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 address

Kensington: for appointments (Fridays, Saturdays, Mondays and Thursdays) 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

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 and hot flushes etc to achieve best treatment results. My devotion and skills are highly praised by my patients. 


Wednesday, 22 August 2012

High FSH level, what to do? Try acupuncture

If you have high follicle stimulating hormone (FSH) level, what does that mean? What is FSH? 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. Sometimes high FSH is masked by high estradiol (E2) level. E2 will artificially suppress FSH to normal range which gives you a false impression that your FSH is normal. If your FSH is high, you chance to get pregnant is low and your chance to succeed for IVF treatment is also low because of poor response to ovary stimulation and poor egg quality.

What treatment is available for high FSH? Does high FSH need to be treated, if you want get pregnant?

Estrogen or birth control pills will temporarily suppress FSH to normal level. However this does not improve your infertility, because this does not help your eggs grow. High FSH which is only an indicator of poor egg quality is not the cause of infertility.

Acupuncture is the best option for now. The purpose of the treatment is not lowering FSH level; restoring ovary function and helping eggs grow is the key of the treatment. Acupuncture improves ovarian blood supply, as a result ovarian function is improved and eggs grow. Egg quality is also improved. Once ovaries respond to FSH and egg quality increases, pituitary gland will not produce excessive FSH. Your chance to get pregnant naturally or through IVF will increase.

Monday, 20 August 2012

Acupuncture is effective for treating antisperm antibodies associated male infertility

Antisperm antibodies can affect fertility in men. 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. It is easy to diagnosis by directly analysing sperms to see if there is antibody present. Once this condition is diagnosed, it is difficult to be treated. High dose of corticosteroids can reduce the number of antibodies; however it produces serious side effects at the same time. Fu B et al have reported that effectiveness of acupuncture and herbal medicines on male immune infertility. This study was involved 100 male with positive antisperm antibody associated infertility. These cases were divided into two groups: 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.

References
Fu B et al J Tradit Chin Med (2005) 25:186-9

Thursday, 16 August 2012

How obesity affects fertility and how acupuncture can help?

Obesity increasingly affects people’s health. It is well studied and extensively agreed that obesity has negative impact on fertility. Women with obesity are three times more likely to suffer from infertility than women with body normal weight. The impaired fertility has been seen in obese women naturally and obese women with assisted conception. Obesity reduced fertility by affecting ovulation, egg development, embryo development, endometrial development implantation and pregnancy loss.

Obesity affects ovulation and period cycles. Obesity has effect on hypothalamus-pituitary-ovarian axis which is important in regulation of sexual hormone production. If this axis is disturbed, normal hormone production is impaired leading to abnormal period cycle and anovulation. This causes infertility. Women with obesity respond poorly to ovulation induction. Weight loss only could restore normal period cycle and ovulation; it increased response to ovulation induction.

Obesity affects egg quality and egg quality is likely to be poor in women with obesity
Obesity has great impact on reproductive health. Women with obesity are nearly three times more likely than women without obesity to have difficulty to conceive and may take longer to conceive. Women with obesity also have an increased risk of miscarriage, pregnancy complications and congenital defects in offspring, if they do get pregnant. Obesity may affect egg competence and maturation caused by alterations in steroid hormone balance, particularly those hormones that trigger follicle maturation. This is because fat tissue is an important site for steroid hormone production and metabolism and excessive fat in obesity may alter steroid hormone levels. Also metabolic alterations in obesity occur in the serum which is reflected in the follicular fluid and some changes in this micro environment may affect egg quality. For example, serum insulin concentrations and resistance to insulin action in cells are increased in obesity. In women with obesity has increased C-reactive protein which is an inflammatory marker in follicular fluid. When undergoing IVF, women with obesity have less quality eggs collected. This is caused by reduced human chorionic gonadotrophin (hCG) concentration impairing egg maturation. Many studies showed that obese women undergoing IVF have lower fertilization rate than women with normal weight. Impaired egg development could lead to impaired embryo development and following impaired implantation.

Obesity reduces uterine receptivity
How obesity affects women’s fertility? Recent research suggested that obesity reduces uterine receptivity in overweight women. Bellver J et al analysed the reproductive outcome of recipients of donated ova according to their body mass index (BMI). These data were from 9587 first cycles of ovum donation from normal weight donors. Recipients received in vitro fertilization (IVF) were divided into four groups according to their BMI: group A lean BMI<20 kg/m2, group B normoweight BMI 20-24.9 kg/m2, group C overweight BMI 25-29.9 kg/m2 and group D obese BMI ≥30 kg/m2. There was no difference among the groups in IVF parameter. However, implantation, biochemical pregnancy, clinical pregnancy, twin pregnancy, and live-birth rates were significantly decreased as BMI increased. In the lean, normoweight, overweight and obese groups, the implantation rate was 40.4%, 39.9%, 38.5% and 30.9%. Clinical pregnancy rate was 56.9%, 55.9%, 54.3% and 45.3% and live-birth rate was 38.6%, 37.9%, 34.9% and 27.7% respectively. Clinical miscarriage rates were similar in all groups. They suggested that female obesity impairs the reproductive outcome of donated ovum because of reduced uterine receptivity. To make uterus more acceptable for pregnancy, it is time to lose weight for those overweight women.

