Alternative medicine - what every IVF specialist needs to know

Doctors – Scientists and/or Healers ?
Dr Anjali Malpani, MD
www.drmalpani.com

Conventional v/s Alternative Medicine – who Decides?
Money
Colonisation
High Tech
These have made Western medicine occupy the premier position

Yoga, Ayurveda and Chinese medicine have a much longer tradition than modern medicine
In Germany homeopathy is mainstream medicine –not alternative!
Conventional v/s Alternative Medicine

Doctors are Sceptical
Lack of available scientific documentation and evidence

No need to be critical and dismissive
No need to look down upon these treatments just because there are no publications !

Wake up!
40% of all infertile patients use some form of CAM

Doctors don’t know everything
Doctors need to be humble,keep an open mind and be willing to learn!

Jenner “discovered” vaccination by being willing to listen to cowgirls!

Alternative medicine is usually self-prescribed
Why do patients look for alternatives in the first place ?
Because they are not happy with modern medicine !
Good doctors need to be empathetic and to acknowledge this fact

Scientists or Healers?
“ ART” specialists
have lost the ART of Medicine

Alternative Therapy
Why ?
When ?
Who ?
How ?

Why?
Holistic approach
Personalized touch
Patients experience control over their situation- “doing something themselves”
Low cost
Avoid side effects of drugs

When?
When they have been given the frustrating diagnosis of “unexplained infertility”
When they have failed standard fertility treatments
To maximize their chances of having a child
Cultural beliefs

How do they work?
Bringing the body back into balance?
Reducing stress level?
Placebo effect?

Who Benefits?
Unexplained infertility
Ovulation disorders
IVF waiting list “ treatment independent “ pregnancies

Integrative Medicine
Alternative therapies are very often used in conjunction with conventional treatments
Prior to undergoing treatment

Patients will often not tell us that they are using CAM
Are scared that we will criticize or pooh-pooh these

Show Me The Data!
Western Medicine is evidence-based Medicine
Efficacy of a treatment has to be proven scientifically by convincing experts and scientific committees
The Randomized controlled trial (RCT) is considered the “gold standard” for evaluating the effects of interventions.

Why are there no trials in alternative medicine ?
Too expensive, not enough funding
No money to be made by pharmaceutical companies
Drugs cannot be patented
Difficult to enroll patients for these trials
Difficult to conduct double blind trials

Lack of evidence of an effect
does not equal
evidence of the lack of an effect

Anecdotal successes
Story of the old man and the starfish

“ Not everything which counts can be measured,
Not everything which we can measure is worth counting.”
Einstein

New trend
Patients are doing research for themselves
Social networking
Health 2.0
www.patientslikeme.com

Why are doctors sceptical?
Quackery flourishes as there is no formal training required and there is no monitoring of practitioners of alternative medicine.

Dubious?
That’s fine
We should be!
But we need to be equally skeptical about all medical interventions!

Modern medicine also uses Untested and unproven treatments!
DHEA as a miracle drug in the treatment of poor responders; hype or hope? Human Reproduction. Kayhan and Urman
Is recombinant FSH really better than urinary HMG ?
Male infertility treated with hormones, vitamins,antiestrogens.
Operative treatment of varicocoeles
IVIG for treatment of repeated IVF failures

Evidence-Based Medicine : can the evidence be trusted?
Many well reported RCTs are designed to deceive by biased study designs!
Vested financial interests!
Manipulation of statistics to produce desired outcomes that are selectively reported.

Keep an open mind
Rather than looking down upon alternative medicine treatments it is better to be accepting and be willing to learn from our patients

Different Methods of CAM

Alternative Medical Systems
Ayurveda
Homeopathy
Naturopathy
Manipulative Bodybased Therapies
Acupuncture
Massage
Chiropactry
Osteopathy

Mind body Therapies
Yoga
Meditation
Reiki
Hypnotherapy
Aroma Therapy
Diet based Therapies
Chinese herbs
Vitamin therapy

Commonest methods
Acupuncture
Chinese herbs
Yoga and Meditation

Acupuncture

Acupuncture – how does it act?
Acts centrally by increasing B-endorphin levels which in turn affect the HPO axis and GnRH secretion
Acts peripherally by increasing the uterine artery blood flow and hence improving endometrial thickness and implantation.
Chang and Rosenwaks –Fertility and Sterility
Vol 78,No.6, Dec 2002

How does Yoga help?
Has a calming restorative effect on the mind and body
Reduces stress levels
Reduces depression
Feeling of control over one’s reproductive destiny

How does Yoga Help?
Improves strained relationships
Helps to cope anxiousness, nervousness, helplessness
Reduces emotional stress

One cannot control what’s happening to your body but you can control how you feel about it!

What is success?
We need to redefine the term success
pregnancy? or
patient wellbeing?

We need to acknowledge that CAM works!
How it works really does not matter

Information Therapy
Better to be an agnostic rather than an atheist
It’s fine to say – We do not know!
Cannot be an expert on everything !

Patient – centered medicine
Putting Patients First !
Respect patient’s desires
Best to offer all complementary therapies under one roof
Integrative medicine combines conventional medicine and CAM
Why lose your patients to another doctor ?

Best to keep an open mind
The “ label “ does not matter ! We need to do what’s best for our patients
This is not a competition. We are all on the same side!

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Alternative medicine - what every IVF specialist needs to know

by Aniruddha Malpani on Nov 23, 2011

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Alternative medicine - what every IVF specialist needs to know — Presentation Transcript