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The Integrative Approach of Traditional Chinese Medicine (TCM) and Reproductive Technology (i.e. IUI and IVF)

22 Jan 2024

By: Kang Ting Tan

Article, Acupuncture, Blog, Fertility, IVF, Physician KT 陈医师

Infertility, characterized by the inability to conceive after a year of active attempts, affects both men and women alike. Assisted Reproductive Technology (ART), such as Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF), becomes a viable option when conventional methods fall short. However, the challenges of these fertility treatments, marked by stress and expenses, create high expectations for success. IUI is a fertility treatment involving placing sperm inside a woman’s uterus through a catheter by a gynaecologist to facilitate fertilisation. The goal is to improve the chances of fertilization by increasing the number of sperms (by giving them a “shortcut”) that reach the fallopian tubes during ovulation and thus increase the chances of pregnancy. IVF refers to the fertilisation of an egg outside the body. During IVF, mature eggs are retrieved from ovaries and combined with sperm in the laboratory to achieve fertilisation. Then, the fertilised egg(s)/embryo(s) are transferred to a uterus.  Both are commonly used to improve the chances of pregnancy. Contrary to common belief, TCM, particularly acupuncture, proves to be a synergistic partner with modern medicine, enhancing the body’s condition and augmenting the success rates of IUI and IVF. Let’s understand conception first “Seed  and Soil” Analogy (种子论) Conception is like gardening and there are 3 basic requirements for fertilization to take place. Fertile, nutritious Soil  肥沃的土地–having a healthy developed uterus and endometrium lining and no “weeds” like cysts, endometriosis or fibroids that can affect implantation and growth  Seeds of life 种(zhong3)子 ( *种子必先育卵*) – Healthy egg and the sperm are crucial components for successful fertilization Time is key 对的时间点– Sperm and egg need to meet at the correct time and location, i.e. during ovulation (usually day 12-16 of the period cycle)  Age and its Impact on Fertility: For decades, the average marriage age has been in the 20s. However, getting married in the 30s may just be the new normal. Getting married later in life is a modern trend and hence affects reproductive and fertility status.  The optimal age for childbearing is between 20 and 35. The proportion of women aged 35 years and above who are intentionally delaying pregnancies has been rising in the past few years. Delayed pregnancies lead to an increased chance of infertility. Ovarian Reserve and Ageing: TCM acknowledges the natural reduction in ovarian reserve with age, emphasizing the correlation between age and declining fertility. Women are born with a fixed number of oocytes (eggs) inside their ovaries. 1 Age No of Eggs Puberty 300,000-500,000 20-30 100,000-300,000 30-40 10,000-50,000 40-50 1,000-10,000 50 (Menopause) 1000+ Ageing naturally reduces a woman’s ovarian reserve. The quantity and quality of a woman’s ovarian reserve declines with age. At the start of puberty, there can be 300,000- 500,000 eggs and it reduces to about 25,000 at around the age of 37. Male Infertility and Its Causes: On the other hand, male infertility is responsible for up to 30% of infertility. It can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm.  Sperm quality: low sperm count, poor sperm mobility, abnormally shaped sperm or no sperm present.  Varicoceles (enlarged veins in the scrotum) can negatively impacts testicular sperm production Obstruction of the vas deferens or epididymis (the tubes that carry sperm). Blockages can be a result of infection such as traumatic injury or gonorrhoea. Enhancing sperm count and quality involves adopting positive lifestyle changes. Consider the following measures: Stop smoking  Tobacco smoke contains more than 4000 kinds of chemicals, including nicotine, tar, carbon monoxide, polycyclic aromatic hydrocarbons and heavy metals. Smoking is associated with dysfunction of spermatogenesis and impaired spermatozoa function2, leading to reduced semen quality including semen volume, sperm mobility, sperm density and normal morphology.  