Integrative approach 4


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  • Please turn down your cell phone to vibrate mode If you have questions during the lecture, Please write up and pass over to the front.
  • How many practitioners here are involving fertility treatment? 1996. Met a patient with lupus. Fertility enhancement program is not only a treatment but changes people’s life.
  • Let’s talk about female first. Before we begin our program, let’s review of some hormones involves in the menstrual cycle. FSH, LH secreted by posterior pituitary gland. Estrogen and progesterone produced by ovary.
  • Simple and easiest way to monitor the hormone levels. Patients measure their temperature in the morning just wake up. Catch the ovulation time Predict the progesterone release The mean difference before ovulation and after should be more than 0.5
  • We are working with 6 organization of fertility specialists. The two phases of treatment not only speed of the conceive process but also increased IVF procedure significantly.
  • Following the patient’s fertility treatment plan and well communicate with the fertility specialist to have parallel treatment. Focus the weakness and schedules. Hormonal balance during the ART treatment is most important.
  • F.S.H. <11
  • Egg and Sperm become less healthy and poor quality as we age. Thus, women have a diminished ability to conceive. Experience has shown that if the hormonal system is in perfect working order and a woman has clockwork menstrual cycles,, a healthy egg can be released on time. It then has a good chance of becoming fertilized, implanting and making it through embryologic development to become a child.
  • Male: Female:
  • The effects of acupuncture tend to be cumulative. Most effective when given in a series. A course of 10-12 is frequently recommend in order to begin to effect cellular change. Please do educate your patient understand the their personalized treatment plan from day one. And continue to support and communication during the course. Pre phase : 1-2 tx/wk X 4 wks/cycle Minimum 3 cycles to regulating and balancing hormones Trial phase : Pre-ovulation: 3tx/wk X 2 wks Post ovulation: 2tx/wk X 2 wks Post conceive: 2 tx /wk X 8 wks 1 tx/wk X 4 wks
  • The hypothalamic-anterior pituitary-ovarian axis function Acupuncture releases endorphins that mitigate one’s response to stressful stimuli, thus enhancing the possibility of conception. Since the hypothalamus regulates both stress Reponses as well as the sex hormones. It’s easy to see how stress could cause infertility in some women. Excessive stress may even lead to complete suppression of menstrual cycle. This is often seen in female marathon runners, who develop runners amenorrhea. In less severe cases, it could cause an ovulation or irregular menstrual cycles. When activated by stress, the pituitary gland also produces increased amounts of prolactin. Elevated prolactin could cause irregular ovulation. Female reproductive tract contains stress-hormone receptors, stress can affect fertility. However more complex mechanisms may be at play. Research still do not know how stress interacts with the reproductive system.
  • GIFT-gamete intrafallopian transfer ZIFT-zygote intrafallopian transfer in vitro fertilization . ET- Embryo transfer Like IVF, these procedures involve retrieving an egg from the woman and re-implanting it, but in GIFT and ZIFT the process goes more quickly. While in traditional IVF the embryos are observed and raised in a laboratory for 3 to 5 days, in ZIFT, the fertilized eggs -- at this stage called zygotes -- are placed in the fallopian tubes within 24 hours. In GIFT, the sperm and eggs are just mixed together before being inserted and, with luck, one of the eggs will become fertilized inside the fallopian tubes.
  • Stress and the brain play an important role in fertility, because stress can prevent a woman from ovulating entirely, When women under extreme stress often stop menstruation and Lack of stress often promote fertility. That is why couples often conceive while on a cruise or other relaxing holidays.
  • 21 of 80 patients became pregnant in IVF group Success rate= 26.3% 34 of 80 patients became pregnant in the IVF plus acupuncture group, Success rate= 42.5 %. Acupuncture reduces the uterine contractions that typically occur with embryo transfer and may inhibit implantation.
  • Acupuncture reduces the uterine contractions that typically occur with embryo transfer and may inhibit implantation. Acu1=95 on the day Conceived 37 (39%) - 34 ( 36%) Acu2=91 on the day and 2 days after 25 minutes session 36 % 26 % Control=87 26 % 22 %
  • Dang Gui- effect on uterus: to Have a contractile effect when given intravenously to anesthetized dogs and rabbits. Does cause contraction in situ uteri and relaxation in uterus specimens. Use some studies by direct measurement of myometrium, administration of angelicae enabled the contractions of the uterus to be more orderly. This explained may be is the mechanism to treat dysmenorrheal. There is no estrogen effect. E-Jiao -increase the RBC and Hgb significantly than the control group Huang Qi- immune Enhancer Dang Shen- Sha Ren Du Zhong Gou Qi Zi- Protect liver functions, increase liver phosphrous and lower the blood pressure Huai Shan Xian Mao- Xian Ling Pi Tu Si Zi Bai Shao-
  • Disease cause the DHEA to decrease Anorexia, End stage kidney disease Type II diabetes, Aids, Adrenal insufficiency and in the critical ill. Drugs: insulin, corticosteroids, opiiates, and Danazol
  • Testes are approximally 4 cm long and 2.5 cm wide connective tissue capsule Tunica albuginea, the white coat surrounds each testis Extension of the this capsule, septa ;ige nto the testis and divide it into a large number of the lobules. Each lobules contains one to four tightly coild seminiferous tubules where is the site to produces sperm Each lobe of seminiferous tubules empties sperm into rete testis to the first part of ducts Epididymis hugs the external surface of the testis/ Lying in the soft connective tissue surrounding the seminiferous tubules are the interstitial cells-produces androgens, most importantly testosterone.
  • Body temperature 37.C , Testes= 32 C.
  • Spermatogenesis is the process by which male develop into mature are the mature male in many sexually reproducing organisms. Thus, spermatogenesis is the male version of gametogenesis . In mammals it occurs in the male testes and epididymis in a stepwise fashion, and for humans takes approximately 64 days. [1] Spermatogenesis is highly dependent upon optimal conditions for the process to occur correctly, and is essential for sexual reproduction . It starts at puberty and usually continues uninterrupted until death, although a slight decrease can be discerned in the quantity of produced sperm with increase in age. The entire process can be broken up into several distinct stages, each corresponding to a particular type of cell:
  • 1. Azoospermia- absence of sperm 2. Oligiospermia-lowered sperm density
  • Sperm analysis should repeat 2 times if normal and three times if abnormal.
