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Can acupuncture help with IVF?

January 21, 2019
acupuncture fertility, acupuncture ivf, toronto naturopath, naturopathic doctor toronto

It’s no secret that infertility is on the rise. Women often delay parenthood to pursue higher education, advance their career and attain financial security. Because of this, as their age increases, as does their use of assisted reproductive technologies (ART) to become pregnant.

Acupuncture and IVF

When someone is on the IVF journey, they often use acupuncture as an adjunctive treatment as it has been shown to help with IVF success. Acupuncture is helpful in a couple of ways as it:

  • Promotes and increases blood flow to your ovaries and uterus
  • Causes the release of neurotransmitters to your brain which increases ovulation, menstrual regularity and overall fertility 
  • Reduces stress and anxiety associated with IVF

In fresh, non-donor cycles, studies show that using acupuncture was associated with more live births and fewer biochemical pregnancies (compared to IVF alone). In fresh donor cycles, adding acupuncture was associated with more live births.

In the previous study, they use more than just a defined set of acupuncture points. Treatment may also include herbs, dietary and lifestyle recommendations, as well as vitamins or minerals. This serves as a reminder that individualized medicine is important, and can result in the effects that you want (aka. a live birth). 

When should you start acupuncture?

Unfortunately, having acupuncture done before and after your embryo transfer only isn’t good enough. Yes, it helps to reduce stress (which is incredibly important, because IVF is stressful), but it’s not sufficient to improve birth outcomes.

If you can, it’s best to begin weekly acupuncture treatments at least 3 cycles before you begin IVF as this increases your chance of live birth.

Next Steps

(Unsurprisingly) a Naturopathic Doctor can help you as you tackle IVF! Not only can we help you with acupuncture, but we also take the time to go over your diet, lifestyle habits, and any herbs and vitamins that you might be taking.

References

Prior, Eugenie et al. “Fertility Facts, Figures And Future Plans: An Online Survey Of University Students”. Human Fertility, 2018, pp. 1-8. Informa UK Limited, doi:10.1080/14647273.2018.1482569.

Hullender Rubin, Lee E. et al. “Impact Of Whole Systems Traditional Chinese Medicine On In-Vitro Fertilization Outcomes”. Reproductive Biomedicine Online, vol 30, no. 6, 2015, pp. 602-612. Elsevier BV, doi:10.1016/j.rbmo.2015.02.005.

Hullender Rubin, Lee E et al. “Acupuncture And In Vitro Fertilisation Research: Current And Future Directions”. Acupuncture In Medicine, vol 36, no. 2, 2018, pp. 117-122. BMJ, doi:10.1136/acupmed-2016-011352.

What does AMH tell you about fertility?

January 28, 2019
AMH fertility, toronto naturopath, naturopathic doctor toronto, fertility naturopath

Did you know that tests exist to tell you how fertile you are?

It’s true!

Your ability to become pregnant depends on your chronological age and biological age.

Your chronological age reflects your current age, while your biological age is in reference to your ovarian reserve (the quantity of and quality of oocytes at a certain time point). Chronological age increases year after year, while biological age decreases year after year until menopause.

Fertility Testing

When women are undergoing infertility evaluation, a flurry of testing is usually done. This includes:

  • Anti-müllerian hormone (AMH)
  • Follicle stimulation hormone (FSH)

AMH and Fertility

AMH is produced by developing follicles, and serves as an indicator of ovarian function. An AMH greater than 0.8-1.0 ng/mL is suggestive of a normal ovarian reserve (the ability of your ovaries to provide eggs that are capable of being fertilized and resulting in a pregnancy).

Your AMH levels will gradually decrease after peaking at around 25. Around 5 years before menopause, AMH levels decrease below the detectable limit.

Studies have also shown that low AMH is associated with increased risk of miscarriage. Women with an AMH of 0.4% had over twice the risk of miscarriage, with the increased risk primarily associated with clinical pregnancy loss.

FSH and Fertility

FSH is a hormone produced in the pituitary and stimulates ovarian follicles to grow and develop. In some women, the pituitary secretes a lot of FSH to get the ovary to respond. This usually happens when your ovarian reserve starts to decline. When FSH is over 10mIU/mL, it’s suggestive that ovarian reserve is in decline.

Overall, AMH decreases as you age and FSH increases as you age.