Stop habitual heavy alcohol consumption  Alcohol can affect sperm mobility and alter sperm count, shape and mobility. In men, heavy drinking can lower testosterone, follicle stimulating hormone, and luteinizing hormone levels  and increase estrogen levels3. These hormone changes can reduce sperm production and development.  Have a  healthy diet rich in fruits, vegetables and whole grains.   Do not be a picky eater. You may be lacking zinc, Vitamin B, C or E. Zinc deficiency impedes spermatogenesis and causes sperm abnormalities4. Zinc cannot be stored in the body and hence regular dietary intake is essential. Vitamin C And E are essential antioxidants that protect the cells from damage from oxidative stress and free radicals.  Avoid excessive heat The normal physiological temperature of the human testis ranges between 32 and 35 °C. It is cooler than the core body temperature of 36.9°C. This is essential for optimal sperm production, maturity and function5. Hence, it is important to avoid potential heat exposure to the testicles such as prolonged hot baths, laptop, high-temperature work area and prolonged sitting. Avoid wearing tight pants too as it can affect the blood circulation to the testes.  Reasons for Choosing IUI and IVF: We recognize the various reasons (listed below), including cervical mucus conditions, ovulation disorders, and unexplained infertility, leading couples to opt for ART. Unexplained infertility Hostile cervical mucus condition Ovulation disorder Fallopian tube blockage or damage Impaired sperm production or function (poor sperm motility, count or quality) Ejaculation dysfunction Acupuncture’s Role in Enhancing IUI and IVF Success: Accepted Treatment for IUI and IVF: Acupuncture’s compatibility with Western medicine makes it a widely accepted form of treatment for ART. Optimizing the Body with Acupuncture: TCM’s acupuncture sessions, especially when initiated three months before IUI/IVF treatments, are highlighted for their role in conditioning the body for optimal success. This is especially so for those who have low ovarian reserve or poor egg quality.  Improving Sperm Quality: Acupuncture’s positive impact on reducing structural defects in sperm and enhancing quality, mobility, and concentration of sperm with normal morphology is emphasized6,7. As couples navigate the intricate journey of fertility treatments, the harmonious integration of Traditional Chinese Medicine, notably acupuncture, with modern reproductive technology emerges as a holistic and powerful strategy. This comprehensive approach not only enhances physical well-being but also addresses the emotional toll, providing a personalized path to fertility success. Embracing TCM alongside conventional treatments presents a well-rounded and supportive framework for individuals seeking to maximize their chances of conception. References: https://www.healthline.com/health/womens-health/how-many-eggs-does-a-woman-have#eggs-at-puberty https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814952/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761906/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010824/ https://www.clevelandclinic.org/reproductiveresearchcenter/docs/publications/93_Durairajanayagam_et_al_Heat_Stress.pdf https://www.webmd.com/infertility-and-reproduction/news/20050803/acupuncture-may-improve-sperm-quality https://www.sciencedirect.com/science/article/pii/S2305050015000226
Traditional Chinese Medicine (TCM) in Assisting In-Vitro Fertilization (IVF)