  • Environment factors- Pesticides, exogenous estrogens, heavy metals may negatively impact spermatogenesis.
  • Acupuncture has documented in several studies as having a positive effect on sperm parameters. A muti-faceted approach to improving male fertility involves identifying harmful environmental and occupational risk factors while correcting underlying nutritional imbalances to encourage optimal sperm production and functions.
  • Case report: A 43 male with 3 months of combined treatment Sperm count from < 18 million/ml to 93 million Motility < 50 % to 97% Morphology: Normal <20% to 45 %
  • Acupuncture has been documented in several studies as having a positive effect on sperm parameter.
  • Semen is made mostly of water
  • Studies confirm that male sperm counts are declining Environmental factors: pesticides, exogenous estrogens and heavy metals may negatively impact spermatogenesis.
  • Study shown to improve sperm counts and sperm mobility, including cantinuie, argining, Zinc, selenium and Vit B-12, Numberous antioxidants be beneficial : Vit C, Vitamin E,Glutathione and co-enyme 10. Above all daily dosage
  • Zinc-critical to maintaining optimum semen volume and blood testosterone levels in men. Vit E: Increasing the sperm motility and viability Calcium + D- improve male fertility
  • Berry family contains highest Vit C. for antioxident. A muti-faced
  • Integrative approach 4

    1. 1. Integrative Fertility Enhancement Cathryn Hu, Ph.D., O.M.D., L.Ac .
    2. 2. Conflict of Interest and Financial Disclosure <ul><li>Integrative Fertility Enhancement </li></ul><ul><li>Cathryn Hu, Ph.D., O.M.D., L.Ac. </li></ul><ul><li>President of Advanced Acupuncture, Inc. </li></ul><ul><li>Professor of Advanced Acupuncture Institute </li></ul><ul><li>None </li></ul>
    3. 3. Celebrating A New Life The miracle baby
    4. 4. Human Reproductive System Human Sexuality: Conception from
    5. 5. Hormones involves in the Menstrual Cycle
    6. 6. Basal Temperature Record
    7. 7. Eggs maturation and travel process
    8. 8. www. Ovulation Process
    9. 9. Fertility Enhancement Program -an integrative approach <ul><li>Two phases of treatment in our integrative program: </li></ul><ul><li>1. Preparation phase: </li></ul><ul><li>Treating the causation of infertility, nourishing the reproductive organs and their functions. </li></ul><ul><li>2. Trial phase: </li></ul><ul><li>Promoting the ovarian functions of follicle maturation and increasing the lining of the uterus. </li></ul>
    10. 10. The objectives of Preparation Phase <ul><li>Stress relief </li></ul><ul><li>Causation of infertility </li></ul><ul><li>PMS treatment </li></ul><ul><li>Endometriosis </li></ul><ul><li>Hormone balancing </li></ul><ul><li>Increasing mucus secretion </li></ul><ul><li>Sperm quality & quantity improvement </li></ul>
    11. 11. The objectives of Trial Phase <ul><li>Stimulating follicles maturation </li></ul><ul><li>Promoting the ovulation </li></ul><ul><li>Balancing FSH, Estrogen, LH and Progesterone </li></ul><ul><li>Integrative with IVF procedures </li></ul><ul><li>Integrative with IUI procedures </li></ul>
    12. 12. The Hormonal Imbalanced Conditions <ul><li>High FSH level </li></ul><ul><li>Polycystic Ovarian Syndromes (PCOS) </li></ul><ul><li>Luteal phase defect </li></ul><ul><li>Endometriosis </li></ul><ul><li>Assistant Reproductive Technology </li></ul><ul><li>(ART) </li></ul>
    13. 13. Other Causations of Infertility <ul><li>Stress- </li></ul><ul><li>-Flight-or-fight response </li></ul><ul><li>-Glucocorticoids can raise its level and weaken the reproductive system, potentially making infertility condition worse. (Prolactin) </li></ul><ul><li>Age- </li></ul><ul><li>Conception rate : 30’yrs, 40’yrs, decline 5-10 % each year </li></ul><ul><li>Developing chromosomal abnormalities: </li></ul><ul><li>< 35yrs -the rate of is 1:2000 compare to >35yrs,1: 400 </li></ul><ul><li>Miscarriage: <30 yrs = 15 %, >40yrs =40 % </li></ul>
    14. 14. The Causations of Infertility in Traditional Chinese Medicine <ul><li>Male- </li></ul><ul><li>Kidney yin deficiency </li></ul><ul><li>Kidney yang deficiency </li></ul><ul><li>Liver qi stagnation </li></ul><ul><li>Spleen qi deficiency </li></ul><ul><li>Blood stagnation </li></ul><ul><li>Female- </li></ul><ul><li>Kidney deficiency </li></ul><ul><li>Cold uterus </li></ul><ul><li>Blood deficiency </li></ul><ul><li>Liver depression </li></ul><ul><li>Stagnant heat </li></ul><ul><li>Phlegm dampness </li></ul>
    15. 15. Kidney Yin deficiency signs & symptoms <ul><li>Scanty, dark discharge at the end of the period or amenorrhea </li></ul><ul><li>Severe lumbago, dizziness, tinnitus </li></ul><ul><li>Cold sensation in the lower abdomen, loose stools, copious, clear urine </li></ul><ul><li>Dark facial complexion </li></ul><ul><li>Tongue is pale with thin white coating </li></ul><ul><li>Pulse is deep, thread and weak </li></ul>
