Infertility, Subfertility, and Fertility Enhancement

Paul L. Reller L.Ac. / Last Updated: August 03, 2017


The importance of thorough diagnostic testing to uncover the array of potential problems contributing to both female and male infertility

In both male and female infertility there is a tendency to perform fewer tests than is practical. The cost of testing is not great, but insurance companies and medical clinics often want to cut costs unnecessarily. Since fertility issues are often complicated, thorough testing is warranted. The couple could start with standard minimal testing, but if the results do not give a clear diagnosis, insist on further testing. Bring these test results to the Licensed Acupuncturist to help guide the therapy. While the acupuncturist relies on pulse analysis and other signs and symptoms patterns more than the standard medical doctor, test results and analysis are a concrete and reliable aid to the often tricky diagnosis. Even though this is standard medicine, and TCM uses different protocol, modern diagnostic evidence is important and applicable to the practice of the Complementary Medicine physician, and helps integrate the care with other health professionals.

Making sure you really have a problem with infertility before pursuing expensive synthetic fertilization techniques that have potential health risks

It is important to remember that a diagnosis of infertility is not made until the couple has unsuccessfully tried to get pregnant for one year, and in fact, a majority of couples that have failed to achieve pregnancy even after one year will have success in the following 3 years without standard fertility treatment (see research linked below from the European Society of Human Reproduction published in the Oxford Journals in 2004). CIM/TCM provides an integrative fertility protocol to help with any stage of fertility treatment and enhancement.

The couple must be aware that there is a short window of opportunity each month for an ovum to be fertilized, and timing of intercourse is cited as the most important factor for couples struggling with pregnancy. This window of opportunity, after ovulation, is often just one to three days, and so careful calculation and testing each month to take advantage of this short time period for the viable egg is important. Also, sperm counts may decrease by as much as a third with repeated ejaculations, and most fertility clinics will recommend that the male abstain from ejaculation for at least 2 days prior to collecting samples for measurement of sperm counts. Abstaining from ejaculation, and timing the first attempt each month correctly, may be important for couples that suspect the possibility of problems with getting pregnant, especially with aging. If the sperm and egg are as healthy as possible, the sperm may survive 3 days to fertilize a viable ovum, but if there is some problem with either the health of sperm, or the egg and surrounding support tissues, this window of opportunity for fertilization may be only one day. There are kits and other aids to help you determine this time of fertility each month, and this calculation and planning may be vitally important to conception. If your menstruation is irregular, or a premenstrual syndrome is a problem, these may be problems that inhibit conception, and it is advisable to first correct these problem with acupuncture, herbs and nutritional supplements. Optimum hormonal health within the menstrual cycle may be very important. Sometimes, nature does not give us a baby immediately, and patience and persistence are needed. A couple has to realize that natural conception sometimes takes time, and you can't just buy a pregnancy if you want a natural birth. Receiving healthy treatment with Complementary and Integrative Medicine while trying to conceive naturally is inexpensive and helps increase the chances of success. These treatments with acupuncture, herbs and nutrient medicines may also alleviate other health problems, prevent health problems, and contribute to overall health and quality of life. The side effects of treatment from a Licensed Acupuncturist or Naturopathic Doctor are better overall health, not negatives like we see with standard pharmaceutical care.

Statistics show that a high percentage of couples that assume that they are infertile do have a child if they persist in trying for 3 years. When adding this to the statistics for fertility treatments, we see that perhaps many of the couples that have paid a large amount of money for treatment and took powerful drugs conceived a child because of persistence, and not because something was medically wrong. This would bring down the statistics of real success for ART further, which are only about 30 percent, when couples who conceived merely because of persistence are factored in. Of course, there are no studies comparing these treatments to no treatment, which would emphasize the possible lower rate of real success of ART and drug induced pregnancy. We talk about the lack of evidence based on large randomized placebo controlled trials for so-called "alternative" medicine, where is this same evidence for IVF? This is another reason to first try an inexpensive and healthier method to try to conceive a child. In addition, synthetic hormonal drugs utilized even in IVF create sometimes drastic hormonal changes and have side effects that could potentially inhibit the chance for a natural conception following the IVF or other artificial fertility therapies. Trying to conceive naturally before utilizing these artificial fertility treatments is the sensible choice if there is any desire to try for a natural conception. Drugs used in fertility treatment do also have some potential risk for the fetus, as well as potential contribution down the line for the woman receiving these drugs, and her child. To avoid all risk of contribution to future hormone related pathologies, a natural conception is desirable.

