Welcome to my blog

Acupuncture specialist for Fertility, Facial rejuvenation, Pain relief.
Based at Kensington Central London.Qualified as a medical doctor in Western medicine over 20 years ago in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences

Doctor who is passionate about acupuncture

I love what I do, I am good at it and I am always there for my patients. If you come and see me, you will know why I am standing out.
This blog is to introduce latest development and research of acupuncture and offer a chance of awareness of more treatment options for your condition. The blog is for information purpose only.

About Me

My photo

My specialised areas include fertility for women and men, facial rejuvenation, acne, various pain conditions, chronic fatigue and hormone regulation with acupuncture treatment.

Practice contact for appointments and addresses 

Kensington: for appointments at Anamaya center Kensington please call at 02030110355 or email at info@anamaya.co.uk
Address: 1 Adam and Eve Mews, Kensington, London W8 6UG
2 min walk from High Street Kensington underground station

Harley Street: for appointments  at Harley Street please call ALO clinic at 02076368845 or email at info@aloclinic.com
Address
Suite 3 Harmont House
20 Harley Street, London W1G 9PH
5 min walk from Oxford Circus underground station

My background: I became a qualified medical doctor in Western medicine 20 years ago in China and was well trained in Western medicine together with Chinese medicine in the best Medical University in Beijing, China. Also I was trained with Dr Zheren Xuan--famous orthopedics expert and founder of soft tissue surgery in China. I am dedicated to treat patients with acupuncture and am recognized as one of the world leading acupuncture specialists.

I obtained a PhD degree in the University of Leeds in the UK.

I had post doctoral training and worked as a senior researcher in St George's hospital, London, UK.

I had frequently presented my research findings in the top international conferences in the field.

I have many publications including ebooks and articles.

I have many year clinical experiences. Over the years of practicing, I have developed unique treatment approaches for infertility, skin aging, acne, vulvodynia, neck pain, headache, migraine, shoulder pain, back pain, fatigue, hot flushes, Parkison's disease etc to achieve best treatment results. My devotion and skills are highly praised by my patients. 


Monday, 30 July 2012

Endometriosis associated infertility with acupuncture treatment

Women’s uterus wall has three layers: inner layer is called endometrium; middle layer is smooth muscle; outer layer is myometrium. Endometrium of uterus is special. It undergoes cyclic change and regeneration. During the period cycle, this layer grows thicker and is full of blood vessels and glands. It provides best hospitable environment for implantation of a fertilised egg. If pregnancy does not occur, the inner layer will shed away causing bleeding and the layer will redevelop. Sometimes, if things go wrong, the endometrial tissue can grow outside of uterus. This is a condition called endometriosis. The most common places where this tissue was mislaid are ovaries, fallopian tubes and the pelvic cavity. This misplaced tissue is also responding women’s period cycles, but it could not shed. As a result it will cause inflammation, scar and adhesion. Endometriosis could present chronic pelvic pain including period pain, and intercourse pain, irregular period and associated with infertility.

Endometriosis affects up to 10% of reproductive age of women. Endometriosis is associated with infertility. At least one third of women with endometriosis have infertility. Women with infertility are 6-8 times more likely to have endometriosis. Some women with endometriosis will conceive without difficulty, while others may have difficulty to conceive. Some controlled trial study showed that women with endometriosis were 10% less likely to conceive than those without the condition. The pregnancy success rate among women with endometriosis associated infertility was lower than those with unexplained infertility. A study of 14 randomised controlled trials showed that women with endometriosis were less likely than women with tubal-factor infertility to conceive by means of IVF. Endometriosis is also associated to lower live birth rate.

The mechanisms of association between endometriosis and infertility are not fully understood. Moderate to severe cases can lead to infertility. The connection between severe endometriosis and infertility is due to severe pelvic adhesions which cause a variety of anatomical abnormalities. This can affect ovum capture and transport. The severe ectopic endometrial lesions is also decreasing implantation rates, decreasing egg retrieval rates and decreasing pregnancy rates.

Most of endometriosis cases are mild. Some women with mild endometriosis have also had infertility and many women with infertility have had mild endometriosis. The cause and effect relationships between mild endometriosis and infertility are not clear. Severe endometriosis can cause reproductive organs scarring and distortion. The association of minimal and mild endometriosis with infertility is also possible. This is because endometriosis causes ovulatory dysfunction, impaired follicle development, defective implantation, eutopic endometrium abnormalities, abnormal immunological environment and luteal phase problems. Luiz Fernando et al collected the data from 1985 -2011 to investigate the association between mild endometriosis and infertility. They found there were two randomized controlled trials for this study. In 1997 Marcoux et al conduceted a randomized controlled trial studied the association between endometriosis and pregnancy rates. They compared pregnancy rates in 172 women with stage I and II endometriosis who underwent laparoscopic removing all visible endometrial lesions with 169 women who underwent diagnostic laparoscopy only. All women were followed postoperatively for 36 weeks. The cumulative pregnancy probability rate for the surgery group was 30.7% while pregnancy rate for the diagnostic group was 17.7%. This result showed significant differences between two groups indicating the association of mild endometriosis and infertility. This suggestion was supported by another study. The conclusion is that minimal to mild stages of endometriosis plays an important role related to infertility and has negative impact on pregnancy rate.

In summary, the association between endometriosis and infertility may be caused a few mechanisms.

Distorted pelvic anatomy: endometriosis could cause pelvic adhesions. These organs can adhere to the uterus, bowel or pelvic wall. This distortion of reproductive organs could cause infertility. if the eggs in the ovaries are damaged by the misplaced tissues egg quantity and quality could be compromised which results ovulation abnormalities which can impair egg release from the ovary and egg pickup after being released; The tubes can be damaged and blocked; ovaries can contain cysts formed from misplaced tissue it also can block sperm entry into the distal tube.

Altered peritoneal environment: Also Altered peritoneal function and impaired endometrium and implantation are also contributing to the infertility. women with endometriosis have increased volume of peritoneal fluid, increased immune cells and concentrations of prostaglandin etc. These may impair egg, sperm, embryo and fallopian tube function.

Altered system immune function: women with endometriosis may have increased antibodies and lymphocytes and this may alter endometrial acceptance to embryo implantation.

Endocrine and ovulatory abnormalities: Women with endometriosis may also present abnormal follicle growth, the luteinized unruptured follicle syndrome, luteal phase dysfunction and premature and multiple LH surges.

Abnormal tubal function: egg capture inhibitor was reported present in peritoneal fluid from women with endometriosis.

Abnormal fertilization and implantation: fertilization and implantation may be impaired in women with endometriosis. Endometrial function may be not normal.

Medications could improve the quality of life for many women with endometriosis; however their contraceptive effects are limited their application. There were many researches showing that acupuncture is effective of releasing pain associated with endometriosis. Acupuncture also stops misplaced tissue growing, regulates period and improves fertility. According to traditional Chinese medicine theory, endometriosis is caused by blood stagnation. Acupuncture improves blood flow; this will release the pain and improve other symptoms.

There was a case report about acupuncture treatment for endometriosis associated infertility from China. 25 patients with endometriosis associated with infertility were treated with acupuncture. After 2 months of treatment, 9 patients achieved pregnancy.

A report in Zhong Guo Zhen Jiu (1996) also studied effectiveness of acupuncture on endometriosis associated with infertility. There were 72 women with endometriosis associated with infertility involved. The acupuncture treatment duration is 3-9 month. 42 women achieved pregnancy. Success rate was 58.33%.

References
Zhou et al (2009) Afr J Tradit Complement Altern Med 6: 494-517
http://www.cnki.com.cn/Article/CJFDTotal-ZGZE602.020.htm
Luiz Fernando et al Rev Assoc Med Bras (2012) 58:607-614

Wednesday, 25 July 2012

Fibroids and infertility with acupuncture treatment

Fibroids and infertility with acupuncture treatment

Fibroids are benign tumour growing in uterus. Its occurrence is high about 20-50% in reproductive age group women. Fibroids can grow in inner layer, middle and outer layer of the uterus. Majority fibroids have no symptoms and do not require treatment. The most common symptom is heavy and prolonged menstrual period which could lead to anaemia. Other symptoms include pain in your abdomen, swelling in pelvic area, increased urination due to fibroids pressing on the bladder, and constipation because of fibroids pressing on the bowel. Fibroids growth is very slow and can be stimulated by hormones especially estrogen. Fibroids could become smaller and reduce in number when your estrogen level decrease, such as after the menopause.

What treatments are available for your fibroids?

If you have fibroids, what treatments are used by these women with fibroids. There was a survey from USA showing the use of medical, surgical and complementary treatments among women with fibroids. There were 933 premenopausal women ages 31-54 years with symptomatic fibroids who participated in the Study of Pelvic Problems. Participants were racially and ethnically diverse, with a mean age of 43 years. During study follow-up, 531 participants (57%) did not undergo uterus-preserving surgery (UPS) or hysterectomy, 250 (27%) had at least one UPS, and 152 (16%) underwent hysterectomy. Complementary and alternative treatments were commonly used, including exercise (45%), diet (34%), herbs (37%), and acupuncture (16%): participants reported significant symptom improvement and few side effects with these interventions. Women who did not undergo surgery during the study reported improvement in dyspareunia, pelvic pain, and menstrual cramps. However, women who underwent UPS reported greater overall resolution of "pelvic problems" compared with women who did not have surgical treatment. From this study we can see that uterus-preserving surgery are effective treatments for women with fibroids, but many women use hormonal or complementary treatments and report significant symptom improvement without surgical intervention.

Acupuncture can treat fibroids. There were many case reports in Chinese showing acupuncture made fibroids disappeared or shrank. For example, 20 years ago Wang Li reported 346 fibroids cases with acupuncture treatment. The fibroids were detected by ultrasound and the effects were confirmed by ultrasound tests. In 288 cases (83.2%) the fibroids disappeared; in 39 cases (11.3%) fibroids shrank over two third of original sizes; in 19 cases 5.5% the fibroids shrank less than two third of original sizes. Recent research showed that acupuncture reduces fibroids bleeding suggesting that acupuncture is a useful tool for fibroids nonsurgical treatment. Acupuncture modulates hormone balance which may contribute to the mechanisms. After acupuncture treatment, blood estrogen level is significantly decreased. Acupuncture strength body’s defence system which would be beneficial for fibroids treatment.

Case report: acupuncture reduced bleeding caused by uterine fibroids

Uterine fibroids are benign tumors in uterus originating uterine smooth muscle cells. Heavy and painful menstruation was most common symptoms. If the fibroids grow in the submucous layer in the uterine, they cause heavier bleeding. Acupuncture was used in treating fibroids in China for centuries. Recent research supported this idea of using acupuncture to treat fibroids.

There was a 48 year old woman with submucous uterine fibroid and severe uterine bleeding. She received electroacupuncture to stop to bleeding. Doppler ultrasound test was applied to assess uterine blood flow and number of pads used during bleeding. They found that Dppler untrasound test showed blood flow in the uterine artery reduced with acupuncture stimulation. After a few sessions of acupuncture treatment the number of pads used reduced significantly during the bleeding period. Acupuncture is an effective approach for patients with fibroids.

Body acupuncture was most commonly used in treating uterine fibroids in hospitals in China. In 1994, Yan H and Wang J reported the effect of acupuncture on fibroids and its comparison with medicine including Chinese medicine and Western medicine. They found that acupuncture had better effect than medicine in treating fibroids. In addition, there was no side effect found in acupuncture treatment.

