What is infertility?

When a couple do not conceive (get pregnant), despite having regular sex over a sustained period of time, certainly over 1 year, and generally much longer.


What causes problems conceiving (in Western Medical terms)?

In 25-30% of cases the cause of infertility remains unidentified by medical tests.  The problem can be either with the woman or the man.

For both men and women causes include:

  • Stress
  • Over or under weight
  • Sexually transmitted diseases (STDs)
  • Smoking

For women causes include:

  • Ovulation disorders, perhaps due to Polycystic ovarian syndrome (PCOS), thyroid problems or premature menopause
  • Womb and fallopian tube disorders
  • Previous surgery (to the cervix or pelvis)
  • Cervical mucus defect
  • Fibroids
  • Endometriosis
  • Pelvic inflammatory disease (PID)
  • Drugs or medication
  • Age

For men, the main causes include:

  • Low sperm count
  • Low sperm mobility
  • Abnormal sperm
  • No sperm - due to obstruction
  • Testicular problems (Eg. infection, cancer, surgery, trauma, undescended testicles)
  • Ejaculation problems
  • Low testosterone
  • Medication

Conventional treatment for infertility?

Conventional treatment will begin with questions, a physical examination, blood tests, and potentially physical tests - all to try to understand the cause.

If you have not had cancer, and are under 35, you will probably only see you GP if you have been trying to conceived without success for 1-2 years.

Questions you will be asked may include: your age, how long you've been trying, how often you have sex, history of miscarriage or abortion, length of time off contraception, other medical history, if you smoke, how much you drink, if you take any drugs, your stress levels, etc.  Your weight will be taken.  A woman may have a physical examination of her pelvis.  A man may have a physical investigation of his testicles and penis.

Further tests for a woman:

  • Blood tests will be taken for hormone levels, the day to test, and guide to normal levels:
  • Progesterone: seven days before your period.  It should be > 15 ng/ml (Day 3: <1.5 ng/ml)
  • Follicle stimulating hormone (FSH): at Day 3.  Normal is less than 9
  • Lutenising hormone: around ovulation "surge day".  It should be >20mlU/ml
  • Thyroid: at Day 3. Should be: T3: 1.4-4.4pg/mlT4: 0.8-2 ng/dl
  • Prolactin: Day 3. Should be:  <24 ng/ml
  • Testosterone: Day 3Total Testosterone should be under 50,  free Testosterone: 0.7-3.6 pg/ml
     
  • You may be tested for any sexually transmitted diseases (STDs), particularly chlamydia
  • An AMH test: not often offered on the NHS, but a very valuable test to undertake.  This tests the level of anti-Mullerian Hormone in the blood and indicates if the ovaries are still releasing eggs, and how many eggs are left in the ovaries.
     
  • Optimal fertility: 28.6-48.5 pmol/l
  • Satisfactory: 15.7-28.5 pmol/l
  • Low fertility: 2.2-15.6 pmol/l

 

Physical tests:

  • Hysterosalpingogram (HSG): to identify if the fallopian tubes are blocked
  • Laporoscopy to investigate your womb, fallopian tubes and ovaries

Further tests for a man:

  • Semen analysis
  • Tests for sexually transmitted diseases, particularly chlamydia

Western Medical treatment for infertility

Treatment depends on the outcome to the results above.  There are three options:

  • Medication to aid fertility
  • Surgery
  • Assisted conception

Medication

  • Clomifen or Tamoxifen: for ovulation problems
  • Metformin: for Polycystic Ovarian Syndrome (PCOS)
  • Gonadotrophins: for women to stimulate ovulation
  • Gonadotrophins: for men improve male fertility

Surgery

For women:

  • Fallopian tube surgery: to resolve blockages
  • Laparoscopy: to resolve endometriosis

For men:

  • Correction of an epididymal blockage
  • Surgical extraction of sperm

Assisted conception

  • Intrauterine insemination (IUI):  sperm are collected and selected, and placed into the womb by a fine plastic tube at ovulation.  Ovary stimulating hormones may also be used to increase conception chances.
  •  In-vitro fertilisation: eggs and sperm are collected, fertilised in the laboratory, and the placed back into the woman's body.  The woman takes fertility medication to encourage more eggs than normal.
  • Egg and sperm donation: you may be able to receive eggs or sperm from a donor, if there is a problem with your own.