If a healthier diet and lifestyle, coupled with persistence, is the formula for success in natural conception for many couples, the Licensed Acupuncturist is ideal to help advise on these issues and provide medical care to improve overally health and healthy reproductive function. Added counseling, improvements in overall health, focus on potential problems and solutions, and decrease in stress, are all added benefits to the care of a Licensed Acupuncturist. Integrating this care with standard fertility assessment, and even fertility advice from clinics promoting natural conception and problem solving, provides for even more chance of success. The cost of this integrated care is usually a small fraction of the cost from standard fertility clinics.

Both modern research and a long history of TCM treatment guides the treatment strategies for a Licensed Acupuncturist and Certified Herbalist

As modern research uncovers new methods for fertility treatment, this same research may be utilized in Complementary and Integrative Medicine to achieve success. Herbal chemistry is well studied and use of specific herbal chemicals may accomplish the same physiological actions as chemical pharmaceuticals. These are combined with formulas used successfully for centuries, as well as specific nutrient therapies. Each year the research data with herbal medicine and nutriceuticals grows exponentially. Strategies with acupuncture stimulation are well documented and success in acupuncture often depends upon the skill and experience of the acupuncturist. A number of studies have documented improved success with IVF when utilizing acupuncture, and are cited in the section of this article entitled Additional Information with links to the studies. In addition, more and more studies show that specific acupuncture and electroacupuncture stimulations achieve many of the biological goals needed to restore neurohormonal health that is needed to conceive naturally. Use of herbs that act as phosphodiesterase inhibitors have also been studied with IVF and found to increase success, and as we find the many factors that may inhibit fertility, specific biological mechanisms that may be corrected with herbal chemicals are also found. The successful Complementary Medicine physician, or Licensed Acupuncturist and herbalist, is able to review these studies and separate unsubstantiated claims from scientific fact, applying this research to the specific case.

Treatment outcomes with Complementary and Integrative Medicine (CIM) and Traditional Chinese Medicine (TCM) may be relatively quick, or may take quite some time. The treatment course involves short courses of acupuncture combined with a more prolonged step-by-step and individualized therapy with herbal and nutrient medicines, and advice with diet and lifestyle, and this is relatively inexpensive and easy to fit in a busy schedule. If there are problems with the physiological production of ova or sperm, the successful outcome will occur many months after the correction of the bodily function. There is a 13 month cycle of ovary production, and restoration of healthy ovarian function and ova viability may occur with therapy but still this natural cycle must occur for pregnancy to be successful. The man also may need to wait for a natural period of time of sperm production after the therapy is successful. This is one reason that healthy treatment with Complementary Medicine should be considered early in the process of attempting to get pregnant. Of course, these scenarios depend on the diagnosis, and the acupuncturist will discuss these possibilities with each patient and schedule the therapy accordingly. Other fertility issues, such as hormonal irregularities and metabolic concerns, may resolve quickly and allow for immediate results.