Fibroids may reduce fertility in women. Fibroids may interfere with sperm and ovum transport and embryo implantation. This occurs because in the case of fibroids, uterine cavity form or tube was distorted and uterus contracted abnormally. Local inflammation associated with the presence of fibroids may lead to a hostile environment which disrupts sperm and ovum transport and embryo implantation. Reduced blood flow in the endometrium also contributes to disturbed embryo implantation. Many research showed that fibroids are a risk factor for infertility, though there is still a debate. Women with fibroids have low IVF pregnancy success rate and low live birth rate. After removing fibroids, pregnancy rate increased significantly; also IVF success rate increased as well.

Fibroids affect pregnancy. They increase the miscarriage rate. There was a worry that during pregnancy fibroids may grow. However, some research showed that fibroids only grow in the first trimester and they get smaller late in pregnancy. In most cases fibroids don’t grow. The real worry is that fibroids increase miscarriage rate. This was seen a reduced live birth rate in IVF. After removing the fibroids, miscarriage rate significantly reduced. Fibroids lead to pelvic pain in pregnant women. Fibroids may also increase the rate of a few pregnancy complications during the second and third trimesters. Fibroids are associated with placental rupture, placenta previa, intrauterine growth restriction and fetal malposition and a higher rate of caesarean section.

Surgical treatment is conventional, though there was no sufficient evidence to support myomectomy improving fertility in women with fibroids

Fibroids may have a possible negative effect on fertility as mentioned above. Fibroids can be removed by surgery which is called myomectomy. Does myomectomy improves fertility? Metwally M et al from University of Southampton UK did a review from the data before June 2012. They analysed randomised controlled trials examining the effect of myomectomy on fertility outcomes in a groups of infertility women with uterine fibroids compared to no intervention or different surgical approaches performed. Their study showed that one study showed no evidence for a significant effect of myomectomy on the clinical pregnancy rate for intramural, submucous, combined intramural and subserous, and combined intramural and submucous. There was no evidence for a significant effect of myomectomy for any of the above types of fibroids on the miscarriage rate. Two studies compared open versus laparoscopic myomectomy and found no evidence for a significant effect on the live birth rate, clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, preterm labour rate and caesarean section rate. The authors concluded that there was insufficient evidence from randomised controlled trials to support myomectomy to improve fertility; no significant differences between the laparoscopic and open approach on the effect of fertility; though this evidence needs to be viewed with caution because of the small number of studies.

References
Wang Li Zhong Guo Zhen Jiu (1986) 6:27
Jacoby VL et al Eur Obstet Gynecol Reprod Biol (2014) 182:220-5
Cakmark YO et al Fertil Steril (2011) 96:13-5
Yan H and Wang J Zhen Ci Yan Jiu (1994) 19:14-6
Metwally M et al Cochrane Database Syst Rev (2012) 11:CD003857

Tuesday, 24 July 2012

Inflammation plays a role in infertility and acupuncture treatment

Inflammation is a basic reaction that our body responds to infection, irritation or other injury. Inflammation is a complex biological response of vascular tissue to harmful stimuli. Without inflammation, wound and infection would never heal. Inflammation is a defence and has two aspects of effects: beneficial and harmful. If our body suffered from infection or injury, the defence system tend to remove harmful stimuli, initiating healing process for repair and regeneration. This is beneficial effect. The process of acute inflammation is initiated by local blood vessels with related chemicals accumulated into tissue. Increased blood flow causes characteristic swelling, redness and heat. As a consequence, vasodilation and increased permeability cause slowing of blood flow. Inflammation could stimulates nerves causing pain. It also could damage organs and their function if the inflammation is too strong which is harmful. Inflammation has a significant role in gynecology and infertility, affecting the ovary, uterus as well as the embryo and implantation.

Inflammation is present in women’s reproductive system physiology. There is temporary changes reflected inflammation process observed in ovary during follicular development, ovulation and luteal formation. Immune cells accumulate in the inner lining of uterus during the secretary phase of the menstrual cycle indicating inflammation involved in the endometrial cycles in uterus. Recent research found that a special protein which can inhibits immune cell function and has local anti-inflammatory effect prevented immune attack to embryo and created a local hospitable environment in uterus in early pregnancy without compromising maternal system immune function. Inflammation plays an important role in implantation as well.

Inflammation is involved in infertility. There are two major types of problems that account for most of women’s infertility: anatomic abnormality and ovulatory problems. Most anatomic abnormalities such as tube blockage that cause infertility are acquired. Infection, inflammation, ischemia and surgical injury may be the causes. Anatomic abnormalities may be asymptomatic or may be presenting pelvic pain, pelvic adhesions and infertility. Inflammation causes tissue damage and distortion. The most significant cause of inflammatory infertility is Chlamydia trachomatis infection that may result in infertility in 10-30% of infertile couples in developed countries. Inflammation causes ovulatory abnormalities. Premature ovarian failure (POF) is a typical example of the relationship between ovulatory infertility and inflammation. The incidence of POF is 1% of women under the age of 40. About 50% of POF cases have attributed to immune problems which are involved in inflammation. Antiovarian antibodies have been found in some of these cases and accumulation of immune cells in ovaries has been noted as well. Women with endometriosis are also responding to inflammation differently from those women without endometriosis. There are increased immune cells and antibodies against inner lining of uterus.

Acupuncture reduces inflammation to improve fertility. Inflammation is present in infertility. This was noted in ancient Chinese Medicine. The phenomena were explained that dampness and heat accumulate and blood stagnates in pelvis. This blocks meridian and stops energy flow causing infertility. Acupuncture treating infertility has a long history, but the effect of acupuncture is doubted because it relies on concept of changing the flow of energy on meridian which is not accepted by evidence based medicine. Recently researchers provided evidence that needles insertion into the skin and deeper tissues results in a particular pattern of afferent activity in peripheral nerves. This improves blood circulation of ovaries and uterus etc. As a result it reduces local inflammation and improves infertility.

In men, infection and inflammation of the reproductive tract including testes are widely accepted as important factors of male infertility. Inflammation is associated with disruption of testicular function leading to low sperm count and low quality of sperms. Acupuncture improves sperm count and quality of sperms. This is because acupuncture increased blood supply of testicular artery and acupuncture stimulated immune response and reduced inflammation.

References
Weiss G et al Reprod Sci (2009) 16: 216-229

Friday, 20 July 2012

High FSH to get pregnant ?Acupuncture can help

Age affects fertility

A more recent study of university students in Sweden found that half of the female students were not aware of the age-related decline in fertility and intended to have children after the age of 35. There is clear evidence of an age-related decline in female fertility. By the time women reach 35 years of age, their fertility is declining markedly. This presents that the number and quality of eggs decrease; also genetic abnormalities and spontaneous abortion increase noticeably with female age. A study involved in 1000 women in pregnancy showed that 71% of women aged 30 conceived within 3 months whereas only 41% of women aged 36 conceived within 3 months. A negative effect of increasing male age particularly in the late 30s was also found. A study involved 2112 women in pregnancy showed that increasing age for both men and women take longer time to conceive. There were some other studies presented similar results.

There is a significant decline in clinical pregnancy rate, implantation rate and delivery rate per embryo transfer associated with increasing female age in assist reproductive treatment. A recent study of all IVF clinic in Netherland found that the overall live birth rate per cycle decreased by 2% for each additional year of female age. Another study involved in 36483 treatment cycles in assist reproductive treatment reported that women aged 25-29 achieved a live birth rate of 25.9% while women aged 40-44 only achieved 6.1% live birth rate. The poor live birth rate in older women greatly attributes to spontaneous abortion

What is the best marker of reproductive age in normal women?

Study showed that a woman’s optimal fertility age is before 30-31 years. And then fertility decreases gradually and this decline is accelerated towards age of late thirties. It is generally accepted that reproductive ageing is ovarian ageing and the quantity and quality of the pool of follicles in the ovary decreases. There are many tests that are used to measure ovary function. What is the best marker to measure reproductive age? GJ Scheffer et al compared several markers. These include that antral follicle counts (2-10mm), total ovarian volume, total follicular volume, mean follicular volume, and volume of either the smallest or largest ovary; FSH, estradiol and inhibin B and the response of estradiol and inhibin B to exogenous GnRH agonist. They tested these markers on 162 healthy female volunteers aged 25-46 years. These women were proved with normal fertility and regular menstrual cycles. All marker tested excerpt inhibin B were correlated with age, but the number of antral follicles was highly correlated with age. Their conclusion is that the number of antral follicles has the closest association with age in normal women with proven fertility.

Age and mother’s menopause affect women’s fertility

Women are born with all the eggs they ever have. Women are most fertile between the ages of 18 and 31. When women are getting older, their egg quantity and quality are declining. They become less fertile. Research suggested that genetic factor contributes to women’s fertility. Women whose mothers had an early menopause had much fewer eggs in their ovaries than those mothers had a later menopause. These women with fewer eggs have fewer chances to conceive. At present there is no test that can predict women’s fertility accurately. There are two approaches to assess the supply of eggs remaining in the ovary: anti-Mullerian hormone (AMH) and antral follicle count (AFC). Researchers found that both AMH and AFC declined faster in women whose mothers had an early menopause ( before the age of 45) compared with women whose mothers had a late menopause (after the age of 55). Dr Valentine Akande, a consultant gynaecologist and spokesman for the British Fertility Society said that the findings were helpful, but that women should not be overly concerned if their mother did have an early menopause. The variation of egg quantity in women is enormous. The earlier you are trying for a baby the more chances to be successful.

With age disadvantage and high FSH you still have chance to get pregnant

When women reach their forties, their fertility falls down. As mentioned above in humans the follicles in ovaries are fixed at birth and decrease with age. The follicles are constantly disappearing either died or growing to ovulate. From the age of about 35 onwards, fertility declines quickly. This presents that the number and quality of eggs decrease; also genetic abnormalities and spontaneous abortion increase noticeably with female age. The rate of follicular depletion speeds up resulting in a decreasing number of good qualities of follicles. A protein inhibin B produced by follicles dropped and FSH is elevated in circulation. FSH is a hormone produced by pituitary gland which is located in the brain. FSH stimulates ovaries for eggs growth. If your ovaries don’t function well or you run out of eggs, your ovaries do not respond to FSH like normal ovaries do, the eggs don’t grow well. In this circumstance your pituitary gland works hard to produce more FSH trying to stimulate ovaries function and eggs to grow. As a result your FSH level is high, which means that you have poor ovarian response or poor ovarian function or poor ovarian reserve or ovarian failure. Your egg quality and quantity will be poor. Also endometrial lining became impaired as well. All of these contribute to the declined fertility with aging.

How old a woman can be to achieve pregnancy with assisted conception approach? Check JH reported a case that a 46 year old woman with high day 3 estradiol and FSH. She conceived on her third IVF-ET attempt. She delivered a healthy full term baby girl. This was believed to be the first case report of a successful pregnancy in a woman of such an advanced age with diminished ovary reserve using her own eggs. This report showed that pregnancy is possible in similar circumstance.

How high is FSH that can be treated to achieve pregnancy? There was a case report that a woman with premature ovarian failure and high FSH 164miu/ml was treated and got pregnant in her ninth cycle treatment and delivered a healthy boy.

Is there other treatment available for high FSH? Estrogen or birth control pills will temporarily suppress FSH to normal level. However this does not improve your infertility

Can acupuncture help if your FSH is higher than normal? Acupuncture can stimulate the nerve ends to the ovaries and improve ovarian blood flow and help follicles grow, as a result this restore hormonal balance and lower FSH. Acupuncture also stimulates the brain and rebalances the hormones.

