The Path to Fertility
Date: July 1, 2009
One in eight couples in this country will cope with infertility, according to the 2002 National Survey of Family Growth. And more of these couples are turning to ancient Chinese medicine techniques such as acupuncture, often in conjunction with Western medical treatments, to enhance fertility and reduce stress.
A February 2008 article in the British Medical Journal reported preliminary evidence that acupuncture given with embryo transfer resulted in improved pregnancy rates and live birth in women receiving in vitro fertilization, a commonly used treatment that involves retrieving a woman’s egg, fertilizing the egg in the laboratory and then transferring the embryo back into the woman’s uterus.
Although most Western medical practitioners say more evidence is needed, fertility clinics appear more open to the use of acupuncture in conjunction with medical treatments such as in vitro fertilization.
Infertility is defined as the inability to conceive after one year of unprotected intercourse (six months if the woman is over age 35), or the inability to carry a pregnancy to live birth. That diagnosis, as well as the medical treatment for it, can put women (and couples) into a huge tailspin, particularly if the fertility challenges remain unexplained and unresolved for long periods of time.
Women often end up feeling frustrated, hopeless and isolated as they watch their peers effortlessly become mothers.
A patient’s story
Missy Durkin of Charlotte lived in the isolation of infertility. “Very few people knew I was in a lot of pain,” says Durkin, who sought help when she and her husband faced challenges conceiving a child. “Friends of mine would get pregnant all over the place, and I never felt negative toward them, but it was painful.”
Durkin was 33 years old and had been trying to get pregnant for eight months when she and her husband first sought help. Three and one half years and two fertility clinics later, a friend told Durkin about Wake Forest University Center for Reproductive Medicine. She underwent her first cycle of in vitro fertilization (IVF) in conjunction with acupuncture treatments and is now the mother of Davis, a 6-month-old baby.
Durkin doesn’t know whether her acupuncture treatments had a direct impact on her fertility, and nor does her physician, Temer Yalcinkaya, M.D, the assisted reproductive technology director at the Wake Forest University Center for Reproductive Medicine, but both are pleased that the acupuncture helped reduce the stress associated with the treatment process and that the IVF procedure was successful.
“Any treatment like yoga, massage, [or] acupuncture, we recommend to help the patient cope with the stress of this situation,” says Yalcinkaya, who adds that more research is needed to confirm whether acupuncture has a significant physical benefit for fertility. The center does not have in-house practitioners for acupuncture, but there are acupuncturists in the vicinity.
Julia Woodward, Ph.D, who counsels patients at Duke Fertility Center in Durham, says women are definitely interested in services such as yoga, nutritional counseling and acupuncture.
“Our patients really want those types of services, and they certainly help our patients cope and feel better along the way.”
“We focus on the fact that alternative methods can be helpful with stress reduction,” says Susannah Copland, M.D., an assistant professor in the Division of Reproductive Endocrinology and Fertility at Duke Fertility Center. “There is early literature suggesting that acupuncture might be beneficial for actual fertility — but there are not a lot of randomized studies to confirm that.” The Duke Fertility Clinic refers patients to Duke’s Center for Integrative Medicine for therapies such as yoga and massage.
Retreats for the fertile soul
Randine Lewis, the author of “The Infertility Cure” and “The Way of the Fertile Soul” offers retreats for women experiencing fertility challenges. Retreats include an introduction to Traditional Chinese Medicine and an evaluation of the various energetic components that impact fertility.
Lewis, who has a Ph.D. and a master’s degree in Oriental medicine, has studied both Western and Eastern treatments for reproductive health, and provides education and information in the hope that she can create a shift in attitudes for women. She likes to detour from the problem-oriented “what is wrong with me” view of fertility toward recognizing and overcoming impediments to fertility.
“Chinese medicine is completely based in finding balance in the body, mind and soul,” Lewis says. “And when that is achieved often times the natural expression of fertility is the result.” Lewis does not discount anatomical manifestations of fertility issues but says it is important to have a complete view of a person, rather than just focus on one physical problem.
Lewis says she is pleased that women are empowered after reading her books and are choosing options like healthy diets, yoga, and acupuncture to improve their fertility and overall health.