Hormonal imbalances in Infertility, Pre-Menstrual Syndromes, Anovulation, and related health problems that can be corrected with an holistic protocol

A high percentage of women have hormonal imbalance, many despite leading a healthy lifestyle with few serious health problems. The most common symptoms are premenstrual symptoms, or PMS, which are typically caused by a relative deficiency of progesterone during the second half, or luteinizing phase of the menstrual cycle. This, of course, has direct consequences on the viability of ovulation. A more indirect hormone imbalance results when a woman experiences subclinical adrenal fatique syndrome or a subclinical hypothyroid syndrome. These conditions affect the adrenal pituitary axis in the endocrine system and may produce a deficient hypothalamic hormonal response, affecting the timely release of pituitary hormones that control the fertility cycle, such as LH and FSH (luteinizing and follicle stimulating hormones) and prolactin. All hormonal excesses and deficiencies are seen as relative excesses and deficiencies, with physiological effects relative to the levels of other hormones. Polycystic ovary syndrome is a common fertility problem that actually means that a syndrome of hormonal factors, including a relative excess of androgens, prolactin excess, insulin resistance, leptin resistance, improper conversion of hormones in local tissues, and a relative progesterone deficiency may be present. The ovarian cysts are not causing the problem, but are merely the manifestation of unseen hormonal imbalances. If one is looking for an easy and simple answer to explain hormonal problems affecting fertility, there is none.

The human hormonal system is a complex quantum feedback system that relies on maintenance of endocrine, or hormonal, homeostasis. Hormonal problems in cases of subfertility and infertility are often complicated and not easily addressed by targeting one hormonal aspect with allopathic drugs. Use of these hormonal drugs may further imbalance the endocrine system. Attempting to first restore hormonal balance, or endocrine homeostasis, with Complementary and Integrative Medicine, acupuncture, herbal and nutrient medicine, is the healthy and sensible approach with problems of subfertility and infertility.

The endocrine system, or release of hormones, is a complex system of feedback signals, and one problem with hormones may affect other horomonal functions. We now know that hormones act in a complex quantum manner, both systemically and locally, with one hormone stimulating other hormones that act to control and modulate its effects. Hormones also convert to other hormones in local tissues, and enzymes such as aromatase control the rates of conversion. Hormones stimulate hormone-like growth factors and inflammatory mediators that then act as hormone controls and stimulate other hormones in local tissues. Many hormones are thus implicated in fertility issues. Insulin resistance is another common hormonal imbalance that afflicts a high percentage of our population, and produces indirect effects on the hormone leptin, which is integral to regulation of fertility, as well as creating an indirect progesterone deficiency and affecting PPARG receptors (intercellular receptors that regulate cell inflammatory mechanisms, fatty acid storage and glucose metabolism). Leptin, a hormone associated with appetite and metabolism, also regulates the important pulsatile release patterns of luteinizing hormone that are integral to a healthy reproductive cycle. Insulin resistance is also integral to polycystic ovary syndrome in the majority of cases, which is one of the most prevalent causes of female subfertility and infertility.

These examples of hormone imbalance are highly studied, yet still difficult to understand. In fact, modern science still does not completely understand how the fluctuating mix of hormones in the reproductive cycle actually works. A healthy menstrual cycle is a good indication, though, that the hormonal balance may be optimal, and correction of problems within the menstrual cycle may be very important to the achievement of a natural pregnancy. What is important for the woman seeking fertility therapies is not a full understanding of complex hormonal physiology, but rather the implications presented by these conditions, and the trust that the various physicians helping her have a good working knowledge of these problems.

The book Leptin and Reproduction by Michael Henson and V. Daniel Castracane, outlines how this remarkable hormone has a key role in reproductive health. The hypothalamus is the neural command center for our hormones, and is linked intimately with parts of the brain that regulate mood and emotion, such as the limbic system. This is one explanation of how stress may inhibit fertility. The hypothalamus has long been noted as an important site in the regulation of body weight, and the hormone leptin was not seriously investigated until 1994, with a link in study to obesity and insulin resistance. Since this time, much research has revealed the relationship of leptin to much hormonal regulation in the body, affecting bone health, health of the breast tissues, insulin effects, and reproductive health. Changes in leptin biosynthesis during the menstrual cycle spurred research that showed in recent years how this hormone, and hypothalamic function is integral to the complex flux of hormones that need to be balanced in the menstrual homeostatic mechanisms for fertility and reproduction to be achieved. Leptin resistance, like insulin resistance, may develop unseen over time, and negatively impact follicular development and oocyte (egg) maturation.