    16. 16. Cold Uterus <ul><li>Prolonged menstrual discharge but scanty in volume and mixed with dark clots </li></ul><ul><li>Cold lower abdominal pain relieved by warmth </li></ul><ul><li>The tongue coating is thin and white </li></ul><ul><li>The pulse is deep and slow </li></ul>
    17. 17. Blood deficiency signs & symptoms <ul><li>Withered, sallow complexion </li></ul><ul><li>Scanty menstrual discharge during the last days of the period but light in color, dizziness, blurred vision, dry skin, constipation </li></ul><ul><li>Insidious pain after menstruation. </li></ul><ul><li>Tongue is pale </li></ul><ul><li>Pulse is thready and weak </li></ul>
    18. 18. Liver depression signs & symptoms <ul><li>Early or late menstruation, scanty in volume and dark in color </li></ul><ul><li>Abdominal distention </li></ul><ul><li>Premenstrual breast distention </li></ul><ul><li>Mental depression, eructation and sighing </li></ul><ul><li>Tongue is red with a thin coating </li></ul><ul><li>Pulse is wiry and rapid </li></ul>
    19. 19. Stagnant Heat signs & symptoms <ul><li>Scanty menstrual volume, red purplish in color and mixed with clots. </li></ul><ul><li>Distention and pain in the lower abdomen, especially along the sides, which refuses palpation. </li></ul><ul><li>History of lumbar soreness </li></ul><ul><li>Distension & pain of the chest and hypochondrias </li></ul><ul><li>Tongue is red with a thin coating </li></ul><ul><li>Pulse is wiry and rapid </li></ul>
    20. 20. Phlegm dampness signs & symptoms <ul><li>An obese constitution </li></ul><ul><li>History of excessive phlegm </li></ul><ul><li>Pallor or puffiness </li></ul><ul><li>Delayed menstruation or amenorrhea and excessive leucorrhea </li></ul><ul><li>Tongue has a thin, white coating </li></ul><ul><li>Pulse is wiry and slippery </li></ul>
    21. 21. Individualized Treatment Plan <ul><li>Individualized treatment plan based on etiology </li></ul><ul><li>Acupuncture: </li></ul><ul><li>EA for follicle phase </li></ul><ul><li>MA for Luteal phase </li></ul><ul><li>Herbal formula: Individualized </li></ul><ul><ul><li>Raw herbs </li></ul></ul><ul><ul><li>Granules </li></ul></ul><ul><ul><li>Pills/tablets </li></ul></ul><ul><ul><li>Decoctions </li></ul></ul><ul><ul><li>Moxibustion </li></ul></ul><ul><ul><li>Cupping </li></ul></ul>
    22. 22. Frequencies & Lengths of Acupuncture Treatment <ul><li>Cumulative effect of series </li></ul><ul><li>10-12 sessions to begin cellular change. </li></ul><ul><li>Pre-cycle: 1-2/wk X 3-6 cycles </li></ul><ul><li>Trial phase: 2-3/wk X 6-9 cycles </li></ul><ul><li>Average: 6-12 cycles </li></ul><ul><li>Less frequency with herbal prescription </li></ul><ul><li>Speed of improvement proportional to the length of time of imbalance </li></ul>
    23. 23. Mechanisms of Acupuncture (1) a clinical observation in Shanghai, China <ul><li>Highly increase of the egg production </li></ul><ul><li>Regulate the function of hormone levels </li></ul><ul><li>Influence in the gene expression in the brain, normalizing secretion of GnRH, LH, and E2 . </li></ul>
    24. 24. Researches for acupuncture that benefits the fertility <ul><li>Sandra Emmons, M.D: </li></ul><ul><li>-Oregon Health Science University </li></ul><ul><li>Acupuncture before the IVF, improve the success rate of pregnant woman. </li></ul><ul><li>Rate significantly higher in the patients combine the herbal treatment . </li></ul><ul><li>Cornel University’s </li></ul><ul><li>Weil Medical College: </li></ul><ul><li>Summed up acupuncture’s positive effect o infertility issues. </li></ul><ul><li>There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and treatment of female infertility. </li></ul>
    25. 25. Role of acupuncture in female infertility The institute of East-West Medicine, New York, USA , 2002 <ul><li>Acupuncture are mediated through endogenous opioid peptides in the central nervous system, particularly in Beta-endorphine. </li></ul><ul><li>These neuropeptides influence gondotropin secretion through their action on GnRH </li></ul><ul><li>In IVF patient, undergo IVF, besides its central effect, the sympathoihhibiitory effects of acupuncture may impact on uterine blood flow. </li></ul>
    26. 26. Mechanisms of acupuncture (2) - a study in Harvard, <ul><li>Endorphins releases </li></ul><ul><li>Mitigate one’s response to stressful stimuli, enhance the possibility of conception </li></ul><ul><li>Minimize prolactin </li></ul><ul><li>Elevated prolactin could </li></ul><ul><li>cause irregular ovulation </li></ul>
    27. 27. Acupuncture and Herbal Medicine in IVF: a review of the evidence for clinical practice -Cheong Y. Nardo LG, Rutherford T, Ledger W. DOHaD, UK, 2010 <ul><li>14 trials o f 2670 subjects </li></ul><ul><li>Acupuncture & Herbal medicine in ART </li></ul><ul><li>Outcome measuring rate of pregnant, birthrate, & miscarriage </li></ul><ul><li>Results provide evidence of benefit in the use of acupuncture assisted conception. </li></ul>