Coping with stress
No matter which type of treatments couples choose, fertility issues are stressful.
Woodward says couples should admit to themselves that they are truly in a hard situation.
She offers these stress reduction tips:
1. Reach out to family members, friends or counselors
2. Find a support group
3. Use stress reduction techniques such as yoga, meditation, journaling, mindfulness, progressive muscle relaxation or guided imagery.
“People need to be sure to take some sort of look at what they have done to provide themselves with peace and make that an active, planned for, part of their week,” Woodward says. She also suggests couples plan in advance points along the way when they might stop treatment and review their options.
Advances in IVF offer more options
Recent advances in Western medicine have increased the options and success for couples with fertility challenges.
Yalcinkaya notes these recent advancements in IVF:
1. The ability to screen embryos for diseases such as cystic fibrosis and sickle cell before implantation. Pre-implantation genetic diagnosis has been growing in availability since it was first reported in the 1990s.
2. Some labs, such as Wake Forest University Center for Reproductive Medicine, nourish the embryo for a longer period before transplantation to achieve what is known as the “blastocyst” stage, occurring at day 5. This practice is not widespread because some labs do not have the capability, or are not comfortable, with the technique.
3. Improved freezing techniques allow for more success in preserving, eggs, ovarian tissue and embryos. A new vitrification, or rapid freezing technique, can allow physicians to freeze tissue in a manner that is less damaging to the cells. This option is particularly helpful for women with disease such as lupus, vasculitis or cancer who want to preserve tissue for future use.
“These advances in offering fertility preservation to patients who will be getting chemotherapy have really come to the surface in the past two years,” says Copland. “Oncofertility, offering fertility preservation to patients anticipating chemotherapy, became high profile two to three years ago and we are still working hard to get the word out about the availability of fertility preservation options.”
Both Duke and Wake have good IVF success rates. Given ethical, financial and age-related concerns unique to IVF, it’s best for prospective patients to look at clinics and data based on their individual needs. For further IVF statistics from nationwide clinics visit the Web site of the Society for Assisted Reproductive Technology at www.sart.org.
No matter where people seek help, it’s important for patients to feel validated and uplifted during this difficult process.
“Our philosophy is to work as a team to make this as smooth and successful an experience as possible for the patient because we recognize this is a stressful event and work for the highest success for the patient,” Yalcinkaya says.
Durkin, who went to several clinics, says she never felt comfortable until she went to see Yalcinkaya. “In my experience when you go through infertility, especially unexplained infertility, it can really leave you lacking in confidence,” Durkin says. “I needed a team of people with that sense of a positive attitude that this can happen, and I never found that until I got to Dr. Yalcinkaya.”
Serena Koonts of High Point also went to several clinics before seeking a second opinion from Yalcinkaya. “The personal attention from Dr. Yalcinkaya and his staff was like ‘night and day’ in comparison with the larger more clinical environment that we had previously experienced,” says Koonts, who is pregnant following treatment at the center that included IVF.
Koonts, who was 40 at the time, had almost lost hope when she went to Wake Forest. Ancient medicine practitioner, Lewis, says hope is crucial. “What I try to do at retreat is bring people to an inherent feeling of hope,” she says.
Did You Know?
• Infertility affects 7.3 million people in the U.S, or 1 in 8 couples
• Approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner and one-third is caused by a combination of problems in both partners or, is unexplained.
• A couple ages 29-33 with a normal functioning reproductive system has a 20-25 percent chance of conceiving in any given month. After six months of trying, 60 percent of couples will conceive without medical assistance.
• About 44 percent of women with infertility have sought medical assistance. Of those who seek medical intervention, approximately 65 percent give birth.
• About 85-90 percent of infertility cases are treated with drug therapy or surgical procedures. Fewer than 3 percent need advanced reproductive technologies such as IVF.
• The most recently available statistics indicate the live birth rate per fresh non-donor embryo transfer is 28 percent.
Source: RESOLVE: The National Infertility Association, American Society for Reproductive Medicine, National Women’s Health Resource Center, U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention.
Carol McGarrahan is a Cary-based freelance writer and mother.