What is In-Vitro Fertilization (IVF)
Very basically, this is how it works. The woman’s ovaries are stimulated with drugs to produce a number of ripe eggs, which are then collected by a needle inserted through her vaginal wall. The eggs are then placed in a Petri dish in a special medium and mixed with a sperm sample that was provided while the eggs were being collected. Embryologists monitor the fertilization of the eggs and the development of embryos over the next 5 days. At the 5 day mark, one or two embryos will be returned to the uterus and any remaining embryos will be frozen for implantation during future cycles.
Couples using IVF have a pregnancy rate of 29 percent. Women younger than 38 have a slightly higher success rate (38% live birth rate) and those over 38 have a lower success rate (8-20% live birth rate depending on age). Women over age 42 have little chance of conception with IVF over natural methods.
How can TCM contribute to a good outcome in an IVF cycle?
-increase ovarian responsivity (and reduce FSH levels if they are elevated)
-increase estrogen levels if they are low
-enhance follicle/egg quality
-improve sperm vitality
-relieve side effects of drugs
-increase endometrium thickness where it is too thin
-increase implantation rates
Traditional Chinese Medicine versus IVF
IVF aims to increase the number of eggs (not the quality of the eggs). It increases the odds of success by increasing the number of eggs produced. The thickness of the uterine lining is the other factor measured. Treatment with Traditional Chinese Medicine does not influence the number of eggs ovulated but rather focuses on how well the eggs are nourished and stimulated to grow and travel down the fallopian tubes. It can also increase the number, motility, and genetic quality of sperm. Chinese medicine focuses on the overall health of the parents with special emphasis on the kidney-Qi (energy) and jing (essence) as the kidneys are in charge of reproduction and development according to TCM.
TCM is free of side effects and risks to mother and baby, is time-tested, and holistic. One thing about TCM that patients should be patient with is the fact that it is a bit slower acting than most western medical procedures.
TCM emphasizes quality over quantity in IVF clinics. Kidney-Jing (essence) is the quality of inheritance that is being ignored in IVF clinics. Some studies are showing an increased risk of low birth weight and birth defects in IVF and ICSI (Intracytoplasmic sperm injection) babies.
Traditional Chinese Medicine is not necessarily the best method of treatment for all to-be-parents. The TCM doctor will tell the patients if they think that they should seek IVF treatment instead of or in addition to TCM.
Chinese Herbal Medicine
Typically for patients undergoing IVF and other Assisted Reproductive technologies (ART), I may not prescribe Chinese herbal medicine. The drugs that they are given are very strong and have unpredictable responses. Always consult your doctor before taking any herbal medicinals or supplements if you are on hormonal medications.
Chinese medicine increases the thickness and the quality of the lining of the uterus. It does this by promoting corpus luteal function in producing high levels of progesterone and increasing blood flow to the uterus. Patients who take Chinese medicine before and after egg pick-up during IVF have high progesterone readings.
The use of acupuncture has a very good effect and enhances IVF results. There is no restriction with its use. Acupuncture is useful in facilitating movement in the fallopian tubes and preventing spasm of the fine muscles in the walls of the tubes.
Acupuncture improves the outcome of IVF in four ways:
- Can alleviate the side effects of medical treatments and improve response to hormonal stimulation.
- Can improve the blood flow to the uterus and ovaries
- Can alleviate tension which is caused by these extremely stressful procedures
- Can calm the uterus to prepare it for implantation
When ovaries are functioning well, they are responsive to stimulation by FSH and the estrogen levels will be high. High estrogen levels prime endometrium development, stimulate more follicles and possibly contribute to better quality eggs.
Traditional Chinese Medicine (TCM) for preparation of an IVF cycle:
Considering the low success rates of IVF, anything you can do to prepare your body for a successful procedure is worthwhile. The need for hormonal health before IVF is important for men as well. Conceptions resulting from fathers with low sperm count, poor sperm morphology, or impaired motility have higher incidences of miscarriage and increased chance of genetic defects. A study in the New England Journal of Medicine in spring 2002 reported that the risk of defect doubles when IVF procedures include ICSI (Intracytoplasmic sperm injection – used when sperm are not healthy enough to penetrate the egg on their own).
A woman’s best response to IVF will depend on her overall endocrine status the few months before the procedure, when the follicles are developing within the ovary. Often women become pregnant in the few months that they are preparing themselves for the IVF procedure as a result of TCM.
Research on Effectiveness of Acupuncture with IVF
A recent study published in Fertility and Sterility found that 26% of women undergoing in-vitro fertilization (IVF) became pregnant following the procedure compared to 43% who received acupuncture before and after IVF. This represents a nearly 50% increase in effectiveness of IVF combined with acupuncture. Women in both groups were matched for age, number of transferred embryos and number of previous cycles among other criteria. As IVF is an expensive procedure, increasing pregnancy rates with acupuncture can save women both money as well as decrease emotional distress associated with the repeated use of this procedure.
According to another study recently published in the journal Medical Acupuncture, acupuncture may stimulate egg follicle development in women undergoing in-vitro fertilization (IVF). In a small study of six women who all had difficulty with follicle production despite maximum hormonal therapy, three produced significantly more follicles with acupuncture treatment and all three conceived, although only one pregnancy lasted past the first trimester. Acupuncture also appeared to increase estrogen levels.