Women with obesity are more likely to have early pregnancy loss once they are pregnant. Increased miscarriage rates were observed in pregnancy from natural conception, ovulation induction and assisted conception. This suggests that endometrium may play a part in early pregnancy loss.

Obesity affects assisted conception treatments. Many studies have shown that obese women undergoing assisted conception such as IVF have lower live birth rates. This is accumulated effect of lower implantation and pregnancy rate, higher miscarriage rates and increased pregnancy complications.

Weight loss improves fertility greatly no matter what weight loss methods were used. The first method used should be life style changes including diet and exercises. Many evidences showed improvement of ovulation frequency and pregnancy rates after good weight loss.

Acupuncture helps reduce appetite in women with obesity. Acupuncture helps increase ovarian and uterine blood flow to improve egg quality and uterine lining for conceiving and implantation and supporting pregnancy.

References
Bellver J et al Fertil Steril (2013) Jul 3
Yao H et al Zhen Ci Yan Jiu (2012) 37:497-501

Friday, 10 August 2012

Keep fit for pregnancy, acupuncture can help

How long it takes to conceive when you start trying?

How long it takes for you to get pregnant. This is difficult to say. There is an average time for a couple to conceive. Within one month, 30% couples get pregnant; within three months, 60% get pregnant, within 6 month, 80% get pregnant, within one year 85% get pregnant. Within two years 92% get pregnant. This is only a guide. Many factors affect the figures. For example age is obviously an important factor and it takes longer to conceive, if you have age disadvantage, but it is not impossible.

When do you need to get your fertility tested?

You need to get your fertility tested, if you have tried to get pregnant for a year without success or if you are over 35 year old and you have tried for 6 months without success. Basic fertility tests are to check your egg quantity and quality, your ovulation and your tubes and uterus. These include day 3 FSH (follicle stimulating hormone) and E2 (estradiol) test, AMH (anti-mullerian hormone) test which could be done at any day of a woman’s cycle, antral follicle count to measure and count small follicles. Your ovulation could be tested by ovulation prediction kit, BBT (basal body temperature) chart, ultrasound scan and day 21 progesterone tests. HSG (Hysterosalpinggogram) is used to test your tube and uterine cavity.

There are a few things you can do to improve your fertility.

Keep a healthy weight

Obesity is associated with a number of health problems, such as cardiovascular diseases and diabetes. Obesity which causes hormone imbalances and ovulation problem associated with infertility is extensively agreed. A healthy weight is important for women who want to conceive. Obesity is associated with reduced female fertility. Women with obesity are more likely to suffer dysfunction of hypothalamic-pituitary-ovarian axis, irregular period cycle and anovulation. Hormone balance to regulate follicular development and egg maturation is disturbed. Endometrial development and implantation are also affected by obesity. Weight loss will restore normal period cycle and ovulation and improve the chance of conception.

Obesity is also associated with reduced male fertility. It reduces semen quality, changes sperm proteomes, contributes to erectile and induces other physical problems related to obesity including increased scrotal temperatures. Obesity affects hormone balance. Weight loss may restore fertility in male.

Low body weight is also linked to infertility. Keep normal body weight can optimise your fertility. Body mass index (BMI kg/m2) which is body weight over height is used to measure healthy weight. Normal BMI is 20-25. High or low BMI is abnormal. BMI higher than 30 is obese. Numerous studies showed that it takes longer time for women with high or low body weight to conceive. For example, a study involved in 87 obese women with infertility showed the impact of obesity on ovulation. 80% of women before weight loss were anovulating; after 6 months of a weight loss programme, average weight loss of the women was 10.2 kg/m2 and 90% of them were ovulating spontaneously. 77.6% of those women became pregnant and 67% achieved a live birth. Abnormal body weight in men is associated with reduction of sperm count which causes male infertility. Many studies showed that IVF success rate for women with obesity is 50% less than that for women with normal BMI. Increased risk of early pregnancy loss results in lower live birth rate in women with obesity compared to women with normal BMI.

Keep a balanced diet. A balanced diet should provide about 2000 kilocalories each day. About 200 kilocalories more would be requested during pregnancy.

What is well balanced diet? When it comes to a healthy diet, balance is the key, which means eating a wide range of foods in the right proportions to achieve and maintain a healthy body weight. If you are overweight or obese which means you eat more than you need and should eat less; and vice versa. Healthy eating does not have to be complicated; it can be really straightforward. All the food we eat can be allocated into five groups. They are

1, Fruit and vegetables: They are main source of vitamins and minerals for the body. They also contain fibers. Five portions of a variety of fruit and vegetables a day will provide enough vitamins and minerals for body needs. How much is one portion? Just one apple, banana, pear a slice of pineapple or melon or one similar-sized fruits is one portion. Three heaped tablespoons of vegetables is another portion. This is not hard to achieve.

2, Starchy foods, such as rice, pasta, bread and potatoes, cereals: They are main source of energy and calories which are fuels of the body. They also contain some vitamins, minerals and fibers. This group of foods should make up around one third of everything we eat. Or meals are based on these foods.

