Category Archives: Fertility
This article is intended for couples who have been trying to conceive for around six to twelve months or more, without success. In it, I shall outline some of the issues which are important from a Chinese medical perspective, so that you can consider whether acupuncture is something you might like to try with the aim of improving your chances of a natural conception. A report(1) in 2012 found that fertility acupuncture treatment by professional acupuncturists, increased fivefold over a ten year period. The HFEA identified in 2007 that infertility is the second most common reason for which UK women in the 20 to 45 age group, visit their GP.
We can simplify this complex subject a little for ourselves to start with. There are three main causes of infertility to bear in mind. Firstly, a woman may not be releasing an egg every month ie. not ovulating. Secondly, fertilisation may not be taking place, perhaps due to problems with sperm quality or blocked Fallopian tubes. Thirdly, the embryo is failing to implant in the womb lining, perhaps because it is not thick enough.
Couples I see are at one of two stages:
1) The first group have been trying to conceive for long enough (often around two years) for their GP to have arranged some tests, usually a semen analysis for men and blood hormone tests for women, depending on any accompanying signs and symptoms. The results of these tests are of interest to me, and they may or may not point towards anything of significance. If one partner’s tests are revealing an abnormality, then it is that partner who should come to see me. If neither partner’s tests indicate any significant abnormalities, then in the first instance, I recommend you both attend for individual consultations.
The tendency in the NHS is for this group to move swiftly to the IVF waiting list, but there are other steps that can be worth taking and which may avoid the need for IVF. Remember also that IVF circumvents the first two causes of infertility mentioned above, but still only around 30% of transferred embryos will successfully implant. Furthermore, a natural conception is always the most desirable way forward where possible.
2)The second group are those who have been trying for a shorter time, perhaps six to twelve months as a guide, but who would like to take the step of arranging an acupuncture consultation. If you fall within this group, then in the absence of any orthodox medical investigations to this point, we can see whether a Chinese medical analysis of your health, reveals patterns which could be impeding conception. Hence it again makes sense for you both to come for individual initial assessments.
At the first interview, I shall be interested in your general health, and details such as your age, whether one or both of you is already a parent (indicating past fertility), your occupation, energy levels, your diet, smoking, alcohol consumption etc. For women, the precise characteristics of your cycle offer invaluable information from a Chinese perspective: your cycle length, period length, and flow for example. Have there been any changes in the last few years? Do you experience any PMS, and if so, how? Have you used the contraceptive pill and when? If you use a lubricant, is it harmless to sperm, and their motility? (KY Jelly for example, is not recommended.)
Your levels of stress and anxiety, particularly around trying to conceive, are very important. Over the years, I have noticed what an effective contraceptive stress can be. Acupuncture can be very helpful here: see the research reported below (Stress reduces chances of Conception, 15 June 2011). Stress can for example, raise prolactin levels, thus interfering with ovulation.
As regards men, if you have had a sperm sample analysed, and have had a result indicating low fertility, then that is obviously significant. Besides that though, Chinese medicine looks at a much wider picture of your health and lifestyle, so I will have many other questions to put to you. At this point, it’s worth digressing a little and saying some more about male sub-fertility. Western medicine has usually put its focus on female infertility: a female reproductive system which is as healthy as possible, can assist the sperm in several useful ways; further, western medicine has few treatment options for male sub-fertility and often cannot even find a cause. The latter is however, a growing problem worldwide.
Reports began appearing in medical journals in the early 1990s, and explanations include lifestyle factors and/or chemicals in our environment: oestrogens excreted into the water supply by women using the contraceptive pill or hormone replacement therapy, may be one small factor; a larger contribution might come from oestrogen-like chemicals released from common products as diverse as plastic bottles, sunscreen lotions and clingfilm; more significant still might be anti-androgens used in a similar range of products for decades. Whatever the causes, the Aberdeen Fertility Centre in Scotland reported several years ago, a drop in average sperm concentrations among its patients, from 87 million/ml to 62 million/ml, between 1989 and 2002.
Lifestyle factors are fortunately more in our control. There is growing evidence that a high intake of soya eg milk, yoghurts, tofu, is associated with reduced sperm counts. It also seems that a high intake of saturated and monounsaturated fat is associated with significantly reduced sperm concentration, whereas a high intake of healthier polyunsaturated fatty acids is associated with improved sperm motility and morphology (2). Have plenty of fish, fruit and vegetables. Avoid ready-meals, as these are so often high in sugar, salt and fat. Consider taking a good quality male preconceptual supplement containing vitamins B12, C, E, selenium and zinc.
Male fertility declines with age. There is also a correlation between body weight and male fertility: in one study of 1500 men, those with a body mass index (BMI) below 20, had a 28% lower sperm count, and those with a BMI above 25, had a 22% lower sperm count, so maintenance of a health body weight appears important. Sperm production is most efficient at 34 degC, which is 3 degrees below normal overall body temperature. Men might therefore be well-advised to avoid hot baths, saunas, intense exercise, and using a laptop computer literally on the lap; a change from tight underwear to loose boxer shorts would seem sensible. Smoking can reduce fertility (3), as can excessive alcohol and cannabis use.