In 2011, experts at the Harvard University Medical School found that leptin deficiency creates a chronic state of biologically perceived starvation, resulting in elevated circulating glucocorticoid (cortisol) concentrations, obesity and infertility, while leptin deficiency with deficient glucocorticoid (cortisol) results in normal fertility. Leptin is required for fertility, but acts in a field of chemical factors that includes cortisol. The cortisol effects induced by stress also affects kisspeptin-1 (K1), now known to be an important neurohormone in reproductive regulation. Both stress induced cortisol and endogenous glucocorticods, such as prednisone and numerous corticosteroids that are overused now in medicine as injections for painful joints, topical skin treatment, and in asthma inhalers, were found to inhibit K1 expression in the hypothalamus. This study clearly implicated cortisol and corticosteroid medications in both reproductive subfertility and obesity. Such studies are used to research specific new drugs to alter specific biochemical parameters, but actually continue to show that a quantum field of biochemicals are involved in these hormonal pathologies such infertility and subfertility, and link the associated health problems such as obesity and PCOS.

While numerous studies now link obesity and infertility, the woman does not have to have overt signs of obesity for leptin resistance, and leptin dysregulation to affect fertility. Problems with leptin physiology are also found to affect male fertility. The researchers in this book found that leptin has equal potency in the male metabolism to affect hypothalamic control of LH releasing hormone to affect the balanced release of FHS and LH, which have an important role in sperm count and viability, as well as the quality of prostatic fluid and semen. These processes are controlled by the regulation of nitric oxide, a key molecule in vasodilation and blood pressure control, and chronic inflammatory regulation as well. These mechanisms exert much control of gonadotropin releasing hormone, and the subsequent regulation of gonadotropins which regulate the gonads, which of course produce male sperm and most of the testosterone in circulation. So a restoration of normal healthy hormonal homeostasis, optimization of hypothalamic and adrenal function, and a healthy leptin metabolism are important in fertility issues to both the man and the woman.

Leptin is closely associated with obesity and total amount of body fat in women more than men. A number of factors contribute to excess leptin production from fat cells. These include the adrenal hormones and catecholamines, the sexual steroid hormones, and certain inflammatory cytokines. Imbalance of diurnal cortisol, both excesses and deficiencies, have been shown to have a direct affect on leptin production. Relative deficiency of testosterone or other androgens, and relative excess of estrogen, specifically estradiol over progesterone, both are proven to be able to stimulate excess leptin production from the fat cells. Conversion of excess androgens to estrogen in fat cells, which occurs in polycystic ovary syndrome, stimulates excess leptin, and shows how complex the analysis of hormonal problems can be. Excess androgens can mean excess estrogens in specific tissues. Catecholamines, namely adrenaline, norepinephrine, and dopamine, have been shown to affect leptin production, and the diurnal mechanisms are intricately tied to levels of melatonin. Hormonal imbalances and diurnal cortisol levels should be assessed with saliva and veinous blood stick metabolites and necessary corrections of homeostasis achieved if these problems are a suspected contributor to infertility. Inflammatory cytokines have also been found in research to stimulate excess leptin production at the fat cells, and resolution of chronic inflammatory problems and inhibition of TNF-alpha and interleukin 1a may resolve contributing factors to leptin excess affecting fertility. The authors of Leptin and Reproduction state that the research reveals that leptin plays a central role in the physiology of reproduction, mainly because the major function of leptin is to inform the central nervous system of the size of energy stores in the body, and the brain then modulates energy intake and expenditure appropriately for successful reproduction.