3, Meat fish, eggs and beans: This group of foods is good source of protein, which are fundamental for growth and repair of the body. They also have a variety of vitamins and minerals. Meat provides vitamin B12. At least two portions of fish per week are very healthy.

4, Milk and dairy foods: These are a good source of protein and calcium. These four groups of foods are healthy foods from which a range of foods should be chosen.

5, Foods containing fat and sugar: Fat and sugar provide energy for the body. If there is too much sugar and fat, it will lead to overweight. Fat can be divided into saturated fat and unsaturated fat. Saturated fat can raise blood cholesterol and increase risk of heart disease. However unsaturated fat can help lower cholesterol and provides body with essential fatty acids which help body stay healthy. Oily fish, nuts, seeds, vegetable oils and olive oils are main sources of unsaturated fat.

Try to control fat and sugar intake and eat foods contain unsaturated fat.

Do you need to take vitamin and mineral supplements?

Most people can get all the vitamins and minerals they need by eating a balanced, varied diet. You don’t have to take supplements if you don’t have symptoms of deficiency. If you choose to take supplements, be careful not to take too much otherwise it would be harmful. There are two types of vitamins: water-soluble or fat- soluble. There are 9 water-soluble vitamins: 8 vitamin Bs and vitamin C. For water-soluble vitamins your body will choose what is needed and the rest will be excreted. But for fat-soluble vitamin, thing is different. There are 4 types of fat-soluble vitamins A, D, E, and K. They are ready to store in the body. If intake is more than need, the excessive amount of vitamin will not be excreted from the body, and they will stay in the body for a long time and will be toxic to the organs.

Be careful with what you drink if you want to get pregnant

Stop drinking alcohol.

Do you drink alcohol? Drinking alcohol, especially large amount of alcohol is associated with reduced fertility and spontaneous abortion. This was agreed by many researches. One drink per week might be associated with reduced fertility. The mechanism that alcohol affects fertility is not clear, but it may alter hormone levels causing follicle development, ovulation, and implantation problems. Both men and women drinking alcohol affects success rate of assist reproductive treatment. Women drinking alcohol increased miscarriage in early pregnancy.Excessive consumption of alcohol disturbs hypothalamic-pituitary function leading to ovulation disorder. Too much alcohol can damage sperm quality. Infertility improved with stop of alcohol consumption. Drinking alcohol during early pregnancy can cause severe developmental abnormalities in the baby, such as retardation and physical malformation.

You might say that I don’t drink alcohol at all; what else could affect my fertility. Do you drink a lot of coffee, tea or soft drinks? Do you know what the component of them? In this drinks, caffeine is one of the important components. Caffeine is a stimulant of the brain. It has been reported to prolong the time to pregnancy, but the mechanism for this is not clear. It may affect female reproduction by changing hormone levels. This results in ovulatory problem and corpus luteal dysfunction. There was a study of 104 women on links between pregnancy and caffeine consumption. They found that women who drank less than a cup of coffee a day were two times as likely to get pregnant compared with the moderate coffee drinkers. A reduced chance of conception was found with increased coffee consumption. Large amount of caffeine consumption is associated with delayed conception. Also it causes higher spontaneous abortion in early pregnancy. For women undergoing assist reproductive treatment, caffeine might decrease live birth rate.

Stop smoking. The metabolites of cigarette smoking are toxic to eggs (causing oxidative damage to mitochondrial), sperm and embryos (causing miscarriage). Smoking decreases the chances of conceiving. Increasing numbers of cigarettes consumption per day significantly decreased fertility. If smoking during pregnancy, miscarriage risk is doubled and premature labour is increased 50%. Low birth weight baby and interurine retardation and perinatal mortality are also increased. Stopping smoking is another step to take to be ready for pregnancy.

Sleep well. Good sleep is important to get your mind and body rested to keep healthy. Sleep loss may affect your hormones levels.

Do regular exercises to improve eggs and sperm quantity and quality

Reduce stress. Stress can alter hormones causing fertility problems. Keeping stress free is very important. Severe stress may affect ovulation and sperm production. Prolonged stress makes some part of your body not function properly including reproductive system. Try to relax. Try to eat regularly and get good sleep which could help your body relaxed and healthy. This is very important. If your body healthier and stress free, your fertility improves and you may get pregnant naturally or it may improve your chance of IVF success, if you decide to go through the IVF treatment.

Fertility acupuncture

Getting pregnant seems so easy 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. Many people don’t realise that infertility is a disorder that occurs in women’s reproductive systems. There are many underlying causes such as polycystic ovarian syndrome (PCOS), endometriosis and premature ovarian failure etc that could explain why infertility happens. Even if it is unexplained infertility, there may be a reason. The reason cannot be explained, only because science is not advanced enough to know why it happens. It is still unclear how pregnancy happens in many ways physiologically and biochemically.

Do you know acupuncture boosts your fertility?