    28. 28. Integrative Acupuncture Tx <ul><li>Reduces stress </li></ul><ul><li>Enhances hormone regulation </li></ul><ul><li>Regulates the menstrual cycle </li></ul><ul><li>Promotes the ovarian functions </li></ul><ul><li>Invigorate the sperm qualities </li></ul><ul><li>Treats PMS, Amenorrhea, Endometriosis and blocked fallopian tubes </li></ul><ul><li>Increases the effectiveness of IVF, GIFT, ZIFT, and ET. Procedures </li></ul><ul><li>Protects the fragile embryo </li></ul><ul><li>Strengthen the immune system </li></ul>
    29. 29. Treatment Protocols (1) Stress-relieve <ul><li>Objectives: </li></ul><ul><li>Reduces stress and minimizes prolactin </li></ul><ul><li>By release certain chemicals and neuron-transmitter, such as endorphin, ekenephilin and serotonin, specially benefits the ART patient go through their procedure smoothly </li></ul><ul><li>Tx Protocols : </li></ul><ul><li>Acupuncture: Shenmen, P 6, Sp-6 </li></ul><ul><li>Herbal formula: Suan Zao Ren Tang </li></ul><ul><li>(Sour jujube decoction) </li></ul><ul><li>Frequency: </li></ul><ul><li>Combine with other treatment </li></ul>
    30. 30. Acupuncture & IVF procedures -Research in Christian Lairize Institute in Germany <ul><li>160 women getting IVF </li></ul><ul><li>Acupuncture before & after the embryo transfer </li></ul><ul><li>50% of the patients increased successful implantation. </li></ul><ul><li>IVF group= 26.3 % </li></ul><ul><li>IVF plus acupuncture </li></ul><ul><li>= 42.5 % </li></ul><ul><li>AAI successful rate is 68.9 % </li></ul><ul><li>of integrative IVF patients at December, 2008. </li></ul>
    31. 31. Acupuncture on the day of Embryo Transfer <ul><li>Acu1= 95, on the day 36%/34% </li></ul><ul><li>Acu2 =91, on the day and 2 days after 36%/26% </li></ul><ul><li>Control=87, no acupuncture. 26%/22% </li></ul><ul><li>Conclusion: </li></ul><ul><li>Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ ICSI. Compare to no acupuncture. </li></ul><ul><li>2. Repeating acupuncture on ET day and 2 days after provided no additional benefit </li></ul><ul><li>Westergaard LG , Mao Q , Krogslund M , Sandrini S , Lenz S , Grinsted J. </li></ul><ul><li>Fertility Clinic Tranglen, Hellerup, Denmark. </li></ul><ul><li>Fertil Steril . 2006 May;85(5):1341-6. Epub 2006 Apr 5. </li></ul>
    32. 32. Pain Relieve During Oocyte Retrieval <ul><li>EA has proven analgesic effect </li></ul><ul><li>Frequency at 80/20/2 Hz </li></ul><ul><li>Study of 152 cases </li></ul><ul><li>Conclude that </li></ul><ul><li>No differences in EA </li></ul><ul><li>Frequencies. </li></ul><ul><li>Humaidan P . Brock K Bungum L . Stener-Victorin E. </li></ul><ul><li>The fertility clinic, Vyborg Hospital, Skive, DK7800 Skive, Denmark, </li></ul><ul><li>Reprod Biomed. Online, 2006 Jul; 13, (1):120-S. </li></ul>
    33. 33. Acupuncture & Protection of Embryo <ul><li>Acupuncture boost blood flow to women’s reproductive organs and providing better nourishment. </li></ul><ul><li>Improve the lining of the uterus, enhance the embryo becomes embedded after conception. </li></ul><ul><li>Improve implantation and prevent the risk of miscarriage. </li></ul>
    34. 34. Herbal Treatment <ul><li>Affects many parts of the reproductive cycle by triggering the bodies own natural processes. </li></ul><ul><li>Trigger the hypothalamus and pituitary to release hormones that stimulates the production of FSH and LH </li></ul><ul><li>Individualized herbal formula </li></ul><ul><li>is most effective </li></ul><ul><li>Follow up monthly objective evaluation of hormone test. </li></ul><ul><li>Aware of the ART treatment and drug interactions. </li></ul>
    35. 35. Individualized Herbal Treatment <ul><li>Mainly to nourish the reproductive organs, enhance ovarian function, promote follicles maturation and increase linings of the uterus. </li></ul><ul><li>Classic Herbal formula </li></ul><ul><li>Individualized herbal formula modification </li></ul><ul><li>Length of treatment various from 2 to 6 cycles </li></ul><ul><li>Safe for early pregnancy and prevent miscarriage. </li></ul>
    36. 36. Herbs that Benefits Fertility Angelicae Sinensis (Dang Gui) Asini Gelatinum ( E Jiao) Astragali (Huang Qi) Condonopsis (Dang Shen) Amomi (Sha Ren) Eucommiae (Du Zhong) Lycii Chinensis (Gou Qi Zi) Dioscoreae Oppositae (Huai Shan) Carculiginis (Xian Mao) Epimenddi (Xian Ling Pi) Sm. Cuscutae (Tu Si Zi) White Paeoniae (Bai Shao) Hetrophylii (Yi Mu Cao) Actinolitum (Yang Qi Shi) Epimedii (Yin Yang Huo) Gecko (Ge Jie)
    37. 37. Classic Herbal Formulas Benefits Fertility <ul><li>1. Yu Lin Zhu- kidney deficiency </li></ul><ul><li>2. You Gui Wan- kidney deficiency </li></ul><ul><li>3. Wu Zi Yan Zong Wan- kidney deficiency </li></ul><ul><li>4. Ai Fu Nuan Gong Wan- cold uterus </li></ul><ul><li>5. Ren Shen Yang Rong Tang- Blood deficiency </li></ul><ul><li>6. Yang Jing Zhong Yu Tang- Blood deficiency </li></ul><ul><li>7. Chai Hu Shu Gan San- liver depression </li></ul><ul><li>8. Kai Yu Zhong Yu Tang- liver depression </li></ul><ul><li>9. Qi Re Xiao Yu Tang- Stagnant heat </li></ul><ul><li>10. Xiao Zhi Mo Dao Tan Tang- Phlegm dampness </li></ul><ul><li>11. Qi Gong Wan- Stagnant heat </li></ul>