NHS offers IVF to women in age 40-42

New NHS guidelines state that couples struggling to have a baby should get fertility treatment more quickly and older women should gain access to IVF. The guidelines recommend that women aged between 40-42 should be offered one cycle of IVF if it is their first time and they have enough eggs; women aged under 40 are offered three cycles of IVF. It is widely known when a woman reaches her 30s her fertility begins to decline, and this decline in fertility is speeding up in her late 30s. IVF success rate is going down with increased age. IVF success is rare in women over 45.

Why this is the case? The ovary aging is the cause of this declined fertility. It has become clear that the decline in fertility with increasing female age is largely due to a rapid decrease in egg quantity and quality with a higher proportion of eggs having genetic abnormalities. On the contrary, the reproductive capacity of the uterus does not decrease with age even in late 40s and 50s. This is seen in the use of younger donor eggs, women who are menopausal can achieve very high rates of conception.

Fertility declines with aging in both men and women and acupuncture can help.

Women are born with all eggs in the ovary which cannot be divided into other cells. The egg numbers are only declining with age. The process is speeded after women turn 35 years of age. On the contrary, there are gonocytes or primitive germ cells in the normal men’s testes. These cells can split without limitation. The cells split can become another gonocytes which could further divide; or they can become mature sperm cells. Gonocytes supply within testes can be last very long time and mature sperm cells can be produced. This is the main reason why a man’s fertility does not decrease significantly with age as women’s.

However, fertility in both men and women decreases when they reach certain age. In men semen parameters could begin to decline as early as age 35. Semen volume and motility would decrease and morphology could gradually become abnormal. After age 40, there could be notably DNA damage in their sperm; motility and viability continues declining. With an increase in age in men, the time to pregnancy for their partner increases. In women, fertility is significantly lower in the 30s and 40s. The number of eggs decline, woman’s menstrual cycle become shorter, menstrual irregularity begins 6-7 years before menopause, infertility increases, the time to pregnancy increases and also the chances of staying pregnancy becomes lower. If you start trying to get pregnant and there is still no luck, this could be not because something is wrong, but it could simply because you and your partner’s age. It takes longer for you to get pregnant. In this situation, apart from changing life style and exercises etc that you can help yourselves, why don’t you try acupuncture? Acupuncture is recommended as one of the treatments to encourage fertility by some doctors.

References
Check JH Clin Exp Obstet Gynecol (2011) 38:209-10
Check ML Clin Exp Obstet Gynecol (2004) 31:299-301
http://www.bbc.co.uk/news/health-20217735
http://www.bbc.co.uk/news/health-21505578
Fotrman EJ et al Maturitas (2011) 70:216-21
GJ Scheffer et al Human Reproduction 18:700-706
http://www.webmd.com/baby/features/getting-pregnant-easy-ways-to-encourage-fertility?page=3
Homan GF et al Human Reproduction Update (2007) 13:209-223

Wednesday, 18 July 2012

Acupuncture increases sperm count and improves sperm quality and male fertility

Whenever we talk about infertility, the first thought is women’s problem. Actually this is not true at all. Male infertility explained 40-50% of infertility cases. Sperm defect including low sperm count and/or poor quality of sperm is the main cause of male infertility. Semen analysis is very simple and important test to check male infertility. In this test, sperm concentration (sperm numbers), sperm motility (percentage of them are swimming forward) and shape of sperm are checked. If you have abnormal sperm, this may be the cause of your infertility.

If you have infertility associated with sperm abnormality, acupuncture can help to correct them. Current research provided evidence that acupuncture increased sperm concentration. As early as 1980’s, there was a research on improvement of sperms after acupuncture treatment from Germany. 28 patients with subfertility participated the study. These patients received 10 acupuncture treatments for a period of three weeks. After acupuncture treatments, total sperm count, concentration and motility were improved significantly. They also evaluated subjective parameters by written psychological tests. The psychological test showed no change caused by acupuncture. This excluded that the effect of acupuncture on sperm quality was caused by placebo-mechanisms. Siterman S et al. studied 40 patients with low sperm count in two groups: acupuncture group and control group. They found that after 5 weeks acupuncture treatment sperm numbers were significantly increased compared to the control group. Pei J et al also studied the effect of acupuncture on sperm count. There were 28 patients with low sperm count in acupuncture group and 12 patients with low sperm count in untreated control group. After 5 weeks acupuncture treatment (twice a week) the sperm count was significantly increased in acupuncture group compared to control group. They also found that acupuncture improved sperm quality as well. Siterman S et al and Fischl F et al also investigated the effect of acupuncture on sperm quality. They found that after 10 acupuncture treatments acupuncture treatment, sperm quality was significantly increased compared to the control group.

It is widely accepted that men with low sperm count is associated with high scrotal temperature and this impaired sperm output. Recently Siterman S et al investigated the mechanism of acupuncture increasing sperm count to see if this is related to decrease scrotal temperature. There were 39 patients with low sperm counts in acupuncture group. They found that the result was agreed with previous studies that men with infertility have high scrotal temperature. This was caused by testicular inflammation. After 8-10 acupuncture treatments, the scrotal temperature was significantly decreased and sperm counts were significantly increased. This is because acupuncture increased blood supply of testicular artery and acupuncture stimulated immune response and reduced inflammation.

Acupuncture is effective for treating antisperm antibodies associated male infertility

10% of male infertility is caused by antisperm antibodies. Immune system can respond to produce antisperm antibodies in some circumstances such as infection. These antibodies tend to destroy sperms causing infertility. The antibodies can be present in tail of sperm which may cause mobility problems; they can be found in the head of the sperm as well which may prevent sperm binding to eggs resulting in fertilisation problems. Fu B et al have reported that effectiveness of acupuncture and herbal medicines on male with positive antisperm antibody associated infertility. In this study 50 cases in acupuncture and herbal group and another 50 cases in control group treated with prednisone. Antisperm antibodies were monitored in the two groups for measuring the effect. They found that antibodies were decreased in both groups but acupuncture group had significantly better effect than that for prednisone group.

Acupuncture helps fertilisation of ICSI in male infertility

There was a case report that acupuncture improves sperm quality and the outcome of intracytoplasmic sperm injection (ICSI). 22 male patients with infertility who failed ICSI participated the study. They received acupuncture treatment twice a week for 8 weeks followed by ICSI. At the end of the treatment, sperm motility and normality was improved. The fertilisation rates after acupuncture treatment were 66.2% significantly higher than that before the treatment (40.2%). Embryo quality was also improved. Acupuncture has a positive prospect for men with infertility undergoing ICSI treatment.

A case report: acupuncture increased sperm count

A 31 year old man was diagnosed azoospermia (no measurable level of sperm in his semen). His testis and vasa deferentia were normal. The tests showed that his sperm production was impaired which was difficult to cure. The couple failed one cycle of percutaneous sperm aspiration and intracytosplasmic sperm injection. He was referred for acupuncture treatment. He received a course of 20 session acupuncture treatment (twice a week). After a course of acupuncture treatment, his sperm count was 10 millions/ml with 10% good motility and 60% normal shape of sperms. With continuing another course, his sperm count increased to 18 millions/ml with 30% good motility and 60% normal shape of sperms.

Poor sperm quality could contribute to the causes of recurrent miscarriage.

There was a case control study by Li B et al. They compared semen analysis results from men whose spouses had a history of miscarriage (case group) with those without spouses with recurrent miscarriage (control group). They found that men in case group had lower volume of semen, low sperm concentration and higher misshaped sperms. Other parameters including percentage of grade B sperm, acrosomal enzyme activity and sugar content etc were lower in case group compared to control group. This research finding suggests that there could be a link between poor sperm quality and recurrent miscarriage.

Brahem S et al did a research to evaluate standard sperm parameters and sperm DNA fragmentation by comparing men whose partners had s history of recurrent pregnancy loss (RPL) with control group with proven fertility. They found that there was significant lower sperm motility in RPL group compared to control group. The mean number of sperm cells with fragmented DNA was significantly increased in RPL group compared to control group. The results suggest that poor sperm motility and high incidence of sperms with fragmented DNA could contribute to a cause of recurrent miscarriage.

A systematic review just published in Human Reproduction journal studied the association of sperm DNA fragmentation with miscarriage. There were 16 studies involved in 2969 couples. They found that a significant increase in miscarriage in patients with high DNA damage (DNA fragmentation) compared with those with low DNA damage. Because of this finding, selecting sperm without DNA damage for use in assisted conception treatment may reduce the risk of miscarriage.

References
Siterman S et al Andrologia (2000) 32:31-9
Pei J et al Fertil Steril (2005) 84:141-7
Siterman S et al Arch Androl (1997) 39:155-61
Fischl F Geburtshilfe Frauenheilkd (1984) 44:510-2
Siterman S et al Asian Journal of Adrology (2009) 200-208
Riegler R et al Urologe A (1984) 23:329-33
Bidouee F et al J Kidney Dis Transpl (2011) 22:1039
Li B et al Zhonghua Nan Ke Xue (2011) 17:596-600
Brahem S et al Urology (2011) 78:792-6
Robinson L et al Hum Reprod. (2012) 27:2908-17
Zhang M et al J Huazhong Uni Sci Technology Med Sci (2002) 22:228-30
Fu B et al J Tradit Chin Med (2005) 25:186-9

Tuesday, 17 July 2012

Acupuncture is effective on dysfunctional uterine bleeding and restoring ovulation

As we all know, women have menstrual cycles which occurs as a result of cyclic hormonal changes are usually 21-40 days long, with bleeding duration of 3-7 days and an average blood loss of 20-80 ml. Many women experience some kind of menstrual cycle disturbance; this could be minor disorders or a sign of malignant diseases. Malignant endometrial and cervical disorders include endometrial carcinoma, endometrial heperplasia, cervical cancer and cervical intra-epithelial neoplasia which could present abnormal uterine bleeding.

If a woman is pregnant, vaginal bleeding is abnormal. This often occurs in early pregnancy and is often associated with miscarriage or ectopic pregnancy. Ectopic pregnancy is one of the most severe pregnancy related conditions in women with abnormal uterine bleeding. Threatened miscarriage and miscarriage also present abnormal uterine bleeding.

Benign endometrial and cervical diseases: Fibroids is benign smooth muscle tumors in uterus which is either asymptomatic or presenting abnormal uterine bleeding. Endometrial polyps are a significant cause.

More frequent vaginal bleeding could be caused by pelvic inflammatory disease which is caused by sexually transmitted diseases such as Chlamydia or gonorrhoea. This causes inflammation in the uterus. Endometriosis can also cause more frequent vaginal bleeding. Polycystic ovary syndrome is also the underline causes of abnormal uterine bleeding. Irregular interval of vaginal bleeding could be caused by oral contraceptive pills and perimenopause.

Abnormality presents as duration, interval and amount of the bleeding, if a woman is not pregnant and ovulates regularly.

Very heavy vaginal bleeding: This could be caused by benign conditions including uterine fibroids, endometrial polyps, adenomyosis, intrauterine devices, hypothyroidism, an autoimmune disorders, blood clotting disorders and medications disturbing blood clotting.

Lighter vaginal bleeding could be caused by hyperthoroidism, oral contraceptive pills.

Bleeding between periods could be caused by contraceptive pills, intrauterine device, psychological stress and anticoagulant medications.

If a woman does not ovulate reduction of periods or period blood flow could be seen in some conditions, such as, some chronic conditions and physical and psychological stress, hypothalamus dysfunction, anorexia nervosa, and polycystic ovarian syndrome.