It does not help if only asking why me? One has to do something to solve the problem. Many women recognize that acupuncture could help their fertility treatment and this is their chance. Bovey et al (2010) performed a survey of acupuncture practitioners to study acceptance of acupuncture for infertility treatment in the UK. They found that 15% of 861 practitioners responded support fertility issues; patients with infertility comprise a large part of their cases. 60% of these practitioners had specialist training. They stated that the benefit of acupuncture treatment for infertility included stress reduction, relaxation, regulation of menstrual cycle and of course, emotional support. Hopton et al (2012) conducted a survey in surrey, UK. They showed that women seeking infertility treatment with acupuncture increased 5% from 2.5% in 2002 to 13% in 2009. Most commonly these were treated by independent acupuncturists. There was a survey in the US about women with infertility seeking complementary and alternative treatment. They showed that during 18 months 22% had tried acupuncture, 17% herbal therapy, 5% a form of body work and 1% medication.

Acupuncture is originated from ancient China. Not only because of its history, but also because of evidence from current scientific research, acupuncture becomes very popular. Acupuncture can boost your fertility and help you conceive naturally by stimulating nerve endings and regulating reproductive system physiological function. Needles inserted into particular acupoints stimulate nervous system. Acupuncture decreases sympathetic nerve activity, as a result, it helps improve blood flow of the ovaries and uterus to develop high quality eggs to be fertillized and better uterine lining to get ready for implantation. It also helps relax fallopian tubes and uterus to provide an uninterrupted passageway and a fertile environment for egg and embryo. It also helps regulate hormone balance to improve ovulation and support pregnancy. Acupuncture can also reduce fertility related stress to help you conceive.

Success rate is what many people concern about. I would say that it is difficult to calculate success rate for infertility with acupuncture treatment though there is some research showing over 60% success rate. Human body is a living biological body. Our body does not work like computer which run the same programme if you give it the same command. Everyone is different which is responding differently to the treatments. This is why no treatments for any diseases have 100% success rate. Acupuncture is different from IVF which has clear cycles. It is easy to see whether it is successful or not. Acupuncture has accumulating effects. Some people may need three month treatments, while others may need six months and some need 1 year. If you give it a cut off time, like research does, this does not reflex actual success rate. Women with infertility may have other symptoms, such as chronic backache or abdominal pains; their chosen acupuncture points must be different. How can you compare success rate between them? Some people see acupuncturist for treating other diseases such as chronic pelvic pain, as a result, they end up getting pregnant. Acupuncture can also treat underlying causes of infertility and improve overall health to benefit fertility.

Acupuncture supports IVF as well. If you do want to go ahead for IVF, acupuncture also can help. There is no conflict between IVF and acupuncture. Manheimer E studied effects of acupuncture on pregnancy rates and live birth among women undergoing IVF by analysing seven trails involved in 1366 women. They suggested that acupuncture given with embryo transfer improves pregnancy rates and live birth among women undergoing IVF. Recently, there is a randomized controlled trial of study conducted in Western Sydney. They examined the effectiveness of acupuncture for reducing infertility-related stress. The effect of acupuncture group was compared with a waiting-list control group. The patients involved were 32 women aged 20-45 years, with a diagnosis of infertility or a history of unsuccessfully trying to conceive for over 12 months. Six sessions of acupuncture over 8 weeks were given. The result showed that women in acupuncture group have significantly reduction of infertility stress compared with those in the waiting-list control. Women described the experience and impact of acupuncture as positive relating to a sense of relaxation and intervention with few negative side effects. A research conducted by Balk et al studied the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. They found that women who received this acupuncture achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. Those who received acupuncture had a low stress scores before and after ET. They concluded that lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

References
Smith CA J Altern omplement Med (2011) 17:923-30
Balk J et al Complement Ther Clin Pract. (2010) 16:154-7
Manheimer E et al BMJ (2008) 336:545-9
Homan GF et al Human Reproduction Update (2007) 13:209-223

Thursday, 9 August 2012

Smoking affects fertility and IVF success rate, acupuncture can help

Smoking affects on many aspects on health. Fertility is one side. There is strong evidence showing the negative effects of smoking on fertility both in male and female. In female, smoking affects follicular microenvironment and changes hormone levels in the luteal phase. Many studies showed strong association between female smoke and compromised fertility. Menopause occurs 1-4 year earlier in women who smoke compared to those who don’t smoke. A study involved in 14893 women in pregnancy showed delayed pregnancy more than 12 months in women who smoke compared to women who don’t. In male, smoking reduces sperm production, sperm motility and changes sperm morphology. Smoking also increases risk of DNA damage. In adult men smoking leads to hypoxia in testis this is because smoking causes small blood vessel contraction and reduces blood and oxygen supply to the testis. Compromised oxygen supply to testis would impair sperm production. Mother in pregnancy smoked heavily could affect her son’s sperm production when he grew up. Men’s sperm production could decrease about 40% by maternal smoking in pregnancy.

Both male and female smoking decrease IVF success rate. A study with 301 couples undergoing IVF or ICSI revealed that men smoking significantly decreased the success rate. There are many studies of association between women who smoke or passively smoke and IVF success rate. The findings are very similar: women who smoke have reduced IVF pregnancy rate and live birth rate compared to women who don’t smoke.