Restoration of hypothalamic function and metabolic mechanisms, decrease in inflammatory stress, and addressing aspects of suspected insulin resistance may play important roles in reproductive hormonal health for the female and the male. These problems may be addressed with Complementary and Integrative Medicine. Standard medicine does not have the goals of restoration of health homeostatic mechanisms, but instead concentrates on more severe dysfunctions and their correction. This is where Integrative and Complementary Medicine come into play in modern medicine. Much research is now documenting how acupuncture, herbal chemicals, and nutrient medicines can achieve these goals with very specific guidelines of therapy.

Research into the role of leptin in the fertility cycle has revealed other important aspects of neurohormonal health that may also inhibit fertility. Leptin is a hormone that fluctuates during the day and night, with circadian rhythms that have normal peak values in the middle of the night. All aspects of circadian rhythm pertaining to hormones and the central nervous system (CNS) are partially controlled by the hormone neurotransmitter melatonin. Restoration of a healthy sleep cycle and quality, and normal melatonin metabolism may be integral to restoration of circadian cycles of leptin production and have an important effect on pulsatile release of the key fertility hormone LH (luteinizing hormone). The integral relationship between leptin and the CNS, especially the hypothalamus, also shows the intimate relationship of this hormone with prolactin production. Now prolactin is another key hormone that in the past was thought to only exert an appreciable effect on milk production in breast feeding (hence the name pro-lactin), but is now recognized as an important hormone in a number of physiological systems. Hyperprolactinemia, or excess prolactin release, is now a well known cause of a high percentage of infertility problems, as well as linked intimately with polycystic ovarian syndrome, a predominant cause of infertility in young otherwise healthy women. One does not need to have a severe hyperprolactinenia and drastic growth of ovarian cysts to have these problems. A large percentage of young healthy women are surprised when they receive the diagnosis at a fertility clinic that polycystic ovarian syndrome (PCOS) is probably the cause of their infertility. The growth of multiple cysts on the ovaries may come and go in this syndrome, and are driven by excess androgens and hormonal imbalance. Underlying problems of hormonal health may be both complex and elusive, but restoration of hormonal balance often will restore health in these circumstances. Complementary and integrative Medicine such as Traditional Chinese Medicine (CIM/TCM) has much to offer with such restoration.

Chronic adrenal stress syndromes have also been implicated in lowered leptin levels within a circadian cycle of production. Beta-adrenergic stimulation has been shown in studies to lower circulating leptin levels. Chronic inflammatory states are also implicated in this neurohormonal dysfunction. Leptin acts as an inflammatory cytokine excreted from fat cells, and chronic inflammation has a direct role on both leptin and insulin dysfunction and receptor resistance. All of these factors may contribute to leptin deficiency, receptor resistance and excess leptin, or other problems with the metabolism. Since leptin is found to increase the luteinizing hormone releasing hormone (LHRH) via the hypothalamus and pituitary, leptin fluctuations may have a direct effect on luteinizing hormone and viability of the ovum, or egg, to be fertilized. The solution to these problems is neurohormonal restoration, resolution of chronic inflammation, improved hypothalamic function, resolution of adrenal stress, and correction of metabolic syndromes. A comprehensive treatment protocol will individually assess each patient and concentrate on the areas of greatest need and impact.

Many of these imbalances in individuals dealing with subfertility do not manifest as overt and serious disorders. The problem is that most women, and men, with imbalances causing subfertility are very healthy, and accepting a holistic treatment protocol that addresses the array of potential problems is of course difficult to accept. Understanding that the perspective and approach in standard medicine and holistic medicine is different, and cannot be equated, is the real cognitive challenge for couples. Integrative therapy with restorative medicine is good for you, and ultimately good for the pregnancy and the baby. Utilizing various benign therapies to achieve a better homeostatic balance has no negative side to it. One may utilize these therapies a little, or a lot, and this is the choice of the couple, and any degree of therapy will be beneficial and improve the chances of a healthy pregnancy.

