A Personalized, Participatory and Preventative Approach
The healthcare model that I have long bought into is one that acknowledges and respects a personalized, participatory, and preventive approach. This is a model that reflects the customization of healthcare, with medical decisions, practices and products tailored to the individual patient, a method by which one shifts from being a passenger to a driver of one’s own health. In this model, providers encourage patients and value them as full partners, and build a movement that focuses on protecting, promoting and maintaining health, as well as forestalling the development of disease, disability and death.
If you are looking to enhance your chances of getting pregnant naturally, it should first be understood that the chances of getting pregnant is only about 20% for the average healthy fertile couple per ovulation. Many people think that they will conceive the first time they try but usually a pregnancy does not occur for many months and may even take longer than a year. Infertility affects 15% of all couples.
Dr. Timothy Cook is the Medical Director & Internal Medicine Specialist at our P3 Health Clinic in Toronto. He takes an interest in mindfulness-based stress reduction and believes that there are some common contributors to a couple’s inability to conceive that are not well appreciated. According to Dr. Cook, these include lifestyle habits; poor diet, being sedentary, smoking, sleep deprivation and perhaps most important of all, stress.
It seems everyone has excessive stress these days, but couples trying to conceive often have additional stressors that can contribute to metabolic changes – too much of the fight or flight hormones cortisol and adrenaline, that in turn reduce their fertility. Obesity and the associated abnormalities of cholesterol, blood sugar, blood pressure, arteries, kidneys and liver may all be a result of stress-filled lives and also adversely affect conception for both men and women.
“The Domar Centre near Boston was the first clinic to offer MindBody programs for fertility support in North America” says Dr. Cook. “In her book, “Conquering Infertility: Dr. Alice Domar’s Mind/Body Guide to Enhancing Fertility and Coping with Infertility” Dr. Domar refers to research showing integrative approaches that include lifestyle modification founded upon mindfulness meditation and stress reduction can increase take-home baby rates by 50%!”
The reality is other researchers and fertility clinics have begun to incorporate these practices into their programs and have reproduced these results. Mindfulness-Based Stress Reduction (MBSR) is a standardized approach to training the brain to turn off the stress response and turn on the relaxation response. Regular practice has been shown to lead to permanent, beneficial changes in brain structure and function as well as general health and well-being. MBSR is increasingly available in hospitals and community centres.
Ideally, for couples trying to conceive, such lifestyle support is combined with complementary approaches including acupuncture and Traditional Chinese medicine as well as appropriate medical assessments. Tests for metabolic parameters, hormone levels, and genomics are now particularly useful to help guide lifestyle choices such as diet and exercise, use of nutritional supplements and prescription medications.
Francis Rock, R.TCMP and R.Ac. from London in the UK graduated from the International College of TCM in Vancouver having completed a four year program followed by post graduate work at the Anhui Hospital of TCM in China. He joined P3 Health after having been in practice for the last 10 years with a special focus on reproductive health and infertility and has worked with some of the leading reproductive endocrinologists in Canada helping patients conceive whilst undergoing IVF and other ART procedures. Francis also sees many patients who are trying to conceive naturally through the use of acupuncture and herbal medicine alone, along with other auto-immune issues and sports injuries.
“A large number of couples experience infertility in the population, however awareness of Traditional Chinese Medicine as an effective therapy for treating fertility issues in men and women is still quite low” says Rock. “Often patients are started on a regimen of drug therapy and are even started on ART (Assisted Reproductive Technology) procedures such as IUI and IVF before trying other natural therapies which may be suitable for them at least initially particularly in cases of ‘unexplained infertility’”. He goes on to say “these procedures are known to be highly invasive and can cause a great deal of anguish both physically and emotionally along with risks and side effects.”
While there is no denying the advantages of Western medical techniques for fertility treatments especially in more severe cases, Chinese medicine has many benefits for women and men.
I am all for integrating east and west medical philosophies and when I asked my TCM colleague about his thoughts on integrating the two forms of treatment, Rock said: “for women undergoing ART procedures such as IVF, research has shown that success rates can be greatly increased by using acupuncture and Chinese medicine at the same time. The Chinese medicine approach is all about taking a natural approach to dealing with infertility with the underlying concept being one of balance”.