How can physicians help stop smoking?

Stop smoking can hard to some people who smoke. Many methods are considered to help patients stop smoking such as individual counselling, pharmacotherapy, and group therapy etc. There is a survey from Swiss to assess how physicians help patients stop smoking. 84% prescribed nicotine replacement therapy; 65% prescribed bupropion, or 70% provided counselling. 26% recommended acupuncture, 8% recommended hypnosis, 7% recommended relaxation and 24% recommended self-help material.

How can acupuncture help giving up smoking?

Some complementary and alternative medicine (CAM) was used to help adult smokers to give up smoking. There was a National Health Interview Survey (NHIS) in the United State survey to analyse CAM usage in adult smokers. A total 54437 aged over 18 smokers were participated the survey from 2002 and 2007. 10 type of CAM therapies were analysed including acupuncture, Ayurveda, biofeedback, chelation therapy, chiropractic care, energytherapy, folk medicine, hypnosis, massage and naturopathy. The percentage of recent users of CAM therapies increased from 12.5% to 15.4% between 2002 and 2007. The largest increases were seen in massage, chiropractic, and acupuncture. Despite a decrease in the national average smokers, proportions of smokers within specific CAM remained consistent. CAM practitioners in particular those in chiropractic, acupuncture and massage, represent new groups in the health care community to promote giving up smoking.

Acupuncture can help giving up smoking. A research paper has recently been just published. Kang OS et al studied that acupuncture reduces the desire for smoking using fMRI- a brain scan through which brain activity can be measured. There were 25 male smokers involved in the study in two groups real acupuncture group and sham acupuncture group. After 36 hour of smoking ban for them, their brain activity was measured using fMRI scan and then treatments of real acupuncture and sham acupuncture were given. They found that the desire for smoking scored lower in real acupuncture group compared with sham acupuncture group. Brain activities in a few regions were significantly different including prefrontal cortex, the premotor cortex, the amygdale, the hippocampus and the thalamus. These regions were involved in attention, motivation and reward. Acupuncture helps reduce desires of smoking through altering particular part of brain activity in smokers after stop smoking.

References
Kang OS et al. Psychopharmacology (Berl) 2013 Feb 28 [Epub ahead of print]
Homan GF et al Human Reproduction Update (2007) 13:209-223
Hamm E et al Am J Health Promot 2013 Dec 20.

Wednesday, 8 August 2012

Get to know your body for pregnancy by charting your basal body temperature

What is basal body temperature? Basal body temperature (BBT) is the lowest body temperature during rest. It is usually measured in the morning as soon as you wake up and before you engage any physical activity. In women, BBT changes with the menstrual cycles. If you make a daily BBT chart in a full menstrual cycle you can see the BBT chart is biphasic which means there are two temperature phases. Ovulation increases BBT for about up to 0.5 degree Celsius. The average BBT is 36.37 ±0.12 ºC during follicular phase (the phase prior to ovulation) and 36.72 ±0.12 ºC in luteal phase (the phase after ovulation). If conception does not occur, the temperature goes down and then the next menstrual cycle starts. If the conception occurs, the temperature stays at the higher level until the end of first trimester of the pregnancy.

If you are trying to conceive, making your BBT chart is the easiest way to know if or when you are ovulated precisely, though it does not predict ovulation. Your BBT chart also can tell if your body is the best form and is ready to sustain a pregnancy. BBT was regulated by hormones estrogen and progesterone which produced by ovaries. High levels of estrogen lower BBTs while high levels of progesterone increase BBTs. If your BBT chart is normal, this means your ovaries are functioning well and you are ready for pregnancy.

If you have difficulty to conceive, it may reflex on your BBT chart. For example, if you are not ovulating, your BBT chart does not have two phases. If you have short luteal phase which is difficult to sustain your pregnancy it shows a disturbed BBT chart. If your first three day’s BBT is greater than 36.6 ºC, this may be associated with endometriosis.

Monday, 6 August 2012

Thyroid function affects fertility both in males and females

Thyroid gland is located at the neck below the thyroid cartilage. It produces thyroid hormones including triiodothyronine (T3) and thyroxine (tetraiodothyronine, T4). These hormones regulate the metabolism rate of the body and affect growth and function of other part of the body. These hormones are important to maintain normal reproductive function. It has been extensively agreed that there are significant associations between thyroid disorders and abnormalities of the reproductive system; both hyperthyroidism and hypothyroidism in males and females affect reproductive function.

Changes of the thyroid function can lead to infertility both in male and female. In male, hyperthyroidism is associated with low sperm count and low sperm motility. Erectile function is also affected by thyroid function. These factors may contribute to male infertility. Restore of thyroid function after treatment results in sperm count increased and sperm motility improved. Erectile function is also improved after treatment. Hypothyroidism may cause testicular pathology, low testosterone levels and sperm abnormality.

Thyroid dysfunction and autoimmunity are common among women in reproductive age. In women with hyperthyroidism blood hormone levels including testosterone, adrostenedione, oestrogen (E2), luteinizing hormone (LH) and follicle stimulating hormone (FSH) are increased. Abnormal period is noted in women with hyperthyroidism. Absence of period is very common. Reduced infertility is found in women with hyperthyroidism. Likewise hormonal changes and period cycle disturbances are also present in women with hypothyroidism.

