehabilitation Medicine and Acupuncture Center
1171 East Putnam Avenue, Building 1, 2nd Floor
Greenwich, CT 06878
Tel: (203) 637-7720
Case Discussion 1:
Amy S., a 36-year-old woman, is an OB-GYN at a Connecticut hospital, who delivers babies every day. When she finished her residency two years ago, she and her husband wanted to have a baby and tried for a pregnancy for a year to no avail. As a doctor, Amy is well aware of the workings of her body. She consulted the best endocrinologist and infertility specialist in the area, who checked her hormone levels, including the thyroid, pituitary gland, adrenal gland, ovaries, etc., only to find nothing was wrong. She was careful about nutrition, was at her ideal weight of 120 pounds and neither drank nor smoked. She also had an ultrasound study which showed no problem in her tubes, uterus or ovaries. Amy’s husband was also examined and shown to have a normal quantity and quality of sperm with no antisperm antibodies; the delivery of his sperm was also normal. He showed no retrograde ejaculation and no blockage in the ejaculatory duct.
Amy came to me for consultation and evaluation. She is an open-minded physician, devoted to her job, and works between 55 and 60 hours a week. Her husband is an emergency physician who works in the same hospital and he, too, works hard. Amy and her husband are often on call, causing much stress. They both keep irregular hours and often do not see much of each other. From her history, I could tell she was very stressed, unhelpful to her pregnancy situation.
Amy told me she had read an article which indicated that acupuncture plus IVF (in vitro fertilization) could help the patient increase the success rate for pregnancy. She tried it once without success.
Based on the above information, Amy has unexplained infertility. Unexplained infertility is, by definition, when a couple has not conceived after 12 months of contraceptive free intercourse.
There are many causes of infertility, including the following:
For the male:
Impaired production and function of sperm, low sperm concentration. Normal sperm concentration is greater than or equal to 20 million sperm per milliliter of semen. A count of 10 million or fewer sperm per milliliter of semen indicates low sperm concentration, and the chances of conception lessen. A count of 40 million sperm or higher per milliliter of semen indicates increased fertility; also, if a sperm changes its shape and mobility or is slow, the sperm may not be able to reach or penetrate the egg.
The malfunction of the Hypothalamic-Pituitary-Gonadal Axis: if the axis is not working properly, the male hormone level will be disturbed and the sperm will be both low in count and slow in activity.
The testes system, including transportation and maturation.
For the female:
Fallopian tube damage or blockage.
Polycystic ovary syndrome.
Fibroid in the uterine.
Even though there are many women who cannot conceive because of the above reasons, there are also 15 % of couples who cannot conceive due to unexplained reasons, and Amy falls into this category.
Amy was encouraged to have IVF treatment and, beforehand, get acupuncture treatments. She was scheduled to have hormone regulation (hormone treatment) for a month before trying to become pregnant again, and to have acupuncture treatments with me three times a week during that month.
Two groups of key acupuncture points were selected for Amy:
Zhong Ji (Ren # 3), Guan Yuan (Ren # 4), Gui Lai (Stomach # 29), Chong Men (Spleen # 12), and Fushe (Spleen # 13). This group of acupuncture points adjusts the hormonal level of the entire body. Zhong Ji and Guan Yuan (Ren # 3 and Ren # 4) directly stimulate the uterus, which makes the uterus muscle very relaxed, and will increase the chance of contraception and easy implantation. Stimulation of the point Fushe (Spleen 12), and Chongmen (Spleen 13)—both points bilateral and adjacent to the ovary and uterus—will directly adjust the ovary’s hormonal secretion cycle, in turn increasing the activity of the pituitary, adrenal and ovary axis and increasing the chance of contraception. Gui Lai (Stomach 29) is also adjacent to the ovary and uterus, which assists the first four points in adjusting the entire female hormone system.
Eight-liao points (eight points on both sides of the sacral area) directly stimulate the pudendal nerve and the pelvic splanchnic nerve. These nerves will stimulate the uterus and ovaries and help increase the chance of contraception, as well as adjust the entire hormonal system of the female reproductive system.
The two groups above of key acupuncture points will be alternatively treated during each day’s visit, in addition to the Hegu Large Intestine # 4, Quchi Large Intestine # 11, San Yin Jiao Spleen # 6, Xue Hai Spleen # 10 and Tai Chong Liver # 3 – all of which will help adjust the hormone environment in the entire body and thus aid contraception.
After four weeks of treatment, Amy underwent the IVF procedure and was kept on the acupuncture treatment twice a week. Amy reported to me that she had eight eggs mature, an improvement from the first IVF treatment which had produced only three mature eggs.
After a 48 to 72 hour culture, six of her eggs were fertilized and Amy’s doctor implanted four into the uterus. The doctor told her she should have bed rest overnight and that she could return to work the next day; however, I told her to have bed rest for two days, because Amy’s job is more stressful than most people’s, and she has to bend forward in her work to deliver babies.
A month after insemination Amy told me she was pregnant. She was very excited about her condition and eight months later delivered twins, a boy and a girl. She was thrilled with the results, as was her husband.
In my personal experience:
In unexplained infertility, most of the cases are stress related. As an OB-GYN doctor, Amy worked very hard, as did her husband, and they had little time to be together. They are both under constant stress, their bodies always tight, in particular Amy’s uterus muscles. These factors made it very difficult for the fertilized eggs to attach themselves to the uterus. Some patients may be lucky enough to be pregnant; however, they may not retain their baby in the uterus because of the stress and tightness of their uteruses. They may have frequent miscarriages. My treatment is mainly for stress-reduction.
Many unexplained infertility patients have irregular hormone environments in their bodies because of their high stress levels. These will affect the patient’s entire reproductive system, such as Oocyte maturation, delivery, fertilization, implantation, etc. My acupuncture points are selected to adjust the hormone environment and make the different hormones harmony.
Each patient should have about one month of acupuncture treatment before starting the IVF procedure to prepare the patient’s hormonal system and to have her relax psychologically.
It is extremely important for the patient to have 48 hours of bed rest after insemination before taking up normal activities, because at this time the fertilized eggs are very weakly bound to the uterus. Any inappropriate movement during these first 48 hours might cause an early miscarriage.
For the key acupuncture points, you may do the acupressure by yourself as indicated above.
According to studies from Germany and Australia, the IVF treatment without acupuncture has a 29% success rate for pregnancy. However, the combination of acupuncture with IVF increases the success rate to 49%–almost a third higher than IVF alone. Therefore, it would seem advisable to combine the two treatments.