05 Jan 2024

By: Sheryl Tay

Article, Acupuncture, Blog, Fertility, IVF, Physician Tay 郑医师, Pregnancy

In recent years, the integration of Traditional Chinese Medicine (TCM) with Western medical practices has gained significant attention, one notable application is the complementary role TCM plays in enhancing the outcomes of In-Vitro Fertilization (IVF). As more couples seek fertility treatments, the holistic approach of TCM is increasingly gaining popularity and getting recognized for its ability to support and optimize the IVF process.IVF is a type of fertility treatment where sperm and an egg are fertilized outside of the human body. Several days after fertilization, the fertilized egg (embryo) is placed inside the uterus. Pregnancy occurs when the embryo implants into the uterine wall. It’s a procedure used to aid in achieving pregnancy conception in individuals who are having difficulty doing so spontaneously. IVF involves many complex steps and is an effective form of assisted reproductive technology (ART). https://yitcm.com.sg/wp-content/uploads/2024/02/ivf.mp4A competent embryo and receptive uterus are two critical components for a successful implantation and therefore successful conception. TCM is shown to be a useful complementary tool to support IVF procedures and increase success rates. How does TCM support IVF? Optimising womb environmentTCM practitioners focus on promoting a balanced flow of Qi and enhancing blood circulation throughout the body, especially to the reproductive organs. Improved blood flow helps nourish the ovaries and uterus, creating a more conducive environment for successful embryo implantation[1]. TCM herbs and acupuncture can also help improve uterine lining thickness, as well as to increase endometrium receptivity (the ability of the endometrium to accept embryos) [2]. Enhancing Egg Quality and Sperm HealthImproving the quality of egg and sperm is crucial for successful fertilisation and the development of a good quality embryo. This can therefore increase the chances of conception [3].  Kidneys in TCM govern the reproductive system. Hence, by invigorating the kidneys is one of the ways to improve egg quality as well as sperm quality. Increasing blood circulation throughout the body also enhances the blood circulation to the ovaries and testes, thereby nourishing the eggs and sperm with good oxygen and blood flow, hence enhancing the quality of eggs and sperm.Reducing inflammation and stress also plays a part in improving the quality of egg and sperm, hence increasing the chances of a successful pregnancy. Reducing Stress:The process of IVF can be emotionally and physically taxing, involving hormonal treatments, invasive procedures, and the emotional rollercoaster of hope and disappointment. This stress may further exacerbate the challenges of infertility. Some researchers suggest that a patient’s mental and physical health can influence the success rate of IVF. TCM, through acupuncture and herbal medication, helps reduce stress levels, promoting a more favorable environment for successful IVF. Stress management can also positively impact the hormonal balance and improve the chances of conception. Minimising Side Effects of IVF Medications:The medications used in IVF procedures can sometimes cause side effects such as bloating, hot flushes, irritability, headaches etc. TCM interventions can help alleviate these side effects, promoting the overall well-being of the individual undergoing IVF [4]. Supporting Implantation and Pregnancy:TCM treatment before and after embryo transfer can help prepare the uterus for implantation and support the embryo’s attachment and reduce the risk of miscarriage. It can also reduce stress and anxiety, which can positively impact the success of the transfer.   