The prevalence of thyroid dysfunction during pregnancy is about 2-3% and is mainly caused by chronic autoimmune thyroiditis. Thyroid auto-antibodies are found in 5-15% of women in reproductive age with or without thyroid dysfunction. Either thyroid dysfunction or thyroid autoimmunity is associated with negative pregnancy outcomes during pregnancy. Emmyvan den Boogaard et al conducted a systematic review on the clinical significance of thyroid dysfunction and thyroid autoimmunity prior to conception and in early pregnancy. They found that subclinical hypothyroidism (with high Thyroid stimulating hormone-TSH and normal free T4) in early pregnancy was associated with hypertension in pregnancy and perinatal mortality. Presence of thyroid antibodies was associated with an increased risk of unexplained subfertility, miscarriage, recurrent miscarriage, preterm birth and maternal post-partum thyroiditis.

More recently acupuncture was reported in regulating thyroid function and treating thyroid function disorders. There was a report of effectiveness of acupuncture on hyperthyroidism. This was involved in 125 patients. After acupuncture treatment symptoms were controlled completely in 71 patients which were 56.8%. Other 41 patient’s symptoms were partly controlled. Recent study by Lyzina KE et al investigated the effect of acupuncture in 27 female patients with subclinical hypothyroidism. The treatment period was 3-4 month. They found that after the treatment, the initial clinical symptoms decreased significantly; TSH level decreased to normal range; the quality of life was improved. They concluded that acupuncture may be an alternative therapy for patients with subclinical hypothyroidism.

Acupuncture is used to treat hyperthyroidism as an adjunct therapy

Hyperthyroidism or overactive thyroid is a common hormonal condition in which too much thyroid hormone is produced in the thyroid gland. Excessive thyroid hormones can speed up metabolism causing a series symptoms. These include that anxiety, irritability and nervousness, insomnia, fatigue, muscle weakness, sensitive to heat, excessive sweating, weight loss, frequent passing stolls and urination, light periods or infrequent periods or missing periods, infertility. Physical signs include that enlarged thyroid gland, fast heart beat, tremor, warm skin, redness on the palms of the hands, hives, hair loss twitching in the face and limbs. Blood tests show that low level of thyroid-stimulating hormone (TSH) and high level of thyroxine and triiodothyronine (the thyroid hormones). The most common used medication is thionamides, such as carbimazole and propylthiouracil. In China, acupuncture is used as adjunct therapy together with these medications to increase the effect of medications and reduce the side effect of medications. As early as 1934 acupuncture was reported to treat thyperthyroidism. In 1970s, there were more researches on this subject. Now many researches were done and provided the evidence that acupuncture improves metabolism, improves symptoms, reduces side effect of the medications and reduces recurrence rate. For example, there was a report with 125 cases of hyperthyroidism. After acupuncture treatment, the symptoms were controlled in 71 cases, improved in 41 cases, no effect in 13 cases. More recently a research studied the therapeutic effect and side effect of treatment on hyperthyroid exophthalmos with the combination of acupuncture and medication. Fifty-two cases were randomly divided into an acupuncture and medication group (27 cases) and a medication group (25 cases). Acupuncture in combination of oral taking of Thiamazole and Euthyrox were adopted for the acupuncture and medication group. And acupoints such as Jingming (BL 1), Chengqi (ST 1) and Sizhukong (TE 23) etc. were selected. Western medication for oral taking was applied as the only treatment for the medication group. The results have shown that the improvement of the objective marks of eye syndrome in the acupuncture and medication group was better than that in the medication group. There were 4 cases with hypoleucocytosis, 3 cases with rash and 3 cases with aggravated symptom of exophthalmos in the medication group during the treatment, while no case with side effects was observed in the acupuncture and medication group.

References
Emmyvan den Boogaard et al Human Reproduction Update (2011) 17:605-619
Vopr Kurortol Fizioter Lech Fiz Kult (2011) 5:29-33
http://www.pharmnet.com.cn/tcm/zjdq/zjzl/100091.html
Xia Y et al Zhongguo Zhen Jiu (2010) 30:806-9

Friday, 3 August 2012

How much acupuncture treatment is adequate?

How much acupuncture treatment is adequate?

If you go to see different acupuncturists, you would probably notice that different acupuncturists do acupuncture differently. Many different styles of acupuncture practice exist. Acupuncture is so individualized and there is no agreement on the optimal acupuncture treatment for any particular condition. Birkeflet O et al did a research about the agreement of acupuncture diagnosis and treatment in 30 infertile and 24 previously pregnant women. These women were examined for traditional Chinese medicine (TCM) patterns by two acupuncturists who would independently decide on the TCM patterns and the prescription of acupuncture points. They found that 39 different TCM patterns and 36 different acupuncture points were used. Poor to no agreement was found for the choice of acupuncture points. On one hand this makes acupuncture unique; on the other hand this makes it difficult to be recognised. Some research trials failed to distinguish the differences between acupuncture treatment and sham controlled treatment because of the generalization of acupuncture and inadequate treatment received. There was review by Errington-Evans N on effect of acupuncture for anxiety. They found that there was enormous variety regarding the points used, number of points used in a session, duration of sessions, frequency of treatment and duration of treatment programme; all of these makes conclusion difficult. White A et al analysed 47 acupuncture trials to evaluate the adequacy of acupuncture treatment which leads to reliable conclusion. They recommend the concept of dose of acupuncture treatment. Different doses may be required for different conditions and adequate dose is established by clinical experiences or basic research studies. They found that out of 47 reviews only 6 met the criteria of adequacy of the acupuncture treatment.