Majority of women with abnormal uterine bleeding do not have structural and histological abnormalities fortunately. Dysfunctional uterine bleeding is not due to certain pelvic disease, complications of pregnancy or systemic illness but mostly related to hormonal dysfunction. These affect 30% of women in reproductive age. Dysfunctional uterine bleeding is a common condition in women in reproductive age. This could be caused by psychological and/or physical stress, malnutrition, or systematic disorders which affect hypathalumic-pituitary-ovarian axis. They present with heavy abnormal uterine bleeding patterns: longer bleeding days, heavy blood loss, more frequent period cycles. In such cases, it is likely associated with aovulations. Changes of normal menstrual cycles are normally caused by disturbances of the hypothalamus-pituitary-ovarian axis. Most cases of anovulatory bleeding are caused by estrogen withdrawal or estrogen breakthrough bleeding. This could present midcycle spotting or intermittent spotting. This also could present irregular or prolonged heavy bleeding. In the case of no ovulation, the uterine endometrium at the presence of estrogen stimulation reaches abnormal heights and lacks structural support and it becomes fragile. The fragile endometrium breaks down and bleeding occurs. The fundamental issue in anovulatory bleeding is that the ovary does not function well causing hormonal imbalance. If a woman with anovulatory bleeding is trying to conceive, she would have difficulty to get pregnant because of anovulation. Improving ovary function is the key to treat anovulatory bleeding.

In Traditional Chinese Medicine (TCM) dysfunctional uterine bleeding can be divided into three types

1. Spleen and kidney yang deficiency, the symptoms include prolonged uterine bleeding, heavy periods, light red without clot, excessive vaginal discharge, tireness, lower back pain, feeling cold, cold hands and feet, diarrhoea, swelling tongue with light white coating, and week and sink pulse.

2. liver and kidney yin deficiency, the symptoms include irregular periods, prolonged uterine bleeding, red blood, dizziness tinnitus, lower backpain, dry mouth, red tongue, week and sink pulse.

3. kidney deficiency and liver stagnation, the symptoms include irregular periods, breast pain, lower back pain, lower tummy pain, excessive vaginal discharge, light tongue and week and sink pulse.

Apart from medication and surgery treatments, acupuncture is an effective treatment for dysfunctional uterine bleeding

Acupuncture could stimulate nerve end to improve ovarian blood circulation. This could improve ovarian function, restore hormonal balance and ovulation and stop abnormal vaginal bleeding and improve fertility.

Zeng et al conducted a controlled trial to investigate effectiveness of acupuncture on dysfunctional uterine bleeding. It was involved in 252 patients. These patients were divided into three groups acupuncture group, Chinese medicine group and conventional medicine group with 84 patients in each group. The result showed that acupuncture has the best effect compared with Chinese medicine and conventional medicine groups. Dr Cheng reported 90 cases of dysfunctional uterine bleeding treated with acupuncture or acupuncture and moxbustion. These women were aged between 16-46, most of them were 25-35. Uterine bleeding days were from 9 days to 65 days. They found that acupuncture and moxibustion are effective treatments for women with dysfunctional uterine bleeding.

References
http://www.acumoxj.com/readlist.asp?id=383
Hickey M et al. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD001895.
http://journal.9med.net/html/qikan/zxyjh/zhzxyzz/20047514/zyzy/20080903023004133_2488.html
http://www.cqvip.com/QK/92077A/200404/9576315.html

Monday, 16 July 2012

Not ovulate, acupuncture improves ovulation

The ovary is a special reproductive organ in women. In ovaries follicles develop into oocytes; eggs are released from ovaries; remaining part of the follicles forms corpus luteum. This generates women’s menstrual cycles. There are three phases of menstrual cycles: follicular phase, ovulation and luteal phase. Each phase has distinct with featured hormone levels. The hormones are produced in three areas: hypothalamus, anterior pituitary gland and ovaries. The hypothalamus produces gonadotropin releasing hormone (GnR) which stimulates the pituitary gland. The pituitary gland produces both follicle stimulating hormone (FSH) and luteinizing hormone (LH) which stimulate the ovary. The ovary secrets estrogen and progesterone. FSH and LH inhibits production of GnRH. Low concentration of estrogen increases release of FSH from the pituitary gland. High level of estrogen decreases FSH and increases LH secretion causing LH surge. This is called hypothalamus-pituitary-ovarian axis. This axis is in control ovulation. Any dysfunction of this axis may result in anovulation and irregular period. It also can lead to infertility caused by no ovulation. The leading cause of infertility is ovulation dysfunction, either no ovulation or irregular ovulation.

Anovulatory cycle is a menstrual cycle which ovulation does not occur and there is no egg released from the ovaries. Women would think if they have periods, they must be ovulating. This is not necessarily the case. You don’t have to ovulate to have periods. This is called anovulatory cycle. The cycles could be regular with variations of period intervals. These cycles are without ovulation and a luteal phase. Anovulation is a common cause of infertility which occurs in up to 40% of infertile women. Women without ovulating may have irregular periods, or no periods. It is possible that women with regular periods have no ovulation. Once they try to conceive and they start to detect the problem. Because no egg is released and fertilization becomes impossible, the women cannot conceive. Basal body temperature charting is a valuable tool to identify anovulation.

Normal menstrual cycles are 28 days (21-35 days) with follicular phase, ovulation and luteal phase. Ovulation occurs in the middle of the cycle and corpus luteum which produces progesterone forms after ovulation. After 14 days, corpus luteum decayed and stopped producing progesterone. Uterine inner lining shed off without the support of progesterone in the case without pregnancy. This is called progesterone withdrawal bleeding. In the case of anovulation, there is no progesterone produced. Bleeding is caused by inability of oestrogen to support uterine inner lining growth. It is called oestrogen breakthrough bleeding.

There are many factors that cause anovulation and here are some common causes of anovulation.

Hypothalamic-pituitary causes

Hypothalamus-pituitary-ovarian-axis dysfunction. This is caused by problems of hypothalamus or pituitary gland in the brain. As a result the hormones are not balanced which does not trigger ovulation and leads to infertility. The reasons that affect hormone balance include stress (see below); the other common causes are excessive exercises and/or underweight.

As we already known that subtle environmental changes may alter the menstrual cycle and cause anovulation. For example, summer camp menstrual disturbances and exam anovulation. Women in emotional stress could have no ovulation. This is temporary situation. If women get out of the stress environment, menstruation and ovulation could be returned. However if this situation is prolonged, anovulation could be persistent. Finding the causes of stress situation and avoiding the causes are the keys for ovulation to return. Many therapies could help reduce stress, such as psychological therapy, yoga and acupuncture etc.

Ovarian causes. If ovary does not respond to FSH and LH, this also causes ovulation problem.

Polycystic ovary syndrome (PCOS). This is commonest cause of anovulation related infertility. It explained 70% of the cases. Women with PCOS have imbalanced hormone levels. This may produce multiple cysts in ovaries, irregular period cycle, anovulation, infertility, acne and excessive hair growth and other symproms.

Premature ovarian failure (POF). In women with POF, their ovaries fail to function properly before menopause occurs. The ovaries don’t respond to FSH and there is no ovulation. They have difficulty to get pregnant.

Treatments that reduce stress can be effective to improve ovulation. Acupuncture helps treating anovulation by stimulating nerve endings and correcting hormonal imbalance. Acupuncture is very effective treatment for anovulation. Acupuncture reduces stress by regulating response to stress and altering stress related chemical substances levels; improves hypothalamus-pituitary-ovarian axis function and regulates blood hormone level. As a consequence, it improves ovulation and pregnancy rate.

Here are some clinical reports about the effectiveness of acupuncture on anovulation.

There was a control trial with acupuncture group and control group (treated with Clomephene). 25 cases in each group were given 6 cycles treatments. And then ovulation and pregnancy rate were compared between the two groups. Ovulation rate is not significantly different between the two groups. The pregnancy rate is higher (44%) in the acupuncture group than in the control group (16%).

There was a case report from a reproductive health institute center in Sichuan in China. They reported the effectiveness of acupuncture on women with anovulation. Ovulation rate was from 70-80% and pregnancy rate was from 40% - 60%.

Recently Yan and Liu summarised some case reports about effectiveness of acupuncture on increasing ovulation. They collected 21 papers which used acupuncture treated anovulation associated infertility.

Here are some typical cases.

Chen et al treated 42 patients with infertility associated with anovulation. 41 of them ovulated.

Kou et al used acupuncture treatment for 50 cases of anovulation associated infertility. 40 of 50 patients achieved pregnancy.

Chang et al used acupuncture for 32 patients with anovulation associated infertility. 9 patients achieved pregnancy during 1-3 month of acupuncture treatment. 22 patients achieved pregnancy over 4 months of acupuncture treatments.

Case report for effectiveness of acupuncture on infertility caused by anovulation

There was a study about effectiveness of acupuncture for infertility without ovulation. There were 50 women with infertility without ovulation. There women were divided into two groups: acupuncture group and control group. Control group was treated with clomiphere and injection of chorionic gonadotropin. The period of treatment was 6 cycles and ovulation rate and pregnancy rate were measured. The results showed that there was no difference in the ovulation rate between the acupuncture group and clomiphere group. However the pregnancy rate in acupuncture group was significantly higher (44%) than that for control group (16%). In addition the score of mucus and endometrial thickness was greater in acupuncture group.

This is a case report on effect of acupuncture treatment of infertility caused by ovulatory problems. 120 patients with infertility caused by ovulatory problems were divided into two groups: acupuncture group and clomiphene control group. 3 treatment cycles were applied. Result showed that similar ovulation rate was observed in both group, but pregnancy rate was higher and abortion rate was lower in acupuncture group compared to control group.

References
Yan and Liu Shanghai J Acu-mox, (2005) 24:40-42 (针灸促排卵临床概况)
Song FJ et al Zhongguo Zhen Jiu (2008) 28:21-23
Jiang and Ding Zhongguo Zhen Jiu (2009) 29:21-4

Saturday, 14 July 2012

Infertility caused by tube blockage with acupuncture treatment

Fallopian tubes which are the pathway where eggs travel to the uterus are very important for normal fertility. They play a key role in picking up eggs and transporting eggs, sperm and embryo. The fallopian tubes are the places where eggs are fertilised. Fallopian tubes are vulnerable to infection and surgical damage. This may affect tube function and cause infertility. If the tubes are blocked, this will cause infertility. Falllopian tube obstructions are the most common cause of female infertility, accounting for 30%-40% of cases.

Causes of tubal infertility: Pelvic infection is a major cause of tubal infertility. Infective tubal damage can be caused by sexually transmitted diseases, for example Chlamydia trachomatis accounts for half of the cases of acute inflammatory pelvic infections in developed countries. Tubal damage can also occur after miscarriage, termination of pregnancy, puerperal sepsis, or insertion of an intrauterine contraceptive device. Pelvic endometriosis rarely causes complete tubal occlusion. Endometriosis associated adhesions likely cause tubal distortion. Previous laparotomy is a risk factor for tubal infertility. In addition, ectopic pregnancy and uterine fibroids can also damage the tubes.

Tube obstruction may occur at any part along the course of the tube. Tube occlusions may be caused by tube spasm, infection and surgery. Tube spasm likely occurs in the proximal and middle part of the tubes. Distal part of the tube (which is close to the ovary) occlusion is likely caused by pelvic infection. If your tubes were damaged, the body healing procedure will be initiated automatically in order to repair the damage. If you have a wound in your hand, you can see the repairing process clearly which is inflammatory process. The body was trying to repair and regenerate to heal the wound. There was a similar process going on if your tubes were damaged.

