This document provides an overview of an integrative fertility enhancement program that uses acupuncture and herbal medicine. The program has two phases - a preparation phase to treat causes of infertility, and a trial phase to promote ovarian function and increase uterine lining. The document discusses hormonal imbalances, causes of infertility according to traditional Chinese medicine, individualized treatment plans, protocols for stress relief and stimulating follicles, and how acupuncture and herbal medicine can benefit fertility and IVF outcomes.

1. Integrative Fertility Enhancement Cathryn Hu, Ph.D., O.M.D., L.Ac .

2. Conflict of Interest and Financial Disclosure Integrative Fertility Enhancement Cathryn Hu, Ph.D., O.M.D., L.Ac. President of Advanced Acupuncture, Inc. Professor of Advanced Acupuncture Institute None

3. Celebrating A New Life The miracle baby

4. Human Reproductive System Human Sexuality: Conception from www.abuhmed.org

5. Hormones involves in the Menstrual Cycle

6. Basal Temperature Record

7. Eggs maturation and travel process

8. www. newscientist.com Ovulation Process

9. Fertility Enhancement Program -an integrative approach Two phases of treatment in our integrative program: 1. Preparation phase: Treating the causation of infertility, nourishing the reproductive organs and their functions. 2. Trial phase: Promoting the ovarian functions of follicle maturation and increasing the lining of the uterus.

10. The objectives of Preparation Phase Stress relief Causation of infertility PMS treatment Endometriosis Hormone balancing Increasing mucus secretion Sperm quality & quantity improvement

11. The objectives of Trial Phase Stimulating follicles maturation Promoting the ovulation Balancing FSH, Estrogen, LH and Progesterone Integrative with IVF procedures Integrative with IUI procedures

12. The Hormonal Imbalanced Conditions High FSH level Polycystic Ovarian Syndromes (PCOS) Luteal phase defect Endometriosis Assistant Reproductive Technology (ART)

13. Other Causations of Infertility Stress- -Flight-or-fight response -Glucocorticoids can raise its level and weaken the reproductive system, potentially making infertility condition worse. (Prolactin) Age- Conception rate : 30’yrs, 40’yrs, decline 5-10 % each year Developing chromosomal abnormalities: < 35yrs -the rate of is 1:2000 compare to >35yrs,1: 400 Miscarriage: <30 yrs = 15 %, >40yrs =40 %

14. The Causations of Infertility in Traditional Chinese Medicine Male- Kidney yin deficiency Kidney yang deficiency Liver qi stagnation Spleen qi deficiency Blood stagnation Female- Kidney deficiency Cold uterus Blood deficiency Liver depression Stagnant heat Phlegm dampness

15. Kidney Yin deficiency signs & symptoms Scanty, dark discharge at the end of the period or amenorrhea Severe lumbago, dizziness, tinnitus Cold sensation in the lower abdomen, loose stools, copious, clear urine Dark facial complexion Tongue is pale with thin white coating Pulse is deep, thread and weak

16. Cold Uterus Prolonged menstrual discharge but scanty in volume and mixed with dark clots Cold lower abdominal pain relieved by warmth The tongue coating is thin and white The pulse is deep and slow

17. Blood deficiency signs & symptoms Withered, sallow complexion Scanty menstrual discharge during the last days of the period but light in color, dizziness, blurred vision, dry skin, constipation Insidious pain after menstruation. Tongue is pale Pulse is thready and weak

18. Liver depression signs & symptoms Early or late menstruation, scanty in volume and dark in color Abdominal distention Premenstrual breast distention Mental depression, eructation and sighing Tongue is red with a thin coating Pulse is wiry and rapid

19. Stagnant Heat signs & symptoms Scanty menstrual volume, red purplish in color and mixed with clots. Distention and pain in the lower abdomen, especially along the sides, which refuses palpation. History of lumbar soreness Distension & pain of the chest and hypochondrias Tongue is red with a thin coating Pulse is wiry and rapid