    38. 38. Herbal Treatment Prevents Miscarriage -a Study from Fudan University of Shanghai, 2001 <ul><li>The process of conception and pregnancy involves a suppression of the T-help immune response </li></ul><ul><li>Herbal medicine could inhibit specific immune injury, reprogram the immune system to not react to self-tissue, allow the normal suppression involved in implantation to occur. </li></ul><ul><li>Individualized herbs: Du zhong </li></ul><ul><li>Classical Formulas: Dingxiang shi di tang (Clove and Persimmon Calyx decoction) </li></ul>
    39. 39. Chinese herbal medicine for subfertile women with polycystic ovarian syndrome - Reproductive endocrinology of Sichuan University medical school, China, 2010 <ul><li>RCTs, 344 patients of PCOS </li></ul><ul><li>CHM + Clomiphene vs. Clomiphene </li></ul><ul><li>There was evidence improving pregnancy rate </li></ul>
    40. 40. Chinese Herbal Medicine and Clomiphene citrate for Anovulation: RCTs by acupuncture Kitchen, San Francisco, CA, 2011 <ul><li>14 studies from Review of 1009 studies between 2000-2006 </li></ul><ul><li>CHM+CC vs. CC </li></ul><ul><li>4 studies (28.6%) reported 14% higher BBT </li></ul><ul><li>6 studies (42.9%) reported 18% increase in OV rate </li></ul><ul><li>2 studies (14.3% reported 78% increase in endometrial lining > 6 mm </li></ul><ul><li>13 studies (92.9%) reported 50 % increase in pregnancy rate </li></ul>
    41. 41. Objective Evaluations <ul><li>Initial evaluation </li></ul><ul><li>Infertility -causation </li></ul><ul><li>Consider the etiology in TCM </li></ul><ul><li>Refer to fertility specialist </li></ul><ul><li>Evaluates partner’s health conditions </li></ul><ul><li>Release medical records for the history of illness </li></ul><ul><li>Follow up evaluation: </li></ul><ul><li>Monthly hormonal tests: </li></ul><ul><ul><li>Day 2/3: FSH, Estrogen, prolactin </li></ul></ul><ul><ul><li>During ovulation: Basal temperature chart, mucus and ovulation kits </li></ul></ul><ul><ul><li>Day 21 or 7 days post ovulation: Progesterone </li></ul></ul><ul><li>Ultrasound: </li></ul><ul><ul><li>Day 2: # of follicles & size </li></ul></ul><ul><ul><li>Day12/13: sizes of follicles </li></ul></ul><ul><li>Follow up with fertility physician’s plan closely and report any unexpected reactions. </li></ul>
    42. 42. Food Flavors Recommendation <ul><li>Sweet -Tonifies and harmonizes and relaxes. </li></ul><ul><li>Pungent - Dispersing and invigorating, promote circulation, moves Qi, blood, & body fluid. </li></ul><ul><li>Sour Astringent -Absorbing, consolidating </li></ul><ul><li>Bitter - Dries damp, disperses, often clears, damp, edema and heat </li></ul><ul><li>Salty -softens and dissolves hard masses. Moistens and lubricates the intestines </li></ul><ul><li>Bland - diuretic, promotes urination and relieves edema </li></ul>
    43. 43. Foods that Invigorates Blood Week 1 of the cycle Eggplant Peanuts Red Bean Dates
    44. 44. Foods Nourishes Blood Week 2 of the cycle Beef Chicken eggs Grapes Lamb Chicken Fish
    45. 45. Foods that Benefits the lining growth (Week 3 of the cycle) Kale Spinach Apple Appricot Cherry Chinese Date Lemon Asian Pear Sesame seed ( brown) Sesame seed ( black)
    46. 46. Foods that benefits Kidney deficiency ( Week 4 of the cycle) Green beans Mulberry Raspberry Black beans Chestnut Lotus seed Walnut Honey
    47. 47. Food for clear the heat Papaya Lemon Cucumber Cantaloupe White rice Asparagus Carrot Sweet potato Fig Lenti Bok choy Celery Cucumber Peach Mung bean Red/green cabbage Chard Banana Pineapple White fungus
    48. 48. Foods that detoxifies Shitake mushroom Snow pea Pumpkin seeds Sunflower seed Soybean Olive Rice vinegar Tea
    49. 49. Food for drain dampness Alfalfa sprout Chinese Chive Onion or leek Parsnip Pumpkin and winter squash Turnip Winter melon Dried papaya Barley Rice bran Wheat bran Adzuki bean Beef Fish Cardamom seed
    50. 50. Foods that Relieves Food Retention Bamboo shoots Bell pepper Daiko radish Howthone Berry Plums Tomato Oats Pea Parsley Barley Malt syrup
    51. 51. Food that Strengthen Digestion Arise seed Brown sugar Cinnamon Clove Fennel seed Ginger root Molasses
    52. 52. Prenatal Vitamins-Woman <ul><li>Folic Acid - 400mg/day- development of baby’s brain and spinal cord (fortified cereals, green leafy vegetables, citrus, grapefruit) </li></ul><ul><li>Calcium - bone develop </li></ul><ul><li>Iron -prevent anemia ( green leaf vegetable, red meat) </li></ul><ul><li>Fibers - 30-35g/day (unrefined grains, whole wheat, beans, fruits and vegetables </li></ul>
    53. 53. DHEA(dehydroepiandrosterone) <ul><li>Is an endogenous hormone, made in human adrenal gland </li></ul><ul><li>Serve as precursor to make androgens and estrogens </li></ul><ul><li>Level decreases due to disease or drugs </li></ul><ul><li>Evidence of use DHEA to treat </li></ul><ul><li>adrenal insufficiency, depression, induction of labor and lupus. </li></ul><ul><li>Side effect: increase the risk of hormone sensitive cancers </li></ul><ul><li>Under professional guidance. </li></ul>- Mayo
