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Where to Next for the IVF patient


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IVF has taken us as far as it can with embryo quality now that screening of embryos with PGS is becoming routine. Yet only half of chromosomally normal embryos implant to become a viable pregnancy. Our attention must turn towards the uterus and the receptivity of its lining, the endometrium. Chinese medicine may be able to lead the way with helpful interventions to improve the quality of the lining.

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Where to Next for the IVF patient

  1. 1. A good looking uterine lining! What is a good looking lining? Why do I want one? How do I get one?
  2. 2. Where to next? - The hidden frontier PGD tested embryos still only have a 50% chance of creating a viable pregnancy. That is why we are must now focus more on the uterine lining, its receptivity, blood flow and implantation sites. How can we improve those?
  3. 3. Looking inside the uterus (saline infusion hysteroscopy) A Abdel-Gadir, The smooth edges indicate that there are no polyps or fibroids. .
  4. 4. A good looking uterine lining looks a bit like this
  5. 5. Or this
  6. 6. Actually, like this A Abdel-Gadir, www.gynaecologist4u.coml The endometrium appears as a single thin line immediately after menstruation. This then expands under the influence of oestrogen in the follicular phase of the cycle to the typical trilaminar appearance.
  7. 7. Or this, can you see the 3 layers? A Abdel-Gadir, Studies of women having frozen embryo transfers show that this triple-line pattern is more often present in those who successfully conceive.
  8. 8. And it is good and thick and juicy A Abdel-Gadir, Studies suggest that a uterine lining thickness of 6 mm or less results in fewer pregnancies. Ideally it will be 8- 10 mm before implantation.
  9. 9. An implantation site Errol R. Norwitz, et al NEJM 2001 345: 19,1400-1408 Cytokines (immune factors), integrins (adhesion molecules) and pinopodes (attachment structures) are among just some of the important components in the lining which make up an implantation site.
  10. 10. Blood flow to the lining is important A Abdel-Gadir, Women with good endometrial blood flow were often found to have better outcomes during IVF cycles.
  11. 11. Blood flow and implantation A Abdel-Gadir, Some studies show that when good blood flow is visible on ultrasound in the endometrial and sub-endometrial regions, implantation and pregnancy rates can be significantly higher.
  12. 12. Electro-acupuncture increases flow of blood in the uterine arteries. arteries-of-infertile-women-with-electro-acupuncture/
  13. 13. Why is all this important? • Its really important if you are trying to conceive whether naturally or with IVF A good uterine lining means …..... • Embryo implantation rates are better • You are more likely to have healthy placenta • And bottom line, you more likely to have a baby
  14. 14. And cutting to the chase…’s how you can improve your lining before trying to conceive or attempting an IVF cycle 1. Check for polyps and if you’ve had a previous miscarriage, retained products. Some fibroids may need removing 2. Ensure hormone levels are advantageous for implantation (especially important in IVF cycles) 3. A complete and thorough menstrual discharge in the previous cycle helps build a new lining (use herbs for this) 4. Have electro stimulation on specific acupuncture points at specific times. 5. Use certain well known herb formulas to improve implantation.
  15. 15. What should you do? • Ask the radiographer if there are any polyps, retained products, impeding fibroids or structural abnormalities that need surgery. • Make sure your menstrual flow is fresh red, not clotty, flows smoothly and is completely discharged – use Chinese herbs to help this. • Talk to your Chinese medicine doctor about the use of electro-acupuncture and certain herbal formulae to improve the uterine lining.
  16. 16. What is electro-stimulation of acupuncture points? Fine needles are gently inserted into acupuncture points on the abdomen and legs, or TENS pads are placed on these points, and a mild current is passed through them so a pulse can be felt.
  17. 17. How do we know it works? • Several studies in China, using electro-stimulation of acupuncture points have shown increased implantation and pregnancy rates in IVF patients. • One of these studies looked at the effect of electro-stimulation of acupuncture points on the pregnancy rate after frozen embryo transfer and noted that the uterine lining of the women who had the treatment was much improved in structure and quality. This correlated with significantly higher implantation rates and birth rates. • reviews/acupuncture-herbs-and-ivf-other-publications/
  18. 18. What did they do? • For the 3 menstrual cycles before the frozen embryo transfer, these women had treatment using acupuncture points on the abdomen and legs. They came 4-6 times a month, especially in the first half of the month when the uterine lining is being prepared.
  19. 19. Zi Shen Yutai Pills reviews/acupuncture-herbs-and-ivf-other-publications/ This formula, which has been used for hundreds of years in China to help prevent miscarriage has been shown to improve implantation rates in IVF patients. The mechanism appears to be improving uterine receptivity by upregulation of integrins and other markers.
  20. 20. What we offer in our clinic • We advise all our patients who are preparing for an embryo transfer to take the time to prepare the endometrium as well as possible before hand. • This means a good diet, avoiding toxic substances, having stable and balanced hormones and qi (this helps to balance the immune system) and priming the uterine lining with acupuncture treatment, and in some cases herbs. transfer/
  21. 21. For information on other treatment programmes and clinical trials please see