It is recommend to start receiving TCM treatments three months before going through IVF. This gives the TCM physician a chance to assess and adjust the underlying body constitution to improve fertility and increase chances of conceiving. However, if you have already started on drug stimulations, your TCM practitioner will schedule your treatments in line with your IVF procedure schedule. The image below is a rough timeline of the acupuncture sessions in preparation for and during IVF treatment. TCM Treatment modalities in supporting IVF 1. Acupuncture Acupuncture is the insertion of fine needles into the body at specific points called “acupoints”. Acupuncture points are believed to stimulate the central nervous system. This, in turn, releases chemicals into the brain. These biochemical changes may stimulate the body’s natural healing abilities and promote physical and emotional well-being.    Therapeutic effects of acupuncture: Remote therapeutic effect of acupuncture: Infertility is due to imbalances in the organ systems in the body e.g. the kidney, liver and spleen. Therefore, via Remote Therapeutic Effect of acupuncture, by stimulating the acupoints located along the meridian channels governed by the respective organ system, it helps to rebalance the organ system, facilitating natural healing mechanisms, thereby improving fertility.   Systemic Therapeutic Effect of acupuncture: It is known that TCM can help to improve blood circulation, be it to the womb, ovaries or testes. Therefore, via Systemic Therapeutic Effect of acupuncture, some acupoints are known to have “unique” functions such as to improve “blood” (血海 SP10 acupoint), regulate menstruation(三阴交 SP6 acupoint), improve “qi” (足三里 ST 36acupoint),  etc, thereby contributing to increasing chances of conceiving. 2. Herbal medicationHerbal medication will be prescribed according to the individual’s body constitution, restoring the body’s imbalances thereby improving fertility. A licensed TCM Physician would first consult the patient to understand and diagnose their body constitution, before prescribing herbal medication which can help to improve the quality of eggs or sperms, to increase the thickness and quality of endometrium lining, to improve uterine environment etc.Secondly, some may experience stress and anxiety. Herbal medication could help manage stress, anxiety, and mood swings. Furthermore some may experience side effects of going through IVF. Herbal prescription could also be prescribed to aid the patient in having a better experience going through IVF.Do note to consult a licensed physician and always check with the physician before taking any herbal supplements or medicine. 3. MoxibustionInvolves the burning of the herb mugwort (艾草), the effects of mugwort would penetrate through the skin and into the body. Mugwort is used due to its warming properties. Secondly, due to its abilities to dispel dampness, eliminate stagnation, dissolve stasis, thereby improving blood circulation in the body. Moxibustion for fertility would usually be done on the lower abdomen or on the lower back. References:[1] Chen Q., Hau C. Impacts on pregnancy outcome treated with acupuncture and moxibustion in IVF-ET patients. Zhongguo Zhen Jiu . 2015;35(4):313–317.[2] Jin F, Ruan X, Qin S, Xu X, Yang Y, Gu M, Li Y, Cheng J, Du J, Yin X, Mueck AO. Traditional Chinese medicine Dingkun pill to increase fertility in women with a thin endometrium-a prospective randomized study. Front Endocrinol (Lausanne). 2023 Sep 28;14:1168175.[3] Zhou L., Xia Y., Ma X., et al. Effects of menstrual cycle-based acupuncture therapy on IVF-ET in patients with decline in ovarian reserve. Zhongguo Zhen Jiu . 2016;36(1):25–28[4] Altutunji A. Z., Liu L., Cai J., Wang Z., Gao Y. The effect of acupuncture on anti-mullerian hormone and assisted reproduction outcome in Polycystic Ovary Syndrome patients undergoing in vitro fertilization. JPMA. The Journal of the Pakistan Medical Association . 2019;69(Suppl 3)(8):S4–S8