20. Phlegm dampness signs & symptoms An obese constitution History of excessive phlegm Pallor or puffiness Delayed menstruation or amenorrhea and excessive leucorrhea Tongue has a thin, white coating Pulse is wiry and slippery

21. Individualized Treatment Plan Individualized treatment plan based on etiology Acupuncture: EA for follicle phase MA for Luteal phase Herbal formula: Individualized Raw herbs Granules Pills/tablets Decoctions Moxibustion Cupping

22. Frequencies & Lengths of Acupuncture Treatment Cumulative effect of series 10-12 sessions to begin cellular change. Pre-cycle: 1-2/wk X 3-6 cycles Trial phase: 2-3/wk X 6-9 cycles Average: 6-12 cycles Less frequency with herbal prescription Speed of improvement proportional to the length of time of imbalance

23. Mechanisms of Acupuncture (1) a clinical observation in Shanghai, China Highly increase of the egg production Regulate the function of hormone levels Influence in the gene expression in the brain, normalizing secretion of GnRH, LH, and E2 .

24. Researches for acupuncture that benefits the fertility Sandra Emmons, M.D: -Oregon Health Science University Acupuncture before the IVF, improve the success rate of pregnant woman. Rate significantly higher in the patients combine the herbal treatment . Cornel University’s Weil Medical College: Summed up acupuncture’s positive effect o infertility issues. There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and treatment of female infertility.

25. Role of acupuncture in female infertility The institute of East-West Medicine, New York, USA , 2002 Acupuncture are mediated through endogenous opioid peptides in the central nervous system, particularly in Beta-endorphine. These neuropeptides influence gondotropin secretion through their action on GnRH In IVF patient, undergo IVF, besides its central effect, the sympathoihhibiitory effects of acupuncture may impact on uterine blood flow.

26. Mechanisms of acupuncture (2) - a study in Harvard, Endorphins releases Mitigate one’s response to stressful stimuli, enhance the possibility of conception Minimize prolactin Elevated prolactin could cause irregular ovulation

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 14 trials o f 2670 subjects Acupuncture & Herbal medicine in ART Outcome measuring rate of pregnant, birthrate, & miscarriage Results provide evidence of benefit in the use of acupuncture assisted conception.

28. Integrative Acupuncture Tx Reduces stress Enhances hormone regulation Regulates the menstrual cycle Promotes the ovarian functions Invigorate the sperm qualities Treats PMS, Amenorrhea, Endometriosis and blocked fallopian tubes Increases the effectiveness of IVF, GIFT, ZIFT, and ET. Procedures Protects the fragile embryo Strengthen the immune system

29. Treatment Protocols (1) Stress-relieve Objectives: Reduces stress and minimizes prolactin By release certain chemicals and neuron-transmitter, such as endorphin, ekenephilin and serotonin, specially benefits the ART patient go through their procedure smoothly Tx Protocols : Acupuncture: Shenmen, P 6, Sp-6 Herbal formula: Suan Zao Ren Tang (Sour jujube decoction) Frequency: Combine with other treatment

30. Acupuncture & IVF procedures -Research in Christian Lairize Institute in Germany 160 women getting IVF Acupuncture before & after the embryo transfer 50% of the patients increased successful implantation. IVF group= 26.3 % IVF plus acupuncture = 42.5 % AAI successful rate is 68.9 % of integrative IVF patients at December, 2008.

31. Acupuncture on the day of Embryo Transfer Acu1= 95, on the day 36%/34% Acu2 =91, on the day and 2 days after 36%/26% Control=87, no acupuncture. 26%/22% Conclusion: Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ ICSI. Compare to no acupuncture. 2. Repeating acupuncture on ET day and 2 days after provided no additional benefit Westergaard LG , Mao Q , Krogslund M , Sandrini S , Lenz S , Grinsted J. Fertility Clinic Tranglen, Hellerup, Denmark. Fertil Steril . 2006 May;85(5):1341-6. Epub 2006 Apr 5.