Patients with tubal infertility have reduced chance of natural conception, depending on the extent of tube damage. Transcervical cannulation is good option for proximal tube occlusion. Other surgical procedures could be another option. The disadvantage of surgery is that it can cause scar tissue and adhesion. The tubes may become blocked again, cause new pelvic infections and risk for ectopic pregnancy.

Apart from surgical treatment option, acupuncture is a good choice that can be very effective without causing additional scars and infection. Acupuncture increases reproductive system blood flow, reduces inflammation; as a result, it releases tube spasms, reduces scar tissues and helps healing process. This may get blocked tubes open again. There were a few case reports in Chinese that tubal infertility with acupuncture treatment, pregnancy rate was up to 72%.

Friday, 13 July 2012

Labour induction with acupuncture

Labour induction with acupuncture

Induction of labour is a relatively common procedure. One in every five deliveries in the UK was induced. Acupuncture involves the insertion of very fine needles into designated locations with the purpose of preventing or curing disease. In TCM, it is thought that acupuncture stimulates channels of qi. This energy flows along 12 meridians, with designated points along these meridians. In Western medicine, it is thought that acupuncture may stimulate the release of prostaglandins and oxytocin. Acupuncture is used for induction of labour which is listed on WHO guideline. Recently a study from China analysed data from 2002 to 2008, sixty-five papers were retrieved. The results reveals that the research of acupuncture application in inducing labor focused on clinical practices, acupuncture has remarkable effectiveness and its advantages in facilitating contractions, shortening birth process, and elevating labor pain. A recent study has shown that absence of obstetric complication, higher duration of labor and tendency to a higher satisfaction of the patients were observed among patients in acupuncture group. There was also significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications. Higher frequency of cesarean sections and obstetric complications were observed among patients in control group. A study from Astria has shown that the cervical length in the acupuncture group was shorter than that in the control group suggesting a cupuncture supports cervical ripening at term and can shorten the time interval between the EDC and the actual time of delivery.

Applications of acupuncture on delivery of baby in China

Acupuncture was used in introducing delivery of baby in ancient China. Is acupuncture still used in delivery today in China? Chen et al analysed research about acupuncture on delivery in past ten years from 2002 to 2012. They found that there are many clinical researches on five aspect of delivery including acupuncture for pain relief during delivery, acupuncture for the process of labor, acupuncture for the disorders of postpartum (such as postpartum uroschesis, postpartum abdominal pain, and insufficient lactation), acupuncture for abortion, and the influence of psychological factors in the pain relieving effects of acupuncture during delivery.

For pain relief during delivery, Interventions include body acupuncture, scalp acupuncture, acupressure, combination of auricular acupressure and body acupuncture, acupoint injection, and the combination of acupuncture or moxibustion with herbal or modern medicine. All researchers found that acupuncture can significantly relieve the pain during delivery, without adverse effects to both mother and child and they suggested that acupuncture may be an economic and convenient therapy in relieving pain during delivery.

For induction of labour or shortening the length of delivery, interventions include boy acupuncture and acupressure. They found that that acupuncture can effectively reduce the duration of delivery (the whole length of delivery or second trimester of pregnancy), strengthen the uterine contraction, decrease the amount of oxytocin given during delivery, and significantly extend the length of uterine contraction and shorten the intermittent periods of contraction. No adverse event occurred.

A study compared acupuncture/acupressure with conventional methods to induce labour. The study group consisted of 50 women who received acupressure and/or Acupuncture prior to and/or during hospitalization. The control group consisted of 30 women who received customary hospital labor inducement methods. Result has shown that acupressure/Acupuncture significantly reduced additional interventions throughout the birth process, when these were given during hospitalization or before hospitalization. The birth process time was significantly shortened when combining acupressure/acupunture and conventional inducement methods (medicinal/mechanical). This study suggested that acupressure/acupuncture alone or combined with conventional methods is effective to reduce the extent of intervention throughout the birth process and also to reduce delivery completion interventions.

For disorders of postpartum period, the urine retention was focused on. The interventions include body acupuncture, combination of acupuncture and moxibustion, or herb or Guasha. Their finding was that either the single use of acupuncture or the combination of acupuncture and herbal medicine can relieve urine retention and achieve very high satisfaction. Meanwhile, studies of acupuncture in treating stress urinary incontinence, promoting recovery after cesarean section, treating abdominal pain, vaginal bleeding, and lactation difficulty of postpartum had satisfactory results.

For abortion, acupuncture was all used in the combination of mifepristone and misoprostol in the researches. No acupuncture alone was used in the research.

For psychological factors and acupuncture Effects Researchers investigated the influence of maternal personality type on the pain relieving effects of acupuncture in delivery and they found that personality stability could significantly affect the parturient women’s satisfaction and the effectiveness of acupuncture.

Acupuncture is used for treatment of labour pain.

Acupuncture is an effective treatment for pain management. Acupuncture is also used for treating labour pain. Is there point specificity in labour pain treatment? Recently a study compared the effect of acupuncture with different acupuncture points on labour pain. In this study, Ex-B2 point and SP6 acupuncture points were chosen. Pain is assessed during active phase of labor before and 30, 60, 120 min after intervention. The duration of active phase, the duration of second stage of labor, the duration of third stage of labor, use of oxytocin, neonatal birth weight, neonatal Apgar score at 1 and 5 min. . After 30 min intervention, the mean VAS scores of both EX-B2 group and SP6 group were significantly decreased compared with the control group; however, no significant difference was observed between the two experimental groups. After 60 and 120 min intervention, the mean VAS scores of EX-B2 group were significantly lower than SP-6 group. Both EX-B2 group and SP6 group had significant lower VAS scores after interventions and shorter time used in active phase of labor than the control group. They suggested that the application of electro-acupuncture at EX-B2 and SP6 acupoints could be used as a non-pharmacologic method to reduce labor pain and shorten the duration of active phase of labor.

References

Chen and Zhu Zhongguo Zhen Jiu (2010) 30:877-80

Gribel et al Arch Gynecol Obstet (2011) 283:1233-8

Amir N et al Harefuah (2015) 154:47-51

Rabl M et al Wien Klin Wochenschr 92001) 113:942-6

Chen Y et al Evid Based Complement Alternat Med (2014) 2014:672508

Dong C et al Arch Gynecol Obstet (2014)

Thursday, 12 July 2012

Acupuncture is effective for unexplained infertility

What is infertility? Infertility is defined as inability to conceive after 1 year of regular unprotected intercourse. It is 6 months with women older than 35 years. If you were told that you had unexplained infertility, what does that mean? If you have difficulty to conceive for some time, you would be put on some tests to evaluate the underlying causes for the infertility. There is some standard infertility evaluation. It includes a semen analysis, assessment of ovulation, and a hysterosalpingogram (to detect uterine and fallopian tube pathology); ovarian reserve and laparoscopy are further tests that could be done to examine function of reproductive system. When these results are normal, you would be diagnosed unexplained infertility which means that there are no underlying causes for your infertility found. Are there many people suffer from this condition? Yes. 1 in 6 couples are seeking specialist help in trying for a baby. There are about 30% of infertility is unexplained which means the causes for the infertility are unknown. This diagnosis will be based on a series of fertility tests without revealing any abnormality. The frustrating thing is that there is no reason for the infertility, how can you improve the fertility? Change life style? Many people have already had a very healthy life style, good nutritious diet. They do exercises regularly. General health is good. Nothing on this aspect needs to be improved. What causes their reproductive system problems?

Research showed that subclinical pelvic inflammatory disease (PID) is very common in women. Women with undetected subclinical PID have no symptoms, but the pathological mechanisms are similar to those of acute PID. Wiesenfeld et al studied whether women with subclinical PID are at an increased risk for infertility. They found that women with subclinical diagnosed at enrolment had a 40% reduced incidence of pregnancy compared with women without PID. Undetected subclinical PID could be one of the unfound causes for infertility. Subclinical conditions do not cause symptoms but they make reproductive system not functioning properly causing infertility. Embryos are so delicate and they cannot survive in any unfavourable environment.

Genetic reasons, there are many inflammation events going on in women’s reproductive system. Women’s body has an ability to clear this inflammation very quickly, but some women have difficulty to clear the inflammation in their reproductive system. This may affect their ovarian function including egg quality and poor microenvironment. As a result, they present difficult to get pregnant.

Stress, having been trying to conceive for a long time without success makes those couples stressed. Furthermore they are told that the reasons for the difficulty of conceiving are not clear and the diagnosis of the infertility is unexplained. This makes them more stressed. At least some unexplained infertility is caused by stress and all of this stress mentally and physically also makes the condition worse. Stress makes hormone unbalanced and this affects egg development in female and sperm development in male resulting poor quality of eggs and sperms. This makes low fertilization rate and low quality of embryo.

Do you need to be treated to get pregnant, if you were diagnosed unexplained infertility? Is there a chance to get pregnant on your own without any treatment? What treatments are available for unexplained infertility? Yes, you do need treatment. Many studies showed that the pregnant rate was 1.3 to 4.1% in the untreated group with unexplained infertility. This was lower than most treatment intervention. You have more chances to get pregnant with less than two years duration of unexplained infertility and fewer chances when the duration of infertility exceeds three years and greater than 35 years of age. The duration of infertility is important. The longer the infertility, the less likely the couple is to conceive on their own. With infertility 1 year duration, the couple have 20% chances to get pregnant after a year on their own. After 5 year infertility, the chances dropped to less than 10% without any treatments.

What treatments are available for couples with unexplained infertility? There are some treatment approaches available for unexplained infertility, but they are empiric. The standard protocol is to start from low technology to high technology treatment options. There is no evidence showing that any one treatment is better than the other. The treatment of unexplained infertility is dependent on availability of resources and patients’ age and duration of infertility.

Here are some treatment options:

Controlled ovarian hyperstimulation (COH) and Intrauterine insemination (IUI): To maximize the chance of fertilization, COH and IUI have been used. COH involves medications stimulating the development of multiple eggs of the ovaries in one single cycle, resulting in multiple ovulations. Both clomiphene citrate and gonadotropins have been used for COH. This expects more eggs available for fertilisation. IUI involves placement of washed sperms into uterine cavity around the time of ovulation. IUI may increase the density of motile sperm available to ovulated eggs. There has been a marked increase in the use of COH with or without IUI in the treatment of unexplained infertility over the past decades.

In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI): IVF is most expensive, but also most successful treatment of unexplained infertility; it could be done with or without ICSI. IVF involves stimulating multiple eggs to develop; egg collection to get eggs; fertilising the eggs in the laboratory; and embryo transfer to the uterus. ICSI involves picking up individual sperm and injecting the sperm into the cytoplasm (the inner part) of the egg. The same procedure as IVF in women is also involved.

About ten years ago Guzick DS et al from University of Rochester New York analysed the efficacy of alternative treatments for unexplained infertility from 45 published reports. They found that combined pregnancy rates per initiated cycle were IUI 3.8%, clomiphene citrate (CC) 5.6%, CC + IUI 8.3%, gonadotropins (hCG) 7.7%, hCG + IUI 17.1%, IVF 20.7%. More recently research also showed that IVF is more effective technique for unexplained infertility treatment.