    54. 54. Part II: Male Factors
    55. 55. Infertility isn’t just the woman’s problem anymore <ul><li>40-50 % male infertility </li></ul><ul><li>Inadequate # of sperm </li></ul><ul><li>Inhibited ejaculation </li></ul><ul><li>Retrograde ejaculation </li></ul><ul><li>Failure of descend into the scrotum </li></ul><ul><li>Antibodies to the sperm </li></ul>
    56. 56. Male Factors of infertility <ul><li>Spermophlebectasia </li></ul><ul><li>Sperm dysfunction </li></ul><ul><li>Sexually transmitted disease </li></ul><ul><li>Physical damage </li></ul><ul><li>Genetic disease </li></ul><ul><li>Auto immune disease </li></ul>
    57. 57. Male Reproductive Anatomy
    58. 58. Male Reproductive Organs <ul><li>Testes (gonads): </li></ul><ul><ul><li>Sperm (exocrine) </li></ul></ul><ul><ul><li>Testosterone (endocrine) </li></ul></ul><ul><li>Ducts </li></ul><ul><li>Glands </li></ul>
    59. 59. I. Male Organs-Testes <ul><li>Size: 4 cm X 2.5 cm </li></ul><ul><li>Connective tissue capsule </li></ul><ul><li>Tunica albuginea </li></ul><ul><li>Seminferous tubules </li></ul><ul><li>Rete testis </li></ul><ul><li>Duct system </li></ul><ul><li>Epididymis </li></ul><ul><li>Interstitial cells -produces androgens & testosterone. </li></ul>
    60. 60. Testosterone Production <ul><li>Produced by interstitial cells </li></ul><ul><li>Stimulated by LH </li></ul><ul><li>Testosterone stimulate the male reproductive organs develop & 2 nd male characteristics </li></ul><ul><li>Lack of the testosterone will result in sexual infantilism & sterility. </li></ul>
    61. 61. Testes Malfunction
    62. 62. II . Male organs- Duct System <ul><li>Transport sperm from the body: </li></ul><ul><li>Epididymis </li></ul><ul><li>Ductus deferens </li></ul><ul><li>Urethra </li></ul>
    63. 63. Male Organs- Epididymis <ul><li>Highly coiled tube 6M </li></ul><ul><li>Caps superior of testes </li></ul><ul><li>1 st part of male duct </li></ul><ul><li>Storage site of immature sperm </li></ul><ul><li>Mature in 20 days </li></ul><ul><li>Ability to swim </li></ul><ul><li>Walls of epididymis contract to expel the sperm to ductus deference </li></ul>
    64. 64. Male organs - Ductus Deferens <ul><li>Enclosed tube along with blood vessels & nerves in sperm cord </li></ul><ul><li>Propel live sperm into urethra by peristaltic waves rapidly squeeze the sperm forward </li></ul><ul><li>Scrotal Sac </li></ul><ul><li>Vasectomy- cauterizing the vas deferens. Sperm is still produced but no longer reach the outside </li></ul><ul><li>Sterile- testosterone still produced and libido remained. </li></ul>
    65. 65. Sperm Ascending
    66. 66. Vas Deferens Blockage
    67. 67. Male Organs- Urethra <ul><li>3 main regions </li></ul><ul><ul><li>Prostate Urethra </li></ul></ul><ul><ul><li>Membranous urethra </li></ul></ul><ul><ul><li>Spongy urethra </li></ul></ul><ul><li>Carry urine and sperm to exterior </li></ul><ul><li>Ejaculation </li></ul>
    68. 68. Male Organs-Scrotum <ul><li>Providing the testes with a temperature that is below body temp. </li></ul><ul><li>Cold->scrotum wrinkled ->testes closer to the body to maintain viable sperm production </li></ul>
    69. 69. Male Organs- Penis <ul><li>To deliver sperm into the female reproductive tract </li></ul><ul><li>Circumcision- surgically removed after birth </li></ul><ul><li>3 enlarged eretile tissue </li></ul><ul><li>Erection-blood flow </li></ul>
    70. 70. Good Sperm Formation <ul><li>Sperm takes 100 days to develop (70/30) </li></ul><ul><li>3 main factors: </li></ul><ul><li>Sperm count: > 20 million/ml/ejaculate </li></ul><ul><li>Morphology (shape of the sperm) </li></ul><ul><li>Motility (How fast and straight the sperm swim) </li></ul>
    71. 71. Spermatogenesis
    72. 72. Spermatogenesis
    73. 73. Functions of Sperm
    74. 74. Macho Sperm Theory <ul><li>Damage fertilized eggs. </li></ul><ul><li>Some toxins may alter the sperm’s DNA. Damaged chromosomes still carry genetic information </li></ul><ul><li>Results in infertility, miscarriage, birth defects, learning disabilities, childhood cancer and kidney cancer. </li></ul>
    75. 75. Male Infertility Assessment <ul><li>Sperm count < 10 million/ml (200 million) </li></ul><ul><li>Volume < 5 ml per ejaculate </li></ul><ul><li>Sperm motility < 60 % </li></ul><ul><li>Sperm Morphology < 50 % normal </li></ul>
    76. 76. Getting Tested <ul><li>Urologist evaluation </li></ul><ul><li>Sperm analysis 2-3 Tx </li></ul><ul><li>Defect factors: </li></ul><ul><ul><li>Azoospermia </li></ul></ul><ul><ul><li>Oligiospermia </li></ul></ul><ul><ul><li>Sperm motility decreases </li></ul></ul><ul><ul><li>Sperm morphology abnormalities </li></ul></ul>
    77. 77. Normal Sperm Analysis <ul><li>Volume= 3 ml (2-6ml) </li></ul><ul><li>Concentration=20M/ml </li></ul><ul><li>Motility: 50 %> 2 hrs </li></ul><ul><li>Morphology: >60 % </li></ul><ul><li>Viscosity </li></ul><ul><li>Ejaculate normally liquefies < 1hr </li></ul><ul><li>pH= 7-8 </li></ul>