Acupuncture dosage comprise two components: the numbers of points selected in a single treatment and total number of the treatments that patients received. It is possible for patients to have beneficial effects from a couple of treatments together with a couple of points selected for stimulation, but this is rather more exceptional than general. The nature and duration of the condition is a very significant determining factor that how many treatments are effective. Acute conditions of short duration in younger patients are most likely to respond to small dosage of acupuncture. On the contrary, chronic conditions of long term duration need larger dosages of acupuncture.

How many sessions of acupuncture are needed for lower back pain?

During the past 40 years, acupuncture, a therapeutic technique of oriental medicine, has become more and more popular, evolving into one of the most utilized forms of complementary integrative medicine interventions in the United States. More than 10 million acupuncture treatments are administered annually in the United States alone. Its rise in popularity, particularly in the West, can be attributed in part to its effectiveness for pain relief and in part to the fact that scientific studies have begun to prove its efficacy.

Non-specific low back pain is the most common application of acupuncture. It is listed in NICE guidelines in the UK. A course of acupuncture needling comprising up to a maximum of 10 sessions may be offered for non specific back pain over a period of up to 12 weeks. In some cases with long history of lower back pain, much more sessions are needed to completely live in pain free life.

What clinical evidences used for NICE guidalines for low back pain treatment with acupuncture?

Five studies were included to support the application of acupuncture: 4 RCTs and 1 systematic review on acupuncture. In these trials patients received 6 x 30min over 6 weeks in one, 20 x 30min over 12 weeks in another, 8 x 30min over 4 weeks in the third trial and 12 x 30min (3 times a week) in the fourth one.

For example, One randomised controlled trial recruited patients through their GPs (a total of 16 GP practices were involved which included 39 GPs) (Thomas, K. J., MacPherson, H., Ratcliffe, J. et al , 2005). Patients included had to be between age 18-65 and had nonspecific low back pain for 4-52 weeks. They also had to have been assessed by their GP to check that primary care management was suitable. A total of 289 patients were identified and approached to join the study, of these 241 accepted and met the criteria. 160 were allocated to receive acupuncture and 81 were allocated to receive usual care, however, 1 patient from each group dropped out, 159 actually received acupuncture (146 were followed up at 3 months, 147 at 12 months and 123 and 24 months) and 80 received usual care (71 were followed up at 3 months, 68 at 12 months and 59 and 24 months). Participants in the acupuncture group received 10 individualised acupuncture treatments over 3 months from one of 6 qualified acupuncturists. The usual care group received 10 NHS treatment sessions according the GPs assessment of the patients clinical need; this was a mixture of interventions, including drugs and recommended back exercises. Half the group also received physiotherapy or manipulation during the first three months. Both groups also received adjunctive care which included massage and advice on diet, rest and exercise. The results showed that acupuncture does give a greater long-term benefit compared to usual care. Acupuncture was significantly more effective in reducing pain at 24 months than usual care. The study also showed that traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain.

References

White A et al Acupunct Med (2008) 26:111-20

Errington-Evans N CNS Neurosci Ther (2012) 18:277-84

Birkeflet O et al Acupunct Med (2011) 29:51-7

Anderson B and Rosenthal L. Complement Ther Clin Pract (2013) 19:1-5

http://www.nice.org.uk/guidance/cg88/resources/cg88-low-back-pain-full-guideline3

Thursday, 2 August 2012

Acupuncture increases IVF success rate

We know women have menstrual cycles. In the middle of the cycles an egg is released from the ovary. In each cycle, only one egg is matured and released. For those who want to conceive with in vitro fertilization (IVF), one matured egg is not enough. Doctors use medications to stimulate ovaries to develop more follicles and eggs. With egg retrieval, doctors will get more than one eggs. These give them more eggs to work with. More eggs are very likely to lead to having two good qualities of embryos before the embryos are transferred back to uterus. These would increase IVF success rate. How many eggs do you need from egg retrieval? Generally speaking, 10-20 eggs are good numbers and better qualities. These may vary from clinic to clinic. Age has effect on these numbers; younger women give more eggs than older women. Women’s conditions also have impacts on the numbers retrieved. Women with more than 10 eggs retrieved have better chances to succeed.