Testing AMH and FSH

If you are sent for testing to better understand your fertility, most of the tests will be done on day 3 of your period (ex. 3 days after you start your period).

FSH needs to be tested on Day 3, whereas AMH remains stable during your period. It’s independent of any other hormones (ex. FSH, LH and estradiol are usually tested together). AMH is also more predictive of hyper-response and ovarian hyperstimulation syndrome risk during IVF than FSH.

Next Steps

Getting your AMH tested may sound frightening especially as it tells you about your ovarian reserve. This is something that your Naturopathic Doctor can test for you.

Moreover, if you’re worried about your chances at a successful pregnancy, working with a ND may be worthwhile as we take a look at your diet and lifestyle habits, lab work, and more!

References

Iwase, Akira et al. “Clinical Application Of Serum Anti-Müllerian Hormone As An Ovarian Reserve Marker: A Review Of Recent Studies”. Journal Of Obstetrics And Gynaecology Research, vol 44, no. 6, 2018, pp. 998-1006. Wiley, doi:10.1111/jog.13633. 

Wang, Shunping et al. “Discordant Anti-Müllerian Hormone (AMH) And Follicle Stimulating Hormone (FSH) Among Women Undergoing In Vitro Fertilization (IVF): Which One Is The Better Predictor For Live Birth?”. Journal Of Ovarian Research, vol 11, no. 1, 2018. Springer Nature, doi:10.1186/s13048-018-0430-z. Accessed 13 Jan 2019.

Zamah, A. Musa, and Mary D. Stephenson. “Antimüllerian Hormone And Miscarriage: Fifty Shades Of Gray…”. Fertility And Sterility, vol 109, no. 6, 2018, pp. 1008-1009. Elsevier BV, doi:10.1016/j.fertnstert.2018.02.140. 

Zhu, Jieru et al. “Chronological Age Vs Biological Age: A Retrospective Analysis On Age-Specific Serum Anti-Müllerian Hormone Levels For 3280 Females In Reproductive Center Clinic”. Gynecological Endocrinology, vol 34, no. 10, 2018, pp. 890-894. Informa UK Limited, doi:10.1080/09513590.2018.1462317. 

What are Uterine Fibroids?

January 7, 2019
uterine fibroids, toronto naturopath, naturopathic doctor toronto, fertility naturopath

When you think of fibroids, your brain may automatically jump to the scary C word. But fibroids are not the same as cancer.

Uterine fibroids are tumours that that come from the same tissue as the uterus. They grow at a modest rate, and are affected by hormones like estrogen and progesterone.

Uterine Fibroid Risk Factors

Some of the risk factors for uterine fibroids include:

  • Increasing age, around 40-50 years old
  • Family history of uterine fibroids
  • Getting your period before 12 year old
  • African American
  • Obesity

Types of Uterine Fibroids

Subserosal Uterine Fibroids

These fibroids project outside of the uterus. Surgical removal isn’t typically recommended and they don’t appear to impact fertility.

Submucosal Uterine Fibroids

These fibroids project within the uterus and can impact fertility in a negative way by affecting implantation rates, clinical pregnancy rates, ongoing pregnancy, miscarriage and live birth rates. Pregnancy rates may improve following surgical removal of the fibroids.

Intramural Uterine Fibroids

These fibroids are found within the myometrium (middle layer of uterine wall). They may affect fertility by negatively impacting implantation and clinical pregnancy rates.

Signs and Symptoms of Uterine Fibroids

The most common symptom is heavy, prolonged or abnormal bleeding. Unsurprisingly this can be followed by iron deficiency anemia.

You may also notice pelvic pain or pressure, although this is rare. And obstructive symptoms may present with larger fibroids.

Fertility may also be impacted depending on the type of fibroid you have.

Confirming the Presence of Uterine Fibroids

Palpation can give you an idea if you have fibroids, but you’ll need a more definitive diagnosis – preferably with imaging.

Two of the most common (and least invasive) tests are:

  • Transvaginal and transabdominal ultrasonography
  • MRI

Uterine Fibroids in Fertility

Depending on the location of your fibroid, it may decrease your fertility. Fibroids may decrease implantation and clinical pregnancy rates, based on where they present. Intramural and submucosal will affect fertility more than subserosal.

Uterine Fibroids in Pregnancy

Fibroids might remain the same size or become smaller in pregnancy. In the postpartum period, fibroids may shrink or completely disappear.