By looking at the whole person and not just the reproductive system, Francis Rock endeavors to get the individual into the most healthy and fertile state they can be. The foundation for getting pregnant rests on getting your body in a state of maximum health and fortunately with the help of Chinese medicine this can be done in as natural a way as possible. This would always “…entail a detailed analysis of a person’s lifestyle including sleep habits, diet, exercise and of course every aspect of a woman’s menstrual cycle” he reminds me.
So how does acupuncture help in treating infertility?
- Improves blood flow to the uterus and reproductive organs
- Helps to thicken the uterine lining
- Helps to regulate the menstrual cycle to a normal time length
- Helps ensure the flow is smooth and without pain
- Helps to decrease stress levels
- Encourages embryo implantation when used in conjunction with IVF
- Increases the number of follicles
- Decreases the chances of miscarriage
- Boosts the immune system
- Improves sperm count and motility in men
When getting pregnant becomes a challenge, I prefer to use the word “subfertile” because most patients I see who have been initially diagnosed with infertility are actually subfertile. I see many patients who have been diagnosed with infertility still get pregnant with natural treatments alone or integrative treatments combined with IVF.
The need to evaluate individual hormones is paramount. Estrogen and progesterone (or more accurately its metabolite called pregnanediol) levels can be tested to evaluate ovulatory function in pre-menopausal women with menstrual irregularities and/or infertility.
Other tests may include:
- Day 3 FSH, estradiol, and a newer test called Anti-Mullerian hormone can help us determine a woman’s ovarian reserve
- Progesterone if low can indicate that ovulation may not have happened; if it’s low it may be a sign of PCOS. Sufficient levels are needed to sustain pregnancy.
- Low or high TSH may indicate a thyroid problem (low or high thyroid)
- Low or high cortisol may impair ovulation and implantation
- High testosterone and high DHEA may be a sign of PCOS or low DHEA may affect egg quality
- Problems with blood count or inflammation can also be tested for and can affect fertility
- Depending on the situation and indication, fertility optimization may include MBSR, TCM and Acupuncture, and the following natural medicines are often considered for those with PCOS:
- Helps restore ovulation
- improves insulin sensitivity
- improves egg quality
- reduces androgens in women with PCOS
A recent study published in Fertility and Sterility on women with PCOS doing medicated fertility cycles found that taking inositol resulted in a 20% improvement in clinical pregnancy rate.
- Chastetree (Vitex)
- regulates menstrual cycle
- improves luteal phase progesterone
- N-Acetyl Cysteine (NAC)
- helps improve ovulation in PCOS
A study published in Fertility and Sterility found that NAC supplementation reduced testosterone and improved insulin sensitivity in PCOS patients
- good for cysts
- Molecular Human Reproduction. 2010 Apr;16(4):251-9. Epub 2010 Jan 12. Effects of resveratrol on proliferation and apoptosis in rat ovarian theca-interstitial cells)
Depending on the situation and indication, fertility optimization may include MBSR, TCM and Acupuncture, and the following natural medicines are often considered for those who are older where the focus becomes improving egg quality and Improving circulation to the uterus and ovaries. Oxidative stress associated with repeated ovulations appears to lower egg quality in the remaining eggs as a woman ages.
- improves fertility in mature women by acting as an antioxidant
- A 2010 Japanese study found that L Carnitine protected egg quality from oxidative effects on aging ovaries. http://www.ncbi.nlm.nih.gov/pubmed/20621580
- mitochondrial antioxidant
In a Toronto study it was found that using COQ10 in aging mice improved egg quality in aging mice. They have currently initiated a randomized placebo control trial on the effectiveness of COQ10 in older women seeking fertility treatments.
Study done in the journal fertility and sterility in 2010 showed ALA /DHA improved embryo morphology. EPA and DHA regulated estrogen and follicles in a more optimal range.
- A study published in “Reproductive Biomedicine Online” 2010 showed that DHEA improves ovarian reserve in both older and younger women (AMH values improve). Note: it is really important to be overseen by a healthcare practitioner.
Wheat grass juice
- extremely high in chlorophyll which improves excretion of xenoestrogens and fat soluble waste products. Animals that graze on wheat grass have better quality eggs.
- A 2008 study found that chlorophyll was protective against DNA damage in cells, which is very important in the case of advanced maternal age.