Featured

Acupuncture for IVF

14 Jun 2023

By: Tian Chi Peh

Article, Acupuncture, Fertility, IVF, Physician Peh 白医师

In Vitro Fertilization (IVF) is a fertility procedure that fertilizes an egg with sperm in a laboratory dish. During IVF treatment, the ovaries are stimulated through the use of medication that is injected beneath the skin with a thin needle. Matured eggs from the ovaries are then collected and cleaned by the doctors before they can be fertilized by sperm in the lab. The successfully fertilized egg will then be prepared for implantation and placed in the uterus to achieve a healthy pregnancy. Acupuncture treatment can be regarded as a complement to IVF treatment  as it can stimulate blood flow and create harmony within the body. Moreover, acupuncture treatment can induce relaxation and improve the physical and emotional well-being of our patients. Acupuncture plays a major role in relieving stress and supporting IVF in various ways.  We hope to go through this stressful and intense procedure with you and make your IVF journey a pleasant one. TIMELINE OF ACUPUNCTURE FOR IVF The pretreatment phase of acupuncture for IVF is a crucial starting point. During this stage, you’ll consult with a licensed acupuncturist who specializes in fertility to assess your individual needs and create a personalized treatment plan. The goal here is to prepare your body for the upcoming IVF cycle by addressing any existing health issues, reducing stress, and optimizing your overall well-being. Acupuncture sessions during this phase can help regulate your menstrual cycle, balance hormones, and lay the foundation for a successful IVF journey. Ovarian stimulation is a vital part of the IVF process where fertility medications are used to stimulate the ovaries to produce multiple eggs. Acupuncture can complement this phase by promoting optimal blood flow to the ovaries. Improved circulation can enhance the response to fertility medications, potentially leading to better egg quality and increased egg production. Acupuncture sessions during this stage are carefully timed to align with your medication schedule to maximize their benefits. Just before egg retrieval, the final egg maturation phase is crucial. Acupuncture can be used to support the body as it prepares for this pivotal moment. By focusing on specific acupuncture points, your practitioner can help ensure that the eggs are of the highest quality and that your body is in the best possible condition for the retrieval procedure. Egg retrieval is a minor surgical procedure that retrieves mature eggs from the ovaries. Acupuncture can help reduce anxiety and discomfort associated with this procedure by promoting relaxation. Many patients find that acupuncture before and after egg retrieval helps them stay calm and recover more comfortably. In vitro fertilization (IVF) is the process of fertilizing eggs with sperm outside the body. Acupuncture can support this phase by continuing to regulate hormone levels, improve blood flow to the uterus, and enhance overall reproductive health. These benefits can contribute to the success of fertilization and the development of healthy embryos. During the culturing of embryos, the developing embryos are monitored and nurtured in the laboratory. Acupuncture can aid this phase by promoting relaxation and reducing stress. Stress reduction is essential, as high stress levels can potentially interfere with the implantation of embryos into the uterus. Embryo transfer is a pivotal moment in the IVF journey. Acupuncture before and after the transfer can help prepare the uterus for implantation and support the embryo’s attachment. Acupuncture can also reduce stress and anxiety, which can positively impact the success of the transfer. The two-week wait refers to the period following embryo transfer, during which you await the results of a pregnancy test. Acupuncture during this phase can provide emotional support and relaxation, helping you manage the anxiety and uncertainty of this waiting period. It can also assist in stabilizing hormone levels to support a potential pregnancy. Stress Reduction Stress is a common factor that can negatively impact fertility. The emotional and physical toll of infertility and the IVF process can be overwhelming. Acupuncture offers a holistic approach to stress reduction by stimulating the release of endorphins, the body’s natural stress relievers. By reducing stress levels, acupuncture can help create a more conducive environment for successful IVF treatments. Improved Blood Flow Acupuncture enhances blood circulation by dilating blood vessels and increasing blood flow to the reproductive organs. Improved blood flow can lead to better nourishment of the ovaries and uterus, potentially enhancing the development of healthy eggs and a receptive uterine lining for embryo implantation. Hormone Regulation Hormonal imbalances can be a significant factor in infertility. Acupuncture can help regulate hormone levels by influencing the endocrine system. This can be particularly beneficial for women with irregular menstrual cycles or conditions like polycystic ovary syndrome (PCOS) that affect hormone production. Enhanced Egg Quality Acupuncture may contribute to better egg quality by reducing oxidative stress. Oxidative stress can damage eggs and sperm, affecting their viability. By minimizing oxidative stress, acupuncture can potentially improve the quality of eggs retrieved during IVF, increasing the chances of a successful pregnancy. Increased IVF Success Rates Numerous studies suggest that acupuncture can improve IVF success rates. By addressing various aspects of fertility, such as stress reduction, improved blood flow, hormone regulation, and egg quality, acupuncture can help couples achieve their dream of parenthood. This natural approach complements the medical interventions of IVF, offering a holistic solution to infertility. Personalized Treatment Plans Acupuncture practitioners create individualized treatment plans tailored to the unique needs of each patient. This personalized approach ensures that the acupuncture sessions target specific fertility issues, maximizing their effectiveness throughout the IVF process. Conclusion As an adjunct therapy to IVF, acupuncture offers a holistic approach to fertility enhancement. By addressing stress, improving blood flow, regulating hormones, and enhancing egg quality, acupuncture can increase the chances of a successful IVF outcome. If you are considering IVF or seeking natural ways to optimize your fertility, acupuncture may be a valuable addition to your journey towards parenthood. If you’re interested in exploring the benefits of acupuncture for IVF, consult with a qualified acupuncture practitioner who specializes in fertility treatments. Together with your medical team, they can help you create a comprehensive approach to support your fertility goals. For more information on acupuncture and IVF, or to schedule a consultation with our experienced practitioners, contact Yi TCM today. Our team is dedicated to helping you achieve your dreams of building a family through personalized and holistic fertility support.