32. Pain Relieve During Oocyte Retrieval EA has proven analgesic effect Frequency at 80/20/2 Hz Study of 152 cases Conclude that No differences in EA Frequencies. Humaidan P . Brock K Bungum L . Stener-Victorin E. The fertility clinic, Vyborg Hospital, Skive, DK7800 Skive, Denmark, Reprod Biomed. Online, 2006 Jul; 13, (1):120-S.

33. Acupuncture & Protection of Embryo Acupuncture boost blood flow to women’s reproductive organs and providing better nourishment. Improve the lining of the uterus, enhance the embryo becomes embedded after conception. Improve implantation and prevent the risk of miscarriage.

34. Herbal Treatment Affects many parts of the reproductive cycle by triggering the bodies own natural processes. Trigger the hypothalamus and pituitary to release hormones that stimulates the production of FSH and LH Individualized herbal formula is most effective Follow up monthly objective evaluation of hormone test. Aware of the ART treatment and drug interactions.

35. Individualized Herbal Treatment Mainly to nourish the reproductive organs, enhance ovarian function, promote follicles maturation and increase linings of the uterus. Classic Herbal formula Individualized herbal formula modification Length of treatment various from 2 to 6 cycles Safe for early pregnancy and prevent miscarriage.

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. Classic Herbal Formulas Benefits Fertility 1. Yu Lin Zhu- kidney deficiency 2. You Gui Wan- kidney deficiency 3. Wu Zi Yan Zong Wan- kidney deficiency 4. Ai Fu Nuan Gong Wan- cold uterus 5. Ren Shen Yang Rong Tang- Blood deficiency 6. Yang Jing Zhong Yu Tang- Blood deficiency 7. Chai Hu Shu Gan San- liver depression 8. Kai Yu Zhong Yu Tang- liver depression 9. Qi Re Xiao Yu Tang- Stagnant heat 10. Xiao Zhi Mo Dao Tan Tang- Phlegm dampness 11. Qi Gong Wan- Stagnant heat

38. Herbal Treatment Prevents Miscarriage -a Study from Fudan University of Shanghai, 2001 The process of conception and pregnancy involves a suppression of the T-help immune response 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. Individualized herbs: Du zhong Classical Formulas: Dingxiang shi di tang (Clove and Persimmon Calyx decoction)

39. Chinese herbal medicine for subfertile women with polycystic ovarian syndrome - Reproductive endocrinology of Sichuan University medical school, China, 2010 RCTs, 344 patients of PCOS CHM + Clomiphene vs. Clomiphene There was evidence improving pregnancy rate

40. Chinese Herbal Medicine and Clomiphene citrate for Anovulation: RCTs by acupuncture Kitchen, San Francisco, CA, 2011 14 studies from Review of 1009 studies between 2000-2006 CHM+CC vs. CC 4 studies (28.6%) reported 14% higher BBT 6 studies (42.9%) reported 18% increase in OV rate 2 studies (14.3% reported 78% increase in endometrial lining > 6 mm 13 studies (92.9%) reported 50 % increase in pregnancy rate

41. Objective Evaluations Initial evaluation Infertility -causation Consider the etiology in TCM Refer to fertility specialist Evaluates partner’s health conditions Release medical records for the history of illness Follow up evaluation: Monthly hormonal tests: Day 2/3: FSH, Estrogen, prolactin During ovulation: Basal temperature chart, mucus and ovulation kits Day 21 or 7 days post ovulation: Progesterone Ultrasound: Day 2: # of follicles & size Day12/13: sizes of follicles Follow up with fertility physician’s plan closely and report any unexpected reactions.