The most difficult problem for the couple unable to conceive, or the woman utilizing insemination or assisted reproductive technologies, is the determination of what is wrong, and how it can be fixed. Of course, everyone would like to have a simple, direct answer and treatment, but for many couples and individuals, there is no obvious reason for apparent infertility or subfertility. Even after tests are performed, the diagnosis may be one of exclusion, meaning that no test results clearly point to a problem, and so we can assume that the diagnosis is one that has not been excluded by test data. A majority of women with subfertility issues are faced with this type of unclear diagnosis. This is another reason to choose Complementary Medicine and a holistic approach, which seeks to restore the healthy function to the couple and is comprehensive in its approach. Holistic medicine, while focusing on an apparent fertility or subfertility problem, also works to correct any possible problem with hormonal homeostasis, or contributing health problems. The various reasons for infertility are all tied together, one problem caused by or causing another, and with holistic medicine, healthy function, or homeostasis, may be restored, thus restoring the ability to conceive.

Dietary and Lifestyle Recommendations in Fertility Therapy

A 2007 study by the Harvard School of Public Health found that a sixfold decrease in infertility risk occurred if at least 5 of 7 dietary factors were observed. These dietary regimens are: 1) avoid transfats and simple carbohydrates, such as refined sugars and flours; 2) eat a greater percentage of fresh vegetables as opposed to meat; 3) eat more whole grains to obtain fiber and usable iron; 4) eat more whole dairy products and avoid low-fat items in your diet; 5) consume more vitamins, preferrably from fresh vegetables and fruits; 6) achieve a better BMI index by reducing excess fatty weight if necessary; and 7) exercise more. These recommendations are proven and should be the basis for all fertility treatment.

Essential fatty acid imbalance or deficiency is a major factor in female infertility. Essential fatty acids (EFAs) are integral building blocks for antioxidant and inflammatory regulating chemicals in the body. Essential is a term meaning that they must be obtained from the diet. Our modern diet of dominance of red meat and refined foods has lead to an overabundance of arachidonic acid and subsequent problems. Following the above dietary recommendations from Harvard Medical School as well as consumption of healthy EFAs may be the most important basic ingredient to natural restoration of fertility physiology. It has been found that during the periovulatory phase of the menstrual cycle, enhanced activity of various antioxidant pathways are present in the normally fertile woman. An imbalance of essential fatty acids may inhibit this needed increase in antioxidant activity, and increased oxidative stress may negatively affect ovulation. Imbalances of hormonal stimulation combined with EFA deficiency or imbalance of the Omega-3 and Omega-6 fatty acids may be an explanation for many cases of infertility. Krill oil, a type of fish oil, is extremely high in the healthy EFAs, EPA and DHA, and contains a natural preservative to protect the fish oil from oxidative degeneration. This product is highly recommended in the fertility protocol. A diet high in antioxidants, and avoidance of excess omega-6 arachidonic acid, which comes with a diet high in meat and simple carbohydrates, explains why the Harvard public health study cited above reduces risk of infertility.

The book entitled The Fertility Diet, written by researchers at the Harvard School of Public Health, Drs. Chavarro and Willet, decribes how their research follow-up on findings of the long range Nurses Health Study found that ovulatory infertility may be due to excess poor quality meat fats and trans fats, refined carbohydrates, essential fatty acid imbalances, and chemicals in red meat, and that a dietary protocol with healthy vegetable fats, whole grain and plant proteins are proven to significantly guard against ovulatory infertility. These researchers conclude that full-fat dairy products appear to be good for fertility, while low-fat dairy products and sugared sodas contribute to the root problems of ovulatory infertility and hormonal imbalance. The Nurses Health Study revealed that adoption of 5 of 10 simple dietary strategies appeared to reduce the risk of ovulatory infertility by 80-90%. Considering the enormous cost and health risks associated with in vitro fertilization and other chemically induced pregnancies, recommendation of such a diet as a standard treatment protocol would seem a no-brainer, yet we still do not see a significant set of such guidelines suggested to the patient population.

How does acupuncture and TCM herbal and nutrient protocol work in restoration of fertility? Many physiological benefits have been measured. There is no longer any doubt. It is evidence-based.