Is acupuncture effective for unexplained infertility? Yes, acupuncture is effective and it is one option for couples with unexplained infertility. Acupuncture is playing an important role in infertility treatment. The treatment for infertility with acupuncture increased fivefold in 10 years time. Currently there are many researches show that acupuncture stimulates brain to improve hormone balance. Acupuncture is well known to produce endorphins in brain releasing pain and also affect the levels of pituitary and ovarian hormones which regulate ovulation. Acupuncture stimulates nerve ending, as a result it improves reproductive system blood flow. Subsequently egg quality and ovulation are improved, fallopian tube spam is released, intrauterine environment is more suitable for embryo implantation and growth. Acupuncture regulates immune function to benefit fertilized eggs survival. Acupuncture also increases in sperm count and improves sperm quality in men suffering from infertility. Acupuncture can help reduce stress both in women and men. After a few month acupuncture treatment, women have better quality of eggs and men have better quality of sperms. Better fertilization and good quality of embryos will be obtained.

Acupuncture is also a useful tool for IVF support to increase IVF success rate because of high quality of eggs and sperms. Acupuncture increases two fold of the pregnancy rate of IVF, if acupuncture is performed during IVF treatment. A study has shown that when combining IUI with acupuncture treatments, 65.5 per cent of the test group pregnancy rate was achieved, compared with 39.4 per cent of the control group, who received no acupuncture therapy. These are major benefits of acupuncture

Here are some case studies showing the effectiveness of acupuncture for unexplained infertility.

There is a report in Chinese for effectiveness of acupuncture on unexplained infertility. 58 patients with unexplained infertility were included in acupuncture group. The age was from 26-38 and trying to conceive from 2-5 years. 41 patients had primary infertility and 17 patients had secondary infertility. All patients had normal fertility evaluation. After 3-5 period cycles of acupuncture treatment, 42 patients achieved pregnancy. Following is a typical case. A 26 year old woman was trying to conceive for 4 year without success. Her period was normal but she had a severe period pain. All fertility tests were normal and the diagnosis was unexplained infertility. After 4 month acupuncture treatment, she was pregnant and gave birth to a lovely girl.

There was a study using acupuncture to treat explained infertility.104 women with unexplained infertility were involved in this study. The age of participants was from 26 to 41 and the average age was 32. The length of history of infertility was from 20.8 to 50.3 weeks with average 33.5 weeks. 41 participants (39.4%) had undergone an assisted reproductive technology (ART) treatment before joining the study. The average number of the ART treatments was 1.4 cycles. Acupuncture were offered for 6 month. At the end of the study, 60% of the patients achieved pregnancy.

References
Wiesenfeld H et al Obstet Gynecol (2012) 120:37-43
Ray A et al Reprod Biomed Online (2012) 24:591-602
Hopton AK et al Acupuncture in practice: mapping the providers, the patients and the settings in a national cross-sectional survey. BMJ Open. (2012)11:2-9
Yu Ng et al Fertility and Sterility 2008, 90: 1-13
Gnoth C et al Hum Reprod (2005) 20:1144-7
Guzick DS et al Fertil Steril (1998) 70:207-13
Pandian Z et al Cochrane Database Syst Rev (2012) 4:CD003357
Park JJ et al J Altern Complement Med (2010) 16:193-8

Monday, 9 July 2012

Facial acupuncture is in the NEWS

Facial acupuncture for cosmetic purpose has increased in popularity in the US and the UK. Here is facial acupuncture in the NEWS.

There was an article from Telegraph titled <A few pointers for a new face>. In this article, it stated that facial acupuncture is the Hollywood star's shortcut to younger looking skin; some famous people such as Madonna, Gwyneth Paltrow and Cher are having weekly "acupuncture facelifts" to wipe off their wrinkles; after a few sessions, eyes brighten, skin feels firmer, lips become plumper and blemishes vanish.

New York acupuncturist Billy Villano explained that facial acupuncture stimulates the cells to lay down new collagen fibres under wrinkles, thereby filling them in. And the needles relax muscles, which combats sagging in facial areas. The results are amazing.

The author has tried facial acupuncture and thought: “My skin looks markedly brighter and fresher than it did when I arrived”. It makes you look young and bursting with health.

References
http://www.telegraph.co.uk/news/health/alternative-medicine/3309548/A-few-pointers-for-a-new-face.html

Another article from New York times titled <Hold the Chemicals, Bring on the Needles> By NORA ISAACS also described some people’s experiences on facial acupuncture

JANE BECKER, a composer and solo pianist said “I can really see a difference in my face,” “It looks younger, smoother, brighter and uplifted.”

Sheila Schmidt, 35, a telecom consultant from Denver, started facial acupuncture after noticing crow’s feet. They diminished, but she still goes for sessions. “I leave feeling more balanced and less anxious,” she said.

A half-dozen women interviewed for the article said they have seen puffiness decrease, under-eye bags disappear and lines diminish or soften.

There’s a rise in interest all over the US.

Mary Elizabeth Wakefield, a licensed acupuncturist who headed the 2005 Oscars event, has trained more than 2,000 teachers in 40 states in her technique: constitutional facial acupuncture.

Practitioners of this style of cosmetic acupuncture called Mei Zen offer their services in 16 states.

The aim of facial acupuncture or cosmetic acupuncture is to tackle wrinkles, muscle tension that may be causing unsightly lines, as well as systematic issues standing between you and glowing skin. Now cosmetic acupuncture has caught the attention of more of the wrinkled public particularly to women who want to slow signs of aging, but don’t want to undergo surgery or to inject chemicals.

References
http://www.nytimes.com/2007/12/13/fashion/13SKIN.html?pagewanted=all&_r=0

Saturday, 7 July 2012

Miscarriage, acupuncture can help

A miscarriage is the loss of a pregnancy during the first 23 weeks. About 1 in 5 of all recognised pregnancies is miscarried usually before the 13th week of pregnancy. Because of more sensitive techniques developed for detecting early pregnancy, research showed that about up to 70% of all pregnancies are lost. The most common cause of early pregnancy loss is chromosomal abnormalities. Collagen vascular disease is one of the causes. Collagen vascular diseases are conditions in which a person’s own immune system attacks their own organs, such as systemic lupus erythematosus and antiphospholipid antibody syndrome. Uncontrolled diabetes could cause miscarriage. Hormonal problems are also the cause of miscarriage, such as thyroid disease and polycystic ovary syndrome (PCOS). Infection increases the risk of miscarriage. Abnormal anatomy of the uterus could cause miscarriage, such as uterine septum, fibroids. Some life style factors could increase the risk of miscarriage, such as smoking, alcohol, caffeine. Nonsteroidal anti inflammatory drugs are also a risk factor.

Recurrent miscarriage

Recurrent miscarriage is the spontaneous loss of three or more consecutive pregnancies in the first trimester. It affects 1-2% of women, half of whom have no identifiable cause. The causes of recurrent pregnancy loss (RPL) are classified as genetic, anatomic, endocrinological, immunological, microbiological and environmental. Anatomic abnormalities account for 10% to 15% of cases of RPL and are generally thought to cause miscarriage by interrupting the vasculature of the endometrium. There is an association between RPL and heritable thrombophilias which is a condition where the blood has an increased tendency to form clots. Blood clot impairing placental development and function could lead to miscarriage. Imbalanced hormones such as abnormal LH surge, low progesterone and high androgen result in premature egg aging and impaired endometrial development.

Uterine blood flow changes can be seen in the uterus and ovaries during the menstrual cycle and uterine blood flow affects uterine receptivity and an important factor in achieving a normal pregnancy. Differences in uterine blood flow impedance between fertile and infertile women and reduced uterine blood flow may be one cause of unexplained infertility. Recent research also has suggested that impaired uterine blood flow is associated with recurrent pregnancy loss. In women with recurrent miscarriage their blood flow resistance in uterine artery was elevated which means the blood flow was reduced. As we can see that reduced blood circulation in endometrium and placenta is the reason for many miscarriages.

The treatments for recurrent miscarriage are limited. There is a systematic review that evaluated the effectiveness of current treatment methods. Their finding is as follows:

Bed rest: they found no systematic reviews or control trials to show the effectiveness of bed rest in women with recurrent miscarriage.

Early scanning in subsequent pregnancies: There were no systematic review and control trials for this method. Early scanning might reduce anxiety of women with recurrent miscarriage which may be beneficial.

Human chorionic gonadotrophin (HCG) treatment: There were four control trials showing that HCG reduced the miscarriage rate though the standard of the trials were not high.

Progesterone treatment: One systematic review showed that progesterone reduced miscarriage rate.

Intravenous immunoglobulin treatment, trophoblastic membrane infusion, paternal white cell immunisation: There were high standard control trials showing that these treatments did not increase live birth rate in women with recurrent miscarriage.

Lifestyle adaptation (stop smoking, reduce alcohol consumption, Loss weight): There was no systematic review or control trial to show the effectiveness of this methods on recurrent miscarriage.

Low dose aspirin, oestrogen, corticosterioids, vitamin supplementation: There was no systematic review or control trial showing effectiveness of these treatments in women with recurrent miscarriage.

Acupuncture was applied to treat miscarriage in China. There was a case report by Zhang in Tianjin gynecology hospital showing effectiveness of acupuncture in women with recurrent miscarriage. This report is involved 558 cases with recurrent miscarriage. 86.6-93% cases were successful.

In early pregnancy your body starts to change because of the hormonal changes in the body. For example, the uterine and vaginal lining becomes ticker and breast becomes tender. When miscarriage occurred, your body has to go back to normal from the pregnancy loss, physically and emotionally.

Acupuncture can help you recover from miscarriage and get your body ready for next pregnancy. Acupuncture stimulates nerve endings to helps hormone balance; improves ovarian and uterine blood flow; reduces inflammation and reduces stress. All of these could help prevent miscarriage from happening again and have a successful pregnancy.

Here is a case report. Sophia had two miscarriges in 6 weeks and 12 weeks before. After this, she had been trying to get pregnant for a year without success. She started acupuncture treatment, after three cycles, she got pregnant and this time the pregnancy stayed to full term and she had a lovely girl.

References

Duckitt K and Qureshi A Clin Evid (Online) 2008 pii:1409
http://www.pharmnet.com.cn/tcm/zjdq/zjzl/100031.html
Alexandros Sotiriadis BMJ 2004 http://www.bmj.com/content/329/7458/152

Wednesday, 4 July 2012

Acupuncture provides hope of conceiving for women with premature ovarian failure

When women reach age 45, their ovaries may stop functioning. There is no egg supply and no ovulation. Hormone levels are changing. This is so called menopause. The signal for arrived menopause is stopped period which indicates the end of fertile life in a woman. This is a stage that every woman has to go through. For some women, their ovaries stop working before 40 years old. This is called premature ovarian failure (POF), or primary ovarian insufficiency (POI), or premature menopause or hypergonadotropic hypogonadism. POF is the result of premature exhaustion of the follicle pool or follicular dysfunction, such as due to mutations in the follicle-stimulating hormone (FSH) receptor. This is a common condition, affecting 1-2% women younger than 40 years of age and 0.1% of women younger than 30 years of age. The cause for POF could be genetic, because there is family history found in 10-20% women with POF. It also could be due to poor ovarian blood supply. Autoimmune damage could contribute to the cause of POF. Ovaries could be damaged by cancer therapies.