How do I treat infertility?

Acupuncture

Chinese Medicine, not surprisingly has a rather different view of infertility.  "Age related Yin deficiency is one of the most common reasons for infertility in the West."  Says According to Jane Lyttleton, a mid-wife and acupuncturist.

I view Yin, as the energy in the batteries when we are born - as we grow older we use up the batteries - they are re-chargable, by good lifestyle, for example, a nourishing diet with lots of water, good rest, regular exercise, avoiding stress and overwork.  Looking after yourself is vital to prepare yourself for a healthy pregnancy.  If you are not healthy your chances of conception and a healthy pregnancy are greatly diminished.

Furthermore, cold is also a problem - Yang energy is experienced as women get hotter in the second part of their cycle - this energy moves the egg into the uterus and ensures it is safely implanted.  If there is cold, due to skimpy tops, or a tendency to cold this will affect ovulation, conception and the movement and support of the embryo after conception.  Also, Kidney Yang is consumed by miscarriages, abortions and burning the candle at both ends.  Thyroid problems can compromise the Kidney Yang.

Prolonged stress causes stagnation of energy - of the Heart or Liver, and can cause Kidney Yang to suffer too.  This therefore affects the ability to conceive.

To identify what is going on for you I like my female patients to record their temperature first thing each morning, and note any other observations: bleeding or spotting, changes of mucus, breast changes, abdominal pain, or any other symptoms such as insomnia, etc.

The healthy cycle follows a pattern:

Day 1 - 10 lower temperatures

Day 12 - 14 a higher temperature

Day 14 - ovulation the temperature should rise 0.3-0.4 degrees

If this is not happening it enables much easier diagnosis and treatment: yin deficiency, cold, yang deficiency, etc.

I treat weekly - to accommodate the different phases of the cycle - nourishing Yin, boosting Yang, moving Qi, etc at the right time of the cycle.

Acupuncture for ART

If you are already planning ART, I use acupuncture to support the process, and improve the success rate.  This helps both emotionally and physically, and according to a German study by Shulan Tang, Chinese Medicine has been shown to increase the success rates of IVF by up to 70%.

Frequency of treatment suggested:

  • Down regulation: weekly treatment
  • Ovarian stimulation: weekly
  • Egg ripening: treatment at this stage
  • Egg collection: treatment immediately before egg collection*
     
  • emen collection: immediately before
     
  • Embryo transfer: 30 mins or as soon as possible before
  • After embryo transfer: 30 mins or as soon as possible after transfer
  • Until 12 weeks after embryo transfer: weekly - or more regularly if symptoms arise
  • Thereafter: weekly or as the patient feels they want it

* My practice is located close to the Chelsea and Westminster Hospital, so it is easy for patients attending there.  However, other patients have come as close to these times as possible, dependent on where they are being treated.

Kinesiology

I will muscle test for any pathogens, toxicity, homocystein or any other markers of compromised health.  If you are not in top health yourself, it is difficult to conceive.

I will test both partners (if both seek guidance) for common supplements advised for pre-pregnancy eg. a multivitamin and mineral supplement, folic acid, essential fatty acids, perhaps Glutathione (to reduce homocystein, if present), plus any relevant herbs.

I will give lifestyle and dietary advice.

EFT

EFT may be used to clear the strong emotions and anxiety of another month without conception.  In addition, it can be used to clear any limiting beliefs about your ability to get pregnant, your ability to be a good mother, your guilt about previous abortions, or other key emotional blocks that might be preventing your conception.

Hypnotherapy

I have found outstanding success combining my therapies with hypnotherapy for infertility.  I do not practice hypnotherapy, but I work with two excellent practitioners which complements my own treatment.

Effectiveness of treatment

It is difficult to generalise. In my clinic, I have witnessed successful conception with both unassisted conception and with IVF.  However, not all patients will fall pregnant, and not all patients can come weekly.  However, most patients do notice an improvement in their stress levels, and an improvement in any symptoms - hence their overall health is improving as we work together.

Evidence

1. A report published in the journal Fertility and Sterility (2002) found the pregnancy rate in the group receiving acupuncture group was 42.5%, compared to the group which did not receive the therapy, where the rate was 26.3%.