How does acupuncture work is the question that is most frequently heard from couples that are seeking consultation when deciding what treatments to utilize to help conceive. There is no simple answer to the question, and the question itself perhaps reflects skepticism about the science, which is only natural, considering the fact that standard medicine and medical doctors have told patients for many years that acupuncture didn't work, despite overwhelming evidence to the contrary. The term acupuncture refers both to the treatment with trigger point stimulation and to the overall medical specialty, though, and the term "acupuncture" actually refers to the full array of herbal and nutrient medicine, with needle stimulation, dietary and lifestyle advice, and patient instruction and education. All of these modalities of treatment have been heavily researched and the effects verified objectively with scientific study, testing, and human clinical trials. Much of this research and links to clinical trials that show that TCM is evidence-based are found in the section of this article entitled Additional Information. Finally, acceptance of the science of acupuncture, and the knowledge that the Licensed Acupuncturist also is well trained in herbal science and nutritional medicine, is becoming generally accepted in the medical community and general population.

In 2015, a meta-analysis of all published randomized controlled human clinical trials of women diagnosed with infertility who opted to try Chinese Herbal Medicine for 3-6 months to enhance fertility, conducted by the National Institute of Integrative Medicine, in Melbourne, Australia, found that "Chinese herbal medicine can improve pregnancy rates 2-fold within a 3-6 month period compared with Western medical fertility drug therapy. In addition, fertility indicators such as ovulation rates, cervical mucus score, biphasic basal body temperature, and appropriate thickness of the endometrial lining were positively influenced by CHM therapy, indicating an ameliorating physiological effect conducive for a viable pregnancy" (PMID: 25637159). In 2013, a meta-review of all published studies of Complementary Medicine to aid fertility treatments, by the University of Michigan School of Medicine, found 37 high quality randomized controlled human clinical trials that confirmed efficacy, especially for acupuncture in female fertility, and selenium in male fertility (PMID: 23796256). In recent years, studies at the University of Illinois, in Chicago, the Harvard University School of Medicine, the Reproductive and Fertility Centers in Colorado Springs, Colorado, the University of Pittsburgh, and other U.S. institutions confirmed that acupuncture improved success in fertility treatment, whether used with IVF or alone. None of these studies have noted adverse effects, and more and more studies confirm that an array of physiological benefits have been measure in fertility study with the holistic protocols of Traditional Chinese Medicine (TCM). There should no longer be doubt that the whole package of care in TCM can increase the odds for a healthy successful pregnancy, and the cost of this treatment is just a small fraction of the high cost of standard fertility therapy, which also has potential for adverse effects.

Much scientific study has been performed showing how acupuncture stimulation affects both the central nervous system and local tissue responses, including organ function. Specific research supporting acupuncture in fertility treatments has demonstrated how acupuncture stimulation increases production of endogenous opioid peptide neurotransmitters, such as endorphin, and that these chemicals are a key to healthy neuroendocrine function controlling the pulsatile release of leutinizing hormone. Acupuncture has both these specific types of effects, as well as overall balancing effects that greatly benefit systems like the hormonal, or neuroendocrine system. The acupuncturist also utilizes herbal and nutrient chemicals that are well studied and have been proven to affect pulsatile release of GnRH and LH when prescribed properly. Studies have proven that specific acupuncture and electroacupuncture stimulations modulate GnRH and kisspeptin-1 expression, and provide a healthier adrenal function. Hormonal balance can be achieved with both herbal formulas and topical creams. The use of low dose bioidentical pregnenelone and progesterone stimulating creams will insure that hormonal imbalances do not drive the imbalances of leptin and excesses of K1, and there are no known side effects. The list of studied effects of herbs and nutrient chemicals useful in fertility treatment is a long list at this point in time. The last section of this article provides many sound scientific studies of these herbs and nutrient medicines, as well as acupuncture RCTs. The knowledge of the physician himself in the practice of acupuncture and TCM is perhaps the most important fact, though, and this varies greatly.