The main symptoms of POF include no regular periods, low blood oestrogen level and high FSH under the age 40. Anti-Mullerian hormone (AMH) level is low. Oestrogen is produced by follicles and its blood level is low if follicles are short of supply or dysfunctional. FSH is produced in the pituitary gland at the base of the brain and it stimulates follicles growing. If a woman is running out of eggs in ovaries in the case of POF, resulting in low level of oestrogen, the pituitary gland will work hard to produce more FSH in order to stimulate ovaries to make more good eggs. AMH is a substance produced only in small ovarian follicles and its level is quite constant correlating strongly with the number of growing follicles. Since this hormone is not dependent on hypothalamic-pituitary-gonadal axis function and decreased to undetectable level at menopause, it could potentially help assess remaining function of ovaries and egg supply.

Women with POF could experience menopause symptoms, for instance hot flushes, night sweats and vaginal dryness, similar to those going through a natural menopause. POF could result in many health problems, such as osteoporosis, heart diseases etc. Associated with the development of POF is the loss of fertility, which in most cases is due to the absence of follicles, and in other cases the inability of remaining follicles to respond to stimulation. For most women, there are no obvious signs before the stop of periods. Most women have a normal period history, and possibly fertility before the start of POF symptoms. A common presentation is for women to fail to resume period after a pregnancy or after stop of taking oral contraceptive pills. For most of women, it is a deeply upset diagnosis not only with unpleasant symptoms, but also with infertility. It may have a huge psychological impact on those diagnosed this condition. Infertility is a significant issue for most women with POF, though many women may ovulate at some points, this cannot be predicted with any reliability.

There are treatments that can help some of the symptoms; however women with POF are unlikely to get pregnant without treatments because their ovaries do not work properly. There is no proven medicine to improve a woman’s ability to get pregnant, if she is diagnosed with POF. A number of treatment regimens have been evaluated with the aim of restore fertility; however, treatments with clomiphene, gonadotrophins, GNRH agonists or immunosuppressants do not significantly improve the chance of conception and are not used. Use of donor eggs is only a reliable option from Western medicine point of view. Is there really nothing you can do apart from accepting that you will no longer have a chance to have a child naturally with your own eggs? Why not try acupuncture? There is a chance to conceive naturally with acupuncture treatment.
According to traditional Chinese medicine (TCM) theory, POF is mainly caused by kidney qi deficiency. Liver and spleen qi deficiency may also contribute. Qi deficiency causes blood stagnation and blockage of channels resulting in ovaries losing function. Acupuncture unblocks the channels and restores qi flowing and blood supply to ovaries. From western medicine point of view, acupuncture improves function of hypothalamic-pituitary-ovarian axis regulating blood hormone levels; acupuncture increases ovarian blood flow improving ovarian function. Acupuncture also regulates nervous system function.

There was a case report in Chinese acupuncture website about effectiveness of acupuncture treatment for POF. There were 76 patients aged from 26-40 with POF diagnosis for 1-9 years. These cases were treated from 1990-1996. Acupuncture treatment was given for 6 months. 68% patients restored normal period, ovulation or pregnancy. FSH level decreased to normal and oestrogen level increased significantly.

Recently research provided evidence of effectiveness of acupuncture on POF. Kehua Zhou et al investigated the effects of acupuncture on FSH, oestrogen (E2) and LH in women with POF. They also studied the menstruation changes in these women. They recruited 11 women with diagnosed POF for 4 months to 10 years. Ages of these women were from 25-39. These women had no menstrual period for at least four months or longer. They had high FSH over 40 iu/l. Before acupuncture treatment, they stopped all medications that possibly affect hormones. After the treatments, there was three month follow-up. Assessments were done before the treatment, at the end of three month treatment and at the end of three month follow-up. They found that after acupuncture treatment, E2 increased while FSH and LH decreased which last at the end of three month follow-up. 10 out of 11 patients resumed menstruation; 9 of them still had menstruation at the end of follow-up. Other symptoms such as night sweating, hot flashes and mood swings were reduced during acupuncture treatments and at the end of follow-up.
The advantage of acupuncture treatment for women with POF is that it is not only effective for improving symptoms caused by POF, but also increases fertility.

References
http://www.wfas.org.cn/lunwen/wfas10/200709/1055.html
Kehua Zhou et al Evid Based Complement Alternat Med (2013) 2013: 657234 Published on line 2013 Feb 28

Success stories of infertility with acupuncture treatment

Getting pregnant seems so natural for most of women; however wanting to have a baby seems unreachable for those who suffer from infertility for years. It is hard to imagine what they have been going through, physically and emotionally. If you have been trying for baby for sometime without success, it is important for you to recognize the problem, get it checked out and ask help earlier rather than later. Ovarian dysfunction is a common cause of infertility in women. I have written a book about the ovary in women's fertility to help women with ovarian conditions who want to have a baby. http://www.amazon.co.uk/Know-Your-Ovary-Get-Pregnant-ebook/dp/B00P4K5AUQ Many women recognize that acupuncture could help their fertility treatment.

Here I summarized some tips to help you to know how acupuncture may help to boost fertility. I also summarized some amazing success stories.

How can acupuncture help your fertility?

Acupuncture alone may help to achieve pregnancy naturally. In this case, acupuncture helps to improve women’s fertility as well as their overall health and this makes conception happen naturally. Acupuncture stimulates central and peripheral system. It regulates hormone production in brain and improves ovulation; it increases blood flow in reproductive system including ovaries, fallopian tubes, and uterus; it improves egg quality, relaxes tubes and prepares good uterine lining for implantation; it modulates immune function, reduces stress and improves fertility.

You can get pregnant quickly with the help of acupuncture.

Average age of women having first child is delayed to their 30’s. Some women have problems when they start trying for a baby. With the help of acupuncture, some women can get pregnant very quickly. Here are some amazing stories about some women at age 30 who succeeded from short course of acupuncture treatments. In these cases, their husband’s sperms were good.

Elisa has been trying for a baby for a year without success. All fertility tests were normal, so her fertility was unexplained. She heard about Chinese acupuncture and decided to try it. After 4 treatments on weekly basis, she became pregnant.

Anna has only one tube left. She lost one tube in previous ectopic pregnancy. She has been trying for a baby for 6 months without success. She decided to get help from acupuncture. After 2 month acupuncture treatments on weekly basis, she became pregnant.

Amy has one early miscarriage. She was afraid to have another one and decided to try acupuncture. After 8 treatments she became pregnant again and this time she carried the baby to full term.

Case Study: Infertility with severe period pain treated with acupuncture successfully.

These were a few typical cases with common symptoms that included period pain, lower abdominal pain, external genitalia pain, painful intercourse and primary infertility. The tenderness at groin region was found in examination. In these cases, they responded to acupuncture treatment very well. The pain was reduced with a few sessions of acupuncture treatments and with more treatments they became pregnant quickly.

Case1, Alice was 30 year old. She started getting period pain 6 years ago. There was severe pain at lower abdomen and external genitalia. The pain normally began 3 days before the period and got better after period. Period was heavy. Her period pain was getting worse over time. Apart from the pain there were other unbearable symptoms such as nausea, vomiting, pale and sweating. She also had painful intercourse. She never got pregnant even though they had been trying for 5 years. Her husband’s sperms were good. Tenderness was found in the groin region by examination. Acupuncture treatment was offered to her twice a week for four weeks and then once a week for another four weeks. During the period of treatment, all pain and other symptoms had disappeared. After 2 month acupuncture treatment, she was pregnant naturally.

Case 2, Nancy was 36 year old. She had lower back pain for 20 years. She also had period pain at lower back and lower abdomen. She had painful intercourse. She had been trying to get pregnant for 6 years without success. Her husband’s sperms were normal. Recently the pain was getting worse. The examination showed tenderness at lower back and groin region. After two month of acupuncture treatment, the pain was getting better. And after another four month treatment, she became pregnant naturally.

Case 3, Zara was 30 year old. She always had period pain. The pain was at the lower abdomen and external genitalia. She also had painful intercourse. Apart from pain, her period was normal. She had been trying to conceive for 3 years without success. A year ago she had pin and needle at groin region and the pain was shooting to the thigh. Period pain got worse. Examination showed tenderness at groin region. Her husband’s sperm were good. With a few sessions of acupuncture treatments, her pain was reduced significantly. After 3 month treatment, she became pregnant naturally.

Case 4, Millie was 37 year old. She had lower abdominal pain for 20 years and severe period pain. Pain reduced after period. Her period was heavy. She also had painful intercourse. She had been trying to get pregnant for 12 years without success. Fertility test showed that one tube was blocked. There was tenderness at the groin region. After 2 month acupuncture treatments, the pain was disappeared and she became pregnant.

Case study: Infertility accompanied with back pain with successful acupuncture treatment

Rose was 34 year old. She had one child. After giving birth to her girl, she had been having irregular periods without period pain. She was trying to conceive to have another child for 13 years without success. She had lower back pain for 3 years. At first she only had a lower back pain after a long walk, but the pain was getting worse over time. The pain was spread to upper back, neck and head. She also had breathless, stomach-ache and upper abdominal pain. Tenderness was found at lower back and groin region in examination. After a few sessions of acupuncture treatments, the pain was getting better and so were other symptoms. After two month acupuncture treatment, she became pregnant. This was a typical case that infertility was accompanied with back pain. Acupuncture was effective to treat back pain and infertility. Pregnancy could occur as soon as back pain disappeared.

For most women with complex history of infertility and gynaecological conditions, much more acupuncture treatments and longer duration is needed to achieve pregnancy. Here are some other stories.

Success acupuncture treatment for infertility with endometriosis.

Case 1, Ameli who was 33 year old with 10 year history of taking oral contraceptive pills were trying to conceive for 2 years without success. Her period cycle was 28-45 days. She suffered from severe period pain and heavy period bleeding. Her blood test suggested that there was no ovulation. After failed a course of clomid treatment and one cycle of IUI, she had an operation of removing the ovarian cyst and some endometriosis tissue. She still had difficulty to conceive. Her period became 20-25 days. Blood FSH level was 24 iu/l with oestrogen 75 pmol/l. She chose to try acupuncture. After about 2 month treatment, her FSH dropped to 10 iu/l and oestrogen raised to 135 pmol/l. With continuing another 3 month treatment she was pregnant naturally.

Case 2, Philippa was 34 year old and tried to get pregnant for 5 years with no luck. Her periods were irregular about 35-50 days with heavy bleeding and severe period pain. She was diagnosed with severe endometriosis, ovarian cysts and blocked left tube. She had three operations to remove ectopic endometriosis tissues and ovarian cysts over two years, but the conditions kept recurring. She also had two cycles of IUI, two cycles of IVF, but unfortunately they all failed as a result. The last resort was acupuncture. After 2 month treatment, her period became normal 30 days with normal bleeding pattern. With continuing treatment for another two months, she became pregnant naturally.

Success acupuncture treatment for infertility with PCOS

Gracie was 30 year old and had a child. She was trying to have another child for a year without success. She was diagnosed with PCOS with multiple cysts in her ovaries; she was overweight and had excessive hair growth. She was treated with clomiphene twice. As a result she was pregnant, but both pregnancies ended up with miscarriage. Her FSH was 10 iu/l. After received acupuncture for 4 months, she became pregnant and gave birth to a healthy boy.

Two success acupuncture treatments for unexplained infertility

Iris and Emily had similar stories. Iris was 31 year old and Emily was 30. They had infertility for 6 years and 5 years respectively. The reasons for infertility were not clear. Their periods were normal. FSH was a bit higher than normal. Thyroid function was normal. They were offered IVF treatment, but they both decided to try acupuncture first. Acupuncture was given twice a week for two months. They both became pregnant.