    78. 78. Sperm abnormalities <ul><li>Adequate </li></ul><ul><li>Aspermia </li></ul><ul><li>Azoospermia </li></ul><ul><li>Oligospermia </li></ul><ul><li>Poor motility & forward movement </li></ul><ul><li>High percent of abnormal sperm morphology </li></ul><ul><li>Anti-sperm antibodies </li></ul>
    79. 79. Diagnosis of Male infertility <ul><li>Medical History Physical Examination-structure </li></ul><ul><li>Secondary sex characteristics evaluation </li></ul><ul><li>Endocrine function test </li></ul><ul><li>Sperm analysis and morphology </li></ul>
    80. 80. Causes of Male Infertility <ul><li>Radiation </li></ul><ul><li>Environment toxins </li></ul><ul><li>Undescended testis </li></ul><ul><li>Varicocele </li></ul><ul><li>Traumatic injury </li></ul><ul><li>Infectious injury </li></ul><ul><li>Testicular atrophy </li></ul><ul><li>Drug effects </li></ul><ul><li>Alcohol, nicotine, marijuana, cocaine Prolonged fever </li></ul><ul><li>Endocrine disorders </li></ul><ul><li>Congenital abnormalities </li></ul><ul><li>Surgery of the lower abdominal region </li></ul><ul><li>Tight underwear </li></ul><ul><li>Stress, lack of sleep </li></ul>
    81. 81. Acupuncture Treatment <ul><li>Acupuncture can stimulate histamine release to dilate the blood vessels, therefore to improve the blood circulation, thus reduces varicose veins in the region </li></ul><ul><li>Most commonly selected points are located on the back and leg areas. </li></ul><ul><li>Frequency at 1-2 tx/wk or </li></ul><ul><li>based individualized treatment plan </li></ul>
    82. 82. Responses of TCM treatment <ul><li>Case report: </li></ul><ul><ul><li>A 43 male with 3 months of combined </li></ul></ul><ul><ul><li>treatment </li></ul></ul><ul><ul><li>Sperm count: </li></ul></ul><ul><ul><li>From < 18 million/ml to 93 million </li></ul></ul><ul><ul><li>Motility : from < 50 % to 97% </li></ul></ul><ul><ul><li>Morphology: from normal <20 % to 45 % </li></ul></ul><ul><ul><li>Hu,C. etl . Advanced Acupuncture, Inc. 2006 </li></ul></ul><ul><ul><li>Los Angels, U.S.A </li></ul></ul>
    83. 83. Acupuncture & Sperm Quality Improvement <ul><li>Acupuncture effects on sperm production and quality without causing any changes in behavior and sexual desire. </li></ul><ul><li>Study of 28 men who ere diagnosed with idiopathic infertility received acupuncture twice a week over 5 weeks, significantly increase the quantities of normal sperm and equally reduces in structural defects. </li></ul><ul><li>Hu,C. etl </li></ul><ul><li>Advanced Acupuncture, Inc. 2006, Los Angeles, U.S.A. </li></ul>
    84. 84. Effect of Acupuncture on Sperm Parameters <ul><li>16 subject were coanalyzed before & 1 month after treatment </li></ul><ul><li>(Two times/week for 5 weeks) </li></ul><ul><li>16 subject of controlled, untreated for comparison </li></ul><ul><li>Evaluated by semen analysis and ultramorphyological observations. </li></ul><ul><li>Conclusion; </li></ul><ul><li>The fertility index increased significantly in the treatment group (p<or =0.5) </li></ul><ul><li>Sperm motility and axonema intactness were highly correlated </li></ul><ul><li>(corr:= 0.50, p< or = 0.5) </li></ul><ul><li>Siterman S, Israel, 1997 </li></ul>
    85. 85. Protocols improves sperm count and motility <ul><li>Electro-acupuncture: </li></ul><ul><ul><li>Points: UB-23, 25, K5, Sp 6 </li></ul></ul><ul><ul><li>Frequencies: 2 tx/wk X 5 weeks. </li></ul></ul><ul><ul><li>Lengths: 2-3 courses until sperm analysis become normalized </li></ul></ul><ul><li>Herbal formulas: </li></ul><ul><ul><li>Jin Gui Shen Qi Wan </li></ul></ul><ul><li>Evaluation: </li></ul><ul><ul><li>by repeat Sperm analysis between the acupuncture course. </li></ul></ul>
    86. 86. Chinese Medicine improves semen morphology, motility, & count <ul><li>Randomized clinical trial in Sydney, Australia, 2004 </li></ul><ul><li>Acupuncture and herbal medicine </li></ul><ul><li>Improve sperm normal form: p<0.038 </li></ul><ul><li>Improve semen motility: p<0.008 </li></ul><ul><li>Improve count: mean increase 220 million sperm </li></ul>
    87. 87. Acupuncture in the treatment of Psychogenic Erectile Dysfunction <ul><li>Randomized placebo-controlled pilots study, Austria, 2003 </li></ul><ul><li>22 patients, satisfactory response =68.4% </li></ul><ul><li>Acupuncture can be effective option >2/3 of PED </li></ul>
    88. 88. Artificial Insemination (IUI) <ul><li>The sperms are collected and send to sperm wash </li></ul><ul><li>More concentrated sperm count without semen. </li></ul><ul><li>Inject to female, let sperm surround with egg to penetration. </li></ul><ul><li>Option for male infertility </li></ul><ul><li>Alternative procedure when IVF did not respond well. </li></ul>
    89. 89. Intracytoplasmic sperm injection ICSI <ul><li>For low sperm count & male infertility </li></ul><ul><li>Sperm & eggs are retrieved </li></ul><ul><li>Inject 1 sperm into an egg </li></ul><ul><li>Fertilized egg is then implanted </li></ul>www.