2. A 2004 study conducted by the Reproductive Medicine and Fertility Center in Colorado found that 51% of women who underwent both IVF and acupuncture treatment at the same time became pregnant, while only 36% of those who only underwent IVF did. The latter group also had higher rates of miscarriage and stillbirth (20%) compared to those women who had received acupuncture (8%).

3. A 2005 study conducted by Shanghai University in China found that acupuncture also helped treat male infertility. Of the men who participated, those who had acupuncture had an increased percentage of sperm in their semen; their sperm structure and morphology was also healthier than their counterparts who did not undergo acupuncture infertility treatment.

Source: British Acupuncture Council

4. Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39471.430451.BE (Published 6 March 2008)

Cite this as: BMJ 2008;336:545

Further research into female infertility and acupuncture is provided by the British Acupuncture Association

Further research into male infertility and acupuncture is provided by the British Acupuncture Council

 

Each case is slightly different, so to discuss your symptoms further call 020 7370 4693 or email.


A case study from my clinic

Vanessa, 34 years

Vanessa was referred to me by a psychotherapist (not getting pregnant was really getting to her) - she and her husband had been trying to conceive for 18 months.  Her periods were regular - anywhere between 28 to 31 days, she would get a little spotting before her period, and would need painkillers on the first day, for cramping pain.  Her health generally was good, she did get hay fever, and other allergies; she'd had knee problems in the past, and was prone to getting hot in the afternoons and at night.

I saw Vanessa either two weekly, or monthly as her work schedule would allow.  First with acupuncture - although Vanessa wasn't keen to take her temperature every day because she was keen to avoid over emphasis on "certain times of the month".  Even without this extra information I could still identity the stuck energy - cramps at the beginning of her period.  The Kidney Yin deficiency - the tendency to get hot, and the knee problems; and the Spleen deficiency - indicated by the spotting.  My treatment plan reflected these symptoms.

Kinesiology identified toxicity, for which alpha lipoic acid was recommended - a strong anti-oxidant.  Evening Primrose Oil and a good multi-vitamin were recommended.

EFT was used - there were two main emotional issues.  Vanessa had had chlamydia when she was 21 years, and she was convinced this had affected her fertility.  Additionally, her mother had had problems conceiving and she felt she too would have problems.  We worked on these beliefs with EFT, plus any other stresses as they presented.

Within the first two months Vanessa was feeling much better emotionally, physically the spotting had stopped, and she no longer needed a painkiller at the beginning of her period, after six months her cycle was a regular 28 days.  Around this time she was mentally preparing for IVF.  After about 12 treatments - she started the IVF programme, I treated her a little to support her through this - although her hospital was not near to me, so it wasn't geographically easy to get to me around egg collection and implantation.  Sadly, the IVF failed.  During the "rest" month, before the next round of IVF she took a break from work, went away for 2 weeks, and had a good rest - during this time she conceived, naturally!

Vanessa had a healthy pregnancy, although she was careful to look after herself, she was able to work throughout her pregnancy, and gave birth to a healthy 9lb boy.


Lifestyle advice for infertility

Remember the cause of infertility could be either partner - so both should try to follow these guidelines as much as possible.

  • Avoid stress

Stress reducing tips:

  • Get good rest, at least 8 hours a night, the more before midnight the better
  • Take a walk in nature: the countryside or a park
  • Try yoga, Qi Gong or Tai Chi
  • Engage your creativity: painting, playing an instrument, taking pictures, creative writing (start with a journal)
  • Avoid over obsessing about emails, texts and the internet
  • Anything to provide balance to counteract a busy life

Ask yourself, what do I do to relax?  I hope you have an answer!  If so, make time for it.  If not - play and find out.

Other lifestyle advice

  • Get good rest
  • Take at least 30 minutes of gentle exercise each day: walking, swimming, yoga, or your favourite
  • Stop smoking
  • Reduce or avoid alcohol
  • Avoid processed food, including snacks of biscuits and crisps
  • Cut out or at least cut down on caffeine - coffee, tea, energy drinks, cola, etc
  • Cut down sugar consumption
  • Have good quantities of fresh fruit and vegetables
  • Drink 2 litres of water a day
  • Avoid icy food and drinks
  • Keep your lower back warm, particularly during your period
  • If you have a high BMI (body mass index) ie. >25 - make an effort to lose weight
  • Get tested for any sexually transmitted diseases

Finally of course, have lots of sex!  Enjoy this bit, don't do it just when it's a certain time of the month ... do it because it's fun!