What is natural cycle IVF? This is the IVF that takes place in your regular menstrual cycle. The fertility medication to stimulate the ovaries will not be applied. The eggs produced in women’s regular cycles will be collected and used for IVF. Normally a few eggs could be collected. This could be modified with a small dose of medication to achieve a goal of a few eggs collected. There are some advantages of natural cycle IVF. The cost per cycle of natural cycle IVF is lower. The treatment can be repeated every month. In stimulated IVF cycles, 2-3 month duration is recommended between the treatment cycles. There are more chances to create a normal embryo. Side effects from ovary stimulation drugs are minimised and there is no risk of ovarian hyperstimulation syndrome (OHSS).

In vitro fertilization (IVF) embryo transfer is one of the most successful infertility treatments. However, the success rate of IVF is not satisfactory. IVF is expensive, lengthy and stressful with low success rates. It also affects physical and mental health. New techniques have been developing to improve IVF success rates, one of which is acupuncture. More recently acupuncture has attracted clinicians attention by increasing IVF success rate. The first report that acupuncture increased IVF success rate was from Stener-Victorin et al in 1999. They applied acupuncture before occytes aspiration. They found that women in acupuncture group had significantly higher implantation rate, pregnancy rate and live birth rate in IVF embryo transfer.

Craig L et al performed a research to investigate the effect of acupuncture on in vitro fertilization (IVF) performed offsite. They recruited two groups: acupuncture group and control group. In acupuncture group the women were received acupuncture at offsite location for 25 minutes before and after embryo transfer. The protocol they used was that the following points before ET: GV-20, CV-6, ST-29, SP-8, PC-6, LV-3; Shenmen and Brain on the left ear; and Uterus and Endocrine on the right ear. After transfer the points were LI-4, SP-10, ST-36, SP-6, KI-3; Uterus and Endocrine on the left ear; and Shenmen and Brain on the right ear. They found that the pregnancy rate was higher in control group than in acupuncture group. Recently Hullender Rubin LE et al did a chart review using the same protocol as Craig L et al. The research was conducted in a private infertility clinic. The patients underwent fresh donor (N70) or nondonor (N=402) IVF-ET interventions. They found that the protocol did not lower live birth rate in acupuncture group for non donor cycles; live birth rate in donor cycles is higher in acupuncture group than that for control group.

IVF with acupuncture support has higher live birth rate
Though the effectiveness is still in debate, as early as 2008, Eric Manheimer et al did first systematic review and mega analysis to investigate the effects of acupuncture on pregnancy rates and live birth rates among women with infertility undergoing IVF. This review was published in BMJ. 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 two of the leading reproductive medicine journals either in full articles or abstracts. In all trials, women received acupuncture immediately before or immediately after the embryo transfer. The acupuncture points selected in all trials are fixed and the acupuncture sessions lasted 25-30 minutes. No electroacupunture was involved. They showed that clinical pregnancy, ongoing pregnancy and live birth rates were improved. There was no side effect found. Their conclusion is that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing IVF.

There was a new review that just came out by Zheng CH et al (July 2012). They did a systematic review to analyse effect of acupuncture during IVF. They 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. All 5 studies showed that pregnant rate was higher in acupuncture group than that in control group for women undergoing IVF.They also analysed other applications of acupuncture during IVF which did not distinguish IVF success rate between acupuncture group and control group which only had one acupuncture treatment around egg collection or embryo implantation. They suggested that most of the courses of acupuncture treatment during IVF were too short to completely correct infertility states caused by long term imbalance. In addition, the acupuncture programs lacked syndrome differentiation and treatment according to individual characteristics. In conclusion, appropriate acupuncture during IVF with suitable time in the cycle, enough treatment courses and individual program is a promising technique to increase IVF success rate.

References
Evid Based Complement Alternat Med 2012 2012:543924
Craig L et al Fertil Steril (2007) 88 suppl 1:S40
Hullender Rubin LE et al (2013) Jan 30
Manheimer E et al (2008) BMJ 8: 545-549

Importance of water intake to keep healthy skin, acupuncture helps skin hydration

When you see water flows in the river, do you ever imagine that 70% of our body weight is made up from water? Water is an essential medium for chemical reactions occurring in our body; it brings nutrients for our body needs; and it takes away wastes produced in our body. Water is constantly lost from our body through sweat, urine and breath. Without regular top-up water, our body can only survive a few days. If we don’t drink enough water to replace the lost, we became dehydrated.

The early sign of dehydration is thirst. If you are thirsty, you are in dehydration. The other common signs of dehydration include: dark yellow coloured urine and not passing much urine when you go to the toilet, headaches, tiredness and feeling lightheaded. How much water do we need a day? We need 1.5 to 3 litres to make up to the water that we loss every day in moderate condition. This is about 8 medium glasses of water. We may need more water during hot weather or physical activity. You can tell if you drink enough of water by the colour of your urine. If the urine is pale straw colour, you have enough water intakes.

The skin also contains plenty of water, and functions as a protective barrier to prevent excess fluid loss. Keeping skin hydration makes skin looking good. Dehydration makes skin dry and wrinkled.

Facial acupuncture can help increase water and oil content for facial skin.

References
N. Donoyama, A. Kojima, S. Suoh, and N. Ohkoshi, “Cosmetic acupuncture to enhance facial skin appearance: a preliminary study,” Acupuncture in Medicine, vol. 30, no. 2, pp. 152–153, 2012.