Since the release of a number of studies showing that acupuncture increases the success rates of IVF by decreasing stress, many physicians and patients are focused on this aspect of treatment. The patient needs to understand what the term "stress" refers to scientifically, though, in relation to the positive effects on fertilization. The public generally thinks that the term stress refers only to an emotionally anxious state generated by worry or overwork. In actuality, the term stress applied physiologically in a scientific report refers to the decrease in biochemical and physiological stress parameters that may negatively affect optimum ability of the body, especially the organs, to function. In regards to fertility, decreasing stress may refer to resolution of oxidant stress, or a physical or chemical cause of disease or dysfunction. The positive effects of acupuncture are to improve physiological functions and reduce physical stress, or to improve homeostasis. Medical definitions of stress define it as the body's response to environmental demands and pressures, which include excess immune stressors such as toxins, pathogens, and diseases, as well as social circumstances and overwork. Webster's dictionary defines stress as "a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation." The reference to acupuncture decreasing stress refers to more than just calming the patient. Hormones related to fertility that are affected by stress, mental and physical, include cortisol and prolactin. A 2009 study cited below shows how acupuncture performed concurrently with IVF treatments significantly modulated circulating cortisol and prolactin levels in a beneficial manner, which may explain some of the success with this strategy.

How do you utilize Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) in the treatment of infertility? Acupuncture with herbal and nutrient therapy is not an alternative to standard care, or at odds with standard care. It is a safe and conservative method of treatment that you should try first, before resorting to expensive and possibly dangerous treatments. It is a medical science that is proven to increase the chances with IVF, and may prevent or reduce potential side effects. It will not interfere with your standard medical treatment, and has produced no harm in many years, in fact, thousands of years of practice. It is not a simple form of treatment, and in fact is more varied and complex than standard medicine in dealing with the wide variety of factors that could affect fertility. You need to spend the time for a thorough history and consult. Careful monitoring and adjustment of the therapy may be needed over time.

The couples seeking help with infertility and subfertility should not avoid allopathic fertility clinics. Standard medicine offers as its chief benefit the ability to test and diagnose. Thorough testing and diagnosis will help the Complementary and Integrative Medicine physician, or Licensed Acupuncturist, to apply more specific treatment protocols and enhance effectiveness. By utilizing a standard fertility clinic, the patient does not need to commit to harsh drug therapies or assisted reproductive technologies immediately. A responsible medical doctor will advise that you may try more conservative means first and see what happens. If this fails, acupuncture and herbal/nutrient medicine may also be utilized to increase the effectiveness of assisted reproductive technologies. Most fertility clinics today even offer some form of acupuncture and Complementary Medicine, although a specific practitioner in private practice may offer better overall knowledge and skills than those employed in the fertility clinic, as well as lower costs. Often, the array of protocols to be offered by the TCM physician is limited by the medical doctors in standard fertility clinics. Also, if ART and drug therapies are utilized, acupuncture and TCM may be utilized to restore aspects of the health that are damaged by these therapies, and mollify symptoms of adverse health effects.

When you and your health provider are on the same page you can expect to get great results. In complementary medicine you need to take a proactive approach to the therapeutic course and the adjustments in therapy that are needed. You need to gain an understanding and work with the Complementary Medicine physician to insure that lasting success is obtained. Some causes of infertility may be resolved quickly, while others, such as ovarian dysfunction, may need patience. If your ovaries are not producing viable eggs, and there are a number of reasons this may occur, not limited to the presence of polycystic ovarian syndrome, there may be a 13 month wait for the healthy egg production cycle once the ovarian function and health is restored with acupuncture and herbal medicine. In other cases, the results of treatment may be quick. In all cases a comprehensive assessment and individualized treatment protocol should address any possibility that could interfere with pregnancy. The end result of this comprehensive holistic care will be the assurance that you did everything possible to insure that your pregnancy is natural and that your baby is healthy, and that you avoided potential health problems with chemical fertility treatments as much as possible. You'll be glad you did.