The SSRI group of anti-depressants has also been associated with sperm damage, specifically increased sperm DNA fragmentation. Steroids such as prednisone and cortisone can be unhelpful too, so if you take prescribed medication, ask your GP about any possible unwanted effects on sperm. See also my research article below on the positively helpful effects of walnuts.
Recent research (4) from the Newcastle Fertility Centre at Life, suggests that up to the age of 45, a man’s age is less important than his sperm quality, suggesting lifestyle factors are worth paying close attention to.
Returning to our main topic then, I will gather together all of the information gained from interview, and will put together a treatment plan for either or both of you, and offer some lifestyle advice. The latter may involve diet, exercise, more rest etc. You should bear in mind that I always recommend that both of you consume no alcohol and stop smoking. I will then usually suggest a fixed number of treatments followed by a review.
If you are a woman of 35 or over, or if either of you have in the past had any medical conditions which could have affected reproductive health, then it is my recommendation that you see your GP if you have not already done so. It does not prevent you embarking on a course of acupuncture treatment, but it might save us valuable time.
I hope the above has given you an outline of my approach, but you are always welcome to call me if you would like to discuss acupuncture further.
(1) Acupuncture in Practice: Mapping the Providers, the Patients and the Settings in a National Cross-Sectional Survey. British Medical Journal Open, January 2012.
(2) American Society for Reproductive Medicine 66th Annual Meeting.
(3) Analysis of the functional aspects and seminal plasma proteomic profile of sperm from smokers. BJUI, online 20 June 2016.
(4) European Society of Human Reproduction and Embryology (ESHRE). “The outcome of fertility treatments using donor sperm is not dependent on male age, but on the quality of sperm.” ScienceDaily, 30 June 2014.
A pilot pragmatic trial undertaken by researchers at Western Sydney University, Australia, suggests that acupuncture can reduce by half, the time taken for sub-fertile women to conceive. A total of 56 sub-fertile women were recruited from the community in Sydney, and offered either lifestyle modification advice, or the same advice plus acupuncture. Inclusion criteria were women aged 18 to 44 who had been trying to conceive for at least 12 months, and who had a diagnosis of the causes of their sub-fertility. Acupuncture treatments were given weekly for three months and individually tailored for each patient.
Seven women became pregnant during the study, those receiving acupuncture conceiving within an average 5.5 weeks, and those receiving lifestyle advice only, taking an average 10.7 weeks. Acupuncture compared to lifestyle advice only, also resulted in significant increases in fertility awareness and quality of life measures in relation to wellbeing. Further, it increased the ability of the recipients to engage in desired activities, such as exercise or rest.
(Prior to Conception: The Role of an Acupuncture Protocol in Improving Women’s Reproductive Functioning Assessed by a Pilot Pragmatic Randomised Controlled Trial. Evidence Based Complementary & Alternative Medicine 2016.)
A study in the US has found that regular consumption of walnuts can improve sperm morphology, motility and vitality. A total of 117 healthy men ranging in age from 21 to 35, were randomly allocated to one of two groups: the intervention group of 59 men consumed 75g of walnuts per day, provided to them in small snack packs; the remaining 58 men adhered to their usual diet, whilst avoiding tree nuts.
Interestingly, these findings correlate with the use of walnuts for centuries in traditional Chinese medicine, to support sexual function and fertility.
(Walnuts Improve Semen Quality in Men Consuming a Western-Style Diet: Randomised Control Dietary Intervention Trial. Biology of Reproduction Journal, October 2012.)
Research conducted by the University of Western Sydney in Australia, suggests women experiencing infertility, find acupuncture can help to reduce their stress levels. In the pilot study, 32 women with infertility, aged 20 to 45, received six acupuncture treatments over eight weeks. Compared to another group of women left on a waiting-list as controls, the women in the acupuncture group described acupuncture as having a positive impact: they reported among other things, reduced stress and anxiety, increased physical relaxation and psychological calm, and an altered perspective in relation to coping. They also regarded acupuncture as an intervention having very few negative side-effects.
(The Effect of Acupuncture on Psychosocial Outcomes for Women Experiencing Infertility: A Pilot Randomised Controlled Trial. Journal of Altern & Complementary Medicine, October 2011.)
A UK study suggests that stress can reduce the chances of a woman conceiving during the fertile mid-phase of her monthly cycle.
A total of 274 healthy women , aged between 18 and 40, and who were trying to become pregnant, provided saliva samples which were tested for levels of cortisol (a stress hormone) and adrenalin (the latter via an indicator known as alpha-amylase). Tests were conducted for six menstrual cycles or until pregnancy if sooner.
The results showed that those women with high adrenalin levels across the fertile window of their cycle, were less likely to conceive. In fact, the chance of conception for women with the highest levels, was about 12% lower than that for women in the bottom quarter of the adrenalin level range. The authors of the study comment that these findings support the use of relaxation techniques to increase the chances of becoming pregnant.
(Stress Reduces Conception Probabilities across the Fertile Window: Evidence in Support of Relaxation. Fertility & Sterility, June 2011.)