42. Food Flavors Recommendation Sweet -Tonifies and harmonizes and relaxes. Pungent - Dispersing and invigorating, promote circulation, moves Qi, blood, & body fluid. Sour Astringent -Absorbing, consolidating Bitter - Dries damp, disperses, often clears, damp, edema and heat Salty -softens and dissolves hard masses. Moistens and lubricates the intestines Bland - diuretic, promotes urination and relieves edema

43. Foods that Invigorates Blood Week 1 of the cycle Eggplant Peanuts Red Bean Dates

44. Foods Nourishes Blood Week 2 of the cycle Beef Chicken eggs Grapes Lamb Chicken Fish

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. Foods that benefits Kidney deficiency ( Week 4 of the cycle) Green beans Mulberry Raspberry Black beans Chestnut Lotus seed Walnut Honey

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. Foods that detoxifies Shitake mushroom Snow pea Pumpkin seeds Sunflower seed Soybean Olive Rice vinegar Tea

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. Foods that Relieves Food Retention Bamboo shoots Bell pepper Daiko radish Howthone Berry Plums Tomato Oats Pea Parsley Barley Malt syrup

51. Food that Strengthen Digestion Arise seed Brown sugar Cinnamon Clove Fennel seed Ginger root Molasses

52. Prenatal Vitamins-Woman Folic Acid - 400mg/day- development of baby’s brain and spinal cord (fortified cereals, green leafy vegetables, citrus, grapefruit) Calcium - bone develop Iron -prevent anemia ( green leaf vegetable, red meat) Fibers - 30-35g/day (unrefined grains, whole wheat, beans, fruits and vegetables

53. DHEA(dehydroepiandrosterone) Is an endogenous hormone, made in human adrenal gland Serve as precursor to make androgens and estrogens Level decreases due to disease or drugs Evidence of use DHEA to treat adrenal insufficiency, depression, induction of labor and lupus. Side effect: increase the risk of hormone sensitive cancers Under professional guidance. - Mayo Clinic.com

54. Part II: Male Factors

55. Infertility isn’t just the woman’s problem anymore 40-50 % male infertility Inadequate # of sperm Inhibited ejaculation Retrograde ejaculation Failure of descend into the scrotum Antibodies to the sperm

56. Male Factors of infertility Spermophlebectasia Sperm dysfunction Sexually transmitted disease Physical damage Genetic disease Auto immune disease

57. Male Reproductive Anatomy

58. Male Reproductive Organs Testes (gonads): Sperm (exocrine) Testosterone (endocrine) Ducts Glands

59. I. Male Organs-Testes Size: 4 cm X 2.5 cm Connective tissue capsule Tunica albuginea Seminferous tubules Rete testis Duct system Epididymis Interstitial cells -produces androgens & testosterone.

60. Testosterone Production Produced by interstitial cells Stimulated by LH Testosterone stimulate the male reproductive organs develop & 2 nd male characteristics Lack of the testosterone will result in sexual infantilism & sterility.

61. Testes Malfunction

62. II . Male organs- Duct System Transport sperm from the body: Epididymis Ductus deferens Urethra

63. Male Organs- Epididymis Highly coiled tube 6M Caps superior of testes 1 st part of male duct Storage site of immature sperm Mature in 20 days Ability to swim Walls of epididymis contract to expel the sperm to ductus deference

64. Male organs - Ductus Deferens Enclosed tube along with blood vessels & nerves in sperm cord Propel live sperm into urethra by peristaltic waves rapidly squeeze the sperm forward Scrotal Sac Vasectomy- cauterizing the vas deferens. Sperm is still produced but no longer reach the outside Sterile- testosterone still produced and libido remained.

65. Sperm Ascending

66. Vas Deferens Blockage

67. Male Organs- Urethra 3 main regions Prostate Urethra Membranous urethra Spongy urethra Carry urine and sperm to exterior Ejaculation

68. Male Organs-Scrotum Providing the testes with a temperature that is below body temp. Cold->scrotum wrinkled ->testes closer to the body to maintain viable sperm production

69. Male Organs- Penis To deliver sperm into the female reproductive tract Circumcision- surgically removed after birth 3 enlarged eretile tissue Erection-blood flow

70. Good Sperm Formation Sperm takes 100 days to develop (70/30) 3 main factors: Sperm count: > 20 million/ml/ejaculate Morphology (shape of the sperm) Motility (How fast and straight the sperm swim)

71. Spermatogenesis

72. Spermatogenesis

73. Functions of Sperm

74. Macho Sperm Theory Damage fertilized eggs. Some toxins may alter the sperm’s DNA. Damaged chromosomes still carry genetic information Results in infertility, miscarriage, birth defects, learning disabilities, childhood cancer and kidney cancer.