Acupuncture helps treating anovulation and IVF success

Layla was 35 year old with difficulty to conceive for 5 years. Her periods were normal. She was very much stressed. She wanted IVF treatment. But her fertility test showed that there was no ovulation though her periods were normal. FSH was 15.8 iu/l and blood haemoglobin was low. She decided to try acupuncture first. After 4 month acupuncture treatment, her basal body temperature showed that there was ovulation. FSH became 8.6iu/l and blood haemoglobin was normal. She decided to go ahead with IVF. She achieved pregnancy in first round cycle of IVF.

Success acupuncture treatment for secondary infertility

Lily was 35 year old. She had given birth to a girl. After giving birth to first child, she had tried to get pregnant again for 5 years without success. She had severe period pain, but other fertility tests were normal. She was diagnosed with unexplained secondary infertility. She decided to try acupuncture. After 3 month acupuncture treatment, she had become pregnant.

Success acupuncture treatment for luteal phase defect associated infertility

Sophie was 33 years of age. She was trying to conceive for 5 years without success. Her period cycles were 28-32 days with 4-6 period days. Her basal body temperature (BBT) showed short luteal phase less than 11 days with disrupted BBT curve. Other fertility tests were normal. She decided to try acupuncture. After 2 month treatment, her luteal phase was 14 days with good BBT curve. With continuing another 3 month acupuncture treatment, she became pregnant.

Success acupuncture treatment for premature ovarian failure associated (POF) infertility

Emma was 40 year old. Her periods were 4 times a year but stopped for las 6 months. Ultrasound scan showed normal ovaries and uterus. Her FSH was 86.5 iu/l oestradiol was 66.7. She was trying to conceive for 3 years without success. She decided to try acupuncture. After 2 month acupuncture her FSH fell to 30. With continuing another 4 month acupuncture treatment she achieved pregnancy naturally.

Success acupuncture treatment for PCOS with infertility and recurrent miscarriage

Zoe was 26 year old and had a few miscarriages. After that, she had difficulty to conceive. She had severe period pain. Ovary test found that there were some ovary cysts in her left ovary. The biggest one was 5.5*4.3 cm. Two month later the cyst was 6.5*5.1 cm. She decided to try acupuncture. After a month acupuncture treatment the cysts shrunk. With continuing another month of acupuncture treatment, she became pregnant naturally.

Success acupuncture treatment for recurrent miscarriage

Rosie was 28 year old. She had an abortion when she was 24 year old. After that she got pregnant for a few times, but all had been miscarried when the pregnant was 2-3 months. She was diagnosed as recurrent miscarriage. She was very depressed when she was told that she may not have a baby. So she decided to try acupuncture. After 6 month acupuncture treatment, she became pregnant again. She continued to receive acupuncture until the end of 3 month pregnancy. The pregnancy last and she carried the bay to full term.

Success acupuncture treatment for unexplained infertility

Florence was 38 year old. She has been trying to get pregnant for a year without success. Her period cycles were regular with 28 day. She was very much stressed. She did not sleep well. Her diet was healthy. All fertility tests came out in normal range and no underlying causes were found. She was determined to get pregnant naturally, so she decided to get help from acupuncture. After a few sessions of acupuncture, her stress level was reduced and she could get a good night sleep. After 4 month acupuncture without pregnancy she was frustrated, but she was so determined and continued for another 4 months. Finally her determination was paid off. After 8 month acupuncture on weekly basis, she became pregnant.

Success acupuncture treatment for low antral follicle counts and low AMH

Laura was 38 year old. She has been trying to get pregnant for three years without success. Her period cycle was getting shorter to 22 days. Recent 6 months she started to get spotting before period. She had light period without period pain. She lived in very healthy life style with normal body weight. Fertility test showed low AMH and low antral follicles counts. FSH was normal. She did not want to go down to IVF route. She found that acupuncture could help to conceive naturally, so she decided to try. After three months acupuncture treatment, her cycle was getting normal, spotting was getting less, and antral follicle counts increased. With further three months acupuncture, she found out that she became pregnant naturally. Can you imagine how excited she was?

Can acupuncture help with IVF success?

About 1 in 6 couples have difficulty conceiving and seek specialist fertility treatment. There are various treatments available depending on the causes of the infertility. In vitro fertilisation (IVF) is one of the most successful treatments for couples with infertility. Since IVF technique was developed 30 years ago, it helped many couples to achieve pregnancy. In 2003 over 120000 IVF treatment cycles were carried out in clinics in the USA. According to the European Society of Human Reproduction and Embryology, over 300000 treatment cycles of IVF and intracytoplasmic sperm injection (ICSI) were performed each year in Europe. In 2000, about 200000 babies worldwide were conceived through IVF. However, the success rate of IVF is still not satisfactory. IVFalso is expensive, lengthy and stressful. It also affects physical and mental health. To improve IVF success rate, reduce stress, anxiety and depression, acupuncture is a technique used by clinicians. Acupuncture became a popular choice for women undergoing IVF. A survey to study the state of acupuncture treatments in assisted reproductive technology in fertility centers in Swiss, German and Austrian fertility centers has shown40% fertility centers offer acupuncture treatments. In these centers acupuncture points selected were standardized and acupuncture was performed by physician-acupuncturist.

How can acupuncture help IVF?

First of all, IVF with acupuncture support has higher live birth rate. The first report that acupuncture increased IVF success rate was from Stener-Victorin et al in 1999. They applied acupuncture before occytes collection. They found that women in acupuncture group had significantly higher implantation rate, pregnancy rate and live birth rate in IVF embryo transfer. Eric Manheimer et al did first systematic review published in BMJ to investigate the effects of acupuncture on pregnancy rates and live birth rates among women with infertility undergoing IVF. They analysed seven trials involved in 1366 women undergoing IVF. All trials were conducted in four different Western countries and published in English since 2002. In all trials, women received acupuncture immediately before or immediately after the embryo transfer. Clinical pregnancy, ongoing pregnancy and live birth rates were improved. There was no side effect found. Recently a new review found that there were 5 studies involved 463 women who were undergoing IVF. They were given acupuncture twice a week for 2 weeks during the controlled ovarian hyperstimulation period for IVF. The pregnant rate was higher in acupuncture group than that in control group for women undergoing IVF.

Secondly, acupuncture increases embryo implantation potential for patients with infertility. There was a study involved in 210 patients with infertility. These patients with infertility were treated with electroacupuncture and in vitro fertilization and embryo transplantation (IVF-ET). Electroacupuncture was applied before controlled ovarian hyperstimulation and during ovarian hyperstimulation. The levels of human leukocytes antigen-G (HLA-G) in the serum were determined for evaluating embryo implantation potentials. HLA-G may play a role in immune tolerance in pregnancy and its presence in embryo is associated with better pregnancy rates. They found that electroacupuncture can increase HLA-G for the patients undergoing IVF-ET; their HLA-G increased on hCG injection day and on embryo transfer day which indicated increased embryo implantation potential for patients with infertility.

Thirdly, acupuncture improves egg quality. There was a study from Zhongguo Zhen Jiu – an acupuncture journal in China. They studied 60 patients with infertility with poor ovarian response and poor ovarian reserve undergoing IVF-ET. After treatment, in acupuncture group, the symptoms of kidney deficiency were improved; estrdiol (E2) level was higher; egg maturation rate, fertilization rate and good quality embryo rate and implantation rate were higher on the day of human chorionic gonadotropin (hCG) injection. Most importantly the pregnancy rate was increased. Another study investigated the effects of acupuncture on egg quality and pregnancy for patients with polycystic ovary syndrome (PCOS) undergoing IVF. In this study there were 66 patients with PCOS and infertility and undergoing IVF-ET. All fertilization rate, cleavage rate and high quality embryos were higher in acupuncture group than that for control group. There was a study showing Luteal phase acupuncture increased pregnancy rate in women undergoing IVF. 109 patients received luteal phase acupuncture had higher pregnancy rate than those without acupuncture intervention.

Fourthly, acupuncture helps reducing stress and anxiety in women undergoing IVF. Research studied the effect of acupuncture on symptoms of anxiety in women undergoing IVF. 43 patients participated in the study. After 4 week treatment the anxiety score for acupuncture group was significantly lower than for the control group. There is perceived stress on the day of embryo transfer (ET). There was a study on the effect of acupuncture on perceived stress and pregnancy rate on the day of ET. In this study, 57 patients with infertility and undergoing IVF or IVF/ISI were involved. Women who received acupuncture treatment achieved 64.7% pregnancy rate while those who didn’t receive acupuncture treatment had 42.5% pregnancy rate. Women with acupuncture had lower stress score both pre-ET and post-ET compared to those without acupuncture. Women with lower stress score had higher pregnancy rate.

Finally, acupuncture can help after failed IVF. Recently a research paper has shown that acupuncture increased pregnancy rate in women with previous failed IVF cycles. In this study, there were 84 patients participated the study. These patients had at least two unsuccessful attempts of IVF cycles. The predicted success rate for these patients was 10% for this group of patients. Acupuncture was performed on the first and seventh day of ovulation induction, on the day before egg collection and on the day after embryo transfer. The result has shown that the clinical pregnancy rate in the acupuncture group was significantly higher than that in the control and sham groups (35.7%, 7.1% and 10.7% respectively).

How can acupuncture help male fertility?

Recent some research data suggest that acupuncture improves male fertility by increasing sperm count and improving sperm quality and motility. The possible mechanisms for these are: acupuncture helps lower scrotal temperature; acupuncture improves blood flow of male reproductive system and reduces inflammation in the reproductive system; acupuncture also corrects hormonal imbalance to improve sperm maturation, acupuncture modulates the immune system and improves sexual and ejaculatory dysfunction in male infertility. A simple and popular hypothesis is that acupuncture stimulates nerve receptors at point location, transmitting signals to specific areas of the central nervous system, which initiate physiological changes in the body. From traditional Chinese medicine point of view, there is disharmony of kidney and liver in male infertility. Kidney Qi deficiency and stagnation fail to regulate liver blood flow causing blood stagnation and fluid and damp accumulation. Acupuncture makes Qi flow freely again to restore kidney and liver harmony. Acupuncture treatment for male infertility period is up to 3 month per course.

A case report: acupuncture increased sperm count

A 31 year old man was diagnosed azoospermia (no measurable level of sperm in his semen). His testis and vasa deferentia were normal. The tests showed that his sperm production was impaired which was difficult to cure. The couple failed one cycle of percutaneous sperm aspiration and intracytosplasmic sperm injection. He was referred for acupuncture treatment. He received a course of 20 session acupuncture treatment (twice a week). After a course of acupuncture treatment, his sperm count was 10 millions/ml with 10% good motility and 60% normal shape of sperms. With continuing another course, his sperm count increased to 18 millions/ml with 30% good motility and 60% normal shape of sperms.

Further reading



References
Nedeljkovic M et al Forsch Komplementmed (2013) 20:112-8
Manheimer E et al (2008) BMJ 8: 545-549
Zheng CH et al Evid Based Complement Alternat Med (2012)2012:543924
Kong FY et al Zhongguo Zhen Jiu (2012) 32:113-116
Chen J et al Zhongguo Zhen Jiu (2009) 29:775-9
Cui W et al Zhongguo Zhen Jiu (2011) 31:687-691
Dieterle S et al Fertil Steril (2006) 85:1347-51
Isoyama D et al Acupunct Med (2012) 30:85-8
Balk J et al Complement Ther Clin Pract (2010) 16:154-7
Villahemosa et al Acupunct Med 2013 31:157-62
Bidouee F et al J Kidney Dis Transpl (2011) 22:1039