Sometimes they may have an impact on pregnancy outcomes, including an increased risk of malpresentation of your baby, increased chance of c-section, and increased risk of preterm delivery.

Treating Uterine Fibroids Naturally

Uterine fibroid treatment is dependent on the symptoms you’re experiencing.

If you’re not experiencing any symptoms, then doctors usually take a watch and wait approach. If you are experiencing symptoms, then treatment depends on your desire for fertility.

There are many drugs out there for the treatment of fibroids, and if you’re familiar with my website, I often focus on natural alternatives instead. Moreover, if you’re here because your fibroids are affecting your fertility, many of the recommended treatments wouldn’t be compatible (ex. birth control).

It’s important to note that natural therapies may not make your fibroid completely disappear. And this is one of the conditions where we’re focusing on the symptoms you’re experiencing.

Nutrition and Uterine Fibroids

One of the goals when you have fibroids is to adopt an anti-inflammatory diet. This means whole foods, fresh and organic fruits and vegetables, cold-pressed oils, oily fish, and nuts and seeds.

Sadly this leads to an avoidance of red meat, processed foods, refined carbohydrates, sugar, saturated fats, fried foods, dairy, caffeine, and alcohol.

Fibre is very important in assisting the elimination of estrogen and promoting bowel movements. Before you chug back some psyllium husk, berries and leafy greens are a great source of soluble fibre (the type of fibre that bulks up your stool). An easy way to ensure you’re getting enough fibre during the day is to start your morning off with a berry and spinach smoothie (ps. don’t forget the fat and protein!).

Lifestyle and Uterine Fibroids

Because obesity plays a role in fibroid development, it may be helpful to achieve a healthy body weight. Obviously many factors (ex. hormones) affect weight, so one of the simplest ways to start to process is to focus on nutrition.

Stored fat is often transformed into estrogen which may become stored in the body and ultimately affect hormones.

Liver Support and Uterine Fibroids

Yes, I brought up the liver because it detoxes! While we know that your liver knows how to detox. It’s important to consider that it may be burdened with outside estrogens. This may be affecting how your fibroids grow, and ultimately, this might slow down its detoxing job.

Detoxification happens in 2 steps, and if you don’t have the necessary nutrients for both, your liver may not do its best work. So what’s a person to do? Instead of tossing a pre-packaged detox into your cart, make sure you’re eating a variety of protein, getting your daily dose of B vitamins, and making broccoli (and other brassica vegetables) are you friend.

Once your liver gets these toxins out, they still need to be excreted via urine or stool. A healthy gut microbiome and frequent bowel movements will ensure that estrogen is not recirculated back into your system. But if you experience constipation (ex. less than 1 bowel movement per day) or uncomfortable digestive symptoms, then you may need some digestive support.

Nutrients and Uterine Fibroids

These vary and are based on the symptoms you may be experiencing. However, one important nutrient will be iron, especially if you’re noticing excessive menstrual bleeding (losing over 90mL of blood each cycle). Having your ferritin tested, will give your ND an idea if you should be supplementing.

Other nutrient actions that may be beneficial are anti-inflammatories, immune support, and specific antioxidants.

Herbs and Uterine Fibroids

This is another category that varies based on your symptoms and goals. We may want to consider:

  • Hormonal modulators (to improve hormonal regulation)
  • Liver tonics (to support liver detox)
  • Uterine tonics (to improve uterine tone)
  • Uterine astringents (to reduce uterine bleeding)
  • Uterine stimulants (to relieve pelvic stagnation)
  • Uterine antispasmodics (to reduce pain)

Obviously this is a huge list, and I haven’t listed off any herbs – mostly because you should be taking them under the supervision of a ND or herbalist.

Acupuncture and Uterine Fibroids

It’s no secret that I love acupuncture the most out of all my tools. This can’t be done at home, and should be done in your Naturopath’s or Acupuncturist’s office.

In the case fibroids, your ND will likely focus on ensuring the smooth flow of energy and movement of blood throughout the body. A few treatments are typically needed to see results (it’s not a one and done type of treatment).

Final Thoughts

If you’re experiencing heavy bleeding, it’s important to know that fibroids may be the reason why. Moreover, they may also interfere with your fertility.

If you’re hoping to retain your fertility and address your symptoms through a natural lens, feel free to try some of the above ways or work with a Naturopathic Doctor.

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