75. Male Infertility Assessment Sperm count < 10 million/ml (200 million) Volume < 5 ml per ejaculate Sperm motility < 60 % Sperm Morphology < 50 % normal

76. Getting Tested Urologist evaluation Sperm analysis 2-3 Tx Defect factors: Azoospermia Oligiospermia Sperm motility decreases Sperm morphology abnormalities

77. Normal Sperm Analysis Volume= 3 ml (2-6ml) Concentration=20M/ml Motility: 50 %> 2 hrs Morphology: >60 % Viscosity Ejaculate normally liquefies < 1hr pH= 7-8

78. Sperm abnormalities Adequate Aspermia Azoospermia Oligospermia Poor motility & forward movement High percent of abnormal sperm morphology Anti-sperm antibodies

79. Diagnosis of Male infertility Medical History Physical Examination-structure Secondary sex characteristics evaluation Endocrine function test Sperm analysis and morphology

80. Causes of Male Infertility Radiation Environment toxins Undescended testis Varicocele Traumatic injury Infectious injury Testicular atrophy Drug effects Alcohol, nicotine, marijuana, cocaine Prolonged fever Endocrine disorders Congenital abnormalities Surgery of the lower abdominal region Tight underwear Stress, lack of sleep

81. Acupuncture Treatment Acupuncture can stimulate histamine release to dilate the blood vessels, therefore to improve the blood circulation, thus reduces varicose veins in the region Most commonly selected points are located on the back and leg areas. Frequency at 1-2 tx/wk or based individualized treatment plan

82. Responses of TCM treatment Case report: A 43 male with 3 months of combined treatment Sperm count: From < 18 million/ml to 93 million Motility : from < 50 % to 97% Morphology: from normal <20 % to 45 % Hu,C. etl . Advanced Acupuncture, Inc. 2006 Los Angels, U.S.A

83. Acupuncture & Sperm Quality Improvement Acupuncture effects on sperm production and quality without causing any changes in behavior and sexual desire. 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. Hu,C. etl Advanced Acupuncture, Inc. 2006, Los Angeles, U.S.A.

84. Effect of Acupuncture on Sperm Parameters 16 subject were coanalyzed before & 1 month after treatment (Two times/week for 5 weeks) 16 subject of controlled, untreated for comparison Evaluated by semen analysis and ultramorphyological observations. Conclusion; The fertility index increased significantly in the treatment group (p<or =0.5) Sperm motility and axonema intactness were highly correlated (corr:= 0.50, p< or = 0.5) Siterman S, Israel, 1997

85. Protocols improves sperm count and motility Electro-acupuncture: Points: UB-23, 25, K5, Sp 6 Frequencies: 2 tx/wk X 5 weeks. Lengths: 2-3 courses until sperm analysis become normalized Herbal formulas: Jin Gui Shen Qi Wan Evaluation: by repeat Sperm analysis between the acupuncture course.

86. Chinese Medicine improves semen morphology, motility, & count Randomized clinical trial in Sydney, Australia, 2004 Acupuncture and herbal medicine Improve sperm normal form: p<0.038 Improve semen motility: p<0.008 Improve count: mean increase 220 million sperm

87. Acupuncture in the treatment of Psychogenic Erectile Dysfunction Randomized placebo-controlled pilots study, Austria, 2003 22 patients, satisfactory response =68.4% Acupuncture can be effective option >2/3 of PED

88. Artificial Insemination (IUI) The sperms are collected and send to sperm wash More concentrated sperm count without semen. Inject to female, let sperm surround with egg to penetration. Option for male infertility Alternative procedure when IVF did not respond well.

