Acupuncture for IVF and Assisted Reproduction

An integrated approach to treatment and management

Irina Szmelskyj, Lianne Aquilina, Alan Szmelskyj

• Publisher: Churchill Livingstone
• Year: 2014
• eBook ISBN: 9780702061189
• Topic: Medicine
• Subtopic: Acupuncture

The management of infertility using acupuncture is an expanding area of practice and one which is frequently rewarding for TCM acupuncture practitioners.Acupuncture for IVF and Assisted Reproduction has been specially prepared to meet the growing demand for information in this area and draws upon 20 years combined experience of the authors together with the latest evidence from both orthodox medicine and TCM.Richly illustrated and clearly written throughout, the book takes the reader through the anatomy and physiology of reproductive medicine (from both an orthodox and TCM perspective) and explains the underlying basis of orthodox medical fertility tests and investigations. The volume then explores the pathology and aetiology of TCM syndromes and shows how common fertility-related conditions, such as endometriosis and male factor infertility, affect Assisted Reproductive Technology (ART) success rates. It explains in great detail how to take a reproductive medical history and successfully diagnose TCM syndromes. Acupuncture for IVF and Assisted Reproduction also provides guidelines on how to regulate the menstrual cycle in preparation for IVF treatment and shows how lifestyle can affect fertility and ART success rates.Placing a strong emphasis on the practical aspects of patient care, Acupuncture for IVF and Assisted Reproduction contains an abundance of case history templates, algorithmic acupuncture treatment pathways and patient fact sheets and will be ideal for all acupuncture practitioners working in this field."A must have for the bookshelf of any acupuncturist who is ever called upon to treat fertility issues - if you have room for one book this surely must be it." Reviewed by The Acupuncture Fertility Centre March 2015"Practitioners of all levels of experience and TCM students should find it compelling reading and an invaluable companion to their learning." Reviewed by Stephen Clarke, Journal of the Australian Traditional Medicine Society May 2015"This book is extremely well re-searched and referenced." Reviewed by Danny Maxwell on behalf of Journal of Chinese Medicine, February 2015

Chapter 1

Subfertility overview

Introduction

‘Now the girls are here it could be so easy to forget just how different things were when we first met. But I won’t ever forget all of the advice and support you gave us, as well as your time (fitting us in around our [IVF] treatment even though it took some of your own valuable family time). You have made a real difference to us…’

‘We can't thank you enough for all your help (with your magic needles) – without you we don’t think we would have our beautiful daughter… We really believe you are… one of those who really make a difference in the world’.

‘I just wanted to convey my warmest thanks for your support, advice and clinical expertise which has helped us to conceive. We are over the moon. I am absolutely sure that we couldn't have done it without your input. Not only the acupuncture itself, but [also] the additional advice’.

‘I firmly believe that it was your knowledge, expertise and support that helped us conceive this much wanted baby and for this I thank you… I will never forget the impact you have made on my health, my grief and my ability to look to the future with positivity and happiness’.

‘Please accept a huge thank you from us, we truly believe that our successful IVF treatment, which resulted in our gorgeous little boy, was down to not only the excellent and professional acupuncture treatment but also your support and positive attitude. We feel incredibly lucky to have him and are loving every moment with him’.

‘A huge thank you for all the help and encouragement you have given me over the past year in the lead up to our IVF process. Your continued support during my pregnancy meant a lot and you gave me the added peace of mind… I am sure us now having our beautiful daughter is a result of your knowledge and care’.

‘I truly believe that acupuncture was one amongst all the treatments I had that led to my conception’.

‘We would like to just say a big thank you for all your help with the acupuncture and all the advice and support whilst I was going through my IVF…[for] going out of your way to always be available for our treatments. We will never forget your kindness and we will always be grateful we found such a good acupuncturist and also a lovely and caring person’.

‘You've made our dreams come true!’

‘We are pleased to announce the safe arrival of our baby boy. After five failed IVF cycles I am sure having acupuncture helped us to be successful on our sixth attempt. So thank you very, very much. Thank you once again and may all your good work continue to help others’.

Our treatment rooms’ bookshelves are full of cards with messages such as these. They are from our past patients who were previously considered subfertile, people who experienced infertility first hand and conceived as a result of an integrated acupuncture approach to Assisted Reproductive Technology (ART) treatments.