    90. 90. Spermophlebectasia (varicose vein of the spermatic cord) <ul><li>Increases blood in the vein of the spermatic cord  increases temp. in testicle  decrease live sperm count and activity </li></ul><ul><li>Prolonged presence of the varicosity can result in poor blood circulation to the area & shrinkage/or dysfunction of the testicle  unable to produce healthy sperm </li></ul>
    91. 91. Symptoms of Spermophlebectasia <ul><li>Male age 20-30 </li></ul><ul><li>Chief complain-pain </li></ul><ul><li>Heaviness of scrotum </li></ul><ul><li>Pain at testicles, groin and lower abdomen </li></ul><ul><li>Standing and walking aggravates. </li></ul><ul><li>Resting in supine position alleviates </li></ul><ul><li>Signs: Scrotum enlarged and loose </li></ul><ul><li>Vein is enlarged and purple </li></ul><ul><li>Varicose veins are also present in the groin and inner thigh </li></ul><ul><li>Press vein, it shrinks or disappears </li></ul>
    92. 92. TCM treatment for Spermophelebectasia <ul><li>Acupuncture </li></ul><ul><li>Acupuncture can stimulate histamine release to dilate the blood vessels to improve the blood circulation, thus reduces varicose veins in the region </li></ul><ul><li>Herbal Formula </li></ul><ul><li>Individualized formulas based on the etiology to improve blood circulation, resolve blockage, and promote healthy sperm </li></ul>
    93. 93. TCM Treating Male Immune Infertility <ul><li>Observation of “Yikang Tang” (decoction) to treat 100 pt with immune infertility </li></ul><ul><li>Compare with 100 cases treated with prednisone </li></ul><ul><li>Results: </li></ul><ul><li>AsAb decreased significantly, (p<0.01) </li></ul><ul><li>The sperm density and motile spermatozoa increased significantly </li></ul><ul><li>The sperm agglutination rate decreased </li></ul><ul><li>The improvement rate of the symptoms and stability of the therapeutic effect were more dramatic in the treatment group. </li></ul><ul><li>Has more stable effect for male immune infertility than Prednisone . </li></ul><ul><li>-Sun Z. Bao Y. 2006,Honzhong, China </li></ul>
    94. 94. Herbs That Benefits for Sperm Ginseng (Ren Shen) Tribulus ( Bai Ji Li ) Epimedii (Yin Yang Huo) Sm. Cuscutae (Tu Si Zi) Curculiginis Orchioidis (Xian Mao) Actinolitum ( Yang Qi Shi) Fr. Rubi (Fu Peng zi) Fr. Rosae Laevigatae (Jing Yin Zi) Eucommiae Ulmoidis (Du Zhong)
    95. 95. Classic Herbal Formulas <ul><li>Modified Jin Gui Shen Qi Wan </li></ul><ul><li>Main ingredients : Ginseng, Deer horn, Sea horse, Hokuo, Epimedii, Angelica, Cinnamomi, Poria cocos </li></ul><ul><li>Used for low sperm count, low motility and morphology </li></ul><ul><li>Modified Jin Suo Gu Jin Wan </li></ul><ul><li>Main ingredients : </li></ul><ul><li>Eucommiae, Epimedii, Achyrabthis,Cistanches, </li></ul><ul><li>Cynomorii, Cuscutae. </li></ul><ul><li>Used for impotency, low libido and early ejaculation </li></ul>
    96. 96. Modified Jin Gui Shen Qi Wan (Kidney Qi Pill from Golden Cabinet) <ul><li>87 male pts. were treated and observed in our clinic </li></ul><ul><li>Comparison made before and after treatment 3-6 months. </li></ul><ul><li>Measured by routine semen analysis </li></ul><ul><li>3 months enhanced function significantly, spouse pregnant rate =56% (49/87) </li></ul><ul><li>Sperm analysis improvement after 6 months= 68.40% </li></ul><ul><li>This formula influences regulatory function in FSH, LH, Testosterone, Coticosterone level </li></ul><ul><li>Hu C. Etl </li></ul><ul><li>Advanced Acupuncture, Inc. 2006, Los Angeles, U.S.A. </li></ul>
    97. 97. Modified Jin Suo Gu Jin Wan ( Mental lock pill to stabilize the essence ) <ul><li>82 male patients were treated and observed </li></ul><ul><li>The length of treatment is 3-6 months </li></ul><ul><li>The sperm count improves 67.4 % </li></ul><ul><li>The activity rate of sperm markedly improved after treatment. </li></ul><ul><li>Hu,C. etl </li></ul><ul><li>Advanced Acupuncture, Inc. 2006, Los Angeles, U.S.A. </li></ul>
    98. 98. Making Good Sperm <ul><li>Eating Healthily </li></ul><ul><li>Taking Vitamins </li></ul><ul><li>Drinking more water </li></ul><ul><li>Copping Stress </li></ul><ul><li>Staying active </li></ul><ul><li>Enjoying regular sex </li></ul><ul><li>Sleeping enough </li></ul><ul><li>Liver Detox </li></ul><ul><li>Weekly acupuncture </li></ul><ul><li>Stop smoking </li></ul><ul><li>Cut down alcohol </li></ul><ul><li>Avoid drug intake </li></ul><ul><li>Minimize caffeine </li></ul>
    99. 99. Things to avoid <ul><li>High temperature </li></ul><ul><li>( best at 32 degrees C) </li></ul><ul><li>Stress ( testes malnourished) </li></ul><ul><li>Alcohol ( interferes of testosterone secretion) </li></ul><ul><li>Smoking (40 % sperm damage by free radicals) </li></ul><ul><li>Environmental Estrogen </li></ul><ul><li>(meat, microwave plastics) </li></ul><ul><li>Drugs ( reduces testosterone & libido) </li></ul><ul><li>Caffeine (impair sperm production & cause chromosomal abnormalities) </li></ul><ul><li>Toxins (pesticides, heavy metals) </li></ul><ul><li>Pollutants </li></ul>
    100. 100. Nutrients for Sperm Altern Med Rev. 2000 Feb;5(1):28-38. Green Valley Health, Hagerstown, MD 21742, USA Amino Acids 500 mg Vitamin A 700mcg Vitamin B6 1.4-500mg Vitamin B12 1.5mcg Folic Acid 200-400mcg Vitamin C 500- 1000 mg Vitamin E 400 IU Selenium 75 mcg Manganese 1.4 mg Zinc 10-30 mg Coenzyme Q 10- 90 mg Essential Fatty Acids 2000 mg
    101. 101. Pro-vitamin for Men <ul><li>Zinc -15 mg/day, (oyster) </li></ul><ul><li>Vitamin E 100-400IU (Olive oil, wheat germ) </li></ul><ul><li>Calcium 1000mg </li></ul><ul><li>Vitamin D 10 mcg </li></ul>
    102. 102. Good Sperm Diet Black berries Blue berries Rosen berries Kale Strawberries Brussels sprouts Broccoli Red peppers Grape seed extract Pink bark extract Garlic Oyster
    103. 103. Resources <ul><li> chart </li></ul><ul><li> A nonprofit organization </li></ul><ul><li>Making babies-Book by M.D. </li></ul>
    104. 104. Questions? Contact information Cathryn Hu, Ph.D., O.M.D., L.Ac . Phone: 310-458-2848 Fax: 310-458-2899 Web: www. Email: Advanced_Acupuncture @