89. Intracytoplasmic sperm injection ICSI For low sperm count & male infertility Sperm & eggs are retrieved Inject 1 sperm into an egg Fertilized egg is then implanted www. medfix.com

90. Spermophlebectasia (varicose vein of the spermatic cord) Increases blood in the vein of the spermatic cord  increases temp. in testicle  decrease live sperm count and activity 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

91. Symptoms of Spermophlebectasia Male age 20-30 Chief complain-pain Heaviness of scrotum Pain at testicles, groin and lower abdomen Standing and walking aggravates. Resting in supine position alleviates Signs: Scrotum enlarged and loose Vein is enlarged and purple Varicose veins are also present in the groin and inner thigh Press vein, it shrinks or disappears

92. TCM treatment for Spermophelebectasia Acupuncture Acupuncture can stimulate histamine release to dilate the blood vessels to improve the blood circulation, thus reduces varicose veins in the region Herbal Formula Individualized formulas based on the etiology to improve blood circulation, resolve blockage, and promote healthy sperm

93. TCM Treating Male Immune Infertility Observation of “Yikang Tang” (decoction) to treat 100 pt with immune infertility Compare with 100 cases treated with prednisone Results: AsAb decreased significantly, (p<0.01) The sperm density and motile spermatozoa increased significantly The sperm agglutination rate decreased The improvement rate of the symptoms and stability of the therapeutic effect were more dramatic in the treatment group. Has more stable effect for male immune infertility than Prednisone . -Sun Z. Bao Y. 2006,Honzhong, China

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. Classic Herbal Formulas Modified Jin Gui Shen Qi Wan Main ingredients : Ginseng, Deer horn, Sea horse, Hokuo, Epimedii, Angelica, Cinnamomi, Poria cocos Used for low sperm count, low motility and morphology Modified Jin Suo Gu Jin Wan Main ingredients : Eucommiae, Epimedii, Achyrabthis,Cistanches, Cynomorii, Cuscutae. Used for impotency, low libido and early ejaculation

96. Modified Jin Gui Shen Qi Wan (Kidney Qi Pill from Golden Cabinet) 87 male pts. were treated and observed in our clinic Comparison made before and after treatment 3-6 months. Measured by routine semen analysis 3 months enhanced function significantly, spouse pregnant rate =56% (49/87) Sperm analysis improvement after 6 months= 68.40% This formula influences regulatory function in FSH, LH, Testosterone, Coticosterone level Hu C. Etl Advanced Acupuncture, Inc. 2006, Los Angeles, U.S.A.

97. Modified Jin Suo Gu Jin Wan ( Mental lock pill to stabilize the essence ) 82 male patients were treated and observed The length of treatment is 3-6 months The sperm count improves 67.4 % The activity rate of sperm markedly improved after treatment. Hu,C. etl Advanced Acupuncture, Inc. 2006, Los Angeles, U.S.A.

98. Making Good Sperm Eating Healthily Taking Vitamins Drinking more water Copping Stress Staying active Enjoying regular sex Sleeping enough Liver Detox Weekly acupuncture Stop smoking Cut down alcohol Avoid drug intake Minimize caffeine

99. Things to avoid High temperature ( best at 32 degrees C) Stress ( testes malnourished) Alcohol ( interferes of testosterone secretion) Smoking (40 % sperm damage by free radicals) Environmental Estrogen (meat, microwave plastics) Drugs ( reduces testosterone & libido) Caffeine (impair sperm production & cause chromosomal abnormalities) Toxins (pesticides, heavy metals) Pollutants

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. Pro-vitamin for Men Zinc -15 mg/day, (oyster) Vitamin E 100-400IU (Olive oil, wheat germ) Calcium 1000mg Vitamin D 10 mcg

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. Resources Fertilityfriend.com-my chart Resolve.com- A nonprofit organization Making babies-Book by M.D.

104. Questions? Contact information Cathryn Hu, Ph.D., O.M.D., L.Ac . Phone: 310-458-2848 Fax: 310-458-2899 Web: www. Advancedacupuncture.com Email: Advanced_Acupuncture @ Yahoo.com