Many patients believe that it was acupuncture alone that made all the difference. But as fertility acupuncturists, we know that the reality is more complex. Infertility is a multifactorial disease, with many causes and many approaches to treatment. What makes a difference is not a single solution, but a combined team effort on the part of patients, ART clinics, acupuncturists, and sometimes other professionals.

Being a reproductive medicine acupuncturist is both rewarding and challenging – rewarding because we make a real difference in other people’s lives. We help them achieve their greatest dreams and become part of a team that helps to bring new life into the world. It is challenging because it takes a lot of dedication and determination to effectively help those suffering from infertility.

In this book, we hope to share with you the knowledge and experience that we have gained during our two decades of specializing in ART acupuncture. We begin by introducing you to infertility and explaining exactly what this disease is and what causes it.

Definition of Infertility Disorder

Most medical organizations agree that infertility should be defined as the inability to conceive after 1 year of regular unprotected intercourse (see Table 1.1). However, this definition can be confusing and open to varied interpretation.

Table 1.1

Definition of infertility

Organization	Infertility definition
WHO 2009^1	Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse
ASRM 2013^2	Failure to achieve a successful pregnancy after 12 months or more of appropriately, timed unprotected intercourse or therapeutic donor insemination
ESHRE 2010^3	Failure to conceive after 12 months of regular unprotected sexual intercourse
National Institute for Health and Clinical Excellence (NICE) 2013^4	Failure to conceive after frequent unprotected sexual intercourse for 1–2 years

Definition of pregnancy

Success in the field of reproductive medicine is defined as, for example, a ‘clinical pregnancy’, a ‘successful pregnancy’, and ‘conception’. So what is meant by ‘clinical’ or ‘successful’? The World Health Organization (WHO) defines a clinical pregnancy as ‘a pregnancy diagnosed by ultrasonographic visualization of one or more gestational sacs or definitive clinical signs of pregnancy. It includes ectopic pregnancy’.¹ The European Society of Human Reproduction and Embryology (ESHRE) definition is ‘a pregnancy diagnosed by ultrasound or by definite signs of pregnancy’.³ The American Society for Reproductive Medicine (ASRM) defines pregnancy as ‘a clinical pregnancy documented by ultrasonography or histopathologic examination’.²

If a woman experiences ‘pregnancy signs’ such as delayed menstruation, nausea, swollen and tender breasts, yet a pregnancy test result is negative, should this be classed as ‘clinical pregnancy’? Definite clinical signs of pregnancy can be evident within days of ovulation, yet up to 60% of pregnancies will fail even before they are confirmed by a pregnancy test.⁵ Ultrasonographic evaluation is not usually utilized until 12 weeks gestation, by which time up to 70% of pregnancies fail.⁵ So whilst WHO includes in its definition ectopic pregnancies, this may be inappropriate and more than just a tautological oxymoron. For example, if a woman loses both fallopian tubes as a result of ectopic pregnancies, she will be completely sterile. Yet by WHO’s de...

Table of contents

• Cover image
• Title page
• Table of Contents
• Dedication
• Copyright
• Biographies
• Foreword
• Preface
• Acknowledgements
• Chapter 1: Subfertility overview
• Chapter 2: Anatomy and physiology of the reproductive system: Prerequirements for conception
• Chapter 3: The magic of conception
• Chapter 4: Orthodox medical tests and investigations: Optimizing patient care
• Chapter 5: Investigations from a TCM perspective
• Chapter 6: The fundamentals of ART
• Chapter 7: Preconception care in preparation for ART
• Chapter 8: Identification and management of conditions detrimental to IVF outcome
• Chapter 9: Acupuncture during ART
• Chapter 10: Clinical issues during ART
• Chapter 11: ART complications
• Chapter 12: Managing the patient with a complex medical history
• Chapter 13: The therapeutic relationship in acupuncture practice
• Chapter 14: Aftercare
• Appendix I: Templates
• Appendix II: Basal body temperature (BBT) chart template and instructions
• Appendix III: Investigation reference ranges at a glance
• Appendix IV: Fertility factsheets
• Appendix V: Commonly used medications in ART
• Appendix VI: Medications known to adversely affect fertility
• Glossary of Orthodox medical terms
• Glossary of Traditional Chinese Medicine (TCM) terms
• Index